O pragmatismo na educação médica

The decree, called REUNI, has fostered intense discussion and controversy in the Federal Institutions of Higher Education (IFES). In this scenario, the medical training is in the spotlight. Several guidelines are not suitable to form a physician prepared for the professional practice. So pursued by the reality of the public health, it is essential the interaction between the University and the State to overcome the teaching-learning process challenges and to ensure the quality of the graduated students.O decreto denominado REUNI tem fomentado intensa discussão e polêmica nas instituições Federais de Ensino Superior (IFES). Nesse cenário, a formação médica encontra-se na berlinda. Várias diretrizes não são adequadas para formar um médico preparado para o seu exercício profissional. Assim, acossados pela realidade da saúde pública, é imprescindível que a universidade e o Estado interajam para superar os desafios do processo ensino-aprendizagem e para zelar pela qualidade dos egressos

Editorial

Editoria

Educação à distância e práticas cirúrgicas: reflexões e desafios

In the last years there has been a great and exponential expansion of distance educational courses (undergraduate, postgraduate, lato ou stricto sensu, or in sequential bases) taking place in institutions with different juridical conceptions (public, private, confessional or communitarian). In fact it was the approval of the Lei de Diretrizes e Bases da Educação (LDB) from the Ministério da Educação that encouraged the development of the distance education learning modality. However it is necessary to understand the existence of challenges to be overcome, especially when that innovation will be applied to the surgical field.Nos últimos anos, a sociedade tem se deparado com uma expansão exponencial dos cursos à distância (de graduação, pós-graduação lato ou stricto sensu, ou seqüencial) em instituições de natureza jurídica variada (públicas, privadas, confessionais ou comunitárias). De fato, o Ministério da Educação, mediante a promulgação da Lei de Diretrizes e Bases da Educação (LDB), estimulou o desenvolvimento dessa modalidade de ensino. Entretanto, é preciso compreender que existem desafios a serem superados, em especial quando se propõe essa inovação na área cirúrgica

Dispositivo de contenção para animais de pequeno porte

DepositadaO presente modelo de utilidade se refere a um dispositivo de contenção para animais de pequeno porte, que é consistido de uma caixa, uma tampa estojo, um regulador de tamanho e uma trava de segurança. Este dispositivo é indicado para uso em exames de imagem, tais como ressonância magnética, tomografia e cintilografia que proporciona conforto, imobilização adequada, contenção e isolamento do animal, bem como, segurança ao profissional veterinário e pesquisador em ciências cirúrgicas, cirurgia experimental, entre outros

Rat thyroid graft transplantation after cryopreservation with scintigraphic standardization for an experimental study

Purpose: Budget cuts among other factors undermine the use of state-of-the-art equipment by many research groups. This doesn't mean that their scientific data are not reliable or top-notch. Resort to adaptations is a recurrent need in their reality. The aim of this study was to assess whether scintigraphy with 99mTcO4 is effective in evaluating the functionality of thyroid grafts after cryopreservation in rats. Material and methods: 24 rats were randomly distributed into 3 groups: Control Group (CG), without surgical procedure, Hypothyroidism Group (HTG), submitted to total thyroidectomy, and Transplanted Group (TG), with total thyroidectomy and cryopreservation of the thyroid gland for 7 days followed by grafting of a thyroid lobe. A protocol using a gamma camera imaging was conducted fourteen weeks after transplantation, and the whole body 99mTc, focusing on the topic of heterotopic thyroid uptake was evaluated. Results: The images acquired had good quality with no noise and artifacts that could jeopardize its analysis. On the 14th day, HTG displayed no thyroid uptake, and the TG had a clear uptake of the thyroid graft in the topography of the biceps femoris muscle. Presented data also showed that both equipment spatial resolution and alignment (4.375 mm) did not interfere with the physiological uptake of 99mTc by the thyroid graft. Conclusion: The viability and functionality of cryopreserved thyroid autotransplantation in rats who underwent total thyroidectomy were successfully accessed by the scintigraphy protocol developed

Evisceration of Right Pulmonary Lobe after Dog Bite Injury

Background: Pneumothorax is the presence of free air in the pleural cavity. Air in the thoracic cavity causes respiratory discomfort, severe hypoxemia, decreased venous return, and haemodynamic instability, and it may lead to death. Pneumothorax can be triggered by wounds from firearm projectiles, bladed weapons, or sharp or piercing objects, as well as bites and barotrauma. The diagnosis of open pneumothorax is based on anamnesis, in combination with clinical signs observed on physical examination. The objective of this report is to discuss the relevance of clinical-surgical management to adequately treat evisceration of the pulmonary lobe caused by a bite in the thoracic region of a female dog.Case: This report discusses a 15-year-old female canine weighing approximately six kg with a history of wounds in the thoracic region and respiratory difficulty after being bitten by another dog. On clinical examination, she presented with a bruised wound in the right thoracic region and another in the scapular region. The examination revealed evisceration of the right cranial lung lobe, which exhibited atelectasis. The animal was immediately referred to the Surgical Center. Anaesthesia was induced using propofol 2.0 mg/kg combined with ketamine hydrochloride 2.0 mg/kg, followed by intubation and maintenance under inhalation anaesthesia with isoflurane and 100% oxygen and fentanyl 2.5 mcg/kg every 15 min. The temperature, non-invasive blood pressure, cardiac and respiratory frequency, pulse oximetry, capnography and electrocardiogram were monitored. Tricotomy and antisepsis of the wound were performed with 0.9% NaCl and 2% chlorhexidine. The eviscerated pulmonary lobe was immersed in saline solution, and positive pressure insufflation was performed in the inhalation circuit to verify the presence of perforation of the eviscerated lung, which was not observed. The lobe was repositioned in the correct anatomical location in the thoracic region, noting that there was no further damage beyond the blunt wound with laceration of the intercostal muscles. The thoracic cavity was washed with saline solution, which was aspirated prior to thoracorrhaphy with a 2-0 nylon suture, applied with mass-separated stitches covering the pleura and intercostal musculature. When the last stitch of the thoracorrhaphy was placed, the anaesthesiologist kept the lung inflated. A No. 8 drain was fixed in a tobacco pouch coupled to a three-way tap in the region between the seventh and eighth ribs. The adipose panicle was stitched with a 2-0 910 polygalactine suture and continuous pattern, and the skin was sutured with a 2-0 nylon suture using Wolff stitches. The dressing consisted of a bandage around the thorax for 48 h, when the drain was removed. Meloxicam 0.1 mg/kg, ceftriaxone 30 mg/kg per day and metronidazole 10 mg/kg every 12 h were prescribed postoperatively for seven days. For analgesic therapy, 0.3 mg/kg morphine sulfate was used every six hours for 48 h, dipyrone 25 mg/kg was used for 72 h, and tramadol hydrochloride 2.4 mg/kg was used every eight hours for five days. At the site of the dressing, there was topical application every 48 hours of fibrinolysin combined with chloramphenicol.Discussion: Open thoracic injuries with pulmonary evisceration are always considered a serious and a death threat. An early care by a specialized team is of paramount importance in restoring respiratory and cardiovascular parameters with a better prognosis

Early impact of abdominal compartment syndrome on liver, kidney and lung damage in a rodent model

Background: Abdominal compartment syndrome (ACS) sometimes occurs in critically ill patients following damage control surgery. The purpose of the present study was to develop a model of ACS and to evaluate its pathologic impact on liver, kidney, and lung morphology. Methods: Twenty Wistar rats (mass 300\u2013350 g) were randomly divided into four groups: 1) intra-abdominal hypertension (IAH): a laparotomy was performed and the abdomen packed with cotton until an intra-abdominal pressure (IAP) of 15 mm Hg was reached; 2) hypovolemia (HYPO): blood was withdrawn until a mean arterial pressure ~60 mm Hg was reached; 3) IAH + HYPO (to resemble clinical ACS); and 4) sham surgery. After 3 hours of protective mechanical ventilation, the animals were euthanized and the liver, kidney and lungs removed to examine the degree of tissue damage. Results: IAH resulted in the following: oedema and neutrophil infiltration in the kidney; necrosis, congestion, and microsteatosis in the liver; and alveolar collapse, haemorrhage, interstitial oedema, and neutrophil infiltration in the lungs. Furthermore, IAH was associated with greater cell apoptosis in the kidney, liver and lungs compared to sham surgery. HYPO led to oedema and neutrophil infiltration in the kidney. The combination of IAH and HYPO resulted in all the aforementioned changes in lung, kidney and liver tissue, as well as exacerbation of the inflammatory process in the kidney and liver and kidney cell necrosis and apoptosis. Conclusions: Intra-abdominal hypertension by itself is associated with kidney, liver and lung damage; when combined with hypovolemia, it leads to further impairment and organ damage