Trématodes parasites de poissons marins du littoral de Rio de Janeiro, Brésil

Les Trématodes de 35 espèces de poissons marins, d'importance commerciale, collectés dans le littoral de Rio de Janeiro, ont été étudiés. Dix-sept espèces de Trématodes appartenant à 13 familles ont été recensées. Quatre de ces espèces sont référés pour la première fois au Brésil: Diphtherostomum americanum, Diplomonorchis floridensis, Pancreadium otagoensis et Neomegasolena chaetodipteri, neuf dans de nouveaux hôtes: D. americanum, Diplangus paxillus, Hurleytrema shorti, Lecithochirium microstomum, Morascus filiformis, Neolebouria multilobatus, P. otagoensis, Pleorchis mollis et Opechona bacillaris, une a été recontrée dans un hôte mentionné pour la première fois au Brésil: Vitellibaculum spinosum et cinq autres espècies sont déjà répertoriées: Acanthocollaritrema umbilicatum, Bucephalopsis calliocotyle, Bucephalus varicus, Parahemiurus merus et Tergestia pauca. Tergestia selenei est consideré synonyme de T. pauca. Les principales mesures sont données pour chaque espèce.

Derivação biliopancreática com preservação gástrica videolaparoscópica: sistematização técnica

BACKGROUND: The authors describe a videolaparoscopic technical variation of biliopancreatic diversion, and its rationale, as well as its preliminary results.They operated on 12 female patients, age between 26 and 49 years, BMI range 47,4 and 59,5kg/m². There were no intraoperative complications; operative time ranged from 2 to 4,5 hours; discharge in the 3rd. postoperative day. Liquid dietetic recommendations in the early period, and normal diet after the first week. One patient was readmmitted after 1 week with abdominal pain because of excessive ingestion of food; there was deep venous trombosis in one patient. Follow-up showed loss of excess weight of 27,4% after four months. Initial results of the described operation sugests it may be a good alternative to morbid obesity surgical treatment; it is strongly required a multidisciplinar pre and postoperative treatment program.

Cistectomia radical laparoscópica com reservatório ileal

Worldwide experience with laparoscopic radical cystectomy is increasing in the last few years. We describe a 29-year-old female who underwent a laparoscopic radical cystectomy with ileal reservoir for a bladder sarcoma. Operative time was 405 minutes and estimated blood loss was 500 mL. She had an uneventful postoperative course and was discharged in the fifth postoperative day. Key-words: bladder, cystectomy, laparoscopy, urinary diversion, bladder neoplasms.

Complicated diverticular disease: the changing paradigm for treatment

The term "complicated" diverticulitis is reserved for inflamed diverticular disease complicated by bleeding, abscess, peritonitis, fistula or bowel obstruction. Hemorrhage is best treated by angioembolization (interventional radiology). Treatment of infected diverticulitis has evolved enormously thanks to: 1) laparoscopic colonic resection followed or not (Hartmann's procedure) by restoration of intestinal continuity, 2) simple laparoscopic lavage (for peritonitis +/- resection). Diverticulitis (inflammation) may be treated with antibiotics alone, anti-inflammatory drugs, combined with bed rest and hygienic measures. Diverticular abscesses (Hinchey Grades I, II) may be initially treated by antibiotics alone and/or percutaneous drainage, depending on the size of the abscess. Generalized purulent peritonitis (Hinchey III) may be treated by the classic Hartmann procedure, or exteriorization of the perforation as a stoma, primary resection with or without anastomosis, with or without diversion, and last, simple laparoscopic lavage, usually even without drainage. Feculent peritonitis (Hinchey IV), a traditional indication for Hartmann's procedure, may also benefit from primary resection followed by anastomosis, with or without diversion, and even laparoscopic lavage. Acute obstruction (nearby inflammation, or adhesions, pseudotumoral formation, chronic strictures) and fistula are most often treated by resection, ideally laparoscopic. Minimal invasive therapeutic algorithms that, combined with less strict indications for radical surgery before a definite recurrence pattern is established, has definitely lead to fewer resections and/or stomas, reducing their attendant morbidity and mortality, improved post-interventional quality of life, and less costly therapeutic policies.

Evaluation of prognostic factors of decompressive craniectomy in the treatment of severe traumatic brain injury

OBJECTIVE: to determine predictive factors for prognosis of decompressive craniectomy in patients with severe traumatic brain injury (TBI), describing epidemiological findings and the major complications of this procedure.METHODS: we conducted a retrospective study based on analysis of clinical and neurological outcome, using the extended Glasgow outcome in 56 consecutive patients diagnosed with severe TBI scale treated in the emergency department from February 2004 to July 2012. The variables assessed were age, mechanism of injury, presence of pupillary changes, Glasgow coma scale (GCS) score on admission, CT scan findings (volume, type and association of intracranial lesions, deviation from the midline structures and classification in the scale of Marshall and Rotterdam).RESULTS: we observed that 96.4% of patients underwent unilateral decompressive craniectomy (DC) with expansion duraplasty, and the remainder to bilateral DC, 53.6% of cases being on the right 42.9% on the left, and 3.6% bilaterally, with predominance of the fourth decade of life and males (83.9%). Complications were described as transcalvarial herniation (17.9%), increased volume of brain contusions (16.1%) higroma (16.1%), hydrocephalus (10.7%), swelling of the contralateral lesions (5.3%) and CSF leak (3.6%).CONCLUSION: among the factors studied, only the presence of mydriasis with absence of pupillary reflex, scoring 4 and 5 in the Glasgow Coma Scale, association of intracranial lesions and diversion of midline structures (DML) exceeding 15mm correlated statistically as predictors of poor prognosis.