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Background: the barriers to implement emergency laparoscopy in public teaching hospitals involve issues such as resident learning curves and resource costs and availability. This study was designed to describe the issues facing the implementation of laparoscopic approach for acute appendicitis over 15 years in a single academic center in Brazil. Materials and Methods: retrospective study of patients undergoing emergency appendectomy from 2004 to 2018. Clinical data were compared to four major actions implemented in the emergency surgical service: minimally invasive surgery training for residents (2007), laparoscopic stump closure using metal clips (2008), 24/7 availability of laparoscopic instruments for emergency surgeries (2010), and third-party contract for maintenance of the laparoscopic instruments and implementation of polymeric clips for stump closure (2013). We evaluated the increase in laparoscopic appendectomy after the implementation of those major changes. Results: we identified 1168 appendectomies during the study period, of which 691 (59%), 465 (40%), and 12 (1%) were open, laparoscopic, and converted, respectively. The implementation of the major changes since 2004 resulted in an increase of laparoscopic appendectomies from 11% in 2007 to 80% in 2016. These actions were decisive in the widespread use of laparoscopy for acute appendicitis (p

Relato de lesão incomum de esôfago e rara associação desta com lesão em tronco braquiocefálico (TBC) em paciente vítima de trauma fechado. Paciente vítima de acidenteautomobilístico (auto x caminhão), masc., 19a., passageiro do banco traseiro do auto e sem cinto de segurança. Chegou ao PSHC-FMUSP consciente, orientado e estável hemodinamicamente. Exames iniciais evidenciaram alargamento de mediastino. À arteriografia, identificou-se alargamento proximal de TBC sugestivo de pseudoaneurisma e à endoscopia, duas lesões esofágicas de aproximadamente 6cm que acometiam a serosa e a muscular, mas poupavam a mucosa. Foi submetido a uma esternotomia para enxerto do TBC e posterior toracotomia ântero-lateral para correção das lesões esofágicas. Evoluiu bem, sem intercorrências significativas, recebendo alta no 10o PO. Consideram os autores, após revisão da literatura, que lesões de esôfago e de TBC causados por trauma fechado são individualmente raras e, a associação das lesões não foi observada na literatura estudada.

Uncommom gastrointestinal manifestation in immunodeficient patients report case. A 26-year-old man with Commom Variable Immunodeficiency (CVID), using Prednisone and other drugs, presented 3 days of diffuse abdominal pain, nausea, vomiting and constipation. He refered 5 years of recurrent diarrhea and negative tests for S. stercoralis. Physical examination revealed bad general condition, anemy, dehidration, distended abdomen without abdominal sounds and abdominal pain with guarding. The radiologic study showed marked dilation of small bowel which was oedematous. Ressection of the affected loop was done and the histopatology showed transmural infection with S. stercoralis andhaemorrhagic necrosis of muscular layer, without mucosal destruction. He developed malabsorption syndrome and septic shock, treated with antibiotics and thiabendazol. In the revision of literature, CVID is considered a rare disease and associated strongyloidiasis is uncommom, but it is seen in patients using corticosteroid. Haemorrhagic necrosis of muscular layer, without mucosal destruction wasn't mentioned in the studied literature.