Ecological barriers mediate spatiotemporal shifts of bird communities at a continental scale.

Species' range shifts and local extinctions caused by climate change lead to community composition changes. At large spatial scales, ecological barriers, such as biome boundaries, coastlines, and elevation, can influence a community's ability to shift in response to climate change. Yet, ecological barriers are rarely considered in climate change studies, potentially hindering predictions of biodiversity shifts. We used data from two consecutive European breeding bird atlases to calculate the geographic distance and direction between communities in the 1980s and their compositional best match in the 2010s and modeled their response to barriers. The ecological barriers affected both the distance and direction of bird community composition shifts, with coastlines and elevation having the strongest influence. Our results underscore the relevance of combining ecological barriers and community shift projections for identifying the forces hindering community adjustments under global change. Notably, due to (macro)ecological barriers, communities are not able to track their climatic niches, which may lead to drastic changes, and potential losses, in community compositions in the future.

The historical ecological background of West Nile virus in Portugal indicates One Health opportunities.

West Nile (WNV) is a zoonotic arbovirus with an expanding geographical range and epidemic activity in Europe. Not having yet experienced a human-associated epidemic, Portugal remains an outlier in the Mediterranean basin. In this study, we apply ecological niche modelling informed by WNV historical evidence and a multitude of environmental variables from across Portugal. We identify that ecological backgrounds compatible with WNV historical circulation are mostly restricted to the south, characterized by a warmer and drier climate, high avian diversity, specific avian species and land types. We estimate WNV ecological suitability across the country, identifying overlaps with the distributions of the three relevant hosts (humans, birds, equines) for public and animal health. From this, we propose a category-based spatial framework providing first of a kind valuable insights for WNV surveillance in Portugal under the One Health nexus. We forecast that near future climate trends alone will contribute to pushing adequate WNV ecological suitability northwards, towards regions with higher human density. This unique perspective on the past, present and future ecology of WNV addresses existing national knowledge gaps, enhances our understanding of the evolving emergence of WNV, and offers opportunities to prepare and respond to the first human-associated epidemic in Portugal.

A nationwide collapse of a priority grassland bird related to livestock conversion and intensification.

Grassland birds are among the most threatened and fastest declining terrestrial vertebrate species in Europe, principally due to agricultural intensification and transformation. The little bustard is a priority grassland bird under the European Directive (2009/147/CE) that led to the classification of a network of Special Protected Areas (SPAs) in Portugal. A third national survey carried out in 2022 reveals a worsening of an ongoing population collapse at a national scale. The population declined by 77% and 56% compared to the previous surveys in 2006 and 2016, respectively. We found that the little bustard has greatly disappeared outside SPAs, while the remaining breeding population concentrated within the protected area network is showing a steep decline at a rate of 9% a year. This decline is now twice as fast when compared to the period 2006-2016. Analysis of the variation of the breeding densities between 2006 and 2022 at 49 survey sites revealed that those that initially had higher bustard densities and shifted toward a higher proportion of cattle among the total stocking rate experienced steeper declines. Areas where the density of roads increased also experienced declines over the course of the study period. Agricultural areas converted to or dominated by beef production likely relate to low breeding success and mortality of nesting females in fodder crops. Still, major habitat conversion outside SPAs to permanent crops led to overall habitat destruction, which contributed to the species decline and range contraction. Other threats are likely acting synergistically such as fragmentation, climate change and anthropogenic mortality. The extinction of the little bustard in Portugal is expected in the short term if no conservation actions are put in place.

Local colonisations and extinctions of European birds are poorly explained by changes in climate suitability.

Climate change has been associated with both latitudinal and elevational shifts in species' ranges. The extent, however, to which climate change has driven recent range shifts alongside other putative drivers remains uncertain. Here, we use the changing distributions of 378 European breeding bird species over 30 years to explore the putative drivers of recent range dynamics, considering the effects of climate, land cover, other environmental variables, and species' traits on the probability of local colonisation and extinction. On average, species shifted their ranges by 2.4 km/year. These shifts, however, were significantly different from expectations due to changing climate and land cover. We found that local colonisation and extinction events were influenced primarily by initial climate conditions and by species' range traits. By contrast, changes in climate suitability over the period were less important. This highlights the limitations of using only climate and land cover when projecting future changes in species' ranges and emphasises the need for integrative, multi-predictor approaches for more robust forecasting.

Changes in grassland management and linear infrastructures associated to the decline of an endangered bird population.

European grassland birds are experiencing major population declines, mainly due to changes in farmland management. We analyzed the role of habitat availability, grazing management and linear infrastructures (roads and power lines) in explaining spatial and temporal variation in the population density of little bustards (Tetrax tetrax) in Portugal, during a decade in which the species population size halved. We used data from 51 areas (totaling ca. 1,50,000 ha) that were sampled in two different periods (2003-2006 and 2016). In 2003-2006, when the species occurred at high densities, habitat availability was the only factor affecting spatial variation in bustard density. In the 2016 survey, variation in density was explained by habitat availability and livestock management, with reduced bird numbers in areas with higher proportions of cattle. Population declines across the study period were steeper in areas that initially held higher densities of bustards and in areas with a higher proportion of cattle in the total stocking rate. Areas with higher densities of power lines also registered greater density declines, probably due to avoidance behavior and to increased mortality. Overall, our results show little bustards are currently lacking high quality grassland habitat, whose persistence depends on extensive grazing regimes and low linear infrastructure densities.

Contrasting impacts of precipitation on Mediterranean birds and butterflies.

The climatic preferences of the species determine to a large extent their response to climate change. Temperature preferences have been shown to play a key role in driving trends in animal populations. However, the relative importance of temperature and precipitation preferences is still poorly understood, particularly in systems where ecological processes are strongly constrained by the amount and timing of rainfall. In this study, we estimated the role played by temperature and precipitation preferences in determining population trends for birds and butterflies in a Mediterranean area. Trends were derived from long-term biodiversity monitoring data and temperature and precipitation preferences were estimated from species distribution data at three different geographical scales. We show that population trends were first and foremost related to precipitation preferences both in birds and in butterflies. Temperature preferences had a weaker effect on population trends, and were significant only in birds. The effect of precipitation on population trends operated in opposite directions in the two groups of species: butterfly species from arid environments and bird species from humid habitats are decreasing most. Our results indicate that, although commonly neglected, water availability is likely an important driver of animal population change in the Mediterranean region, with highly contrasting impacts among taxonomical groups.

[Central inferior bisegmentectomy (S4B+S5) for gallbladder carcinoma treatment: a series of seven resectable cases]. / Bissegmentectomia central inferior (S4B+S5) para o tratamento do carcinoma invasor da vesícula biliar: revisão de sete casos operados.

BACKGROUND: Despite its rarity, gallbladder cancer is an aggressive type of neoplasia with a very poor prognosis. The best resection for oncological purposes continues to be right hepatectomy extended to segment IV. However, bisegmentectomy IV-V is becoming an interesting alternative because of greater preservation of the parenchyma. AIM: To report the early and late results from bisegmentectomy IV-V in cases of carcinoma of the gallbladder. METHODS: A series of seven cases of invasive carcinoma is presented (six women and one man). These patients underwent bisegmentectomy IV-V at the General Surgery Service of the Teaching Hospital of the ABC Medical School, Santo André, SP, Brazil. The study was conducted between 2002 and 2006. The patients ages ranged from 52 to 72 years. The diagnosis was preoperative (radiological) in five cases, which were all confirmed by intraoperative frozen-tissue examination, while in two cases the diagnosis was postoperative, following open cholecystectomy. RESULTS: The duration of the operation ranged from 180 to 340 minutes. The quantity of intraoperative bleeding ranged from 200 to 1500 mL. There were two major complications but no mortality. Six patients did not present any recurrence over the course of 3 to 30 months of follow-up. CONCLUSION: Bisegmentectomy IV-V may constitute a curative surgical alternative for treating gallbladder cancer. This procedure presents acceptable morbidity and mortality.

EU protected area network did not prevent a country wide population decline in a threatened grassland bird.

BACKGROUND: Few studies have assessed the effectiveness of the Protected Area networks on the conservation status of target species. Here, we assess the effectiveness of the Portuguese Natura 2000 (the European Union network of protected areas) in maintaining a species included in the Annex I of the Bird Directive, namely the population of a priority farmland bird, the little bustard Tetrax tetrax. METHODS: We measured the effectiveness of the Natura 2000 by comparing population trends across time (2003-2006 and 2016) in 51 areas, 21 of which within 12 Special Protection Areas (SPA) that were mostly designated for farmland bird conservation and another 30 areas without EU protection. RESULTS: Overall, the national population is estimated to have declined 49% over the last 10-14 years. This loss was found to be proportionally larger outside SPA (64% decline) compared to losses within SPA (25% decline). However, the absolute male density decline was significantly larger within SPA . DISCUSSION: In spite of holding higher population densities and having prevented habitat loss, we conclude that Natura 2000 was not effective in buffering against the overall bustard population decline. Results show that the mere designation of SPA in farmland is not enough to secure species populations and has to be combined with agricultural policies and investment to maintain not only habitat availability but also habitat quality.

An unusual variety of the extensor digiti muscles: report with notes on repetition strain injuries.

In over 500 human cadaveric dissections of arms and forearms, performed to the present date, we find frequent anatomical variations, corresponding to classic descriptions. Last year, we found a singular anatomic variation of the extensor muscles of the forearm, which seems previously undescribed. It is our strong belief that gross anatomy studies, and gross dissection should be updated and reintroduced in modern anatomical studies, for teaching, research, or surgical training purposes. We detected a peculiar anatomical variant of the Superficial Extensor Digiti Muscles in the forearm of a human 73 year old male Caucasian cadaver. We clearly identified a thick bundle of muscular fibres, connecting the main muscular shafts of the Extensor Digiti Minimi, and the Extensor Digitorum Communis Muscles, in a perfectly defined muscular expansion, bridging obliquely downwards and outwards, between the two main muscular shafts. In our series, this is the first occurrence of such anatomical disposition. Anatomical variations of the extensor tendons to the fingers are frequently detected in the wrist, hand and fingers compartments. The careful analysis of the variants of muscular shafts in the forearm compartment, as commonly reported in the earliest anatomical descriptions will bring renewed light to the functional assessment of the extensor mechanism of the human fingers. In this sense, we reviewed the oldest anatomical descriptions, from the 16th century to the present date.

Na série alargada de mais de 500 dissecções de antebraços e mãos cadavéricas humanas, efectuadas por rotina anual do Departamento de Anatomia da Faculdade de Ciências Médicas da Universidade Nova de Lisboa desde 1973, detectam-se frequentemente variações anatómicas, com especial incidência a nível dos tendões extensores dos dedos. Detectámos em 2011, uma disposição peculiar dos feixes musculares dos músculos extensores superficiais dos dedos de que, por extensa revisão bibliográfica, não encontramos descrição. Identificou-se um curto feixe de fibras musculares unindo os ventres principais dos músculos extensor comum dos dedos e extensor do dedo mínimo, na margem ulnar do terço médio do antebraço de um caucasiano do sexo masculino, com 73 anos de idade. Consultando textos de Anatomia publicados, desde o séc. XVI até á actualidade, verifica-se que as mais antigas descrições anatómicas se referem precisamente a uma maior coesão, com divisão baixa entre os ventres musculares destes dois músculos. Apresentámos os resultados preliminares deste estudo no XXII International Symposium of Morphological Sciences, em Fevereiro de 2012, reservando a redacção pormenorizada deste achado anatómico para um dos primeiros números da publicaçãoArchives of Anatomy da Sociedade Anatómica Portuguesa. É nossa profunda convicção de que os estudos anatómicos, e em particular a dissecção cadavérica humana, necessitam ser revalorizados e modernizados, no início do novo milénio, pelo seu imprescindível contributo aos estudos médicos, tanto em termos curriculares básicos, como ainda na investigação clínica e cirúrgica, ou em termos de treino pósgraduado de técnicas cirúrgicas.

[Transhiatal esophagectomiy using partial sternotomy]. / Esofagectomia trans-hiatal com esternotomia parcial.

Transhiatal Esophagectomy offers the advantage of not requiring thoracotomy or thoracoscopy. Nevertheless, it has the disadvantage of having to be performed, at least in part, with blind, blunt dissection, with high frequency of pleural lesions, increased bleeding, among other complications. The association of median diaphragm transection with partial sternotomy allows the isolation of the esophagus completely under direct vision. The authors present the technique of transhiatal esophagectomy with partial sternotomy.

Cervical esophagogastric anastomosis with invagination after esophagectomy.

PURPOSE: To evaluate the incidence of fistula and stenosis of the cervical esophagogastric anastomosis with invagination of the proximal esophageal stump into the stomach after subtotal esophagectomy. METHODS: We studied 54 patients who underwent subtotal esophagectomy, 45 (83.3%) patients with carcinoma and nine (16.6%) with advanced megaesophagus. In all cases the cervical esophagogastric anastomosis was performed with the invagination of the proximal esophageal stump inside the stomach. RESULTS: Three (5.5%) patients had a fistula at the esophagogastric anastomosis, two of whom with minimal leakage of air or saliva and with mild clinical repercussion; the third had a low output fistula that drained into the pleural space, and this patient developed empyema that showed good progress with drainage. Fibrotic stenosis of anastomosis occurred in thirteen (24%) subjects and was treated successfully with endoscopic dilatation. CONCLUSION: Cervical esophagogastric anastomosis with invagination of the proximal esophageal stump into the stomach tube presented a low rate of esophagogastric fistula and stenosis, thus becoming an attractive option for the reconstruction of alimentary transit after subtotal esophagectomy.

Esophagogastric anastomosis with invagination into stomach: New technique to reduce fistula formation.

AIM: To present a new technique of cervical esophagogastric anastomosis to reduce the frequency of fistula formation. METHODS: A group of 31 patients with thoracic and abdominal esophageal cancer underwent cervical esophagogastric anastomosis with invagination of the proximal esophageal stump into the stomach tube. In the region elected for anastomosis, a transverse myotomy of the esophagus was carried out around the entire circumference of the esophagus. Afterwards, a 4-cm long segment of esophagus was invaginated into the stomach and anastomosed to the anterior and the posterior walls. RESULTS: Postoperative minor complications occurred in 22 (70.9%) patients. Four (12.9%) patients had serious complications that led to death. The discharge of saliva was at a lower region, while attempting to leave the anastomosis site out of the alimentary transit. Three (9.7%) patients had fistula at the esophagogastric anastomosis, with minimal leakage of air or saliva and with mild clinical repercussions. No patients had esophagogastric fistula with intense saliva leakage from either the cervical incision or the thoracic drain. Fibrotic stenosis of anastomoses occurred in seven (22.6%) patients. All these patients obtained relief from their dysphagia with endoscopic dilatation of the anastomosis. CONCLUSION: Cervical esophagogastric anastomosis with invagination of the proximal esophageal stump into the stomach tube presented a low rate of esophagogastric fistula with mild clinical repercussions.

[Comparative study of end-to-end cervical esophagogastric anastomosis with or without invagination after esophagectomy for cancer]. / Estudo comparativo entre as anastomoses cervicais esofagogástrica término-terminal com e sem invaginação após esofagectomia para câncer.

OBJECTIVE: To assess the incidence of fistula and stenosis of cervical esophagogastric anastomosis with invagination of the esophageal stump into the gastric tube in esophagectomy for esophagus cancer. METHODS: Two groups of patients with thoracic and abdominal esophagus cancer undergoing esophagectomy and esophagogastroplasty were studied. Group I comprised 29 patients who underwent cervical esophagogastric anastomosis with invagination of the proximal esophageal stump segment within the stomach, in the period of 1998 to 2007 while Group II was composed of 36 patients submitted to end-to-end cervical esophago-gastric anastomosis without invagination during the period of 1989 to 1997. RESULTS: In Group I, esophagogastric anastomosis by invagination presented fistula with mild clinical implications in 3 (10.3%) patients, whereas in Group II, fistulas with heavy saliva leaks were observed in 11 (30.5%) patients. The frequency of fistulas was significantly lower in Group I patients (p=0.04) than in Group II. In Group I, fibrotic stenosis of anastomoses occurred in 7 (24.1%) subjects, and 10 patients (27.7%) in Group II evolved with stenosis, while no significant difference (p=0.72) was found between the two groups. CONCLUSION: In esophagectomy for esophagus cancer, cervical esophagogastric anastomosis with invagination presented a lower rate of esophagogastric fistula versus anastomosis without invagination. Stenosis rates in esophagogastric anastomosis proved similar in both approach with or without invagination.

Cervical esophagogastric anastomosis with invagination after esophagectomy / Anastomose esofagogástrica cervical com invaginação após esofagectomia

PURPOSE: To evaluate the incidence of fistula and stenosis of the cervical esophagogastric anastomosis with invagination of the proximal esophageal stump into the stomach after subtotal esophagectomy. METHODS: We studied 54 patients who underwent subtotal esophagectomy, 45 (83.3%) patients with carcinoma and nine (16.6%) with advanced megaesophagus. In all cases the cervical esophagogastric anastomosis was performed with the invagination of the proximal esophageal stump inside the stomach. RESULTS: Three (5.5%) patients had a fistula at the esophagogastric anastomosis, two of whom with minimal leakage of air or saliva and with mild clinical repercussion; the third had a low output fistula that drained into the pleural space, and this patient developed empyema that showed good progress with drainage. Fibrotic stenosis of anastomosis occurred in thirteen (24%) subjects and was treated successfully with endoscopic dilatation. CONCLUSION: Cervical esophagogastric anastomosis with invagination of the proximal esophageal stump into the stomach tube presented a low rate of esophagogastric fistula and stenosis, thus becoming an attractive option for the reconstruction of alimentary transit after subtotal esophagectomy.

OBJETIVO: Avaliar a incidência de fístula e estenose da anastomose esofagogástrica cervical com invaginação do coto esofágico proximal no interior do estômago após esofagectomia subtotal. MÉTODOS: Foram estudados 54 pacientes submetidos à esofagectomia subtotal, 45 (83,3%) com carcinoma e nove (16,6%) com megaesôfago chagásico avançado. Em todos os casos, a anastomose esofagogástrica cervical foi realizada com invaginação do coto esofágico proximal no interior do estômago. RESULTADOS: Três (5,5%) pacientes apresentaram fístula, dois deles com saída mínima de ar e saliva pela incisão cervical que evoluíram com rápida cicatrização; o terceiro apresentou fístula de pequeno débito que drenou para o espaço pleural causando empiema que teve boa evolução após drenagem. Treze (24%) doentes apresentaram estenose fibrótica e foram tratados com sucesso com dilatação endoscópica. CONCLUSÃO: A anastomose esofagogástrica cervical com invaginação do coto esofágico proximal no interior do estômago apresentou baixa incidência de fístula e estenose tornando-se opção atraente para a reconstrução do trânsito alimentar após esofagectomia subtotal.

Estudo comparativo entre as anastomoses cervicais esofagogástrica término-terminal com e sem invaginação após esofagectomia para câncer / Comparative study of end-to-end cervical esophagogastric anastomosis with or without invagination after esophagectomy for cancer

OBJETIVO: Avaliar a incidência de fístula e estenose da anastomose esofagogástrica cervical com invaginação do coto esofágico no interior do estômago na esofagectomia para tratamento do carcinoma do esôfago. MÉTODOS: Foram estudados dois grupos de doentes com carcinoma do esôfago torácico ou abdominal submetidos à esofagectomia subtotal e esofagogastroplastia. O grupo I (estudo) foi constituído por 29 doentes operados no período de 1998 a 2007, no qual foi realizada a anastomose esofagogástrica cervical com invaginação de segmento do coto esofágico no interior do estômago. O grupo II (controle) foi constituído por 36 doentes operados no período de 1989 a 1997 submetidos à anastomose esfagogástrica cervical término-terminal sem invaginação. RESULTADOS: No grupo I, 3 (10,3 por cento) doentes apresentaram fístula da anastomose esofagogástrica com repercussão clínica mínima. No grupo II observou-se fístula com franca saída de saliva em 11 (30,5 por cento) doentes. A freqüência de fístula nos doentes do grupo I foi significantemente menor (p=0,04) do que nos do grupo II. No grupo I, estenose fibrótica da anastomose ocorreu em 7 (24,1 por cento) enfermos, ao passo que no grupo II 10 (27,7 por cento) evoluíram com estenose, não se constatando diferença significante (p=0,72) entre esses grupos. CONCLUSÃO: No tratamento do carcinoma do esôfago, a esofagectomia com anastomose esofagogástrica cervical com invaginação do coto esofágico no interior do estômago determina menor ocorrência de fístula esofagogástrica quando comparado à anastomose sem invaginação. A incidência de estenose da anastomose esofagogástrica não diferiu em ambos os grupos.

OBJECTIVE: To assess the incidence of fistula and stenosis of cervical esophagogastric anastomosis with invagination of the esophageal stump into the gastric tube in esophagectomy for esophagus cancer. METHODS: Two groups of patients with thoracic and abdominal esophagus cancer undergoing esophagectomy and esophagogastroplasty were studied. Group I comprised 29 patients who underwent cervical esophagogastric anastomosis with invagination of the proximal esophageal stump segment within the stomach, in the period of 1998 to 2007 while Group II was composed of 36 patients submitted to end-to-end cervical esophago-gastric anastomosis without invagination during the period of 1989 to 1997. RESULTS: In Group I, esophagogastric anastomosis by invagination presented fistula with mild clinical implications in 3 (10.3 percent) patients, whereas in Group II, fistulas with heavy saliva leaks were observed in 11 (30.5 percent) patients. The frequency of fistulas was significantly lower in Group I patients (p=0.04) than in Group II. In Group I, fibrotic stenosis of anastomoses occurred in 7 (24.1 percent) subjects, and 10 patients (27.7 percent) in Group II evolved with stenosis, while no significant difference (p=0.72) was found between the two groups. CONCLUSION: In esophagectomy for esophagus cancer, cervical esophagogastric anastomosis with invagination presented a lower rate of esophagogastric fistula versus anastomosis without invagination. Stenosis rates in esophagogastric anastomosis proved similar in both approach with or without invagination.

Bissegmentectomia central inferior (S4B+S5) para o tratamento do carcinoma invasor da vesícula biliar: revisão de sete casos operados / Central inferior bisegmentectomy (S4B+S5) for gallbladder carcinoma treatment: a series of seven resectable cases

RACIONAL: A despeito de sua raridade, o câncer da vesícula biliar é uma neoplasia agressiva com péssimo prognóstico. A melhor ressecção oncológica permanece sendo a hepatectomia direita ampliada para o segmento IV; no entanto a bissegmentectomia IV-V tem se tornado uma alternativa interessante, pela maior preservação do parênquima hepático. OBJETIVO: Reportar os resultados precoces e tardios com a bissegmentectomia IV-V no carcinoma da vesícula biliar. MÉTODOS: É apresentada uma série de sete doentes (seis mulheres e um homem) com carcinoma invasivo submetidos a bissegmentectomia IV-V no Serviço de Cirurgia Geral do Hospital de Ensino - Faculdade de Medicina do ABC, Santo André, SP. O estudo foi realizado no período de 2002 a 2006. A idade dos pacientes variou de 52 a 72 anos. O diagnóstico foi pré-operatório (radiológico) em cinco doentes, todos confirmados por exame de congelação intra-operatório. Em dois doentes foi dado pós-operatório de colecistectomia aberta. RESULTADOS: O tempo cirúrgico variou de 180 a 340 minutos. O sangramento intra-operatório variou de 200 a 1500 mL. Houve duas complicações maiores. A mortalidade foi nula. Seis doentes não apresentaram recurrência entre 3 a 30 meses de seguimento. CONCLUSÃO: A bissegmentectomia IV-V pode ser uma alternativa cirúrgica curativa para o tratamento do câncer de vesícula biliar. Esse procedimento apresenta morbidade e mortalidade aceitáveis.

BACKGROUND: Despite its rarity, gallbladder cancer is an aggressive type of neoplasia with a very poor prognosis. The best resection for oncological purposes continues to be right hepatectomy extended to segment IV. However, bisegmentectomy IV-V is becoming an interesting alternative because of greater preservation of the parenchyma. AIM: To report the early and late results from bisegmentectomy IV-V in cases of carcinoma of the gallbladder. METHODS: A series of seven cases of invasive carcinoma is presented (six women and one man). These patients underwent bisegmentectomy IV-V at the General Surgery Service of the Teaching Hospital of the ABC Medical School, Santo André, SP, Brazil. The study was conducted between 2002 and 2006. The patients’ ages ranged from 52 to 72 years. The diagnosis was preoperative (radiological) in five cases, which were all confirmed by intraoperative frozen-tissue examination, while in two cases the diagnosis was postoperative, following open cholecystectomy. RESULTS: The duration of the operation ranged from 180 to 340 minutes. The quantity of intraoperative bleeding ranged from 200 to 1500 mL. There were two major complications but no mortality. Six patients did not present any recurrence over the course of 3 to 30 months of follow-up. CONCLUSION: Bisegmentectomy IV-V may constitute a curative surgical alternative for treating gallbladder cancer. This procedure presents acceptable morbidity and mortality.

Experiência inicial do serviço de cirurgia bariátrica da Faculdade de Medicina do ABC / Initial Experience of Bariatric Surgery Group from Faculdade de Medicina do ABC

Paradoxo da realidade econômica mundial, no qual a fome é um flagelo da sociedade, a obesidade ganha espaço na humanidade, atingindo cerca de 300 milhões de pessoas, sendo que cerca de 10% expressem a variedade mórbida (IMC > 40 kg/m²), tendo na cirurgia seu único tratamento efetivo. Os autores relatam a experiência e dificuldades na implantação do Serviço de Cirurgia Bariátrica da Faculdade de Medicina do ABC, bem como os resultados alcançados em 312 obesos mórbidos tratados. A opção cirúrgica foi a Gastroplastia Vertical com Banda e Reconstrução Intestinal em Y de Roux (GVYR) em 273 pacientes; colocação endoscópica de BIB em 33; derivação bileopancreática em 4 e banda gástrica ajustável em 2 pacientes. Cinco pacientes apresentaram obstrução anastomótica sendo reoperadas. Foram observados 7 casos de fístula no pósoperatório, sendo que três pacientes foram reoperados. Houve 4 óbitos (1,3%): uma paciente por infarto agudo do miocárdio; duas pacientes por tromboembolismo pulmonar e um óbito devido a sepsis por deiscência da linha de grampos, sendo a paciente idosa, diabética, hipertensa e cardiopata. Dentre os 308 pacientes restantes, a resposta a um questionário sobre a qualidade de vida, 293 afirmaram terem uma qualidade ótima/boa (95,1%) e 15 pacientes qualidade regular (4,9%). Após um ano de pós-operatório, 98,5% dos pacientes tiveram redução de peso superior a 40%. Destarte, conclui-se que, sendo a obesidade doença complexa e multifatorial, os serviços universitários, públicos e particulares devem compor equipe multidisciplinar que agirá integradamente na atenção ao obeso, individualizando suas características, tratamento e acompanhamento, ciente de suas particularidades e riscos.

Hérnia de Spieghel / Spieghel hernia

Os autores apresentam um caso de paciente feminina, 75 anos com queixa de abaulamento em fossa ilíaca esquerda há 5 anos com antecedente cirúrgico de parto cesárea e três herniorrafias incisionais. Ao exame físico apresentava, abaulamento em fossa ilíaca esquerda e hipogástrio margeando a extremidade lateral da cicatriz prévia, visível à manobra de Valsalva, redutível com manobras manuais e sem identificação precisa do anel herniário. Com o diagnóstico de hérnia incisional recidivada optou-se pelo tratamento cirúrgico. Foi diagnosticado, no intraoperatório, hérnia de Spieghel. A correção da hérnia foi realizada utilizando uma tela de marlex. A paciente recebeu alta hospitalar e apresentou boa evolução pósoperatória. A literatura afirma que a hérnia de Spieghel é uma hérnia ventral rara, manifesta-se com ausência de sinais clínicos consistentes levando, muitas vezes, o seu diagnóstico para o intra-operatório. Os exames de imagem auxiliam no seu diagnóstico e a correção cirúrgica está sempre indicada, Apresenta bom prognóstico com mínimo índice de recidiva.