Resumo em Português:

Para avaliar os efeitos da gastrectomia segmentar do corpo associada à vagotomia gástrica proximal (GS + VGP), sobre a vascularização arterial da curvatura menor do estômago, foram utilizados 24 cães distribuídos em dois grupos de 12 animais, com as seguintes denominações: Grupo I, animais submetidos à laparotomia e manipulação gástrica; Grupo II, animais submetidos à GS + VGP. Em cada grupo, metade dos animais foi sacrificada no terceiro, metade no oitavo dia pós- operatório. No dia do sacrifício, procedeu-se à injeção de mistura de bário-gelatina, na vascularização arterial do estômago. A seguir, o estômago foi removido do animal, fixado em solução de formol, aberto pela curvatura maior e radiografado com técnica padronizada. A intensidade da vascularização da curvatura menor do estômago foi determinada por microdensitometria e morfometria. Pela microdensitometria, foram determinados os valores de densidade óptica, convertidos em equivalentes de milímetros de alumínio, da imagem radiográfica da curvatura menor do estômago. Com base nesses resultados, verificou-se que os valores médios de densidade óptica do grupo II foram significativamente maiores do que o grupo I (p<0,001). Pelo estudo morfométrico de fragmento histológico da curvatura menor, observou-se que os valores médios de volume relativo das arteríolas, em relação ao volume total da camada submucosa, foram significativamente maiores no grupo II em comparação ao grupo I (p<0,001). Os valores médios dos diâmetros das arteríolas da camada submucosa foram significativamente mais elevados no grupo II que no grupo I (p<0,001). O número de arteríolas por mm2 da camada submucosa não diferiu significativamente entre os dois grupos (p>0,05). Embora a execução da GS + VGP implique desvascularização da curvatura menor do estômago, observou-se aumento da intensidade da vascularização arterial desta curvatura nos animais do grupo II, conseqüente à dilatação das arteríolas da camada submucosa.

Resumo em Inglês:

In order to evaluate the possible effects determined by combined body segmental gastrectomy and proximal gastric vagotomy on the arterial vascularization of the lesser curvature of the stomach, twenty-four dogs. weighing 10 to 20 kg, were divided into two groups of 12 animals each: Group 1, animals were submitted to laparotomy and gastric manipulation for 30 minutes; Group II, animals were submitted to segmental gastrectomy with proximal gastric vagotomy. In each group, six animals were sacrificed on the third postoperative day and six on the eighth postoperative day. Neither death nor other postoperative complications occurred. On the sacrifice day barium-gelatin contrast was injected into the arterial vascularization of the stomach, which was then removed from the animal, opened along the greater curvature, fixed in formalin and submitted to radiographs. The intensity of the vascularization of the lesser curvature of the stomach was determined by microdensitometric and molphometric study. By means of microdensitometry. values of the optical densities were determined of the radiograph image of the lesser curvature of the stomach. Considering the microspectrophotometry principies. the values of the optical densities converted in aluminum equivalent were directly proportional to the intensity of vascularization of the gastric lesser curvature. The analysis of the obtained microdensitometry data revealed mean values of optical densities significantly more intense in group 11, when compared to group 1 (p<0.001). On the basis of the morphometric study of the histologic fragment of the lesser curvature, it was observed that: a) the mean arteriole volumes, relative to total submucosa volumes, were significantly greater in group 11 than in group 1 (p<0.001); b) the mean values of the arterioles diameter of the submucosal of group 11 were significantly larger than in the group 1 (p<0.001); c) there was no change in the number of arterioles per mm2 of the submucosal between the two groups (p>0.05). Therefore. it was found an increased intensity of the arterial vascularization of the lesser. The increased vascularization was consequence of arteriole dilatation of the submucosal layer.

Resumo em Português:

Foram estudados prospectivamente cinqüenta pacientes com megaesôfago não avançado tratados por cardiomiectomia com fundoplicatura parcial por via laparoscópica, avaliados sob o ponto de vista clínico e funcional. Houve 12% de complicações intra-operatórias, duas complicações pós-operatórias imediatas e um óbito. Não houve conversões ou complicações tardias. Os resultados ótimos e bons somaram 97,9% dos casos. Houve tendência à diminuição radiológica do calibre do esôfago e desaparecimento da esofagite à endoscopia. A eletromanometria mostrou diminuição significativa da pressão média do esfíncter inferior do esôfago após a operação; a pHmetria de 24 horas constatou diminuição da estase esofágica e ausência de refluxo gastro-esofágico no pós-operatório. Não houve diferença entre os resultados do tratamento de pacientes com megaesôfago chagásico e não chagásico. Os pacientes tiveram o benefício da cirurgia laparoscópica de menor dor, rápida realimentação, alta precoce e breve retorno às atividades habituais.

Resumo em Inglês:

This is a prospective study of 50 patients with non-advanced achalasia treated by videolaparoscopic cardiomyectomy with partial fundoplication. The technical standardization of the operative procedure was evaluated, and the patients studied by clinical evaluation, endoscopy, eletromanometry, radiology and 24 hour pHmetry. The operation was completed laparoscopically in all patients, with no convertion to laparotomy. There were six (12%) intra-operative complications (mucosal perforation, pleural lesion and subcutaneous emphysema), two (4%) immediate post-operative ocurrencies and one (2%) death. There was no late complication. Clinical evaluation showed significant improvement of dysphagia, no regurgitation and weight gain after operation, and excellent and good results were obtained in 97.9% of the patients. In the post-operative period ocurred radiological improvement of esophageal dilatation and less endoscopic esophagitis. The eletromanometry showed significative decrease of lower esophageal sphincter pressure after operation, as well as 24 hour pHmetry verified less esophageal stasis and no gastro-esophageal refluxo There was no difference in the treatment of chagasic or non-chagasic patients. The benefits of laparoscopic surgery were obtained: less pain, early oral intake, short hospitalization and fast return to norma activities.

Resumo em Português:

O objetivo do presente trabalho é avaliar os resultados iniciais obtidos com a simpatectomia cervicotorácica videotoracoscópica. De outubro de 1995 a outubro de 1997 foram realizados 24 procedimentos em 14 pacientes: dez homens e quatro mulheres, com idades que variaram de 16 a 56 anos, média de 30 anos. Indicações para a operação foram: hiperidrose palmar em dez pacientes, isquemia de mão em três e causalgia em um. Nos casos de hiperidrose, a ressecção da cadeia simpática incluiu T2 e T3. Nos portadores de isquemia e causalgia também o gânglio estrelado foi ressecado. Vinte e três das 24 extremidades mostraram excelente resposta imediata à simpatectomia. Somente uma extremidade de paciente com hiperidrose permaneceu inalterada devido a procedimento incompleto, tendo sido desnervada pela mesma técnica em reoperação posterior, com bom resultado. Pneumotórax residual pós-operatório ocorreu em uma paciente com resolução espontânea. Treze pacientes tiveram seguimento que variou de dois a 18 meses, com média de 11 meses. Não houve mortalidade nessa série, e a principal complicação tardia observada nos pacientes operados por hiperidrose foi a hiperidrose compensatória, que ocorreu, em grau variado, nos nove pacientes com seguimento, sendo que em 30% deles esta manifestação foi significativa. Concluímos tratar-se de procedimento simples, seguro, eficiente e de melhor aceitação por parte dos pacientes do que a operação convencional.

Resumo em Inglês:

This report analyzes the initial results of thoracoscopic cervicodorsal sympathectomy. From October 1995 to October 1997, 24 procedures were accomplished in 14 patients. Ten were males and four were females ranging in age from 16 to 56 (mean 30). Surgical indications were: palmar hyperhidrosis in ten, ischemia of the hand in three and causalgia in one. Resection of the sympathetic chain in hyperhidrosis included T2 and T3. In those with ischemia and causalgia the stellate ganglion was also resected. The imediate results of sympathectomy were excellent in twenty-three of the extremities. Only one extremity with hyperhidrosis remained unchanged due to an incomplete procedure. The same technique was used in a later reoperation with good results. There was one case of residual postoperative pneumothorax which recovered spontaneously. Thirteen patients were followed from two to eighteen months (mean 11 months). Mortality was null in this series. The main late complication in patients operated on for hyperhidrosis was compensatory hyperhidrosis which occurred in various degrees in the nine patients followed-up. The latter was significant in 30%. The authors consider this a simple, safe, effective procedure which is more acceptable by patients than conventional surgery.

Resumo em Português:

As técnicas laparoscópicas e toracoscópicas proporcionaram uma nova dimensão para a correção dos distúrbios funcionais do esôfago. O sucesso terapêutico, entretanto, depende da confirmação da doença esofágica como causa dos sintomas, da compreensão da causa básica da disfunção e da identificação do paciente cirúrgico. O presente trabalho é um estudo retrospectivo em pacientes operados pela técnica de Lind para doença do refluxo gastroesofágico (DRGE). Tem por objetivo estabelecer o valor do uso sistemático da esofagomanometria e da pHmetria de 24 horas na seleção de pacientes e na avaliação funcional pré e pós-operatória. Quarenta e um pacientes (68,3%) tinham hipotonia do esfíncter inferior do esôfago. A pressão foi em média de 9,2 mmHg no pré-operatório e de 15,2mmHg no pós-operatório, com um aumento de 6,0 mmHg. Este aumento foi de 8,8mmHg nos hipotônicos e 4,3 mmHg nos normotônicos. Houve algum grau de hipomotilidade do corpo do esôfago em 14 pacientes (23,3%), sendo que, deste grupo, quatro (28,5%) obtiveram melhora pós-operatória. Refluxo ácido patológico foi constatado em 51 casos (85,0%) pela pHmetria. A média do score de DeMeester pré-operatório foi de 31,4, baixando depois para 3,2. A esofagomanometria e a pHmetria de 24 horas são métodos eficazes em revelar o nível de modificação funcional estabelecido pela cirurgia anti-refluxo e ajudam objetivamente na seleção.

Resumo em Inglês:

The recent introduction and widespread use of laparoscopic and thoracoscopic techniques has given a new dimension to esophageal functional surgery. A successful result depends on the documentation of esophageal disease as the cause of symptoms, the understanding of the cause of esophageal dysfunction, and the identification of patients who should have surgical treatment. This paper is a retrospective study developed in patients underwent Lind operation for gastroesophageal reflux. The study wants to establish the value of rotine use of esophageal manometry and 24 hour pH monitoring for selection and evaluation. Forty-one patients (68.3%) had mechanically defective lower esophageal sphincter. The preoperative pressure was 9.2 mmHg and postoperative 15.2 mmHg. The general increase was 6.0 mmHg, the increase in defective sphincters was 8.8 mmHg and in normal sphincters was 4.3. We found some diminished peristalsis of esophageal body in 14 patients (23.3%), and this group had four patients (28.5%) with improved peristalsis after surgery. Abnormal acid reflux was detected in 51 cases (85.0%) by pH monitoring. The preoperative DeMeester score was 31.4, decreasing to 3.2 at postoperative period. Esophageal manometry and 24 hour pH monitoring are efficient methods to detect and measure the functional modifications established with an antireflux procedure.

Resumo em Português:

Estudo conduzido com o objetivo de avaliar a confiabilidade, acurácia e dificuldades do exame de congelação, utilizando-se pequenos fragmentos de tumores mamários obtidos com a biópsia histológica por agulha grossa (bioptycut). Durante 13 meses, 37 pacientes foram submetidas ao Bioptycut (pistola BIP 2.2 ou Promag 1.2, agulhas l4G), sendo que, de cada uma delas, foram retirados no mínimo dois fragmentos, um a fresco para congelação e outro submerso em formol para inclusão posterior em parafina. O estudo de congelação constituiu-se de exame citológico do "imprimir" da peça e de exame histológico usando cortes através de congelação. Os cortes foram feitos usando criostato e micrótomo, com cortes de 8µ. O tamanho do tumor puncionado variou de 1cm a 12cm (média 4,8cm). A congelação foi conclusiva em 33 casos (89%), sendo trinta carcinomas e três benignos, e inconclusiva em quatro casos (11%). A obtenção deste dia:nóstico se deu pelo "imprint" e corte em 29 casos (78%), só pelo "imprint" em quatro casos (11 %), em dois casos tanto o corte quanto o "imprint" foram inadequados e dois não foram descritos. Posteriormente foram obtidas peças por exérese da lesão (até a análise) em 28 casos, dos quais 25 carcinomas e três tumores benignos (11 %). Houve um caso de congelação conclusiva de benignidade, em que a exérese posterior revelou se tratar de carcinoma (falso-negativo). Não houve falsos-positivos. A sensibilidade foi de 96% e a especificidade de 100%. Assim, conclui-se que o exame por congelação, usando-se peças obtidas com bioptycut se mostrou confiável, evitando biópsias abertas em 81 % dos casos, garantindo rapidez e melhor preparo das pacientes para terapêutica definitiva.

Resumo em Inglês:

A prospective study was carried out to evaluate the reliability, accuracy and difficulties of froozen section, by using small fragments of breast tumors obtained through core needle biopsy. During 13 months, 37 patients with breast lumps underwent core needle biopsy (bioptycut), using two types of guns of 2.2 and 1.2, with 14G needles. At least two specimens were taken from each of these patients: one was kept fresh, for froozen section, and the other was immersed in formal saline to be later imbedded in paraffin. The froozen section constitutes in a cytological examination of the imprinting of the sample and of a histological examination using cuts made by freezing. The 8-m cuts were made with cryostat and microtome. The tumor size ranged from 1 to 12cm (average 4.8cm). Froozen section was conclusive in 33 cases (89%): thirty were carcinomas and three benign tumors. In four cases (11 %) this test was not conclusive. This diagnosis was achieved by imprint and cut in 29 cases (78%), only by imprint in four cases (11%). In two cases both the cut and the imprint were inadequate. Two cases were not described. Later, 28 samples were obtained through exeresis of the lesions (until analysis). Twenty-five were found to be carcinomas, while three were benign tumors (11 %). There was a conclusive case of benign diagnosis through the froozen section which the later exeresis proved that it was a carcinoma (false negative). There were no false positive cases. Sensitivity was of 96% and specificity was of 1 00%. It is concluded that the froozen section, using small samples obtained through bioptycut was shown to be reliable, and in 81 % of the cases open biopsies were avoided. This ensured a faster definite therapy and better patient preparation.

Resumo em Português:

Os autores revisam 96 procedimentos colangiográficos peroperatórios realizados no Departamento de Cirurgia da Faculdade de Medicina de Marília (FAMEMA) entre janeiro de 1993 e fevereiro de 1995. Dos exames estudados, setenta foram considerados normais, 23 alterados e três inconclusivos. Os autores apresentam casos onde a colangiografia peroperatória (CPO) não confirmou a suspeita pré-operatória, o que evitou explorações desnecessárias da via biliar (6,25%) ou não permitiu diagnóstico incorreto (9,36%). Do exposto, os autores concluem que a CPO continuará sendo rotina nas operações sobre a vesícula e vias biliares e sugerem a necessidade do estabelecimento de padrão técnico para a realização do exame.

Resumo em Inglês:

The authors revise operative cholangiographies peformed at the Department of Surgery of the “Faculdade de Medicina de Marília” (FAMEMA) from January 1993 to February 1995, with the objective of characterizing the pattern of these exams at FAMEMA. It was possible to rescue 96 findings of the registrations from Service of Radiology of FAMEMA. In this study, 70 were considered normal, 23 altered and three inconclusive. The authors present cases where the operative cholangiographies did not clinch pre-operative suspicion, which avoided unnecessary profiteering of the common bile duct (6.25%) or did not allow improper diagnosis (9.36%), considered the main advantages of the operative cholangiography. Then, they present discussion over this kind of procedure, unsuspected choledocolithiasis and about the new point of view: the cholangiography at videolaparoscopic cholecystectomy. Finally, the authors conclude that operative cholangiography will proceed as a routine on operations on gallblader and common bile duct and they propose the institution of a pattern to the accomplishment of this procedure.

Resumo em Português:

Os autores descrevem técnica de via de acesso para exposição ampla da coluna toracolombar anterior (T10 -L5) a que foi submetida uma série de cem pacientes com indicação cirúrgica para correção de diversas doenças da coluna. A partir das estruturas envolvidas, são analisados e comentados os tempos operatórios pertinentes bem como as complicações transoperatórias e pós-operatórias decorrentes da técnica. Sugere-se que a técnica de acesso proposta seja utilizada quando adequada à doença a cuja correção se destina, independente da área de comprometimento clinicamente objetivada.

Resumo em Inglês:

The authors describe a technique for extensive anterior approach to the thoracolumbar spine (T10 -L5), to which 100 patients with surgical indication for correcting orthopedic anomalies were submitted. The anatomical structures involved in surgical procedures are analyzed and discussed. Results have shown that this extensive anterior approach to the thoracolumbar spine a) allows the aimed approach in 100% for the cases, making easier the arthopedic management necessary to the correction of the spine deformity to be treated; b) makes possible to avoid transoperative complications from the knowledge of anatomical structures exposed in the surgical field, except for the sympathetic trunk, in which lesion can occur in 70% of cases; and c) presents a low rate (2%) of post operative complications. It is suggested that this technique for extensive anterior approach to the thoracolumbar spine should be used, independently of the extension of the clinically diagnosed affected area.

Resumo em Português:

Foram estudados, no período de 1987 a 1991, trinta doentes esquistossomóticos submetidos anteriormente a operações não descompressivas para tratamento da hemorragia digestiva alta, e que apresentaram recidiva hemorrágica. Através de endoscopia digestiva alta, ultra-sonografia abdominal e estudo angiográfico, procurou-se determinar o local do novo sangramento e quais os possíveis fatores de recidiva hemorrágica presentes. Procurou-se também determinar a influência da cirurgia anterior no intervalo de tempo decorrido entre esta e o primeiro episódio de recidiva hemorrágica. Os autores concluem que as varizes esofágicas foram significativamente o local mais freqüente do sangramento nas recidivas hemorrágicas (86,7%); que a úlcera péptica gástrica (13,3%), a não desvascularização gastroesofágica (30%), a desvascularização incompleta (16,7%) ou a trombose da veia porta (26,7%) estão presentes na maioria dos casos de recidiva hemorrágica; e que a associação da desvascularização gastroesofágica à esplenectomia não alterou o intervalo médio de tempo decorrido entre a cirurgia anterior e o primeiro episódio de recidiva do sangramento.

Resumo em Inglês:

The authors studied 30 schistosomotic patients between 1987 to 1991, previously submitted to non-decompressive surgery for the treatment of upper gastrointestinal hemorrhage who rebled after the surgery. Upper digestive endoscopy, abdominal ultrasonography and angiographic study were carried out in this patients with the aim of trying to detemine the source of rebleeding, and possible factors correlated to this new onset of bleeding. An attempt was also made to determine the influence of previous surgery in the free-time interval from bleding till the first episode of upper hemorrhage. 1t was concluded that esophageal varices are the most common site of bleeding in the rebleeding (86.7%). It was found that peptic gastric ulcer (13.3%) non-gastroesophagic devascularization (30%), uncomplet devascularization (16.7%), and portal thrombosis (26.7%), are present in most cases of rebleeding. It was also found that the association of the gastroesophagic devascularization to esplenectomy did not significantly alter the average time interval between previous surgery and first episode of the rebleeding.

Resumo em Português:

Cerca de 4% a 15% dos tumores colorretais são hereditários e divididos em dois grupos: polipose adenomatosa familiar (FAP) e câncer colorretal hereditário sem polipose (HNPCC). Ambas são doenças autossômicas dominantes, com transmissão vertical, geração após geração, sem preferência por sexo. A FAP tem penetrância praticamente completa, caracterizada por mais de cem pólipos adenomatosos no intestino grosso, que aparecem em geral após a puberdade e se transformam em câncer em todos os casos não tratados, levando o paciente ao óbito em tomo dos 45 anos de idade. Manifestações extracolônicas são comuns, tais como: pólipos em estômago e duodeno, sarcomas abdominais, pigmentação de retina, osteomas, entre outras. A FAP é causada por mutação no gene APC, que está localizado no cromossomo 5q. Seu tratamento é basicamente cirúrgico, com retirada do intestino grosso, podendo-se preservar o reto, se este não apresentar muitos pólipos. O HNPCC tem penetrância em torno de 80% e não apresenta os pólipos benignos como na FAP, que permitem identificar pacientes com o fenótipo da doença. Geralmente, o diagnóstico da lesão colônica é realizado já na fase maligna, em torno dos 45 anos de idade, com preferência para o lado direito do cólon. Pode haver associação com tumores de endométrio na mulher, estômago, pâncreas, entre outros. É causada por mutação em genes de reparo do DNA (hMSH2, hMLH1, hPMS1, hPMS2, hMSH6/GTBP). A colectomia total deve ser realizada em pacientes com câncer de cólon e HNPCC. Se o tumor estiver localizado no reto, a proctocolectomia total pode ser uma opção. Em indivíduos portadores do defeito genético predisponente ao HNPCC, porém, assintomáticos, a indicação de cirurgias profiláticas é controversa. Atualmente, podem-se identificar indivíduos portadores de defeito genético herdado tanto na FAP como no HNPCC. Esses testes baseiam-se no estudo direto dos genes responsáveis pela respectiva doença ou pela proteína produto dos mesmos. É de suma importância uma abordagem multidisciplinar de pacientes portadores de FAP ou HNPCC, pois existe uma preocupação ética muito grande na realização dos testes genéticos de predisposição, considerando suas conseqüências psicológicas e sociais.

Resumo em Inglês:

About 15% of the colorectal tumors are hereditary. There are two main groups: the familiar adenomatous polyposis (FAP) and the non-polyposis colorectal cancer (HNPCC), both autosomal dominant diseases. Patients with FAP present hundreds to thousands of adenomas in colorectum. usually after puberty. The cause of FAP is mutation of the adenomatous polyposis coli (APC) gene, located on long arm of chromosome 5 (5q). Patients who have not undergone to colectomy, the only treatment avaiable, will develop colorectal cancer and die at the age of 45 years. Extracolonic manifestations can occur: gastric and small bowel adenomas, soft tissue tumors, retinal pigmentation. osteomas. Patients with HNPCC do not present hundreds of benign polyps, but already a solitary colorectal cancer: This disease is caused by mutations in one of the several mismatch repair genes (hMSH2, hMLHI, hPMSI, hPMS2, hPMS6/GTBP). The average age of the diagnosis is 45 years and usually the disease produces cancer in the right colon. Other carcinomas can occur: endometrial, stomach, pancreas and others. Prophylactic surgery in asymptomatic gene carriers are controversial. Nowadays it is possible to identify asymptomatic genes carriers of FAP and HNPCC by genetic testing. The analysis can be done by direct gene sequencing or by in vitro synthesized protein assay (IVSP), which finds defective truncate proteins. Genetic testing for hereditary forms of colorectal cancer requires not only an appropriate laboratory, but genetic counseling with an ethical multidisciplinary approach considering the psychological and social consequences.

Resumo em Inglês:

Intestinal complications after laparoscopic cholecystectomy are rare and usually caused by direct injury sustained on trocar insertion. However, intestinal ischaemia has been reported as an unusual complication of the pneumoperitoneum. We describe a 55-years-old patient who underwent an uneventful laparoscopic cholecystectomy after an episode of acute cholecystitis. Initial recovery was complicated by development of increasing abdominal pain which led to open laparotomy on day 2. Gangrene of the distal ileum and right-sided colon was detected and small bowel resection with right colectomy and primary anastomosis was performed. Histological examination of the resected ileum showed features of venous hemorragic infarction and trombosis. In view of the proximity of the operation it is assumed that ileal ischaemia was precipitated by carbon dioxide pneumoperitoneum. Some studies have been demonstrated that, within 30 minutes of establishing a pneumoperitoneum at an intraabdominal pressure of 16 mmHg, cardiac output, blood flow in the superior mesenteric artery and portal vein decrease progressively. Carbon dioxide pneumoperitoneum may lead to mechanical compression of the splanchnic veins and mesenteric vasoconstriction as a result of carbon dioxide absortion. The distribution of the ischaemic segment of intestine is also unusual as the most precarious blood supply is traditionally at the splenic flexure of the colon. It has been suggested that intermittent decompression of the abdomen reduces the risk of mesenteric ischaemia during penumoperitoneum especially in patients with predisposing clinical features for arteriosclerosis intestinal. In present patient was observed intestinal venous infarction what remains unclear but we think the carbon dioxide pneumoperitoneum have been related to it.

Resumo em Inglês:

This is a case report about a seven year-old child who arrived at Emergency Department of Hospital da Restauração with gunshot wound on precordial area and clinical signs of cardiac tamponade. The roentgenogram showed 27 retained pellets in cardiac area. Thoracotomy was performed and repaired a cardiac wound in right ventricule. The patient developed conduction disturbance and valvar defect, but was discharged on the tenth postoperative day. Diagnosis, treatment and complications of retained projectiles are discussed.

Resumo em Inglês:

With the improvement of laparoscopic techniques, endoscopic liver surgery has become feasible. While laparoscopic wedge liver resection are performed more frequently, laparoscopic (anatomical or nonanatomical) liver resection are still at an early stage of development and are somewhat controversial. We reporte laparoscopic hepatic resection without use of sophisticated laparoscopic instruments. A 47-year-old woman underwent radical mastectomy for adenocarcinoma in 1995. 1n the postoperative follow-up presented, a lesion in the left hepatic lobe and, after laparoscopic approach, left lateral segmentectomy was performed. The hepatic resection elapsed without complications. The surgical time was 4 hours and the blood loss was minimal, without transfusion being necessary.The abdominal drain was removed in 24 hours and the patient was discharged in the second postoperative day. Compared to the classic approach by laparotomy, this method was less traumatic, required a shorter hospital stay, and followed by faster recovery.

Resumo em Inglês:

Small cell carcinoma of the esophagus is a rare tumor described to the first time by Mckeown in 1952. Clinically it is very similar to small cell carcinoma of the lung. with quick evolution and early dissemination.It is more frequent in men between 60 and 70 years of age. The patients usually have dysphagia and weight loss. Most of the tumours arise in the middle and distal third of the esophagus. Chronic alcohol and tobacco use are usually present. The manegement of primary small cell cancer of the esophagus remains controversial with groups reporting treatment based on operation alone, local radiotherapy, chemotherapyalone, or operation with adjuvant therapy. Overall survivel remains poor at a mean of 5.1 months, with the best rate of survivel in patients undergoing operation with adjuvant chemotherapy. The authors relate two cases of a small cell carcinoma of the esophagus. Both of these patients was female and white, with 51 and 64 years old. The first mainestation was dysphagia and weight loss. Histologic study from endoscopic biopsies reveled the diagnosis. The treatment was, in the both cases surgery, however in one case, chemotherapy and mediastinal irradiation was associated to the ressection. The authors comment the more important aspects about this pathology and the treatment and survival of the patients.

Resumo em Inglês:

The clinical and pathological aspects of neurofibromatosis are summarized and an updated pathogeny of the tumor is made. The malignancy of the NFS senns to be linled to the NF - 1 gene mutations, with loss of the suppressor gene in the chromosone 17 pl. The surgical treatment is always useful because it lowers the pressure and relieves the patient.