Muscle-Splitting Augmentation-Mastopexy: Implant Protection With an Inferior Dermoglandular Flap.

Simultaneous augmentation-mastopexy can achieve excellent patient and surgeon satisfaction but continues to pose a challenge, with revision rates of up to 25%. Recurrent ptosis and poor overall breast shape are 2 common reasons for reoperation, whereas some of the most feared complications is breast implant exposure, infection, and loss secondary to wound breakdown; excessively large implants or too much tension during closure are possible contributing factors. We describe a technique for augmentation-mastopexy combining a muscle-splitting pocket for implant placement along with an inferior flap, which helps secure the implant in place and provides coverage in case of wound dehiscence.

The impact of machine learning techniques in the study of bipolar disorder: A systematic review.

Machine learning techniques provide new methods to predict diagnosis and clinical outcomes at an individual level. We aim to review the existing literature on the use of machine learning techniques in the assessment of subjects with bipolar disorder. We systematically searched PubMed, Embase and Web of Science for articles published in any language up to January 2017.

Low mortality rate in 97 consecutive pancreaticoduodenectomies: the experience of a group.

Context: Pancreaticoduodenectomy is the procedure of choice for resectable cancer of the periampullary region. These tumors account for 4% of deaths from cancer, being referred to as one of the lowest survival rates at 5 years. Surgery remains a complex procedure with substantial morbidity and mortality.

[Evaluation of hepatic resection for hepatocellular carcinoma on cirrhotic livers].

Background: The hepatocellular carcinoma is a disorder that affects patients suffering from cirrhosis. Liver resection, orthotopic liver transplantation and percutaneous ablation are some forms of therapy currently used to provide a cure for this disease.

Aim: To assess the results achieved through liver resection for the treatment of the hepatocellular carcinoma in patients with cirrhosis being under treatment in a general hospital.

Endoscopic laser lithotripsy for complicated bile duct stones: is cholangioscopic guidance necessary?

Background: Endoscopic papillotomy is successful in more than 95% of the cases of choledocholithiasis. For patients with difficult bile duct stones not responding to mechanical lithotripsy, different methods for stone fragmentation have been developed.

Aim: To compare the results of laser lithotripsy with a stone-tissue recognizing system, when guided by fluoroscopy only or by cholangioscopy.

The role of cagA Helicobacter pylori strains in gastro-oesophageal reflux disease.

Background And Aims: The role of Helicobacter pylori infection in gastro-oesophageal reflux disease is controversial. The aim of this study was to evaluate the prevalence of colonization by cagA-positive and cagA-negative H. pylori strains in the spectrum of gastro-oesophageal reflux disease.

The efficacy of endoscopic ligation for the prevention of variceal rebleeding in cirrhotic patients according to the hepatocellular function.

Background/aims: Endoscopic variceal ligation is considered the leading therapy for the prevention of variceal rebleeding in cirrhotic patients. However, the efficacy of this method in cirrhotic patients with poor hepatocellular function is not well-known yet. The aim of this study is to compare the efficacy of endoscopic variceal ligation for the eradication of esophageal varices, rebleeding and mortality rates, based on hepatocellular function, as graded by Child-Pugh.

The role of nitric oxide pathway in the renal ischemia-reperfusion injury in rats.

Introduction: Nitric oxide (NO), synthesized from L-arginine by the enzyme nitric oxide synthase (NOS), seems to play an ambiguous role during tissue ischemia-reperfusion injury. Our objective was to evaluate the effects of L-arginine, a NO donor, and N(G)-nitro-L-arginine-methylester (L-NAME), a NOS inhibitor, on oxidative stress, renal dysfunction, histologic alterations and surgical mortality rate induced by renal ischemia-reperfusion (RIR) in uninephrectomized rats.

Materials And Methods: One-hundred and ninety-seven Wistar rats were randomized into five experimental groups.

Beneficial effect of alpha-tocopherol in renal ischemia-reperfusion in rats.

We evaluated the effects of alpha-tocopherol (vitamin E) on the products of lipid peroxidation and serum creatinine levels in a rat model of renal ischemia-reperfusion. The animals were submitted to sham operation or renal ischemia-reperfusion, and they were pretreated with alpha-tocopherol or the vehicle saline. In four groups, we analyzed the lipid peroxidation products by measuring malondialdehyde and chemiluminescence levels.

Effects of L-arginine on the kidney levels of malondialdehyde in rats submitted to renal ischaemia-reperfusion.

Objective: To evaluate the effects of L-arginine, a nitric oxide donor, on kidney levels of malondialdehyde (MDA, a product of cellular lipid peroxidation), serum creatinine levels, and urinary volume in rats undergoing unilateral renal ischaemia-reperfusion.

Materials And Methods: Wistar rats (117) were randomly distributed into three experimental groups (of four subgroups each) in which were assessed renal cell-lipid peroxidation (kidney levels of MDA), serum creatinine levels and urinary volume. The rats underwent unilateral nephrectomy followed by contralateral renal ischaemia-reperfusion with or with no pretreatment with L-arginine (200 mg/kg) given intraperitoneally.

The role of liver transplantation in patients with Caroli's disease.

Caroli's disease, characterized by segmental or diffuse dilation of the intrahepatic biliary ducts, is a rare disease which is difficult to treat. The course of the disorder is characterized by recurrent episodes of cholangitis and hospital stays, with a consequent loss of quality-of-life and productive capacity, often ending in death due to uncontrolled infection. Endoscopic drainage of the bile duct, percutaneously or surgically, is palliative, and presents bad results in the follow-up of these patients.

A comparison between topical and infiltrative bupivacaine and intravenous meperidine for postoperative analgesia after inguinal herniorrhaphy.

The purpose of the present study is to compare postoperative analgesia offered by the simple instillation of local anesthetic on the surgical wound, its infiltration with the same local anesthetic, and the use of an intravenous opioid. Sixty patients were divided into the three analgesia groups to be studied: instillation of local anesthetic (Group I), injection of local anesthetic (Group II), and intravenous opioid (Group III). The pain was quantified using the visual analogue scale.

Effects of ischemia and reperfusion on oxidative stress in hepatic cirrhosis induced by carbon tetrachloride in rats.

The present study was undertaken to determine the effect of ischemia and reperfusion on oxidative stress in hepatic cirrhosis induced by carbon tetrachloride (CCl4) in rats by the evaluation of lipid peroxidation products (LPO). Cirrhosis of the liver was induced by CCl4 administration. This drug was dissolved in mineral oil and the control group received only mineral oil intraperitoneally.

Role of the L-arginine/nitric oxide pathway in renal ischaemia-reperfusion in rats.

Objective: To study the role of the L-arginine/nitric oxide (NO) pathway during renal ischaemia-reperfusion in rats.

Design: Randomised experimental study.

Setting: Teaching hospital, Brazil.

The effects of allopurinol in hepatic ischemia and reperfusion: experimental study in rats.

Background/aims: Some studies have shown that postischemic hepatic dysfunction is mainly due to oxygen free radicals that are generated by xanthine oxidase. The present study was undertaken to determine the effect of allopurinol, an inhibitor of xanthine oxidase, on oxidative stress, liver injury and histologic alterations induced by hepatic ischemia-reperfusion in rats.

Methods: One hundred and sixty Wistar rats were used and divided into three groups.

Comparative post-operative study of prostheses, with and without an anti-reflux valve system, in the palliative treatment of esophageal carcinoma.

Background/aims: Palliative treatment of advanced esophageal carcinoma by esophageal tunnelization with a prosthesis allows immediate relief of dysphagia. However, the procedure is subject to a high rate of morbidity, including gastroesophageal reflux (GER) present in all patients with a prosthesis positioned through the gastroesophageal junction, resulting in complications (pyrosis, aspiration pneumonias, sleep disorders) and reduced quality of life in these patients who already have a lower rate of survival. In an attempt to reduce GER and its complications, the authors created a surgical prosthesis coupled to an anti-reflux valve system, comparing it to the use of an esophageal prosthesis without an anti-reflux valve mechanism.

Liver resections for metastases from intraabdominal leiomyosarcoma.

This paper discusses liver resection for intraabdominal leiomyosarcoma metastases as a therapy for carefully selected patients. Of the 83 hepatectomies performed from 1992 to 1996, five were resections for liver metastases due to intraabdominal leiomyosarcoma, in 3 patients. The surgical indication was single liver metastases, without any evidence of extrahepatic disease.

Pancreatic fistula after pancreaticoduodenectomy: a comparison between patients with periampullary tumors and chronic pancreatitis.

Background/aims: Whether the frequency of anastomotic leak after pancreaticoduodenectomy for benign diseases is greater than for malignant conditions and whether fistula development is associated with surgical mortality remains controversial. The purpose of this study is to compare the incidence of anastomotic leak in patients operated on for chronic pancreatitis and periampullary tumors.

Methodology: The authors retrospectively reviewed the charts of 67 patients (46 males, 21 females, mean age 47 years) submitted to pancreaticoduodenectomy for chronic pancreatitis and periampullary tumors between 1990 and 1996.

[Value of left cholangiojejunostomy in palliative treatment of malignant obstruction of the hepatic hilus].

The aim of this study is to analyse the results of the intrahepatic cholangiojejunostomy in the duct of segment III for malignant hilar obstruction performed in a group of 17 consecutive patients. An index for life quality, named comfort index, allowing the numeric comparison of the results was evaluated. An important reduction of the jaundice in 100% of the cases that were discharged from the hospital was observed.

[Internal pancreatic fistula: surgical treatment].

The authors present 13 cases of internal pancreatic fistula, of which 11 were secondary to a chronic pancreatitis and two were caused by an abdominal trauma. Beside the clinical picture, the diagnosis was anticipated by the high amylase levels present in the fluid obtained by paracentesis or thoracocentesis. The diagnosis was confirmed by the radiological analysis of the pancreatic duct system, when an endoscopic retrograde pancreatography was performed in seven patients, one pancreatography was carried out during surgery in five cases, and one patient underwent an injection of hydrosoluble contrast in the pleural cavity.

Helicobacter pylori-associated gastritis: does it play a role in functional dyspepsia?

Objectives: The goal of this study is to averiguate whether Helicobacter pylori (Hp)-associated gastritis is involved in the etiology of functional dyspepsia (FD) or, at least in a subset of these patients.

Methods: 103 consecutive FD patients were prospectively analyzed and subdivided according to their main complaints into ulcer-like FD (n = 31), dysmotility-like FD (n = 24) or nonspecific FD (n = 48). After endoscopy with gastric biopsy, gastritis and Hp infection were assessed and graded by histology according to the Sydney System.

Biliary reconstruction in benign postoperative stricture with transhepatic tubes.

This study reports our experience with 31 patients who underwent biliary reconstructions due to iatrogenic lesions of the main biliary tract. The technique of Hepp and Couinaud, associated with the use of transhepatic Silastic tubes, was utilized in 90% of the patients, and the mucosal graft was employed in only three patients. The recommended time for keeping the transhepatic tube in place was 6 months.