RESUMO
O conceito "controle de danos" está estabelecido no manejo de pacientes gravemente traumatizados. Essa estratégia salva vidas ao adiar o reparo definitivo das lesões anatômicas e concentrar-se na restauração da fisiologia. O objetivo da laparotomia no controle de danos é interromper a hemorragia e a contaminação em pacientes, com choque hemorrágico grave, que estejam exaurindo suas reservas fisiológicas. A seguir, esses pacientes serão submetidos à ressuscitação e correção de coagulopatia, hipotermia e acidose no centro de tratamento intensivo, antes de retornarem à sala de cirurgia. Tal abordagem tem alcançado taxas de sobrevida melhor que o esperado para o trauma abdominal e sua aplicação tem sido estendida para incluir o trauma torácico e ortopédico.
The concept of "damage control" is established in the management of severely traumatized patients. This strategy saves lives in delaying definitive repair of anatomic lesions and focus on restoring physiology. The purpose of laparotomy in damage control is stopping bleeding and infection in patients with severe hemorrhagic shock who are exhausting their physiological reserves. Subsequently, these patients will be submitted to CPR and correction of coagulopathy, hypothermia, and acidosis in intensive treatment center before returning to the operating room. Such approach has achieved high survival rates, better than expected for abdominal trauma, and its application has been extended to include thoracic and orthopedic trauma.
RESUMO
BACKGROUND: Obesity represents a major public health problem in western countries. Initial studies suggest that injection of botulinum A toxin (Btx-A) into the antropyloric region inhibits propulsive contractions of the antral pump, with delay in gastric emptying, early satiety and weight loss. METHODS: After approval by the University Ethics Committee, we prospectively evaluated 12 patients with class III obesity divided into 4 groups of 3 patients each. In groups I and II, 200 U Btx-A were injected into the antropyloric region at 8 and 16 sites, respectively. Groups III and IV received 300 U Btx-A into the antropyloric region at 16 and 24 sites, respectively. Body weight and gastric emptying time (GET) of solids and semi-solids using 13C-octanoic acid breath test and 13C-acetic acid breath test, respectively, were determined before and after injection over a period of 12 weeks. RESULTS: Pre- and post-treatment body weight or solid and semi-solid GET did not differ significantly between groups (P>0.05). All patients reported a feeling of early satiety. No adverse effects related to BtxA or complications resulting from the endoscopic procedure were observed. CONCLUSION: The injection of different doses of BtxA at different sites in the antropyloric region of patients with class III obesity did not interfere significantly with the solid and semi-solid GET or body weight of these individuals. However, early satiety was reported by all patients, the procedure was safe and no side-effects of the treatment were observed. Further controlled studies involving different methodologies regarding dosage of Btx-A and sites of injection are necessary.
