Cervical necrotizing fasciitis due to bacterial tonsillitis.

Necrotizing fasciitis is a severe and potentially fatal soft tissue infection, but involvement of the head and neck is rare. We report on 4 cases of cervical necrotizing fasciitis arising from tonsillitis. One patient was diabetic and one had received steroids before disease development. One patient developed acute respiratory failure and died of septic shock. Three patients recovered, helped by early recognition, aggressive surgical intervention, appropriate broad-spectrum antibiotics, and supportive therapy. The common bacteria found in all abscess samples were Streptococcus sp., but mixed flora with anaerobic organisms was seen in all but 1 case. Tonsillitis and peritonsillar abscess must be suspected as a cause of cervical necrotizing fasciitis and a successful result can be achieved with immediate aggressive treatment.

Cervical necrotizing fasciitis due to bacterial tonsillitis

A fasceite necrotizante cervical é uma infecção grave de partes moles do pescoço. Trata-se de entidade rara, porém quando presente tem como principal origem um foco infeccioso odontogênico. São descritos 4 casos de fasceite necrotizante cervical a partir de tonsilites e abscesso peritonsilar, os quais, foram admitidos e tratados na unidade de terapia intensiva. Um dos pacientes era portador de Diabetes Melittus não insulino- dependente e outro paciente havia recebido corticoterapia antes do desenvolvimento da infecção. Em um dos casos ocorreu mediastinite, insuficiência respiratória e o paciente evolui para o óbito em decorrência de choque séptico. Durante o tratamento, 3 pacientes evoluíram satisfatoriamente devido ao diagnostico precoce, tratamento cirúrgico agressivo e utilização de antibiótico terapia de largo espectro. A bactéria mais comumente encontrada foi o Streptococcus sp, mas flora mista com germes anaeróbios foi encontrada em 3 dos casos descritos. CONCLUSÕES: Deve-se suspeitar de tonsilite e abscesso peritonsilar como causa de fasceite necrotizante cervical para que tratamento agressivo e precoce seja realizado.

Perfusão hipotérmica in situ versus exclusão vascular total do fígado para ressecções hepáticas complexas / In situ hypothermic perfusion of the liver versus standard total vascular exclusion for complex liver resection

Este estudo visa comparar os resultados da ressecção hepática com EVTF, realizada sob hipotermia, com aqueles obtidos quando se realiza esta ressecção com EVTF com tempo de isquemia menor que 60 minutos, e maior ou igual a 60 minutos. Para tanto, os parâmetros analisados foram: função renal e hepática, morbidade e mortalidade pós-operatórias, buscando-se determinar valores preditivos para indicação das técnicas.Foram estudados 81 pacientes, divididos em três grupos segundo o tempo de EVTF, analisando as transaminases, Bilirrubinas totais, creatinina, tempo de protrombina , índices de morbidade e de mortalidade pós-operatórias.Os pacientes submetidos a hipotermia toleraram melhor a isquemia com melhor preservação da função hepática, da função renal, e menores índices de morbidade, quando comparada com a EVTF>60’’ sem hipotermia / To compare the results of liver resection performed under in situ hypothermic perfusion vs standard total vascular exclusion (TVE) of the liver < 60 minutes and ≥ 60 minutes in terms of liver tolerance, liver and renal functions, postoperative morbidity and mortality.We study 81 consecutive liver resections divided in three groups, comparing liver and kidney function, morbidity and in-hospital mortality. On multivariate analysis, the size of the tumor, portal vein embolization and a planned vascular reconstruction were significantly predictive of TVE ≥ 60 minutes. Compared to standard TVE of any duration, hypothermic perfusion of the liver is associated with a better tolerance to ischemia. In addition, compared to TVE ≥ 60 minutes, it is associated with better postoperative liver and renal functions, and a lower morbidity...

Simultaneous gastric banding and cholecystectomy in the treatment of morbid obesity: is it feasible?

BACKGROUND: In the last decade, laparoscopic surgery for morbid obesity has become widely employed, including a marked increase in the placement of adjustable gastric bands (AGB). Among the co-morbidities of morbid obesity is cholelithiasis. The question arises whether concomitant cholecystectomy increases the risk of postoperative infectious complications due to the association of a potentially contaminated procedure with a clean operation, placement of an AGB. The aim of this study is to evaluate the postoperative outcome in patients submitted to laparoscopic AGB with cholecystectomy. METHODS: From January 2000 to January 2004, 308 patients (85 men and 223 women) had AGB placed. BMI ranged from 38.9 to 65.6 kg/m(2) (mean 41.6). In 17 patients (5.5%), gallstones were detected by ultrasonography, and cholecystectomy was performed together with the AGB. Mean operative time for placement of the AGB was 58 +/- 18 min, and in those with cholecystectomy 86 +/- 17 min (P =0.20). RESULTS: All patients that had placement of AGB and cholecystectomy had satisfactory postoperative outcome. No infectious complications were observed. CONCLUSION: Laparoscopic cholecystectomy performed simultaneously with placement of an AGB has been a safe procedure.

Topiramate after adjustable gastric banding in patients with binge eating and difficulty losing weight.

BACKGROUND: About 15% of patients who undergo adjustable gastric banding (AGB) have difficulty losing weight due to, among other factors, the development or maintenance of binge eating disorder. Topiramate is an anticonvulsive drug with proven good results in controlling binge eating episodes. The objective of this study was to analyze the effect of topiramate in patients with AGB. METHODS: 16 patients with binge eating and inadequate weight loss after AGB were analyzed prospectively for 3 months while receiving topiramate in doses varying from 12.5 to 50 mg per day. RESULTS: There was a mean increase in excess weight loss from 20.4% to 34.1% without the need for band readjustment. 2 patients had intolerance to topiramate and were changed to fluoxetine 40 mg per day. CONCLUSION: Topiramate may be a useful adjuvant for patients with AGB and binge eating disorder.

Cirurgia de tikhoff-linberg para tratamento de condrossarcoma localmente avançado da região escápulo-umeral: [relato de caso] / Tikhoff-linberg operation for the treatment of locally advanced chondrosarcoma of the scapular girdle region: [case report]

Chondrosarcoma is a rare malignant neoplasia that most of the time affects young adults. Its location is preferentially the pelvic and scapular girdle and surgery is its treatment of choice. There are no role for chemo or radiation therapy, because of their low index of response. We describe a case of a 45 year-old male patient with an extensive low grade right umerus chondrosarcoma. In spite of the local extension, there was no invasion of the shoulder neurovascular structures. Treatment proposed was the Tikhoff-Linberg procedure, and the operation was performed with success, with no complications. Free margins were obtained. The patient is now on two years follow-up with no evidence of recurrent disease and is able to drive, fish and carry packs. He can not abduct his arm, but he could not do that even before surgery, due to severe pain. We believe this is an excellent conservative approach to such tumors, that otherwise would require a forequarter amputation, and strongly recommend the technique.

An alternative linear stapling technique for performing Roux-en-Y anastomosis.

BACKGROUND: The use of stapling devices for performing gastrointestinal anastomosis has gained wide acceptance in the last decade. Linear cutting devices have been used routinely during gastrointestinal operations in our hospital since 1992. However, we still have shortage of stapling devices due to cost reduction politics. METHODS: We propose a modification of the standard technique in order to reduce the number of devices used. Our technique employs a single stapled including the section of the jejunum and the side-to-side jejunoanastomosis. RESULTS: We have used this technique for 1 year without complications related to the stapled anastomosis. CONCLUSIONS: This technique may reduce the time of reconstruction of Roux-en-Y anastomosis without interfering in its final result. This modified technique may be useful in hospitals with reduced economic resources.

Ressecção sacrococcígea por volumoso cordoma invadindo forame isquiático: relato de caso / Sacrococcygeal resection of a voluminous chordoma invading the sciatic pelvic foramen: case report

Chordoma is a rare and locally invasive bone malignant tumor derived from embryonic notochordal remnants. Most of them originate from the sacrococcygeal region and present with a large size at the moment of the diagnosis. The treatment consists of extended resection en bloc with sacral nerves, if necessary. Chemotherapy and radiation therapy are of limited utility. The authors present the case of a 74-year-old male patient with a voluminous sacrococcygeal chordoma invading the pelvic sciatic foramen. His symptoms were lower limb pain and partial fecal and urinary incontinence. The tumor was resected by a combined approach (abdominal and posterior), with exiguous margins. The post-operative course was uneventful besides a liquor fistula which resolved spontaneously. The patient had resolution of the pain, but maintained the sphincter dysfunction. At the moment, he is at the 4th month of follow-up.

Tratamento video-laparoscopico da hipertensao portal no situs inversus totalis / Video-laparoscopy therapy of portal hypertension in the \"situs inversus totalis\"

O situs inversus e uma anomalia congenita caracterizada pela alteracao dos planos de simetria do embriao. Um paciente de 32 anos, sexo masculino, admitido no hospital por hematemese devido a ruptura de varizes esofago-gastricas, foi tratado pela primeira vez por cirurgia video-laparoscopica. Apresentava hipertensao portal por cirrose de Laenec. O diagnostico do situs inversus foi obtido por radiografia toracica, eletrocardiograma, ecocardiograma, ultrassonografia abdominal e tomografia computadorizada. O exame endoscopico mostrava varizes esofagicas e de fundo gastrico. A cirurgia (desconexao azigo-portal com ligadura da arteria esplenica, sem esplenectomia; sutura das varizes esofagicas e gastricas sem abertura do esofago e colecistectomia) foi realizada por video-laparoscopia...

Laparoscopy appendectomy: technical procedure

Foram submetidos a apendicectomia por videolaparoscopia 154 pacientes, sendo 92 (59,7 por cento) do sexo masculino e 62 (40,3 por cento) do feminino. A idade variou de 13 a 74 anos, com media de 31 anos. O acesso a cavidade abdominal era realizado com a utilizacao de tres trocateres. Tratava-se o mesoapendice em sua base com eletrocauterizacao bipolar e sua posterior seccao. O apendice era tratado da mesma maneira utilizando-se coagulacao bipolar para cauterizar e selar sua base. A seguir, procedia-se ligadura do apendice junto ao ceco com auxilio de no endoscopico previamente montado. O apendice era seccionado na regiao eletrocoagulada e retirado do abdome em bolsa plastica de protecao...

Laparoscopic cholecystectomy in children and adolescents

During the period between August 1991 and November 1995, seven patients under age 17 were submitted to videolaparoscopic cholecystectomy (LC). Two were males and five females with ages ranging from 12 to 16 years (mean 13.8 years). The diagnosis of chronic cholecystitis with gallstones was made by the clinical history and physical and ultrasonographic examinations. There was no evidence of an association with hemolytic diseases, familial hyperlipidemia or Glucose-6-phosphate dehydrogenase (G6PD) deficiency. The surgery was performed under general anesthesia and the abdomen approached by four ports: a 10 mm umbilical incision, a 5 mm cystic, a 5 mm one at the xiphoid appendix and a 10 mm one at the left lateral margin of the left rectus abdominal muscle between the umbilical scar and the xiphoid appendix. Operative time averaged 120 minutes (105-150 min). One case required conversion to laparotomic approach because of Mirizzi's Syndrome, which was diagnosed by intraoperative cholangiography performed in all cases. There were no deaths or major postoperative complications. Hospital stays ranged from 1-3 days in the six patients submitted to LC. Thus LC in children can be considered a good method, requiring only more care regarding the use of proper equipment, complete and careful dissection of the biliary hilus, and intraoperative cholangiography. The latter is indispensable, as these children can present a higher rate of anatomic anomalies. The advantages of this techniques include a less painful postoperative period with a faster recovery, and it is especially recommended in children, who are less tolerant to physical restriction and pain than adults.