Perforated duodenal ulcer after Roux-en-Y gastric bypass: an unusual complication.

Summary: Bariatric surgery is increasingly being accepted as a viable treatment for managing the growing obesity epidemic. Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed procedures. Perforated duodenal ulcer following RYGB is a rare condition with a low incidence. We report a case of a patient with a perforated duodenal ulcer post RYGB, and the surgical approach. A 66-year-old man with hypertension and a history of laparoscopic RYGB for class III obesity was admitted to the emergency department with severe epigastric pain radiating to the right side of his abdomen and right shoulder, associated with nausea and vomiting. Computed tomography (CT) showed intraperitoneal free fluid, a thickened wall of the duodenum and free air, duodenal perforation was suspected. The patient underwent exploratory laparoscopy that revealed a perforated duodenal ulcer that was closed with an absorbable barbed suture and omental patch. Perforated ulcers in excluded segments after RYGB are a rare entity with a challenging diagnosis, and clinicians should be aware of and have a low threshold for diagnostic laparoscopy. Learning points: Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed procedures in bariatric surgery. Perforated ulcers in excluded segments after RYGB are a rare entity with a challenging diagnosis. The pathophysiology of this perforation is not clear, but several mechanisms have been proposed. Helicobacter pylori has been implicated. Clinicians should be aware and have a low threshold for diagnostic laparoscopy for a patient who has acute abdominal pain after RYGB, despite negative diagnostic measures.

Evaluation of the Influence of Geodimensional and Histological Parameters on the Need for Margin Widening in Breast Lesions Marked With Magnetic Seeds.

Objective: Breast cancer is an important topic worldwide, posing morbidity and mortality to women. Considerable efforts have been put in the early recognition of malignancy through different screening methods, such as mammography and ultrasound. The precise localization of infraclinical malignant lesions is key in surgical management and magnetic seeds gather particular interest for this purpose. As with other systems, a need for reintervention may be needed to obtain adequate surgical margins. This work evaluated the relation between the need for surgical reintervention in order to obtain negative margins and geodimensional and histological parameters. The main objective was the identification of parameters significantly associated with reintervention for margin widening. Materials and Methods: A retrospective analysis of 198 patients from a single centre was performed. The association between pre-defined geodimensional and histological parameters and the need for margin widening in infraclinical lesions marked with magnetic seed was evaluated. Results: Results showed that reintervention to widen margins was significantly higher in patients with ductal carcinoma in situ (DCIS) in the pre-operative biopsy when compared with invasive carcinoma (p = 0.03) in the bivariate analysis. No statistically significant differences were observed between the need for reintervention and lesion size (p = 0.197), breast quadrant location (p = 0.626) and distance of skin to lesion (p = 0.356). Conclusion: This work suggests that a more invasive margin clearance in lesions with a pre-operative DCIS diagnosis might obviate the need for reintervention to obtain negative margins. On the other hand, it is not necessary to be surgically more invasive in larger lesions, deeply located or that are present in a certain quadrant, since there are no significant differences regarding the need for reintervention.

Liderança no exercício docente no ensino superior: um olhar psicodinâmico / Leadership in teaching in higher education: a psychodynamic perspective / Liderazgo en la enseñanza en la educación superior: una perspectiva psicodinámica

O trabalho docente representa um campo fundamental na sociedade, dada sua importância na formação de futuros profissionais e, especialmente, cidadãos. Dessa forma, a intenção do presente artigo consiste em levantar as questões oriundas do exercício de liderança na atribuição docente e refletir acerca desta liderança no Ensino Superior no que tange à sua importância para o processo formativo, bem como a inspiração que esse ofício pode proporcionar aos educandos, partindo da ideia de que a docência é um exercício de liderança. A proposta metodológica com que analisamos tal exercício, consiste na perspectiva qualitativa de caráter descritivo-analítico. Dois professores foram entrevistados por meio de um roteiro semi-dirigido com vistas a levantar e compreender as experimentações oriundas de suas trajetórias de vida que culminaram no trabalho docente que atualmente exercem. Como fundamentação teórica e metodológica de análise, utilizou-se a Psicodinâmica do Trabalho, por seu olhar quanto aos modos de ser dos sujeitos provocados pelo encontro com o trabalho e as exigências pertinentes aos processos deste. Como resultado, a amostra revelou significativa concordância com os aspectos de liderança na prática docente que exercem, embora reiterassem que existem consideráveis dificuldades nesse ofício. Essa clareza requer uma mobilização por parte dos professores líderes que por vezes se sentem sobrecarregados e redescobrindo meios de não adoecerem. Tais resultados têm potência para que novos estudos sejam elaborados no sentido de ampliar a discussão e contribuir para ações docentes, mas, sobretudo, humanas, melhores e mais afetivas.(AU)

Teaching work represents a fundamental field in society, given its importance in the training of future professionals and, especially, citizens. In this way, the intention of this article is to raise the matters arising from the exercise of leadership in teaching assignments and to reflect on this leadership in Higher Education in terms of its importance for the training process, as well as the inspiration that this craft can provide to students, based on the idea that teaching is an exercise in leadership. The methodological proposal with which we analyze this exercise consists of a qualitative perspective of a descriptive-analytical nature. Two teachers were interviewed through a semi-guided script which intended to raise and understand the experiences arising from their life trajectories that culminated in the teaching work they currently perform. As a theoretical and methodological basis for the analysis, the Psychodynamics of Work was used, due to its view on the subjects' ways of being, provoked by the encounter with work and the demands pertinent to its processes. As a result, the sample revealed significant agreement with the aspects of leadership in their teaching practice, although they reiterated that there are considerable difficulties in this job. This clarity requires mobi-lization on the part of leading teachers who sometimes feel overwhelmed and rediscover ways not to get sick. Such results have the power for new studies to be developed in order to broaden the discussion and contribute to teaching actions, but, above all, human, better and more affective actions. (AU)

El trabajo docente representa un campo fundamental en la sociedad, dada su importancia en la formación de los futuros profesionales y, en especial, de los ciudadanos. De esta forma, la intención de este artículo es plantear las cues-tiones derivadas del ejercicio del liderazgo en la tarea docente y reflexionar sobre este liderazgo en la Educación Superior en cuanto a su importancia para el proceso formativo, así como la inspiración que este oficio puede brindar a los estudiantes, partiendo de la idea de que enseñar es un ejercicio de liderazgo. La propuesta metodológica con la que analizamos este ejercicio consiste en una perspectiva cualitativa de carácter descriptivo-analítico. Se entrevistó a dos docentes a través de un guion semidirigido con miras a plantear y comprender las experiencias surgidas de sus trayectorias de vida que culminaron en la labor docente que desempeñan actualmente. Como base teórica y metodológica para el análisis, se utilizó la Psicodinámica del Trabajo, por su mirada sobre las formas de los sujetos de ser provocados por el encuentro con el trabajo y las exigencias propias de sus procesos. Como resultado, la muestra reveló un acuerdo significativo con los aspectos de liderazgo en su práctica docente, aunque reiteraron que existen dificultades considerables en este trabajo. Esta claridad requiere movilización por parte de los docentes líderes que a veces se sienten abrumados y redescubriendo formas de no enfermarse. Tales resul-tados tienen el poder de que se desarrollen nuevos estudios para ampliar la discusión y contribuir a la acción docente, pero, principalmente, a la acción humana, mejor y más afectiva. (AU)

Manifestaçöes otorrinolaringológicas em pacientes com síndrome de imunodeficiência adquirida (Sida) / Otolaryngologic manifestations in patients with acquired immunodeficiency syndrome (AIDS)

Os sintomas, diagnósticos e tratamentos das manifestaçoes otorrinolaringológicas de 25 pacientes com Sida, foram retrospectivamente estudados. Oitenta e sete sintomas diferentes foram relatados, 51 diagnósticos e 17 intervençoes cirúrgicas foram realizadas. A maioria dos pacientes apresentou mais de uma manifestaçao. A grande variedade de patologias e a alta incidência de afecçoes otorrinolaringológicas na Sida foram também discutidas.

Artrite psoriásica associada com hiperprolactinemia: relato de caso / Psoriatic arthritis in association with hyperprolactinemia: report of a case

Relatamos um caso raro de paciente do sexo feminino, 32 anos com diagnóstico de Artrite Psoriásica que na evoluçäo apresentou Hiperprolactinemia e conseqüente galactorréia e amenorréia. Esta associaçäo mostrou um caso raro na literatura médica nos últimos dez anos