Manuel Domingos da Cruz Gonçalves

Ectopic and extranumerary parathyroid glands location in patients with hyperparathyroidism secondary to end stage renal disease

UNLABELLED Supranumerary or ectopic parathyroid glands are the main cause of persistent hyperparathyroidism (HPT) in patients with end stage renal disease (ESRD) submitted to parathyroidectomy (PTx). PURPOSE To evaluate the prevalence and location of parathyroid glands in these patients. METHODS Thirty-five patients with ESRD and severe secondary hyperparathyroidism (HPT2) had been submitted to total PTx at HUCFF from December 2001 to July 2005. Surgery was always performed by the same surgeon, who described in details the location of the glands. RESULTS Sixteen patients (45.7%) had ectopic glands, which were also extranumerary in five of them (14.3%). The most common locations were the thyroid parenchyma (33.3%), thyroid-thymus conduit (18.5%), and thymus (14.8%). Before PTx, the sensibility of ultrasonography and scintigraphy with technetium-99m Sestamibi was low (48.3% and 35.3%, respectively). Moreover, 51.4% of the nodules found at US were thyroid nodules. However, 99mTc-Sestamibi was useful to identify ectopic glands in those two patients with persistent HPT after PTx. CONCLUSION The presence of extranumerary and ectopic parathyroid glands in HPT2 is sufficiently important to justify their exhaustive search. As the preoperative image exams present low sensibility to locate them, it is necessary to develop an exploratory routine embracing the most common sites of location.

Use of intraluminal protection in colonic anastomosis in dogs

PURPOSE To test the use of intraluminal protection in colonic anastomosis without intestinal cleansing. The intraluminal liner was fashioned from porcine submucosa preserved in glycerin and then fixed 10 cm anteriorly to the anastomotic site. This technique was compared with the one used in termino-terminal colonic anastomosis without intraluminal protection. METHODS Twenty-eight dogs were divided into two groups of fourteen animals each. Clinical and histopathological tests were performed on the fourth and twenty-first postoperative days. RESULTS The morbidity and mortality rates were higher in animals that did not receive the intraluminal liner. Histopathological examinations in animals in which the intraluminal liner was used showed better healing, characterized by milder inflammation and increased amount of collagen. CONCLUSION It can be concluded that the use of intraluminal protection decreases complication rates in colonic anastomosis and promotes better healing.

Cirurgia do hiperparatireoidismo

Hyperparathyroidism is a desease caused by increase of parathormone secretion, leading to a misfunction of calcium metabolism. Although not very common among population in general, it is frequently observed in patients with cronic renal disease. It can involve a slight syntomatic form, but as a whole, its main repercurssions occur in skeletic muscles, urinary and intestinal systems. The authors conduct a broad revision of the literature, focusing on the methods of diagnosis and spot checking before and during the operations of parathyroid glands. Surgical recommendations, tatic aspects and types of surgery to be implemented are discussed. A systematization for adequate surgical technics performed at the General Surgery Service of Clementino Fraga Filho Hospital of Federal University of Rio de Janeiro is fully discribed and recommended.

Valor da dosagem da tireoglobulina no seguimento de pacientes com carcinoma diferenciado da tireóide submetidos à tireoidectomia parcial

1. Professor Adjunto do Departamento de Cirur gia da Faculdade de Medicina da UFRJ.2. Professor Adjunto do Departamento de Cirurgia da Faculdade de Medicina da UFRJ.3. Professor Adjunto do Departamento de Cirurgia da Faculdade de Medicina da UFRJ.4. Professor Adjunto do Departamento de Cirurgia da Faculdade de Medicina da UFRJ.Recebido em 25/06/2001Aceito para publicacao em 08/10/2001Trabalho realizado no Hospital Universitario Clementino Fraga Filho da UFRJ.

Grau de aderência após ressecção parcial e reconstituição do ovário

Purpose: to compare ovarian adhesion according to different types of ovarian cortex closure. Methods: fifteen rabbits were randomly assigned to 3 groups according to the type of ovarian cortex closure, consisting of bipolar diathermy, 5-0 polyglactin 910 and 5-0 plain catgut. After 2 weeks the animals were sacrificed and the adhesion scores were evaluated in the right ovary using the Diamond classification. The left ovary, not incised, was used as control. Statistical analyses were done using analysis of variance (ANOVA), Scheffe test and Students t test. Results:the mean adhesion scores for the bipolar, polyglactin and plain catgut groups were 0.7, 1.5 and 2.0, respectively. The analysis of variance detected a significant difference (p=0.02) between the three groups. Using Scheffe test for the two by two comparison of the groups, a significant difference was found between the bipolar and the plain catgut groups. Comparing the group in which sutures were used (independent of the material employed) with the bipolar group, a statistically significant difference was observed (1.8 and 0.7, respectively, p=0.01). Conclusions: the results obtained in this study are in accordance with the literature data, showing that second intention closure is more advantageous, concerning adhesion formation, than closure using sutures.

Tireoidectomia unilateral no carcinoma diferenciado da tireóide de baixo risco: uma cirurgia inadequada

BACKGROUND: Recent studies challenge the efficacy of unilateral resection in the prevention of recurrences in differentiated thyroid carcinoma of low-risk group. Our objectives were to compare recurrence rates after unilateral and bilateral resections in our so-called low-risk group and to evaluated the accuracy of the criteria used to classify patients into high and low-risk group. METHODS: We evaluate outcome of 169 patients who underwent surgery for differentiated thyroid carcinoma at the HUCFF. They were divided in 2 groups: low-risk patients (n = 127) and high-risk patients (n = 42). Unilateral resection was undertaken in 71 patients of the low-risk group and in 4 of the high-risk group; bilateral resection was the operation used in 56 and 38 patients, respectively, in each of these groups. RESULTS: Follow-up was obtained in 155 patients in a mean period of 8.4 years for 116 low-risk patients and 5 years for 39 high-risk ones. In high-risk group recurrence occurred in 3 patients (7.5%) and there were 5 tumor related deaths (12.5%). In the low-risk group, there were 13 recurrences (8,3%) but no death occurred. The difference in recurrence rate between groups does not attain statistical e significance (p= 0.57). Recurrence occurred in 5 (7.5%) in the low-risk patients submmited to unilateral resection and in 5 (10%) of those submmited to bilateral resection. CONCLUSIONS: The division of patients with differentiated thyroid carcinoma in high and low-risk groups is useful is predicting more aggressive recurrences and tumor-related deaths. Unilateral resection in low-risk patients is not associated with higher recurrence rates.

Ensino com pesquisa: uma estratégia formadora para alunos de pós-graduação em medicina

OBJECTIVE Promoting a scientific activity of research to students of a graduation program as a reflexive tool of teacher and formative practice of necessary activities to construction of a research in medical education. METHODS Graduation students of surgery at UFRJ did a research, randomly interviewing a population of medical teachers who acts at Medicine Universities of Rio de Janeiro. The study was structured in three steps: definition of the investigative content; realization of 150 interviews before field research and discussion about the results. RESULTS The majority of interviewees (85%) assert to know the recent trends of education, but when they express their thoughts they leave doubts about the real knowledge of the subject. The expositive classes were used by 90% of the interviewees; only 10% of them utilized strategies of teaching to transmit the contents. Just 52% of the doctors said that they had already heard about the Resolution CNE/CES N° 4/2001. CONCLUSION The teaching with research challenged the students as investigators preparing them to the research and construction of the necessary scientific attitudes in the graduation and assisting them in solving the investigated problem. The results highlighted that the found peaces of information in the research were not accurate to feature a real dimension of the update, showing that it is recommended new studies.