Posicionamiento de implantes dentales simultáneos a la elevación de seno maxilar en rebordes con reabsorción severa / Dental implant placement simultaneous with maxillary sinus lifting on ridges with severe resorption

Introducción: El posicionamiento de implantes dentales simultáneos a la elevación de seno maxilar en rebordes con reabsorción severa < 4mm es una técnica quirúrgica sensible que disminuye los tiempos operatorios. Sin embargo, es considerada cirujano-dependiente y en caso de no darse el manejo adecuado puede generar complicaciones. Objetivo: Evaluar, luego de 24 meses de carga funcional, la estabilidad de los tejidos periimplantares del implante dental que se posicionó simultáneo a la elevación de seno maxilar en un reborde alveolar con reabsorción ósea severa < 4mm. Presentación de caso: Paciente masculino de 62 años con reabsorción ósea severa en zona de primer molar superior derecho. Luego de analizar los medios diagnósticos y la evidencia científica; se logró posicionar un implante dental simultáneo a la elevación de seno maxilar técnica de ventana lateral; cuatro meses después se realizó la segunda fase quirúrgica y finalmente fue rehabilitado con una corona en zirconio. Tuvo un periodo de seguimiento de 24 meses. Conclusiones: Un buen diagnóstico, manejo quirúrgico adecuado, la colaboración del paciente y los controles periódicos, resultan en una técnica segura, que proporciona estabilidad de los tejidos periimplantares(AU)

Introduction: Dental implant placement simultaneous with maxillary sinus lifting on ridges with severe resorption < 4 mm is a sensitive surgical technique that shortens the duration of interventions. However, it is considered to be operator dependent, and may cause complications if not appropriately managed. Objective: After 24 months of functional load, evaluate the stability of the peri-implant tissue of a dental implant placed simultaneously with maxillary sinus lifting on an alveolar ridge with severe bone resorption. Case presentation: A case is presented of a male 62-year-old patient with severe bone resorption in the area of the first upper right molar. Analysis of the diagnostic means and scientific evidence involved led to placement of a dental implant simultaneous with maxillary sinus lifting (lateral window technique). The second surgical stage was performed four months later. A zirconium crown was finally placed, and a 24-month follow-up period was started. Conclusions: With a good diagnosis, appropriate surgical management, patient cooperation and periodic controls, it is a safe technique that ensures the stability of peri-implant tissue(AU)

Perioperative cardiac arrest: an evolutionary analysis of the intra-operative cardiac arrest incidence in tertiary centers in Brazil / Parada cardíaca perioperatória: uma análise evolutiva da incidência de parada cardíaca intraoperatória em centros terciários no Brasil

ABSTRACT BACKGROUND: Great changes in medicine have taken place over the last 25 years worldwide. These changes in technologies, patient risks, patient profile, and laws regulating the medicine have impacted the incidence of cardiac arrest. It has been postulated that the incidence of intraoperative cardiac arrest has decreased over the years, especially in developed countries. The authors hypothesized that, as in the rest of the world, the incidence of intraoperative cardiac arrest is decreasing in Brazil, a developing country. OBJECTIVES: The aim of this study was to search the literature to evaluate the publications that relate the incidence of intraoperative cardiac arrest in Brazil and analyze the trend in the incidence of intraoperative cardiac arrest. CONTENTS: There were 4 articles that met our inclusion criteria, resulting in 204,072 patients undergoing regional or general anesthesia in two tertiary and academic hospitals, totalizing 627 cases of intraoperative cardiac arrest. The mean intraoperative cardiac arrest incidence for the 25 years period was 30.72:10,000 anesthesias. There was a decrease from 39:10,000 anesthesias to 13:10,000 anesthesias in the analyzed period, with the related lethality from 48.3% to 30.8%. Also, the main causes of anesthesia-related cause of mortality changed from machine malfunction and drug overdose to hypovolemia and respiratory causes. CONCLUSIONS: There was a clear reduction in the incidence of intraoperative cardiac arrest in the last 25 years in Brazil. This reduction is seen worldwide and might be a result of multiple factors, including new laws regulating the medicine in Brazil, incorporation of technologies, better human development level of the country, and better patient care.

RESUMO JUSTIFICATIVA: Nos últimos 25 anos ocorreram grandes mudanças na medicina em todo o mundo. Essas mudanças de tecnologias, riscos do paciente, perfil do paciente e leis que regulam medicamentos tiveram impacto na incidência de parada cardíaca (PC). Postula-se que a incidência de parada cardíaca intraoperatória (PCI) tem diminuído ao longo dos anos, especialmente em países desenvolvidos. A nossa hipótese foi que, como no resto do mundo, a incidência de PCI está diminuindo no Brasil, um país em desenvolvimento. OBJETIVOS: O objetivo deste estudo foi pesquisar e avaliar na literatura as publicações que relacionam a incidência de PCI no Brasil e analisar a tendência na incidência de PCI. CONTEÚDO: Descobrimos quatro artigos que atenderam aos critérios de inclusão, que resultaram em 204.072 pacientes submetidos à anestesia regional ou geral em dois hospitais terciários e acadêmicos e 627 casos de PCI. A média de incidência de PCI para o período de 25 anos foi de 30,72:10.000 anestesias. Houve uma diminuição de 39:10.000 anestesias para 13:10.000 anestesias no período analisado, com letalidade relacionada de 48,3% para 30,8%. Além disso, as principais causas de mortalidade relacionadas à anestesia mudaram de mau funcionamento de máquinas e overdose de medicamentos para hipovolemia e causas respiratórias. CONCLUSÕES: Houve uma clara redução na incidência de PCI nos últimos 25 anos no Brasil. Essa redução é observada em todo o mundo e pode ser o resultado de vários fatores, incluindo novas leis que regulam medicamentos no Brasil, incorporação de tecnologias, melhor nível de desenvolvimento humano do país e melhor assistência ao paciente.

Analysis and countermeasures of complications in video-assisted thoracoscopic lobectomy / 中国肿瘤临床

Objective: To summarize the methods of preventing and managing the complications in thoracoscopic lobectomy. Methods:The participants of this study included 317 patients undergoing lobectomy with video-assisted thoracoscopic surgery in the Department of Thoracic Surgery between January 2007 and December 2012. Intra-operative complications were observed, and countermeasures were summarized. Results: Complications occurred 28 times (8.8%), including bleeding in 16 cases because of accidental vascular injury (5.0%), accidental injury/break of bronchus in two cases (0.6%), vascular stump errhysis from cutting stapler in four cases (1.3%), lung stump air leakage in three cases (0.9%), lung injury in two cases (0.6%), and diaphragmatic injury in one case (0.3%). Conversion to thoracotomy was conducted in 17 cases, with a conversion rate of 5.4%. Thoracoscopic repair operation was performed in 14 cases that exhibited bleeding, with a success rate of 70% (14/20). No mortality was reported during the operation. Conclusion:Thoracoscopic lobectomy is a highly difficult method in thoracic surgeries. The procedure requires substantial attention on the timely prevention and correct management of intra-operative complications, particularly the injury and bleeding of major vessels, to reduce the rate of conversion to thoracotomy and the incidence of post-operative complications, as well as to promote the surgery in clinics.

Intra-operative complications increase with successive number of cesarean sections: Myth or fact?

OBJECTIVE: To determine whether complications related to surgery increase with increasing number of cesarean sections (CSs) in upper segment placenta. To compare the complications in urgent and elective high order (4-6) repeat CSs. METHODS: A retrospective analysis of 519 women who underwent repeat CS was performed from January to December 2012. Women were divided into 3 groups: group 1 with previous 3 CS (n=325), group 2 with previous 4 CS (n=139), and group 3 with previous > or =5 CS (n=55). RESULTS: Statistically significant differences (P < 0.001) were observed among 3 groups, regarding mean gravidity, type of CS, midline incision and bilateral tubal ligation performed. The risks of severe intra-peritoneal adhesions, thin out lower uterine segment and bladder injury were significantly increased (P < 0.001) with increasing number of CS deliveries. Only one cesarean hysterectomy was done in group 1 due to post partum hemorrhage. No significant differences were found in blood loss, duration of surgery, post operative hospital stay as well as birth weight and Apgar scores of newborns. The elective and emergency CS groups of high order repeat CS had no remarkable differences in operative, post operative complications and fetal outcome. CONCLUSION: Women with repeat CS are at increased risk of having multiple intra-operative surgical complications which increase with each subsequent CS. Pregnant women must be informed of the related risks which may affect counselling regarding possible tubal ligation.Women with repeat CS are at increased risk of having multiple intra-operative surgical complications which increase with each subsequent CS. Pregnant women must be informed of the related risks which may affect counselling regarding possible tubal ligation.

Fatores intraoperatórios nas cirurgias de revascularização do miocárdio em hospitais do município do Rio de Janeiro / Intra-operative factors in coronary artery bypass graft (GABG) surgery in government hospitals, Rio de Janeiro, Brazil

Fundamentos: Performance cirúrgica depende de condições pré e pós-operatórias. Eventos que ocorrem no período intraoperatório também podem estas associados à evolução. Objetivo: Avaliar a associação de fatores intraoperatórios com época de óbito de pacientes submetidos à cirurgia de revascularização miocárdica (RVM), em quatro hospitais públicos da cidade do Rio de Janeiro, entre janeiro 1999 e dezembro 2001. Métodos: Selecionadas, em quatro hospitais públicos da cidde do Rio de Janeiro, amostras aleatórias e ponderadas de 150 prontuários de pacientes, entre sobreviventes e óbitos. Informações sobre características intraoperatórias e época do óbito foram coletadas retrospectivamente dos prontuários e das declarações de óbitos. Estimaram-se taxas de letalidade em diversas faixas de tempo até um ano após cirurgia. Resultados: Na sala de operações ocorreram 7,4 por cento dos ópbitos; até o terceiro dia, 40,3 por cento; e até o 15º dia, 69 por cento dos óbitos do primeiro ano. Ao final do primeiro ano, 14,9 por cento dos pacientes faleceram. Tempos mais elevados de circulação extracorporea ou de clampeamento aórtico ocorreram naqueles que morreram durante acirurgia. Baixo débito, parada cardiorrespiratória (PCR) e arritmia ventricular grave intraoperatórios se associaram significativamente com o óbito precoce. Fibrilação atrialintraoperatória se associou com óbito mais frequente nos segundo e terceiro dias de pós-operatório. Conclusão: Fatores intraoperatórios favoreceram aocorrência de óbitos precoces, representando 2/3 das mortes do primeiro ano.

Background: Although surgical performance depends largely on pre- and post-operative conditions, intraoperative events may also be associated with these outcomes.Objective: To evaluate the association between intraoperative factors and times of death among patientsundergoing CABG surgery in four government hospitals in the City of Rio de Janeiro, between January 1999 andDecember 2003. Methods: Random weighted samples of 150 patient records with survivors and deaths were selected at four government hospitals in the City of Rio de Janeiro. Information on intra-operative characteristics and timesof death was collected retrospectively from the medical records and declarations of death. The lethality rates were estimated for several timeframes extending up to a year after the operation. Results: 7.4% of the deaths occurred in the operating theater; 40.3% by Day 3 and by Day 15, 69% of the deaths occurring during the first year. By the end of the first year, 14.9% of the patients were deceased. Longerextracorporeal circulation or aortic clamping times were found among patients who died during surgery. Low debit, cardio-respiratory failure (CRF) and severe intra-operative ventricular arrhythmia were significantly associated with early death. Intra-operative atrialfibrillation was associated more frequently with death on the second and third days after surgery. Conclusion: Intra-operative factors contributed to theoccurrence of early deaths, representing two thirds of deaths during the first year after surgery.

Operative treatment on 14 cases with tumors closed to hepatic hilar / 中国基层医药

Objective To sum up operative experience and prevention of complications while resecting the hepatic hilar tumor. Methods 14 cases with hepatic hilar tumor were analyzed in respect of operative method,complications, experience and prevention of complications. Results Some peri-operative complications happened. such as massive hemorrhage in 2 cases,billiary fistula in 1 case,hepatic failure in 1 case and tumor remained at resection edge in 1 case. No patients died during the operation. Conclusion The resection of hepatic hilar tumor is very difficult and risky,safety of surgery can be improved by paying attention to pre-operative evaluation and preparation,as well as carefulness during operation.

Complications associated with the b agby and kuslich method of lumbar int erbody fusion in the treat-ment of spondylolisthesis / 中华骨科杂志

Objective To review and analyze the complications of spondylolisthesis treated wi th BAK interbody fusion cages.Methods One hundred and eighteen patients wi th spondylolisthesis were treated with BAK interbody fusion ca ges,the intraoperative and postoperative complications were reviewed,which include dural tear,nerve root injury,unsatisfactory cage position,cage retropulsion,cage subsidence and postlaminectomy adhesive arachnoiditis.Results The intraoperative complication ra te was 11%and the most commonly seen were dural tear 4c ases(3.4%),nerve root damage 3cases(2.5%)and unsatisfactory cage position 9cases(7.6%),2cases had both dural tear and unsatisfactory cage position,1patient had both nerve root injury and unsatisfactory cage position.The postoperative c omplication rate was 7.6%,which chiefly consisted of cage retropuls ion 3cases(2.5%),cage subsidence 4cases(3.4%),and postlaminec-tomy adhesive arachnoiditis 2cases(1.7%),2cases of cage retropulsion and 2ca ses of cage subsidence show partial nonunion,2cases of cage subsidence had arachnoiditis.Conclusion As a new technique,lumbar interbody fusion with BAK cages are r apidly gaining popularity,however,the complications described here suggest the importance of selection s of surgical indications and proper manipulations.[