Recipient vessels for free flaps in advanced facial oncologic defects.

OBJECTIVES: To prospectively compare the results of microvascular flap reconstruction of midface and scalp advanced oncologic defects using superficial temporal versus cervical as recipient vessels. METHODS: This is a parallel group clinical trial with 1:1 allocation ratio of patients who underwent midface and scalp oncologic reconstruction with free tissue flap from April 2018 to April 2022 in a tertiary oncologic center. Two groups were analyzed: those in whom superficial temporal vessels were used as the recipient vessels (Group A) and those in whom cervical vessels were used as the recipient vessels (Group B). Patient gender and age, cause and localization of the defect, flap choice for reconstruction, recipient vessels, intraoperative outcome, postoperative course, and complications were recorded and analyzed. A Fisher's exact test was used to compare outcomes between the 2 groups. RESULTS: On the basis of the different recipient vessels, 32 patients were randomized into 2 groups, and of these 27 patients completed the study: Group A with superficial temporal recipient vessels (n = 12) and Group B with cervical recipient vessels (n = 15). There were 18 male and 09 female patients with an average age of 53.92 ±â€¯17.49 years. The overall flap survival rate was 88.89%. The overall complication rate for vascular anastomosis was 14.81%. The total flap loss rate in patients with superficial temporal recipient vessels was higher than the complication rate in those with cervical recipient vessels but with no statistical significance (16.67% vs. 6.66%, p = 0.569). Minor complications occurred in 05 patients without statistical significance between the groups (p = 0.342). CONCLUSION: In the group with superficial temporal recipient vessels, the postoperative rate of free flap complications was similar than the cervical recipient vessel group. Therefore the use of superficial temporal recipient vessels for midface and scalp oncologic reconstruction could be a reliable option.

Recipient vessels for free flaps in advanced facial oncologic defects

Abstract Objectives To prospectively compare the results of microvascular flap reconstruction of midface and scalp advanced oncologic defects using superficial temporal versus cervical as recipient vessels. Methods This is a parallel group clinical trial with 1:1 allocation ratio of patients who underwent midface and scalp oncologic reconstruction with free tissue flap from April 2018 to April 2022 in a tertiary oncologic center. Two groups were analyzed: those in whom superficial temporal vessels were used as the recipient vessels (Group A) and those in whom cervical vessels were used as the recipient vessels (Group B). Patient gender and age, cause and localization of the defect, flap choice for reconstruction, recipient vessels, intraoperative outcome, postoperative course, and complications were recorded and analyzed. A Fisher's exact test was used to compare outcomes between the 2 groups. Results On the basis of the different recipient vessels, 32 patients were randomized into 2 groups, and of these 27 patients completed the study: Group A with superficial temporal recipient vessels (n = 12) and Group B with cervical recipient vessels (n = 15). There were 18 male and 09 female patients with an average age of 53.92 ± 17.49 years. The overall flap survival rate was 88.89%. The overall complication rate for vascular anastomosis was 14.81%. The total flap loss rate in patients with superficial temporal recipient vessels was higher than the complication rate in those with cervical recipient vessels but with no statistical significance (16.67% vs. 6.66%, p= 0.569). Minor complications occurred in 05 patients without statistical significance between the groups (p= 0.342). Conclusion In the group with superficial temporal recipient vessels, the postoperative rate of free flap complications was similar than the cervical recipient vessel group. Therefore the use of superficial temporal recipient vessels for midface and scalp oncologic reconstruction could be a reliable option.

Tratamento cirúrgico da doença valvar aórtica com anel pequeno / Surgical treatment of aortic valve disease with small ring

O presente estudo visa discutir sobre as possibilidades de tratamento cirúrgico em pacientes com valvopatias aórticas e portadores de anéis aórticos pequenos, abordando indicações e contra-indicações dos principais procedimentos existentes, assim como avaliar as próteses mais utilizadas e sua capacidade. Diferentemente de anéis largos ou normais, uma das complicações mais preocupantes é a desproporção prótese-paciente que ocorre quando a área efetiva do orifício da prótese é fisiologicamente muito pequena em relação a superfície corpórea do paciente...

Single access laparoscopic cholecystectomy: technique without the need for special materials and with better ergonomics.

The authors describe a surgical technique which allows, without increasing costs, to perform laparoscopic cholecystectomy with a single incision, without using specific materials and with better surgical ergonomics. The technique consists of a longitudinal umbilical incision, navel detachment, use of a permanent 10mm trocar and two clamps directly and bilaterally through the aponeurosis without the use of 5mm trocars, transcutaneous gallbladder repair with straight needle cotton suture, ligation with unabsorbable suture and umbilical incision for the specimen extraction. The presented technique enables the procedure with conventional and permanent materials, improving surgical ergonomics, with safety and aesthetic advantages.

Single access laparoscopic cholecystectomy: technique without the need for special materials and with better ergonomics / Colecistectomia videolaparoscópica através de acesso único: técnica sem necessidade de materiais especiais e melhor ergonomia

The authors describe a surgical technique which allows, without increasing costs, to perform laparoscopic cholecystectomy with a single incision, without using specific materials and with better surgical ergonomics. The technique consists of a longitudinal umbilical incision, navel detachment, use of a permanent 10mm trocar and two clamps directly and bilaterally through the aponeurosis without the use of 5mm trocars, transcutaneous gallbladder repair with straight needle cotton suture, ligation with unabsorbable suture and umbilical incision for the specimen extraction. The presented technique enables the procedure with conventional and permanent materials, improving surgical ergonomics, with safety and aesthetic advantages.

Os autores descrevem uma técnica operatória que permite, sem aumento do custo, realizar a colecistectomia videolaparoscópicas, por única incisão, sem necessidade de utilizar materiais específicos, com melhor ergonomia cirúrgica. A técnica consiste na incisão umbilical longitudinal, descolamento de cicatriz umbilical, utilização de trocarter permanente de 10mm e duas pinças atravessando diretamente a aponeurose bilateralmente sem uso de trocarteres de 5mm, reparo de vesícula biliar transcutânea com fio de algodão de agulha reta, ligadura com fio inabsorvível e extração de peça cirúrgica por incisão umbilical. A técnica apresentada viabiliza o procedimento com materiais convencionais e permanentes, melhora a ergonomia cirúrgica, com segurança e vantagens estéticas.

Translation into brazilian portuguese, cultural adaptation and validation of the prosthesis evaluation questionnaire / Tradução para o português, adaptação cultural e validação do questionário de avaliação de próteses

BACKGROUND: Quality of life has been one of the main issues for patients with a chronic condition. OBJECTIVE: To translate, adapt and validate a Brazilian Portuguese version of the Prosthesis Evaluation Questionnaire (PEQ). METHODS: The questionnaire was translated into Portuguese, back translated into English, and cross-culturally adapted to the Brazilian Population. Sixty-five transtibial unilateral amputees were recruited. The sample comprised 45 men and 20 women with a mean age of 44 years, 47 with traumatic amputations, 14 with vascular dysfunction and 4 with other reasons for amputation, and all of them fitted with prostheses. Patients were interviewed twice, at baseline and again after 15 days. The Brazilian Portuguese version of the SF-36 (a generic Quality of Life outcome measure) and the FIM (a Functional Independence Measure) were also administered.RESULTS: The internal consistency of the nine PEQ scales was tested by computing Cronbach's Alpha coefficients (0.65 - 0.89: high values). Student's t test coefficients were used for interobserver evaluation (0.35 to 084: reliable values with one exception- the Residual Limb Health scale), and Intraclass Correlation Coefficients (ICC), which ranged from 0.65 to 0.92: reliable values. Student's t test coefficients and ICCs were also used for intraobserver evaluation (0.42 to 0.83, except the Residual Limb Health scale and 0.80 to 0.94, respectively: reliable values). Correlations between PEQ, SF-36 and FIM were tested using Pearson's correlation coefficients, which were not statistically significant (p > 0, 01).CONCLUSION: The Brazilian-Portuguese version of the PEQ has high internal consistency and is a reliable quality of life measure for use in amputee patients, but is not associated with the SF-36 or FIM.

CONTEXTO: Qualidade de vida tem sido a principal preocupação em pacientes com disfunção permanente.OBJETIVO: Traduzir, adaptar e validar uma versão Brasileira do Prosthesis Evaluation Questionnaire (PEQ). MÉTODOS: O questionário foi traduzido para o Português, retraduzido para inglês e adaptado culturalmente para a população brasileira. Sessenta e cinco amputados transtibiais unilaterais (45 homens, 20 mulheres, média de idade: 44 anos); 47 de etiologia traumática, 14 vascular e 4 de outras causas, todos protetizados, foram entrevistados duas vezes no mesmo dia e no intervalo de 15 dias. A versão brasileira do SF 36 (Medida de Qualidade de Vida genérica) e MIF (Medida de Independência Funcional) foram aplicadas. RESULTADOS: A consistência interna de 9 escalas da PEQ foi testada pelo coeficiente Alpha de Cronbach (0,65-0,89; valores altos). O teste T de Student foi usado para a avaliação interobservadores (0,35-0,84; valores de confiança, exceto para Escala de Saúde do Membro Residual) e para o Coeficiente de Correlação Intraclasses (ICC), que variou de 0,65 a 0,92, valores de confiança. O teste T de Student foi usado durante a avaliação intraobservadores (0,42-0,83; exceto para Escala de Saúde do Membro Residual) e o ICC também (0,80-0,94), ambos valores de confiança. A correlação entre PEQ, SF 36 e MIF foi testada pelo coeficiente de correlação de Pearson e foi estatisticamente insignificante (p>0,01).CONCLUSÃO: A versão brasileira da PEQ tem alta consistência interna e é uma medida de qualidade de vida confiável para pacientes amputados, mas não mostrou associação com SF 36 e MIF.

High prevalence of vitamin A deficiency in Crohn's disease patients according to serum retinol levels and the relative dose-response test.

AIM: To assess the vitamin A status of patients with Crohn's disease (CD) by evaluating serum retinol levels and the relative dose response (RDR) test (liver retinol stores). METHODS: Vitamin A nutritional status was measured by serum retinol obtained by high performance liquid chromatography and the RDR test for evaluation of the hepatic stores. Body composition was performed by densitometry by dual-energy X-ray absorptiometry. Vitamin A dietary intake was assessed from a semi-quantitative food frequency questionnaire. RESULTS: This study included 38 CD patients and 33 controls. Low serum retinol concentrations were detected in 29% of CD patients vs 15% in controls (P < 0.005). The RDR test was positive in 37% of CD patients vs 12% in controls, which indicated inadequate hepatic vitamin A stores (P < 0.005). Individuals with hypovitaminosis A had lower BMI and body fat compared with those without this deficiency. There was no association between vitamin A deficiency and its dietary intake, ileal location, presence of disease activity and prior bowel resections. CONCLUSION: Patients with CD have higher prevalence of vitamin A deficiency, as assessed by two independent methods.

Valor prognóstico da espessura tumoral no carcinoma escamocelular avançado do lábio inferior e sua correlação com metástases cervicais / Prognostic value of tumor thickness in advanced squamous cell carcinoma of the lower lip and their correlation with neck metastases

Introdução: O carcinoma escamocelular (CEC) do lábio inferioré um dos tumores malignos mais comuns da cavidade oral. Aespessura tumoral é relativamente um novo fator prognósticopara o câncer de lábio inferior e sua importância em casosavançados é incerto. Objetivo: Avaliar o valor prognóstico daespessura tumoral no CEC avançado do lábio inferior. Método:Análise retrospectiva de 31 pacientes diagnosticados com CECavançado do lábio inferior e tratados cirurgicamente no InstitutoNacional do Câncer (Rio de Janeiro, Brasil), durante o períodoentre 2000 e 2009. Foram analisadas variáveis relacionadasà espessura tumoral, metástase cervical e sobrevida global.Resultados: Metástases cervicais ocorreram em 61,2% dospacientes. A espessura tumoral foi um fator preditor independentede metástases cervicais, e quando utilizado o ponto de corte de 5mm, a taxa de metástases cervicais foi de 5,3% em comparaçãocom 94,7% dos pacientes com tumores maiores que 5 mm deespessura (p = 0,001). A ocorrência de metástases cervicais foium fator preditor independente para a redução da sobrevivênciaglobal (p = 0,003). Conclusão: A espessura tumoral foi um fatorpreditor independente de metástase cervical no CEC avançadode lábio inferior. Na ocorrência de metástases cervicais há umasignificativa redução da sobrevida global.

Does active Crohn's disease have decreased intestinal antioxidant capacity?

BACKGROUND AND AIMS: Oxidative stress is presumed to play an important role in Crohn's disease (CD) pathogenesis. Nevertheless, the evaluation of the intestinal antioxidant capacity through the analysis of glutathione peroxidase activity in CD remains to be determined. METHODS: 20 CD outpatients and 16 volunteers going through colonic cancer screening were enrolled. Colonoscopy with biopsies was performed in all individuals. Samples from inflamed and non-inflamed mucosa were taken when there was CD endoscopic activity. Spectrophotometric assays were performed to measure tissue glutathione peroxidase (GPx) activity, and total (GSHT) and oxidized (GSSG) glutathione in all samples. Demographics and clinical characteristics were collected from clinical charts. RESULTS: Inflamed CD mucosa presented reduced GPx activity compared to non-inflamed CD mucosa (42.94mU/mg protein vs 79.62mU/mg protein, P<0.05) and control mucosa (42.94mU/mg protein vs 95.08mU/mg protein, P<0.001). GSHT concentration was reduced in inflamed mucosa when compared to non-inflamed CD mucosa (0.78µmol/g vs 1.98µmol/g, P<0.01) and the control group (0.78µmol/g vs 2.11µmol/g, P<0.001). A significant correlation was detected between GPx activity and GSSG (r=-0.599), disease duration (r=0.546), and thiopurine treatment (r=-0.480) in non-inflamed CD mucosa. CONCLUSION: Our findings suggest that reduced GPx activity is present in inflamed CD mucosa. In addition, endoscopic activity, disease duration and thiopurine therapy could be associated with mucosal decreased antioxidant activity.

Seasonal variation of vegetative growth, essential oil yield and composition of menthol mint genotypes at southern Brazil / Variação sazonal do crescimento vegetativo, produtividade e composição de óleo essencial em genótipos de menta no sudeste brasileiro

Menthol has economic importance to the flavor, food and pharmaceutical industries. Ten menthol mint (Mentha spp) genotypes were assessed for essential oil content and composition at Southern Brazil environmental conditions at two harvest times (February and May). The experimental design was in completely randomized blocks with a 10 x 2 factorial for genotypes and harvest time. The essential oil was obtained by hydrodistillation in a Clevenger apparatus. The essential oil content varied from 0.8 to 5.3% and was greater in February for all the investigated genotypes. The main constituents identified in the essential oil samples were menthol (12 - 92.7%), mentone (2.2 - 56.9%), and neomenthol (2.9 - 12.1%). Menthol levels were superior in May and showed a negative correlation with mentone and neomenthol, which in turn were higher in February. Menthol levels were positively correlated with menthyl acetate. Pulegone, 1.8 cineol, and limonene were also detected in lower concentrations in some genotypes. Thirteen other essential oil constituents were identified as trace elements in essential oil. Mentha canadensis L. showed the highest essential oil content (5.3 % - February and 3.5% - May) as well as the highest menthol content (89.6% - February, 92.7% - May) in both harvests. From the analyzed results, Southern Brazil local environmental conditions are appropriated for menthol production, with two harvests and M. canadensis L. can be recommended as a promising genetic source. The summer harvest (February) favored oil yield, although with a slight decrease in menthol content. The challenge of achieving higher essential oil and menthol yields depends on strategies to increase herb yield by developing innovative agronomic practices.

O mentol, constituinte majoritário do óleo essencial de menta é usado nas indústrias farmacêutica, alimentícia e de aromas. Onze genótipos de Mentha sp. foram estudados em relação ao desenvolvimento vegetativo, rendimento, produtividade e composição de óleo essencial nas condições edafoclimáticas do litoral Norte Catarinense, em duas épocas (fevereiro e maio). O trabalho foi conduzido em delineamento experimental de blocos ao acaso, em esquema fatorial 10 x 2 para genótipos e épocas de colheita. A extração do óleo essencial foi realizada por hidrodestilação em aparelho graduado Clevenger. O teor de óleo essencial variou entre 0,8 e 5,3%, sendo maior em fevereiro para todos os genótipos. Os constituintes majoritários identificados foram mentol (12 ­ 92,7%), mentona (2,2 ­ 56,9%), e neomentol (2,9 ­ 12,1). Os maiores teores de mentol foram observados em maio, apresentando correlação negativa com mentona e neomentol, os quais foram superiores em fevereiro. Os teores de acetato de metila apresentaram correlação positiva com os de mentol. Pulegona, 1,8 cineol, e limoneno foram identificados em menores concentrações e outros treze constituintes foram detectados como elementos traço em alguns genótipos. Mentha canadensis L. apresentou os maiores teores de óleo essencial, (5,3 % - Fevereiro e 3,5% - Maio) e mentol (89,6% - Fevereiro, 92,7% - Maio) em ambas as colheitas. Os resultados obtidos permitem concluir que as condições edafoclimáticas do litoral Norte Catarinense são adequadas para a produção de mentol, com duas colheitas, recomendando-se o genótipo M. canadensis L. A colheita de verão (fevereiro) favorece a produtividade de óleo essencial reduzindo o teor de mentol. O desafio para aumentar a produtividade de óleo essencial e de mentol depende de estratégias que aumentem a produção de biomassa através do desenvolvimento de práticas agronômicas inovativas.

Influence of tissue perfusion on the outcome of surgical patients who need blood transfusion.

PURPOSE: The aim this study was to evaluate the clinical outcome of patients needing intra-operative blood transfusion by tissue perfusion markers. METHODS: A prospective single center cohort study. Adult patients needing blood transfusion during the intra-operative period were recruited. RESULTS: This study included 61 patients. At the time of blood transfusion the hemoglobin level was 8.4+/-1.8 g/dL. Scv02 has been the best tissue perfusion marker to determine mortality, compared with hematemetric values and other tissue perfusion markers, with a cut-off point at ROC curve equal to 80% (AUC=0.75; sensitivity=80%; specificity=65.2%). Patients who received blood transfusion and had Scv02 80% (N=32), had lower mortality rates (12.5% vs. 47.1%; p=0.008) and lower incidence of postoperative complications (58.9% vs. 72.9%; p=0.06). Blood transfusion with a Scv02 80%, are associated with worse clinical outcomes.

Transfusão sangüínea no intra-operatório, complicações e prognóstico / Transfusión sanguínea en el intraoperatorio, complicaciones y pronóstico / Complications and prognosis of intraoperative blood transfusion

JUSTIFICATIVA E OBJETIVOS: Transfusões sangüíneas no intra-operatório estão associadas a aumento de complicações no pós-operatório e custos hospitalares. Portanto, este estudo avaliou as características, complicações e possíveis fatores de riscos para morte em pacientes cirúrgicos que necessitaram de transfusões sangüíneas no intra-operatório. MÉTODO: Coorte prospectiva, durante período de um ano, no centro cirúrgico de hospital terciário. Incluíram-se pacientes com idade acima de 18 anos que necessitaram de transfusões sangüíneas no intra-operatório. Testemunhas de Jeová, pacientes que receberam transfusões prévias, falência coronariana e lesão encefálica aguda foram excluídos. RESULTADOS: O estudo envolveu 80 pacientes, com idade média de 68,4 ± 14,1 anos. Os pacientes ASA II foram prevalentes com 69,6 por cento dos casos, os escores APACHE II e POSSUM foram em média, respectivamente, 13,6 ± 4,4 e 37,5 ± 11,4. A hemoglobina média no momento da transfusão era 8,2 ± 1,8 g.dL-1 e 19 por cento dos pacientes apresentavam hemoglobina maior que 10 g.dL-1. Os pacientes receberam em média 2,2 ± 0,9 UI de concentrados de hemácias. A mortalidade hospitalar foi 26,3 por cento. As complicações pós-transfusões totalizaram 57,5 por cento dos casos no pós-operatório e a mais freqüente foi infecção. Foram fatores independentes de morte na regressão logística os escores APACHE II (OR = 1,34; IC 95 por cento 1,102 - 1,622), POSSUM (OR = 1,08; IC 95 por cento 1,008 - 1,150) e número de unidades de concentrados de hemácias recebidas (OR = 2,22; IC 95 por cento 1,100 - 4,463). Quanto maior o número de transfusões sangüíneas, maiores as incidências de complicações e mortalidade. CONCLUSÕES: O valor de hemoglobina e o número de unidades de concentrados de hemácias utilizados foram elevados comparados com os estudos que preconizam estratégias restritivas. Foi encontrada nesta amostra alta incidência...

BACKGROUND AND OBJECTIVES: Intraoperative blood transfusions are associated with an increase in postoperative complications and hospital costs. Thus, this study evaluated the characteristics, complications, and probable risk factors for death in surgical patients who needed intraoperative blood transfusions. METHODS: This is a prospective study that spanned a one-year period, undertaken at the surgical suite of a tertiary hospital. Patients older than 18 years who needed intraoperative blood transfusions were included in this study. Jehovah witnesses, patients with a history of prior blood transfusions, coronary failure, and acute brain lesions were excluded. RESULTS: Eighty patients with mean age of 68.4 ± 14.1 years participated in the study. Most patients were ASA II, representing 69.6 percent of the study group; APACHE and POSSUM scores were 13.6 ± 4.4 and 37.5 ± 11.4, respectively. Mean hemoglobin at the time of transfusion was 8.2 ±1.8 g.dL-1 and 19 percent of the patients had hemoglobin levels higher than 10 g.dL-1. Patients received an average of 2.2 ± 0.9 IU of packed red blood cells. Hospital mortality was 26.3 percent. Post-transfusion complications totaled 57.5 percent of the cases in the postoperative period, and most of them were due to infections. In the logistic regression, independent factors for death included APACHE II (OR = 1.34; 95 percent CI 1.102-1.622), POSSUM (OR = 1.08; 95 percent CI 1.008-1.150) and the number of packed red blood cells received (OR = 2.22; 95 percent CI 1.100-4.463). Thus, the higher the number of transfusions, the greater the incidence of complications and mortality. CONCLUSIONS: Hemoglobin level, and the number of packed red blood cells used were elevated when compared with studies that suggest restrictive strategies. This sample presented a high incidence of complications, especially infections, and complications. APACHE II and POSSUM scores and the number of transfusions were independent...

JUSTIFICATIVA Y OBJETIVOS: Transfusiones sanguíneas en el intraoperatorio están asociadas al aumento de complicaciones en el postoperatorio y costes hospitalarios. Por tanto, este estudio evaluó las características, complicaciones y los posibles factores de riesgos para muerte en pacientes quirúrgicos que necesitaron transfusiones sanguíneas en el intraoperatorio. MÉTODO: Categoría prospectiva, durante el período de un año, en el centro quirúrgico de hospital terciario. Se incluyeron pacientes con edad por encima de los 18 años que necesitaron transfusiones sanguíneas en el intraoperatorio. Testigos de Jeová, pacientes que recibieron transfusiones previas, fracaso coronario y lesión encefálica aguda quedaron excluidos del estudio. RESULTADOS: El estudio involucró a 80 pacientes, con una edad promedio entre los 68,4 ± 14,1 años. Los pacientes ASA II eran prevalecientes con 69,6 por ciento de los casos, las puntuaciones APACHE II y POSSUM fueron, como promedio respectivamente de 13,6 ± 4,4 y 37,5 ± 11,4. La hemoglobina promedio al momento de la transfusión era de 8,2 ± 1,8 g.dL-1 y un 19 por ciento de los pacientes tuvieron hemoglobina por encima de 10 g.dL-1. Los pacientes recibieron como promedio 2,2 ± 0,9 UI de concentrados de hematíes. La mortalidad hospitalaria fue de un 26,3 por ciento. Las complicaciones postransfusiones totalizaron un 57,5 por ciento de los casos en el postoperatorio y la más frecuente fue la infección. Fueron factores independientes de muerte en la regresión logística las puntuaciones APACHE II (OR = 1,34; IC 95 por ciento 1,102-1,622), POSSUM (OR = 1,08; IC 95 por ciento 1,008 - 1,150) y número de unidades de concentrados de hematíes recibidos (OR = 2,22; IC 95 por ciento 1,100 - 4,463). Mientras mayor es el número de transfusiones sanguíneas, mayores son las incidencias de las complicaciones y de la mortalidad. CONCLUSIONES: El valor de la hemoglobina y el número de unidades de concentrados de hematíes utilizados...

Complications and prognosis of intraoperative blood transfusion.

BACKGROUND AND OBJECTIVES: Intraoperative blood transfusions are associated with an increase in postoperative complications and hospital costs. Thus, this study evaluated the characteristics, complications, and probable risk factors for death in surgical patients who needed intraoperative blood transfusions. METHODS: This is a prospective study that spanned a one-year period, undertaken at the surgical suite of a tertiary hospital. Patients older than 18 years who needed intraoperative blood transfusions were included in this study Jehovah witnesses, patients with a history of prior blood transfusions, coronary failure, and acute brain lesions were excluded. RESULTS: Eighty patients with mean age of 68.4 +/- 14.1 years participated in the study. Most patients were ASA II, representing 69.6% of the study group; APACHE and POSSUM scores were 13.6 +/- 4.4 and 37.5 +/- 11.4, respectively. Mean hemoglobin at the time of transfusion was 8.2 +/-1.8 g x dL(-1) and 19% of the patients had hemoglobin levels higher than 10 g x dL(-1). Patients received an average of 2.2 +/- 0.9 IU of packed red blood cells. Hospital mortality was 26.3%. Post-transfusion complications totaled 57.5% of the cases in the postoperative period, and most of them were due to infections. In the logistic regression, independent factors for death included APACHE II (OR = 1.34; 95% CI 1.102-1.622), POSSUM (OR = 1.08; 95% CI 1.008-1.150) and the number of packed red blood cells received (OR = 2.22; 95% CI 1.100-4.463). Thus, the higher the number of transfusions, the greater the incidence of complications and mortality. CONCLUSIONS: Hemoglobin level, and the number of packed red blood cells used were elevated when compared with studies that suggest restrictive strategies. This sample presented a high incidence of complications, especially infections, and complications. APACHE II and POSSUM scores and the number of transfusions were independent risk factors for a worse postoperative prognosis.

Ponte óssea na amputaçäo transtibial / Bone bridge in transtibial amputation

Entre setembro de 1987 e junho de 1997, 23 pacientes com idade variando entre 12 e 53 anos foram submetidos à amputaçao transtibial unilateral, sendo a tíbia e a fíbula estimuladas a unir-se por uma ponte óssea entre suas extremidades distais. Todos os pacientes foram operados pelo mesno cirurgiao. A finalidade era: 1) criaçao de uma moldura óssea rígida e estável; 2) restaurar a fisiologia óssea intramedular; e 3) aumentar a capacidade da extremidade distal do coto de suportar o peso do corpo. Dois dos pacientes eram portadores de vasculopatia periférica por diabetes. Ambos tiveram sucesso na formaçao da ponte óssea, embora um apresentasse importante infecçao de partes moles por pseudomonas no pós-operatório imediato, comprometendo a cicatrizaçao e a qualidade da reabilitaçao com uso de prótese. Dois outros pacientes apresentavam formaçao espontânea da ponte óssea entre a tíbia e a fíbula. A cirurgia visou somente melhorar o aspecto funcional do coto de amputaçao. Duas falhas na formaçao da ponte óssea sao atribuídas à técnica operatória insuficiente.