The use of synthetic mesh in contaminated and infected abdominal wall repairs: challenging the dogma-A long-term prospective clinical trial.

Background: Abdominal wall reconstruction in patients presenting with enteric fistulas and mesh infection is challenging. There is a consensus that synthetic mesh must be avoided in infected operations, and the alternatives to using synthetic mesh, such as component separation techniques and biologic mesh, present disappointing results with expressive wound infection and hernia recurrence rates.

Methods: A prospective clinical trial designed to evaluate the short- and long-term outcomes of 40 patients submitted to elective abdominal wall repair with synthetic mesh in the dirty-infected setting, and compared to a cohort of 40 patients submitted to clean ventral hernia repairs.

Surgery in Brazilian Health Care: funding and physician distribution.

Objective: to analyze demographic Brazilian medical data from the national public healthcare system (SUS), which provides free universal health coverage for the entire population, and discuss the problems revealed, with particular focus on surgical care.

Methods: data was obtained from public healthcare databases including the Medical Demography, the Brazilian Federal Council of Medicine, the Brazilian Institute of Geography and Statistics, and the National Database of Healthcare Establishments. Density and distribution of the medical workforce and healthcare facilities were calculated, and the geographic regions were analyzed using the public private inequality index.

Safety in selective surgical exploration in penetrating neck trauma.

Background: Selective management of penetrating neck injuries has been considered the standard of care with minimal risks to patient safety. In a previous non-randomized prospective study conducted at our center, selective management proved to be safe and reduced unnecessary exploratory cervicotomies. In the present study, the role of clinical examination and selective diagnostic tests were assessed by reviewing demographic and clinical data.

Unintentionally retained foreign bodies after surgical procedures. Analysis of 4547 cases.

Objective: this study aims to explore the experience of Brazilian surgeons on Unintentionally Retained Foreign Bodies (RFB) after surgical procedures.

Methods: A questionnaire was sent to surgeons by electronic mail, between March and July 2012. The questions analyzed their experience with foreign bodies (FB), foreign bodies' types, clinical manifestations, diagnoses, risk factors and legal implications.

Active Staphylococcus aureus infection: Is it a contra-indication to the repair of complex hernias with synthetic mesh? A prospective observational study on the outcomes of synthetic mesh replacement, in patients with chronic mesh infection caused by Staphylococcus aureus.

Introduction: The management of chronic mesh infection is challenging and controversial. The use of synthetic material to repair the abdominal wall in the infected setting is not recommended, especially in the presence of active infection caused by Staphylococcus aureus.

Methods: This is a prospective observational study designed to evaluate the outcomes in patients with active mesh infection caused by Staphylococcus aureus.

Retrospective study of heart injuries occurred in Manaus - Amazon.

Objective: To evaluate the forms of treatment employed to heart injuries and the main aspects related to their morbidity and mortality.

Methods: A retrospective study of 102 patients with cardiac injuries treated in the two emergency rooms in Manaus (Dr. John Lucio Pereira Machado Emergency Hospital and August 28 County Emergency Hospital) from January 1998 to June 2006.

Blood loss and transcapillary refill in uncontrolled treated hemorrhage in dogs.

Objective: This study evaluated retroperitoneal hematomas produced by bilateral injury of iliac arteries (uncontrolled hemorrhage), blood volume loss, transcapillary refill, the effects of volume replacement on retroperitoneal bleeding and the hemodynamic changes with and without treatment.

Methods: Initial blood volume was determined with Tc(99m)-labelled red cells, and bleeding was evaluated by means of a portable scintillation camera positioned over the abdomen. Previously splenectomized mongrel dogs (16.

A perivascular epithelioid cell tumor of the stomach: an unsuspected diagnosis.

Perivascular epithelioid cell tumor (PEComa) is a rare mesenchymal neoplasia and currently well recognized as a distinct entity with characteristic morphological, immunohistochemical and molecular findings. We report a case of PEComa arising in the antrum of a 71-year-old female with melena. The tumor, located predominantly in the submucosa as a well delimited nodule, measured 3.

A computerized tomography scan method for calculating the hernia sac and abdominal cavity volume in complex large incisional hernia with loss of domain.

Preoperative progressive pneumoperitoneum (PPP) is a safe and effective procedure in the treatment of large incisional hernia (size > 10 cm in width or length) with loss of domain (LIHLD). There is no consensus in the literature on the amount of gas that must be insufflated in a PPP program or even how long it should be maintained. We describe a technique for calculating the hernia sac volume (HSV) and abdominal cavity volume (ACV) based on abdominal computerized tomography (ACT) scanning that eliminates the need for subjective criteria for inclusion in a PPP program and shows the amount of gas that must be insufflated into the abdominal cavity in the PPP program.

Standard examination system for laparoscopy in penetrating abdominal trauma.

Background: The high missed occult small bowel injuries (SBI) associated with laparoscopy in trauma (LIT) is a major reason why some surgeons still preclude LIT today. No standardized laparoscopic examination for evaluation of the peritoneal cavity is described for trauma. The objective of this article is to verify if a systematic standardized laparoscopic approach could correctly identify SBI in the peritoneal cavity for penetrating abdominal trauma (PAT).

[Aortoesophageal fistula: successful management of hazardous complication caused by foreign body].

The rate of foreign body ingestion in the gastrointestinal tract requiring endoscopic treatment is 10% to 20% and its retention in the esophagus may represent risk of severe complications. Additionally to endoscopic treatment, surgical procedure might be necessary in approximately 1%.The case of an alcoholic patient, which accidentally ingested a dental prosthesis during an episode of severe drunkenness, is reported.

Gut ischemia/reperfusion induced acute lung injury is an alveolar macrophage dependent event.

Background: Although the role of the lung alveolar macrophage (AM) as a mediator of acute lung injury (ALI) after lung ischemia/reperfusion (I/R) has been suggested by animal experiments, it has not been determined whether AMs mediate ALI after intestinal I/R. The objective of this study was to determine the effect of AM elimination on ALI after intestinal I/R in rats.

Methods: Male Wistar rats (n = 90) were randomly divided into three groups: the clodronate-liposomes (CLOD-LIP) group received intratracheal treatment with CLOD-LIP; the liposomes (LIP) group received intratracheal treatment with LIP; and the nontreated (UNTREAT) group received no treatment.

Hyperbaric oxygen therapy: types of injury and number of sessions--a review of 1506 cases.

Objective: The aim of this work was to identify clinical data indicative of the number of hyperbaric oxygen therapy HBO2 sessions that should be prescribed for adjuvant treatment of tissue injuries of differing severity.

Patients: A total of 1730 cases of patients treated with HBO2 using an open protocol (without a predetermined number of sessions) was examined in this study.

Method: A retrospective study involving charts review was conducted.

Comparison of anterior gastric wall and greater gastric curvature invaginations for weight loss in rats.

Background: Many bariatric endoscopic or surgical procedures performed today reduce gastric capacity and/or induce an early sensation of gastric satiety, alone or in combination with a distal enteric intervention. A form of prosthetic wrap of the folded stomach was used in the past for treating obesity with a high rate of prosthesis-related reintervention. Nissen gastric fundoplication used in the treatment of gastroesophageal reflux disease induces a small but significant weight loss without gastric stapling, partitioning, or prosthesis-related morbidity.

The "oligoanalgesia problem" in the emergency care.

Introduction: Pain is a common occurrence in trauma victims that provokes harmful effects on the body. However, there is a gap in the literature about this problem, which is still underevaluated and undertreated in Brazil, especially concerning the use of opioids.

Objectives: To estimate pain intensity and the use of analgesia in traffic accident victims.

Responsiveness to different volume therapies following hemodilution and hemorrhagic shock: a comparative experimental study in rats.

Unlabelled: Guidelines for volume replacement for acutely hemorrhaged and hemodiluted trauma patients have not been well established.

Purpose: To evaluate the effects of acute hemodilution on mean arterial pressure (MAP), and responsiveness of acutely hemodiluted and subsequently hemorrhaged rats to different volume therapies.

Methods: 180 rats were hemodiluted to simulate hemorrhaged trauma patients with persistent bleeding after high volume replacement with isotonic solutions.

Evaluation of the mortality rate caused by different periods of selective portal vein occlusion in rats.

Unlabelled: Mortality from acute selective portal vein occlusion (SPVO) is a matter of concern for surgeons during the management of traumatic portal vein injury. However, mortality rates related to different periods of SPVO remains undetermined.

Purpose: To determine the mortality rates resulting from different periods of acute SPVO in rats.

Obstructive jaundice induces early depression of mitochondrial respiration in rat hepatocytes.

Introduction: Oxidative phosphorylation dysfunction of hepatocyte mitochondria is involved in the pathophysiology of organ dysfunction following obstructive jaundice (OJ). However the time period from biliary occlusion to the occurrence of the dysfunction has not been determined decisively.

Purpose: To evaluate the early effects (1 d and 7 d) of OJ on liver mitochondria respiratory function in rats.

Transgastric access by balloon overtube for intraperitoneal surgery.

The final frontier in endoscopy is the peritoneal cavity which was recently reached through natural orifice transluminal endoscopic surgery (NOTES). Endoscopic perforation caused by NOTES has been the major challenge for this procedure because of the risk of peritonitis and consequent complications. We describe in a dog model the use of an overtube system, one of them with a balloon, to access the peritoneal cavity by NOTES.

Isolated right atrial appendage (RAA) rupture in blunt trauma--a case report and an anatomic study comparing RAA and right atrium (RA) wall thickness.

Background: Heart chambers rupture in blunt trauma is uncommon and is associated with a high mortality. The determinant factors, and the incidence of isolated heart chambers rupture remains undetermined. Isolated rupture of the right atrium appendage (RAA) is very rare, with 8 cases reported in the reviewed literature.

An unusual case of pneumoperitoneum: nephrocolic fistula due to a giant renal staghorn calculus.

Gastrointestinal perforations usually lead to pneumoperitoneum and peritonitis. Rarely, if ever described, a complete giant staghorn renal stone might cause a nephrocolic fistula with sigmoid impaction and perforation similar to gallstone ileus. Few nephrointestinal fistulae have been described in the literature and none of them were presented as an acute abdomen with pneumoperitoneum and pneumoretroperitoneum.

An experimental model for the treatment of lethal bleeding injury to the juxtahepatic vena cava with stent graft.

Background: Juxtahepatic vein injuries present a high mortality rate. Our objectives were to develop an experimental model of endovascular lethal injury of the juxtahepatic inferior vena cava (JHIVC) and to evaluate its hemodynamic alterations; to treat the lesion with volume replacement, and a stent graft (SG); and to follow the animals after treatment.

Methods: Twenty dogs were anesthetized and monitored [heart rate (HR), mean arterial pressure (MAP), vesical and peritoneal pressures], and submitted to a JHIVC endovascular injury.