Hernia recurrence inventory: inguinal hernia recurrence can be accurately assessed using patient-reported outcomes.

PURPOSE: Relying solely on in-person encounters to assess long-term outcomes of hernia repair leads to substantial loss of information and patients lost-to-follow-up, hindering research and quality improvement initiatives. We aimed to determine if inguinal hernia recurrences could be assessed using the Ventral Hernia Recurrence Inventory (VHRI), a previously existing patient-reported outcome (PRO) tool that can be administered through the telephone and has already been validated for diagnosing ventral hernia recurrence. METHODS: A prospective, multicentric comparative study was conducted. Adult patients from two centers (United States and Brazil) at least 1 year after open or minimally invasive inguinal hernia repair were asked to answer the questions of the VHRI in relation to their prior repair. A physical exam was then performed by a blinded surgeon. Testing characteristics and diagnostic performance of the PRO were calculated. Patients with suspected recurrences were preferentially recruited. RESULTS: 128 patients were enrolled after 175 repairs. All patients answered the VHRI and were further examined, where a recurrence was present in 32% of the repairs. Self-reported bulge and patient perception of a recurrence were highly sensitive (84-94%) and specific (93-94%) for the diagnosis of an inguinal hernia recurrence. Test performance was similar in the American and Brazilian populations despite several baseline differences in demographic and clinical characteristics. CONCLUSION: The VHRI can be used to assess long-term inguinal hernia recurrence and should be reestablished as the Hernia Recurrence Inventory (HRI). Its implementation in registries, quality improvement efforts, and research could contribute to improving long-term follow-up rates in hernia patients.

Consequences of the implementation of the Model for End-stage Liver Disease system for liver allocation in Brazil.

BACKGROUND: In July 2006, the system for liver allocation in Brazil started to rely on the Model for End-stage Liver Disease (MELD) scale, replacing the previous chronological criteria. Under the new system, the score for listing pediatric patients is obtained by multiplication of the calculated PELD score by 3. The current criteria also features extra points for diseases such as hepatocellular carcinoma (HCC). This study sought to analyze the consequences of implementation of the MELD system on waiting list mortality, posttransplant survival rates and characteristics of the transplanted patients. METHODS: We retrospectively studied data from the State Health Secretariat of São Paulo, regarding all patients registered on the waiting list for liver transplantation in the State of São Paulo, in two periods: July 2005 to July 2006 (pre-MELD era) and July 2006 to July 2010 (MELD era). Patient survival rates calculated using the Kaplan-Meier method were compared by the log-rank test. P values <.05 were considered statistically relevant. RESULTS: After implementation of the MELD, waiting list registrations decreased by 39.8%; the percentage of transplants in HCC recipients increased from 2.4% to 23.7%; pediatric transplants increased from 6.5% to 9.3%; deaths on the list fell from 599 in the pre-MELD era to 359 in the last year analyzed; recipients with higher MELD displayed significantly lower posttransplant survival rates; HCC patients, better survival after transplantation (P = .002); No difference was observed comparing survival rates between pre-MELD and MELD eras (P = 474) or between adults and children (P = .867). CONCLUSION: Under the MELD system for liver allocation in Brazil, there was a reduction in waiting list mortality and an increased number of transplantations in pediatric and HCC recipients. Survival rates of patients with higher MELD score were inferior. However, this result was offset by the greater survival in HCC recipients, with no difference in patient survival rates between the pre-MELD and MELD eras.

Systematic review and meta-analysis of biliary reconstruction techniques in orthotopic deceased donor liver transplantation.

BACKGROUND: Biliary complications remain a major cause of morbidity and mortality in liver transplantation and the biliary anastomosis technique could increase this risk. The aim of this study was to compare the effects of biliary reconstruction techniques in orthotopic liver transplantation on the incidence of biliary complications. METHODS: A systematic review and meta-analysis using the Medline-PubMed, EMBASE, Scielo-LILACS, and Cochrane Databases were performed comparing biliary reconstruction techniques in liver transplantation with regard to the occurrence of biliary complications. Number needed to treat (NNT) was calculated at a 95% confidence interval. RESULTS: Fifty-seven articles were selected (3 randomized clinical trials, 6 clinical trials, and 48 historical cohort studies). There was a lower risk for biliary complications (NNT = 6) using end-to-end choledochocholedochostomy (EECC) without drainage compared with EECC with drainage. The biliary complication risk was lower (NNT = 4) for side-to-side choledochocholedochostomy (SSCC) with drainage compared with SSCC without drainage. No difference was found between EECC without drainage and SSCC with drainage. CONCLUSIONS: According to our results, considering the highest level of evidence available in the literature, we suggest that biliary reconstruction in liver transplantation should be performed using EECC or SSCC, without drainage in the former, and with drainage in the latter.

Experimental training model of pancreas transplant.

UNLABELLED: Pancreas transplant (Ptx) is the gold standard for the treatment of type I diabetes, mainly when associated with renal failure. The number of Ptx is increasing worldwide, but in developing countries, such as Brazil, the number of centers is small and transplant surgeons need to practice the technique. METHODS: For this model, 21 pancreas harvestings were performed in patient corpses after death from extra-abdominal causes, without pancreatic disease and peritoneal or systemic infection. The vessels of the grafts were prepared on the backtable according to the usual practice in humans. The pancreas was implanted in the inferior vena cava and aorta of mixed breed dogs, with 10 exocrine-bladder drainage and 11 duodenum-ileal anastomosis. RESULTS: There were anastomotic strictures of the portal vein in dogs 1 and 2. There was no arterial stricture or large bleeding. None of the animals died until the revascularization of the graft. Dogs 2, 5, and 8 died during the exocrine anastomosis. The arterial flow was initially high, but at the end of the procedure there were thromboses of small arteries. CONCLUSION: The experimental surgical technique model is feasible, repeating the stages of clinical pancreatic transplantation and allowing the training of surgeons.

Introducao de um metodo rapido e simples para a determinacao de imunecomplexos circulantes em neoplasias:correlacao com o progresso da doenca. / A rapid and simple method for the determination of circulating immune complexes in neoplasms: correlation with the course of the disease

No presente trabalho os autores introduzem um metodo rapido, simples e sensivel de quantificacao de imunecomplexos circulantes no soro de individuos normais e em pacientes portadores de neoplasias solidas. Elevacoes significativas foram encontradas em pacientes portadores de neoplasias, quando comparados com aqueles observados em individuos normais, e comparavel a valores observados em pacientes portadores de colagenoses. Sao discutidas as aplicacoes deste ensaio e demonstradas as correlacoes com a presenca de massa tural localizada ou disseminada

Dupla vesicular biliar. Apresentacao de um caso simulando tumor abdominal. / Double gallbladder. Report of a case simulating abdominal tumor

Os autores apresentam um caso de vesicula dupla, sendo que uma delas simulava um tumor abdominal. Tecem consideracoes acerca da incidencia, anatomia e quadro clinico