Three-Port Laparoscopic Cholecystectomy in a Brazilian Amazon Woman with Situs Inversus Totalis: Surgical Approach

Situs inversus totalis (SIT) is an uncommon anomaly characterized by transposition of organs to the opposite side of the body in a mirror image of normal. We report on an adult woman, born and resident in Brazilian Amazonia, presenting acute pain located at the left hypochondrium and epigastrium. During clinical and radiological evaluation, the patient was found to have SIT and multiple stones cholelithiasis. Laparoscopic cholecystectomy was safely performed with the three-port technique in a reverse fashion. In conclusion, this case confirms that three-port laparoscopic cholecystectomy is a safe and feasible surgical approach to treat cholelithiasis even in rare and challenging conditions like SIT

Controle das crises epilépticas após calosotomia anterior versus completa em crianças: uma revisão sistemática com metanálise

Introduction Refractory epilepsy is a debilitating and challenging condition to manage. Corpus callosotomy (CC) seems to be an effective treatment option for patients with seizures not amenable to focal resection. The aim of the present study is to compare seizure outcome of pediatric patients following anterior CC, compared with complete CC. Method The authors performed a systematic review and meta-analysis of the English literature involving comparative studies. Results The present investigation includes four retrospective case-controlled studies and authors perform a pooled analysis of the surgical results. Seizure outcome presented favorable results in patients who underwent complete CC (Odds Ratio, M-H, Fixed, 95% CI: 3.02 [1.43, 6.387], p-value: 0.005). Clinical and neurological complications occurred independently when a complete or anterior CC was performed. Conclusion Complete CC seems to be the most effective treatment option to control intractable seizure in children not amenable to focal resection._________________________________________________________________________________________ RESUMO: Introdução Epilepsia refratária é uma condição debilitante e desafiadora para lidar. Calosotomia parece ser uma opção de tratamento eficaz para pacientes com convulsões não passíveis de ressecção focal. O objetivo do presente estudo é comparar o resultado de convulsões em pacientes pediátricos de acordo com calosotomia anterior e completa. Métodos Uma revisão sistemática e metanálise da literatura médica em inglês envolvendo estudos comparativos. Resultados Quatro casos retrospectivos foram incluídos na presente investigação e uma análise dos resultados cirúrgicos foi realizada. Convulsões decorrentes tiveram resultados favoráveis em pacientes submetidos a calosotomia complete (odds ratio, M-H, fixo, 95% IC: 3,02 [1,43; 6,387], valor de p: 0,005). Complicações clínicas e neurológicas ocorreram independentemente de se calosotomia complete ou anterior. Conclusão Calosotomia completa parece ser a opção de tratamento mais eficaz para controlar convulsões não rastreáveis e não passíveis de ressecção focal em crianças

Controle das crises epilépticas após calosotomia anterior versus completa em crianças: uma revisão sistemática com metanálise

Introduction Refractory epilepsy is a debilitating and challenging condition to manage. Corpus callosotomy (CC) seems to be an effective treatment option for patients with seizures not amenable to focal resection. The aim of the present study is to compare seizure outcome of pediatric patients following anterior CC, compared with complete CC. Method The authors performed a systematic review and meta-analysis of the English literature involving comparative studies. Results The present investigation includes four retrospective case-controlled studies and authors perform a pooled analysis of the surgical results. Seizure outcome presented favorable results in patients who underwent complete CC (Odds Ratio, M-H, Fixed, 95% CI: 3.02 [1.43, 6.387], p-value: 0.005). Clinical and neurological complications occurred independently when a complete or anterior CC was performed. Conclusion Complete CC seems to be the most effective treatment option to control intractable seizure in children not amenable to focal resection._________________________________________________________________________________________ RESUMO: Introdução Epilepsia refratária é uma condição debilitante e desafiadora para lidar. Calosotomia parece ser uma opção de tratamento eficaz para pacientes com convulsões não passíveis de ressecção focal. O objetivo do presente estudo é comparar o resultado de convulsões em pacientes pediátricos de acordo com calosotomia anterior e completa. Métodos Uma revisão sistemática e metanálise da literatura médica em inglês envolvendo estudos comparativos. Resultados Quatro casos retrospectivos foram incluídos na presente investigação e uma análise dos resultados cirúrgicos foi realizada. Convulsões decorrentes tiveram resultados favoráveis em pacientes submetidos a calosotomia complete (odds ratio, M-H, fixo, 95% IC: 3,02 [1,43; 6,387], valor de p: 0,005). Complicações clínicas e neurológicas ocorreram independentemente de se calosotomia complete ou anterior. Conclusão Calosotomia completa parece ser a opção de tratamento mais eficaz para controlar convulsões não rastreáveis e não passíveis de ressecção focal em crianças

Pneumoperitoneum in association with perforated appendicitis in a Brazilian Amazon woman. Case report

Radiographic findings of free air in the peritoneal cavity secondary to perforation of a acutely inflamed appendix are extremely rare. It accounts for about 0-7% of all patients with pneumoperitoneum. We report on a 58-years-old Brazilian Amazon woman presenting a 1- week history of abdominal pain, tenderness and distension associated with asthenia and without passage of stool or gas. Abdominal percussion revealed a tympanic sound located on the right hypocondrium. Plain chest radiography revealed a large amount of free air beneath the right leaf of the diaphram. The patient was taken immediately to the operation room and, during surgery, a gangrenous appendix with an apex perforation was verified. Appendectomy was performed as routinely. The patient evolved with pneumonia and septic shock that responded well to intravenous antibiotics and vasoactive drugs. She was discharged to home on the twenty-first post-operative day in good clinical conditions. This case highlights that perforated acute appendicitis is rarely associated with pneumoperitoneum, but it must be considered in the differential diagnosis of patients presenting right abdominal pain and free intraperitoneal air