A Research Report submitted to the Faculty of Medicine of the University of the Witwatersrand Johannesburg in partial fulfilment of the requirements for the degree of Master of Medicine in the discipline of surgery 1991 / Severe intra-abdominal infection (IAI) carries a high mortality. Methods of treatment such as radical peritonaal debridement, continuos post-operative lavage and local intra-peritonaal instillation of anti-biotics have not improved. [Abbreviated Abstract. Open document to view full version] / MT2016

Thesis (MScPhysio)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Question: What are the effects of Intermittent Positive Pressure Breathing (with and without a Positive End Expiratory Pressure [PEEP] Valve), compared to deep breathing exercises, on ventilation distribution in high-risk adults following open upper abdominal surgery (UAS)? Design: This study comprised an observational descriptive component as well as a prospective triple blind randomised controlled crossover trial with concealed allocation and patient, assessor and statistician blinding Participants: Seven patients at high risk for postoperative pulmonary complications following UAS Intervention: Deep breathing exercises (DBExs) were compared to Intermittent Positive Pressure Breathing (IPPB), with IPPB further applied with and without a PEEP Valve, using a randomised cross-over design with 30 minute washout duration between periods. Outcome measures: Global and regional impedance changes in the lungs were measured using Electrical Impedance Tomography. Vital signs, visual analogue pain scale (VAS) and modified Borg scale (MBS) were measured pre– and post-intervention. Results: A greater mean global lung impedance change ( Z) was detected with IPPB compared to DBExs (mean difference in Z 2803.8; 95% CI 5189.9 to 8512.5 and 2046 to 96047.9; P<0.01). These changes in lung impedance lasted 30 minutes before returning to baseline. There was no difference in Z when patients received IPPB with 5cmH20 PEEP compared to IPPB with no PEEP. No specific regional ventilation changes were noted. IPPB did not increase VAS, MBS scores or adversely affect vital signs. Conclusion: IPPB is an effective technique to improve lung volumes compared to deep breathing exercises. Further studies are required to investigate the effect of IPPB on clinical outcome. / AFRIKAANSE OPSOMMING: Vraag: Watter uitwerking het onderbroke positiewe-drukasemhaling (met én sonder ’n positiewe-endekspiratoriesedruk-[PEEP-]klep) in vergelyking met diepasemhalings-oefeninge op ventilasieverspreiding by hoërisikovolwassenes ná bo-buikchirurgie? Ontwerp: ’n Waarnemingsgegronde, vergelykende en ondersoekende, driedubbelblinde, verewekansigde gekontroleerde oorskakelproef, met verborge toewysing en blinding van pasiënte, die assesseerder en statistikus Deelnemers: Sewe pasiënte met ’n hoë risiko vir post-operatiewe pulmonêre komplikasies na bo-buikchirurgie Intervensie: Diepasemhalingsoefeninge (DBEx) is vergelyk met onderbroke positiewedrukasemhaling (IPPB), wat op sy beurt met én sonder ’n PEEP-klep toegepas is, met behulp van ’n verewekansigde oorskakelstudie met ’n halfuur lange uitspoeling tussen oorskakelings. Uitkomsmetings: Algehele en regionale impedansieveranderinge in die longe is met behulp van elektriese impedansietomografie gemeet. Vitale tekens, die visuele analoogskaal (VAS) en die aangepaste Borg-skaal (MBS) is voor, sowel as na die intervensie afgeneem. Resultate: ’n Groter gemiddelde algehele impedansieverandering ( Z) is opgemerk met IPPB in vergelyking met DBEx (gemiddelde verskil 2803.8; 95% CI 5189.9: 8512.5 en 2046: 96047.9; P<0.01). Hierdie veranderinge in longimpedansie het ’n halfuur of langer geduur voordat dit na die basislyn teruggekeer het. Daar was geen verskil in Z toe pasiënte IPPB met ’n PEEP-klep van 5cmH20 ontvang het teenoor IPPB sonder ’n PEEP-klep nie. Geen spesifieke regionale voorkeure is opgemerk nie. IPPB het nie die VAS- of MBS-tellings verhoog of vitale tekens verswak nie. Stellenbosch University https://scholar.sun.ac.za iv Gevolgtrekking: In vergelyking met DBEx, is IPPB ’n doeltreffende tegniek om longvolumes te verbeter. Verdere studies word vereis om die uitwerking van IPPB op kliniese uitkomste te ondersoek.

HIV epidemic is one of the major challenges to the South Africa’s socio-economic development. The incidence of tuberculosis is rising in sub-Saharan Africa, and in 2009 South Africa had the second highest incidence of tuberculosis in the world. Approximately 80% of incident tuberculosis cases in South Africa are HIV positive. In HIV positive individual, abdominal tuberculosis has been reported as the most common form of extra-pulmonary tuberculosis. HIV/AIDS has resulted in a resurgence of abdominal tuberculosis in South Africa. Making the diagnosis of abdominal tuberculosis is still difficult, though the condition is common. The role of laparoscopy in making the diagnosis is undefined. Method: All patients with clinically and radiologically suspected but histologically or microbiologically unconfirmed abdominal tuberculosis were referred to the investigating team and laparoscopy was performed to diagnose abdominal tuberculosis. Histology was performed on tissue biopsy specimens and TB culture on ascitic fluid and peripheral blood specimens. Results: From January 2008 to June 2010 a total of 190 patients were referred to us. No surgical intervention was taken in 60 patients; all of them were HIV positive. Twenty six of them died (43%) in the hospital during the evaluation period before the diagnostic laparoscopy, and the rest (57%) were unfit for anaesthesia. Forty nine patients required emergency laparotomy either for bowel obstruction or peritonitis and 39% of them died. Eighty one patients underwent diagnostic laparoscopy and 77% of them were HIV positive, in 16% the HIV status was unknown. Two percent had clinical ascites. Laparoscopic findings included intra-abdominal lymphadenopathy in 56, minimal ascitic fluid in 46, intra-abdominal mass in 17, and deposits on bowel wall, peritoneum or omentum in 20 patients. Fifty five patients (68%) had positive histology for tuberculosis. In 15 patients (19%) histology revealed non-specific inflammation, no pathology was found in one patient and no specimen was taken from one patient. Eighty percent of peritoneal deposits and 77% of lymph nodes were positive for tuberculosis, whereas 35% ascitic fluid culture was positive. In nine patients (11%) an alternative diagnosis was found (appendicitis, adenocarcinoma, lymphoma). Conclusion: Laparoscopy was feasible and showed a high yield to establish the diagnosis of abdominal tuberculosis and to provide an alternate diagnosis. Laparoscopy was useful to establish the gross features of abdominal tuberculosis and to provide the adequate specimens for examinations. Very poor follow negated the evaluation of the clinical response to anti tuberculosis therapy. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2011.

No description available.

A abdominoplastia é uma das cirurgias plásticas mais realizadas. A associação entre a lipoaspiração e o descolamento reduzido trouxe uma nova perspectiva em relação à maior preservação da inervação cutânea sensitiva. Novos métodos de avaliação de sensibilidade têm permitido melhor quantificação e uma análise mais completa da evolução pós-operatória. Foi realizado um estudo do tipo caso-controle comparando-se um grupo controle de pacientes não operadas, um grupo de pacientes que realizou abdominoplastia convencional e um grupo que realizou abdominoplastia associada a lipoaspiração e descolamento reduzido. Para a avaliação da sensibilidade, utilizou-se o PSSD (dispositivo específico de sensibilidade de pressão), testes para sensibilidade térmica e dolorosa (agulhas). O PSSD foi aplicado em nove regiões da parede abdominal anterior para determinação do limiar cutâneo de pressão (LCP) em duas modalidades sensoriais: um ponto estático (1PE), para avaliação de fibras de adaptação lenta, e um teste dinâmico (1PD), para avaliação de fibras de adaptação rápida. Quanto maior o LCP, menor a sensibilidade na região. Foram incluídas 46 pacientes nos três grupos. O grupo controle continha 10 pacientes, cujos limiares cutâneos de pressão (LCP) variaram de 0,82 a 0,84 e de 0,77 a 0,79 g/mm2 para 1PE e 1PD, respectivamente. O grupo de abdominoplastia convencional (AC) continha 14 pacientes com medidas em dois momentos de pós-operatório, precoce (5,75 meses) e tardio (17,36 meses). Os resultados demonstraram LCPs entre 1,02 e 39,94 para a medida precoce e 0,79 e 20,07 g/mm2 para a medida tardia. O grupo de abdominoplastia associada a lipoaspiração (LA) continha 22 pacientes com acompanhamento de 5,72 meses (precoce) e 14,91 meses (tardio). Os resultados demonstraram LCPs entre 0,62 e 4,98 para a medida precoce e 0,67 e 1,91 g/mm2 para a medida tardia. A análise estatística usou método de análise de variância com medidas repetidas. O nível de significância adotado foi de 0,05. A análise estatística para a medida de 1PE revelou redução da sensibilidade significante no grupo AC em todas as regiões (precoce e tardia). No grupo LA, houve redução da sensibilidade apenas nas regiões de mesogastro e hipogastro na medida precoce com regularização total na análise tardia. Entretanto, a análise estatística para 1PD revelou, no grupo AC, redução na medida precoce em todas as regiões e redução apenas das regiões centrais (mesogastro e hipogastro) na análise tardia. Já no grupo LA, todas as medidas estavam normalizadas na análise precoce e tardia. A análise da sensibilidade térmica e dolorosa revelou reduções centrais, especialmente nas regiões de mesogastro e hipogastro no grupo AC. O grupo LA revelou áreas de anestesia térmica e dolorosa apenas em pequena área do hipogastro. Concluiu-se que as três modalidades sensoriais (tátil, térmica e dolorosa) são mais preservadas no grupo LA que no grupo AC. A recuperação da medida 1PD é mais rápida que a medida de 1PE / Abdominoplasties are common plastic surgery procedures. New techniques associating lipoaspiration with selective undermining are bringing new perspectives with regard to the preservation of cutaneous sensibility. New methods of evaluation of cutaneous sensibility have allowed researchers to do a more complete analysis. This is a case-control study comparing a control group of patients non operated with one group submitted to conventional abdominoplasty and another group submitted to abdominoplasty associating lipoaspiration with selective undermining. The abdominal surface was divided into nine regions for sensibility evaluation. Superficial tactile sensibility was tested using the Pressure Specified Sensory Device (PSSD) which allows the determination of the cutaneous pressure threshold (static and moving). Tests of pain and thermal sensibility were also performed. A total of 46 patients were divided in three groups. In the control group, with 10 patients, the cutaneous pressure thershold (CPT) oscilated from 0.82 to 0.84 and from 0.77 to 0.79 g/mm2 for one point static and one point moving sensibility evaluations, respectively. The group of patients submitted to conventional abdominoplasty (AC), with 14 patients, was evaluated in two moments of follow-up: early (mean of 5.75 months after surgical procedure) and late (17.36 months). The results showed CPTs betwen 1.02 and 39.94 in the early follow-up, versus 0.79 to 20.07 g/mm2 in the late follow-up. The group submitted to abdominoplasty associated with lipoaspiration and selective underminig (LA) had 22 patients, with a mean follow-up period of 5.75 (early) and 14.91 (late) months. The results showed CPTs betwen 0.62 and 4.98 (early) and 0.67 and 1.91 g/mm2 (late). The statistical analysis was conducted with the analysis of variance with repeated measurements. The level of significance adopted was p < 0.05. The estatistical analysis for one point static showed significant reduction of sensibility in the group AC in all abdominal regions (in the early and late follow-up periods). The group LA presented reduced CPT only in the mesogastric and hypogastric in the early evaluation; the late evaluation was normal. On the other hand, the analisis of one point moving showed, in the group AC, a reduction of early evaluation measurement in all abdominal regions and a reduction only in central regions (mesogastric and hypogastric) in the late. The LA group presented normal in all measurements. The analysis of pain and thermal sensibility shows that the centermost regions of the abdomen, mesogastric and hypogastric, presented the highest anesthesia index in the AC group. The LA group showed just some islands in the hipogastric regions. The recuperation of the 1PD evaluation was faster than the 1PE. In conclusion, the three sensibilities (tactile, thermal and pain) were more preservated in the LA group. Abdominoplasty with lipoaspiration could be considered a better choice than conventional abdominoplasty considering the preservation of cutaneous sensibility

University of Macau / Faculty of Science and Technology / Department of Computer and Information Science

Orientadores: Elinton Adami Chaim, José Carlos Pareja / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-16T22:56:32Z (GMT). No. of bitstreams: 1 Gestic_MartinhoAntonio_M.pdf: 3381516 bytes, checksum: 2ac6e6bb2938cf49388dd92cfe4fb63c (MD5) Previous issue date: 2010 / Resumo: O tratamento cirúrgico da pancreatite crônica é indicado na falência do tratamento clínico da dor e na presença de complicações da doença. O emprego da melhor técnica ainda é um desafio e, ao longo do último século, várias técnicas foram desenvolvidas determinando três padrões de procedimento: descompressivos, ressecativos e mistos. A técnica de Frey é do tipo mista, recentemente desenvolvida e que apresenta excelentes resultados no alívio da dor secundária à pancreatite crônica. Seu princípio propõe baixas taxas de morbidade e mortalidade pós-operatórias e menor dano às funções pancreáticas comparáveis às cirurgias descompressivas (Partington-Rochelle, Puestow) com a mesma efetividade das cirurgias ressecativas (duodenopancreatectomias) no controle da dor. O objetivo deste trabalho é descrever a casuística e analisar os resultados de uma série consecutiva de pacientes com pancreatite crônica submetidos à técnica de Frey no Hospital de Clínicas da UNICAMP. Foram analisados retrospectivamente 73 pacientes consecutivos de janeiro de 1991 a dezembro de 2007, sem tratamento cirúrgico prévio para pancreatite crônica e com pelo menos um ano de seguimento pós-operatório. Estudou-se o perfil da população, indicação cirúrgica, complicações pós-operatórias e resultados a longo prazo no controle da dor e das complicações. Os pacientes apresentaram idade média de 40,6 anos, sendo a maioria homens (97,3%) e a etiologia alcoólica foi a mais freqüente (95,9%). A dor abdominal acometia todos os pacientes, 98,8% com intensidade moderada ou severa. A taxa de morbidade global foi de 28,7% e as complicações mais freqüentes foram as infecciosas (13,7%), dentre elas as pneumonias; a prevalência de fístulas da anastomose pancreática foi de 6,8%. Não houve mortalidade cirúrgica. Em seguimento médio de 77,0 meses, 91,4% dos pacientes apresentavam remissão dolorosa completa e houve aumento do IMC no pós-operatório (p < 0,001). Insuficiência exócrina nova apareceu em 49% dos pacientes e diabetes de novo em 36,7%. A recidiva de ingestão alcoólica ocorreu em 32,9% dos pacientes, os quais apresentaram menor expectativa de vida em relação àqueles que se mantiveram abstêmios (p = 0,02). As principais causas de mortalidade tardia foram as neoplasias do trato aéreo-digestivo superior e complicações de cirrose hepática. Identificaram-se associações estatisticamente significativas entre abstinência alcoólica pré-operatória com menor taxa de complicações infecciosas e fistulas; a quantidade de ingestão de álcool e o tempo de aparecimento de diabetes nova pós-operatória; o calibre do ducto pancreático com o surgimento de diabetes pós-operatória; e níveis elevados de amilase sérica e no liquido do dreno abdominal no primeiro dia pós-operatório com fístulas. A técnica de Frey mostrou-se uma opção segura e eficaz para o tratamento cirúrgico da pancreatite crônica, proporciononando melhora da sintomatologia dolorosa e reganho de peso e não interrompeu a deterioração das funções exócrina e endócrina do pâncreas. A recidiva do abuso da ingestão de etanol é um problema freqüente nesses pacientes e interfere na sobrevida deles / Abstract: Surgical treatment of chronic pancreatitis is indicated for failure in clinical pain management of the disease. Frey's surgery is one of the techniques available for intervention in this process. Application of the best technique is still a challenge today and, over the last century, several techniques were developed by determining three patterns of treatment: decompression, resection and mixed. Frey's procedure is a mixed technique, which was recently developed and shows excellent results in pain relief. Its principle suggests low rates of morbidity and mortality after surgery and less damage to pancreatic function comparable to surgical decompression (Partington-Rochelle, Puestow) with the same effectiveness of the resection procedures (pancreatoduodenectomy) in pain control. The aim of this paper is to describe and analyze the results of a consecutive series of patients with chronic pancreatitis underwent Frey technique at the Hospital de Clínicas of UNICAMP. Seventy-three consecutive patients were retrospectively analyzed from January 1991 to December 2007, with no previous surgical treatment for chronic pancreatitis and with at least one year of follow-up. We studied the profile of the population, surgical indication, postoperative complications and long-term results in controlling pain and complications. Patients had mean age of 40.6 years, most were men (97.3%) and alcoholic etiology was the most frequent (95.9%). Abdominal pain gripped all patients, 98.8% with moderate or severe intensity. The overall morbidity rate was 28.7% and the most frequent complications were infections (13.7%), among them pneumonia. Fistulas of pancreatic anastomosis were 6.8%. There was no surgical mortality. At mean follow-up of 77.0 months, 91.4% of patients had complete pain remission and there was increased of BMI postoperatively (p < 0.001). New exocrine insufficiency appeared in 49% and new diabetes in 36.7%. Recurrence of alcohol consumption occurred in 32.9% of patients, which showed a lower life expectancy than those who remained abstinent (p = 0.02). The main causes of late death were neoplasm of the upper aero-digestive tract and complications of liver cirrhosis. We identified significant associations between preoperative alcohol abstinence with a lower rate of infectious complications and fistulas; the amount of alcohol intake and time of onset of postoperative diabetes; diameter of the pancreatic duct with the onset of postoperative diabetes; and elevated levels of amylase in blood and abdominal drain fluid on the first postoperative day with fistulas. Frey procedure proved to be a safe and effective option for the surgical treatment of disabling pain caused by chronic pancreatitis provided regained weight but did not stop the deterioration of exocrine and endocrine functions of the pancreas. Recurrence of ethanol abuse is a frequent problem in these patients and interferes with their life expectancy / Mestrado / Fisiopatologia Cirúrgica / Mestre em Ciências da Cirurgia

A abdominoplastia é uma das cirurgias plásticas mais realizadas. A associação entre a lipoaspiração e o descolamento reduzido trouxe uma nova perspectiva em relação à maior preservação da inervação cutânea sensitiva. Novos métodos de avaliação de sensibilidade têm permitido melhor quantificação e uma análise mais completa da evolução pós-operatória. Foi realizado um estudo do tipo caso-controle comparando-se um grupo controle de pacientes não operadas, um grupo de pacientes que realizou abdominoplastia convencional e um grupo que realizou abdominoplastia associada a lipoaspiração e descolamento reduzido. Para a avaliação da sensibilidade, utilizou-se o PSSD (dispositivo específico de sensibilidade de pressão), testes para sensibilidade térmica e dolorosa (agulhas). O PSSD foi aplicado em nove regiões da parede abdominal anterior para determinação do limiar cutâneo de pressão (LCP) em duas modalidades sensoriais: um ponto estático (1PE), para avaliação de fibras de adaptação lenta, e um teste dinâmico (1PD), para avaliação de fibras de adaptação rápida. Quanto maior o LCP, menor a sensibilidade na região. Foram incluídas 46 pacientes nos três grupos. O grupo controle continha 10 pacientes, cujos limiares cutâneos de pressão (LCP) variaram de 0,82 a 0,84 e de 0,77 a 0,79 g/mm2 para 1PE e 1PD, respectivamente. O grupo de abdominoplastia convencional (AC) continha 14 pacientes com medidas em dois momentos de pós-operatório, precoce (5,75 meses) e tardio (17,36 meses). Os resultados demonstraram LCPs entre 1,02 e 39,94 para a medida precoce e 0,79 e 20,07 g/mm2 para a medida tardia. O grupo de abdominoplastia associada a lipoaspiração (LA) continha 22 pacientes com acompanhamento de 5,72 meses (precoce) e 14,91 meses (tardio). Os resultados demonstraram LCPs entre 0,62 e 4,98 para a medida precoce e 0,67 e 1,91 g/mm2 para a medida tardia. A análise estatística usou método de análise de variância com medidas repetidas. O nível de significância adotado foi de 0,05. A análise estatística para a medida de 1PE revelou redução da sensibilidade significante no grupo AC em todas as regiões (precoce e tardia). No grupo LA, houve redução da sensibilidade apenas nas regiões de mesogastro e hipogastro na medida precoce com regularização total na análise tardia. Entretanto, a análise estatística para 1PD revelou, no grupo AC, redução na medida precoce em todas as regiões e redução apenas das regiões centrais (mesogastro e hipogastro) na análise tardia. Já no grupo LA, todas as medidas estavam normalizadas na análise precoce e tardia. A análise da sensibilidade térmica e dolorosa revelou reduções centrais, especialmente nas regiões de mesogastro e hipogastro no grupo AC. O grupo LA revelou áreas de anestesia térmica e dolorosa apenas em pequena área do hipogastro. Concluiu-se que as três modalidades sensoriais (tátil, térmica e dolorosa) são mais preservadas no grupo LA que no grupo AC. A recuperação da medida 1PD é mais rápida que a medida de 1PE / Abdominoplasties are common plastic surgery procedures. New techniques associating lipoaspiration with selective undermining are bringing new perspectives with regard to the preservation of cutaneous sensibility. New methods of evaluation of cutaneous sensibility have allowed researchers to do a more complete analysis. This is a case-control study comparing a control group of patients non operated with one group submitted to conventional abdominoplasty and another group submitted to abdominoplasty associating lipoaspiration with selective undermining. The abdominal surface was divided into nine regions for sensibility evaluation. Superficial tactile sensibility was tested using the Pressure Specified Sensory Device (PSSD) which allows the determination of the cutaneous pressure threshold (static and moving). Tests of pain and thermal sensibility were also performed. A total of 46 patients were divided in three groups. In the control group, with 10 patients, the cutaneous pressure thershold (CPT) oscilated from 0.82 to 0.84 and from 0.77 to 0.79 g/mm2 for one point static and one point moving sensibility evaluations, respectively. The group of patients submitted to conventional abdominoplasty (AC), with 14 patients, was evaluated in two moments of follow-up: early (mean of 5.75 months after surgical procedure) and late (17.36 months). The results showed CPTs betwen 1.02 and 39.94 in the early follow-up, versus 0.79 to 20.07 g/mm2 in the late follow-up. The group submitted to abdominoplasty associated with lipoaspiration and selective underminig (LA) had 22 patients, with a mean follow-up period of 5.75 (early) and 14.91 (late) months. The results showed CPTs betwen 0.62 and 4.98 (early) and 0.67 and 1.91 g/mm2 (late). The statistical analysis was conducted with the analysis of variance with repeated measurements. The level of significance adopted was p < 0.05. The estatistical analysis for one point static showed significant reduction of sensibility in the group AC in all abdominal regions (in the early and late follow-up periods). The group LA presented reduced CPT only in the mesogastric and hypogastric in the early evaluation; the late evaluation was normal. On the other hand, the analisis of one point moving showed, in the group AC, a reduction of early evaluation measurement in all abdominal regions and a reduction only in central regions (mesogastric and hypogastric) in the late. The LA group presented normal in all measurements. The analysis of pain and thermal sensibility shows that the centermost regions of the abdomen, mesogastric and hypogastric, presented the highest anesthesia index in the AC group. The LA group showed just some islands in the hipogastric regions. The recuperation of the 1PD evaluation was faster than the 1PE. In conclusion, the three sensibilities (tactile, thermal and pain) were more preservated in the LA group. Abdominoplasty with lipoaspiration could be considered a better choice than conventional abdominoplasty considering the preservation of cutaneous sensibility

INTRODUÇÃO: A síndrome compartimental abdominal (SCA) é uma complicação frequente da cirurgia de controle de dano, podendo ocorrer em até 33% dos casos. A medida da pressão intra-abdominal para diagnóstico da SCA é avaliada através da pressão intravesical. OBJETIVO: Avaliar, através de modelo experimental, as repercussões da colocação de compressas sobre a pressão intravesical e em diferentes regiões do abdome. MÉTODO: Foram utilizados 10 porcos machos, entre 45 e 60 dias, com peso entre 15 e 18 kg, submetidos a laparotomia exploradora para colocação de compressas e avaliação de medidas de pressão no espaço supra-hepático (Psh), espaço infra-hepático (Pih), espaço subfrênico esquerdo (Psfe), veia cava inferior (Pvci), veia porta (Pvp) e bexiga (Pv). Foi também avaliada a pressão arterial média (PAM) e o débito cardíaco. As diferentes medidas de pressão foram comparadas no mesmo animal com diferentes tipos de fechamento da parede abdominal: bolsa de Bogotá (CCB), total da aponeurose (CCAF), pele (CCPF) e total da pele e aponeurose (CF). Os resultados foram submetidos a análise estatística. RESULTADOS: Não houve diferença (p>0,05) entre as medidas de PAM em todas as fases de fechamento do abdome. A pressão de veia cava inferior e a pressão intravesical foram diferentes (p<0,05) entre os grupos CF e CCAF. Psfe, Psfd e Psh foram diferentes (p<0,05) entre CF e CCB, CF e CCPF e CF e CCAF. Foram diferentes (p<0,05) Pv e Psfd, Pv e Psh e Psfe e Psfd nos grupos CCB, CCPF e CCAF. No grupo CCAF ainda foram diferentes (p<0,05) Pv e Psfe e Psh e Psfd. A avaliação de Pvp mostrou-se diferente (p<0,05) em relação ao grupo controle (CF) nos grupos CCB, CCPF e CCAF, e ainda entre CCB e CCAF. CONCLUSÃO: A pressão intra-abdominal não é uniforme quando são colocadas compressas na cavidade peritoneal. A pressão vesical é menor que em outras regiões da cavidade peritoneal. As pressões não ultrapassaram níveis de Síndrome Compartimental Abdominal. / INTRODUCTION: Abdominal compartment syndrome is a frequent complication of damage control surgery and can occur in approximately 33% of cases. Diagnosis of abdominal compartment syndrome depends on measurement of abdominal pressure which is usually assessed through intravesical pressure. OBJECTIVE: Evaluate the consequences of liver packing with sponges to the intravesical pressure and to pressures in different sites of the abdomen in an animal experimental model. METHODS: 10 adult male pigs, aged 45 to 60 days, weighing 15 to 18 kg, underwent laparotomies for liver packing and evaluation of pressures in suprahepatic space (Psh), infrahepatic space (Pih), left subphrenic space (Psfe), inferior vena cava (Pvci), portal vein (Pvp) and bladder (Pv). Other variables such as mean arterial pressure and cardiac output, were also measured. Different pressure measurements were compared in the same animal with different types of closures of the abdominal wall: Bogota bag (CCB), total closure of aponeurosis (CCAF), skin closure (CCPF) and total skin and aponeurosis closure (CF). Results were analyzed statistically. RESULTS: There was no difference (p>0,05) between mean arterial blood pressure in all phases of abdominal closure. Pressure in inferior vena cava and intravesical pressure were different (p<0,05) in groups CF and CCAF. Psfe, Psfd and Psh were different (p<0,05) between CF vs CCB, CF vs CCPF and CF vs CCAF. Pv vs Psfd, Pv vs Psh and Psfe vs Psfd were different (p<0,05) in groups CCB, CCPF and CCAF. In group CCAF, Pv vs Psfe and Psh vs Psfd were also different (p<0,05). Evaluation of Pvp has shown to be different (p<0,05) when compared to control group (p<0,05) in groups CCB, CCPF and CCAF, and also between CCB and CCAF. CONCLUSION: Intra-abdominal pressure is not uniform when sponges are placed in the abdomen. Intravesical pressure is lower than pressures in other sites of the peritoneal cavity. No pressure measurement reached levels of abdominal compartment syndrome.

INTRODUÇÃO: A síndrome compartimental abdominal (SCA) é uma complicação frequente da cirurgia de controle de dano, podendo ocorrer em até 33% dos casos. A medida da pressão intra-abdominal para diagnóstico da SCA é avaliada através da pressão intravesical. OBJETIVO: Avaliar, através de modelo experimental, as repercussões da colocação de compressas sobre a pressão intravesical e em diferentes regiões do abdome. MÉTODO: Foram utilizados 10 porcos machos, entre 45 e 60 dias, com peso entre 15 e 18 kg, submetidos a laparotomia exploradora para colocação de compressas e avaliação de medidas de pressão no espaço supra-hepático (Psh), espaço infra-hepático (Pih), espaço subfrênico esquerdo (Psfe), veia cava inferior (Pvci), veia porta (Pvp) e bexiga (Pv). Foi também avaliada a pressão arterial média (PAM) e o débito cardíaco. As diferentes medidas de pressão foram comparadas no mesmo animal com diferentes tipos de fechamento da parede abdominal: bolsa de Bogotá (CCB), total da aponeurose (CCAF), pele (CCPF) e total da pele e aponeurose (CF). Os resultados foram submetidos a análise estatística. RESULTADOS: Não houve diferença (p>0,05) entre as medidas de PAM em todas as fases de fechamento do abdome. A pressão de veia cava inferior e a pressão intravesical foram diferentes (p<0,05) entre os grupos CF e CCAF. Psfe, Psfd e Psh foram diferentes (p<0,05) entre CF e CCB, CF e CCPF e CF e CCAF. Foram diferentes (p<0,05) Pv e Psfd, Pv e Psh e Psfe e Psfd nos grupos CCB, CCPF e CCAF. No grupo CCAF ainda foram diferentes (p<0,05) Pv e Psfe e Psh e Psfd. A avaliação de Pvp mostrou-se diferente (p<0,05) em relação ao grupo controle (CF) nos grupos CCB, CCPF e CCAF, e ainda entre CCB e CCAF. CONCLUSÃO: A pressão intra-abdominal não é uniforme quando são colocadas compressas na cavidade peritoneal. A pressão vesical é menor que em outras regiões da cavidade peritoneal. As pressões não ultrapassaram níveis de Síndrome Compartimental Abdominal. / INTRODUCTION: Abdominal compartment syndrome is a frequent complication of damage control surgery and can occur in approximately 33% of cases. Diagnosis of abdominal compartment syndrome depends on measurement of abdominal pressure which is usually assessed through intravesical pressure. OBJECTIVE: Evaluate the consequences of liver packing with sponges to the intravesical pressure and to pressures in different sites of the abdomen in an animal experimental model. METHODS: 10 adult male pigs, aged 45 to 60 days, weighing 15 to 18 kg, underwent laparotomies for liver packing and evaluation of pressures in suprahepatic space (Psh), infrahepatic space (Pih), left subphrenic space (Psfe), inferior vena cava (Pvci), portal vein (Pvp) and bladder (Pv). Other variables such as mean arterial pressure and cardiac output, were also measured. Different pressure measurements were compared in the same animal with different types of closures of the abdominal wall: Bogota bag (CCB), total closure of aponeurosis (CCAF), skin closure (CCPF) and total skin and aponeurosis closure (CF). Results were analyzed statistically. RESULTS: There was no difference (p>0,05) between mean arterial blood pressure in all phases of abdominal closure. Pressure in inferior vena cava and intravesical pressure were different (p<0,05) in groups CF and CCAF. Psfe, Psfd and Psh were different (p<0,05) between CF vs CCB, CF vs CCPF and CF vs CCAF. Pv vs Psfd, Pv vs Psh and Psfe vs Psfd were different (p<0,05) in groups CCB, CCPF and CCAF. In group CCAF, Pv vs Psfe and Psh vs Psfd were also different (p<0,05). Evaluation of Pvp has shown to be different (p<0,05) when compared to control group (p<0,05) in groups CCB, CCPF and CCAF, and also between CCB and CCAF. CONCLUSION: Intra-abdominal pressure is not uniform when sponges are placed in the abdomen. Intravesical pressure is lower than pressures in other sites of the peritoneal cavity. No pressure measurement reached levels of abdominal compartment syndrome.