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Background Acute pancreatitis is the most common complication after ERCP, occurring in about 4 % of the procedures. Only the placement of pancreatic duct prosthesis and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) have shown benefit in the prevention of post-ERCP pancreatitis (PEP). Although the benefit of rectal administration of indomethacin or diclofenac is recommended by some studies and society guidelines especially in a selected group of high-risk patients, there is so far, no standardization of time or route of NSAID administration. The aim of the current study is to investigate the role of an intravenous NSAID administered before the procedure for PEP prevention. Methods In this randomized double-blind clinical trial, all consecutive patients who underwent ERCP were randomized to receive saline infusion with ketoprofen or saline, immediately before the procedure. Results A total of 477 patients were enrolled and completed follow-up. The majority of patients (72.1 %) had bile duct stones, and only 1.5 % had a clinical suspicion of sphincter of Oddi dysfunction. PEP developed in 5 of 253 (2 %) patients in the placebo group and in 5 of 224 (2.2 %) patients in the ketoprofen group (p = 1.). Conclusions Intravenous administration of ketoprofen immediately prior to ERCP did not result in reduction in PEP in a general population of ERCP patients.

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Objective: To provide a description of our transsexual population. Method: This descriptive observational study included 138 patients with a diagnosis of Transsexualism in Brazil, between March 1998 and September 2005. Demographic, clinical and psychiatry data were collected.Results: Age ranged from 16 to 54 years; 88.4% were male. The prevalence of sexually transmitted diseases was 19.5%, and 17.6% were HIV-positive. Hormone therapy was reported by 91.2%, and 47.4% referred drug and alcohol use; 14.2%, attempted suicide; and 12.5%, history of sexual abuse. Self-mutilation was reported by 5.2%s. Fifty-nine patients (42.7%) had at least one currently psychiatric comorbidity (axis I or II).Conclusions: Mental health professionals have a central role in coordinating the multidisciplinary care of transsexuals.

PALAVRAS-CHAVE-Aprendizagem Baseada em Problemas;-Educação Médica;-Métodos de Ensino. RESUMO A aprendizagem baseada em problemas (ABP) é uma técnica em que a transmissão do conhecimento se dá a partir de casos elaborados com base em casos reais, tendo como principal objetivo a busca da aprendizagem pelo próprio estudante. Este trabalho tem por finalidade revisar os artigos originais publicados nos últimos dois anos sobre o tema, na graduação médica. A maioria dos trabalhos revisados demonstrou bons resultados quando utilizada a ABP, principalmente no que diz respeito a pensamento crítico e habilidades técnicas. O uso concomitante de mais de uma técnica, porém, traz maiores benefícios na formação médica. ABSTRACT Problem-based learning (PBL) is a technique whereby knowledge is transmitted through cases basedon real life situations, aimed at self-motivated learning by the student. This study aims to review original articles published in the last two years on the subject in relation to medical education. It was observed that most of the studies reviewed showed good results when PBL was used, especially with regard to critical thinking and technical skills. The concomitant use of more than one method, however, brings benefits to medical training.

Background and aim  Guidelines recommend use of ligation and vasoactive drugs as first-line therapy and as grade A evidence for acute variceal bleeding (AVB), although Western studies about this issue are lacking. Methods  We performed a systematic review and meta-analysis of randomized controlled trials (RCT) to evaluate the efficacy of endoscopic treatments for AVB in patients with cirrhosis. Trials that included patients with hepatocellular carcinoma, use of portocaval shunts or esophageal resection, balloon tamponade as first bleeding control measure, or that received placebo or elective treatment in one study arm were excluded. Results  A total of 8382 publications were searched, of which 36 RCTs with 3593 patients were included. Ligation was associated with a significant improvement in bleeding control (relative risk [RR] 1.08; 95 % confidence interval [CI] 1.02 – 1.15) when compared to sclerotherapy. Sclerotherapy combined with vasoactive drugs showed higher efficacy in active bleeding control compared to sclerotherapy alone (RR 1.17; 95 % CI 1.10 – 1.25). The combination of ligation and vasoactive drugs was not superior to ligation alone in terms of overall rebleeding (RR 2.21; 95 %CI 0.55 – 8.92) and in-hospital mortality (RR 1.97; 95 %CI 0.78 – 4.97). Other treatments did not generate meta-analysis. Conclusions  This study showed that ligation is superior to sclerotherapy, although with moderate heterogeneity. The combination of sclerotherapy and vasoactive drugs was more effective than sclerotherapy alone. Although current guidelines recommend combined use of ligation with vasoactive drugs in treatment of esophageal variceal bleeding, this study failed to demonstrate the superiority of this combined treatment.