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RESUMO A atual pandemia do novo coronavírus, Covid-19, tem sido o assunto mais discutido no momento, tanto na mídia como em periódicos científicos. O medo, a incerteza e o desconhecimento sobre o comportamento da doença são os fatores preponderantes que podem justificar essa realidade. Sabe-se de antemão que a enfermidade tem grande disseminação, é mais grave entre idosos e está associada a grande impacto socioeconômico mundial. Além dos desafios em lidar com o desconhecido, há outros relacionados com a sobrecarga de informação e nesse quesito, a grande quantidade de estudos científicos, que englobam pesquisas in vitro, relatos de casos, estudos observacionais e randomizados, além de revisões sistemáticas complementam o panorama de dúvidas. Essa situação é piorada porque o conhecimento sobre o método científico não é dominado pela maioria dos profissionais de saúde, algo que há muito já vem sendo divulgado por vários autores. De sorte que em função desta realidade, torna-se fundamental que sociedades de especialidades apoiadas por dados da Organização Mundial da Saúde e do Ministério da Saúde assumam a liderança da divulgação da informação correta e confiável. O Colégio Brasileiro de Cirurgiões sugere neste documento medidas que podem auxiliar cirurgiões e outros profissionais de saúde, assim como pacientes, em caso de necessidade cirúrgica, a lidar com a atual pandemia. ABSTRACT The current world Covid-19 pandemic has been the most discussed topic in the media and scientific journals. Fear, uncertainty, and lack of knowledge about the disease may be the significant factors that justify such reality. It has been known that the disease presents with a rapidly spreading, it is significantly more severe among the elderly, and it has a substantial global socioeconomic impact. Besides the challenges associated with the unknown, there are other factors, such as the deluge of information. In this regard, the high number of scientific publications, encompassing in vitro, case studies, observational and randomized clinical studies, and even systematic reviews add up to the uncertainty. Such a situation is even worse when considering that most healthcare professionals lack adequate knowledge to critically appraise the scientific method, something that has been previously addressed by some authors. Therefore, it is of utmost importance that expert societies supported by data provided by the World Health Organization and the National Health Department take the lead in spreading trustworthy and reliable information. The Brazilian College of Surgeons suggests in this document various initiatives that may help surgeons, healthcare providers, and patients who will have to face a surgical event under the pandemic.

RESUMO A atual pandemia do novo coronavírus, Covid-19, tem sido o assunto mais discutido no momento, tanto na mídia como em periódicos científicos. O medo, a incerteza e o desconhecimento sobre o comportamento da doença são os fatores preponderantes que podem justificar essa realidade. Sabe-se de antemão que a enfermidade tem grande disseminação, é mais grave entre idosos e está associada a grande impacto socioeconômico mundial. Além dos desafios em lidar com o desconhecido, há outros relacionados com a sobrecarga de informação e nesse quesito, a grande quantidade de estudos científicos, que englobam pesquisas in vitro, relatos de casos, estudos observacionais e randomizados, além de revisões sistemáticas complementam o panorama de dúvidas. Essa situação é piorada porque o conhecimento sobre o método científico não é dominado pela maioria dos profissionais de saúde, algo que há muito já vem sendo divulgado por vários autores. De sorte que em função desta realidade, torna-se fundamental que sociedades de especialidades apoiadas por dados da Organização Mundial da Saúde e do Ministério da Saúde assumam a liderança da divulgação da informação correta e confiável. O Colégio Brasileiro de Cirurgiões sugere neste documento medidas que podem auxiliar cirurgiões e outros profissionais de saúde, assim como pacientes, em caso de necessidade cirúrgica, a lidar com a atual pandemia.

Background: Hemodilution, transoperative bleeding and cardiopulmonary bypass (CPB) are some of the factors associated with high transfusion rates in cardiac surgery. Objective: To analyze the incidence of blood transfusion and early postoperative outcomes in cardiac surgery patients. Methods: Cohort study of patients undergoing cardiac surgery in a university hospital, consecutively enrolled from May 2015 to February 2017. Data were prospectively collected and comparisons were made between two patients’ groups: transfused and not transfused. Student's t-test, chi-square test, and logistic regression were used, and a p-value < 0.05 was considered significant. Results: Among the 271 patients evaluated, 100 (37%) required transfusion in the transoperative (32.1%) and/or postoperative periods (19.5%). The following predictors of transfusion were identified by multivariate analysis: EuroScore II (OR 1.2); chronic kidney disease (CKD) (OR 3.2); transoperative bleeding ≥ 500 mL (OR 6.7); baseline hemoglobin (Hb) ≤ 10 g/dL (OR 11.5); activated partial thromboplastin time (aPTT) (OR 1.1) and CPB duration (OR 1.03). Transfusion was associated with prolonged mechanical ventilation (≥ 24h) (2.4% vs. 23%), delirium (5.9% vs. 18%), bronchopneumonia (1.2% vs. 16%), acute renal failure (3.5% vs. 25%), acute on CKD (0.6% vs. 8%), stroke or transient ischemic attack (1.8% vs. 8%), intensive care unit stay ≥ 72 h (36% vs. 57%), longer hospital stay (8 ± 4 days vs. 16 ± 15 days), as well as increased early mortality (1.75% vs. 15%). Conclusion: EuroScore II, CKD, major transoperative bleeding, preoperative Hb and aPTT values and CPB time were independent predictors of transfusion, which was associated with a higher rate of adverse outcomes, including early mortality.

OBJETIVO: Avaliar o efeito do 5-fluorouracil (5FU) injetado intralesionalmente na cabeça do pterígio no período pré-operatório. MÉTODOS: Foram estudados 53 olhos (52 pacientes), sendo 28 pterígios primários e 25 recidivados, divididos em dois grupos: grupo 1 (G1), composto por indivíduos que receberam a injeção de 5-fluorouracil 30 dias antes do procedimento cirúrgico e grupo 2 (G2), no qual o 5-fluorouracil foi injetado 10 dias antes da cirurgia. Todas as cirurgias foram realizadas seguindo-se a mesma técnica cirúrgica, pelo mesmo cirurgião. Os pacientes foram reavaliados 7, 30 e 60 dias após a cirurgia. Os resultados observados foram submetidos à análise estatística. RESULTADOS: A amostra estudada foi constituída por 52,8% de pterígios primários e 47,2% de recidivados, sendo composta igualmente por indivíduos de ambos os sexos. Não ocorreram complicações decorrentes da infiltração da droga. A recidiva foi mais freqüente nos pterígios recidivados e no G1. CONCLUSÃO: O uso intralesional de 5-fluorouracil no pré-operatório do pterígio não provocou efeitos deletérios aos olhos estudados. Houve menor recorrência quando usado o 5-fluorouracil 10 dias antes da exérese cirúrgica, em relação à aplicação 30 dias antes do procedimento.PURPOSE: To assess the effect of 5-fluorouracil (5FU) injected in pterygia before surgery. METHODS: 53 eyes of 52 patients (28 primary and 25 recurrent pterygia) underwent subconjunctival 5-fluorouracil application 30 days before surgery - group 1 (G1) and 10 days before surgery - group 2 (G2). All surgeries were performed by the same surgeon, who used the same technique in all patients. Patients were assessed 7, 30 and 60 days after surgery. Results were submitted to statistical analysis (p

A 51-year-old man with a renal carcinoma with inferior vena cava (IVC) invasion was referred to our hospital for the performance of a radical nephrectomy with IVC thrombus excision. To prevent embolism, an IVC filter was implanted the day before surgery below the suprahepatic veins. On nephrectomy completion, the clinical status of the patient started to deteriorate and an unsuccessful attempt was made to excise the IVC thrombus. The patient developed profound refractory hypotension without significant bleeding and worsening splanchnic stasis was noted. A transesophageal echocardiogram was immediately performed in the operating room, revealing a hemispheric mass protruding from the IVC ostium to the right atrium, completely blocking all venous return. Volume depletion was evident by low left and right atrial volumes and increased septum mobility. No other abnormalities were found that could explain the shock, namely ventricular dysfunction or valvular disease. Cardiac surgery consultation was immediately obtained, ultimately deciding to perform a median sternotomy with direct exploration of right atrium. Under cardiopulmonary bypass, a 6-cm long thrombotic mass was identified, involving the IVC filter, blocking all lower body venous return; the removal of the mass reversed the shock. The patient had an uneventful recovery. Adverse outcomes associated with IVC filters are common. Our case highlights the importance of a team approach to rapid changes in hemodynamic status in the operating room, including the surgeon, the anesthesiologist, and the cardiologist. It also emphasizes the pivotal role of transesophageal echocardiogram in the clinical evaluation of severely unstable patients.

Paciente de 45 anos do sexo masculino, com diagnóstico de cardiomiopatia hipertrófica septal assimétrica, tendo sido submetido a implante de cardiodesfibrilador no passado. Apesar do tratamento clínico otimizado, evoluiu com progressiva deterioração clínica suscitando tratamento invasivo. Entretanto, não havia gradiente importante na via de saída do ventrículo esquerdo (VSVE) ao ecocardiograma de repouso e o teste provocativo com dobutamina foi inconclusivo por não atingir a frequência cardíaca preconizada. A avaliação intraoperatória com ecocardiograma transesofágico em uso de isoproterenol foi fundamental no diagnóstico de obstrução da VSVE. A miectomia septal foi realizada com sucesso e o paciente apresentou boa evolução pós-operatória. A male, 45 year old patient, with diagnosis of septum hypertrophic cardiomyopathy, having undergone a cardiofibrilator implant in the past. Despite the optimized clinical treatment, he evolved to a progressive clinical deterioration that led to invasive treatment. However, there was not an important gradient in the exit pathway of the left ventricle (EPLV) at the echocardiogram in rest and the challenging test with dobutamine was non conclusive because it did not reach the preconized cardiac frequency. The intraoperative evaluation with a transesophageal echocardiogram using isoproterenol was fundamental for the diagnosis of the EPLV obstruction. The septum myectomy was performed successfully and the patient presented good post-operative evolution. Paciente de 45 años del sexo masculino, con diagnóstico de cardiomiopatía hipertrófica septal asimétrica, habiendo sido sometido a implante de cardiodesfibrilador en el pasado. A pesar del tratamiento clínico optimizado, evolucionó con progresivo deterioro clínico suscitando tratamiento invasivo. Entre tanto, no había gradiente importante en la vía de salida del ventrículo izquierdo (VSVI) al ecocardiograma de reposo y el test provocativo con dobutamina fue inconclusivo por no alcanzar la frecuencia cardíaca preconizada. La evaluación intraoperatoria con ecocardiograma transesofágico en uso de isoproterenol fue fundamental en el diagnóstico de obstrucción de la VSVI. La miectomía septal fue realizada con éxito y el paciente presentó buena evolución postoperatoria.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:40:30Z No. of bitstreams: 1 S0004-27492003000400020.pdf: 151307 bytes, checksum: 3bb272ecf2badb82a9318678f39a7a28 (MD5) Made available in DSpace on 2013-08-22T18:40:30Z (GMT). No. of bitstreams: 1 S0004-27492003000400020.pdf: 151307 bytes, checksum: 3bb272ecf2badb82a9318678f39a7a28 (MD5) Previous issue date: 2003-08-01 Made available in DSpace on 2013-09-30T19:26:13Z (GMT). No. of bitstreams: 2 S0004-27492003000400020.pdf: 151307 bytes, checksum: 3bb272ecf2badb82a9318678f39a7a28 (MD5) S0004-27492003000400020.pdf.txt: 23642 bytes, checksum: 2af3f7b15201cad6d9ac9946f70a401c (MD5) Previous issue date: 2003-08-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T15:07:22Z No. of bitstreams: 2 S0004-27492003000400020.pdf: 151307 bytes, checksum: 3bb272ecf2badb82a9318678f39a7a28 (MD5) S0004-27492003000400020.pdf.txt: 23642 bytes, checksum: 2af3f7b15201cad6d9ac9946f70a401c (MD5) Made available in DSpace on 2014-05-20T15:07:22Z (GMT). No. of bitstreams: 2 S0004-27492003000400020.pdf: 151307 bytes, checksum: 3bb272ecf2badb82a9318678f39a7a28 (MD5) S0004-27492003000400020.pdf.txt: 23642 bytes, checksum: 2af3f7b15201cad6d9ac9946f70a401c (MD5) Previous issue date: 2003-08-01 OBJETIVO: Avaliar o efeito do 5-fluorouracil (5FU) injetado intralesionalmente na cabeça do pterígio no período pré-operatório. MÉTODOS: Foram estudados 53 olhos (52 pacientes), sendo 28 pterígios primários e 25 recidivados, divididos em dois grupos: grupo 1 (G1), composto por indivíduos que receberam a injeção de 5-fluorouracil 30 dias antes do procedimento cirúrgico e grupo 2 (G2), no qual o 5-fluorouracil foi injetado 10 dias antes da cirurgia. Todas as cirurgias foram realizadas seguindo-se a mesma técnica cirúrgica, pelo mesmo cirurgião. Os pacientes foram reavaliados 7, 30 e 60 dias após a cirurgia. Os resultados observados foram submetidos à análise estatística. RESULTADOS: A amostra estudada foi constituída por 52,8% de pterígios primários e 47,2% de recidivados, sendo composta igualmente por indivíduos de ambos os sexos. Não ocorreram complicações decorrentes da infiltração da droga. A recidiva foi mais freqüente nos pterígios recidivados e no G1. CONCLUSÃO: O uso intralesional de 5-fluorouracil no pré-operatório do pterígio não provocou efeitos deletérios aos olhos estudados. Houve menor recorrência quando usado o 5-fluorouracil 10 dias antes da exérese cirúrgica, em relação à aplicação 30 dias antes do procedimento. PURPOSE: To assess the effect of 5-fluorouracil (5FU) injected in pterygia before surgery. METHODS: 53 eyes of 52 patients (28 primary and 25 recurrent pterygia) underwent subconjunctival 5-fluorouracil application 30 days before surgery - group 1 (G1) and 10 days before surgery - group 2 (G2). All surgeries were performed by the same surgeon, who used the same technique in all patients. Patients were assessed 7, 30 and 60 days after surgery. Results were submitted to statistical analysis (p

AMILIAL amyloidotic polyneuropathy (FAP) is a genetic dominant disease with a meaningful prevalence in Portugal, Sweden, and Japan. A large number of biochemistry anomalies could underlie this disease but by far the most frequent is the transthyretin methionine 30 anomaly (FAP ATTR Met 30) 1 whose symptoms start in adult age and death ensues commonly 10 to 15 years after the initial complaints. Liver transplantation is the only therapy that has proved to stop this disease. As opposed to transplant recipients with liver diseases, FAP patients present without preoperative coagulation disorders and portal hypertension, and the transplant tends to be technically easier, with less blood loss and shorter operating time. 2,3 Nevertheless the circulatory involvement is always present in the natural course of this disease with autonomic dysfunction being a characteristic finding and cardiac arrhythmias and diastolic dysfunction being frequently observed. 4 A high incidence of severe hypotension is reported during liver transplant in FAP 2,5 and rhythm and intracardiac conduction anomalies have also been reported as a troublesome problem during FAP anesthesia. 6 The aim of this study was to assess the intraoperative interventions on the circulatory system and to correlate them with the findings of preoperative routine examinations and intra-operative events. PATIENTS Group I included all 90 FAP ATTR Met 30 recipients of first liver transplant during a 7-year period, 50 male and 40 female, with age of 35.6 6 7.2 years, weight of 56.4 6 11.9 kg, body mass index (BMI) of 20.8 6 4.1 kg/m 2 , disease duration (since the first symptom) of 4.8 6 2.5 years, and a neurologic score of 33.9 6 12.6 in the scale of Macedo and col. Group II included all the 125 adults (79 male, 46 female) with other diseases that received a first liver transplant during the same period. Groups were not different with regard to height and sex. Group II was older (42.3 6 12.8 years, P , .001), and had a greater weight (65.7 6 12.0 kg, P , .001) and BMI (23.8 6 4.3 kg/m 2 , P , .001). Hematologic and liver function tests were normal in group I. Group II presented lower hemoglobin (P , .001), fibrinogen (P , .001), and albumin (P , .001) and higher prothrombin time (P , .001), direct (P , .001) and total bilirubin (P , .001), AST (P , .001), ALT (P , .001), and creatinine (P , .001). The transplant was done by classic technique in 27 patients (30.0%) of group I and 39 (31.2%) of group II (P 5 ns) and by piggy-back technique in the remaining. Seventeen patients (18.9%) in group I and none in group II had a permanent pacemaker. METHOD Anaesthesia, monitoring, and circulatory support protocols were identical in the two groups and did not change during the years of the study. Low-dose dopamine (3 mg/kg/min or less) was used in all patients. Higher doses of dopamine were used as a first line circulatory support. Dobutamine was used to treat low cardiac output with adequate filling pressures and phenylephrine to treat vasodilatation. Antiarrhythmic agents or vasodilators were used as standard in general practice. Emergency transcutaneous pacing was always available. Group I values were compared with group II values by Mann-Whitney U test or chi-square test followed by Fisher test, as appropriate. Within each group, if one drug was used in a number of patients that allowed subsequent statistics, patients that used it and patients that did not use it were compared with the same statistical tests. Data as mean 6 standard deviation. RESULTS Venovenous bypass was used in 31.1% of group I and 33.6% of group II (P 5 ns). Group I patients needed 5.2 6 9.4 units of red blood cells (RBC), 12.7 6 16.6 units of fresh frozen plasma (FFP), and 3.4 6 8.9 units of platelets. Blood products consumption was significantly higher in group II: 13.1 6 12.7 units of RBC (P , .001), 26.4 6 21.4 units of FFP (P , .001), and 9.0 6 8.6 units of platelets (P , .001). Except for low-dose dopamine, at least one sympathomimetic drug was used in 75.6% of group I and 38.4% of group II patients (P , .001). Dopamine (5 mg/kg/min or more), dobutamine, phenylephrine, and epinephrine were respectively used in 43.3%, 2.2%, 48.9%, and 7.8% of group I patients. The respective values in group II patients were 27.2% (P , .05), 12.8% (P 5 ns), 3.2% (P , .001), and 4.0% (P 5 ns). Lidocaine was used in 7.8% of group I and 3.2% of group II patients (P 5 ns). Norepinephrine, digoxin, verapamil, amiodarone, sodium nitroprusside, or nitroglycerine were used in a maximum of one patient in each group (P 5 ns). Emergency pacing was never used. Within group II, the patients that needed inotropic drugs had lower albumin (P , .05) and higher creatinine

Submitted by Ana Quininha (ana.quininha@chlc.min-saude.pt) on 2017-03-23T16:05:00Z No. of bitstreams: 1 AMP 1993 123.pdf: 642639 bytes, checksum: 2a9270cfb43e08c289b9ca05544cf5d0 (MD5) Made available in DSpace on 2017-03-23T16:05:00Z (GMT). No. of bitstreams: 1 AMP 1993 123.pdf: 642639 bytes, checksum: 2a9270cfb43e08c289b9ca05544cf5d0 (MD5) Previous issue date: 1993 info:eu-repo/semantics/publishedVersion

Os autores apresentam a sua experiência de 3 anos, com a ecografia per-operatória em 200 doentes sujeitos a colecistectomia por litíase biliar. A ecografia per-operatória e a colangiografia per-operatória foram praticadas em todos estes doentes e comparadas com os achados operatórios. A precisão diagnóstica da ecografia foi 98% e a da colangiografia 96%, no total de doentes desta série. O valor da previsão duma ecografia positiva foi 92.5% enquanto que com uma colangiografia positiva foi inferior, 8 1.5%. Nos 32 doentes em que se praticou a exploração da via biliar principal a utilização destes dois métodos conjuntos levou a uma exploração positiva em 75% dos casos. A morbilidade total nestas séries foi 4.8% contra 12.8% (no grupo com exploração do hepato-colédoco) e cálculos retidos a seguir à exploração da via biliar, foram encontrados numa doente e em situação intra-hepática. A mortalidade total de toda a série de doentes foi 0%. A ecografia per-operatória das vias biliares como procedimento de estudo é um método valioso, possível substituto da colangiografia per-operatória, embora na realidade ambos os métodos possam ter um papel complementar. info:eu-repo/semantics/publishedVersion