Resumo em Português:

INTRODUÇÃO: Os cuidados com as preservações dos nervos laríngeos recorrentes e das glândulas paratireóides, nas tireoidectomias, continuam desafiando os cirurgiões em razão das graves complicações que podem ocorrer quando são manipulados inadequadamente. O trabalho teve como objetivo, no curso das tireoidectomias totais e parciais, estabelecer protocolo anatômico-cirúrgico das relações anatômicas entre os nervos laríngeos recorrentes com as artérias tireóideas inferiores, identificar-preservar esses nervos e as glândulas partireóides. MÉTODO: Os registros fotográficos durante os trans-operatórios foram obtidos de 79 pacientes submetidos às tireoidectomias totais e parciais (lobectomia total direita ou esquerda e istmectomia), respectivamente, com as identificações dos nervos e artérias bi ou unilateralmente, propondo expor as relações anatômicas entre essas estruturas, operados entre janeiro de 2005 e julho de 2006. RESULTADOS: Os registros fotográficos foram adaptados aos desenhos esquemáticos para estabelecer os principais pontos de referências anatômicas dos nervos laríngeos recorrentes em relação às artérias tireóideas inferiores, totalizando 116 nervos laríngeos recorrentes. CONCLUSÃO: A íntima relação dos nervos laríngeos recorrentes e as artérias tireóideas inferiores podem se apresentar de diversas formas, incluindo as anomalias congênitas, como a do laríngeo não recorrente, as duplicações e triplicações pré-laríngeas do nervo, sem dúvida, algumas vezes, dificultando a identificação dessas estruturas. São imperativas as claras identificações dessas estruturas e das glândulas paratireóides para preservá-las, no curso das tireoidectomias totais e parciais, a fim de evitar as complicações pós-operatórias.

Resumo em Inglês:

BACKGROUND: Care in preserving the recurrent laryngeal nerves and the parathyroids glands, during thyroidectomies, continue to challenge surgeons because of the serious complications, which can occur when they are inadequately handled. The work aimed at establishing a surgical-anatomical protocol of the relations between the recurrent laryngeal nerves with the lower thyroidal arteries and identify and preserve the nerves and the parathyroids glands, in the course of total and partial thyroidectomies. METHODS: The photographic records during the surgery have been obtained from 79 patients who were submitted to total and partial thyroidectomies (total right or left lobectomy and istmectomy) respectively, with identification of the nerves and arteries, both unilateral and bilateral, proposing to expose the anatomical relations between these structures, operated on between January 2005 and July 2006. RESULTS: The photographic records were adapted to the schematic drawings so as to establish the major anatomical points of reference of the recurrent laryngeal nerves vis-à-vis the inferior thyroidal arteries were completed in a total of 116 recurrent laryngeal nerves. CONCLUSION: The intrinsic relation of the nerves with the arteries can occur in different forms, including the congenital abnormalities, as that of the non-recurrent laryngeal, the prelaryngeal duplications and triplications of the nerve, undoubtedly hindering the identification of such structures. Even under the protection of the anatomic and surgical difficulties, a clear identification of the nerve, artery and the parathyroid glands is imperative to preserve them in the course of total and partial thyroidectomies in order to avoid post-surgical complications.

Resumo em Português:

OBJETIVO: Avaliar o estado nutricional de pacientes com megaesôfago não-avançado no pré-operatório. MÉTODO: Foram selecionados dez pacientes adultos (seis do sexo masculino, quatro do feminino) provenientes dos Ambulatórios de Cirurgia do Hospital Regional do Vale do Paraíba-SAB e do Hospital Universitário de Taubaté. O diagnóstico do megaesôfago foi realizado por meio de um protocolo com informações referentes à origem epidemiológica, quadro clínico, sorologia para doença de Chagas, esofagrafia, endoscopia digestiva alta e eletromanometria. A avaliação do estado nutricional foi feita com dados antropométricos (Peso, IMC, CB, PCT e CMB) e bioquímicos (albumina, transferrina e linfocitometria). RESULTADOS: O peso foi o parâmetro mais comprometido, sendo a porcentagem de perda de peso considerada grave em oito pacientes. Somente um paciente classificou-se como percentil 5. Não houve alteração bioquímica significante. CONCLUSÃO: A maioria dos pacientes é eutrófica, sendo um paciente considerado desnutrido.

Resumo em Inglês:

BACKGROUND: Evaluating the nutritional condition of patients with not advanced esophagus preoperatively. METHODS: Ten adult patients were selected (6 male and 4 female) from Surgery Ambulatories of a public regional Hospital in Vale do Paraiba and of University Hospital of Taubaté. The mega esophagus diagnosis was made based on a guidance with information concerning to the epidemiological origin, clinical status, Chagas disease evidence and exams such as contrasted esophagogram, upper digestive endoscopies and electromanometry. The evaluation of the nutritional condition was made with anthropometric data (weight, Body Mass Index, Arm Circumference, and Arm muscular circumference) and biochemicals (transferrine albumin and lymphocitometer). RESULTS: The weight was the most affected parameter, and the percentage of weight loss was considered severe in eight patients. Only one patient was classified with a percentage of 5. There was no significant biochemical change. CONCLUSION: Most of the patients are eutrophic, and one patient is considered undernourished.

Resumo em Português:

OBJETIVO: O carcinoma epidermóide do esôfago é neoplasia com alta taxa de mortalidade. A necessidade do entendimento do processo de carcinogênse na melhora de resultados desta doença, conduz aos estudos experimentais. MÉTODO: Induzida a carcinogênese esofágica quimicamente por meio da dietilnitrosamina(DEN), em um grupo de 100 camundongos fêmeas. Utilizados quatro grupos, onde os Grupos 1 e 2 foram considerados controles, sendo diferenciados por gavagem esofágica, uma vez semana, com água em temperatura ambiente (20-25ºC) ou quente (60º-70ºC). E os Grupos 3 e 4, considerados estudos, receberam DEN por três dias consecutivos semanalmente, também sendo diferenciados por gavagem quente ou fria. Progressivas eutanásias com coletas de peças esofágicas, com início no 30º dia do experimento e terminando no 150º dia. RESULTADOS: Demonstrou-se que não houve diferença na incidência tumoral quando foi acrescida a variável temperatura da água (p=0,6854). Observou-se, que a carcinogênese durante o experimento, considerados os grupos que receberam DEN como sendo um único grupo, demonstrou clara e evidente progressão de lesões neoplásicas. CONCLUSÃO: Houve progressão neoplásica esofágica com a utilização de DEN, bem como o método pode ser utilizado em estudos para investigação do processo mutagênico.

Resumo em Inglês:

BACKGROUND: Esophageal epidermoid carcinoma is a neoplasm with high mortality rates and a peculiar geographic distribution. Experimental studies are necessary to better understand the carcinogenesis process and improve therapeutic protocols. METHODS: Esophageal carcinogenesis has been chemically induced with diethylnitrosamine (DEN) in 100 female mices. Four groups of animals were separated. Control groups I and II were treated weekly by esophageal gavage at room temperature or hot (60º-70ºC) water. Study groups III and IV were treated weekly for 3 consecutive days with diethylnitrosamine receiving also esophageal gavage with room temperature or hot water. Mices were sequentially sacrificed from day 30 until day 150 for collection and analysis of the esophagus. RESULTS: Results showed tumor incidence has not been affected by water temperature used for gavage (p=0.6854). Carcinogenesis has been induced in both groups receiving DEN, with clear and evident progression of pathological lesions. CONCLUSION: The model can be used for the study of mutagenic processes.

Resumo em Português:

OBJETIVO: Os objetivos deste estudo foram avaliar o diagnóstico e o tratamento das lesões de intestino delgado e determinar os fatores que influenciaram a morbimortalidade. MÉTODO: Estudo retrospectivo incluindo 410 pacientes com lesão de intestino delgado operados entre janeiro de 1994 e dezembro de 2004. Os dados coletados incluíram: mecanismo de trauma, métodos diagnósticos, tempo transcorrido até a intervenção cirúrgica, grau das lesões, índices de trauma, conduta cirúrgica (sutura ou ressecção e anastomose), morbidade (especialmente fístula) e mortalidade. A comparação entre os grupos foi feita usando os testes de Fisher e Yates. RESULTADOS: O mecanismo de trauma foi penetrante em 321 pacientes (78,3%) e fechado em 89 (21,7%). Houve mais pacientes tratados cirurgicamente com intervalo maior que 6 horas após o trauma no grupo trauma contuso se comparados com trauma penetrante (p<0,05). Sutura da lesão foi feita em 52,2% dos pacientes e ressecção e anastomose em 46,8%, e ambos procedimentos apresentaram a mesma incidência de fístula (4,7%). A morbidade foi de 35,1%. A incidência de fistula foi maior nos pacientes submetidos à laparotomia com mais de 12 horas após o trauma quando comparados com aqueles operados com menos de 12 horas (8,3% vs. 4,3%; sem diferença estatística), mas isto não foi fator determinante para maior mortalidade. A mortalidade foi de 13,7% e foi relacionada com escores de gravidade mais elevados. CONCLUSÃO: A lesão de intestino delgado é freqüente após o trauma abdominal, sendo mais comum nos traumas penetrantes. O diagnóstico desta lesão após trauma fechado pode ser difícil, com demora para o tratamento cirúrgico. A ocorrência de fistula não esteve relacionada aos seguintes fatores analisados: mecanismo de trauma, tempo transcorrido entre o trauma e a operação, conduta cirúrgica, lesões intra-abdominais associadas ou gravidade das lesões. A mortalidade esteve relacionada com lesões associadas.

Resumo em Inglês:

BACKGROUND: The purposes of this study were to evaluate the diagnosis and management of small bowel injury (SBI) and to determine significant factors affecting morbidity and mortality. METHODS: A retrospective chart review was performed including 410 patients with SBI operated between January 1994 and December 2004. Data included mechanism of injury, methods of diagnosis, time to operation, organ injury scaling, trauma scores, type of repair (enterorrhaphy vs. resection and anastomosis), morbidity (specifically fistula) and mortality. Comparisons between groups were analyzed using the Fisher and Yates tests. RESULTS: The mechanism of injury was penetrating in 321 patients (78.3%) and blunt in 89 (21.7%). There were more patients with at least 6 hours of delay to operation in the blunt trauma group than in the penetrating one (p<0.05). Enterorrhaphy was performed in 52.2% of the patients and resection with anastomosis in 46.8%, both with the same incidence of fistula (approximately 4.7%). Morbidity rate was 35.1% and fistula was more frequent in patients with therapeutic laparotomy with more than 12 hours after injury compared with laparotomy performed less than 12 hours (8.3% vs. 4.3%; not statistically significant), and it was not a determinant factor of higher mortality. The mortality rate was 13.7%, and was related to higher injury severity scores. CONCLUSION: SBI is frequent after trauma and it was most common in penetrating injuries. Blunt SBI diagnosis may be difficult, therefore causing delay in operative treatment. Occurrence of fistula was not related to the different evaluated factors: mechanism of injury, time to treatment, surgical repair, associated intra-abdominal lesions, and/or injury severity score. Mortality was related to associated injuries.

Resumo em Português:

OBJETIVO: Avaliar se existe diferença no estadiamento de doentes submetidos à ressecção intestinal por câncer colorretal no sistema previdenciário e na clínica privada. MÉTODO: Foram estudados de forma retrospectiva 41 doentes (16 homens e 25 mulheres) com idade média de 59,4 anos operados no sistema previdenciário (SP) e 33 doentes (18 homens e 15 mulheres) com idade média de 60,8 anos operados na clínica privada (CP). Foram avaliados o estadiamento TNM, a frequência de operações de urgência, de operações paliativas e do uso de colostomia. RESULTADOS: Não se observou diferença entre o estadiamento dos dois grupos. A frequência de operações de urgência foi 26,8% no SP e 12,1% na CP (p=0,100). As operações paliativas ( 19,5% SP x 6,1% CP) e o uso de colostomia ( 26,8 SP X 15,2 CP) foram maiores no sistema previdenciário porém os valores não foram estatisticamente significantes, valores de p=0,087 e p=0,352 respectivamente. CONCLUSÃO: Não há diferença significante entre o estadiamento TNM de doentes operados no sistema previdenciário e privado.

Resumo em Inglês:

BACKGROUND: To examine whether there is any difference in staging between patients operated on for colorectal cancer in public or private hospital. METHODS: This study included 41 patients (16 men and 25 women, mean age of 59.4 years old) who underwent colorectal resection for adenocarcinoma in public hospital (PU) and 33 patients (18 men and 15 women, mean age 60.8 years old) operated in private hospital (PR). They were evaluated regarding the TNM stage, mode of presentation (elective or emergency), type of resection (curative or palliative) and the use of colostomy. RESULTS: There was no significant difference in the staging among the two groups. Emergency presentation were 26.8% in the PU group and 12.1% in the PR group (p=0.100). Palliative resection (19.5% PU x 6.1% PR) and the use of colostomy (26.8% PU X 15.2% PR) were more frequently in the patients operated in public hospital but differences were not significant, p=0.087 and p=0.352 respectively. CONCLUSION: These findings demonstrate that there was no significant difference in staging between patients operated on for colorectal cancer in public or private hospital.

Resumo em Português:

OBJETIVO: Avaliar as alterações anatomopatológicas e histopatológicas da pleura e do parênquima pulmonar após a injeção de óleo de copaíba, extrato aquoso de crajiru e polivinilpirrolidona iodado (PVPI) no espaço pleural de ratos. MÉTODO: Foram utilizados 128 Rattus norvegicus var. Wistar, machos, com peso médio 198,9g (± 24,9g), randomizados em quatro grupos: copaíba, PVPI, crajiru e simulação. As substâncias foram injetadas no espaço pleural direito dos animais, os quais foram mortos em 24 h, 48 h, 72 h e 504 h, para análise macro e microscópica da pleura visceral e pulmão direito. RESULTADOS: Macroscopicamente, observou-se intensa reação pleuro-pulmonar no grupo copaíba com significância estatística (p= 0,001) em relação aos outros grupos e entre os diferentes momentos. Microscopicamente, a espessura pleural apresentou maior aumento no grupo copaíba com significância estatística nos tempos 72 h e 504 h. O PVPI provocou reação inflamatória aguda em 24 h e 48 h com melhora em 72 h, porém, na última observação, evidenciou-se lesão crônica pulmonar. O crajiru apresentou-se pouco irritativo e sem significância em relação aos demais. CONCLUSÃO: A copaíba mostrou-se muito irritante; o PVPI, moderadamente irritante, e o extrato aquoso de crajiru apresentou pouca reação inflamatória na pleura e parênquima pulmonar dos animais de experimentação.

Resumo em Inglês:

BACKGROUND: Copaiba oil and crajiru are Amazon phytotherapics which have anti-inflammatory and cicatrisation properties. There are no descriptions about their effects in the pleural space. Therefore, the purpose of this study is to evaluate macro and microscopic pleuropulmonary alterations after injection of copaiba's oil, aqueous extract of crajiru and iodine PVP in the pleural space of mice. METHODS: 128 Rattus norvegicus var. Wistar, male, with average weight of 198.9g (± 24.9g), were used and assigned for four groups: copaíba, PVPI, crajiru and control. These substances were injected in the right pleural space of the animals, which were killed in 24h, 48h, 72h and 504h. They were submitted to macroscopical and microscopical analysis of the lung and right visceral pleura. RESULTS: Macroscopic evaluation showed intense pleuropulmonary reaction in the copaiba's group with statistical significance (p=0.001) in opposite to the other groups and the different studied moments (24h, 48h, 72h and 504h). Microscopically, the pleural thickness had greater increase in the copaiba's group with statistical significance at the moments 72h and 504h. The PVPI caused an acute inflammatory reaction in the beginning of the experiment (24h and 48h) with improvement in 72h, however, in the last observation, chronic injury was shown The crajiru's group presented little damage and without significance in relation to the other groups. CONCLUSION: Copaíba revealed to be greatly irritating; the PVPI was moderately irritating and the watery extract of crajiru presented little inflammatory reaction for the pleura and lung of rats.

Resumo em Português:

OBJETIVO: Estudar a influência do baço, da asplenia e do implante esplênico autógeno no metabolismo lipídico, por meio da avaliação do lipidograma sérico de camundongos e da verificação do efeito do transplante autógeno de baço em diferentes locais do abdome. MÉTODO: Foram utilizados camundongos BALB/c distribuídos em sete grupos de 10 animais: controle normal (CN); controle obeso (CO); operação simulada (OS); esplenectomia total (ET); três grupos submetidos ao transplante autógeno do baço: omento maior (OM), retroperitônio (RP), tecido subcutâneo da parede abdominal (PA). Os animais, com exceção do grupo CN, foram submetidos a dieta com 1,25% de colesterol. A intervenção cirúrgica foi realizada 30 dias após o início da dieta. A coleta de sangue ocorreu no 60º dia pós-operatório. Foram dosados os níveis de triglicérides, de colesterol total e de suas frações, bem como a glicemia. O baço, os implantes esplênicos e o fígado foram submetidos a estudo histológico. RESULTADOS: A dieta aumentou os níveis plasmáticos de colesterol total, HDL e LDL dos camundongos (p < 0,05 versus CN). Entre os animais em uso da dieta, não houve diferença no lipidograma dos grupos controles (CO e OS) quando comparados ao grupo esplenectomizado (ET), assim como em relação aos animais submetidos ao transplante autógeno do baço (OM, RP, PA). A capacidade de preservação da arquitetura histológica esplênica foi semelhante nos três locais de implante. Todos os animais que utilizaram a dieta enriquecida apresentaram esteatose hepática. CONCLUSÃO: De acordo com os resultados obtidos o baço não parece participar da regulação dos níveis de lipídeos plasmáticos em camundongos BALB/c.

Resumo em Inglês:

BACKGROUND: This work evaluated the influence of the spleen and splenic remnants on lipid metabolism, by evaluating the impact of splenectomy on the lipidogram of mice and by studying the effect of autogenous spleen tissue implanted in different sites. METHODS: 70 BALB/c mice were divided into seven groups of 10 animals: normal control group, with no diet or surgery; fat control group, without surgery; surgical procedure sham group; total splenectomy group and three groups with implants in different sites: greater omentum, retroperitonium and abdominal subcutaneous tissue. The animals, except the normal control group, received food with 1.25% cholesterol. The surgical procedure was carried out 30 days after the beginning of the food administration. Two months after the operations, serum triglycerides, cholesterol and glycemia were studied. Histological assessments of the spleen or implants and the liver were carried out. RESULTS: The enriched food increased the plasmatic levels of total cholesterol, HDL, and mainly LDL of the mice (p<0.05). No significant difference was found in the lipidograms of the animals of the control groups when compared with the splenectomized ones, as well as in the animals submitted to the autogenous splenic tissue transplantation. The preservation of the splenic histological architecture was similar on the three implantation sites. All the animals receiving enriched food presented liver steatosis. CONCLUSION: The spleen, splenectomy and splenic implants do not influence lipidogram in BALB/c mice.

Resumo em Português:

OBJETIVO: O termo de consentimento informado é uma obrigação para o exercício profissional e para a pesquisa envolvendo seres humanos. Representa o respeito à autonomia. Este estudo teve por objetivo reconhecer o grau de entendimento dos indivíduos que participam de uma pesquisa ou de um tratamento. MÉTODOS: Um termo de consentimento foi preparado com linguagem potencialmente clara e acessível, com índice de facilidade de leitura de Flesch igual a 95, o que o classificou como muito fácil. Foram analisados dados como idade, grau de escolaridade, hábito de leitura, meios de acesso à informação e internet e renda familiar, como fatores que modificam o entendimento do consentimento livre e esclarecido. RESULTADOS: Apesar do termo ter sido preparado para atingir pontuação de acerto entre 9 e 10, observou-se que ele atingiu 7,5 ± 1,62 e não esteve relacionado à idade ou ao sexo. O nível de escolaridade influenciou a capacidade de entendimento (p=0,0013), bem como o hábito de leitura (p=0,0001) e o acesso à Internet (p=0,0070). A análise de ganho mostrou que os que ganham mais de dez salários mínimos são os que compreendem melhor (p=0,0041). CONCLUSÃO: Pode-se admitir que os sujeitos para pesquisa devem ser aqueles com melhor nível de escolaridade, com habitualidade para a leitura, com facilidade de acesso à internet e os que têm melhor faixa salarial. Na prática médica, observar a condição de cada um dos doentes, entender as suas limitações de compreensão, ler junto com eles, um à um, explicando todos os pontos.

Resumo em Inglês:

BACKGROUND: Informed consent is compulsory in professional practice and research studies involving human beings. It represents respect to autonomy. This study aims at identifying the degree of understanding displayed by individuals who participate in research studies or treatment. METHODS: An informed concent form was prepared and written in a clear and comprehensible language, with a Flesch Reading Ease Score of 95, and thus classified as very easy. Age, schooling, readership frequency, access to information and to the Internet, and family income were analyzed as factors bearing on comprehension of free and informed consent. RESULTS: Even though the form was prepared to result in a comprehension score of 9 and 10, the score observed was 7.5 ± 1.62 and was not related to age or gender. Schooling level was seen to affect comprehension (p=0.0013) as well as readership frequency (p=0.0001) and access to the Internet (p=0.0070). The income level analysis revealed that individuals who earn more than 10 times the minimum wage showed better comprehension (p=0.0041). CONCLUSION: It can be concluded that individuals participating in research studies should be chosen among those with better schooling, frequent readership, easy access to the Internet, and within a higher income bracket. In medical practice, each patient's condition should be observed, their comprehension limitations understood, and the informed consent form should be read on a one-to-one basis, and all the details and implications should be clearly explained.

Resumo em Inglês:

The first application of laparoscopic liver surgery consisted of wedge liver biopsies or resection of peripheral lesions, mostly benign. More recently, reports of anatomic left and right hepatectomy have been seen in the literature. Expertise in some centers has evolved to such an extent that even living related donor hepatectomy has been performed. The aim of this paper is to report a laparoscopic right hepatectomy and describe in detail the surgical technique employed. To our knowledge this is the first case performed in Brazil totally laparoscopically. The surgery followed four distinct phases: complete mobilization of the liver; hilum dissection with encircling of right portal vein and right hepatic artery, caval dissection using linear vascular stapler to divide right hepatic vein and parenchymal transection with harmonic shears and firings of linear staplers are used to divide segmental 5 and 8 branches of middle hepatic vein. The liver specimen was removed by Pfannenstiel incision. Intraoperative blood loss was estimated in 120 ml with no need for blood transfusion. Hospital stay was 5 days. Laparoscopic right hepatectomy is feasible, technically demanding but can be safely accomplished by surgeons who have experience in advanced laparoscopic procedures and open hepatic surgery. In Brazil laparoscopic liver surgery is still in its first years and there is a lack of technical description of this complex procedure.

Resumo em Inglês:

The colorectal cancer has become a world public health problem as a consequence of the great number of new cases which have been diagnosed each year and the existence of some conditions related to the disease's natural history that can be identified and the cancer prevented. Knowing the fact that 20% out of all colorectal cancers develops as part of a hereditary cancer syndrome, it is crucial that the physician (not only the surgeon) be updated with this entity, being able to recognize, and mainly, implement screening programs to identify family members at risk of developing cancer and to allow the intervention to prevent the occurrence of the adenoma-carcinoma sequence.

Resumo em Inglês:

The International Committee of Medical Journal Editors (ICMJE) proposed trials registration in a public trials registry, as a condition for publication. This policy started after July 1, 2005, and was supported by the World Association of Medical Editors (WAME). In May 19, 2006, the WHO urged research institutions and companies to register all medical studies that test treatments on human beings, whether they involve patients or healthy volunteers. The WHO also started the International Clinical Trials Registry Platform (ICTRP), aimed at standardizing the way information of studies is made available to the public. The following registers contribute data directly to the Who Search Portal: Australian Clinical Trials Registry, ClinicalTrials.gov, and International Standard Randomized Controlled Trial Number Register. In May 15, 2007, the Latin American and Caribbean Center on Health Sciences Information (BIREME) published a recommendation for editors of health journals indexed in Latin American and Caribbean Literature on Health Sciences (LILACS) and Scientific Library Electronic Online (ScieLO) about registration of clinical trials. In addition to the UMIN Clinical Trial Registry and the Nederlands Trial Register, the ICMJE is now accepting registration in any of the primary registers that participate in the WHO ICTRP. The ICMJE is also adopting the WHO's definition of clinical trial. Three years ago, trials registration was the exception; now it is the rule. Registration facilitates the dissemination of information, and it helps to assure trial participants that the information that accrues as a result of their altruism will become part of the public record.

Resumo em Inglês:

Rhabdomyoma is a rare soft tissue tumor and account for 1 to 2 % of skeletal muscle tumors. Rhabdomyomas are uncommon with less than one hundred cases reported. Head and neck rhabdomyomas have their origin in the third and fourth branchial clefts skeletal muscle. Describe the clinical, histopathological and radiological aspects of a recurrent adult mouth floor rhabdomyoma and the differential diagnosis for this uncommon entity. Two years after surgical resection, of a fifty-four years old male patient, with mouth floor rhabdomyoma, he started to complain of submucosal lesion at the oropharynx right lateral wall. The CT scan has shown extension to the parapharyngeal space and recurrent rhabdomyoma hypothesis has been done. The patient underwent a new surgical resection and the histopathological examination confirmed a recurrent adult rhabdomyoma.

Resumo em Inglês:

Blunt rupture of the renal pelvis is a exceedingly rare injury. Hematuria is absent in one-third of cases. Such injuries are usually caused by desacceleration forces. Despite improved imaging techniques, diagnosis of this injuries is frequently delayed. Diagnosis is suggested by the presence of massive medial extravasation of contrast material at excretory urography or computed tomography. Surgical treatment consists in pyeloplasty or pyeloraphy with stent placement (double J) or nephrostomy.

Resumo em Inglês:

Juxtahepatic veins, retrohepatic vena cava or major hepatic veins injuries carry a very high mortality rate regardless the technique used for its repair. Isolated survivor reports have for the most part been managed by vascular isolation techniques, usually with atriocaval shunt. We report one case with a unique management technique in a patient who sustained gunshot wound to the retrohepatic vena cava. Hemorrhage control had been obtained by intrahepatic balloon tamponade after others maneuvers have failed. The balloon was left in situ for two days as damaged control laparotomy principles and planned reoperation has been chosen.