IMPORTANCEAppendectomy remains the standard of care for uncomplicated acute appendicitis despite several randomized clinical trials pointing to the safety and efficacy of nonoperative management of this disease. A meta-analysis of randomized clinical trials may contribute to the body of evidence and help surgeons select which patients may benefit from surgical and nonsurgical treatment.OBJECTIVE To assess the efficacy and safety of nonoperative management vs appendectomy for acute uncomplicated appendicitis.DATA SOURCES A systematic review was conducted using indexed sources (Embase and PubMed) to search for published randomized clinical trials in English comparing nonoperative management with appendectomy in adult patients presenting with uncomplicated acute appendicitis. To increase sensitivity, no limits were set for outcomes reported, sex, or year of publication. All nonrandomized or quasi-randomized trials were excluded, and validated primers were used.STUDY SELECTION Among 1504 studies imported for screening, 805 were duplicates, and 595 were excluded for irrelevancy. A further 96 were excluded after full-text review, mainly owing to wrong study design or inclusion of pediatric populations. Eight studies met the inclusion criteria and were selected for the meta-analysis. DATA EXTRACTION AND SYNTHESISMeta-extraction was conducted with independent extraction by multiple reviewers using the Covidence platform for systematic reviews and in accordance with PRISMA guidelines. Data were pooled by a random-effects model. MAIN OUTCOMES AND MEASURESTreatment success and major adverse effects at 30 days' follow-up. RESULTSThe main outcome (treatment success proportion at 30 days of follow-up) was not significantly different in the operative and nonoperative management cohorts (risk ratio [RR], 0.85; 95% CI, 0.66-1.11). Likewise, the percentage of major adverse effects was similar in both cohorts (RR, 0.72; 95% CI, 0.29-1.79). However, in the nonoperative management group, length of stay was significantly longer (RR, 1.48; 95% CI, 1.26-1.70), and a median cumulative incidence of 18% of recurrent appendicitis was observed.CONCLUSIONS AND RELEVANCE These results point to the general safety and efficacy of nonoperative management of uncomplicated acute appendicitis. However, this strategy may be associated with an increase in duration of hospital stay and a higher rate of recurrent appendicitis. This meta-analysis may help inform decision-making in nonoperative management of uncomplicated acute appendicitis.

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Background Evidence regarding the effects of plastic bag use for appendix removal during minimally invasive appendectomy remains scarce and conflicting. Objective This study aimed to analyze the effects of plastic bag use during minimally invasive appendectomy on preoperative infection risk, morbidity and mortality. Design This retrospective analysis of the prospective National Surgical Quality Improvement Program (NSQIP) cohort program. Setting This study included data from the NSQIP database between the years of 2016 and 2019. Patient Adult patients undergoing minimally invasive (laparoscopic or robotic) without unplanned conversion to open surgery. Intervention Use of plastic bag for specimen removal during appendectomy. Main Outcome Measures Risk ratios for the incidence of superficial surgical site infection, intra-abdominal abscess, overall medical morbidity, and overall mortality. Results There were 43 783 cases of minimally invasive appendectomy in the NSQIP database between the years of 2016 and 2019. Among those who reported information regarding use of plastic bag, 28 589 (91.87%) reported use of plastic bag for specimen removal. Use of plastic bag was associated with a significant decrease in superficial surgical site infection (RR .39 (95% CI: .31-.49), P < .001), and in the risk of postoperative intra-abdominal abscess (RR: 0.66 (.57-.77), P < .001)). We also observed a robust reduction in overall medical-related morbidity and overall mortality, even after adjusting for multiple confounders. Limitations Observational nature of the study cannot exclude residual bias. Also, there was a significant rate of missing values for plastic bag use, which may bias results. Conclusions In this global prospective cohort using NSQIP database, use of plastic bag for appendix removal during minimally invasive appendectomy was associated with a significant improvement in surgical related outcomes and reduction in morbidity and overall mortality.

BACKGROND AND OBJECTIVES: Triggering and chronicity of failed back surgery syndrome should consider psychosocial and emotional factors which impair quality of life. This study aimed at identifying such factors and at evaluating quality of life of failed back surgery syndrome patients. METHODS: This is a descriptive, exploratory, comparative, cross-sectional study with quantitative approach. Sample was made up of a test group (I) diagnosed with failed back surgery syndrome (n=16) and a control group (II) undergoing inter-consultation in the Pain Clinic (n=15). Tools were the visual analog scale and Fischer dolorimeter. WHOQOL-Bref questionnaire was used to evaluate quality of life and Beck Anxiety Inventory and Depression Inventory were used to evaluate emotional factors anxiety and depression. RESULTS: There has been predominance of females on both groups, mean age was 42.3±5.8 (group I), most were married and mean education was 8.4±3.0 years. Mean pain duration was 0.7±0.3 months after surgery in group I with lower pain threshold. Physical dimensions and social relations were the most affected on quality of life, as well as anxiety and depression levels. CONCLUSION: Our results have shown worse pain, quality of life, anxiety and depression in group I, suggesting a better knowledge of potential postoperative complications aiming at preventing the establishment of an abnormal functionality pattern.

A temática do luto e melancolia é demasiadamente importante no estudo psicanalítico e tem sido estudada desde o criador da psicanálise, Sigmund Freud, até autores contemporâneos que acrescentaram e revisaram as ideias iniciais. A perda do objeto de amor propicia ao indivíduo a experiência do luto, enquanto, na melancolia, o estado de sofrimento psíquico se dá a partir da perda ou danificação dos objetos internos sem, necessariamente, a perda de um objeto real. Os estados de luto e melancolia desencadeiam sofrimento psíquico, podendo inclusive levar o indivíduo ao patológico. O presente estudo tem como objetivo elucidar elementos presentes no luto e na melancolia e o processo de elaboração psíquica, utilizando como recurso artístico o filme Melancolia (2011) do diretor dinamarquês Lars Von Trier, articulando as teorias psicanalíticas acerca do tema, seus desdobramentos e consequências psíquicas. Para isso, utilizou-se como metodologia a revisão bibliográfica. A análise dos mecanismos encontrados na personagem Justine da obra de Lars Von Trier e suas vivências subjetivas dos processos ligados à melancolia permite avaliar importantes aspectos sobre a identificação melancólica e a temática da perda de objeto e investimentos afetivos com o mundo externo. Conclui-se que a melancolia, apesar de apresentar aspectos patológicos e prejuízos no campo afetivo e social, pode possibilitar potencialidades e saídas criativas em situações de desamparo diante da possibilidade de finitude humana, enquanto no processo de elaboração do luto envolve a escolha de um objeto substituto.   PSYCHOANALYTICAL CONTRIBUTIONS TO MOURNING AND MELANCHOLY   ABSTRACT The mourning and the melancholy issues are profoundly important for psychoanalytic study, and it has been studied from the creator of psychoanalysis Sigmund Freud to contemporary authors who added and revised the first concepts. Losing beloved ones results in the mourning experience to the individual, whereas in melancholy the suffering mental feeling comes from losing or damaging internal objects, without necessarily losing a real object. Mourning and melancholy conditions trigger mental suffering and may even lead the individual to a pathological condition. The present study aims at elucidating mourning and melancholy elements, and the psychic elaboration process, using the film Melancolia (2011) by the Danish director Lars Von Trier as an artistic resource, articulating the psychoanalytic theories about the issue, outcomes, and psychic consequences. In this regard, the literature review was used as a methodology. The analysis of the mechanisms found in the character Justine of Lars Von Trier's artwork, and his subjective experiences of the processes related to melancholy, allows us to evaluate important aspects as concerns melancholy identification and the loss of object issue and affective investments with the external world. It is concluded that melancholy, despite presenting pathologic aspects and damages for affective and social areas, may provide potentialities and creative results for abandon situations when facing the possibility of human finitude, whereas in the natural mourning stage involves the displacement mechanism.   Descriptors: Mourning. Melancholy. Movie theater. Psychoanalysis.