Cirurgia
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- Arteriovenous fistula with a saphenous long loopPublication . Patrício, J; Silveira, JAAfter radiation, chronic infection or previous operations recipient vessels for free tissue transfer become difficult to find. It may be necessary to locate vessels remote from the area of reconstruction and to construct long venous grafts. Long venous grafts can be compressed in the tissue tunnels that may be required. In this series of patients, an arteriovenous fistula was created with a long saphenous loop 10 to 21 days prior to tissue transfer. The saphenous loops were placed close to the area for reconstruction and when divided at the time of transplantation, provided one artery and one vein. In this series of 12 cases, adequate vascularization was achieved in 10 cases. In the other 2 cases, we believe that maturation of the fistula may have been necessary before proper function. The other advantages of the technique are: the procedure can be carried out under local anaesthesia, ease of positioning of the patient on the operating table, and a reduction in the time taken to perform the tissue transfer
- Pulmonary function after laparoscopic cholecystectomy in the elderlyPublication . Milheiro, A; Castro e Sousa, F; Oliveira, L; Matos, MJThe results of laparoscopic cholecystectomy in a group of 52 patients older than 69 years (group 1) were compared with the results of the same operation in a group of 338 younger patients (group 2). In group 1, 23 per cent of patients had acute cholecystitis and 13 per cent were operated on after an episode of acute pancreatitis. In group 2, 8 per cent of patients had acute cholecystitis and 4 per cent were operated on after acute pancreatitis. Pulmonary function was assessed prospectively before operation, 24 h after surgery and on the seventh day after operation, in 20 patients in group 1 and 30 in group 2. In group 1 there was one death (2 per cent); the morbidity rate was 14 per cent and conversion to laparotomy was required in 15 per cent. In group 2 there were no deaths, the morbidity rate was 11 per cent and the conversion rate 4 per cent. No significant differences were found between the two groups in mortality and morbidity rates. Preoperative values of forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were significantly lower in group 1 than in group 2 (P < 0.05); the values of FVC, FEV1 and forced expiratory flow at 50 per cent 24 h after surgery were less depressed in group 1 (P < 0.01) and also recovered more quickly in these patients 7 days after operation. Laparoscopic cholecystectomy gives excellent results in geriatric patients and can be recommended as the treatment of choice for symptomatic cholelithiasis in the elderly.
- Mesenteric arteriovenous fistula causing portal hypertension and bleeding duodenal varicesPublication . Baranda, J; Pontes, JM; Portela, F; Silveira, L; Amaro, P; Ministro, P; Rosa, A; Pimenta, I; Andrade, P; Bernardes, A; Pereira, J; Leitão, M; Donato, A; Freitas, DWe report a case of portal hypertension associated with a non-traumatic arteriovenous fistula, presenting with bleeding duodenal varices. The patient was admitted for melaena. Emergency endoscopy showed oesophageal varices with no signs of recent bleeding and with no blood in the upper gastrointestinal tract. Arteriography of the coeliac axis and superior mesenteric artery failed to detect any bleeding source. Endoscopy was repeated because of persistent bleeding and revealed active bleeding from varices in the distal duodenum. The patient underwent surgery and a large paraduodenal varicose vein associated with an arteriovenous fistula was found. Resection of the paramural varix and surgical occlusion of the arteriovenous fistula were effective in the control of bleeding. Liver biopsy revealed mild portal fibrosis without cirrhosis. Three years after surgery the patient still has oesophageal varices but has not had recurrent bleeding. There was regression of intraduodenal varices.
- Sequential liver transplantationPublication . Furtado, AL; Tomé, L; Oliveira, FJ; Furtado, E; Viana, JS; Perdigoto, R
- Techniques of intestinal transplantation in ratPublication . Lopes, MF; Cartucho, DJ; Cabrita, AM; Patrício, JTwo surgical models of intestinal transplantation in the rat are described. One is the implantation of fetal and newborn intestine as free grafts into the omentum of adult recipients, the other the adult intestine transplantation as an accessory graft using vascular anastomoses. A hundred and sixteen small-bowel transplantations were done; 36 of which were fetal intestine (group I), 40 of newborn intestine (group II), and 40 of adult intestine (group III). In the fetal and newborn intestinal transplantation, we emphasize the practices that allowed us to avoid ischemic and traumatic injury to the graft. In the adult intestine transplantation with vascular anastomoses, we heighten the modifications in the surgical technique that made the operation easier and the strategies used to prevent hypothermia and hypovolemic shock. Once experienced with the two chosen surgical techniques, transplantation using an avascular segment became much easier and quicker than transplantation with vascular anastomoses
- Water enema computed tomography (WE-CT) in the local staging of low colorectal neoplasms: comparison with transrectal ultrasoundPublication . Caseiro-Alves, F; Gonçalo, Manuela; Ilharco, J; Agostinho, A; Castro e Sousa, F; Vilaça-Ramos, HBACKGROUND: To determine the accuracy of computed tomography performed with a water enema application (WE-CT) in the local staging of low colorectal neoplasms and to compare the results with those of transrectal ultrasonography (TRUS). METHODS: Forty patients with low colorectal tumors were evaluated prospectively by CT with the simultaneous administration of a lukewarm rectal enema (0.5-1.5 L). Thin slices (5 mm) and intravenous application of iodinated contrast media were routinely used. TRUS was performed in 18 patients. Tumor size, location, and staging according to the TNM classification of the UICC were registered. Tumors were classified as < T3 (T1 or T2) or as T3 or T4. For staging peritumoral lymph node metastases on WE-CT, two criteria of positivity were tested: N+ if at least one peritumoral node > or 5 mm in diameter was seen (reading A); N+ if at least one peritumoral node > or = 5 mm or three peritumoral nodes < 5 mm were identified (reading B). RESULTS: For the tumor staging, WE-CT showed a sensitivity of 90%, a specificity of 73%, a positive predictive value (PPV) of 90%, a negative predictive value (NPV) of 73%, and an accuracy of 85%. For TRUS, the results were sensitivity of 73%, specificity of 29%, PPV of 62%, NPV of 40%, and an accuracy of 39%. Concerning nodal staging with WE-CT, results were superior when reading A was used: sensitivity = 84%, specificity = 83%, PPV = 73%, NPV = 91%, and accuracy = 84%. TRUS showed a sensitivity of 29%, specificity of 100%, PPV of 100%, NPV of 67%, and an accuracy of 71%. CONCLUSION: WE-CT is a reliable technique for the local staging of low colorectal tumors that can be superior to TRUS. For diagnosis of peritumoral metastatic lymph nodes on WE-CT, the 5-mm diameter cutoff value is the most appropriate size criterion.
- Early gastric cancer: Report of 58 casesPublication . Oliveira, FJ; Ferrão, H; Furtado, E; Batista, H; Conçeição, LBACKGROUND: This retrospective study was carried out to review our surgical experience and to define the clinicopathologic profile of early gastric cancer in a Western country with one of the highest incidences in the world.METHODS: Fifty-eight patients who had gastric surgery for early gastric cancer were included in this study.RESULTS: The incidence of early gastric cancer was 13.9% of the patients with resected gastric cancer (58/416). The mean age of these 58 patients at diagnosis was 56.8 +/- 12.3 years (range, 30-81 years) and the male: female ratio was 2.4 : 1. The most common presenting symptom was epigastric pain (52.4%). All patients were treated by surgical resection. Tumors were typically located in the antrum (72.4%), with a predominance of lesser curvature lesions (89.7%). Macroscopically, the majority of the lesions (63.8%) were excavated (types IIc and III). Thirty tumors were intramucosal and 28 extended into the submucosa. Thirty were of the intestinal type and 28 of the diffuse type. The rate of regional lymph node metastasis was 10.4%. The overall 5-year survival rate was 93.9%.CONCLUSIONS: The excellent response to surgical resection of early gastric cancer reported by Japanese authors is reproducible in Western countries even in the presence of regional lymph node metastasis. For this reason an aggressive surgical approach should be taken for all early gastric cancer.
- Peripheral blood lymphocyte phenotype can predict rejection episodes after orthotopic liver transplantationPublication . Perdigoto, R; Paiva, A; Freitas, A; Coimbra, HB; Mota, O; Ferrão, J; Tomé, L; Furtado, E; Cipriano, MA; Geraldes, B; Oliveira, FJ; Furtado, AL
- Maximum sharing of cadaver liver grafts composite split and domino liver transplantsPublication . Furtado, AL; Oliveira, FJ; Furtado, E; Geraldes, B; Reis, A; Viana, JS; Bento, C; Vieira, H; Neves, S
- Síndrome de MirizziPublication . Lérias, C; Souto, P; Pina-Cabral, JE; Saraiva, S; Gomes, D; Durão, A; Moreira, A; Sofia, C; Leitão, M; Donato, A; Freitas, D