Feasibility study of combined dynamic imaging and lymphaticovenous anastomosis surgery for breast cancer-related lymphoedema.

Background Breast cancer-related lymphoedema (BCRL) presents a significant healthcare burden and adversely affects quality of life of breast cancer survivors. A prospective feasibility study was performed on lymphaticovenous anastomosis (LVA) for the treatment of BCRL.Methods Patients with BCRL underwent near-infrared spectroscopy with indocyanine green lymphatic mapping to identify suitable lymphatic channels for LVA. End-to-end anastomoses to subdermal venules were performed and patients recommenced compression garment therapy (CGT) after surgery. Volumetric assessment of the affected limb was performed at regular intervals using infrared perometry to calculate the excess volume reduction.Results Over a 24-month interval, 27 patients with BCRL underwent LVA. The mean duration of lymphoedema was 3·5 (range 0·5-18) years, and the mean number of LVAs performed was 3 (range 2-5). Twenty-four of the 27 patients completed 12-month follow-up. Patients exhibited three patterns of volumetric response following LVA: sustained response (16 patients), transient response (5) or no response (6). Sustained responders showed an excess volume reduction of -33·2 per cent at 12 months, and this correlated positively with the number of LVAs performed (r = -0·56, P = 0·034). Overall, ten patients were able to downgrade CGT after surgery, and two patients were CGT-free at 12 months.Conclusion LVA resulted in a sustained volume reduction in selected patients and may offset the burden of CGT. Further work is required to identify biomarkers that predict a favourable response to LVA surgery

Aberrant right hepatic artery with a prepancreatic course visualized prior to pancreaticoduodenectomy.

Liver vascularization is known to present with several different variations. Generally, a normal vascular anatomy is reported in up to 50-80 % of cases. For this reason, a precise preoperative mapping of the hepatic vascularization prior to pancreatic surgery is essential to avoid injuries and subsequent complications. We report here a case of a young patient scheduled for Whipple procedure, who presented an arterial pattern type Michels IV, variation reported in 0.6 to 3 % in the literature. Another interesting particularity of this case was the fact that the right hepatic artery had a prepancreatic course. We think that every surgeon performing hepatopancreatic surgery should have heard of this special and rare situation

Videotoracoscopia no trauma de tórax

OBJETIVOS: Com o intuito de definir a função da videotoracoscopia no diagnóstico e tratamento no trauma torácico, foram estudados 51 traumatizados por traumas penetrantes ocasionados por arma branca, ferimentos por projétil de arma de fogo ou traumas fechados do tórax, com suspeita diagnóstica por exame clínico e/ou radiológico de lesões torácicas. MÉTODOS: Foram selecionados doentes estáveis vítimas de trauma torácico (pressão arterial sistólica igual ou superior a 90mmHg) com diagnóstico de: hemotórax em 20 (cinco hemotórax estacionários, quatro hemotórax progressivos e 11 hemotórax coagulados), contusões e ferimentos precordiais (três), ferimentos da zona de transição tóraco-abdominal (24), corpo estranho no tórax (dois) e ferimentos transfixantes do mediastino (dois). Todos foram submetidos à videotoracoscopia. RESULTADOS: A videotoracoscopia se mostrou eficiente na investigação diagnóstica nos casos de hemotórax progressivo (quatro casos), hemotórax coagulado (11 casos), contusões e ferimentos precordiais (três casos), ferimentos da zona da transição tóraco-abdominal (confirmação de nove lesões diafragmáticas em 24 traumatizados examinados, 37,5%) e corpos estranhos no tórax, retirada do corpo estranho com sucesso (dois casos). O procedimento também foi eficiente, além do diagnóstico, no tratamento de hemotórax progressivo (ligadura de artéria mamária um caso, cauterização de vasos intercostais um caso), hemotórax coagulado (remoção de coágulos e decorticação, 11 casos) tendo evitado a realização de toracotomia em 33,3% dos traumatizados examinados. CONCLUSÕES: A videotoracoscopia é método eficiente para diagnóstico e tratamento no traumatismo do tórax e ainda pode evitar a toracotomia em expressivo número de pacientes submetidos ao procedimento