Marco Serôdio

Introducao: Diversos estudos sugerem que a citrulinemia pode constituir um parâmetro objectivo e reprodutivel da massa enterocitaria funcionante. Objectivos: Analisar o valor da citrulinemia na avaliacao da funcao intestinal na sindroma do intestino curto. Material e metodos: Realizou-se um estudo caso-controlo, incluindo 11 doentes com sindroma do intestino curto, resultante de enterectomia extensa e 11 individuos controlo. As concentracoes plasmaticas de aminoacidos foram determinadas por cromatografia de troca ionica. Resultados: Seis doentes apresentavam uma sindroma do tipo III, cinco encontravam-se na fase de manutencao e nove possuiam autonomia nutricional; a extensao media do intestino delgado restante foi de 87,5±48,2 (30-190) cm. A citrulinemia foi mais reduzida nos pacientes com sindroma do intestino curto (28,6±11,3 versus 32,2±6,6; n.s.), atingindo valores inferiores a 24 μmol/L em 45,5% dos casos (versus 9,1%; p=0,056; sensibilidade=46%; especificidade=91%; acuidade=68...

Coronavirus disease 2019 (COVID-19) pandemic is challenging healthcare systems Surgical care during the COVID-19 pandemic presents numerous challenges regarding not only patient and community safety, but also the safety of physicians and operating room (OR) staff In the OR, general anaesthesia poses a risk of aerosolization during the intubation process There is also concern about minimally invasive surgery due to aerosol formation The SARS-CoV-2 virus was also identified in the faeces, so this is a possible pathway for transmission This article presents the role of spinal anaesthesia (SA) and AirSeal® device in reducing the risk of COVID-19 contamination while performing transanal minimally invasive surgery (TAMIS) A 59-year-old patient, diagnosed with a T1 rectal adenocarcinoma, was submitted to TAMIS The surgery was done during COVID-19 pandemic due to the risk of oncological progression with delayed treatment, under SA and using the AirSeal® system and adequate personnel protect...

Purpose Hepatectomy (Hp) is an alternative approach for the treatment of gastric carcinoma liver metastases (GCLM). However, prognostic factors that may assist patient selection are still controversial. Several pathologic features, such as the growth pattern (GP), associated with prognosis in colorectal cancer liver metastases, were never investigated in GCLM. Our principal aim was to assess if the GP has prognostic impact on GCLM. Patients and Methods Review of the clinical and pathological characteristics of 19 consecutive patients submitted to surgical resection of GCLM with curative intent at our department. Major potential prognostic factors considered were patients’ gender, age, timing and extent of Hp, postoperative course, as well as histopathological characteristics of primary and secondary tumors. Results Major morbidity occurred in four patients, mortality in one. Median and 5-year overall survival were 17 months and 26.7%, respectively. Ten patients developed recurrent d...

A 62-year-old Caucasian female patient presented with abdominal pain, vomiting and fever 1 day after administration of COVID-19 vaccine. Bloodwork revealed anaemia and thrombocytosis. Abdominal CT angiography showed a mural thrombus at the emergence of the coeliac trunk, hepatic and splenic arteries, and extensive thrombosis of the superior and inferior mesenteric veins, splenic and portal veins, and the inferior vena cava, extending to the left common iliac vein. The spleen displayed extensive areas of infarction. Aetiological investigation included assessment of congenital coagulation disorders and acquired causes with no relevant findings. Administration of COVID-19 vaccine was considered a possible cause of the extensive multifocal thrombosis. After reviewing relevant literature, it was considered that other causes of this event should be further investigated. Thrombosis associated with COVID-19 vaccine is rare and an aetiological relationship should only be considered in the ap...

We present a rare case of high-grade functional neuroendocrine carcinoma of the pancreas secreting insulin. Our patient, an 80 years old woman, presented with neuropsychiatric symptoms consistent with hypoglycaemia that regressed with food intake and dextrose administration. Abdominal imaging showed a pancreatic tumour with invasion of the spleen and lymph node metastasis, highly suggestive of an insulinoma as the cause of the hypoglycaemia. The patient underwent left pancreatectomy with splenectomy and atypical gastric resection. The postoperative course of our patient was uneventful, with complete remission of the hypoglycaemic episodes, and the definitive histological examination showed three poorly differentiated large cell neuroendocrine carcinomas of the pancreas.

Background Three-dimensional (3D) models are increasingly used to help surgeons, guiding them through the complex hepatic vasculobiliary anatomy. The biliary tract is a relatively untapped territory with only a few case reports described in medical literature. Our aim is to present an innovative 3D reconstruction methodology for biliary imaging and surgical planning, applied to a case of iatrogenic biliary stricture, with fusion of segmented CT and MRI images. Case presentation A selected case of Bismuth type III iatrogenic biliary stenosis for 3D planning. CT and MR studies were acquired with dedicated protocols for segmentation. Two radiologists performed segmentation and 3D model post-processing, fusing both imaging techniques to faithfully render the anatomical structures. Measurements of anatomical landmarks were taken in both the CT/MRI and the 3D model to assure its accuracy and differences in measurement were calculated. The 3D model replicates anatomical structures and path...

Serous pancreatic cystadenomas are benign tumours and most cases are detected incidentally. Complications are unusual. A patient with a history of a large pancreatic serous cystadenoma (SCA) presented to the emergency department with abdominal pain and haemodynamic shock. After haemodynamic stabilisation, an urgent abdominal CT scan revealed a large hemoperitoneum but the origin of the bleeding was not found. The patient was submitted to an angiography that revealed a bleeding hypervascular pancreatic mass and an embolisation was done successfully. After 3 weeks, the patient underwent a laparotomic left pancreatectomy with en bloc splenectomy. The anatomopathological results were consistent with a microcystic SCA of the pancreas. Despite the high vascularity of pancreatic SCA, haemorrhage is a very rare but life-threatening complication.

Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed surgeries for morbid obesity. Perforated duodenal ulcers are very rare in these patients (with a 0.25% incidence reported) and the diagnosis can be challenging. We report a case of a 43-year-old woman who presented with severe acute abdominal pain to the emergency department. She had undergone a laparoscopic RYGB 5 years previously. Exploratory laparoscopy revealed a duodenal perforation, which was repaired by primary closure. As Helicobacter pylori has been implicated in the formation of ulcers in this population, eradication therapy should be started.

Liver resection combined with neoadjuvant chemotherapy (NAC) has reported notable results in patients with colorectal liver metastases (CRLM). Tumoral response to NAC is associated with specific histopathologic patterns with prognostic implications. The main objective of this study was to evaluate the influence of pathological findings on overall survival (OS), disease-free survival (DFS) and liver recurrence-free survival (LRFS). Analysis of clinical and outcome data from 110 patients who underwent first CRLM resection between January 2010 and July 2013. Blinded pathological review of histological material of several parameters: resection margin, tumor regression grade (TRG), tumor thickness at the tumor-normal interface (TTNI) and the growth pattern (GP). The median survival following hepatic resection was 52 months and 3- and 5- year Kaplan-Meier estimates were 69 and 48%, respectively. Seventy-four patients developed recurrent disease. Oxaliplatin-based chemotherapy was signific...

INTRODUCTION Advances in neoadjuvant chemotherapy (NCT) have allowed surgical treatment in otherwise unresectable patients with colorectal liver metastases (CRLM). It is well known that NCT induces liver lesions such as sinusoidal obstruction syndrome (SOS) and steatohepatitis (SH). However, whether it affects postoperative morbidity remains controversial. The aim of this study was both to evaluate the impact of NCT on liver parenchyma and postoperative morbidity, and to identify preoperative predictive markers for liver injury. PATIENTS AND METHODS Among 140 patients undergoing liver resection for CRLM between 2010 and 2013, 70 underwent systemic NCT. Liver function tests, pathology, postoperative morbidity and mortality were compared between the two groups. RESULTS Univariate analysis revealed NCT as a cause of sinusoidal dilation (p = 0.09), peliosis (p = 0.028) and moderate and severe SOS (p = 0.004) and bevacizumab as a protective agent against moderate and severe SOS (p = 0.045). Diabetic patients were identified as having a lower incidence of sinusoidal dilation (p = 0.034) and a higher incidence of steatosis (p = 0.003). Multivariate analysis confirmed sinusoidal dilation as an independent cause for morbidity (p = 0.02) and liver-specific complications (p = 0.016). Preoperative level of GGT was identified as predictive factor for moderate and severe SOS and peliosis (p < 0.001 and p = 0.004, respectively). CONCLUSION The administration of NCT induces SOS-lesions, but can be partially prevented by bevacizumab and diabetes. Sinusoidal dilation is associated with increased postoperative morbidity. Preoperative GGT levels can be useful to predict the presence of SOS.

Introduction: intrahepatic cholangiocarcinoma (CCIhp) is a rare malignant tumor usually diagnosed at an advanced stage. This study intends to assess the treatment results of CCIhp and to define the prognostic factors of survival in treated at our department. Material and methods: Twenty-one patients undergoing treatment for CCIhp in recent years, of which eleven were operated with curative intent: four left hepatectomies, two left hepatectomies extended to segments V and VIII, two right hepatectomies, two bisegmentectomies and a trisegmentectomy. Results: Perioperative mortality was 0%, postoperative (three months) 6%. The cumulative survival rates at 5 years were 14% in the total population, 26% in patients who underwent curative surgery and 26% for the disease free cumulative survival. There was recurrence in five patients, which was diagnosed at 1.09 ± 0.82 years (range: 0.24 to 2.08). Factors that influenced the overall survival of patients were surgery with curative intent (p=0...