Percentual de utilização de instrumentais em procedimentos cirúrgicos / Percentage of use of instruments in surgical procedures / Porcentaje de uso de instrumentos en procedimientos quirúrgicos

Objetivo: analisar o percentual de instrumentais cirúrgicos que compõem a caixa de laparotomia exploradora e não são utilizados durante as cirurgias. Método: estudo descritivo, transversal com abordagem quantitativa, que contabilizou instrumentais constituintes da caixa de laparotomia exploradora utilizados e não utilizados durante 13 cirurgias realizadas em um período de 17 dias, em um hospital do interior paulista. Resultados: nas 13 cirurgias analisadas, obteve-se um total de 1300 (100%) pinças presentes nas caixas, onde 832 (64%) não foram utilizadas e 468 (36%) foram utilizadas. Nos tempos cirúrgicos, o maior número de uso foi de 166 (35,5%) artigos, para preensão e afastadores. Conclusão: houve 64% de instrumentais não utilizados nas cirurgias analisadas. Há necessidade de implementar estratégias gerenciais que reduzam os números encontrados e, consequentemente, reduzam gastos, para gerar menor desperdício e reduzir falhas no gerenciamento de recursos materiais.

Objective: to analyze the percentage of surgical instruments that make up the operating laparotomy box and are not used during surgeries. Method: descriptive, cross-sectional study with quantitative approach, which counted instrumental constituents of the exploratory laparotomy box used and not used during 13 surgeries performed in a period of 17 days, in a hospital in the interior of São Paulo. Results: in the 13 surgeries analyzed, a total of 1300 (100%) tweezers were obtained in the boxes, where 832 (64%) were not used and 468 (36%) were used. In surgical times, the highest number of use was 166 (35.5%) articles, for seizures and reparators. Conclusion: there were 64% of instruments not used in the analyzed surgeries. There is a need to implement management strategies that reduce the numbers found and, consequently, reduce expenses, to generate less waste and reduce failures in the management of material resources.

Objetivo: analizar el porcentaje de instrumentos quirúrgicos que componen la caja de laparotomía quirúrgica y no se utilizan durante las cirugías. Método: estudio descriptivo, transversal con enfoque cuantitativo, que contó constituyentes instrumentales de la caja de laparotomía exploratoria utilizada y no utilizada durante 13 cirugías realizadas en un período de 17 días, en un hospital del interior de São Paulo. Resultados: en las 13 cirugías analizadas, se obtuvieron un total de 1300 (100%) pinzas en las cajas, donde no se utilizaron 832 (64%) y 468 (36%). En tiempos quirúrgicos, el mayor número de uso fue de 166 (35,5%) artículos, para convulsiones y reparadores. Conclusión: hubieran 64% de instrumentos no utilizados en las quirurgias analizadas. Es necesario implementar estrategias de gestión que reduzcan los números encontrados y, en consecuencia, reduzcan los gastos, para generar menos residuos y reducir las fallas en la gestión de los recursos materiales.

Reporte de caso. Uso de toxina botulínica tipo A para la reparación de hernia ventral gigante planeada / Surgical treatment of diabetic foot based on Wagner classification, Case report

Introducción: La incidencia de eventración post quirúrgica es del 2-20%, se da mayormente en pacientes con factores de riesgo durante los primeros tres años posteriores a la cirugía inicial. La mayoría de las hernias de la pared abdominal pueden ser reparadas fácilmente, sin embargo, las hernias gigantes (>10cm de diámetro) o aquellas con pérdida de domicilio requieren métodos de expansión gradual de la pared abdominal pre y/o transoperatoriamente. Se ha descrito que posterior a la aplicación de toxina botulínica serotipo A (TBA) de forma bilateral en la pared abdominal, los defectos disminuyen clínica y tomográficamente hasta 5.25cm, por su efecto selectivo en terminaciones nerviosas periféricas colinérgicas, provocando atrofia muscular sin fibrosis. El efecto máximo ocurre al mes de la aplicación y dura 28 semanas. Esta técnica permite planear preoperatoriamente la magnitud de la cirugía. Nuestro caso, paciente masculino de 33 años. Quien ingresa por politrauma. Se realiza procedimiento quirúrgico abdominal y posteriormente se eviscera en múltiples ocasiones. Se cierra herida y posteriormente desarrolla hernia ventral gigante con la que egresa. Se realiza TC abdominal evidenciando defecto herniario de 15.9cm, con este resultado se aplica toxina botulínica serotipo A en la pared abdominal bilateral (50 unidades en cada lado) guiado por ultrasonido. 25 días después se realiza TC abdominal control que evidencia defecto herniario de 14.7cm y se decide ingreso para cirugía electiva. Se decide llevar a sala de operaciones donde se realiza hernioplastía con liberación de componentes anteriores mas colocación de malla de polietileno (cuatro semanas posteriores a la aplicación de la toxina), quedando defecto totalmente cerrado y sin tensión. Paciente con adecuada evolución posterior a intervención por lo que egresa. Actualmente sin defecto herniario recurrente. Conclusión: El uso de toxina botulínica serotipo A es un nuevo recurso prequirúrgico para la preparación de pacientes con hernias ventrales gigantes, ya que permite el cierre sin tensión en la mayoría de los casos. Además, ayuda a que transoperatoriamente la separación de componentes se realice de una mejor manera, ya que se da mejor manipulación al momento de desplazar las estructuras musculares. Idealmente se debe de realizar la intervención quirúrgica cuatro semanas posteriores a su aplicación. (AU)

ntroduction: The incidence of post-surgical eventration is 2-20%, it occurs mostly in patients with risk factors during the first three years after the initial surgery. Most abdominal wall hernias can be easily repaired, however, giant hernias (>10cm of diameter) or those with the loss of domain require methods of gradual expansion of the abdominal wall pre or intraoperatively. It has been described that after the application of botulinum toxin A bilaterally in the abdominal wall, the defect can decrease clinically and tomographically up to 5.25cm, due to its selective effect on cholinergic peripheral nerve endings, that cause muscle atrophy without fibrosis. The maximum effect occurs one month after the application and lasts 28 weeks. This technique allows to plan preoperatively the magnitude of the surgery. Description of case: A 33 year old male patient, who entered the emergency room due to polytrauma. Abdominal surgical procedure was performed and later he eviscerates on multiple occasions. The wound was closed and later he develops a giant ventral hernia with which it is discharged. An abdominal CT was performed, showing a hernia defect of 15.9cm. With this result botulinum toxin A was applied guided by ultrasound bilaterally in the abdominal wall (50 U on each side). A control abdominal CT was performed after 25 days, which it revealed a hernia defect of 14.7 cms, so admission was decided for elective surgery. The patient was taken to the operating room where a hernioplasty with anterior components separation plus the placement of a polyethylene mesh was performed (four weeks after the application of the botulinum toxin A), the hernia defect was completely close without tension. The patient had an adequate post-surgical evolution for which it was discharge. Currently without a recurrent hernia defect. Conclusion: The use of botulinum toxin A is a new pre-surgical resource for the preparation of patients with giant ventral hernias, since it allows the closure without tension in most cases. In addition, it helps transoperatively with the components separation, since there is a better manipulation at the time of displacing the muscular structures. Ideally, the surgical intervention should be performed four weeks after its application. (AU)

An alternative approach to treatment of inferior vena cava filter perforation / Tratamento alternativo para perfuração de veia cava inferior por filtro

Abstract We report a case of inferior vena cava filter perforation immediately after filter implantation, recognized intraoperatively in a patient undergoing laparotomy for resection of locally advanced ovarian cancer. We describe an alternative approach with strut resection, less invasive than filter removal, enabling the device to be maintained and bleeding to be controlled.

Resumo Relatamos um caso de perfuração de veia cava inferior imediatamente após o implante de um filtro. A complicação foi reconhecida no intraoperatório de uma laparotomia para ressecção de um câncer de ovário localmente avançado. Descrevemos uma abordagem alternativa, menos invasiva do que a remoção do filtro, consistindo na ressecção das hastes do dispositivo. Essa abordagem permitiu a manutenção do filtro e o controle efetivo do sangramento.

Comparison of Video-Assisted Minilaparotomy, Open, and Laparoscopic Partial Nephrectomy for Renal Masses

PURPOSE: Minimally invasive management of small renal tumors has become more common. We compared the results of partial nephrectomy by video-assisted minilaparotomy surgery (VAMS), open, and laparoscopic techniques. MATERIALS AND METHODS: We retrospectively compared clinicopathological, oncological, and functional outcomes in 271 patients who underwent partial nephrectomy for renal tumors at one institution from 1993 to 2007; including 138 by VAMS, 102 by open, and 31 by laparoscopic technique. RESULTS: Mean follow-up was 47.7+/-29.1 months. No statistically significant differences in the three groups were found in tumor size, tumor location, estimated blood loss, complication rate, preoperative glomerular filtration rate (GFR), and GFR at last follow-up. Ischemic time was shorter in the open (26.9 min) and VAMS (29.3 min) groups than in the laparoscopic group (31.0 min, p=0.021). Time to normal diet and hospital stay were shorter in the VAMS (1.8 days and 5.4 days) and laparoscopic (1.8 days and 4.7 days) groups than in the open group (2.4 days and 7.3 days, p=0.036 and p<0.001, respectively). Of 180 patients with cancer, positive surgical margins occurred in 2 of 82 patients (2.4%) in the VAMS group, none of 75 patients in the open group, and 3 of 23 patients (13.0%) in the laparoscopic group (p=0.084). In the VAMS, open, and laparoscopic groups, 5-year disease-free survival was 94.8%, 95.8%, and 90.3% (p=0.485), and 5-year cancer-specific survival was 96.3%, 98.6%, and 100%, respectively (p=0.452). CONCLUSION: Partial nephrectomy using VAMS technique provides surgical, oncologic, and functional outcomes similar to open and laparoscopic techniques.

Intersexuality in a crab-eating fox (cerdocyon thous) / Intersexualidade em uma raposa (cerdocyon thous)

Intersexuality is a reproductive pathology that has been described in wild animals in recent years. However, its occurrence and consequences remain obscure and therefore all aspects of this reproductive disorder deserve attention. The aim of this study is to report a case of intersexuality with probable absence of gonadal tissue in the crab-eating fox (Cerdocyon thous) native to Brazil. The animal has male external genitalia, but its prepuce and penis were both hypoplastic. Because of a clinical suspicion of bilateral cryptorchidism, a laparotomy was performed and the absence of prostate and gonads were revealed. The procedure also revealed vas deferentia, extending laterally from the each side of the bladder basis to the right and left abdominal wall muscles. The animal died one month later, and post mortem examination confirmed the absence of prostatic and gonadal tissues. Muscular structures similar to uterine horns and cervix were founded macroscopically and confirmed by optic microscopy. In addition, post mortem findings corroborate with penis hypoplasia, since penile bone presence was observed. The vasa deferentia had a normal tissue structure, although hypoplastic. In conclusion, the case of a crab-eating fox (Cerdocyon thous) reported here represents a proved intersexual animal with probable absence of gonadal tissue.

A intersexualidade é uma das patologias reprodutivas, hereditária e/ou congênita, que têm sido mais reportada em animais selvagens nos últimos anos. Entretanto, suas ocorrências e conseqüências permanecem obscuras, sendo que todos os aspectos relacionados a este distúrbio reprodutivo merecem atenção. O objetivo deste estudo foi relatar um caso de intersexualidade com provável ausência de tecido gonadal em uma raposa (Cerdocyon thous) do Brasil. O animal apresentava sexo fenotípico masculino, mas seu prepúcio e pênis eram pequenos. Devido a uma suspeita clínica de criptorquidismo bilateral, foi realizada uma laparotomia, sendo, no procedimento cirúrgico, revelada a ausência de próstata e gônadas. Os ductos deferentes foram localizados lateralmente à bexiga, entendendo-se desde a sua base, inserindo-se na musculatura da parede abdominal direita e esquerda. Um mês após, o animal morreu e os achados necroscópicos confirmaram a ausência de tecidos prostático e gonadal. Entretanto, uma estrutura muscular histologicamente semelhante a cornos e cérvix uterinos foram encontradas. Além disso, pelo mesmo método, ratificou-se a ausência de próstata e o pênis exibiu aspecto normal contendo osso peniano. Os ductos deferentes apresentaram estrutura tecidual normal, porém hipoplásicos. Concluiu-se que o caso reportado no presente trabalho representa um exemplo de intersexualidade com provável ausência de tecido gonadal em um animal da espécie Cerdocyon thous.

Pneumotórax hipertensivo na sala de recuperação pós-anestésica: relato de caso / Tension pneumothorax in post-anesthetic care unit: case report

JUSTIFICATIVA E OBJETIVOS: Há 100 por cento de prevalência de pneumotórax nos casos de trauma penetrante torácico, sendo que o pneumotórax hipertensivo pode ser desencadeado, entre outras causas, por uma lesão pulmonar não diagnosticada inicialmente, ou associado à ventilação mecânica, apresentando alta taxa de mortalidade. O objetivo deste relato é apresentar um caso de pneumotórax hipertensivo diagnosticado na Sala de Recuperação Pós-Anestésica (SRPA). RELATO DO CASO: Paciente do sexo masculino, 34 anos, estado físico ASA I E, vítima de lesões por arma de fogo. Foi submetido a laparotomia exploradora e exploração de artéria e veia femorais à direita, sob anestesia geral balanceada com indução em seqüência rápida, com estabilidade hemodinâmica durante todo o procedimento cirúrgico. Na SRPA, apresentou instabilidade hemodinâmica, com insuficiência respiratória, sudorese, taquicardia e hipertensão arterial. A tomografia computadorizada de tórax evidenciou hemopneumotórax à direita, sendo imediatamente drenado. Foi transferido para o Centro de Terapia Intensiva, apresentando melhora progressiva do quadro, com alta hospitalar, sem seqüelas, após 22 dias. CONCLUSÕES: O pneumotórax hipertensivo é uma doença letal que pode ser facilmente reconhecida através dos exames clínico e radiológico; devendo ser sempre suspeitado na presença de traumatismo torácico, e neste caso, deve-se realizar imediatamente a drenagem de tórax antes da ventilação mecânica e de procedimentos cirúrgicos.

Laparostomía contenida en manejo de sepsis abdominal: uso de mallas versus ventrofil como forma de contención / Contained laparostomy in the management of abdominal sepsis: use of meshs versus ventrofil as contention method

En un intento de disminuir la mortalidad de los cuadros sépticos peritoneales graves, se han introducido nuevos enfoques quirúrgicos, entre ellos la laparostomía y su variante la laparostomía contenida o semiabierta. Existen diversas formas de contención, entre ellas el uso de ventrofil y de mallas. El objetivo de este trabajo es comparar ambos tipós de contención en relación a los resultados y complicaciones observadas. Para ello se estudiaron retrospectivamente 35 pacientes en los cuales se realizó laparostomía contenida. De ellos en 22 casos se uso ventrofil y en 13 pacientes (6 hombres y 7 mujeres con edad promedio de 50 años) mallas suturadas a pared abdominal. Se clasificó a los pacientes según su gravedad al ingreso mediante puntaje APACHE II, subdividiéndose en tres grupos para facilitar su análisis. Se observó una distribución similar de los pacientes en relación al índice de gravedad. Las causas que llevaron a la laparostomía en ambos grupos fueron proporcionales, encontrándose en más del 50 por ciento como etiología la perforación de tracto gastrointestinal. El tiempo promedio de laparostomía fue de 11,8 días de los casos con ventrofil y de 20,1 días en los con malla, con un promedio de 3,9 aseos en el primer caso y 4,8 en el otro. En cuanto a las complicaciones intraabdominales observadas derivadas del método, en los pacientes en que se usó ventrofil hubo 8 fístulas intestinales (36,3 por ciento). En los que se utilizó malla las complicaciones intraabdominales fueron 3 casos (23 por ciento) de fístula intestinal. La mortalidad fue de 27 por ciento en pacientes con ventrofil y 23 por ciento en uso de malla, estando ésta dada por la gravedad de la sepsis abdominal y no por el tipo de laparostomía. Se concluye que para el manejo de la laparostomía contenida, el uso de mallas como forma de contención sería la mejor opción, permitiendo un fácil manejo y un menor índice de complicaciones

Efecto de la adventectomía perivascular en anastomosis microquirúrgicas / Effect of perivascular adventitectomy on microsurgical anastomoses

Evaluamos el efecto de la adventectomía perivascular (AP) sobre las anastomosis de los vasos mesentéricos de un modelo animal canino. Se efectuaron anastomosis término-terminal en un grupo experimental con AP y en un grupo control sin AP. El diámetro de los vasos se midió con angiografía antes y después del procedimiento en cada grupo y se registró la permeabilidad de la anastomosis. Después del procedimiento la diferencia de los diámetros entre los dos grupos de significativa (t=-5.893, pó0.0001). En el grupo control después del procedimiento hubo una pérdida de más de 50 por ciento del diámetro y el 20 por ciento de los casos se ocluyó. En el grupo experimental la pérdida de su diámetro fue del 20 por ciento y todas las anastomosis se mantuvieron permeables. Se concluye que la AP es un método útil para evitar los fenómenos vosoespásticos por la manipulación, el flujo sanguíneo se mantiene y la anastomosis continúa permeable

Laparostato artesanal para ratos / Handmade autostatic retractor for rats

O adequado afastamento dos tecidos é fundamental para a obtençäo de campo operatório que permita visibilizaçäo das estruturas a serem abordadas e facilidade de atuaçäo do cirurgiäo. Os afastadores utilizados em ciruria experimental no rato, frequentemente, säo industrializados e têm como desvantagem principal, o alto custo de aquisiçäo e reparo. Justifica-se entäo, a criaçäo de aparelhos de baixo custo, eficazes e idealizados de acordo com os padröes anatômicos do animal. Desta maneira, o objetivo deste trabalho é demonstrar a confeçäo e a aplicabilidade de um afastador artesanal auto est estático para ratos. O laparostato artesanal é constituído de duas (02) estruturas idênticas, sendo uma a imagem espetacular da outra, e compostas de seis (06) partes principais. Säo elas: palheta elipsóide, alça lateral, haste horizontal, haste diagonal, cabo e articulaçäo. Para aplicaçäo e teste do laparostato artesanal foram utilizados 15 ratus norvegicus albinus, machos, adultos, pesando entre 250 e 300g, submetidos a laparotomia mediana xilopubiana, am ato operatório com duraçäo de 60 minutos, durante o qual foram observadas as seguintes variáveis: viabilidade de abordagem dos espaços e recessos peritoniais, estabilidade e deformaçäo do laparostato. Após análise dos resultados foi observado que o aparelho apresenta grande estabilidade, grau de deformidade sem prejuízo da funçäo, e permite acessar o retroperitônio, a cavidade pélvica e o espaço subdiafragmático. Desta maneira, conclui-se que o afastador artesanal auto estático proposto, possui confecçäo simples, é barato, anatômico e aplicável à aquisiçäo de campo operatório para acessar os espaços e recessos intraperitoniais estudados

Estudio comparativo entre la plastias tubaricas laparoscopicas y las microquirurgicas / Comparative study between the laparoscopic tube plastics and the microsurgical

El objetivo de este trabajo es comparar los resultados obtenidos, en cuanto a permeabilidad tubarica, embarazos y complicaciones se refiere, en un grupo de mujeres con lesiones tubaricas consideradas como la causa de su infertilidad. Para ello se revisan las historias clinicas de 109 pacientes atendidas en la consulta de infertilidad del Hospital Ginecoobtetrico Docente "Ramon Gonzalez Coro" y a quienes se les practico plastia tubarica por laparotomia (45 casos) o por laparoscopia (64 casos). En las laparotomias se utilizaron los mas modernos recursos (laser, microscopio quirurgico, etc). Aunque los grupos no se seleccionaron aleatoriamente, resultaron comparables por sus caracteristicas de edad y tipo de infertilidad y de lesion. Los resultados de ambas tecnicas fueron buenas en cuanto a permeabilidad tubarica y a embarazos normales alcanzados. La cifra de embarazos ectopicos fue de 9,5 vs 5,7

Técnica del abdomen contenido para el tratamiento de las colecciones purulentas intraperitoneales / The open packing laparostomy technique for treatment of the intraabdominal abscess

Se presenta una técnica de laparostomía que consiste en colocar una malla multiperforada de polietileno de alta densidad entre las vísceras y la cara interna de la pared abdominal sin ningún tipo de fijación, suturando además dos mallas de fibra poliamídica a los bordes del peritoneo y aponeurosis tomados conjuntamente. Se cierra luego la brecha enhebrando una aguja de tejer en las mallas de fibra poliamídica. Diariamente se quita la aguja y se observa el contenido abdominal para lavar o drenar focos sépticos. Al reinsertar la aguja se procura una progresiva reducción del diámetro transversal de la herida. Se emplea el procedimiento en 25 casos. No hubo complicaciones imputables al método

Role of zipper in the management of abdominal sepsis.

BACKGROUND: Continuous peritoneal lavage, staged laparotomies and radical peritoneal debridement have been used to reduce mortality from severe abdominal sepsis. Recently, open abdomen technique using a 'zipper' with or without mesh for abdominal lavage has shown promising results. AIMS: To evaluate open abdominal technique using a zipper in patients with advanced diffuse peritonitis with impending or established multiple organ failure. METHODS: Modified open abdomen technique using zipper with or without mesh was used for abdominal closure in eight patients with severe generalized peritonitis (APACHE-II score range 27-30). RESULTS: Zipper was inserted at first laparotomy in three patients, at second exploration in four and at the time of third laparotomy in one case. Two patients required strips of mesh in addition to zipper. Six of eight patients survived and were discharged after an average period of 27 days. Two deaths were due to multisystem organ failure. In four patients additional surgical procedures like closure of perforation, temporary ileostomy and resection anastomosis of small bowel was carried out through the zipper. Zipper-mesh were removed an average of 10.5 days after insertion. Three patients developed incisional hernia at 6 months follow-up. CONCLUSION: This technique merits further controlled trials to ascertain its indications and benefits.

Abdominal tuberculosis: a varied presentation

Abdominal Tuberculosis presents to the general surgeon in one of the three forms: 1, intestinal obstruction 2, tuberculous peritonitis 3, abdominal mass. In this report, patients presenting with intestinal obstruction [Acute or sub acute], over a two year period at the Department of General Surgery, Shaikh Zayed Hospital, Lahore, 30 cases were found to have intestinal tuberculosis out of a total 100 cases studied. All patients were diagnosed on exploration with hisopathological evidence of tuberculosis and/or demonstration of A.F.B. in the lesion. The mean age was 34.9 years, male to female ratio 2: 1. 86% of the patients had primary intestinal tuberculosis whereas 14% were considered to be suffering from secondary intestinal tuberculosis. Majority of the patients [66%], had single multiple strictures involving the triminal ileum and ileocaecal region, 20% of the patients were found to have mass in the ileocaecal region and perforation was seen in 14% of the cases. Primary resection of the tuberculous lesion was carried out in 28 patients. Stricturoplasty was performed in the remaining 2 patients. Hospital mortality was zero and major post operative complications were noted in 8% of the cases. The patients received standard anti-tuberculosis treatment for a period of 12 months, follow up record was available on only 26 patients. All 26 patients had completed the anti-tuberculosis medication without any ill effects. No patient had presented with recurrent problem of obstruction

Ectopic pregnancy a clinical study of 44 cases at England and 32 cased at Ahmed Maher hospital

Ectopic pregnancy is an acute potentially fatal gynecological emergency, and needs a correct, firm diagnosis and quick action. The incidence of ectopic pregnancy at Medway is slightly higher than the incidence in the United Kingdom. But like incidence at Ahmed Maher Hospital, is very low in comparison with the United Kingdom, Medway incidence, Baltimore [U.S.A.] and Jamaica in West Indies. There was no difference in the etiological factors, symptoms, signs and diagnosis of ectopic pregnancy between the patients in the Medway, Ahmed Maher Hospital area and other areas

Significance of human chorionic gondotrophin value in tubal pregnancy

The study has been conducted on 20 conclusive cases, surgically proved to be tubal pregnancy, to detect whether serum B-HCG can predict site of rupture of tubal pregnancy, their ages ranged between 21 and 35 years and their parity ranged from nullipara to five parities. The gestational age at operation averaged 59.9 +/- 12.08 days. Out of 20 cases, 13 cases were ruptured [65%] while only 7 cases [35%] were unruptured. The mean serum B-HCG for ruptured tubal pregnancy was much higher than that of unruptured tubal cases. The mean levels were 528.8 +/- 303.8 and 222.4 +/- 51.5 mul/ml, respectively. Those planning for conservative or chemotherapeutic management of tubal pregnancy, an arbitrary serum HCG value of 280 mul/ml can be used as cut off limit for integrity of tubal pregnancy

Volvulus of the caecum

Five cases of volvulus of the cecum were diagnosed at Al-Azhar University Hospitals during period of seven years. Treatment was derotation and ileostomy in situ. This operation was recommended for cases with viable intestine [two cases]

Use of fresh placental membranes for ureteral replacement [experimental work]

In the present work, the use of placental membranes for ureteric reconstruction, was assessed. Ten adult dogs were divided into two groups, five in each. Group I was subjected to partial replacement of ureteric wall using a patch of placental membranes. Group II was subjected for total replacement of a ureteric segment using a tube fashioned from a placental membranes. Postoperative intravenous urography was satisfactory in group I. Histopathological examination showed evidence of regeneration of lining epithelium and encircling ureteric muscles along the placental patch in group I. However, unsatisfactory results were obtained from group II

Tratamento das peritonites difusas graves com abdome aberto protegido com tela de filó associado a reoperaçöes planejadas / Treatment of severe diffuse peritonites with open abdomen protected with cotton mesh followed bu planned reoperations

Säo analisados 50 pacientes portadores de peritonite difusa grave tratados com abdome aberto (laparostomia) protegido com tela de filó, em associaçäo com reoperaçöes planejadas, com o objetivo de estudar o comportamento da tela como material de proteçäo da cavidade peritoneal e demonstrar a experiência regional com esta forma de tratamento. Säo analisados aspectos relativos à aplicaçäo desta opçäo cirúrgica, afecçöes causadoras, material de proteçäo, complicaçöes e mortalidade. Os resultados permitem afirmar a utilidade da tela de filó como material de proteçäo da cavidade peritoneal e o melhor resultado desta forma de tratamento quando empregado primariamente

Posterior sagittal anorectoplasty for management of children with anorectal malfomation: applications and results

Over the past 5 years, 120 children with anorectal malformations [A.R.M] underwent their repair using the posterior sagittal approach. There were 112 primary cases and 8 redoes [following prior pull-through procedures]. fifty of our patients were males and 70 females. Their age at the time of procedure ranged from 3 months to 9 years, [mean 0.8 yr]. Eighty seven patients are now over 3 years of age and are available for evaluation regarding fecal continence. In our patients functional results of the procedure are found to be affected by the type of the original anomaly, sacral anatomy and the damage imposed by the previous repair in redo cases

role of ultrasonography in the diagnosis of suspected acute appendicitis

180 patients with suspected clinical diagnosis of acute appendicitis during 20 months period were examined by graded compression ultrasonography 56 patients were true positive. Appendicitis was proved at surgery in 64 patients; criteria for ultrasonographic diagnosis was the visualization of the non compressible appendix with diameter > 6 mm., hypoechogenic layer > 2 mm. and the presence of periappendiceal fluid or the presence of appendicolith. Non visulaization is considered a negative sign. True positive ultrasonographic diagnosis was observed in 56 out of 64 surgically proven appendicitis [87.5%]. 18 patients were negative at laparotomy 4 of them were seen by ultrasonography with a diameter < 6 mm. and 14 were not visualized. The remaining 98 patients improved on conservative measures, 9 of them were visualized by ultrasonography with diameter > 6 mm. but on repetition of ultrasonography during follow up the diameter decreased to reach < 6 mm. in 4 cases and appendix was not seen in 3 cases while in the rest [2 cases] the diameter was still > 6 mm but with hypoechogenic layer < 2 mm and clinically all the 9 cases improved. In the rest of patients [89 patients] the appendix could not be visualized. The sensitivity of ultrasonography in this work was 56 /64 [87.5%], specificity was 107/116 [92.2%]. The positive predictive value was 56/56+9 [86%] and the negative predictive value was 107/107+8 [93%]. For this ultrasonography is a valuable tool in the diagnosis of acute appendicitis in patients with equivocal clinical findings