Laparoscopic Transumbilical Cholecystectomy: Surgical Technique

Even when conventional laparoscopic instrumentation was used, laparoscopic transumbilical cholecystectomy appeared to be a feasible alternative to conventional laparoscopic cholecystectomy

A Comparison of Hand-Assisted and Pure Laparoscopic Techniques in Live Donor Nephrectomy

PURPOSE: To compare hand-assisted laparoscopic donor nephrectomy and pure laparoscopic live donor nephrectomy techniques in live donor nephrectomy. METHODS: In this retrospective study, we included all patients submitted to hand-assisted laparoscopic donor nephrectomy and pure laparoscopic live donor nephrectomy between May 2002 and December 2007. The operative data and post-operative courses were reviewed. Information was collected on the operative time, warm ischemia time, estimated blood loss, intra-operative complications, time to first oral intake, length of hospital stay, and post-operative complications. The data were analyzed using Student's t -tests and Fisher exact tests as appropriate, with statistical significance defined as p < 0.05. RESULTS: The means of the operative duration, warm ischemia time and intra-operative bleeding were 83 min, 3.6 min and 130.9 cc, respectively, for hand-assisted laparoscopic donor nephrectomy, and 78.4 min, 2.5 min and 98.9 cc, respectively, for pure laparoscopic live donor nephrectomy (p=0.29,

Avaliação das premissas do Programa de Reestruturação e Ajuste Fiscal e seus impactos para a situação fiscal dos Estados brasileiros

O estudo possui dois objetivos, a saber: discutir as premissas inerentes aos programas de reestruturação e ajuste fiscal (PAF) firmados entre a União e os Estados brasileiros; e propor uma equação formal da relação dívida financeira/receita que garanta para esta a convergência para a meta prevista nos contratos. Para dar conta dos objetivos realizouse revisão da legislação pertinente, a partir da qual foi formalizada matematicamente a equação de convergência. Os resultados indicam que os Estados que possuírem relação dívida financeira/receita líquida real inferior ou igual a 2,50, em 2009, tendem a cumprir a meta de redução de endividamento prevista pelo PAF, em 20 anos. Aponta-se também o desvio das hipóteses do PAF causado pela indexação da dívida ao IGP

Worldwide trends in underweight and obesity from 1990 to 2022 : a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

A list of authors and their affiliations appears online. A supplementary appendix is herewith attached.Background: Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods: We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI 2 SD above the median). Findings: From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation: The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity.peer-reviewe

Colangiopancreatografia endoscópica retrógrada transgástrica laparoscópica após cirurgia bariátrica

Access to the gastric remnant and duodenum is lost after Roux-en-Y gastric bypasses for morbid obesity. Laparoscopic transgastric endoscopic retrograde cholangiopancreatography has recently been described to manage biliary problems in such cases. We describe the first brazilian case of management of choledocholithiasis after a Roux-en-Y gastric bypass using this approach

Cistectomia radical laparoscópica com reservatório ileal

Worldwide experience with laparoscopic radical cystectomy is increasing in the last few years. We describe a 29-year-old female who underwent a laparoscopic radical cystectomy with ileal reservoir for a bladder sarcoma. Operative time was 405 minutes and estimated blood loss was 500 mL. She had an uneventful postoperative course and was discharged in the fifth postoperative day. Key-words: bladder, cystectomy, laparoscopy, urinary diversion, bladder neoplasms

Avaliação das premissas do Programa de Reestruturação e Ajuste Fiscal e seus impactos para a situação fiscal dos Estados brasileiros

O estudo possui dois objetivos, a saber: discutir as premissas inerentes aos programas de reestruturação e ajuste fiscal (PAF) firmados entre a União e os Estados brasileiros; e propor uma equação formal da relação dívida financeira/receita que garanta para esta a convergência para a meta prevista nos contratos. Para dar conta dos objetivos realizouse revisão da legislação pertinente, a partir da qual foi formalizada matematicamente a equação de convergência. Os resultados indicam que os Estados que possuírem relação dívida financeira/receita líquida real inferior ou igual a 2,50, em 2009, tendem a cumprir a meta de redução de endividamento prevista pelo PAF, em 20 anos. Aponta-se também o desvio das hipóteses do PAF causado pela indexação da dívida ao IGP