Experience of a Tertiary-Level Urology Center in the Clinical Urological Events of Rare and Very Rare Incidence. I. Surgical Never Events: 3. Urological Electrosurgical Never Events

Introduction: Surgical fires are unique topics that belong to surgical never events and deserve urological attention. Materials and Methods: A retrospective search of our hospital records was done for the states of electrosurgical never events in the period from July 2001 to June 2016. The included events were classified according to the site of occurrence in relation to the patient's body and possibilities of human involvement. The events were studied for the type, extent, damages, personnel involvements, complications, and management. Results: Of more than 82,000 urological interventions, 18 cases (0.022%) of electrosurgical never events were detected. Four subcategories were differentiated: electrosurgical theater fires (33.3%), electrosurgical contact skin burns (38.9%), electrosurgical internal injuries (16.7%), and electrocutions (11.1%). Electrosurgical theater fires included 3 ignition fires with fire skin burns and 3 device explosions. Fires only occurred with the use of alcoholic skin disinfectants. Contact skin burns resulted from inadvertent direct electrosurgical contacts, with 2 burns on the back, 3 burns on the lower limbs, 1 burn at the penile shaft, and 1 burn at the suprapubic region. Only 1 case of contact skin burn required plastic surgery. Electrosurgical internal in-juries involved the intestine, spleen, and urethra and were followed by major complications. Electrocutions involved a doctor and a patient with multiple bone fractures in the former. Conclusion: Urological electrosurgical never events are very rare incidents and were differentiated into 4 clinical subcategories. Human involvements varied from absence to major devastating complications. Reduction of these events depends on the adjusted use of electricity-based armamentarium.

Post-traumatic Tension Pneumoventricle: Case Report

Pneumoventricle and liquoric fistula are possible complications of traumatic brain injury (TBI), the main cause of morbimortality related to trauma in Brazil. Liquoric fistulae are more common after direct trauma with skull base fractures. However, pneumoventricle is rare and occurs due to excessive cerebrospinal fluid (CSF) drainage in the presence of a poorly compliant ventricle system, resulting in the influx of air to its interior. The pathophysiology of tension pneumoventricle remains uncertain. However, the traumatic cause is certain and multiple bone fractures of the face and liquoric fistula may contribute to the process. If symptomatic, the tension pneumoventricle can cause rapid clinical deterioration. The authors aim to report a rare case of post-TBI tension pneumoventricle with complete resolution and without signs of recurrence of the liquoric fistula after surgical treatment.

CASE REPORT: OSTEOPOROSIS AND OSTEOMALACIA WITH MULTIPLE BONE FRACTURES IN A MUNTIACUS REEVESI

A young female Reeves’s muntjac (Muntiacus reevesi) was presented with signs of weakness and inability to stand. Radiographic examination revealed a healed bone fracture in the right radius and ulna. The animal failed to respond to therapy and died two days later. At necropsy, serous atrophy was mainly present in the subcutis of the skull and ventral cervical skin. Muscular atrophy was also evident, especially around the right femur. Multiple bone calluses with newly developed bone fractures were distributed on both sides of the ribs. Microscopically, decreased and irregularly thin bony trabeculae and widened trabeculae with excess unmineralized osteoid were observed in both femurs. Multiple sarcocysts were incidentally noted in the right femoral and longissimus dorsi muscles. It was concluded that M. reevesi in the present case appeared to have suffered from osteoporosis and osteomalacia with multiple bone fractures.