ABSTRACT BACKGROUND: Since the impact of the coronavirus disease 2019 (COVID-19) pandemic in March 2020, several studies have shown a strong relationship between obesity and severe cases of COVID-19. It is imperative to assess whether bariatric surgery exerts a protective effect in such cases. OBJECTIVE: This study aimed to assess the impact of bariatric surgery on the morbidity and mortality in obese patients during the COVID-19 pandemic. A comprehensive search was performed using the PubMed and Cochrane Library databases. DESIGN AND SETTING: Retrospective cohort studies conducted in the Faculdade de Medicina da Universidade Cidade de São Paulo, São Paulo (SP), Brazil. METHODS: The search comprised the following descriptors: “bariatric, surgery, COVID-19”. Current retrospective cohort studies that examined the influence of bariatric surgery on the morbidity and mortality of obese patients during the COVID-19 pandemic were considered eligible. RESULTS: After removing duplicates, 184 studies were obtained from the databases. Of these, 181 were excluded from the analysis as they did not meet the eligibility criteria. Patients undergoing postoperative follow-up of bariatric surgery had a similar probability of SARS-CoV-2 infection compared to the general population, and persistent comorbidities were associated with an increased risk and severity of infection. CONCLUSION: Bariatric surgery has a protective effect against severe COVID-19 in the obese population, bringing the prevalence of severe disease cases to levels equivalent to those of the nonobese general population, with a positive impact on morbidity and mortality.

RESUMO Este artigo, parte de uma pesquisa maior, intitulada Fundamentos e autores recorrentes do campo da Educação de Jovens e Adultos no Brasil: a construção de um glossário eletrônico, tem como objetivo apresentar um balanço das publicações sobre Políticas Públicas de/para Educação de Jovens e Adultos (EJA) no Brasil, tendo como base de informação o Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES). De abordagem qualitativa de tipo bibliográfico, com inspiração nas pesquisas de Estado do Conhecimento, como definido por Romanowski e Ens (2006), do ponto de vista teórico, dialoga com o conceito de política pública a partir de Souza (2006), Teixeira (2002) e Mainardes (2018). Em linhas gerais, o estudo revelou a complexidade que envolve a análise das políticas públicas de/para a EJA, em decorrência das nuances e multiplicidades de categorias e temas associados.

ABSTRACT This article, part of a larger research entitled Fundaments and recurrent authors in the field of Youth and Adult Education in Brazil: the construction of an electronic glossary, aims at presenting a review of publications on Public Policies of/for Youth and Adult Education (YAE) in Brazil, with Coordenação de Aperfeiçoamento de Pessoal de Nível Superior [Coordination for the Improvement of Higher Education Personnel] (CAPES) Journals Portal as information base. The research applies a qualitative, bibliographic approach and type of the State of Knowledge type as defined by Romanowski and Ens (2006), and dialogues, from theoretical point of view, with the concept of public policy by Souza (2006), Teixeira (2002) and Mainardes (2018). In broadly terms, the study revealed the complexity that involves the YAE public policies analysis, due to the nuances and categories multiplicity, further associated themes.

ABSTRACT BACKGROUND: Since the impact of the coronavirus disease 2019 (COVID-19) pandemic in March 2020, several studies have shown a strong relationship between obesity and severe cases of COVID-19. It is imperative to assess whether bariatric surgery exerts a protective effect in such cases. OBJECTIVE: This study aimed to assess the impact of bariatric surgery on the morbidity and mortality in obese patients during the COVID-19 pandemic. A comprehensive search was performed using the PubMed and Cochrane Library databases. DESIGN AND SETTING: Retrospective cohort studies conducted in the Faculdade de Medicina da Universidade Cidade de São Paulo, São Paulo (SP), Brazil. METHODS: The search comprised the following descriptors: “bariatric, surgery, COVID-19”. Current retrospective cohort studies that examined the influence of bariatric surgery on the morbidity and mortality of obese patients during the COVID-19 pandemic were considered eligible. RESULTS: After removing duplicates, 184 studies were obtained from the databases. Of these, 181 were excluded from the analysis as they did not meet the eligibility criteria. Patients undergoing postoperative follow-up of bariatric surgery had a similar probability of SARS-CoV-2 infection compared to the general population, and persistent comorbidities were associated with an increased risk and severity of infection. CONCLUSION: Bariatric surgery has a protective effect against severe COVID-19 in the obese population, bringing the prevalence of severe disease cases to levels equivalent to those of the nonobese general population, with a positive impact on morbidity and mortality.

RESUMO Este artigo apresenta um balanço da produção acadêmica sobre ação afirmativa na pós-graduação brasileira, tendo em vista identificar as principais características dessa agenda de pesquisa. Para tanto, utiliza abordagem qualitativa, do tipo estado da arte, a partir da análise de conteúdo de teses, dissertações e artigos publicados nos principais portais disponíveis. O texto evidencia um campo incipiente e a necessidade de investimento em redes de pesquisadores de diversas regiões brasileiras para estimular o mapeamento e a análise de experiências existentes e apontar caminhos de resistência neste momento de desinvestimento do Estado em políticas educacionais de desenvolvimento científico associado ao fortalecimento das políticas de ação afirmativa. pósgraduação pós graduação brasileira pesquisa tanto qualitativa arte teses disponíveis

RESUMEN Este artículo presenta una revisión de la producción académica sobre acción afirmativa en el posgrado brasileño, con la intención de identificar las principales características de esa agenda de investigación. Para ello, utiliza del abordaje cualitativo del tipo Estado del Arte, desde el análisis de contenido de teses, disertaciones y artículos publicados en las principales portadas disponibles. El texto hace evidente un campo incipiente y la necesidad de inversión en redes de investigadores de diversas regiones brasileñas para estimular el mapeo y análisis de experiencias existentes, y apuntar caminos de resistencia en este momento de desinversiones del Estado en políticas educativas de desarrollo científico asociado con el fortalecimiento de las políticas de acción afirmativa. brasileño investigación ello Arte teses disponibles existentes

ABSTRACT This paper presents an academic production review on affirmative actions in Brazilian graduation, aiming at identifying the main characteristics of this research agenda. Thereunto, it uses a qualitative State of Art approach from the content analysis of thesis, dissertations, and papers published by the main websites available. The text evinces an incipient field, as well as the need for investment in researchers’ networks from several Brazilian regions in order to stimulate the mapping and analysis of existing experiences, also pointing resistance paths in this moment of State disinvestment in educational policies for scientific development associated to the strengthening of affirmative action policies. graduation agenda Thereunto thesis dissertations available field researchers experiences

ABSTRACT Purpose Herein we evaluated the effects of platelet concentrate (PC) and platelet-poor plasma (PPP) on bone repair using noncritical defects in the calvaria of rabbits and compared them to the presence of TGF-β1 and osteocalcin on reparative sites. Methods Five noncritical defects of 8.7 mm in diameter were created on the calvaria of 15 animals. Each defect was treated differently, using autograft (ABG), ABG associated with PC (ABG + PC), ABG with PPP (ABG + PPP), isolated PPP, and blood clot (control). The animals were submitted to euthanasia on the second, fourth and sixth week post-surgery. Results The defects that received ABG+PC or PPP demonstrated lower bone formation when compared to specimens that received ABG in the same period. These results coincided to significant higher immunopositivity for TGF-β1 for specimens that received PC, and lower presence of cytokine in the group PPP. However, either higher or lower presence of TGF-β1 were also correlated to lower presence of osteocalcin. Likewise, these results were similar to findings in specimens treated only with PPP when compared to control. Conclusions PC and PPP were not effective when applied in association with ABG. Similarly, isolated use of PPP was not beneficial in optimizing the bone repair.

This study aimed to observe if the order of the predominantly aerobic exercise, concerning the predominantly anaerobic exercises, in the concurrent training affects the body composition. Nine young males and nine young females were equitably dived into three groups that performed for ten weeks a concurrent training, differing between them in the order of the predominantly aerobic exercise in relation to the predominantly anaerobic exercises, with the objective to change the body composition: i) before; ii) after; and iii) interleaved. The measurements of the body composition were performed before (T0) and after ten weeks (T1) of concurrent training, a protocol using the dual-energy x-ray absorptiometry (DXA). It was observed a significant (p<0.05) reduction in the percentage of total body fat in all groups (25.75±9.34 to 25.08±9.38, 26.08±8.17 to 25.51±7.54, 28.20±4.29 to 26.45±5.56, T0 and T1, before, after and, interleaved, respectively). The total fat-free mass it was significantly increased in the after order group (50.74±11.82 kg to 51.01±11.85 kg, T0, and T1, respectively) and the upper limbs fat-free mass also significantly increased only in the before order group (6.66±2.64kg to 7.15±2.95kg, T0, and T1, respectively). No statistical differences were observed in any study variables between groups. Based on the data of the present study, the order of the predominantly aerobic exercise concerning the predominantly anaerobic exercises in the concurrent training did not influence the alterations in the body composition.

Resumo Balneário Camboriú (SC - Brasil) é uma cidade turística, onde o crescimento desordenado da população urbana e a implementação de obras costeiras sem uma avaliação adequada tem gerado impactos ambientais e afetado severamenteou a qualidade sanitária da água e do sedimento do rio Camboriú e da área marinha adjacente. Um dos fenômenos mais recentes e alarmantes observados são as florações de briozoários invasivos (Arboscuspis bellula e Membraniporopsis tubigera) associados com as diatomáceas epibênticas (Amphitetras antediluviana e Biddulphia biddulphiana). Vários indícios associam esses fenômenos, iniciados em 2003, com o excesso de nutrientes e matéria orgânica na enseada Camboriú e com grandes obras costeiras locais, como dragagem, aterro e construção de molhes, levando a mudanças na estrutura ecológica bêntica. Sendo um problema de estético e ambiental, a preocupação da comunidade e órgãos governamentais gerou uma intensificação nos estudos, uma vez que as ocorrências se tornaram mais frequentes e persistentes. O presente trabalho aborda este problema através de estudos ambientais e experimentais. A coleta de material bêntico com embarcação e mergulhos e monitoramento florações junto a praia compuseram a abordagem ambiental. Os trabalhos de laboratório incluíram o isolamento e a cultura de algas e brioozários, bem como a avalição do crescimento desses organismos, além da análise e avaliação química biomassa. Os dados de monitoramento mostraram uma tendência sazonal nas florações, com eventos mais evidentes nos meses mais quentes. Diatomáceas aumentaram em abundância nos meses mais frios e briozoários nos mais quentes. A diatomácea A. antediluviana, predominante nas florações, cresceu de forma satisfatória em cultivo laboratorial, mostrando um melhor crescimento em meios com concentrações mais elevadas de silicato e fosfato. Os briozoários mostraram crescimento lento em condições de laboratório. O material depositado no ambiente mostrou baixas concentrações de ácidos graxos, predominantemente saturados, mas a elevada biomassa sugere um possível uso para a produção de biocombustíveis. Amostras de biomassa dominadas por briozoários apresentaram atividade antimicrobiana moderada contra Klebsiella pneumoniae. A explicação para a ocorrência destes eventos ainda são inconclusivas, mas há evidências consideráveis de que há um efeito sinérgico entre a alta concentração de bactérias e detritos orgânicos na água, relacionada com a poluição local, e a eliminação de competidores naturais pelos impactos das obras costeiras.

Abstract Balneário Camboriu (SC - Brazil) is a touristic city where the disordered growth of the urban population and the implementation of coastal works without proper evaluation generated environmental impacts and affected the sanitary quality of water and sediment of Camboriu River and marine adjacent area. One of the most recent and alarming phenomena observed are the blooms of invasive bryozoans (Arboscuspis bellula and Membraniporopsis tubigera) associated with epibenthic diatoms (Amphitetras antediluviana and Biddulphia biddulphiana). Several clues associate these phenomena, started in 2003, with the excess of nutrients and organic matter in the Camboriú cove and large coastal works such as dredging, landfills and construction of jetties, leading to changes in benthic ecological structure. Being an aesthetic and environmental health problem, the concern of the scientific community and government agencies intensified as the occurrences become more frequent and persistent. This research addresses this issue through environmental and experimental studies. Samplings of the benthic material collected by boat and diving, and blooms monitoring were the environmental approach. The laboratory work included the algal isolation and culture, in addition to growth conditions assessment and chemical biomass analysis. Monitoring data showed a seasonal trend in the blooms, with more conspicuous events in warmer months. Diatoms increase in abundance in colder months and bryozoans in the warmer ones. The diatom A. antediluviana, predominant in the blooms, grew satisfactorily in laboratory cultivation, showing better growth in media with higher concentrations of silicate and phosphate. Bryozoans showed slow growth in laboratory conditions. The deposited material collected in the environment showed low concentrations of saturated fatty acids, but the high biomass suggest a possible use for biofuels production. Biomass samples dominated by bryozoans showed moderate antimicrobial activity against Klebsiella pneumoniae. The explanation for the occurrence of these blooms are still inconclusive, but there is considerable evidence that it is a synergistic effect between the high concentration of bacteria and organic debris in the water related to local pollution and the elimination of natural competitors by coastal works.

ABSTRACT Validate the EORTC risk tables in Brazilian patients with NMIBC. Methods: 205 patients were analyzed. The 6 parameters analyzed were: histologic grading, pathologic stage, size and number of tumors, previous recurrence rate and concomitant CIS. The time for first recurrence (TFR), risk score and probability of recurrence were calculated and compared to the probabilities obtained from EORTC risk tables. C-index was calculated and accuracy of EORTC tables was analyzed. Results: pTa was presented in 91 (44.4%) patients and pT1 in 114 (55.6%). Ninety-seven (47.3%) patients had solitary tumor, and 108 (52.7%) multiple tumors. One hundred and three (50.2%) patients had tumors smaller than 3 cm and 102 (40.8%) had bigger than 3 cm. Concomitant CIS was observed in 21 (10.2%) patients. Low grade was presented in 95 (46.3%) patients, and high grade in 110 (53.7%). Intravesical therapy was utilized in 105 (56.1%) patients. Recurrence was observed in 117 (57.1%) patients and the mean TFR was 14,2 ± 7,3 months. C-index was 0,72 for 1 year and 0,7 for 5 years. The recurrence risk was 28,8% in 1 year and 57,1% in 5 years, independently of the scoring risk. In our population, the EORTC risk tables overestimated the risk of recurrence in 1 year and underestimated in 5 years. Conclusion: The validation of the EORTC risk tables in Brazilian patients with NMIBC was satisfactory and should be stimulated to predict recurrence, although these may overestimated the risk of recurrence in 1 year and underestimated in 5 years.

O objetivo do presente estudo foi verificar possíveis alterações nas proteínas de fase aguda em ovinos infectados experimentalmente com Trypanosoma vivax. Para tanto, foram utilizados oito ovinos machos, sendo quatro usados como controle e quatro infectados com 10(5) tripomastigotas de T. vivax. Colheram-se amostras de sangue em dois tempos antes da infecção e, posteriormente, aos 5, 7, 9, 11, 13, 15, 20, 30, 45, 60, 75, 90, 105 e 120 dias após a infecção (dpi); após centrifugação e aliquotização das amostras. As proteínas de fase aguda foram separadas por eletroforese em gel de acrilamida, contendo dodecil sulfato de sódio, e suas concentrações foram determinadas através de densitometria computadorizada. A dosagem de proteína total foi realizada pelo método colorimétrico do biureto. A contagem dos tripanossomas foi realizada diariamente, utilizando-se uma alíquota de 5 µL de sangue disperso em lâmina de microscopia, sob lamínula de 22 × 22 mm, contando-se os parasitos em 100 campos microscópicos, com objetiva de 40×, multiplicados pelo fator de correção do microscópio, e o resultado expresso em parasitos por mL de sangue. Para a análise estatística, empregou-se o teste de Wilcoxon a 5% de probabilidade. Foi observada a diminuição de diversas proteínas de fase aguda e aumento de antitripsina e transferrina que podem ser utilizadas para auxiliar no diagnóstico da infecção por T. vivax, principalmente na fase crônica da infecção.

The present study aimed to assess potential changes in acute phase proteins in sheep experimentally infected with Trypanosoma vivax. There were studied eight male sheep, four used as controls and four infected with 10(5) T. vivax trypomastigotes. Blood samples were collected at two points times before infection and then at 5,7, 9, 11, 13, 15, 20, 30, 45, 60, 75, 90, 105 and 120 days post-infection (dpi). Blood samples were centrifuged and allotted, and acute phase proteins were then separated by electrophoresis on acrylamide gel containing sodium dodecyl sulfate. Protein concentrations were determined by computer-assisted densitometry. Total protein was determined by colorimetric biuret method. Trypanosomes were counted daily using a 5 mL aliquot of blood smear on a glass slide under a 22 × 22 mm coverslip. Parasites were counted in 100 microscopic fields (40× magnification), and then multiplied by a correction factor. The results were expressed as parasites per mL of blood. For statistical analyses, we used the Wilcoxon test at 5% significance level. There was found a reduction in several acute phase proteins and increase in antitrypsin and transferrin. This finding can be used for the diagnosis of T. vivax infection, especially in chronic infection.

RACIONAL: A principal causa de morte em pacientes com sepse em cirurgia é a síndrome de disfunção de múltiplos órgãos. Assim, modelos experimentais que simulem alterações orgânicas da sepse em humanos são necessários. OBJETIVO: Apresentar dois modelos que induzem a síndrome de disfunção de múltiplos órgãos e comparar as alterações induzidas por inoculação endovenosa de 36UE de lipopolissacarídeo ou célula viável de Escherichia coli, em relação à: mortalidade e sobrevivência; nível de lipopolissacarídeo; liberação de fator de necrose tumoral alfa; alterações hematológicas e das funções hepática e renal. MÉTODO: Este estudo teve duração de sete dias e utilizou-se nele 50 ratos Wistar machos, divididos em três grupos: controle, lipopolissacarídeo e Escherichia coli. Os grupos experimento eram inoculados e separados em dois subgrupos, com inoculação a cada 24 ou 48 horas. No sétimo dia eram procedidas coletas de sangue e análise histopatológica de fígado, rins e pulmões. RESULTADOS: Houve sobrevivência de dez animais no grupo controle; zero no bacteriano de 24 horas e seis no de 48 horas; dez no lipopolissacarídeo de 24 horas e seis no de 48 horas. Nos grupos experimentais, os níveis de lipopolissacarídeo, fator de necrose tumoral alfa, leucócitos, plaquetas, bastonetes e as alterações renais e hepáticas foram superiores ao grupo controle. Houve alterações histopatológicas no grupo bacteriano. CONCLUSÃO: Os dois modelos de sepse induziram síndrome de disfunção de múltiplos órgãos, contudo a administração de 36UE de endotoxina a cada 48 horas pode ser utilizada com vantagens sobre os demais por não induzir morte em número significativo durante o período de sete dias.

BACKGROUND: The leading cause of death in patients with sepsis in surgery is syndrome of multiple organ dysfunction. Thus, experimental models that simulate organic changes of sepsis in humans are required. AIM: To present two models that induce the syndrome of multiple organ dysfunction and to compare, the changes induced, by intravenous injection of lipopolysaccharide or cell 36UE of viable Escherichia coli in relation to mortality and survival, level of lipopolysaccharide, release of tumor necrosis factor alpha ; hematological, liver and kidney function. METHOD: The study lasted seven days and it was used on it 50 male Wistar rats divided into three groups: control, lipopolysaccharide and Escherichia coli. The experimental groups were inoculated and divided into two subgroups, with inocuation with 24 or 48 hours. On the seventh day were proceeded blood collection and histopathologic analysis of liver, kidneys and lungs. RESULTS: There was a survival of ten animals in the control group; zero in bacteria group of 24 hours and six in 48 hours; ten of lipopolysaccharide in 24 hours and six in 48 hours. In the experimental groups, levels of endotoxin, tumor necrosis factor alpha, leukocytes, platelets, renal and liver levels were higher than the control group. There were histopathological changes in the bacterial group. CONCLUSION: The two models of sepsis induced multiple organ dysfunction syndrome; yet the administration 36UE endotoxin every 48 hours could be utilized in advantage over the other for not induce death in significant numbers during the period of seven days.

O hemograma e proteínas de fase aguda foram avaliados durante 28 dias em coelhos adultos, machos, raça branco Nova Zelândia, infectados experimentalmente, via oral, com oocistos esporulados de Eimeria stiedai. Foram usados 50 animais distribuídos em dois grupos: grupo A infectado com 1 × 10(4) oocistos esporulados de E. stiedai e grupo B inoculado com água destilada. No 7º dia após a infecção (dpi), os animais infectados tiveram anemia, leucocitose com neutrofilia e monocitose. O método de fracionamento de proteínas por eletroforese identificou 19 proteínas de fase aguda com pesos moleculares que variaram entre 24 e 238 kD. A ceruloplasmina, transferrina e haptoglobina tiveram níveis elevados no 7° dpi com aumento progressivo de suas concentrações até o término do período experimental. Desta forma, considerando-se os dados encontrados no presente estudo, E. stiedai é considerado um agente etiológico piogênico que pode ter sua infecção monitorada por determinação do leucograma e das concentrações séricas de ceruloplasmina, transferrina e haptoglobina, podendo ser estes recomendados como exames complementares.

Hemograms and acute-phase proteins in adult male New Zealand White rabbits that had been experimentally infected orally with sporulated oocysts of Eimeria stiedai were evaluated over a 28-day period. Fifty animals were used, divided into two groups: group A infected with 1 × 10(4) sporulated oocysts of E. stiedai and group B inoculated with distilled water. On the seventh day after infection, the infected animals presented anemia and leukocytosis with neutrophilia and monocytosis. Protein fractionation by means of electrophoresis identified 19 acute-phase proteins with molecular weights ranging from 24 to 238 kD. Ceruloplasmin, transferrin and haptoglobin showed high levels on the seventh day after infection, with gradual increases in their concentrations until the end of the experimental period. Thus, from the data of the present study, E. stiedai is considered to be a pyogenic etiological agent for which the infection level can be monitored through the leukocyte count and serum concentrations of ceruloplasmin, transferrin and haptoglobin, and these can be recommended as complementary tests.

OBJETIVO: Avaliar se o tratamento das malformações vasculares venosas congênitas realizado com o emprego da tecnologia laser oferece clareamento ou desaparecimento das lesões com elevado grau de satisfação informado pelos pacientes e observado pelo médico. MÉTODOS: O estudo retrospectivo reuniu 26 pacientes, portadores de malformação vascular venosa, dos quais 73,07% eram do sexo feminino e que foram tratados com o aparelho PhotoDerm®. O tratamento das malformações vasculares necessitou uma média de 6,43 sessões, com intervalos de seis a oito semanas. Os pacientes incluídos neste estudo apresentavam pele tipo II (57,40%) e tipo III (42,30%), conforme classificação de Fitzpatric. A idade média variou de 14 a 61 anos, com média de 36,70 anos. Os dados foram obtidos através do preenchimento de protocolo informado pelo paciente. RESULTADOS: Foi informado elevado grau de satisfação (96,16%) e apenas um caso (3,84%) parcialmente satisfeito, considerando o clareamento ou desaparecimento das lesões. Houve desaparecimento das lesões avaliado pelo profissional médico em 80,76% dos casos e em 19,24% apenas clareamento. CONCLUSÃO: O tratamento das malformações vasculares venosas com o Photo-Derm® é seguro e eficiente tendo proporcionado elevado grau de satisfação dos pacientes assim como bons resultados em relação ao desaparecimento das lesões.

OBJECTIVE: To evaluate whether treatment of venous congenital vascular malformations with the use of laser technology provides lightening or disappearance of lesions with a high degree of satisfaction reported by patients and observed by the physician. METHODS: A retrospective study gathered 26 patients suffering from vascular malformation, of which 73.07% were female and were treated with the PhotoDerm® device. The treatment of vascular malformations needed an average of 6.43 sessions, with intervals of six to eight weeks. Patients included in this study had skin type II (57.40%) and type III (42.30%), according to the Fitzpatric's classification. The mean age ranged from 14 to 61 years, averaging 36.70 years. Data were obtained through the completion of an informed protocol by the patient. RESULTS: High satisfaction rates were reported (96.16%) and only one case (3.84%) was partially satisfied when considering lightening or disappearance of lesions. When evaluated by medical professionals, lesions disappeared in 80.76% and became lighter in 19.24%. CONCLUSION: The treatment of venous vascular malformations with Photo-Derm® is safe and effective as it offered a high degree of patient satisfaction and good results in the disappearance of the lesions.

OBJETIVO: Relatar a experiência com as principais técnicas de reconstrução do trato alimentar após esofagectomia por câncer de esôfago. METODOS: Foram analisados retrospectivamente 68 pacientes submetidos à esofagectomia entre fevereiro de 1997 e novembro de 2005. Todos os pacientes incluídos no estudo foram submetidos à esofagectomia com reconstrução com tubo gástrico ou colônico e anastomose cervical. RESULTADOS: A idade média foi de 55,4 anos (25-74 anos), 50 pacientes eram do sexo masculino e 18 pacientes do sexo feminino, 27 pacientes apresentavam o tumor localizado no esôfago médio e 41 pacientes no esôfago distal, sendo carcinoma epidermóide em 35 pacientes e adenocarcinoma em 33 pacientes. A ressecção foi por via transtorácica em 35 indivíduos e por via transhiatal em 33. A reconstrução com tubo gástrico se deu em 58 pacientes e com tubo colônico em 10 pacientes. A morbidade total da série foi de 52,9%. A mortalidade operatória foi de 5,8%. A sobrevida média foi de 35 meses. CONCLUSÃO: A esofagectomia com reconstrução com tubo gástrico e anastomose cervical é factível tecnicamente, sendo um procedimento realizado de rotina nos pacientes portadores de câncer de esôfago com indicação cirúrgica. Utilizamos, e recomendamos, a reconstrução com tubo colônico principalmente nos pacientes com cirurgia prévia no estômago ou quando da necessidade de ressecção ampliada deste, impossibilitando a confecção da reconstrução do trânsito alimentar com a gastroplastia.

BACKGROUND: To describe the main reconstruction techniques of the alimentary tract after esophagectomy due to esophagus cancer in patients enrolled. METHODS: We analyzed retrospectively 68 patients submitted to the esophagectomy between february of 1997 and november of 2005. All of the patients included in the study were submitted to the reconstruction with gastric tube and colon segment and cervical anastomosis. RESULTS: The mean age was 55,4 years (25-74 years). 50 patients were of male gender and 18 patients of female gender. 27 patients presented the tumor localized in the medium esophagus and 41 patients in the distal esophagus, being epidermoid carcinoma in 35 patients and adenocarcinoma in 33 patients. The ressection was performed through transthoracic access in 35 individuals and through transhiatal access in 33. The reconstruction with gastric tube was performed in 58 patients and with colonic tube in 10 patients. The series total morbidity was 52,9%. The operative mortality was 5,8%. The mean survival was of 35 months. CONCLUSION: The esophagectomy with reconstruction with gastric tube and cervical anastomosis is feasible technically; being a routine procedure realized in the patients carriers of esophagus cancer with surgical indication. The reconstruction with the colonic tube is indicated mainly for the patients without possibility of the stomach use for reconstruction of the alimentary tract, being a valid option and with excellent results.

OBJETIVO: O objetivo deste trabalho foi relatar a morbimortalidade associada à técnica de reconstrução pancreática utilizando anastomose pancreato-jejunal tipo ducto-mucosa, sem cateter transanastomótico, em pâncreas de consistência mole e ducto de Wirsung menor que três mm. MÉTODOS: Analisamos consecutivamente os resultados de 16 pacientes submetidos à GDP com técnica de anastomose pancreato-jejunal tipo ducto-mucosa no Serviço de Cirurgia Abdômino-pélvica do INCA. Todos pacientes eram portadores de pâncreas de consistência mole e ducto pancreático fino (< 3mm). RESULTADOS: Dos 16 pacientes analisados, oito eram do sexo masculino e com mediana de idade de 55 anos. No período pós-operatório um paciente apresentou fístula pancreática e houve um caso que evoluiu para óbito. CONCLUSÃO: Acreditamos que é possível a realização de anastomose pancreática tipo ducto-mucosa, sem cateter transanastomótico, em pacientes com ducto pancreático menor que três mm sem aumento da morbimortalidade.

BACKGROUND: Our goal is to report the morbimortality associated to the pancreatic reconstruction technique using duct-to-mucosa nonstented pancreatojejunostomy in soft pancreas and Wirsung's duct less than 3 mm. METHODS: We analyzed 16 consecutive patients submitted to DP with duct-to-mucosa pancreatojejunostomy technique in the Service of Abdominal-pelvic Surgery of NCI-Brazil. All patients had soft pancreatic texture and small pancreatic duct (< 3mm). RESULTS: From those 16 patients, eight were males, with an mean age of 55 years old. In the post-operative period one patient developed pancreatic fistula. There had been one death. CONCLUSION: We believe that duct-to-mucosa nonstented pancreatojejunostomy is possible in patients with pancreatic duct less than three mm and soft texture pancreas without increased morbimortality.

OBJETIVO: Avaliar a morbi-mortalidade cirúrgica e a evolução dos pacientes submetidos a gastroduodenopancreatectomia (GDP) ampliada para tumores não periampulares. MÉTODO: Foram analisados retrospectivamente 15 pacientes submetidos a GDP para tumores não periampulares, no Serviço de Cirurgia Abdômino-Pélvica do INCa-RJ, no período de 1990 a 2005. RESULTADOS: Os tipos histológicos dos tumores primários incluíam o adenocarcinoma de cólon (n=9), adenocarcinoma gástrico (n=3), tumor estromal gastro-intestinal (GIST) de delgado (n=2) e carcinoma de células renais (n=1). A mediana de tempo de internação foi de 13,5 dias (6 a 36), a mediana de tempo de cirurgia foi de 360 minutos, a média de hemotransfusão foi de 307ml, a mediana de linfonodos ressecados foi de 19, sendo três pacientes com linfonodos positivos, a mediana do tamanho do tumor foi de 7,8cm (2,5 a 24), a morbidade cirúrgica foi de 53%, a mortalidade operatória foi de 6,6% (1/15) e a mediana de sobrevida global foi de 38 meses. CONCLUSÃO: A gastroduodenopancreatectomia ampliada para tumores não periampulares é um procedimento de excessão e deve ser considerada somente para paciente selecionados.

BACKGROUND: To evaluate the surgical morbimortality and the outcome of patients submitted to extended duodenopancreatectomy (DP) for nonperiampulary tumors. METHODS: A retrospective evaluation of 15 patients submitted to DP for nonperiampulary tumors was performed in the abdominal-pelvic surgery service of National Cancer Institute- Brazil, from 1990 to 2005. RESULTS: The histological types of primary tumors included adenocarcinoma of colon (n=9), gastric adenocarcinoma (n=3), gastrointestinal stromal tumors (n=2) and renal carcinoma (n=1). The average hospital length of stay was 13.5 days (6 to 36), the average operation time was 360 minutes, the hemotransfusion average volume was 307 ml, the ressected lymph nodes average number was 19, where 3 patients had positive lymph nodes. The average size of the tumor was 7.8cm (2.5 to 24), the surgical morbidity was 53%, the operative mortality was 6.6% (one patient) and the overall survival average was 38 months. CONCLUSION: The duodenopancreatectomy for nonperiampulary tumors is an procedure of exception and it must be considered only for selected patients.