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Unsuspected colon adenocarcinoma revealed after laparoscopic cholecystectomy

A particularly rapid and fatal outcome has been noted in cases of malignant soft-tissue metastases occurring after cancer surgery. Abdominal wall metastases occurring in scars after laparotomy for cancer resection show a similar poor outcome. On the other hand, neoplasm seeding at trocar sites after laparoscopy has been reported with an increasing frequency. A case is presented of a 68-years-old woman with metastatic seeding of non-diagnosed colon cancer at the umbilical trocar site used for a laparoscopic cholecystectomy. The gallbladder was extracted through the umbilical incision. Pathological examination confirmed chronic cholecystitis. Eight months latter, the patient was seen with a tender umbilical mass protruded through a 4,5 cm the umbilical incision site. Biopsies of this tissue were taken and histopathological examination showed metastatic adenocarcinoma, probably of a gastrointestinal origin. A colonoscopy performed at the same time revealed a 2-cm lesion at the hepatic flexur which was shown to be a differentiated adenocarcinoma. An 8.0 x 6.0 x 6.0-cm pelvic mass without signs of liver metastases was identified by computerised tomography. Diagnostic laparoscopy showed a diffuse peritoneal carcinomatosis. The pelvis could not be approached, except for simple biopsy, and no surgical procedure was performed. It is presumed that the primary colon cancer existed prior to cholecystectomy. Laparoscopy is the procedure of choice to perform cholecystectomy and fundoplication. It has also been increasingly used to diagnose, resect and perform the staging of malignant tumours. As in any relatively new technique, questions arising about its safety and risk of complications must be extensively studied. Many questions about the specific features of laparoscopy promoting cancer growth remain unanswered.UNIFESP-EPM Departamento de CirurgiaHospital do Servidor Público Estadual de São PauloUNIFESP, EPM, Depto. de CirurgiaSciEL

ASPECTOS CONTEMPORÂNEOS DA NOVA LEI DE ABUSO DE AUTORIDADE – LEI 13.869/19 – E O CRIME DE VIOLAÇÃO DE DOMICÍLIO

The Federal Constitution guarantees to individuals, fixed or resident, the right to inviolability of domicile, and the State should penalize in the civil, criminal and administrative spheres, public agents who in the exercise of their functions commit such a crime for abuse of their position. Law nº 13.869/2019, recently enacted, updates the concepts for such a crime, introducing in its article 22, the provisions that must restrict the conduct of agents. Therefore, the objective of the study is to analyze the crime of violation of domicile from the perspective of Law nº 13.869/ 19. Considering the concepts presented in the development of the study, it was concluded that the crime of violation of domicile should have special attention on the part of public agents, as the theme permeates and is supported by several spheres, and such agents should only execute what is provided for in article 22 , thus avoiding public criminal actions..   Keywords: Home violation; Abuse of authority; Law nº 13.869/19; New law of abuse of authority.La Constitución Federal garantiza a las personas físicas, fijas o residentes, el derecho a la inviolabilidad del domicilio, y el Estado debe sancionar en los ámbitos civil, penal y administrativo, a los agentes públicos que en el ejercicio de sus funciones cometan dicho delito por abuso de cargo. La Ley N° 13.869/2019, recientemente promulgada, actualiza los conceptos para dicho delito, presentando en su artículo 22 las disposiciones que deben garantizar la conducta de los agentes. Por lo tanto, el objetivo del estudio es analizar el delito de violación domiciliaria desde la perspectiva de la Ley Nº 13.869/19. Considerando los conceptos presentados en el desarrollo del estudio, se concluyó que el delito de violación de domicilio debe prestar especial atención por parte de los agentes públicos, pues el tema impregna y se basa en varias áreas, y dichos agentes deben realizar únicamente la prevista en el artículo 22, evitando así el enjuiciamiento público.A Constituição Federal garante aos indivíduos, fixos ou residentes, o direito a inviolabilidade de domicílio, devendo o Estado penalizar na esfera civil, penal e administrativa, agente públicos que no exercício de suas funções cometam tal crime por abuso de seu cargo. A Lei nº 13.869/2019, promulgada recentemente, atualiza os conceitos para tal crime, apresentando em seu artigo 22, os dispositivos que devem cercear a conduta dos agentes. Logo, o objetivo do estudo é analisar o crime de violação de domicílio sob a ótica da Lei nº 13.869/19. Considerando os conceitos apresentados no desenvolvimento do estudo, concluiu-se que o crime de violação de domicílio deve ter atenção especial por parte dos agentes públicos, pois o tema permeia e é amparado por diversos âmbitos, devendo tais agentes executarem somente o previsto pelo artigo 22, evitando assim ações penais públicas.    A Constituição Federal garante aos indivíduos, fixos ou residentes, o direito a inviolabilidade de domicílio, devendo o Estado penalizar na esfera civil, penal e administrativa, agente públicos que no exercício de suas funções cometam tal crime por abuso de seu cargo. A Lei nº 13.869/2019, promulgada recentemente, atualiza os conceitos para tal crime, apresentando em seu artigo 22, os dispositivos que devem cercear a conduta dos agentes. Logo, o objetivo do estudo é analisar o crime de violação de domicílio sob a ótica da Lei nº 13.869/19. Considerando os conceitos apresentados no desenvolvimento do estudo, concluiu-se que o crime de violação de domicílio deve ter atenção especial por parte dos agentes públicos, pois o tema permeia e é amparado por diversos âmbitos, devendo tais agentes executarem somente o previsto pelo artigo 22, evitando assim ações penais públicas.  

The VISCACHA survey : IV. The SMC West Halo in 8D

The structure of the Small Magellanic Cloud (SMC) is very complex, in particular in the periphery that suffers more from the interactions with the Large Magellanic Cloud (LMC). A wealth of observational evidence has been accumulated revealing tidal tails and bridges made up of gas, stars, and star clusters. Nevertheless, a full picture of the SMC outskirts is only recently starting to emerge with a 6D phase-space map plus age and metallicity using star clusters as tracers. In this work, we continue our analysis of another outer region of the SMC, the so-called West Halo, and combined it with the previously analysed Northern Bridge. We use both structures to define the Bridge and Counter-bridge trailing and leading tidal tails. These two structures are moving away from each other, roughly in the SMC–LMC direction. The West Halo form a ring around the SMC inner regions that goes up to the background of the Northern Bridge shaping an extended layer of the Counter-bridge. Four old Bridge clusters were identified at distances larger than 8 kpc from the SMC centre moving towards the LMC, which is consistent with the SMC–LMC closest distance of 7.5 kpc when the Magellanic Bridge was formed about 150Myr ago; this shows that the Magellanic Bridge was not formed only by pulled gas, but it also removed older stars from the SMC during its formation. We also found age and metallicity radial gradients using projected distances on sky, which are vanished when we use the real 3D distances

Evaluation of the position of veress' needle tip during establishment of pneumoperitoneum by closed technique, in pigs

BACKGROUND: To establish reliable evidence regarding the adequate positioning of the tip of a Veress needle in the interior of the peritoneal sac during the establishment of the pneumoperitoneum by the closed technique. METHODS: In 11 pigs, the needle was introduced in the peritoneal sac through the left hipocondrium. Tests of positioning of the tip of the instrument were carried out. Gas (CO2) was injected, and pressures, flows and volumes were registered periodically. The correct intraperitoneal position of the needle was confirmed and, subsequently, removed, being reintroduced in the right hipocondrium and placed under direct vision in the pre-peritoneal space. The same parameters were surveyed. RESULTS: The test of the draining was always positive in the peritoneum. Resistance to the infusion of serum in the peritoneal sac was not observed, but resistance was detected on 45.5% of cases in the pre-peritoneal space. Some serum was recouped in 63.5% of cases in the peritoneal sac and in 54.5% in the pre-peritoneal space. The dripping flowed freely in 66.6% of cases in the peritoneal sac and in 45.5% in the pre-peritoneal space. In the peritoneal sac, = 5mmHg initial pressure increased gradually during 120 seconds until reaching 15 mmHg. In the pre-peritoneal space, the initial pressure was of 15mmHg and oscillated between 12 and 15mmHg. The volume of gas injected was of 1500 ml in the peritoneal sac and of 100 ml in the pre-peritoneal space. CONCLUSION: Initial pressure of ±5mmHg is indicative of the tip of the needle being placed in the peritoneal sac, inside of which there should fit ten times more gas than in the pre-peritoneal space. When the tip of the Veress needle is placed in the interior of the peritoneal sac, the increase of intraperitoneal pressures and volumes can be predicted by statistics.OBJETIVO: Estabelecer parâmetros fidedignos do posicionamento adequado da agulha de Veress na cavidade peritoneal durante o estabelecimento do pneumoperitônio pela técnica fechada. MÉTODO: Em 11 porcos a agulha foi introduzida na cavidade peritoneal através do hipocôndrio esquerdo. Provas de posicionamento da ponta do instrumento foram efetuadas. Insuflou-se CO2 e registraram-se periodicamente pressões, fluxos e volumes. A posição intraperitoneal da agulha foi confirmada e esta foi retirada, sendo re-introduzida no hipocôndrio direito e posicionada sob visão direta no espaço pré-peritoneal. Os mesmos parâmetros foram aferidos. RESULTADOS: A prova do escoamento foi sempre positiva no peritônio. Não se encontrou resistência à introdução de soro no peritônio em nenhum caso, mas sim em 45,5% dos casos no pré-peritônio. Soro algum foi recuperado em 63,5% no peritônio e em 54,5% no pré-peritônio. O gotejamento fluiu livremente em 66,6% das vezes no peritônio e em 45,5% dos casos no préperitônio. No peritônio, pressões iniciais de 5,20 mmHg aumentaram progressivamente durante 123 segundos até atingir 15 mmHg. No pré-peritônio a pressão inicial foi de 15,60 mmHg e oscilou entre 12 e 15,60 mmHg. O volume de gás injetado no peritônio foi de 1500 ml e de 100 ml no pré-peritônio. CONCLUSÕES: Aspiração e observação do escoamento e do gotejamento são importantes; recuperar ou não o soro é inconclusivo. Pressão inicial menor ou igual a 5 mmHg é indicativo da ponta da agulha no peritônio, onde devem caber dez vezes mais gás que no pré-peritônio. No peritônio os aumentos das pressões e dos volumes pode ser previstos mediante estatísticas.UNIFESP Departamento de CirurgiaUNIFESP Setor de VideocirurgiaSociedade Brasileira de Cirurgia LaparoscópicaUniversidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM)Hospital do Servidor Público do Estado de São PauloUNIFESPUNIFESP, Depto. de CirurgiaUNIFESP, Setor de VideocirurgiaUNIFESP, EPMUNIFESPSciEL