Revista Portuguesa de Cirurgia
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Reappraisal of preoperative bowel preparation in colorectal surgery
Get PDFFor over a century, mechanical bowel preparation prior to elective colorectal surgery is a time – honored dogma. However, this dogma is based on experience and observation only. Challenges of this dogma began when surgeon started performing primary repair of colonic injury in trauma case with good results. This review aims to evaluate the evidence for and against the use of mechanical bowel preparation in elective colorectal surgery. A literature search was done on Pubmed and Medline in recent 10 years, and emphasis was put on randomized controlled trial and meta-analysis. It is concluded that there is no statistical evidence that patients significantly benefit from mechanical bowel preparation. Thus the routine use of mechanical bowel preparation in elective colorectal surgery should be reconsidered. Keywords: mechanical bowel preparation, colorectal surgery For over a century, mechanical bowel preparation prior to elective colorectal surgery is a time – honored dogma. However, this dogma is based on experience and observation only. Challenges of this dogma began when surgeon started performing primary repair of colonic injury in trauma case with good results. This review aims to evaluate the evidence for and against the use of mechanical bowel preparation in elective colorectal surgery. A literature search was done on Pubmed and Medline in recent 10 years, and emphasis was put on randomized controlled trial and meta-analysis. It is concluded that there is no statistical evidence that patients significantly benefit from mechanical bowel preparation. Thus the routine use of mechanical bowel preparation in elective colorectal surgery should be reconsidered. Key words: mechanical bowel preparation, colorectal surgery
Tamponamento cardíaco por cateterismo venoso central
Get PDFCentral venous catheterization is an excellent power to treat medical or surgical diseases, in adults or children. Cardiac tamponade is his fearest complication. A 67 years old man, was admitted by heavy acute pancreatitis and we perform an abdominal washing and drainage. A central venous catheter was placed at subclavian vein in order to administration parenteral nutrition. At fifth day the patient was submitted to another surgical operation for sequestrectomy. The evolution was very good, when at ninth day, occur suddenly cardiac arrest, without recuperation instead immediate reanimation assistance. At autopsy we verify that he died with a cardiac taponade by Vitrimix®. We have no detected any cardiac perforation. The product cross the cardiac wall by osmosis. Keywords: cardiac tamponade, central venous catheterization, complication. A cateterização venosa central tornou-se uma arma poderosa para tratamento de doenças do foro médico ou cirúrgico, tanto em crianças como em adultos. O tamponamento cardíaco é a sua complicação mais temível. Um homem com 67 anos, foi internado por pancreatite aguda grave e operado para lavagem e drenagem abdominal. Foi colocado catéter na subclávia direita para alimentação parenteral. Ao quinto dia foi reoperado para sequestrectomia e lavagem da loca pancreática e abdominal. A evolução era boa, quando ao nono dia, teve paragem cardíaca súbita, que não cedeu a manobras de reanimação. Na autópsia verificamos que a causa da morte foi um tamponamento cardíaco por Vitrimix®. Não se detectou perfuração cardíaca. O produto atravessou a parede cardíaca por osmose. Palavras-chave: tamponamento cardíaco, cateterização venosa central, complicações.
