Apendicectomia laparoscópica na gestante

OBJETIVO: A apendicite aguda é a doença cirúrgica não-obstétrica mais comum da gravidez e pode ocorrer em qualquer idade gestacional. O seu diagnóstico freqüentemente é tardio, o que pode acarretar alto índice de perfuração e complicações. O presente estudo visa apresentar os resultados da videolaparoscopia no tratamento da apendicite aguda na gravidez. MÉTODO: São analisados retrospectivamente quatro casos de pacientes com suspeita de apendicite aguda avaliadas em serviço de cirurgia de urgência e submetidas à cirurgia videolaparoscópica no segundo trimestre da gestação. RESULTADOS: A videolaparoscopia confirmou o diagnóstico de apendicite aguda em três casos e o outro tratava-se de cisto ovariano roto. Todas foram tratadas pelo método laparoscópico, sem necessidade de conversão, e receberam alta hospitalar em cerca de 72 horas. Não houve complicações pós-operatórias. As pacientes foram acompanhadas no restante da gestação, e os partos ocorreram na data prevista, sem complicações maternas ou para os recém-nascidos. CONCLUSÃO: A apendicectomia laparoscópica na gravidez revelou-se um procedimento seguro, que possibilita uma recuperação pós-operatória mais rápida e sem evidências de que interfira com o curso da gestação. Entretanto, estudos com maior número de casos são necessários para estabelecer o seu real valor

Vitamin D levels in healthy men in eastern Saudi Arabia

<b>Background:</b> Studies in 1980s and 1990s indicated that vitamin D levels in the ethnic Saudi Arabian population were low but no studies since that time have evaluated vitamin D levels among healthy young or middle-aged Saudi men. Thus, we assessed the serum level of 25-hydroxyvitamin D (25OHD) among healthy Saudi Arabian men living in the Eastern Province. <b> Subjects and Methods : </b>One hundred males aged 25-35 years (the age range of peak bone mass) and 100 males aged 50 years or older were randomly selected and evaluated clinically, including measurement of serum calcium, parathyroid hormone (PTH) and serum 25OHD levels. Vitamin D deficiency was defined as a serum level of 25OHD of &#8804;20 ng/mL and insufficiency as a serum level between&#62; 20 ng/mL and &#60; 30 ng/mL and normal &#8805;30 ng/mL. <b> Results: </b> The mean (SD) age of subjects in the younger age group was 28.2 (4.5) years. Twenty-eight (28&#x0025;) had low 25OHD levels; 10 (10&#x0025;) subjects were vitamin D deficient with a mean level of 16.6 (3.4) ng/mL and 18 (18&#x0025;) were vitamin D insufficient with a mean level of 25.4 (2.7) ng/mL. In the older age group, the mean age was 59.4 (15.6) years and 37 (37&#x0025;) had low 25OHD; 12 (12&#x0025;) subjects were deficient with a mean 25OHD level of 16.7 (3.4) ng/mL and 25 (25&#x0025;) were insufficient with a mean 25OHD level of 25.3 (3.3) ng/mL. <b>Conclusions:</b> The prevalence of vitamin D deficiency among healthy Saudi men is between 28&#x0025; to 37&#x0025;. Vitamin D deficiency among young and middle age Saudi Arabian males could lead to serious health consequences if the issue is not urgently addressed

Laparoscopy for small bowel obstruction: the reason for conversion matters

BACKGROUND: Although laparoscopy is associated with reduced hospital stay, early recovery, and decreased morbidity compared with open surgery, it is not well established for the treatment of small bowel obstruction (SBO). METHODS: This study analyzed a prospective nationwide database of the Swiss Association of Laparoscopic and Thoracoscopic Surgery. RESULTS: From 1995 to 2006, 537 patients underwent laparoscopy for SBO. Matted adhesions were the main cause of obstruction (62.6%). Intraoperative complications occurred for 9.5% of the patients. Postoperative morbidity was 14% and mortality 0.6%. Within 30 days, 13 patients (2.4%) were readmitted because of early recurrence or complications. The conversion rate was 32.4%. The conversions resulted from inability to visualize the site of obstruction or matted adhesions (53.4%), intraoperative complications (21.3%), and small target incisions for resection (25.3%). Emergency operations were associated with higher conversion rates (43.6% vs 19.8%; p < 0.001) but not with significantly more postoperative complications (15.2% vs 11.9%; p = 0.17). Intraoperative complications and conversion were associated with significantly increased postoperative morbidity (39.2% vs 11.3%; p < 0.001 and 24.7% vs 8.3%; p < 0.001, respectively). Reactive conversion due to intraoperative complications was associated with the highest postoperative complication rate (48.6%). Morbidity for preemptive conversion due to impaired visualization/matted adhesions or a small-target incision was significantly lower (20% and 26.1%; p = 0.02 and p < 0.001, respectively). American Society of Anesthesiology (ASA) scores higher than 2 also were associated with postoperative morbidity (p < 0.001). However, multivariate regression analysis showed that reactive conversion was the only independent risk factor for postoperative morbidity (p < 0.001; odds ratio, 3.97; 95% confidence interval, 1.83-8.64). CONCLUSIONS: Laparoscopic management of SBO is feasible with acceptable morbidity and low mortality but with a considerable conversion rate. Early conversion is recommended to reduce postoperative morbidity