Objective : to identify the main risk factors associated with the development of complications in patients with acute appendicitis. Methods: we conducted a case-control study of 402 patients with acute appendicitis hospitalized in a secondary hospital, divided into two groups: the control group, with 373 patients who progressed without postoperative complications (Group 1) and the study group, with 29 patients who presented complications (Group 2). We evaluated demographic data, signs and symptoms of the disease, imaging tests and hospitalization data. Results: factors associated with complications were fever, radiological and sonographic changes, abrupt positive decompression and diarrhea. Migration of pain, nausea, vomiting and abrupt positive decompression were the findings that were significantly more frequent in both groups (p = 0.05). The duration of signs and symptoms in days in group 2 was significantly higher than in group 1, with a median of three days for the group with complications (p = 0.05). Conclusion: alterations in imaging, fever, diarrhea, positive abrupt decompression, duration of symptoms and lower age are associated with a higher frequency of complications in acute appendicitis, which reinforces the importance of anamnesis, physical examination and indication of complementary exams in the approach of these patients.

The principle of autonomy was a significant bioethical achievement in terms of its positive impact on the physician-patient relationship. The search for balance in the paternalistic doctor and indigenous patient relationship is fundamental for the symmetrical maintenance of such relations. In this context, it is essential that the medical professional considers and accepts the existence of social and cultural diversity when planning therapeutic strategies that aim to ensure the autonomy of the patient, the family and community, thus guaranteeing a good quality of service and of life. The aim of this article is to characterize, from the perspective of bioethics, the challenge faced by the physician-indigenous patient relationship, indicate critical situations and suggest means for an ideally harmonious relationship between these cultures in the area of health. Keywords: Indigenous population. Health of indigenous peoples. Physician-patient relations. Bioethics. ResumoConsiderações bioéticas sobre a relação médico-paciente indígena O princípio da autonomia foi conquista bioética significativa, uma vez que teve impactos positivos na relação médico-paciente. A busca do equilíbrio no contato entre o tradicional paternalismo médico e a especificidade cultural do paciente indígena é fundamental para a manutenção simétrica dessa relação. Diante disso, é indispensável que o médico considere e admita a existência da diversidade social e cultural para elaborar projetos terapêuticos que visem a autonomia do paciente, da família e comunidade, garantindo, assim, bom atendimento e qualidade de vida. Este artigo objetiva caracterizar, sob o enfoque da bioética, o desafio enfrentado na relação médico-paciente indígena, pontuar situações críticas e sugerir aos profissionais estratégias para estabelecer relações idealmente harmoniosas entre essas culturas na área da saúde. Palavras-chave: População indígena. Saúde de populações indígenas. Relações médico-paciente. Bioética. ResumenConsideraciones bioéticas sobre la relación médico-paciente indígena El principio de la autonomía fue una conquista bioética significativa, en la medida en que tuvo impacto positivo en la relación médico-paciente. La búsqueda del equilibrio en el contacto entre el tradicional paternalismo mé-dico y la especificidad cultural del paciente indígena es fundamental para el mantenimiento simétrico de esta relación. Frente a ello, es indispensable que el médico considere y admita la existencia de la diversidad social y cultural para elaborar proyectos terapéuticos que contemplen la autonomía del paciente, de la familia y de la comunidad, garantizando así una buena atención y calidad de vida. El presente artículo tiene como objetivo caracterizar, desde el enfoque de la bioética, el desafío enfrentado en la relación médico-paciente indígena, puntuar situaciones críticas y sugerir a los profesionales estrategias para establecer relaciones idealmente armoniosas entre esas culturas en el área de la salud. Palabras-clave: Población indígena. Salud de poblacio...

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BACKGROUNDGallbladder cancer is the most common malignant tumor of the biliary tract. The majority of cases are adenocarcinoma. Squamous cell carcinoma is the histological type present in 12% of all neoplasias accounting for approximately 12% of gallbladder neoplasms. It can occur in its pure form reaching 1%-3% of the tumors. Many patients are at an advanced stage when diagnosed and have bad therapeutic efficacy.CASE SUMMARYA 45-year-old male patient presented with left flank pain for 1 year and irradiated to the mesogastric region. He denied fever, vomiting, and any other intestinal changes. He reported a weight loss of 10 kg in a period of 7 mo. He denied alcoholism, smoking, drug use, or prior illness. Computed tomography of the abdomen showed in the gallbladder fossa a voluminous mesogastric heterogeneous collection that had a thick and irregular capsule with liquid and gaseous contents. A predominantly hypoattenuating rounded material with partially calcified margins measuring about 2.0 cm related to gallstone was also emphasized. No lymphadenomegalies or free fluid was observed in the abdominal cavity. Patient underwent laparotomy where a huge tumor was observed affecting the transverse colon and gallbladder. This mass was resected en bloc removing gallbladder and transverse colon together with corresponding mesocolon and regional lymphadenectomy. There were no complications in the postoperative period. Although oncological treatment was performed, the patient died 6 mo after surgery.CONCLUSIONSquamous cell carcinoma represents a rare disease. Patients often present with large, bulky tumors with involvement of adjacent organs. In spite of progress in surgical techniques and adjuvant chemotherapy, the prognosis remains poor.

Background: Pilonidal cysts are a painful condition that primarily affect young adult men. In the literature, numerous operative techniques for resolving pilonidal cysts are described, with variable outcomes. The objective of this study was to compare primarily closed midline incisions managed with or without the use of closed incision negative pressure therapy after pilonidal cyst excision. Methods: Twenty-one patients underwent excision and midline primary closure. Postoperative care composed of closed incisional negative pressure therapy (study group; n = 10) or gauze dressings (control group; n = 11). In both groups, the sutures were partially removed on day 14 and completely removed on day 21. Compared outcomes included the duration of hospitalization, pain on the day of surgical procedure, and on postoperative day 7, and time-to-healing. Results: The median hospital stay was about 9 hours and 23 hours in the study and control groups, respectively ( P < 0.05). The median pain scores on the day of operation were 1.20/10 in the study group and 3.36/10 in the control group ( P < 0.05). On day 7, study group showed median pain score 0.9/10 and control group showed 2.63/10 ( P < 0.05). The mean healing time was 23.8 and 57.9 days in the ciNPT group and gauze group, respectively ( P < 0.05). Conclusion: These outcomes supported the incorporation of closed incision negative pressure therapy into our surgical treatment protocol for pilonidal cysts.

RESUMO Objetivo: avaliar a acurácia da ultrassonografia no diagnóstico de hérnia inguinal no pré-operatório de pacientes submetidos à herniorrafia inguinal. Métodos: estudo retrospectivo descritivo, analítico, baseado em dados obtidos dos prontuários de pacientes submetidos à herniorrafia inguinal entre janeiro de 2016 e dezembro de 2017 e que realizaram ultrassonografia no período pré-operatório. A amostra foi composta por 232 pacientes e foram comparados os resultados da ultrassonografia com as queixas, exame físico e achados intraoperatórios desses pacientes. Resultados: a ultrassonografia apresentou concordância com a queixa de hérnia inguinal em 52% dos pacientes (p=0,019). Houve discordância entre a porcentagem de pacientes que apresentaram hérnia ao exame físico não confirmada pelo exame ultrassonográfico (28,57%) e a porcentagem de hérnias identificadas somente ao exame complementar (8,93%), com significância estatística (p=0,0291). Quando comparados os resultados ultrassonográficos com achados intraoperatórios, 32,70% dos pacientes que apresentavam hérnia tinham ultrassonografia normal com significância estatística para discordância (p=0,001). Conclusão: a ultrassonografia mostrou-se método não confiável para auxiliar no diagnóstico em casos duvidosos de hérnia inguinal e dispensável quando o diagnóstico era confirmado por queixas típicas e exame físico compatível.

Background: Acute appendicitis is one of the most common causes of abdominal pain, accounting for about one-third of patients presenting at emergency services with acute abdomen. A high degree of suspicion is essential for diagnosis. Aim: Evaluate the correlation between the Alvarado score and the tomographic and Intraoperative findings of patients with acute appendicitis. Methods: Descriptive, cross-sectional, retrospective study using data obtained from the Internment Management System of all hospitalized patients with acute appendicitis from June 2014 to June 2015. Data were analyzed and Statistics generated through the Epi Info 7.0 program. Results: 240 patients were evaluated. Of these, 150(62.5%) were male and 90(37.5%) were female, with a mean age of 28.6years. The exclusive clinical diagnosis was performed in 42 patients(17.4%). The relationship between the positive Alvarado score and the tomographic findings was evaluated, being considered positive in the presence of two or more findings. The positive association between Positive Alvarado Score and the presence of tomographic findings was obtained, with Odds Ratio of 1.665 and P=0.1805. The association between the intraoperative findings and the positive Alvarado score was evaluated, in which 8(11.11%) patients were in the edematous phase(Odds Ratio=0,8182 P=0,6474), 31(43,05%) were phlegmonous(Odds Ratio=0,8128, P=0,4655), 15(20.83%) in the gangrenous phase(Odds Ratio=0,9175, P=0,8028) and 18(25%) in the perforated phase(Odds Ratio=1,7949, P=0,1278). Conclusion: There is a positive association between Alvarado score and the presence of tomographic findings, as well as the association between positive Alvarado score and perforation phase.

During which period should we avoid cholecystectomy in patients who underwent endoscopic retrograde cholangiopancreatography? Durante qual período devemos evitar a colecistectomia em pacientes que realizaram colangiopancreatografia retrógrada endoscópica?