CT scan in the evaluation of pediatric abdominal trauma.

OBJECTIVE: to assess the need of computed tomography (CT) for the definition of management in pediatric abdominal trauma. METHODS: observational retrospective study with patients under 18 years old victims of blunt or penetrating abdominal trauma that underwent CT of the abdomen and pelvis at admission. We evaluated CT scan findings, indications and management. We calculated the sensitivity, specificity, positive predictive value and negative predictive value of clinical variables and energy of trauma for findings on CT. RESULTS: among the 236 patients included in our study, 72% (n=170) did not present abnormal findings on CT. It was performed surgical treatment in 15% (n=10), conservative treatment in 54,5% (n=36) and 27% (n=18) did not receive treatment for abdominal injuries. In the assessment of CT indications, 28,8% (n=68) presented no justifications. In this group, 91% (n=62) did not show any abnormal findings. Among the six patients with positive findings, half were selected for conservative treatment, while the rest did not need any treatment for abdominal injuries. The presence of abdominal pain, hemodynamic alterations and high energy blunt trauma had low positive predictive values when isolated, whereas the negative predictive values were higher. CONCLUSION: although CT is necessary in some instances, there is a possible high number of exams that did not make any difference in the management of the pediatric population.

LAPAROSCOPIC INGUINAL HERNIA REPAIR: THE LONG-TERM ASSESSMENT OF CHRONIC PAIN AND QUALITY OF LIFE.

BACKGROUND: Laparoscopic approaches to inguinal hernia repair include transabdominal extraperitoneal and transabdominal preperitoneal, both of which are widely performed and employ mesh. Indicators of success for these surgical procedures include incidence of complications, time to return to daily activities, incidence of postoperative chronic pain, and the long-term postoperative patient satisfaction. OBJECTIVE: This study aimed to evaluate and compare long-term postoperative incidence of chronic pain and overall quality of life among patients undergoing transabdominal extraperitoneal or transabdominal preperitoneal inguinal hernia repair. METHODS: This was a retrospective cross-sectional study. Medical records were analyzed, and the SF-36 questionnaire and Visual Analog Scale were applied to assess quality of life and chronic pain in patients undergoing laparoscopic inguinal hernia repair between January 2017 and February 2021. RESULTS: A total of 167 patients status post laparoscopic inguinal hernia repair, who were 3 months postoperatively or longer, were included in the study. Among the early complications seen, seroma was most common in the transabdominal preperitoneal group (p=0.04). Subsequently, 40 of the initial 167 patients answered to the survey instrument (SF-36 and Visual Analog Scale). Mean patient-reported pain (Visual Analog Scale score) was statistically similar between groups, with 1.29 for transabdominal preperitoneal and 1.68 for transabdominal extraperitoneal (p=0.92). In the domains evaluated by the SF-36, there was no significant difference between the samples. CONCLUSION: Both transabdominal extraperitoneal and transabdominal preperitoneal techniques for hernia repair have similar results in the late postoperative period regarding quality of life and prevalence of chronic pain. They are also comparable in terms of major early postoperative complications, except for seroma, with a higher incidence in patients undergoing transabdominal preperitoneal.

RISK FACTORS FOR SURGICAL WOUND INFECTION AFTER ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY.

BACKGROUND: One of the ways to avoid infection after surgical procedures is through antibiotic prophylaxis. This occurs in cholecystectomies with certain risk factors for infection. However, some guidelines suggest the use of antibiotic prophylaxis for all cholecystectomies, although current evidence does not indicate any advantage of this practice in the absence of risk factors. AIMS: This study aims to evaluate the incidence of wound infection after elective laparoscopic cholecystectomies and the use of antibiotic prophylaxis in these procedures. METHODS: This is a retrospective study of 439 patients with chronic cholecystitis and cholelithiasis, accounting for different risk factors for wound infection. RESULTS: There were seven cases of wound infection (1.59%). No antibiotic prophylaxis regimen significantly altered infection rates. There was a statistically significant correlation between wound infection and male patients (p=0.013). No other analyzed risk factor showed a statistical correlation with wound infection. CONCLUSIONS: The nonuse of antibiotic prophylaxis and other analyzed factors did not present a significant correlation for the increase in the occurrence of wound infection. Studies with a larger sample and a control group without antibiotic prophylaxis are necessary.

RISK FACTORS FOR SURGICAL WOUND INFECTION AFTER ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY.

AIM: One of the ways to avoid infection after surgical procedures is through antibiotic prophylaxis. This occurs in cholecystectomies with certain risk factors for infection. However, some guidelines suggest the use of antibiotic prophylaxis for all cholecystectomies, although current evidence does not indicate any advantage of this practice in the absence of risk factors. This study aimed to evaluate the incidence of wound infection after elective laparoscopic cholecystectomies and the use of antibiotic prophylaxis in these procedures. METHODS: This is a retrospective study of 439 patients with chronic cholecystitis and cholelithiasis, accounting for different risk factors for wound infection. RESULTS: There were 7 (1.59%) cases of wound infection. No antibiotic prophylaxis regimen significantly altered infection rates. There was a statistically significant correlation between wound infection and male patients (p=0.013). No other analyzed risk factor showed a statistical correlation with wound infection. CONCLUSIONS: The non-use of antibiotic prophylaxis and other analyzed factors did not present a significant correlation for the increase in the occurrence of wound infection. Studies with a larger sample and a control group without antibiotic prophylaxis are necessary.

Risk factors for surgical wound infection after elective laparoscopic cholecystectomy / Fatores de risco para infecção de ferida operatória após colecistectomia laparoscópica eletiva

ABSTRACT - BACKGROUND: One of the ways to avoid infection after surgical procedures is through antibiotic prophylaxis. This occurs in cholecystectomies with certain risk factors for infection. However, some guidelines suggest the use of antibiotic prophylaxis for all cholecystectomies, although current evidence does not indicate any advantage of this practice in the absence of risk factors. AIM: This study aimed to evaluate the incidence of wound infection after elective laparoscopic cholecystectomies and the use of antibiotic prophylaxis in these procedures. METHODS: This is a retrospective study of 439 patients with chronic cholecystitis and cholelithiasis, accounting for different risk factors for wound infection. RESULTS: There were 7 (1.59%) cases of wound infection. No antibiotic prophylaxis regimen significantly altered infection rates. There was a statistically significant correlation between wound infection and male patients (p=0.013). No other analyzed risk factor showed a statistical correlation with wound infection. CONCLUSIONS: The non-use of antibiotic prophylaxis and other analyzed factors did not present a significant correlation for the increase in the occurrence of wound infection. Studies with a larger sample and a control group without antibiotic prophylaxis are necessary.

RESUMO - RACIONAL: Uma das formas de evitar infecção após procedimentos cirúrgicos é por meio de profilaxia antibiótica. Isso ocorre em colecistectomias com certos fatores de risco para infecção. No entanto, algumas diretrizes sugerem o uso de profilaxia antibiótica para todas as colecistectomias, embora evidências atuais não indiquem qualquer benefício dessa prática na ausência de fatores de risco. OBJETIVO: Avaliar a incidência de infecção em ferida operatória após colecistectomias laparoscópicas eletivas e o uso de antibioticoprofilaxia nesses procedimentos. MÉTODOS: Estudo retrospectivo de 439 pacientes com colecistite crônica e colelitíase, contabilizados os diferentes fatores de risco para infecção de feridas. RESULTADOS: Ocorreram sete casos de infecção de ferida operatória (1.59%). Nenhum esquema de antibioticoprofilaxia alterou significativamente as taxas de infecção. Foi registrada correlação estatisticamente significativa entre infecção de ferida operatória e pacientes do sexo masculino (p=0.013). Nenhum outro fator de risco analisado demonstrou correlação estatística com infecção de ferida operatória. CONCLUSÕES: O não emprego de antibioticoprofilaxia e outros fatores analisados não apresentaram correlação significativa para aumento da frequência de infecção de ferida operatória. Estudos com maior amostra e grupo controle sem antibioticoprofilaxia são necessários.

Laparoscopic inguinal hernia repair: the long-term assessment of chronic pain and quality of life / Herniorrafia inguinal laparoscópica: avaliação a longo prazo da dor crônica e qualidade de vida

ABSTRACT BACKGROUND: Laparoscopic approaches to inguinal hernia repair include transabdominal extraperitoneal and transabdominal preperitoneal, both of which are widely performed and employ mesh. Indicators of success for these surgical procedures include incidence of complications, time to return to daily activities, incidence of postoperative chronic pain, and the long-term postoperative patient satisfaction. OBJECTIVE: This study aimed to evaluate and compare long-term postoperative incidence of chronic pain and overall quality of life among patients undergoing transabdominal extraperitoneal or transabdominal preperitoneal inguinal hernia repair. METHODS: This was a retrospective cross-sectional study. Medical records were analyzed, and the SF-36 questionnaire and Visual Analog Scale were applied to assess quality of life and chronic pain in patients undergoing laparoscopic inguinal hernia repair between January 2017 and February 2021. RESULTS: A total of 167 patients status post laparoscopic inguinal hernia repair, who were 3 months postoperatively or longer, were included in the study. Among the early complications seen, seroma was most common in the transabdominal preperitoneal group (p=0.04). Subsequently, 40 of the initial 167 patients answered to the survey instrument (SF-36 and Visual Analog Scale). Mean patient-reported pain (Visual Analog Scale score) was statistically similar between groups, with 1.29 for transabdominal preperitoneal and 1.68 for transabdominal extraperitoneal (p=0.92). In the domains evaluated by the SF-36, there was no significant difference between the samples. CONCLUSION: Both transabdominal extraperitoneal and transabdominal preperitoneal techniques for hernia repair have similar results in the late postoperative period regarding quality of life and prevalence of chronic pain. They are also comparable in terms of major early postoperative complications, except for seroma, with a higher incidence in patients undergoing transabdominal preperitoneal.

RESUMO RACIONAL: Atualmente o tratamento da hérnia inguinal pode ser laparoscópico totalmente extraperitoneal ou transabdominal pré-peritoneal, ambas as técnicas utilizam tela e são amplamente empregadas. O sucesso do procedimento cirúrgico é medido pelo menor número de complicações, retorno rápido às atividades cotidianas, presença ou não de dor crônica e pelo grau de satisfação do paciente no pós-operatório. OBJETIVOS: Avaliar e comparar a presença de dor crônica e qualidade de vida no pós operatório tardio de pacientes submetidos às duas técnicas de cirurgias laparoscópicas de correção de hérnia inguinal. MÉTODOS: O estudo consistiu em uma abordagem quantitativa transversal retrospectiva. Foi realizada análise de prontuários e aplicação de questionário SF-36 e Escala Visual Analógica para avaliação de qualidade de vida e dor crônica em pacientes submetidos a hernioplastia inguinal laparoscópica entre janeiro de 2017 a fevereiro de 2021. RESULTADOS: Foram analisados 167 prontuários com mais de 3 meses de pós-operatório. Dentre as complicações precoces avaliadas, o seroma foi mais comumente diagnosticado no grupo transabdominal pré-peritoneal (p=0,04). Posteriormente, 40 dos 167 pacientes responderam ao instrumento de pesquisa composto por SF-36 e Escala Visual Analógica. A média para dor crônica, mensurada através da Escala Visual Analógica, foi de 1,29 para transabdominal pré-peritoneal versus totalmente extraperitoneal com 1,68 (p=0,92). Já nos domínios avaliados pelo SF-36 não houve diferença significativa entre as amostras (p>0,05). CONCLUSÕES: As técnicas totalmente extraperitoneal e transabdominal pré-peritoneal apresentam resultados semelhantes no pós-operatório tardio com base na qualidade de vida e dor crônica. As técnicas também são comparáveis em termos das principais complicações pós-operatórias precoces, exceto para seroma, que apresentou maior incidência em pacientes submetidos a transabdominal pré-peritoneal.

CT scan in the evaluation of pediatric abdominal trauma / Tomografia computadorizada na avaliação do trauma abdominal pediátrico

ABSTRACT Objective: to assess the need of computed tomography (CT) for the definition of management in pediatric abdominal trauma. Methods: observational retrospective study with patients under 18 years old victims of blunt or penetrating abdominal trauma that underwent CT of the abdomen and pelvis at admission. We evaluated CT scan findings, indications and management. We calculated the sensitivity, specificity, positive predictive value and negative predictive value of clinical variables and energy of trauma for findings on CT. Results: among the 236 patients included in our study, 72% (n=170) did not present abnormal findings on CT. It was performed surgical treatment in 15% (n=10), conservative treatment in 54,5% (n=36) and 27% (n=18) did not receive treatment for abdominal injuries. In the assessment of CT indications, 28,8% (n=68) presented no justifications. In this group, 91% (n=62) did not show any abnormal findings. Among the six patients with positive findings, half were selected for conservative treatment, while the rest did not need any treatment for abdominal injuries. The presence of abdominal pain, hemodynamic alterations and high energy blunt trauma had low positive predictive values when isolated, whereas the negative predictive values were higher. Conclusion: although CT is necessary in some instances, there is a possible high number of exams that did not make any difference in the management of the pediatric population.

RESUMO Introdução: avaliar a necessidade da tomografia computadorizada (TC) para definição de condutas em trauma abdominal pediátrico. Métodos: estudo observacional retrospectivo com pacientes menores de 18 anos vítimas de trauma abdominal contuso ou penetrante e que realizaram TC de abdome e pelve na admissão. Avaliou-se achados das tomografias, condutas e justificativas para indicação da TC. Foram calculados sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo de fatores clínicos e energia do trauma para alterações na TC. Resultados: dentre os 236 pacientes incluídos, 72% (n=170) não apresentaram alterações na TC. Foi realizado tratamento cirúrgico em 15% (n=10), tratamento conservador em 54,5% (n=36) e 27% (n=18) não receberam tratamento por lesões abdominais. Na avaliação das indicações de TC, 28,8% (n=68) não apresentavam nenhuma justificativa, sendo que nesse grupo 91% (n=62) resultaram em ausência de achados. Dentre os seis pacientes com achados positivos, metade recebeu tratamento conservador, enquanto o restante não necessitou de tratamento por lesões abdominais. A presença de dor abdominal, alteração hemodinâmica e trauma contuso de alta energia apresentaram baixos valores preditivos positivos de forma isolada, enquanto os valores preditivos negativos foram mais altos. Conclusão: apesar de a TC ser necessária e justificável em alguns casos, há um possível excesso de tomografias dispensáveis para definição de condutas em população pediátrica.

CARVEDILOL AS PRIMARY PROPHYLAXIS FOR GASTRIC VARICEAL BLEEDING IN PORTAL HYPERTENSION MODEL IN RATS.

BACKGROUND: Portal hypertension (PH) can be measured indirectly through a hepatic vein pressure gradient greater than 5 mmHg. Cirrhosis is the leading cause for PH and can present as complications ascites, hepatic dysfunction, renal dysfunction, and esophagogastric varices, characterizing gastropathy. AIM: To evaluate the use of carvedilol as primary prophylaxis in the development of collateral circulation in rats submitted to the partial portal vein ligament (PPVL) model. METHOD: This is a combined qualitative and quantitative experimental study in which 32 Wistar rats were divided into four groups (8 animals in each): group I - cirrhosis + carvedilol (PPVL + C); group II - cirrhosis + vehicle (PPVL); group III - control + carvedilol (SO-sham-operated + C); group IV - control + vehicle (SO-sham-operated). After seven days of the surgical procedure (PPVL or sham), carvedilol (10 mg/kg) or vehicle (1 mL normal saline) were administered to the respective groups daily for seven days. RESULTS: The histological analysis showed no hepatic alteration in any group and a decrease in edema and vasodilatation in the PPVL + C group. The laboratory evaluation of liver function did not show a statistically significant change between the groups. CONCLUSION: Carvedilol was shown to have a positive effect on gastric varices without significant adverse effects.

Surgical cricothyroidostomy. Analysis and comparison between teaching and validation models of simulator models.

OBJECTIVE: to compare the acquisition and retention of knowledge about surgical cricothyroidostomy by the rapid four-step technique (RFST), when taught by expository lecture, low fidelity and high-fidelity simulation models. METHODS: ninety medical students at UFPR in the first years of training were randomized assigned into 3 groups, submitted to different teaching methods: 1) expository lectures, 2) low-fidelity simulator model, developed by the research team or 3) high-fidelity simulator model (commercial). The procedure chosen was surgical cricothyroidostomy using the RFST. Soon after lectures, the groups were submitted to a multiple-choice test with 20 questions (P1). Four months later, they underwent another test (P2) with similar content. Analysis of Variance was used to compare the grades of each group in P1 with their grades in P2, and the grades of the 3 groups 2 by 2 in P1 and P2. A multiple comparisons test (post-hoc) was used to check differences within each factor (test and group). Statistical significance was considered when p<0.05. Statistical analysis was performed in the statistical software R version 3.6.1. RESULTS: each group was composed of 30 medical students, without demographic differences between them. The mean scores of the groups of the expositive lecture, of the simulator of low fidelity model and of high-fidelity simulator model in P1 were, respectively, 75.00, 76.09, and 68.79, (p<0.05). In P2 the grades were 69.84, 75.32, 69.46, respectively, (p>0.05). CONCLUSIONS: the simulation of low fidelity model was more effective in learning and knowledge retention, being feasible for RFST cricothyroidostomy training in inexperienced students.

Predictive factors of low anterior resection syndrome following anterior resection of the rectum. / Síndrome da ressecção anterior do reto: fatores preditivos.

OBJECTIVE: to identify predictors of low anterior resection syndrome (LARS) that can contribute to its early diagnosis and treatment. METHODS: we conducted a retrospective cohort study of patients undergoing anterior resection of the rectum between 2007 and 2017 in the Coloproctology Service of the Federal University of Parana Clinics Hospital. We performed Receiver Operating Characteristic Curve (ROC) analysis to identify LARS predictive factors. RESULTS: we included 64 patients with complete data. The men's age was 60.1±11.4 years and 37.10% were male. Twenty patients (32.26%) had LARS. The most reported symptoms were incomplete evacuation (60%) and urgency (55%). In the univariate analysis, the distance from the anastomosis to the anal margin (p<0.001), neoadjuvant therapy (p=0.0014) and ileostomy at the time of resection (p=0.0023) were predictive of LARS. The ROC curve analysis showed a 6.5cm cut-off distance from the anastomosis to the anal margin as a predictor of LARS. CONCLUSION: distance between the anastomosis and the anal margin, neoadjuvant therapy history and preparation of stoma are conditions that can help predict the development of LARS. Guidance and involvement in patient education, as well as early management, can potentially reduce the impact of these symptoms on patients' quality of life.

OBJETIVO: identificar fatores preditivos da síndrome da ressecção anterior do reto (SRAR) que podem contribuir para o seu diagnóstico e tratamento precoces. MÉTODOS: estudo de coorte retrospectivo de pacientes submetidos à ressecção anterior do reto entre 2007 e 2017 no Serviço de Coloproctologia do Hospital de Clínicas da Universidade Federal do Paraná. Foram realizadas análises de curva ROC (Receiver Operating Characteristic Curve Analysis) ou COR (Característica de Operação do Receptor) para identificar os fatores preditivos da SRAR. RESULTADOS: foram incluídos 64 pacientes com dados completos. A idade dos homens foi de 60,1±11,4 anos e 37,10% eram do sexo masculino. Vinte pacientes (32,26%) apresentaram SRAR. Os sintomas mais relatados foram evacuação incompleta (60%) e urgência (55%). Na análise univariada, a distância da anastomose à margem anal (p<0,001), terapia neoadjuvante (p=0,0014) e confecção de ileostomia no momento da ressecção (p=0,0023) foram preditivos da SRAR. Análise da curva ROC mostrou um ponto de corte de 6,5cm na distância da anastomose à margem anal como preditor da SRAR. CONCLUSÃO: distância entre anastomose e margem anal, história de terapia neoajuvante e confecção de estoma são condições que podem ajudar a predizer o desenvolvimento da SRAR. A orientação e o envolvimento na educação do paciente, bem como, o manejo precoce podem reduzir potencialmente o impacto desses sintomas na qualidade de vida dos pacientes.

Carvedilol as primary prophylaxis for gastric variceal bleeding in portal hypertension model in rats / Carvedilol como profilaxia de sangramento em varizes gástricas em modelo de hipertensão portal em ratos

ABSTRACT Background: Portal hypertension (PH) can be measured indirectly through a hepatic vein pressure gradient greater than 5 mmHg. Cirrhosis is the leading cause for PH and can present as complications ascites, hepatic dysfunction, renal dysfunction, and esophagogastric varices, characterizing gastropathy. Aim: To evaluate the use of carvedilol as primary prophylaxis in the development of collateral circulation in rats submitted to the partial portal vein ligament (PPVL) model. Method: This is a combined qualitative and quantitative experimental study in which 32 Wistar rats were divided into four groups (8 animals in each): group I - cirrhosis + carvedilol (PPVL + C); group II - cirrhosis + vehicle (PPVL); group III - control + carvedilol (SO-sham-operated + C); group IV - control + vehicle (SO-sham-operated). After seven days of the surgical procedure (PPVL or sham), carvedilol (10 mg/kg) or vehicle (1 mL normal saline) were administered to the respective groups daily for seven days. Results: The histological analysis showed no hepatic alteration in any group and a decrease in edema and vasodilatation in the PPVL + C group. The laboratory evaluation of liver function did not show a statistically significant change between the groups. Conclusion: Carvedilol was shown to have a positive effect on gastric varices without significant adverse effects.

RESUMO Racional: A hipertensão portal (HP), medida indiretamente através do gradiente pressórico da veia hepática >5 mmHg, tem como principal causa etiológica a cirrose. Possui como complicações a ascite, disfunção hepática, disfunção renal e varizes esofagogástricas, que caracterizam o quadro de gastropatia. Objetivo: Avaliar o uso do carvedilol como profilaxia primária no desenvolvimento da circulação colateral em ratos submetidos ao modelo de ligadura parcial de veia porta (LPVP). Método: Estudo experimental qualitativo e quantitativo no qual foram utilizados 32 ratos Wistar, divididos em quatro grupos (n=8): grupo I - cirrose + carvedilol (LPVP+C); grupo II - cirrose + veículo (LPVP); grupo III - controle + carvedilol (SO - sham-operated+C); grupo IV - controle + veículo (SO - sham-operated). Após transcorridos sete dias do procedimento cirúrgico, foi administrado carvedilol (10 mg/kg) e veículo (1mL) para os respectivos grupos por sete dias consecutivos. Resultados: A análise histológica não mostrou alteração hepática em nenhum grupo e diminuição de edema e vasodilatação no grupo LPVP+C. A avaliação laboratorial da função hepática não mostrou alteração com significância estatística entre os grupos. Conclusão: Carvedilol mostrou ser fármaco com efeito positivo no sangramento das varizes gástricas e sem efeitos adversos significantes.

Surgical cricothyroidostomy. Analysis and comparison between teaching and validation models of simulator models / Cricotireoidostomia cirúrgica. Análise e comparação entre modelos de ensino e validação de simuladores

ABSTRACT Objective: to compare the acquisition and retention of knowledge about surgical cricothyroidostomy by the rapid four-step technique (RFST), when taught by expository lecture, low fidelity and high-fidelity simulation models. Methods: ninety medical students at UFPR in the first years of training were randomized assigned into 3 groups, submitted to different teaching methods: 1) expository lectures, 2) low-fidelity simulator model, developed by the research team or 3) high-fidelity simulator model (commercial). The procedure chosen was surgical cricothyroidostomy using the RFST. Soon after lectures, the groups were submitted to a multiple-choice test with 20 questions (P1). Four months later, they underwent another test (P2) with similar content. Analysis of Variance was used to compare the grades of each group in P1 with their grades in P2, and the grades of the 3 groups 2 by 2 in P1 and P2. A multiple comparisons test (post-hoc) was used to check differences within each factor (test and group). Statistical significance was considered when p<0.05. Statistical analysis was performed in the statistical software R version 3.6.1. Results: each group was composed of 30 medical students, without demographic differences between them. The mean scores of the groups of the expositive lecture, of the simulator of low fidelity model and of high-fidelity simulator model in P1 were, respectively, 75.00, 76.09, and 68.79, (p<0.05). In P2 the grades were 69.84, 75.32, 69.46, respectively, (p>0.05). Conclusions: the simulation of low fidelity model was more effective in learning and knowledge retention, being feasible for RFST cricothyroidostomy training in inexperienced students.

RESUMO Objetivo: comparar a aquisição e retenção de conhecimento, sobre cricotireoidostomia cirúrgica pela técnica rápida de quatro tempos (TRQT), quando ensinada por aula expositiva, simulação de baixa fidelidade e de alta fidelidade. Métodos: noventa alunos de medicina da UFPR dos primeiros anos foram randomizados em 3 grupos: 1) aula expositiva, 2) simulador de baixa fidelidade, ou 3) simulador de alta fidelidade (comercial). O tema exposto foi a cricotireoidostomia cirúrgica pela técnica rápida de quatro tempos (TRQT). Logo após as aulas, os grupos foram submetidos a uma prova de múltipla escolha com 20 questões (P1). Quatro meses após, realizaram uma outra prova (P2), com conteúdo similar. Análise de Variância foi usada para comparar as notas de cada grupo na P1 com suas notas na P2, e as notas dos 3 grupos de 2 a 2 na P1 e na P2. Utilizou-se um teste de comparações múltiplas (post-hoc) para verificar diferenças dentro de cada fator (prova e grupo). Considerou-se significância estatística quando p<0,05. A análise estatística foi feita no software estatístico R versão 3.6.1. Resultados: cada grupo foi composto de 30 estudantes de medicina, sem diferenças demográficas entre os grupos. As notas médias dos grupos da aula expositiva, do modelo de baixa fidelidade e de alta fidelidade na P1 foram, respectivamente, 75,00, 76,09, e 68,79, (p<0,05). Na P2 as notas foram respectivamente 69,84, 75,32, 69,46, (p>0,05). Conclusão: a simulação de baixa fidelidade foi mais eficaz no aprendizado e na retenção de conhecimento, sendo viável para o treinamento de cricotireoidostomia TRQT em alunos inexperientes.

Síndrome da bolsa roxa de urina: um diagnóstico raro na sala de emergência / Purple urine bag syndrome: a rare diagnosis in the emergency room

A Síndrome da Bolsa Roxa de Urina, ou Síndrome da Urina Roxa, é uma manifestação rara de infecção do trato urinário. A cor roxa apresentada pela urina é decorrente de produtos metabólicos de reações bioquímicas desencadeadas por enzimas bacterianas. Este é um diagnóstico pontual, mas a falta de conhecimento dos prestadores de cuidados de saúde sobre esta condição pode resultar em erros diagnósticos e tratamentos inadequados. O presente relato traz o caso de um paciente idoso com episódios recorrentes de Síndrome da Bolsa Roxa de Urina. Este buscava repetidamente atendimentos de emergência e obteve resultado favorável após a mudança do saco coletor de urina e orientação adequada de medidas preventivas.

Purple Urine Bag Syndrome is an uncommon manifestation of urinary tract infection. The purple color observed in the urine is a result of metabolic products from biochemical reactions of bacterial enzymes. This syndrome is very specific. Nevertheless, the lack of awareness among healthcare providers can result in misdiagnosis and inappropriate treatment regimens. We report the case of an elderly patient with recurrent episodes of Purple Urine Bag Syndrome who repeatedly sought medical care in acute care facilities, and presented favorable outcome after change of the urine bag and after receiving information on preventive and behavioral measures.

Evaluation of traumatic brain injury patients with signs of alcohol intoxication. / Avaliação de pacientes vítimas de trauma cranioencefálico com sinais de intoxicação alcoólica.

OBJETIVE: to evaluate the influence of alcohol intoxication in the time to perform head computed tomography and tomographic findings in traumatic brain injury patients. METHODS: a retrospective study of 183 traumatic brain injury patients, divided into two groups: 90 alcoholics and 93 non-alcoholics. Time interval from patient's arrival at emergency room to tomography was calculated for comparison between the groups, and tomographic findings were analyzed. RESULTS: in the alcoholic group, the percentage of male patients was higher, the predominant age was between 31 and 40 years, aggression was the most frequent trauma mechanism, and these patients showed lower values on the Glasgow coma scale. It was observed that there was no statistical difference between the two groups regarding the time interval for tomography execution, as well as regarding the tomographic findings. In addition, in the alcoholic patients, when the Glasgow coma scale values were correlated with the time interval, there was no difference from scores 13 to 15 (mild traumatic brain injury) and those equal to or inferior than 12 (moderate and severe traumatic brain injury). CONCLUSION: signs of alcoholic intoxication did not influence the time interval for tomography execution. Patients under alcohol influence showed lower scores on the Glasgow coma scale due to the direct effect of alcohol and not due to a higher prevalence of tomographic findings.

OBJETIVO: avaliar, em vítimas de traumatismo cranioencefálico, a influência da intoxicação alcoólica no tempo para submissão destes pacientes à tomografia de crânio, comparando também os achados tomográficos nos pacientes alcoolizados e não alcoolizados. MÉTODOS: estudo retrospectivo de 183 pacientes com traumatismo cranioencefálico, divididos em dois grupos: 90 alcoolizados e 93 não alcoolizados. Foi calculado o intervalo de tempo desde a chegada do paciente ao pronto socorro até a realização da tomografia para comparação entre os grupos, e analisados os achados tomográficos. RESULTADOS: no grupo alcoolizado, o percentual de pacientes do sexo masculino foi maior, a idade predominante situava-se entre os 31 e os 40 anos, a agressão foi o mecanismo de trauma mais frequente e estes pacientes apresentaram valores mais baixos na escala de coma de Glasgow. Observou-se que não houve diferença estatística entre os dois grupos quanto ao intervalo de tempo para realização de tomografia, bem como, em relação aos achados tomográficos. Além disso, nos pacientes alcoolizados, quando correlacionados os valores da escala de coma de Glasgow com o intervalo de tempo, não houve diferença entre valores de 13 a 15 (traumatismo cranioencefálico leve) e os iguais ou menores do que 12 (traumatismo cranioencefálico moderado e grave). CONCLUSÃO: os sinais de intoxicação alcoólica não influenciaram no intervalo de tempo para realização da tomografia. Os pacientes alcoolizados apresentaram escores mais baixos na escala de coma de Glasgow por efeito direto do álcool e não por uma maior prevalência de achados tomográficos.

Avaliação de pacientes vítimas de trauma cranioencefálico com sinais de intoxicação alcoólica / Evaluation of traumatic brain injury patients with signs of alcohol intoxication

RESUMO Objetivo: avaliar, em vítimas de traumatismo cranioencefálico, a influência da intoxicação alcoólica no tempo para submissão destes pacientes à tomografia de crânio, comparando também os achados tomográficos nos pacientes alcoolizados e não alcoolizados. Métodos: estudo retrospectivo de 183 pacientes com traumatismo cranioencefálico, divididos em dois grupos: 90 alcoolizados e 93 não alcoolizados. Foi calculado o intervalo de tempo desde a chegada do paciente ao pronto socorro até a realização da tomografia para comparação entre os grupos, e analisados os achados tomográficos. Resultados: no grupo alcoolizado, o percentual de pacientes do sexo masculino foi maior, a idade predominante situava-se entre os 31 e os 40 anos, a agressão foi o mecanismo de trauma mais frequente e estes pacientes apresentaram valores mais baixos na escala de coma de Glasgow. Observou-se que não houve diferença estatística entre os dois grupos quanto ao intervalo de tempo para realização de tomografia, bem como, em relação aos achados tomográficos. Além disso, nos pacientes alcoolizados, quando correlacionados os valores da escala de coma de Glasgow com o intervalo de tempo, não houve diferença entre valores de 13 a 15 (traumatismo cranioencefálico leve) e os iguais ou menores do que 12 (traumatismo cranioencefálico moderado e grave). Conclusão: os sinais de intoxicação alcoólica não influenciaram no intervalo de tempo para realização da tomografia. Os pacientes alcoolizados apresentaram escores mais baixos na escala de coma de Glasgow por efeito direto do álcool e não por uma maior prevalência de achados tomográficos.

ABSTRACT Objetive: to evaluate the influence of alcohol intoxication in the time to perform head computed tomography and tomographic findings in traumatic brain injury patients. Methods: a retrospective study of 183 traumatic brain injury patients, divided into two groups: 90 alcoholics and 93 non-alcoholics. Time interval from patient's arrival at emergency room to tomography was calculated for comparison between the groups, and tomographic findings were analyzed. Results: in the alcoholic group, the percentage of male patients was higher, the predominant age was between 31 and 40 years, aggression was the most frequent trauma mechanism, and these patients showed lower values on the Glasgow coma scale. It was observed that there was no statistical difference between the two groups regarding the time interval for tomography execution, as well as regarding the tomographic findings. In addition, in the alcoholic patients, when the Glasgow coma scale values were correlated with the time interval, there was no difference from scores 13 to 15 (mild traumatic brain injury) and those equal to or inferior than 12 (moderate and severe traumatic brain injury). Conclusion: signs of alcoholic intoxication did not influence the time interval for tomography execution. Patients under alcohol influence showed lower scores on the Glasgow coma scale due to the direct effect of alcohol and not due to a higher prevalence of tomographic findings.

Síndrome da ressecção anterior do reto: fatores preditivos / Predictive factors of low anterior resection syndrome following anterior resection of the rectum

RESUMO Objetivo: identificar fatores preditivos da síndrome da ressecção anterior do reto (SRAR) que podem contribuir para o seu diagnóstico e tratamento precoces. Métodos: estudo de coorte retrospectivo de pacientes submetidos à ressecção anterior do reto entre 2007 e 2017 no Serviço de Coloproctologia do Hospital de Clínicas da Universidade Federal do Paraná. Foram realizadas análises de curva ROC (Receiver Operating Characteristic Curve Analysis) ou COR (Característica de Operação do Receptor) para identificar os fatores preditivos da SRAR. Resultados: foram incluídos 64 pacientes com dados completos. A idade dos homens foi de 60,1±11,4 anos e 37,10% eram do sexo masculino. Vinte pacientes (32,26%) apresentaram SRAR. Os sintomas mais relatados foram evacuação incompleta (60%) e urgência (55%). Na análise univariada, a distância da anastomose à margem anal (p<0,001), terapia neoadjuvante (p=0,0014) e confecção de ileostomia no momento da ressecção (p=0,0023) foram preditivos da SRAR. Análise da curva ROC mostrou um ponto de corte de 6,5cm na distância da anastomose à margem anal como preditor da SRAR. Conclusão: distância entre anastomose e margem anal, história de terapia neoajuvante e confecção de estoma são condições que podem ajudar a predizer o desenvolvimento da SRAR. A orientação e o envolvimento na educação do paciente, bem como, o manejo precoce podem reduzir potencialmente o impacto desses sintomas na qualidade de vida dos pacientes.

ABSTRACT Objective: to identify predictors of low anterior resection syndrome (LARS) that can contribute to its early diagnosis and treatment. Methods: we conducted a retrospective cohort study of patients undergoing anterior resection of the rectum between 2007 and 2017 in the Coloproctology Service of the Federal University of Parana Clinics Hospital. We performed Receiver Operating Characteristic Curve (ROC) analysis to identify LARS predictive factors. Results: we included 64 patients with complete data. The men's age was 60.1±11.4 years and 37.10% were male. Twenty patients (32.26%) had LARS. The most reported symptoms were incomplete evacuation (60%) and urgency (55%). In the univariate analysis, the distance from the anastomosis to the anal margin (p<0.001), neoadjuvant therapy (p=0.0014) and ileostomy at the time of resection (p=0.0023) were predictive of LARS. The ROC curve analysis showed a 6.5cm cut-off distance from the anastomosis to the anal margin as a predictor of LARS. Conclusion: distance between the anastomosis and the anal margin, neoadjuvant therapy history and preparation of stoma are conditions that can help predict the development of LARS. Guidance and involvement in patient education, as well as early management, can potentially reduce the impact of these symptoms on patients' quality of life.

Influence of trauma origin site on admission rates of patients submitted to emergency laparotomy. / Influência do local de origem do trauma nos índices de admissão de pacientes submetidos à laparotomia de emergência.

OBJECTIVE: to evaluate the influence of the site of trauma occurrence on the trauma scores of patients submitted to emergency laparotomy. METHODS: this is a retrospective, observational, analytical study. We included 212 patients who underwent exploratory laparotomies in the period of January 2015 and December 2017. We obtained information about the accident site and vital data of the patients based on data collection through electronic and physical records. We analyzed the trauma indices of patients from Curitiba and its Metropolitan Region and the place where the patient was rescued (physical establishment or public road). RESULTS: among the 212 patients studied, 184 (86.7%) were brought by the Prehospital Care Service from the city of Curitiba, and 28 (13.3%), from the Metropolitan Region of Curitiba. Twenty-five patients (17.6%) were rescued in physical establishments, while 117 (82.4%) were rescued on public roads. We observed higher values ​​of Injurity Severity Scores (ISS) in patients coming from the Metropolitan Region than in those coming from Curitiba (29.78 vs 22.46, P=0.009), but higher values ​​of Trauma and Injury Severity Scores (TRISS) in patients from Curitiba than the ones from the Metropolitan Region (90.62 vs 81.30, P=0.015). Patients rescued in public roads presented lower Revised Trauma Scores (RTS) (6.96 vs 7.65, P=0.024) and TRISS (86.42 vs 97.21; P=0.012). CONCLUSION: trauma victims from sites more distant from the referral center and rescued on public roads presented worse prognosis.

OBJETIVO: avaliar a influência do local de ocorrência do trauma nos escores de trauma de pacientes submetidos à laparotomia de emergência. MÉTODOS: estudo retrospectivo observacional analítico. Foram incluídos 212 pacientes submetidos à laparotomias exploratórias no período de janeiro de 2015 e dezembro de 2017. Informações sobre o local do acidente e dados vitais dos pacientes foram obtidas com base na coleta de dados por meio de prontuários eletrônicos e físicos. Foram analisados os índices de trauma de pacientes provenientes de Curitiba e Região Metropolitana e o local em que o paciente foi socorrido (estabelecimento físico ou via pública). RESULTADOS: entre os 212 pacientes estudados, 184 (86,7%) foram trazidos pelo Serviço de Atendimento Pré-Hospitalar provenientes da cidade Curitiba e 28 (13,3%) provenientes de Região Metropolitana de Curitiba. Foram socorridos em estabelecimentos físicos 25 pacientes (17,6%), enquanto 117 (82,4%) foram socorridos em via pública. Observou-se maiores valores de ISS (Injurity Severity Score) dos pacientes procedentes da Região Metropolitana em relação aos procedentes de Curitiba (29,78 vs 22,46, P=0,009), enquanto valores maiores do TRISS (Trauma Trauma and Injury Severity Score) foram observados em pacientes procedentes de Curitiba em relação aos da Região Metropolitana (90,62 vs 81,30; P=0,015). Pacientes socorridos em via pública apresentaram menor valor de RTS (Revised Trauma Score) (6,96 vs 7,65; P=0,024) e TRISS (86,42 vs 97,21; P=0,012). CONCLUSÃO: pacientes vítimas de trauma procedentes de locais mais distantes do atendimento no centro de referência apresentaram pior prognóstico à admissão e foi observado pior prognóstico em pacientes socorridos em via pública.

The role of computerized tomography in penetrating abdominal trauma.

OBJECTIVE: to evaluate the role of abdominal computed tomography in the management of penetrating abdominal trauma. METHODS: we conducted a historical cohort study of patients treated for penetrating trauma in the anterior abdomen, dorsum or thoracoabdominal transition, that were submitted to a computed tomography carried out on admission. We evaluated the location of the wound and the presence of tomographic findings, and the management of these patients as for nonoperative treatment or laparotomy. We calculated the sensitivity and specificity of computed tomography according to the evolution of the nonoperative treatment or the surgical findings. RESULTS: we selected 61 patients, 31 with trauma to the anterior abdomen and 30 to the dorsum or thoracoabdominal transition. The mortality rate was 6.5% (n=4), all in the late postoperative period. Eleven patients with trauma to the anterior abdomen were submitted to nonoperative treatment, and 20, to laparotomy. Of the 30 patients with trauma to the dorsum or thoracoabdominal transition, 23 underwent nonoperative treatment and seven, laparotomy. There were three nonoperative treatment failures. In penetrating trauma of the anterior abdomen, the sensitivity of computed tomography was 94.1% and the negative predictive value was 93.3%. In dorsal or thoracoabdominal transition lesions, the sensitivity was 90% and the negative predictive value was 95.5%. In both groups, the specificity and the positive predictive value were 100%. CONCLUSION: the accuracy of computed tomography was adequate to guide the management of stable patients who could be treated conservatively, avoiding mandatory surgery in 34 patients and reducing the morbidity and mortality of non-therapeutic laparotomies.

The role of computerized tomography in penetrating abdominal trauma / O papel da tomografia no trauma abdominal penetrante

ABSTRACT Objective: to evaluate the role of abdominal computed tomography in the management of penetrating abdominal trauma. Methods: we conducted a historical cohort study of patients treated for penetrating trauma in the anterior abdomen, dorsum or thoracoabdominal transition, that were submitted to a computed tomography carried out on admission. We evaluated the location of the wound and the presence of tomographic findings, and the management of these patients as for nonoperative treatment or laparotomy. We calculated the sensitivity and specificity of computed tomography according to the evolution of the nonoperative treatment or the surgical findings. Results: we selected 61 patients, 31 with trauma to the anterior abdomen and 30 to the dorsum or thoracoabdominal transition. The mortality rate was 6.5% (n=4), all in the late postoperative period. Eleven patients with trauma to the anterior abdomen were submitted to nonoperative treatment, and 20, to laparotomy. Of the 30 patients with trauma to the dorsum or thoracoabdominal transition, 23 underwent nonoperative treatment and seven, laparotomy. There were three nonoperative treatment failures. In penetrating trauma of the anterior abdomen, the sensitivity of computed tomography was 94.1% and the negative predictive value was 93.3%. In dorsal or thoracoabdominal transition lesions, the sensitivity was 90% and the negative predictive value was 95.5%. In both groups, the specificity and the positive predictive value were 100%. Conclusion: the accuracy of computed tomography was adequate to guide the management of stable patients who could be treated conservatively, avoiding mandatory surgery in 34 patients and reducing the morbidity and mortality of non-therapeutic laparotomies.

RESUMO Objetivo: avaliar o papel da tomografia computadorizada de abdome no manejo do trauma abdominal penetrante. Métodos: estudo de coorte histórico de pacientes tratados por trauma penetrante em abdome anterior, dorso ou transição tóraco-abdominal que realizaram tomografia computadorizada à admissão. Avaliou-se a localização do ferimento e a presença de achados tomográficos, e o manejo desses pacientes quanto ao tratamento não operatório ou laparotomia. A sensibilidade e especificidade da tomografia computadorizada foram calculadas de acordo com a evolução do tratamento não operatório ou com os achados cirúrgicos. Resultados: foram selecionados 61 pacientes, 31 com trauma em abdome anterior e 30 em dorso ou transição tóraco-abdominal. A taxa de mortalidade foi de 6,5% (n=4), todos no pós-operatório tardio. Onze pacientes com trauma em abdome anterior foram submetidos a tratamento não operatório e 20 à laparotomia. Dos 30 pacientes com trauma em dorso ou transição tóraco-abdominal, 23 realizaram tratamento não operatório e sete foram submetidos à laparotomia. Houve três falhas do tratamento não operatório. Em traumas penetrantes do abdome anterior, a sensibilidade da TC foi de 94,1% e o valor preditivo negativo, 93,3%. Em lesões de dorso ou transição tóraco-abdominal, a sensibilidade foi de 90%, e o valor preditivo negativo foi de 95,5%. Em ambos os grupos, a especificidade e o valor preditivo positivo foram de 100%. Conclusão: a acurácia da tomografia computadorizada foi adequada para direcionar o manejo de pacientes estáveis que puderam ser tratados de forma conservadora, evitando cirurgia mandatória em 34 pacientes e reduzindo a morbimortalidade de laparotomias não terapêuticas.

Influência do local de origem do trauma nos índices de admissão de pacientes submetidos à laparotomia de emergência / Influence of trauma origin site on admission rates of patients submitted to emergency laparotomy

RESUMO Objetivo: avaliar a influência do local de ocorrência do trauma nos escores de trauma de pacientes submetidos à laparotomia de emergência. Métodos: estudo retrospectivo observacional analítico. Foram incluídos 212 pacientes submetidos à laparotomias exploratórias no período de janeiro de 2015 e dezembro de 2017. Informações sobre o local do acidente e dados vitais dos pacientes foram obtidas com base na coleta de dados por meio de prontuários eletrônicos e físicos. Foram analisados os índices de trauma de pacientes provenientes de Curitiba e Região Metropolitana e o local em que o paciente foi socorrido (estabelecimento físico ou via pública). Resultados: entre os 212 pacientes estudados, 184 (86,7%) foram trazidos pelo Serviço de Atendimento Pré-Hospitalar provenientes da cidade Curitiba e 28 (13,3%) provenientes de Região Metropolitana de Curitiba. Foram socorridos em estabelecimentos físicos 25 pacientes (17,6%), enquanto 117 (82,4%) foram socorridos em via pública. Observou-se maiores valores de ISS (Injurity Severity Score) dos pacientes procedentes da Região Metropolitana em relação aos procedentes de Curitiba (29,78 vs 22,46, P=0,009), enquanto valores maiores do TRISS (Trauma Trauma and Injury Severity Score) foram observados em pacientes procedentes de Curitiba em relação aos da Região Metropolitana (90,62 vs 81,30; P=0,015). Pacientes socorridos em via pública apresentaram menor valor de RTS (Revised Trauma Score) (6,96 vs 7,65; P=0,024) e TRISS (86,42 vs 97,21; P=0,012). Conclusão: pacientes vítimas de trauma procedentes de locais mais distantes do atendimento no centro de referência apresentaram pior prognóstico à admissão e foi observado pior prognóstico em pacientes socorridos em via pública.

ABSTRACT Objective: to evaluate the influence of the site of trauma occurrence on the trauma scores of patients submitted to emergency laparotomy. Methods: this is a retrospective, observational, analytical study. We included 212 patients who underwent exploratory laparotomies in the period of January 2015 and December 2017. We obtained information about the accident site and vital data of the patients based on data collection through electronic and physical records. We analyzed the trauma indices of patients from Curitiba and its Metropolitan Region and the place where the patient was rescued (physical establishment or public road). Results: among the 212 patients studied, 184 (86.7%) were brought by the Prehospital Care Service from the city of Curitiba, and 28 (13.3%), from the Metropolitan Region of Curitiba. Twenty-five patients (17.6%) were rescued in physical establishments, while 117 (82.4%) were rescued on public roads. We observed higher values ​​of Injurity Severity Scores (ISS) in patients coming from the Metropolitan Region than in those coming from Curitiba (29.78 vs 22.46, P=0.009), but higher values ​​of Trauma and Injury Severity Scores (TRISS) in patients from Curitiba than the ones from the Metropolitan Region (90.62 vs 81.30, P=0.015). Patients rescued in public roads presented lower Revised Trauma Scores (RTS) (6.96 vs 7.65, P=0.024) and TRISS (86.42 vs 97.21; P=0.012). Conclusion: trauma victims from sites more distant from the referral center and rescued on public roads presented worse prognosis.