[True Aneurysms of the Upper Limb: a Single-Centre Experience]. / Aneurismas Verdadeiros do Membro Superior: Revisão da Experiência de um Serviço.

INTRODUCTION: True arterial aneurysms of the upper limb are rare and their treatment is intended to avoid complications as distal embolization, compression of surrounding neurovascular structures or rupture. OBJECTIVE: The purpose of this study is to review the experience of a department in the surgical treatment of true arterial aneurysms of the upper limb. METHODS: A retrospective study was performed between January 2007 and August 2017. RESULTS: From a total of eleven patients, nine were male and two were female. One of the patients had surgery twice because of two consecutive aneurysms of the upper limb. From a total of twelve cases, two were subclavian, one was axillary and nine were brachial aneurysms. Three of them had degenerative/idiopathic aetiology, one was associated to a cervical rib and seven occurred in the setting of arteriovenous fistula or kidney graft. Five patients had emergent surgery and the others had elective surgery. All of the patients were submitted to aneurysmectomy. As 30-day complications, there were two haematomas, one compartment syndrome and two early graft occlusions. Four patients needed re-intervention. During the follow-up period, all the grafts initially preserved were patent. There were no further known complications or amputation procedures. CONCLUSION: In this review most of the aneurysms were found in patients with haemodialysis vascular access or kidney grafts. Despite the need for early re-intervention in some cases, the surgical treatment of true arterial aneurysms of the upper limb is a low morbidity procedure.

complicações como a embolização distal, a compressão de estruturas neurovasculares adjacentes ou a rotura. Objetivo: O objetivo deste estudo é rever a casuística de um serviço no tratamento cirúrgico de aneurismas verdadeiros do membro superior. Métodos: Foi realizado um estudo retrospetivo entre Janeiro de 2007 e Agosto de 2017. Resultados: De um total de onze doentes, nove eram do sexo masculino e dois do sexo feminino. Um dos doentes foi submetido a duas cirurgias por aneurismas consecutivos do membro superior. De um total de doze casos, dois tinham localização na artéria subclávia, um na axilar e nove na braquial. Três aneurismas eram de etiologia degenerativa/idiopática, um estava associado à presença de costela cervical e sete ocorreram no contexto de fístula arteriovenosa para hemodiálise e/ ou transplante renal. Cinco doentes foram submetidos a cirurgia em contexto de urgência e os restantes em contexto eletivo. Todos os pacientes foram submetidos a aneurismectomia. A morbilidade aos 30 dias correspondeu a dois hematomas, um síndrome do compartimento e duas oclusões precoces com um total de quatro pacientes a necessitarem de reintervenção. Durante o período de follow-up todos os doentes com o enxerto inicialmente preservado apresentaram permeabilidade dos enxertos. Não houve necessidade de cirurgia mutiladora. Conclusão: Neste estudo, a maioria dos aneurismas do membro superior ocorreram em doentes com fistulas arteriovenosas para hemodiálise e/ou transplantados renais. Apesar da necessidade de reintervenção em alguns casos, o tratamento cirúrgico dos aneurismas do membro superior acarreta uma baixa morbilidade.

Genetic variation in key genes associated with statin therapy in the Azores Islands (Portugal) healthy population.

BACKGROUND: Inter-individual variation in response to statins (efficacy and toxicity) has been described and may be due to polymorphisms implicated in drug pharmacokinetics or pharmacodynamics. AIM: This study investigates clinically relevant pharmacogenes underlying statin response in 170 healthy Azoreans. METHODS: Eight SNPs in candidate genes-HMGCR (rs3846662, rs17238540, rs17244841), CETP (rs708272), APOE (rs7412, rs429358) and SLCO1B1 (rs2306283, rs4149056)-were genotyped. RESULTS: The allele frequencies were similar to those reported for European derived populations, excepting SLCO1B1 c.388A>G (rs2306283), which has a significant difference when compared with the HapMap CEU population (p = 1 × 10(-8)). The results of statin efficacy showed that 9.1% of Azoreans are APOE4 carriers. This allele has been associated with lower LDLc reduction from statin therapy and also higher LDLc levels at baseline. Regarding SLCO1B1, associated with statin toxicity, 1.8% of individuals have two reduced-function alleles (c.521CC). CONCLUSION: The results contribute to overcome the lack of knowledge regarding the frequency of pharmacogenetic SNPs and their corresponding haplotypes in targeted populations, such as Azores islands. Moreover, the present work constitutes an initial step to implementing pharmacogenomics in clinical practice where physicians could use a patient's genetic make-up to optimize statin therapy, regarding efficiency and myopathy risk.

Teaching laparoscopy to residents: how can we select good candidates?

Modern medicine incorporates minimally invasive approaches in virtually all areas of surgery, and its application will continue to expand. The laparoscopic approach to many complex procedures is accompanied by a long learning curve that is not easily overcome or bypassed. Current training methods involve box trainers, virtual reality simulators, and live animal models that all attempt to replicate laparoscopic scenarios with varying degrees of success. The emphasis in training is now on intensive fellowship courses in high-volume centers that may overcome the learning curves associated with de novo development of laparoscopy. The many attempts to devise tools to assess laparoscopic skills have at best served as tests to discriminate between existing skill levels but do not provide a reliable tool to predict eventual laparoscopic ability. The traditional attributes of sound knowledge and clinical judgement that make a good surgeon are true of a good laparoscopist with perhaps the added requirement of stamina and motivation to complete the arduous training programs that are now needed to become competent in laparoscopy.