A B S T R A C TObjective: to present the epidemiological profile, incidence and outcome of patients who developing postoperative abdominal fistula. Methods: This observational, cross-sectional, prospective study evaluated patients undergoing abdominal surgery. We studied the epidemiological profile, the incidence of postoperative fistulas and their characteristics, the outcome of this complication and the predictors of mortality. Results: The sample consisted of 1,148 patients. The incidence of fistula was 5.5%. There was predominance of biliary fistula (26%), followed by colonic fistulas (22%) and stomach (15%). The average time to onset of fistula was 6.3 days. For closure, the average was 25.6 days. The mortality rate of patients with fistula was 25.4%. Predictors of mortality in patients who developed fistula were age over 60 years, presence of comorbidities, fistula closure time more than 19 days, no spontaneous closure of the fistula, malnutrition, sepsis and need for admission to the Intensive Care Unit . Conclusion: abdominal postoperative fistulas are still relatively frequent and associated with significant morbidity and mortality.

Background: The lactate is a product of anaerobic metabolism; it can be used as a marker on demand and availability of oxygen. Changes in lactate levels can be effectively used as a marker in resuscitation maneuvers, even in patients with stable vital signs. Aim: To verify the lactate clearance as a predictor of mortality in trauma patients, in need of intensive care. Method: A total of 851 patients were admitted in ICU, in which 146 were victims of multiple trauma; due to the exclusion criteria, were included 117. Results: Patients were 87% male, mean age 32.4 years, motorcycle drivers, Glasgow coma scale between 3-8, affected by cranial trauma, followed by abdominal trauma. Was verified mortality up to 48 h and global mortality, that did not show statistical relationship between lactate clearance and mortality (p=0.928). Conclusion: There is no correlation between admission lactate or lactate clearance and mortality in patients treated with multiple trauma.

Background: Acute appendicitis is the most common cause of acute abdomen. Approximately 7% of the population will be affected by this condition during full life. The development of AIR score may contribute to diagnosis associating easy clinical criteria and two simple laboratory tests. Aim: To evaluate the score AIR (Appendicitis Inflammatory Response score) as a tool for the diagnosis and prediction of severity of acute appendicitis. Method: Were evaluated all patients undergoing surgical appendectomy. From 273 patients, 126 were excluded due to exclusion criteria. All patients were submitted o AIR score. Results: The value of the C-reactive protein and the percentage of leukocytes segmented blood count showed a direct relationship with the phase of acute appendicitis. Conclusion: As for the laboratory criteria, serum C-reactive protein and assessment of the percentage of the polymorphonuclear leukocytes count were important to diagnosis and disease stratification.

DESCRITORES -Síndrome do intestino curto. Nutrição parenteral total. Cirurgia.RESUMO -Introdução -A síndrome do intestino curto resulta de comprimento total de intestino delgado inadequado para manter a nutrição, e assim, os pacientes tornam-se cronicamente dependentes de nutrição parenteral total. Numerosas estratégias cirúrgicas foram estudadas para restabelecer a função intestinal normal. Objetivo -Propor a utilização da inversão de segmento de alça associada à STEP -Serial Transverse Enteroplasty -para aumentar a área absortiva intestinal em pacientes com síndrome do intestino curto. Método -Os autores descrevem uma nova alternativa para o tratamento cirúrgico da síndrome do intestino curto, demonstrando sua facilidade e eficiência para o objetivo proposto. Resultados -As duas técnicas associadas permitiram alongar a alça intestinal em 2,6 vezes do comprimento original, com posterior ganho de peso, redução do número de evacuações para uma exoneração ao dia e melhora da qualidade de vida social e psicológica. Conclusão -Essa técnica de inversão de segmento de alça intestinal e posterior STEP surge como tratamento eficiente e definitivo à síndrome do intestino curto de forma promissora e segura permitindo retorno à alimentação por via oral com satisfatória absorção de nutrientes e ganho de peso, retorno da motilidade efetiva intestinal, associada à baixa morbidade e melhoria da qualidade de vida social e psicológica. Apesar de requerer várias cargas de grampeadores lineares apresenta baixa morbidade e passa a tornar-se um potencial substituto para o transplante intestinal.ABSTRACT -Background -The short bowel syndrome results of inadequate total length of small intestine that is not enough to nutrition, and so, the patients become dependents of total parenteral nutrition. Numerous surgical strategies had been studied to reestablish the normal intestinal function. ObjectiveConsider the inversion segment of small intestine associated with STEP -Serial Transverse Enteroplasty -to increase the intestinal absorptive area in patients with short bowel syndrome. Method -The authors describe a new alternative for surgical treatment of short bowel syndrome, demonstrating it's easiness and efficiency for the considered objective. Results -The two techniques associated, had allowed lengthening the small intestine in 2,6 times the original length, with posterior profit of weight, reduction the number of evacuations. ConclusionThis technique of inversion segment of small intestine and posterior STEP is efficient, appears as definitive and promising technique of treatment to short bowel syndrome allowing return to oral feeding, with satisfactory absorption of nutrients, return to normal intestinal movement, associated to low morbidity and improvement the quality of social and psychological life. It presents low morbidity and is a potential substitute to intestinal transplant. INTRODUÇÃOA síndrome do intestino curto (SIC) resulta de um comprimento total de intestino delgado que é inadequado para manter a nutrição via oral sat...

Background : About 20% of cases of acute pancreatitis progress to a severe form, leading to high mortality rates. Several studies suggested methods to identify patients that will progress more severely. However, most studies present problems when used on daily practice. Objective : To assess the efficacy of the PANC 3 score to predict acute pancreatitis severity and its relation to clinical outcome. Methods : Acute pancreatitis patients were assessed as to sex, age, body mass index (BMI), etiology of pancreatitis, intensive care need, length of stay, length of stay in intensive care unit and mortality. The PANC 3 score was determined within the first 24 hours after diagnosis and compared to acute pancreatitis grade of the Revised Atlanta classification. Results : Out of 64 patients diagnosed with acute pancreatitis, 58 met the inclusion criteria. The PANC 3 score was positive in five cases (8.6%), pancreatitis progressed to a severe form in 10 cases (17.2%) and five patients (8.6%) died. Patients with a positive score and severe pancreatitis required intensive care more often, and stayed for a longer period in intensive care units. The PANC 3 score showed sensitivity of 50%, specificity of 100%, accuracy of 91.4%, positive predictive value of 100% and negative predictive value of 90.6% in prediction of severe acute pancreatitis. Conclusion : The PANC 3 score is useful to assess acute pancreatitis because it is easy and quick to use, has high specificity, high accuracy and high predictive value in prediction of severe acute pancreatitis.