The insertion of the Veress needle in the abdominal midline, at the umbilicus, poses serious risk to the life of patients. Therefore, further studies should be conducted to investigate alternative sites for Veress needle insertion.

Transitory, high intraperitoneal pressure (20 mmHg for 5 min) for insertion of the first trocar resulted in changes in HR, MAP, ETCO(2), and ITP that were within the normal range, and no adverse clinical effects were observed. Therefore, the use of transitory, high intraperitoneal pressure is recommended to prevent iatrogenic injury during blind insertion of the first trocar. Nevertheless, it is not clear that this method would be safe in patients with moderate to severe chronic obstructive pulmonary disease.

Values of IP and VG at given time points during insufflation for creation of the pneumoperitoneum, using the Veress needle, can be effective parameters to determine whether the needle is correctly positioned in the peritoneal cavity.

Veress needle insertion into the left hypochondrium for creation of pneumoperitoneum: diagnostic value of tests to determine the position of the needle in unselected patients Original Article Original Article Original Article Original Article Original Article Veress needle insertion into the left hypochondrium for creation Veress needle insertion into the left hypochondrium for creation Veress needle insertion into the left hypochondrium for creation Veress needle insertion into the left hypochondrium for creation Veress needle insertion into the left hypochondrium for creation of pneumoperitoneum: diagnostic value of tests to determine the of pneumoperitoneum: diagnostic value of tests to determine the of pneumoperitoneum: diagnostic value of tests to determine the of pneumoperitoneum: diagnostic value of tests to determine the of pneumoperitoneum: diagnostic value of tests to determine the position of the needle in unselected patients position of the needle in unselected patients position of the needle in unselected patients position of the needle in unselected patients position of the needle in unselected patients Punção com agulha de Veress no hipocôndrio esquerdo para a criação do Punção com agulha de Veress no hipocôndrio esquerdo para a criação do Punção com agulha de Veress no hipocôndrio esquerdo para a criação do Punção com agulha de Veress no hipocôndrio esquerdo para a criação do Punção com agulha de Veress no hipocôndrio esquerdo para a criação do pneumoperitônio: valor diagnóstico das provas de posicionamento da agulha em pneumoperitônio: valor diagnóstico das provas de posicionamento da agulha em pneumoperitônio: valor diagnóstico das provas de posicionamento da agulha em pneumoperitônio: valor diagnóstico das provas de posicionamento da agulha em pneumoperitônio: valor diagnóstico das provas de posicionamento da agulha em pacientes não selecionados pacientes não selecionados pacientes não selecionados pacientes não selecionados pacientes não selecionados OTÁVIO To assess the effectiveness of the Veress needle puncture in the left hypochondrium and the accuracy of the tests described for the intraperitoneal correct positioning of the tip of the Veress needle in an unselected population. Methods:Methods: Methods: Methods: Methods: Ninetyone patients consecutively scheduled for Videolaparoscopy had the abdominal wall punctured in the left hypochondrium. There were no exclusion criteria. The patients received general anesthesia and mechanical ventilation according to the protocol. After puncturing five tests were used to confirm the positioning of the needle tip within the peritoneal cavity: aspiration test -AT; resistance to infusion -Pres; recovery of the infused fluid -Prec, dripping test -DT, and test of initial intraperitoneal pressure -IIPP. The test results were compared with results from literature for groups with defined exclusion criteria. The results were used for calculating sensitivity (S) specificity (E), positive predictive value (PPV) and negative predictive value (NPV). Inferential...

-Background -Two-layer intestinal anastomosis increases the inflammatory response while single-layer anastomosis results in a better wound healing. However the four main kinds of stitches which may be chosen in performing single layer intestinal sutures never before had been comparatively studied. Aim -To compare the four more commonly used types of single layer surgical anastomosis sutures of the digestive tract. Methods -Six mongrel dogs were operated, each one receiving two anastomosis: one at 30 cm from de Treitz angle -sero-submucosal technique, and the other at 60 cm -total technique. This placement was alternatively inverted. The four more commonly used types of single layer surgical anastomosis sutures of the digestive tract, namely: sero-submucosal stitches tied in the lumen, over the submucosa; sero-submucosal stitches tied in the exterior of the organ, over the serosa; total stitches tied in the lumen, over the mucosa; and total sutures tied in the exterior, over the serosa (Gambee's stitches) were tested. After euthanasia (7th post-operative day) macro and microscopic features were evaluated. Friedman's test was applied for morphometry and for evaluation of the peritoneal adhesions. Results -Statistical significance was demonstrated through major residual acute inflammation and proliferation in total sutures and more profuse adhesions with the sero-submucosal stitches tied in the lumen. The sero-submucosal stitches tied in the exterior over the serosa, had excellent realignment and regeneration of the layers. Conclusion -The sero-submucosal stitches tied in the exterior, over the serosa, were the best ones.

Background: Sepsis is the leading cause of death in patients with onco-hematological diseases with mortality rate of up to 60%. Despite the high relevance of sepsis, few studies have analyzed its impact on this population. To evaluate the factors associated with 30- and 90-day mortality in onco-hematological patients and sepsis. Methods: This retrospective cohort study was conducted at the Euryclides de Jesus Zerbini Transplant Hospital, a tertiary service for patients with hematological malignancies and bone marrow transplantation in São Paulo, Brazil. We included patients diagnosed with sepsis consecutively between August 2013 and July 2016 and followed-up for 30 and 90 days. Results: Over the 3-year period, 123 patients with sepsis were diagnosed, median age of 59.7 years. The most frequent hematological disease was acute leukemia (31.0%). Sepsis and septic shock occurred in 52.2% and 47.8% of patients, respectively. The mortality rate was 33.9% at 30 days and 49.1% at 90 days. The main infectious diseases were pneumonia (32.7%) and bloodstream infections (30.1%). In multivariate analysis, the factors related to 30-day mortality were Sequential Organ Failure Assessment (SOFA) score (p=0.001), severe neutropenia (p=0.049), thrombocytopenia (p=0.045), and increased bilirubin (p=0.038). The associated factors to 90-day mortality were Sequential Organ Failure Assessment score (p=0.001), thrombocytopenia (p=0.45), and increased bilirubin (p=0.066). Infectious agents were identified in 46.9% of cases. Klebsiella pneumoniae was the predominant species and carbapenem-resistant in 61.5% of cases. Conclusions: SOFA score, thrombocytopenia and increased bilirubin were factors associated with mortality in onco-hematological patients and sepsis.

Hemodynamic, blood gas and metabolic parameters in brief hypertensive pneumoperitoneum during first trocar introduction was investigated. It causes variations in MAP, pH, HCO3 and BE without adverse effects, and it may protect from iatrogenic injury.

Sepsis is a life-threatening condition which may arise from an extreme response of the body to an infection. While worldwide figures are unknown, it is estimated that sepsis causes millions of yearly fatalities. In this context, it is important to develop tools for decision support and training of healthcare professionals. This paper proposes that artificial intelligence tools be used for prognosis of septic patients. The model used is a neural network trained and validated with cross-validation. The information used includes data regarding patient history and treatment. More importantly, this paper also presents a principled approach of using sensitivity analysis for the identification of discriminatory variables when these are of mixed types such as binary, categorical, and integer. While initial results, validated on over 5000 patients, already show both specificity and sensitivity above 80% and good model robustness against errors in most inputs, even better performance is attained through the utilization of sensitivity analysis to select the variables used as inputs. This work presents a promising tool for input selection in contexts of limited data availability, and successfully applies this technique to obtain a high-performance model for prognosis of septic patients.