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1.
Surgery ; 167(3): 668-674, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31973913

RESUMO

BACKGROUND: The significant burden of emergency operations in low- and middle-income countries can overwhelm surgical capacity leading to a backlog of elective surgical cases. The purpose of this investigation was to determine the burden of emergency procedures on pediatric surgical capacity in Uganda and to determine health metrics that capture surgical backlog and effective coverage of children's surgical disease in low- and middle-income countries. METHODS: We reviewed 2 independent and prospectively collected databases on pediatric surgical admissions at Mulago National Referral Hospital and Mbarara Regional Referral Hospital in Uganda. Pediatric surgical patients admitted at either hospital between October 2015 to June 2017 were included. Our primary outcome was the distribution of surgical acuity and associated mortality. RESULTS: A combined total of 1,930 patients were treated at the two hospitals, and 1,110 surgical procedures were performed. There were 571 emergency cases (51.6%), 108 urgent cases (9.7%), and 429 elective cases (38.6%). Overall mortality correlated with surgical acuity. Emergency intestinal diversions for colorectal congenital malformations (anorectal malformations and Hirschsprung's disease) to elective definitive repair was 3:1. Additionally, 30% of inguinal hernias were incarcerated or strangulated at time of repair. CONCLUSION: Emergency and urgent operations utilize the majority of operative resources for pediatric surgery groups in low- and middle-income countries, leading to a backlog of complex congenital procedures. We propose the ratio of emergency diversion to elective repair of colorectal congenital malformations and the ratio of emergency to elective repair of inguinal hernias as effective health metrics to track this backlog. Surgical capacity for pediatric conditions should be increased in Uganda to prevent a backlog of elective cases.


Assuntos
Benchmarking/métodos , Serviço Hospitalar de Emergência/organização & administração , Tratamento de Emergência/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Pré-Escolar , Bases de Dados Factuais/estatística & dados numéricos , Anormalidades do Sistema Digestório/mortalidade , Anormalidades do Sistema Digestório/cirurgia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Recursos em Saúde , Hérnia Inguinal/mortalidade , Hérnia Inguinal/cirurgia , Mortalidade Hospitalar , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Uganda/epidemiologia
3.
S Afr J Surg ; 57(4): 44, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31773935

RESUMO

SUMMARY: Currarino syndrome is a rare, autosomal dominant condition of caudal anomalies, usually diagnosed in childhood. Adult presentation is rare and malignant transformation of the associated presacral mass even more so. We report a case of a 60-year-old female diagnosed with a malignant neuroendocrine tumour in the presacral mass in Currarino syndrome and describe the surgical management and pathological findings.


Assuntos
Canal Anal/anormalidades , Transformação Celular Neoplásica/patologia , Anormalidades do Sistema Digestório/diagnóstico por imagem , Anormalidades do Sistema Digestório/cirurgia , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/cirurgia , Neoplasias Retais/patologia , Reto/anormalidades , Sacro/anormalidades , Siringomielia/diagnóstico por imagem , Siringomielia/cirurgia , Canal Anal/diagnóstico por imagem , Canal Anal/patologia , Canal Anal/cirurgia , Biópsia por Agulha , Anormalidades do Sistema Digestório/complicações , Anormalidades do Sistema Digestório/patologia , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Imagem Multimodal/métodos , Tumores Neuroendócrinos/complicações , Tumores Neuroendócrinos/diagnóstico por imagem , Doenças Raras , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/cirurgia , Reto/diagnóstico por imagem , Reto/patologia , Reto/cirurgia , Medição de Risco , Sacro/diagnóstico por imagem , Sacro/patologia , Sacro/cirurgia , África do Sul , Siringomielia/complicações , Siringomielia/patologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
6.
Medicine (Baltimore) ; 98(44): e17682, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689788

RESUMO

Due to the various presentations of gastrointestinal tract duplications (GTD), diagnosing and management for this disease might be varied and difficult. We intend to improve the experiences for these difficult, in terms of the clinical presentations, diagnostic investigations, management.We reviewed recent literature and retrospectively analyzed 72 pediatric patients with enteric duplication. Diagnosis was confirmed by surgery and pathological examination for imaging characteristics and clinical and pathological features.The ages of patients ranged from one month to 12.5 years. The clinical presentations of the patients included 57 cases with abdominal pain, followed with nausea or vomiting, abdominal distension, etc. All of the patients were diagnosed by ultrasonography, and most of them presented as intra-abdominal cystic masses. Four cases were diagnosed with the cysts other than GTDs, like, mesenteric cyst, chledochal cyst and abscess, and so on. Computed tomography was performed on 65 patients. X-rays and barium meal showed the outline of the cyst structure, with intestinal displacement due to the pressure from the cyst. Among the 72 cases of enteric duplication, 45 were located with ileocecal area, 41 were ileal and 8 were colonic duplications.Enteric duplication is very rare in children and is prone to misdiagnosis. The preoperative diagnosis of enteric duplication can be improved through comprehensive analysis of various imaging exams and closely related clinical presentations.


Assuntos
Anormalidades do Sistema Digestório/diagnóstico por imagem , Anormalidades do Sistema Digestório/fisiopatologia , Criança , Pré-Escolar , Anormalidades do Sistema Digestório/diagnóstico , Anormalidades do Sistema Digestório/cirurgia , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Ultrassonografia
7.
Niger Postgrad Med J ; 26(4): 239-243, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31621665

RESUMO

Background: Congenital anomalies (CAs) refer to defects that are present in a newborn but occurred during intrauterine life. They can be due to genetic, modifiable environmental or multifactorial causes. There was no prior report of their burden in our state. Aims: This study aims to describe the incidence, spectrum, predisposing factors and outcome of CAs in our setting. Methods: It was a total population study of all neonates with major birth defects admitted into the unit during the study period. Their clinical-demographic features, diagnoses and outcome were entered into an excel sheet. Clinical detection of birth defects was based on standard diagnostic criteria. The data were analysed using IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Patterns and outcome of birth defects were presented as proportions. Selected characteristics were tested for possible association with birth defect using Fisher's exact test. The level of significance was set at P < 0.05. Results: The incidence of major CAs was 4.3/1000 live births. Female neonates were more affected (59.0%). Participants' mean gestational age was 37.7 ± 3.3 weeks. Central nervous system anomalies were the most common (38.5%) birth defects. These were followed by musculoskeletal, body wall and digestive system anomalies: 28.2%, 23.1% and 10.3%, respectively. One-third (33.3%) of the infants had multiple anomalies. Nearly three quarters of them (74.0%) were referred, 18.0% died while 5.0% were discharged alive. Conclusion: A wide range of CAs occur in our setting with dire consequences. Provision of relevant specialised multidisciplinary care is desirable. Furthermore, pubic enlightenment on its modifiable possible causes can reduce the burden.


Assuntos
Sistema Nervoso Central/anormalidades , Anormalidades Congênitas/epidemiologia , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Grupo com Ancestrais do Continente Africano , Criança , Anormalidades Congênitas/classificação , Estudos Transversais , Anormalidades do Sistema Digestório/epidemiologia , Feminino , Idade Gestacional , Humanos , Incidência , Lactente , Recém-Nascido , Anormalidades Musculoesqueléticas/epidemiologia , Nigéria/epidemiologia
8.
Expert Rev Gastroenterol Hepatol ; 13(11): 1089-1105, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31663403

RESUMO

Introduction: Pancreas divisum is the most common congenital malformation of the pancreas with the majority asymptomatic. The etiological role, pathogenesis, clinical significance and management of pancreas divisum in pancreatic disease has not been clearly defined and our understanding is yet to be fully elucidated.Areas covered: This review describes the role of pancreas divisum in the development of pancreatic disease and the ambiguity related to it. In our attempt to offer clarity, a comprehensive search on PubMed, Ovid, Embase and Cochrane Library from inception to May 2019 was undertaken using key words "pancreas divisum", "idiopathic recurrent acute pancreatitis" and "chronic pancreatitis".Expert opinion: Current research fails to define a clear association between pancreas divisum and pancreatic disease. Though debatable, several studies do suggest a pathological role of pancreas divisum in pancreatic disease and a benefit of minor papilla therapy in the setting of acute recurrent pancreatitis. Surgical and endoscopic therapeutic modalities have not been directly compared. With the current data available, it would be imprudent to advise a definitive line of management for pancreatic disease associated with pancreas divisum and should involve a comprehensive discussion with the individual patient to define expectations before embarking on any medical and/or interventional therapy.


Assuntos
Anormalidades do Sistema Digestório/terapia , Pâncreas/diagnóstico por imagem , Pâncreas/cirurgia , Pancreatite Crônica/diagnóstico por imagem , Pancreatite Crônica/terapia , Pancreatite/diagnóstico por imagem , Pancreatite/terapia , Anormalidades do Sistema Digestório/complicações , Anormalidades do Sistema Digestório/diagnóstico por imagem , Humanos , Pâncreas/anormalidades , Pancreatite/etiologia , Pancreatite Crônica/etiologia , Valor Preditivo dos Testes , Prognóstico , Recidiva , Medição de Risco , Fatores de Risco
9.
Gan To Kagaku Ryoho ; 46(10): 1659-1661, 2019 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-31631167

RESUMO

A 52-year-old man whose fecal occult blood test was positive was found to have type 2 sigmoid colon cancer by colonoscopy. On enhanced barium enema study, the cecum was in the pelvis, and the ascending colon was running medially in the abdomen. Enhanced CT scan of the abdomen revealed rotation of the superior mesenteric vein(SMV). We diagnosed the case as sigmoid colon cancer(cT3N0M0, StageⅡA)with non rotation-type intestinal malrotation, and performed laparoscopic surgery. We confirmed the small intestine to be located on the right side of the abdomen, the cecum to be located in the pelvis, and the ascending colon to be running medially in the abdomen. The ascending mesocolon was adherent to the right of the sigmoid mesocolon. Following dissections of the ascending mesocolon from the sigmoid mesocolon, we performed surgery via the inside approach as usual. We dissected the root of the inferior mesenteric artery(IMA), and the operation was completed. In laparoscopic surgery for colorectal cancer with intestinal malrotation, there are some reports that it could be performed safely if attention is paid to adhesion of the mesenteries and vascular variation in the course of preoperative imaging diagnosis. We report a case of laparoscopic surgery that could be safely performed for sigmoid colon cancer with non rotation-type intestinal malrotation.


Assuntos
Anormalidades do Sistema Digestório , Volvo Intestinal , Laparoscopia , Mesocolo , Neoplasias do Colo Sigmoide , Colo Sigmoide , Humanos , Masculino , Mesocolo/cirurgia , Pessoa de Meia-Idade , Neoplasias do Colo Sigmoide/cirurgia
10.
BMJ Case Rep ; 12(10)2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31604719

RESUMO

Nutcracker syndrome (NCS) is a pathological condition in which the left renal vein (LRV) is compressed between the superior mesenteric artery (SMA) and aorta. NCS can predispose patients to the onset of chronic kidney disease because of persistent increase in LRV pressure. Although NCS in children is often idiopathic, it can also be caused by underlying pathologies such as retroperitoneal tumours. To the best of our knowledge, there have been no reports regarding paediatric cases of NCS complicated with intestinal malrotation. Here, we report the case of a 12-year-old girl with intestinal malrotation complicated with NCS whose haematuria resolved after surgical intervention for intestinal malrotation. The present case findings indicate that intestinal malrotation with concomitant weight loss is a potential underlying aetiology in NCS. Thus, when NCS is especially diagnosed with gastrointestinal symptoms, intestinal malrotation should be considered as an underlying aetiology.


Assuntos
Anormalidades do Sistema Digestório/complicações , Volvo Intestinal/complicações , Síndrome do Quebra-Nozes/etiologia , Dor Abdominal , Criança , Anormalidades do Sistema Digestório/diagnóstico por imagem , Anormalidades do Sistema Digestório/cirurgia , Feminino , Hematúria , Humanos , Volvo Intestinal/diagnóstico por imagem , Volvo Intestinal/cirurgia , Laparoscópios , Síndrome do Quebra-Nozes/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Vômito
12.
An Pediatr (Barc) ; 91(4): 273.e1-273.e8, 2019 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-31495740

RESUMO

Survival of patients with congenital malformation has improved over the last decades. Primary care paediatricians must be aware of the most common problems that this group of patients suffers. More importantly, paediatricians can offer a holistic view that is often lost in specialised consultation. This article is focused on common congenital malformation, such as oesophageal atresia, abdominal wall defects, anorectal malformation and Hirschsprung disease, and congenital diaphragmatic hernia. The main problems are shown, with special emphasis on long-term complications and all the dimensions of the individual.


Assuntos
Parede Abdominal/anormalidades , Anormalidades do Sistema Digestório/terapia , Hérnias Diafragmáticas Congênitas/terapia , Atenção Primária à Saúde/métodos , Criança , Anormalidades do Sistema Digestório/fisiopatologia , Hérnias Diafragmáticas Congênitas/fisiopatologia , Doença de Hirschsprung/fisiopatologia , Doença de Hirschsprung/terapia , Humanos , Pediatria
13.
J Med Case Rep ; 13(1): 213, 2019 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-31300067

RESUMO

BACKGROUND: Sirenomelia is a rare and fatal congenital defect. The rarity of this case and its association with abdominal total wall defect drove us to report this case. CASE PRESENTATION: We report a rare case of sirenomelia characterized by lower limb fusion, thoracolumbar spinal anomalies, sacrococcygeal agenesis with a rudimentary tail, and genitourinary and anorectal atresia. Coexistent anterior abdominal wall defect in this case highlights its fatalness because of complications associated with the malformation. CONCLUSIONS: Sirenomelia syndrome has seldom been reported. The present case highlights the rare atypical association of sirenomelia with anterior abdominal wall defect. Because the investigations were done in a low-resource setting, the etiology regarding this case remains unclear.


Assuntos
Anormalidades Múltiplas , Anormalidades do Sistema Digestório , Ectromelia/fisiopatologia , Parede Abdominal/anormalidades , Adulto , Ectromelia/diagnóstico , Feminino , Doenças Fetais/diagnóstico , Doenças Fetais/fisiopatologia , Humanos , Gravidez , Natimorto
15.
BMJ Case Rep ; 12(7)2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31352380

RESUMO

A 20-year-old woman with no medical or surgical history presented with acute onset crampy abdominal pain on a background of uninvestigated similar chronic abdominal pain. She became obstructed during her admission and a contrast swallow showed a complete obstruction at the level of the proximal jejunum. A diagnostic laparoscopy revealed a congenital band adhesion from the greater omentum to the proximal jejunum to be the cause, and dissection of the band relieved her obstruction. This case presents a rare cause of mechanical obstruction, and highlights the seriousness of investigating obstructive symptoms even in atypical patient populations.


Assuntos
Dor Abdominal/patologia , Anormalidades do Sistema Digestório/complicações , Obstrução Intestinal/etiologia , Laparoscopia , Aderências Teciduais/complicações , Tomografia Computadorizada por Raios X , Dor Abdominal/diagnóstico por imagem , Dor Abdominal/etiologia , Anormalidades do Sistema Digestório/diagnóstico por imagem , Anormalidades do Sistema Digestório/fisiopatologia , Feminino , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/patologia , Jejuno/anormalidades , Omento/anormalidades , Aderências Teciduais/diagnóstico por imagem , Aderências Teciduais/patologia , Resultado do Tratamento , Adulto Jovem
17.
Surg Laparosc Endosc Percutan Tech ; 29(4): e60-e64, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31166291

RESUMO

CONTEXT: Pancreas divisum (PD), the most common congenital anatomic variation of the pancreatic ductal system, is still rare in clinical practice. Endoscopic retrograde cholangiopancreatography (ERCP) is the first-line treatment for patients with symptomatic PD. However, even by experienced endoscopists, the procedure of ERCP can fail in 3% to 10% of cases. Traditionally, if we fail in cannulation we have no choice but to rely on surgery. CASE REPORT: The 2 case reports of PD in this study with cannulation were both unsuccessful, fortunately, the use of endoscopic ultrasonography-guided pancreatic duct puncture combined with ERCP was eventually successful in treatment. CONCLUSIONS: Using endoscopic ultrasonography-guided pancreatic duct puncture combined with ERCP is safe and effective for the treatment of the patients of difficult minor papilla cannulation in patients of PD, and can be used as a remedy for minor papilla cannulation failure.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Pâncreas/anormalidades , Pâncreas/cirurgia , Ductos Pancreáticos/cirurgia , Esfinterotomia Endoscópica/métodos , Cirurgia Assistida por Computador/métodos , Adulto , Idoso de 80 Anos ou mais , Cateterismo , Anormalidades do Sistema Digestório/diagnóstico por imagem , Anormalidades do Sistema Digestório/cirurgia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Prognóstico , Punções , Medição de Risco , Resultado do Tratamento
18.
A A Pract ; 12(11): 393-395, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31162165

RESUMO

Currarino triad is a rare hereditary condition characterized by anorectal malformation, sacral dysgenesis, and a presacral mass. Neuraxial anesthetic techniques pose increased risks to patients with spinal malformations. Ultrasound imaging improves accuracy of intervertebral level identification compared to clinical estimation. We present the case of a parturient with Currarino triad and a low conus medullaris undergoing cesarean delivery where preprocedural magnetic resonance imaging and ultrasound imaging allowed for successful combined spinal-epidural anesthesia to be performed. Despite these measures, however, the patient did develop a high spinal and temporary postoperative dizziness.


Assuntos
Canal Anal/anormalidades , Anestesia Epidural/métodos , Raquianestesia/métodos , Anormalidades do Sistema Digestório/complicações , Reto/anormalidades , Sacro/anormalidades , Siringomielia/complicações , Adulto , Cesárea , Feminino , Humanos , Imagem por Ressonância Magnética , Gravidez , Ultrassonografia
19.
Pediatr Cardiol ; 40(6): 1224-1230, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31240371

RESUMO

Heterotaxy syndrome (HS) is a significant determinant of outcome in single ventricle (SV) physiology. Attrition rate and time-related events associated with intestinal malrotation (IM) are, yet, to be determined. We sought to evaluate hospital and interstage outcomes in relation with operative intervention for IM (IMO). Twelve SV/HS patients, who underwent IMO, from January 2004 to December 2016, were studied. Early shunt failure, time to superior cavopulmonary connection (SCPC) and interstage attrition were assessed. Since September 2014, based on a comprehensive standardized protocol, IMO was performed at the time of hospitalization for stage-I palliation (S1P) irrespective of clinical manifestations. Patients were assigned to Group A (n = 8): expectant /symptoms-driven versus Group B (n = 4): protocol-driven. At S1P 7 had systemic-to-pulmonary shunt (SPS), 1 SPS with anomalous pulmonary venous return (APVR) repair (Group A) compared to 2 SPS, 1 SPS with APVR repair and 1 Norwood operation (Group B). Median duration from S1P to IMO was 82 days (range 57-336; Group A) compared to 14 days (range 11-31; Group B); p < 0.05. Median age at IMO was 87 days (range 8-345) [Group A: 99 days (range 68-345) vs Group B: 25 days (range 8-39)] (p < 0.05). Early SPS failure occurred in 25% (2 of 8) for Group A compared to none in Group B (p < 0.05). Hospital mortality following IMO was 25% [Group A: 37.5% (3 of 8) vs Group B: 0; p < 0.05]. Interstage survival was 67% [Group A: 50% (4 of 8) vs Group B: 100%; p < 0.05]. Time to SCPC following S1P was 186 days (range 169-218) for Group A compared to 118 days (range 97-161) (Group B); p < 0.05. Operative intervention for IM in SV/HS is associated with significant interstage attrition and might impact the time to SCPC. SPS is at risk for early failure after IMO. A comprehensive standardized concept can mitigate detrimental implications.


Assuntos
Anormalidades do Sistema Digestório/mortalidade , Anormalidades do Sistema Digestório/cirurgia , Ventrículos do Coração/anormalidades , Síndrome de Heterotaxia/mortalidade , Volvo Intestinal/mortalidade , Volvo Intestinal/cirurgia , Estudos de Casos e Controles , Feminino , Mortalidade Hospitalar , Humanos , Lactente , Recém-Nascido , Masculino , Cuidados Paliativos/métodos , Assistência Perioperatória/métodos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
20.
Hepatobiliary Pancreat Dis Int ; 18(4): 332-336, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31155429

RESUMO

BACKGROUND: Pancreas divisum is a congenital embryological disease caused by a lack of fusion between the ventral and dorsal pancreatic ducts in the early stages of embryogenesis. Recurrent acute pancreatitis, chronic pancreatitis or chronic abdominal pain are the main clinical syndromes at presentation and occur in only 5% of the patients with pancreas divisum. This review aimed to discuss diagnosis and treatment strategies in patients with symptomatic pancreas divisum. DATA SOURCES: We report a literature review from 1990 up to January 2018 to explore the various diagnostic modalities and surgical techniques and results reported in the surgical treatment of pancreas divisum. RESULTS: There are limited reports available on this topic in the literature. We analyzed and described the main indications in the treatment of pancreas divisum, focusing on surgical treatment and a discussion of the different approaches. Furthermore, we report the results from our experience in two cases of pancreas divisum treated by pancreatic head resection with segmental duodenectomy (the Nakao procedure). CONCLUSIONS: Pancreas divisum is a common pancreatic malformation in which only a few patients develop a symptomatic disease. Surgical treatment is needed in case of endoscopic drainage failure and in cases complicated with chronic pancreatitis and local complications. Many techniques, of greater or lesser complexity, have been proposed.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Anormalidades do Sistema Digestório/diagnóstico por imagem , Anormalidades do Sistema Digestório/cirurgia , Pancreatectomia , Ductos Pancreáticos/diagnóstico por imagem , Ductos Pancreáticos/cirurgia , Pancreaticoduodenectomia , Dor Abdominal/etiologia , Adulto , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Dor Crônica/etiologia , Anormalidades do Sistema Digestório/complicações , Drenagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatectomia/efeitos adversos , Ductos Pancreáticos/anormalidades , Pancreaticoduodenectomia/efeitos adversos , Pancreatite Crônica/etiologia , Recidiva , Resultado do Tratamento
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