Multivisceral resection for retroperitoneal liposarcoma-is it worth it? A 20-year single-center experience.

PURPOSE: Soft tissue sarcomas are rare malignant tumors. Liposarcoma constitutes the most frequent histological subtype of retroperitoneal sarcoma. The prognosis of soft tissue sarcomas depends on clinical and histologic characteristics. OBJECTIVE: Evaluate variables that may be related to the overall and local recurrence-free survival in patients with retroperitoneal liposarcoma and discuss the need for visceral resection en-bloc for tumors. METHODS: A retrospective analysis was conducted of the medical records of 60 patients seen between 1997 and 2017 who underwent surgical resection of retroperitoneal liposarcoma. RESULTS: The overall survival rate at 5 years of follow-up was 75.22% (95% confidence interval [CI] 0.58-0.86). The probability of a local recurrence-free survival at 5 years of follow-up was 26.04% (95% CI 0.11-0.44). The multivariate analysis showed that dedifferentiated or pleomorphic tumors and R2/fragmented resection were associated with a shorter time to recurrence. No other characteristics markedly influenced the overall survival (P > 0.05). CONCLUSION: Patients with dedifferentiated or pleomorphic tumors and incomplete resection were associated with higher local recurrence rates than others. This study reinforces the need for complete and en-bloc resection with organs when there is clear involvement or technical surgical difficulty to maintain the tumor integrity.

Profile of the General Surgery resident: what are the changes in the 21 st Century?

OBJECTIVE: to verify the profile of the General Surgery residents of the Clinics Hospital (HC) of the Faculty of Medicine of the University of São Paulo (FMUSP). METHODS: we evaluated the residents approved in the public contest for the Medical Residency Program in General Surgery of HC-FMUSP in the years 2014, 2015 and 2016. We carried out the study by applying a questionnaire and gathering information from the Medical Residency Commission of the Institution. We analyzed data on identification, origin of the candidate, undergraduate school, surgical teaching received, reason for choosing Surgery, residency expectations, choice of future specialty and pretensions as to the end of medical residency. We also analyzed the result of the examination of access to specialties. RESULTS: the mean age was 25.8 years; 74.3% of residents were male. The majority (84.4%) had attended public medical schools, 68% of which were not in the Southeast region; 85,2% of the residents were approved in the first contest. The specialty choice was present for 75.9% of individuals at the beginning of the residency program, but 49.5% changed their minds during training. Plastic Surgery, Urology and Digestive System Surgery were chosen by 61.5%. Sixty hours per week work were considered adequate by 83.3%; 27.3% favored direct access to the specialty. At the end of the specialty, 53.3% intended to continue in São Paulo, and 26.2%, to return to their State of origin. A strict-sense post-graduate course was intended by 68.3%. CONCLUSION: the current profile of the resident reveals a reduction in the demand for General Surgery, an earlier definition of the specialty, options for increasingly specific areas and an activity that offers a better quality of life.

Profile of the General Surgery resident: what are the changes in the 21 st Century? / Perfil do residente de Cirurgia Geral: quais as mudanças no Século XXI?

ABSTRACT Objective: to verify the profile of the General Surgery residents of the Clinics Hospital (HC) of the Faculty of Medicine of the University of São Paulo (FMUSP). Methods: we evaluated the residents approved in the public contest for the Medical Residency Program in General Surgery of HC-FMUSP in the years 2014, 2015 and 2016. We carried out the study by applying a questionnaire and gathering information from the Medical Residency Commission of the Institution. We analyzed data on identification, origin of the candidate, undergraduate school, surgical teaching received, reason for choosing Surgery, residency expectations, choice of future specialty and pretensions as to the end of medical residency. We also analyzed the result of the examination of access to specialties. Results: the mean age was 25.8 years; 74.3% of residents were male. The majority (84.4%) had attended public medical schools, 68% of which were not in the Southeast region; 85,2% of the residents were approved in the first contest. The specialty choice was present for 75.9% of individuals at the beginning of the residency program, but 49.5% changed their minds during training. Plastic Surgery, Urology and Digestive System Surgery were chosen by 61.5%. Sixty hours per week work were considered adequate by 83.3%; 27.3% favored direct access to the specialty. At the end of the specialty, 53.3% intended to continue in São Paulo, and 26.2%, to return to their State of origin. A strict-sense post-graduate course was intended by 68.3%. Conclusion: the current profile of the resident reveals a reduction in the demand for General Surgery, an earlier definition of the specialty, options for increasingly specific areas and an activity that offers a better quality of life.

RESUMO Objetivo: verificar o perfil dos residentes de Cirurgia Geral do Hospital das Clínicas (HC) da Faculdade de Medicina da Universidade de São Paulo (FMUSP). Métodos: foram avaliados os residentes aprovados no concurso do Programa de Residência Médica em Cirurgia Geral do HC-FMUSP nos anos de 2014, 2015 e 2016. O estudo foi realizado por meio de coleta de dados de questionário e informações obtidas da Comissão de Residência Médica da Instituição. Foram analisados: dados da identificação, origem do candidato, escola da graduação, ensino cirúrgico recebido, razão da escolha pela Cirurgia, expectativas na residência, escolha da especialidade futura e pretensões ao término da residência médica. Também foi analisado o resultado do exame de acesso às especialidades. Resultados: a média de idade foi de 25,8 anos, sendo 74,3% do sexo masculino. A maioria (84,4%) cursou a graduação em escolas públicas, sendo 68% no Sudeste; 85,2% dos residentes foram aprovados no primeiro concurso. A escolha da especialidade estava definida em 75,9% no início da residência, porém 49,5% mudaram ao longo do treinamento. Cirurgia Plástica, Urologia e Cirurgia do Aparelho Digestivo foram escolhidas por 61,5%. Consideraram adequadas as 60 horas semanais 83,3%. Eram favoráveis ao acesso direto à especialidade 27,3%. Ao término da especialidade, 53,3% pretendiam continuar em São Paulo e 26,2% retornar ao Estado de origem. A pós-graduação stricto sensu era pretendida por 68,3%. Conclusão: o perfil atual do residente revela redução na procura pela Cirurgia Geral, definição mais precoce da especialidade, opções por áreas cada vez mais específicas e uma atividade que ofereça melhor qualidade de vida.

Very short cycles of postconditioning have no protective effect against reperfusion injury. Experimental study in rats / Ciclos muito curtos de pós-condicionamento não protegem contra lesão de reperfusão. Estudo experimental em ratos

Introduction: Ischemic postconditioning has been recognized as effective in the prevention of reperfusion injury in situations of ischemia and reperfusion in various organs and tissues. However, it remains unclear what would be the best way to accomplish it, since studies show great variation in the method of their application. Objective: To assess the protective effect of ischemic postconditioning on ischemia and reperfusion in rats undergoing five alternating cycles of reperfusion and ischemia of 30 seconds each one. Methods: We studied 25 Wistar rats distributed in three groups: group A (10 rats), which underwent mesenteric ischemia (30 minutes) and reperfusion (60 minutes); Group B (10 rats), undergoing ischemia (30 minutes) and reperfusion (60 minutes), intercalated by postconditioning (5 alternating cycles of reperfusion and ischemia of 30 seconds each one); and group C - SHAM (5 rats), undergoing only laparotomy and manipulation of mesenteric artery. All animals underwent resection of an ileum segment for histological analysis. Results: The mean lesions degree according to Chiu et al. were: group A, 2.77, group B, 2.67 and group C, 0.12. There was no difference between groups A and B (P>0.05). Conclusion: Ischemic postconditioning was not able to minimize or prevent the intestinal tissue injury in rats undergoing ischemia and reperfusion process when used five cycles lasting 30 seconds each one. .

Introdução: O pós-condicionamento isquêmico tem sido reconhecido como eficaz na prevenção das lesões de reperfusão em situações de isquemia e reperfusão em vários órgãos e tecidos. Entretanto, não está ainda claro qual seria a melhor maneira de realizá-lo, já que as publicações mostram grande variação de método no seu emprego. Objetivo: Avaliar o efeito protetor do pós-condicionamento isquêmico na isquemia e reperfusão intestinal em ratos, através de cinco ciclos alternados de 30 segundos de isquemia e 30 segundos de reperfusão. Métodos: Foram estudados 25 ratos Wistar, distribuídos em três grupos: grupo A (10 ratos), em que se realizou isquemia (30 minutos) e reperfusão (60 minutos) mesentérica; grupo B (10 ratos), isquemia e reperfusão, seguidos de pós-condicionamento isquêmico com 5 ciclos alternados de reperfusão e reoclusão, de 30 segundos cada; e grupo C (5 ratos), controle (SHAM). Ao final, ressecou-se um segmento do intestino delgado para análise histológica. Avaliaram-se os resultados pela classificação de Chiu et al. e procedeu-se ao tratamento estatístico. Resultados: As médias dos graus de lesão tecidual segundo a classificação de Chiu et al. foram: no grupo A, 2,77; no grupo B, 2,67; e no grupo C, 0,12. A diferença entre o resultado do grupo A com o resultado do grupo B não teve significância estatística (P>0,05). Conclusão: O pós-condicionamento isquêmico não foi capaz de minimizar ou prevenir a lesão tecidual intestinal de ratos submetidos ao processo de isquemia e reperfusão mesentérica quando utilizados cinco ciclos com duração de 30 segundos cada. .

Very short cycles of postconditioning have no protective effect against reperfusion injury. Experimental study in rats.

INTRODUCTION: Ischemic postconditioning has been recognized as effective in the prevention of reperfusion injury in situations of ischemia and reperfusion in various organs and tissues. However, it remains unclear what would be the best way to accomplish it, since studies show great variation in the method of their application. OBJECTIVE: To assess the protective effect of ischemic postconditioning on ischemia and reperfusion in rats undergoing five alternating cycles of reperfusion and ischemia of 30 seconds each one. METHODS: We studied 25 Wistar rats distributed in three groups: group A (10 rats), which underwent mesenteric ischemia (30 minutes) and reperfusion (60 minutes); Group B (10 rats), undergoing ischemia (30 minutes) and reperfusion (60 minutes), intercalated by postconditioning (5 alternating cycles of reperfusion and ischemia of 30 seconds each one); and group C - SHAM (5 rats), undergoing only laparotomy and manipulation of mesenteric artery. All animals underwent resection of an ileum segment for histological analysis. RESULTS: The mean lesions degree according to Chiu et al. were: group A, 2.77, group B, 2.67 and group C, 0.12. There was no difference between groups A and B (P>0.05). CONCLUSION: Ischemic postconditioning was not able to minimize or prevent the intestinal tissue injury in rats undergoing ischemia and reperfusion process when used five cycles lasting 30 seconds each one.

Experimental model of anal fistula in rats / Modelo experimental de fistula anal em ratos

INTRODUCTION: the management of anal fistula remains debatable. The lack of a standard treatment free of complications stimulates the development of new options. OBJECTIVE: to develop an experimental model of anal fistula in rats. METHODS: to surgically create an anal fistula in 10 rats with Seton introduced through the anal sphincter musculature. The animals were euthanized for histological fistula tract assessment. RESULTS: all ten specimens histologically assessed had a lumen and surrounding granulation tissue. There was complete epithelialization of the tract in two samples, halfway epithelialization in one sample and epithelialization of only the outer portion in six samples. Epithelialization was not evident in one tract. CONCLUSION: anal fistulas in rats were histologically proved. (AU)

INTRODUÇÃO: o manejo da fístula anal ainda permanece um debate. A ausência de um tratamento ideal isento de complicações estimula o desenvolvimento de novas modalidades terapêuticas. OBJETIVO: desenvolver um modelo experimental de fístula anal em ratos. METODOLOGIA: criação de fístula anal cirúrgica em 10 ratos por meio de passagem de fio de aço através da musculatura do esfíncter anal. Os animais foram submetidos a eutanásia para comprovação histológica do trajeto fistuloso. RESULTADOS: todos os segmentos analisados histologicamente apresentaram lúmen e tecido de granulação. Houve epitelização completa do trajeto em dois espécimes, epitelização até a metade do trajeto em um, e epitelização somente da porção externa em seis. Um trajeto não apresentou área de epitelização. CONCLUSÃO: o desenvolvimento de fístula anal em ratos foi comprovado histologicamente. (AU)