A Brazilian survey regarding the management of acute pancreatitis

OBJETIVO: Avaliar como a pancreatite aguda é vista e tratada pelo cirurgião brasileiro. MÉTODO: Trata-se de um questionário prospectivo enviado aos membros do Colégio Brasileiro de Cirurgiões (CBC). Dois mil questionários foram enviados obtendo-se 618 respostas (30,9%). O questionário constituía de perguntas relacionadas à experiência do cirurgião e ao tratamento da PA. RESULTADOS: Cento e oitente e dois entrevistados (33,6%) disseram tratar até cinco casos por ano e 147 (27,2%) tratam de seis a 10 casos por ano. Dentre os critérios utilizados para a definição de PA, o mais citado foi a avaliação clínica por 306 (57,4%) entrevistados, seguido dos critérios de Ranson por 294 (55,2%) e TC por 262 (49,2%). Com relação ao uso da TC, 275 (51,5%) entrevistados responderam que realizam a TC em todos os doentes com PA. O suporte nutricional parenteral foi o método de escolha indicado por 248 (46,6%) entrevistados. A infecção da coleção e/ou necrose pancreática é a principal indicação operatória com 447 (83,6%) respostas. O melhor período para operar um doente com PA grave foi considerado até quatorze dias por 278 (54,2%) entrevistados. Com relação aos antibióticos, 371 (68,6%) entrevistados disseram que utilizam antibióticos no tratamento da PA grave. CONCLUSÃO: Estes resultados demonstram uma ampla variação no tratamento da PA no Brasil. A pouca experiência dos cirurgiões e os temas controversos são os fatores principais responsável para esta falta de padronização. A realização de um Consenso nacional baseado nos novos conceitos e na experiência mundial é crucial para ajustar estas condutas.BACKGROUND: to evaluate as AP is managed by the Brazilian surgeon. METHODS: A questionnaire has been sent to 2,000 members of the Brazilian College of Surgeons, with 618 (30.9%) answers obtained. The questionnaire consisted of questions related to the experience of the surgeon and in particular to the treatment of AP. RESULTS: One hundred and eighty-two interviewed (33.6%) answered to treat up to five cases per year and 147 (27.2%) treat six to ten cases per year. The most cited criteria used for the definition of severe AP was clinical evaluation for 306 (57.4%) interviewed, followed by the Ranson criteria for 294 (55.2%) and CT scan for 262 (49.2%). Regarding the use of CT, 275 (51.5%) interviewed answered that make use of CT scan for all patients with AP. The parenteral nutritional support was the method of choice indicated for 248 (46.6%) interviewed. The infection of fluid collection and/or pancreatic necrosis was the main reason for surgical treatment with 447 (83.6%) answers. The optimum period to operate a patient with severe AP was considered up to seven days for 278 (54.2%) interviewed. With relation to antibiotics, 371 (68.6%) said that they use antibiotics in the treatment of severe AP. CONCLUSION: These findings demonstrate a wide variation in the treatment of AP in Brazil. Little experience of the surgeons and controversial issues are the main factors responsible for this lack of standardization. A national Consensus based on new concepts and worldwide experience is crucial to adjust these thoughts

Lesões graves em vítimas de queda da própria altura

OBJETIVO: Avaliar as características das vítimas de queda da própria altura, principalmente a respeito da frequência de lesões graves, seu diagnóstico e tratamento. MÉTODOS: Estudo retrospectivo dos protocolos de trauma (coletados prospectivamente) de 10/06/2008 a 10/03/2009, incluindo as vítimas de trauma fechado com idade igual ou superior a 13 anos admitidas na sala de emergência. Consideraremos como "graves" as lesões com escore de AIS (Abbreviated Injury Scale) maior ou igual a três. As variáveis foram comparadas entre o grupo de vítimas de quedas da própria altura (Grupo I) e as demais vítimas de trauma fechado (Grupo II). Empregamos os testes T de Student, Qui quadrado e Fisher para a comparação entre os grupos, considerando o valor de p3) foram mais frequentemente observadas em segmento cefálico (8,9%), seguidas pelas lesões em extremidades (4,9%). A craniotomia foi necessária em 2,3% das vítimas de quedas de própria altura. Observamos que, em comparação às vítimas de outros mecanismos de trauma fechado, as vítimas de quedas da própria altura apresentavam, significantemente (pOBJECTIVE: Assess characteristics of trauma patients who sustained falls from their own height, more specifically focusing on presence of severe injuries, diagnosis and treatment. METHODS: Retrospective study including all adult blunt trauma patients admitted in the emergency room in a period of 9 months. Lesions with AIS (Abbreviated Injury Scale)>3 were considered "severe". Variables were compared between victims of fall from their own height (group I) and other blunt trauma mechanisms (group II). Student's t, chi square and Fisher exact tests were used for statistical analysis, considering p3) were more frequent in the head (8.9%), followed by extremities (4,9%). In group I, craniotomies were needed in 2.3%. By comparing groups, we observed that victims of falls from their own height had significantly higher mean age, higher mean systolic blood pressure, and higher head AIS mean, as well as lower ISS mean, thorax AIS mean, abdomen AIS mean and extremities AIS mean. CONCLUSION: Importance of the trauma mechanism in victims of falls from own height should be emphasized due to a considerable possibility of occult severe injuries, mainly in the cephalic segment

Upper gastrointestinal hemorrhage due to duodenal stromal tumor

BACKGROUND: Gastrointestinal stromal tumor represents a rare neoplasm that originates in the muscular wall of the hollow viscera. AIM: To report gastrointestinal stromal tumor as a source of upper gastrointestinal bleeding, which required urgent surgical control. PATIENT/METHOD: A man with 61 years old was admitted to the emergency service sustaining hematemesis and melena. Endoscopy showed active bleeding from a tumor in the second portion of the duodenum, which was controlled by heater probe cauterization. Surgery was performed through a median laparotomy. A local resection of a 4 cm tumor in the second portion of the duodenum was carried out, together with a primary end-to-end anastomosis and a duodenal diverticulization. No complications happened during the post-operative period. Morphologic examination showed gastrointestinal stromal tumor with no atypical mitosis and a preserved capsule. CONCLUSION: Albeit not being common, gastrointestinal stromal tumors can represent a source of substantial gastrointestinal hemorrhage