Advancements in Graft Placement Techniques.

For decades, the placement of follicular units (FUs) into incisions in the recipient area was exclusively carried out using forceps. In 1992, Dr. Choi introduced an instrument known as the "implanter," which had the advantage of simultaneously creating incisions and placing FUs without damaging sensitive parts.

Pancreatic islet allograft in spleen with immunosuppression with cyclosporine. Experimental model in dogs.

Purpose: To study the functional behavior of the allograft with immunosuppression of pancreatic islets in the spleen.

Methods: Five groups of 10 Mongrel dogs were used: Group A (control) underwent biochemical tests; Group B underwent total pancreatectomy; Group C underwent total pancreatectomy and pancreatic islet autotransplant in the spleen; Group D underwent pancreatic islet allograft in the spleen without immunosuppressive therapy; Group E underwent pancreatic islet allograft in the spleen and immunosuppression with cyclosporine. All of the animals with grafts received pancreatic islets prepared by the mechanical-enzymatic method - stationary collagenase digestion and purification with dextran discontinuous density gradient, implanted in the spleen.

Randomized clinical trial comparing spinal anesthesia with local anesthesia with sedation for loop colostomy closure.

Context: Recent studies have shown that local anesthesia for loop colostomy closure is as safe as spinal anesthesia for this procedure.

Objectives: Randomized clinical trial to compare the results from these two techniques.

Methods: Fifty patients were randomized for loop colostomy closure using spinal anesthesia (n = 25) and using local anesthesia (n = 25).

Esophagogastric anastomosis with invagination into stomach: New technique to reduce fistula formation.

Aim: To present a new technique of cervical esophagogastric anastomosis to reduce the frequency of fistula formation.

Methods: A group of 31 patients with thoracic and abdominal esophageal cancer underwent cervical esophagogastric anastomosis with invagination of the proximal esophageal stump into the stomach tube. In the region elected for anastomosis, a transverse myotomy of the esophagus was carried out around the entire circumference of the esophagus.

[En bloc pancreaticoduodenectomy and right hemicolectomy for locally advanced right colon cancer treatment].

This article reports the case of a patient with a diagnosis of diarrhea and weight loss. Subsidiary exams showed ulcerovegetant lesion in the second duodenal portion and duodenocolic fistula. An exploratory laparotomy was performed and a neoplastic lesion in the hepatic angle of the colon was observed invading the second duodenal portion.

Cost-effectiveness analysis on spinal anesthesia versus local anesthesia plus sedation for loop colostomy closure.

Context: Studies in the area of health economics are still poorly explored and it is known that the cost savings in this area is becoming more necessary, provided that strict criteria.

Objective: To perform a cost-effectiveness analysis of spinal anesthesia versus local anesthesia plus sedation for loop colostomy closure.

Methods: This was a randomized clinical trial with 50 patients undergoing loop colostomy closure either under spinal anesthesia (n = 25) or under local anesthesia plus sedation (n = 25).

En bloc pancreaticoduodenectomy and right hemicolectomy to treat locally advanced right colon cancer: report of three cases.

Although colorectal tumors are fairly common surgical conditions, 5 to 12% of these tumors are locally advanced (T4 tumors) upon diagnosis. In this particular situation, the efficacy of en bloc multivisceral resection has been proven. When right-colon cancer invades the proximal duodenum or even the pancreatic head, a challenging dilemma arises due to complexity of the curative surgical procedure.

[Comparative study of end-to-end cervical esophagogastric anastomosis with or without invagination after esophagectomy for cancer].

Objective: To assess the incidence of fistula and stenosis of cervical esophagogastric anastomosis with invagination of the esophageal stump into the gastric tube in esophagectomy for esophagus cancer.

Methods: Two groups of patients with thoracic and abdominal esophagus cancer undergoing esophagectomy and esophagogastroplasty were studied. Group I comprised 29 patients who underwent cervical esophagogastric anastomosis with invagination of the proximal esophageal stump segment within the stomach, in the period of 1998 to 2007 while Group II was composed of 36 patients submitted to end-to-end cervical esophago-gastric anastomosis without invagination during the period of 1989 to 1997.

En-bloc pancreatoduodenectomy and right hemicolectomy for treating locally advanced right colon cancer (T4): a series of five patients.

A series of five cases of right-colon adenocarcinoma that invaded the proximal duodenum is presented. All patients underwent successful en-bloc pancreatoduodenectomy plus right hemicolectomy by General Surgery Service of the Teaching Hospital of the ABC Medical School, Santo André, SP, Brazil. The study was conducted between 2000 and 2007.

[Transmural endoscopy drainage of pancreatic pseudocyst: long-term outcome].

Background: Pancreatic pseudocysts are relatively common complications of pancreatitis in adults.

Objective: To evaluate the long-term results from transmural endoscopic drainage and thus to establish its role in managing pancreatic pseudocyst.

Methods: Fourteen patients with pancreatic pseudocyst were studied.

Bile duct hamartomas--the von Meyenburg complex.

Hamartomas of the bile duct (von Meyenburg complex) are benign neoplasms of the liver, constituted histologically cystic dilatations of the bile duct, encompassed by fibrous stroma. We report a 42-year-old female patient with symptomatic cholecystitis, whose gross and ultrasonic appearance suggestive of multiple liver metastases. Magnetic resonance imaging and liver biopsy are the gold standards for diagnosis of this rare hepatobiliary condition.

Feasibility analysis of loop colostomy closure in patients under local anesthesia.

Purpose: To verify prospectively the practicability of performing loop colostomy closure under local anesthesia and sedation.

Methods: In this study, 21 patients underwent this operation. Lidocaine 2% and bupivacaine 0.

Neuroendocrine gastric carcinoma expressing somatostatin: a highly malignant, rare tumor.

Poorly differentiated gastric neuroendocrine carcinomas, although rare, deserve particular attention, as they are aggressive and have an extremely poor prognosis. In this report we describe a gastric neuroendocrine carcinoma with rapidly fatal outcome. Immunohistological staining of the resected specimens revealed that the tumor was an endocrine carcinoma.

Why do anal wounds heal adequately? A study of the local immunoinflammatory defense mechanisms.

Purpose: The aim of this study was to identify the tissue defense immunoinflammatory mechanisms present in the healing process of anal region wounds resulting from hemorrhoidectomy by the open technique.

Methods: Immunohistochemical techniques were applied to biopsies of anal wounds obtained on Day 0 and Day 6 after surgery from 20 patients with hemorrhoid disease to characterize and quantify macrophages, T and B lymphocytes, and natural killer cells in high-power fields (400x). These techniques were also used to identify cells showing immunoexpression of cytokines (transforming growth factor beta 1, transforming growth factor beta 2, transforming growth factor beta 3) and constitutive and induced nitric oxide synthase.

[Isolated Crohn's disease of the appendix as a source of enterorrhagia].

Background: Crohn's disease confined to the appendix is relatively rare as a sole primary manifestation of the disease. Young people are more affected. The medical history and the physical examination are similar to the findings in acute appendicitis, but the manifestations are protracted.

Ampullary duodenal diverticulum and cholangitis.

Context: Ampullary duodenal diverticulum complicated by cholangitis is little known in clinical practice, especially when there are no gallstones in the common bile duct or there is no biliary tree ectasia or hyperamylasemia. A case of this association is presented, in which the surgical treatment was a biliary-enteric bypass.

Case Report: A 74-year-old diabetic white woman was admitted to the Taubat University Hospital, complaining of pain in the right upper quadrant, jaundice and fever with chills (Charcot's triad).

Portal thrombosis: late postoperative prevalence in Mansoni's schistosomiasis.

Background/aims: Splenectomy with esophagogastric devascularization and distal splenorenal anastomosis are used for the treatment of bleeding esophageal varices in Mansoni's hepatosplenic schistosomiasis. Portal thrombosis followed by ascitis has been observed in the early postoperative phase, but there are no studies about the spontaneous and late postoperative prevalence of this vascular complication. The aim was to evaluate the spontaneous and late postoperative prevalence of total portal vein thrombosis and of ascitis in these patients.

[Late morphologic and hemodynamic changes in the splenic territory of patients with mansoni's hepatosplenic schistosomiasis after distal splenorenal shunt. (Ultrasonography-Doppler study)].

Background: The distal splenorenal anastomosis (Warren's operation) has been indicated for the treatment of high digestive bleeding caused by esophagic varices because it would ideally reduce the venous pressure in the cardiotuberositary territory without changing the mesenteric-portal venous flow. However, the changes it produce in the splenic territory have not been fully understood.

Aim: To appraise the late morphologic and hemodynamic changes in the splenic territory produced by the distal splenorenal anastomosis in patients with portal hypertension due to mansoni's hepatosplenic schistosomiasis complicated by esophagic bleeding.

[Patent paraumbilical vein: hemodynamic importance in Mansoni's hepatosplenic portal hypertension (Study with ultrasonography Doppler].

Background: The hemodynamical effect of the collateral portosystemic circulation upon the portal system has not yet been fully understood. The US-Doppler made possible the non-invasive study of the portal system by evaluating the parameters: flow direction, diameter and flow velocity in it's vessels.

Aims: To study the paraumbilical vein as a collateral portosystemic pathway and identify patterns for appraising its hemodynamic importance to the portal system.

[Hepatosplenic schistosomiasis portal hypertension: effect of esophagogastric devascularization with splenectomy on the diameter and mean flow velocity in the portal system (ultra-sonographic Doppler].

Background: Esophagogastric devascularization with splenectomy has been used for the treatment of upper digestive bleeding due to esophagic varices in hepatoportal mansoni's schistosomic portal hypertension. Nevertheless, early portal thrombosis has hampered this surgical technique (13.3% and 53.

[Surgical procedures in selected proctological patients with local anesthesia. Study of 150 cases].

Experience in the treatment of 150 patients with anorectal disorders and disorders of the sacrococcygeal region who were operated on with local anesthesia at the University Hospital, ABC Medical School, São Bernardo do Campo, SP, Brazil, from March 1995 to March 1998. The anesthesia technique, the operations carried out and the tolerance to the procedure are reported. Intraoperative morbidity was 10.