Fogo em campo cirúrgico - Medidas preventivas para cirurgia palpebral segura / Operating room fire prevention - preventive measures for safe eyelid surgery

Resumo Fogo em campo cirúrgico durante cirurgia palpebral é uma complicação intra-operatória que é dramática tanto para o paciente quanto para a equipe médica. Relatamos um caso de acidente cirúrgico durante cirurgia palpebral onde o paciente sofreu queimadura de supercílio. Houve interação entre o oxigênio usado para sedação (máscara aberta) e uma fonte de ignição representada pelo cautério monopolar. Embora o paciente tenha apresentado boa evolução clínica com recuperação total da lesão cutânea, este caso é um alerta para se evitar tais tipo de ocorrência. Ressaltamos neste trabalho quais as condições implicadas e o modo de prevenção.

Abstract Fire in the surgical field during eyelid surgery is an intra-operative complication that is dramatic for both the patient and the medical staff. It's being reported a case of surgical accident during eyelid surgery where the patient suffered a brow burn. There was interaction between the oxygen used for sedation (open mask) and a source of ignition represented by monopolar cautery. Although the patient presented good clinical evolution with complete recovery of the cutaneous lesion, this case is an alert to avoid such type of occurrence. This work highlights the conditions involved and the way of prevention.

American cutaneous leishmaniasis triggered by electrocoagulation

Abstract Cutaneous leishmaniasis is usually transmitted by infected phlebotomine sand fly bites that initiate local cutaneous lesions. Few reports in the literature describe other modes of transmission. We report a case of a previously healthy 59-year-old woman who underwent electrocoagulation to remove seborrheic keratosis confirmed by dermatoscopy. Three months later, a skin fragment tested positive for Leishmania culture; the parasite was identified as L. (V.) braziliensis. Trauma may generate inflammatory cascades that favor Leishmania growth and lesion formation in previously infected patients. American cutaneous leishmaniasis is a dynamic disease with unclear pathophysiology because of continually changing environments, demographics, and human behaviors.

Fuego quirúrgico: un incidente prevenible / Surgical fire: an avoidable incident

Introduction: surgical fire requires the presence of three components, known as the "fire triad": a fuel, an ignition source and an oxidizer. Clinical case: we report a patient who, during an ambulatory surgery, suffered a facial burn from a fire. The use of an electrosurgical unit and supplementary oxygen through nasal cannula were important factors in this case. We describe how and why fire start, which are the high-risk surgeries and the strategies to reduce the risk of fire in surgical patients.

Introducción: el fuego quirúrgico requiere tres elementos para que se produzca, conocidos como "triada de fuego": un combustible, una fuente de ignición y un oxidante. Caso clínico: presentamos el caso de una paciente que sufrió una quemadura facial por fuego durante una cirugía ambulatoria, en la que fueron factores importantes el uso de una unidad electroquirúrgica y la administración de oxígeno a través de una cánula nasal. Describimos cómo y por qué se puede producir fuego, cuáles son las cirugías de alto riesgo y las estrategias para reducir el riesgo de fuego en pacientes quirúrgicos.

Síntomas respiratorios causados por el uso del electrocauterio en médicos en formación quirúrgica de un hospital de México / Respiratory symptoms caused by the use of electrocautery in physicans being trained in surgery in a Mexican hospital

Con el objetivo de determinar la frecuencia de síntomas respiratorios entre los residentes de especialidades quirúrgicas expuestos al humo del electrocauterio, se realizó un estudio transversal durante el mes de febrero de 2012. Se incluyeron 50 médicos residentes del tercer año, de diferentes especialidades quirúrgicas, de un hospital de tercer nivel perteneciente al Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado ubicado en Jalisco, México. La selección de sujetos fue no probabilística. Para la recolección de datos, se empleó el cuestionario de síntomas respiratorios desarrollado en Cuba. Los síntomas más comunes fueron sensación de cuerpo extraño (58%) y ardor faríngeo (22%). La especialidad con mayor índice de exposición fue la de neurocirugía (24,1 min/acto quirúrgico). La totalidad de los médicos de esta especialidad tuvieron algún síntoma respiratorio. Se concluye que la inhalación del humo del cauterio puede constituir un riesgo para desarrollar síntomas respiratorios entre los médicos de especialidades quirúrgicas.

In order to determine the frequency of respiratory symptoms among residents from surgical specialties dures exposed to the electrocautery smoke, a cross-sectional study was conducted in February 2012. 50 third-year residents from different surgical specialties coming from a third-level hospital belonging to the Institute of Security and Social Services of the State Workers in Jalisco, Mexico, were included. The subject selection was non-probabilistic. A questionnaire on respiratory symptoms developed in Cuba was used for data collection. The most common symptoms were sensation of a lump in the throat (58%), and a sore throat (22%). The specialty with the highest rate of exposure was neurosurgery (24.1 min/surgical procedure). All, the physicians from this specialty had respiratory symptoms. We conclude that the cauterization smoke may be considered a risk for developing respiratory symptoms among physicians with surgical specialties.

Avaliação dos potenciais evocados cocleares após lesão do utrículo por eletrocauterização / Assessing cochlear evoked potentials after electrocautery-induced trauma to the utricle

A utriculostomia é uma nova alternativa cirúrgica para a doença de Ménière. A hipótese cirúrgica desse procedimento é a de que o desfecho de uma lesão do utrículo por eletrocauterização não interfere na função coclear. Contudo, a hipótese de que essa abordagem do utrículo preserva a audição ainda não foi comprovada. OBJETIVO: Determinar se ocorrem mudanças nos potenciais elétricos evocados na cóclea e no nervo auditivo antes, durante e 1 mês após o procedimento cirúrgico no utrículo em modelo animal. MATERIAIS E MÉTODOS: Estudo experimental: Oito ovelhas foram submetidas à lesão do utrículo por eletrocauterização e sua função coclear foi avaliada por meio de eletrococleografia, registrando-se os potenciais elétricos evocados nos períodos pré-operatório, pós-operatório imediato e pós-operatório de médio prazo. Os resultados foram analisados estatisticamente. RESULTADOS: Não houve variação estatisticamente significativa na amplitude (p = 0,099) e na latência (p = 0,591) antes e 1 mês após o procedimento cirúrgico. Houve alteração estatisticamente significativa na razão entre potencial de somação/potencial de ação (p = 0,0122), representando uma perda calculada de 11,8 dB. CONCLUSÃO: A intervenção realizada no utrículo neste estudo permite concluir que, tendo em conta respostas eletrofisiológicas deficientes observadas durante e 1 mês após o procedimento cirúrgico, houve preservação da audição nas ovelhas operadas.

Utriculostomy is a new surgical alternative for Ménière's disease. The basis of this procedure is that the outcome of an electrocautery-induced utricular trauma does not affect cochlear function. However, a demonstration of the hypothesis that this approach to the utricle would preserve hearing is still pending. OBJECTIVE: To determine whether any changes would occur in the electrical potentials evoked in the cochlea and auditory nerve before, during, and 1 month after a surgical procedure in the utricule in an animal model. MATERIALS AND METHODS: An experimental study. Eight sheep underwent electrocautery-induced utricular trauma, and their cochlear function was assessed by electrocochleography - recording of electrical evoked potentials, in the preoperative, immediate postoperative and medium-term postoperative periods. The results were analyzed statistically. RESULTS: There were no statistically significant variations in amplitude (p = 0.099) and latency (p = 0.591) before and 1 month after the surgical procedure. There was a statistically significant change in the summation of the potential/action potential area ratio (p = 0.0122), a calculated loss of 11.8 dB. CONCLUSION: The intervention performed in this study enabled us to conclude that, taking into account the impaired electrophysiological responses observed during and 1 month after the surgical procedure, hearing was preserved in the operated sheep.

Effects of electrocautery to provoke endovascular thermal injury / Efeitos do eletrocautério para provocar lesão térmica endovascular

PURPOSE: To investigate the effects of a new electrocautery device to provoke endovascular venous thermal injury. METHODS: An experimental endovascular electrocautery was placed inside eight ex-vivo bovine saphenous veins models. Each one was divided in eight segments and progressive intensities of electric energy liberated. The macroscopic and microscopic effects were analyzed. RESULTS: Forty bovine saphenous veins segments were studied. The higher the electric energy applied the greater the nuclear picnosis and more intense the cytoplasmatic shrinkage and electrocoagulation effects. CONCLUSION: The experimental endovascular electrocautery device demonstrated to be both capable of inducing the destruction of the intimal layers of the studied vein model and provoke endovascular thermal injury.

OBJETIVO: Investigar os efeitos de um modelo experimental de eletrocautério em provocar lesão venosa térmica endovascular. MÉTODOS: O eletrocautério endovascular foi colocado dentro de oito modelos experimentais de veia safena bovina. Cada uma foi dividida em oito segmentos e intensidades progressivas de energia elétrica liberada. Os efeitos macroscópicos e microscópicos foram analisados. RESULTADOS: Foram estudados quarenta segmentos de veia safena bovina. Quanto maior a energia elétrica aplicada pelo eletrocauterizador endovascular maiores foram as alteraçoes de picnose nuclear e mais intensa a retração citoplasmática observada. CONCLUSÃO: O eletrocautério endovascular experimental demonstrou ser capaz de induzir a destruição da camada íntima e provocar lesão térmica endovascular.

Síndrome post-polipectomía endoscópica / Post polypectomy endoscopic syndrome

Introducción: El "síndrome post-polipectomía", "síndrome post coagulación endoscópica" o "síndrome de quemadura transmural" son definiciones que hacen referencia a una misma entidad poco frecuente que es el resultado de la progresión de la electrocoagulación endoscópica hasta la serosa luego de una polipectomía. Esto resulta en una quemadura transmural pero que no llega a perforar la pared colónica. Ocurre entre el 0,5 y el 1,2 por ciento de las polipectomías endoscópicas. Objetivo: Comunicar nuestra experiencia con este síndrome y realizar una revisión bibliográfica sobre el tema para conocer la experiencia de otros centros. Pacientes y métodos: Entre enero de 2003 y diciembre de 2007 (casi 5 años) se realizaron 3227 videocolonoscopías en el Servicio de Coloproctología del Hospital Churruca-Visca. Realizadas por médicos residentes el 84 por ciento y por médicos de planta las restantes. Se llegó al ciego en el 91,3 por ciento de los casos. Se realizaron 388 polipectomías (12 por ciento) y se registró un síndrome post-polipectomía en 3 casos (0,77 por ciento). Resultados: Los tres pacientes presentaban pólipos pediculados > 2 cm de diámetro en el ciego y el colon ascendente. Las manifestaciones clínicas fueron similares en los tres pacientes: dolor abdominal con peritonismo, distensión abdominal, leucocitosis leve y exámenes radiológicos normales. Todos evolucionaron favorablemente con el tratamiento conservador: plan de hidratación, reposo digestivo, antibióticoterapia y analgésicos. Fueron dados de alta entre el 2º y 3er día. Conclusión: El síndrome post-polipectomía es infrecuente y subdiagnosticado. Debe ser tenido en cuenta entre los diagnósticos diferenciales de la perforación colónica postvideocolonoscopía, con la que puede confundirse por sus manifestaciones clínico-radiológicas. Su tratamiento es conservador, brindándole al paciente soporte clínico y controles clínicos y radiológicos frecuentes.

Introduction: The “post-polypectomy syndrome”, “post coagulation syndrome” or “endoscopic transmural burn syndrome” are definitions referring to a single entity, infrequent, and that is the result of the progression of endoscopic electrocoagulation to the serosa. This results in a transmural burn, although this not involves the colonic wall. It occurs between 0,5 and 1,2 per cent of the endoscopic polypectomies. Objective: To report on our experience with this syndrome, and learned about other centers experiences through a literature review. Patients and methods: Between January 2003 and December 2007 (almost 5 years) we performed 3227 videocolonoscopies in the Service of Coloproctology, Churruca- Visca Hospital. The 84 per cent was made by medical residents and the rest by the medical staff. The cecum was reached in 91,3 per cent of cases. Among 388 polypectomies (12 per cent) performed, the post-polypectomy syndrome occurred in 3 cases (0,77 per cent). Results: All three patients had pedunculated polyps, > 2 cm in diameter, in the cecum and ascending colon. The clinical symptoms were similar in all three patients: abdominal pain with peritonism, abdominal distension, mild white cell count increase, and normal radiological films. All had a favorable outcome with conservative treatment: IV hydration, no diet, antibiotics, and analgesics. They were discharged between the 2nd and 3rd day. Conclusion: The post-polypectomy syndrome is a rare and underdiagnosed syndrome. It must be taken into account among the differential diagnosis of the postvideocolonoscopy colonic perforation, since its radiological and clinical manifestations can be mistaken. Its treatment is conservative, giving the patient clinical support, and frequent clinical and radiological controls.

comparison of different hemorrhoidectomy procedures

To evaluate the pain level, analgesic consumption, operation time, bleeding and early complications after open and closed hemorrhoidectomy using a harmonic scalpel [HS] and classical methods. Between January 2005 and January 2006, 87 patients with grade III-IV hemorrhoids, admitted in General Surgery Clinic, Gulhane Military Medical Academy, Ankara, Turkey were enrolled in the study. They were randomized into open HS [n=22], closed HS [n=22], Miligan Morgan [n = 22], and Ferguson [n = 21] hemorrhoidectomy. Patients were evaluated for postoperative pain, painkiller consumption, bleeding and operation time. Bleeding volume was significantly lower in Groups I-II [p < 0.001]. Operation time was significantly shorter in Group I [p < 0.001]. Postoperative pain and pain at the time of first defecation, was significantly lower in Groups I-III [p < 0.001] compared with the other 2 groups and lower during days 2-6 in Group I compared to the Group III [p < 0.004]. Visual Analogue Scale results were similar in Groups II and IV. Analgesic consumption in Groups I-III was significantly lower than Groups II-IV [p < 0.001]. Oral analgesic consumption during 2-5 postoperative days was lower in Group I than in Group III [p < 0.007] and similar in closed hemorrhoidectomy group. The use of HS in hemorrhoidectomy reduces postoperative pain, analgesic consumption, operation time, and bleeding. Harmonic scalpel hemorrhoidectomy is an effective, comfortable, and safe procedure. Use of suture in hemorrhoidectomy is a major cause of postoperative pain

Laparoscopic partial nephrectomy in rats

PURPOSE: To establish an experimental model of laparoscopic partial nephrectomy (LPN) in rats and to analyze morphological alterations in the renal parenchyma utilizing an electric cautery and harmonic scalpel. METHODS: Forty Wistar rats were used, divided in 2 experiments with 20 rats each: experiment I, LPN was performed with an electric cautery and the rats were subdivided into groups A and B; experiment II, LPN was performed with a harmonic scalpel and they were subdivided into groups C and D. The animals in groups A and C were sacrificed shortly after surgery and the remnant kidney was removed to study the following variables: necroses and degeneration. In groups B and D a laparatomy was performed for retrieval of the remnant kidney on the 14th day after surgery to analyze fibrous scarring. RESULTS: For the variables necroses and fibrous scarring, the electric cautery creates, on average, greater width than that produced by the harmonic scalpel (p=0.0002 and p=0.0068 respectively). Regarding the variable of degeneration, we found no significant difference between the two types of scalpels (p=0.1267). CONCLUSIONS: LPN in rats is an adequate and feasible experimental model. The electric cautery caused greater damage to remnant renal tissue when compared to harmonic scalpel.

OBJETIVO: Estabelecer um modelo experimental de nefrectomia parcial laparoscópica (NPL) em ratos e analisar as alterações morfológicas no parênquima renal utilizando-se bisturi elétrico e harmônico. MÉTODOS: Foram utilizados 40 ratos Wistar, distribuídos em dois experimentos com 20 ratos cada: experimento I, NPL utilizando-se de bisturi elétrico e subdividindo-se os ratos em grupos A e B; experimento II, NPL realizada com bisturi harmônico e subdividindo-se os ratos em grupos C e D. Os animais dos grupos A e C foram sacrificados após a cirurgia para a remoção do rim operado e estudo das seguintes variáveis: necrose e degeneração. Nos grupos B e D a laparotomia para a retirada do rim operado foi após o décimo quarto dia de pós-operatório para a análise da cicatriz fibrosa. RESULTADOS: O bisturi elétrico provocou uma necrose e cicatriz fibrosa mais extensas em relação ao bisturi harmônico (p=0.0002 e p=0.0068 respectivamente). Em relação a variável degeneração, não houve diferença entre os tipos de bisturis (p=0.1267). CONCLUSÕES: NPL em ratos é um modelo experimental adequado e factível. O bisturi elétrico causa danos teciduais mais intensos no rim operado quando comparado com o bisturi harmônico.

Esófago de Barrett: actualización del tratamiento endoscópico / Barrett's esophagus: update of the endoscopic treatment

El manejo actual del esófago de Barrett incluye el tratamiento de los síntomas de enfermedad por reflujo gastroesofágico, la prevención del daño erosivo y la vigilancia endoscópica para detectar la progresión a displasia de alto grado y adenocarcinoma esofágico. Ante la presencia de displasia de alto grado y cáncer superficial, se han intentado terapias menos invasivas, alternativas a la cirugía resectiva, como el Argon Plasma Coagulator, Electrocoagulación Multipolar, Heater Probe, asociados o no a cirugía antirreflujo, la Terapia Fotodinámica y en los últimos años la ablación endoscópica por radiofrecuencia o BARREx. Se vislumbran además como terapias de destrucción del epitelio de Barrett actualmente en estudio la terapia ultrasónica y la crioterapia. La Resección Mucosa Endoscópica del epitelio de Barrett, procedimiento con potencial curativo, es además la única técnica que permite el análisis histopatológico del tejido. En la presente revisión analizaremos los resultados obtenidos con las diferentes terapias endoscópicas actuales y en desarrollo para el esófago de Barrett.

Actual Barrett’s esophagus management includes symptomatic approach for GERD in order to prevent erosive injury, and endoscopic & histologycal surveillance to detect dysplasia and early cancer. In high-grade dysplasia and superficial carcinoma, less aggressive procedures has been attempted to avoid extended surgery, such as Argon Plasma Coagulator, Multipolar Coagulation, Heater Probe, Photodynamic Therapy, and recently radiofrequency local treatment, associated or not to antireflux surgery. Ultrasonic therapy and Cryotherapy are new approaches, which are under clinical investigation. Barrett’s epithelium resection utilizing endoscopical mucosal resection is a new promising procedure, which comes to the arena, allowing besides the compromised epithelium removal, its complete pathological evaluation and probably a curative intent. The actual revision intents to discuss the results of the different alternatives at the platform of treatment in dysplastic Barrett’s or early carcinoma growing in the Barrett’s epithelium.

Efeitos do eletrocautério nas taxas de infecção de feridas operatórias abdominais / Electrocautwry effects in infection rates of operative abdominal wounds

Os dados existentes na literatura sobre a influência do uso do eletrocautério nas taxas de infecção de feridas operatórias são conflitantes. Objetivamos com este trabalho determinar se o uso do eletrocautério para criar incisões abdominais está associado com maiores índices de infecção de feridas operatórias em relação ao bisturi. Para isso, foi realizado um estudo randomizado, envolvendo 204 pacientes submetidos a procedimentos cirúrgicos abdominais no Hospital Universitário de Santa Maria, no período de agosto de 1990 a novembro de 2000. Observamos o desenvolvimento de infecção da ferida operatória em 10 (10 por cento) dos 100 pacientes do grupo do bisturi e em 12 (11,5 por cento) dos 104 pacientes do grupo do eletrocautério. A diferença nas taxas de infecção não foi estatisticamente significativa.

Closed vs ligasure hemorrhoidectomy: a prospective, randomized clinical trial.

OBJECTIVE: To compare the operative time, postoperative complications, and analgesic requirement between closed hemorrhoidectomy and Ligasure hemorrhoidectomy. MATERIAL AND METHOD: The study was conducted in a prospectively randomized controlled fashion. Forty-seven patients with grade 3 or 4 hemorrhoids plus external component or skin tag were operated on by either hemorrhoidectomy with Ligasure (24 patients) or closed hemorrhoidectomy (23 patients). One patient in each group was lost to follow up. The operative time, postoperative verbal numeric pain score, analgesic requirement, bleeding, and wound dehiscence between the two groups were compared Unpaired t-tests, Mann-Whitney U tests, or Fisher's Exact tests were used where appropriate. RESULTS: Demographic and clinical data between two groups were comparable. Operative time for the Ligasure hemorrhoidectomy was significantly shorter than the closed hemorrhoidectomy group (21.70 +/- 11.76 vs 35.68 +/- 14.25 min, p < 0. 001), while the number of resected hemorrhoids in the study group were 2.91 versus 2.18 in the control group. However, there were no differences in post-operative pain score, analgesic requirement, bleeding, or wound dehiscence between the two groups. CONCLUSION: Ligasure hemorrhoidectomy is superior to closed hemorrhoidectomy in terms of reducing the operative time without affecting postoperative complications.

Intradiscal Electrothermal Treatment for Chronic Lower Back Pain Patients with Internal Disc Disruption

Chronic lower back pain is one of the most common musculoskeletal problems; it is also the most expensive industrial injury. Not surprisingly, many treatments have been developed to combat this expensive and debilitating condition. One of these, intradiscal electrothermal treatment (IDET), was developed for patients with chronic discogenic lower back pain who failed to improve with any of the wide variety of non- surgical treatments. The present study sought to evaluate the efficacy of IDET for patients with chronic lower back pain. Twenty-five patients were enrolled in this prospective study; the patients received IDET between June 2001 and June 2003. MRI was used to confirm the diagnosis of internal disc disruption in all patients. The patients then underwent a pre-operative provocative test and discography. The follow-up duration was at least 1 year in all cases, and the visual analogue scale, recovery rate, and satisfaction of each patient were evaluated. The average age of the patients was 32 years (age range 18 to 49 years), and the patient group was 33% male and 67% female. Of the 25 patients, 5 underwent lumbar fusion surgery within 1 year of IDET. After IDET, 8 patients (32%) reported more pain than before, 14 patients (56%) reported less pain, and 3 patients (12%) experienced no change. Twelve patients (48%) were satisfied with IDET, 11 (44%) were dissatisfied, and 2 (8%) were undecided about the treatment. At least 1 year after IDET, nearly half the study patients were dissatisfied with their medical outcome. Consequently, 5 patients (20%) underwent fusion surgery at 1 year after IDET. Although other studies have shown good results with IDET for at least 2 years, this investigation suggests the IDET may be somewhat less effective. In order to firmly establish the efficacy of IDET for treating chronic discogenic lower back pain, additional studies with larger numbers of patients evaluated over longer time periods are recommended.

Esófago de Barrett: ¿tratamiento ablativo? / Barrett esophagus: ablative therapy?

Se analizan algunas técnicas ablativas para el tratamiento del esófago de Barrett. La electrocoagulación multipolar y la coagulación térmica con argón plasma (APC) se aplican en varias sesiones, tienen buenos resultados para erradicar la mucosa tipo Barrett, en general sin recaídas a largo plazo y se consideran tediosas. La técnica APC tiene más efectos adversos (dolor de tórax y disfagia). Se recomienda mantener el bloqueo de la secreción ácida posterior a la ablación. Las biopsias anteriores y posteriores a este tratamiento son fundamentales para descartar una neoplasia o un Barrett subterráneo. Se discute también la relación Barrett-cáncer, la que es baja en el Barrett de segmento largo y casi ausente en el Barrett de segmento corto, en estudios de largo plazo. Probablemente, en el futuro se pueda realizar la quimioprevención del cáncer con los inhibidores de la ciclooxigenasa 2 (COX-2). Se concluye que la adopción o no del tratamiento ablativo debe establecer en el futuro. Dado que la frecuencia del cáncer esofágico sería menor que la establecida, los tiempos de intervalos entre controles endoscópicos e histológicos actualmente son mayores; se debe poner más énfasis en el control de los pacientes de mayor riesgo de presentar una neoplasia

Electrocoagulación hemorroidal submucosa / Submucosal hemorrhoid electrocoagulation

Se presenta una serie prospectiva de 50 pacientes con patología hemorroidal que requiere tratamiento quirúrgico, 26 mujeres y 24 hombres. Finalizada la resección de los paquetes hemorroidales más grandes, se realizó complementariamente, electrocoagulación de las hemorroides remanentes, en el plano submucoso, (de uno a tres por paciente, total 107), logrando la esclerosis de la vena dilatada, sin objetivo disminuir la probabilidad de crecimiento tardío de las hemorroides que no pudieron ser resecadas. No se registraron complicaciones importantes en el postoperatorio inmediato, cinco presentaron edema del área electrocoagulada y tres, necrosis de la superficie mucosa. El período de seguimiento comprendió desde la operación hasta 38 meses, comprobando la ausencia de las hemorroides electrocoaguladas en 44 pacientes, sin síntomas ni complicaciones tardías

Efectos tardíos post fulguración con radiofrecuencia: experiencia clínica en 5 casos / Late effects of radiofrecuency fulguration: report of 5 cases

Radiofrecuency fulguration is the definitive treatment of several supraventricular and ventricular arrythmias. During radiofrecuency application, the conduction in a specific zone is interrupted as a consequence of cellular necrosis and edema. The disappearance of edema, minutes or hours after the procedure, allows the reappearance of conduction and arrythmias. On the other hand, the definitive lesion is larger than the one caused acutely, due to the progression of the scar. We report four patients, in whom there was an apparent failure of the fulguration, since at the end of the procedure there was conduction in the fulgurated zone, the tachycardia was inducible or pre excitation and arrythmias reappeared during the follow up. All four were subjected to a new eletrophysiological study and in all, fulguration had been effective. We conclude that these late effects of fulguration are due to the slow progression of fibrosis, that continues days or weeks after the procedure

Hemostasia e infecçäo / Haemostasis and infection

O presente estudo tem por objetivo relacionar o fio cirúrgico e sua natureza, na gênese das infecções da ferida operatória, bem como verificar se o uso do cautério propicia maiores índices de infecção. Foram utilizados 78 ratos Wistar, com peso corporal entre 180 e 250 gramas. Após anestesia geral, quatro incisões foram realizadas no dorso do animal. Para a realização da hemostasia e ao mesmo tempo síntese do plano músculo-aponeeurótico, foram utilizados três tipos de fio: Poligglactina, Algodão, Categute simples. Na Quarta incisão foi utilizado cautério. Os animais foram divididos em grupos de acordo com os procedimentos no plano músculo-aponeurótico: GI - utilizou-se fios e cautério GII - inoculou-se bactérias. GIII - utilizou-se fio, cautério e inoculou-se bactérias. Uma semana após, material foi colhido das feridas cirúrgicas para realização de culturas. O grupo GI (n=10), nenhuma das culturas destas feridas desenvolveu crescimento de microorganismos. O grupo II (n=20), 35 por cento infectaram. No grupo III (n=48), verificou-se a presença de 69,8 por cento feridas infectadas. Concluimos que o fio é importante fator na gênese de infecção de feridas independente de suas características e que o uso abusivo do cautério propiciou os maiores índices de infecção.

Estudo experimental comparado a cicatrizaçäo de anastomoses do cólon esquerdo após a diérese com bisturi elétrico e com bisturi frio / Comparative study of the healing of left colon anastomoses after dieresis with an electrocautery and with a cold surgical knife

O presente estudo visa comparar a cicatrizaçäo de anastomoses de cólon, cujas diéreses foram realizadas com bisturi elétrico e compará-la com a das feitas com bisturi frio. Utilizam-se 60 ratos machos com 246 dias de idade e peso médio de 349 gramas, divididos aleatóriamente em 2 grupos, F e E, respectivamente, grupos bisturi frio e bisturi elétrico. Sob anestesia inalatória realiza-se laparotomia mediana e secçäo transversa total do cólon a 2,0 cm da reflexäo peritoneal. Nos ratos do grupo F a secçäo era feita com bisturi frio de lâmina n§15 e nos do grupo E com eletrocautério, regulado para corte. Em ambos os grupos realizava-se anastomose término-terminal com 8 pontos extramucosos de fio monofilamentar ou nylon 6-0. Após laparotomia e recuperaçäo anestésica observava-se os animais até os 3§, 7§ e 14§ dias quando eram sacrificados com dose letal de éter sulfúrico. Ressecava-se 4 cm do cólon contendo anastomose, avaliava-se a formaçäo de aderências, presença de peritonite, deiscência, esporäo interno e reepitelizaçäo. Media-se a pressäo de ruptura e encaminhava-se para estudo histopatológico para se conhecer a reaçäo inflamatória e ordenaçäo da cicatriz. Registrou-se 3 óbitos por deiscência com peritonite, todos do grupo E (p=0,0098). A epitelizaçäo mucosa esteve atrasada no grupo E (U calculado=3, U crítico - 14). As rupturas ocorreram na linha de sutura no 3§ dia. Nos 7§ e 14§ dias ocorreram rupturas na linha de sutura e fora dela. A epitelizaçäo se mostrou incompleta à microscopia na maioria dos cortes histológicos do grupo E no 7§ dia (p=0,0433)e no 14§ dia (0,0010). Neste grupo, necrose esteve presente no 14§ (p=0,0338) e abscesso mural no 3§ dia (p=0,0015). A reaçäo inflamatória foi aguda ou agudo-crônica, de intensidade moderada a intensa no 3§ dia, predominantemente moderada no 7§ dia (0,0142) e mínima no grupo F no 14§ dia no grupo F (0,0008). Conclui-se que existe atraso no processo cicatricial das anastomoses cujos cólons foram seccionados com bisturi elétrico; estas anastomoses suportam menor pressäo quando submetidas a teste manométrico no 3§ dia e embora exista atraso no processo de cicatrizaçäo e menor resistência à pressäo, näo existe aumento significante do número de complicaçöes

Percutaneous retrogasserian radiofrequency thermal rhizotomy for trigeminal neuralgia.

Forty patients suffering from intractable unilateral trigeminal neuralgia involving more than one division of the trigeminal nerve were treated by percutaneous radiofrequency thermocoagulation of the trigeminal sensory root. The aim of the operation was to relieve the pain without producing dense sensory deficit in the face. This goal was achieved by making selective lesions in the sensory root with gradually increasing temperature 60 degrees C to 90 degrees C. Three to four consecutive lesions each for 60 seconds have been found to produce excellent pain relief in 77.7% with good and fair results in the rest. The recurrence rate has been found to be 15% during 2 years of follow-up. Considerable dysaesthesia was observed in 5% of cases. Corneal anaesthesia was found in 5% cases while one patient developed neuroparalytic keratitis. Transient trigeminal motor weakness was observed in 10% of patients.