Óbitos pós-cirúrgicos em neonatos com malformações congênitas do aparelho digestivo ou osteomuscular / Post-surgical deaths in neonates with congenital malformations in the digestive or musculoskeletal systems / Muertes post-quirúrgicas en neonatos con malformaciones congénitas digestivas o musculoesqueléticas

Objetivo: Analisar a ocorrência de óbitos pós-cirúrgicos em recém-nascidos com malformação do aparelho digestivo ou osteomuscular em uma maternidade de referência. Método: Estudo exploratório, retrospectivo, de abordagem quantitativa, realizado em uma maternidade de referência localizada em Teresina ­ PI. Os dados foram coletados do Tabwin e de fichas de investigação de óbito infantil de neonatos nascidos em 2016 e 2017 e analisados no software Statistical Package for the Social Sciences. Resultados: O tipo de malformação mais prevalente do aparelho digestivo e osteomuscular entre os neonatos que foram a óbito após cirurgia foi o ânus imperfurado (41%) e a gastrosquise (64,2%), respectivamente. O choque séptico, seguido da insuficiência renal aguda foram os fatores determinantes dos óbitos analisados. Conclusão: O diagnóstico precoce é o fator primordial para redução da morbimortalidade de neonatos acometidos por malformações congênitas, uma vez que contribui para o direcionamento e planejamento dos cuidados imprescindíveis a esses pacientes

Objective: To analyze the occurrence of post-surgical deaths in newborns with malformation in the digestive or musculoskeletal systems in a reference maternity hospital. Method: This is an exploratory and retrospective study, with a quantitative approach, conducted in a reference maternity located in Teresina ­ PI. Data were collected from Tabwin and infant death investigation forms of neonates born in 2016 and 2017 and analyzed through the Statistical Package for the Social Sciences software. Results: The most prevalent type of malformation of the digestive and musculoskeletal systems among neonates who died after surgery was the imperforate anus (41%) and gastroschisis (64.2%), respectively. Septic shock, followed by acute kidney failure, constituted the determining factors of the analyzed deaths. Conclusion: Early diagnosis is the key factor for reducing morbidity and mortality in neonates affected by congenital malformations, as it contributes to the targeting and planning of care actions essential for these patients

Objetivo: Analizar la ocurrencia de muertes post-quirúrgicas en recién nacidos con malformación digestiva o musculoesquelética en una maternidad de referencia. Método: Estudio exploratorio, retrospectivo, con enfoque cuantitativo, realizado en una maternidad de referencia ubicada en Teresina - PI. Los datos se recopilaron de Tabwin y de registros de investigación de muerte infantil de neonatos en 2016 y 2017 y se analizaron utilizando el programa Statistical Package for the Social Sciences. Resultados: El tipo de malformación digestiva y musculoesquelética más frecuente entre los neonatos que murieron después de la cirugía fue el ano imperforado (41%) y la gastrosquisis (64,2%), respectivamente. El shock séptico, seguido de insuficiencia renal aguda, constituyeron los factores determinantes de las muertes analizadas. Conclusión: El diagnóstico temprano es el factor principal para reducir la morbimortalidad en los neonatos afectados por malformaciones congénitas, ya que contribuye a la dirección y planificación de la atención esencial para estos pacientes

Relação entre orientação em saúde e complicações no pós-operatório de cirurgias torácicas e abdominais altas / Correlation between the healthcare guidance and thoracic and upper abdominal post-operative care / Relación entre orientación en salud y complicaciones en el postoperatorio de cirugías torácicas y abdominales alta

Objetivo: avaliar a influência das orientações em saúde nas complicações no pós-operatório de cirurgias torácicas e abdominais altas. Método: estudo quantitativo transversal realizado com 266 indivíduos. Os dados foram coletados por um questionário sociodemográfico, clínico e assistencial. Foram incluídos sujeitos de ambos os sexos, com faixa etária de 18 a 80 anos, que estivessem na enfermaria em pós-operatório de cirurgias torácicas e ou abdominais altas. Resultados: 82 (30%) dos indivíduos receberam orientações no período de pós-operatório e 184 (70%) não receberam nenhum tipo de orientação. Quatro dos sujeitos que receberam orientações desenvolveram algum tipo de complicação e 16 dos que não receberam tiveram complicações; não apresentando resultados estatisticamente significativos quanto aos pesquisados que tiveram orientação e os que não tiveram orientações (p=0,4). Conclusão: em relação ao número de complicações, ao comparar os indivíduos que receberam orientações com os que não receberam não houve resultado estatisticamente significativo

Objective: to evaluate correlation between health guidelines and complications in the postoperative period after thoracic and upper abdominal surgeries. Method: a cross-sectional quantitative study with 266 individuals. Data were collected by a sociodemographic, clinical and care questionnaire. We included subjects of both sexes, with ages ranging from 18 to 80 years, who were in the postoperative ward after thoracic and/ or upper abdominal surgeries. Results: 82 (30%) of the subjects received guidance in the postoperative period and 184 (70%) received no guidance. Four of the subjects who received guidelines developed some type of complication while 16 of those who did not receive guidance developed complications; therefore, the results were not statistically significant (p=0,4). Conclusion: in relation to the number of complications, when comparing individuals who received guidelines with those who did not receive, there was no statistically significant result

Objetivo: evaluar la influencia de las orientaciones en salud en las complicaciones en el postoperatorio de cirugías torácicas y abdominales altas. Metodo: estudio cuantitativo transversal realizado con 266 individuos. Los datos fueron recolectados por un cuestionario sociodemográfico, clínico y asistencial. Se incluyeron sujetos de ambos sexos, con rango de edad de 18 a 80 años, que estuvieran en la enfermería en postoperatorio de cirugías torácicas y / o abdominales alta. Resultados: 82 (30%) de los individuos recibieron orientaciones en el período de postoperatorio y 184 (70%) no recibieron ningún tipo de orientación. Cuatro de los sujetos que recibieron orientaciones, desarrollaron algún tipo de complicación y 16 de los que no recibieron tuvieron complicaciones; no presentando resultados estadísticamente significativos en cuanto a los encuestados que tuvieron orientación y los que no tuvieron orientaciones (p=0,4). Conclusión: en relación al número de complicaciones, al comparar a los individuos que recibieron orientaciones con los que no recibieron no hubo resultado estadísticamente significativo

Diagnósticos de enfermería del Dominio de Seguridad/protección en pacientes en postoperatorio / Nursing d iagnoses of Domain Security/protection in patients on the postoperative period

Introducción: el periodo postoperatorio (PO) es una fase crítica que demanda cuidados redoblados de todo el equipo de sanidad, sobre todo del equipo de enfermería. Objetivo: caracterizar los diagnósticos de enfermería del Dominio Seguridad/ protección en pacientes en periodo de postoperatorio en un hospital universitario en Natal, Rio Grande do Norte. Métodos: estudio descriptivo de tipo transversal. Los datos fueron recogidos entre octubre y diciembre de 2012. Para la investigación se utilizó un protocolo de recogida de datos y el examen físico basado en la taxonomía NANDA-I. Resultados: de los 80 pacientes, 60,0 por ciento eran del sexo masculino, con una media de 47,46 años de edad. Se encontró mayor relevancia en las cirugías abdominales (70 por ciento) y se destaca que el 45 por ciento de los pacientes presentaba un cuadro de infección. Los diagnósticos de enfermería del Dominio de Seguridad/ protección que presentaron una frecuencia mayor al 50 por ciento fueron: Riesgo de caídas (86,3 por ciento), Problemas de dentición (71,3 por ciento) y el Riesgo de infección (55 por ciento). En este contexto, los enfermeros deben planear los cuidados considerando los aspectos de seguridad y protección para los pacientes en período postoperatorio(AU)

Introduction: the postoperative period (PO) it is mainly a critical phase that demands doubled cares of the whole team of sanity, of the infirmary team. Objective: to characterize the diagnoses of infirmary of the Domain Security / protection in patient in period of postoperative in an university hospital in Native, Laughs Big North do. Methods: I study descriptive of traverse type. The data were picked up between October and December of 2012. For the investigation a protocol of collection of data and the physical exam based on the taxonomía NANDA-I was used. Results: of the 80 patients, 60,0 percent was of the masculine sex, with a 47,46 year-old stocking. It was bigger relevance in the abdominal surgeries (70 percent) and he/she stands out that 45 percent of the patients presented an infection square. The diagnoses of infirmary of the Domain of Security / protection that you/they presented a bigger frequency to 50 percent was: Risk of fallen (86,3 percent), teething Problems (71,3 percent) and the infection Risk (55 percent). In this context, the male nurses should plan the cares considering the aspects of security and protection for the patients in postoperative period(AU)

Menor tempo de jejum pré-operatório e alimentação precoce no pós-operatório são seguros? / Lesser time of preoperative fasting and early postoperative feeding are safe?

INTRODUÇÃO: O jejum noturno praticado antes de operações eletivas foi instituído para prevenir complicações pulmonares, vômitos, regurgitação e aspiração do conteúdo gástrico. No ano de 2005 foi desenvolvido o projeto de Aceleração da Recuperação Total Pós-operatória, denominado ACERTO. O projeto é composto por uma equipe multidisciplinar que visa à recuperação do paciente cirúrgico administrando de duas a seis horas antes da operação uma bebida rica em carboidratos (12,5% de dextrinomaltose). A equipe multidisciplinar é composta por anestesistas, cirurgiões, nutricionistas, enfermeiros e fisioterapeutas. OBJETIVO: Frente aos novos métodos de controle no pré-operatório verificar a qual a necessidade de jejum antes de procedimentos cirúrgicos. MÉTODOS: Revisão sobre jejum pré-operatório realizada nos meses de setembro e outubro de 2011, nos sites de busca Scielo e PubMed. Foram selecionados 24 artigos. CONCLUSÃO: Reduzir o tempo de jejum pré-operatório com solução rica em carboidratos até duas horas antes da operação, tal como alimentação precoce no pós-operatório, trazem inúmeros benefícios ao paciente. O projeto ACERTO tem demonstrado bons resultados e estas novas condutas devem ser encorajadas, diminuindo assim o tempo de recuperação do paciente cirúrgico.

INTRODUCTION: Fasting in the night before elective surgery has been established to prevent pulmonary complications, vomiting, regurgitation and aspiration of gastric contents. The year of 2005 was developed the project ACERTO. It consists in a multidisciplinary team that aims to recover the surgical patient by administering two our six hours before surgery, a carbohydrate-rich beverage (12.5% dextrinomaltose). The multidisciplinary team consists of anesthesiologists, surgeons, nutritionists, nurses and physiotherapists. METHODS: Literature review of preoperative fasting conducted during September and October of 2011 in Scielo and PubMed. CONCLUSION: Reducing the time of preoperative fasting with high carbohydrate solution until two hours before the operation as early feeding postoperatively, bring numerous benefits to the patient. The ACERTO project has shown good results and these new behaviors should be encouraged, thereby reducing the recovery time of the surgical patient.

Does administering albumin to postoperative gastroschisis patients improve outcome?

OBJECTIVES: Newborns who undergo surgery for gastroschisis correction may present with oliguria, anasarca, prolonged postoperative ileus, and infection. New postoperative therapeutic procedures were tested with the objective of improving postoperative outcome. PATIENTS AND METHODS: One hundred thirty-six newborns participated in one of two phases. Newborns in the first phase received infusions of large volumes of crystalloid solution and integral enteral formula, and newborns in the second phase received crystalloid solutions in smaller volumes, with albumin solution infusion when necessary and the late introduction of a semi-elemental diet. The studied variables were serum sodium and albumin levels, the need for albumin solution expansion, the occurrence of anasarca, the length of time on parenteral nutrition, the length of time before initiating an enteral diet and reaching a full enteral diet, orotracheal intubation time, length of hospitalization, and survival rates. RESULTS: Serum sodium levels were higher in newborns in the second phase. There was a correlation between low serum sodium levels and orotracheal intubation time; additionally, low serum albumin levels correlated with the length of time before the initiation of an oral diet and the time until a full enteral diet was reached. However, the discharge weights of newborns in the second phase were higher than in the first phase. The other studied variables, including survival rates (83.4 percent and 92.0 percent, respectively), were similar for both phases. CONCLUSIONS: The administration of an albumin solution to newborns in the early postoperative period following gastroschisis repair increased their low serum sodium levels but did not improve the final outcome. The introduction of a semi-elemental diet promoted an increase in body weight at the time of discharge.

Avaliação da ventilação não-invasiva com dois níveis de pressão positiva nas vias aéreas após cirurgia cardíaca / Assessment of noninvasive ventilation with two levels of positive airway pressure in patients after cardiac surgery

INTRODUÇÃO: A aplicação de ventilação por dois níveis de pressão positiva (BiPAP®) associada à fisioterapia respiratória convencional (FRC) no pós-operatório (PO) imediato de cirurgia cardíaca pode contribuir para a diminuição das complicações pulmonares. OBJETIVO: Avaliar a segurança e a adesão da aplicação preventiva do BiPAP® associado a FRC no PO imediato de revascularização do miocárdio. MÉTODOS: Vinte e seis pacientes submetidos a revascularização do miocárdio foram aleatoriamente alocados. O Grupo Controle (GC) foi tratado com FRC, o Grupo BiPAP (GB) foi submetido a 30 minutos de BiPAP®, duas vezes ao dia, associado à FRC. A FRC foi realizada em ambos os grupos, duas vezes ao dia. Todos os pacientes foram avaliados quanto: capacidade vital, permeabilidade das vias aéreas, pressões respiratórias máximas, saturação de oxigênio, frequência cardíaca, frequência respiratória, volume minuto, volume corrente, pressões arteriais sistólica e diastólica. As avaliações foram realizadas durante a internação no pré-operatório, imediatamente após a extubação, e na 24ª e 48ª horas após extubação. RESULTADOS: No GC, 61,5 por cento dos pacientes tiveram algum grau de atelectasias, no GB, 54 por cento (P=0,691). A capacidade vital foi estatisticamente maior no GB no PO (P<0,015). Todos os outros parâmetros de ventilometria, gasometria, manovacuometria e hemodinâmicos foram semelhantes entre os grupos. CONCLUSÃO: A cirurgia de revascularização do miocárdio leva à degradação da função respiratória no PO, e a aplicação da ventilação com pressão positiva (BiPAP®) pode ser benéfica para reestabelecer a função pulmonar mais rapidamente, principalmente a capacidade vital, de forma segura, sendo bem aceita pelos paciente, devido ao maior conforto em relação à sensação de dor durante a execução da fisioterapia respiratória.

INTRODUCTION: The application of two levels of ventilation by positive pressure (BiPAP®) associated with conventional respiratory therapy (CRT) in postoperative periord of cardiac surgery may contribute to reduction of pulmonary complications. OBJECTIVES: To evaluate the safety and compliance of preventive application of BiPAP® CRT associated with immediate postoperative myocardial revascularization. METHODS: 26 patients undergoing coronary artery bypass grafting were randomly allocated in one of the groups. Patients of the Control Group (CG) were treated only with conventional respiratory therapy, compared to BiPAP group (BG) (in addition to conventional respiratory therapy the patients were subjected to 30 minutes of ventilation by two levels twice a day). The conventional respiratory therapy was held in both groups, twice a day. All patients were evaluated for vital capacity, airway permeability, maximal respiratory pressures, oxygen saturation, heart rate, respiratory frequency, Volume Minute, tidal volume, systolic and diastolic blood pressure. Evaluations were performed during hospitalization preoperatively, immediately after extubation, 24h and 48h after extubation. RESULTS: In CG 61.5 percent of patients had some degree of atelectasias, in comparison to 54 percent of BG (P=0.691). The vital capacity was higher in the GB postoperatively (P<0.015). All the other ventilometric, gasometric, hemodynamic and manometric parameters were similar between groups. CONCLUSION: Coronary artery bypass grafting leads to deterioration of respiratory function postoperatively, and the application of positive pressure ventilation (BiPAP®) may be beneficial to restore lung function more quickly, especially vital capacity, safely, and well accepted by patients due to greater comfort with the sensation of pain during the execution of respiratory therapy.

Tratamento endovascular de pseudoaneurisma da aorta abdominal: relato de caso / Endovascular treatment of an abdominal aortic pseudoaneurysm: a case report

Um estudante de 17 anos, masculino, sofreu ferimentos por arma de fogo e foi submetido a uma laparotomia exploradora. No pós-operatório, queixava-se de dores em membros inferiores e de massa abdominal pulsátil. Realizou tomografia computadorizada (TC) de abdome, que evidenciou pseudoaneurisma de aorta abdominal de cerca de 8 cm no maior diâmetro, localizado entre o tronco celíaco e a artéria mesentérica superior. Uma arteriografia confirmou o diagnóstico e procedeu-se, então, a embolização da lesão com fragmentos de fio-guia montados com fios de algodão. Após seis meses, realizou ecoDoppler de aorta abdominal e nova TC de abdome, que evidenciaram fluxo no interior do saco do pseudoaneurisma. Foi, então, submetido a nova embolização endovascular e implante de stent não-revestido de 18 x 58 mm. Após seis meses do último procedimento, realizou-se nova TC de abdome que demonstrou exclusão da lesão.

A 17 years old male student has received several gunshots and was submitted to exploratory laparotomy. After surgery, he complained of pain in the lower limbs and a pulsatile abdominal mass. An abdominal computerized tomography (CT) scan was carried out and revealed an abdominal aorta pseudoaneurysm of about 8 cm in the larger diameter between the celiac trunk and the superior mesenteric artery. An arteriography confirmed the diagnosis and he was submitted to the lesion embolization with cotton suture wires attached to metallic guide wire fragments. After six months, an abdominal aorta Doppler ultrasonography and a new abdominal CT scan were ordered and depicted flow inside the pseudoaneurysm. The patient was then submitted to a new endovascular embolization, and an 18 x 58 mm uncovered stent was placed. After six months from the last procedure, a new abdominal CT scan showed exclusion of the lesion.

Degree of risk related to procedures performed in conjunction with surgical myocardial revascularization in octogenarians

INTRODUCTION/OBJECTIVES: We determined the degree of risk produced by the association of other surgical procedures with surgical myocardial revascularization in octogenarian patients and identified the risk factors that best explain hospital mortality. METHODS: This study was an observational analytical historical cohort study involving octogenarians operated on at our institution between January 1, 2000 and January 1, 2005. We stratified the objective population as follows: Group 1 comprised octogenarians revascularized without associated procedures, and Group 2 comprised octogenarians revascularized with associated procedures. Statistical analyses included the t test for independent samples and multiple logistic regression analysis. Significance was accepted with an alpha error of 5 percent. RESULTS: Univariate analyses revealed the following clinical and statistically significant variables: hospital mortality (P=0.002), diabetes mellitus (P=0.017), preoperative endocarditis (P=0.001), cardiogenic shock (P=0.019), use of an intra-aortic balloon pump (P=0.026), preoperative risk score (Parsonnet), P<0.001, procedure associated with revascularization (P<0.001), medium number of affected coronary arteries (P<0.001), use of extracorporeal circulation (P<0.001), time of extracorporeal circulation (P<0.001), number of distal anastomoses (P=0.002), graft type (P<0.001), postoperative breathing support (P<0.001), stroke (P<0.001), infection (P=0.002), creatinine level (P=0.018), and quality of life score (P=0.050). DISCUSSION/CONCLUSIONS: In octogenarian patients, the need for a procedure associated with surgical myocardial revascularization produces an absolute increase in hospital mortality risk of 45 percent. The variables that contributed to hospital mortality were preoperative endocarditis, preoperative cardiogenic shock, the use of extracorporeal circulation, the length of time of extracorporeal circulation, postoperative creatinine level, ...

Transplante hepático: problemas de enfermagem em pacientes no pós-operatório / Liver transplant: nursing problems with post-operative patients

Este trabalho teve a finalidade de levantar os problemas de enfermagem na clínica cirúrgica, de forma a oferecer elementos para a sistematização da assistência de enfermagem. O objetivo foi identificar o perfil epidemiológico de pacietnes submetidos ao transplante hepático e os problemas de enfermagem no período pós-operatório mediato...

Processo anestésico-cirúrgico: alterações metabólicas, sistêmicas e imunológicas e complicações / Anesthetic and surgical process: metabolic, systemic and immunologic alterations and complications

O processoa anestésico-cirúrgico implica alterações metabólicas, sistêmicas e imunológicas, resultantes do trauma, que representam estratégias fundamentais do organismo para o restabelecimento do equilíbrio fisiológico. Sendo assim, consideramos que o conhecimento da fisiologia acerca das respostas ao trauma anestésico-cirúrgico, das complicações relaciondas com a interação medicamentosa, da insuficiência renal aguda e da infecção constitui recurso básico para a otimização do cuidado durante o período pós-operatório.

Evaluación prospectiva de la seguridad y tolerancia de los procedimientos colonoscópicos en pacientes pediátricos / Prospective evaluation of safety and tolerance of colonoscopy in children

Background: Colonoscopy is a well established diagnostic and therapeutic procedure in pediatrics. Aim: To evaluate colon preparation alternatives for colonoscopy or sigmoidoscopy, type of sedation, clinical indications and findings. Patients and methods: Prospective study of 123 children referred for colonoscopy. Demographic data, type of colon preparation, sedation, type of endoscope and endoscopic results were obtained. The following day, a phone interview was carried out inquiring about duration, quality and adverse effects of the sedation and procedure. Results: Seventy one boys (58%) and 52 girls (42%) with a mean age of 6.7±4.4 years, were recruited. The main indication was lower gastrointestinal bleeding (71%). The different colon preparations produced elimination of clear liquid stools in 50%, non transparent liquid in 23%, semi liquid in 22% and solid in 6% of the patients. Most common side effects were abdominal distension (20%) and nausea (16.8%). The most commonly used drugs were midazolam (76%) and demerol (43%). The average duration of the procedure was 18.3 minutes (range: 4-50). The most common findings were rectal polyps (18.7%) and hemorrhagic colitis (14.6%). In 77% of cases, the sedation was considered very good or good. Colon visualization was described as very good (51%) or good (36%). Seventy three percent of children had complete amnesia. The most common adverse effect was vomiting (7.5%). Conclusion: Lower endoscopies are feasible procedures to carry out in children, in an ambulatory basis, with intravenous sedation and minimum adverse effects.

The Effects of Ketorolac Injected via Patient Controlled Analgesia Postoperatively on Spinal Fusion

Lumbar spinal fusions have been performed for spinal stability, pain relief and improved function in spinal stenosis, scoliosis, spinal fractures, infectious conditions and other lumbar spinal problems. The success of lumbar spinal fusion depends on multifactors, such as types of bone graft materials, levels and numbers of fusion, spinal instrumentation, electrical stimulation, smoking and some drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs). From January 2000 to December 2001, 88 consecutive patients, who were diagnosed with spinal stenosis or spondylolisthesis, were retrospectively enrolled in this study. One surgeon performed all 88 posterolateral spinal fusions with instrumentation and autoiliac bone graft. The patients were divided into two groups. The first group (n=30) was infused with ketorolac and fentanyl intravenously via patient controlled analgesia (PCA) postoperatively and the second group (n=58) was infused only with fentanyl. The spinal fusion rates and clinical outcomes of the two groups were compared. The incidence of incomplete union or nonunion was much higher in the ketorolac group, and the relative risk was approximately 6 times higher than control group (odds ratio: 5.64). The clinical outcomes, which were checked at least 1 year after surgery, showed strong correlations with the spinal fusion status. The control group (93.1%) showed significantly better clinical results than the ketorolac group (77.6%). Smoking had no effect on the spinal fusion outcome in this study. Even though the use of ketorolac after spinal fusion can reduce the need for morphine, thereby decreasing morphine related complications, ketorolac used via PCA at the immediate postoperative state inhibits spinal fusion resulting in a poorer clinical outcome. Therefore, NSAIDs such as ketorolac, should be avoided after posterolateral spinal fusion.

Seleção da artéria radial para utilização como enxerto aortocoronário: avaliação pré-operatória com eco-color-Doppler e fotopletismografia digital e confirmação por avaliação cirúrgica / Selection of radial artery for use as aortocoronary graft: preoperative assessment with Doppler ultrasound and digital photoplethysmography and surgical confirmation

Objetivo: Com o crescente uso da artéria radial como enxerto aortocoronário, torna-se necessário reavaliar os critérios utilizados para a seleção desse vaso no pré-operatório da cirurgia de revascularização miocárdica. O objetivo deste estudo foi utilizar a avaliação do vaso pelo cirurgião cardíaco no perioperatório para confirmação da viabilidade da artéria radial selecionada, por meio de dois métodos não-invasivos (eco-color-Doppler e fotopletismografia digital) no pré-operatório. Métodos: Entre julho de 1998 e maio de 2000, foram estudadas 78 artérias radiais e 78 artérias ulnares de 39 pacientes, candidatos à cirugia de revascularização do miocárdio. O estudo foi realizado bilateralmente através do aparelho de ultra-sonografia ATL HDI 5000...

Atresia de las vías biliares / Biliary tract atresia

Los recientes avances en el manejo de este problema quirúrgico han cambiado por completo el grave pronóstico que antiguamente se le atribuía. El artículo revisa conceptos actuales en Atresia Biliar y presenta las últimas cifras del Registro Americano de Atresia Biliar