HTS improved tissue oxygenation and perfusion and reduced systemic and pulmonary inflammatory responses compared with IS in the treatment of HeS in rats.

HighlightsBRBNS most commonly manifests as bleeding, however complications such as obstruction and infarction may be present.In obstructive complications, with lesions deffusely present, surgical treatment without resection is a viable alternative.DIVC should be promptly detected in such patients during the postoperative course. Although rare, it is a life-threatening condition.

Pancreatic necrosis occurs in 15% of acute pancreatitis. The presence of infection is the most important factor in the evolution of pancreatitis. The diagnosis of infection is still challenging. Mortality in infected necrosis is 20%; in the presence of organic dysfunction, mortality reaches 60%. In the last three decades, there has been a real revolution in the treatment of infected pancreatic necrosis. However, the challenges persist and there are many unsolved questions: antibiotic treatment alone, tomography-guided percutaneous drainage, endoscopic drainage, video-assisted extraperitoneal debridement, extraperitoneal access, open necrosectomy? A step up approach has been proposed, beginning with less invasive procedures and reserving the operative intervention for patients in which the previous procedure did not solve the problem definitively. Indication and timing of the intervention should be determined by the clinical course. Ideally, the intervention should be done only after the fourth week of evolution, when it is observed a better delimitation of necrosis. Treatment should be individualized. There is no procedure that should be the first and best option for all patients. The objective of this work is to critically review the current state of the art of the treatment of infected pancreatic necrosis.

OBJECTIVES:The benefits of implementing point-of-care ultrasound (POCUS) in the emergency department are well established. Ideally, physicians should be taught POCUS during medical school. Several different courses have been designed for that purpose and have yielded good results. However, medical students need specifically designed courses that address the main objectives of knowledge acquisition and retention. Despite that, there is limited evidence to support knowledge retention, especially in the mid-term. The purpose of this study is to evaluate short- and mid-term knowledge retention after a student-aimed ultrasound course.METHODS:Medical students participating in a medical student trauma symposium (SIMPALT) in 2017 were included. Their profiles and baseline ultrasound knowledge were assessed by a precourse questionnaire (PRT). The same questionnaire was used one week (1POT) and three months (3POT) after the course.RESULTS:Most of the participants were 1st- to 4th- year medical students. None had prior ultrasound knowledge. They reported costs as the major barrier (65%) to enrollment in an ultrasound course. A comparison between the PRT and 1POT results showed a statistically significant difference (p<0.02), while no difference was found between 1POT and 3POT (p>0.09).CONCLUSION:Our findings support the use of a tailored ultrasound course for medical students. Knowledge acquisition and mid-term retention may be achieved by this specific population.

. Today, despite advances in AA use with the development of vacuum therapy, the Bogota Stock Exchange (BB) is still widely used. In our institution and throughout Brazil, both techniques are used and the study's goal is to evaluate the morbidity and the result of the integrity of the abdominal wall after the use of both techniques. METHODS METHODS METHODS METHODS METHODSA retrospective study was conducted at HCFMUSP, identifying patients undergoing temporary abdominal closure (FAT) between January 2005 and December 2011. Data were collected through review of medical records. Data were compared in patients undergoing treatment with assisted closing the vacuum and the Bogota bag.Inclusion criteria were temporary abdominal closure indication survival and the definitive abdominal closure. FAT indications included: abdominal trauma, severe abdominal sepsis and ACS. Data collected included age, FAT indication, the number of procedures in the operating room and the primary fascial closure rate. In the postoperative period, one group of three surgeons followed all patients and performed all reoperations. As soon as possible, the aponeurosis of the edges were subjected to progressive approach with careful not to cause abdominal hypertension.The demographics of the two study groups (BB and VAC) were compared using the chi-square test of Pearson or Fisher's exact test for categorical variables and the Student t test for continuous variables. RESULTS RESULTS RESULTS RESULTS RESULTSDuring the study period, 59 patients require some kind of temporary abdominal closure (FAT), however, only 29 patients survived the final abdominal closure (52.5% mortality). One patient was excluded (subject to closure Backaus forceps). Thus, 28 patients were included, and, after two years of follow-up, none of them developed abdominal hernia or intestinal fistulas.There was no statistical difference between the study groups with respect to age (p> 0.05) and a significant difference regarding indications for temporary abdominal closure (p <0.05) ( Table 1).The primary closure rates were similar in both groups (p = 0.98). The average time (days) for fascial closure was 10.8 days for the BB group and 7.52 days in the group VAC (Table 2). DISCUSSION DISCUSSION DISCUSSION DISCUSSION DISCUSSIONIn this study, there was no statistical difference between the closing assisted vacuum and the Bogota bag (VAC and BB) when analyzed the number of operations, the primary closure, and the average time of closing. However, a previous study 19 showed better results when using VAC BB was compared on the primary closure (50 to 70 %% and 88% for BB VAC). The best approach to achieve the definitive abdominal closure in patients with open abdomen remains controversial. To improve the fascial closure rate, the excess volume resuscitation should be avoided, the water balance should be carefully implemented, not only on admission, but also throughout the course of treatment with open abdomen 20 . The high rate of primary closure found in our patients, 80% for BB and 96% f...

OBJECTIVE:To present our experience in the management of patients with infected pancreatic necrosis without drainage.METHODS:The records of patients with pancreatic necrosis admitted to our facility from 2011 to 2015 were retrospectively reviewed.RESULTS:We identified 61 patients with pancreatic necrosis. Six patients with pancreatic necrosis and gas in the retroperitoneum were treated exclusively with clinical support without any type of drainage. Only 2 patients had an APACHE II score >8. The first computed tomography scan revealed the presence of gas in 5 patients. The Balthazar computed tomography severity index score was >9 in 5 of the 6 patients. All patients were treated with antibiotics for at least 3 weeks. Blood cultures were positive in only 2 patients. Parenteral nutrition was not used in these patients. The length of hospital stay exceeded three weeks for 5 patients; 3 patients had to be readmitted. A cholecystectomy was performed after necrosis was completely resolved; pancreatitis recurred in 2 patients before the operation. No patients died.CONCLUSIONS:In selected patients, infected pancreatic necrosis (gas in the retroperitoneum) can be treated without percutaneous drainage or any additional surgical intervention. Intervention procedures should be performed for patients who exhibit clinical and laboratory deterioration.

RESUMO Objetivo: avaliar epidemiologia, características anatômicas, manejo e prognóstico de pacientes críticos com fraturas de esterno. Métodos: análise retrospectiva de pacientes internados em unidade de terapia intensiva (UTI) de emergências cirúrgicas e trauma de um centro de trauma Tipo III em São Paulo, Brasil. Resultados: foram admitidos 1552 pacientes traumatizados no período de janeiro de 2012 a abril de 2016. Desses, 439 apresentavam trauma torácico e 13 apresentavam fratura de esterno, configurando 0,9% das admissões de trauma e 3% dos traumas torácicos. Desses pacientes, três apresentavam tórax instável e dois foram submetidos à conduta cirúrgica para fixação da fratura. A mortalidade de pacientes com fratura de esterno foi de 29% (três pacientes). Em um dos óbitos pôde-se atribuir a fratura do esterno como contribuinte principal para o desfecho. Conclusão: a fratura de esterno foi diagnosticada em 0,9% dos pacientes críticos vítimas de trauma em UTI especializada. Somente 15% dos pacientes necessitaram de conduta cirúrgica específica na fase aguda e a mortalidade foi decorrente das outras lesões na maior parte dos casos.

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