Objective To correlate the patient's clinical data and the Alvarado's Score as predictors of acute appendicitis. Methods This is an observational, descriptive and prospective study performed at a public urgency and emergency hospital in the city of Fortaleza, Ceará, between July and December 2016, with 34 patients undergoing open appendectomy with ages between 18 and 70 years. Statistical analysis was performed using the SPSS program. Results The following statistical correlations were performed: number of days with abdominal pain until the operative event and degree of inflammation according to a macroscopic analysis of the appendix, Alvarado's Score and number of days with abdominal pain until the operative event, Alvarado's Score and degree of inflammation according to a macroscopic analysis of the appendix, number of days with abdominal pain until the operative event, and number of days of hospitalization in the postoperative period, degree of inflammation according to amacroscopic analysis of the appendix, number of days of hospitalization in the postoperative period and Alvarado's Score, and number of days of hospitalization in the postoperative period; the first five correlations were statistically significant ( p < 0.05). Conclusion The use of this Alvarado's Score in health services emerges as a tool for the diagnosis of acute appendicitis.
RESUMO:Objetivo: Desenvolver e aplicar modelo de baixo custo para treinamento de dissecção venosa para acadêmicos de Medicina. Métodos: O modelo foi elaborado com custo fixo de 35 reais (10,5 dólares) e mais 50 centavos a cada reposição, tendo sido aprovados por 6 cirurgiões vinculados ao curso de Medicina da Universidade de Fortaleza e utilizados durante curso teórico prático. Os alunos responderam a um teste pré e pós-atividade, foram avaliados durante a prática através de check list e responderam questionário de percepção sobre o modelo. Resultados: Foi notado crescimento teórico, porém, percebeu-se a necessidade de mais treinamento procedural, o que é viável com nosso modelo de baixo custo. Em relação aos questionários de percepção, 91,95% dos alunos concordaram que os modelos mantinham boa correlação anatômica, 89,96% que o material utilizado é de boa qualidade, 95,40% que o modelo permitiu o aprendizado da dissecção venosa e 96,55% que o modelo pode ser utilizado para ensino do procedimento, números que reafirmam a eficácia e viabilidade do modelo. Conclusões: É possível a criação de modelo realista, de boa qualidade e viável para o ensino, apenas com materiais de baixo custo para treinamento de dissecção venosa.Descritores: Materiais de ensino; Dissecação/educação; Treinamento por simulação; Estudantes de medicina. ABSTRACT: Objective:We aim to develop and apply a low cost model for venous dissection training for medical students. Methods: The model was elaborated with a fixed cost of 35 reais (10,5 dollars) and 50 cents at each replacement, and was approved by 6 surgeons tied to the Medicine course of the Universidade de Fortaleza and used during practical theoretical course. The students answered a pre and post activity test, were evaluated during the practice through check list and answered the perception questionnaire about the model. Results: We noticed a theoretical growth, however, we noticed the need for more procedural training, which is feasible with our low cost model. Regarding the perception questionnaires, 91.95% of the students agreed that the models maintained good anatomical correlation, 89.96% that the material used was of good quality, 95.40% that the model allowed the learning of the venous dissection and 96.55% that the model can be used for teaching the procedure, numbers that reaffirm the effectiveness and feasibility of the model. Conclusions: It is possible to create a realistic model, of good quality and feasible for teaching, only with low cost materials for venous dissection training.
Background: Three-dimensional videosurgery is already a reality worldwide. The trainee program for this procedure should be done initially and preferably in simulators. Aim: Assemble low-cost simulator for three-dimensional videosurgery training. Methods: The simulator presented here was mounted in two parts, base and glasses. After, several stations can be inserted into the simulator for skills training in videosurgery. Results: It was possible to set up three dimensional (3D) video simulations with low cost. It has proved to be easy to assemble and allows the training surgeon of various video surgical skills. Conclusion: This equipment may be used in undergraduate programs and advanced courses for residents and surgeons. The acrylic box allows the visualization of the task executed by the tutor and even by other experienced students.
Background: In the Western world, the population developed an overweight profile. The morbidly obese generate higher cost to the health system. However, there is a gap in this approach with regard to individuals above the eutrofic pattern, who are not considered as morbidly obese. Aim: To correlate nutritional status according to BMI with the costs of laparoscopic cholecystectomy in a public hospital. Method: Data were collected from medical records about: nutritional risk assessment, nutricional state and hospital cost in patients undergoing elective laparoscopic cholecystectomy. Results: Were enrolled 814 procedures. Average age was 39.15 (±12.16) years; 47 subjects (78.3%) were women. The cost was on average R$ 6,167.32 (±1830.85) to 4.06 (±2.76) days of hospitalization; 41 (68.4%) presented some degree of overweight; mean BMI was 28.07 (±5.41) kg/m²; six (10%) individuals presented nutritional risk ≥3. There was a weak correlation (r=0.2) and not significant (p <0.08) between the cost of hospitalization of the sample and length of stay; however, in individuals with normal BMI, the correlation was strong (r=0,57) and significant (p<0.01). Conclusion: Overweight showed no correlation between cost and length of stay. However, overweight individuals had higher cost of hospitalization than those who had no complications, but with no correlation with nutritional status. Compared to those with normal BMI, there was a strong and statistically significant correlation with the cost of hospital stay, stressing that there is normal distribution involving adequate nutritional status and success of the surgical procedure with the consequent impact on the cost of hospitalization.
Insulinoma is the most common pancreatic neuroendocrine tumor. The clinical manifestation is diverse, some of which may cause irreversible neurological deficits due to persistent hypoglycemia. This article reports a case of a 17-year-old patient who presented with visual scotoma, somnolence and loss of consciousness with blood glucose documentation of 15 mg / dL. He was admitted and underwent imaging tests. Tomography and Magnetic Resonance imaging did not clearly identify the pancreatic lesion, but tumor lesions were identified after arterial stimulation with calcium. Patient was submitted to surgical enucleation by laparotomy. In this context, there is still much discussion about the optimal sequence of exams for the exact tumor location. However, the use of less invasive exams such as arterial calcium stimulation is essential for adequate surgical resection.
Therefore, we will report the unusual case of a patient, who was submitted to surgery for suspected appendicitis and during the intraoperative period it was observed that he had diverticulitis of cecum. Case reportPatient, 42 years old, male, reported a lancinating pain in the lower right quadrant of the abdomen for 48 hours, associated with episodes of unmeasured fever and chills, denying vomiting, adynamia and changes in bowel habit. Physical examination revealed the presence of localized tenderness and painful decompression in right lower quadrant of abdomen, described as a Blumberg signal.A hemogram showed 9,800 leukocytes per mm 3 . The patient had undergone a surgical procedure. It was initially performed as a Davis incision, which revealed hyperemia of the vermiform appendix and inflammatory mass surrounding a perforated cecum. So, the surgical team changed to xipho-pubic incision in order to perform a ileotiflectomy. The bowel transit was reconstructed by side-to-side ileotransverse anastomosis. The patient recovered well in the postoperative staying and was discharged after 6 days. Histopathological examination revealed: diverticular disease of the colon with diverticulitis and perforation associated with lymphoid hyperplasia of the cecal appendix.
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