Rodrigo de Oliveira Peixoto

Índices diagnósticos da ultrassonografia abdominal na apendicite aguda: influência do gênero e constituição física, tempo evolutivo da doença e experiência do radiologista

OBJETIVO: Verificar o valor da ultrassonografia abdominal no diagnostico da apendicite aguda e a influencia do genero, constituicao fisica, experiencia do radiologista e o tempo evolutivo da doenca nos resultados dos indices diagnosticos. METODOS: Avaliou-se prospectivamente 156 pacientes com diagnostico clinico de apendicite aguda, submetidos a ultrassonografia abdominal e apendicectomia laparoscopica, acompanhado de estudo anatomopatologico dos apendices extirpados. Os pacientes foram alocados quanto ao IMC em dois grupos (abaixo ou acima de 25kg/m2) e os radiologistas, em tres grupos conforme a experiencia profissional (menos de cinco anos, entre cinco e 10 anos e mais de 10 anos). A pesquisa avaliou tambem a interferencia do genero e do tempo de evolucao da doenca utilizando-se a mediana de 36 horas. RESULTADOS: A sensibilidade e especificidade da ultrassonografia abdominal para o diagnostico da apendicite aguda foram 64,9 e 72%, respectivamente. O genero, o indice de massa corporea, o tempo de experiencia dos radiologistas nos tres grupos estudados e o tempo de inicio de sintomas da doenca, nao demonstraram diferencas significativas no estabelecimento do diagnostico ecografico da apendicite aguda. CONCLUSAO: A ultrassonografia abdominal apresentou baixa sensibilidade e especificidade e pouco contribuiu para diagnostico da apendicite aguda. O genero, a constituicao fisica, a experiencia do radiologista e tempo de inicio de sintomas da doenca nao interferiram no resultado do exame ecografico.

Tolerância, coragem e compaixão: virtudes cardinais do cirurgião

Interactions among human beings are very complex. Using only an ethical code as reference to deal with moral conflicts is hardly ever enough. Responsibility ethics demand such a profound reflection as well as a discussion about human essence and its role in society. The responsibility of a surgeon is inherent in a profession based since its origin, not only on altruism and humanity, but also on compassion, courage and tolerance. The studies and the comprehension of these qualities as well as the transmission of these values to the students and to the surgery residents are essential for human education of these individuals. This essay offers to show that these essential virtues are strongly connected to the work the surgeon develops whereas his/her responsibility starts before the surgery - when one intends to act.

Uso de adesivos teciduais em cirurgia digestiva

BACKGROUND: Despite refinements in the field of gastrointestinal surgery, anastomotic leakage still remains a serious problem associated with substantial morbidity and mortality and is the fearest life threatening complication in digestive surgery. To prevent or reduce these complications, a diversity of line reinforcement techniques have been investigated and several adjunctive measures have been developed. AIM: To review the data associated with the application of adhesives in digestive surgery procedures. METHOD: Review of papers available at Medline/Pubmed database using the follow headings: adhesive, gastrointestinal tract, surgical anastomosis, fistula. It was chosen recent articles on the subject which showed adhesives as strategy to reduce morbidity and mortality related to digestive surgery. CONCLUSION: Tissue adhesives appears to be safe in the clinical setting and are been used with increasing frequency in a variety of surgical field for its unique hemostatic and adhesive abilities, gaining increasing acceptance among surgeons. Studies suggest that surgical adhesive can be useful to reinforce and improve intestinal anastomotic healing, increase anastomotic bursting pressures and tensile strength. The potentially harmful tissue effects of the preparations might compromise the use of these substances. Because of the heterogeneity and lack of high level evidence, new studies have to be performed.

Spleen-preserving distal pancreatectomy in the management of solid papillary-cystic tumor of the pancreas: case report and literature review

BACKGROUND: Solid papillary-cystic pancreatic tumors have been recognized as a distinct neoplastic disease, whose incidence has increased in recent years with advancements in imaging technology. CASE REPORT: Woman 17-year-old consulted with a symptomatic giant homogeneous solid-cystic mass in the pancreatic tail, undergone a spleen preserving distal pancreatectomy, with excision of the splenic vessels. Histopathology revealed epithelium-lined pseudopapillary protrusions, without malignant change. The patients postoperative course was uneventful. CONCLUSION: Solid papillary-cystic pancreatic tumor has uncommon incidence and silent presentation, a high degree of suspicion on the part of the surgeon is warranted. In early diagnosis, complete resection is curative. The spleen should be preserved, if feasible.

Colangite como uma manifestação clínica atípica de linfoma pancreático: relato de caso

. O papel da resseccao cirurgica na cura desta doenca e mal definido.A maioria dos pacientes com linfoma de pâncreas apresenta massa na cabeca da 13glândula, e e muitas vezes descrito como uma grande massa, com ou sem linfadenopatia associada. Devido a que o carcinoma pancreatico tem perspectiva sombria, muitos pacientes nao sao submetidos a biopsia e o fracasso em fazer este diagnostico elimina a chance de cura