PURPOSE:To evaluate the efficacy of surgical treatment for esophageal perforation. METHODS:A systematic review of the literature was performed. We conducted a search strategy in the main electronic databases such as PubMed, Embase and Lilacs to identify all case series. RESULTS:Thirty three case series met the inclusion criteria with a total of 1417 participants. The predominant etiology was iatrogenic (54.2%) followed by spontaneous cause (20.4%) and in 66.1% the localization was thoracic. In 65.4% and 33.4% surgical and conservative therapy, respectively, was considered the first choice. There was a statistically significance different with regards mortality rate favoring the surgical group (16.3%) versus conservative treatment (21.2%) (p<0.05). CONCLUSION:Surgical treatment was more effective and safe than conservative treatment concerning mortality rates, although the possibility of bias due to clinical and methodological heterogeneity among the included studies and the level of evidence that cannot be ruled out.

Despite progress in treatment strategies, only ~24% of pancreatic ductal adenocarcinoma (PDAC) patients survive >1 year. Our goal was to elucidate deregulated pathways modulated by microRNAs (miRNAs) in PDAC and Vater ampulla (AMP) cancers. Global miRNA expression was identified in 19 PDAC, 6 AMP and 25 paired, histologically normal pancreatic tissues using the GeneChip 4.0 miRNA arrays. Computational approaches were used for miRNA target prediction/identification of miRNA-regulated pathways. Target gene expression was validated in 178 pancreatic cancer and 4 pancreatic normal tissues from The Cancer Genome Atlas (TCGA). 20 miRNAs were significantly deregulated (FC≥2 and p <0.05) (15 down- and 5 up-regulated) in PDAC. miR-216 family (miR-216a-3p, miR-216a-5p, miR-216b-3p and miR-216b-5p) was consistently down-regulated in PDAC. miRNA-modulated pathways are associated with innate and adaptive immune system responses in PDAC. AMP cancers showed 8 down- and 1 up-regulated miRNAs (FDR p <0.05). Most enriched pathways ( p <0.01) were RAS and Nerve Growth Factor signaling. PDAC and AMP display different global miRNA expression profiles and miRNA regulated networks/tumorigenesis pathways. The immune response was enriched in PDAC, suggesting the existence of immune checkpoint pathways more relevant to PDAC than AMP.

Antibiotic prophylaxis for surgical site infection in people undergoing liver transplantation.

PURPOSE:To investigate the effects of alloxan diabetes on the abdominal wall healing of rats undergoing laparotomy. METHODS:Ninety-six male Wistar rats weighing between 200 and 300 grams, divided into two groups: non-diabetic group (G1) and another with untreated diabetes (G2). Three months after diabetes induction, the animals underwent a 5cm-long-laparotomy and 5.0 nylon monofilament suture. After the surgery, 12 animals from each group were euthanized on days 4, 14, 21 and 30 corresponding to the moments M1, M2, M3 and M4. In each moment a fragment of the abdominal wall containing the scar was removed for tensile strength measurement, histological and morphometric study. Clinical and biochemical parameters were also analyzed. RESULTS:G2 animals showed parameters compatible with severe diabetes and decreased plasma levels of insulin. The tensile strength in G2 was significantly smaller in M2 and M4, with a tendency to fall in the other two. Through light microscope, diabetic animals showed more difficulty to increase collagen density and contraction. G2 animals showed high cellularity of fibroblasts in later healing moments, with collagen thinning in M2 and M4. CONCLUSION:The abdominal wound healing in untreated diabetic animals was altered and led to a higher incidence of dehiscence and infections.Key words: Diabetes Mellitus. Alloxan. Tensile Strength. Wound Healing. Histology. Rats. Alloxan diabetes alters the tensile strength, morphological and morphometric parameters of abdominal wall healing in rats

. Mentor, designed the protocol and critical review. ABSTRACT PURPOSE:To study the effect of alcoholism on intestinal healing and postoperative complications in rats. METHODS:One hundred and sixty rats were divided into two groups: control and treated. The control group received water and the treated group 30% ethanol. After 180 days, colotomy with anastomosis were performed. After, the groups were divided into four subgroups: 20 rats for study at the following moments: 4 th , 7 th , 14 th and 21 st postoperative. The analyzed parameters were: weight gain, breaking strength, tissue hydroxyproline, postoperative complications and histopathological study. RESULTS:Weight gain was greater in the control group (p<0.05). When all the subgroups were clustered, breaking strength was significantly greater in the control (p<0.05). Histopathology and hydroxyproline dosage did not show differences. There were five surgical site infections in the treated group while the control group showed two (p>0.05). Nine fistulas occurred in the treated group whereas the control group two (p<0.05). There were three deaths in the control group and seven in the treated group (p>0.05). CONCLUSIONS:Treated group undergo a malnutrition process that is revealed by lower weight gain. Impaired intestinal healing as indicated by smaller breaking strength. There were a larger number of postoperative complications in the treated animals.Key words: Wound Healing. Alcoholism. Ethanol. Tensile Strenght. Hydroxyproline. Rats. RESUMO OBJETIVO:Estudar o efeito do alcoolismo no processo de cicatrização intestinal e suas complicações pós-operatórias em ratos. MÉTODOS:Cento e sessenta ratos foram divididos em dois grupos: tratado e controle. O controle recebeu água, enquanto o tratado etanol a 30%. Após 180 dias foram realizadas colotomia, seguida de anastomose. Após os animais foram divididos em quatro subgrupos de 20 ratos para estudo nos seguintes momentos: 4º, 7º, 14º e 21º pós-operatório. Os parâmetros analisados foram: ganho de peso, força de ruptura, hidroxiprolina tecidual, complicações pós-operatórias e estudo histopatológico. RESULTADOS:O ganho de peso foi superior no grupo controle (p<0,05). Após agrupamento dos momentos a força de ruptura foi superior no controle (p<0,05). Não houve diferença quanto à histopatologia e hidroxiprolina. Houve cinco infecções de incisão no grupo tratado, enquanto no controle ocorreram duas (p>0,05). Houve nove fístulas no grupo tratado, enquanto no controle duas (p<0,05).Ocorreram sete mortes no grupo tratado e apenas três no controle (p>0,05). Intestinal healing in rats submitted to ethanol ingestionActa Cirúrgica Brasileira -Vol. 27 (3) 2012 -237 CONCLUSÕES:No grupo tratado ocorreu um processo de subnutrição evidenciado pelo menor ganho de peso. Piora na cicatrização intestinal, indicada pela menor força de ruptura. Ocorreu um maior número de complicações pós-operatórias no grupo tratado.Descritores: Cicatrização. Alcoolismo. Etanol. Resistência à Tração. Hidroxiprolina. Ratos.

RESUMO -Contexto -A correção das hérnias volumosas e dos grandes defeitos da parede abdominal constitui grande desafio da prática cirúrgica, em virtude das dificuldades técnicas e do alto índice de complicações respiratórias e cardiovasculares. Objetivos -Apresentar experiência com a indução do pneumoperitônio progressivo no pré-operatório do tratamento cirúrgico das hérnias volumosas da parede abdominal. INTRODUÇÃOA correção das hérnias volumosas e dos grandes defeitos da parede abdominal constitui grande desafio da prática cirúrgica, em virtude das dificuldades técnicas e do alto índice de complicações locais e sistêmicas, como a recidiva e a infecção e, principalmente, as complicações respiratórias e cardiovasculares.Em razão disso, muitos recursos têm sido utilizados no pré e no pós-operatório destas cirurgias, de modo a permitir a sutura dos tecidos sem tensão e também prevenir as complicações anteriormente citadas (6) . A indução de pneumoperitônio progressivo pré-operatório visando o tratamento das hérnias muito grandes, com perda de domicílio na cavidade abdominal, foi introduzida na década de 1940 por GOÑI-MORENO (2) . Posteriormente, HERSZAGE (3) , MARTINEZ (7) e MAYAGOITIA et al. (9) promoveram interessantes modificações no método original.O pneumoperitônio progressivo pré-operatório é recomendado para pacientes com hérnias volumosas, com grande quantidade de vísceras no saco herniário, cuja redução do conteúdo para o interior da cavidade peritonial pode levar o paciente a desenvolver síndrome compartimental abdominal no pós-operatório (11) . A capacidade da cavidade abdominal varia de acordo com as alterações de volume do seu conteúdo. Na gravidez ou ascite, por exemplo, a parede abdominal distendese de forma gradual, aumentando consideravelmente o seu continente.Nas hérnias volumosas, no entanto, parte do conteúdo abdominal se aloja no saco herniário, ocorrendo queda da pressão intra-abdominal e, consequentemente, adaptação da mesma a menor volume.A queda da pressão intracavitária produz dificuldade no retorno venoso, vasodilatação e estase venosa abdominal, pélvica e dos membros inferiores. O diafragma também enfraquece, por não encontrar resistência à contração,

PURPOSE:To evaluate morphological changes of the gastric stump and not resected stomach mucosa after the completion of truncal vagotomy. METHODS: RESULTS:CONCLUSION: Truncal vagotomy is a safe and non-carcinogenic method in not resected and partially resected stomach.

Aim: To identify deregulated expression of miRNAs and target genes in cholangiocarcinoma (CCA), as well as drug-gene interactions that may be useful for patient treatment. Methods:We analyzed quantitative transcriptome and miRNA deep sequencing expression data from 45 samples, 36 CCA and 9 histologically normal biliary tissues, obtained from the public repository The Cancer Genome Atlas (TCGA). Bioinformatic methods were used to identify and integrate differential expression of miRNA and transcriptome profiles in CCA vs. normal tissues. Deregulated miRNA and corresponding target genes were identified and mapped into miRNA-mRNA networks. Results:Results showed 64 differentially expressed miRNAs (48 over and 16 under-expressed) between CCA and corresponding normal biliary tissues. Additionally, 432 genes (180 over and 252 under-expressed) were identified between CCA and normal samples. We identified individual miRNAs with the largest number of gene targets. Among these, miR-125a was over-expressed and had the highest number of direct interactions with 33 mRNA targets. miRNAs miR-122 and miR-139 were the under-expressed miRNAs with the highest number of interactions (9 targets each). miR-122 was found to modulate the expression of the transcription factor FOXM1, known to be involved in tumorigenesis and the matrix metalloproteinase MMP7, an important mediator of tumor invasion. miR-148 and miR-194 were predicted to modulate NQO1, which is up-regulated in cancer and associated with treatment resistance in cholangiocarcinoma. Conclusion:The novelty of our study is the identification of complex deregulated networks of miRNAs and target genes in CCA. miRNAs with a large number of targets may have a higher functional impact on cell regulation. These findings contribute for a better understanding of CCA biology. Identified miRNAs and target genes are potential candidates for the design of validation strategies towards the characterization of clinically applicable biomarkers; such biomarkers may be useful for the development of molecularly-targeted therapeutics that can benefit patients.