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Biomedical subjects

R Coimbra

Publications and source records attributed to R Coimbra.

27 records · Page 2Linked to original sources
PubMed1995

Factors related to the occurrence of postoperative complications following penetrating gastric injuries.

The aim of this study was to determine the relationship between diaphragmatic injury and gross contamination of the peritoneal cavity caused by gastric injuries and the occurrence of postoperative complications, especially those related to the pleural cavity. Charts of 73 patients sustaining gastric injuries due to penetrating trauma were retrospectively reviewed. There were 66 males and mean age was 28 years. Stab wounds were the most frequent mechanism of injury, occurring in 46 cases. Most of the injuries were treated using simple suture and minor debridement. Postoperative morbidity rate was 30 per cent and thoracic complications occurred in 11 patients. Twenty-six patients had diaphragmatic injuries; 54 per cent of them developed postoperative complications. Of the remaining 47 patients without diaphragmatic injuries, only eight developed complications. Of the 26 patients with diaphragmatic injuries, seven developed pleuropulmonary complications compared with 4 of 47 without diaphragmatic injury. Of sixteen patients who had gross contamination secondary to gastric injury, characterized by the presence of food or great amounts of gastric contents in the peritoneal cavity, 10 developed postoperative complications compared with 12 of 57 without gross contamination. Overall mortality rate was 11 per cent mostly due to sepsis. In conclusion, the presence of a diaphragmatic injury as well as gross contamination of the abdominal cavity are important factors related to the development of postoperative infections particularly in the pleural space.

Adolescent↗
PubMed1995

Hypertonic/hyperoncotic fluids reverse prostaglandin E2 (PGE2)-induced T-cell suppression.

In recent years, hypertonic, and hyperoncotic fluids have been examined for their potential to replace conventional isotonic fluids. This study describes the effects of commonly used intravenous fluids on immune function. The action of increased concentrations of hypertonic saline (HTS), hypertonic saline-dextran (HSD), dextran (Dx), albumin (ALB), and hydroxyethylstarch (HET) on in vitro proliferation of phytohemagglutinin-stimulated normal and prostaglandin E2-suppressed human peripheral blood mononuclear cells was tested. At clinically relevant levels, HTS, HSD (20-40 mM hypertonicity), and ALB (2.5 mg/mL) enhanced T-cell proliferation by 65, 75, and 70%, respectively. Dx and HET had little effect. HTS also reversed prostaglandin E2-suppressed (10 ng/mL) T-cell proliferation to normal levels, and HSD enhanced T-cell proliferation by 40%, in contrast to Dx, ALB, and HET which had minimal effects. The results suggest that hypertonic/hyperoncotic solutions might improve prostaglandin-mediated suppression of T-cell function in patients and may be a useful adjunct to reduce the risk of infection.

Adult↗
PubMed1995

Penetrating cardiac wounds: predictive value of trauma indices and the necessity of terminology standardization.

The authors evaluated the usefulness of different trauma indices in the prediction of outcome following penetrating cardiac wounds. Sixty-three patients were retrospectively reviewed. Age, mechanism of injury, Physiologic Index (PI) on admission, site of injury, associated injuries, ISS, RTS, Penetrating Cardiac Trauma Index (PCTI), Penetrating Thoracic Trauma Index (PTTI), Penetrating Trauma Index (PTI), TRISS and mortality rate were reviewed. There were 34 patients with a gunshot wound (GSW) and 29 with a stab wound (SW). Shock was present on admission in 88.9 per cent. Mortality was 83 per cent for GSW, 44 per cent for SW, and 39 per cent for patients arriving the hospital with measurable blood pressure. RTS, PI, PCTI, PTTI, PTI, and ISS reached statistical significance when comparing survivors and nonsurvivors. The probability of survival (PS) based on the TRISS methodology was 37.84 +/- 5.14. The observed survival rate was 38 per cent. Fourteen patients were considered "fatal" on admission and underwent an emergency thoracothomy. Mortality rate for this selected group was 100 per cent. We conclude that physiologic impairment, shock, and GSW are variables with high significance on mortality. Trauma indices such as PI, RTS, PCTI, PTTI, PTI, and ISS are good predictors of outcome. Trauma indices are an important tool to objectively compare results among different institutions.

Adolescent↗
PubMed1987

[Rett's syndrome: analysis of the 1st 5 cases diagnosed in Brazil].

Five cases of patients with the Rett syndrome are reported. The criteria for this diagnosis in these cases are discussed. These are the first cases of the Rett syndrome reported in Brazil and the authors call attention to the fact that this syndrome seems to be in our country as frequent as in USA, Europe and Japan where it has been more studied.

Ataxia↗
PubMedDate not supplied

Factors related to mortality in inferior vena cava injuries. A 5 year experience.

Forty-nine patients sustaining Inferior Vena Cava (IVC) injuries, during a 5 year period were retrospectively analyzed in order to assess those factors related to early deaths. Mean age was 32 and 45 were male. GSW was the most frequent mechanism of injury (59.2%), followed by SW (28.6%) and blunt trauma (12.2%). There were 4 injuries in the supra diaphragmatic IVC, 14 retrohepatic, 16 suprarenal and the remaining 15 were in the infrarenal portion of the IVC. Twenty patients were in shock and 8 were unstable on admission. The liver was the most frequently injured organ in association with IVC and there were also 7 concomitant abdominal vascular injuries. Venorrhaphy was performed in 28 patients, IVC ligature in 5, intracaval shunt in 3 and in the remaining 13, only temporary hemostasis was attempted. Mortality rate was 100% in supra diaphragmatic injuries, 71.4% in retrohepatic, 68.8% in suprarenal and 33% in infrarenal injuries. There was a significant difference when comparing mortality rate in stable against shock or unstable patients on admission (p < 0.001), as well as in those with diaphragmatic IVC injuries compared with all other injury sites together (p < 0.05). Hemodynamic instability on admission was the most important cause of early deaths, and all patients with concomitant abdominal vascular injuries also died.

Adolescent↗
PubMedDate not supplied

[Inferior vena cava trauma: analysis of 36 cases].

The authors analysed 36 trauma patients with inferior vena cava injuries to evaluate different surgical approaches, as well as, important aspects related to morbidity and mortality. Gunshot wounds were the most frequent cause of inferior vena cava injuries and 55% of the patients had circulatory instability on admission. Retrohepatic inferior vena cava was frequently injured in association with liver injury. From those 20 unstable patients on admission, there were 17 deaths, and injury was in the retrohepatic portion of the inferior vena cava in 9, and in the supradiaphragmatic portion in 3. These data support the concept that site of injury and hemodynamic status on admission are the principal factors related to morbidity and mortality in inferior vena cava injuries.

Adolescent↗
PubMedDate not supplied

Severely injured patients in the intensive care unit: a critical analysis of outcome and unexpected deaths identified by the TRISS methodology.

An analysis of the factors related to the morbidity and mortality of 64 patients sustaining abdominal trauma requiring intensive care during the postoperative period, and an evaluation of the unexpected deaths based on trauma indices was carried out to identify factors that could have contributed to the observed outcome. Head and chest injuries occurred in approximately 40% of all patients. Pneumonia was the most common complication. ISS (p = 0.03), but not TS was statistically significant as predictor of outcome. Probability of survival (TRISS) was 62.4 +/- 4.2%, while observed overall survival rate was 54.7%. Multivariate analysis identified age greater than 45 years (p = 0.02; RR = 2.5) and ISS greater than 20 (p = 0.03; RR = 4.0) as the most predictive factors for systemic complications. Mortality was directly influenced by age greater than 45 years (p = 0.05; RR = 2.4) and by the presence of a systemic complication (p = 0.003; RR = 5.5). Eleven patients were classified as "unexpected death"; 5 were considered preventable, 3 non preventable, 1 potentially preventable, and 2 cases had incomplete data and could not be classified. Changes in the care of the severely injured due to a review of complications and deaths may ultimately lead to a reduction in errors and a better quality of care.

Abdominal Injuries↗