Antonio Cavalcanti de Albuquerque Martins

Porcine liver: experimental model for the intra-hepatic glissonian approach

PURPOSE The aim of the study is to evaluate the porcine liver as a teaching and training model for the glissonian approach. METHODS Ten livers were removed from domestic adult white pigs weighting 35 to 45 kg. Based on anatomical landmarks, the glissonian pedicles of each liver segments were dissected and biopsies were taken for histological examination, to analyze the presence of the glissonian sheath. RESULTS During microscopic examination, a sheath of conjunctive tissue was observed wrapping each segmental pedicle in porcine liver. This could be clearly seen when histological preparation for connective tissue was obtained (Masson technique). CONCLUSION The morphological arrangement of glissonian pedicles in porcine liver makes this model a useful tool for training the intra-hepatic glissonian approach.

Abscesso esplênico: mudanças nos fatores de risco e nas opções de tratamento

OBJETIVO: A origem dos abscessos esplenicos esta relacionada a episodios de bacteremia apos infarto esplenico. Recentemente, a SIDA, a tuberculose, a imunossupressao e as neoplasias tem mudado a apresentacao clinica desse abscesso. Tradicionalmente, o tratamento de escolha e a esplenectomia. Entretanto, a drenagem percutânea pode ser uma alternativa util em casos selecionados O objetivo desse trabalho foi determinar o perfil dos pacientes com abscesso esplenico tratados em um hospital terciario. METODO: Dados referentes aos pacientes atendidos no Servico de Cirurgia Geral HC-UFPE no periodo de novembro de1993 a fevereiro de 2004 foram analisados. Sete pacientes dentre os 73094 tratados no periodo constituiram o objeto desse estudo. RESULTADOS: Cinco pacientes foram tratados inicialmente com esplenectomia e dois por drenagem percutânea. Quatro pacientes (57%) apresentavam abscessos secundarios a imunossupressao, tuberculose ou doenca neoplasica. Tres (43%) apresentavam abscessos decorrentes de infeccao metastatica (endocardite). A drenagem percutânea foi o unico tratamento utilizado em um caso. CONCLUSOES: Houve uma mudanca no padrao classico, e quase que exclusivo, de origem hematogenica do abscesso esplenico para abscessos decorrentes de uma condicao de imunossupressao (câncer, tuberculose, transplantes etc.). Em casos selecionados, a drenagem percutânea pode ser a unica forma de tratamento invasivo utilizada.

O acesso glissoniano intra-hepático nas ressecções do fígado

The intra-hepatic glissonian approach has been considered an advance in the modern hepatic surgery by allowing a safe resection, with minor bleeding and maximum preservation of hepatic tissue. This paper explores the history, the anatomy, the techniques and how to perform and understand the intra-hepatic glissonian approaches.

PREVALENCE OF INCIDENTAL GALLBLADDER CANCER IN A TERTIARY-CARE HOSPITAL FROM PERNAMBUCO, BRAZIL

BACKGROUND Gallbladder cancer is sometimes incidentally uncovered following cholecystectomy for gallstones diseases. The supposed highly variable prevalence of incidental gallbladder cancer through our country is unknown. OBJECTIVE To explore the prevalence of incidental gallbladder cancer in our tertiary-care hospital. METHODS A cross-sectional study was carried out on patients who consecutively underwent cholecystectomy due to gallstones disease at Faculdade Pernambucana de Saúde, Instituto de Medicina Integral Professor Fernando Figueira - FPS/IMIP, from January, 2007 to December, 2010. Data on incidental gallbladder cancer patients were explored for prevalence estimation and description of our experience with the management of this malignancy. RESULTS Our analysis involved 2018 patients with a marked predominance of women (n=1.697; 84.1%) over men (n=321; 15.9%). The 3-year prevalence estimate of 0.34% was recorded for incidental gallbladder cancer in our sample. Regarding tumor staging, there were 1 T1a, 1 T1b, and 5 T2 adenocarcinoma tumors. Laparoscopic cholecystectomy alone was performed for the T1a tumor, and additional radical surgery was performed in five others. One patient presented metastatic disease at the time of repeat surgery. The final pathology revealed residual/additional disease in all T2 tumors after radical surgery whereas the T1b patient underwent a salvage Whipples procedure due to a secondary distal cholangiocarcinoma. The patient with T1a tumor is alive after 3-year follow-up but all of the others died because of disease recurrence/progression up to 12 months. CONCLUSION This study confirms the poor prognosis of Gallbladder cancer even when incidentally diagnosed following cholecystectomy and supposes a 3-year prevalence estimate of 0.34% for incidental gallbladder cancer in our Center from Pernambuco State, Brazil.

Linfomas em pacientes com a forma hepatoesplênica da esquistossomose mansônica

BACKGROUND: Correlation between infectious agents and linfoproliferative diseases are more stablished, over all virus and bacteria, through the activation of linfocytes. AIM: To describe six new cases, of a series of 254 patients (2,36%) with mansonic schistosomiasis, in the hepatosplenic form. METHODS: Six patients will be described, amongst the 254 carriers of mansonic schistosomiasis, in the hepatosplenic form, followed in the last 13 years. RESULTS: All the six cases had occurred in women. The histopathologic examinations had evidenced two cases of marginal splenic zone lymphomas, one of great cells with immunoblasts lymphomas, one diffuse lymphomas, a great cells malignant lymphomas, a great not clivads cells, and another case of Hodgkin. Half of the six evolved for the death 4-15 months after the diagnosis. The others three persist in accompaniment in the Oncology Division of the Clinics Hospital. CONCLUSION: The incidence of lymphomas in the 254 mansonic schistosomiasis patients followed in our clinic was of 2,36%. At last, this article intends to call the attention, for the occurrence of lymphomas, in the spleen of patients with mansonic schistosomiasis, in the hepatosplenic form.

Neoplasias do intestino delgado: experiência de cinco anos

OBJETIVO: Analisar a experiencia do Servico de Cirurgia Geral - HC/UFPE com os tumores do intestino delgado, na tentativa de colaborar com a definicao de metas para o manejo dessas lesoes. METODO: Constitui-se este estudo em uma analise retrospectiva de12 pacientes portadores de neoplasias intestinais atendidos no SCG-HC/UFPE, no periodo de cinco anos (1994-1999). Sete eram do sexo masculino (58%). A media de idade a admissao foi de 52 anos. A principal queixa referida foi dor abdominal (83%), seguida por sangramento digestivo e perda ponderal (42%). Massa abdominal palpavel foi evidenciada em 50% dos casos. Sete (58%) apresentavam lesoes malignas. Dentre as neoplasias benignas, quatro eram leiomiomas. Uma paciente, portadora de sindrome de Peutz-Jeghers, apresentou um hamartoma. Dez foram submetidos a tratamento operatorio. Em seis, enterectomia com enteroanastomose foi empregada. Tres foram operados em carater de urgencia (um por perfuracao intestinal, um por enterorragia macica e um por obstrucao intestinal). RESULTADOS: A mortalidade relacionada a operacao foi de 17%. Todos os pacientes que evoluiram para obito apresentavam neoplasias malignas avancadas e perda ponderal superior a15% de seu peso. CONCLUSOES: Tumores do intestino delgado sao lesoes incomuns, mesmo em servicos de referencia. Um alto grau de suspeicao deve ser mantido visando o diagnostico precoce.

Leiomioma perfurado do intestino delgado

A perforated jejunal leiomyoma is a rare condition; only seven cases have been described in the literature. We report a case of a 45 years old man with a perforate acute abdomen. At laparotomy, a 12 cm multilobulated firm mass, located 20 cm distal from Treitz ligament, was removed. Histological sections disclosed a jejunal leiomyoma. The benign pattern of the lesion was confirmed with no mitosis and no atypical cellurarity. Five years later, the patient is free of the disease.

Volvo gástrico agudo perfurado

The authors report a case of acute gastric volvulus in a 20-year-old male, complicated by perforation near the gastroesophageal junction and generalized peritonitis. This is an uncommon and potentially lethal conditon although our patient has been handled successfully with a partial gastrectomy.