Suprapubic laparoscopic cholecystectomy: technique and preliminary results / Colecistectomia laparoscopica suprapubica: tecnica e resultados preliminares

Background : The minimally invasive abdominal surgery has evolved to reduce portals, culminating with a single incision and natural orifice operation. However, these methods are still expensive, difficult to implement and with questionable aesthetic results. Aim : To present the standardization and preliminary results of a technique for performing laparoscopic suprapubic access by the principle which was called the Supra Pubic Endoscopic Surgery for cholecystectomy. Method : The average body mass index of patients, the mean operative time, clinical data of the postoperative complications and quality of life were prospectively studied. The operation incisions consisted of: A) umbilical for instrumental dissection and clipping; B) in the right groin for handling and gallbladder gripping; C) suprapubic for the camera. With the patient in reverse Trendelenburg and left lateral decubitus, the operation flew by the camera trocar in C, proceeding with dissection and isolation of the biliary pedicle, identification of cystic duct and artery, with usual instrumentation. Transcystic intraoperative cholangiography was performed in all cases in which there were indications. The procedure was completed with clipping and sectioning of the cystic duct and artery, retrograde resection of the gallbladder and extracting it by the umbilical trocar incision under direct vision. Results : Thirty patients undergone this surgical procedure between March and June 2012 and were evaluated. The mean age was 40.7 years and the indications were typical biliary colic in 18 cases (60 %), cholecystitis in five cases (16.6 %), biliary pancreatitis in one case (3.3%); polyp in three cases (10%) and obstructive jaundice at three cases (10%). The average body mass index was 27.8 (23.1-35.1) and surgical time ranged between 24 and 70 minutes. Conclusion : The technique proved to be feasible and safe , with no significant complications, and satisfactory cosmetic results. .

Racional: A cirurgia minimamente invasiva abdominal tem evoluído para redução dos portais, culminando com a por incisão única e a operação por orifícios naturais. Porém, estes métodos ainda são dispendiosos, de difícil execução e com resultados estéticos questionáveis. Objetivo : Apresentar a padronização e os resultados preliminares de uma técnica para realização de colecistectomia por acesso suprapúbico pelo princípio que foi chamado de Supra-Pubic Endoscopic Surgery para colecistectomia . Método: Foram pesquisados prospectivamente o índice de massa corporal médio dos pacientes, a média do tempo operatório e os dados clínicos do pós-operatório com vistas às complicações e qualidade de vida. A operação consistiu de incisão: A) umbilical para o instrumental de dissecção e clipagem; B) na região inguinal direita para manipulação e preensão da vesícula biliar; C) suprapúbica para a câmera. Com o paciente em proclive e decúbito lateral esquerdo, a operação transcorria com a câmera no trocarte C. Procedia-se a dissecção e isolamento do pedículo biliar, identificação de ducto e artéria císticas, utilizando instrumental habitual. Colangiografia transoperatória transcística era realizada em todos os casos em que havia indicação. O procedimento era concluído com a clipagem e secção do ducto e artéria cística, ressecção retrógrada da vesícula biliar e extração dela pelo trocarte na incisão umbilical, sob visão direta. Resultados : Foram avaliados 30 pacientes submetidos a esta modalidade cirúrgica entre março e junho de 2012. A média de idade foi de 40,7 anos ...

In silico analysis of ESTs from roots of Rangpur lime (Citrus limonia Osbeck) under water stress

CitEST project resulted in the construction of cDNA libraries from different Citrus sp. tissues under various physiological conditions. Among them, plantlets of Rangpur lime were exposed to hydroponic conditions with and without water stress using PEG6000. RNA from roots was obtained and generated a total of 4,130 valid cDNA reads, with 2,020 from the non-stressed condition and 2,110 from the stressed set. Bioinformatic analyses measured the frequency of each read in the libraries and yielded an in silico transcriptional profile for each condition. A total of 40 contigs were differentially expressed and allowed to detect up-regulated homologue sequences to well known genes involved in stress response, such as aquaporins, dehydrin, sucrose synthase, and proline-related synthase. Some sequences could not be classified by using FunCat and remained with an unknown function. A large number of sequences presented high similarities to annotated genes involved with cell energy, protein synthesis and cellular transport, suggesting that Rangpur lime may sustain active cell growth under stressed condition. The presence of membrane transporters and cell signaling components could be an indication of a coordinated morphological adaptation and biochemical response during drought, helping to explain the higher tolerance of this rootstock to water stress.

Analysis of expressed sequence tags from Citrus sinensis L. Osbeck infected with Xylella fastidiosa

In order to understand the genetic responses resulting from physiological changes that occur in plants displaying citrus variegated chlorosis (CVC) symptoms, we adopted a strategy of comparing two EST libraries from sweet orange [Citrus sinensis (L.) Osbeck]. One of them was prepared with plants showing typical CVC symptoms caused by Xylella fastidiosa and the other with non-inoculated plants. We obtained 15,944 ESTs by sequencing the two cDNA libraries. Using an in silico hybridization strategy, 37 genes were found to have significant variation at the transcriptional level. Within this subset, 21 were up-regulated and 16 were down-regulated in plants with CVC. The main functional categories of the down-regulated transcripts in plants with CVC were associated with metabolism, protein modification, energy and transport facilitation. The majority of the up-regulated transcripts were associated with metabolism and defense response. Some transcripts associated with adaptation to stress conditions were up-regulated in plants with CVC and could explain why plants remain alive even under severe water and nutritional stress. Others of the up-regulated transcripts are related to defense response suggesting that sweet orange plants activate their defense machinery. The genes associated with stress response might be expressed as part of a secondary response related to physiological alterations caused by the infection.

Comparative analysis of differentially expressed sequence tags of sweet orange and mandarin infected with Xylella fastidiosa

The Citrus ESTs Sequencing Project (CitEST) conducted at Centro APTA Citros Sylvio Moreira/IAC has identified and catalogued ESTs representing a set of citrus genes expressed under relevant stress responses, including diseases such as citrus variegated chlorosis (CVC), caused by Xylella fastidiosa. All sweet orange (Citrus sinensis L. Osb.) varieties are susceptible to X. fastidiosa. On the other hand, mandarins (C. reticulata Blanco) are considered tolerant or resistant to the disease, although the bacterium can be sporadically detected within the trees, but no disease symptoms or economic losses are observed. To study their genetic responses to the presence of X. fastidiosa, we have compared EST libraries of leaf tissue of sweet orange Pêra IAC (highly susceptible cultivar to X. fastidiosa) and mandarin ‘Ponkan’ (tolerant) artificially infected with the bacterium. Using an in silico differential display, 172 genes were found to be significantly differentially expressed in such conditions. Sweet orange presented an increase in expression of photosynthesis related genes that could reveal a strategy to counterbalance a possible lower photosynthetic activity resulting from early effects of the bacterial colonization in affected plants. On the other hand, mandarin showed an active multi-component defense response against the bacterium similar to the non-host resistance pattern.

Doença renal terminal associada à obstrução crônica do trato urinário por cálculo vesical gigante / End stage renal disease following long-term urinary tract obstruction dDue to giant bladder stone

Cálculos vesicais compreendem 5 de todos os cálculos do trato urinário e estão freqüentemente associados à presença de corpos estranhos, obstrução e infecção. Relatamos o caso de um paciente do sexo masculino, 23 anos, que deu entrada na Emergência do Hospital Geral de Fortaleza com quadro de disúria, peritonite e sinais de uremia. A radiografia abdominal mostrava uma imagem hiperdensa na topografia vesical. A ultrassonografia abdominal mostrava hidronefrose bilateral. Os exames laboratoriais evidenciaram creatinina sérica 7,6 mg/dL, potássio 7,1 mEq/L, pH 7,29, pCO2 15,7 mmHg e HCO37,5 mEq/L. Hemodiálise diária foi instituída devido à severa uremia. Laparotomia foi realizada, sendo os principais achados cirúrgicos coleção purulenta nacavidade pélvica, perfuração na parede lateral da bexiga e divertículo vesical. Um cálculo vesical gigante, com o maior diâmetro de 7 cm, foi identificado e retirado da bexiga. O paciente evoluiu estável, necessitando de hemodiálise três vezes por semana. Este caso ilustra a ocorrência de uma importante complicação de um cálculo vesical gigante, que causou a obstrução crônica do trato urinário, levando ao desenvolvimento de insuficiência renal crônica. A pronta instituição do tratamento dialítico no primeiro dia de internamento e a cirurgia de urgência foram cruciais para a recuperação do paciente que passou a necessitar de hemodiálise regular.

Esclerodermia sistêmica e gravidez - Relato de caso / Systemic sclerosis and pregnancy - A case report

Os autores realtam um caso de gravidez em mulher portadora de Esclerodermia Sistêmica que evoluiu com sinais vasculares, piora da lesäo da pele e crescimento intra-uterino retardado finalizando com perda fetal

Doença de Takayasu e gestaçäo: relato de caso / Takayasu's disease and pregancy: case report

Os autores relatam caso de gravidez em mulher portadora de doença de Takayasu com um abortamento espontâneo prévio. A gestaçäo evoluiu de maneira satisfatória, sem complicaçöes causadas pela doença. A PA manteve-se estável durante a gestaçäo, estando a paciente em uso de vasodilatadores que favoreceu a diminuiçäo dos sintomas da doença. A paciente foi acompanhada por equipe médica, com parto cesáreo, por questöes exclusivamente obstétricas, e a obtençäo de um recém-nato com peso adequado.

Deformidades congênitas da coluna vertebral: estudo de 46 pacientes / Congenital deformities of the spine: study of 46 patients

Os autores estudaram dados obtidos de prontuários e exames radiográficos de 46 pacientes portadores de escoliose e/ou cifose congênita quanto ao sexo, idade, tipo, localizaçao, intensidade da deformidade e presença de outras malformaçöes e comparam seus resultados aos dos obtidos na literatura.