Revista Do Colegio Brasileiro De Cirurgioes[JOURNAL]
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200 papers
Innovations in surgical training: exploring the role of artificial intelligence and large language models (LLM).
Varas J, Coronel BV, Villagrán I … +8 more , Escalona G, Hernandez R, Schuit G, Durán V, Lagos-Villaseca A, Jarry C, Neyem A, Achurra P
Rev Col Bras Cir · 2023 · PMID 37646729 · Full text
The landscape of surgical training is rapidly evolving with the advent of artificial intelligence (AI) and its integration into education and simulation. This manuscript aims to explore the potential applications and ben...
The landscape of surgical training is rapidly evolving with the advent of artificial intelligence (AI) and its integration into education and simulation. This manuscript aims to explore the potential applications and benefits of AI-assisted surgical training, particularly the use of large language models (LLMs), in enhancing communication, personalizing feedback, and promoting skill development. We discuss the advancements in simulation-based training, AI-driven assessment tools, video-based assessment systems, virtual reality (VR) and augmented reality (AR) platforms, and the potential role of LLMs in the transcription, translation, and summarization of feedback. Despite the promising opportunities presented by AI integration, several challenges must be addressed, including accuracy and reliability, ethical and privacy concerns, bias in AI models, integration with existing training systems, and training and adoption of AI-assisted tools. By proactively addressing these challenges and harnessing the potential of AI, the future of surgical training may be reshaped to provide a more comprehensive, safe, and effective learning experience for trainees, ultimately leading to better patient outcomes. .
Acute abdomen in patients with covid-19: an integrative review.
Lima MI, Fonseca Neto OCLD
Rev Col Bras Cir · 2023 · PMID 37646728 · Full text
INTRODUCTION: upon infection with SARS-CoV-2, patients presented with non-classical symptoms, such as gastrointestinal phenomena including loss of appetite, nausea, vomiting, diarrhea, and abdominal pain abdominal pain....
INTRODUCTION: upon infection with SARS-CoV-2, patients presented with non-classical symptoms, such as gastrointestinal phenomena including loss of appetite, nausea, vomiting, diarrhea, and abdominal pain abdominal pain. These occurrences, typically, were found in severely affected patients with COVID-19. With this, the aim of this paper is to analyze the available knowledge on the development of acute abdomen in SARS-CoV-2 infected patients. METHODOLOGY: this is an Integrative Review in PubMed, Web of Science and VHL databases. The following descriptors were used: "Acute abdomen", "COVID-19", "Abdominal pain" and "SARS-CoV-2" with the Boolean operator "AND", and articles relevant to the theme were selected. Initially, 331 articles were selected, all published between 2020 and 2023, in Portuguese and/or English. After analysis, 11 articles matched the proposed objective. RESULTS: the relationship between tenderness in the right upper region or the presence of Murphy's sign contributed in the association between abdominal pain and the more severe forms of COVID-19 in infected patients. The number of diagnoses for acute conditions such as cholecystitis, appendicitis, diverticulitis and pancreatitis decreased with the pandemic, but at the same time there was an increase in the duration of surgical procedures and in the length of hospital stays. These acute abdominal conditions were the result of delayed demand for hospital care, which also contributed to an increase in the conversion rate to open surgery and in the number of perforative conditions. CONCLUSION: the development of acute abdomen in SARS-CoV-2 infected patients was predictive of an unfavorable prognosis.
The influence of institutional pancreaticoduodenectomy volume on short-term outcomes in the Brazilian public health system: 2008-2021.
Szor DJ, Tustumi F
Rev Col Bras Cir · 2023 · PMID 37646727 · Full text
INTRODUCTION: pancreaticoduodenectomy is a complex surgical procedure that can result in high rates of complications and morbimortality. Due to its complexity, the establishment of referral centers has increased in recen...
INTRODUCTION: pancreaticoduodenectomy is a complex surgical procedure that can result in high rates of complications and morbimortality. Due to its complexity, the establishment of referral centers has increased in recent decades. This study aims to evaluate the influence of the institutional volume of pancreaticoduodenectomy for periampullary cancer on short-term outcomes in the Brazilian public health system. METHODS: this study used a population-based approach and investigated the number of pancreaticoduodenectomies performed by institutions within Brazil's public health system between 2008 and 2021. High-volume institutions were defined as those that performed more than two standard deviations above the mean number of procedures per year. Specifically, if a center performed eight or more pancreaticoduodenectomies annually, it was considered a high-volume institution. RESULTS: in Brazil, 283 public hospitals performed pancreaticoduodenectomy for cancer between 2008 and 2021. Only ten hospitals performed at least eight pancreaticoduodenectomies per year, accounting for approximately 3.5% of the institutions. High-volume institutions had a significantly lower in-hospital mortality rate than low-volume institutions (8 vs. 17%). No significant differences between groups were observed for length of stay, hospitalizations using the ICU, and ICU length of stay. The linear regression model showed that the number of hospital admissions for pancreaticoduodenectomy and age were significantly associated with hospital mortality. CONCLUSION: institutional pancreaticoduodenectomy volume implies a lowering of in-hospital mortality. The findings of this nationwide study can affect how the public health system manages pancreaticoduodenectomy care.
Limitations of using the DATASUS database as a primary source of data in surgical research: a scoping review.
Viana SW, Faleiro MD, Mendes ALF … +8 more , Torquato AC, Tavares CPO, Feres B, Fernandez MG, Sobreira IRM, Aquino CM, Abib SCV, Botelho F
Rev Col Bras Cir · 2023 · PMID 37646726 · Full text
OBJECTIVE: DATASUS is the Brazilian Public Unified Health System (SUS) department responsible for providing health data that are used as a primary source of data in several studies on surgery and surgical specialties alt...
OBJECTIVE: DATASUS is the Brazilian Public Unified Health System (SUS) department responsible for providing health data that are used as a primary source of data in several studies on surgery and surgical specialties although its main limitations have not been previously reviewed. The objective of this work is to synthesize information from studies on surgery that used DATASUS systems as a data source and to identify the main gaps in this platform. METHODS: a scoping review was conducted according to the PRISMA-ScR method to identify papers on surgery, and other surgical specialties, that used the DATASUS platform as a primary data source. No restrictions were imposed regarding the type of study or year of publication. Grounded Theory was used to analyze the content of the articles. RESULTS: 248 works were initially analyzed and 47 were included in the final analysis of this study. The original articles included were published between 2009 and 2022 and the majority (12.76%, n=6) were published in the Journal of the Brazilian College of Surgeons. Retrospective studies (40.43%, n=19) were the most common type of study found. Content analysis of the articles identified four predominant domains in the scientific literature about the limitations of using DATASUS in surgical research: lack of data, reliability, precision and data integration. CONCLUSION: the information systems available in DATASUS are the largest source of information about the SUS, but the scientific literature on the quality of data available in these systems remains scarce and studies aimed at measuring this metric are necessary.
Epidemiological study of pediatric trauma in a reference hospital in Curitiba.
Scharnoski FG, Desconsi IM, Linnenkamp MDW … +4 more , Fontes HS, Pereira CO, Martins RK, Sarquis LM
Rev Col Bras Cir · 2023 · PMID 37610921 · Full text
OBJECTIVE: to analyze the prevalence of types of trauma, resulting injuries and managements in children and adolescents between 0 and 17 years old, treated in an Emergency Room in 2019. METHODS: a retrospective cross-sec...
OBJECTIVE: to analyze the prevalence of types of trauma, resulting injuries and managements in children and adolescents between 0 and 17 years old, treated in an Emergency Room in 2019. METHODS: a retrospective cross-sectional descriptive study carried out by collecting data from medical records from January to December of 2019, encompassing pediatric trauma victims, divided according to age groups: infants (0-1 year), preschool children (2-4 years), school children (5-10 years) and adolescents (11-17 years). RESULTS: 3,741 patients records were included in the study. The search for assistance occurred spontaneously in about 70% of the cases and males were the most affected at all ages. In infants and preschoolers, the main mechanism of trauma was fall from heights, corresponding to 57.2% and 34.1%, respectively, whereas in school children and adolescents, the main mechanism was ground-level falls (38%) and sports trauma (22,3%), in this order. The main injuries presented, in general, were traumatic brain injury (28,2%), upper limb contusion (23,2%) and upper limb fractures (16,3%). CONCLUSIONS: the profile of the victims analyzed indicates the male sex as the most affected, with the trauma mechanism being the differential according to age. The most frequent mechanism is falls, more prevalent in infants and preschoolers, and the most common injury is extremity contusion, with the upper limbs being the most affected. In general, the cases were considered of low complexity, with a hospitalization rate of 6%.
Oncological safety of nipple-sparing mastectomy after neoadjuvant chemotherapy: a systematic review.
Nissen L, Soares ICM, Lima RS … +2 more , Urban CA, Rabinovich I
Rev Col Bras Cir · 2023 · PMID 37556611 · Full text
BACKGROUND: the use of nipple-sparing mastectomy (NSM) in local advanced breast cancer after neoadjuvant chemotherapy (NQT) is increasing, despite few studies on the subject. The aim of this systematic review was to dete...
BACKGROUND: the use of nipple-sparing mastectomy (NSM) in local advanced breast cancer after neoadjuvant chemotherapy (NQT) is increasing, despite few studies on the subject. The aim of this systematic review was to determine the safety of NSM after neoadjuvant chemotherapy. METHODS: for this systematic review we searched MEDLINE; Cochrane; Scientific Electronic Library Online (SciELO); Embase and Scopus. A literature search of all original studies including randomized controlled trials, cohort studies and case-control studies comparing women undergoing NSM after neoadjuvant chemotherapy for breast cancer was undertaken. Outcomes were locoregional recurrence (LRR), nipple recurrence and distant recurrence (DR). Data analysis was undertaken to explore the safety of NSM after NQT. The quality of the evidence was assessed with the Cochrane risk of bias tool. This study is registered on PROSPERO, number CRD42021276778. FINDINGS: a total of 437 articles were identified. Four articles were included with 1466 patients all of which had a high to serious risk of overall bias. Local recurrence in the NSM after the NQT group ranged from zero to 9.8%. Nippleareolar complex (NAC) recurrence ranged from zero to 2.1%. The distant recurrence rate ranged from 6.5% to 16%. Due to the lack of pattern among the control groups, it was not possible to perform a meta-analysis. INTERPRETATION: this review provides information for decision making in performing NSM after NQT. Despite the low rates of local recurrence and patients should be counseled about limited oncological information.
Cross-cultural adaptation of the milestones project in otolaryngology for the brazilian reality.
Mendes NFB, Coelho ICM
Rev Col Bras Cir · 2023 · PMID 37531505 · Full text
INTRODUCTION: competency-based medical education is well established, but there is a worldwide shortage of instruments capable of assessing these doctors in training. OBJECTIVE: to validate the instrument The Otolaryngol...
INTRODUCTION: competency-based medical education is well established, but there is a worldwide shortage of instruments capable of assessing these doctors in training. OBJECTIVE: to validate the instrument The Otolaryngology - Head and Neck Surgery Milestone Project for use in Residency Programs in Otorhinolaryngology in Brazil. METHOD: The study had 5 stages. In stage I, two independent translations of the Milestones Project in otorhinolaryngology were carried out. In step II, a synthesis of the translations was performed. Subsequently, the competencies required by the Brazilian Association of Otorhinolaryngology for training otorhinolaryngologists in Brazil were added. In step III, a back-translation of the instrument was carried out and sent to the original authors. Then, the instrument was sent to be evaluated by a committee of 8 experts. In stage IV, each expert made comments about each of the items, and after analyzing the suggestions, a new instrument was created. In stage V, this instrument was sent for evaluation by otorhinolaryngologists across the country. RESULTS: after translations and expert evaluation, an instrument with 19 items was created. The instrument was submitted to analysis by Otorhinolaryngologists from all over Brazil. Acceptance percentages were: applicability (99.25%), reliability (99.5%), reproducibility (98.6%), reliability (93.84%), relevance (93.15%). CONCLUSION: the created instrument was considered applicable, reproducible, relevant, reliable and trustworthy, presenting content validity.
Liver transplantation for the treatment of iatrogenic bile duct injury.
Cirilo Neto O, Moutinho LER, Melo PSV … +3 more , Rabêlo PJM, Amorim AG, Melo CML
Rev Col Bras Cir · 2023 · PMID 37531504 · Full text
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Access to reconstructive plastic surgery for patients undergoing bariatric surgery in the Unified Health System (SUS).
Secanho MS, Cintra W, Carneiro IC … +2 more , Alves GFF, Gemperli R
Rev Col Bras Cir · 2023 · PMID 37531503 · Full text
INTRODUCTION: obesity is one of the most common diseases worldwide, and the most effective treatment to it is the bariatric surgery. One of the negative impacts of this procedure is the body dysmorphia caused by overhang...
INTRODUCTION: obesity is one of the most common diseases worldwide, and the most effective treatment to it is the bariatric surgery. One of the negative impacts of this procedure is the body dysmorphia caused by overhanging skin. In Brazil, the national health system - Sistema Único de Sáude (SUS) - provide body contouring surgery to treat post-bariatric patients, since 2007. This article aims to describe the Brazilian public health approach to post bariatric patients and perform an analyze in the Brazilian health care database. METHODS: in Brazilian Health System database, a search for the post-bariatric procedures performed between 2007 to 2021 was done. The variables analyzed were geographic location, year, mean days of hospitalization, death, and mortality rate. Also, we evaluated the number of bariatric procedures done in the same period. Statistical analysis was performed using the Student-t and the chi-square tests and p-value <0.5 was considered significant. RESULTS: a total of 12,717 plastic surgery procedures in post bariatric patients were done, with a national prevalence of 13.8%. Dermolipectomy was the most performed procedure, with 6,719. The years of 2020 and 2021 suffered a decreased of 64.3% and 70.9% in the number of surgeries (p<0,001). Bariatric Procedures had a high rate and a higher percentage of growth comparing to post bariatric surgery (p<0,001), totalizing 93,589 surgeries. CONCLUSIONS: Brazil had a significant number of body contouring surgery, however with a low prevalence. Dermoliepctomy was the most common procedure performed. We could notice a significant impact of COVID pandemic in those procedures .
Clinical and economic comparative analysis of laparotomy versus laparoscopy in the first gastric bypass surgeries in a bariatric and metabolic surgery service in a city in southern Brazil.
Reichenbach R, Sgarioni A, Gullo MC … +2 more , Giovanardi HJ, Moura GS
Rev Col Bras Cir · 2023 · PMID 37531502 · Full text
INTRODUCTION: this paper aims to evaluate the main direct and indirect costs of the first laparotomies and laparoscopies in bariatric surgeries with a clinical-economical retrospective and cross-sectional analysis from 2...
INTRODUCTION: this paper aims to evaluate the main direct and indirect costs of the first laparotomies and laparoscopies in bariatric surgeries with a clinical-economical retrospective and cross-sectional analysis from 2017 to 2020 at a hospital with specialties besides the basic ones in southern Brazil. METHODS: the study sample included 26 participants. The first 13 laparotomies, and the first 13 laparoscopies performed at the bariatric surgery service of the institution were evaluated. The values evaluated in such comparison analyzed the costs of operation and hospitalization. It is important to highlight that, in addition to the cost benefit, other costs take significance in the health area, such as: cost-utility, cost-effectiveness and cost-minimization, in addition to the cost-opportunity that is reassessed in the observation of the broad context associating all the values raised here. The software used for data analysis was Excel version® 365. The economic analysis was performed evidencing the profile of the patients and the direct and indirect costs involved in each segmentation. RESULTS: the direct and indirect costs of videolaparoscopy amounted to BRL 10,108.10 and laparoscopy to the amount of BRL 12,568.14. CONCLUSION: it was concluded that laparoscopy presents more savings in the aspects of all health valuations to the detriment of laparotomy. It was concluded that the videolaparoscopy presents more savings in the aspects of all health valuations than the laparotomy.
Gastrotomy followed by gastrorrhaphy as a reliable and more physiologic technique for inducing peritoneal adhesion in rats.
Pires AARD, Takiya CM, Silva PC … +1 more , Manso JEF
Rev Col Bras Cir · 2023 · PMID 37531501 · Full text
OBJECTIVE: this research objective was to develop a new peritoneal adhesion animal model that would lead to adhesions formation in all operated animals, simple and reproducible, associated with maintenance the animal's h...
OBJECTIVE: this research objective was to develop a new peritoneal adhesion animal model that would lead to adhesions formation in all operated animals, simple and reproducible, associated with maintenance the animal's health. METHODS: eighteen adult male Wistar rats (Rattus norvegicus) were randomly distributed into three groups: Control Group (anatomical and clinical parameters), Sham Group (delicate manipulation of the stomach and exposure of the peritoneal cavity to ambient air) and Surgery Group (gastrotomy followed by gastrorrhaphy). The animals were analyzed and classificated macroscopically according to two adhesion classification models and differences between groups were considered significant when p<0.05. RESULTS: the six animals in the control group had no peritoneal adhesions, three of the six animals in the sham group had focal peritoneal adhesions, and all animals in the surgery group (gastrotomy followed by gastrorraphy) had firm peritoneal adhesions. All adhesions found were macroscopically quantified and microscopically confirmed, without carrying out a microscopic classification of the adhesions. CONCLUSION: the new model developed of gastrotomy followed by gastrorrhaphy, proved to be safe and efficient to induce and study peritoneal adhesions.
Surgical treatment of rectal cancer: prospective cohort study about good oncologic results and low rates of abdominoperineal excision.
Faier TAS, Queiroz FL, Lacerda-Filho A … +5 more , Paiva RA, França Neto PR, Cortes MGW, Carvalho AR, Pereira BMT
Rev Col Bras Cir · 2023 · PMID 37531500 · Full text
OBJECTIVES: the purpose of this study was to evaluate the outcome of rectal cancer surgery, in a unit adopting the principles of total mesorectal excision (TME) with a high restorative procedure rate and with a low rate...
OBJECTIVES: the purpose of this study was to evaluate the outcome of rectal cancer surgery, in a unit adopting the principles of total mesorectal excision (TME) with a high restorative procedure rate and with a low rate of abdominoperineal excision (APE). METHODS: we enrolles patients with extraperitoneal rectal cancer undergoing TME or TME+APE. Patients with mid rectal tumors underwent TME, and patients with tumors of the lower rectum and no criteria for APE underwent TME and intersphincteric resection. Those in which the intersphincteric space was invaded and in those with a free distal margin less than 1cm or a tumor free radial margin were unattainable underwent APE or extralevator abdominoperineal excision (ELAPE). We assessed local recurrence rates, overall survival and involvement of the radial margin. RESULTS: sixty (89.6%) patients underwent TME and seven (10.4%) TME + APE, of which five underwent ELAPE. The local recurrence, in pacientes undergoing TME+LAR, was 3.3% and in patients undergoing APE, 14.3%. The local recurrence rate (p=0.286) or the distant recurrence rate (p=1.000) was similar between groups. There was no involvement of radial margins. Survival after 120 months was similar (p=0.239). CONCLUSION: rectal malignancies, including those located in the low rectum, may be surgically treated with a low rate of APE without compromising oncological principles and with a low local recurrence rates.
Erratum.
Rev Col Bras Cir · 2023 Jul · PMID 37436289 · Full text
[This corrects the article doi: 10.1590/0100-6991e-20233536_en] [This corrects the article doi: 10.1590/0100-6991e-20233536].
[This corrects the article doi: 10.1590/0100-6991e-20233536_en] [This corrects the article doi: 10.1590/0100-6991e-20233536].
Use of artificial intelligence for sepsis risk prediction after flexible ureteroscopy: a systematic review.
Alves BM, Belkovsky M, Passerotti CC … +3 more , Artifon ELA, Otoch JP, Cruz JASD
Rev Col Bras Cir · 2023 · PMID 37436288 · Full text
INTRODUCTION: flexible ureteroscopy is a minimally invasive surgical technique used for the treatment of renal lithiasis. Postoperative urosepsis is a rare but potentially fatal complication. Traditional models used to p...
INTRODUCTION: flexible ureteroscopy is a minimally invasive surgical technique used for the treatment of renal lithiasis. Postoperative urosepsis is a rare but potentially fatal complication. Traditional models used to predict the risk of this condition have limited accuracy, while models based on artificial intelligence are more promising. The objective of this study is to carry out a systematic review regarding the use of artificial intelligence to detect the risk of sepsis in patients with renal lithiasis undergoing flexible ureteroscopy. METHODS: the literature review is in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The keyword search was performed in MEDLINE, Embase, Web of Science and Scopus and resulted in a total of 2,496 articles, of which 2 met the inclusion criteria. RESULTS: both studies used artificial intelligence models to predict the risk of sepsis after flexible uteroscopy. The first had a sample of 114 patients and was based on clinical and laboratory parameters. The second had an initial sample of 132 patients and was based on preoperative computed tomography images. Both obtained good measurements of Area Under the Curve (AUC), sensitivity and specificity, demonstrating good performance. CONCLUSION: artificial intelligence provides multiple effective strategies for sepsis risk stratification in patients undergoing urological procedures for renal lithiasis, although further studies are needed.
Bibliometric analysis and conversion rate of abstracts presented at the Brazilian Congress of Coloproctology into publication of full articles.
Samartine Junior H, Paiva DF, Gracitelli GB … +4 more , Mazzini LR, Levy NG, Aquino JLB, Mendes EDT
Rev Col Bras Cir · 2023 · PMID 37436287 · Full text
INTRODUCTION: the presentation of research at a congress is an interesting means for scientific dissemination, but only with publication in an indexed journal does the data become accessible and disseminated. The convers...
INTRODUCTION: the presentation of research at a congress is an interesting means for scientific dissemination, but only with publication in an indexed journal does the data become accessible and disseminated. The conversion rate in published articles of abstracts presented at congresses is an indicator to assess the scientific quality of those events. The aim of this study is to evaluate bibliometric characteristics of abstracts presented at the Brazilian Congress of Coloproctology and to determine the factors that affect publication rates. METHODS: Retrospective evaluation of all abstracts presented at the Brazilian Congresses of Coloproctology from 2015 to 2019. Multiple databases were analyzed to estimate the conversion rate of the presented papers, as well as variables associated with the conversion of abstracts into full manuscripts through bivariate analysis and multivariate variables of these predictors. RESULTS: 1756 abstracts were analyzed. Most studies are retrospective, series or case reports, and even personal experience. The conversion rate was 6.9%. The presence of statistical analysis was twice as high for published abstracts as for unpublished ones. CONCLUSION: the data presented demonstrate a low scientific productivity of the specialty, since the research carried out is, for the most part, not published as complete manuscripts. The predictors of publication of abstracts were: multicenter studies, studies with statistical analysis, study designs with a higher level of evidence and studies awarded by the congress.
Acute pancreatitis and COVID-19: an integrative review of the literature.
Silva JTC, Fonseca Neto OCLD
Rev Col Bras Cir · 2023 · PMID 37436286 · Full text
The first cases of the COVID-19 disease were identified in late 2019 in China, but it didnt take long for it to become pandemic. At first, it was believed that it was restricted to respiratory symptoms only, until extrap...
The first cases of the COVID-19 disease were identified in late 2019 in China, but it didnt take long for it to become pandemic. At first, it was believed that it was restricted to respiratory symptoms only, until extrapulmonary manifestations were reported worldwide. Acute pancreatitis concomitant with the diagnosis of SARS-CoV-2 infection has been observed in some patients, in the absence of the most common etiologies described in the literature. It is postulated that the presence of the ECA-2 viral receptor in the pancreas is responsible for the direct cellular damage and that the hyperinflammatory state of COVID-19 favors the development of pancreatitis through an immune-mediated mechanism. This study aimed to analyze the correlation between acute pancreatitis and COVID-19 disease as a probable causality factor. An integrative literature review was carried out, including studies published between January 2020 and December 2022 that brought data on patients diagnosed with acute pancreatitis according to the revised Atlanta Classification with a confirmed diagnosis of COVID-19 in the same period. A total of thirty studies were reviewed. Demographic, clinical, laboratory and imaging aspects were analyzed and discussed. It is believed that SARS-CoV-2 was responsible for the development of acute pancreatitis in these patients, due to the absence of other precipitating risk factors, as well as the close temporal relationship between both. Attention should be given to gastrointestinal manifestations in patients affected by COVID-19.
Bleeding hepatocellular adenoma: historical series and outcomes.
Cacciatori FA, Rodrigues PD, Fontes PRO
Rev Col Bras Cir · 2023 · PMID 37436285 · Full text
INTRODUCTION: hepatocellular adenoma - AHC - is a rare benign neoplasm of the liver more prevalent in women at reproductive age and its main complication is hemorrhage. In the literature, case series addressing this comp...
INTRODUCTION: hepatocellular adenoma - AHC - is a rare benign neoplasm of the liver more prevalent in women at reproductive age and its main complication is hemorrhage. In the literature, case series addressing this complication are limited. METHODS: between 2010 and 2022, 12 cases of bleeding AHC were attended in a high-complexity university hospital in southern Brazil, whose medical records were retrospectively evaluated. RESULTS: all patients were female, with a mean age of 32 years and a BMI of 33kg/m2. The use of oral contraceptives was identified in half of the sample and also half of the patients had a single lesion. The mean diameter of the largest lesion was 9.60cm and the largest lesion was responsible for bleeding in all cases. The presence of hemoperitoneum was documented in 33% of the patients and their age was significantly higher than the patients who did not have hemoperitoneum - 38 vs 30 years, respectively. Surgical resection of the bleeding lesion was performed in 50% of the patients and the median number of days between bleeding and resection was 27 days. In only one case, embolization was used. The relation between ingrowth of the lesions and the time, in months, was not obtained in this study. CONCLUSION: it is concluded that the bleeding AHC of the present series shows epidemiological agreement with the literature and may suggest that older patients trend to have hemoperitoneum more frequently, a fact that should be investigated in further studies.
Comparison of tomographic reports by radiologists and non-radiologists in trauma and interferences in management in a trauma reference center.
Nogueira GM, Rafael LK, Reichardt GS … +2 more , Dall'agnol M, Pimentel SK
Rev Col Bras Cir · 2023 · PMID 37436284 · Full text
OBJECTIVE: diagnostic errors during the interpretation of an imaging test by the physician can lead to increased mortality and length of hospital stay for patients. The rate of divergence in the report given by a radiolo...
OBJECTIVE: diagnostic errors during the interpretation of an imaging test by the physician can lead to increased mortality and length of hospital stay for patients. The rate of divergence in the report given by a radiologist and an Emergency Physicians (EP) can reach over 20%. The objective of this study was to compare the unofficial tomographic reports issued by EP with the official reports issued by radiologists. METHODS: a cross-sectional study, in which interpretations of the exams (documented in the medical records by the EP) of all patients undergoing computed tomography (CT) of the chest, abdomen or pelvis performed in the emergency room, at an interval of 8 months, were evaluated. These data were compared with the official reports of the radiologist (gold standard). RESULTS: 508 patients were included. The divergence between EP and the radiologist occurred in 27% of the cases. The most common type of divergence was the one not described by the EP, but described by the radiologist. The chance of having divergence in a case of multiple trauma is 4.93 times greater in relation to the case of only blunt trauma in one segment. A statistically relevant difference was also found in the length of stay of patients who had different interpretations of the CT scans. CONCLUSION: the study found a relatively high divergence rate between the EP report and the official radiologist report. However, less than 4% of these were considered to be clinically relevant, indicating the ability of the EP to interpret it satisfactorily.
Evaluation of konjac noodle as a microsurgery training model: learning curve analysis.
Avelar TM, Lovato RM, Barbosa TG … +8 more , Xander PAW, Rodrigues LHDS, Campos AJB, Riechelmann RS, Flores JAC, Aguiar GB, Oliveira JG, Veiga JCE
Rev Col Bras Cir · 2023 · PMID 37436283 · Full text
BACKGROUND: classical models of microsurgical anastomosis training are expensive and have ethical implications. Some alternatives join low cost and easiness to store. However, the translation of knowledge acquired by tra...
BACKGROUND: classical models of microsurgical anastomosis training are expensive and have ethical implications. Some alternatives join low cost and easiness to store. However, the translation of knowledge acquired by training in these methods into the traditional ones is not clear. This project aims to assess the feasibility of konjac noodles as a reliable microsurgery-training model. METHODS: 10 neurosurgery residents performed an end-to-end anastomosis in a 2-3mm placenta artery. The anastomoses were evaluated quantitatively, recording time; and qualitatively, applying a validated score (Anastomosis Lapse Index - ALI) by three experienced neurosurgeons and verifying the presence of gross leakage through the infusion of fluorescein. Subsequently, they performed 10 non-consecutive sessions of anastomosis training in the konjac noodle. Eventually, a final anastomosis in the placenta model was performed and the same parameters were scored. RESULTS: we observed a 17min reduction in the mean time to perform the anastomosis in the placenta model after the training in the konjac (p<0.05). There was a non-significant 20% reduction in gross leakage, but the training sessions were not able to consistently improve the ALI score. CONCLUSIONS: we demonstrate a reduction in anastomosis performing time in placental arteries after training sessions in the konjac noodle model, which can be regarded as a feasible low-cost method, particularly useful in centers with surgical microscopes only in the operation room.
Evaluation of tumor load in sentinel lymph node in patients with cutaneous melanoma.
Almeida PD, Lavareze L, Rangel CEDS … +7 more , Mariano FV, Rodrigues DVN, Baldasso TA, Fanni RV, Casarim ALM, Negro AD, Tincani AJ
Rev Col Bras Cir · 2023 · PMID 37436282 · Full text
INTRODUCTION: cutaneous melanoma (MC) is a malignant neoplasm derived from melanocytic cells with an aggressive behavior. It is usually associated with the multifactorial interaction of genetic susceptibility and environ...
INTRODUCTION: cutaneous melanoma (MC) is a malignant neoplasm derived from melanocytic cells with an aggressive behavior. It is usually associated with the multifactorial interaction of genetic susceptibility and environmental exposure, usually ultraviolet radiation. Despite advances in treatment, the disease remains relentless with poor prognosis. Sentinel lymph node (SLN) biopsy is a technique used to screen patients in need of lymph node dissection. OBJECTIVES: to correlate the tumor burden in the SLN with the mortality of patients undergoing SLN biopsy. METHODOLOGY: the medical records and histological slides of patients with MC who underwent SLN biopsy treated at HC-Unicamp from 2001 to 2021 were retrospectively analyzed. The positive SLN were measured according to the size of the tumor infiltration area, for analysis of the depth of invasion (DI), closest proximity to the capsule (CPC) and tumor burden (TB). For statistical analysis, associations between variables were analyzed using Fishers exact test, with post Bonferroni test and Wilcoxon test. RESULTS: 105 records of patients who underwent SLN biopsy of MC were identified. Of these, nine (8.6%) had positive SLN and 81 (77.1%) had negative SLN. The performed lymphadenectomies resulted in 55.6% (n=5) affected, 22.2% (n=2) without disease and 22.2% (n=2) were not performed. Mean CPC, TB, and DI were 0.14mm, 32.10mm and 2.33mm, respectively. Patients with T2 and T3 tumors were more likely to show the SLN affected (p=0.022). No patient with positive SLN died during follow-up. CONCLUSION: patients who presented T3 staging are the ones who most presented positive SLN.
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