BACKGROUND AND OBJECTIVES: Failure or delay to diagnose brain death leads to needless occupation of a hospital bed, emotional and fi nancial losses, and unavailability of organs for transplants. The intensive care physician plays an essential role in this diagnosis. This study intended to evaluate intensivists' knowledge concerning brain death. METHODS: Cross-sectional study in 15 intensive care units (ICU) in eight hospitals in the city of Porto Alegre, Brazil. RESULTS: Two hundred forty-six intensivists were interviewed in a consecutive sample between April and December 2005. The prevalence of lack of knowledge regarding the concept was of 17%. Twenty per cent of the interviewees ignored the legal need for complementary confi rmatory tests for their diagnosis. Forty-seven per cent considered themselves Evaluation of Intensivists' Knowledge on Brain Death*

One year following pain onset, she began to present paresis of the right hand. The patient was depressed, having been under psychiatric treatment for seven years. Physical examination presented cervical muscle contracture, palmar muscle atrophy with weakened grasp movement and sensory alteration in the same region. The results of Adson's test, military posture and Ross test were positive. The patient was therefore diagnosed with a clinical profile consistent with thoracic outlet syndrome.Electroneuromyography revealed decreased amplitudes in the sensory conduction of the right ulnar nerve, as well as in the motor conduction of the right ulnar and median nerves, conduction block of the right ulnar nerve at elbow level and reinnervation at the C8-T1 level. The motor conduction speed of the right ulnar nerve was 66.7 m/s below elbow level and 47.6 m/s above elbow level.A Doppler ultrasound of the elevated right upper limb revealed significant compression of IntroductionThe supraclavicular approach to surgical treatment of thoracic outlet syndrome is frequently used, since it presents a high rate of therapeutic success and a low risk of complications.(1,2) Brachial plexus lesion and vascular lesions are the most frequent complications. (1,(3)(4)(5) Chylothorax as a complication of this surgical procedure is rare, (6,7) and, if occurring, is normally left-sided.(8) Its incidence ranges from 0.25% to 0.5%, even in general thoracic surgery.(8) Here, we report a case of chylothorax occurring after resection of a right cervical rib and of the right first rib. The chylothorax was successfully treated through an additional surgical procedure. Case reportA 25-year-old female patient, a seamstress having worked in a shoe factory for seven years, was referred to our facility for investigation of a two-year history of progressive pain in the right wrist, accompanied by local paresthesia. AbstractChylothorax as a complication of the surgical treatment of thoracic outlet syndrome is a quite rare event. We report a case of right-sided chylothorax and present a brief review on the treatment of postoperative chylothorax.Keywords: Chylothorax; Thoracic outlet syndrome; Cervical rib syndrome; Postoperative complications. ResumoA fístula linfática como complicação de correção de síndrome do desfiladeiro torácico é um evento muito raro. Relatamos um caso de fístula linfática à direita e apresentamos uma breve revisão do tratamento de quilotórax pós-cirúrgico.Descritores: Quilotórax; Síndrome do desfiladeiro torácico; Síndrome da costela cervical; Complicações pós-operatórias.

-Context -Laparotomy is the gold standard treatment of patients with intestinal obstruction without response to clinical management. Nowadays, literature has been demonstrating the feasibility of videolaparoscopy in the treatment of intestinal obstruction. Objectives -To report the clinical-epidemiological profile of patients with intestinal obstruction submitted to surgery and verify the presence of contraindications for laparoscopy. Methods -It was done a observational, descriptive and retrospective study including adults patients with intestinal obstruction submitted to surgery at Hospital de Clínicas de Porto Alegre, RS, Brazil, between January of 2004 and October of 2008. Results -It was included 135 patients in the study, with a total of 126 patients submitted to open surgery and 9 to laparoscopy. There was similar distribution between gender and the mean age was 59 years (SD ± 16.9). The most frequent site of obstruction was the small bowel and the most frequent etiology was adhesions. Among the patients submitted to laparotomy, 75.4% presented with abdominal distention, 68.3% previous abdominal surgery, 11.9% body mass index >30 kg/m 2 , 4.8% coagulopathy and 3.2% hemodynamic instability. Among the 135 patients, only 5 of them presented with none contraindications for videolaparoscopy. Conclusion -The epidemiological findings of this study are similar to the ones of the worldwide literature. Indications of videolaparoscopy in retrospective analyses have the limitation of subjective evaluation of intestinal obstruction, which was included in this study as a relative contraindication to laparoscopy. HEADINGS -Intestinal obstruction. Video-assisted surgery.

Introduction  Colorectal cancer has the second highest prevalence and the third highest incidence in the world. Mortality is directly related to the stage of the disease. Objective  To evaluate the staging of patients with colorectal adenocarcinoma treated at the Coloproctology Department of the Hospital Nossa Senhora da Conceição between 2010 and 2015. Method  Prevalence study. Data collection was performed retrospectively through a survey in the electronic system of the Hospital Group Conceição, seeking all patients with ICD 10 C18, C19 and C20 who were attended at the Coloproctology Department between 2010 and 2015. Results  Four hundred and twenty patients were eligible for the study. The mean age was 65.6 years (±12.8). Regarding staging, we observed the following distribution: 7.9%, stage I; 23.6%, stage II; 37.6%, stage III; and 30.2%, stage IV. The percentage of patients with advanced colorectal adenocarcinoma (stage III + stage IV) is 67.8%. Regarding the origin, 51% of the patients were attended at the emergency department. Conclusion  Most patients treated at this hospital have advanced disease (67%) and come from the emergency department (51%).

Blind pouch syndrome is the set of signs and symptoms caused by intestinal content stasis and consequent bacterial hyperproliferation in a segment excluded from the intestinal flow after surgical procedure. This paper reports the case of a 65-year-old male patient complaining of diffuse abdominal pain, poor oral intake, nausea, diarrhea, fever and chills. Surgical history included cecal resection five years before due to a tubulovillous adenoma. On physical examination, the abdomen was tender and distended, without signs of peritonitis. Complete blood cells count showed microcytic anemia. Computed tomography of the abdomen revealed ileocolonic anastomosis (ascending) with blind loop presenting signs of inflammatory process. Exploratory laparotomy was indicated, in which the resection of the blind loop was performed. After gradual improvement of the symptoms, the patient was discharged in12 th post-operative day.

Methods: This experimental controlled trial randomly assigned 55 rats to four groups. Anastomoses were performed in non-ischemic colon segments (control group) and in ischemic colon segments measuring 1, 2 or 3 cm long (groups 1, 2 and 3, respectively). Fluorescein was injected and the tissues were examined under ultraviolet light. Seven days later, a second-look surgery was performed to check for the presence or absence of anastomosis dehiscence. Results: Twenty-four rats presented anastomotic dehiscence during the second-look surgery. Reticular and nonfluorescent patterns were significantly associated with the occurrence of anastomotic dehiscence. Fluorescein fluorescence had a sensitivity of 95.8%, specificity of 89.2%, positive predictive value of 88.4%, negative predictive value of 96.2%, and accuracy of 92.3% to predict anastomotic dehiscence. Conclusion: Fluorescein fluorescent test can accurately predict leak in a model of ischemic colonic anastomosis in rats.