RESUMO
La disección aórtica rota que compromete la raíz y la aorta ascendente es una emergencia que requiere cirugía inmediata, debido al mal pronóstico y sus complicaciones agudas: ruptura, insuficiencia aórtica aguda, hematoma intramural y endocarditis aguda; con elevadas tasas de morbilidad y mortalidad posoperatoria temprana, estimada en las 24 horas el 1 % por cada hora, a las 48 horas 29 %, en la primera semana 44 % y a las 2 semanas 50 %; con una mortalidad global de 15 % a 35 % y una sobrevida del 65 % al 75 % en un rango de 5 años [1 - 3]. En Ecuador se llevó a cabo un estudio tipo prospectivo que incluyo 120 pacientes, llevado a cabo desde 1999 a 2000, en Guayaquil; en el que reportaron 34 casos, con edad promedio de 64 años, sexo masculino, cuyo factor de riesgo más importante fue hipertensión arterial. Se presentó en el 100 % de los casos, dolor torácico transfictivo, soplo aórtico diastólico en el 70 % y solo el 2 % presentaron infarto de miocardio posteroinferior transmural sin fibrinólisis, por ser contraindicado en pacientes con disección aórtica [4]. El tratamiento quirúrgico consiste en la resección y reemplazo de la porción rota por una prótesis vascular asociada o no al reemplazo valvular aórtico dependiendo del grado de insuficiencia. El tratamiento estará orientado en función del grado de afectación de la disección y la rotura, pudiendo requerir un reemplazo convencional de la aorta ascendente (RCAA) con o sin reemplazo total del arco aórtico (RTAA); el tratamiento de elección de la disección rota tipo A es el reemplazo de la raíz y la aorta ascendente con injerto tubular valvulado, denominado procedimiento de Bentall De Bono [1 - 3, 5, 6]. Dentro de las complicaciones postquirúrgicas se encuentran: pseudoaneurisma, disección radical recurrente o residual, cambios importantes en el diámetro de la raíz o insuficiencia aórtica significativa [7]
The rupture aortic dissection that compromises the root and the ascending aorta is an emergency that requires immediate surgery; for it is poor prognosis, acute complications: rupture, acute aortic insufficiency, intramural hematoma and acute endocarditis, with high morbidity rates and early postoperative mortality, estimated at first 24 hours in 1 % per each hour, 48 hours 29 %, in the first week 44 % and at 2 weeks 50 %; with a global mortality of 15 % to 35 % and a survival of 65 % to 75 % in a range of 5 years [1-3]. In Ecuador, a prospective study realized that included 120 patients, since 1999 to 2000, in Guayaquil; in that they reported 34 cases with an average age of 64 years, male, whose most important risk factor was hypertension. The patients presented, 100 % transfictive chest pain, diastolic aortic murmur in 70 %, and only 2 % had transmural posteroinferior myocardial infarction without fibrinolysis, as it was contraindicated in patients with aortic dissection [4]. Surgical treatment consists of the resection and replacement of the broken portion by a vascular prosthesis associated or not with aortic valve replacement depending on the degree of insufficiency. The treatment will be oriented according to the degree of involvement of the dissection and rupture, and may require a conventional replacement of the ascending aorta (CRAA) with or without total aortic arch replacement (TRAA); the treatment of choice for the rupture aortic dissection type A is the replacement of the root and the ascending aorta with valvular tubular graft, called the Bentall De Bono surgery [1 - 3, 5, 6]. Of the postsurgical complications we found: pseudoaneurysm, radical or recurrent radical dissection, important changes in the diameter of the root or significant aortic insufficiency
Assuntos
Humanos , Masculino , Cirurgia Geral/classificação , Dissecção AórticaRESUMO
Para entender a enfrentar os desafios do ato cirúrgico torna-se necessário a leitura obrigatória do livro O século dos cirurgiões, onde o autor descreveu os primórdios dos procedimentos antes e após o advento e descoberta das drogas anestésicas, as técnicas cruentas utilizadas na época, as amputações, a operação cesariana, a comprovação da contaminação bacteriana e os princípios da antissepsia (Thorwald, 2010). As dificuldades em improvisações enfrentadas pelos praticantes pioneiros da medicina veterinária equina estão historicamente relatadas no livro Ars Veterinária detalhadamente compiladas por Walker (1991), onde escreveu uma narrativa da importância do cavalo na história do ser humano e sua utilização como meio de transporte, lazer e atividade militar nas grandes batalhas principalmente dos exploradores e dos impérios greco-romano, contendo ilustrações do instrumental cirúrgico artesanal utilizado na época. O objetivo desse texto será o de apresentar uma súmula dos principais obstáculos enfrentados nas cirurgias do trato reprodutivo das éguas sem a pretensão de esgotar o assunto, mas sim deixar registrado uma parte da experiência pessoal deste profissional embasado na literatura especializada.(AU)
In order to face the challenges of surgical act, reading Jürgen Thorwald's book The Century of the Surgeon (Das Jahrhundert der Chirurgen) is a must. In his book, the author describes the beginning of surgical procedures before and after the discovery of anaesthetic drugs, the bloody techniques used in those times, the amputations, the caesarean section, the evidence of bacterial contamination, and the principles of antisepsis (Thorwald, 2010). The difficulties and improvisations faced by the pioneers in equine medicine are historically reported in the book ArsVeterinaria, carefully reported by Walker (1991), who tells about the importance of horses in human history and about the use of those animals for transportation, leisure and military purposes, specially on great battles involving explorers and the Greek-Roman empire, including illustrations of the handmade surgical instruments used in that time. The aim of this text is to present a summary of the main obstacles faced in mares reproductive surgery, with no pretension to exhaust the subject, but to report part of the personal experience of this professional, grounded in specialized literature.(AU)
Assuntos
Animais , Feminino , Cirurgia Geral/classificação , Cirurgia Geral/tendências , Cavalos/embriologia , Comportamento ReprodutivoRESUMO
Para entender a enfrentar os desafios do ato cirúrgico torna-se necessário a leitura obrigatória do livro O século dos cirurgiões, onde o autor descreveu os primórdios dos procedimentos antes e após o advento e descoberta das drogas anestésicas, as técnicas cruentas utilizadas na época, as amputações, a operação cesariana, a comprovação da contaminação bacteriana e os princípios da antissepsia (Thorwald, 2010). As dificuldades em improvisações enfrentadas pelos praticantes pioneiros da medicina veterinária equina estão historicamente relatadas no livro Ars Veterinária detalhadamente compiladas por Walker (1991), onde escreveu uma narrativa da importância do cavalo na história do ser humano e sua utilização como meio de transporte, lazer e atividade militar nas grandes batalhas principalmente dos exploradores e dos impérios greco-romano, contendo ilustrações do instrumental cirúrgico artesanal utilizado na época. O objetivo desse texto será o de apresentar uma súmula dos principais obstáculos enfrentados nas cirurgias do trato reprodutivo das éguas sem a pretensão de esgotar o assunto, mas sim deixar registrado uma parte da experiência pessoal deste profissional embasado na literatura especializada.
In order to face the challenges of surgical act, reading Jürgen Thorwald's book The Century of the Surgeon (Das Jahrhundert der Chirurgen) is a must. In his book, the author describes the beginning of surgical procedures before and after the discovery of anaesthetic drugs, the bloody techniques used in those times, the amputations, the caesarean section, the evidence of bacterial contamination, and the principles of antisepsis (Thorwald, 2010). The difficulties and improvisations faced by the pioneers in equine medicine are historically reported in the book ArsVeterinaria, carefully reported by Walker (1991), who tells about the importance of horses in human history and about the use of those animals for transportation, leisure and military purposes, specially on great battles involving explorers and the Greek-Roman empire, including illustrations of the handmade surgical instruments used in that time. The aim of this text is to present a summary of the main obstacles faced in mares reproductive surgery, with no pretension to exhaust the subject, but to report part of the personal experience of this professional, grounded in specialized literature.
Assuntos
Feminino , Animais , Cavalos/embriologia , Cirurgia Geral/classificação , Cirurgia Geral/tendências , Comportamento ReprodutivoRESUMO
OBJECTIVES: To identify the most cited articles in general surgery published by Brazilian authors. INTRODUCTION: There are several ways for the international community to recognize the quality of a scientific article. Although controversial, the most widely used and reliable methodology to identify the importance of an article is citation analysis. METHODS: A search using the Institute for Scientific Information citation database (Science Citation Index Expanded) was performed to identify highly cited Brazilian papers published in twenty-six highly cited general surgery journals, selected based on their elevated impact factors, from 1970 to 2009. Further analysis was done on the 65 most-cited papers. RESULTS: We identified 1,713 Brazilian articles, from which nine papers emerged as classics (more than 100 citations received). For the Brazilian contributions, a total increase of about 21-fold was evident between 1970 and 2009. Although several topics were covered, articles covering trauma, oncology and organ transplantation were the most cited. The majority of classic studies were done with international cooperation. CONCLUSIONS: This study identified the most influential Brazilian articles published in internationally renowned general surgery journals.
Assuntos
Bibliometria , Cirurgia Geral/estatística & dados numéricos , Publicações Periódicas como Assunto/estatística & dados numéricos , Pesquisa Biomédica/estatística & dados numéricos , Brasil , Cirurgia Geral/classificação , Humanos , Fator de Impacto de RevistasRESUMO
OBJECTIVES: To identify the most cited articles in general surgery published by Brazilian authors. INTRODUCTION: There are several ways for the international community to recognize the quality of a scientific article. Although controversial, the most widely used and reliable methodology to identify the importance of an article is citation analysis. METHODS: A search using the Institute for Scientific Information citation database (Science Citation Index Expanded) was performed to identify highly cited Brazilian papers published in twenty-six highly cited general surgery journals, selected based on their elevated impact factors, from 1970 to 2009. Further analysis was done on the 65 most-cited papers. RESULTS: We identified 1,713 Brazilian articles, from which nine papers emerged as classics (more than 100 citations received). For the Brazilian contributions, a total increase of about 21-fold was evident between 1970 and 2009. Although several topics were covered, articles covering trauma, oncology and organ transplantation were the most cited. The majority of classic studies were done with international cooperation. CONCLUSIONS: This study identified the most influential Brazilian articles published in internationally renowned general surgery journals.
Assuntos
Humanos , Bibliometria , Cirurgia Geral/estatística & dados numéricos , Publicações Periódicas como Assunto/estatística & dados numéricos , Brasil , Pesquisa Biomédica/estatística & dados numéricos , Cirurgia Geral/classificação , Fator de Impacto de RevistasRESUMO
Introdução: Hipotermia não intencional é caracterizada por temperatura sanguínea central inferior a 36°C e pode estar presente em 53-85% dos adultos que chegam à Sala de Recuperação Pós-anestésica (SRPA). Objetivos: Avaliar a hipotermia na SRPA em pacientessubmetidos a cirurgias abdominais com duração maior de duas horas, no Hospital Nossa Senhora da Conceição, em Tubarão SC. Métodos: Foi realizado um estudo transversal no qualpacientes submetidos a cirurgias abdominais com duração maior de duas horas, tiveram as temperaturas axilaresmonitoradas antes e depois da cirurgia e no momento da alta da SRPA. As variáveis utilizadas foram gênero,faixa etária, etnia, peso, altura, tipo de cirurgia, especialidade, tempo de cirurgia e tempo de permanência naSRPA. Resultados: A média de temperatura após a cirurgia foi de 34,5°C, já a média da alta da SRPA foi de35,7°C. Pacientes acima de 40 anos apresentaram uma média de 1,0°C menor em relação ao grupo com idadeinferior ao final da cirurgia. O grupo de pacientes com menos de 70 Kg obteve uma temperatura média menor após a cirurgia quando comparado ao outro grupo. Cirurgias com mais de 180 minutos e tempo na SRPA superiora 180 minutos apresentaram menor temperatura média posterior. Conclusões: A média de temperatura após a cirurgia foi classificada em hipotermia de grau leve. Característicasdo paciente como peso menor que 70Kg, idade maior de 40 anos e cirurgias prolongadas estiveram associadas a uma menor temperatura pós-operatória.
Introduction: Non intentional hypothermia is characterized by central blood temperature lower than 36ºC,and is present in 53-85% of adults upon arrival at the post-anesthetic recovery room. Objective: To analyze hypothermia in the post-anestheticroom, in patients submitted to abdominal surgery with duration of over two hours, in the Nossa Senhora da Conceição Hospital, in Tubarão SC. Methods: A cross sectional study was realized.Patients submitted to abdominal surgeries with over two hours of duration, had their axillaries temperatures monitored, before and after of the surgery, and at the timeof discharge of the post-anesthetic recovery room. The variables used were, gender, age group, ethnicity, weight, height, type of surgery, and time spent in the post- anesthetic recovery room. Results: The average body temperature after surgery was 34.5°C while the average body temperature atthe post-anesthetic recovery room was 35.7°C. Patients over 40 years old presented an average temperature0.5°C lower when compared to the group less than this age, at the end of the surgery. The group of patientsweighting less than 70 Kg obtained a lower average temperatureafter surgery when compared to the other group. Surgeries longer than 180 minutes and patients that remainedmore than 180 minutes in the post-anesthetic recovery room presented lower average temperatures. Conclusion: The average temperature after surgery was classified as low level hypothermia. Patients characteristicssuch as weight lower than 70 Kg, age over 40 years old and prolonged surgeries were associated with lower post-operative temperature.
Assuntos
Pessoa de Meia-Idade , Regulação da Temperatura Corporal , Hipotermia/cirurgia , Sala de Recuperação , Análise de Variância , Distribuição de Qui-Quadrado , Cirurgia Geral/classificação , Hipotermia/cirurgia , Hipotermia/complicações , Hipotermia/metabolismo , Regulação da Temperatura Corporal/fisiologia , Estatísticas não ParamétricasRESUMO
Una opción acatual para la atención de pacientes quirurgicos sin internación que, ofrece satisfacción plena al paciente, al cirujano y a la institución de salud por los bajos costos. Se define la cirugía ambulatoria, se expone las ventajas, desventajas, sus exigencias, tipos de cirugía ambulatoria, selección de pacientes, valoración preoperatoria y sus complicaciones postoperatorias.