Quedas em idosos: fatores associados em estudo de base populacional

The aim of the present study was to identify factors associated with the occurrence of falls among elderly adults in a population-based study (ISACamp 2008). A population-based cross-sectional study was carried out with two-stage cluster sampling. The sample was composed of 1,520 elderly adults living in the urban area of the city of Campinas, São Paulo, Brazil. The occurrence of falls was analyzed based on reports of the main accident occurred in the previous 12 months. Data on socioeconomic/demographic factors and adverse health conditions were tested for possible associations with the outcome. Prevalence ratios (PR) were estimated and adjusted for gender and age using the Poisson multiple regression analysis. Falls were more frequent, after adjustment for gender and age, among female elderly participants (PR = 2.39; 95% confidence interval (95% CI) 1.47 - 3.87), elderly adults (80 years old and older) (PR = 2.50; 95% CI 1.61 - 3.88), widowed (PR = 1.74; 95% CI 1.04 - 2.89) and among elderly adults who had rheumatism/arthritis/arthrosis (PR = 1.58; 95% CI 1.00 - 2.48), osteoporosis (PR = 1.71; 95% CI 1.18 - 2.49), asthma/bronchitis/emphysema (PR = 1,73; 95% CI 1.09 - 2.74), headache (PR = 1.59; 95% CI 1.07 - 2.38), mental common disorder (PR = 1.72; 95% CI 1.12 - 2.64), dizziness (PR = 2.82; 95% CI 1.98 - 4.02), insomnia (PR = 1.75; 95% CI 1.16 - 2.65), use of multiple medications (five or more) (PR = 2.50; 95% CI 1.12 - 5.56) and use of cane/walker (PR = 2.16; 95% CI 1.19 - 3,93). The present study shows segments of the elderly population who are more prone to falls through the identification of factors associated with this outcome. The findings can contribute to the planning of public health policies and programs addressed to the prevention of falls.The aim of the present study was to identify factors associated with the occurrence of falls among elderly adults in a population-based study (ISACamp 2008). A population-based cross-sectional study was carried out with two-stage cluster sampling. The sam173705718sem informaçãosem informaçãoIdentificar fatores associados à ocorrência de quedas em idosos, em estudo de base populaciona

The Use Of Corticosteroid For The Prophylaxis Of Fat Embolism Syndrome In Patients With Long Bone Fracture [uso De Corticoide Na Profilaxia Para Síndrome De Embolia Gordurosa Em Pacientes Com Fratura De Osso Longo]

The "Evidence-based Telemedicine - Trauma & Acute Care Surgery" (EBT-TACS) Journal Club conducted a critical review of the literature and selected three recent studies on the use of corticosteroids for the prophylaxis of fat embolism syndrome (FES). The review focused on the potential role of corticosteroids administration to patients admitted to the intensive care unit (ICU) at risk of developing post-traumatic fat embolism. The first study was prospective and aimed at identifying reliable predictors, which could be detected early and were associated with the onset of fat embolism syndrome in trauma patients. The second manuscript was a literature review on the role of corticosteroids as a prophylactic measure for FES. The last manuscript was a meta-analysis on the potential for corticosteroids to prophylactically reduce the risk of fat embolism syndrome in patients with long bone fractures. The main conclusions and recommendations reached were that traumatized patients should be monitored with non-invasive pulse oximetry and lactate levels since these commonly-available tests may predict the development of FES, and the lack of evidence to recommend the use of steroids for the prophylaxis of this syndrome.405423426Gopinathan, N.R., Sen, R.K., Viswanathan, V.K., Aggarwal, A., Mallikarjun, H.C., Rajaram Manoharan, S.R., Early, reliable, utilitarian predictive factors for fat embolism syndrome in polytrauma patients (2013) Indian J Crit Care Med., 17 (1), pp. 38-42Sen, R.K., Tripathy, S.K., Krishnan, V., Role of corticosteroid as a prophylactic measure in fat embolism syndrome: A literature review (2012) Musculoskelet Surg., 96 (1), pp. 1-8Bederman, S.S., Bhandari, M., McKee, M.D., Schemitsch, E.H., Do corticosteroids reduce the risk of fat embolism syndrome in patients with long-bone fractures? A meta-analysis (2009) Can J Surg., 52 (5), pp. 386-393Moore, F.A., Haenel, J.B., Moore, E.E., Whitehill, T.A., Incommensurate oxygen consumption in response to maximal oxygen availability predicts postinjury multiple oxygen failure (1992) J Trauma., 33 (1), pp. 58-65. , discussion 65-7Kim, P.K., Deutschman, C.S., Inflammatory responses and mediators (2000) Surg Clin North Am., 80 (3), pp. 885-894Kallenbach, J., Lewis, M., Zaltzman, M., Feldman, C., Orford, A., Zwi, S., 'Low-dose' corticosteroid prophylaxis against fat embolism (1987) J Trauma., 27 (10), pp. 1173-1176Lindeque, B.G., Schoeman, H.S., Dommisse, G.F., Boeyens, M.C., Vlok, A.L., Fat embolism and the fat embolism syndrome. A double-blind therapeutic study (1987) J Bone Joint Surg Br., 69 (1), pp. 128-131Schonfeld, S.A., Ploysongsang, Y., DiLisio, R., Crissman, J.D., Miller, E., Hammerschmidt, D.E., Fat embolism prophylaxis with corticosteroids. A prospective study in high-risk patients (1983) Ann Intern Med., 99 (4), pp. 438-44

Hepatic Trauma: A 21-year Experience [trauma Hepático: Uma Experiência De 21 Anos]

Objective: To evaluate the epidemiological aspects, behavior, morbidity and treatment outcomes for liver trauma. Methods: We conducted a retrospective study of patients over 13 years of age admitted to a university hospital from 1990 to 2010, submitted to surgery or nonoperative management (NOM). Results: 748 patients were admitted with liver trauma. The most common mechanism of injury was penetrating trauma (461 cases, 61.6%), blunt trauma occurring in 287 patients (38.4%). According to the degree of liver injury (AAST-OIS) in blunt trauma we predominantly observed Grades I and II and in penetrating trauma, Grade III. NOM was performed in 25.7% of patients with blunt injury. As for surgical procedures, suturing was performed more frequently (41.2%). The liver-related morbidity was 16.7%. The survival rate for patients with liver trauma was 73.5% for blunt and 84.2% for penetrating trauma. Mortality in complex trauma was 45.9%. Conclusion: trauma remains more common in younger populations and in males. There was a reduction of penetrating liver trauma. NOM proved safe and effective, and often has been used to treat patients with penetrating liver trauma. Morbidity was high and mortality was higher in victims of blunt trauma and complex liver injuries.404318322Talving, P., Beckman, M., Häggmark, T., Iselius, L., Epidemiology of liver injuries (2003) Scand J Surg., 92 (3), pp. 192-194Diorio, A.C., Fraga, G.P., Dutra Jr., I., Joaquim, J.L., Mantovani, M., Predictive factors of morbidity and mortality in hepatic trauma (2008) Rev Col Bras Cir., 35 (6), pp. 397-405Smaniotto, B., von Bahten, L.C., Nogueira Filho, D.C., Tano, A.L., Thomaz Júnior, L., Fayad, O., Hepatic trauma: Analysis of the treatment with intrahepatic balloon in a university hospital of Curitiba (2009) Rev Col Bras Cir., 36 (3), pp. 217-222Croce, M.A., Fabian, T.C., Menke, P.G., Waddle-Smith, L., Minard, G., Kudsk, K.A., Nonoperative management of blunt hepatic trauma is the treatment of choice for hemodynamically stable patients. Results of a prospective trial (1995) Ann Surg., 221 (6), pp. 744-753Sriussadaporn, S., Pak-art, R., Tharavej, C., Sirichindakul, B., Chiamananthapong, S., A multidisciplinary approach in the management of hepatic injuries (2002) Injury., 33 (4), pp. 309-315Champion, H.R., Sacco, W.J., Copes, W.S., Gann, D.S., Gennarelli, T.A., Flanagan, M.E., A revision of the Trauma Score (1989) J Trauma., 29 (5), pp. 623-629Baker, S.P., O'Neill, B., Haddon Jr., W., Long, W.B., The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care (1974) J Trauma., 14 (3), pp. 187-196Boyd, C.R., Tolson, M.A., Copes, W.S., Evaluating trauma care: The TRISS method. Trauma Score and the Injury Severity Score (1987) J Trauma., 27 (4), pp. 370-378Moore, E.E., Cogbill, T.H., Jurkovich, G.J., Shackford, S.R., Malangoni, M.A., Champion, H.R., Organ injury scaling: Spleen and liver (1994 revision) (1995) J Trauma., 38 (3), pp. 323-324Stalhschmidt, C.M., Formighieri, B., Marcon, D.M., Takejima, A.L., Soares, L.G.S., Hepatic trauma: Five years of epidemiology in an emergency service (2008) Rev Col Bras Cir., 35 (4), pp. 225-228Malhotra, A.K., Fabian, T.C., Croce, M.A., Gavin, T.J., Kudsk, K.A., Minard, G., Blunt hepatic injury: A paradigm shift from operative to nonoperative management in the 1990s (2000) Ann Surg., 231 (6), pp. 804-813Matthes, G., Stengel, D., Seifert, J., Rademacher, G., Mutze, S., Ekkernkamp, A., Blunt liver injuries in polytrauma: Results from a cohort study with the regular use of whole-body helical computed tomography (2003) World J Surg., 27 (10), pp. 1124-1130Krige, J.E., Bornman, P.C., Terblanche, J., Liver trauma in 446 patients (1997) S Afr J Surg., 35 (1), pp. 10-15Scollay, J.M., Beard, D., Smith, R., McKeown, D., Garden, O.J., Parks, R., Eleven years of liver trauma: The Scottish experience (2005) World J Surg., 29 (6), pp. 744-749Pachter, H.L., Knudson, M.M., Esrig, B., Ross, S., Hoyt, D., Cogbill, T., Status of nonoperative management of blunt hepatic injuries in 1995: A multicenter experience with 404 patients (1996) J Trauma., 40 (1), pp. 31-38Asensio, J.A., Demetriades, D., Chahwan, S., Gomez, H., Hanpeter, D., Velmahos, G., Approach to the management of complex hepatic injuries (2000) J Trauma, 48 (1), pp. 66-69Kozar, R.A., Moore, J.B., Niles, S.E., Holcomb, J.B., Moore, E.E., Cothren, C.C., Complications of nonoperative management of high-grade blunt hepatic injuries (2005) J Trauma., 59 (5), pp. 1066-1071Sikhondze, W.L., Madiba, T.E., Naidoo, N.M., Muckart, D.J., Predictors of outcome in patients requiring surgery for liver trauma (2007) Injury., 38 (1), pp. 65-70Fraga, G.P., Zago, T.M., Pereira, B.M., Calderan, T.R., Silveira, H.J., Use of Sengstaken-Blakemore intrahepatic balloon: An alternative for liver-penetrating injuries (2012) World J Surg., 36 (9), pp. 2119-2124Meredith, J.W., Young, J.S., Bowling, J., Roboussin, D., Nonoperative management of blunt hepatic trauma: The exception or the rule? (1994) J Trauma., 36 (4), pp. 529-534Bynoe, R.P., Bell, R.M., Miles, W.S., Close, T.P., Ross, M.A., Fine, J.G., Complications of nonoperative management of blunt hepatic injuries (1992) J Trauma., 32 (3), pp. 308-314Sherman, H.F., Savage, B.A., Jones, L.M., Barrette, R.R., Latenser, B.A., Varcelotti, J.R., Nonoperative management of blunt hepatic injuries: Safe at any grade? (1994) J Trauma., 37 (4), pp. 616-621Coimbra, R., Hoyt, D.B., Engelhart, S., Fortlage, D., Nonoperative management reduces the overall mortality of grades 3 and 4 blunt liver injuries (2006) Int Surg., 91 (5), pp. 251-257Norrman, G., Tingstedt, B., Ekelund, M., Andersson, R., Non-operative management of blunt liver trauma: Feasible and safe also in centres with a low trauma incidence (2009) HPB., 11 (1), pp. 50-56Zago, T.M., Pereira, B.M., Calderan, T.R., Hirano, E.S., Rizoli, S., Fraga, G.P., Blunt hepatic trauma: Comparison between surgical and nonoperative treatment (2012) Rev Col Bras Cir., 39 (4), pp. 307-313Zago, T.M., Tavares Pereira, B.M., Araujo Calderan, T.R., Godinho, M., Nascimento, B., Fraga, G.P., Nonoperative management for patients with grade IV blunt hepatic trauma (2012) World J Emerg Surg., 7 (SUPPL. 1), pp. S8Pereira, B.M., Non-operative management of hepatic trauma and the interventional radiology: An update review (2012) Indian J Surg., , [on line]Carrasco, C.E., Godinho, M., de Azevedo Barros Berti, M., Rizoli, S., Fraga, G.P., Fatal motorcycle crashes: A serious public health problem in Brazil (2012) World J Emerg Surg., 7 (SUPPL. 1), pp. S

Nonoperative Management Of Splenic Injury Grade Iv Is Safe Using Rigid Protocol [tratamento Não Operatório De Lesão Esplênica Grau Iv é Seguro Usando-se Rígido Protocolo]

Objective: To demonstrate the protocol and experience of our service in the nonoperative management (NOM) of grade IV blunt splenic injuries. Methods: This is a retrospective study based on trauma registry of a university hospital between 1990-2010. Charts of all patients with splenic injury were reviewed and patients with grade IV lesions treated nonoperatively were included in the study. Results: ninety-four patients with grade IV blunt splenic injury were admitted during this period. Twenty-six (27.6%) met the inclusion criteria for NOM. The average systolic blood pressure on admission was 113.07 ± 22.22 mmHg, RTS 7.66 ± 0.49 and ISS 18.34 ± 3.90. Ten patients (38.5%) required blood transfusion, with a mean of 1.92 ± 1.77 packed red cells per patient. Associated abdominal injuries were present in two patients (7.7%). NOM failed in two patients (7.7%), operated on due to worsening of abdominal pain and hypovolemic shock. No patient developed complications related to the spleen and there were no deaths in this series. Average length of hospital stay was 7.12 ± 1.98 days. Conclusion: Nonoperative treatment of grade IV splenic injuries in blunt abdominal trauma is safe when a rigid protocol is followed.404323328Raza, M., Abbas, Y., Devi, V., Prasad, K.V., Rizk, K.N., Nair, P.P., Non operative management of abdominal trauma-a 10 years review (2013) World J Emerg Surg., 8 (1), p. 14. , [online] Acessado em 05/04/2013Moore, E.E., Cogbill, T.H., Jurkovich, G.J., Shackford, S.R., Malangoni, M.A., Champion, H.R., Organ injury scaling: Spleen and liver (1994 revision) (1995) J Trauma, 38, p. 323Jeremitsky, E., Smith, R.S., Ong, A.W., Starting the clock: Defining nonoperative management of blunt splenic injury by time (2013) Am J Surg., 205 (3), pp. 298-301Lippert, S.J., Hartin Jr., C.W., Ozgediz, P.L., Glick, P.L., Caty, M.G., Flynn, W.J., Splenic conservation: Variation between pediatric and adut trauma centers (2013) J Surg Res., 182 (1), pp. 17-20Stassen, N.A., Bhullar, I., Cheng, J.D., Crandall, M.L., Friese, R.S., Guillamondegui, O.D., Selective nonoperative management of blunt splenic injury: An Eastern Association for the Surgery of Trauma practice management guideline (2012) J Trauma Acute Care Surg., 73 (5 SUPPL. 4), pp. S294-S300Starling, S.V., Rodrigues, J.M.S., Reis, M.C.W., Trauma contuso do baço: Quando operar? (2011) Atualidades em Clínica Cirúrgica-Intergastro e Trauma, pp. 29-51. , In: Fraga GP, Sevá-Pereira G, Lopes LR, Editora Atheneu, São Paulo, 2011Carvalho, F.H., Romeiro, P.C., Collaço, I.A., Baretta, G.A., Freitas, A.C., Matias, J.E., Prognostics factors related to non surgical treatment failure of splenic injuries in the abdominal blunt trauma (2009) Rev Col Bras Cir., 36 (2), pp. 123-130Olthof, D.C., Joosse, P., Van Der Vlies, C.H., De Haan, R.J., Goslings, J.C., Prognostic factors for failure of nonoperative management in adults with blunt splenic injury: A systematic review (2013) J Trauma Acute Care Surg., 74 (2), pp. 546-557Bhullar, I.S., Frykberg, E.R., Siragusa, D., Chesire, D., Paul, J., Tepas III, J.J., Age does not affect outcomes of nonperative management of blunt splenic trauma (2012) J Am Coll Surg., 214 (6), pp. 958-964Galvan, D.A., Peitzman, A.B., Failure of nonoperative management of abdominal solid organ injuries (2006) Curr Opin Crit Care., 12 (6), pp. 590-594Mantovani, M., Mauro, J.F., Fraga, G.P., Meirelles, G.V., Trauma abdominal fechado: Tratamento não-operatório das lesões esplênicas (2002) Rev Para Med., 16 (2), pp. 46-51Zarzaur, B.L., Kozar, R.A., Fabian, T.C., Coimbra, R., A survey of American Association for the Surgery of Trauma member practices in the management of blunt splenic injury (2011) J Trauma., 70 (5), pp. 1026-1031Bhullar, I.S., Frykberg, E.R., Tepas III, J.J., Siragusa, D., Loper, T., Kerwin, A.J., At first blush: Absence of computed tomography contrast extravasation in grade IV or V adult blunt splenic trauma should not preclude angioembolization (2013) J Trauma Acute Care Surg., 74 (1), pp. 105-111Meguid, A.A., Bair, H.A., Howells, G.A., Bendick, P.J., Kerr, H.H., Villalba, M.R., Prospective evaluation of criteria for the nonoperative management of blunt splenic trauma (2003) Am Surg., 69, pp. 238-243Peitzman, A.B., Heil, B., Rivera, L., Federle, M.B., Harbrecht, B.G., Clancy, K.D., Blunt splenic injury in adults: Multi-institutional study of the Eastern Association for the surgery of trauma (2000) J Trauma., 49, pp. 177-189Pearl, R.H., Wesson, D.E., Spence, L.J., Filler, R.M., Ein, S.H., Shandling, B., Splenic injury: A 5-year update with improved results and changing criteria for conservative management (1989) J Pediatr Surg., 24, pp. 428-431Albrecht, R.M., Schermer, C.R., Morris, A., Nonoperative management of blunt splenic injuries: Factors influencing success in age > 55 years (2002) Am Surg., 68, pp. 227-231Cocanour, C.S., Moore, F.A., Ware, D.N., Marvin, R.G., Duke, J.H., Age should not be a consideration for nonoperative management of blunt splenic injury (2000) J Trauma., 48, pp. 606-612Tsugawa, K., Koyanagi, N., Hashizume, M., Ayukawa, K., Wada, H., Tomikawai, M., New insight for management of blunt splenic trauma: Significant differences between young and elderly (2002) Hepato-gastroenterology., 49, pp. 1144-1149Krause, K.R., Howells, G.A., Bair, H.A., Glover, J.L., Madrazo, B.L., Wasvary, H.J., Nonoperative management of blunt splenic injury in adults 55 years and older: A twenty-year experience (2000) Am Surg., 66, pp. 636-640Harbrecht, B.G., Peitzman, A.B., Rivera, L., Heil, B., Croce, M., Morris Jr., J.A., Contribution of age and gender to outcome of blunt splenic injury in adults: Multicenter study of the eastern association for the surgery of trauma (2001) J Trauma., 51, pp. 887-895Willmann, J.K., Roos, J.E., Platz, A., Pfammatter, T., Hilfiker, P.R., Marincek, B., Multidetector CT: Detection of active hemorrhage in patients with blunt abdominal trauma (2002) AJR., 179 (2), pp. 437-444Malangoni, M.A., Cué, J.I., Fallat, M.E., Willing, S.J., Richardson, J.D., Evaluation of splenic injury by computed tomography and its impact on treatment (1990) Ann Surg., 211, pp. 592-599Mirvis, S.E., Whitley, N.O., Gens, D.R., Blunt splenic trauma in adults: CTbased classification and correlation with prognosis and treatment (1989) Radiology., 171, pp. 33-39Skattum, J., Titze, T.L., Dormagen, J.B., Aaberge, I.S., Bechensteen, A.G., Gaarder, P.I., Preserved splenic function after angioembolisation of high grade injury (2012) Injury., 43, pp. 62-66Pachter, H.L., Guth, A.A., Hofstetter, S.R., Spencer, F.C., Changing patterns in the management of splenic trauma: The impact of nonoperative management (1998) Ann Surg., 227, pp. 708-719Powell, M., Courcoulas, A., Gardner, M., Lynch, J., Harbrecht, B.G., Udekwu, A.O., Management of blunt splenic trauma: Significant differences between adults and children (1997) Surgery, 122, pp. 654-660Hunt, J.P., Lentz, C.W., Cairns, B.A., Ramadan, F.M., Smith, D.L., Rutledge, R., Management and outcome of splenic injury: The results of a five-year statewide population-based study (1996) Am. Surg., 62, pp. 911-917Velmahos, G.C., Zacharias, N., Emhoff, T.A., Feeney, J.M., Hurst, J.M., Crookes, B.A., Management of the most severely injured spleen: A multicenter study of the Research Consortium of New England Centers for Trauma (ReCONECT) (2010) Arch Surg., 145 (5), pp. 456-460Branco, B.C., Tang, A.L., Rhee, P., Fraga, G.P., Nascimento, B., Rizoli, S., O'Keeffe, T., Selective Nonoperative Management of High Grade Splenic Trauma (2013) Rev Col Bras Cir, 40 (3), pp. 246-25

Acute Intestinal Obstruction Due To Gallstone Ileus [abdome Agudo Por Obstrução Por Ileobiliar]

Objective: Small bowel obstruction (SBO) due to gallstones (gallstone ileus) is an uncommon complication of cholelithiasis, for which there is no defined surgical procedure. The objective of this study was to perform a systematic review of the history, available image exams and clinical approach to the diagnosis and treatment of gallstone ileus. Method: We conducted a retrospective study in a university hospital including all cases of SBO treated over a period of 23 years. According to the surgical treatment, the patients were divided into two groups: (1) enterolithotomy with posterior cholecystectomy (two-stage surgery); and (2) enterolithotomy, cholecystectomy and fistula closure (one-stage surgery). Results: Twelve patients were included in the study, including 11 females (91,6%), with a mean age of 72.2 years. All patients presented associated diseases, mainly arterial hypertension (75%). All except one patient had multiple SBO symptoms. Gallstone ileus diagnosis was made before laparotomy in six patients (50%). There were eight patients in group 1 and four in group 2, and the morbidity was, respectively, 33.3% and 8.3%. Overall mortality was 16.6% (one patient in each group). Conclusion: Gallstone ileus should be suspected in the elderly with SBO symptoms. Early diagnosis can reduce post-operative complications. Treatment is urgent laparotomy and the surgical approach must be individualized for each case. The majority of patients in this study were treated with enterolithotomy, with cholecystectomy being performed later in two symptomatic patients.404275280Martin, F., Intestinal obstruction due to gall-stones: With report of three successful cases (1912) Ann Surg., 55 (5), pp. 725-743Reisner, R.M., Cohen, J.R., Gallstone ileus: A review of 1001 reported cases (1994) Am Surg., 60 (6), pp. 441-446Lobo, D.N., Jobling, J.C., Balfour, T.W., Gallstone ileus: Diagnostic pittfalls and therapeutic successes (2000) J Clin Gastroenterol., 30 (1), pp. 72-76Hayes, N., Saha, S., Recurrent gallstone Ileus (2012) Clin Med Res., 10 (4), pp. 236-239Carrascosa, M.F., Riego-Martín, M.D., Salcines Caviedes, J.R., González Gutiérrez, P., Gallstone ileus (2012) BMJ Case Rep., , Feb 21;2012Rojas-Rojas, D.J., Martínez-Ordaz, J.L., Romero-Hernández, T., Biliary ileus: 10-years experience (2012) Cir Cir., 80 (3), pp. 228-232Tucker, A., Garstin, I., A peculiar cause of bowel obstruction (2013) Int J Surg Case Rep., 4 (5), pp. 473-476Halabi, W.J., Kang, C.Y., Ketana, N.K., Lafaro, K.J., Nguyen, V.K., Stamos, M.J., Surgery for gallstone ileus: A nationwide comparison of trends and outcomes (2013) Ann Surg., , jan 4 [Epub ahead of print]Pronio, A., Piroli, S., Caporilli, D., Ciamberlano, B., Coluzzi, M., Castellucci, G., Recurrent gallstone ileus: Case report and literature review (2013) G Chir., 34 (1-2), pp. 35-37McHado, M.A.C., Jukemura, J., Volpe, P., Abdo, E.E., Penteado, S., Bacchella, T., Fístulas biliares internas: Estudo de 13 casos e revisão da literatura (1995) Hos Clin Fac Med S Paulo., 50 (1), pp. 45-48Ayantunde, A.A., Agrawal, A., Gallstone Ileus: Diagnosis and management (2007) World J Surg., 31 (6), pp. 1292-1297Ravikumar, R., Williams, J.G., The operative management of gallstone ileus (2010) Ann R Coll Surg Engl., 92 (4), pp. 279-281Day, E.A., Marks, C., Gallstone ileus: Review of literature and presentation of thirty-four new cases (1975) Am J Surg., 129 (5), pp. 552-558Deitz, D.M., Standage, B.A., Pinson, C.W., McConnell, D.B., Krippaehne, W.W., Improving the outcome in gallstone ileus (1986) Am J Surg., 151 (5), pp. 572-576Bouveret, L., Stenose du pylore, adherent a la vesicule calculeuse (1896) Rev Med., 16, pp. 1-16Gajendran, M., Muniraj, T., Gelrud, A., A challenging case of gastric outlet obstruction (Bouveret's syndrome): A case report (2011) J Med Case Rep., 5, p. 497Costil, V., Jullès, M.C., Zins, M., Loriau, J., Bouveretś syndrome. An unusual localization of gallstone ileus (2012) J Visc Surg., 149 (4), pp. e284-e286Kasahara, Y., Umemura, H., Shiraha, S., Kuyama, T., Sakata, K., Kubota, H., Gallstone ileus. Review of 112 patients in the Japanese literature (1980) Am J Surg., 140 (3), pp. 437-440van Hillo, M., van der Vliet, J.A., Wiggers, T., Obertop, H., Terpstra, O.T., Greep, J.M., Gallstone obstruction of the intestine: An analysis of ten patients and a review of the literature (1987) Surgery., 101 (3), pp. 273-276Nuño-Guzmán, C.M., Arróniz-Jáuregui, J., Moreno-Pérez, P.A., Chávez-Solís, E.A., Esparza-Arias, N., Hernández-González, C.I., Gallstone ileus: One-stage surgery in a patient with intermittent obstruction (2010) World J Gastrointest Surg., 2 (5), pp. 172-176Clavien, P.A., Richon, J., Burgan, S., Rohner, A., Gallstone ileus (1990) Br J Surg., 77 (7), pp. 737-742Murphy, K.P., Kearney, D.E., Mc Laughlin, P.D., Maher, M.M., Complete radiological findings in gallstone ileus (2012) J Neurogastroenterol Motil., 18 (4), pp. 448-449Huang, S.T., Huang, M.Y., Gallstone ileus: A diagnostic challenge by plain radiography (2013) Emerg Med J., 30 (5), p. 370Lasson, A., Lorén, I., Nilsson, A., Nirhov, N., Nilsson, P., Ultrasonography in gallstone ileus: A diagnostic challenge (1995) Eur J Surg., 161 (4), pp. 259-263Mishin, I., Ghidirim, G., Zastavnitsky, G., Non-operative treatment for gall-stone ileus-a case report (2011) Pol Przegl Chir., 83 (4), pp. 223-226Conzo, G., Mauriello, C., Gambardella, C., Napolitano, S., Cavallo, F., Tartaglia, E., Gallstone ileus: One-stage surgery in an elderly patient: One-stage surgery in gallstone ileus (2013) Int J Surg Case Rep., 4 (3), pp. 316-318Mallipeddi, M.K., Pappas, T.N., Shapiro, M.L., Scarborough, J.E., Gallstone ileus: Revisiting surgical outcomes using National Surgical Quality Improvement Program data (2013) J Surg Res., , May 31. [Epub ahead of print]Beriner, S.D., Burson, L.C., One-stage repair for cholecyst-duodenal fistula and gallstone ileus (1965) Arch Surg., 90, pp. 313-316Jones, R., Broman, D., Hawkins, R., Corless, D., Twice recurrent gallstone ileus: A case report (2012) J Med Case Rep., 6 (1), p. 362Paiva-Coronel, G., Martínez-Ramos, D., Cosa-Rodríguez, R., Salvador-Sanchis, J.L., Íleo biliar. Abordaje asistido por laparoscopia (2010) Cir Esp., 87 (4), pp. 255-25

Evaluation Of Gasometric Parameters In Trauma Patients During Mobile Prehospital Care [avaliação Dos Parâmetros Gasométricos Dos Traumatizados Durante O Atendimento Pré-hospitalar Móvel]

Objective: To evaluate gasometric differences of severe trauma patients requiring intubation in prehospital care. Methods: Patients requiring airway management were submitted to collection of arterial blood samples at the beginning of pre-hospital care and at arrival at the Emergency Room. We analyzed: Glasgow Coma Scale, respiratory rate, arterial pH, arterial partial pressure of CO2 (PaCO2), arterial partial pressure of O2 (PaO2), base excess (BE), hemoglobin O2 saturation (SpO2) and the relation of PaO2 and inspired O2 (PaO2/FiO2). Results: There was statistical significance of the mean differences between the data collected at the site of the accident and at the entrance of the ER as for respiratory rate (p = 0.0181), Glasgow Coma Scale (p = 0.0084), PaO2 (p <0.0001) and SpO2 (p = 0.0018). Conclusion: tracheal intubation changes the parameters PaO2 and SpO2. There was no difference in metabolic parameters (pH, bicarbonate and base excess). In the analysis of blood gas parameters between survivors and non-survivors there was statistical difference between PaO2, hemoglobin oxygen saturation and base excess.404293299Gonsaga, R.A., Brugugnolli, I.D., Fraga, G.P., Comparison between two mobile pre-hospital care services for trauma patients (2012) Word J Emerg Surg., 7 (SUPPL. 1), pp. S6Pereira Júnior, G.A., Carvalho, J.B., Ponte Filho, A.D., Malzone, D.A., Pedersoli, C.E., Transporte intra-hospitalar do paciente crítico (2007) Medicina., 40 (4), pp. 500-508Kue, R., Brown, P., Ness, C., Scheulen, J., Adverse clinical events during intrahospital transport by a specialized team: A preliminary report (2011) Am J Crit Care., 20 (2), pp. 153-161Lima Junior, N.A., Bacelar, S.C., Japiassú, A.M., Cader, S.A., Lima, R.C.F., Dantas, E.H.M., Gasometria arterial em dois diferentes métodos de transporte intra-hospitalar no pós-operatório imediato de cirurgia cardíaca (2012) Rev bras ter intensiva., 24 (2), pp. 162-166Waydhas, C., Schneck, G., Duswald, K.H., Deterioration of respiratory function after intra-hospital transport of critically ill surgical patients (1995) Intensive Care Med., 21 (10), pp. 784-789Zuchelo, L.T.S., Chiavone, P.A., Transporte intra-hospitalar de pacientes sob ventilação invasiva: Repercussões cardiorrespiratórias e eventos adversos (2009) J bras pneumol., 35 (4), pp. 367-374Gervais, H.W., Eberle, B., Konietzke, D., Hennes, H.J., Dick, W., Comparison of blood gases of ventilated patients during transport (1987) Crit Care Med., 15 (8), pp. 761-763Wildner, G., Pauker, N., Archan, S., Gemes, G., Rigaud, M., Pocivalnik, M., Arterial line in prehospital emergency settings-A feasibility study in four physician-staffed emergency medical systems (2011) Resuscitation., 82 (9), pp. 1198-1201Schmelzer, T.M., Perron, A.D., Thomason, M.H., Sing, R.F., A comparison of central venous and arterial base deficit as a predictor of survival in acute trauma (2008) Am J Emerg Med., 26 (2), pp. 119-123Bilello, J.F., Davis, J.W., Lemaster, D., Townsend, R.N., Parks, S.N., Sue, L.P., Prehospital hypotension in blunt trauma: Identifying the "crump factor" (2011) J Trauma., 70 (5), pp. 1038-1042(2012) Atendimento pré-hospitalar ao traumatizado, PHTLS / NAEMT, , Tradução do original Prehospital trauma life support, por Renata Scavone, et al. 7a ed. Rio de Janeiro: ElsevierFraga, G.P., Mantovani, M., Magna, L.A., Índices de trauma em pacientes submetidos à laparotomia (2004) Rev Col Bras Cir., 31 (5), pp. 299-306Barros, M.D.A., Ximenes, R., Lima, M.L.C., Mortalidade por causas externas em crianças e adolescentes: Tendência de 1979 a 1995 (2001) Rev Saúde Pública., 35 (2), pp. 142-149Gonsaga, R.A.T., Rimoli, C.F., Pires, E.A., Zogheib, F.S., Fujino, M.V.T., Cunha, M.B., Avaliação da mortalidade por causas externas (2012) Rev Col Bras Cir., 39 (4), pp. 263-267Batista, S.E.A., Baccani, J.G., Silva, R.A.P., Gualda, K.P.F., Vianna Junior, R.J.A., Análise comparativa entre os mecanismos de trauma, as lesões e o perfil de gravidade das vítimas, em Catanduva-SP (2006) Rev Col Bras Cir., 33 (1), pp. 6-10Carrasco, C.E., Godinho, M., Berti de Azevedo Barros, M., Rizoli, S., Fraga, G.P., Fatal motorcycle crashes: A serious public health problem in Brazil (2012) World J Emerg Surg., 7 (SUPPL. 1), pp. S5Marín-León, L., Belon, A.P., Barros, M.B.A., Almeida, S.D.M., Restitutti, M.C., Tendênica dos acidentes de trânsito em Campinas, São paulo, Brasil: Importância crescente dos motociclistas (2012) Cad Saúde Pública., 28 (1), pp. 39-51Jousi, M., Reitala, J., Lund, V., Katila, A., Leppäniemi, A., The role of prehospital blood gas analysis in trauma resuscitation (2010) World J Emerg Surg., 5, p. 10Martin, M., Oh, J., Currier, H., Tai, N., Beekley, A., Eckert, M., An analysis of in-hospital deaths at a modern combat support hospital (2009) J Trauma., 66 (4 SUPPL.), pp. S51-S60. , discussion S60-1Ouellet, J.F., Roberts, D.J., Tiruta, C., Kirkpatrick, A.W., Mercado, M., Trottier, V., Admission base deficit and lactate levels in Canadian patients with blunt trauma: Are they useful markers of mortality? (2012) J Trauma Acute Care Surg., 72 (6), pp. 1532-1535Darlington, D.N., Kheirabadi, B.S., Delgado, A.V., Scherer, M.R., Martini, W.Z., Dubick, M.A., Coagulation changes to systemic acidosis and bicarbonate correction in swine (2011) J Trauma., 71 (5), pp. 1271-1277Rudkin, S.E., Kahn, C.A., Oman, J.A., Dolich, M.O., Lotfipour, S., Lush, S., Prospective correlation of arterial vs venous blood gas measurements in trauma patients (2012) Am J Emerg Med., 30 (8), pp. 1371-1377Hussmann, B., Lefering, R., Waydhas, C., Ruchholtz, S., Wafaisade, A., Kauther, M.D., Prehospital intubation of the moderately injured patient: A cause of morbidity? A matched-pairs analysis of 1,200 patients from the DGU Trauma Registry (2011) Crit Care., 15 (5), pp. R207Park, M., Costa, E.L.V., McIel, A.T., Hirota, A.S., Vasconcelos, E., Azevedo, L.C.P., Alterações hemodinâmicas, respiratórias e metabólicas agudas após o contato do sangue com o circuito extracorpóreo da ECMO: Estudo experimental (2012) Rev bras ter intensiva., 24 (2), pp. 137-14

Iroa: the international register of open abdomen. an international effort to better understand the open abdomen: call for participants

Actually the most common indications for Open Abdomen (OA) are trauma, abdominal sepsis, severe acute pancreatitis and more in general all those situations in which an intra-abdominal hypertension condition is present, in order to prevent the development of an abdominal compartment syndrome. The mortality and morbidity rate in patients undergone to OA procedures is still high. At present many studies have been published about the OA management and the progresses in survival rate of critically ill trauma and septic surgical patients. However several issues are still unclear and need more extensive studies. The definitions of indications, applications and methods to close the OA are still matter of debate. To overcome this lack of high level of evidence data about the OA indications, management, definitive closure and follow-up, the World Society of Emergency Surgery (WSES) promoted the International Register of Open Abdomen (IROA). The register will be held on a web platform (Clinical Registers (R)) through a dedicated web site: www. clinicalregisters. org. This will allow to all surgeons and physicians to participate from all around the world only by having a computer and a web connection. The IROA protocol has been approved by the coordinating center Ethical Committee (Papa Giovanni XXIII hospital, Bergamo, Italy).Actually the most common indications for Open Abdomen (OA) are trauma, abdominal sepsis, severe acute pancreatitis and more in general all those situations in which an intra-abdominal hypertension condition is present, in order to prevent the development103713sem informaçãosem informaçã

Caustic ingestion management: world society of emergency surgery preliminary survey of expert opinion

[This corrects the article DOI: 10.1186/s13017-015-0043-4.].sem informação1056sem informaçãosem informaçã

New therapeutic perspectives to manage refractory immune checkpoint-related toxicities.

Immune checkpoint inhibitors are reshaping the prognosis of many cancer and are progressively becoming the standard of care in the treatment of many tumour types. Immunotherapy is bringing new hope to patients, but also a whole new spectrum of toxicities for healthcare practitioners to manage. Oncologists and specialists involved in the pluridisciplinary management of patients with cancer are increasingly confronted with the therapeutic challenge of treating patients with severe and refractory immune-related adverse events. In this Personal View, we summarise the therapeutic strategies that have been used to manage such toxicities resulting from immune checkpoint inhibitor treatment. On the basis of current knowledge about their pathogenesis, we discuss the use of new biological and non-biological immunosuppressive drugs to treat severe and steroid refractory immune-related adverse events. Depending on the immune infiltrate type that is predominant, we propose a treatment algorithm for personalised management that goes beyond typical corticosteroid use. We propose a so-called shut-off strategy that aims at inhibiting key inflammatory components involved in the pathophysiological processes of immune-related adverse events, and limits potential adverse effects of drug immunosuppression on tumour response. This approach develops on current guidelines and challenges the step-by-step increase approach to drug immunosuppression