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A atual caracterização de infecção do sítio cirúrgico em incisional superficial, incisional profunda e órgão cavidade, em substituição à tradicional definição de "infecção de ferida operatória", associada a estratificação dos pacientes em grupos de risco de infecção cirúrgica de acordo com a metodologia NNISS (National Nosocomial Infection Surveillance System), permitiram a obtenção de taxas de infecção mais fidedignas e estudos comparativos entre instituições diferentes. Baseado nessa metodologia, o presente trabalho analisa prospectivamente 2.149 pacientes operados no Serviço de Cirurgia do Hospital Geral César Cals (HGCC)-CE, estratificados pelo IRIC (Índice de Risco de Infecção Cirúrgica) e comprova diferenças estatisticamente significativas nas taxas de infecção de sítio cirúrgico para os grupos de IRIC 0, 1,2 e 3, respectivamente de 3,2%, 7,4%, 16,6% e 20,9%. As infecções de maior gravidade ocorrem em pacientes com IRIC 3 e a vigilância pós-alta é importante, na medida em que muitas infecções somente serão diagnosticadas após a alta hospitalar.

The aim of the study was to assess the evolution of food acquisition for away from home consumption in Brazil from 2002 to 2018. The trend of food purchases for out-of-home consumption in Brazil was evaluated by comparing food purchase data from the Household Budget Surveys (HBS) of 2002-2003, 2008-2009, and 2017-2018. The frequency of food acquisition was estimated according to sociodemographic variables and the mean cost. In 2002-2003, the frequency of purchase of food for out-of-home consumption was 35.2% (95%CI: 34.4-35.9), increasing to 41.2% (95%CI: 40.4-42.0) in 2008-2009, followed by a decline in 2017-2018 (32.3%; 95%CI: 31.7-32.9). A declining trend was observed in the frequency of purchases of alcoholic beverages and soft drinks and fast foods maintained the frequency between the last two surveys. Spending on this type of food increased between 2002-2003 and 2008-2009, while the mean value of this type of expenditure was maintained between 2008-2009 and 2017-2018. Brazilians increased food purchases for out-of-home consumption between 2002-2003 and 2008-2009, declining in 2017-2018. A consistent fall in the purchase of alcoholic beverages and soft drinks was observed over time, while the group of meals grew significantly.

computed tomography scan of the chest and abdomen, pelvic magnetic resonance imaging scan and endorectal ultrasound identified a lesion at 3 cm from the anal verge, T2/T3a, and a lesion at 15 cm, T2N0, with no evidence of distant metastases. A biopsy was taken and histology revealed an adenocarcinoma. After a multidisciplinary oncology consultation, the patient had neoadjuvant chemoradiation followed by surgery.Circumferential rectal dissection was initiated at the level of the anorectal ring and proceeded posteriorly and cranially in the avascular presacral plane, between the fascia propria of the rectum (enveloping the mesorectum and rectum) and presacral fascia (covering the presacral vein over the sacrum). In the beginning, the dissection needs to be in a downward direction, in order to avoid rectal perforation and respect the presacral plane. This posterior dissection can be more difficult because the posterior slope can be quite steep in some patients, so in these cases the sequence of TaTME does not need to be uniform and can be initiated by the anterior dissection. At the third and fourth sacral vertebra, the Waldeyer fascia is dissected, leading to a superior portion of the retrorectal compartment. The failure to recognize and divide it may result in perforation of the rectum or hemorrhage from the presacral venous plexus. In addition, full mobilization of the rectum is not possible unless the rectosacral fascia is divided. At the level of the sacral promontory, the mesorectum becomes a thick envelope mainly in the dorsolateral position containing perirectal fat, the superior rectal vessels, lymphatic tissue and nerve structures. Usually, the rectal fascia surrounding the mesorectum adheres to the inferior hypogastric plexus (IHP). If careful dissection is not performed, the IHP could be injured and this could lead to postoperative autonomic dysfunction [4].The dissection is extended to the right and to the left of the rectum with the section of the lateral ligament and division of the middle rectal artery, if needed. The lateral ligament Transanal total mesorectal excision (TaTME) is presented as a promising new surgical technique for the approach to the distal rectum, providing the ability to perform a highquality resection, with technical advantages over the laparoscopic approach [1]. However, the new surgical anatomy of the TaTME resection complicates surgical understanding and increases the risks of inadvertent injuries to important anatomic structures [2]. Detailed technical reports and stepwise description are necessary, to facilitate the surgeon's familiarization with this new technique and to reduce the learning curve in a safe manner. This video describes, in both sexes, the TaTME approach highlighting the unique anatomic structures and pitfalls, organized into four virtual triangles (anterior, posterior and two laterals) defining a road map of anatomic landmarks [3].We report the case of a 47-year-old woman complaining of blood loss per rectum. A standard workup which included digital rectal ...

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