Hematologic disorders in trauma patients during parenteral alimentation with lipids

Total parenteral nutrition with lipids is a well-accepted modality of metabolic support in seriously ill trauma patients. Intolerance to lipid administration is unusual when dosage limits are not exceeded, and few hematologic disturbances have been recorded with modern fat emulsions. In the course of intravenous alimentation of six adults admitted for traumatic lesions, eosinophilia with or without leukocytopenia was noticed after periods of four days to five weeks. Principal clinical events and hematologic derangements were documented in this population. Sepsis was not always present in the patients by the time of the complication, and in those that did require antibiotics and other drugs, the prescription remained unchanged along the episode. Discontinuation of the nutritional regimen with lipids was followed by normalization of the hematologic profile, suggesting that an acute or sub-acute allergic reaction was responsible. The appearance of skin rash in two occasions reinforces this hypothesis, and the possibility of hemophagocytosis merits consideration in two of the cases who displayed reversible acute leukocytopenia. It is concluded that blood cell aberrations are possible during intravenous feeding with lipids in trauma subjects, but tend to respond to suppression of the lipid-containing nutritional prescription.

E necessário realizar colangiografia operatória como rotina nas colecistectomias? / Is it necessary to perform routine intraoperative cholangiography during cholecystectomy?

Säo apresentados 361 casos de colangiografia operatória realizadas no período de janeiro de 1982 a dezembro de 1987, no Hosptial Jaraguá. Em 293 (81,16%) pacientes a exploraçäo radiológica intra-operatória da via biliar foi normal e em 68 (18.83%) casos houve suspeita de cálculos na via biliar principal dos quais 36 (9,97%) eram coledocolitíase no pré-operatório e 20 (5,54%) tiveram confirmadas as suspeitas de coledocolitíase pela colangiografia operatória. O erro do exame deu-se em 13 casos, sendo que 12 (3,32%) eram falsos positivos e eum (0,27%) era falso negativo. E salientada a importância do uso rotineiro da colangiografia operatória, principalmente para o diagnóstico da litíase da via biliar principal assintomática