Guidelines of the Brazilian Hernia Society (BHS) for the management of inguinocrural hernias in adults. / Orientações da Sociedade Brasileira de Hérnia (SBH) para o manejo das hérnias inguinocrurais em adultos.

Inguinal hernias are a frequent problem and their repair is the most commonly performed procedure by general surgeons. In the last years, new principles, products and techniques have changed the routine of surgeons, who need to recycle knowledge and perfect new skills. In addition, old concepts regarding surgical indication and risk of complications have been reevaluated. In order to create a guideline for the management of inguinal hernias in adult patients, the Brazilian Hernia Society assembled a group of experts to review various topics, such as surgical indication, perioperative management, surgical techniques, complications and postoperative guidance.

As hérnias inguinais são um problema frequente e o seu reparo representa a cirurgia mais comumente realizada por cirurgiões gerais. Nos últimos anos, novos princípios, produtos e técnicas têm mudado a rotina dos cirurgiões que precisam reciclar conhecimentos e aperfeiçoar novas habilidades. Além disso, antigos conceitos sobre indicação cirúrgica e riscos de complicações vêm sendo reavaliados. Visando criar um guia de orientações sobre o manejo das hérnias inguinais em pacientes adultos, a Sociedade Brasileira de Hérnias reuniu um grupo de experts com objetivo de revisar diversos tópicos, como indicação cirúrgica, manejo perioperatório, técnicas cirúrgicas, complicações e orientações pós-operatórias.

Orientações da Sociedade Brasileira de Hérnia (SBH) para o manejo das hérnias inguinocrurais em adultos / Guidelines of the Brazilian Hernia Society (BHS) for the management of inguinocrural hernias in adults

RESUMO As hérnias inguinais são um problema frequente e o seu reparo representa a cirurgia mais comumente realizada por cirurgiões gerais. Nos últimos anos, novos princípios, produtos e técnicas têm mudado a rotina dos cirurgiões que precisam reciclar conhecimentos e aperfeiçoar novas habilidades. Além disso, antigos conceitos sobre indicação cirúrgica e riscos de complicações vêm sendo reavaliados. Visando criar um guia de orientações sobre o manejo das hérnias inguinais em pacientes adultos, a Sociedade Brasileira de Hérnias reuniu um grupo de experts com objetivo de revisar diversos tópicos, como indicação cirúrgica, manejo perioperatório, técnicas cirúrgicas, complicações e orientações pós-operatórias.

ABSTRACT Inguinal hernias are a frequent problem and their repair is the most commonly performed procedure by general surgeons. In the last years, new principles, products and techniques have changed the routine of surgeons, who need to recycle knowledge and perfect new skills. In addition, old concepts regarding surgical indication and risk of complications have been reevaluated. In order to create a guideline for the management of inguinal hernias in adult patients, the Brazilian Hernia Society assembled a group of experts to review various topics, such as surgical indication, perioperative management, surgical techniques, complications and postoperative guidance.

Lateral resolution of nanoscaled images delivered by surface-analytical instruments: application of the BAM-L200 certified reference material and related ISO standards.

The certified reference material BAM-L200, a nanoscale stripe pattern for length calibration and specification of lateral resolution, is described. BAM-L200 is prepared from a cross-sectioned epitaxially grown layer stack of AlxGa1-xAs and InxGa1-xAs on a GaAs substrate. The surface of BAM-L200 provides a flat pattern with stripe widths ranging down to 1 nm. Calibration distances, grating periods and stripe widths have been certified by TEM with traceability to the length unit. The combination of gratings, isolated narrow stripes and sharp edges of wide stripes offers plenty of options for the determination of lateral resolution, sharpness and calibration of length scale at selected settings of imaging surface-analytical instruments. The feasibility of the reference material for an analysis of the lateral resolution is demonstrated in detail by evaluation of ToF-SIMS, AES and EDX images. Other applications developed in the community are summarized, too. BAM-L200 fully supports the implementation of the revised International Standard ISO 18516 (in preparation) which is based on knowledge outlined in the Technical Report ISO/TR 19319:2013.

Bilateral absence of the anterior cruciate ligament.

We report a rare case of bilateral absence of the anterior cruciate ligament in an adolescent. The clinical picture, the diagnostic and therapeutic approach, the arthroscopic appearance and the follow-up are described. The available literature is discussed.

A prospective, randomized comparison of dexketoprofen, ketoprofen or paracetamol for postoperative analgesia after outpatient knee arthroscopy.

BACKGROUND: This prospective, randomized study was conducted to evaluate the quality of postoperative pain relief when using dexketoprofen, ketoprofen, or paracetamol after outpatient knee arthroscopy. METHODS: Without premedication, 45 ASA physical status I-II patients undergoing elective outpatient knee arthroscopy with combined sciatic-femoral nerve block, were randomly allocated to receive either 25 mg oral dexketoprofen (n = 15), 50 mg oral ketoprofen (n = 15), or 500 mg oral paracetamol (n = 15) before block placement. After completion of surgery the same pain medication was given according to standard protocols, while 50 mg oral tramadol were allowed as rescue analgesic if required by the patient. After standard discharge criteria had been fulfilled, patients were discharged from the day-surgery unit, while a telephone follow-up was performed the day after surgery using standard questionnaires evaluating the quality of pain relief during the first 24 hours after surgery. Total consumption of rescue tramadol, maximum pain complained of after hospital discharge, as well as the visual analogue scale of pain measured at hospital discharge were assessed by an independent trained observer. RESULTS: No differences in anthropometric variables, duration of surgical procedure, and fulfillment of discharge criteria were observed between the three groups. The degree of pain measured at rest at hospital discharge was similar in the three groups, while the VAS measured during motion was higher in patients receiving paracetamol (24 +/- 2.5 mm) than in those patients treated with dexketoprofen (13 +/- 6 mm) or ketoprofen (17 +/- 5 mm) (p = 0.016). Two patients (one in ketoprofen group and one in paracetamol group) required rescue tramadol after hospital discharge; however, no differences in maximum pain complained of after surgery or patient acceptance were observed between groups. CONCLUSIONS: This prospective, randomized study demonstrated that in outpatients receiving arthroscopic knee surgery, the use of 75 mg/day dexketoprofen was as effective and safe as 150 mg/day racemate ketoprofen, with a better pain relief during motion compared to 2 g/day paracetamol when patients were discharged from the day-surgery unit.