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

Non-operative Management Of Hepatic Trauma And The Interventional Radiology: An Update Review

The growing trend to manage hepatic injuries nonoperatively has been increasing demand for advanced endovascular interventions. This brings up the necessity for general and trauma surgeons to update their knowledge in such matter. Effective treatment mandates a multispecialty team effort that is usually led by the trauma surgeon and includes vascular surgery, orthopedics, and, increasingly, interventional radiology. The focus on hemorrhage control and the angiographer's unique access to vascular structures gives interventional radiology (IR) an important and increasingly recognized role in the treatment of patients with hemodynamic instability. Our aim is to review the basic concepts of IR primarily in hepatic trauma and secondarily in some other special situations. A liver vascular anatomy review is also needed for better understanding the roles of IR. As a final point we propose a guideline for the operative/nonoperative management of traumatic hepatic injuries. The benefit of multidisciplinary approach (TAE) appears to be a powerful weapon in the medical arsenal against the high mortality of injured trauma liver patients. © 2012 Association of Surgeons of India.755339345Zealley, I.A., Chakraverty, S., The role of interventional radiology in trauma (2010) Bmj, 340, pp. c497Shaftan, G.W., How interventional radiology changed the practice of a trauma surgeon (2008) Injury, 39 (11), pp. 1229-1231Gould, J.E., Vedantham, S., The role of interventional radiology in trauma (2006) Semin Intervent Radiol, 23 (3), pp. 248-270Pryor, J.P., Braslow, B., Reilly, P.M., Gullamondegi, O., Hedrick, J.H., Schwab, C.W., The evolving role of interventional radiology in trauma care (2005) J Trauma, 59 (1), pp. 102-104Asensio, J.A., Petrone, P., Garcia-Nunez, L., Kimbrell, B., Kuncir, E., Multidisciplinary approach for the management of complex hepatic injuries AAST-OIS grades IV-V: a prospective study (2007) Scand J Surg, 96 (3), pp. 214-220Sriussadaporn, S., Pak-Art, R., Tharavej, C., Sirichindakul, B., Chiamananthapong, S., A multidisciplinary approach in the management of hepatic injuries (2002) Injury, 33 (4), pp. 309-315Bakal, C.W., Advances in imaging technology and the growth of vascular and interventional radiology: a brief history (2003) J Vasc Interv Radiol, 14 (7), pp. 855-860Kononov, A., Egorova, V.A., Interventional radiology: history, priorities, first experimental results Klinichna khirurhiia / Ministerstvo okhorony zdorov'ia Ukrainy, Naukove tovarystvo khirurhiv Ukrainy (2000) Klin Khir, 3, pp. 47-51Zeitler, E., History of interventional radiology (1995) Radiologe, 35 (5), pp. 325-336Rosch, J., Keller, F.S., Kaufman, J.A., The birth, early years, and future of interventional radiology (2003) J Vasc Interv Radiol, 14 (7), pp. 841-853De Toma, G., Mingoli, A., Modini, C., Cavallaro, A., Stipa, S., The value of angiography and selective hepatic artery embolization for continuous bleeding after surgery in liver trauma: case reports (1994) J Trauma, 37 (3), pp. 508-511Fandrich, B.L., Gnanadev, D.A., Jaecks, R., Boyle, W., Selective hepatic artery embolization as an adjunct to liver packing in severe hepatic trauma: case report (1989) J Trauma, 29 (12), pp. 1716-1718Asensio, J.A., Roldan, G., Petrone, P., Rojo, E., Tillou, A., Kuncir, E., Operative management and outcomes in 103 AAST-OIS grades IV and V complex hepatic injuries: trauma surgeons still need to operate, but angioembolization helps (2003) J Trauma, 54 (4), pp. 647-653. , discussion 53-54Mohr, A.M., Lavery, R.F., Barone, A., Bahramipour, P., Magnotti, L.J., Osband, A.J., Angiographic embolization for liver injuries: low mortality, high morbidity (2003) J Trauma, 55 (6), pp. 1077-1081. , discussion 81-82Sikhondze, 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. 65-70Rotondo, M.F., Schwab, C.W., McGonigal, M.D., Phillips III, G.R., Fruchterman, T.M., Kauder, D.R., Damage control': an approach for improved survival in exsanguinating penetrating abdominal injury (1993) J Trauma, 35 (3), pp. 375-382. , discussion 82-83Asensio, 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. 66-69Yitzhak, A., Shaked, G., Lupu, L., Mizrahi, S., Kluger, Y., Selective embolization of hepatic arteries-an additional precaution to control hemorrhage in the management of severe liver trauma (2001) Harefuah, 140 (3), pp. 193-196. , 288Johnson, J.W., Gracias, V.H., Gupta, R., Guillamondegui, O., Reilly, P.M., Shapiro, M.B., Hepatic angiography in patients undergoing damage control laparotomy (2002) J Trauma, 52 (6), pp. 1102-1106Longmire Jr., W.P., Cleveland, R.J., Surgical anatomy and blunt trauma of the liver (1972) Surg Clin North Am, 52 (3), pp. 687-698Skandalakis, J.E., Skandalakis, L.J., Skandalakis, P.N., Mirilas, P., Hepatic surgical anatomy (2004) Surg Clin North Am, 84 (2), pp. 413-435. , viiiGadzijev, E.M., Surgical anatomy of hepatoduodenal ligament and hepatic hilus (2002) J Hepatobiliary Pancreat Surg, 9 (5), pp. 531-533Sharma, D., Deshmukh, A., Raina, V.K., Surgical anatomy of retrohepatic inferior vena cava and hepatic veins: a quantitative assessment. Indian journal of gastroenterology (2001) Indian J Gastroenterol, 20 (4), pp. 136-139Jones, R.M., Hardy, K.J., The hepatic artery: a reminder of surgical anatomy (2001) J Royal Coll Surg Edinburgh, 46 (3), pp. 168-170van Leeuwen, M.S., Noordzij, J., Fernandez, M.A., Hennipman, A., Feldberg, M.A., Dillon, E.H., Portal venous and segmental anatomy of the right hemiliver: observations based on three-dimensional spiral CT renderings (1994) Am J Roentgenol, 163 (6), pp. 1395-1404Trunkey, D.D., Hepatic trauma: contemporary management (2004) Surg Clin North Am, 84 (2), pp. 437-450Velmahos, G.C., Toutouzas, K., Radin, R., Chan, L., Rhee, P., Tillou, A., High success with nonoperative management of blunt hepatic trauma: the liver is a sturdy organ (2003) Arch Surg, 138 (5), pp. 475-480. , discussion 80-81Velmahos, G.C., Toutouzas, K.G., Radin, R., Chan, L., Demetriades, D., Nonoperative treatment of blunt injury to solid abdominal organs: a prospective study (2003) Arch Surg, 138 (8), pp. 844-851Demetriades, D., Gomez, H., Chahwan, S., Charalambides, K., Velmahos, G., Murray, J., Gunshot injuries to the liver: the role of selective nonoperative management (1999) J Am Coll Surg, 188 (4), pp. 343-348Demetriades, D., Hadjizacharia, P., Constantinou, C., Brown, C., Inaba, K., Rhee, P., Selective nonoperative management of penetrating abdominal solid organ injuries (2006) Ann Surg, 244 (4), pp. 620-628Omoshoro-Jones, J.A., Nicol, A.J., Navsaria, P.H., Zellweger, R., Krige, J.E., Kahn, D.H., Selective non-operative management of liver gunshot injuries (2005) Br J Surg, 92 (7), pp. 890-895Beekley, A.C., Blackbourne, L.H., Sebesta, J.A., McMullin, N., Mullenix, P.S., Holcomb, J.B., Selective nonoperative management of penetrating torso injury from combat fragmentation wounds (2008) J Trauma, 64 (2 SUPPL.), pp. S108-S116. , discussion S16-17Carrillo, E.H., Platz, A., Miller, F.B., Richardson, J.D., Polk Jr., H.C., Non-operative management of blunt hepatic trauma (1998) Br J Surg, 85 (4), pp. 461-468Karkiner, A., Temir, G., Utku, M., Ucan, B., Hosgor, M., Karaca, I., The efficacy of non-operative management in childhood blunt hepatic trauma (2005) Ulus Travma Derg, 11 (2), pp. 128-133Sidhu, M.K., Hogan, M.J., Shaw, D.W., Burdick, T., Interventional radiology for paediatric trauma (2009) Pediatr Radiol, 39 (5), pp. 506-515Velmahos, G.C., Demetriades, D., Chahwan, S., Gomez, H., Hanks, S.E., Murray, J.A., Angiographic embolization for arrest of bleeding after penetrating trauma to the abdomen (1999) Am J Surg, 178 (5), pp. 367-373Hagiwara, A., Yukioka, T., Ohta, S., Tokunaga, T., Ohta, S., Matsuda, H., Nonsurgical management of patients with blunt hepatic injury: efficacy of transcatheter arterial embolization (1997) Am J Roentgenol, 169 (4), pp. 1151-1156Gorich, J., Rilinger, N., Brado, M., Huppert, P., Vogel, J., Siech, M., Non-operative management of arterial liver hemorrhages (1999) Eur Radiol, 9 (1), pp. 85-88Rubin, B.E., Katzen, B.T., Selective hepatic artery embolization to control massive hepatic hemorrhage after trauma (1977) Am J Roentgenol, 129 (2), pp. 253-256Petroianu, A., Arterial embolization for hemorrhage caused by hepatic arterial injury (2007) Digest Dis Sci, 52 (10), pp. 2478-2481Tzeng, W.S., Wu, R.H., Chang, J.M., Lin, C.Y., Koay, L.B., Uen, Y.H., Transcatheter arterial embolization for hemorrhage caused by injury of the hepatic artery (2005) J Gastroenterol Hepatol, 20 (7), pp. 1062-1068Petroianu, A., Transcatheter arterial embolization for hemorrhage caused by injury of the hepatic artery (2005) J Gastroenterol Hepatol, 20 (7), pp. 973-974Kokudo, N., Makuuchi, M., Current role of portal vein embolization/hepatic artery chemoembolization (2004) Surg Clin North Am, 84 (2), pp. 643-657Burgmans, M.C., Irani, F.G., Chan, W.Y., Teo, T.K., Kao, Y.H., Goh, A.S., Radioembolization after portal vein embolization in a patient with multifocal hepatocellular carcinoma (2012) Cardiovasc Interv Radiol, , [Epub]Ebata, T., Yokoyama, Y., Igami, T., Sugawara, G., Takahashi, Y., Nagino, M., Portal vein embolization before extended hepatectomy for biliary cancer: current technique and review of 494 consecutive embolizations (2012) Digest Surg, 29 (1), pp. 23-29Siriwardana, R.C., Lo, C.M., Chan, S.C., Fan, S.T., Role of portal vein embolization in hepatocellular carcinoma management and its effect on recurrence: a case-control study (2012) World J SurgOkabe, K., Beppu, T., Masuda, T., Hayashi, H., Okabe, H., Komori, H., Portal vein embolization can prevent intrahepatic metastases to non-embolized liver (2012) Hepatogastroenterology, 59 (114), pp. 538-541Nesher, E., Aizner, A., Kashtan, H., Kaplan, O., Kluger, Y., Greenberg, R., Portal vein air embolization after blunt abdominal trauma: a case report and review of the literature (2002) Eur J Emerg Med, 9 (2), pp. 163-165Vauthey, J.N., Matthews, C.C., Portal vein air embolization after blunt abdominal trauma (1988) Am Surg, 54 (9), pp. 586-588Jalan, R., John, T.G., Redhead, D.N., Garden, O.J., Simpson, K.J., Finlayson, N.D., A comparative study of emergency transjugular intrahepatic portosystemic stent-shunt and esophageal transection in the management of uncontrolled variceal hemorrhage (1995) Am J Gastroenterol, 90 (11), pp. 1932-1937You, L.Y., Li, Y.C., Yan, D., Xu, Y., Yang, J., Yang, L.H., Clinical application of the transjugular intrahepatic portosystemic stent-shunt in the emergency treatment of esophagogastric varices bleeding due to cirrhosis Zhonghua Gan Zang Bing Za Zhi, 19 (7), pp. 490-493Dakkak, A.R., Welp, H., Schmidt, H., Koehler, M., Scheld, H.H., Sindermann, J.R., Treatment of chronic ascites due to right-sided heart failure by transjugular intrahepatic portosystemic shunt stent-implantation after orthotopic heart transplant. Experimental and clinical transplantation (2011) Exp Clin Transplant, 9 (2), pp. 156-158Ogura, Y., Kanazawa, H., Yoshizawa, A., Nitta, T., Ikeda, T., Uemoto, S., Supradiaphragmatic approach for Budd-Chiari syndrome with transjugular intrahepatic portosystemic shunt stent in combination with inferior vena cava reconstruction during living donor liver transplantation: a case report (2011) Transplant Proc, 43 (5), pp. 2093-2096Therapondos, G., Wong, F., Miscellaneous indications for transjugular intrahepatic portosystemic stent-shunt (2006) Eur J Gastroenterol Hepatol, 18 (11), pp. 1161-1166Tripathi, D., Jalan, R., Transjugular intrahepatic portosystemic stent-shunt in the management of gastric and ectopic varices (2006) Eur J Gastroenterol Hepatol, 18 (11), pp. 1155-1160Tripathi, D., Redhead, D., Transjugular intrahepatic portosystemic stent-shunt: technical factors and new developments (2006) Eur J Gastroenterol Hepatol, 18 (11), pp. 1127-113

Can We Predict The Clinical Outcomes Of Genitourinary Trauma Patients And Offer Them An Evidence-based Support? The Case For Telemedicine Network

[No abstract available]32411071108von Klot, C.A.J., Zeckey, C., Tezval, H., Can we predict the clinical outcome of patients with bladder trauma? (2013) World J Urol, 31, pp. 1017-1018Pereira, B.M., de Campos, C.C., Calderan, T.R., Reis, L.O., Fraga, G.P., Bladder injuries after external trauma: 20 years experience report in a population-based cross-sectional view (2013) World J Urol, 31, pp. 913-917Reis, L.O., Kim, F.J., Moore, E.E., Hirano, E.S., Fraga, G.P., Nascimento, B., Rizoli, S., Update in the classification and treatment of complex renal injuries (2013) Rev Col Bras Cir, 40 (4), pp. 347-35

Non-operative Management Of Blunt Major Hepatic Injury In A Young Adult With Severe Haemophilia A

[No abstract available]183e84e86Carrillo, E.H., Platz, A., Miller, F.B., Richardson, J.D., Polk Jr., H.C., Non-operative management of blunt hepatic trauma (1998) Br J Surg, 85, pp. 461-468Kozar, R.A., McNutt, M.K., Management of adult blunt hepatic trauma (2010) Curr Opin Crit Care, 16, pp. 596-601English, P.J., Sheppard, E.M., Wensley, R.T., Traumatic rupture of the liver in a haemophilic patient with factor-VIII inhibitors (1976) Lancet, 1, pp. 1299-1300Sarihan, H., Erduran, E., Abes, M., Nonsurgical therapy of hepatic injury in a hemophilic child (1994) Eur J Pediatr Surg, 4, pp. 366-367Sartorelli, K.H., Rogers, F.B., Vane, D.W., Nonoperative treatment of a major hepatic injury in a hemophiliac (1995) J Trauma, 38, pp. 246-247Tinkoff, G., Esposito, T.J., Reed, J., American Association for the Surgery of Trauma Organ Injury Scale I: spleen, liver, and kidney, validation based on the National Trauma Data Bank (2008) J Am Coll Surg, 207, pp. 646-655Jona, J.Z., Cox-Gill, J., Nonsurgical therapy of splenic rupture in a hemophiliac (1992) J Pediatr Surg, 27, pp. 523-524Fort, D.W., Bernini, J.C., Johnson, A., Cochran, C.J., Buchanan, G.R., Splenic rupture in hemophilia (1994) Am J Pediatr Hematol Oncol, 16, pp. 255-259Zieg, P.M., Cohn, S.M., Beardsley, D.S., Nonoperative management of a splenic tear in a Jehovah's Witness with hemophilia (1996) J Trauma, 40, pp. 299-301Sharma, O.P., Oswanski, M.F., Issa, N.M., Stein, D.T., Role of non-operative management of spleen injury in patients with hemophilia: report of two patients with review of literature (2011) J Emerg Med, 41, pp. e59-e6

Not Complicated Acute Appendicitis In Adults: Clinical Or Surgical Treatment? [apendicite Aguda Não Complicada Em Adultos: Tratamento Cirúrgico Ou Clínico?]

[No abstract available]392159163McBurney, C., Experience with early operative interference in cases of disease of the vermiform appendix (1889) NY Med J, 50, pp. 676-684Coldrey, E., Five years of conservative treatment of acute appendicitis (1959) J Int Coll Surg, 32, pp. 255-261Mason, R.J., Surgery for appendicitis: Is it necessary? (2008) Surg Infect, 9 (4), pp. 481-488Sisson, R.G., Ahlvin, R.C., Harlow, M.C., Superficial mucosal ulceration and the pathogenesis of acute appendicitis (1971) Am J Surg, 122 (3), pp. 378-380Vianna, A.L., Otero, P.M., Cruz, C.A.T., Carvalho, S.M., Oliveira, P.G., Puttini, S.M.B., Tratamento conservador do platrão apendicular (2003) Rev Col Bras Cir, 30 (6), pp. 442-446Fitzmaurice, G.J., McWilliams, B., Hurreiz, H., Epanomeritakis, E., Antibiotics versus appendectomy in the management of acute appendicitis: A review of the current evidence (2011) Can J Surg, 54 (5), pp. 307-314Liu, K., Fogg, L., Use of antibiotics alone for treatment of uncomplicated acute appendicitis: A systematic review and metaanalysis (2011) Surgery, 150 (4), pp. 673-683Wilms, I.M., de Hoog, D.E., de Visser, D.C., Janzing, H.M., Appendectomy versus antibiotic treatment for acute appendicitis (2011) Cochrane Database Syst Rev, 9 (11), pp. CD008359Hansson, J., Körner, U., Khorram-Manesh, A., Solberg, A., Lundholm, K., Randomized clinical trial of antibiotic therapy versus appendicectomy as primary treatment of acute appendicitis in unselected patients (2009) Br J Surg, 96 (5), pp. 473-481. , Erratum in: Br J Surg. 2009;96(7):830Vons, C., Barry, C., Maitre, S., Pautrat, K., Leconte, M., Costaglioli, B., Amoxicillin plus clavulanic acid versus appendicectomy for treatment of acute uncomplicated appendicitis: An open-label, non-inferiority, randomised controlled trial (2011) Lancet, 377 (9777), pp. 1573-157

Is There A Role For Pyloric Exclusion After Severe Duodenal Trauma? [existe Lugar Para A Exclusão Pilórica No Trauma Duodenal Grave?]

Duodenal trauma is an infrequent injury, but linked to high morbidity and mortality. Surgical management of duodenal injuries is dictated by: patient's hemodynamic status, injury severity, time of diagnosis, and presence of concomitant injuries. Even though most cases can be treated with primary repair, some experts advocate adjuvant procedures. Pyloric exclusion (PE) has emerged as an ancillary method to protect suture repair in more complex injuries. However, the effectiveness of this procedure is debatable. The "Evidence Based Telemedicine - Trauma & Acute Care Surgery " (EBT-TACS) Journal Club performed a critical appraisal of the literature and selected three relevant publications on the indications for PE in duodenal trauma. The first study retrospectively compared 14 cases of duodenal injuries greater than grade II treated by PE, with 15 cases repaired primarily, all penetrating mechanisms. Results showed that PE did not improve outcome. The second study, also retrospective, compared primary repair (34 cases) to PE (16 cases) in blunt and penetrating grade > II duodenal injuries. The authors concluded that PE was not necessary in all cases. The third was a literature review on the management of challenging duodenal traumas. The author of that study concluded that PE is indicated for anastomotic leak management after gastrojejunostomies. In conclusion, the choice of the surgical procedure to treat duodenal injuries should be individualized. Moreover, there is insufficient high quality scientific evidence to support the abandonment of PE in severe duodenal injuries with extensive tissue loss.413228231Asensio, J.A., Feliciano, D.V., Britt, L.D., Kerstein, M.D., Management of duodenal injuries (1993) Curr Probl Surg, 30 (11), pp. 1023-1093Fraga, G.P., Biazotto, G., Villaça, M.P., Andreollo, N.A., Mantovani, M., Trauma de duodeno: Análise de fatores relacionados à morbimortalidade (2008) Rev Col Bras Cir, 35 (2), pp. 94-102Lucas, C.E., The therapeutic challenges in treating duodenal injury (2013) Pan J Trauma, 2 (3), pp. 126-133Moore, E.E., Cogbill, T.H., Malangoni, M.A., Jurkovich, G.J., Champion, H.R., Gennarelli, T.A., Organ injury scaling, II: Pancreas, duodenum, small bowel, colon, and rectum (1990) J Trauma, 30 (11), pp. 1427-1429Vaughan, G.D., Frazier, O.H., Graham, D.Y., Mattox, K.L., Petmecky, F.F., Jordan, G.L., The use of pyloric exclusion in the management of severe duodenal injuries (1977) Am J Surg, 134 (6), pp. 785-790Degiannis, E., Krawczykowski, D., Velmahos, G.C., Levy, R.D., Souter, I., Saadia, R., Pyloric exclusion in severe penetrating injuries of the duodenum (1993) World J Surg, 17 (6), pp. 751-754Fraga, G.P., Biazotto, G., Bortoto, J.B., Andreollo, N.A., Mantovani, M., The use of pyloric exclusion for treating duodenal trauma: Case series (2008) Sao Paulo Med J, 126 (6), pp. 337-341Seamon, M.J., Pieri, P.G., Fisher, C.A., Gaughan, J., Santora, T.A., Pathak, A.S., A ten-year retrospective review: Does pyloric exclusion improve clinical outcome after penetrating duodenal and combined pancreaticoduodenal injuries? (2007) J Trauma, 62 (4), pp. 829-833Velmahos, G.C., Constantinou, C., Kasotakis, G., Safety of repair for severe duodenal injuries (2008) World J Surg, 32 (1), pp. 7-12Ordoñez, C., García, A., Parra, M.W., Scavo, D., Pino, L.F., Millán, M., Complex penetrating duodenal injuries: Less is better (2014) J Trauma Acute Care Surg, 76 (5), pp. 1177-118

Initial Experience At A University Teaching Hospital From Using Telemedicine To Promote Education Through Video Conferencing [experiência Inicial De Um Hospital Universitário Utilizando A Telemedicina Na Promoção De Educação Através De Vídeo-conferências]

CONTEXT AND OBJECTIVE: Telehealth and telemedicine services are advancing rapidly, with an increasing spectrum of information and communication technologies that can be applied broadly to the population's health, and to medical education. The aim here was to report our institution's experience from 100 videoconferencing meetings between five different countries in the Americas over a one-year period. DESIGN AND SETTING: Retrospective study at Universidade Estadual de Campinas. METHODS: Through a Microsoft Excel database, all conferences in all specialties held at our institution from September 2009 to August 2010 were analyzed retrospectively. RESULTS: A total of 647 students, physicians and professors participated in telemedicine meetings. A monthly mean of 8.3 (± 4.3) teleconferences were held over the analysis period. Excluding holidays and the month of inaugurating the telemedicine theatre, our teleconference rate reached a mean of 10.3 (± 2.7), or two teleconferences a week, on average. Trauma surgery and meetings on patient safety were by far the most common subjects discussed in our teleconference meetings, accounting for 22% and 21% of the total calls. CONCLUSION: Our experience with telemedicine meetings has increased students' interest; helped our institution to follow and discuss protocols that are already accepted worldwide; and stimulated professors to promote telemedicine-related research in their own specialties and keep up-to-date. These high-technology meetings have shortened distances in our vast country, and to other reference centers abroad. This virtual proximity has enabled discussion of international training with students and residents, to increase their overall knowledge and improve their education within this institution.13013236Bashshur, R.L., On the definition and evaluation of telemedicine (1995) Telemed J, 1 (1), pp. 19-30Alverson, D.C., Edison, K., Flournoy, L., Telehealth tools for public health, emergency, or disaster preparedness and response: A summary report (2010) Telemed J E Health, 16 (1), pp. 112-114Ereso, A.Q., Garcia, P., Tseng, E., Live transference of surgical subspecialty skills using telerobotic proctoring to remote general surgeons (2010) J Am Coll Surg, 211 (3), pp. 400-411Mauer, U.M., Kunz, U., Management of neurotrauma by surgeons and orthopedists in a military operational setting (2010) Neurosurg Focus, 28 (5), pp. E10Huang, C.M., Chan, E., Hyder, A.A., Web 2.0 and internet social networking: A new tool for disaster management? --lessons from Taiwan (2010) BMC Med Inform Decis Mak, 10, p. 57Blanche, P.A., Bablumian, A., Voorakaranam, R., Holographic three-dimensional telepresence using large-area photorefractive polymer (2010) Nature, 468 (7320), pp. 80-83Jabbour, P., Gonzalez, L.F., Tjoumakaris, S., Randazzo, C., Rosenwasser, R., Stroke in the robotic era (2010) World Neurosurg, 73 (6), pp. 603-604Latifi, R., Stanonik, M.L., Merrell, R.C., Weinstein, R.S., Telemedicine in extreme conditions: Supporting the Martin Strel Amazon Swim Expedition (2009) Telemed J E Health, 15 (1), pp. 93-100Landers, S.H., Why health care is going home (2010) N Engl J Med, 363 (18), pp. 1690-1691Hede, K., Teleoncology gaining acceptance with physicians, patients (2010) J Natl Cancer Inst, 102 (20), pp. 1531-1533García jordá, E., Telemedicine: Shortening distances (2010) Clin Transl Oncol, 12 (10), pp. 650-651Latifi, R., Telepresence and telemedicine in trauma and emergency (2008) Stud Health Technol Inform, 131, pp. 275-280Hays, R.B., Peterson, L., Options in education for advanced trainees in isolated general practice (1996) Aust Fam Physician, 25 (3), pp. 362-366Ekeland, A.G., Bowes, A., Flottorp, S., Effectiveness of telemedicine: A systematic review of reviews (2010) Int J Med Inform, 79 (11), pp. 736-771Scuffham, P., Systematic review of cost effectiveness in telemedicine. Quality of cost effectiveness studies in systematic reviews is problematic (2002) BMJ, 325 (7364), p. 598. , author reply 598Rezende, E.J.C., Melo, M.C.B., Tavares, E.C., Santos, A.F., Souza, C., Ethics and eHealth: Reflections for a safe practice (2010) Rev Panam Salud Pública = Pan Am J Public Health, 28 (1), pp. 58-65Motoi, K., Ogawa, M., Ueno, H., A fully automated health-care monitoring at home without attachment of any biological sensors and its clinical evaluation (2009) Conf Proc IEEE Eng Med Biol Soc, 2009, pp. 4323-4326Azpiroz-Leehan, J., Martínez, L.F., Cadena, M.M., Imaging Facilities for Basic Medical Units: A Case in the State of Guerrero, Mexico (2010) J Digit Imaging, , Epub ahead of printKailas, A., Chong, C.C., Watanabe, F., From mobile phones to personal wellness dashboards (2010) IEEE Pulse, 1 (1), pp. 57-63Eron, L., Telemedicine: The future of outpatient therapy? (2010) Clin Infect Dis, 51 (SUPPL. 2), pp. S224-S230Nakajima, I., Japanese telemedical concept of ambulatory application (2011) J Med Syst, 35 (2), pp. 215-220Haidegger, T., Sándor, J., Benyó, Z., Surgery in space: The future of robotic telesurgery (2011) Surg Endosc, 25 (3), pp. 681-690Machado, F.S.N., Carvalho, M.A.P., Mataresi, A., Use of telemedicine technology as a strategy to promote health care of riverside communities in the Amazon: Experience with interdisciplinary work, integrating NHS guidelines (2010) Ciên Saúde Coletiva, 15 (1), pp. 247-254Latifi, R., Hadeed, G.J., Rhee, P., Initial experiences and outcomes of telepresence in the management of trauma and emergency surgical patients (2009) Am J Surg, 198 (6), pp. 905-910Bulik, R.J., Shokar, G.S., Integrating telemedicine instruction into the curriculum: Expanding student perspectives of the scope of clinical practice (2010) J Telemed Telecare, 16 (7), pp. 355-35

Diferenças florísticas e estruturais entre fitofisionomias do cerrado em Assis, SP, Brasil

A classificação das fitofisionomias tem-se constituído em desafio entre os pesquisadores da vegetação de cerrado, seja por não haver critérios florísticos ou quantitativos claros para sua separação, seja pelas alterações que sofrem ao longo do tempo. O objetivo deste estudo foi caracterizar três tipos fitofisionômicos de cerrado na Estação Ecológica de Assis, bem como verificar se são florística e, ou, estruturalmente distintos, buscando-se as melhores variáveis para caracterizá-los. A área amostral compreendeu 30 parcelas permanentes de 20 x 50 m, sendo 10 parcelas para cada um dos tipos fisionômicos: cerrado típico, cerrado denso e cerradão, em que foram identificadas e medidas as árvores com diâmetro à altura do peito > 5 cm. As três fitofisionomias de cerradoestudadas mostraram-se estruturalmente distintas em classes de área basal, cobertura de copas e altura das maiores árvores. O melhor descritor para classificar as fitofisionomias, por ser facilmente mensurável e pouco variável com o critério de inclusão, é a área basal (m² ha-1). Floristicamente, as fitofisionomias savânicas (cerradotípico e cerrado denso) não se diferenciam, quer seja analisando apenas a presença e ausência das espécies, quer seja analisando a importância relativa das espécies na comunidade (fitossociologia). Em síntese, há três fitofisionomias distintas, mas a flora se diferencia apenas entre o cerradão e as fitofisionomias savânicas. A análise das espécies exclusivas de cada fitofisionomia quanto à tolerância à sombra, com base na literatura, indicou que a baixa disponibilidade de luz sob as copas no cerradão pode ter sido o fator condicionante da diferenciação entre esta e as demais fitofisionomias do cerrado lato sensu