Isolated subcutaneous emphysema of the abdominal wall following endoscopic retrograde cholangiopancreatography.

Isolated subcutaneous emphysema without retroperitoneal perforation is a rare complication of endoscopic retrograde cholangiopancreatography (ERCP). We present the case of an 87-year-old female who developed extensive subcutaneous emphysema following ERCP for choledocholithiasis. Abdominal computed tomography showed air perfectly dissecting the abdominal wall muscle layers and no evidence of an air leak in the pleural, mediastinal, or peritoneal spaces.

Perspectivas em cirurgia robótica: a visão do cirurgião / Robotic surgery: the surgeon's perspective

Introdução: Avaliar os níveis de conhecimento, interesse e treinamento dos cirurgiões inscritos no Colégio Brasileiro dos Cirurgiões (CBC) da cidade de Porto Alegre, Rio Grande do Sul, em relação à cirurgia robótica. Métodos: Estudo transversal, baseado em informações coletadas por meio de questionário enviado via plataforma digital para potenciais participantes. O formulário continha perguntas estruturadas e autoaplicáveis, a fim de caracterizar o perfil profissional, capacitação em cirurgia minimamente invasiva, conhecimento, opinião e treinamento específico em cirurgia robótica. Resultados: Dos 146 membros inscritos no CBC na cidade de Porto Alegre, 99 (67,8%) responderam ao questionário. Houve predomínio do sexo masculino (88%) e a mediana de idade dos participantes foi de 48 anos. Os procedimentos videolaparoscópicos ou vídeo-assistidos foram maioria na rotina dos cirurgiões. Da totalidade da amostra, a maior parte (78%) já assistiu ao menos um procedimento robótico, e um terço (n = 30) já realizou algum tipo de treinamento ou simulação em cirurgia robótica. Entre os que não realizaram, dois terços pretendem se qualificar no futuro. Apenas 10% dos cirurgiões possuem certificação na área. Conclusão: A maioria dos cirurgiões respondentes inscritos no CBC em Porto Alegre tem em sua rotina predominância de procedimentos minimamente invasivos e acredita que a plataforma robótica será o futuro da cirurgia. Embora ainda não disponível na maioria dos serviços gaúchos, espera-se que o desenvolvimento de novas plataformas e a redução dos custos envolvidos na aquisição de equipamento e de capacitação do cirurgião facilitem a disseminação dessa tecnologia.

Introduction: To assess the practical knowledge, interest, and training levels of surgeons enrolled in the Brazilian College of Surgeons (CBC) of the municipality of Porto Alegre, Rio Grande do Sul, regarding robotic surgery. Methods: Cross-sectional study, based on information collected with a questionnaire sent to potential participants via digital platform. The form contained structured and self-administered questions, to characterize their professional profile, skills in minimally invasive surgery, knowledge, opinion, and specific training in robotic surgery. Results: Of the 146 members enrolled in the CBC of the municipality of Porto Alegre, 99 (67.8%) responded to the questionnaire. Most were males (88%) with a mean age of 48 years. Video-laparoscopic or video-assisted procedures were the most frequent in the participants' practice. Of the sample, most (78%) already watched at least one robotic surgery, and one third (n = 30) had already completed some sort of training or simulation course in robotic surgery. Among those who did not, two thirds intend to pursue formal training in the future. Only 10% of participating surgeons are certified in the area. Conclusion: Most responding surgeons enrolled in the CBC in Porto Alegre perform mostly minimally invasive procedures daily and believe that the robotic technology will be the future of surgery. Although not yet available in most services of the state of Rio Grande do Sul, it is expected that the development of new platforms and the reduction of costs involved in equipment acquisition and surgical training will facilitate the dissemination of this technology.

Carnoy solution versus GEWF solution for lymph node revealing in colorectal cancer: a randomized controlled trial.

PURPOSE: This study aimed to compare the performance of two lymph node revealing solutions. METHODS: This randomized clinical trial (NTC02704988) investigated patients with colon or rectal cancer who underwent surgical resection with D2 lymphadenectomy. Specimens submitted for conventional pathological examination were randomly assigned for additional fixation with Carnoy or GEWF solution, and dissection was performed to examine the missed lymph nodes. The number of lymph nodes retrieved, additional identified metastatic lymph nodes, lymph node upstaging, and complementary indication of adjuvant therapy were investigated. RESULTS: The number of lymph nodes retrieved was significantly higher with the use of lymph node revealing solutions than with the conventional method in colon cancer (GEWF: 29.5 vs 27; p < 0.001; Carnoy: 27.7 vs 25.2; p < 0.001) and rectal cancer (GEWF: 25.8 vs 23.6; p < 0.001; Carnoy: 23.1 vs 20.8; p < 0.001). There were no differences between the solutions and conventional examination with respect to the median number of additional metastatic lymph nodes identified (0 in all arms), the number of patients with lymph node upstaging (colon cancer: 1 in the Carnoy arm, 0 in the GEWF arm; rectal cancer: 1 in the GEWF arm, 0 in the Carnoy arm), or the number of patients with complementary indication of adjuvant therapy (colon cancer: 1 in the Carnoy arm, 0 in the GEWF arm; rectal cancer: 0 in both arms). CONCLUSION: Despite the higher number of lymph nodes retrieved, neither solution resulted in significant changes in patient staging or treatment. Both solutions exhibited equal performance with respect to all outcomes. TRIAL REGISTRATION: NTC02704988.

Score of "eat-ability" as a predictor of malnutrition in patients with gastrointestinal tract cancer: a pilot study.

INTRODUCTION: decreased food intake, loss of appetite, and dysphagia are relevant symptoms in patients with gastrointestinal tract (GIT) cancer. However, these symptoms have been isolated or indirectly assessed when comprising quality of life questionnaires or risk assessment tools. OBJECTIVE: to determine whether a combined assessment of dysphagia, appetite and food intake may be used as a parameter of eat-ability (food capacity) in patients with GIT cancer. METHODS: a cross-sectional pilot study on 41 patients with GIT cancer were evaluated using a score for "eat-ability"(SEA) as compared to the Patient Generated Subjective Global Assessment(PG-SGA), anthropometry and laboratory profile. RESULTS: eleven (27%) patients had full eat-ability(SEA 0), three (7%) had moderate (SEA 1) and 27 (66%) had poor (SEA ≥ 2) eat-ability, which were significantly different, between upper and lower GIT tumors (p ≤ 0.05). By ROC curves, SEA 1 and ≥ 2 showed an 80% for both sensibility (95% CI: 0.48-0.95) and specificity (95% CI: 0.63-0.91) to PG-SGA (A and B), with an area under curve (AUC) of 0.79 (95% CI: 0.64-0.95) (p = 0.006). Patients with SEA ≥ 2 had a significant weight loss within three (p = 0.001) and six months (p < 0.001) when compared to patients with SEA 0 and 1. Mortality was also significantly higher (p = 0.01) among patients with critical food capacity by SEA (77%) in severely malnourished patients by PG-SGA (84%). CONCLUSION: by combining food intake, dysphagia and appetite assessment altogether, a reliable score clearly demonstrated compromised eating capacity affecting nutritional status of patients with GIT tumors at a higher risk for death.

Score of "eat-ability" as a predictor of malnutrition in patients with gastrointestinal tract cancer: a pilot study / Evaluación de la "capacidad alimentaria" como predictor de desnutrición en pacientes con cáncer del tracto gastrointestinal: un estudio piloto

Introduction: decreased food intake, loss of appetite, and dysphagia are relevant symptoms in patients with gastrointestinal tract (GIT) cancer. However, these symptoms have been isolated or indirectly assessed when comprising quality of life questionnaires or risk assessment tools. Objective: to determine whether a combined assessment of dysphagia, appetite and food intake may be used as a parameter of eat-ability (food capacity) in patients with GIT cancer. Methods: a cross-sectional pilot study on 41 patients with GIT cancer were evaluated using a score for "eat-ability" (SEA) as compared to the Patient Generated Subjective Global Assessment(PG-SGA), anthropometry and laboratory profile. Results: eleven (27%) patients had full eat-ability(SEA 0), three (7%) had moderate (SEA 1) and 27 (66%) had poor (SEA ≥ 2) eat-ability, which were significantly different, between upper and lower GIT tumors (p ≤ 0.05). By ROC curves, SEA 1 and ≥ 2 showed an 80% for both sensibility (95% CI: 0.48-0.95) and specificity (95% CI: 0.63-0.91) to PG-SGA (A and B), with an area under curve (AUC) of 0.79 (95% CI: 0.64-0.95) (p = 0.006). Patients with SEA ≥ 2 had a significant weight loss within three (p = 0.001) and six months (p < 0.001) when compared to patients with SEA 0 and 1. Mortality was also significantly higher (p = 0.01) among patients with critical food capacity by SEA (77%) in severely malnourished patients by PG-SGA (84%).Conclusion: by combining food intake, dysphagia and appetite assessment altogether, a reliable score clearly demonstrated compromised eating capacity affecting nutritional status of patients with GIT tumors at a higher risk for death

Introducción: la disminución de la ingesta alimentaria, la pérdida de apetito y la disfagia son síntomas impactantes en pacientes con cáncer del tracto gastrointestinal (TGI). Sin embargo, estos síntomas se han estudiado individualmente o indirectamente al formar parte de cuestionarios de calidad de vida o herramientas de riesgo nutricional. Objetivo: determinar la significancia del análisis combinado de disfagia, apetito e ingesta alimentaria como parámetros de "capacidad" alimentaria en pacientes con cáncer del TGI por medio de una nueva escala. Métodos: estudio piloto transversal en el cual fueron evaluados 41 pacientes con cáncer del TGI utilizando la valoración de "eat-ability" (SEA), que se comparó con la valoración global subjetiva generada por el paciente (VGS-GP), la antropometría y métodos de laboratorio. Resultados: once (27%) pacientes tenían capacidad alimentaria completa (SEA = 0), tres (7%) presentaban capacidad moderada (SEA = 1) y 27 (66%), severa (SEA ≥ 2). Se observó una diferencia significativa entre la capacidad alimentaria, cuando se comparó el TGI superior con el inferior (p = 0,05). Las SEA con valoración 1 y ≥ 2 fueron analizadas mediante la curva ROC para obtener un poder discriminatorio con respecto a VGS-GP (B y C), respectivamente. La sensibilidad y especificidad fue del 80% para ambos, con IC 95%: 0,48-0,95 e IC 95%: 0,63-0,91 respectivamente y área bajo la curva (AUC) de 0,79 (IC 95%: 0,64-0,95) (p = 0,006). Los pacientes con SEA ≥ 2 presentaron un mayor porcentaje de pérdida ponderal a los tres (p = 0,001) y seis meses (p < 0,001) en comparación con los pacientes con SEA 0 y 1. La mortalidad también fue significativamente mayor (p = 0,01) entre los pacientes con SEA ≥ 2 (77%) y los pacientes gravemente desnutridos por VGS-GP (84%). Conclusión: al combinar la ingesta alimentaria, la disfagia y la evaluación del apetito, se demostró claramente una capacidad alimentaria comprometida que afecta al estado nutricional de los pacientes con tumores en TGI con un mayor riesgo de muerte

ADDUCTOR POLLICIS MUSCLE THICKNESS AND PREDICTION OF POSTOPERATIVE MORTALITY IN PATIENTS WITH STOMACH CANCER.

BACKGROUND: Malnutrition is very prevalent in patients with gastric cancer and increases the risk of morbidity and mortality. Adductor pollicis muscle thickness (APMT) appears as an important objective, quick, inexpensive and noninvasive measure to assess the muscle compartment. AIM: To compare APMT and other nutritional assessment methods and to correlate these methods with postoperative mortality. METHODS: Forty-four patients, 29 men and 15 women, mean age of 63±10.2 and ranging from 34-83 years, who underwent nine (20.5%) partial and 34 (77.3%) total gastrectomies due to stomach cancer (stage II to IIIa) were preoperatively assessed by Patient Generated Subjective Global Assessment (PG-SGA), anthropometry and laboratorial profile. RESULTS: APMT better predicted death (p<0.001) on both, dominant and non-dominant hand, and well correlated with albumin (p=0.039) and PG-SGA (p=0.007). CONCLUSION: APMT clearly allowed to determine malnutrition and to predict risk of death in patients with gastric cancer.

Adductor pollicis muscle thickness and prediction of postoperative mortality in patients with stomach cancer / Espessura do músculo adutor do polegar e predição de mortalidade pós-operatória em pacientes com câncer gástrico

ABSTRACT Background: Malnutrition is very prevalent in patients with gastric cancer and increases the risk of morbidity and mortality. Adductor pollicis muscle thickness (APMT) appears as an important objective, quick, inexpensive and noninvasive measure to assess the muscle compartment Aim: To compare APMT and other nutritional assessment methods and to correlate these methods with postoperative mortality Methods: Forty-four patients, 29 men and 15 women, mean age of 63±10.2 and ranging from 34-83 years, who underwent nine (20.5%) partial and 34 (77.3%) total gastrectomies due to stomach cancer (stage II to IIIa) were preoperatively assessed by Patient Generated Subjective Global Assessment (PG-SGA), anthropometry and laboratorial profile Results: APMT better predicted death (p<0.001) on both, dominant and non-dominant hand, and well correlated with albumin (p=0.039) and PG-SGA (p=0.007) Conclusion: APMT clearly allowed to determine malnutrition and to predict risk of death in patients with gastric cancer.

RESUMO Racional: A desnutrição é muito prevalente em pacientes com câncer gástrico e aumenta o risco de morbidade e mortalidade. A espessura do músculo adutor do polegar (APMT) aparece como uma importante medida objetiva, rápida, barata e não invasiva para avaliar o compartimento muscular. Objetivo: O objetivo deste estudo foi comparar a APMT e outros métodos de avaliação nutricional e correlacionar esses métodos com a mortalidade pós-operatória. Métodos: Quarenta e quatro pacientes, 29 homens e 15 mulheres; média (SD) de 63 anos (10,2) e variando de 34 a 83 anos, que foram submetidos a 9 (20,5%) gastrectomias parciais e 34 (77,3%) totais por câncer de estômago (Estágio II a IIIa) e avaliados no pré operatório por Avaliação Subjetiva Global Produzida Pelo Paciente (PG-SGA), antropometria e perfil laboratorial. Resultados: APMT melhor predisse morte (p<0,001) em ambas mãos, dominante e não-dominante, e se correlacionou bem com albumina (p=0,039) e PG-SGA (p=0,007). Conclusão: APMT permitiu claramente determinar a desnutrição e prever o risco de morte em pacientes com câncer gástrico.

Fluorescent test accurately predicts leak of ischemic colon anastomosis in rats.

PURPOSE:: To investigate if fluorescein fluorescent test can predict dehiscence in a model of ischemic colonic anastomosis in rats. METHODS:: This experimental controlled trial randomly assigned 55 rats to four groups. Anastomoses were performed in non-ischemic colon segments (control group) and in ischemic colon segments measuring 1, 2 or 3 cm long (groups 1, 2 and 3, respectively). Fluorescein was injected and the tissues were examined under ultraviolet light. Seven days later, a second-look surgery was performed to check for the presence or absence of anastomosis dehiscence. RESULTS:: Twenty-four rats presented anastomotic dehiscence during the second-look surgery. Reticular and nonfluorescent patterns were significantly associated with the occurrence of anastomotic dehiscence. Fluorescein fluorescence had a sensitivity of 95.8%, specificity of 89.2%, positive predictive value of 88.4%, negative predictive value of 96.2%, and accuracy of 92.3% to predict anastomotic dehiscence. CONCLUSION:: Fluorescein fluorescent test can accurately predict leak in a model of ischemic colonic anastomosis in rats.

Fluorescent test accurately predicts leak of ischemic colon anastomosis in rats

Abstract Purpose: To investigate if fluorescein fluorescent test can predict dehiscence in a model of ischemic colonic anastomosis in rats. Methods: This experimental controlled trial randomly assigned 55 rats to four groups. Anastomoses were performed in non-ischemic colon segments (control group) and in ischemic colon segments measuring 1, 2 or 3 cm long (groups 1, 2 and 3, respectively). Fluorescein was injected and the tissues were examined under ultraviolet light. Seven days later, a second-look surgery was performed to check for the presence or absence of anastomosis dehiscence. Results: Twenty-four rats presented anastomotic dehiscence during the second-look surgery. Reticular and nonfluorescent patterns were significantly associated with the occurrence of anastomotic dehiscence. Fluorescein fluorescence had a sensitivity of 95.8%, specificity of 89.2%, positive predictive value of 88.4%, negative predictive value of 96.2%, and accuracy of 92.3% to predict anastomotic dehiscence. Conclusion: Fluorescein fluorescent test can accurately predict leak in a model of ischemic colonic anastomosis in rats.

Angiotensin-converting enzyme inhibitorsinduced angioedema of the small bowel mimicking postoperative complication

No disponible

Angiotensin-converting enzyme inhibitors-induced angioedema of the small bowel mimicking postoperative complication.

Angioedema of the small bowel (ASB) is an extremely rare side effect of the angiotensin-converting enzyme inhibitors (ACEI). We present a case of ACEI-induced ASB mimicking postoperative complication. The diagnosis of ACEI-induced ASB should be considered in patients using these drugs and presenting sudden gastrointestinal symptoms and thickening of small bowel not attributable to other diseases.

30 Years of Robotic Surgery.

The idea of reproducing himself with the use of a mechanical robot structure has been in man's imagination in the last 3000 years. However, the use of robots in medicine has only 30 years of history. The application of robots in surgery originates from the need of modern man to achieve two goals: the telepresence and the performance of repetitive and accurate tasks. The first "robot surgeon" used on a human patient was the PUMA 200 in 1985. In the 1990s, scientists developed the concept of "master-slave" robot, which consisted of a robot with remote manipulators controlled by a surgeon at a surgical workstation. Despite the lack of force and tactile feedback, technical advantages of robotic surgery, such as 3D vision, stable and magnified image, EndoWrist instruments, physiologic tremor filtering, and motion scaling, have been considered fundamental to overcome many of the limitations of the laparoscopic surgery. Since the approval of the da Vinci(®) robot by international agencies, American, European, and Asian surgeons have proved its factibility and safety for the performance of many different robot-assisted surgeries. Comparative studies of robotic and laparoscopic surgical procedures in general surgery have shown similar results with regard to perioperative, oncological, and functional outcomes. However, higher costs and lack of haptic feedback represent the major limitations of current robotic technology to become the standard technique of minimally invasive surgery worldwide. Therefore, the future of robotic surgery involves cost reduction, development of new platforms and technologies, creation and validation of curriculum and virtual simulators, and conduction of randomized clinical trials to determine the best applications of robotics.

Comparison of Nonablative Fractional Erbium Laser 1,340 nm and Microneedling for the Treatment of Atrophic Acne Scars: A Randomized Clinical Trial.

BACKGROUND: The efficacy and safety of nonablative fractional laser for acne scars treatment has been described in several studies. Recently, microneedling treatment has been showing promising results with lower costs, quick healing time, and low risk of postinflammatory hyperpigmentation (PIH). OBJECTIVE: To compare the effectiveness and safety of nonablative fractional erbium laser 1,340 nm and microneedling for the treatment of facial atrophic acne scars. METHODS: Forty-six patients with atrophic facial acne scars were randomized to microneedling and laser groups, receiving 3 sessions performed monthly. Two blinded dermatologists applied the validated "Quantitative Global Grading System for Postacne Scarring" scale, before, 2 months, and 6 months after the treatment. Side effects were recorded at each follow-up visit and patient's satisfaction was evaluated. RESULTS: Both groups showed a significant improvement, and there was no statistically significant difference between results of both therapies (p = .264). The erythema after each session was longer in the laser group and 13.6% subjects experienced PIH. No PIH was observed in the microneedling group. CONCLUSION: This study shows that both nonablative fractional laser 1,340 nm and microneedling are comparable and effective in the treatment of atrophic acne scars. Microneedling is well tolerated, with fewer side effects and lower down time.

Blind pouch syndrome: case report and literature review

Blind pouch syndrome is the set of signs and symptoms caused by intestinal content stasis and consequent bacterial hyperproliferation in a segment excluded from the intestinal flow after surgical procedure. This paper reports the case of a 65-year-old male patient complaining of diffuse abdominal pain, poor oral intake, nausea, diarrhea, fever and chills. Surgical history included cecal resection five years before due to a tubulovillous adenoma. On physical examination, the abdomen was tender and distended, without signs of peritonitis. Complete blood cells count showed microcytic anemia. Computed tomography of the abdomen revealed ileocolonic anastomosis (ascending) with blind loop presenting signs of inflammatory process. Exploratory laparotomy was indicated, in which the resection of the blind loop was performed. After gradual improvement of the symptoms, the patient was discharged in12th post-operative day...

A comparison of radical vaginal hysterectomy combined with extraperitoneal or laparoscopic pelvic lymphadenectomy in the treatment of cervical cancer.

BACKGROUND: The use of radical vaginal hysterectomy in the treatment of cervical cancer is associated with lower morbidity and a similar cure rate when compared with the abdominal approach. The present study reports a case series of radical vaginal hysterectomy followed by extraperitoneal (Mitra) or video-laparoscopic (VLP) lymphadenectomy, with comparison of the 2 techniques. METHODS: Twenty-five patients with cervical carcinoma (stages IA1 to IIA) were submitted to radical vaginal hysterectomy and extraperitoneal or laparoscopic lymphadenectomy. RESULTS: The Mitra technique was used in 17 cases, and VLP was used in 8. Seventeen patients presented minor postoperative complications. The number of resected lymph nodes was similar with both techniques (median of 14 with VLP vs. 21 with Mitra) (P = 0.215). The duration of surgery in the VLP group (mean, 339 minutes) was shorter than that of the Mitra group (mean, 421 minutes) (P = 0.015). CONCLUSIONS: The results obtained with both techniques are similar to those reported in the literature. The duration of extraperitoneal lymphadenectomy was longer than that of VLP lymphadenectomy. There were no differences between the 2 techniques concerning the number of resected lymph nodes and hospital stay.

Sarcomas de partes moles: experiência cirúrgica de cinco anos em hospital escola / Soft tissue sarcomas: five-year surgical experience in a teaching hospital

Introdução: Os sarcomas de partes moles compõem um grupo heterogêneo de neoplasias malignas com diferentes padrões morfológicos da linhagem mesenquimal. O Hospital de Clínicas de Porto Alegre (HCPA) é um centro de referência para tratamento desta doença, interessando, por isso, o conhecimento de dados demográficos, clínicos, anátomo-patológicos e terapêuticos dos casos aqui tratados.Objetivo: Estudar retrospectivamente os registros de pacientes operados por sarcomas de partes moles no HCPA nos últimos cinco anos e cotejar os resultados com os encontrados na literatura, como estadiamento, tipo histológico,localizaçãoe tratamento.Métodos: Foram revisados os prontuários eletrônicos de pacientes com 18 ou mais anos de idade, que foram submetidos a tratamento cirúrgico de sarcoma de partes moles, no período entre 2006-2011. Os dados foram registrados em banco de dados no Microsoft Excel, no qual se coletaram informações referentes a idade, sexo, características histopatológicas, estadiamento, tipo de cirurgia,margens cirúrgicas, complicações cirúrgicas, tempo livre de doença, sobrevida e tratamentos complementares.Resultados: Os prontuários de 141 pacientes foram avaliados. Excluídos os casos com cirurgia em outra instituição e os que não foram tratados com cirurgia, 40 prontuários compuseram esta amostra. Os tipos histológicos mais frequentes foram histiocitoma fibroso maligno (27,5%) e fibrossarcoma (15%), tumor desmoide(12,5%), leiomiossarcoma (10%) e GIST (10%). Os locais mais acometidos foram os membros inferiores (40%) e o abdome (30%).

A maioria dos pacientes apresentava doença em estádio avançado (III) no momento da cirurgia, principalmente devido ao grande tamanho do tumor (média de 12,2 cm) e ao alto grau histológico (G3),encontrado em 50% dos pacientes. Cirurgias conservadoras de extremidades foram realizadas em 85% dos pacientes. Em 80% dos casos foi indicado tratamento complementar. A média do tempo livre de doença foi 15,7 meses, a sobrevida média foi 24,6 meses e tempo médio de acompanhamento foi 25,3 meses.Conclusão: Nesta amostra os parâmetros idade, sexo e localização tumoral não foram diferentes daqueles encontrados na literatura. A média do tamanho do tumor é maior do que a apresentada na literatura, bem como o grau histológico III é mais frequente nesta amostra.

Background: Soft tissue sarcomas (STS) compose a heterogeneous group of malignant neoplasm with different morphological patterns of the mesenchymal lineage. The Porto Alegre Clinical Hospital is a reference center for the treatment of this disease. Therefore, there is an inherent interest concerning the demographic, clinical, anatomical-pathologic, and therapeutic data of the cases studied here.Aims: This is a retrospective study of the records of patients undergoing surgery resulting from STS at Porto Alegre Clinical Hospital over a period of 5 years. It is also a comparison of the results found in those documents: details such as staging, histological type, location, and treatment are all closely examined.Methods: Electronic records of 18-year-old patients, or older, were reviewed, including those who have submitted to surgical treatment for STS during the period between 2006 and 2011. The data were recorded using a Microsoft Excel database in which information concerning age, sex, histopathological characteristics, staging, surgery type, surgical margins, surgical complications,disease-free periods, survival, and complementary treatments was collected.Results: The records of 141 patients were assessed. Excluding those surgery cases being held at another institution and those in which surgery was not necessary, 40 sets of medical records comprised this sample.

The most frequent histological types were: malignant fibrous histiocytoma(27.5%), fibrosarcoma (15%), desmoid tumor (12.5%), leiomyosarcoma (10%), and gastrointestinal stromal tumor (GIST) (10%). The most affected areas were the lower limbs (40%) and the abdomen(30%). Most of the patients presented STS in an advanced stage (Stage III) at the time of surgery,largely a result of the size of the tumor (an average of 12.2 cm) or of the high histological degree(G3) found in 50% of the patients. Conservative surgery of the extremities was performed on 85% of the patients. In 80% of the cases, a complementary treatment was suggested. The average diseasefree period was 15.7 months. The average survival period was 24.6 months, and the average followup period lasted 25.3 months.Conclusion: In this sample, the parameters age, sex, and tumor location were not different from those described in the literature. However, the average tumor size is larger than those discussed in the literature, and the histological degree III is more frequently discovered in this sample.Therapeutic modalities and global survival are difficult to be compared using data from the literature, because most studies analyze such information for specific histological types.

Litíase sintomática em vesícula biliar residual / Symptomatic lithiasis in residual gallbladder

Sintomas pós-colecistectomia muitas vezes tem causas extra-biliares. As causas biliares mais comuns são presença de cálculos ou cirurgia incompleta. O uso da colangiorressonância magnética pode evitar complicações intraoperatórias decorrentes anatomia biliar pouco usual facilitando o acesso cirúrgico. No presente trabalho é relatado caso de paciente com litíase sintomática em vesícula residual.

Most post cholecystectomy symptoms have extrabiliary causes. The most common biliary causes are calculi and incomplete surgery. The use of magnetic resonance cholangiography (MRC) seems to avoid intraoperative complications due to a possible unusual biliary anatomy and to facilitate surgical access. Here in is reported a case of patient with symptomatic lithiasis in residual gallbladder.

Transient middle cerebral artery occlusion in rats as an experimental model of brain ischemia / Modelo experimental de isquemia cerebral em ratos por obliteração temporária da artéria cerebral média

PURPOSE: To assess a rat model of cerebral ischemia induced by occlusion of the middle cerebral artery and its effect on the area of cerebral infarction. METHODS: Brain ischemia was induced in 52 male Wistar rats by introduction of a 3-0 nylon suture into the middle cerebral artery for either 90 (n=28) or 120 (n=24) minutes. Ischemic injury volume was determined by TTC staining, digital photography and analysis with the Image J software. Statistical analysis employed Student’s t test and the Mann-Whitney U test. RESULTS: The groups were similar in terms of weight (p=0.59). The length of thread inserted was 14.7 mm in the 90 min group and 20.2 mm in the 120 min group (p=0.37). Ischemic injury was detected in 11 animals (39 percent) after 90 min and 11 (45 percent) after 120 min (p=0.77). In animals exhibiting injury, filament length was 16.1±11 mm (90 min) vs. 21.9±7.4 mm (120 min) (p=0.15). The mean infarction zone volume was greater after 120 (259.2 mm³) than after 90 min (162.9 mm³) (p=0.04). The neurological deficit score for the 90 and 120 min groups was 2.0 and 2.4, respectively (p=0.84). CONCLUSION: The experimental model induced significant ischemic cerebral injury in both groups.

OBJETIVO: Avaliar o modelo de isquemia cerebral por oclusão da artéria cerebral média, mediante introdução de fio intraluminal por 90 e 120 minutos, e seu efeito sobre a área de infarto cerebral em ratos. MÉTODOS: 52 ratos machos Wistar foram submetidos à isquemia cerebral por introdução de fio de nylon 3-0 na artéria cerebral média por 90 ou 120 minutos. O volume da lesão isquêmica foi determinado pelo corante TTC, fotografia digital e utilização do programa ImageJ. Na análise estatística, foi utilizado o teste t- student e o U de Mann-Whitney. RESULTADOS: O comprimento do fio introduzido foi de 14,7 mm no grupo 90 minutos e 20,2 mm no grupo 120 minutos. Lesão isquêmica foi detectada em 11 animais (39 por cento) no grupo que de 90 minutos e 11 (45 por cento) do grupo de 120 minutos. Nos animais que apresentaram lesão, o comprimento do fio foi de 16,1±11 mm (90 minutos) e 21,9±7,4 mm (120 minutos). O volume médio da área de infarto foi maior no grupo 120 minutos do que no grupo 90 minutos. O escore de déficit neurológico foi de 2,0 no grupo 90 minutos e de 2,4 no grupo 120 minutos. CONCLUSÃO: O modelo experimental estudado induz lesão isquêmica cerebral significativa em ambos os grupos.

Transient middle cerebral artery occlusion in rats as an experimental model of brain ischemia.

PURPOSE: To assess a rat model of cerebral ischemia induced by occlusion of the middle cerebral artery and its effect on the area of cerebral infarction. METHODS: Brain ischemia was induced in 52 male Wistar rats by introduction of a 3-0 nylon suture into the middle cerebral artery for either 90 (n=28) or 120 (n=24) minutes. Ischemic injury volume was determined by TTC staining, digital photography and analysis with the Image J software. Statistical analysis employed Student's t test and the Mann-Whitney U test. RESULTS: The groups were similar in terms of weight (p=0.59). The length of thread inserted was 14.7 mm in the 90 min group and 20.2 mm in the 120 min group (p=0.37). Ischemic injury was detected in 11 animals (39%) after 90 min and 11 (45%) after 120 min (p=0.77). In animals exhibiting injury, filament length was 16.1 ± 11 mm (90 min) vs. 21.9 ± 7.4 mm (120 min) (p=0.15). The mean infarction zone volume was greater after 120 (259.2 mm³) than after 90 min (162.9 mm³) (p=0.04). The neurological deficit score for the 90 and 120 min groups was 2.0 and 2.4, respectively (p=0.84). CONCLUSION: The experimental model induced significant ischemic cerebral injury in both groups.