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

A RELAÇÃO ENTRE O IGC E O PROJETO PEDAGÓGICO INSTITUCIONAL: REFLEXÕES A PARTIR DE UMA ANÁLISE DO PDI EM FACULDADES ISOLADAS

O artigo versa sobre um estudo que tem a intenção de apresentar as principais ações que confirmam a relação entre o IGC e o PDI na perspectiva do Projeto Pedagógico Institucional no contexto de Faculdades Isoladas localizadas no sul do estado de Santa Catarina. No escopo teórico, a pesquisa elenca aspectos que contextualizam a estrutura das faculdades isoladas, considerando a expansão proporcionada a partir de 1996 sob o advento da LDB. Elenca, ainda, considerações sobre o PDI e sua estrutura dinâmica de seus eixos, os quais são responsáveis pelo desenvolvimento das questões operacionais e estratégicas das instituições. O trabalho, ainda em seu escopo teórico, traz assertivas que consideram o IGC um referencial no contexto avaliativo e regulatório, orientando as atividades acadêmicas e administrativas em nível institucional. A metodologia, para tanto, se esmera em uma pesquisa predominantemente qualitativa, considerando uma entrevista semi-estruturada como instrumento de coleta de dados, utilizando, também, bases da pesquisa descritiva e explicativa no contexto metodológico. Os resultados permitem concluir, entre outros aspectos, que o IGC traz influencia no PPI das Instituições e orienta um processo de reflexão sobre o desenvolvimento institucional

A colaboração do segmento privado da educação superior na proposta de democratização do acesso: um estudo da perspectiva sul catarinese

http://dx.doi.org/10.5007/1983-4535.2014v7n1p79 Considerando a democratização do acesso à educação superior, o artigo tem como objetivo apresentar quais são as principais contribuições de Faculdades Isoladas localizadas no Sul do Estado de Santa Catarina. Para tanto, as contribuições teóricas se estruturam sob a égide de uma reflexão baseada na evolução da educação superior no Brasil, em reflexões sobre a qualidade no segmento e sobre o PNE como instrumento norteador da expansão da educação superior. Desse modo, com base nas orientações metodológicas, a pesquisa configura-se como sendo predominantemente qualitativa, tendo suas bases principais centradas em um estudo de caso de IES localizadas no sul do estado de Santa Catarina.  Os resultados permitem inferir que os principais indicadores que práticas vinculadas a observância das características sociais do entorno permitem alinhar ações acadêmicas e administrativas que fomentam a democratização do acesso, a equidade e a permanência, fomentando oportunidades para a consecução dos objetivos do Plano Nacional da Educação

SARS-CoV-2 and Obesity: "CoVesity"-a Pandemic Within a Pandemic

Individuals who are overweight or suffering from obesity are in a chronic state of low-grade inflammation, making them particularly susceptible to developing severe forms of respiratory failure. Studies conducted in past pandemics link obesity with worse health outcomes. This population is thus of particular concern within the context of the COVID-19 pandemic, considering the cessation of obesity management services. This systematic review highlights [1] the reciprocal link between the obesity and COVID-19 pandemics, [2] obesity as a risk factor for more severe disease in past pandemics, [3] potential mechanisms that make individual's suffering from obesity more susceptible to severe disease and higher viral load, and [4] the need to safely resume bariatric services as recommended by expert guidelines, in order to mitigate the health outcomes of an already vulnerable population

Operative management of acute abdomen after bariatric surgery in the emergency setting: the OBA guidelines

Background: Patients presenting with acute abdominal pain that occurs after months or years following bariatric surgery may present for assessment and management in the local emergency units. Due to the large variety of surgical bariatric techniques, emergency surgeons have to be aware of the main functional outcomes and long-term surgical complications following the most performed bariatric surgical procedures. The purpose of these evidence-based guidelines is to present a consensus position from members of the WSES in collaboration with IFSO bariatric experienced surgeons, on the management of acute abdomen after bariatric surgery focusing on long-term complications in patients who have undergone laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. Method: A working group of experienced general, acute care, and bariatric surgeons was created to carry out a systematic review of the literature following the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) and to answer the PICO questions formulated after the Operative management in bariatric acute abdomen survey. The literature search was limited to late/long-term complications following laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. Conclusions: The acute abdomen after bariatric surgery is a common cause of admission in emergency departments. Knowledge of the most common late/long-term complications (> 4 weeks after surgical procedure) following sleeve gastrectomy and Roux-en-Y gastric bypass and their anatomy leads to a focused management in the emergency setting with good outcomes and decreased morbidity and mortality rates. A close collaboration between emergency surgeons, radiologists, endoscopists, and anesthesiologists is mandatory in the management of this group of patients in the emergency setting

Multicenter evaluation of the clinical utility of laparoscopy-assisted ERCP in patients with Roux-en-Y gastric bypass

Background and Aims The obesity epidemic has led to increased use of Roux-en-Y gastric bypass (RYGB). These patients have an increased incidence of pancreaticobiliary diseases yet standard ERCP is not possible due to surgically altered gastroduodenal anatomy. Laparoscopic-ERCP (LA-ERCP) has been proposed as an option but supporting data are derived from single center small case-series. Therefore, we conducted a large multicenter study to evaluate the feasibility, safety, and outcomes of LA-ERCP. Methods This is retrospective cohort study of adult patients with RYGB who underwent LA-ERCP in 34 centers. Data on demographics, indications, procedure success, and adverse events were collected. Procedure success was defined when all of the following were achieved: reaching the papilla, cannulating the desired duct and providing endoscopic therapy as clinically indicated. Results A total of 579 patients (median age 51, 84% women) were included. Indication for LA-ERCP was biliary in 89%, pancreatic in 8%, and both in 3%. Procedure success was achieved in 98%. Median total procedure time was 152 minutes (IQR 109-210) with median ERCP time 40 minutes (IQR 28-56). Median hospital stay was 2 days (IQR 1-3). Adverse events were 18% (laparoscopy-related 10%, ERCP-related 7%, both 1%) with the clear majority (92%) classified as mild/moderate whereas 8% were severe and 1 death occurred. Conclusion Our large multicenter study indicates that LA-ERCP in patients with RYGB is feasible with a high procedure success rate comparable with that of standard ERCP in patients with normal anatomy. ERCP-related adverse events rate is comparable with conventional ERCP, but the overall adverse event rate was higher due to the added laparoscopy-related events

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