Jose Ricardo Guimaraes

Thyroglobulin measurements in washout of fine needle aspirates in cervical lymph nodes for detection of papillary thyroid cancer metastases

OBJECTIVE The aim of this study was to evaluate the accuracy of the measurement of thyroglobulin in washout needle aspiration biopsy (FNAB-Tg) to detect papillary thyroid cancer (PTC) metastases. SUBJECTS AND METHODS Forty-three patients (51.4 ± 14.6 years) with PTC diagnosis and evidence of enlarged cervical lymph nodes (LN) were included. An ultrasound-guided fine-needle aspiration of suspicious LN was performed, for both cytological examination and measurement of FNAB-Tg. RESULTS The median values of FNAB-Tg in patients with metastatic LN (n = 5) was 3,419 ng/mL (11.1-25,538), while patients without LN metastasis (n = 38) showed levels of 3.7 ng/mL (0.8-7.4). Considering a 10 ng/mL cutoff value for FNAB-Tg, the sensitivity and specificity was 100%. There were no differences on the median of FNAB-Tg measurements between those on (TSH 0.07 mUI/mL) or off levothyroxine (TSH 97.4 mUI/mL) therapy (3.3 vs. 3.8 ng/mL, respectively; P = 0.2). CONCLUSION The results show that evaluation of FNAB-Tg in cervical LN is a valuable diagnostic tool for PTC metastases that can be used independent of the thyroid status.

ROBOTIC ASSISTED SINGLE SITE FOR BILATERAL INGUINAL HERNIA REPAIR

ABSTRACT Background: The inguinal hernia is one of the most frequent surgical diseases, being frequent procedure and surgeon´s everyday practice. Aim: To present technical details in making hernioplasty using robotic equipment on bilateral inguinal hernia repair with single port and preliminary results with the method. Method: The bilateral inguinal hernia repair was performed by using the Single-Site(c) Da Vinci Surgical Access Platform to the abdominal cavity and the placement of clamps. Results: This technique proved to be effective for inguinal hernia and have more aesthetic result when compared to other techniques. Conclusions: Inguinal hernia repair robot-assisted with single-trocar is feasible and effective. However, still has higher costs needing surgical team special training.

Evaluation of three different techniques for insertion of totally implantable venous access device: A randomized clinical trial

Although totally implantable venous access devices (TIVAD) are increasingly being used in oncology patients, more robust evidence about the best technique is lacking, especially regarding to ultrasound (US) guided puncture.

Experiência de 20 anos em adrenalectomia videolaparoscópica

Introducao: As operacoes na glândula adrenal sao realizadas para determinadoscânceres, todas as massas biologicamente ativas, metastases, massas com mais de 4-5 cm encontradas incidentalmente e hiperplasia adrenal primaria. Metodos: Estudo transversal edescritivo. Foram analisados os prontuarios dos pacientes submetidos a adrenalectomia videolaparoscopica entre agosto de 1994 e novembro de 2014. Resultados: Foram realizadas 146 adrenalectomias videolaparoscopicas. Em 134 casos, foi realizada com sucesso, mas em 12 casos (8,2%), o procedimento foi convertido. Foram 97 pacientes do sexo feminino e 49 do sexo masculino, com idade variando de 9 a 81 anos (media de 46,7 anos). Foram removidas 56 adrenais direitas, 75 esquerdas e 15 bilaterais. O tamanho medio das adrenais foi de 5,7 cm, variando de 0,9 a 15 cm. A mediana do tempo de internacao hospitalar pos-operatoria foi de 4,5 dias. A mediana do tempo de cirurgia foi de 144 minutos. Houve complicacoes em22,5% dos casos (maiores – casos em que houve conversao para cirurgia aberta, necessidade de reinternacao hospitalar e obito– e menores), sendo 10,9% complicacoes intraoperatorias e 11,6% pos-operatorias. Apenas sete (4,7%) pacientes foram considerados complicacoes maiores. Conclusao : A cirurgia realizada em nosso servico esta de acordo com o descrito na literatura, com taxas aceitaveis de complicacoes, com motivos de conversao compativeis e com as indicacoes totalmente aceitaveis e condizentes.A adrenalectomia videolaparoscopica e a cirurgia de escolha para patologias cirurgicas da glândula adrenal, exceto em casos de carcinoma adrenal localmente invasivo com comprometimento de outras estruturas. Palavras-chave : Glândulas suprarrenais; adrenalectomia; laparoscopia