Endoscopy-assisted laparoscopic wedge-resection of gastric glomus tumor: A case report.

INTRODUCTION: Glomus tumor is a pericytic mesenchymal neoplasm that most commonly occurs in the extremities. The occurrence in visceral organs is rare and is a differential diagnosis with other gastric submucosal tumors. PRESENTATION OF CASE: A woman with epigastric pain underwent esophagogastroduodenoscopy (EGD) which revealed a gastric submucosal tumor. Endoscopic ultrasound with fine-needle aspiration allowed preoperative diagnosis of gastric glomus tumor. Intraoperative EGD-assisted laparoscopic segmental gastrectomy was successfully performed. The patient was discharged in the second postoperative day. There was no evidence of recurrence at 8 months of follow-up. DISCUSSION: The stomach is a rare location for the glomus tumor, a neoplasm of the glomus body, which is a perivascular structure with thermoregulatory function. Preoperative diagnosis is challenging, and endoscopic ultrasound (EUS) is useful for both assessing malignancy-associated features and biopsy guiding. The treatment is surgical resection with attention to adequate oncological margins while preserving healthy gastric wall. CONCLUSION: Immunohistochemical analysis of specimen obtained by EUS fine-needle allows accurate preoperative diagnosis and laparoscopic-endoscopic combined surgery allows good oncological and functional results.

Lymphoepithelial cyst of uncinated process of the pancreas associated with chronic cholecystitis: Case report and review of literature.

Introduction: Lymphoepithelial cysts (LECs) are extremely uncommon disorders with pancreatic affection. It is predominant in middle-aged men and may be located in any portion of the pancreas. Differential diagnosis with malignant conditions is difficult. Case presentation: A 53-year-old woman with abdominal pain and cystic lesion involving pancreas managed thorugh laparoscopic excision and colecistectomy due to chronic cholecystitis. Discussion and conclusion: LECs are a type of true cysts that may occur in any portion of the pancreas, most common sites are the tail and body, with unclear pathogenesis. Accuracy in diagnosis with proper image investigation is necessary to separate surgical cases from conservatively managed.

Brazilian Society of Surgical Oncology consensus on fertility-sparing surgery for cervical cancer.

OBJECTIVE: Several controversies remain on conservative management of cervical cancer. Our aim was to develop a consensus recommendation on important and novel topics of fertility-sparing treatment of cervical cancer. METHODS: The consensus was sponsored by the Brazilian Society of Surgical Oncology (BSSO) from March 2020 to September 2020 and included a multidisciplinary team of 55 specialists. A total of 21 questions were addressed and they were assigned to specialists' groups that reviewed the literature and drafted preliminary recommendations. Further, the coordinators evaluated the recommendations that were classified by the level of evidence, and finally, they were voted by all participants. RESULTS: The questions included controversial topics on tumor assessment, surgical treatment, and surveillance in conservative management of cervical cancer. The two topics with lower agreement rates were the role of minimally invasive approach in radical trachelectomy and parametrial preservation. Additionally, only three recommendations had <90% of agreement (fertility preservation in Stage Ib2, anti-stenosis device, and uterine transposition). CONCLUSIONS: As very few clinical trials have been developed in surgery for cervical cancer, most recommendations were supported by low levels of evidence. We addressed important and novel topics in conservative management of cervical cancer and our study may contribute to literature.

Tecnologia educacional para empoderamento materno na autoeficácia em amamentar / Educational technology for empowerment in maternal breastfeeding self-efficacy

Objetivo: descrever a experiência da elaboração e aplicação de uma tecnologia educativa como forma de promover a autoeficácia materna em amamentar no período pós-parto. Método: trata-se de um estudo descritivo, tipo relato de experiência, sobre o desenvolvimento da tecnologia educativa, no qual se desenvolveram as seguintes etapas: capacitação discente; pesquisa bibliográfica sobre a temática; e elaboração e aplicação da tecnologia educativa com puérperas em puerpério imediato. Resultados: propiciou-se, por meio da tecnologia educativa, um ambiente favorável para o emponderamento das puérperas. Utilizou-se o folder "Toda mulher é capaz de amamentar!", que favoreceu a interatividade, o conhecimento e o debate a respeito da autoeficácia materna para amamentar, criando um ambiente propício ao diálogo acerca de fatores que podem intervir negativamente para a instituição e manutenção do aleitamento materno no período pós-parto. Conclusão: verificou-se que a tecnologia educativa favoreceu o compartilhamento do conhecimento com as puérperas e seus acompanhantes, contribuindo significativamente para o empoderamento materno em amamentar.(AU)

Objective: to describe the experience of the preparation and use of educational technology as a way to promote breastfeeding self-efficacy in the postpartum period. Method: this is an experience report-type descriptive study based on the development of educational technology, in which the following stages were carried out: students' training; bibliographic research on the topic; and preparation and use of educational technology with puerperal women in the immediate postpartum period. Results: a favorable environment for the empowerment of puerperal women was provided through educational technology. We used the folder "Every woman is capable of breastfeeding!", which favored interactivity, knowledge, and debate about breastfeeding self-efficacy, creating a proper environment for dialoguing about factors that may negatively affect breastfeeding during the postpartum period. Conclusion: we observed that the educational technology favored the sharing of knowledge with the puerperal women and their caregivers, contributing significantly to maternal empowerment in breastfeeding.(AU)

Objetivo: describir la experiencia de desarrollar e implementar una tecnología educativa como una forma de promover la auto-eficacia materna en el período de lactancia después del parto. Método: este es un estudio descriptivo, tipo informe de experiencia, sobre el desarrollo de tecnología educativa, en el que se llevaron a cabo las siguientes etapas: capacitación de estudiantes; investigación bibliográfica sobre el tema; y elaboración y aplicación de tecnología educativa con mujeres puérperas durante el puerperio inmediato. Resultados: se proporcionó un entorno favorable para el empoderamiento de las mujeres puérperas a través de la tecnología educativa. Se usó el folleto "¡Toda mujer es capaz de amamantar!", lo que favoreció la interactividad, el conocimiento y el debate acerca de la auto-eficacia para la lactancia materna, creando un ambiente propicio para el diálogo sobre los factores que pueden intervenir negativamente en el mantenimiento de la lactancia materna en el posparto. Conclusión: se encontró que la tecnología educativa favoreció el intercambio de conocimientos con las puérperas y sus compañeros, contribuyendo de manera significativa al empoderamiento materno en la lactancia.(AU)

HMSH2 and HMSH6 gene expression profiles in colorectal adenocarcinoma in patients up to 50 years of age.

Lynch syndrome, previously called hereditary non-polyposis colorectal cancer (HNPCC), is a major mortality threat. It is an autosomal dominant disease which is caused by a germline mutation in the DNA mismatch repair (MMR), especially in patients aged up to 50 years. Such mutation more frequently occurs in the hMSH2 gene (38-40%) and less frequently in the hMSH6 gene (14-16%). These mutations, when associated with the patient's lifestyle, may reveal a considerable variability in the disease manifestations, such as the degrees of penetrance and clinical aggressiveness. The aim of this study is to analyze the expression of DNA MMR genes, and correlate this expression with the clinical and anatomopathological findings of the neoplasia in patients aged between 39 and 49 years. A total of 45 patients were included: (48.9%) males and (51.1%) females, and they all underwent resection of a colorectal adenocarcinoma. The tissue microarray technique was used to analyze the relative and absolute expression of hMSH2 and hMSH6. Amsterdam II criteria for the diagnosis of HNPCC were obtained from the data provided by medical records and interviews with patients. hMSH2 and hMSH6 was expressed in all patients, which correlated between each other (RHO=0.669 and p<0.001) but not to age. There is a positive correlation between the expressions of males (RHO=0.673 and p=0.001) and females (RHO=0.006 and p<0.001). It is possible to evaluate the expression of MMR genes in embedded anatomopathological samples. Gene expressions correlated between each other and to the sex of the patients, but no difference in relation to age.

Resultados del trasplante renal en portadores de ríñones poliquísticos / Outcome of renal transplantation in patients with autosomal dominant polycystic kidney disease

Background: Patients with autosomal dominant polycystic kidney disease (ADPKD) have a better survival in chronic dialysis than patients with other etiologies of renal failure. It has been suggested that extra-renal manifestations of ADPKD may increase the odds of complications and mortality, if these patients are transplanted. Aim: To determine whether survival and complications in transplanted patients with ADPKD are different from kidney graft recipients with other etiologies of renal failure. Subjects and Methods: Four hundred six patients with kidney transplantation were followed in three hospitals between 1976 and 2011 and 19 were carriers of ADPKD. The latter were matched by type of donor, gender, age and date of kidney transplant, with 38 graft recipients with other etiologies of renal failure. Results: Graft and patient 1, 5, 10 and 15 years survival were similar in both groups. Hospitalizations due to viral infections and sepsis were more common in patients with ADPKD. There were no differences in the rate of acute rejection, delayed graft function, cancer, gastrointestinal disorders and hospitalizations due to cardiovascular diseases. The frequency of graft loss due to death with a functioning kidney was similar between both groups. Conclusions: Patient and graft survival in transplanted patients with ADPKD were similar to patients with other etiologies of renal failure. The rate and type of complications were similar between groups with the exception of hospitalizations due to sepsis and viral infections, which were more common in ADPKD patients.

[Outcome of renal transplantation in patients with autosomal dominant polycystic kidney disease]. / Resultados del trasplante renal en portadores de ríñones poliquísticos.

BACKGROUND: Patients with autosomal dominant polycystic kidney disease (ADPKD) have a better survival in chronic dialysis than patients with other etiologies of renal failure. It has been suggested that extra-renal manifestations of ADPKD may increase the odds of complications and mortality, if these patients are transplanted. AIM: To determine whether survival and complications in transplanted patients with ADPKD are different from kidney graft recipients with other etiologies of renal failure. SUBJECTS AND METHODS: Four hundred six patients with kidney transplantation were followed in three hospitals between 1976 and 2011 and 19 were carriers of ADPKD. The latter were matched by type of donor, gender, age and date of kidney transplant, with 38 graft recipients with other etiologies of renal failure. RESULTS: Graft and patient 1, 5, 10 and 15 years survival were similar in both groups. Hospitalizations due to viral infections and sepsis were more common in patients with ADPKD. There were no differences in the rate of acute rejection, delayed graft function, cancer, gastrointestinal disorders and hospitalizations due to cardiovascular diseases. The frequency of graft loss due to death with a functioning kidney was similar between both groups. CONCLUSIONS: Patient and graft survival in transplanted patients with ADPKD were similar to patients with other etiologies of renal failure. The rate and type of complications were similar between groups with the exception of hospitalizations due to sepsis and viral infections, which were more common in ADPKD patients.