The circumferential resection margins status: A comparison of robotic, laparoscopic and open total mesorectal excision for mid and low rectal cancer.

INTRODUCTION: Minimally invasive surgery for rectal cancer (RC) is now widely performed via the laparoscopic approach, but robotic-assisted surgery may overcome some limitations of laparoscopy in RC treatment. We compared the rate of positive circumferential margins between robotic, laparoscopic and open total mesorectal excision (TME) for RC in our institution. METHODS: Mid and low rectal adenocarcinoma patients consecutively submitted to robotic surgery were compared to laparoscopic and open approach. From our prospective database, 59 patients underwent robotic-assisted rectal surgery from 2012 to 2015 (RTME group) were compared to our historical control group comprising 200 open TME (OTME group) and 41 laparoscopic TME (LTME group) approaches from July 2008 to February 2012. Primary endpoint was to compare the rate of involved circumferential resection margins (CRM) and the mean CRM between the three groups. Secondary endpoint was to compare the mean number of resected lymph nodes between the three groups. RESULTS: CRM involvement was demonstrated in 20 patients (15.5%) in OTME, 4 (16%) in LTME and 9 (16.4%) in the RTME (p = 0.988). The mean CRM in OTME, LTME and RTME were respectively 0.6 cm (0-2.7), 0.7 cm (0-2.0) and 0.6 cm (0-2.0) (p = 0.960). Overall mean LN harvest was 14 (0-56); 16 (0-52) in OTME, 13 (1-56) in LTME and 10 (0-45) in RTME (p = 0.156). CONCLUSION: Our results suggest that robotic TME has the same oncological short-term results when compared to the open and laparoscopic technique, and it could be safely offered for the treatment of mid and low rectal cancer.

Nonoperative management of rectal cancer after chemoradiation opposed to resection after complete clinical response. A comparative study.

INTRODUCTION: Surgery is the standard treatment of rectal cancer after neoadjuvant therapy. Some authors advocate a nonoperative management (NOM) after complete clinical response (cCR) following chemoradiotherapy (CRT). We compare our results with NOM to standard resection in a retrospective analysis. METHODS: Rectal adenocarcinomas submitted to NOM after CRT between September 2002 and December 2013 were compared to surgical patients that had pathological complete response (pCR) during the same period. Endpoints were Overall Survival (OS), Disease Free Survival (DFS), Local Relapse (LR) and Distant Relapse (DR). RESULTS: Forty-two NOM patients compared to 69 pCR patients operated after a median interval of 35 weeks after CRT. NOM tumors were distal (83.3% vs 59.4%, p = 0.011), less obstructive (26.2% vs 54.4%, p = 0.005) and had a lower digital rectal score (p = 0.024). Twelve (28.0%) recurrences in NOM group and eight (11.5%) in the surgical group occurred after a follow-up of 47.7 and 46.7 months respectively. Isolated LR occurred in five (11%) NOM patients and one (1.4%) in the surgical group. Four (80%) LR were surgically salvaged in NOM group. No difference in OS was found (71.6% vs 89.9%, p = 0.316) but there was a higher DFS favoring surgical group (60.9% vs 82.8%, p = 0.011). Distal tumors had worse OS compared to proximal tumors in surgical group (5-year OS of 85.5% vs 96.2%, p = 0.038). CONCLUSION: The NOM achieved OS comparable to surgical treatment and spared patients from surgical morbidity but it resulted in more recurrences. This approach cannot be advocated routinely and controlled trials are warranted.

Grynfelt hernia: case report and literature review.

Back lumbar hernia is a rare abdominal wall defect that usually presents spontaneously after trauma or lumbar surgery or, less frequently, during infancy (congenital). Few reports have been published in the literature describing primary lumbar hernia. A general surgeon will have the opportunity to repair only one or a few lumbar hernia cases in his/her lifetime. We report a case of a healthy 50-year-old man, with no previous surgeries or history of trauma, who presented to the outpatient department with abdominal discomfort, pain, and a sensation of a growing mass on his lower left back for 4 years. CT scan of the abdomen showed a mass in the left posterolateral abdominal wall. Specifically, a herniation of retroperitoneal fat between the erector spinae muscle group and internal oblique muscles through aponeurosis of the transversalis muscle (Grynfeltt hernia). The patient underwent a small lumbotomy, polypropylene mesh was placed and he recovered well. Although many techniques have been described for the surgical management of such hernias, none of them can be recommended as the preferred method. Our impression, however, is that the open approach, with a small lumbotomy, seems to be easy, safe and presents good postoperative recovery.

[Undergraduate students of "Universidade Federal de Minas Gerais": profile and trends]. / O estudante de medicina da Universidade Federal de Minas Gerais: perfil e tendências.

OBJECTIVE: this study was made with the medical students of the "Universidade Federal de Minas Gerais" (UFMG), to get their social economic profile, and their reasons for studying medicine, choosing the specialty, doing medical residence, and showing preferences for being a liberal professional or a salaried employee. METHODS: In 1997, a study was made comparing UFMG's medical students beginning their clinical practice (5th semester) and those medical students during the internship in the last term of clinical practice. Both groups were given questionnaires for evaluation. RESULTS: The results were similar for both groups and showed that women constituted almost 50% of the students and about 50% of them were from Belo Horizonte, the State capital of Minas Gerais, Brazil, and from small families with less than three children, and whose parents held a college degree. These students passed the college entrance exams on their first try. Two thirds of their families had income of about 10 to 50 Brazilian minimum wages, and approximately 12% of the families had an income of less than 10 minimum wages. The majority of the students decided to study medicine for altruism or vocational reason; very few (<5%) chose to study medicine for financial reasons. Almost all students (98%) preferred a liberal medical practice; however 80% would accept civil-service employment as an alternative. Nearly all of them (98%) chose to do medical residence to specialize. Most students would prefer to be specialists and only less than 20% would prefer to do general practice in areas such as adult and pediatric clinic, gynecology-obstetric and general surgery. CONCLUSION: This study shows that medical students from UFMG have an elite social economic profile and a preference for specialized medical practice.

O estudante de medicina da Universidade Federal de Minas Gerais: perfil e tendências / Undergraduate students of \"Universidade Federal de Minas Gerais\": profile and trends

OBJETIVOS: A proposta deste trabalho é investigar o perfil socioeconômico, o motivo de estudar medicina, a opçao por especialidade e residência médica e a preferência em trabalhar como profissional liberal ou assalariado entre os estudantes de medicina da Universidade Federal de Minas Gerais (UFMG). MÉTODO: Durante o ano de 1997, realizou-se estudo comparativo entre os estudantes de medicina da UFMG do 5o. período, iniciando o ciclo clínico, e aqueles do internato, terminando o ciclo clínico. Como instrumento foi utilizado um questionário distribuído a todos alunos das duas turmas. RESULTADOS: Houve grande semelhança entre os estudantes de 5o. período e os do internato. Em torno de 50 por cento dos estudantes eram do sexo feminino, mais da metade procedeu da capital do Estado, em Belo Horizonte, nasceu em família pequena com menos de três filhos, foi aprovada no primeiro vestibular e o pai cursou escola superior. A renda familiar situou-se entre 10 e 50 salários em 2/3 dos casos. Estes dados sao compatíveis com a origem de classe média alta, embora em aproximadamente 12 por cento a renda familiar foi inferior a 10 salários. A grande maioria estudou medicina por vocaçao ou altruísmo (80 por cento), raramente por questoes de mercado (<5 por cento). Houve grande preferência pela medicina como profissao liberal (98 por cento), mas em torno de 80 por cento aceitaria o emprego público como alternativa. Quase todos (98 por cento) pretendiam fazer residência médica e se tornar especialistas, poucos (<20 por cento) indicaram entre estas as especialidades de área geral, como clínica médica, gineco-obstetrícia, pediatria e cirurgia. CONCLUSAO: O estudo mostrou perfil socioeconômico relativamente elevado do estudante de medicina da UFMG e preferência pela prática especializada da medicina

Aplastic crisis due to human parvovirus B19 infection in hereditary hemolytic anaemia

Specific anti-B19 IgM was demonstrated in sera from three children showing transient aplastic crisis. A two years-old boy living in Rio de Janeiro suffering from sickle-cell anaemia showed the crisis during August, 1990. Two siblings living in Santa Maria, RS, developed aplastic crisis during May, 1991, when they were also diagnosed for hereditary spherocytosis. For a third child from this same family, who first developed aplastic crisis no IgM anti-B19 was detected in her sera

Aplastic crisis due to human parvovirus B19 infection in hereditary hemolytic anaemia.

Specific anti-B19 IgM was demonstrated in sera from three children showing transient aplastic crisis. A two years-old boy living in Rio de Janeiro suffering from sickle-cell anaemia showed the crisis during August, 1990. Two siblings living in Santa Maria, RS, developed aplastic crisis during May, 1991, when they were also diagnosed for hereditary spherocytosis. For a third child from this same family, who first developed aplastic crisis no IgM anti-B19 was detected in her sera.