Scielo RSS <![CDATA[Revista do Colégio Brasileiro de Cirurgiões]]> http://www.scielo.br/rss.php?pid=0100-699120020002&lang=en vol. 29 num. 2 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.br/img/en/fbpelogp.gif http://www.scielo.br <![CDATA[<b>Saúde, educação e o nosso grande irmão</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-69912002000200001&lng=en&nrm=iso&tlng=en <![CDATA[<b>Use of tissue adhesive butylcyanocrylate for hemorrhage control after hepatic puncture in rats</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-69912002000200002&lng=en&nrm=iso&tlng=en OBJETIVO: Avaliar o uso do adesivo butilcianoacrilato no controle da hemorragia em punções hepáticas de ratos. MÉTODO: Foram utilizados 40 ratos distribuídos em dois grupos, um deles heparinizado e o outro não, submetidos à punção hepática com jelco 14. Metade dos animais de cada grupo foi tratado com o adesivo butilcianoacrilato e a outra metade não recebeu nenhum tipo de tratamento. RESULTADOS: Os animais heparinizados e tratados com adesivo mantiveram os níveis de hematócrito e hemoglobina e uma mínima quantidade de sangue livre na cavidade. Já os animais heparinizados e sem tratamento apresentaram queda significativa dos níveis hematimétricos com moderada quantidade de sangue livre na cavidade (p < 0.005). CONCLUSÃO: O adesivo tecidual butilcianoacrilato mostrou ser eficiente como agente hemostático no controle de sangramento de punções hepáticas em ratos heparinizados.<hr/>BACKGROUND: The objective of this study was to assess the effectiveness of tissue adhesive butylcyanocrylate in liver biopsy. METHOD: Forty rats were divided in two groups: one group included heparin-injected rats; the second group was not injected with heparin. Liver punction was performed with a 14-gauge needle. Half of the animals in each group was treated with tissue adhesive butylcyanocrylate and the other half had no treatment. RESULTS: The heparin-injected rats treated with adhesive kept their initial hemoglobin and hematocrit levels and had minimal amount of blood in the abdominal cavity. On the other hand, non treated heparin-injected rats presented a significant drop in hemoglobin and hematocrit levels and had a moderate volume of blood in the cavity. CONCLUSIONS: The tissue adhesive butylcyanocrylate showed be efficient as a hemostatic agent. <![CDATA[<b>Functional evaluation of trapezius muscle and spinal nerve after neck dissection through eletro-neuromiography (ENM)</b>: <b>study of 25 patients</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-69912002000200003&lng=en&nrm=iso&tlng=en OBJETIVO: Foram estudados 25 pacientes portadores de neoplasias malignas da cabeça e pescoço (20 de vias aerodigestivas superiores e cinco da glândula tireóide), submetidos a esvaziamentos cervicais uni ou bilaterais (33 procedimentos), sendo 15 supra-omohióideos, 11 funcionais e sete em campos alargados. MÉTODO: Através da eletroneuromiografia (ENM), foram avaliados funcionalmente o músculo trapézio e o nervo espinhal após os diferentes procedimentos, aos 30 e 180 dias. RESULTADOS: Foram aferidos para as três formas de linfadenectomia 94% de desnervação do músculo trapézio, severa em 68% e moderada 32% (p = 0,001), portanto valores significativos. Quanto à avaliação do tipo de lesão do nervo espinhal, após 30 dias observou-se lesão de axônio (axonotmese) em 31 dos 33 procedimentos. Com relação à reinervação, esta foi detectada após 180 dias, sendo boa (21%), moderada (72%) e ruim (7%) para valores de p = 0,001 de significância estatística. CONCLUSÕES: A eletroneuromiografia foi um método efetivo na avaliação da unidade neuromuscular e o tipo de esvaziamento cervical conservador não foi determinante de alterações destas estruturas.<hr/>BACKGROUND: Twenty fire patients with malignant head and neck neoplasias (20 from superior aerodigestive tract and 5 from thyroid gland), were submitted to 33 unilateral or bilateral neck node dissection (15 supraomohyoid, 11 modified and 7 wide field), at the Head and Neck Service of Hospital Araújo Jorge, Goiânia, Goiás, Brazil. METHOD: Eletroneuromiography (ENM) of the trapezius muscle after spinal nerve dissection. RESULTS: In spite of surgical dissection, 94% of trapezius muscle desnervation were detected, being 38% severe and 62% moderate, (p = 0,001). The degree of lesion for spinal nerve after 30 days, showed axoniumtmese in 31 of 33 procedures, and after 180 days, 21% of severe, 72% of moderate and 7% of unsatisfactory reinervation were diagnosed (p = 0,001). CONCLUSIONS: ENM is an effective method of evaluation of neuromuscular unit (trapezius muscle/spinal nerve) and the type of neck node dissection was not determinant of structural nerve alteration. <![CDATA[<b>Surgical treatment of incisional hernias</b>: <b>personal experience with polypropylene monofilament mesh-marlex</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-69912002000200004&lng=en&nrm=iso&tlng=en OBJETIVO: Relatar a experiência pessoal no tratamento cirúrgico de hérnias incisionais com a utilização da malha de polipropileno monofilamentar-márlex. MÉTODOS: Foram operados e seguidos 74 pacientes portadores de hérnia incisional originada de tratamento cirúrgico de diferentes afecções da cavidde abdominal, com idade entre 30 e 94 anos, sendo 39 do sexo feminino e 35 do sexo masculino. Destes 41,9% foram submetidos a hernioplastia incisional pela primeira vez e 58,1% já haviam tentado o tratamento sem sucesso. A técnica operatória usada foi a dissecção do saco herniário, ressecção da fibrose resultante de operações anteriores e fixação de tela de márlex substituindo ou reforçando a fáscia transversal por baixo dos músculos da parede abdominal. RESULTADO: 74 pacientes foram operados e seguidos de 1975 a 1995. Na última revisão, em maio de 1998, três pacientes haviam falecido, dois de doenças cardíacas e um de doença neoplasia. Apenas um paciente (1,3%) apresentou recidiva, no início da experiência. Este foi reoperado e terve sua hérnia incisional curada. CONCLUSÃO: o uso da tela de márlex tecnicamente aplicada é o método ideal para a cura definitiva das hérnias incisionais.<hr/>BACKGROUND: Personal experience in the treatment of incisional hernia with the use of polypropylene monofilament mesh - marlex, is discussed. METHOD: Seventy-four patients, with ages ranging from 30 to 94 years (39 females and 35 males), with hernia secundary to surgical abdominal procedures, were studied. Half (41,9%) of these patients were submitted to surgical correction for the first time, however 58,1% were recurrences. Dissection of hernia sac, excision of old fibrosis and marlex mesh interposition were carried out to reinforce transversalis fascia under the muscles of the abdominal wall. RESULTS: Seventy-four patients were operated uppon from 1975 to 1995. Last follow-up carried out in 1998 disclosed three deaths not related to previous surgery. There was one recurrence (1,3%) at the beginning of our experience, which required second intervention. CONCLUSION: The use of marlex mesh interposition is a reliable method to correct incisional hernia providing adequate technique is utilized for its fixation. <![CDATA[<b>Distal pancreatectomy with splenic preservation in traumatic injuries of pancreas</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-69912002000200005&lng=en&nrm=iso&tlng=en OBJETIVOS: A esplenectomia simplifica a pancreatectomia distal no trauma mas tem o inconveniente de aumentar a vulnerabilidade do paciente às infecções. O objetivo é avaliar se a preservação do baço na referida cirurgia é exeqüível e segura. MÉTODOS: A preservação do baço foi feita em 52 pacientes (48%) entre 108 submetidos à pancreatectomia distal. Quarenta e cinco (86,5%) do sexo masculino e sete (13,5%) do sexo feminino. Idade variou de seis a 42 anos com média de 22,1 anos. Trauma penetrante foi a causa da lesão em 35 (67%) com 27 (77%) por arma de fogo e oito (23%) por arma branca. Contusão foi responsável pela lesão em 17 (33%). RESULTADOS: Não houve óbito. Fístula pancreática ocorreu em seis (11,5%) pacientes; coleção subfrênica em seis (11,5%); pancreatite em dois (3,8%); abcesso de parede em quatro (8%); pneumonia em quatro (8%). Quarenta pacientes tiveram lesões associadas. O ISS médio foi de 19,3. O baço apresentava lesão em 13 pacientes. Sete foram submetidos à esplenorrafia e seis à ressecção parcial. Em 51 pacientes o baço foi conservado com os vasos esplênicos. Em um caso foi feita a ligadura proximal e distal dos vasos esplênicos (técnica Warschaw). Permanência hospitalar média de 12 dias. CONCLUSÃO: A pacreatectomia distal com preservação do baço mostrou ser segura nos pacientes estáveis, mesmo na presença de lesões associadas. A ausência de óbitos e a participação de cirurgiões em fase de treinamento confirmam sua segurança.<hr/>OBJECTIVES: Splenectomy simplifies distal pancreatectomy in trauma but has the inconvenience of increasing vulnerability to infection. The objective of this study is to assess whether spleen preservation in the aforementioned surgical procedure is feasible and safe. METHODS: Spleen preservation was performed in 52 patients (48%) of 108 undergoing distal pancreatectomy. Forty-five (86.5%) were males and 7 (13,5%) were females. The mean age was 22.1 years, varying from 6 to 42 years. Penetrating trauma was the cause of injury in 35 cases (67%), 27 of which (77%) due to gunshot wounds and 8 (23%) due to stab wounds. Blunt trauma was the cause of injury in 17 cases (33%). RESULTS: There were no deaths. Pancreatic leaks occurred in 6 (11.5%) patients, fluid collection in the splenic fossa in 6 (11.5%), pancreatitis in 2 (3.8%), surgical wound abscesses in 4 (8%) and pneumonia in 4 (8%) patients. Forty patients had associated injuries. The average ISS was 19.3. The spleen was injured in 13 patients. Seven underwent splenorrhaphy and 6 required partial splenic resection. The spleen and splenic vessels were preserved in 51 patients. In one case, proximal and distal ligation of the splenic vessels (Warschaw technique) was performed. Hospital stay averaged 12 days. CONCLUSION: Distal pancreatectomy with spleen preservation was shown to be a safe procedure in stable patients, even with associated injuries. The absence of deaths and the co-participation of surgeons in training confirms the safety of this procedure. <![CDATA[<b>Cholelithiasis and gallbladder carcinoma</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-69912002000200006&lng=en&nrm=iso&tlng=en OBJETIVO: O presente estudo tem por objetivo analisar os achados histológicos da vesícula biliar de pacientes submetidos à colecistectomia eletiva no Hospital Universitário Presidente Dutra, São Luís-MA. MÉTODO: Foram avaliados 2.008 pacientes, 359 do sexo masculino (17,9%) e 1.649 do sexo feminino (82,1%), com média de idade de 46,3 anos, operados no período de janeiro de 1990 a dezembro de 1998. A vesícula biliar, imediatamente após a colecitectoma era aberta e examinada macroscopicamente pelo cirurgião e em seguida enviada para exame histopatológico. RESULTADOS: A prevalência de câncer da vesícula biliar foi de 2,3 % (46 pacientes). Trinta e três pacientes (71,7%) apresentavam idade superior a 60 anos. CONCLUSÕES: Os autores concluem que a colecistectomia profilática eletiva deve ser realizada em pacientes assintomáticos com colelitíase, com idade superior a 60 anos e em boas condições cirúrgicas.<hr/>BACKGROUND: The aim of the present study is to analyze histological findings of the gallbladders removed during elective cholecystectomy at Hospital Universitário Presidente Dutra, São Luís, MA. METHOD: From January 1990 to December 1998, 2.008 patients underwent elective cholecystectomy, 359 of them males (17,9%) and 1.649 females (82,1%), with a mean age of 46,3 years. The gallbladder was oppened and examined by the surgeon and sent to histological examination. RESULTS: The prevalence of gallbladder carcinoma was 2,3% (46 patients). Thirty-three patients (71,7%) were over 60 years old. CONCLUSIONS: Elective prophylatic cholecystectomy should be performed in asymptomatic patients over 60 years of age with cholelythiasis and good clinical conditions. <![CDATA[<b>Systematic cholangiography during laparoscopic cholecystectomy</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-69912002000200007&lng=en&nrm=iso&tlng=en OBJETIVO: Analisar os resultados de colangiografias peroperatórias (CPO), realizadas sistematicamente durante colecistectomias videolaparoscópicas (CVL). MÉTODO: No período de janeiro de 1998 a dezembro de 1999, foram realizadas CVL em 250 pacientes não selecionados, 65 (26%) do sexo masculino e 185 (74%) do sexo feminino, independente da presença ou não de sinais clínicos, laboratoriais, ultra-sonográficos ou de outros métodos diagnósticos, indicativos de coledocolitíase ou outras doenças da via biliar principal. RESULTADOS: A CPO pôde ser realizada em 237 (94,6%) pacientes. Foram encontradas 31 (13%) alterações, entre as quais seis (2,5%) casos de coledocolitíase e 25 (10,5%) casos de anomalias anatômicas. CONCLUSÃO: A CPO, durante a CVL, mostrou-se um procedimento seguro, sem complicações relacionadas ao exame, definindo a anatomia, prevenindo as lesões biliares e permitindo a detecção de coledocolitíase insuspeitada.<hr/>BACKGROUND: We present our results from peroperative cholangiography (POC) systematically performed during video laparoscopic cholecystectomies (VLC). METHOD: From January 1998 to December 1999, VLP was performed in 250 non-selected patients from both sexes, being 65 males (26%) and 185 females (74%), independent of the presence or not of clinical signals, laboratorial and ultrasonographics results or of other diagnostic method, indicatives of choledocholithiasis or other biliary ducts pathologies. RESULTS: POC could be performed in 94,6% of the cases. It was found 31 modifications (13%), being the most important six cases of choledocholithiasis (2,5%) and 25 cases of anatomical anomalies (10,5%). CONCLUSIONS: POC during VLC showed to be a safe procedure, with no complications, defining anatomy, forewarning biliary injuries and allowing assymptomatic choledocholithiasis detection. <![CDATA[<b>Results of conservative surgery in larynx carcinoma</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-69912002000200008&lng=en&nrm=iso&tlng=en OBJETIVO: Avaliar retrospectivamente os resultados de pacientes submetidos a laringectomias parciais por carcinoma epidermóide de laringe no serviço do HMCP. MÉTODOS: Dos doentes estudados, 28 eram do sexo masculino (93,5%) e dois do feminino (6,5%) com idade variável de 42 a 66 anos, com média de 58 anos. Em relação ao procedimento cirúrgico, este foi variável, dependendo do local da extensão tumoral e do estádio. A técnica mais utilizada foi a laringectomia frontolateral em 12 pacientes (40%), seguido pela laringectomia vertical em oito (26,6%), laringectomia supraglótica em quatro (13,3%), laringectomia supracricóidea em quatro (13,3%), laringectomia near-total em um (3,3%) e cordectomia em um (3,3%). RESULTADOS: Na avaliação pós-operatória precoce, três pacientes (10%) apresentaram complicações evidenciadas por fístula faringocutâneas em dois, com boa evolução após tratamento conservador, e pneumotórax no paciente restante com boa evolução após drenagem do tórax. No que se refere à avaliação da deglutição, cinco pacientes (16,6%) apresentaram dificuldade de ingestão oral devido a aspirações recorrentes com tempo variável de 45 a 180 dias (média - 65 dias), o que obrigou a um paciente ser submetido à totalização da laringectomia devido a pneumonias recorrentes. Na avaliação tardia, de seis a 125 meses e média de 29 meses, quatro pacientes (13,3%) apresentaram recidiva locorregional, sendo dois submetidos à laringectomia vertical, um à frontolateral e o restante à supracricóidea. Em todos foram realizadas totalização e/ou radioterapia, e dois evoluíram a óbito pela doença. Vinte e quatro pacientes (84%) apresentaram preservação da voz. CONCLUSÃO: Assim, os autores concluem que a cirurgia conservadora da laringe proporciona bom controle da doença e com sobrevida aceitável, já que 90% dos pacientes estudados estão vivos e sem doença até o final da avaliação. Além disso, apresentam melhor qualidade de vida já que a maioria dos pacientes demonstrou voz e ingestão oral bem satisfatórias.<hr/>BACKGROUND: This is of a retrospective study of the results obtained from partial laryngectomy for epidermoid carcinoma. METHODS: Twenty-eight males (93.5%) and 2 females (6.5%), between 42 years and 66 years old (mean age, 58 years). The surgical procedure varied in accordance to the site, extension and stage of the tumor. The technique most used was the frontolateral laryngectomy, performed on 12 patients (40%), followed by the vertical laryngectomy on 8 patients (26.6%), the supraglottic laryngectomy on 4 patients (13.3%), supracricoid laryngectomy on 4 patients (13.3%), near total laryngectomy on 1 patient (3.3%) and chordectomy on 1 patient (3.3%). RESULTS: An early postoperative assessment showed that 3 patients (10%) had complications. Two of them had pharyngocutaneous fistulas that responded well to conservative treatment and the remaining patient had pneumothorax, which improved after thoracic drainage. Deglutition assessment revealed that 5 patients (16.6%) presented difficulty in oral ingestion as a result of recurrent aspirations that occurred at periods that varied between 15 days to 180 days (average 180 days) and caused recurrent pneumonia. The only remaining option was total laryngectomy. The next assessment was performed after a period that varied between 6 months to 125 months (mean of 29 months) and revealed that 4 patients (13.3%) had recurrence in the same region. Two of these patients underwent vertical laryngectomy, 1 patient had a frontolateral laryngectomy and the remaining patient underwent supracricoid laryngectomy. All patients underwent total laryngectomy and/or radiotherapy, but the disease caused the death of 2 patients. Twenty four patients (84%) demonstrated that their voice was preserved and at the end of the assessment, 90% of the patients were alive and without any signs of the disease. These patients had a far better quality of life as they presented fairly satisfactory voice and oral ingestion. CONCLUSION: The conservative surgery of the larynx provided good disease control and increased the patient's life span. <![CDATA[<b>Tumor markers in colorectal cancer</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-69912002000200009&lng=en&nrm=iso&tlng=en Colorectal cancer is a clinical entity of a persistent relevance in clinical practice and its early diagnosis is a determinant factor to obtain better therapeutic results. Tumor markers are helpful means for a better approach to individuals with such neoplasm. In the present review, the authors analyze the phases in which surgical-clinical treatment markers must be used: diagnosis, determination of tumor stage, establishment of prognosis and detection of recurrence. Current and future markers and the consensus on their use are discussed. Causal factors for errors in diagnosis with markers and perspectives of use are also presented. <![CDATA[<b>Inflammatory pseudotumor of the liver</b>: <b>differential diagnosis of hepatocellular carcinoma</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-69912002000200010&lng=en&nrm=iso&tlng=en The authors present a rare case of inflammatory pseudotumor of the liver whose differential diagnosis with hepatocellular carcinoma - in some cases - is only possible with the histological examination. In this case, a female patient, 38 years-old was suffering from abdominal pain, enlarged liver, thinning, tiredness and fever; alpha-fetoprotein, the liver function tests, amylase and lipase were normal. Abdominal ultrasound and computed tomography showed a node in the right liver lobe. The patient was submitted to a right hepatectomy for hepatocellular carcinoma. Histological examination showed an inflammatory pseudotumor of the liver. The patient was discharged from the hospital on the seventh postoperative day; she is asymptomatic for three years. <![CDATA[<b>Inflammatory pseudotumor of the lung</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-69912002000200011&lng=en&nrm=iso&tlng=en We report a case of a ten year old boy with an inflammatory pseudotumor in the right upper lobe. Surgical excision was undertaken. Inflammatory pseudotumors of the lung often occur in children. We recommend complete resection for diagnosis and cure. This tumor can mimic malignant neoplastic lesions and can recur after surgical treatment. <![CDATA[<b>Barrett's esophagus after total gastrectomy with roux-en-Y reconstruction</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-69912002000200012&lng=en&nrm=iso&tlng=en Reflux esophagitis and Barrett's esophagus after total gastrectomy is related to reconstructive procedure of intestinal continuity. The Roux-en-Y operation with length of limb of 40 cm occasionally is not enough to prevent biliary reflux to distal esophagus. Barrett's esophagus is thought to develop as a consequence of biliary reflux and has a malignant potential. Symptoms of retroesternal burning and dysphagia that does not improve with conservative management has to be treated by an operative procedure. To prevent biliary reflux to distal esophagus after total gastrectomy the lenght of limb of Roux-en-Y should be at lest 60 cm. <![CDATA[<b>Ruptured splenic artery aneurysm</b>: <b>tomographic snapshot of bleeding</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-69912002000200013&lng=en&nrm=iso&tlng=en The splenic artery aneurysm is a rare entity and its rupture is the most feared complication. The tomographic computed scan is a potential tool in the diagnosis, and can be used to patients with a suspicion of intra-abdominal bleeding, after adequate resuscitation. A case of a 68-year old male, hypertense patient, with a ruptured splenic artery aneurysm is reported. The diagnosis and treatment were given successfully by the abdominal computed tomographic scan and conventional surgery. The tomographic computed scan can be useful to the diagnosis of ruptured splenic artery aneurism, after the hemodynamic stabilization. <![CDATA[<b>Videolaparoscopic ligation of inferior mesenteric artery as a treatment of persistent endoleak after endoluminal abdominal aortic aneurysm repair</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-69912002000200014&lng=en&nrm=iso&tlng=en Videolaparoscopy has been widely used in the treatment of pathologies as cholelithiasis, appendicitis and adrenal tumor. Nowadays, has also been used to treat type II endoleaks after endovascular repair of abdominal aortic aneurysms. The goal of this work is to report one case of inferior mesenteric artery endoleak treated by videolaparoscopy.