DAVID DE SOUZA GOMEZ
Projetos de Pesquisa
Unidades Organizacionais
LIM/04 - Laboratório de Microcirurgia, Hospital das Clínicas, Faculdade de Medicina
6 resultados
Resultados de Busca
Agora exibindo 1 - 6 de 6
- Case Report: Stage VI Morel-Lavallee Lesion with a Large Challenging Defect(2021) NICOLAS, Gregory; ABBAS, Laielly; PRADO, Ariadne; TAKEMURA, Rafael Eiki; WADA, Alexandre; GOMEZ, David Souza; GEMPERLI, RolfMorel-Lavallee lesion (MLL) is a closed degloving soft-tissue injury that results in the accumulation of a hemolymphatic fluid between the skin/superficial fascia and the deep fascia. This is a rare injury that may be challenging to diagnose, and necessitates early identification and treatment to achieve the best outcomes. We report the case of a 45-year-old male patient who was referred to our institution for large wound closure after undergoing debridement of a misdiagnosed MLL that became complicated by infection and sepsis. The patient was retrospectively diagnosed with a Stage VI MLL and had to undergo 4 operations with skin grafting and vacuum-assisted closure therapy playing an essential role in achieving tissue closure. This case was presented as a reminder of this rare diagnosis, and the importance of considering it when faced with a patient presenting with a relevant clinical picture post trauma. An early diagnosis is important because early intervention can prevent complications and lead to better outcomes. The misdiagnosis in the case of our patient and delayed treatment led to an aggressive debridement with a large wound that was challenging to close.
- Estudo epidemiológico de queimaduras em crianças atendidas em hospital terciário na cidade de São Paulo(2012) MILLAN, Lincoln Saito; GEMPERLI, Rolf; TOVO, Fernando Melhado; MENDAÇOLLI, Thiago Jung; GOMEZ, David Souza; FERREIRA, Marcus CastroBACKGROUND: This study describes the experience with the care of burned children in the Burn Treatment Unit, Division of Plastic Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (Hospital of the Faculty of Medicine, University of São Paulo - HCFMUSP) over 15 consecutive months. METHODS: The data of 98 patients up to 13 years of age treated in the Burn Treatment Unit of HCFMUSP from October 2009 to December 2010 were analyzed. RESULTS: The average age of the children was 5.2 years; 67 (68.4%) were boys. Accidents were responsible for burns in 93 (94.9%) cases, whereas 1 (1%) case of burns was caused by aggression. There was a higher incidence of burns in children under 2 years of age. The main agent causing burns was hot liquids (48%), followed by fire (17%) and hot solids (17%). The mean body surface area affected by second- and third-degree burns was 10%. Six (6.1%) patients had burns over more than 20% of their body surface area - 5 (83.3%) of them had burns due to burning alcohol and 1 (16.7%) due to scalding water. All cases in which more than 30% of the body surface was affected by second- and third-degree burns were due to alcohol burns. CONCLUSIONS: This survey demonstrates the importance of burn injuries in pediatric patients. The dataset suggests prevention efforts should focus on the domestic environment, particularly against scalding in children less than 5 years of age. In children older than 5 years, prevention programs should focus on both domestic and extradomestic environments.
- Characterization of critically ill adult burn patients admitted to a Brazilian intensive care unit(2014) CAMPOS, Edvaldo Vieira de; PARK, Marcelo; GOMEZ, David Souza; FERREIRA, Marcus Castro; AZEVEDO, Luciano Cesar PontesIntroduction: To characterize the evolution of clinical and physiological variables in severe adult burn patients admitted to a Brazilian burn ICU, we hypothesized that characteristics of survivors are different from non-survivors after ICU admission. Methods: A five-year observational study was carried out. The clinical characteristics, physiological variables, and outcomes were collected during this period. Results: A total of 163 patients required ICU support and were analyzed. Median age was 34 [25,47] years. Total burn surface area (TBSA) was 29 [18,43]%, and hospital mortality rate was 42%. Lethal burn area at which fifty percent of patients died (LA50%) was 36.5%. Median SAPS3 was 41 [34,54]. Factors associated with hospital mortality were analyzed in three steps, the first incorporated ICU admission data, the second incorporated first day ICU data, and the third incorporated data from the first week of an ICU stay. We found a significant association between hospital mortality and SAPS3 [OR(95%CI) = 1.114(1.062-1.168)], TBSA [OR(95%CI) = 1.043(1.010-1.076)], suicide attempts [OR(95%CI) = 8.126(2.284-28.907)], and cumulative fluid balance per liter within the first week [OR(95%CI) = 1.090(1.030-1.154)]. Inhalation injury was present in 45% of patients, and it was not significantly associated with hospital mortality. Conclusions: In this study of an ICU in a developing country, the mortality rate of critically ill burn patients was high and the TBSA was an independent risk factor for death. SAPS3 at admission and cumulative fluid balance in the first seven days, were also associated with unfavorable outcomes. The implementation of judicious fluid management after an acute resuscitation phase may help to improve outcomes in this scenario.
- Pharmacokinetic-pharmacodynamic correlation of imipenem in pediatric burn patients using a bioanalytical liquid chromatographic method(2015) SANTOS, Silvia Regina Cavani Jorge; SANCHES-GIRAUD, Cristina; SILVA JUNIOR, Carlindo Vieira; GOMEZ, David SouzaA bioanalytical method was developed and applied to quantify the free imipenem concentrations for pharmacokinetics and PK/PD correlation studies of the dose adjustments required to maintain antimicrobial effectiveness in pediatric burn patients. A reverse-phase Supelcosil LC18 column (250 x 4.6 mm 5 micra), binary mobile phase consisting of 0.01 M, pH 7.0 phosphate buffer and acetonitrile (99: 1, v/v), flow rate of 0.8 mL/min, was applied. The method showed good absolute recovery (above 90%), good linearity (0.25-100.0 mu g/mL, r(2)=0.999), good sensitivity (LLOQ: 0.25 mu g/mL; LLOD: 0.12 mu g/mL) and acceptable stability. Inter/intraday precision values were 7.3/5.9%, and mean accuracy was 92.9%. A bioanalytical method was applied to quantify free drug concentrations in children with burns. Six pediatric burn patients (median 7.0 years old, 27.5 kg), normal renal function, and 33% total burn surface area were prospectively investigated; inhalation injuries were present in 4/6 (67%) of the patients. Plasma monitoring and PK assessments were performed using a serial blood sample collection for each set, totaling 10 sets. The PK/PD target attained (40% T>MIC) for each minimum inhibitory concentration (MIC: 0.5, 1.0, 2.0, 4.0 mg/L) occurred at a percentage higher than 80% of the sets investigated and 100% after dose adjustment. In conclusion, the purification of plasma samples using an ultrafiltration technique followed by quantification of imipenem plasma measurements using the LC method is quite simple, useful, and requires small volumes for blood sampling. In addition, a small amount of plasma (0.25 mL) is needed to guarantee drug effectiveness in pediatric burn patients. There is also a low risk of neurotoxicity, which is important because pharmacokinetics are unpredictable in these critical patients with severe hospital infection. Finally, the PK/PD target was attained for imipenem in the control of sepsis in pediatric patients with burns.
conferenceObject Dermal Matrices Versatility(2021) SANCHES-PINTO, Debora C.; GOMEZ, David Souza; GEMPERLI, Rolf- Effect of nitrous oxide on fentanyl consumption in burned patients undergoing dressing change(2016) VALE, Arthur Halley Barbosa do; VIDEIRA, Rogerio Luiz da Rocha; GOMEZ, David Souza; CARMONA, Maria Jose Carvalho; TSUCHIE, Sara Yume; FLORIO, Claudia; VANE, Matheus Fachini; POSSO, Irimar de PaulaBackground and objectives: Thermal injuries and injured areas management are important causes of pain in burned patients, requiring that these patients are constantly undergoing general anesthesia for dressing change. Nitrous oxide (N2O) has analgesic and sedative properties; it is easy to use and widely available. Thus, the aim of this study was to evaluate the analgesic effect of N2O combined with fentanyl in burned patients during dressing change. Method: After approval by the institutional Ethics Committee, 15 adult burned patients requiring daily dressing change were evaluated. Patient analgesia was controlled with fentanyl 0.0005% administered by intravenous pump infusion on-demand. Randomly, in one of the days a mixture of 65% N2O in oxygen (O-2) was associated via mask, with a flow of 10 L/min (N2O group) and on the other day only O-2 under the same flow (control group). Results: No significant pain reduction was seen in N2O group compared to control group. VAS score before dressing change was 4.07 and 3.4, respectively, in N2O and control groups. Regarding pain at the end of the dressing, patients in N2O group reported pain severity of 2.8; while the control group reported 2.87. There was no significant difference in fentanyl consumption in both groups. Conclusions: The association of N2O was not effective in reducing opioid consumption during dressing changes.