ABSTRACT Introduction: Portal hypertension still represents an important health problem worldwide. In the search for knowledge regarding this syndrome, experimental studies with animal models have proven to be useful to point the direction to be taken in future randomized clinical trials. Purpose: To validate the experimental model of portal hypertension and esophagogastric varices in a medium-sized animal. Methods: This study included five minipigs br1. Midline laparotomy with dissection of the portal vein and production of a calibrated stenosis of this vein was performed. Measurement of pressure in the portal venous and digestive endoscopic were performed before and five weeks after the production of a stenosis. Results: All animals were 8 months old, average weight of 17 ± 2.5 kg. The mean pressure of the portal vein immediately before the partial ligation of the portal vein was 8.9 + 1.6 mm Hg, with 26.6 + 5.4 mm Hg in the second measurement five weeks later (p < 0.05). No gastroesophageal varices or hypertensive portal gastropathy were seen at endoscopy procedures in our sample at any time in the study. Conclusion: Portal vein ligation in minipigs has been validated in the production of portal hypertension, but not in the formation of esophageal varices.

Abstract Fine motor skills (FMS) allow for the control and coordination of the distal musculature of hands and fingers, a skill required to brush teeth. The objective of this study was to investigate the association between FMS and toothbrushing efficacy. This cross-sectional study included 42 low-income Latino children aged 5 to 9 years from Pasto, Colombia. Toothbrushing efficacy was determined by the children’s dental plaque Quigley-Hein Index (QH-I) mean-score difference from before and after toothbrushing. FMS were evaluated using the 5–15R parent evaluation, the spiral drawing Archimedes test, and a neurodevelopmental assessment of movements and prehension patterns during toothbrushing. A descriptive analysis was performed to assess the characteristics of FMS and children’s toothbrushing, and a generalized linear model was used to determine associations between these skills and toothbrushing efficacy. Eighty-six percent of the children had at least one difficulty with FMS, and in 7%, they interfered with daily activities. Fourteen percent presented a moderate pattern in the Archimedes test, and 43% had inefficient prehension patterns. Toothbrushing reduced the QH-I by a mean of 1.45 (SD = 0.78–2.12) (p < 0.001). Toothbrushing efficacy was only significantly associated with age (mean-difference = -0.315, 95%CI: -0.481 to -0.148, p < 0.001). FMS and toothbrushing efficacy were not significantly associated. Other components of fine motor control should be analyzed to understand the kinetics of toothbrushing.

RACIONAL: Dentre as correções endoscópicas das hérnias, as abordagens totalmente extraperitoneal (TEP) e transabdominal pré-peritoneal (TAPP) são amplamente aceitas como alternativas à operação aberta, fornecendo menos dor no período pós-operatório, menor tempo de permanência hospitalar e retorno precoce ao trabalho. A técnica TEP clássica requer três incisões na pele para a colocação de três trocárteres na linha média ou em triangulação. OBJETIVO: Descrever uma técnica utilizando apenas dois trocárteres para hernioplastia laparoscópica totalmente extraperitoneal (TEP). MÉTODO: Acesso extraperitoneal: são inseridos dois trocárteres sobre a linha média; um de 10 mm é inserido no subcutâneo em direção horizontal após incisão infra-umbilical transversal e, em seguida, elevado ao ângulo de 60°; outro de 5 mm é inserido ao nível do pubis com visão direta. Tempos operatórios: 1) dissecção do espaço preperitoneal: introdução da ótica laparoscópica de 0º através da incisão infra-umbilical para visualização e dissecção pré-peritoneal; pressão de insuflação inferior a 12 mmHg; 2) Dissecção de alguns reparos anatômicos: pubis, linha arqueada e vasos epigástricos inferiores; 3) reconhecimento do "triângulo da dor" e "triângulo do desastre"; 4) Inserção através do trocáter de 10 mm de tela de polipropileno de 10x15 cm para cobrir o sitio da hérnia; 5) Reposicionamento do peritônio e da borda dorsal da tela para evitar dobras ou deslocamento da tela. Não é necessária a drenagem. RESULTADOS: Esta técnica foi utilizada em nove pacientes e apresentou bom resultado sem necessidade de um cirurgião auxiliar para executá-la, apenas dois trocáteres, menos material de sutura e de curativos. Além disso, exigiu apenas duas incisões, o que proporcionou melhor resultado estético e menor dor no período pós-operatório. CONCLUSÃO: A técnica proposta utilizando dois trocárteres é uma alternativa viável, com melhora dos resultados cosméticos e financeiros.

BACKGROUND: Among endoscopic hernioplasties, totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) approach are widely accepted alternatives to open surgery, both providing less postoperative pain, hospital length of stay and early return to work. Classical TEP technique requires three skin incisions for placement of three trocars in the midline or in triangulation. AIM: To describe a technique using only two trocars for laparoscopic total extraperitoneal for inguinal hernia repair. METHOD: Extraperitoneal access: place two regular trocars on the midline. The 10 mm is inserted into the subcutaneous in horizontal direction after a transverse infra-umbilical incision and then elevated at 60º angle. The 5 mm trocar is inserted at the same level of the pubis with direct vision. Preperitoneal space dissection: introduction 0º optical laparoscope through the infra-umbilical incision for visualization and preperitoneal dissection; insufflation pressure must be below 12 mmHg. Dissection of some anatomical landmarks: pubic bone, arcuate line and inferior epigastric vessels. Exposure of "triangle of pain" and "triangle of doom". Insertion through the 10 mm trocar polypropylene mesh of 10x15 cm to cover the hernia sites. Peritoneal sac and the dorsal edge of the mesh are repositioned in order to avoid bending or mesh displacement. It is also important to remember that the drainage is not necessary. RESULTS: The 2-port TEP required less financial costs than usual because it is not necessary an auxiliary surgeon to perform the technique. Trocars, suturing material and wound dressing were spared in comparison to the classical technique. Besides, there were only two incisions, which provides a better plastic result and less postoperative pain. CONCLUSION: The TEP technique using two trocars is an alternative technique which improves cosmetic and financial outcomes.

The notion of literary posture, developed by Jérôme Meizoz, has recently integrated the field of postcolonial studies, thanks in particular to the edited book by Anthony Mangeon, Postures postcoloniales. Domaines africains et antillais (2012). Based on the concepts of Pierre Bourdieu-field, habitusand especially illusio-posture could be defined, in the domain of literary studies, as a way to "acquire" a position in the field, negotiated and renegotiated in a personal way, in order to inhabit a role, or even a status. The notion of posture would thus allow to better taking hold of the way authors present their positions not only in terms of symbolic capital and notoriety, but also in terms of their worldview. Posture has a rhetoric dimension, which is reflected in the textual, and an "actional" dimension, reflected in the contextual. It is in this framework that this article analyzes the most recent literary production (the textual) of the Franco-Congolese writer Alain Mabanckou, at a time this writer had to reinvent himself, following his huge positive critical acclaim. This production is linked to his activities on the margins of literature (the contextual), mainly his presence on social media and his participation to the Etonnants voyageurs literary festival (and in particular the festival organized in Brazzaville in February 2013). This "child of the postcolony" (Abdourahman Waberi), fervent advocate of the littérature-monde movement, displays in his latest work a certain return to the Africa of his childhood. This posture will be analyzed through his latest works, two novels and two essays, published between 2010 and 2013. The article will conclude on the validity of the notion of posture in postcolonial Francophone studies.

OBJETIVO: identificar e avaliar as complicações do tratamento da hérnia inguinal com a colocação de tela totalmente extraperitoneal. MÉTODOS: Foram incluídos, em uma série consecutiva de 4565 reparos de hérnia laparoscópica, pacientes que haviam sido submetidos ao procedimento TEP entre janeiro de 2001 e janeiro de 2011. Os critérios de inclusão foram: diagnóstico com hérnia inguinal sintomática, incluindo recorrência após correção de hérnia inguinal e cirurgia prévia em abdômen inferior e pelve. Todos os pacientes > 18 anos de idade. Pacientes com hérnia encarcerada na urgência foram excluídos do estudo. RESULTADOS: Um total de 4565 hérnias foram incluídas no estudo. Ocorreram 27 complicações graves (0,6%): 12 hemorragias (0,25%), duas lesões da bexiga (0,04%), cinco oclusões (0,11%), quatro perfurações intestinais (0,09%), uma lesão da veia ilíaca (0,02%), uma lesão do nervo femoral (0,02%), duas lesões dos vasos deferentes (0,04%) e dois óbitos (0,02%) (embolia pulmonar, peritonite). CONCLUSÃO: A taxa de complicações com o procedimento TEP é baixa. Correção de hérnia laparoscópica é uma técnica reprodutível e confiável. Em nossa experiência, existem contraindicações para o procedimento de TEP. A técnica TEP deve ser minuciosa para evitar complicações intraoperatórias (diatermia bipolar). As complicações podem ocorrer mesmo após o cirurgião ter adquirido experiência substancial.

OBJECTIVE: To identify and assess the complications of laparoscopic inguinal hernia treatment with totally extraperitoneal mesh placement (TEP). METHODS: We included patients who had undergone the TEP procedure in a consecutive series of 4565 laparoscopic hernia repairs between January 2001 and January 2011. Inclusion criteria were diagnosis with symptomatic inguinal hernia, including recurrence after inguinal hernia repair and previous surgery in the lower abdomen and pelvis. All patients were 18 years of age or above. Patients with incarcerated hernia in emergency were excluded from the study. RESULTS: A total of 4565 hernias were included in the study. In the group, there were 27 severe complications (0.6%): 12 bleedings (0.25%), two bladder lesions (0.04%), five intestinal obstructions (0.11%), four intestinal perforations (0.09%) one injury to the iliac vein (0.02%), one femoral nerve injury (0.02%), two lesions of vas deferens (0.04%) and two deaths (0.02%) (pulmonary embolism, peritonitis). CONCLUSION: The rate of complications with the TEP procedure is low. Laparoscopic hernia repair technique is reproducible and reliable. In our experience, there are contraindications to the TEP procedure. TEP technique must be meticulous to avoid intraoperative complications (bipolar diathermy). Complications can occur even after the surgeon has gained substantial experience.