RESUMEN

Cardiac impalement is a rare and usually fatal injury. Immediate recognition and surgical intervention are decisive factors for patient survival. This is a reported case of cardiac impalement with left ventricular transfixation, whose prehospital management, surgical treatment and postoperative care were successful.

RESUMEN

Fall from height traumas are considered of high energy, being a significant cause of morbidity and mortality, especially when greater heights are involved. Minor repercussions or expectant health care provided in high-energy falling trauma have been scarcely reported. This case report describes a healthy female child's history, a victim from a high energy trauma, and considerable potential risk of severe injuries, which surprisingly showed minor repercussions. She was founded on the floor, walking, and was brought to the hospital by the local primary trauma emergency service. The initial trauma evaluation found nothing, except a small wound on the chin. A full-body CT-SCAN (Computerized Tomography Scan) was performed and diagnosed with a small laminar pneumothorax, which did not need medical procedures or interventions. She evolved well during the hospitalization, and daily chest X-rays showed the regression of the pulmonary lesion. She had hospital discharge after a few days with no sequels. This case report is probably unique, and apparently, few situations like this were previously published.

RESUMEN

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.

Asunto(s)

RESUMEN

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.

Asunto(s)

RESUMEN

O octreotide, análogo da somastatina, tem sido utilizado no tratamento de várias doenças por sua ampla distribuição no sistema nervoso e digestório. É frequentemente utilizado nas fístulas enterocutâneas. Entretanto, pelo fato dele inibir hormônios tróficos e anabólicos e por reduzir o fluxo sanguíneo, surgiu a hipótese de que poderia ser prejudicial na cicatrização de feridas cirúrgicas...

Octreotide, an analogous of somastatin, has been used in the treatment of enterocutaneous fistulas. However, because of its inhibitory effects of trophic and anabolic hormones and because it reduces blood flow, a hypothesis was created, wich suggested that octreotide...

Asunto(s)

RESUMEN

Apesar dos avanços no conhecimento da patogênese e nos procedimentos terapêuticos na pancreatite aguda bibliar, é de extrema importância a avaliaçäo dos fatores associados a complicaçöes e óbitos nessa doença. Entre janeiro de 1980 e junho de 1994 foram atendidos 365 pacientes portadores de pancreatite aguda. Deste total, 133 pacientes (36,4 por cento) eram portadores de pancreatite aguda biliar confirmada por dor abdominal, amilasemia acima de 200 UL/dL, ultra sonografia compatível com pancreatite aguda na presença de colelitíase. Oitenta e sete pacientes eram do sexo feminino e 46 do sexo masculino (1,89:1). A idade variou de 17 a 83 anos com uma média de 49,2 anos. O protocolo de estudo incluiu tipo de tratamento, se clínico ou cirúrgico, tempo de internamento, exames laboratoriais, ocorrência de complicaçöes e a evoluçäo final. Os fatores que se associaram a pior prognóstico foram a contagem de bastonetes maior que 10 por cento (p<0,5) e a de leucócitos maior que 16.000mm(3) (p<0,01). Os valores da amilasemia, hematócrito, bilirrubina direta e indireta näo influíram na morbimortalidade. Igualmente, näo tiveram influência o sexo do paciente, a idade maior ou menor que 55 anos e o tempo de internamento. O tipo de tratamento, se clínico ou cirúrgico, também näo influiu na incidência de complicaçöes e óbitos. No entanto, na presença de complicaçöes a mortalidade foi menor dentre os pacientes operados em comparaçäo com os submetidos a tratamento clínico, ressaltando a importância do tratamento cirúrgico bem indicado na reduçäo na morbimortalidade da pancreatite aguda biliar

Asunto(s)