Crossed testicular ectopia

Crossed testicular ectopia (CTE) is a rare anomaly, characterized by migration of one testis towards the opposite inguinal canal. Presented here is a case of crossed ectopia of the right testis, treated by extraperitoneal transposition of the gonad and right orchiopexy. Embriology and surgical findings suggest that CTE is a common consequence of many unclear ethiologic factors, specially mechanical ones, and can be associated with Muller duct persistence. Review of literature suggests a classification of CTE into 3 types: I - associated with inguinal hernia alone; II - associated with persistent mullerian remnants; III - associated with other anomalies without mullerian remnants. Treatment includes transeptal orchiopexy or extraperitoneal transposition of the testis, research for mullerian remnants and other anomalies, and long term postoperative follow-up, due to the risk of becoming malignant.INTRODUÇÃO: A ectopia testicular cruzada (ETC) é uma anomalia rara, caracterizada pela descida de um testítulo no canal inguinal do lado oposto. Apresentamos um caso de ectopia cruzada do testículo direito, tratado por transposição extraperitoneal da gônada e orquipexia direita. CONCLUSÃO: Os conhecimentos embriológicos e os achados cirúrgicos sugerem que a ETC seja uma conseqüência comum de vários fatores etiológicos, sobretudo fatores mecânicos, e pode causar persistência do ducto de Müller. Após extensa revisão da literatura,sugerimos uma classificação da ETC em 3 tipos: 1 - associada somente à hérnia inguinal; II associada a remanescentes mullerianos; III - associada a outras anomalias, sem remanescentes mullerianos. O tratamento inclui orquipexia trans-septal ou transposição trans-abdominal do testículo, pesquisa de remanescentes mullerianos e outras anomalias, e seguimento pós-operatório a longo prazo, devido a risco de malignização.Escola Paulista de Medicina Department of Surgery Pediatric Surgery DivisionUNIFESP, EPM, Department of Surgery Pediatric Surgery DivisionSciEL

Tratamento conservador de ferimento penetrante isolado do esôfago cervical: relato de caso

Non-iatrogenic traumatic cervical esophageal perforations are usually hard to manage in the clinical setting, and often require a careful and individualized approach. The low incidence of this particular problem leads to a restricted clinical experience among most centers and justify the lack of a standardized surgical approach. Conservative treatment of esophageal perforation remains a controversial topic, although early and sporadic reports have registered the efficacy of non-operative care, especially following perforation in patients that do not sustain any other kind of injuries, and who are hemodynamically stable and non-septic. We report a case of a patient sustaining a single cervical gunshot wound compromising the cervical esophagus and who was treated exclusively with cervical drainage, enteral support and antibiotics.Ferimentos traumáticos do esôfago não iatrogênicos são de difícil manejo clínico e requerem condutas individualizadas e cuidadosas. Frente à baixa incidência dessa afecção, a maioria dos centros não possui experiência suficiente para a definição de uma conduta padronizada para o manejo de tais lesões. O tratamento conservador da perfuração do esôfago permanece um tema controverso, embora relatos mais recentes tenham documentado sua eficácia, especialmente após a perfuração, em pacientes que não apresentam outras lesões associadas, instabilidade hemodinâmica ou sinais de sepse. É apresentado aqui o caso de um paciente com ferimento por projétil no esôfago cervical tratado exclusivamente com manejo conservador, tendo sido realizados drenagem da lesão, suporte nutricional por meio de sonda nasoenteral e antibioticoterapia, com evolução satisfatória.Universidade de Santo Amaro General Surgery Residency ProgramHospital Municipal Dr. Moyses Deutsch Emergency ServiceUniversidade de Santo AmaroUniversidade de São Paulo Faculdade de Medicina Hospital das ClínicasUniversidade Federal de São Paulo (UNIFESP)Hospital Municipal Dr. Moyses DeutschHospital Municipal Dr. Moyses Deutsch General Surgery ServiceUNIFESPSciEL

Anorretomiectomia no tratamento do megarreto aglanglionar na criança

BV UNIFESP: Teses e dissertaçõe

Contribuição para o estudo anátomo-radiológico da origem da artéria gastroepiplóica esquerda

BV UNIFESP: Teses e dissertaçõe

Crossed testicular ectopia

Crossed testicular ectopia (CTE) is a rare anomaly, characterized by migration of one testis towards the opposite inguinal canal. Presented here is a case of crossed ectopia of the right testis, treated by extraperitoneal transposition of the gonad and right orchiopexy. Embriology and surgical findings suggest that CTE is a common consequence of many unclear ethiologic factors, specially mechanical ones, and can be associated with Muller duct persistence. Review of literature suggests a classification of CTE into 3 types: I - associated with inguinal hernia alone; II - associated with persistent mullerian remnants; III - associated with other anomalies without mullerian remnants. Treatment includes transeptal orchiopexy or extraperitoneal transposition of the testis, research for mullerian remnants and other anomalies, and long term postoperative follow-up, due to the risk of becoming malignant

Intussusception of cecal appendix

The authors report the case of a child with the diagnosis of appendiceal intussusception and describe the clinical, ultrasonographic, colonoscopic and surgical aspects. The authors discuss these aspects based on a review of recent literature

Neuroendocrine brake for the treatment of morbid obesity. Preliminary report

Objectives: To demonstrate the preliminary results of a newtechnique named neuroendocrine brake, for surgical treatment ofmorbid obesity. Methods: In November 2003, three patientsunderwent the neuroendocrine brake operation performed by thelaparoscopic approach. The mean age was 46.4 years; all patientswere female. Mean BMI was 42.3 kg/m2. The patients selectedpresented some relative or absolute contraindications to the useof gastrointestinal bypass techniques, including gastric ulcer anda family history of gastric malignancy(1) and chronic anemia (2).All patients had associated diseases, including type II diabetesmellitus (2), hypertension (2), obstructive sleep apnea (1),dyslipidemia (3), cholecystolithiasis (1), gastric ulcer (1) andchronic anemia (2). The laparoscopic technique consisted of anileal interposition at the proximal jejunum and longitudinalgastrectomy. Results: There was no conversion to open surgery orpostoperative complications. Sixteen months later, the meanpercentage of initial body weight loss was 44.6% and the meanBMI was 24.3 kg/m2. Glucose, triglyceride and cholesterol levelswere normalized, and sleep apnea showed remission. Conclusion:In spite of the reduced number of patients and short term followup, the good results suggest that the neuroendocrine brake maybecome an option for surgical treatment of morbid obesity in thenear future