Endoscopic self-expandable metal stent versus endoscopy vacuum therapy for traumatic esophageal perforations: a retrospective cohort study.

BACKGROUND: Traumatic esophageal perforations (TEP) are a grave medical condition and require immediate intervention. Techniques such as Esophageal Self-Expandable Metal Stent (E-SEMS) and Endoscopic Vacuum Therapy (EVT) show promise in reducing tissue damage and controlling esophageal leakage. The present study aims to compare the application of EVT to E-SEMS placement in TEP. METHODS: Retrospective cohort study valuated 30 patients with TEP. The E-SEMS and EVT groups were assessed for time of hospitalization, treatment duration, costs, and clinical outcome. RESULTS: Patients treated with EVT (24.4 ± 13.2) demonstrated significantly shorter treatment duration (p < 0.005) compared to the group treated with E-SEMS (45.8 ± 12.9) and patients submitted to E-SEMS demonstrated a significant reduction (p = 0.02) in the time of hospitalization compared to the EVT (34 ± 2 vs 82 ± 5 days). Both groups demonstrated a satisfactory discharge rate (E-SEMS 93.7% vs EVT 71.4%) but did not show statistically significant difference (p = 0.3155). E-SEMS treatment had a lower mean cost than EVT (p < 0.05). Descriptive statistics were utilized, arranged in table form, where frequencies, percentages, mean, median, and standard deviation of the study variables were calculated and counted. The Fisher's Exact Test was used to evaluate the relationship between two categorical variables. To evaluate differences between means and central points, the parametric t-test was utilized. Comparisons with p value up to 0.05 were considered significant. CONCLUSION: E-SEMS showed a shorter time of hospitalization, but a longer duration of treatment compared to EVT. The placement of E-SEMS and EVT had the same clinical outcome. Treatment with E-SEMS had a lower cost compared with EVT.

The role of TNF-α and NFkß in an experimental model of intestinal carcinogenesis with 1,2-dimethyhydrazine.

PURPOSE: To analyze the potential of tumor necrosis factor-α (TNF-α) and factor nuclear kappa B (NF-κB) as colorectal cancer (CRC) biomarkers in an experimental model of intestinal carcinogenesis with 1,2-dimethyhydrazine (1,2-DMH). METHODS: Twenty-four male Wistar rats were divided into two groups: sham and 1,2-DMH. First, 1,2-DMH (20 mg/kg/week) was administered for 15 consecutive weeks. In the 25th week, proctocolectomy was conducted. Histopathological analysis, immunohistochemistry, and gene expression of TNF-α and NF-κB were performed. Statistical analysis was performed using GraphPad Prism. The location of aberrant crypt foci (ACF) was analyzed by Kruskal-Wallis' test. For analyses with two groups with parametric data, the t-test was used; for non-parametric data, the Mann-Whitney's test was used. P < 0.05 was considered significant. RESULTS: The number of ACF and macroscopic lesions was significantly higher (p < 0.5) in the 1,2-DMH group compared to the sham group, and most ACF were concentrated in the distal segment of the colon. There was a statistically significant increase (p < 0.5) in protein and gene expression of TNF-α and NF-κB in the 1,2-DMH group compared to the sham group. CONCLUSIONS: Our results provide supportive evidence that TNF-α and NF-κB pathways are strongly involved in CRC development in rats and might be used as early biomarkers of CRC pathogenesis in experimental studies.

Pterostilbene and Probiotic Complex in Chemoprevention of Putative Precursor Lesions for Colorectal Cancer in an Experimental Model of Intestinal Carcinogenesis with 1,2-Dimethylhydrazine.

Dietary supplementation with pterostilbene (PS) and/or a probiotic (PRO) may ameliorate the intestinal microbiota in disease conditions. This study aims to evaluate PS and PRO for the chemoprevention of putative precursor lesions for colorectal cancer (CRC) in an experimental model of intestinal carcinogenesis with 1,2-dimethylhydrazine (1,2-DMH). Sixty male Wistar rats were equally divided into five groups: Sham, 1,2-DMH, 1,2-DMH + PS, 1,2-DMH + PRO, and 1,2-DMH + PS + PRO. PRO (5 × 107/mL) was offered in water, and PS (300 ppm) was provided in the diet ad libitum. 1,2-DMH (20 mg/kg/week) was administered for 15 consecutive weeks. In the 25th week, proctocolectomy was conducted. PRO alone and PRO combined with PS were the best intervention strategies to improve experimental 1,2-DMH-induced CRC regarding several parameters of carcinogenesis. Our findings may contribute to the development of novel preventive strategies for CRC and may help to identify novel modulators of colon carcinogenesis.

The role of TNF-α and NFkß in an experimental model of intestinal carcinogenesis with 1, 2-dimethyhydrazine

ABSTRACT Purpose: To analyze the potential of tumor necrosis factor-α (TNF-α) and factor nuclear kappa B (NF-κB) as colorectal cancer (CRC) biomarkers in an experimental model of intestinal carcinogenesis with 1,2-dimethyhydrazine (1,2-DMH). Methods: Twenty-four male Wistar rats were divided into two groups: sham and 1,2-DMH. First, 1,2-DMH (20 mg/kg/week) was administered for 15 consecutive weeks. In the 25th week, proctocolectomy was conducted. Histopathological analysis, immunohistochemistry, and gene expression of TNF-α and NF-κB were performed. Statistical analysis was performed using GraphPad Prism. The location of aberrant crypt foci (ACF) was analyzed by Kruskal-Wallis' test. For analyses with two groups with parametric data, the t-test was used; for non-parametric data, the Mann-Whitney's test was used. P < 0.05 was considered significant. Results: The number of ACF and macroscopic lesions was significantly higher (p < 0.5) in the 1,2-DMH group compared to the sham group, and most ACF were concentrated in the distal segment of the colon. There was a statistically significant increase (p < 0.5) in protein and gene expression of TNF-α and NF-κB in the 1,2-DMH group compared to the sham group. Conclusions: Our results provide supportive evidence that TNF-α and NF-κB pathways are strongly involved in CRC development in rats and might be used as early biomarkers of CRC pathogenesis in experimental studies.

Effect of co-administration of BRL-37344 and tadalafil on reduction of overactive bladder symptoms after induction of detrusor overactivity in mice1.

PURPOSE: To evaluate the impact of the combination of BRL 37344 and tadalafil (TDF) on the reduction of overactive bladder (OB) symptoms. METHODS: Thirty mice were randomized into 5 groups (G) of 6 animals each. L-NAME was used to induce DO. G1: Control; G2: L-NAME; G3: L-NAME + TDF; G4: L-NAME + BRL 37344; G5: L-NAME + TDF + BRL 37344. After 30 days of treatment, the animals were submitted to cystometry to evaluate non-voiding contractions (NVC), threshold pressure (TP), baseline pressure (BP), frequency of micturition (FM) and threshold volume (TV). Differences between the groups were analyzed with ANOVA followed by the Tukey test. RESULTS: NVC increased in G2 (4.33±2.58) in relation to G1 (1.50±0.55). NVC decreased in G3 (2.00±1.10), G4 (1.50±1.52) and G5 (2.00±1.26) compared to G2 (p<0.05). FM decreased in G3 (0.97±0.71), G4 (0.92±0.38) and G5 (1.05±0.44) compared to G2 (p<0.05). However, the combination of TDF and BRL37344 was not more effective at increasing NVC and improving FM than either drug alone. The five groups did not differ significantly with regard to TV. CONCLUSION: The combination of BRL 37344 and TDF produced no measurable additive effect on reduction of OB symptoms.

Evaluation tool for a gastroenterostomy simulated training1.

PURPOSE: To create a checklist to evaluate the performance and systematize the gastroenterostomy simulated training. METHODS: Experimental longitudinal study of a quantitative character. The sample consisted of twelve general surgery residents. The training was divided into 5 sessions and consisted of participation in 20 gastroenterostomys in synthetic organs. The training was accompanied by an experienced surgeon who was responsible for the feedback and the anastomoses evaluation. The anastomoses evaluated were the first, fourth, sixth, eighth and tenth. A 10 item checklist and the time to evaluate performance were used. RESULTS: Residents showed a reduction in operative time and evolution in the surgical technique statistically significant (p<0.01). The correlation index of 0.545 and 0,295 showed a high linear correlation between time variables and Checklist. The average Checklist score went from 6.8 to 9 points. CONCLUSION: The proposed checklist can be used to evaluate the performance and systematization of a simulated training aimed at configuring a gastroenterostomy.

Effect of co-administration of BRL-37344 and tadalafil on reduction of overactive bladder symptoms after induction of detrusor overactivity in mice

Abstract Purpose: To evaluate the impact of the combination of BRL 37344 and tadalafil (TDF) on the reduction of overactive bladder (OB) symptoms. Methods: Thirty mice were randomized into 5 groups (G) of 6 animals each. L-NAME was used to induce DO. G1: Control; G2: L-NAME; G3: L-NAME + TDF; G4: L-NAME + BRL 37344; G5: L-NAME + TDF + BRL 37344. After 30 days of treatment, the animals were submitted to cystometry to evaluate non-voiding contractions (NVC), threshold pressure (TP), baseline pressure (BP), frequency of micturition (FM) and threshold volume (TV). Differences between the groups were analyzed with ANOVA followed by the Tukey test. Results: NVC increased in G2 (4.33±2.58) in relation to G1 (1.50±0.55). NVC decreased in G3 (2.00±1.10), G4 (1.50±1.52) and G5 (2.00±1.26) compared to G2 (p<0.05). FM decreased in G3 (0.97±0.71), G4 (0.92±0.38) and G5 (1.05±0.44) compared to G2 (p<0.05). However, the combination of TDF and BRL37344 was not more effective at increasing NVC and improving FM than either drug alone. The five groups did not differ significantly with regard to TV. Conclusion: The combination of BRL 37344 and TDF produced no measurable additive effect on reduction of OB symptoms.

Evaluation tool for a gastroenterostomy simulated training

Abstract Purpose: To create a checklist to evaluate the performance and systematize the gastroenterostomy simulated training. Methods: Experimental longitudinal study of a quantitative character. The sample consisted of twelve general surgery residents. The training was divided into 5 sessions and consisted of participation in 20 gastroenterostomys in synthetic organs. The training was accompanied by an experienced surgeon who was responsible for the feedback and the anastomoses evaluation. The anastomoses evaluated were the first, fourth, sixth, eighth and tenth. A 10 item checklist and the time to evaluate performance were used. Results: Residents showed a reduction in operative time and evolution in the surgical technique statistically significant (p<0.01). The correlation index of 0.545 and 0,295 showed a high linear correlation between time variables and Checklist. The average Checklist score went from 6.8 to 9 points. Conclusion: The proposed checklist can be used to evaluate the performance and systematization of a simulated training aimed at configuring a gastroenterostomy.

Hepatic retractor in an ex vivo model1.

PURPOSE: To discuss the use of models of hepatic retraction by laparoscopy, to present a new Hepatic Retractor (HR) and to evaluate its practicality, efficacy and safety in Esophageal Hiatus Exposure (EHE). METHODS: Experimental cross - sectional study with a quantitative character. It was carried out in the Laboratory of Health Training of Christus University Center. The sample consisted of 12 livers of adult pigs weighing between 30 and 45 kg. A circular-shaped HR, 5 cm diameter and deformable materials was developed with a polypropylene cloth, metallic guide wire, epidural needle plastic guide and nylon string. The practicality of HR management was measured by the time required to use the instrument, efficacy by exposure to the operative field and safety by macroscopic assessment of liver damage. RESULTS: The average time to complete the procedure was 3.24 minutes and reached less than 2 minutes after 12 repetitions. In eight experiments the maximum degree of EHE was obtained. No macroscopic lesions were observed. CONCLUSION: The use of HR described can broaden the operative field, without causing macroscopic liver lesions and prolonging the surgical time.

Hepatic retractor in an ex vivo model

Abstract Purpose: To discuss the use of models of hepatic retraction by laparoscopy, to present a new Hepatic Retractor (HR) and to evaluate its practicality, efficacy and safety in Esophageal Hiatus Exposure (EHE). Methods: Experimental cross - sectional study with a quantitative character. It was carried out in the Laboratory of Health Training of Christus University Center. The sample consisted of 12 livers of adult pigs weighing between 30 and 45 kg. A circular-shaped HR, 5 cm diameter and deformable materials was developed with a polypropylene cloth, metallic guide wire, epidural needle plastic guide and nylon string. The practicality of HR management was measured by the time required to use the instrument, efficacy by exposure to the operative field and safety by macroscopic assessment of liver damage. Results: The average time to complete the procedure was 3.24 minutes and reached less than 2 minutes after 12 repetitions. In eight experiments the maximum degree of EHE was obtained. No macroscopic lesions were observed. Conclusion: The use of HR described can broaden the operative field, without causing macroscopic liver lesions and prolonging the surgical time.

Análise dos principais fatores epidemiológicos relacionados ao suicídio em uma cidade no interior do Ceará, Brasil / Analysis of the main epidemiological factors related to suicide in a town of Ceará country-side, Brazil

Introdução: o município de Iguatu, localizado no interior do estado do Ceará no Nordeste brasileiro, é popularmente conhecido pelo alto número de pessoas que cometem suicídio. No entanto, até o presente momento, não existe um estudo que confirme essa crença popular e analise o perfil dos suicidas. Objetivo: este trabalho avaliou a incidência e o perfil dos suicidas, no município do Iguatu, para obtenção de dados que tornem possíveis ações de prevenção. Metodologia: trata-se de um estudo retrospectivo e transversal de natureza descritiva sobre óbitos por suicídio coletados sob autorização da coordenação de vigilância epidemiológica com dados fornecidos pela Secretaria de Saúde no Município do Iguatu entre os anos de 2006 a 2015. As variáveis analisadas foram sexo, idade, estado civil, raça, escolaridade, ocupação e causas de óbito por suicídio. Foi realizada análise dos dados e esses apresentados em tabelas e gráficos. Resultados: o número de causas externas de mortalidade foi de setecentos e vinte, sendo setenta e dois casos de morte por suicídio. As pessoas que cometeram suicídio eram principalmente homens (78%), de coloração parda (73,5%) e faixa etária predominante entre 20 a 29 anos de idade (27,8%) e estado civil solteiro (43%) ou casado (41,7%). Nenhum apresentava nível superior completo, e a maioria tinha como ocupação a produção agrícola (36,1%). As principais causas de morte foram por enforcamento (59,7%) e uso de pesticidas (23,6%). Conclusão: o perfil dos suicidas é composto por homens de cor parda, sem nível superior completo, produtores agrícolas, adultos jovens e solteiros. O Iguatu apresenta uma alta incidência de suicídio, e as pessoas se matam mais por enforcamento e autointoxicação por pesticidas.(AU)

Introduction: The city of Iguatu, located in the state of Ceará in the Brazilian Northeast, is popularly known for its high numbers of people committing suicide. However, to the present moment, there is no work that confirms this popular belief and analyzes the profile of suicides. Objective: Evaluate the incidence and the profile of suicidal in the city of Iguatu, aiming to discuss preventive actions. Methods: Retrospective, cross-sectional and descriptive study of deaths by suicide collected with the authorization of the coordination of epidemiological surveillance as public data in Iguatu, between 2006 and 2015. The analyzed variables were: gender, age, marital status, race, schooling, occupation and causes of death by suicide. Descriptive analysis of the data was performed in tables and graphs from Excell 2011. Results: The number of external mortality causes was seven hundred and twenty, with seventy-two cases of death by suicide. The people who committed suicide were mainly men (78%), brown coloration (73.5%) and the predominant age group between 20 and 29 years old (27.8%). The predominant marital status was single (43%), but followed closely by people who were married (41.7%). None had a complete upper level, and the majority had agricultural production as the occupation (36.1%). The main causes of death were intentional self-harm by hanging, strangulation and suffocation (59.7%) and pesticide autointoxication. Conclusion: The profile of people who committed suicide is predominantly composed of brown colored males, under graduated people, agricultural producers, young adults and single. The city of Iguatu town shows a high incidence of suicide and the most used kinds of killing are by hanging and pesticide autointoxication.(AU)

Tratamento não operatório de lesão renal e esplênica: relato de caso / Non-operative treatment of renal and splenic injury: case report

Introdução: em algumas situações, o trauma abdominal contuso com lesão renal ou esplênica pode ser conduzido com tratamento não operatório (TNO). Uma lesão simultânea de rim e baço não apresenta uma conduta padrão e existem situações limítrofes que necessitam de maior discussão. Relato de caso: paciente com lesão renal complexa e hemoperitônio secundário a lesão esplênica que teve boa evolução após compensação clínica do sangramento. Conclusão: o TNO de lesões combinadas do rim e do baço pode ser possível em algumas situações.(AU)

Introduction: In some situations, blunt abdominal trauma with renal or splenic injury can be conducted with non-operative treatment (NOT). A simultaneous lesion of the kidney and spleen does not present a standard conduct and there are borderline situations that need further discussion. Case report: patient with complex renal injury and hemoperitoneum secondary to splenic lesion who had a good evolution after clinical bleeding compensation. Conclusion: NOT of combined kidney and spleen lesions may be possible in some situations.(AU)

Simulated training of a laparoscopic vesicourethral anastomosis.

PURPOSE: To develop a model and curriculum for simulated training of an effective and well accepted laparoscopic vesicourethral anastomosis (VUA). METHODS: Experimental longitudinal study of quantitative character. The sample consisted of 12 general surgery residents and 6 urology residents (R3). The training consisted of making twelve VUAs on synthetic organs. The training was divided into four sessions and accompanied by an instructor who performed positive feedback. The evaluation of the anastomoses considered the time and the analysis of the operative technique through the global evaluation scale Objective Structured Assessment of Technical Skills (OSATS). RESULTS: Residents showed a reduction in operative time and evolution in the surgical technique statistically significant (p<0.01). The best-rated items were the facilitator positive feedback and the fact that the training was carried out at the teaching hospital premises. CONCLUSIONS: The proposed training model was well accepted and proved to be effective in reducing operative time and improving laparoscopic skills. The training should be fractionated (4 sessions in 3 weeks), repetitive (12 anastomoses) and have positive feedback.

Simulated training of a laparoscopic vesicourethral anastomosis

Abstract Purpose: To develop a model and curriculum for simulated training of an effective and well accepted laparoscopic vesicourethral anastomosis (VUA). Methods: Experimental longitudinal study of quantitative character. The sample consisted of 12 general surgery residents and 6 urology residents (R3). The training consisted of making twelve VUAs on synthetic organs. The training was divided into four sessions and accompanied by an instructor who performed positive feedback. The evaluation of the anastomoses considered the time and the analysis of the operative technique through the global evaluation scale Objective Structured Assessment of Technical Skills (OSATS). Results: Residents showed a reduction in operative time and evolution in the surgical technique statistically significant (p<0.01). The best-rated items were the facilitator positive feedback and the fact that the training was carried out at the teaching hospital premises. Conclusions: The proposed training model was well accepted and proved to be effective in reducing operative time and improving laparoscopic skills. The training should be fractionated (4 sessions in 3 weeks), repetitive (12 anastomoses) and have positive feedback.

LIVER TRANSPLANTATION IN HEPATITIS DELTA: SOUTH AMERICA EXPERIENCE.

BACKGROUND: The Amazon region is one of the main endemic areas of hepatitis delta in the world and the only one related to the presence of genotype 3 of the delta virus. OBJECTIVE: To analyze the profile, mortality and survival of cirrhotic patients submitted to liver transplantation for chronic hepatitis delta virus and compare with those transplanted by hepatitis B virus monoinfection. METHODS: Retrospective, observational and descriptive study. From May 2002 to December 2011, 629 liver transplants were performed at the Walter Cantídio University Hospital, of which 29 patients were transplanted due to cirrhosis caused by chronic delta virus infection and 40 by hepatitis B chronic monoinfection. The variables analyzed were: age, sex, MELD score, Child-Pugh score, upper gastrointestinal bleeding and hepatocellular carcinoma occurrence before the transplantation, perioperative platelet count, mortality and survival. RESULTS: The Delta Group was younger and all came from the Brazilian Amazon Region. Group B presented a higher proportion of male patients (92.5%) compared to Group D (58.6%). The occurrence of upper gastrointestinal bleeding before transplantation, MELD score, and Child-Pugh score did not show statistical differences between groups. The occurrence of hepatocellular carcinoma and mortality were higher in the hepatitis B Group. The survival in 4 years was 95% in the Delta Group and 75% in the B Group, with a statistically significant difference (P=0.034). Patients with hepatitis delta presented more evident thrombocytopenia in the pre-transplantation and in the immediate postoperative period. CONCLUSION: The hepatitis by delta virus patients who underwent liver transplantation were predominantly male, coming from the Brazilian Amazon region and with similar liver function to the hepatitis B virus patients. They had a lower incidence of hepatocellular carcinoma, more marked perioperative thrombocytopenia levels and frequent episodes of upper gastrointestinal bleeding. Patients with hepatitis by delta virus had lower mortality and higher survival than patients with hepatitis B virus.

Transplante hepático na hepatite delta: experiência da América do Sul / Liver transplantation in hepatitis delta: south america experience

ABSTRACT BACKGROUND: The Amazon region is one of the main endemic areas of hepatitis delta in the world and the only one related to the presence of genotype 3 of the delta virus. OBJECTIVE: To analyze the profile, mortality and survival of cirrhotic patients submitted to liver transplantation for chronic hepatitis delta virus and compare with those transplanted by hepatitis B virus monoinfection. METHODS: Retrospective, observational and descriptive study. From May 2002 to December 2011, 629 liver transplants were performed at the Walter Cantídio University Hospital, of which 29 patients were transplanted due to cirrhosis caused by chronic delta virus infection and 40 by hepatitis B chronic monoinfection. The variables analyzed were: age, sex, MELD score, Child-Pugh score, upper gastrointestinal bleeding and hepatocellular carcinoma occurrence before the transplantation, perioperative platelet count, mortality and survival. RESULTS: The Delta Group was younger and all came from the Brazilian Amazon Region. Group B presented a higher proportion of male patients (92.5%) compared to Group D (58.6%). The occurrence of upper gastrointestinal bleeding before transplantation, MELD score, and Child-Pugh score did not show statistical differences between groups. The occurrence of hepatocellular carcinoma and mortality were higher in the hepatitis B Group. The survival in 4 years was 95% in the Delta Group and 75% in the B Group, with a statistically significant difference (P=0.034). Patients with hepatitis delta presented more evident thrombocytopenia in the pre-transplantation and in the immediate postoperative period. CONCLUSION: The hepatitis by delta virus patients who underwent liver transplantation were predominantly male, coming from the Brazilian Amazon region and with similar liver function to the hepatitis B virus patients. They had a lower incidence of hepatocellular carcinoma, more marked perioperative thrombocytopenia levels and frequent episodes of upper gastrointestinal bleeding. Patients with hepatitis by delta virus had lower mortality and higher survival than patients with hepatitis B virus.

RESUMO CONTEXTO: A região Amazônica é uma das principais áreas endêmicas da hepatite delta no mundo e a única relacionada com a presença do genótipo 3 do vírus delta. OBJETIVO: Analisar o perfil, mortalidade e sobrevida dos pacientes cirróticos submetidos a transplante hepático por hepatite crônica pelo vírus delta e comparar com os transplantados pela monoinfecção do vírus da hepatite B. MÉTODOS: Estudo retrospectivo, observacional e descritivo. Entre maio de 2002 a dezembro de 2011, foram realizados 629 transplantes de fígado no Hospital Universitário Walter Cantídio, dos quais 29 pacientes foram transplantados por cirrose causada pela infecção crônica do vírus delta e 40 pela monoinfecção crônica da hepatite B. As variáveis analisadas foram: origem, idade, sexo, escore de MELD, classificação de Child-Pugh, ocorrência de hemorragia digestiva alta e carcinoma hepatocelular antes do transplante, número de plaquetas perioperatória, mortalidade e sobrevida. RESULTADOS: O Grupo Delta foi mais jovem e todos oriundos da região Amazônica Brasileira. O Grupo B apresentou maior proporção de pacientes do sexo masculino (92,5%) em relação ao Grupo D (58,6%). A ocorrência de hemorragia digestiva alta antes do transplante, escore de MELD e classificação de Child-Pugh não obtiveram diferenças estatísticas entre os grupos. A ocorrência de carcinoma hepatocelular e a mortalidade foram maiores no grupo com hepatite B. A sobrevida em 4 anos foi de 95% no Grupo delta e 75% no Grupo B com diferença estatisticamente significante (P=0,034). Pacientes com hepatite delta, apresentaram mais acentuada plaquetopenia no pré-transplante e no pós-operatório imediato. CONCLUSÃO: Os pacientes com hepatite por vírus delta submetidos ao transplante hepático eram predominantemente homens, vindos da região da Amazônia brasileira e com função hepática semelhante a dos pacientes com vírus da hepatite B. Apresentavam menor incidência de carcinoma hepatocelular, níveis de trombocitopenia perioperatória mais acentuados e episódios frequentes de hemorragia digestiva alta. Os pacientes com hepatite por vírus delta apresentaram menor mortalidade e maior sobrevida que os pacientes com vírus da hepatite B.

Desenvolvimento de um Currículo para Treinamento Simulado de uma Anastomose Laparoscópica / Development of a Curriculum for Simulated Training of a Laparoscopic Anastomosis

RESUMO Introdução: Os programas de simulação permitem um ambiente seguro e eficiente para a aquisição de habilidades cirúrgicas, e o currículo estruturado para realizar um treinamento simulado de uma anastomose intestinal é um exercício educacional valioso para residentes do segundo ano.No momento, inexiste um currículo de treinamento padronizado que possa ser utilizado no ensino da cirurgia laparoscópica básica e avançada por meio da confecção de uma gastroenteroanastomose. Objetivo: Desenvolver um currículo sistematizado para treinamento por simulação de uma anastomose cirúrgica laparoscópica. Métodos: Estudo experimental longitudinal e de caráter quantitativo. A amostra foi de 12 residentes de Cirurgia Geraloriundos de quatro hospitais. O treinamento consistiu na confecção de dez anastomoses, divididas igualmente em cinco sessões e ocorridasnum período de seis semanas. A anastomose entre um estômago e um intestino sintéticos por laparoscopia foi realizada numa caixa preta com fios de seda. No final do treinamento, os residentes utilizaram um questionário com a escala de Likert para avaliar o currículo de treinamento proposto. Resultados: Os participantes do treinamento pontuaram muito bem o currículo de treinamento proposto, tendo como itens mais bem avaliados a necessidade de ter o treinamento inserido no hospital de ensino e fazer parte da carga horária obrigatória. Os quesitos com pior avaliação foram as pinças e fios utilizados. Houve redução do tempo operatório, que se aproximou daquele dos experts. Conclusão: Um currículo estruturado para a simulação de uma anastomose gastrojejunal laparoscópica pode ter em sua programação a participação em 20 anastomoses, sendo dez como cirurgião principal e dez como cirurgião assistente. A distribuição dos procedimentos deve ocorrer em cinco sessões, com intervalo aproximado de uma semana e duração de seis semanas. O treinamento com órgãos sintéticos e uma caixa preta deve ser obrigatório, acessível e acompanhado por um cirurgião experiente que forneça um feedback individualizado.

ABSTRACT Introduction: Simulation programs allow a safe and efficient environment for acquiring surgical skills, and astructured curriculum for simulated bowel anastomosis training provides a valuable educational exercise for second year medical residents. Presently, there is no standardized training curriculum which can be used to teach basic and advanced laparoscopic surgery through the preparation of a gastroenteroanastomose. Objective: To develop a systematized curriculum for training by simulation of a laparoscopic surgical anastomosis. Methods: A longitudinal and quantitative experimental study. The sample consisted of twelve general surgery residents from four hospitals. The training consisted of proceeding ten anastomoses divided equally into five sessions and it took place over a six-week period. Laparoscopy-assisted anastomosis between asynthetic stomach and synthetic bowel was performed in a black box with silk threads. At the end of the training, a Likert scale-based questionnaire was answered by the residents to evaluate the proposed training curriculum. Results: The training participants scored the proposed training curriculum very well. The items that recorded the highest evaluation were the need for the training to be offered at the teaching hospital and for it to be a compulsory element of the work. The lowest scoring items were the tweezers and wires used. A reduction in the operation time was observed, taking it close to that achieved by specialist surgeons. Conclusion: A structured curriculum for the simulation of a laparoscopic gastrojejunal anastomosis should foresee participation in 20 anastomoses, 10 as the main surgeon and 10 as the assistant surgeon. The procedures should be distributed over 5 sessions, with an approximate interval of 1 week and over the course of a 6-week period. Training using synthetic organs and a black box should be mandatory, accessible and accompanied by an experienced surgeon who provides individualized feedback.

Model for simulated training of laparoscopic gastroenterostomy.

PURPOSE:: To develop a model of gastroenterostomy and to analyze the acquisition of skills after training by simulation. METHODS:: Experimental longitudinal study and of a quantitative character. The sample consisted of twelve general surgery residents from four hospitals. The training consisted of making ten anastomoses divided equally into five sessions and it took place over a period of six weeks. The evaluation of the anastomoses considered the time and the analysis of the operative technique through the global evaluation scale Objective Structured Assessment of Technical Skills (OSATS). RESULTS:: Residents showed a reduction in operative time and evolution in the surgical technique statistically significant (p<0.01). The correlation index of 0.545 and 0.497 showed a high linear correlation between time variables and OSATS. CONCLUSION:: The preparation of ten gastroenterostomies is an exercise capable of transferring basic and advanced skills in laparoscopy through a standardized training using synthetic organs and a simulator.

Model for simulated training of laparoscopic gastroenterostomy

Abstract Purpose: To develop a model of gastroenterostomy and to analyze the acquisition of skills after training by simulation. Methods: Experimental longitudinal study and of a quantitative character. The sample consisted of twelve general surgery residents from four hospitals. The training consisted of making ten anastomoses divided equally into five sessions and it took place over a period of six weeks. The evaluation of the anastomoses considered the time and the analysis of the operative technique through the global evaluation scale Objective Structured Assessment of Technical Skills (OSATS). Results: Residents showed a reduction in operative time and evolution in the surgical technique statistically significant (p<0.01). The correlation index of 0.545 and 0.497 showed a high linear correlation between time variables and OSATS. Conclusion: The preparation of ten gastroenterostomies is an exercise capable of transferring basic and advanced skills in laparoscopy through a standardized training using synthetic organs and a simulator.

Hérnia Incisional: proposta de um fluxograma que oriente o tratamento / Incisional Hernia: proposal for a flow chart to guide treatment

Introdução: A hérnia incisional (HI) é conceituada como qualquer falha ou orifício na parede abdominal, com ou sem protuberância, em área de cicatriz pós-operatória, diagnosticada pelo exame clínico ou de imagem. Objetivo: criar um fluxograma que, embasado por uma relevante bibliografia, oriente o tratamento de tais hérnias. Método: Trata-se de um estudo de cará ter descritivo, exploratório e observacional retrospectivo, tipo revisão integrativa. O período de coleta de dados desenvolveu-se entre os meses de janeiro e setembro de 2016, nas seguintes bases de dados: Biblioteca Virtual da Saúde: Scielo (Scientific Eletronic Library Online) e PubMed (Medical Literature Analysis and Retrieval System Online) - free full text e em língua portuguesa e inglesa - com publicaç ões realizadas no perí odo entre 2000 e 2015, por meio do seguinte descritor: incisional hernia review. Como critério de inclusão, foram selecionados os artigos cujo título indicasse alguma forma de diagnóstico, tratamento ou abordagem de HI. Após a leitura do Abstract, foram excluídos das propedêuticas os artigos que, em sua metodologia, não se apresentassem como revisão sistemática ou metanálise, culminando em nove artigos. Para a coleta de informação, todos os artigos foram lidos em sua íntegra, visando às mais variadas abordagens de HI em várias situações e sempre conferindo a referência bibliográfica. Assim, foram avaliados os artigos citados como referência entre os nove selecionados, mesmo que fossem de anos inferiores a 2000. Resultados: Foram localizados 42 artigos no Scielo e 351 no Pubmed. Foram obtidos nove artigos entre os anos 2000 e 2015 e 21 de anos anteriores. O diagnóstico, na maioria dos casos, foi clínico. Geralmente, o tratamento é cirúrgico, podendo ser por via aberta ou laparoscópica. Em ambos os casos, o uso de prótese é quase mandatório, salvo algumas exceções. Quanto maior o tamanho da hérnia, mais se tende indicar a via aberta. Nos tamanhos maiores que 15 cm, o estudo da pressão abdominal é necessário, também nos estudos com pressão maior que 10 cmH2O que sejam indicativos de procedimentos prévios ao reparo definitivo da hérnia, tais como o pneumoperitônio progressivo e a aplicação intraparietal de toxina botulínica tipo A. Nos casos de urgência, como o estrangulamento e a síndrome compartimental, a laparotomia imediata se faz necessária. Conclusões: Por meio deste estudo, pudemos criar um verdadeiro roteiro para o tratamento das Hérnias Incisionais. Tal fluxograma poderia ser adotado em qualquer centro hospitalar que cuida de tal patologia, uma vez que ele segue as recomendações vigentes em vários artigos científicos especializados no tema. (AU)

Introduction: Incisional hernia is conceptualized as any defect or orifice in the abdominal wall, with or without protuberance, in post-operative scar area, diagnosed in clinical examination or imaging techniques. Objective: create a flowchart which, based on the relevant bibliography, can be used as a guideline for the treatment of such hernias; Methods: This is a retrospective study of descriptive, exploratory and observational nature, in the manner of integrative review. The period of data collection was from January to September 2016 in the following databases: Virtual Health Library: Scielo (Scientific Electronic Library Online) and PubMed (Medical Literature Analysis and Retrieval System On-line) - free full text, in English and in Portuguese - regarding publications going from 2000 to 2015 with the following descriptor: incisional hernia review. The criterion of inclusion was the selection of articles whose titles indicated some form of IH diagnosis, treatment or approach. After reading the Abstract of the articles, we excluded those whose methodology was not a systematic review or meta-analysis, culminating in 9 articles. All articles were read in full, focusing on the different IH approaches in several situations and, in each case, examining the bibliographic reference. Thus, we examined articles indicated as reference in the 9 selected articles even when they were prior to 2000. Results 42 articles were found in Scielo and 351 in PubMed. The result was 9 articles between 2000 and 2015 and 21 articles related to previous years. In most cases, the diagnosis is clinical. The treatment is usually surgical, either in open surgery or laparoscopy. In both cases, the use of prosthetic meshes is practically mandatory, with some exceptions. The larger the hernia is, the more open surgery is recommended. In sizes above 15 cm (5.91 inches) it is necessary to examine the abdominal pressure and if it is higher than 10 cmH2O other procedures before the definitive hernia repair are recommended, such as progressive pneumoperitoneum and intraparietal application of botulinum toxin type A. In emergency cases, such as strangulation and compartmental syndrome, immediate laparotomy is required. Conclusions: This study enabled the creation of a guideline for the treatment of Incisional Hernias. The resulting flowchart could be adopted in any hospital center that addresses this pathology, since it follows the current recommendations of several specialized scientific articles. (AU)