Predictive factors of post-discharge surgical site infections among patients from a teaching hospital

Introduction Surgical site infections (SSIs) often manifest after patients are discharged and are missed by hospital-based surveillance. Methods We conducted a case-reference study nested in a prospective cohort of patients from six surgical specialties in a teaching hospital. The factors related to SSI were compared for cases identified during the hospital stay and after discharge. Results Among 3,427 patients, 222 (6.4%) acquired an SSI. In 138 of these patients, the onset of the SSI occurred after discharge. Neurological surgery and the use of steroids were independently associated with a greater likelihood of SSI diagnosis during the hospital stay. Conclusions Our results support the idea of a specialty-based strategy for post-discharge SSI surveillance.

Enhanced Recovery after Elective Open Surgical Repair of Abdominal Aortic Aneurysm: A Complementary Overview through a Pooled Analysis of Proportions from Case Series Studies

Objectives: To evaluate the efficacy and safety of enhanced recovery after surgery (ERAS) programs in elective open surgical repair (OSR) of abdominal aortic aneurysm (AAA).Background: Open surgical repair of AAA is associated with high morbidity and mortality, prolonged hospital stay and high costs. ERAS programs contribute to the optimization of treatment by reducing hospital stay and improving clinical outcomes.Methods: A review of PubMed, EMBASE and LILACS databases was conducted. As only one randomized controlled trial was found, a pooled analysis of proportions from case series was conducted, considering it a complementary overview of the topic. Inclusion criteria were case series with more than five cases reported, adult patients who underwent an elective OSR of AAA and use of an ERAS program. ERAS was compared to conventional perioperative care. The pooled proportion and the confidence interval (CI) are shown for each outcome. The overlap of the CI suggests similar effect of the interventions studied.Results: Thirteen case series studies with ERAS involving 1,250 patients were compared to six case series with conventional care with a total of 1,429 patients. The pooled, respective proportions for ERAS and conventional care were: mortality, 1.51% [95% CI: 0.0091, 0.0226] and 3.0% [95% CI 0.0183, 0.0445]; and incidence of complications, 3.82% [95% CI 0.0259, 0.0528] and 4.0% [95% CI 0.03, 0.05].Conclusion: This review shows that ERAS and conventional care therapies have similar mortality and complication rates in OSR of AAA.

Block Bone Graft Fixation ( Onlay): A Modification of the Surgical Technique

Several reconstructive methods of the alveolar ridge have been reported to make possible future rehabilitations with implants. Many of these methods come from studies done in animals, mainly rats. With this clinical practice based on scientific evidence, any experimental procedure that can be undertaken in real life is fundamental. Thus, any research that emulates as closely as possible those techniques used in humans are important. This study describes the modification of the technique for block bone graft fixation (onlay) in rats using the lag screw-type technique, normally used in clinical procedures for grafts in humans. The conclusion was that the execution of the described procedures minimizes interference of blood flow in the area because of the maintenance of the muscle insertion in the buckle aspect of the most anterior region of the mandible, providing better stability to the graft and better contact interface of the graft and receptor bed.

Assessment of postoperative pain after unilateral mastectomy using two different surgical techniques in dogs

Background: There are few studies reporting pain and postoperative analgesia associated with mastectomy in dogs. The aim of this study was to evaluate postoperative pain after unilateral mastectomy using two different surgical techniques in the dog.Findings: Twenty female dogs were assigned (n=10/group) to undergo unilateral mastectomy using either the combination of sharp and blunt dissection (SBD) or the modified SBD (mSBD) technique, in which the mammary chain is separated from the abdominal wall entirely by blunt (hand and finger) dissection except for a small area cranial to the first gland, in a prospective, randomized, clinical trial. All dogs were premedicated with intramuscular acepromazine (0.05 mg/kg) and morphine (0.3 mg/kg). Anesthesia was induced with intravenous ketamine (5 mg/kg) and diazepam (0.25 mg/kg), and maintained with isoflurane. Subcutaneous meloxicam (0.2 mg/kg) was administered before surgery. Postoperative pain was evaluated according to the University of Melbourne pain scale (UMPS) by an observer who was blinded to the surgical technique.. Rescue analgesia was provided by the administration of intramuscular morphine (0.5 mg/kg) if pain scores were > 14 according to the UMPS. Data were analyzed using t-tests and ANOVA (P>0.05). There were no significant differences between the groups for age, weight, extubation time, and duration of surgery and anesthesia (P>0.05). There were no significant differences for postoperative pain scores between groups. Rescue analgesia was required in one dog in each group.Conclusions: The two surgical techniques produced similar surgical times, incidence of perioperative complications and postoperative pain. Multimodal analgesia is recommended for treatment of postoperative pain in dogs undergoing unilateral mastectomy.

Ovarian blood vessel occlusion as a surgical sterilization method in rats

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

A new surgical technique to treat corneal perforations using amniotic membrane and surgical adhesive

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Endoscopic endonasal approach for pituitary adenoma: surgical complications in 301 patients

The authors investigate the complications of transnasal transsphenoidal endoscopic surgery in the treatment of 301 patients with pituitary adenomas. A retrospective analysis of complications in 301 patients submitted to transsphenoidal transnasal endoscopic surgery at the General Hospital of Fortaleza, Brazil between January 1998 and December 2009. The complications were divided in two groups: anatomical (oronasofacial, sphenoid sinus, intrasellar, suprasellar and parasellar) and endocrinological complications (anterior and posterior pituitary dysfunctions). We observed a total of 81 complications (26.9%) in our series. Anatomical complications occurred in 8.97% (27 cases): 8 CSF postoperative leaks (2.6%), 6 cases (1.9%) of delayed nasal bleeding, 5 cases (1.6%) of sphenoidal sinusitis, 3 cases (0.9%) of carotid artery lesion, 2 cases of meningitis (0.6%) and one case (0.3%) of each of the uncommon following complications: intrasella-suprasella hematoma, pontine hematoma and chiasmaplexy. Endocrinological complications occurred in 17.9% (54 cases): additional postoperative anterior lobe insufficiency in 35 cases (11.6%), and postoperative diabetes insipidus in 19 cases (6.3%). In our series, 3 cases of deaths (not directly related to the procedure) were also observed. Endoscopic transsphenoidal surgery represents an effective option for the treatment of patients with pituitary tumor. Complications still occur and must be reduced as much as possible. Successful endoscopic pituitary surgery requires extensive training in the use of an endoscope and careful planning of the surgery. Additional improvement can be expected with greater experience and new technical developments.

Can cone-beam computed tomography superimposition help orthodontists better understand relapse in surgical patients?

This case report describes the interdisciplinary treatment of a 19-year-old Brazilian man with a Class I malocclusion, a hyperdivergent profile, an anterior open bite, and signs of temporomandibular joint internal derangement. The treatment plan included evaluation with a temporomandibular joint specialist and a rheumatologist, orthodontic appliances, and maxillomandibular surgical advancement with counterclockwise rotation. Cone-beam computed tomography images were taken before and after surgery at different times and superimposed at the cranial base to assess the changes after orthognathic surgery and to monitor quantitatively the internal derangement of the temporomandibular joints and surgical relapse. Our protocol can improve the orthodontist's understanding of surgical instability, demonstrate the clinical value of cone-beam computed tomography analysis beyond the multiplanar reconstruction, and guide patient management for the best outcome possible.

Electroencephalographic Responses to a Noxious Surgical Stimulus in Mules, Horses, and Ponies

The aim of this study was to investigate the electroencephalographic (EEG) response of equidae to a castration stimulus. Study 1 included 11 mules (2 1/2-8 years; 230-315 kg) and 11 horses (1 1/2-3 1/2 years; 315-480 kg); study 2 included four ponies (15-17 months; 176-229 kg). They were castrated under halothane anesthesia after acepromazine premedication (IV [study 1] and intramuscular [study 2]) and thiopental anesthetic induction. Animals were castrated using a semiclosed technique (study 1) and a closed technique (study 2). Raw EEG data were analyzed and the EEG variables, median frequency (F50), total power (Ptot), and spectral edge frequency (F95), were derived using standard techniques at skin incision (skin) and emasculation (emasc) time points. Baseline values of F50, Ptot, and F95 for each animal were used to calculate percentage change from baseline at skin incision and emasculation. Differences were observed in Ptot and F50 data between hemispheres in horses but not mules (study 1) and in one pony (study 2). A response to castration (>10% change relative to baseline) was observed in eight horses (73% of animals) and four mules (36% of animals) for F50 and nine horses (82%) and four mules (36%) for Ptot. No changes in F95 data were observed in any animal in study 1. Responses to castration were observed in three ponies (75% of animals) for F50, one pony (25%) for F95, and all ponies for Ptot Alteration of acepromazine administration and castration technique produced a protocol that identified changes in EEG frequency and power in response to castration. (c) 2014 Elsevier Inc. All rights reserved.

Balanced anesthesia with sevoflurane does not alter redox status in patients undergoing surgical procedures

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

PREDICTABLE INTERPROXIMAL TISSUE REMOVAL WITH A SURGICAL STENT

The correction of diastemas in the anterior region with composite resin is considered to be practical and conservative. Harmony between the restorative material and the periodontium is necessary to achieve satisfactory functional and esthetic results. Whenever excessive gingiva occurs in the interproximal region, removal is necessary to avoid excessively contoured restorations. A predictable technique is described to conservatively remove interproximal tissue in situations in which crown lengthening is required to treat bilateral diastemas. A surgical template based on the diagnostically waxed cast was produced to serve as a reference during periodontal surgery.

Central Giant Cell Granuloma in Pediatric Maxilla: Surgical Management

Central giant cell granuloma (CGCG) is an intraosseous lesion consisting of fibrous cellular tissue that contains multiple foci of hemorrhage, multinucleated giant cells, and occasional trabeculae of woven bone. An 8-year-old boy presented himself complaining of a painless swelling in the left maxilla that had started 1 year. Computed tomography (CT) scan confirmed a poorly defined multilocular radiolucent lesion in the left maxilla crossing the midline. The patient underwent enucleation through an intraoral approach of the lesion. The biopsy revealed multinucleated giant cells in a fibrous stroma. A CT was taken approximately 1 year postoperatively. There was no clinical or radiographic evidence of recurrence. Therefore, surgical treatment of CGCG can be performed, trying to preserve the surrounding anatomic structures, which can be maintained in case the lesion does not show an aggressive clinical behavior, avoiding large surgical defects which are undesirable in children.

Probabilistic ictal EEG sources and temporal lobe epilepsy surgical outcome

Objective - For patients with medication refractory medial temporal lobe epilepsy (MTLE), surgery offers the hope of a cure. However, up to 30% of patients with MTLE continue to experience disabling seizures after surgery. The reasons why some patients do not achieve seizure freedom are poorly understood. A promising theory suggests that epileptogenic networks are broadly distributed in surgically refractory MTLE, involving regions beyond the medial temporal lobe. In this retrospective study, we aimed to investigate the distribution of epileptogenic networks in MTLE using Bayesian distributed EEG source analysis from preoperative ictal onset recordings. This analysis has the advantage of generating maps of source probability, which can be subjected to voxel-based statistical analyses.Methods - We compared 10 patients who achieved post-surgical seizure freedom with 10 patients who continued experiencing seizures after surgery. Voxel-based Wilcoxon tests were employed with correction for multiple comparisons.Results - We observed that ictal EEG source intensities were significantly more likely to occur in lateral temporal and posterior medial temporal regions in patients with continued seizures post-surgery.Conclusions - Our findings support the theory of broader spatial distribution of epileptogenic networks at seizure onset in patients with surgically refractory MTLE.

Avaliação da Taxa de Exposição em Exames Radiológicos Realizados em Procedimentos Cirúrgicos - Minimização dos Riscos em Indivíduos Ocupacionalmente Expostos

This paper consists in the evaluation of the exposure rate to ionizing radiation to which professionals working in surgical procedures which require radiological examinations are subjected. Were initially performed real-time readings of exposure rate within four distinct operating rooms during the execution of four surgical procedures that made use of fluoroscopy equipment (including three orthopedic surgeries, one in the shoulder, one in the arm, another for deployment of metal pin in the leg region, and a fourth for vascular procedure); in these surgeries were used ionization chamber detector and an electrometer. In order to check the values achieved, was made a re-evaluation of the distribution of the rate of exposure to radiation, from the surgical procedures, now with thermoluminescent dosimeters (TLDs). For this, thirty TLDs were distributed in the operating rooms, arranged in points of interest as occupation by professionals. The TLDs were prepared for thirty consecutive days, after which they were removed and replaced with new dosimeters not exposed yet. The dosimeters were subjected to reading of the rate of exposure; this procedure was repeated for four months without interruption. The quantification of the results sought primarily to convert the rate of exposure for equivalent dose rate, both in measurements with ionization chamber as in measurements with TLDs, in order to highlight the presence of the biological effect of ionizing radiation for comparisons within scientific context. Then, the results were plotted to establish the relationship between the values of equivalent dose and the distance to the central axis of the x -ray source, confirming the inverse square law for distance. Finally, the values were associated with the maximum limit recommended by the legislation for occupationally exposed individuals. The methodology for the analysis and quantification of the data in this work aims at implementing a work plan that meets ...