ABSTRACT ABSTRACTResidency programs, especially in surgery, have been undergoing constant changes, not only in our country, but also internationally. Due to the depreciation of medical specialties and their lowering compensation, expectations and profile of residents in surgical fields are changing. The assessment of attitudes, experience in training and professional expectations among residents is an important topic. Recent international studies published in the area demonstrate this fact. It is worth noting the absence of similar studies in our country, as well as others. This study aims to assess the residents of the area of surgery, through a questionnaire, their attitudes, experiences during training and professional expectations. We applied and analyzed questionnaires adapted and translated into Portuguese to 50 professionals of both sexes and different years of residence. The results of this study showed high satisfaction with the specialty, but large financial concern and conflicting opinions about the future of the specialty.
Conception and design of the study; acquisition, analysis and interpretation of data; drafting the article; final approval of the version to be published.
Purpose:To compare four types of mesh regarding visceral adhesions, inflammatory response and incorporation.Methods:Sixty Wistar rats were divided into four groups, with different meshes implanted intraperitoneally: polytetrafluoroethylene (ePTFE group); polypropylene with polydioxanone and oxidized cellulose (PCD); polypropylene (PM) and polypropylene with silicone (PMS). The variables analyzed were: area covered by adhesions, incorporation of the mesh and inflammatory reaction (evaluated histologically and by COX2 immunochemistry).Results:The PMS group had the lowest adhesion area (63.1%) and grade 1 adhesions. The ePTFE and PM groups presented almost the total area of their surface covered by adherences (99.8% and 97.7% respectively) The group ePTFE had the highest percentage of area without incorporation (42%; p <0.001) with no difference between the other meshes. The PMS group had the best incorporation rate. And the histological analysis revealed that the inflammation scores were significantly different.Conclusions:The PM mesh had higher density of adherences, larger area of adherences, adherences to organs and percentage of incorporation. ePTFE had the higher area of adherences and lower incorporation. The PMS mesh performed best in the inflammation score, had a higher incorporation and lower area of adherences, and it was considered the best type of mesh.
Background: Pancreatic cancer is a highly aggressive tumor mainly associated with poor prognosis. Aim: The main goal of our study was to assess the expression levels of the genes SIGMAR1 and TMEM97 encoding s1R and s2R, respectively, in pancreatic cancer as compared to healthy controls. Materials and methods: Gene expression data of SIGMAR1 and TMEM97 were analyzed from a database (Pei H, et al. Cancer Cell 2009 Sep 8;16(3):259-66) comprising of n=52 pancreatic cancer specimens and normal specimens. The gene expression data were logtransformed, median centered per array and the standard deviation was normalized to one per array. All values from the transformed data were downloaded from the PubMed GEO dataset (https://www.ncbi.nlm.nih.gov/gds). Gene expression was considered to be significantly over-or under-expressed when p< 0.05 comparing pancreatic cancer vs. healthy controls. Results: The gene expression of SIGMAR1 was similar between pancreatic cancer and healthy controls. On the contrary, the TMEM97 was significantly under-expressed in pancreatic cancer compared to healthy controls (p = 0.0001). We also found a negative correlation between the gene expression of SIGMAR1 and TMEM97 (p = 0.0132 and Spearman's r= -0.2423). Deming regression analysis revealed significant negative association (p = 0.0132) between the gene expression of SIGMAR1 and TMEM97 given by the following equation: TMEM97 =À10,66*SIGMAR1 + 76,62. Conclusions: Our results indicate that TMEM97 that encodes s2R is significantly under-expressed in human pancreatic cancer. The prognostic value of s2R along with its possible utility as biomarker for pancreatic cancer requires further investigation.
chronic pseudotumoral pancreatitis by contrast-enhanced ultrasound. Materials and methods: Contrast-enhanced ultrasound with TIC-analysis was performed on 23 patients with focal pancreas lesions. The indicators were evaluated by phases: arterial e 13 sec, pancreatic e 17 sec, venous e 37 sec, delayed e 120 sec. Valuation options: the intensity and the time at which the maximum accumulation of contrast substance (time to peak) was achieved in the zone of detected focal changes and the pancreas parenchyma. All patients were operated on, tumors were verified morphologically: adenocarcinoma of the pancreas in 18(78%) patients, chronic pseudotumoral pancreatitis e in 5(22%) patients. Results: The results about intensity of the tumors obtained by the TIC-analysis do not allow to differentiate these pathological processes statistically significant (p>0,05), which, in all probability, due to the fact that pancreatic adenocarcinoma and chronic pseudotumoral pancreatitis have similar morphological characteristics in the form of pronounced desmoplastic stromal response and fibrosishyalinosis, respectively. The "Time to peak" parameter allowed us to determine statistically significant that pancreatic adenocarcinoma had an early accumulation of contrast agent (average 16 sec) and early washout (from an average of 17 sec); the chronic pseudotumoral pancreatitis had the slow accumulation of contrast agent (average 85 sec) and slow washout (from an average of 86 seconds) (p< 0,05). Conclusion: The "Time to peak" parameter at ultrasound examination with echocontrast allows statistically significantly differentiate adenocarcinoma of the pancreas and chronic pseudotumoral pancreatitis.
Introduction: Hydatidosis is an endemic zoonosis, caused by the parasite Echinoccocus granulosus. The liver is the most commonly affected organ. The disease is slowly progressive and may remain asymptomatic for several years. When symptomatic, the clinical presentation may vary from abdominal pain, jaundice and even anaphylactic shock in extreme cases. One of the most common complications of disease is the fistulization of a hydatid cyst into the biliary tree. However, other intrahepatic structures may be rarely involved. The purpose of this study is to report a case of liver hydatid cyst with direct portal vein invasion, an unusual complication of this condition. Methods: case report. Results: A 62-year-old man comes to the outpatient clinic referring abdominal pain in the right hypocondrium for 3 months. He denies jaundice and weight loss. He claims to have been travelling in South America for several months. CT scan shows multiple confluent cysts in segments VII and VIII, with heterogeneous content and parietal calcifications, measuring about 13 x 6.5 cm. Two other cystic images with the same characteristics are present in segment V. There is thrombosis of the right portal branch. The thrombus has attenuation similar to the cystic lesions described above, corresponding to the portal extension of the hydatid cyst. The patient underwent an open right hepatectomy and gross examination of the surgical specimen confirmed the presence of hydatid material inside the right portal branch. Conclusion: Although rarely, hydatid cysts may directly involve the portal vein.
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