Cistadenoma mucinoso retroperitoneal primário - relato de caso

Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM)UNIFESP, EPMSciEL

Portal blood flow volume measurement in schistosomal patients: evaluation of Doppler ultrasonography reproducibility

OBJECTIVE: To evaluate the reproducibility of Doppler ultrasonography in the measurement of portal blood flow volume in schistosomal patients. MATERIALS AND METHODOS: Prospective, transversal, observational and self-paired study evaluating 21 patients with hepatosplenic schistosomiasis submitted to Doppler ultrasonography performed by three independent observers for measurement of portal blood flow. Pairwise interobserver agreement was calculated by means of the intraclass correlation coefficient, paired t-test and Pearson's correlation coefficient. RESULTS: Interobserver agreement was excellent. Intraclass correlation ranged from 80.6% to 93.0% (IC at 95% [65.3% ; 95.8%]), with the Pearson's correlation coefficient ranging between 81.6% and 92.7% with no statistically significant interobserver difference regarding the mean portal blood flow volume measured by Doppler ultrasonography (p = 0.954 / 0.758 / 0.749). CONCLUSION: Doppler ultrasonography has demonstrated to be a reliable method for measuring the portal blood flow volume in patients with portal hypertension secondary to schistosomiasis, with a good interobserver agreement.OBJETIVO: Avaliar a reprodutibilidade do ultra-som Doppler na quantificação do volume de fluxo portal em pacientes esquistossomóticos. MATERIAIS E MÉTODOS: Estudo prospectivo, transversal, observacional e autopareado, avaliando 21 pacientes portadores de esquistossomose hepatoesplênica, submetidos a mensuração do fluxo portal pelo ultra-som Doppler por três observadores, de forma independente, sendo calculada a concordância entre estes, dois a dois, pelo coeficiente de correlação intraclasse, teste t-pareado e grau de linearidade de Pearson. RESULTADOS: A concordância interobservador foi excelente. O coeficiente de correlação intraclasse variou entre 80,6% e 93,0% (IC a 95% [65,3% ; 95,8%]), com coeficiente de correlação de Pearson variando entre 81,6% e 92,7% e sem diferença estatisticamente significante entre os observadores quanto à média do fluxo portal mensurado pelo ultra-som Doppler (p = 0,954 / 0,758 / 0,749). CONCLUSÃO: O ultra-som Doppler é um método confiável para quantificar o fluxo portal em pacientes portadores de hipertensão porta de origem esquistossomótica, apresentando boa concordância interobservador.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Diagnóstico por ImagemUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPM, Depto. de Diagnóstico por ImagemUNIFESP, EPMSciEL

Agreement between magnetic resonance imaging and ultrasonography in the classification of schistosomal periportal fibrosis, according to Niamey's criteria

OBJECTIVE: To evaluate the reproducibility of magnetic resonance imaging and the agreement between ultrasound and magnetic resonance imaging in the classification of periportal fibrosis in patients with schistosomiasis based on Niamey's qualitative criteria. MATERIALS AND METHODS: A prospective, double-blinded study was conducted between February 2005 and June 2006 with 20 patients (10 men and 10 women, with ages ranging between 24 and 60 years, mean age 42.7 years) diagnosed with schistosomiasis mansoni. Both ultrasound and magnetic resonance images were independently evaluated by two experienced observers. Interobserver agreement was evaluated for findings of periportal fibrosis on magnetic resonance images and in a comparison between magnetic resonance and ultrasound images. RESULTS: The analysis of magnetic resonance images showed total interobserver agreement in 14 patients (70%). The comparison between ultrasound and magnetic resonance imaging showed agreement between images in only six cases (30%) by observer 1, and in eight cases (40%) by observer 2. CONCLUSION: Magnetic resonance imaging presents a good reproducibility in the evaluation of periportal fibrosis in later stages of schistosomiasis, however, the correlation between magnetic resonance imaging and ultrasound is poor.OBJETIVO: Avaliar a reprodutibilidade da ressonância magnética e a concordância entre a ultra-sonografia e a ressonância magnética na classificação da fibrose periportal em pacientes esquistossomóticos, segundo os critérios qualitativos de Niamey. MATERIAIS E MÉTODOS: Foi realizado estudo prospectivo e duplo-cego, entre fevereiro de 2005 e junho de 2006, em 20 pacientes (10 homens e 10 mulheres, idades entre 24 e 60 anos, média de 42,75 anos) com diagnóstico de esquistossomose mansônica. As imagens de ultra-sonografia e de ressonância magnética foram avaliadas por dois examinadores experientes de forma independente. Foi medida a concordância interobservador para a ressonância magnética e entre a ressonância magnética e a ultra-sonografia. RESULTADOS: A ressonância magnética apresentou resultados concordantes entre os observadores em 14 pacientes (70%). Quando comparamos a ressonância magnética com a ultra-sonografia, obtivemos concordância em apenas seis pacientes pelo observador 1 (30%) e em oito pacientes pelo observador 2 (40%). CONCLUSÃO: A ressonância magnética tem boa reprodutibilidade na avaliação de fibrose periportal em pacientes com esquistossomose avançada, porém sua concordância com a ultra-sonografia é fraca.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Diagnóstico por ImagemUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de GastroenterologiaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de MedicinaUNIFESP, EPM, Depto. de Diagnóstico por ImagemUNIFESP, EPM, Depto. de GastroenterologiaUNIFESP, EPM, Depto. de MedicinaSciEL

High-resolution Manometry Findings in Patients After Sclerotherapy for Esophageal Varices

Background/Aims Endoscopic therapy for esophageal varices may lead to esophageal dysmotility. High-resolution manometry is probably the more adequate tool to measure esophageal motility in these patients. This study aimed to evaluate esophageal motility using high resolution manometry following eradication of esophageal varices by endoscopic sclerotherapy. Methods We studied 21 patients (11 women, age 52 [45-59] years). All patients underwent eradication of esophageal varices with endoscopic sclerotherapy and subsequent high resolution manometry. Results A significant percentage of defective lower esophageal sphincter (basal pressure 14.3 [8.0-20.0] mmHg43% hypertonic) and hypocontractility (distal esophageal amplitude 50 [31-64] mmHgproximal esophageal amplitude 40 [31-61] mmHgdistal contractile integral 617 [403-920] mmHg center dot sec center dot cm48% ineffective) was noticed. Lower sphincter basal pressure and esophageal amplitude correlated inversely with the number of sessions (P < 0.001). No manometric parameter correlated with symptoms or interval between last endoscopy and manometry. Conclusions Esophageal motility after endoscopic sclerotherapy is characterized by: (1) defective lower sphincter and (2) defective and hypotensive peristalsis. Esophageal dysmotility is associated to an increased number of endoscopic sessions, but manometric parameters do not predict symptoms.Univ Fed Sao Paulo, Escola Paulista Med, Dept Surg, Sao Paulo, BrazilUniv Chicago, Dept Surg, 5841 S Maryland Ave, Chicago, IL 60637 USAUniv Fed Sao Paulo, Escola Paulista Med, Dept Surg, Sao Paulo, BrazilWeb of Scienc

Prospective Analysis of Short- and Mid-term Knowledge Retention after a Brief Ultrasound Course for Undergraduate Medical Students

OBJECTIVES: The benefits of implementing point-of-care ultrasound (POCUS) in the emergency department are well established. Ideally, physicians should be taught POCUS during medical school. Several different courses have been designed for that purpose and have yielded good results. However, medical students need specifically designed courses that address the main objectives of knowledge acquisition and retention. Despite that, there is limited evidence to support knowledge retention, especially in the mid-term. The purpose of this study is to evaluate short- and mid-term knowledge retention after a student-aimed ultrasound course. METHODS: Medical students participating in a medical student trauma symposium (SIMPALT) in 2017 were included. Their profiles and baseline ultrasound knowledge were assessed by a precourse questionnaire (PRT). The same questionnaire was used one week (1POT) and three months (3POT) after the course. RESULTS: Most of the participants were 1st- to 4th- year medical students. None had prior ultrasound knowledge. They reported costs as the major barrier (65%) to enrollment in an ultrasound course. A comparison between the PRT and 1POT results showed a statistically significant difference (po0.02), while no difference was found between 1POT and 3POT (p40.09). CONCLUSION: Our findings support the use of a tailored ultrasound course for medical students. Knowledge acquisition and mid-term retention may be achieved by this specific population

Cuidados perioperatórios em cirurgia digestiva: protocolos eras e acerto – posicionamento do Colégio Brasileiro de Cirurgia Digestiva

Background: The concept introduced by enhanced recovery after surgery protocols modifies perioperative traditional care in digestive surgery. The integration of these modern recommendations components during the perioperative period are highly important to ensure less postoperative complications, reduced length of hospital stay and decreased surgical costs. Aims: The aim of this position paper is to emphasize the most important points of a multimodal perioperative care protocol. Methods:&nbsp; A careful analysis of each recommendation of both ERAS and ACERTO protocols is presented, justifying its inclusion in the recommended multimodal care of digestive surgery patients. Results: Enhanced recovery programs (ERPs) such as ERAS and ACERTO protocols are a cornerstone in modern perioperative care. Nutritional therapy is highly important in digestive surgery and thus both preoperative and postoperative nutrition care are key to ensure less postoperative complications and to reduce the length of hospital stay. The concept of prehabilitation is another key element in ERPs. Management of crystalloid fluids in a perfect balance in vital. Fluid overload may delay the recovery of patients and increase postoperative complications. Abbreviation of preoperative fast for 2h before anesthesia is now accepted by various guidelines of both surgical and anesthesiology societies. Combined with early postoperative refeeding, these prescriptions are not only safe but can also enhance recovery of patients undergoing digestive procedures. Conclusions: This Brazilian College of Digestive Surgery position paper strongly emphasizes that the implementation of ERPs in digestive surgery represents a paradigm shift in perioperative care, transcending traditional practices and embracing an intelligent approach to patient well-being. &nbsp; Background: The concept introduced by enhanced recovery after surgery protocols modifies perioperative traditional care in digestive surgery. The integration of these modern recommendations components during the perioperative period are highly important to ensure less postoperative complications, reduced length of hospital stay and decreased surgical costs. Aims: The aim of this position paper is to emphasize the most important points of a multimodal perioperative care protocol. Methods:&nbsp; A careful analysis of each recommendation of both ERAS and ACERTO protocols is presented, justifying its inclusion in the recommended multimodal care of digestive surgery patients. Results: Enhanced recovery programs (ERPs) such as ERAS and ACERTO protocols are a cornerstone in modern perioperative care. Nutritional therapy is highly important in digestive surgery and thus both preoperative and postoperative nutrition care are key to ensure less postoperative complications and to reduce the length of hospital stay. The concept of prehabilitation is another key element in ERPs. Management of crystalloid fluids in a perfect balance in vital. Fluid overload may delay the recovery of patients and increase postoperative complications. Abbreviation of preoperative fast for 2h before anesthesia is now accepted by various guidelines of both surgical and anesthesiology societies. Combined with early postoperative refeeding, these prescriptions are not only safe but can also enhance recovery of patients undergoing digestive procedures. Conclusions: This Brazilian College of Digestive Surgery position paper strongly emphasizes that the implementation of ERPs in digestive surgery represents a paradigm shift in perioperative care, transcending traditional practices and embracing an intelligent approach to patient well-being

Why should Medical Societies increasingly attend to their Specialist Title exams and why should medical professionals obtain it?

ABSTRACT Medical societies must maintain high standards of competence and quality when awarding specialist titles, defining the certification criteria, taking into account the needs and realities of the health system and medical practice

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020