Late evaluation of the relationship between morphological and functional renal changes and hypertension after non-operative treatment of high-grade renal injuries.

OBJECTIVE: To evaluate the anatomical and functional renal alterations and the association with post-traumatic arterial hypertension. METHODS: The studied population included patients who sustained high grades renal injury (grades III to V) successfully non-operative management after staging by computed tomography over a 16-year period. Beyond the review of medical records, these patients were invited to the following protocol: clinical and laboratory evaluation, abdominal computed tomography, magnetic resonance angiography, DMSA renal scintigraphy, and ambulatory blood pressure monitoring. The hypertensive patients also were submitted to dynamic renal scintigraphy (99mTc EC), using captopril stimulation to verify renal vascular etiology. RESULTS: Of the 31 patients, there were thirteen grade III, sixteen grade IV (nine lacerations, and seven vascular lesions), and two grade V injuries. All the patients were asymptomatic and an average follow up post-injury of 6.4 years. None had abnormal BUN or seric creatinine. The percentage of renal volume reduction correlates with the severity as defined by OIS. There was no evidence of renal artery stenosis in Magnetic Resonance angiography (MRA). DMSA scanning demonstrated a decline in percentage of total renal function corresponding to injury severity (42.2 ± 5.5% for grade III, 35.3 ± 12.8% for grade IV, 13.5 ± 19.1 for grade V). Six patients (19.4%) had severe compromised function (< 30%). There was statistically significant difference in the decrease in renal function between parenchymal and vascular causes for grade IV injuries (p < 0.001). The 24-hour ambulatory blood pressure monitoring detected nine patients (29%) with post-traumatic hypertension. All the patients were male, mean 35.6 years, 77.8 % had a familial history of arterial hypertension, 66.7% had grade III renal injury, and average post-injury time was 7.8 years. Seven patients had negative captopril renography. CONCLUSIONS: Late results of renal function after conservative treatment of high grades renal injuries are favorable, except for patients with grades IV with vascular injuries and grade V renal injuries. Moreover, arterial hypertension does not correlate with the grade of renal injury or reduction of renal function.

Implementing 1-dose antibiotic prophylaxis for prevention of surgical site infection.

HYPOTHESIS: Replacing a 24-hour regimen with a 1-dose antibiotic prophylaxis for elective surgery would not increase rates of surgical site infection and would decrease costs. DESIGN AND SETTING: Before-after trial in a tertiary, private general hospital in Ribeirão Preto, São Paulo, Brazil. PATIENTS: Surgery was performed on 6140 consecutive patients from February 2002 through October 2002 (period 1) and 6159 consecutive patients from December 2002 through August 2003 (period 2). Studied surgeries included orthopedic, gastrointestinal, urology, vascular, lung, head and neck, heart, gynecologic, oncology, colon, neurologic, and pediatric surgeries. The study excluded patients with infection at the time of surgery. INTERVENTION: Decreasing the 24-hour prophylactic antibiotic regimen to 1-dose antibiotic prophylaxis. MAIN OUTCOME MEASURES: Surgical site infections in both periods measured by in-hospital surveillance and postdischarge surveillance; compliance with 1-dose prophylaxis; and costs with cephazolin. RESULTS: We followed up 12,299 patients during their hospital stay; postdischarge surveillance increased significantly from 2717 patients (44%) to 3066 patients (50%, P<.001). One-dose prophylaxis was correctly followed in 6123 patients (99% compliance). The rate of surgical site infection did not change in either period (2% and 2.1% respectively, P = .67). The number of cephazolin vials purchased monthly decreased from 1259 to 467 with a corresponding monthly savings of $1980. CONCLUSIONS: One-dose antibiotic prophylaxis did not lead to an increase in rates of surgical site infection and brought a monthly savings of $1980 considering cephazolin alone. High compliance to 1-dose prophylaxis was achieved through an educational intervention encouraged by the hospital director and administrative measures that reduced access to extra doses.

The TRISS method applied to the victims of traffic accidents attended at a tertiary level emergency hospital in a developing country.

In Brazil, trauma occupies third place among the various causes of death and is the first cause of death among young people. Among the various approaches to the study of trauma, analysis of the organisation and quality of care has been frequently reported in the literature. The objective of the present study was to assess the quality of care for victims of trauma due to traffic accidents provided at the Emergency Unit of the University Hospital, Faculty of Medicine of Ribeirão Preto, SP, Brazil. The quality of care was compared between two different periods, i.e., before and after the introduction of modifications in prehospital care, and was also compared to the North American standards of the Major Trauma Outcome Study (MTOS). The Trauma Score and Injury Severity Score (TRISS) was used to calculate the probability of survival and the Z statistic was used for comparison with the MTOS. During both periods studied, the results were inferior to those obtained by the MTOS, although positive signs were detected at the Emergency Unit regarding the organisation of the system of trauma care during the study period.

Efeitos do trauma cranio-encefalico sobre o refluxo duodenogastrico: resultados preliminares / Effects of cranial-encephalus lesion over duodenogastric reflux: preliminar results

In 1988, Podestá et al pointed out that injury increases duodenogastric reflux, DGR. Therefore, the objective of this was to compare the amount of DGR in normal subjects, C group, and in patients with head injury, T group. DGR was assessed by intravenous injection of 99m Technetium+HIDA followed by aspiration of gastric juice. The amount of DGR was reported as the total percentagem of the injected rediotracer recovered in the gastric aspirate. Reflux values did not differ significantly between the two groups, C group-median of 1,60 for percentage, range of 0,13 for percentage - 3,01 for percentage and T group-median of 1,12 for percentage range of 0,04 for percentage - 4,4 for percentage, p>0,10. Our results show ta DGR is not increased in patients with severe head injury