Incidental finding of adenocarcinoma in a gallbladder lumen with no wall involvement.

Gallbladder cancer (GBC) is a rare disease characterized by its aggressiveness. Resection with free tumour margins is the sole curative treatment and, in incidental findings, surgical reapproach is recommended for segmentectomy IVb and V or wedge resection of the gallbladder fossa and lymphadenectomy. Here we report a case of gallbladder adenocarcinoma as an incidental finding in a fragment in its lumen with no wall involvement evidentiated. The patient was reoperated for resection of the gallbladder bed with hepatic hilum and cystic duct lymphadenectomy, later evidentiated as free of residual disease. The normality of the bile ducts evidenced by imaging studies, in addition to signs of chronic cholecystitis corroborate to GBC diagnosis. We suspect that the fragment was detached gallbladder polypoid neoplastic lesion. Despite the lack of clinical manifestations, the fast surgical interventions and the histopathological analysis of the material was probably a prognostic determinant for the patient.

Whole-body vibration improves functional capacity and quality of life in patients with severe chronic obstructive pulmonary disease (COPD): a pilot study.

BACKGROUND: Exercise intolerance is a common development in patients with chronic obstructive pulmonary disease (COPD). There is little data on the use of an isolated program using vibration platform training on functional capacity in these patients, which is an area that deserves investigation. AIM: To investigate the effect of training on a vibrating platform (whole-body vibration [WBV]) on functional performance and quality of life of subjects with COPD. METHODS: A randomized controlled crossover pilot study with eleven subjects with COPD (forced expiratory volume in 1 second [FEV1]% predicted =14.63±11.14; forced vital capacity [FVC]% predicted =48.84±15.21; FEV1/FVC =47.39±11.63) underwent a 12-week WBV training program. Participants were randomized into the intervention group (IG) undergoing three sessions per week for a total of 12 weeks and control group (CG) without intervention. We evaluated the 6-minute walk test (6MWT), distance walked (DW), duration of the walk (TW), and index of perceived exertion (IPE), quality of life using St George's Respiratory Questionnaire (SGRQ) and developed a 12-week program of training on a vibrating platform. RESULTS: The mean age was 62.91±8.82 years old (72.7% male). The DW increased at the end of training with a difference between groups of 75 m; all domains of the SGRQ improved at the end of training. The effect size Cohen's d ranged from small to large for all the measured results. CONCLUSION: These preliminary results suggest that WBV may potentially be a safe and feasible way to improve functional capacity in the 6MWT of patients with COPD undergoing a training program on the vibrating platform as well as in all domains of the SGRQ quality of life. However, further studies with a larger number of patients are needed to establish the long-term effect on functional capacity and quality of life in these patients.

Influence of posture on the ventilatory pattern and the thoraco-abdominal kinematics of patients with chronic obstructive pulmonary disease (COPD).

OBJECTIVE: Evaluate the influence of posture on ventilatory pattern, compartmental distribution of volume of chest wall and thoraco-abdominal kinematics of patients with severe chronic obstructive pulmonary disease (COPD). DESIGN: Cross-sectional study. METHODS: Twelve, male patients with severe COPD (Forced Expiratory Volume in the first second (FEV1) = 24.35 ± 4.52%, Forced Vital Capacity% (FVC%) = 60 ± 13.39% and relationship FEV1/FVC = 53.42 ± 14.47). The distribution of the volume of the ribcage [pulmonary rib cage (Rcp), abdominal ribcage (Rca) and abdomen (Ab)] during quiet breathing in a sitting position without back support (SWB), sitting with backrest (SB) and supine position (SUP) was determined using an opto-electronic plethysmograph. RESULTS: The following differences were observed: a greater tidal volume in the SWB position when compared to the SB position (p = 0.01); greater expiratory time in the SUP position in relation to the SWB (p = 0.03) and SB (p = 0.01); and increased abdominal contribution to the tidal volume in the SUP position in relation to the SWB (p < 0.01) and SB (p < 0.001). No difference was found in the thoraco-abdominal synchrony among the positions. CONCLUSION: Sitting position without back support enhances the activation of respiratory muscles by increasing the tidal volume and supine position seems to favor lung deflation by increasing the expiratory time. It seems appropriate to adopt these positions to optimize the ventilation/perfusion relationship and physiotherapeutic intervention in different clinical conditions.

Factors associated with the need for blood transfusion during hysterectomy.

OBJECTIVE: To identify the preoperative clinical conditions associated with the need to perform a blood transfusion among patients undergoing hysterectomy. METHODS: In a retrospective, comparative, case-control trial at the University Hospital, Nuevo León, Mexico, the records of patients who underwent elective hysterectomy between 2007 and 2009 were reviewed. Patients were grouped depending on whether or not they required blood transfusion. Clinical features were compared and statistical analysis was performed via the χ(2) test. RESULTS: Among 794 patients who underwent hysterectomy, 89 (11.2%) required transfusion. The factors significantly associated with transfusion were history of abnormal uterine bleeding (67.0% versus 52.1%), preoperative hemoglobin level (10.1g/dL versus 12.3g/dL), magnitude of intra-operative bleeding (410 mL versus 298 mL), and operative time (172 min versus 144 min); P<0.001. A significant number of patients who underwent transfusion had increased preoperative prothrombin levels; P=0.04. CONCLUSION: Hemoglobin level before surgery and a history of abnormal uterine bleeding can be identified preoperatively and might warn about the possibility of a need for transfusion among patients undergoing hysterectomy. For young patients, alterations in clotting mechanisms should be ruled out.