Can temporary artery catheterization extend limits of ischemia time for macroreplantation? / Cateterização temporária arterial amplia o limite de tempo de isquemia no macrorreimplante?

ABSTRACT We observe delayed referrals to appropriate Microsurgery Unit and definitive treatment of traumatic limb amputations. Cases with wrist proximal amputations have a deadline for surgical replantation as these configure life-threatening injuries. Objective: To analyze patients with traumatic proximal wrist upper limb amputations with prolonged ischemic time who underwent temporary artery catheterization to assess stump viability and results. Methods: A case-series study including all patients with a proximal wrist upper limb amputation and a cold ischemic time equal to or above six hours from 2017 to 2021. Results: In total, two surgeons operated eight patients who had experienced forearm amputation injuries. Median ischemia time totaled eight hours. All patients required additional surgeries, most commonly split-thickness skin graft or fixation revision (three patients). This study obtained five successful macroreimplantations. The mean cold ischemia time was longer in the group with successful macroreimplantations (7.4 hours) than of the unsuccessful group (9 hours). Conclusion: Macroreplantations require immediate referral to microsurgery and, although temporary artery catheterization helps surgical decision making, the technique seems to fail to influence outcomes. Level of Evidence IV, Retrospective Case Series.

RESUMO Observa-se um atraso no referenciamento dos casos para o tratamento definitivo das amputações traumáticas de membros no Brasil. Casos com amputações proximais ao punho apresentam um prazo limite para reimplante, sendo lesões que promovem risco de vida ao paciente. Objetivo: Analisar os macrorreimplantes com tempo de isquemia prolongado submetidos à cateterização temporária da artéria, para determinar a viabilidade do coto de amputação, e seus resultados. Métodos: Série de casos de todos os pacientes com amputações traumáticas proximais ao punho, cujo tempo de isquemia fria foi igual ou superior a seis horas, entre 2017 e 2021. Resultados: A amostra foi composta por oito pacientes com amputações traumáticas de antebraço operados por dois cirurgiões. O tempo médio de isquemia foi de oito horas. Todos os pacientes necessitaram de cirurgias adicionais, sendo as mais comuns o enxerto de pele ou a revisão da fixação óssea. Sucesso do macrorreimplante foi observado em cinco pacientes. O tempo médio de isquemia fria foi maior no grupo com sucesso no macrorreimplante (7,4 horas) quando comparado com o grupo sem sucesso (9 horas). Conclusão: Os macrorreimplantes necessitam de transferência imediata para serviços especializados, e, apesar de a cateterização temporária arterial auxiliar no manejo cirúrgico, a técnica parece não interferir nos resultados. Nível de Evidência IV, Série de Casos.

Construção e validação de um instrumento sobre manejo de ferida neoplásica para capacitação de enfermeiros / Construction and validation of an instrument on neoplastic wound management for training nurses

Introdução: Cerca de 5% a 10% dos pacientes com câncer avançado irão desenvolver feridas neoplásicas durante os seis últimos meses de vida. O tratamento das feridas neoplásica é complexo, pois exige avaliação de etiologia oncológica, características e estadiamento da lesão, estado físico, emocional, social e espiritual do paciente, bem como produtos e coberturas específicos para o controle dos sinais e sintomas. O conhecimento de enfermeiros sobre avaliação e tratamento de feridas neoplásicas, apresenta limitações, bem como déficit de capacitação para a assistência à pessoa com esse tipo de lesão. Objetivo: Propor um instrumento para capacitação de enfermeiros no manejo de ferida neoplásica. Métodos: Pesquisa metodológica. O estudo compreendeu a construção do instrumento por meio de revisão de escopo da literatura; validação do conteúdo e aparência por juízes especialistas. A coleta de dados ocorreu entre outubro/2021 e fevereiro/2022, a análise foi feita pelo Índice de Validação de Conteúdo e Fleiss generalized Kappa. Este projeto de pesquisa, foi aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Medicina da Universidade Federal Fluminense (FMUFF) com o registro CAAE: 50525121.0.0000.5243, atendendo à Resolução nº 466/12, das Diretrizes e Normas de Pesquisa Envolvendo Seres Humanos do Conselho Nacional de Saúde. Resultados: Os juízes especialistas recrutados validaram o conteúdo e aparência do instrumento relacionado a exatidão científica, conteúdo, apresentação textual e diagramação, ilustração e compreensão do instrumento, atingindo um IVC > 0.80, kappa satisfatório e nível de concordância entre os juízes > 75%. Conclusões: As categorias de validação atingiram o índice de validação de conteúdo e de aparência adequados, além de reunir as evidências para o manejo adequado da ferida neoplásica e contribuir para a capacitação dos enfermeiros na aérea, gerando um produto ­ material didático - a ser utilizado na assistência de enfermagem. Como limitação o estudo apresenta a ausência de validação clínica do instrumento. Como perspectivas futuras, esta pesquisa proporciona a oportunidade de expandir as informações contidas no instrumento, englobando os aspectos sociais e emocionais que envolvem o cuidado da pessoa com ferida neoplásica. Também há a implementação do instrumento como material didático de programas de educação permanente que abordem esta temática.

Introduction: About 5% to 10% of patients with advanced cancer will develop malignant fungating wounds during the last six months of life. The treatment of malignant fungating wounds is complex, as it requires evaluation of oncological etiology, characteristics, and staging of the lesion, physical, emotional, social, and spiritual state of the patient, as well as specific products and dressings for the control of signs and symptoms. The knowledge of nurses about the assessment and treatment of malignant fungating wounds presents limiting factors, as well as lower training to take care of people with this type of injury. Objective: Propose an instrument for training nurses in malignant fungating wound management. Methods: Methodological research. The study comprised the construction of the instrument through a literature scoping review; content and appearance validation by expert judges. Data collection occurred between October/2021 and February/2022, analysis was done by the Content Validation Index and Fleiss generalized Kappa. This research project was approved by the Research Ethics Committee of the Faculdade de Medicina of Universidade Federal Fluminense (FMUFF) with CAAE registration: 50525121.0.0000.5243, meeting Resolution No. 466/12, of the Guidelines and Standards for Research Involving Human Beings of the National Health Council. Results: The expert judges recruited validated the content and appearance of the instrument related to scientific accuracy, content, textual presentation and layout, illustration, and understanding of the instrument, reaching the CVI > 0.80, a satisfactory kappa, and agreement level among the expert judges > 75%. Conclusions: The validation categories reached the appropriate content and appearance validation index, in addition to gathering evidence for the proper management of the neoplastic wound and contributing to the training of nurses in the field, also developed a product -courseware- to help out at nursing care.

Early repair of iatrogenic bile duct injury caused by laparoscopic cholecystectomy / 中华普通外科杂志

Objective To study the characteristics,operative timing,repair methods for iatrogenic bile duct injury caused by laparoscopic cholecystectomy.Methods Clinical data of 30 cases of iatrogenic bile duct injury found during or after laparoscopic cholecystectomy were studied retrospectively.Results There were type Ⅱ 1 bile duct injury in 9 patients,type Ⅱ 2 in 4 patients,type Ⅱ 3 in 2 patients,and type Ⅱ 4 in 15 patient.17 cases underwent immediate repair,13 cases did early repair.All cases followed up from 5 months to 10 years,the follow-up rate was 83.3％.1 case with end-to-end anastomosis and biliary stent underwent Roux-en-Y choledochojejunostomy for biliary stenosis 13 months postoperatively,4 cases underwent secondary Roux-en-Y choledochojejunostomy because of obstructive jaundice and the cicatricial anastomotic orifice stenosis one to one and half years after primary repairs.The remaining cases were doing well up to the end of the follow-up.Conclusion Most iatrogenic bile duct injury after laparoscopic cholecystectomy were high in position,while Roux-en-Y choledochojejunostomy is the mainstay of repair.

Condições clínicas de idosos vítimas de trauma musculoesquelético1 / Condiciones clínicas de ancianos víctimas de trauma musculoesquelético / Clinical conditions of elderly who are victims of muscle-skeletal trauma1

RESUMO O objetivo do estudo foi avaliar as condições clínicas do idoso com traumas musculoesqueléticos. Estudo transversal, descritivo e observacional realizado com 133 idosos hospitalizados com traumas de membros inferiores. Os dados foram coletados entre janeiro e agosto de 2014. Aplicou-se formulário fundamentado na teoria de Henderson. As condições clínicas dos idosos foram avaliadas a partir das variáveis: quedas da própria altura, uso de medicação, acuidade visual e auditiva, comprometimento musculoesquelético, tabagismo, uso de álcool e doenças de base. Analisou-se a associação entre a queda da própria altura e as características demográficas/clínicas pelos testes de □2 e razão de verossimilhança, calculou-se as RCs e seus IC95%. Predominou o sexo feminino (52,6%), média de idade 78,7±9,9 anos. Adoecimentos como hipertensão e diabetes favorecem a ocorrência de quedas. Verificou-se comprometimento da faixa etária de 79 a 98 anos com fraturas de colo de fêmur (RC= 1,07; IC95% 0,42-270) e trocânter (RC=1,52; IC95% 0,59-3,92). Dentre as necessidades fundamentais avaliadas, destacou-se: dependência total para alimentar-se, uso de fraldas, queda da própria altura, diminuição visual e fraturas de fêmur. Os resultados apontam para o despertar do enfermeiro no atendimento dessa parcela populacional de modo a planejar cuidados preventivos de complicações e reestabelecer sua capacidade funcional.

RESUMEN El objetivo del estudio fue evaluar las condiciones clínicas del anciano con traumas musculoesqueléticos. Estudio transversal, descriptivo y observacional realizado con 133 ancianos hospitalizados con traumas de miembros inferiores. Los datos fueron recolectados entre enero y agosto de 2014. Se aplicó un formulario fundamentado en la teoría de Henderson. Las condiciones clínicas de los ancianos fueron evaluadas a partir de las variables: caídas de la propia altura, uso de medicación, acuidad visual y auditiva, comprometimiento musculoesquelético, tabaquismo, uso de alcohol y enfermedades de base. Se analizó la asociación entre la caída de la propia altura y las características demográficas/clínicas por las pruebas de □2 y la razón de verosimilitud, se calcularon las RCs y sus IC95%. Predominó el sexo femenino (52,6%), promedio de edad 78,7±9,9 años. Enfermedades como hipertensión y diabetes favorecen la ocurrencia de caídas. Se verificó comprometimiento de la franja de edad de 79 a 98 años con fracturas del cuello del fémur (RC= 1,07; IC95% 0,42-270) y trocánter (RC=1,52; IC95% 0,59-3,92). Entre las necesidades fundamentales evaluadas, se destacó: dependencia total para alimentarse, uso de pañales, caída de la propia altura, disminución visual y fracturas de fémur. Los resultados señalan para el despertar del enfermero en la atención de esta parte de la población de modo a planificar cuidados preventivos de complicaciones y restablecer su capacidad funcional.

ABSTRACT The objective of this study was to evaluate the clinical conditions of the elderly with muscle-skeletal trauma. A cross-sectional, descriptive and observational study was carried out with 133 elderly patients hospitalized with lower limb traumas. The data were collected between January and August 2014. A form based on Henderson's theory was applied. The clinical conditions of the elderly were evaluated from the following variables: height, medication use, visual and auditory acuity, muscle-skeletal impairment, smoking, alcohol use and basic diseases. The association between height decrease and demographic/clinical characteristics by the □2 and likelihood ratio tests was analyzed; the CRs and their IC95% were calculated. The prevalence was female (52.6%), mean age 78.7 ± 9.9 years-old. Diseases such as hypertension and diabetes favor the occurrence of falls. There was a compromise of the age group 79-98 with femoral neck fractures (CR = 1.07, IC95% 0.42-270) and trochanter (CR = 1.52, IC95% 0.59-3, 92). Among the fundamental needs assessed, the following stand out: total dependence on feeding, diaper use, height decrease, visual impairment and femoral fractures. The results point to the nurses' awakening in the care of this population in order to plan preventive care of complications and reestablish their functional capacity.

Quality of life of victims of traumatic brain injury six months after the trauma / Qualidade de vida das vitimas de trauma craniencefalico seis meses apos o trauma / Calidad de vida de las victimas de trauma craneoencefalico seis meses despues del trauma

OBJECTIVE: to describe the quality of life of victims of traumatic brain injury six months after the event and to show the relationship between the results observed and the clinical, sociodemographic and return to productivity data. METHOD: data were analyzed from 47 victims assisted in a trauma reference hospital in the municipality of Aracaju and monitored in an outpatient neurosurgery clinic. The data were obtained through analysis of the patient records and structured interviews, with the application of the World Health Organization Quality of Life, brief version, questionnaire. RESULTS: the victims presented positive perceptions of their quality of life, and the physical domain presented the highest mean value (68.4±22.9). Among the sociodemographic characteristics, a statistically significant correlation was found between marital status and the psychological domain. However, the return to productivity was related to all the domains. CONCLUSION: the return to productivity was an important factor for the quality of life of the victims of traumatic brain injury and should direct the public policies in promoting the health of these victims. .

OBJETIVOS: descrever a qualidade de vida das vítimas de trauma craniencefálico, após seis meses do evento, e mostrar a relação entre os resultados observados e os dados clínicos, sociodemográficos e retorno à produtividade. MÉTODO: foram analisados dados de 47 vítimas assistidas em hospital referência ao trauma, no município de Aracaju, SE, e acompanhadas em ambulatório de neurocirurgia. Os dados foram obtidos pela análise dos prontuários e entrevistas estruturadas, com aplicação do questionário World Health Organization Quality of Life, versão breve. RESULTADOS: as vítimas apresentaram percepção positiva de sua qualidade de vida e o domínio físico (68,4±22,9) apresentou o maior valor médio. Entre as características sociodemográficas, correlação estatisticamente significante foi verificada entre estado civil e o domínio psicológico. Entretanto, o retorno à produtividade se relacionou com todos os domínios. CONCLUSÃO: o retorno à produtividade foi fator importante para a qualidade de vida das vítimas de trauma craniencefálico e deve direcionar as políticas públicas na promoção à saúde dessas vítimas. .

OBJETIVOS: describir la calidad de vida de las víctimas de trauma craneoencefálico después de seis meses del evento y mostrar la relación entre los resultados observados y los datos clínicos, los sociodemográficos y el retorno la productividad. MÉTODO: fueron analizados datos de 47 víctimas asistidas en un hospital referencia en trauma en el municipio de Aracaju y acompañadas en ambulatorio de neurocirugía. Los datos fueron obtenidos por análisis de fichas y entrevistas estructuradas, con aplicación del cuestionario World Health Organization Quality of Life, versión breve. RESULTADOS: las víctimas presentaron una percepción positiva de su calidad de vida y el dominio físico (68,4±22,9) presentó el mayor valor promedio. Entre las características sociodemográficas, una correlación estadísticamente significante fue verificada entre el estado civil y el dominio psicológico. Entretanto el retorno a la productividad se relacionó con todos los dominios. CONCLUSIÓN: el retorno a la productividad fue un factor importante para la calidad de vida de las víctimas de trauma craneoencefálico y debe guiar las políticas públicas en la promoción de la salud de esas víctimas. .

Internet como suporte à pessoa com lesão medular: padrões de uso e reabilitação / Internet as a support for people with spinal cord injuries: usage patterns and rehabilitation / Internet como apoyo a las personas con lesión medular: estándares de uso y rehabilitación

As Tecnologias de Informação e Comunicação (TIC) estão em expansão na área da saúde e desencadeiam transformações nas relações profissional-usuário. Considerando, portanto, a relevância atual deste tema, o presente estudo foi desenvolvido com o objetivo de conhecer os padrões de uso e a percepção sobre internet de pessoas com lesão medular adquirida. Constataram-se diferenças estatisticamente significativas entre o tempo de uso e a influência da internet antes e após a lesão. Apesar de se verificar padrão de uso similar ao da população geral, identificaram-se especificidades que requerem atenção dos serviços especializados de reabilitação, no intuito de aprimorar rotinas de atendimento. Recomendam-se mais pesquisas em diferentes níveis assistenciais.

Information and Communication Technologies (ICT) is expanding in the health field and triggering changes in the relationship between professionals and patients. Considering the current relevance of this issue, this study was conducted to identify the usage patterns and perceptions concerning the internet of people with acquired spinal cord injuries. Statistically significant differences were found between the usage time and the influence of the internet before and after injury. Although the respondents' usage pattern is similar to that of the general population, some particularities were identified, which require the attention of specialized rehabilitation services in order to improve service routines. Further research is recommended at different levels of care delivery.

Las Tecnologías de Información y de Comunicación (TIC) están expandiéndose en las áreas de salud, y con eso inician cambios en las relaciones profesional-usuario. Por lo tanto, ante la relevancia actual de este tema, este estudio tuvo como objetivo describir los estándares de uso y las percepciones de la internet de las personas con lesiones adquiridas en la médula espinal. Se encontró diferencias estadísticamente significativas entre el tiempo de uso y la influencia de la internet antes y después de la lesión. Fueran identificados especificidades que requieren atención especializada de los servicios específicos de rehabilitación con el fin de mejorar las rutinas. Se recomienda seguir investigaciones en diferentes niveles de asistencia.

Protection of recurrent laryngeal nerve during thyroidectomy / 中华普通外科杂志

ObjectiveTo evaluate the effectiveness of surgical technique improvement in thyroid lobectomy for prevention of recurrent laryngeal nerve (RLN) injury. MethodsThe clinical data of 85 patients of thyroid disease undergoing 126 lobectomies from Jan 2010 to Jan 2011 were retrospectively analyzed.All patients undergone accurate thyroid lobectomy with accurate envelop anatomic dissection,skeletonized blood vessels. Recurrent laryngeal nerve was all dearly exposed.ResultsNo-bleeding surgical area was achieved.The RLN was exposed.Unilateral temporary RLN injury occurred in 2 cases.The rate of RLN injury was 1.59％(2/126). There was no bilateral and perpetual RLN injury.ConclusionsCarrying through the accurate thyroid lobectomy,the incidence of RLN injury is low.

Experience in dealing with iatrogenic bile duct injury due to laparoscocpic cholecystecomy / 中华普通外科杂志

Objective To explore the diagnosis and treatment of iatrogenic bile duct injury during choledochocystectomy. Methods Clinical data of 24 cases of iatrogenic bile duct injury were analyzed retrospectively from 2005 to 2009. Results Eight patients underwent early repair of bile duct within 4 days after the injury. 14 patients with later recognized bile duct injury underwent selective operations, and two patients were discharged after their jaundice were relieved without any surgical treatment. Supporting T tubes were left in place in 22 patients for 8 to 14 months after operations, without any biliary obstruction found after one year and six months to five year follow-up. Conclusions Early bile duct injury within 4 days was easily treated, but later bile duct injury should have selective operation. The patients with jaundice could be diagnosed with PTCD and ERCP to observe the bile duct injury. During operation membrane-to-membrane wide hepatojejunostomy helps prevent later anastomotic stenosis. The left in drainage tube in anastomotic stoma for more than 8 months improves success rate in the process of injuried bile duct repair.

Radiographical diagnosis of posttraumatic knee joints hemarthrosis and lipohemarthrosis / 中华放射学杂志

Objective To explore the imaging findings and diagnostic values of X-ray, CT, MR,and ultrasonography in traumatic knee joints hemarthrosis and lipohemarthrosis. Methods Traumatic knee joints hemarthrosis (12 knees) and lipohemarthrosis (18 knees) proved by operation (27 knees) or puncturation (3 knees) were included in the study. Horizontal-beam plain radiographs (16 knees), CT (30 knees), MRI (30 knees) and ultrasonography (24 knees) in supine position were investigated. Results (1)supine position horizontal-beam plain radiographs: Fat-liquid layer was found in 8 cases of lipohemarthrosis. Dense supragenual bursa was found in 1 case of lipohemarthrosis and 7 cases of hemarthrosis. Fracture (13 knees) was diagnosed correctly. (2) CT findings: double fluid-fluid layer was found in 11 of all 18 cases, and single fluid-fluid layer was found in 7 of 11 cases of lipohemarthrosis. Single fluid-fluid layer was found in 3 of 12 cases of hemarthrosis. Isodensity was detected in 9 cases, and high-density blood clot was found in 4 cases. Fracture (30 knees) was diagnosed correctly. (3) MRI findings: in 12 of 18 cases of lipohemarthrosis, double fluid-fluid layer was shown including supernatant layer as short T1, long T2signal and low signal after fat-suppression, middle layer as long T1, long T2 signal and high signal after fat-suppression, and dependent layer as iso-T1, iso-T2 and slight high signal after fat-suppression. Single fluid-fluid layer was seen in 6 cases, only had aforementioned upper and under layer.Only aforementioned supernatant layer and dependent layer were seen in 12 cases of hemarthrosis. 4 cases showed entire blood clot in fluid, T1WI showed middle signal or center iso-signal accompanied with peripheral high signal ring, and fat-suppression imaging showed high signal. T2WI and fat-suppressionimaging showed middling or high signal accompanied with peripheral low signal ring. Fracture (30 knees) was diagnosed correctly. (4) Ultrasound findings: In 10 of 14 cases of lipohemarthrosis, double fluid-fluid level was shown, supernatant layer as equal echo, middle layer as echoless, and dependent layer as cloudy echo. Four cases with single fluid-fluid level only showed aforementioned upper and under layer. Three of 10 cases of hemarthrosis showed single fluid-fluid level, only showing aforementioned upper and under layer,and 7 cases showed cloudy echo and float. In 3 cases the fluid blood clot showed irregular shape low-equal echo bolus. No fracture hne was found. Conclusions CT can clearly detect fracture line, hemarthrosis and lipohemarthresis, and can substitute plain radiography. MRI is the best way to diagnose hemarthresis and lipohemarthrosis. Ultrasonography can be used in diagnosing hemarthresis and lipohemarthrosis but not helpful in the diagnosis of fracture.

Outcome of the application of axonal repair technique for the treatment of peripheral nerve injury / 中华骨科杂志

Objective To evaluate clinical effects of using axonal repair technique (cell surgery) for the treatment of peripheral nerve injuries. Methods 12 patients with 13 injured peripheral nerves were treated with axonal repair technique of soaking the stumps of the nerve in a modified Collins fluid, freezing the stumps with liquid nitrogen, trimming the solidified stumps with a sharp blade, coapting the nerve with glue and two stitches of epineurium, so that the injured peripheral nerves were repaired at the axonal level. The postoperative evaluation was performed at an average of 9.7 months. Results In four of 12 cases operated upon with contralateral C 7 nerve root transfer(C 7 to ulnar nerve), regenerating axons had reached to the ipsilateral sternoclavicular joint or axilla at postoperative 4-7 months, so that the second stage of contralateral C7 nerve root transfer procedure could be performed. In five cases of which the accessory nerves were transferred to suprascapular nerves, the strength of supra-and infraspinatus of 3 patients had recovered to MRC 3-4 at postoperative 16 months, and that of the other two, to MRC 1-2 at 12 months. In one case undergoing the second stage procedure of contralateral C 7 nerve root transfer (ulnar nerve to median nerve), the flexor carpi radialis showed some nerve regeneration shown in EMG at postoperative 4 months. In one case of which phrenic nerve was transferred to the musculocutaneous nerve (the nerve graft 8 cm), the biceps showed some nerves regeneration shown in the EMG 15 months postoperatively. In one patient for whom two digital nerves were repaired, the protective sensation had recovered 3 months postoperatively. Conclusion Axonal repair technique is an effective and practical way for the treatment of peripheral nerve injury.

The protective effect of heat shock gene expression against hydrogen peroxide一induced pulmonary endothelial cells injury / 中国病理生理杂志

To ascertain whether heat shock gene expression could protect pulmonaryendothelial cell from hydrogen peroxide(H2O2)一indueed injury,the protective effect of HSPgene expression induced by pretreatment of bovine pulmonary endothelial eells(BPAECs)by heat shock (42 ℃, 2h)against lethal dose(lmmol?L(-1),45min) of H2O2一induced cyt-otoxieity was observed in vitro.It was found that BPAECs heat一shocked prior to exposureto H2O2(Immol?L(-1) 45min)showed significant decrease in H2O2一mediated incrementof LDH rdlease and TBARS production and had an obvious alleviation of H2O2一induccddecreased activities of catalase and superoxide dismutase. Further study showed thatcycloheximide, a protein synthesis inhibitor and Actinomycin D,a mRNA transcriptioninhibitor blocked the expression of HSP 70 and HSP 70 mRNA respectively.Both agentsprevented the cytoprotective effect of heat shock pretreatment against H2O2一mediatedBPAECs injury. The results suggested that HSP70 gene selectively translated after heat shockwas invoived in enhancement of eellular antioxidant mechanism and protected BPAECsagainst H2O2一induced injury