[Can the inguinal hernia became a dilemma].
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Aged↗
Biomedical subjects
D Birolini
Publications and source records attributed to D Birolini.
[Stress-related erosive syndrome: where are we?].
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Gastric Mucosa↗
Gallstone ileus resulting in strong intestinal obstruction.
Mechanic intestinal obstruction, caused by the passage of biliary calculus from vesicle to intestine, through fistulization, although not frequent, deserve study due to the morbi-mortality rates. Incidence in elder people explains the association with chronic degenerative diseases, increasing complexity in terms of therapy decision. Literature discusses the need and opportunity for the one or two-phase surgical attack of the cholecyst-enteric fistule, in front of the resolution on the obstructive urgency and makes reference to Gallstone Ileus as an exception for strong intestinal obstruction. The more frequent intestinal obstruction observed is when it occurs a Gallstone Ileus impacting in terms of ileocecal valve. The authors submit a Gallstone Ileus manifestation as causing strong intestinal obstruction, discussing aspects regarding diagnostic and treatment.
Aged↗
Gallstone ileus as a cause of upper intestinal obstruction.
Gallstone ileus, a mechanical intestinal obstruction caused by the passage of a gallstone into the intestinal lumen through a fistula, although not common, deserves to more carefully studied due to its morbidity and mortality. Its incidence among older-age groups explains its association with chronic and degenerative diseases, which increase the complexity of the treatment choice. The need and appropriateness of a surgical approach to a cholecystenteric fistula to solve the obstructive emergency, in a one or two stage procedure, has been discussed in the literature. It has also been reported that gallstone ileus is an uncommon cause of upper intestinal obstruction. Intestinal obstruction is seen more frequently after a gallstone impacts at the ileocecal valve. The authors report a case of gallstone ileus as a cause of upper intestinal obstruction and discuss its diagnosis and treatment.
Aged↗
Extrahepatic bile ducts injury: a report on 14 cases.
Traumatic injuries of the extrahepatic biliary tract are infrequent, occurring in approximately 0.5% of all patients with blunt and penetrating abdominal trauma. The incidence of this injury due to blunt abdominal trauma is rare. This study reviewed patients with injuries of the extrahepatic biliary tract due to abdominal trauma over a 6-year period to determine the incidence, trauma scores, associated injuries, surgical treatment performed, complications and mortality rate. We report our experience with 14 patients with extrahepatic biliary tract trauma. A review of the literature and the discussion about the management are presented.
Abdominal Injuries↗
[Penetrating trauma of the neck: prospective study of 53 cases].
The treatment of penetrating injuries of the neck is still controversial nowadays, especially when there is doubt concerning the existence of any anatomic structure lesion. The delay to indicate surgical cervical exploration may predispose the patient to have serious sequels when the esophagus or the trachea are injured. The infection which may occur in this eventuality progresses rapidly to the mediastinum, determining the patient's death. The purpose of this work was to identify and to analyze the parameters which suggest the best treatment indicated for patients with penetrating injuries of the neck. This is a non-randomized prospective study which gathered 53 patients, victims of penetrating wounds of the neck, treated at the Emergency Surgical Service of the Hospital das Clínicas, University of São Paulo School of Medicine, during a three-year period, starting in October, 1990. All the patients were evaluated by the surgical team on call who elected the selective exploration approach for the cases that did not present clear evidence of injuries in the cervical structures nor hemodynamic alterations. For the fifteen carriers of evident injuries, immediate surgical exploration was the treatment adopted. All the patients had epidemiologic data, evaluation results, hospitalization period, complications, morbidity and mortality rates, besides trauma indexes, collected. For patients whose clinical observation was allowed, endoscopic studies were also performed and compared. In order to evaluate variable correlations, statistical analysis were performed using Q square test, Student test and Z statistics, which leaded to the following conclusions: 1. Penetrating wounds of the neck were most frequent in white people aged from 20 to 30 years. They were mostly located in the right side of cervical zone II and were caused by gunshot. 2. Trauma indexes correlated with patients' clinical evolution. 3. In cases when there was doubt about the effective presence of injuries, complementary digestive and respiratory evaluations were indicated. These exams contributed for reducing the rate of unnecessary surgical explorations.
Adolescent↗
Cardiac herniation mimics cardiac tamponade in blunt trauma. Must early resuscitative thoracotomy be done?
Blunt rupture of the pericardium is a rare injury. Strangulated cardiac hernia following blunt trauma is one cause of reversible cardiac arrest. Traumatic pericardial tears usually have delayed diagnoses and carry high mortality rates (64%). Clinical signs mimic cardiac tamponade during the primary survey. We report here two cases of blunt trauma. Both patients arrived alive in the emergency room and presented signs of cardiac tamponade caused by pericardial rupture.
Accidents, Traffic↗
[Metabolic response to trauma: potassium and water content in skeletal muscles].
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Animals↗
[Ogilvie's syndrome].
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Colonic Pseudo-Obstruction↗
[Recurrence in post-splenectomy spherocytosis anemia due to presence of accessory spleens].
A young female patient had a recurrence of severe spherocytic anemia there years after having been submitted to splenectomy. The presence of two accessory spleens with a size of 3.5 cm and 4.0 cm, was demonstrated by technetium scanning and ultrasound images. Surgical removal of these noduli resulted again in prompt recovery. The development of the spleen beings in the fifth week of intrauterine life at the dorsal mesogastrium. The lack of fusion of splenic lobuli is responsible for the occurrence of accessory spleens. A surgeon performing splenectomy for the treatment of hemolytic anemia should always search for possible existences of accessory spleens.
Adult↗
[Fournier syndrome: evaluation and initial treatment].
The records of 48 patients with Fournier's syndrome (FS) treated at the Emergency Surgical Service of the Hospital das Clínicas of the University of São Paulo Medical School in the period 1982-1991 were reviewed. Clinical and laboratory data at admission were analysed. The following factors were statistically significant when associated with bad prognosis: elevated serum creatinine, hypoxemia, metabolic alkalosis or acidosis, diabetes and age over 50 years. Based on these five criteria, the patients were divided into two groups: Group I, mild FS (32 cases) and Group II, severe FS (16 patients). This classification permits a better planning of therapy. In cases classified as severe, treatment should include wide débridement, with resection of all necrotic tissues, scheduled reoperations for further débridements, transverse colostomy, wide spectrum antibiotic therapy and total parenteral nutrition. In the mild cases, the patients may be treated with débridement and antibiotics only.
Adolescent↗
[The teaching of resuscitation and intensive care medicine].
The authors analyze the relationship between development of anesthesiology as a specialty and cardiopulmonary resuscitation in the last decades, pointing out to the link between them. In this context, the anesthesiologist is seen as a professional particularly suited to take care of emergency cases. Training programs, both at graduate and postgraduate levels, that are carried on at the Anesthesiology Department of the University of São Paulo are presented. The main goal of these programs is the full training of the anesthesiologist rescuer physician.
Anesthesiology↗
Gallbladder injuries due to blunt abdominal trauma: report on five cases and review of the literature.
Gallbladder lesions by blunt abdominal trauma are rare, due to the organ's anatomical particularities. Diagnosis is difficult, and it generally occurs during surgery. The trauma is usually associated with other lesions and is related to very serious traumas or to deceleration. Due to the scarcity of publications on this topic and to its reduced incidence, we present here a report of five patients who had suffered blunt abdominal trauma with gallbladder lesion and who were attended at the General Hospital (of the University of São Paulo Medical School) Emergency Service between 1986 and 1991. Furthermore, we analyze the incidence of this trauma, presence of associated lesion, treatment, morbidity and mortality of the patients, as well as a review of the literature.
Abdominal Injuries↗
Percutaneous catheterization of the subclavian vein in hemophiliac patients: report of 47 cases.
Hemophiliac patients frequently require venous access, but usually their peripheral veins are collapsed and not puncturable. Several procedures employed to overcome this difficulty present a high complication rate. The authors report 47 cases of percutaneous subclavian vein catheterization (PSC) in hemophiliacs with an overall complication rate of 23%. Six patients (13%) had complications attributed to the coagulation disorder. The complications attributed to the coagulopathy and presenting major clinical importance occurred early in the series. After the improvement of the coagulation control with a routine AHG administration policy, the authors observed that among the last 22 patients there were 3 complications related to the coagulopathy, all of them without major clinical importance. The authors conclude that, in the lack of a safer access, PSC seems to be an acceptable procedure in hemophiliac patients, if employed with strict indication, accurate technique and rigorous control of the coagulopathhy.
Adolescent↗
[Trauma: a forgotten epidemic or Brazil in times of trauma].
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Adolescent↗
[Comparative analysis of the diagnostic value of ultrasonography and laparoscopy in acute abdomen].
Patients with traumatic or non-traumatic acute abdomen, often exhibit difficulties in the assessment of the real intra-abdominal visceral compromise. This study intends to compare laparoscopy and ultrasonography in patients with non-traumatic or traumatic acute abdomen, in whom there is a doubt on the actual visceral compromise. Forty-five patients were studied in this protocol. Both procedures were performed in 28 and in 17 patients with non-traumatic or traumatic acute abdomen, respectively. The laparoscopic examination was shown to be superior to the ultrasound even when one subtracts from the ultrasound data all pathologies that involved bowel transit and the bowel wall such as the acute appendicitis and cases of pelvic inflammatory disease. The laparoscopic and ultrasound accuracy were 97.8% and 53%, respectively.
Abdomen, Acute↗
[Laparoscopy as an auxiliary aid in abdominal emergencies].
The authors present a prospective study of 159 diagnostic laparoscopy performed in patients about whom doubts existed about the actual visceral involvement after initial clinical and laboratory examination by the Surgical Staff on duty. Patients whose initial diagnosis was easily made were immediately submitted to surgery and were not examined by laparoscopy. The laparoscopic exam was shown to be able to diagnose a large number of acute intra-abdominal disturbances, whether or not traumatic, and to be efficient, with accuracy values of 97.4%. The exam also allowed to avoid 44.6% to unnecessary surgical procedures on patients with suspected non-traumatic acute abdomen, and 70% among those with suspicion of traumatic acute abdomen.
Abdomen, Acute↗
Emergency laparoscopy in patients submitted previously to abdominal surgery: a study of 20 cases.
The authors performed 20 laparoscopies in patients previously submitted to abdominal surgery, in whom after clinical evaluation by the medical staff, the existence of intra-abdominal affection was still questioned. In this study group 14 patients exhibited more than 19 days old former abdominal incisions while in six patients they were recent ones. The incisions were median and para-median, McBurney incisions and Pfannenstiel incisions; one patient had been previously submitted to laparoscopy. The laparoscopic findings were hemoperitoneum, encapsulating peritonitis, ascites, subphrenic abscess, acute adnexitis, acute traumatic pancreatitis, genital tuberculosis, acute cholecystitis and one case of peritonitis due to a hollow viscus perforation by a fish bone. In one patient presenting encapsulating peritonitis the laparoscopic examination was complicated by a hollow viscus perforation.
Abdomen, Acute↗