RESUMO
Organized pancreatic and peripancreatic collections are complications of pancreatitis and should be treated when symptomatic or complicated. When feasible, the endoscopic ultrasound approach presents high efficacy and low morbidity and mortality, making it the first likely option. Among the available accessories for endoscopic drainage, the lumen-apposing metal stent can be a better option, with a low migration rate; furthermore, it allows endoscopic necrosectomy. Here, we present the case of complex walled-off necrosis treated with two lumen-apposing metal stents in the same procedure. A 41-year-old male patient with walled-off necrosis presented with delayed gastric emptying and obstruction of the main biliary duct. Magnetic resonance imaging and endoscopic ultrasound revealed two non-communicating collections. We opted for endoscopic ultrasound-guided drainage with the deployment of two simultaneous lumen-apposing metal stents: one transduodenal and the other transgastric, with clinical improvement. After three weeks, endoscopic retrograde cholangiopancreatography showed a biliary fistula communicating with the periduodenal collection, which was treated with a biliary plastic stent. An endoscopic necrosectomy was performed, and the metal stents were removed. Control magnetic resonance imaging demonstrated improvement. The patient was asymptomatic at the six-month follow-up. The treatment of symptomatic complex walled-off necrosis remains a challenge and may require multiple endoscopic approaches; moreover, surgical treatment may be necessary in case of failure. In the present report, we demonstrate that the deployment of two lumen-apposing metal stents in the same procedure is feasible when necessary as it was associated with technical success and short-term clinical success.
RESUMO
Colorectal cancer represents the most common malignancy of the gastrointestinal tract and the second most frequently diagnosed malignancy in adults. The most common site of metastases is the liver and 40% of patients in stage IV have liver only disease.1 Hepatic metastases are the major determinants of morbidity and mortality in these patients, with surgery being the treatment of choice or even curative in these cases.2 Therefore, aggressive surgeries should be considered in patients with liver only disease. In this context, hepatectomy and metastasectomy have emerged as promising techniques for improving survival in patients with metastatic disease, also providing long-term cure.3 The use of liver volumetrics, tridimensional reconstructions with vessel extraction and 3D virtual surgery simulations allows better surgical planning and potentially decrease transfusions, surgery time and complications.4 For major hepatectomies (>4 resected segments), surgical planning with computed angiotomography and liver remnant volume calculation potentially increases the safety of surgery. We report a case in which preoperative 3D surgical simulation was crucial for conducting a safe major hepatectomy in a patient with multiple colorectal liver metastases.
RESUMO
Introdução: A doação de órgãos envolve diversas entidades e profissionais para que seja bem sucedida e para que os familiares do provável doador sintam-se seguros quanto a essa decisão. Objetivos: Conhecer o perfil dos potenciais doadores em um complexo hospitalar do interior do estado de São Paulo e verificar melhorias no serviço de captação de órgãos e tecidos após a contratação de um profissional treinado com dedicação exclusiva. Material e Métodos: Estudo descritivo com informações obtidas do banco de dados da Comissão Intra-hospitalar de Doação de Órgãos e Tecidos dos hospitais escola Padre Albino e Emílio Carlos, referentes aos casos notificados de potenciais doadores no período de Janeiro de 2008 a Dezembro de 2013. As variáveis estudadas foram: dados demográficos, circunstância do óbito, parentesco na entrevista do acolhimento, motivos de recusa e impacto da contratação de um profissional treinado exclusivamente para o processo de doação. Resultados: Dos 235 potenciais doadores notificados, obteve-se 142 (60,4%) doações não efetivas e 93 (39,6%) efetivas, das quais 149 (63,4%) eram do gênero feminino e 165 (70,2%) apresentavam ensino fundamental. A religião ma...
Introduction: Organ donation involves several organizations and professionals in order to be successful and to provide to the families of a potential donor a safety feeling about their decision. Objectives: To know the profile of potential donors at a Hospital in the state of São Paulo and to verify improvements of the organs and tissues catchment service after hiring a trained professional with exclusive dedication. Methods: Descriptive study with information obtained from the database of the hospital organs and tissues donation committee from the School Hospitals Padre Albino and Emilio Carlos, referring to the reported cases of potential donors in the period from January 2008 to December 2013.The variables studied were: demographics, circumstances of death, kinship in the reception interview, reasons for refusal and impact of hiring a professional trained exclusively for the donation process. Results: Among the 235 potential donors reported, 142 (60.4%) effective and 93 ineffective (39.6%) donations were obtained. 149 (63.4%) of them were female and 165 (70.2 %) had primary education. The most prevalent religion was the Catholic, accounting for 182 (77.4%) potential donors. The average age of the donors was 62 years, with a median of 53 years. The area in which died the potential donor and the degree of kinship of the person responsible for the decision to donate were the statistically significant variables which defined the profile of the potential donor. The main reason for refusing the donation was the desire to keep intact the body of the deceased. There was a significant increase in donations right after hiring a professional...
Introducción: La donación de órganos comprende varias entidades y profesionales para tener éxito y para que los familiares del probable donante se sientan seguros de tal decisión. Objetivos: Conocer el perfil de los potenciales donantes en el ambiente hospitalario en el interior del estado de São Paulo y verificar mejoras en el servicio de adquisición de órganos y tejidos luego de contratar un profesional entrenado con dedicación exclusiva. Material y Método: Estudio descriptivo con información de la base de datos de la comisión inter-hospitalaria de donación de órganos y tejidos de los Hospitales Escuela Padre Albino y Emílio Carlos, referente a los casos reportados de posibles donantes desde Enero de 2008 a Diciembre de 2013. Las variables estudiadas fueron: datos demográficos, las circunstancias de la muerte, parentesco en entrevista de aceptación, los motivos de la recusa no admisión y el impacto de contratar a un profesional...
