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ABSTRACT BACKGROUND: Umbilical and epigastric hernias are among the most common hernias of the abdominal wall; however, there is a lack of standardization for their treatment. AIMS: To clarify the controversies regarding therapeutic possibilities, indications, and surgical techniques for umbilical and epigastric hernia repair. METHODS: A systematic review and qualitative analysis of randomized clinical trials published in the last 20 years, involving adults (aged 18 years and over) with umbilical and/or epigastric hernias, was performed by systematically searching the PubMed/Medline, Cochrane, SciELO, and LILACS databases. The risk of bias in individual studies was assessed using the Cochrane Risk of Bias Tool. RESULTS: Initially, 492 studies were selected and, subsequently, 15 randomized controlled clinical trials were chosen that met the inclusion criteria and underwent full reading and qualitative analysis, considering possible bias. CONCLUSIONS: This review concluded that it is evident the superiority of the use of meshes in the repair of epigastric/primary umbilical hernias with a defect larger than 1 cm, even in certain emergency situations. However, suture repair is a good option for patients with a defect smaller than 1 cm. In the laparoscopic approach, recent evidence points towards possible superiority in fixation with fibrin sealant, and fascial defect closure is recommended. In addition, due to a scarcity of randomized controlled trials with low risk of bias, further studies are needed on types, positioning and fixation techniques, as well as the real role of video-assisted laparoscopic surgery in the correction of hernias, especially umbilical.

Meckel’s diverticulum is the most common gastrointestinal congenital defect, which, although asymptomatic in adults, may present symptoms in obstruction, inflammation, bleeding and foreign body perforation. There are only 8 cases reported of Meckel’s diverticulum perforation by chicken bone. We report a case of a 24-yearold man presenting a 2-day-history of periumbilical pain that shifted to the right lower quadrant in 24 hours. Clinical and laboratory findings led to an appendicitis diagnosis, followed by laparotomy. Normal appendix was found intraoperatively along with an incidental finding of an inflamed and perforated Meckel’s diverticulum by chicken bone. Diverticulectomy and enteroanastomosis were performed and the patient had a successful recovery, being discharged 5 days after. Although rare, its clinical presentation might be similar to acuteappendicitis, which restate the importance of collecting a detailed clinical history and examining the small bowel towards to investigate a possible Meckel’s diverticulum complication in the differential diagnosis.

ABSTRACT BACKGROUND: New recommendations for the management of patients with acute pancreatitis were set after the Atlanta Classification was revised in 2012. OBJECTIVE: The aim of the present systematic review is to assess whether these recommendations have already been accepted and implemented in daily medical practices. METHODS: A systematic literature review was carried out in studies conducted with humans and published in English and Portuguese language from 10/25/2012 to 11/30/2018. The search was conducted in databases such as PubMed/Medline, Cochrane and SciELO, based on the following descriptors/Boolean operator: “Acute pancreatitis” AND “Atlanta”. Only Randomized Clinical Trials comprising some recommendations released after the revised Atlanta Classification in 2012 were included in the study. RESULTS: Eighty-nine studies were selected and considered valid after inclusion, exclusion and qualitative evaluation criteria application. These studies were stratified as to whether, or not, they applied the recommendations suggested after the Atlanta Classification revision. Based on the results, 68.5% of the studies applied the recommendations, with emphasis on the application of severity classification (mild, moderately severe, severe); 16.4% of them were North-American and 14.7% were Chinese. The remaining 31.5% just focused on comparing or validating the severity classification. CONCLUSION: Few studies have disclosed any form of acceptance or practice of these recommendations, despite the US and Chinese efforts. The lack of incorporation of these recommendations didn’t enable harnessing the benefits of their application in the clinical practice (particularly the improvement of the communication among health professionals and directly association with the worst prognoses); thus, it is necessary mobilizing the international medical community in order to change this scenario.

ABSTRACT BACKGROUND: Barrett’s esophagus (BE) is a premalignant condition that raises controversy among general practitioners and specialists, especially regarding its diagnosis, treatment, and follow-up protocols. OBJECTIVE: This systematic review aims to present the particularities and to clarify controversies related to the diagnosis, treatment and surveillance of BE. METHODS: A systematic review was conducted on PubMed, Cochrane, and SciELO based on articles published in the last 10 years. PRISMA guidelines were followed and the search was made using MeSH and non-MeSH terms “Barrett” and “diagnosis or treatment or therapy or surveillance”. We searched for complete randomized controlled clinical trials or Phase IV studies, carried out with individuals over 18 years old. RESULTS: A total of 42 randomized controlled trials were selected after applying all inclusion and exclusion criteria. A growing trend of alternative and safer techniques to traditional upper gastrointestinal endoscopy were identified, which could improve the detection of BE and patient acceptance. The use of chromoendoscopy-guided biopsy protocols significantly reduced the number of biopsies required to maintain similar BE detection rates. Furthermore, the value of BE chemoprophylaxis with esomeprazole and acetylsalicylic acid was relevant, as well as the establishment of protocols for the follow-up and endoscopic surveillance of patients with BE based predominantly on the presence and degree of dysplasia, as well as on the length of the follow-up affected by BE. CONCLUSION: Although further studies regarding the diagnosis, treatment and follow-up of BE are warranted, in light of the best evidence presented in the last decade, there is a trend towards electronic chromoendoscopy-guided biopsies for the diagnosis of BE, while treatment should encompass endoscopic techniques such as radiofrequency ablation. Risks of ablative endoscopic methods should be weighted against those of resective surgery. It is also important to consider lifetime endoscopic follow-up for both short and long term BE patients, with consideration to limitations imposed by a range of comorbidities. Unfortunately, there are no randomized controlled trials that have evaluated which is the best recommendation for BE follow-up and endoscopic surveillance (>1 cm) protocols, however, based on current International Guidelines, it is recommended esophagogastroduodenoscopy (EGD) every 5 years in BE without dysplasia with 1 up to 3 cm of extension; every 3 years in BE without dysplasia with >3 up to 10 cm of extension, every 6 to 12 months in BE with low grade dysplasia and, finally, EGD every 3 months after ablative endoscopic therapy in cases of BE with high grade dysplasia.

ABSTRACT Objective: to describe the implications of the diagnosis and treatment of non-inflammatory pancreatic cysts in a series of patients. Methods: we included patients with pancreatic cysts ≥1.0 cm, excluding those with a presumptive diagnosis of a pseudocyst. Imaging tests, echoendoscopy, and histopathology determined the diagnosis of the type of cyst. We applied the guidelines of the International Association of Pancreatology, with some modifications, in patients with mucinous or indeterminate lesions. Results: 97 adult patients participated in the study. A cystic neoplasm of the pancreas was diagnosed in 82.5% of cases. Diagnosis was mainly made by magnetic resonance (46% of cases). The two most common diagnoses were intraductal papillary mucinous neoplasm (43.3%) and serous cystadenoma (26%). Twenty-nine patients underwent surgery (33.3%). The most common surgical procedure was distal pancreatectomy associated with splenectomy in 19 cases (65.5%). Among the operated patients, 11 were diagnosed with cancer. None of the followed, non-operated patients had a diagnosis of cancer. Conclusions: magnetic resonance showed good accuracy, particularly in the diagnosis of intraductal papillary mucinous neoplasm. The guidelines of the International Association of Pancreatology, as applied in this study, showed a negative predictive value for cancer of 100%. A development of better diagnostic tests can reduce the number of unnecessary operations.

ABSTRACT Background: The hypervascular liver lesions represent a diagnostic challenge. Aim: To identify risk factors for cancer in patients with non-hemangiomatous hypervascular hepatic lesions in radiologically normal liver. Method: This prospective study included patients with hypervascular liver lesions in radiologically normal liver. The diagnosis was made by biopsy or was presumed on the basis of radiologic stability in follow-up period of one year. Cirrhosis or patients with typical imaging characteristics of haemangioma were excluded. Results: Eighty-eight patients were included. The average age was 42.4. The lesions were unique and were between 2-5 cm in size in most cases. Liver biopsy was performed in approximately 1/3 of cases. The lesions were benign or most likely benign in 81.8%, while cancer was diagnosed in 12.5% of cases. Univariate analysis showed that age >45 years (p< 0.001), personal history of cancer (p=0.020), presence of >3 nodules (p=0.003) and elevated alkaline phosphatase (p=0.013) were significant risk factors for cancer. Conclusion: It is safe to observe hypervascular liver lesions in normal liver in patients up to 45 years, normal alanine aminotransaminase, up to three nodules and no personal history of cancer. Lesion biopsies are safe in patients with atypical lesions and define the treatment to be established for most of these patients.

ABSTRACT Background: Hepatectomies have been increasingly recommended and performed in Brazil; they present great differences related to immediate complications. Aim: Assessing the immediate postoperative complications in a series of 88 open liver resections. Method: Prospective database of patients subjected to consecutive hepatectomies over nine years. The post-hepatectomy complications were categorized according to the Clavien-Dindo classification; complications presenting grade equal to or greater than 3 were considered major complications. Hepatic resections involving three or more resected liver segments were considered major hepatectomies. Results: Eighty-four patients were subjected to 88 hepatectomies, mostly were minor liver resections (50 cases, 56.8%). Most patients had malignant diseases (63 cases; 71.6%). The mean hospitalization time was 10.9 days (4-43). Overall morbidity and mortality rates were 37.5% and 6.8%, respectively. The two most common immediate general complications were intra-peritoneal collections (12.5%) and pleural effusion (12.5%). Bleeding, biliary fistula and liver failure were identified in 6.8%, 4.5% and 1.1% of the cases, respectively, among the hepatectomy-specific complications. Conclusion: The patients operated in the second half of the series showed better results, which were apparently influenced by the increased surgical expertise, by the modification of the hepatic parenchyma section method and by the increased organ preservation.

Background Some authors consider the fluctuating jaundice as a classic sign of the adenocarcinoma of the ampulla of Vater. Objetive Assessing the frequency of fluctuating jaundice in their forms of its depiction in the patients with adenocarcinoma of the ampulla of Vater. Methods Observational and retrospective study, conducted through analyses of medical records from patients subjected to pancreatic cephalic resections between February 2008 and July 2013. The pathological examination of the surgical specimen was positive to adenocarcinoma of the ampulla of Vater. Concepts and differences on clinical and laboratory fluctuating jaundice were standardized. It was subdivided into type A and type B laboratory fluctuating jaundice. Results Twenty patients were selected. One of them always remained anicteric, 11 patients developed progressive jaundice, 2 of them developed clinical and laboratory fluctuating jaundice, 5 presented only laboratory fluctuating jaundice and one did not present significant variations on total serum bilirubin levels. Among the seven patients with fluctuating jaundice, two were classified as type A, one as type B and four were not classified due to lack information. Finally, progressive jaundice was the prevailing presentation form in these patients (11 cases). Conclusion This series of cases suggested that clinical fluctuating jaundice is a uncommon signal in adenocarcinoma of the ampulla of Vater.

BACKGROUND: Due to their complexity and risks, mesenteric-portal axis resection and reconstruction during the pancreatectomy procedure were not recommended back in the early nineties. However, as per technical improvements and the reduction in morbidity and mortality rates, they have been routinely indicated in large medical centers. AIM: To show results from cases of patients subjected to mesenteric-portal axis resection during pancreatectomy. METHOD: Patients subjected to mesenteric-portal axis resection during pancreatectomy were prospectively and consecutively assessed. The procedure was indicated according to anatomical criteria defined by imaging exams or intraoperative assessment. RESULTS: Ten patients, half of them were male, with mean age of 55.7 years (40-76) were included. The most frequent underlying diseases were pancreatic adenocarcinoma and Frantz tumor. The circumferential resection of the portal vein associated with the superior mesenteric vein with splenic vein ligature (4 cases=40%) and the primary anastomosis of the vascular stumps (5 cases=50%) were, respectively, the most performed types of vascular resection and reconstruction. Surgery time ranged from 480 to 600 minutes (average=556 minutes) and postoperative hospitalization time ranged from 9 to 114 days (average=34.8 days). Morbidity rate was 60%, and clinical pancreatic fistula (grade B and C) was the most common complication (3 cases=30%). Mortality rate was 10% (1 case). CONCLUSION: Mesenteric-portal axis resection is a valid technical procedure. It should be taken into account after a clinical assessment that included not only the patients' clinical condition but also the technical and anatomical conditions of the mesenteric-portal axis tumor infiltration as well as life expectancy based on the patient's cancer prognosis.

RACIONAL: No Brasil existe escassa publicação científica destinada à divulgação dos resultados das ressecções pancreáticas. OBJETIVO: Apresentar os resultados cirúrgicos das ressecções pancreáticas. MÉTODOS: Analisou-se prospectivamente 54 casos consecutivos de pacientes submetidos à pancreatectomias. Foi avaliada a ocorrência de complicações pós-operatórias (fístula pancreática, retardo do esvaziamento gástrico e hemorragia pós-operatória) fundamentadas nos critérios dos Grupos Internacionais de Estudo sobre a Definição de Fístula Pancreática e de Cirurgia Pancreática. RESULTADOS: Das 54 pancreatectomias, 32 foram realizadas em mulheres (59,26%) e 22 em homens (40,74%). A média de idade dos pacientes foi de 54,5 anos. O procedimento mais praticado foi à cirurgia de Whipple em 38 pacientes. Em oito destes, houve ressecção do eixo mesentérico-portal. O tempo médio de internação foi de 20,7 dias. A maioria dos pacientes (51%) esteve internada por até 10 dias. A fístula pancreática foi observada em 50% da amostra em 44,7% dos pacientes submetidos à operação de Whipple. O sangramento pós-operatório e o retardo do esvaziamento gástrico nos pacientes submetidos à essa operação ocorreram, respectivamente, em 13,15% e 18,41%. Na amostra a taxa global de morbidade e mortalidade foi respectivamente de 62,9% e 5,5%. CONCLUSÃO: Há necessidade das publicações nacionais assimilarem os conceitos e critérios apresentados pelas classificações GIEDFP e GIECP para permitir a comparação dos resultados obtidos com o tratamento cirúrgico de doenças pancreáticas, no contexto brasileiro. Quem sabe, se o grande avançado visto nos últimos 40 anos em termos de redução das taxas de mortalidade associadas com ressecções pancreáticas também pode ocorrer com os níveis persistentemente elevados de complicações pós-operatórias.

PURPOSE: Create and validate a proposed animal model for training in sentinel lymph node biopsy of the stomach. METHODS: In thirty-two rabbits, through a laparotomy, they received a subserosal injection of 0.1 ml of phytate labeled with technetium-99m (0.2 mCi) in the anterior wall of the gastric corpus, followed by 0.2 ml of Blue Patent V® 2.5%, through the same puncture site. Suspicious lymph nodes were searched in vivo at five, ten and 20 minutes, both visually (Blue Patent stained lymph nodes) and with a manual gamma radiation detector (to detect suspected radioactive lymph nodes). After 20 minutes, was performed resection of these for further evaluation of radioactivity (ex vivo) and histological study. RESULTS: Lymph nodes were identified in 30 rabbits (Average of 2.2 lymph nodes per animal). Of the 90 suspected lymph nodes that occurred in the study, 70 cases (77.8%) were histologically confirmed for lymphoid tissue. Of these, the majority were located in the periesophageal region of the gastric fundus. The sample presented a mortality rate of 6.25% and nine complications related to the method, which interfered in the identification of the lymph nodes. CONCLUSION: The animal model for sentinel node biopsy in rabbit stomachs proved to be feasible, with low complexity and reproduced the difficulties encountered for gastric lymph node biopsy in humans, being adequate for surgical training.OBJETIVO: Criar e validar uma proposta de modelo animal para o treinamento em pesquisa de linfonodos sentinelas no estômago. MÉTODOS: Em trinta e dois coelhos, mediante laparotomia, foi injetado na subserosa da parede anterior do corpo gástrico, 0,1 ml de fitato marcado com tecnécio-99m (0,2 mCi), seguido pelo mesmo orifício, de 0,2 ml de Azul Patente V® 2,5%. A cavidade abdominal foi avaliada, in vivo, por meio de inspeção para pesquisa de suspeitas de linfonodos azuis e com detector manual de radiação gamma aos cinco, dez e 20 minutos para pesquisa de suspeitas de linfonodos radioativas. Após 20 minutos, foi realizada a ressecção dessas para posterior avaliação da radioactividade (ex vivo) e estudo histológico. RESULTADOS: Foram identificados linfonodos em 30 coelhos (Média de 2,2 linfonodos por animal). Das 90 suspeitas de linfonodos ocorridas no estudo, em 70 casos (77,8%) obteve-se confirmação histológica para tecido linfóide. Destas, a maioria estava localizada na região periesofágica do fundo gástrico. A amostra apresentou taxa de mortalidade de 6,25% e nove intercorrências relacionadas ao método, que interferiram na identificação dos linfonodos. CONCLUSÃO: O modelo animal para pesquisa de linfonodos sentinelas em estômago de coelhos mostrou-se factível, pouco complexo e reproduziu as dificuldades encontradas para a pesquisa de linfonodos gástricos em humanos, sendo adequado para o treinamento cirúrgico.

PURPOSE: Demonstrate that the rabbit may be used in the training of surgery, in addition to present its perioperative care. METHODS: Thirty two animals, with age and weight, respectively, from 3 to 5.5 months old and 3000 to 4200 grams, were undergone different periods of pre-operative fasting, exclusive intramuscular anesthesia (ketamine+xylazine), laparotomy with total gastrectomy and total splenectomy. It was dosed the pre-operative (initial) and post-surgical (end) serum blood glucose, in addition to quantify the gastric content after the resection of the part. RESULTS: The anesthetical-surgical procedure presented a mortality rate of 3.125% (1:32) and a morbidity rate of 6.25% (2:32). It was evidenced an initial mean blood glucose = 199.4 mg/dl and the end = 326.1 mg/dl. In spite of extended fasting (minimum of 2 hours for the absolute fasting and maximum of 8.5 hours for liquids, and 20.5 hours for solids) all animals presented at the end of the surgical procedure any gastric content and a blood glucose increase. Those with fasting for liquids and solids when compared to the quantity of solid gastric content, presented a moderate negative degree of correlation. CONCLUSION: The rabbit is a good model to be used in training of surgery, with a low morbi-mortality, able to be anesthetized intramuscularly, with no need of pre-operative fasting and does not present hypoglycemia even with the extended fasting period.OBJETIVO: Demonstrar que o coelho pode ser utilizado no treinamento em cirurgia, além de apresentar seus cuidados perioperatórios. MÉTODOS: Trinta e dois animais, com idade e peso respectivamente, entre 3 a 5,5 meses e 3000 a 4200 gramas, foram submetidos a variados tempos de jejum pré-operatório, anestesia intramuscular exclusiva (quetamina+xilasina), laparotomia com gastrectomia e esplenectomia totais. Dosou-se a glicemia sérica pré-operatória (inicial) e pós-cirúrgica (final), além de quantificado o conteúdo gástrico pós-gastrectomia. RESULTADOS: O procedimento anestésico-cirúrgico apresentou taxa de mortalidade de 3,125 % (1:32) e morbidade de 6,25 % (2:32). Evidenciou-se glicemia média inicial = 199,4 mg/dl e final = 326,1 mg/dl. Apesar de jejuns prolongados (mínimo de 2 horas para jejum absoluto e máximo de 8,5 horas para líquidos, e 20,5 horas para sólidos) todos os animais apresentaram no final do procedimento cirúrgico algum conteúdo gástrico e aumento da glicemia. Aqueles com jejum para líquidos e sólidos quando comparados com a quantidade de conteúdo gástrico sólido e total apresentaram grau moderadamente negativo de correlação linear. CONCLUSÃO: O coelho é um bom modelo para ser utilizado em treinamento de cirurgia, com baixa morbimortalidade, passível de ser anestesiado por via intramuscular, sem necessidade de jejum pré-operatório e ausência de hipoglicemia.

INTRODUÇÃO: É considerado câncer do estômago precoce aquele que ocorre limitado à mucosa ou submucosa da parede gástrica, independentemente da presença de metástases. Apesar de alta prevalência, o câncer gástrico é de diagnóstico tardio, pois na maioria dos casos quando precoce possui apresentação silenciosa. Assim, muitas vezes, através de um exame complementar realizado por outras causas, incidentalmente identifica-se a sua presença proporcionando tratamento de forma precoce e menos invasiva. Atualmente, a cirurgia minimamente invasiva, através da videolaparoscopia, apresenta-se cada vez mais como solução para diminuir-se a incidência de complicações pós-cirúrgicas, assim como melhorar a qualidade da recuperação pós-operatória. OBJETIVO: Verificar o grau de evidência relacionado às vantagens e desvantagens inerentes a utilização da gastrectomia videoassistida para o tratamento do câncer gástrico precoce. MÉTODO: Foram utilizados os descritores: câncer, estômago, cirurgia laparoscópica, para pesquisa no PubMed (www.pubmed.com), na Bireme (www.bireme.br) e na Cochrane BVS (http://cochrane.bvsalud.org). A seguir foram selecionados os artigos pertinentes relacionados à abordagem cirúrgica videoassistida para o tratamento do câncer gástrico precoce. CONCLUSÃO: É possível evidenciar-se que o uso da videolaparoscopia para o tratamento do câncer gástrico precoce, mesmo que em parte do ato operatório, tem potencial para diminuir as complicações relacionadas às gastrectomias parciais.INTRODUCTION: Early gastric cancer limits the mucosa or submucosa of the gastric wall, regardless of metastases. Despite the high prevalence, gastric cancer is diagnosed in advanced stage, since in most cases the earliness is silent. Thus, is identified such cancer at first using a diagnostic test performed for other reasons. Nowadays, minimally invasive surgery by laparoscopy has usually been presented as a solution to decrease the incidence of postoperative complications and to improve the quality of postoperative recovery. AIM: To assess the evidence related to the advantages and disadvantages inherent in the use of laparoscopy-assisted partial gastrectomy for the treatment of early gastric cancer. METHOD: The headings used were: cancer; stomach; laparoscopic surgery in PubMed (www.pubmed.com), in Bireme (www.bireme.br) and in Cochrane VHL (http://cochrane.bvsalud.org). Afterwards, the relevant articles for laparoscopic-assisted surgery to treat early gastric cancer were selected. CONCLUSION: Laparoscopy to treat early gastric cancer was proved beneficial, even when used in part during surgery and can reduce complications related to partial gastrectomy.

Resection of the confluence of the superior mesenteric and portal veins has been performed most frequently in the treatment of adenocarcinoma of the pancreas, in view of the reported positive results, but it can also be used in cases of benign pancreatic neolpasias when they are strongly adhered to the mesenteric-portal trunk. Nevertheless, there is no study on the best type of venous grafts for reconstruction of the mesenteric-portal trunk when required. The choice of graft depends on the preference of the surgeon or the institution. This technical note critically discusses the use of the splenic vein as an option for mesenteric-portal trunk reconstruction after gastroduodenopancreatectomy.

American cutaneous leishmaniasis (ACL) occurs in epidemic outbreaks and in sporadic cases with small annual variation in the Pontal of Paranapanema, SP. There is little research on the sandfly fauna of this region. The last outbreaks were related to the Movement of the Landless Workers (MST) and with the ecological tourism in preserved forest of the Parque Estadual do Morro do Diabo (PEMD). AIM: identification of the sandfly fauna within the PEMD, mainly anthropophilic species already incriminated as vectors of ACL, as well as their seasonality, hourly frequency and data of the behavior. M&M: The captures were undertaken with CDC light and Shannon traps from 6:00 pm to 10:00 pm, monthly from May 2000 to December 2001. The temperature and relative humidity data were registered at hourly intervals. RESULTS: The captured species were: Brumptomyia brumpti, Nyssomyia neivai, Nyssomyia whitmani, Pintomyia fischeri and Pintomyia pessoai. The P. pessoai predominated (34.39%) and N. neivai was less found (0.74%), only being captured in CDC traps. Shannon trap captured more sandflies (63.01%) than the CDC traps (36.99%). Despite the environmental degradation anthropophilic species, indicates favorable bioecological conditions for persistence of vectors and potential transmission of leishmaniasis.LCA ocorre em surtos epidêmicos e casos esporádicos com pequena variação anual no Pontal do Paranapanema, SP. Há pouca pesquisa sobre a fauna flebotomínea na região. Os últimos surtos estão relacionados ao MST e turismo ecológico na floresta do Parque Estadual do Morro do Diabo (PEMD). OBJETIVO: identificar a fauna flebotomínea no PEMD, principalmente as espécies antropofílicas já incriminadas como vetores da LCA, também, sua sazonalidade, horários e dados de comportamento. M&M: As capturas foram feitas com armadilhas CDC e Shannon das 18 às 22h, mensalmente de maio de 2000 a dezembro de 2001. Dados de temperatura e umidade relativa foram registrados com intervalo de uma hora. RESULTADOS: As espécies capturadas foram: Brumptomyia brumpti, Nyssomyia neivai, Nyssomyia whitmani, Pintomyia fischeri e Pintomyia pessoai. A P. pessoai predominou (34,39%) e a N. neivai foi a menos encontrada (0,74%), capturada com a CDC. A Shannon capturou mais flebotomíneos (63,01%) que a CDC (36,99%). Apesar da degradação ambiental espécies, antropofílicas foram encontradas, indicando condições bioecológicas para persistência de vetores e potencial transmissão da leishmaniose.

Este estudo avaliou o stress associado ao trabalho do enfermeiro no trabalho com o portador de transtorno mental inserido no contexto do hospital psiquiátrico. Trata-se de pesquisa quantitativa, analítica, realizada em sete hospitais psiquiátricos da cidade de Fortaleza, Ceará. Utilizou-se os seguintes instrumentos: dados sociodemográficos para descrição da amostra e um inventário para identificar os sintomas de stress no enfermeiro. A população total abrangeu 48 participantes e a amostra 42, a maioria do sexo feminino, o que corresponde a 92,9% do total. Os resultados mostram que em 62% da amostra não apresentaram stress, 30,9% encontravam-se na fase de Resistência e apenas 7,1% na fase de Exaustão. Não houve associação estatisticamente significativa entre a variável tempo de trabalho com o portador de transtorno mental e sintomas de stress. Portanto, o presente estudo não evidenciou a ocorrência do stress nesses profissionais enfermeiros.Este estudio evaluó el estrés del enfermero asociado al trabajo con el portador de trastorno mental en el contexto del hospital psiquiátrico. Se trata de una investigación cuantitativa, analítica, realizada en siete hospitales psiquiátricos, en la ciudad de Fortaleza, Ceará. Se utilizó los siguientes instrumentos: datos sociodemográficos para la descripción de la muestra y un inventario para identificar los síntomas de stress en el enfermero. La población total abarcó 48, siendo la muestra de 42 participantes, la mayoría del sexo femenino, lo que corresponde al 92,9% del total. Los resultados mostraron que no hubo stress en el 62% de los participantes, el 30,9% se encontró en fase de resistencia y el 7,1% en fase de exhausto. No hubo asociación estadísticamente significativa entre el tiempo de trabajo y los síntomas de stress. Por lo tanto, el presente estudio no evidenció la ocurrencia de stress en los profesionales enfermeros.The aim of this study was to appraise stress levels of nurses working with mentally ill psychiatric hospital patients. This quantitative study was conducted in seven psychiatric hospitals in the city of Fortaleza, Ceará, Brazil, and was carried out with the use of the following instruments: Socio-demographic descriptive information of the sample and an inventory to identify the stress symptoms of the nurses. The sample size was 48, of which 42 (93%) were female. The results of the sample showed that 62% felt no stress, 31% were at the endurance level and 7% at the exhaustion level. No statistically significant relationship was found between the hours of work performed and the symptoms of stress. Therefore, the present study showed no occurrence of stress in these nurses.

Objective: to report the group's experience with a series of patients undergoing pancreatic resection presenting null mortality rates. Methods: we prospectively studied 50 consecutive patients undergoing pancreatic resections for peri-ampullary or pancreatic diseases. Main local complications were defined according to international criteria. In-hospital mortality was defined as death occurring in the first 90 postoperative days. Results: patients' age ranged between 16 and 90 years (average: 53.3). We found anemia (Hb < 12g/dl) and preoperative jaundice in 38% and 40% of cases, respectively. Most patients presented with peri-ampullary tumors (66%). The most common surgical procedure was the Kausch - Whipple operation (70%). Six patients (12%) needed to undergo resection of a segment of the mesenteric-portal axis. The mean operative time was 445.1 minutes. Twenty two patients (44%) showed no clinical complications and presented mean hospital stay of 10.3 days. The most frequent complications were pancreatic fistula (56%), delayed gastric emptying (17.1%) and bleeding (16%). Conclusion : within the last three decades, pancreatic resection is still considered a challenge, especially outside large specialized centers. Nevertheless, even in our country (Brazil), teams seasoned in such procedure can reach low mortality rates.

ABSTRACT Background Bactibilia has several consequences to human health. Objetive Assessing the bile microbiology of patients with biliopancreatic diseases in order to identify bacteria and their possible infectious complications. Methods Retrospective study of 30 bile culture samples from patients with benign and malignant biliopancreatic diseases. The samples were assessed to set the bile microbiological flora and to search for its possible link with comorbidity, carcinogenesis and postoperative infectious complications. Results Thirty bile samples from patients at mean age ≈57.7 years, mostly female (n=18), were assessed. Bactibilia was found in 12 cases, mostly in patients with benign diseases (n=8), older than 50 years (n=23) and female (n=10). Adenocarcinoma of the duodenal papilla (n=9) and cholelithiasis (n=8) were the most common diseases. Escherichia coli (n=5) and Klebsiella sp (n=3) were predominantly found in patients with benign diseases; and Klebsiella sp (n=2) and Streptococcus sp (n=2) were prevalent in cancer patients. There were postoperative infectious complications in seven cases, five of them in bactibilia-associated patients (P=0.084). Conclusion Bactibilia was found in 12 samples and Escherichia coli and Klebsiella sp were most often identified in patients with benign diseases, as well as Streptococcus sp and Klebsiella sp in cancer patients. There was a trend of higher postoperative infectious complication incidence in patients with bactibilia.

Idiopathic pneumoperitoneum is considered a rare condition, as only twenty cases have been described in the last thirty years. The authors report a case of idiopathic massive pneumoperitoneum in a patient aged 45, showing the possible causes of this clinical picture based on a review of medical literature.