RESUMO
INTRODUCTION: mild head trauma (MHT) is defined as a transient neurological deficit after trauma with a history of impairment or loss of consciousness lasting less than 15 min and/or posttraumatic amnesia, and a Glasgow Coma Scale between 13 and 15 on hospital admission. We evaluated 50 MHT patients 18 months after the trauma, addressing signs and symptoms of post-concussion syndrome, quality of life and the presence of anxiety and depression. We correlate those findings with the S100B protein levels and cranial CT scan performed at hospital admission after the trauma. METHOD: patients were asked to fill out questionnaires to assess quality of life (SF36), anxiety and depression (HADS), and signs and symptoms of post-concussion syndrome. For the control group, we asked the patient's household members, who had no history of head trauma of any type, to answer the same questionnaires for comparison. RESULTS: total quality of life index for patients with MHT was 58.16 (+/-5), lower than the 73.47 (+/-4) presented by the control group. Twenty patients (55.2%) and four (11.1%) controls were depressed. Seventeen patients (47.2%) presented anxiety, whereas only eight (22.2%) controls were considered anxious. Victims of MHT complained more frequently of loss of balance, dry mouth, pain in the arms, loss of memory and dizziness than their respective controls (p<0.05). We found no correlation between the presence of these signs and symptoms, quality of life, presence of anxiety and depression with S100B protein levels or with presence of injury in the cranial CT performed at hospital admission. CONCLUSION: MHT is associated with a higher incidence of post-concussion syndrome symptoms, lower quality of life and anxiety than their respective controls even 18 months after the trauma.
Assuntos
Transtornos de Ansiedade/psicologia , Traumatismos Craniocerebrais/complicações , Transtorno Depressivo/psicologia , Fatores de Crescimento Neural/sangue , Síndrome Pós-Concussão/etiologia , Qualidade de Vida/psicologia , Proteínas S100/sangue , Transtornos de Ansiedade/etiologia , Biomarcadores/sangue , Brasil , Estudos de Casos e Controles , Transtorno Depressivo/etiologia , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Subunidade beta da Proteína Ligante de Cálcio S100 , Tomografia Computadorizada por Raios XRESUMO
Small volumes of hypertonic saline solution ([HS] 7.5% NaCl) produce systemic and microcirculatory benefits in hemorrhaged animals. Pentoxifylline (PTX) has beneficial effects when administrated after hemorrhagic shock. We tested the hypothesis that the combination of HS and PTX in the initial treatment of hemorrhagic shock provides synergistic hemodynamic benefits. Twenty-four dogs were bled to a target arterial blood pressure of 40 mm Hg and randomized into 3 groups: lactated Ringer's solution (33 mL/kg; n = 6); HS (7.5% NaCl 4 mL/kg; n = 9); and HS+PTX (7.5% NaCl 4 mL/kg + PTX 15 mg/kg; n = 9). Systemic hemodynamics were measured by Swan-Ganz and arterial catheters. Gastric mucosal-arterial Pco2 gradient (D(g-a)Pco2; gas tonometry), portal vein blood flow (ultrasonic flowprobe), and systemic and regional O2-derived variables were also evaluated. HS induced a partial increase in mean arterial blood pressure, cardiac output, and portal vein blood flow. In the HS+PTX group, we observed a significant, but transitory, increase in systemic oxygen delivery (180 +/- 17 versus 141 +/- 13 mL/min) in comparison to HS alone. PTX infusion during hypertonic resuscitation promoted a significant reduction in D(g-a)Pco2 (41.8 +/- 4.8 to 25.7 +/- 3.9 mm Hg) when compared with isolated HS infusion (48.2 +/- 6.4 to 39.4 +/- 5.5 mm Hg). We conclude that PTX as an adjunct drug during hypertonic resuscitation improves cardiovascular performance and gastric mucosal oxygenation.
Assuntos
Pentoxifilina/uso terapêutico , Perfusão/métodos , Ressuscitação/métodos , Solução Salina Hipertônica/uso terapêutico , Choque Hemorrágico/terapia , Animais , Pressão Sanguínea/efeitos dos fármacos , Pressão Sanguínea/fisiologia , Volume Sanguíneo/efeitos dos fármacos , Volume Sanguíneo/fisiologia , Cães , Hidratação/métodos , Soluções Isotônicas/farmacologia , Soluções Isotônicas/uso terapêutico , Masculino , Pentoxifilina/farmacologia , Lactato de Ringer , Solução Salina Hipertônica/farmacologia , Choque Hemorrágico/fisiopatologiaRESUMO
PURPOSE: We created an experimental model of urethral defect and then repaired it using a tunica vaginalis graft applied on the dorsal surface of the urethra. We studied the histological and radiological characteristics of free tunica vaginalis graft urethroplasty. MATERIALS AND METHODS: In 20 New Zealand rabbits a dorsal urethral defect was created by excising a portion of the dorsal urethral surface. The tunica vaginalis graft was placed dorsally over the corpora cavernosa and tied with 4 interrupted sutures. The mucosal margin of the urethral defect was sutured to the graft using 6-zero polydioxanone sutures in continuous fashion. The animals were divided into 4 equal groups and were sacrificed 14 days, and 4, 8 and 12 weeks after surgery, respectively. A retrograde urethrogram was done at autopsy. The penis was sent for histological analysis and an experienced pathologist evaluated the severity of acute and chronic inflammation, foreign body reaction and scar formation. RESULTS: There were no deaths related to the procedure and no intraoperative complications. All rabbits voided spontaneously after surgery. Retrograde urethrograms showed no fistula or stricture. As time after surgery increased, the signs of inflammation response disappeared, and the orientation of collagen fibrils and smooth muscle fascicles resembled that of a normal urethra. The mesothelial lining of the tunica vaginalis gradually became replaced by a more stratified epithelial lining, similar to the urothelial lining of the native urethra. CONCLUSIONS: In the current study we noted that a tunica vaginalis graft placed dorsally can be a successful urethral substitute in the animal model.
Assuntos
Membrana Serosa/transplante , Uretra/cirurgia , Animais , Inflamação , Masculino , Pênis/cirurgia , Coelhos , Radiografia , Testículo , Uretra/diagnóstico por imagemRESUMO
PURPOSE: The authors present and describe an original adaptation for the use of "boatman's knot" in renal vein ligation during laparoscopic nephrectomy. This procedure may replace the need for the endovascular stapler, which is considered the standard of care, but not available in several institutions in Brazil. The knot presented is also known as the "pig's knot" in several farms in Brazil. METHODS: Fourteen laparoscopic nephrectomies were performed by the same surgeon in a standard fashion in seven female pigs. Both the renal artery and vein were ligated using the "boatman's knot" as the only method for hemostasis with conventional intracorporeal technique. Two knots were applied in each artery and vein; one knot was tied proximally and the other distally. The vessels were then sectioned in between both knots. This technique is based on the intracorporeal confection of two loops by the right hand pair of dissectors with the help of the left hand. The arteries and the veins were then sectioned and the capability to accomplish full hemostasis was observed. RESULTS: All the laparoscopic nephrectomies were performed successfully. The "boatman's knot" was performed by the same surgeon with neither complications nor difficulties during the confection of the knot. In all cases hemostasis was fully achieved using only the "boatman's knot" as the hemostatic method. CONCLUSION: The "boatman's knot" is feasible and safe for hilum control during laparoscopic nephrectomy in pigs and total hemostasis can be achieved using it as the only method of hemostasis. However, the safety and the capacity of others to learn how to apply it should be tested before it may be advised to use it routinely.
Assuntos
Hemostasia Cirúrgica/instrumentação , Laparoscopia/métodos , Nefrectomia/métodos , Artéria Renal/cirurgia , Veias Renais/cirurgia , Animais , Feminino , Hemostasia Cirúrgica/métodos , Ligadura/métodos , SuínosRESUMO
BACKGROUND: Supraceliac aortic occlusion (AO) has been recommended to avoid hypotension during hepatic vascular exclusion (HVE). We hypothesized that AO may negatively affect splanchnic perfusion during HVE. METHODS: Twenty-six dogs (16 +/- 0.3 kg) were randomly assigned to HVE (n = 13) or HVE+AO (n = 13), during 30 minutes followed by a 60-minute reperfusion period. Cardiac output (CO), mean arterial pressure (MAP), superior mesenteric artery blood flow (SMABF, ultrasonic flowprobe), gastric mucosal PCO(2) (gas tonometry) and PCO(2)-gap were evaluated. RESULTS: HVE alone induced decreases in MAP from 115 +/- 5.1 to 26 +/- 1 mm Hg, in CO from 2.0 +/- 0.1 to 0.4 +/- 0.1 L/min and SMABF from 398 +/- 42 to 16 +/- 7.6 mL/min, while PCO(2) gap increased from 4 +/- 3.7 to 52 +/- 5.4 mm Hg. Supraceliac aortic occlusion only avoided severe hypotension. During reperfusion MAP, CO, and SMABF were partially restored, while PCO(2) gap showed no improvements in either group. CONCLUSIONS: HVE promotes major systemic and splanchnic perfusional derangement. Concomitant AO may avoid HVE-induced hypotension without producing further deleterious effects.
Assuntos
Aorta Abdominal/cirurgia , Sistema Digestório/irrigação sanguínea , Hemodinâmica/fisiologia , Hipotensão/prevenção & controle , Isquemia/etiologia , Fígado/irrigação sanguínea , Circulação Esplâncnica/fisiologia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Animais , Gasometria , Constrição , Cães , Hepatectomia/efeitos adversos , Hipotensão/etiologia , Transplante de Fígado/efeitos adversos , Masculino , Modelos Animais , Traumatismo por Reperfusão/etiologia , Traumatismo por Reperfusão/prevenção & controleRESUMO
BACKGROUND: Fluid resuscitation administered before hemorrhage control for trauma victims sustaining penetrating abdominal injury is controversial. Our objective was to evaluate intra-abdominal blood loss and hemodynamic and metabolic effects of no fluid resuscitation, small-volume 7.5% sodium chloride/6% dextran-70 (HSD), or large-volume lactated Ringer's (LR) solution during intra-abdominal vascular injury and uncontrolled hemorrhage. METHODS: In pentobarbital-anesthetized dogs (n = 26, 17 +/- 0.3 kg), a suture was placed through the common iliac artery to produce a 3-mm tear when the exteriorized suture lines were pulled after incision closure. Dogs were randomized to three groups, according to the treatment used after 20 minutes of uncontrolled hemorrhage: controls, no fluid resuscitation (CT group) (n = 6); the HSD group (4 mL/kg over 4 minutes, n = 6); and the LR group (32 mL/kg over 15 minutes, n = 6). After 40 minutes of uncontrolled bleeding, animals were killed, and intra-abdominal blood loss was measured. RESULTS: Eight dogs died from severe hemorrhagic shock before randomization and were excluded. After 20 minutes, animals presented lower blood pressure (approximately 35 mm Hg), low cardiac output (approximately 1.0 L/min/m(2)), and metabolic acidosis (pH approximately 7.23, base excess approximately -9 mmol/L). After HSD and LR solution, arterial pressure presented a transient increase, but remained below baseline. Two animals died before the end of the experiment, both in the LR group. Cardiac index was partially improved in the LR and HSD groups, whereas the CT group sustained a low-flow state. There were no significant differences between groups regarding intra-abdominal blood loss (CT group, 47.8 +/- 5.9 mL/kg; HSD group, 41.7 +/- 2.3 mL/kg; and LR group, 49.4 +/- 0.7 mL/kg). CONCLUSION: Fluid resuscitation with either large-volume LR solution or small-volume HSD, during uncontrolled hemorrhage from intra-abdominal vascular injury, produced hemodynamic and metabolic benefits, without additional blood loss, whereas no fluid resuscitation was associated with sustained low cardiac output and hypotension.