Use of videoscopy as an aid in the placement of tissue expanders.

In this preliminary note the authors describe a new technique consisting in the use of videoscopy as an aid in surgery for the placement of tissue expanders in a patient with sequelae due to burn scarring on the posterior thorax. The surgical steps are described, together with the technical details of the use of the videolaparoscopy equipment. The authors discuss the advantages of this new technique which permits the use of small routes of approach, perpendicular to the expansion area, thus, providing an excellent view with a minimal amount of trauma. The method prevents complications such as dehiscence with prosthesis exposure and hematomas. A precise dissection of the necessary area can be achieved by this technique, a process facilitated by the continuous expansion and bulging of the dissected area obtained by controlled injection of carbon dioxide. The disadvantages are the high cost of the procedure and the long surgical time. The authors emphasize the need for future rationalization of the indications and for an appropriate methodology for the procedure.

Videolaparoscopic cholecystectomy. Report of the first Brazilian series.

The authors present the first Brazilian series of laparoscopic cholecystectomy. Forty-one patients were operated on for gallstone disease between July and December 1990. Thirty-one operations were conducted by laparoscopy with no complications and good recovery of the patients. Two had to be submitted to laparotomy due to acute cholecystitis and a very difficult field for dissection. The authors concluded that the procedure is feasible, safe and has great advantages such as better cosmetic result, shorter hospital stay and home recovery time, lower postoperative pain and lower personal and social cost.

Duodenogastric bile reflux before and after selective proximal vagotomy with and without pyloroplasty.

Duodenogastric bile reflux was determined by nasogastric aspiration in 60 patients with prepyloric, pyloric, or duodenal ulcer before and after selective proximal vagotomy (SPV) or SPV and pyloroplasty (PP). All patients underwent two aspiration tests before and 3 months, 1 year, and 3 years after operation. The highest 1-h output of bile acids was recorded, and 100 mumol x h-1 or more was considered a positive reflux test. Sixteen patients (27%) had positive tests before operation; seven of them had previously been cholecystectomized. Forty-four patients (73%) had negative tests preoperatively; one had been cholecystectomized. Of 43 non-reflux patients without previous cholecystectomy 21 were randomized to SPV and 22 to SPV + PP. Sixteen patients (76%) remained negative after SPV, and 19 of 22 (86%) after SPV + PP. The incidence of negative bile reflux before and after SPV or SPV + PP did not differ. Cholecystectomized patients had a high incidence of bile reflux before (seven of eight) and after (six of eight) SPV or SPV + PP. It is concluded that neither SPV nor PP causes bile reflux.

Nutricao enteral - consideracoes tecnicas cuidados e complicacoes. / Enteral feeding-technical considerations care and complications

Os autores asalisam as propriedades e limitacoes do uso da nutricao enteral. Descrevem os detalhes tecnicos da aplicacao das sondas enterais e da administracao das dietas. Citam os cuidados a serem tomados com estes pacientes e avaliam as complicacoes, orientando sua profilaxia e tratamento

Nutricao por sondas nasoentericas.Experiencia com 50 casos. / Nasoenteral tube feeding. Experience with 50 cases

Apresenta-se uma serie consecutiva de 50 casos tratados pela nutricao enteral, durante periodo de quatro anos. Todos os pacientes receberam sua alimentacao atraves de sonda nasoenterica de "Silastic", tendo 76% sido assistidos com auxilio de preparados a base de soja, e os demais com dieta elementar, ou seu substituto, qual seja a propria mistura de nutricao parenteral administrada por via digestiva. Houve melhora do peso e da albumina em respectivamente 68,4% e 66,6% dos enfermos, nao se registrando qualquer complicacao de monta.Analisam-se as vantagens da nutricao enteral com dieta de soja (Sobee) comparativamente as outras alternativas de suporte nutricional

Nutricao enteral em cirurgia - estudo comparativo de tres diferentes dietas / Enteral feeding in surgery - comparative study of 3 different diets

Foram analisados tres grupos de pacientes com problemas nutricionais relacionados ou nao a cirurgia, os quais se submeteram a alimentacao por sonda naso-enterica. O periodo de tratamento usual foi de tres a quatro semanas, com oferta calorica media situando-se entre 45,6 e 70,1 kcal/kg/d.As dietas em estudo foram representadas por uma preparacao de soja confeccionada no Hospital das Clinicas, por uma dieta de soja, industrializada (Sobee), e por uma solucao completa de nutricao parenteral diluida, administrada pela sonda enteral (NPP oral). Em todos os grupos houve tendencia a melhora do peso da albumina serica, sendo que o maior ganho ponderal foi observado nos casos que receberam Sobee

Adenocarcinoma of the gallbladder in two siblings.

The authors present two siblings with adenocarcinoma of the gallbladder. This is the third report on familial occurrence of such disease. The cancer was diagnosed at age earlier than usual. One of the patients did not have gallstones. The literature is reviewed. Remarks are made about the relationship between heredity and cancer.

Avaliacao qualitativa do refluxo entero-gastrico com o emprego de Tc99 HIDA. / Quantitative evaluation of entero-gastric reflux with the use of Tc99 HIDA

Os autores utilizaram o Tc99 HIDA para evidenciar o refluxo entero-gastrico em 24 pacientes, seis assintomaticos e 18 submetidos previamente a cirurgia por ulceras gastroduodenais, por varias tecnicas (vagotomia troncular e piloroplastia, gastrectomia com reconstrucao e BI e BII). Nos controles nao observaram refluxo em nenhum caso. Nos pacientes previamente operados observaram refluxo em sete dos 18 pacientes estudados.Concluem que o metodo e de facil realizacao, sem morbidade na serie e de boa resolucao na evidenciacao do refluxo entero-gastrico