Total Clipless Cholecystectomy by Means of Harmonic Sealing

Background In traditional laparoscopic cholecistectomy, the cystic duct and artery are commonly closed by metallic clips just before their division. Although the placement of these clips for occluding cystic artery and duct can be considered safe, biliary leaks and bleeding may occur especially by its dislodgement. Aim To report a prospective case-series in total clipless cholecystectomy by means of harmonic shears for closure and division of the artery and cystic duct as well removal of the gallbladder from the liver. Methods Was evaluate a series of 125 patients who underwent laparoscopic cholecystectomy where the sealing and division of cystic artery and duct was carried out only by harmonic shears. The intact extracted gallbladder was submitted to a reverse pressure test for assessment of the technique safety by means of CO2 insuflation. Results The most common indication for surgery was gallstones. The mean operative time was 26 min and all gallbladders were dissected intact from the liver bed. There was no mortality and the overall morbidity rate was 0.8% with no hemorrhage or leaks. The reverse pressure test showed that all specimens support at least 36-mmHg of pressure without leaking. Conclusions The harmonic shears is effective and safe in laparoscopic cholecystectomy as a sole instrument for sealing and division of the artery and cystic duct. The main advantages could be related to the safety and decreased operative time

Avaliação do efeito inibidor da vitamina C na carcinogenese esofagica experimental induzida pela dietilnitrosamina

Orientadores: Nelson Adami Andreollo, Rachel LewinsohnDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: O câncer é atualmente a segunda causa de morte nos países desenvolvidos. Embora tenham sido obtidos alguns avanços no seu tratamento, o prognóstico da doença ainda está longe de ser satisfatório. Apesar do câncer de esôfago não estar entre os mais freqüentes, sendo a quarta neoplasia que mais acomete o aparelho digestivo do homem, seu estudo é muito importante, principalmente por duas razões: atinge as pessoas numa das funções mais importantes para a manutenção da vida, a nutrição; e as taxas de incidência são muito similares às de mortalidade, demonstrando a ineficiência do tratamento. A melhora desta realidade pode ser conseguida de duas maneiras: diagnóstico e tratamento precoce e prevenção. Assim, a procura de substâncias que possam interferir na carcinogênese, impedindo o aparecimento de tumores, parece ser uma idéia atrativa. O objetivo deste estudo foi avaliar o efeito da vitamina C na inibição da carcinogênese esofágica experimental induzida pela dietilnitrosamina (DEN). Foram estudados 240 ratos da raça Wistar todos machos, com peso médio de 155g e três meses de idade. Os animais foram acondicionados em gaiolas com cinco ratos cada, recebendo água e alimentação ad libitum. As drogas eram colocadas na água, sendo a DEN usada na dosagem de l0mg/kg/dia e a vitamina C, na de 1290mg/kg/dia. Para melhor estudo dos efeitos destas substâncias, os animais foram divididos em grupos segundo a droga ou drogas que receberiam: grupo I, controle, somente água nos sete dias da semana; grupo II, vitamina C nos sete dias da semana; grupo III, DEN três dias por semana e água nos outros quatro dias; grupo IV, DEN três dias por semana e vitamina C nos outros quatro dias; grupo V, DEN e vitamina C juntos no mesmo frasco, por três dias, e água nos outros quatro dias; e grupo VI, DEN e vitamina C juntos no mesmo frasco, por três dias, e vitan1ina C nos outros quatro dias. Cada grupo foi dividido em subgrupos de 10 animais, segundo o tempo de observação (T), sendo o sacrifício dos animais realizado em quatro diferentes T: 90, 120, 150 e 180 dias. A seguir, o esôfago era removido e avaliado macro e microscopicamente, para a identificação de tumores. A análise dos resultados mostrou que nos grupos I, II e nos T90 e T 120 dos grupos III, IV, V e VI não ocorreu a formação de nenhum tipo de tumor. No T150, na análise macroscópica, foram encontradas 10 le~ões no grupo III (1 lesão por animal) e sete lesões no grupo IV (0,7 lesão por animal), não ocorrendo nenhuma lesão nos grupos V e VI. Na análise microscópica foram identificadas seis lesões no grupo m (0,6 lesão por animal) e cinco no grupo IV (0,5 lesão por animal), não ocorrendo nenhuma lesão nos grupos V e VI. No T180, na análise macroscópica, foram encontradas 48 lesões no grupo m (4,8 lesões por animal);"31 lesões no grupo IV (3,1 lesões por animal); cinco lesões no grupo V (0,5 lesão por animal) e uma lesão no grupo VI (O, 1 lesão por animal). Na análise microscópica foram identificadas 23 lesões no grupo m (2,3 lesões por animal); 17 lesões no grupo IV (1,7 lesões por animal); três lesões no grupo V (0,3 lesão por animal) e uma lesão no grupo VI (O, 1 lesão por animal). Houve diferença significativa entre os grupos em relação à formação de tumores, verificando-se no grupo m o maior índice de neoplasias. Nos grupos que receberam vitamina C como inibidor (grupos IV, V e VI) ocorreu menor incidência de tumores, sendo o melhor efeito inibidor observado nos grupos que receberam a vitamina C e o DEN no mesmo frasco (grupo V e VI). Dessa forma, pode-se concluir que a vitamina C apresentou efeito inibidor do aparecimento de tumores de esôfago induzidos experimentalmente com a DEN, com melhores resultados quando as drogas eram dadas conjuntamenteAbstract: Cancer is today the second death cause in developed countries. In spite of the fact that certain advances have been obtained in the course of its treatment, the prognosis of this disease is still far from being satisfactory. Although esophageal cancer is not among the most frequent kinds of cancer actually it is the fourth neoplasia to affect man's digestive system - its studies are very important, basically for two reasons: first, this type of cancer affects people in their most natural life proceeding: nutrition; second, its occurrence rates are quite similar to those of mortality, clearly demonstrating the inefficiency of the treatment. However, two procedures may change this terrifying picture: early diagnosis and prevention. So, the search for substances that may interfere with the carcinogenesis keeping away the possibilities of new tumors looks like a very attractive idea. The aim of this report was to evaluate the inhibiting effect of vitamin C in the experimental esophageal carcinogenesis induced by diethylnitrosamine (NDEA). Were employed 240 male Wistar rats, all of them with approximately 155 gr. of weight and three months old. The animals were kept in cages with five rats each and fed with food and water ad libitum. Drugs were dissolved in water. Dosages were: NDEA: 10mg. / kg. / day and vitamin C: 1,290 mg. / kg. / day. The animals were divided into different groups according to the drug/drugs they would be given, for a better study of the drug effects Group I, control, only water, seven days a week; Group II, only vitamin C, seven days a week; Group III, NDEA, three days a week and water, the other four days; Group IV, NDEA, three days a week and vitamin C, the other four days; Group V, NDEA and vitamin C together in the same bottle, three days a week and only water, the other four days; Group VI, NDEA and vitamin C together in the same bottle, three days and vitamin C, the other from days. Every group was subdivided into other smaller groups of ten animals each, according to the observation time (T). The animals were sacrificed in four different times, 90, 120, 150 and 180 days. After the elapsed time, each animal was sacrificed and its esophagus was macro/microscopically evaluated to identify any tumors. As final results, in the groups I and 11 and in T90 and T120 of groups III, IV, V and VI there was no occurrence of any kind of tumor. The macroscopic studies in T 150 showed ten lesions in the group III (0.1 lesion per animal) and seven lesions in the group IV (0.7 lesion per animal), and no lesion the in the groups V and VI. The microscopic studies showed six lesions in the group III (O.6Iesion per animal) and five lesions in the group IV (OA lesion per animal), and no lesion in the groups V and VI. The macroscopic studies in T180 showed 48 lesions in the group III (4.8 lesions per animal), 31lesions in the group IV (3.1IesiolÍs per animal), 5 lesions in the group V (0.5 ,lesion per animal) and only one lesion in the group VI (0.1 lesion per animal). the microscopic studies identified 23 lesions in the group III (2.3 lesions per animal), 17 lesions in the group IV (1.7 lesions per animal), 3 lesions in the group V (0.3 lesion per animal) and only one lesion in the group VI (0.1 lesion per animal). The analysis of such results shows that there were significant differences among the groups towards the occurrence of tumors. On the other hand, group III was the one that showed the highest rate of neoplasias. Therefore, the analysis of the results demonstrated that vitamin C administered together with diethylnitrosamine (NDEA) showed an inhibiting effect over the occurrence of tumors in animalsMestradoMestre em Cirurgi

MINI-GASTRIC BYPASS: DESCRIPTION OF THE TECHNIQUE AND PRELIMINARY RESULTS

<div><p>ABSTRACT Background : In recent years, a surgical technique known as single-anastomosis gastric bypass or mini-gastric bypass has been developed. Its frequency of performance has increased considerably in the current decade. Aim : To describe the mini-gastric bypass technique, its implementation and preliminary results in a university hospital. Methods : This is an ongoing prospective trial to evaluate the long-term effects of mini-gastric bypass. The main features of the operation were: a gastric pouch with about 15-18 cm (50-150 ml) with a gastroenteric anastomosis in the pre-colic isoperistaltic loop 200 cm from the duodenojejunal angle (biliopancreatic loop). Results : Seventeen individuals have undergone surgery. No procedure needed to be converted to open approach. The overall 30-day morbidity was 5.9% (one individual had intestinal obstruction caused by adhesions). There was no mortality. Conclusion : Mini-gastric bypass is a feasible and safe bariatric surgical procedure.</p></div

Role of the vitamin C in diethylnitrosamine-induced esophageal cancer in Wistar rats O efeito inibidor da vitamina C na carcinogênese esofágica induzida pela dietilnitrosamina em ratos Wistar

PURPOSE: To evaluate the inhibitory effect of vitamin C on the experimental esophageal carcinogenesis induced by diethylnitrosamine (NDEA). METHODS: Sixty Wistar male rats aged three months, with mean weight of 210 g were employed in the study and were divided into four different groups according to the drinking drugs: group I - controls: only water, seven days a week; group II - only vitamin C, seven days a week; group III - NDEA, three days a week and water during the other four days; group IV - NDEA, three days a week and vitamin C during the other four days; group V - NDEA together with vitamin C three days a week, and only water during the other four days and group VI - NDEA together with vitamin C three days a week and vitamin C during the other four days. The dosages of NDEA were: - 10 mg. / Kg / day and vitamin C - 200 mg / animal / day, dissolved in drinking water. The animals were observed during 180 days and after that each one was sacrificed and its esophagus and the stomach were removed together and macro and microscopically analyzed to identify any tumors. RESULTS: The largest number of tumors was observed in the group III: 48 macroscopic lesions (4.8 lesions per animal) and 23 microscopic lesions (2.3 lesions per animal). The groups that received vitamin C (groups IV, V and VI) showed smaller number of tumors: group V - 0.5 macroscopic lesions and 0.3 microscopic lesions per animal and group VI - 0.1 macroscopic lesions and 0.1 microscopic lesions per animal. The incidence of tumors in the groups V and VI showed statistical significance (p<0.05), when compared to the other groups. CONCLUSION: The vitamin C administered together with diethylnitrosamine showed an inhibitory effect on the experimental esophageal carcinogenesis in Wistar rats.<br>OBJETIVO: Avaliar o efeito inibidor da vitamina C na carcinogênese esofágica experimental induzida pela dietilnitrosamina (DEN). MÉTODOS: Sessenta ratos Wistar, com idade de três meses, machos, com peso médio de 210 g foram utilizados no estudo e divididos em quatro grupos diferentes, conforme ingestão das drogas: grupo I - controles: ingerindo água sete dias por semana; grupo II - só vitamina C, sete dias por semana; grupo III - DEN, três dias por semana e água durante os outros quatro dias; grupo IV - DEN, três dias por semana e vitamina C durante os outros quatro dias; grupo V - DEN junto com vitamina C três dias por semana, e água os outros quatro dias e grupo VI - DEN junto com vitamina C três dias por semana e só vitamina C durante os outros quatro dias. As dosagens de DEN empregadas foram - 10 mg. / Kg / dia e de vitamina C - 200 mg / animal / dia, dissolvidos na água de beber. Os animais foram observados durante 180 dias e depois disso sacrificados, tiveram o seu esôfago e o estômago retirados, e macro e microscòpicamente analisados para identificar qualquer tumor. RESULTADOS: O número maior de tumores foi observado no grupo III: 48 lesões macroscópicas (4.8 lesões por animal) e 23 lesões microscópicas (2.3 lesões por animal). Os grupos que receberam vitamina C (grupos IV, V e VI) evidenciaram número menor de tumores: grupo V - 0.5 lesões macroscópicas e 0.3 lesões microscópicas por animal e grupo VI - 0.1 lesões macroscópicas e 0.1 lesões microscópicas por animal. A incidência de tumores nos grupos V e VI mostraram diferença estatística significa (p <0.05), quando comparados aos outros grupos. CONCLUSÃO: A vitamina C administrada junto com dietilnitrosamina mostrou efeito inibidor no aparecimento de tumores esofágicos

Role Of The Vitamin C In Diethylnitrosamine-induced Esophageal Cancer In Wistar Rats.

To evaluate the inhibitory effect of vitamin C on the experimental esophageal carcinogenesis induced by diethylnitrosamine (NDEA). Sixty Wistar male rats aged three months, with mean weight of 210 g were employed in the study and were divided into four different groups according to the drinking drugs: group I--controls: only water, seven days a week; group II--only vitamin C, seven days a week; group III--NDEA, three days a week and water during the other four days; group IV--NDEA, three days a week and vitamin C during the other four days; group V--NDEA together with vitamin C three days a week, and only water during the other four days and group VI--NDEA together with vitamin C three days a week and vitamin C during the other four days. The dosages of NDEA were: --10 mg./Kg/day and vitamin C--200 mg/animal/day, dissolved in drinking water. The animals were observed during 180 days and after that each one was sacrificed and its esophagus and the stomach were removed together and macro and microscopically analyzed to identify any tumors. The largest number of tumors was observed in the group III: 48 macroscopic lesions (4.8 lesions per animal) and 23 microscopic lesions (2.3 lesions per animal). The groups that received vitamin C (groups IV, V and VI) showed smaller number of tumors: group V--0.5 macroscopic lesions and 0.3 microscopic lesions per animal and group VI--0.1 macroscopic lesions and 0.1 microscopic lesions per animal. The incidence of tumors in the groups V and VI showed statistical significance (p<0.05), when compared to the other groups. The vitamin C administered together with diethylnitrosamine showed an inhibitory effect on the experimental esophageal carcinogenesis in Wistar rats.24183-