ContributorsGIW wrote and revised the manuscript in response to co-author comments. He finalized all the figures and tables, performed the literature search, and assisted with data interpretation. HJK critically reviewed the manuscript and made important suggestions to improve it. He assisted with data interpretation. IBA performed the data analysis, constructed the figures and tables, and made important suggestions to improve the manuscript. H-CK assisted with the data analysis and also reviewed the manuscript. GRC critically reviewed the manuscript and made important suggestions to improve it. He assisted with data interpretation. All other authors were given the opportunity to review the manuscript and make suggestions which GIW received, either revising the paper or providing explanations. All who are not deceased were involved with approval of the manuscript.

The surgical outcome of patients requiring conversion to cardiopulmonary bypass (CPB) during myocardial revascularization using the less invasive surgical approach (LISA) was assessed. The LISA was recently introduced as a technique for complete myocardial revascularization without CPB. It combines avoidance of CPB with the versatility of a median sternotomy for access to all coronary vessels. We have previously demonstrated reduced risk-adjusted mortality and complications in off-CPB coronary artery bypass grafting (CABG) using LISA compared to standard myocardial revascularization. From January to December 1997, 1210 patients underwent isolated CABG at our institution. Of these patients, 832 (63%) were scheduled as on-CPB cases and 378 (37%) as off-CPB. Of the off-CPB patients, 48 were converted to CPB. Team A surgeons used LISA as their primary strategy for CABG whereas team B surgeons used off-CPB CABG in selected patients. Conversions were divided in three classes: Class I patients were converted when the surgeon considered complete revascularization impossible off-CPB; Class II patients were converted due to hemodynamic instability during the procedure; and Class III patients were converted due to graft malfunction, determined by flow measurements or clinical evidence. There were four deaths. All had perioperative infarctions and required intra-aortic balloon pump (IABP). Conversion to CPB occurred in up to 25% of patients scheduled for off-CPB CABG. When off-CPB cases are done using the comprehensive LISA technique and modern technology, conversion rates may be reduced to 11%. Conversion is in general well tolerated except when it is instituted for graft malfunction combined with hemodynamic instability or collapse.

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INTRODUÇÃO: A fitoterapia vem despertando crescente interesse na comunidade científica em relação às suas potenciais propriedades cicatriciais. Poucos são os estudos com metodologia científica existentes na literatura, constituindo-se assim um campo aberto para novas investigações. OBJETIVOS: Analisar a ação da Jatropha gossypiifolia L. (pião roxo) na cicatrização de anastomose colônica em ratos. MÉTODOS: Quarenta ratos Wistar foram submetidos à secção de toda a circunferência do cólon, sendo logo anastomosada com oito pontos separados usando fio monofilamentar de polipropileno 6-0. Aleatoriamente, os animais foram distribuídos em grupo controle (GC), contendo 20 ratos, nos quais foi administrada solução de cloreto de sódio a 0,9% por via intraperitoneal (1ml/kg) e grupo Jatropha (GJ), também com 20 nos quais foi administrado o extrato hidroalcoólico de Jatropha gossypiifolia L. por via intraperitoneal (1ml/kg). Cada um dos grupos foi subdividido em dois subgrupos de dez animais de acordo com a data de sacrifício, três e sete dias (GC3/ GC7 e GJ3/GJ7). Após o sacrifício foi retirada parte do cólon compreendendo 1 cm acima e abaixo da anastomose e submetido ao teste de resistência à insuflação de ar atmosférico. A seguir, foi aberta e retirada uma porção de 1,0 x 0,5cm de tamanho colocada em formol a 10% para análise histológica, na qual foram usadas a coloração de Hematoxilina-Eosina e o Tricrômico de Masson. RESULTADOS: Na avaliação do teste de pressão de ruptura entre os grupos houve significância estatística quando avaliados em relação à data de sacrifício Assim no terceiro dia a média no GC (25,4 mmHg.) e no GJ (76,4 mmHg.) estabeleceu p = 0.013, e no sétimo dia a média no GC (187,3 mmHg.) e no GJ (135,1 mmHg.) estabeleceu p = 0.014. Ao analisar as variáveis microscópicas entre os grupos no 3º dia, somente não houve diferença significativa nas variáveis edema e polimorfonucleares. Já no 7º dia todas as variáveis analisadas apresentaram diferença significativa. CONCLUSÕES: Na resistência mecânica pôde-se concluir que houve influência positiva da jatropha na aquisição de força na anastomose no terceiro dia. Entretanto, no sétimo dia o GC suplantou siginificativamente a pressão de ruptura obtida no GJ, sugerindo diminuição da ação da Jatropha em fase mais avançada da cicatrização. Na avaliação histológica pôde-se verificar avanço no processo inflamatório agudo no GJ3 em relação ao GC3, mantendo-se ainda mais intenso na fase crônica quando comparados os dois grupos no sétimo dia.

Objective: to perform an external validation of two clinical decision instruments (DIs) - Chest CT-All and Chest CT-Major - in a cohort of patients with blunt chest trauma undergoing chest CT scanning at a trauma referral center, and determine if these DIs are safe options for selective ordering of chest CT scans in patients with blunt chest trauma admitted to emergency units. Methods: cross-sectional study of patients with blunt chest trauma undergoing chest CT scanning over a period of 11 months. Chest CT reports were cross-checked with the patients’ electronic medical record data. The sensitivity and specificity of both instruments were calculated. Results: the study included 764 patients. The Chest CT-All DI showed 100% sensitivity for all injuries and specificity values of 33.6% for injuries of major clinical significance and 40.4% for any lesion. The Chest CT-Major DI had sensitivity of 100% for injuries of major clinical significance, which decreased to 98.6% for any lesions, and specificity values of 37.4% for injuries of major clinical significance and 44.6% for all lesions. Conclusion: both clinical DIs validated in this study showed adequate sensitivity to detect chest injuries on CT and can be safely used to forego chest CT evaluation in patients without any of the criteria that define each DI. Had the Chest CT-All and Chest CT-Major DIs been applied in this cohort, the number of CT scans performed would have decreased by 23.1% and 24.6%, respectively, resulting in cost reduction and avoiding unnecessary radiation exposure.