BACKGROUND: Malignant transformation of endometriosis in the abdominal wall is a rare and still poorly understood event. Less than 30 cases have been reported in the worldwide literature. Most cases of solid tumors are report in a previous abdominal scar with malignant transformation of a focus of endometriosis. Presence of lymph node metastases in nearby chains is frequent and is associated with poor prognosis. CASE REPORT: We report a case of a 42-year-old woman with a history of abdominal surgery (Pfannenstiel) to resect abdominal wall endometriosis. Physical examination revealed a solid mass of approximately 10 cm x 6 cm in the anterior wall of the abdomen. Computed tomography (CT) of the abdomen and pelvis showed a heterogeneous, predominantly hypoattenuating expansive formation measuring 10.6 cm x 4.7 cm x 8.3 cm. The patient underwent exploratory incisional laparotomy, block resection of the abdominal mass and lymphadenectomy of the external and inguinal iliac chains. The abdominal wall was reconstructed using a semi-absorbable tissue-separating screen to reconstitute the defect caused by resection of the tumor. Histological evaluation revealed infiltration by malignant epithelioid neoplasia, thus confirming the immunohistochemical profile of adenocarcinoma with clear cell components. Lymphadenectomy showed metastatic involvement of an external iliac chain lymph node. CONCLUSION: Resection of the mass along with the abdominal wall, with wall margins, is the most effective treatment. Reconstruction is a challenge for surgeons. The patient has been followed up postoperatively for eight months, without any evidence of disease to date. I MD. Resident Physician,

Background: PCR (C-reactive protein), produced in the liver after stimuli of inflammatory mediators, is determined as a marker of inflammatory activity (adipocytokines) and is present within adipocyte cells; besides being an inflammatory product, many studies have shown to be a predictor of complications. Aim: To determine if the inflammatory state of the obese patient decreases after bariatric surgery, based on pre and post-operative PCR. Methods: A prospective, observational study in patients undergoing Roux-en-Y gastric by-pass surgery followed up for three months after surgery, with serum preoperative CRP in 30, 60 and 90 days after surgery. Results: A total of 19 patients, who had a mean CRP value before the surgical procedure of 0.80(±0.54) mg/dl, were followed, and when compared to the CRP with 30 days of surgery, they presented a significant increase to 2.68 mg/dl (p=0.012). When compared with the PCR of 60 days after the surgical procedure, it was also higher with the value of 3.32 mg/dl (p=0.27). However, at three months after surgery, the CRP showed a decrease when compared to the preoperative mark, with value of 0.45 mg/dl (p=0.0042). Conclusion: Roux-en-Y gastric bypass was able to decrease the chronic inflammation status of these patients, based on the value of CRP, with three months of surgery.

Obesity is an epidemic disease in the modern world. The clinical therapies, when isolated, are not effective to weight loss and control in morbidly obese patients (BMI > 40 Kg/m²) in long term. Surgery is the only method proven effective to achieve these goals. The Gastric Bypass Roux-Y (RYGB) is the most commonly performed bariatric surgery in the world including Brazil and is considered the gold standard of bariatric procedures because of its effectiveness in losing and maintaining long term weight loss associated with lower complication rates. There is a discussion about the need of using the sylastic ring at the end of gastric pouch, when the RYGB surgery is done, surgery known as the Fobi-Capella, because the high incidence of complications related to the ring and the difficulty in the intake of solids. Today, many surgical teams perform Capella’s surgery without placement the ring, with the argument that weight loss is similar without the limitations and complications related to the ring. The proposal of this study is analyzing the need to use the ring in morbidly obese patients comparing the weight loss after one year and nutrition quality. Thus, we compared two groups of patients, first group submitted in 2009 to gastric bypass (RYGB with ring or Capella’s surgery) and the second group operated in 2010 (RYGB without ring), analyzing the results for weight loss and quality of life after 1 year elapsed from surgery through established questionnaires as BAROS and specific questionnaires on nutrition quality. Of the total 21 patients, 12 patients were submitted to RYGB with ring and the other 9 patients were submitted RYGB without placement of the ring. The surgery is aimed at weight loss and resolution of comorbidities associated with obesity. It is considered an effective surgical technique when weight loss is greater than 50% of the overweight in 75% of patients. The study showed that both types of surgery, with or without the ring, reach the objective. The study noted that patients submitted to RYGB with ring have an important restriction on the intake of meat, while the group submitted to RYGB surgery without the ring eat better foods rich in protein and has no postprandial vomiting, with a better-quality food. Regarding quality of life, we observe significant improvement in all variables in both groups without statistical difference.