Expression of p21 is an independent prognostic factor in curatively resected ESC. Definition of new subgroups of patients based on p21 expression may help to enhance the stratification of stage.
-Context -About 9% of the Brazilian population has gallstones and the incidence increases significantly with aging. The choledocholithiasis is found around 15% of these patients, and a third to half of these cases presented as asymptomatic. Once the lithiasis in the common bile duct is characterized through intraoperative cholangiography, the laparoscopic surgical exploration can be done through the transcystic way or directly through choledochotomy. Objective -To evaluate the results and outcomes of the laparoscopic treatment of common bile duct lithiasis. Methods -Seventy consecutive patients were evaluated. They prospectively underwent the treatment of the lithiasis in the common bile duct and the exploration ways were compared according to the following parameters: criteria on their indication, success in the clearance, surgical complications. It was verified that about ½ of the choledocholithiasis carriers did not show any expression of predictive factors (clinical antecedents of jaundice and/or acute pancreatitis, compatible sonographic data and the pertaining lab tests). The laparoscopic exploration through the transcystic way is favored when there are no criteria for the practice of primary choledochotomy, which are: lithiasis in the proximal bile duct, large (over 8 mm) or numerous calculi (multiple calculosis). Results -The transcystic way was employed in about 50% of the casuistic and the choledochotomy in about 30%. A high success rate (around 80%) was achieved in the clearance of the common bile duct stones through laparoscopic exploration. The transcystic way, performed without fluoroscopy or choledochoscopy, attained a low rate of success (around 45%), being 10% of those by transpapilar pushing of calculi less than 3 mm. The exploration through choledochotomy, either primary or secondary, if the latter was performed after the transcystic route failure, showed high success rate (around 95%). When the indication to choledochotomy was primary, the necessity for choledochoscopy through choledochotomy to help in the removal of the calculi was 55%. However, when choledochotomy was performed secondarily, in situations where the common bile duct diameter was larger than 6 mm, the use of choledochoscopy with the same purpose involved about 20% of the cases. There was no mortality in this series. Conclusion -The laparoscopic exploration of the common bile duct was related to a low rate of morbidity. Therefore, the use of laparoscopy for the treatment of the lithiasis in the common bile duct depends on the criteria for the choice of the best access, making it a safe procedure with very good results. HEADINGS -Choledocholithiasis. Laparoscopy. Cholangiography.
IntroductionDespite dating more than 30 years after the first laparoscopic appendectomy, ileocecal appendix resection is still performed by laparotomy in more than 90% of cases, in our country.AimTo describe a technique for laparoscopic removal of the ileocecal appendix with three portals, at low cost and very good aesthetic appearance.TechniqueThree incisions, one umbilical and two suprapubic are made; permanent material used comprises: grasping forceps, hook, scissors, needle holders, three metal trocars and four other usual instruments, and a single strand of cotton. There is no need to use of operative extractors bags, clips, endoloops, staples or bipolar or harmonic energy instruments. Allows triangulation and instrumentation in the conventional manner.ConclusionThe proposed technique is safe and reproducible, easily teachable, at very low cost and can be applied in general hospitals with conventional laparoscopic equipment.
RESUMO -Desde a instalação da cirurgia laparoscópica no Hospital das Clínicas daO programa visa a formar um cirurgião com elevado nível de conhecimento capaz de atender pacientes de grande complexidade clínica, bem como realizar operações em todos os setores do tubo digestivo, incluindo as de grande porte. Com o advento da cirurgia laparoscópica, houve necessidade de estabelecer um programa para completar a formação do cirurgião do aparelho digestivo.Desde a introdução da cirurgia laparoscópica no Hospital das Clínicas, em outubro de 1990, passamos a estruturar um programa para formação do cirurgião em laparoscopia do aparelho digestivo.Acreditamos que os cursos rápidos, organizados em fins de semanas com treinamento em caixas pretas e em animais de laboratórios, têm objetivos Unidade de Cirurgia Laparoscópica no período de outubro 1990 a dezembro de 1998, com índice de conversão de 0,9% e sem mortalidade. A ausência de acidentes operatórios e de complicações verificadas na experiência adquirida nas operações realizadas por nosso grupo cirúrgico, dá consistente suporte à orientação assumida pela Disciplina.CONCLUSÃO. Reforçam-se os princípios que foram adotados dentro da atividade em hospital universitário, que são: necessidade de formação de profissionais dentro de programa bem estruturado, ensejando-lhes preparo educacional humanístico e técnico, em torno de projeto pedagó-gico longo, mas com grande e sólido embasamento informativo e prático.UNITERMOS: Ensino médico. Cirurgia. Laparoscopia. Aparelho digestivo. Colecistectomia. quase que exclusivamente de gerar conhecimentos informativos teóricos com demonstração da aparelhagem e dos procedimentos.Em breves termos, esses cursos "informam", mas "não formam". Funcionam como o "test drive" das empresas concessionárias de automóveis. Embora com instrumentos diferentes, os objetivos são semelhantes: na via comum final, a familiarização com o emprego rotineiro do equipamento só é conseguida depois que o consumidor o adquiriu. ROTEIRO DE TRABALHO a) Função do responsável pelo ensinoCom todos esses recursos em mãos, cabe ao responsável pelo ensino de cirurgia do aparelho digestivo integrar, coordenar e estimular as ações, ensejando oportunidades a todos os interessados para atingir a meta de formar médicos de elevada qualificação profissional. b) Atividade e oportunidade acadêmicaEstrutura da educação médica na Faculdade de
-Background -Mechanical lifting of the abdominal wall, a method based on traction and consequent elevation of the abdominal wall, is an alternative procedure to create enough intra-abdominal space necessary for videolaparoscopic
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