Ciliated Foregut Cyst of the Pancreas

Cystic lesions of the pancreas are relatively uncommon. We describe the case of a young man with a complex cystic mass located within the head of the pancreas. The patient underwent exploration with resection of the mass. Pathology revealed a ciliated epithelial cyst, a rare cystic lesion of the pancreas

Hérnia U: desafios e oportunidades de uma plataforma online para educação cirúrgica

The internet has become an essential tool for education1 . Nowadays, it is widely used by physicians for obtaining medical information. There was no website for surgical education before the year 2000. The pioneer website was WebSurg, from IRCAD, France2 . There are different types of distant education: telesurgery (live or edited), live lectures, case discussions and so on2,3. These new learning methods are considered as distant education and can be integrated in the surgical curriculum2 . There are many online tools used to share knowledge: websites, mobile programs for cell phones or even social media4,5. The aim of this study is to describe an online and free surgical education tool for students, residents and surgeons who want to update their knowledge in abdominal wall surgery.A internet se tornou ferramenta essencial para a educação1 . Atualmente, é amplamente utilizada por médicos para obtenção de informações em distintas áreas de conhecimento. Não existia nenhum site para educação cirúrgica antes de 2000. O pioneiro foi o WebSurg, do IRCAD, França2 . Existem diferentes tipos de educação à distância: telecirurgia (ao vivo ou editada), palestras ao vivo, discussão de casos e assim por diante2,3. Esses novos métodos de aprendizagem são considerados educação à distância e, podem ser integrados ao currículo cirúrgico2 . Existem muitas ferramentas online utilizadas para compartilhar conhecimento: sites, aplicativos para telefones celulares ou até mesmo mídias sociais4,5. O objetivo deste estudo é descrever ferramenta online gratuita de educação cirúrgica para estudantes, residentes e cirurgiões que desejam atualizar seus conhecimentos em cirurgia da parede abdominal

Evaluación de la efectividad del uso de un escáner intraoral y un programa informático de análisis de preparaciones dentarias para prótesis fija en la adquisición de competencias psico-motrices en la asignatura de PRÓTESIS dental II

Depto. de Odontología Conservadora y PrótesisFac. de OdontologíaFALSEsubmitte

Prospective, multicenter study of P4HB (Phasix™) mesh for hernia repair in cohort at risk for complications: 3-Year follow-up

Background: This study represents a prospective, multicenter, open-label study to assess the safety, performance, and outcomes of poly-4-hydroxybutyrate (P4HB, Phasix™) mesh for primary ventral, primary incisional, or multiply-recurrent hernia in subjects at risk for complications. This study reports 3-year clinical outcomes. Materials and methods: P4HB mesh was implanted in 121 patients via retrorectus or onlay technique. Physical exam and/or quality of life surveys were completed at 1, 3, 6,12, 18, 24, and 36 months, with 5-year (60-month) follow-up ongoing. Results: A total of n = 121 patients were implanted with P4HB mesh (n = 75 (62%) female) with a mean age of 54.7 ± 12.0 years and mean BMI of 32.2 ± 4.5 kg/m2 (±standard deviation). Comorbidities included: obesity (78.5%), active smokers (23.1%), COPD (28.1%), diabetes mellitus (33.1%), immunosuppression (8.3%), coronary artery disease (21.5%), chronic corticosteroid use (5.0%), hypo-albuminemia (2.5%), advanced age (5.0%), and renal insufficiency (0.8%). Hernias were repaired via retrorectus (n = 45, 37.2% with myofascial release (MR) or n = 43, 35.5% without MR), onlay (n = 8, 6.6% with MR or n = 24, 19.8% without MR), or not reported (n = 1, 0.8%). 82 patients (67.8%) completed 36-month follow-up. 17 patients (17.9% ± 0.4%) experienced hernia recurrence at 3 years, with n = 9 in the retrorectus group and n = 8 in the onlay group. SSI (n = 11) occurred in 9.3% ± 0.03% of patients. Conclusions: Long-term outcomes following ventral hernia repair with P4HB mesh demonstrate low recurrence rates at 3-year (36-month) postoperative time frame with no patients developing late mesh complications or requiring mesh removal. 5-year (60-month) follow-up is ongoing

Conservative Management of Popliteal Aneurysm: Is There a Role for Selective Observation? A Case Report

Popliteal artery aneurysm (PAA) is the most common peripheral aneurysm, comprising 70% of these lesions. More than two thirds of these patients have bilateral aneurysms and the most common etiology is atherosclerosis. Elderly men in their sixth and seventh decade of life constitute over 90% of these patients, and up to 55% will have an aneurysm in other portions of the vascular tree. Only 3% to 5% of these aneurysms are found in women. The abdominal aorta will be involved in 30% to 75% of cases and, therefore, dictate a full work-up when a PAA is found. The authors report a case of an 80-year-old man with a chief complaint of intermittent calf pain that occurred without any pattern of distance. This atypical pattern of claudication had been recurring for more than three months. The patient underwent a duplex ultrasound that showed a dilation of his arteries measuring 1.7 cm and 2.3 cm on the right and left sides, respectively. Further work-up with a magnetic resonance image demonstrated a 4 cm x 3 cm left PAA with thrombus and a smaller aneurysm on the right side. An angiogram demonstrated single peritoneal artery runoff on the left side and posterior tibial artery runoff on the right side. The patient was cleared for surgery with an ejection fraction of 40%; however, he refused to undergo reconstruction. The patient ehas been followed up for the past four years without change in his symptomatology and repeated ultrasounds have not shown any significant size change

Gasless laparoscopic-assisted intestinal stoma creation through a single incision

Intestinal stoma creation has been performed using both open and laparoscopic surgery. However, each technique still has disadvantages. We created the intestinal stoma through one incision, with the use of the laparoscope in a gasless fashion. This method has not been reported previously. Fourteen adult patients underwent this technique between February 1996 and December 1998. Indications for stoma creation were for various anorectal disease processes, most commonly for purposes of hygiene in patients with spinal cord injury. The average operative time to perform the stoma was 58 (range, 15–78) minutes, with minimal blood loss (<35 ml). Follow-up ranged from 1 to 22 months. Two cases (14 percent) were converted secondary to severe adhesions. All nonconverted patients were able to tolerate a regular diet within two days of surgery. There was only one stoma-related complication. Two patients (14 percent) died of comorbidities during follow-up. In conclusion, the initial experience with gasless laparoscopic-assisted intestinal stoma creation through a single incision is encouraging. Patients requiring ostomy creation as a single intervention may benefit from this approach

Four-arm single docking full robotic surgery for low rectal cancer: techniques and post-operative outcomes

AbstractBackgroundlaparoscopic rectal surgery has not yet achieved a high penetration rate because of its steep learning curve and its relatively high conversion rate. Robotic rectal resection represents the main indication of the use of the robotic platform in colorectal surgery. The aim of this study was to present an early experience with robotic surgery to treat mid and low rectal cancer focusing on the technique and early postoperative outcomes.Methodsfrom December 2012 to October 2013, a total of 16 patients with colorectal diseases were operated on using a four-arm single docking full robotic procedure (daVinci Si Surgical System). The treatment of six consecutive patients who underwent robotic rectal cancer surgery for mid or low rectal adenocarcinoma was prospectively analyzed regarding technique standardization, pathological findings and postoperative outcomes.Resultsthere were no conversions and one intraoperative complication. The mean operative time was 245min (180–360min). The mean console time was 170min (110–240min). All patients underwent a standardized totally robotic rectal dissection. There were no mortality or urinary dysfunction and one complication (postoperative ileo-16%). The median length of hospital stay was 6 (4–11 days). The median number of lymph nodes harvested was 22 (7–38), and distal and circumferential resection margins were negative in all specimen. R0 resection was achieved in all cases and complete total mesorectal excision in five specimen and nearly complete in one.Conclusionstandardized robotic rectal surgery is a promising alternative to treat patients with mid or low rectal cancer and is expected to overcome the low penetration rate of laparoscopic surgery in this field. This technique was successfully performed in six patients with excellent immediate postoperative and pathological results. Additional studies in a large series of patients are necessary to confirm those advantages