Dario Birolini | Universidade de São Paulo (original) (raw)

Papers by Dario Birolini

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

Hernia : the journal of hernias and abdominal wall surgery, 2010

Preoperative progressive pneumoperitoneum (PPP) is a safe and effective procedure in the treatmen... more 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. Our technique is indicated for all patients with large or recurrent incisional hernias evaluated by a senior surgeon with suspected LIHLD. We reviewed our experience from 2001 to 2008 of 23 consecutive hernia surgical procedures of LIHLD undergoing preoperative evaluation with CT scanning and PPP. An ACT was required in...

Research paper thumbnail of Hyperbaric oxygen therapy: types of injury and number of sessions--a review of 1506 cases

Undersea & hyperbaric medicine : journal of the Undersea and Hyperbaric Medical Society, Inc

The aim of this work was to identify clinical data indicative of the number of hyperbaric oxygen ... more 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. 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. A retrospective study involving charts review was conducted. Severity had been previously determined for the treatment of acute (fasciitis, myositis, gangrene, contaminated/infected perineal or lower extremity traumatic injuries) or chronic (osteomyelitis, pressure sore, diabetic or ischemic ulcer) injuries. Only patients that met or exceeded the supposed effective minimal treatment doses (5 sessions for acute, 10 sessions for chronic injuries) were included in the present study. The data analysis included 1506 cases. These consisted of 1014 patients with acute injuries, who required 11 to 18 sessions (depending on injury severity)...

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

World journal of emergency surgery : WJES, 2007

Heart chambers rupture in blunt trauma is uncommon and is associated with a high mortality. The d... more 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. The thin wall of the RAA has been presumed to render this chamber more prone to rupture in blunt trauma. To report a case of isolated RAA rupture in blunt trauma, and to compare right atrium (RA) and RAA wall thickness in a necropsy study. The thickness of RA and RAA wall of hearts from cadavers of fatal penetrating head trauma victims was measured. Our case of isolated RAA rupture is presented. The main findings of the 8 cases reported in the literature, and the findings of our case, were organized in a table. The comparison of the data showed that wall thickness of the RAA (0.53 +/- 0.33 mm) was significantly thinner than that of RA (1.11 +/- 0.42 mm) (p < 0.05). In all thes...

Research paper thumbnail of Hypertonic/hyperoncotic solution in hypovolemic patients: experience in the emergency room

Revista do Hospital das Clínicas

Hypertonic solutions have been studied extensively in the treatment of hypovolemic shock, both in... more Hypertonic solutions have been studied extensively in the treatment of hypovolemic shock, both in experimental and clinical models. Safety, efficacy, and long-term effects on animals and patients have been evaluated. The present article reviews indications, safety, mortality rates, and outcome in patients with hemorrhagic hypovolemic shock who were treated after admission with a hypertonic/hyperoncotic solution under strict observation in the emergency room.

Research paper thumbnail of Autotransfusion with laparoscopically salvaged blood in trauma: report on 21 cases

Surgical laparoscopy & endoscopy, 1996

Autotransfusion is being increasingly used to avoid the complications of homologous blood transfu... more Autotransfusion is being increasingly used to avoid the complications of homologous blood transfusion. In abdominal trauma, however, the collected blood may be contaminated by intestinal contents when digestive or urinary lesions are present. In such situations, the reinfusion of blood is contraindicated. We present our experience with autotransfusion of blood collected by laparoscopy from the abdominal cavity of 21 trauma patients. Laparoscopy allowed the aspiration of blood and, at the same time, permitted diagnosis of visceral lesions, avoiding reinfusion of contaminated blood. No complications occurred, and hematocrit values were significantly elevated. This procedure may represent the only possible method of blood transfusion in Jehovah's Witnesses, as with one patient in our series.

Research paper thumbnail of Fístula aortoesofágica: Manejo exitoso de una complicación peligrosa causada por un cuerpo extraño

ABSTRACT The rate of foreign body ingestion in the gastrointestinal tract requiring endoscopic tr... more ABSTRACT 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. He developed an aortoesophageal fistula that, after endoscopic evaluation, was surgically treated with success.

Research paper thumbnail of Blood loss and transcapillary refill in uncontrolled treated hemorrhage in dogs

Clinics, 2010

This study evaluated retroperitoneal hematomas produced by bilateral injury of iliac arteries (un... more 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 (16.8 ± 2.2 kg) were submitted to hemorrhage for 30 minutes and randomized into three groups: I -no treatment (n=7); II -treatment with 32 mL/kg of Lactated Ringer's for three to five minutes (n=7); and IIItreatment with 4 mL/kg of 7.5% NaCl plus 6.0% dextran 70 for three to five minutes (n=7). They were studied for an additional 45 minutes. RESULTS: Volume replacement produced transitory recovery in hemodynamic variables, including mean pulmonary artery pressure, pulmonary capillary wedge pressure and cardiac index, with significant increase in dogs treated with 32 mL/kg of Lactated Ringer's and 7.5% NaCl plus 6.0% dextran 70 (p<0.001, against no treatment), along with a decrease (p<0.001) in the systemic vascular resistance index. Groups II and III had significant initial decreases in hematocrit and hemoglobin. The treated dogs (groups II and III) presented rebleeding, which was greater during treatment with 32 mL/kg of Lactated Ringer's (group II). CONCLUSIONS: Despite the rebleeding observed in treated groups, the utilization of hypertonic saline solution with dextran proved to be effective in the initial reanimation, producing evident transcapillary refill, while the Lactated Ringer's solution produced capillary extravasation and was ineffective in the initial volume replacement in this model of uncontrolled hemorrhage.

Research paper thumbnail of Surgery in Brazil

... JAMA &amp; Archives Select Journal or Resource ... Fernando Paulino, MD, and José Hilário... more ... JAMA &amp; Archives Select Journal or Resource ... Fernando Paulino, MD, and José Hilário, MD, from Rio de Janeiro; Benedito Montenegro, MD, Alípio Correa Neto, MD, and ...

Research paper thumbnail of Diagnostic and Therapeutic Laparoscopy for Penetrating Abdominal Trauma

The Journal of Trauma: Injury, Infection, and Critical Care, 1997

Considerable skepticism still exists about the role of diagnostic laparoscopy in the evaluation o... more Considerable skepticism still exists about the role of diagnostic laparoscopy in the evaluation of penetrating abdominal trauma. The reported experience with therapeutic laparoscopy has been limited. Retrospective analysis of a collective experience from three large urban trauma centers with 510 patients (316 stab wounds, 194 gunshot wounds) who were hemodynamically stable and had no urgent indications for celiotomy. Laparotomy was avoided in 277 of the 510 patients (54.3%) either because of nonpenetration or insignificant findings on laparoscopy. All were discharged uneventfully after a mean hospital stay of 1.7 days. Twenty-six had successful therapeutic procedures on laparoscopy (diaphragmatic repair in 16 patients, cholecystectomy in 1 patient, hepatic repair in 6 patients, and closure of gastrotomy in 3 patients) with uneventful recovery. In the remaining 203 patients, laparotomy was therapeutic in 155. Fifty-two patients had nontherapeutic celiotomy for exclusion of bowel injuries or as mandatory laparotomy for penetrating gunshot wounds (19.7%). The overall incidence of nontherapeutic laparotomy was 10.2%. Complications from laparoscopy were minimal (10 of 510) and minor. Laparoscopy has an important diagnostic role in stable patients with penetrating abdominal trauma. In carefully selected patients, therapeutic laparoscopy is practical, feasible, and offers all the advantages of minimally invasive surgery.

Research paper thumbnail of Tratamento das hérnias inguinais: Bassani ainda atual? Estudo randomizado, prospectivo e comparativo entre três técnicas operatórias: Bassini, Shouldice, McVay

Revista da Associação Médica Brasileira, 1999

Research paper thumbnail of Tracheostomy in Children: There Is a Place for Acceptable Risk

The Journal of Trauma: Injury, Infection, and Critical Care, 2000

Background: Tracheostomy in chil-dren remains controversial regarding the risk of complications. ... more Background: Tracheostomy in chil-dren remains controversial regarding the risk of complications. Methods: Forty-six trauma patients (35 male and 11 female, mean age 6.8 years) were admitted to the intensive care unit between 1987 and 1991 with severe head ...

Research paper thumbnail of Gut Ischemia/Reperfusion Activates Lung Macrophages for Tumor Necrosis Factor and Hydrogen Peroxide Production

The Journal of Trauma: Injury, Infection, and Critical Care, 2000

Gut ischemia followed by reperfusion (I/R) is implicated as a prime initiating event in the mecha... more Gut ischemia followed by reperfusion (I/R) is implicated as a prime initiating event in the mechanism of multiple organ failure after trauma and hemorrhagic shock. Several lines of evidence indicate that macrophages are involved in this prime event. Our purpose was to evaluate hydrogen peroxide (H2O2) and tumor necrosis factor (TNF) production and phagocytosis by lung macrophages in a gut I/R model of multiple organ failure in rats. In the experimental group (I/R), Wistar rats (n = 35) were anesthetized and subjected to a median laparotomy, and the superior mesenteric artery was clamped for 45 minutes followed by 60 minutes of reperfusion. In the control group (LAP) (n = 37), animals underwent sham laparotomy. After the period of reperfusion, bronchoalveolar lavage (BAL) was performed and the resulting BAL cells were assayed for H2O2 production using the horseradish peroxidase-mediated red phenol oxidation method. TNF release was determined using the L929 cells bioassay. Zymosan phagocytosis by BAL macrophages was quantitated using phase microscopy. H2O2 release in BAL cells of I/R rats (19.90 +/- 7.98 nmol/L/2 x 10(5) cells) is statistically higher than in the LAP group (10.92 +/- 5.01 nmol/L per 2 x 10(5) cells) (p = 0.0155), and the TNF production by BAL cells of the I/R group (38.09 +/- 20.79 units per 10(6) cells) was significantly higher than that of LAP rats (17.16 +/- 13.35 units per 10(6) cells) (p = 0.0281). Phagocytic activity of BAL mac. Macrophages of I/R rats was not statistically different from LAP animals. These results suggest that BAL macrophage play a role in the mechanism of acute lung injury after trauma and hemorrhagic shock.

Research paper thumbnail of Laparoscopic Treatment of Gastric and Diaphragmatic Injury Produced by Thoracoabdominal Stab Wound

The Journal of Trauma: Injury, Infection, and Critical Care, 1998

Research paper thumbnail of Obstructive jaundice induces early depression of mitochondrial respiration in rat hepatocytes

Acta Cirurgica Brasileira, 2007

Oxidative phosphorylation dysfunction of hepatocyte mitochondria is involved in the pathophysiolo... more 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. To evaluate the early effects (1 d and 7 d) of OJ on liver mitochondria respiratory function in rats. Male Wistar rats (200-250 g) were randomly divided into the following 3 groups: laparotomy plus OJ for 24 h (1d group) (n = 10); laparotomy plus OJ for 7 d (7d group) (n = 10); sham control procedure (CTR group) (n = 12). At the end of OJ periods, total serum bilirubin level, hepatic enzyme activity levels (GOT, GTP, Gama-GT, ALP), mitochondrial respiration phases S3 and S4, as well as the respiratory control ratio (RC = S3/S4), and ADP consumption/oxygen consumption (ADP/O) ratio, were determined. Total serum bilirubin, activity of most hepatic enzymes, and O2 consumption during basal (S4) respiration were increased in the 1d and 7d groups (ANOVA, p = 0.05 vs. CTR). After ADP addition, the O2 consumption rate (S3) in the 1d group remained similar to the CTR rate (ANOVA p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; .05), while the RC rate was reduced (ANOVA, p = 0.001) vs. CTR. The effects observed on mitochondrial respiration in the 1d group were exacerbated in the 7d group. These results indicate that OJ induces early (24 h) depression of liver mitochondria respiration, and thus may lead to early reduction in the production of high energy bonds.

Research paper thumbnail of Avaliação diagnóstica da laparoscopia associada à análise do líquido intraperitoneal nas lesões intra-abdominais provocadas por arma de ar comprimido: estudo experimental em cães

Revista do Colégio Brasileiro de Cirurgiões, 2000

Avaliação de eficácia da laparoscopia, associada à análise bacteriológica do líquido intraperiton... more Avaliação de eficácia da laparoscopia, associada à análise bacteriológica do líquido intraperitoneal pela coloração de Gram., no diagnóstico de lesões intra-abdominais provocadas em cães com arma de ar comprimido. A alta incidência de óbitos como resultado de ferimentos por arma de fogo tem contribuído para implantação de novas técnicas diagnósticas. O uso crescente de laparoscopia diagnóstica em urgências torna necessário aprimorar qualidade e fidedignidade dos resultados obtidos. Este experimento avalia acurácia, sensibilidade e especificidade da laparoscopia, incluindo 20 cães submetidos a trauma abdominal, com disparo do tipo encostado, e cinco cães como grupo de controle. Na laparoscopia, foram feitos inventário sistemático da cavidade abdominal, conferido por laparotomia, e coleta de líquido intraperitoneal para análise bacteriológica. A laparoscopia apresentou acurácia de 88,29%, sensibilidade de 88,29% e especificidade de 100%. O valor preditivo positivo da coloração de Gram foi 100%. Concluiu-se que a laparoscopia é eficaz no diagnóstico de lesões intra-abdominais provocadas por arma de ar comprimido, em cães hemodinamicamente estáveis. Mas, algumas lesões, evidenciadas na laparotomia, passaram despercebidas na laparoscopia. Realização concomitante de análise bacteriológica pela coloração de Gram pode aumentar a eficácia e diminuir a possibilidade de erros no diagnóstico de lesões. Laparoscopia associada à análise bacteriológica possibilita melhores resultados com mínimo dano ao paciente

Research paper thumbnail of Enxerto aorto-femoral por via laparoscópica: modelo experimental

Jornal Vascular Brasileiro, 2005

Research paper thumbnail of H ypertonic solutions in the treatment of hypovolemic shock: A prospective, randomized study in patients admitted to the emergency

Background. The inJusion 01 small volumes 01 hypertonic saline solution or hypertonic saline plus... more Background. The inJusion 01 small volumes 01 hypertonic saline solution or hypertonic saline plus dextran 70 is remarkably effective in restoring adequate hemodynamic conditions alter hypovolemic shock. This prospective double-blind study compares the immediate hemodynamic effects 01 a bolus inJusion 01 7.5% NaCl or 7.5% NaCl plus 6% dextran 70 (both 2400 mOsmjL) in severe hypovolemia. Methods. One hundred five adult patients admitted in hypovolemic shock (systolic blood pressure <80 mm Hg) were revived on arrival to the emergency room and administration 01 a 250 ml intravenous bolus 01 hypertonic saline solution (n = 35), hypertonic saline plus dextran (n = 35), or isotonic saline solution (n = 35). This inJusion u,'as immediately 1011owed by standard CT)'stalloid and blood replacement until S),stolic pressure reached 100 mm Hg. Mean arterial pressure (MAP) was measured every 5 minutes, and all intravenous inJusions were registered. Plasma volume expansion was calculated from plasma protein concentration measurements. Patients were 1011owed up throughout their hospital course, and results 01 treatment were recorded. Results. At the end 01 the inJusion period, and 5 and 10 minutes after inJusion, MAP was significantly higher in patients receiving either hypertonic solution, compared with the group receiving isotonic solution. All groups showed similar trends toward restoration 01 hemodynamic parameters thereafter. The calculated plasma volume expansion, immediately after the bolus inJusion, was significantly higher (24.1% :t 1.8% and 24.9% :t 1.1%) in the hypertonic groups, compared with isotonic groups (7.9% :t 1.3%). Significantly greater volumes 01 fiuids were required to restore systolic pressure in the patients receiving isotonic saline solution than in the groups receiving hypertonic solution. There were no significant differences between the groups receiving hypertonic solutions. The incidence 01 complications was low, and the m orta lit y Tale was similar in all groups. Conclusions. InJusion 01250 ml hypertonic saline solution in patients with severe hypovolemia was not related to any comPlications, nor did it affect mortality Tales,. it improved MAP significantly, acutely expanded plasma volume by 24%, and reduced significantiy the volumes 01 crystalloids and blood required in their resuscitation.

Research paper thumbnail of Sigmoid colon adenocarcinoma: 9 years from diagnosis to treatment

Research paper thumbnail of Is the advanced trauma life support simulation exam more stressful for the surgeon than emergency department trauma care?

Clinics, 2005

Stress affects surgeons both during training and during professional activity. To compare stress ... more Stress affects surgeons both during training and during professional activity. To compare stress levels affecting surgical residents during the simulated initial assessment and management in the Advanced Trauma Life Support practical exam vs initial assessment and management of trauma patients in the emergency room. Eighteen surgical residents were evaluated under basal conditions, during the Advanced Trauma Life Support simulation, and during emergency room initial care. Heart rate, systolic arterial pressure, and diastolic arterial pressure were measured. The Student t test was used to test for differences between means, with statistical significance declared when P &amp;amp;amp;amp;amp;amp;lt; .05. Heart rate and systolic arterial pressure were increased at the beginning and at the end of Advanced Trauma Life Support simulation and emergency room initial care. Diastolic arterial pressure was only increased at the end of the Advanced Trauma Life Support simulation. Comparing values obtained during the Advanced Trauma Life Support simulation with those obtained during emergency room initial care, heart rate and systolic arterial pressure were significantly higher during the Advanced Trauma Life Support simulation both at the beginning and end of the test events. However, diastolic arterial pressure was only significantly higher for Advanced Trauma Life Support simulation compared emergency room at the end of the procedures. These results suggest that the simulation in the practical exam portion of the Advanced Trauma Life Support course is more stressful for the resident surgeon than is the actual initial assessment and care of trauma patients in an emergency room.

Research paper thumbnail of UNUSUAL CASE OF THE FOUR ILIAC VEINS INJURIES BY GUNSHOT: CASE REPORT AND REVIEW OF THE LITERATURE

Multiple injuries of iliac veins are uncommon and frequently fatal. An unusual case in which ther... more Multiple injuries of iliac veins are uncommon and frequently fatal. An unusual case in which there were injuries of the four iliac veins by gunshot is described. A review of literature of this condition and a discussion about the diagnosis , treatment and factors affecting mortality rate is presented. No other such case has been found reported.

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

Hernia : the journal of hernias and abdominal wall surgery, 2010

Preoperative progressive pneumoperitoneum (PPP) is a safe and effective procedure in the treatmen... more 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. Our technique is indicated for all patients with large or recurrent incisional hernias evaluated by a senior surgeon with suspected LIHLD. We reviewed our experience from 2001 to 2008 of 23 consecutive hernia surgical procedures of LIHLD undergoing preoperative evaluation with CT scanning and PPP. An ACT was required in...

Research paper thumbnail of Hyperbaric oxygen therapy: types of injury and number of sessions--a review of 1506 cases

Undersea & hyperbaric medicine : journal of the Undersea and Hyperbaric Medical Society, Inc

The aim of this work was to identify clinical data indicative of the number of hyperbaric oxygen ... more 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. 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. A retrospective study involving charts review was conducted. Severity had been previously determined for the treatment of acute (fasciitis, myositis, gangrene, contaminated/infected perineal or lower extremity traumatic injuries) or chronic (osteomyelitis, pressure sore, diabetic or ischemic ulcer) injuries. Only patients that met or exceeded the supposed effective minimal treatment doses (5 sessions for acute, 10 sessions for chronic injuries) were included in the present study. The data analysis included 1506 cases. These consisted of 1014 patients with acute injuries, who required 11 to 18 sessions (depending on injury severity)...

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

World journal of emergency surgery : WJES, 2007

Heart chambers rupture in blunt trauma is uncommon and is associated with a high mortality. The d... more 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. The thin wall of the RAA has been presumed to render this chamber more prone to rupture in blunt trauma. To report a case of isolated RAA rupture in blunt trauma, and to compare right atrium (RA) and RAA wall thickness in a necropsy study. The thickness of RA and RAA wall of hearts from cadavers of fatal penetrating head trauma victims was measured. Our case of isolated RAA rupture is presented. The main findings of the 8 cases reported in the literature, and the findings of our case, were organized in a table. The comparison of the data showed that wall thickness of the RAA (0.53 +/- 0.33 mm) was significantly thinner than that of RA (1.11 +/- 0.42 mm) (p < 0.05). In all thes...

Research paper thumbnail of Hypertonic/hyperoncotic solution in hypovolemic patients: experience in the emergency room

Revista do Hospital das Clínicas

Hypertonic solutions have been studied extensively in the treatment of hypovolemic shock, both in... more Hypertonic solutions have been studied extensively in the treatment of hypovolemic shock, both in experimental and clinical models. Safety, efficacy, and long-term effects on animals and patients have been evaluated. The present article reviews indications, safety, mortality rates, and outcome in patients with hemorrhagic hypovolemic shock who were treated after admission with a hypertonic/hyperoncotic solution under strict observation in the emergency room.

Research paper thumbnail of Autotransfusion with laparoscopically salvaged blood in trauma: report on 21 cases

Surgical laparoscopy & endoscopy, 1996

Autotransfusion is being increasingly used to avoid the complications of homologous blood transfu... more Autotransfusion is being increasingly used to avoid the complications of homologous blood transfusion. In abdominal trauma, however, the collected blood may be contaminated by intestinal contents when digestive or urinary lesions are present. In such situations, the reinfusion of blood is contraindicated. We present our experience with autotransfusion of blood collected by laparoscopy from the abdominal cavity of 21 trauma patients. Laparoscopy allowed the aspiration of blood and, at the same time, permitted diagnosis of visceral lesions, avoiding reinfusion of contaminated blood. No complications occurred, and hematocrit values were significantly elevated. This procedure may represent the only possible method of blood transfusion in Jehovah's Witnesses, as with one patient in our series.

Research paper thumbnail of Fístula aortoesofágica: Manejo exitoso de una complicación peligrosa causada por un cuerpo extraño

ABSTRACT The rate of foreign body ingestion in the gastrointestinal tract requiring endoscopic tr... more ABSTRACT 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. He developed an aortoesophageal fistula that, after endoscopic evaluation, was surgically treated with success.

Research paper thumbnail of Blood loss and transcapillary refill in uncontrolled treated hemorrhage in dogs

Clinics, 2010

This study evaluated retroperitoneal hematomas produced by bilateral injury of iliac arteries (un... more 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 (16.8 ± 2.2 kg) were submitted to hemorrhage for 30 minutes and randomized into three groups: I -no treatment (n=7); II -treatment with 32 mL/kg of Lactated Ringer's for three to five minutes (n=7); and IIItreatment with 4 mL/kg of 7.5% NaCl plus 6.0% dextran 70 for three to five minutes (n=7). They were studied for an additional 45 minutes. RESULTS: Volume replacement produced transitory recovery in hemodynamic variables, including mean pulmonary artery pressure, pulmonary capillary wedge pressure and cardiac index, with significant increase in dogs treated with 32 mL/kg of Lactated Ringer's and 7.5% NaCl plus 6.0% dextran 70 (p<0.001, against no treatment), along with a decrease (p<0.001) in the systemic vascular resistance index. Groups II and III had significant initial decreases in hematocrit and hemoglobin. The treated dogs (groups II and III) presented rebleeding, which was greater during treatment with 32 mL/kg of Lactated Ringer's (group II). CONCLUSIONS: Despite the rebleeding observed in treated groups, the utilization of hypertonic saline solution with dextran proved to be effective in the initial reanimation, producing evident transcapillary refill, while the Lactated Ringer's solution produced capillary extravasation and was ineffective in the initial volume replacement in this model of uncontrolled hemorrhage.

Research paper thumbnail of Surgery in Brazil

... JAMA &amp; Archives Select Journal or Resource ... Fernando Paulino, MD, and José Hilário... more ... JAMA &amp; Archives Select Journal or Resource ... Fernando Paulino, MD, and José Hilário, MD, from Rio de Janeiro; Benedito Montenegro, MD, Alípio Correa Neto, MD, and ...

Research paper thumbnail of Diagnostic and Therapeutic Laparoscopy for Penetrating Abdominal Trauma

The Journal of Trauma: Injury, Infection, and Critical Care, 1997

Considerable skepticism still exists about the role of diagnostic laparoscopy in the evaluation o... more Considerable skepticism still exists about the role of diagnostic laparoscopy in the evaluation of penetrating abdominal trauma. The reported experience with therapeutic laparoscopy has been limited. Retrospective analysis of a collective experience from three large urban trauma centers with 510 patients (316 stab wounds, 194 gunshot wounds) who were hemodynamically stable and had no urgent indications for celiotomy. Laparotomy was avoided in 277 of the 510 patients (54.3%) either because of nonpenetration or insignificant findings on laparoscopy. All were discharged uneventfully after a mean hospital stay of 1.7 days. Twenty-six had successful therapeutic procedures on laparoscopy (diaphragmatic repair in 16 patients, cholecystectomy in 1 patient, hepatic repair in 6 patients, and closure of gastrotomy in 3 patients) with uneventful recovery. In the remaining 203 patients, laparotomy was therapeutic in 155. Fifty-two patients had nontherapeutic celiotomy for exclusion of bowel injuries or as mandatory laparotomy for penetrating gunshot wounds (19.7%). The overall incidence of nontherapeutic laparotomy was 10.2%. Complications from laparoscopy were minimal (10 of 510) and minor. Laparoscopy has an important diagnostic role in stable patients with penetrating abdominal trauma. In carefully selected patients, therapeutic laparoscopy is practical, feasible, and offers all the advantages of minimally invasive surgery.

Research paper thumbnail of Tratamento das hérnias inguinais: Bassani ainda atual? Estudo randomizado, prospectivo e comparativo entre três técnicas operatórias: Bassini, Shouldice, McVay

Revista da Associação Médica Brasileira, 1999

Research paper thumbnail of Tracheostomy in Children: There Is a Place for Acceptable Risk

The Journal of Trauma: Injury, Infection, and Critical Care, 2000

Background: Tracheostomy in chil-dren remains controversial regarding the risk of complications. ... more Background: Tracheostomy in chil-dren remains controversial regarding the risk of complications. Methods: Forty-six trauma patients (35 male and 11 female, mean age 6.8 years) were admitted to the intensive care unit between 1987 and 1991 with severe head ...

Research paper thumbnail of Gut Ischemia/Reperfusion Activates Lung Macrophages for Tumor Necrosis Factor and Hydrogen Peroxide Production

The Journal of Trauma: Injury, Infection, and Critical Care, 2000

Gut ischemia followed by reperfusion (I/R) is implicated as a prime initiating event in the mecha... more Gut ischemia followed by reperfusion (I/R) is implicated as a prime initiating event in the mechanism of multiple organ failure after trauma and hemorrhagic shock. Several lines of evidence indicate that macrophages are involved in this prime event. Our purpose was to evaluate hydrogen peroxide (H2O2) and tumor necrosis factor (TNF) production and phagocytosis by lung macrophages in a gut I/R model of multiple organ failure in rats. In the experimental group (I/R), Wistar rats (n = 35) were anesthetized and subjected to a median laparotomy, and the superior mesenteric artery was clamped for 45 minutes followed by 60 minutes of reperfusion. In the control group (LAP) (n = 37), animals underwent sham laparotomy. After the period of reperfusion, bronchoalveolar lavage (BAL) was performed and the resulting BAL cells were assayed for H2O2 production using the horseradish peroxidase-mediated red phenol oxidation method. TNF release was determined using the L929 cells bioassay. Zymosan phagocytosis by BAL macrophages was quantitated using phase microscopy. H2O2 release in BAL cells of I/R rats (19.90 +/- 7.98 nmol/L/2 x 10(5) cells) is statistically higher than in the LAP group (10.92 +/- 5.01 nmol/L per 2 x 10(5) cells) (p = 0.0155), and the TNF production by BAL cells of the I/R group (38.09 +/- 20.79 units per 10(6) cells) was significantly higher than that of LAP rats (17.16 +/- 13.35 units per 10(6) cells) (p = 0.0281). Phagocytic activity of BAL mac. Macrophages of I/R rats was not statistically different from LAP animals. These results suggest that BAL macrophage play a role in the mechanism of acute lung injury after trauma and hemorrhagic shock.

Research paper thumbnail of Laparoscopic Treatment of Gastric and Diaphragmatic Injury Produced by Thoracoabdominal Stab Wound

The Journal of Trauma: Injury, Infection, and Critical Care, 1998

Research paper thumbnail of Obstructive jaundice induces early depression of mitochondrial respiration in rat hepatocytes

Acta Cirurgica Brasileira, 2007

Oxidative phosphorylation dysfunction of hepatocyte mitochondria is involved in the pathophysiolo... more 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. To evaluate the early effects (1 d and 7 d) of OJ on liver mitochondria respiratory function in rats. Male Wistar rats (200-250 g) were randomly divided into the following 3 groups: laparotomy plus OJ for 24 h (1d group) (n = 10); laparotomy plus OJ for 7 d (7d group) (n = 10); sham control procedure (CTR group) (n = 12). At the end of OJ periods, total serum bilirubin level, hepatic enzyme activity levels (GOT, GTP, Gama-GT, ALP), mitochondrial respiration phases S3 and S4, as well as the respiratory control ratio (RC = S3/S4), and ADP consumption/oxygen consumption (ADP/O) ratio, were determined. Total serum bilirubin, activity of most hepatic enzymes, and O2 consumption during basal (S4) respiration were increased in the 1d and 7d groups (ANOVA, p = 0.05 vs. CTR). After ADP addition, the O2 consumption rate (S3) in the 1d group remained similar to the CTR rate (ANOVA p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; .05), while the RC rate was reduced (ANOVA, p = 0.001) vs. CTR. The effects observed on mitochondrial respiration in the 1d group were exacerbated in the 7d group. These results indicate that OJ induces early (24 h) depression of liver mitochondria respiration, and thus may lead to early reduction in the production of high energy bonds.

Research paper thumbnail of Avaliação diagnóstica da laparoscopia associada à análise do líquido intraperitoneal nas lesões intra-abdominais provocadas por arma de ar comprimido: estudo experimental em cães

Revista do Colégio Brasileiro de Cirurgiões, 2000

Avaliação de eficácia da laparoscopia, associada à análise bacteriológica do líquido intraperiton... more Avaliação de eficácia da laparoscopia, associada à análise bacteriológica do líquido intraperitoneal pela coloração de Gram., no diagnóstico de lesões intra-abdominais provocadas em cães com arma de ar comprimido. A alta incidência de óbitos como resultado de ferimentos por arma de fogo tem contribuído para implantação de novas técnicas diagnósticas. O uso crescente de laparoscopia diagnóstica em urgências torna necessário aprimorar qualidade e fidedignidade dos resultados obtidos. Este experimento avalia acurácia, sensibilidade e especificidade da laparoscopia, incluindo 20 cães submetidos a trauma abdominal, com disparo do tipo encostado, e cinco cães como grupo de controle. Na laparoscopia, foram feitos inventário sistemático da cavidade abdominal, conferido por laparotomia, e coleta de líquido intraperitoneal para análise bacteriológica. A laparoscopia apresentou acurácia de 88,29%, sensibilidade de 88,29% e especificidade de 100%. O valor preditivo positivo da coloração de Gram foi 100%. Concluiu-se que a laparoscopia é eficaz no diagnóstico de lesões intra-abdominais provocadas por arma de ar comprimido, em cães hemodinamicamente estáveis. Mas, algumas lesões, evidenciadas na laparotomia, passaram despercebidas na laparoscopia. Realização concomitante de análise bacteriológica pela coloração de Gram pode aumentar a eficácia e diminuir a possibilidade de erros no diagnóstico de lesões. Laparoscopia associada à análise bacteriológica possibilita melhores resultados com mínimo dano ao paciente

Research paper thumbnail of Enxerto aorto-femoral por via laparoscópica: modelo experimental

Jornal Vascular Brasileiro, 2005

Research paper thumbnail of H ypertonic solutions in the treatment of hypovolemic shock: A prospective, randomized study in patients admitted to the emergency

Background. The inJusion 01 small volumes 01 hypertonic saline solution or hypertonic saline plus... more Background. The inJusion 01 small volumes 01 hypertonic saline solution or hypertonic saline plus dextran 70 is remarkably effective in restoring adequate hemodynamic conditions alter hypovolemic shock. This prospective double-blind study compares the immediate hemodynamic effects 01 a bolus inJusion 01 7.5% NaCl or 7.5% NaCl plus 6% dextran 70 (both 2400 mOsmjL) in severe hypovolemia. Methods. One hundred five adult patients admitted in hypovolemic shock (systolic blood pressure <80 mm Hg) were revived on arrival to the emergency room and administration 01 a 250 ml intravenous bolus 01 hypertonic saline solution (n = 35), hypertonic saline plus dextran (n = 35), or isotonic saline solution (n = 35). This inJusion u,'as immediately 1011owed by standard CT)'stalloid and blood replacement until S),stolic pressure reached 100 mm Hg. Mean arterial pressure (MAP) was measured every 5 minutes, and all intravenous inJusions were registered. Plasma volume expansion was calculated from plasma protein concentration measurements. Patients were 1011owed up throughout their hospital course, and results 01 treatment were recorded. Results. At the end 01 the inJusion period, and 5 and 10 minutes after inJusion, MAP was significantly higher in patients receiving either hypertonic solution, compared with the group receiving isotonic solution. All groups showed similar trends toward restoration 01 hemodynamic parameters thereafter. The calculated plasma volume expansion, immediately after the bolus inJusion, was significantly higher (24.1% :t 1.8% and 24.9% :t 1.1%) in the hypertonic groups, compared with isotonic groups (7.9% :t 1.3%). Significantly greater volumes 01 fiuids were required to restore systolic pressure in the patients receiving isotonic saline solution than in the groups receiving hypertonic solution. There were no significant differences between the groups receiving hypertonic solutions. The incidence 01 complications was low, and the m orta lit y Tale was similar in all groups. Conclusions. InJusion 01250 ml hypertonic saline solution in patients with severe hypovolemia was not related to any comPlications, nor did it affect mortality Tales,. it improved MAP significantly, acutely expanded plasma volume by 24%, and reduced significantiy the volumes 01 crystalloids and blood required in their resuscitation.

Research paper thumbnail of Sigmoid colon adenocarcinoma: 9 years from diagnosis to treatment

Research paper thumbnail of Is the advanced trauma life support simulation exam more stressful for the surgeon than emergency department trauma care?

Clinics, 2005

Stress affects surgeons both during training and during professional activity. To compare stress ... more Stress affects surgeons both during training and during professional activity. To compare stress levels affecting surgical residents during the simulated initial assessment and management in the Advanced Trauma Life Support practical exam vs initial assessment and management of trauma patients in the emergency room. Eighteen surgical residents were evaluated under basal conditions, during the Advanced Trauma Life Support simulation, and during emergency room initial care. Heart rate, systolic arterial pressure, and diastolic arterial pressure were measured. The Student t test was used to test for differences between means, with statistical significance declared when P &amp;amp;amp;amp;amp;amp;lt; .05. Heart rate and systolic arterial pressure were increased at the beginning and at the end of Advanced Trauma Life Support simulation and emergency room initial care. Diastolic arterial pressure was only increased at the end of the Advanced Trauma Life Support simulation. Comparing values obtained during the Advanced Trauma Life Support simulation with those obtained during emergency room initial care, heart rate and systolic arterial pressure were significantly higher during the Advanced Trauma Life Support simulation both at the beginning and end of the test events. However, diastolic arterial pressure was only significantly higher for Advanced Trauma Life Support simulation compared emergency room at the end of the procedures. These results suggest that the simulation in the practical exam portion of the Advanced Trauma Life Support course is more stressful for the resident surgeon than is the actual initial assessment and care of trauma patients in an emergency room.

Research paper thumbnail of UNUSUAL CASE OF THE FOUR ILIAC VEINS INJURIES BY GUNSHOT: CASE REPORT AND REVIEW OF THE LITERATURE

Multiple injuries of iliac veins are uncommon and frequently fatal. An unusual case in which ther... more Multiple injuries of iliac veins are uncommon and frequently fatal. An unusual case in which there were injuries of the four iliac veins by gunshot is described. A review of literature of this condition and a discussion about the diagnosis , treatment and factors affecting mortality rate is presented. No other such case has been found reported.