OBJECTIVES:This study tests the hypothesis that local or remote ischemic preconditioning may protect the intestinal mucosa against ischemia and reperfusion injuries resulting from temporary supraceliac aortic clamping.METHODS:Twenty-eight Wistar rats were divided into four groups: the sham surgery group, the supraceliac aortic occlusion group, the local ischemic preconditioning prior to supraceliac aortic occlusion group, and the remote ischemic preconditioning prior to supraceliac aortic occlusion group. Tissue samples from the small bowel were used for quantitative morphometric analysis of mucosal injury, and blood samples were collected for laboratory analyses.RESULTS:Supraceliac aortic occlusion decreased intestinal mucosal length by reducing villous height and elevated serum lactic dehydrogenase and lactate levels. Both local and remote ischemic preconditioning mitigated these histopathological and laboratory changes.CONCLUSIONS:Both local and remote ischemic preconditioning protect intestinal mucosa against ischemia and reperfusion injury following supraceliac aortic clamping.

OBJETIVO: Avaliar os resultados cirúrgicos após o tratamento convencional e eletivo do aneurisma da aorta abdominal, verificando se existe diferença entre homens e mulheres na mortalidade e morbidade cirúrgicas, bem como nos resultados a longo prazo. PACIENTES E MÉTODOS: Entre dezembro de 1983 e dezembro de 2003, 675 pacientes foram submetidos ao tratamento cirúrgico do aneurisma da aorta abdominal infra-renal, sendo divididos em dois grupos: homens (n = 575) e mulheres (n = 100). Os dados demográficos e aqueles relacionados ao procedimento cirúrgico, bem como os resultados perioperatórios, foram coletados pela revisão dos prontuários. Os pacientes com alta hospitalar formaram uma coorte retrospectiva, onde foram avaliadas as causas tardias de óbito e a sobrevida. RESULTADOS: A média das idades foi similar, sem diferença estatística entre mulheres e homens (68,9 ± 9,1 versus 67,4 ± 7,1 anos; P = 0,089). A presença de hipertensão arterial foi significativamente superior nas mulheres (73 versus 62,4%; P = 0,042), e a cardiopatia isquêmica e história de tabagismo foram mais freqüentes nos homens (P <0,05). A mortalidade operatória total foi de 2,8%, não havendo diferença significativa entre mulheres e homens (4 versus 2,6%, respectivamente; P = 0,43). A morbidade cirúrgica envolveu 14% dos pacientes femininos e 18,4% dos masculinos (P 0,05). A taxa de sobrevida global em 1, 3, 5 e 10 anos não diferiu entre os grupos, sendo a sobrevida em 5 anos de 71% para as mulheres e 72% para os homens (P 0,05). A principal causa de morte tardia foi de origem cardiovascular, seguida de complicações renais nas mulheres e neoplasia nos homens. CONCLUSÂO: A taxa de mortalidade e morbidade cirúrgicas não aumentou significativamente nas mulheres após a correção eletiva do aneurisma da aorta abdominal infra-renal. Além disso, os resultados a longo prazo são semelhantes entre os dois gêneros.

This paper reports a patient who was successfully treated for a ruptured renal artery aneurysm. A 64-year-old man presented with sudden onset of strong abdominal and lumbar pain, and a 2-week history of abdominal discomfort. Abdominal computed tomography and visceral arteriography revealed a retroperitoneal hematoma and a 7.5-cm saccular renal aneurysm with active bleeding. A laparotomy was indicated, and a nephrectomy was performed due to the persistent bleeding and refractory hypotension presented during surgery. The postoperative course was uneventful, and the patient was discharged with a normal renal function on the tenth day. This paper presents the successful management of a ruptured renal aneurysm with a review of the literature, and the management possibilities of such patients is also discussed.

Background: Chronic aortoiliac occlusion (CAIO) is a significant cause of lower limb ischemia and is often found in young patients who smoke. Objective: To review recent results achieved treating CAIO patients with open surgery. Methods: From November 2011 to April 2014, 21 patients with CAIO were treated at the Santa Casa de Misericórdia, Porto Alegre, Brazil. Demographic data, comorbidities, clinical presentation and surgical results were analyzed. Results: Eleven women and ten men were treated with direct aortic bypass (DAB; n=18) or with extra-anatomic bypass (EAD; n=3). Mean age was 53.7 ± 7.3 years (range: 43-79 years) and all patients smoked. Thirteen patients (62%) had critical ischemia. Six of the patients treated with DAB (33.4%) also required additional revascularization (3 renal and 3 femoropopliteal procedures). Perioperative mortality was zero. Four patients (22.2%) suffered transitory renal dysfunction, but only one patient (5.6%) required hemodialysis. Median follow-up time was 17 months (range: 2-29 months) and there was just one late death, from ischemic heart disease, 7 months after the surgery on the abdominal aorta. Conclusions: Aortic reconstruction is a safe method for treating patients with CAIO, with low perioperative morbidity and mortality rates.

Background: Surgical site infection is a severe complication of peripheral vascular surgery with high morbidity and mortality rates. Objective: To evaluate the morbidity and mortality of infections of peripheral artery surgery sites caused by resistant microorganisms. Methods: This was a prospective study of a cohort of patients who underwent peripheral artery revascularization procedures and developed surgical site infections between March 2007 and March 2011. Results: Mean age was 63.7 years; males accounted for 64.3% of all cases. The overall prevalence of bacterial resistance to antimicrobials was 65.7%. The most common microorganism identified was Staphylococcus aureus (30%). Comparison of the demographic and surgical characteristics of both subsets (resistant versus non-resistant) detected a significant difference in length of preoperative hospital stay (9.3 days vs. 3.7 days). The subset of patients with infections by resistant microorganisms had higher rates of reoperation, lower numbers of limb amputations and lower mortality, but the differences compared to the subset without resistant infections were not significant. Long-term survival was similar. Conclusions: This study detected no statistically significant differences in morbidity or mortality between subsets with surgical wound infections caused by resistant and not-resistant microorganisms.