Chronic pancreatitis associated with chylous ascites simulating liver cirrhosis.

Purpose. Ascites, esophageal varicose veins, and acute digestive bleeding are unusual in the clinical presentation of chronic pancreatitis; however, these symptoms are frequently observed in patients with liver cirrhosis. Moreover, it is unlikely to observe chylous ascites in both presentations. Method. We report a patient who presented with chronic pancreatitis with splenic vein thrombosis, necrosis of the pancreatic neck and tail, esophageal varicose veins with previous bleeding, and chylous ascites. After partial pancreatectomy, his treatment was based on low-fat oral diet with medium-chain triglycerides with remarkable resolution of the chylous ascites. After 3 years, he presented with decompensated chronic pancreatitis and underwent plexus alcoholization and biliary-enteric deviation with an unremarkable postoperative course. Conclusion. Ascites is rarely associated with chronic pancreatitis, and chylous ascites is even rarer. The treatment of atraumatic chylous ascites is based on resolution of the obstructive causes and should include drainage and a low-fat diet with medium-chain triglycerides.

[Damage control surgery: an update]. / Cirurgia para controle de danos: estado atual.

The damage control surgery is a widely accepted concept today among abdominal trauma specialists when it comes to the severely traumatized. In these patients, the death is due, in most cases, to the installation of the lethal triad (hypothermia, coagulopathy and acidosis) and not the inability to repair the serious initial damage. In this review, the authors address the lethal triad in its three phases and emphasize the measures taken to prevent them, as well as discussing the indication and employment of damage control surgery in its various stages. Restoring the physiological status of the patient in the ICU, so that he/she can be submitted to final operation and closure of the abdominal cavity, another challenge in severe trauma patients, is also discussed.

Cirurgia para controle de danos: estado atual / Damage control surgery: an update

A cirurgia de controle de danos é um conceito amplamente aceito atualmente entre os especialistas em trauma abdominal quando se trata de doentes gravemente traumatizados. Nestes pacientes a morte decorre, na maioria das vezes, da instalação da tríade letal (hipotermia, coagulopatia e acidose) e não da incapacidade de reparar as graves lesões presentes. Nesta revisão, os autores abordam a tríade letal, em suas três fases, e enfatizam as medidas adotadas para preveni-las. Além de discutirem a indicação e o emprego da cirurgia para o controle de danos em seus vários estágios. A restauração dos padrões fisiológicos do doente na UTI, para que o mesmo possa ser submetido à operação definitiva e ao fechamento da cavidade abdominal, outro desafio no paciente traumatizado grave, também é discutida.

The damage control surgery is a widely accepted concept today among abdominal trauma specialists when it comes to the severely traumatized. In these patients, the death is due, in most cases, to the installation of the lethal triad (hypothermia, coagulopathy and acidosis) and not the inability to repair the serious initial damage. In this review, the authors address the lethal triad in its three phases and emphasize the measures taken to prevent them, as well as discussing the indication and employment of damage control surgery in its various stages. Restoring the physiological status of the patient in the ICU, so that he/she can be submitted to final operation and closure of the abdominal cavity, another challenge in severe trauma patients, is also discussed.

Agenesis of the right hepatic lobe.

Introduction. Agenesis of the right lobe of the liver is a rare finding and was defined as the absence of liver tissue on the right side, with preservation of the middle hepatic vein, without previous disease or surgery. It is usually an incident finding reveled by imaging exams or during abdominal surgery. Case Report. A 32-year-old male patient was admitted to the hospital for abdominal discomfort and loss of appetite. Imaging studies revealed the absence of the right hepatic lobe and hypertrophied left hepatic segments. Discussion. Anomalies of hepatic morphology are rare and correspond to developmental defects during embryogenesis, are a rare diagnosis, and are generally diagnosed incidentally based on imaging. Agenesis or hypoplasia of the right lobe may predispose the patient to the development of portal hypertension and esophageal varices. Surgical knowledge of such anatomical agenesis is necessary for surgical planning, for the appropriate identification of intraoperative surgical findings, and for the design of the postoperative approach to therapy. Conclusion. Agenesis of the right hepatic lobe is a rare condition. We want to highlight the importance of understanding the condition. Surgeons must recognize the entity in order to deal appropriately with the findings.

Percepção da qualidade de vida no trabalho dos neurocirurgiões em São Paulo / Perception on quality of life at work by neurosurgeons in São Paulo

Contexto: Estudos da percepção da qualidade de vida no trabalho (QVT) permitem estimar a percepção de uma classe profissional inteira, identificar desequilíbrios específicos e proporcionar políticas de desenvolvimento profissional. Objetivo: Avaliar a percepção da QVT dos neurocirurgiões que trabalham em Serviços de Emergência em São Paulo usando instrumentos de validação disponíveis na língua portuguesa. Método: A percepção da QVT dos neurocirurgiões da cidade de São Paulo (Capital) foi estudada com questionário validado para língua portuguesa. Resultados: Cinquenta e oito neurocirurgiões responderam ao questionário. A análise revelou fortes tendências negativas na maioria das áreas de QVT. As áreas com forte tendência negativa deveriam ser tratadas com políticas específicas. Conclusão: Há fortes tendências negativas em quase todos os domínios da QVT.

Context: Studies of the perception of quality of work life (QWL) allow estimating the perception of an entire professional class, identifying specific imbalances and provide professional development policies. Objective: To evaluate the perception of QWL of neurosurgeons working in Emergency Services in São Paulo, using available validated instrument in Portuguese language. Method: The city of São Paulo (Capital) was defined as the geographical area to be studied with a validated questionnaire. Results: Fifty-eight neurosurgeons answered the QWL questionnaire revealing strong negative trends in most areas of QWL. These responses can be compared across institutions and over different periods of time, potentially allowing the identification of locations with more suitable development areas related to QWL. To improve the perception of QWL means, areas with strong negative trend should be treated with specific policies. Conclusion: There is strong negative trends in almost all areas of QWL.

A systematic review of randomized trials on the effect of cervical disc arthroplasty on reducing adjacent-level degeneration.

OBJECT: Anterior cervical discectomy and fusion had been considered a safe and effective procedure for radiculopathy and myelopathy in the cervical spine, but degeneration in adjacent spinal levels has been a problem in some patients after fusion. Since 2002, cervical disc arthroplasty has been established as an alternative to fusion. The objective of this study was to review data concerning the role of cervical arthroplasty in reducing adjacent-level degeneration. METHODS: A systematic review was performed using the MEDLINE, EMBASE, Cochrane, and LILACS databases, focusing on a structured question involving the population of interest, types of intervention, types of control, and outcomes studied. RESULTS: No study has specifically compared the results of arthroplasty with the results of fusion with respect to the rate of postoperative development of adjacent-segment degenerative disease. One paper described a rate for adjacent-level surgery. The level of evidence of that paper was classified 2b, and although its authors found a statistically significant between-groups difference (arthroplasty vs fusion) using log-rank analysis, re-analysis according to number needed to treat (in the current paper) did not reveal statistical significance. CONCLUSIONS: Adjacent-level degeneration has not been adequately studied in a review of the available randomized controlled trials on this topic, and there is no clinical evidence of reduction in adjacent-level degeneration with the use of cervical arthroplasty.