Is it possible to do a microvascular anastomosis with an ordinary video camera? Experimental study.

An alternative method of magnification for microvascular anastomosis was analyzed using an ordinary video camera and compared with the traditional method under microscope. For this study 20 rats were divided in two groups of 10 each: control group (microscope-assisted [M]) and experimental group (video-assisted [V]). Magnification was accomplished by a surgical microscope in group M, whereas a video system composed of low-cost camera, audiovisual cable, and analogue television in group V. In both groups, the right femoral artery was severed and sutured with interrupted simple stitches. The criteria examined were: patency, vessel diameter, amount of sutures, anastomosis time, and histologic features. There were no differences between both groups in patency rate and vessel diameter. The video-assisted microanastomosis is a time-consuming procedure as compared with the microscope-assisted anastomosis, to a certain extent due to lack of stereoscopic image and technical inability with the video system as well. There was a smaller quantity of sutures in group V. Higher foreign body tissue reaction was found in group M, consequent to greater amount of suture material. In conclusion, video-assisted microanastomosis is possible with the present video system but is not as safe as conventional microanastomosis.

Nosocomial infections in brazilian pediatric patients: using a decision tree to identify high mortality groups

Nosocomial infections (NI) are frequent events with potentially lethal outcomes. We identified predictive factors for mortality related to NI and developed an algorithm for predicting that risk in order to improve hospital epidemiology and healthcare quality programs. We made a prospective cohort NI surveillance of all acute-care patients according to the National Nosocomial Infections Surveillance System guidelines since 1992, applying the Centers for Disease Control and Prevention 1988 definitions adapted to a Brazilian pediatric hospital. Thirty-eight deaths considered to be related to NI were analyzed as the outcome variable for 754 patients with NI, whose survival time was taken into consideration. The predictive factors for mortality related to NI (p < 0.05 in the Cox regression model) were: invasive procedures and use of two or more antibiotics. The mean survival time was significantly shorter (p < 0.05 with the Kaplan-Meier method) for patients who suffered invasive procedures and for those who received two or more antibiotics. Applying a tree-structured survival analysis (TSSA), two groups with high mortality rates were identified: one group with time from admission to the first NI less than 11 days, received two or more antibiotics and suffered invasive procedures; the other group had the first NI between 12 and 22 days after admission and was subjected to invasive procedures. The possible modifiable factors to prevent mortality involve invasive devices and antibiotics. The TSSA approach is helpful to identify combinations of predictors and to guide protective actions to be taken in continuous-quality-improvement programs.

Nosocomial infections in Brazilian pediatric patients: using a decision tree to identify high mortality groups.

Nosocomial infections (NI) are frequent events with potentially lethal outcomes. We identified predictive factors for mortality related to NI and developed an algorithm for predicting that risk in order to improve hospital epidemiology and healthcare quality programs. We made a prospective cohort NI surveillance of all acute-care patients according to the National Nosocomial Infections Surveillance System guidelines since 1992, applying the Centers for Disease Control and Prevention 1988 definitions adapted to a Brazilian pediatric hospital. Thirty-eight deaths considered to be related to NI were analyzed as the outcome variable for 754 patients with NI, whose survival time was taken into consideration. The predictive factors for mortality related to NI (p < 0.05 in the Cox regression model) were: invasive procedures and use of two or more antibiotics. The mean survival time was significantly shorter (p < 0.05 with the Kaplan-Meier method) for patients who suffered invasive procedures and for those who received two or more antibiotics. Applying a tree-structured survival analysis (TSSA), two groups with high mortality rates were identified: one group with time from admission to the first NI less than 11 days, received two or more antibiotics and suffered invasive procedures; the other group had the first NI between 12 and 22 days after admission and was subjected to invasive procedures. The possible modifiable factors to prevent mortality involve invasive devices and antibiotics. The TSSA approach is helpful to identify combinations of predictors and to guide protective actions to be taken in continuous-quality-improvement programs.

Antiproliferative activity of Copaifera duckei oleoresin on liver regeneration in rats.

Copaiba oleoresin is widely used in folk medicine as an antiinflammatory, healing and antiseptic agent. Wistar rats received Copaifera duckei oleoresin (CDO) or saline solution (SS) from 7 days before surgery until killing. Partial hepatectomy (PH) or sham-operation was performed. Hepatocellular proliferation and liver mitochondrial respiration were evaluated 24 h after the procedure. The proliferating cell nuclear antigen labelling index was significantly lower in CDO-treated plus PH rats than in SS-treated plus PH rats, suggesting that CDO inhibited cell proliferation. The state 3 and state 4 respiration rates were greater for CDO-treated groups, and the stimulation of state 4 respiration was more expressive. These data resulted in a significant decrease in the respiratory control ratio observed for CDO-treated groups, demonstrating the ability of CDO to uncouple oxidative phosphorylation in mitochondria, a fact that may be one explanation for the inhibition of hepatocellular proliferation observed in the CDO-treated plus PH group.