Laparoscopic resection of primary retroperitoneal schwannoma: A case report.

BACKGROUND: Schwannomas are rare, often benign, tumors deriving from Schwann cells that have low incidence in the retroperitoneal region (0.5% to 5%). Their diagnosis is hardly confirmed at early stage due to lack of specific features in signs, symptoms and imaging tests. Thus, it is necessary performing guided punch biopsy in order to identify it. Tumor removal is the treatment of choice due to its low sensitivity to radiation and chemotherapy. CASE SUMMARY: Forty-seven years old female patient who was hospitalized for elective orthopedic procedure, without complications, evolved with severe pain in the lower limbs, thigh and gluteal region associated with neurogenic claudication. Persistent pain required magnetic resonance imaging (MRI) of the lumbar spine, which showed epidural collection with dural compression and massive heterogeneous perihepatic nodular lesion. The surgical team opted for draining the collection, as well as requested an MRI of the abdomen and pelvis, whose analysis showed expansive lesion in the retroperitoneum, in close contact with the inferior vena cava and with the right renal vein. A guided puncture was performed for diagnostic clarification, which showed immunohistochemical profile compatible with schwannoma. The selected treatment comprised retroperitoneum tumor resection in association with laparoscopic cholecystectomy. The patient was discharged and remained stable after 4-mo follow-up; she remains under follow-up to check the need of cancer investigations. CONCLUSION: Schwannoma features requires surgical treatment based on laparoscopic resection, which often presents low relapse rates and optimistic prognosis.

Caring for the surgical patient with limited ICU resources.

PURPOSE OF REVIEW: The current review aims to discuss the management of surgical patients in an ICU in countries where resources are limited. RECENT FINDINGS: ICU beds in low-income and middle-income countries (LMICs) are limited and also have limited human and structural resources. The working force has been described to be the costliest factor. Nevertheless, costs for intensive care in LMICs are one third from the cost reported from high-income countries. Alternative options have been described, so intensive care can be delivered outside ICU. Examples are Rapid-Response Systems and Medical Emergency Teams. SUMMARY: The care of the surgical patients in an intensive care setting in countries with resource limitations should be optimized, protocols for standardized care implemented and Better research and resource allocation, as well as investment in healthcare training are essential for the development of intensive care in LMICs is necessary.

Colostomy closure: risk factors for complications / Fechamento de colostomia: fatores de risco para complicações

ABSTRACT Background : The restoration of intestinal continuity is an elective procedure that is not free of complications; on the contrary, many studies have proven a high level of morbidity and mortality. It is multifactorial, and has factors inherent to the patients and to the surgical technique. Aim : To identify epidemiological features of patients that underwent ostomy closure analyzing the information about the surgical procedure and its arising complications. Method : It was realized a retrospective analysis of medical records of patients who underwent ostomy closure over a period of seven years (2009-2015). Results : A total of 39 patients were included, 53.8% male and 46.2% female, with mean age of 52.4 years. Hartmann´s procedure and ileostomy were the mainly reasons for restoration of intestinal continuity, representing together 87%. Termino-terminal anastomosis was performed in 71.8% of cases, by using mainly the manual technique. 25.6% developed complications, highlighting anastomotic leakage; there were three deaths (7.6%). The surgical time, the necessity of ICU and blood transfusion significantly related to post-operative complications. Conclusion : It was found that the majority of the patients were male, with an average age of 52 years. It was observed that the surgical time, the necessity of blood transfusion and ICU were factors significantly associated with complications.

RESUMO Racional: A reconstrução de trânsito intestinal é procedimento realizado eletivamente que não é isento de complicações, pelo contrário, muitos estudos evidenciam alto grau de morbimortalidade, dependendo de fatores inerentes ao paciente, bem como da própria técnica operatória. Objetivo: Identificar as características epidemiológicas dos pacientes submetidos à reconstrução intestinal, além de analisar as informações a respeito do procedimento cirúrgico e as complicações decorrentes. Método: Foi realizado análise retrospectiva dos prontuários dos pacientes submetidos à reconstrução intestinal no período de sete anos (2009-2015). Resultado: Foram incluídos 39 pacientes, sendo 53,8% homens e 46,2% mulheres, com idade média de 52 anos. As operações tipo Hartmann e ileostomia foram os motivos para a reconstrução do trânsito intestinal, representando juntas 87% dos pacientes. A anastomose terminoterminal foi realizada em 71,8% dos casos, utilizando principalmente a técnica manual. 25,6% dos pacientes apresentaram complicações, destacando-se a fístula de anastomose. Três (7,6%) morreram. O tempo operatório, necessidade de UTI e transfusão sanguínea apresentaram significância estatística com as complicações pós-operatórias. Conclusão: Verificou-se que a maioria foi de homens, com média de idade de 52 anos. Entre as variáveis estudadas, observou-se que a duração da operação, a necessidade de transfusão sanguínea e de UTI foram fatores complicadores com significância estatística.

COLOSTOMY CLOSURE: RISK FACTORS FOR COMPLICATIONS.

BACKGROUND: : The restoration of intestinal continuity is an elective procedure that is not free of complications; on the contrary, many studies have proven a high level of morbidity and mortality. It is multifactorial, and has factors inherent to the patients and to the surgical technique. AIM: : To identify epidemiological features of patients that underwent ostomy closure analyzing the information about the surgical procedure and its arising complications. METHOD: : It was realized a retrospective analysis of medical records of patients who underwent ostomy closure over a period of seven years (2009-2015). RESULTS: : A total of 39 patients were included, 53.8% male and 46.2% female, with mean age of 52.4 years. Hartmann´s procedure and ileostomy were the mainly reasons for restoration of intestinal continuity, representing together 87%. Termino-terminal anastomosis was performed in 71.8% of cases, by using mainly the manual technique. 25.6% developed complications, highlighting anastomotic leakage; there were three deaths (7.6%). The surgical time, the necessity of ICU and blood transfusion significantly related to post-operative complications. CONCLUSION: : It was found that the majority of the patients were male, with an average age of 52 years. It was observed that the surgical time, the necessity of blood transfusion and ICU were factors significantly associated with complications.