Percutaneous Cryoablation versus Robot-Assisted Partial Nephrectomy of Renal T1A Tumors: a Single-Center Retrospective Cost-Effectiveness Analysis.

PURPOSE: To evaluate the cost-effectiveness of percutaneous cryoablation (PCA) versus robot-assisted partial nephrectomy (RPN) in patients with small renal tumors (T1a stage), considering perioperative complications. MATERIALS AND METHODS: Retrospective study from November 2008 to April 2017 of 122 patients with a T1a renal mass who after being analyzed by a multidisciplinary board underwent to PCA (59 patients) or RPN (63 patients). Hospital costs in US dollars, and clinical and tumor data were compared. Non-complicated intervention was considered as an effective outcome. A hypothetical model of possible complications based on Clavien-Dindo classification (CDC) was built, grouping them into mild (CDC I and II) and severe (CDC III and IV). A decision tree model was structured from complications of published data. RESULTS: Patients who underwent PCA were older (62.5 vs. 52.8 years old, p < 0.001), presented with more coronary disease and previous renal cancer (25.4% vs. 10.1%, p = 0.023 and 38% vs. 7.2%, p < 0.001, respectively). Patients treated with PCA had a higher preoperative risk (American Society of Anesthesiologists-ASA ≥ 3) than those in the RPN group (25.4% vs. 0%, p < 0.001). Average operative time was significantly lower with PCA than RPN (99.92 ± 29.05 min vs. 129.28 ± 54.85 min, p < 0.001). Average hospitalization time for PCA was 2.2 ± 2.95 days, significantly lower than RPN (mean 3.03 ± 1.49 days, p = 0.04). The average total cost of PCA was significantly lower than RPN (US$12,435 ± 6,176 vs. US$19,399 ± 6,047, p < 0.001). The incremental effectiveness was 5% higher comparing PCA with RPN, resulting a cost-saving result in favor of PCA. CONCLUSION: PCA was the dominant strategy (less costly and more effective) compared to RPN, considering occurrence of perioperative complications.

Imaging response predictors following drug eluting beads chemoembolization in the neoadjuvant liver transplant treatment of hepatocellular carcinoma.

BACKGROUND: Drug-eluting bead transarterial chemoembolization (DEB-TACE) is an endovascular treatment to release chemotherapeutic agents within a target lesion, minimizing systemic exposure and adverse effects to chemotherapeutics. Therefore, identifying which patient characteristics may predict imaging response to DEB-TACE can improve treatment results while selecting the best candidates. Predictors of the response after DEB-TACE still have not been fully elucidated. This is the first prospective study performed with standardized DEB-TACE technique that aim to identify predictors of radiological response, assessing patients clinical and laboratory characteristics, diagnostic imaging and intraprocedure data of the hepatocellular carcinoma treated in the neoadjuvant context for liver transplantation. AIM: To identify pre- and intraoperative clinical and imaging predictors of the radiological response of drug-eluting bead transarterial chemoembolization (DEB-TACE) for the neoadjuvant treatment of hepatocellular carcinoma (HCC). METHODS: This is prospective, cohort study, performed in a single transplant center, from 2011 to 2014. Consecutive patients with HCC considered for liver transplant who underwent DEB-TACE in the first session for downstaging or bridging purposes were recruited. Pre and post-chemoembolization imaging studies were performed by computed tomography or magnetic resonance. The radiological response of each individual HCC was evaluated by objective response using mRECIST and the percentage of necrosis. RESULTS: Two hundred patients with 380 HCCs were examined. Analysis of the objective response (nodule-based analysis) demonstrated that HCC with pseudocapsules had a 2.01 times greater chance of being responders than those without pseudocapsules (P = 0.01), and the addition of every 1mg of chemoembolic agent increased the chance of therapeutic response in 4% (P < 0.001). Analysis of the percentage of necrosis through multiple linear regression revealed that the addition of each 1mg of the chemoembolic agent caused an average increase of 0.65% (P < 0.001) in necrosis in the treated lesion, whereas the hepatocellular carcinoma with pseudocapsules presented 18.27% (P < 0.001) increased necrosis compared to those without pseudocapsules. CONCLUSION: The presence of a pseudocapsule and the addition of the amount of chemoembolic agent increases the chance of an objective response in hepatocellular carcinoma and increases the percentage of tumor necrosis following drug-eluting bead chemoembolization in the neoadjuvant treatment, prior to liver transplantation.

Minilaparoscopic lumbar sympathectomy with 3 mm instruments for plantar hyperhidrosis.

Severe palmoplantar hyperhidrosis affects about 1.5-2.8% of the general population. Plantar hyperhidrosis (PHH) is related to foot odor, cold feet, skin lesions and infections, and even instability when walking. Endoscopic Lumbar Sympathectomy (ELS) is the treatment of choice for this condition. However, few surgeons have used this technique over the past 20 years because of its technical difficulty. Two and 3 mm instruments, rather than the standard 5 mm instruments, have been used to improve the results of several standard laparoscopic procedures. Use of these minilaparoscopic instruments to perform ELS so far has not yet been published. We describe a technique for ELS using minilaparocopic instruments, which we have used for our last 70 cases and has become our standard technique. The aim of this study is to demonstrate the feasibility of this technique and its advantages compared to the conventional technique.

A hiperidrose palmoplantar grave afeta cerca de 1,5-2,8% da população geral. A hiperidrose plantar está relacionada a odor dos pés, pés frios, lesões cutâneas, infecções, e até instabilidade da marcha. A simpatectomia lombar endoscópica (endoscopic lumbar sympathectomy, ELS) é o tratamento de escolha para essa condição; entretanto, tem sido utilizada por poucos cirurgiões nos últimos 20 anos, devido à sua dificuldade técnica. Instrumentos de 2 e 3 mm em vez de 5 mm vêm sendo utilizados para melhorar os resultados de vários procedimentos laparoscópicos padrão. O uso desses instrumentos para realizar ELS ainda não foi descrito. Descrevemos a técnica para ELS usando microinstrumentos, a qual vem sendo usada para os nossos últimos 70 casos, pois passou a ser nosso procedimento padrão. O objetivo deste estudo é apresentar a experiência com essa modificação técnica, assinalando as vantagens em relação à técnica tradicional.

Minilaparoscopic lumbar sympathectomy with 3 mm instruments for plantar hyperhidrosis / Simpatectomia lombar endoscópica com microinstrumental de 3 mm para hiperidrose plantar

Abstract Severe palmoplantar hyperhidrosis affects about 1.5-2.8% of the general population. Plantar hyperhidrosis (PHH) is related to foot odor, cold feet, skin lesions and infections, and even instability when walking. Endoscopic Lumbar Sympathectomy (ELS) is the treatment of choice for this condition. However, few surgeons have used this technique over the past 20 years because of its technical difficulty. Two and 3 mm instruments, rather than the standard 5 mm instruments, have been used to improve the results of several standard laparoscopic procedures. Use of these minilaparoscopic instruments to perform ELS so far has not yet been published. We describe a technique for ELS using minilaparocopic instruments, which we have used for our last 70 cases and has become our standard technique. The aim of this study is to demonstrate the feasibility of this technique and its advantages compared to the conventional technique.

Resumo A hiperidrose palmoplantar grave afeta cerca de 1,5-2,8% da população geral. A hiperidrose plantar está relacionada a odor dos pés, pés frios, lesões cutâneas, infecções, e até instabilidade da marcha. A simpatectomia lombar endoscópica (endoscopic lumbar sympathectomy, ELS) é o tratamento de escolha para essa condição; entretanto, tem sido utilizada por poucos cirurgiões nos últimos 20 anos, devido à sua dificuldade técnica. Instrumentos de 2 e 3 mm em vez de 5 mm vêm sendo utilizados para melhorar os resultados de vários procedimentos laparoscópicos padrão. O uso desses instrumentos para realizar ELS ainda não foi descrito. Descrevemos a técnica para ELS usando microinstrumentos, a qual vem sendo usada para os nossos últimos 70 casos, pois passou a ser nosso procedimento padrão. O objetivo deste estudo é apresentar a experiência com essa modificação técnica, assinalando as vantagens em relação à técnica tradicional.

Risk factors, surgical complications and graft survival in liver transplant recipients with early allograft dysfunction.

BACKGROUND: Early allograft dysfunction (EAD) is a severe complication after liver transplantation. The associated risk factors and complications have re-gained recent interest. This study investigated risk factors, survival and complications associated with EAD in a large liver transplant center in Latin America. METHODS: Retrospective, unicenter, cohort, based on data from adult patients undergoing first deceased-donor liver transplant from January 2009 to December 2013. EAD was defined by one or more of the following: (i) bilirubin ≥10 mg/dL on postoperative day 7; (ii) international normalized ratio ≥1.6 on postoperative day 7, and (iii) alanine aminotransferase or aspartate aminotransferase >2000 IU/L within the first seven days after transplant. RESULTS: A total of 602 patients were included; of these 34.2% developed EAD. Donor risk factors were male (P = 0.007), age between 50 and 59 years (P = 0.034), overweight (P = 0.028) or grade I obesity (P = 0.012), sodium >157 mmol/L (P = 0.002) and grade IV ischemia/reperfusion injury (P = 0.002). Cold ischemia time ≥10 h (P = 0.008) and warm ischemia time ≥40 min (P = 0.013) were the surgical factors. Male (P <0.001) was the only recipient protective factor. Compared with the non-EAD group, patients with EAD were submitted to more reoperations (24.3% vs. 13.4%, P = 0.001) and had higher graft loss rates (37.9% vs. 21.2%, P <0.001), with similar patient survival rates (P = 0.238). CONCLUSIONS: EAD risk factors are related to donor, surgical procedure and recipient. Donor risk factors for EAD were male, age between 50 and 59 years, donor overweight or grade I obesity, sodium >157 mmol/L and grade IV ischemia/reperfusion injury. Cold ischemia time ≥10 h and warm ischemia time ≥40 min were the surgical risk factors. Male was the only recipient protective factor. Patients with EAD had higher reoperations and graft loss rates.

THE IMPACT OF THE USE OF SYMBIOTICS IN THE PROGRESSION OF NONALCOHOLIC FATTY LIVER DISEASE IN A RAT MODEL.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is characterized by accumulation of intrahepatic lipid. The use of live microorganisms promotes beneficial effects; however, the use of symbiotic and its role in NAFLD is not yet fully understood. AIM: Verify if the symbiotic administration influences the occurrence and progression of NAFLD in rats, after induction of hepatic steatosis by high calorie diet. METHOD: Forty-five rats were divided into four groups: G1 (control); G2 (control+symbiotic); G3 (high calorie+symbiotic) and G4 (high calorie), and euthanized after 60 days of diet. Liver disease was evaluated by biochemical analysis, IL6 measurement and histological assessment. RESULTS: Symbiotic had influence neither on weight gain, nor on coefficient dietary intake in G3 and G4. G2 had the greatest weight gain, while G1 had the highest coefficient dietary intake between groups. G1 showed higher expression of aspartate aminotransferase than those from G2 (150±35 mg/dl, and 75±5 mg/dl) while G4 showed higher expression of the enzyme compared to G3 (141±9.7 mg/dl to 78±4 mg/dl). Liver histology showed different stages of NAFLD between groups. G4 animals showed increased serum interleukin-6 when compared to G3 (240.58±53.68 mg/dl and 104.0±15.31 mg/dl). CONCLUSION: Symbiotic can reduce hepatic aminotransferases and interleukin-6 expression. However, the histology showed that the symbiotic was not able to prevent the severity of NAFLD in rats.

The impact of the use of symbiotics in the progression of nonalcoholic fatty liver disease in a rat model / Impacto do uso de simbiótico na doença hepática gordurosa não alcoólica em modelo de ratos

ABSTRACT Background: Non-alcoholic fatty liver disease (NAFLD) is characterized by accumulation of intrahepatic lipid. The use of live microorganisms promotes beneficial effects; however, the use of symbiotic and its role in NAFLD is not yet fully understood. Aim: Verify if the symbiotic administration influences the occurrence and progression of NAFLD in rats, after induction of hepatic steatosis by high calorie diet. Method: Forty-five rats were divided into four groups: G1 (control); G2 (control+symbiotic); G3 (high calorie+symbiotic) and G4 (high calorie), and euthanized after 60 days of diet. Liver disease was evaluated by biochemical analysis, IL6 measurement and histological assessment. Results: Symbiotic had influence neither on weight gain, nor on coefficient dietary intake in G3 and G4. G2 had the greatest weight gain, while G1 had the highest coefficient dietary intake between groups. G1 showed higher expression of aspartate aminotransferase than those from G2 (150±35 mg/dl, and 75±5 mg/dl) while G4 showed higher expression of the enzyme compared to G3 (141±9.7 mg/dl to 78±4 mg/dl). Liver histology showed different stages of NAFLD between groups. G4 animals showed increased serum interleukin-6 when compared to G3 (240.58±53.68 mg/dl and 104.0±15.31 mg/dl). Conclusion: Symbiotic can reduce hepatic aminotransferases and interleukin-6 expression. However, the histology showed that the symbiotic was not able to prevent the severity of NAFLD in rats.

RESUMO Racional: A doença hepática gordurosa não alcoólica (DHGNA) é caracterizada por acúmulo de lipídios intra-hepáticos. O uso de microrganismos vivos promove diversos efeitos benéficos; porém, a utilização de simbióticos e sua atuação na DHGNA ainda não está totalmente esclarecida. Objetivo: Verificar se a administração de simbióticos influencia na ocorrência e na progressão da DHGNA em ratos, após a indução de esteatose hepática por dieta hipercalórica. Método: Quarenta e cinco ratos Wistar foram divididos em quatro grupos: G1 (controle); G2 (controle+simbiótico); G3 (hipercalórica+ simbiótico) e G4 (hipercalórica), e eutanasiados após 60 dias de dieta. Coleta de sangue foi realizada para obtenção de análises bioquímicas e dosagem de IL6, e de tecido para análise histológica do fígado. Resultados: O simbiótico não influenciou no ganho de peso e no coeficiente de consumo alimentar nos grupos G3 e G4. Já G2 obteve maior ganho de peso, enquanto G1 apresentou o maior coeficiente de consumo alimentar entre os grupos. G1 apresentou maior expressão de aspartato aminotransferase em relação ao G2 (150±35 mg/dl e 75±5 mg/dl), enquanto G4 teve maior expressão desta enzima em relação ao G3 (141±9,7 mg/dl e 78±4 mg/dl,). A análise histológica hepática mostrou diferentes estágios de evolução da DHGNA entre os grupos. Animais do G4 apresentaram aumento sérico de interleucina-6 quando comparados a G3 (240,58±53,68 mg/dl, e 104,0±15,31 mg/dl). Conclusão: Os simbióticos reduziram aminotransferases hepáticas e a expressão de interleucina-6. No entanto, a histopatologia demonstrou que o simbiótico não foi capaz de prevenir a severidade da DHGNA em ratos.

Human Lymph Node-Derived Fibroblastic and Double-Negative Reticular Cells Alter Their Chemokines and Cytokines Expression Profile Following Inflammatory Stimuli.

Lymph node (LN) is a secondary lymphoid organ with highly organized and compartmentalized structure. LNs harbor B, T, and other cells among fibroblastic reticular cells (FRCs). FRCs are characterized by both podoplanin (PDPN/gp38) expression and by the lack of CD31 expression. FRCs are involved in several immune response processes but mechanisms underlying their function are still under investigation. Double-negative cells (DNCs), another cell population within LNs, are even less understood. They do not express PDPN or CD31, their localization within the LN is unknown, and their phenotype and function remain to be elucidated. This study evaluates the gene expression and cytokines and chemokines profile of human LN-derived FRCs and DNCs during homeostasis and following inflammatory stimuli. Cytokines and chemokines secreted by human FRCs and DNCs partially diverged from those identified in murine models that used similar stimulation. Cytokine and chemokine secretion and their receptors expression levels differed between stimulated DNCs and FRCs, with FRCs expressing a broader range of chemokines. Additionally, dendritic cells demonstrated increased migration toward FRCs, possibly due to chemokine-induced chemotaxis since migration was significantly decreased upon neutralization of secreted CCL2 and CCL20. Our study contributes to the understanding of the biology and functions of FRCs and DNCs and, accordingly, of the mechanisms involving them in immune cells activation and migration.

An analysis of the quality indicators of the organ donation process in São Paulo, Brazil.

BACKGROUND: Few studies have investigated whether quality initiatives in the process of organ donation yield better results of the organ donation process. OBJECTIVE: To analyze whether the indicators of the organ donation process in Brazilian hospitals meet the standards established by the Organ Donation European Quality System (ODEQUS). DESIGN: We evaluated the quality of the organ donation in a selected group of Brazilian hospitals served by the Nucleus of Organ Procurement (NOP) using standards of the ODEQUS. RESULTS: Structural and process indicators had 100% conformity. Indicators of results showed a family consent rate of 61% (29% lower than ODEQUS goal); a conversion rate of potential donors to effective donors of 47% (28% below the goal); and a 12% rate of sudden cardiac arrest (higher than the quality limit). CONCLUSIONS: Our findings highlight the importance for the development of quality initiatives in identifying gaps and weaknesses in the process that should be corrected or even restructured, therefore maximizing the number of donors and organs transplanted. Hospitals that participate in the NOP process met 61% of the quality indicators proposed by ODEQUS. Identification of potential donors, family consent, conversion, and sudden cardiac arrest rates are areas that did not conform to ODEQUS standard and revealed a great opportunity for improvement.

Novos conceitos do mecanismo de ação do anticorpo monoclonal anti-CD45RB no transplante de Ilhotas de Langerhans em camundongos / New concept in the mechanism of action of the monoclonal antibody anti-CD45RB on Islet Transplantation in mice

Os objetivos do presente estudo foram avaliar a cinética dos linfócitos CD4+ CD45RBlow CRLA-4+ e se os mesmos melhoram a sobrevida do aloenxerto de ilhotas de Langerhans; analisar os efeitos da administração de um esquema com múltiplas doses de anti-CD45RB na sobrevida do aloenxerto de ilhotas de Langerhans e analisar o papel do timo e da exposição do antígeno do doador no mecanismo de ação de anti-CD45RB. Foram utilizados camundongos machos BALB/c; C57BL/6b; e dba/1 com 6-8 semanas de vida. Animais receberam anticorpo monoclonal anti-CD45RB via retrorbital na dose de 100ug nos dias -1, 0 e 5 transplante. Os animais receberam o enxerto no dia zero. Realizou-se timectomia por sucção no dia -7. Exposição ao aloantígeno foi realizada no dia zero atravé da injeção de 50 ilhotas de Langerhans no receptor. Novas dosagens de anti-CD45RB foram realizadas através da injeção intraperitoneal de 100ug a cada 15 dias. A cinética da expressão das formas de CD45RB eCTLA-4 em linfócitos T CD4+ foi avaliada por fenotipagem seriada dos esplenócitos de camundongos, imunofluorescência direta e citometria de fluxo até que se encontre o dia do retorno da expressão das formas de CD45RB e CTLA-4 ao nível basal. Diabetes química foi induzida nos animais através da injeção de estreptozocina. O pâncreas dos doadores foi digerido com injeção de colagenase e as ilhotas de Langerhans foram purificadas e transplantadas na loja subcapsular renal. Glicemia acima de 250 mg/dl foi considerada rejeição aguda ao enxerto. Realizou-se uma comparação dois a dois dos grupos de animais submetidos ao transplante de ilhotas de Langerhans em relação à variável tempo de sobrevida dos enxertos, utilizando-se o teste não-paramétrico log-rank. Os resultados demonstraram que a alteração da expressão das formas de CD45RB e de CTLA-4 persiste por 17 dias. Camundongos que receberam tratamento standard com anti-CD45RB seguido de dosagem a cada 15 dias apresentaram menor índice de rejeição aguda precoce, mas este novo esquema terapêutico não aumentou a sobrevida do aloenxerto de ilhotas de Langerhans e não gerou um novo aumento da expressão de CTLA-4. Timectomia alterou a expressão das formas de CD45RB e de CTLA-4 por um período prolongado, mas não possibilitou um aumento da sobrevida do aloenxerto de ilhotas de Langerhans

Complicações vasculares pós-transplante hepático / Vascular complications after liver transplantation

Objetivo: O objetivo do estudo é apresentar as complicações vasculares arteriais e venosas observadas em um serviço de transplante hepático universitário brasileiro. Métodos: Os prontuários de todos os pacientes submetidos a transplante hepático no período de setembro de 1991 a janeiro de 2000 foram analisados para determinar as complicações vasculares e correlacioná-las a dados clínicos e do procedimento cirúrgico. Resultados:Foram realizados 169 transplantes, sendo quatro inter vivos e nove retransplantes. Um total de 24 complicações vasculares (14,3%) foi identificado em 22 pacientes (13,0%). A complicação vascular mais comum foi atrombose da artéria hepática (15 casos), seguido da trombose da veia porta (quatro casos). Complicações da veia cava inferior infra ou supra-hepática foram incomuns, ocorrendo em um total de três casos (1,8%). As complicações vasculares foram mais freqüentes nas crianças (26,06%) do que em adultos (13,14%) (p<0,05). Dos pacientes com trombose da artéria hepática, um foi submetido à angioplastia, um a trombectomia, oito a retransplante e cinco evoluíram para o óbito enquanto aguardavam retransplante. Dos quatro casos de trombose da veia porta, dois foram a óbito, um foi submetido à colocação percutânea de prótese e um a tratamento conservador. Os pacientescom estenose da veia porta e da veia cava inferior infra e supra-hepática foram submetidos a tratamento conservador, com boa evolução clínica. Conclusões: que as complicações vasculares são freqüentes após o transplante hepático, principalmente em crianças, e são associadas à elevada morbidade, mortalidade e retransplante.

Background: The authors present the vascular complications observed in an academic Brazilian hepatic transplantation division. Methods: Hospital charts of all patients who were submitted to a liver transplantation between of September 1991 and January 2000, were evaluated to determine vascular complications and to correlated them to clinical data and surgical procedures. Results: Of a total of 169 tranplantations performed, four were from living related donors and 9 retransplantations. Twenty-four vascular complications (14,3%) were identified in 22 patients (13,0%), the most common being hepatic artery thrombosis (15 cases) and portal vein thrombosis (4 cases). Complications of the infra and suprahepatic vena cava were observed in three cases (1,8%). Vascular complications were more common in children (26,06%) than in adults (13,14%) (p<0,05). From the patients with hepatic artery thrombosis, one was submitted to an angioplasty, one to a thrombectomy, while eight underwent retransplantation and five died waiting for retransplantation. Of the patients with portal vein thrombosis, two died, one submitted to an endovascular stent placement, and one to conservative treatment. Patients with stenosis of the portal vein and of the infra and suprahepatic inferior vena cava received a conservative treatment, with good clinical recovery. Conclusion: Vascular complications are frequent after liver transplantation, mainly withchildren. They are associated with an elevated rate of morbidity, mortality and retransplantation.

Colecistite aguda alitiásica pós-papilotomia endoscópica / Acute acalculous cholecystitis after endoscopic sphincterotomy

O objetivo do presente trabalho é descrever o caso de um paciente de 45 anos de idade que apresentou colecistite aguda alitiásica quatro anos após papilotomia endoscópica. O paciente apresentou vários episódios de dor no hipocôndrio direito. A ultra-sonografia abdominal evidenciou vesicula biliar com paredes espessadas, sem imagem de colelitíase ou barro biliar. Durante a colecistectomia laparoscópica, a vesícula biliar apresentava-se distendida, tensa, com edema de parede i intenso bloqueio inflamatório perivesicular. O exame anatomopatológico confirmou o diagnóstico de colecistite aguda alitiásica. Colecistite aguda pode ocorrer após papilotomia endoscópica em pacientes com vesícula biliar in situ, msemo anos após o procedimento

Perfuraçäo gástrica secundária a tricobezoar gigante: descriçäo de caso e revisäo da literatura / Gastric perforation caused by giant trychobezoar: a case report and a review of the literature

Gastric bezoars are impactations of foreign material in the stomach. When they are caused by hair, they are named trichobezoars. The complications of trichobezoars are very rare. In this paper, we describe a case of a 16-year-old girl that had a previous history of tricophagia, and had an acute abdominal pain with a pneumoperitoneum in the abdomen radiography. An operation was performed and a gastric perforation was founded associated with a giant trichobezoar. The trichobezoar was removed by traction through a gastrostomy which was performed in order to remove the trichobezoar. Some fragments of the ulcer were obtained to histological study. The gastrostomy was treated by a gastrorraphy confection. In the postoperative period a left subfrenic abscess was revealed and has been drained by laparatomy 15 days after the first operation. After the second surgical procedure the patient had a good evolution, and left the hospital in good health conditions

Linfangioma de cordäo espermático / Lymphangioma of the spermatic cord

We describe a case of a 22-year-old man that had been submitted to a left herniorraphy 11 years previously to the present admission. He returned to our hospital with another mass in the same side of the groin. At operation, several small cysts linked to the spermatic cord were demonstrated. At this time, an histological exam demonstrated the presence of conective tissue. The final histology report confirmed the diagnosis of lymphangioma of the spermatic cord in the groin region. The patient was discharged from the hospital in a good health, with no complications

Indicaçöes e complicaçöes das derivaçöes biliodigestivas / Bilioenteric anastomosis: indications and complications

O objetivo do estudo é avaliar as indicaçöes mais frequentes das derivaçöes biliodigestivas e verificar quais säo os tipos mais realizados, seus resultados e complicaçöes. Revisou-se os registros dos pacientes submetidos a qualquer tipo de derivaçäo biliodigestiva realizado no serviço de cirurgia do aparelho digestivo do Hospital de Clíncias da Universidade Federal do Paraná, no período de 1 de janeiro de 1985 a 31 de dezembro de 1994. Vinte e cinco (31,6 por cento) homens e 54 (68,4 por cento) mulheres foram submetidos a derivaçäo biliodigestiva. A idade média dos pacientes foi de 54,8 anos. Dor abdominal mostrou ser o sintoma mais prevalente. O diagnóstico pré-operatório mais encontrado foi litíase da via biliar principal (49,4 por cento). A coledocoduodenostomia foi a cirurgia mais realizada. Vinte e cinco (69,6 por cento) pacientes tiveram um pós-operatório sem complicaçöes, e 24 (30,4 por cento) apresentaram algum tipo de complicaçäo. As derivaçöes biliodigestivas constituíram método eficaz de tratamento de diversas doenças e os resultados encontrados no serviço de cirurgia do aparelho digestivo do Hospital de Clínicas da Universidade Federal do Paraná, no que diz respeito às indicaçöes e complicaçöes, estäo em concordância com os da literatura

Síndrome do antro gástrico retido: apresentaçäo de um caso e revisäo dos métodos diangósticos / Retained gastric antrum syndrome: case report and review of the diagnosis methods

A síndrome do antro gástrico retido é uma causa rara de úlcera péptica. Descrevemos o caso de uma paciente de 68 anos de idade que se apresentava com episódios severos de hemorragia digestiva devido a uma úlcera de boca anastomótica após cirurgia gástrica com Y de Roux, e teve diagnóstico de antro retido após a dosagem da gastrina sérica ter sido normal, e uma cintilografia de abdomen com 99m Tc demonstrar a presença de lesäo hepercaptante em hipocôndrio direito. As causas mais comuns de úlcera recorrente säo apresentadas e os exames utilizados para o seu diagnóstico diferencial säo discutidos

Câncer gástrico precoce: apresentaçäo de três casos e revisäo de literatura / Early gastric cancer: presentation of three cases and literature review

Define-se câncer gástrico precoce como aquele limitado às camadas mucosa e submucosa com ou sem invasao de linfonodos adjacentes (1,4,6,9). O prognóstico do câncer gástrico precoce depende da profundidade da lesao e da presença ou nao de comprometimento linfonodal (1,2,4,6,9). Sao descritos três casos de pacientes na sexta e sétima décadas de vida que tiveram diagnóstico anatomopatológico de câncer gástrico precoce após apresentar queixas abdominais inespecíficas ou hemorragia digestiva alta, tendo endoscopia digestiva alta demonstrado lesao ulcerada e/ou adenocarcinoma gástrico. Dois pacientes foram submetidos a gastrectomia à Billroth I, com esvaziamento ganglionar à R2, e o terceiro, a gastrectomia total. Os pacientes receberam alta hospitalar em bom estado geral, evoluindo sem complicaçoes no pós-operatório. O prognóstico dos paciente portadores de adenocarcinoma gástrico depende essencialmente da precocidade do diagnóstico (3,4,6,9). A endoscopia digestiva alta precoce deve ser realizada em pacientes com sintomas dispépticos e dor abdominal para aumentar o número de diagnóstico de câncer gástrico precoce.

Carcinoma epidermóide primário puro de antro gástrico: descriçäo de um caso e revisäo da literatura / Primary squamous cell carcinoma of the antrum of the stomach: report of a case and a review of the literature

O carcinoma epidermóide primário puro do estômago éextremamente raro, embora o carcinoma gástrico permaneça como a neoplasia gastrintestinal mais frequente. Aproximadamente 80 casos de carcinoma epidermoide primário puro do estômago foram descritos. Descrevemos um caso de um paciente masculino de 56 anos de idade, admitido no hospital com dor epigástrica, vômitos, melena e perda de dez quilos de peso nos últimos 4 meses. Ao exame físico näo havia massa abdominal palpável. A gastroscopia demonstrou uma lesäo ulcerada de aproximadamente 3,0 cm de diâmetro no antro gástrico, próximo ao piloro. Biópsias foram realizadas e o estudo histológico demonstrou a presença de carcinoma epidermóide de estomago. A laparotomia, um tumor de aproximadamente 6,0 cm de diâmetro foi encontrado no antro gástrico e uma gastrectomia parcial em Y de Roux foi epidermóide puro primário do estômago com envolvimento de linfonodos locais. O pós-operatório foi sem intercorrências. O paciente foi a óbito dez meses mais tarde devido à doença avançada