RESUMO RACIONAL: A doença de von Hippel Lindau é uma síndrome autossômica dominante que se caracteriza por maior incidência de tumores em diferentes órgãos. OBJETIVO: Descrever um caso de pancreatoduodenectomia em paciente do sexo masculino de 30 anos com von Hippel Lindau. MÉTODO: Apresentamos o caso e a revisão da literatura realizada para otimizar o manejo do paciente, que apresentava feocromocitoma, hemangioblastoma capilar na retina periférica e dois tumores neuroendócrinos no pâncreas. RESULTADOS: O maior tumor pancreático localizava-se no processo uncinado medindo 31 mm. A lesão menor estava localizada no corpo proximal do pâncreas e foi detectada apenas na tomografia computadorizada por emissão de pósitrons com DOTATOC-68Ga. A investigação genética revelou uma mutação no locus NM_000551.3 c.482G>A (p.Arg161Gln) do gene supressor humano de Von Hippel-Lindau. O tumor no processo era maior que 30mm e o paciente apresentava mutação no exon 3. Indicamos pancreatoduodenectomia envolvendo o corpo proximal do pâncreas para ressecar em bloco ambos os tumores. No pós-operatório o paciente apresentou coleção líquida peripancreática que foi tratada como fístula pancreática grau B, com resolução clínica da complicação. Ele recebeu alta hospitalar no vigésimo primeiro dia pós-operatório. CONCLUSÕES: o manejo de pacientes com doença de von Hippel Lindau e tumores neuroendócrinos pancreáticos é complexo e deve ser centrado em instituições terciárias com grande volume de cirurgia pancreática. Embora a literatura atual auxilie na tomada de decisão na maioria das situações, cada etapa do tratamento requer análise e discussão entre diferentes especialidades médicas, incluindo cirurgiões, clínicos, radiologistas e anestesiologistas.

ABSTRACT BACKGROUND: The von Hippel-Lindau disease is a highly penetrant autosomal dominant syndrome characterized by tumor predisposition in different organs. AIM: This study aimed to describe a case of a pancreatoduodenectomy for a 30-year-old male patient with von Hippel-Lindau disease. METHODS: We present a case study and the literature review aiming at the state-of-the-art management of a patient with pheochromocytoma, capillary hemangioblastoma in the peripheral retina, and two neuroendocrine tumors in the pancreas. RESULTS: A larger pancreatic lesion was located in the uncinate process, measuring 31 mm. The smaller lesion was located in the proximal pancreas and was detected only on the positron emission tomography-computed tomography scan with DOTATOC-68Ga. Genetic investigation revealed a mutation in the locus NM_000551.3 c.482G>A (p.Arg161Gln) of the Von Hippel-Lindau Human Suppressor gene. The uncinate process tumor was larger than 30 mm and the patient had a mutation on exon 3; therefore, we indicated a pancreatoduodenectomy involving the proximal pancreas to resect both tumors en bloc. During the postoperative period, the patient presented a peripancreatic fluid collection, which was treated as a grade B pancreatic fistula with clinical resolution of the complication. On postoperative day 21, he was discharged home. CONCLUSION: The management of patients with von Hippel-Lindau disease and pancreatic neuroendocrine tumors is complex and must be centered on tertiary institutions with a large volume of pancreatic surgery. Although the current literature assists in decision-making in most situations, each step of the treatment requires analysis and discussion between different medical specialties, including surgeons, clinicians, radiologists, and anesthesiologists.

Abstract Purpose: To evaluate the most frequent surgical techniques of high-risk colorectal anastomoses in rats. Methods: Wistar rats were enrolled in three different models comprising inflammatory (TNBS enema), vascular (portal vein occlusion) or obstructive (a non-ischemic constricting ring) mechanisms associated with colonic anastomosis that had accomplished after these former lesions. Histological analyses (Hematoxylin and eosin and Picrosirius red) were performed. Results: All anastomoses techniques were associated with risk factors and had complications, mainly anastomotic leakage. In Study 1, the use of a pharmacological agent, trinitrobenzene sulfonic acid (TNBS) mimicked an inflammatory bowel disease such as Crohn’s disease with 50% of anastomosis leakage, the higher percentage among all models tested. In Study 2, after portal ischemia followed by reperfusion it was observed a dense neutrophil infiltrate in the midst of necrotic tissue and fibrin at the anastomotic site and 5 days after the anastomosis, no collagen was produced. In Study 3, 5 days after the mechanical obstruction some denuded areas of epithelium with marked oedema of mucosa and submucosa were seen, at the anastomotic site and anastomosis group showed some reduction of collagen density when compared with Control/Sham group. Conclusion: All the experimental surgical techniques tested in rats were associated with high-risk colorectal anastomoses and were useful to study colonic anastomotic healing and intestinal leakage.

Abstract Purpose: To evaluate a novel and adapted low-cost set model for laparoscopic surgery in rats. Methods: Nine Wistar rats underwent two different laparoscopic procedures, splenectomy (n=3) and distal pancreatectomy with splenectomy (n = 6), after assembling a low-cost set replacing the conventional one (monitor, micro camera, image processor, light source, laparoscope and insufflator). The new set included an Android Tablet 10.5 ", a 5mm USB Endoscope and semiautomatic sphygmomanometer monitor. Results: The same surgeon performed the laparoscopic procedures. Total surgical time ranged from 36 to 60 minutes with a mean of 45.8 minutes. Three rats died during the distal pancreatic and splenectomy procedure (33.3%), due to respiratory failure (n = 1), uncontrolled abdominal hemorrhage (n=1) and iatrogenic gastric perforation (n = 1). We followed the other six rats (66.6%) for seven days with no further evidence of complications. Conclusions: The laparoscopic partial pancreatectomy and splenectomy can be performed with the novel low-cost set assembled in the present experimental study. Both specific training and skills development are required to validate more advanced laparoscopic procedures and achieve a desirable outcome.

Abstract Purpose: To evaluate whether undergraduate students feel motivated to develop surgical skills and know their impression about the importance of having a surgical technique discipline in the curriculum of a medical school. Methods: A prospective study including three classes in a row, from the 8th period (n = 265) evaluated the knowledge acquired at the Center of Experimental Surgery, Department of Surgery, School of Medicine of Federal University of Rio de Janeiro (UFRJ). The importance of the discipline for medical training as a way of encouragement to arouse and deepen the interest in surgical technique was emphasized. The questions were scored from 1 to 5 (worst to best grade) . Results: Concerning the importance of the discipline for medical training, 78% and 18% of the students assigned a score 5 and 4, respectively. Regarding the stimulus to improve their surgical technical skills, 40% and 32% attributed the score 5 and 4, respectively. Conclusion: Undergraduate students from the Medical School of UFRJ effectively shared the understanding that the operative technique bases improve the formative process with significant impact, not only in the development of skills, but also to arouse vocations and stimulate new attitudes aimed to knowledge acquirement in the field of Surgery.

ABSTRACT PURPOSE: To critically analyze and standardize the rat pancreatectomy nomenclature variants. METHODS: It was performed a review of indexed manuscripts in PUBMED from 01/01/1945 to 31/12/2015 with the combined keywords "rat pancreatectomy" and "rat pancreas resection". The following parameters was considered: A. Frequency of publications; B. Purpose of the pancreatectomy in each article; C. Bibliographic references; D. Nomenclature of techniques according to the pancreatic parenchyma resection percentage RESULTS: Among the 468, the main objectives were to surgically induce diabetes and to study the genes regulations and expressions. Five rat pancreatectomy technique references received 15 or more citations. Twenty different terminologies were identified for the pancreas resection: according to the resected parenchyma percentage (30 to 95%); to the procedure type (total, subtotal and partial); or based on the selected anatomical region (distal, longitudinal and segmental). A nomenclature systematization was gathered by cross-checking information between the main surgical techniques, the anatomic parameters descriptions and the resected parenchyma percentages. CONCLUSION: The subtotal pancreatectomy nomenclature for parenchymal resection between 80 and 95% establishes a surgical parameter that also defines the total and partial pancreatectomy limits and standardizes these surgical procedures in rats.

OBJETIVO: Comparar a lesão hepatocelular ocasionada pelo emprego do pré-condicionamento isquêmico e de duas outras modalidades de clampeamento tríade portal: clampeamento contínuo e intermitente. MÉTODO: Quarenta ratos Wistar foram divididos em quatro grupos de 10 animais cada. No Grupo Sham nenhuma espécie de clampeamento foi adotada. Nos outros três, provocamos isquemia de quarenta minutos por meio do clampeamento do pedículo hepático. No Grupo I esta isquemia foi contínua. No Grupo II, também contínua, mas precedida de cinco minutos de isquemia e 10 minutos de reperfusão (précondicionamento isquêmico). No Grupo III foi realizada isquemia intermitente em ciclos de 10 min de isquemia e cinco minutos de reperfusão. Para avaliar a lesão hepatocelular foi adotada a dosagem de transaminase glutâmico oxalacética (TGO), glutâmico pirúvica (TGP) e lactato desidrogenase (LDH), aferidas no início e no final dos procedimentos. RESULTADOS: Não houve diferença estatística nos valores basais das enzimas estudadas, demonstrando uniformidade nos grupos. Os quatro grupos apresentaram variação significativa de todas as enzimas entre os dois momentos de coleta, porém de forma diferenciada. A variação no Grupo Sham foi menor que a do grupo II. Este foi semelhante ao grupo III e em todos a elevação foi significativamente menor que no grupo I (D do Sham CONCLUSÕES: Em ratos Wistar o clampeamento contínuo do pedículo hepático, precedido de um ciclo de cinco minutos de isquemia e 10 minutos de reperfusão (pré-condicionamento isquêmico) provoca menor lesão hepática do que o clampeamento contínuo e apresenta resultados comparáveis aos obtidos através da utilização do clampeamento intermitente, em fígados normais submetidos a um período de isquemia hepática de 40 minutos e um tempo total de cirurgia de 60 minutos.

BACKGROUND: To compare the hepatocyte injury due to the employment of previous ischemic conditioning and two other commonly used maneuvers for clamping the portal triad : continuous clamping and intermittent clamping. METHODS: 40 Wistar rats were divided in 4 groups .On the SHAM group, no clamping was performed. On the other 3 groups , a 40 minutes ischemia was induced by clamping the portal triad. On the Group I we performed a continuous ischemia . On the Group II , before the continuous clamping , a 5 minutes ischemia and a 10 minutes reperfusion was performed (i.e. previous ischemic conditioning).On Group III an intermittent clamping was performed in a 10 minutes ischemia and 5 minutes reperfusion cycle. In order to assess the hepatocyte injury, the Oxalacetic transaminase (SGOT), the pyruvic transaminase (SGPT) , as well the lactic desidrogenase (LDH) were titled before and after the procedures. RESULTS: There was no difference between the values of the starting samples on all the groups , revealing the uniformity of them. The four groups presented significant differences in the starting and ending samples. The odds of SHAM group were lesser significant then in the Group II , that was similar to the group III and in all the groups the rising was significant lower then the Group I (Δ SHAM < Δ Group II = Δ Group III < Δ Group I). CONCLUSION: On Wistar rats , the continuous clamping after the previous ischemic conditioning , induced a minor hepatocyte injury in comparison to the continuous clamping alone and is similar to the intermittent clamping in normal livers, submitted to 40 minutes of hepatic clamping in a whole 60 minutes procedure.

OBJETIVO: Correlacionar a avaliação clínico-laboratorial inicial simplificada com a gravidade da pancreatite aguda e a presença de necrose. MÉTODO: Foi realizado um estudo retrospectivo dos pacientes com diagnóstico final de PA internados no Hospital Universitário Clementino Fraga Filho - UFRJ entre janeiro de 1990 e agosto de 2002. Foi considerado apenas o primeiro episódio de cada paciente. Os dados obtidos foram submetidos a análise estatística. Foram estudados 164 pacientes onde a idade média foi de 43,7 anos. RESULTADOS: A etiologia biliar foi a mais freqüente com 43,9% dos casos. A incidência de necrose foi de 21,3% e a mortalidade global de 23,2%. Observamos que a ausência de taquicardia na admissão estava associada à forma branda da doença, e que os níveis plasmáticos de uréia e creatinina elevados na admissão estão associados à forma grave da doença, e a hiperglicemia (121mg/dl) à necrose pancreática. CONCLUSÕES: A avaliação inicial simplificada ainda tem espaço, embora que limitado, no acompanhamento do paciente com PA.

BACKGROUND: Our goal was to study if early and simplified clinical and laboratorial evaluation are associated to severity and necrosis in acute panceatitis (AP). METHODS: One hundred and sixty four patients, hospitalized at the Clementino Fraga Filho University Hospital between January 1990 and August 2002 with a AP final diagnosis, were included in this study. The study was retrospective and included only the first episode of each patient. From the charts we obtained clinical, laboratorial, imaging exams, operations and death data. From these data we established the severity of each case. Statistical analysis used the Variance Analysis test of Kruskal-Wallis, completed by the Multiple Comparisons test if the diference was significant. Statistic significance was defined as p< 0,05. RESULTS: Biliar etiology was the most common: 43,9% of cases, necrosis incidence was 21,3% and overall mortality was 23,2%. We observed that normal cardiac frequency at admission was associated to mild AP, as high urea and creatinine plasmatic levels at admission to severe AP, and hyperglycemia (121 mg/dl) to pancreatic necrosis. CONCLUSION: We concluded that early and simplified clinical and laboratorial evaluation at admission had a limited but clear role in AP prognosis.