Objective: to identify predictors of chest drainage complications in trauma patients attended at a University Hospital. Methods: we conducted a retrospective study of 68 patients submitted to thoracic drainage after trauma, in a one-year period. We analyzed gender, age, trauma mechanism, trauma indices, thoracic and associated lesions, environment in which the procedure was performed, drainage time, experience of the performer, complications and evolution. Results: the mean age of the patients was 35 years and the male gender was the most prevalent (89%). Blunt trauma was the most frequent, with 67% of cases, and of these, 50% were due to traffic accidents. The mean TRISS (Trauma and Injury Severity Score) was 98, with a mortality rate of 1.4%. The most frequent thoracic and associated lesions were, respectively, rib fractures (51%) and abdominal trauma (32%). The mean drainage time was 6.93 days, being higher in patients under mechanical ventilation (p=0.0163). The complication rate was 26.5%, mainly poor drain positioning (11.77%). Hospital drainage was performed in 89% of cases by doctors in the first year of specialization. Thoracic drainage performed in prehospital care presented nine times more chances of complications (p=0.0015). Conclusion: the predictors of post-trauma complications for chest drainage were a procedure performed in an adverse site and mechanical ventilation. The high rate of complications demonstrates the importance of protocols of care with the thoracic drainage.

Gallstone ileus should be suspected in the elderly with SBO symptoms. Early diagnosis can reduce post-operative complications. Treatment is urgent laparotomy, and surgical treatment must be individualized for each case. The majority of patients in this study were treated with enterolithotomy, with cholecystectomy being performed later in two symptomatic patients.

Background: Some authors consider acute appendicitis as the main cause of acute surgical abdomen. Incident in all ages, contemporary literature suggests that is more frequent in children and young adults, male predominantly. This study aims to test the hypothesis that the disease in question is no longer prevalent in young adults (excluding children) in the surveyed region.Methods: 1150 cases of emergency surgery were performed and prospectively analyzed. 300 cases of appendicitis in adults were selected and variables studied. Patients under 13 years old were excluded.Results: 190 patients older than 60 years had a diagnosis of acute appendicitis confirmed by biopsy. There is a predominance of males. The elderly population takes less time to seek medical assistance and has fewer complications, despite being more often admitted to the ICU due to other comorbidities. Conclusions:A trend regarding acute appendicitis epidemiology may exist. In the specific studied region acute appendicitis is no longer a disease prevalent in young adults. Surgeons and emergency physicians must be aware that acute appendicitis may no longer be predominantly common in young adults in their own specific region. Multicenter studies are needed to determine whether these data are reproduced in a geographical area of greater extent.

How to reduce pleural drainage complications using an ultrasoundguided technique. Como reduzir complicações relacionadas à drenagem pleural utilizando uma técnica guiada por ultrassom.Carlos augusto Metidieri Menegozzo, tCBC-sP 1 ; adriano riBeiro Meyer-Pflug, tCBC-sP 1 ; edivaldo Massazo utiyaMa, tCBC-sP 1 . LETTER TO THE EDITORRev Col Bras Cir. 2018;45(4):e1952Menegozzo How to reduce pleural drainage complications using an ultrasound-guided technique. 2 Rev Col Bras Cir. 2018;45(4):e1952 -Universidade de São Paulo (HC-FMUSP) offers the only course that teaches the step-by-step ultrasoundguided pleural drainage, developed by our group 6 , in addition to other important topics of ultrasound in emergency medicine. Thus, we consider that the incorporation of the ultrasound-guided pleural drainage technique may avoid complications currently observed in our medical centers. For this, physicians need to be adequately trained and hospitals must provide the necessary resources to perform the procedure. Similar to other procedures such as thoracentesis and central venous access, in which the echo-guided technique became the gold standard, we believe that the same positive results can be obtained with echo-guided pleural drainage.