Primary hepatic gastrinoma is a rare disease, with fewer than 40 cases reported in the medical literature. Because it is located in an organ in which metastases are common, its diagnosis is difficult. We report a case of a 19 years old male patient with a history of gastric ulcers since the age of nine. Following gastric surgery, an antrectomy and a vagotomy, there was some alleviation of symptoms. Subsequently, the patient reported various intermittent episodes of diarrhea, diffuse abdominal pain, and vomiting. The patient underwent tomography, which revealed the presence of a hepatic mass measuring 19.5 cm × 12.5 cm × 17 cm. Primary hepatic gastrinoma was diagnosed based on laboratory examinations that indicated hypergastrinemia and a positron emission tomography/magnetic resonance study with somatostatin analogue that confirmed the liver as the primary site. After hepatic trisegmentectomy (II, III, IV, V, VIII), the patient’s symptoms improved. The case is notable for the presence of a rare tumor with uncommon dimensions.

Background We are reporting a rare case of MUTYH-associated polyposis, a colorectal cancer hereditary syndrome, diagnosticated after an intussusception. Colorectal cancer is an important cause of cancer related mortality that can be manifested by an intussusception, a rare occurrence in adults and almost always related to tumors. Approximately 5% of colorectal cancers can be attributed to syndromes known to cause hereditary colorectal cancer, such as MUTYH-associated polyposis, autosomal genetic syndrome associated with this disease. Case presentation We present the case of a 44 years old male, that sought medical consultation with a complaint of abdominal discomfort, that after five days changed its characteristics. The patient was sent to the emergency department were a CT-scan revealed intestinal sub-occlusion by ileocolic invagination. Right colectomy was carried out. The anatomic-pathological examination revealed a moderately differentiated mucinous adenocarcinoma and multiples sessile polyps, which led to the suspicion of a genetic syndrome. In the genetics analysis two mutations were observed in the MUTYH gene, and MUTYH-associated polyposis was diagnosticated. Conclusion This case demonstrates the importance of meticulous analysis of the patient examinations results to identify possible discrete alterations that can lead to improved understanding of disease.

HighlightsTransplantation patients presents associated risk factors that make appearance of incisional hernia more likely.Several aspects of the closure of large hernia defects following liver transplatation remain controversial.A successful approach for selected patient group for whom there is no established standard treatment is described.

Background: Ventral hernias are prevalent results in abdominal surgeries and may represent a surgical challenge in complex cases, mainly due to tension in the abdominal wall musculature. The failure of surgical correction may lead to a more morbid treatment for the patient, in addition to a considerable socioeconomic impact. In order to have a lower risk of complications, the use of Botulinum Toxin A (BTA), may be a preoperative alternative to reduce abdominal wall tension by causing sustained and reversible paralysis. This critical review of the literature proposes to evaluate the adjacent use of BTA in surgical corrections of ventral hernias.Methods: Using the PubMed database, the keywords 'ventral hernia', and 'botulinum toxin' were searched using the Boolean operator AND. Articles were selected based on their relevance and updated information. The outcomes of interest included the change in ventral hernia defect width and in lateral abdominal wall muscle length, pain, hernia recurrence and complications.Results: A total of 20 articles from 2009 to 2018 were found. We excluded some articles due to irrelevant technique, use of animal models and lack of outcome data. Reduction of the abdominal wall thickness increasing it`s length, less perioperative pain, hernia reduction and the correction with less tension were observed after the use of BTA injection. No complications occurred during applications. Conclusion:The use of BTA seems to be a promising alternative in the management of ventral hernias due to the capacity of reducing tension in the abdominal wall. Given the complexity of such cases, however, more studies are necessary to determine the efficacy of this method.

Background: Ventral hernias are prevalent results in abdominal surgeries and may represent a surgical challenge in complex cases, mainly due to tension in abdominal wall musculature. Failure of surgical correction may lead to a more morbid treatment, in addition to a considerable socioeconomic impact. In order to have a lower risk of complications, the use of botulinum toxin A (BTA), may be a preoperative alternative to reduce abdominal wall tension by causing sustained and reversible paralysis. This critical review of the literature proposes to evaluate the adjacent use of BTA in surgical ventral hernias corrections.Methods: Using the PubMed database, the keywords ‘ventral hernia’, and ‘botulinum toxin’ were searched using the Boolean operator AND. Articles were selected based on their relevance and updated information. The outcomes of interest included the change in ventral hernia defect width and in lateral abdominal wall muscle length, pain, hernia recurrence and complications.Results: A total of 20 articles from 2009 to 2018 were found. We excluded some articles due to irrelevant technique, use of animal models and lack of outcome data. Reduction of the abdominal wall thickness increasing its length, less perioperative pain, hernia reduction and the correction with less tension were observed after the use of BTA injection. No complications occurred during applications.Conclusion: The use of BTA seems to be a promising alternative in the management of ventral hernias due to its capacity of reducing tension in the abdominal wall. However, more studies are necessary to determine the efficacy of this method.

Introduction: hepatic cirrhosis (HC) is a disease with high morbidity and mortality in Brazil. Its treatment is complex and requires from lifestyle changes to large surgeries such as liver transplantation. To reach the best treatment results, it is necessary to guarantee a good patient’s adherence to the treatment. Studies indicate that the patient’s self-knowledge about his or her clinical condition is a determining factor in its adherence. Objectives: to assist in the design of an instrument that evaluates knowledge about the disease and treatment of HC. Methodology: The development process of the instrument will be divided into 3 stages: construction of the instrument (1st stage), evaluation of content validity and clarity of the instrument (2nd stage) and assessment of the reliability of the instrument (3 rd stage). Results: an instrument to evaluate the cirrhotic patient knowledge about the disease was made, analyzed by specialists and approved in the criteria proposed. Conclusions: 1) The development of the instrument followed the steps described in literature. 2) The suggestion of the evaluators allowed to restructure the questions making them clearer and more relevant to the proposal of the instrument. 3) it was possible to achieve satisfactorily the proposal of the construction of the instrument.

No abstract

BackgroundIslets of Langerhans transplantation is a promising alternative for glycemic control in patients with type 1 diabetes. The graft site is a factor that has large impact on the functioning of this transplant, and the stomach appears to be a promising location. Our objective is to describe a new experimental model for the grafting of Islets of Langerhans in rat stomachs.MethodologyIslets of Langerhans were extracted from 45 isogenic male rats of the Lewis lineage and transplanted into 9 isogenic rats of the Wistar lineage; 5 in the gastric body submucosa, and 4 in the gastric fundus submucosa. Normoglycemia was defined as two successive measurements of <250 mg/dL. No immunosuppression was used. The two groups glycemia control improvement were compared with t-student test.ResultsThe results obtained following the transplantation of the islets in 9 rats showed between 995 and 2310 islets transplanted (mean of 1367). The rats from the gastric submucosa group had a better glycemic level improvement, with a confidence equal to 83.94%.ConclusionIslets graft into the gastric fundus submucosa is a viable model with potential for adequate glycemic control. This model gives potential for new perspectives and future studies in this area.