RESUMO Racional: Pancreatectomia distal laparoscópica (PDL) é a abordagem de escolha para ressecção de tumores no pâncreas distal devido a suas muitas vantagens sobre a abordagem laparotômica. Objetivo: Analisar e comparar os resultados em curto e longo prazo da PDL realizada por meio de duas técnicas diferentes: com esplenectomia vs. preservação esplênica e preservação dos vasos esplênicos. Método: Cinquenta e oito pacientes foram operados e subsequentemente divididos em dois grupos: grupo 1, PDL com esplenectomia (PDLE) e grupo 2, PDL com preservação esplênica e dos vasos esplênicos (PDLPEVE). Resultados: As características epidemiológicas foram similares entre os dois grupos (idade, gênero, IMC e tamanho da lesão). Ambas as médias de tempo operatório (p=0,04) e de sangramento intraoperatório (p=0,03) foram maiores no grupo 1. A média de linfonodos ressecados também foi maior no grupo 1 (p<0.000). Não houve diferença em relação a conversão, morbidade ou mortalidade pós-operatória precoce. A média de internação hospitalar foi similar entre os grupos. Fístula pancreática (graus B e C) foi similar entre os grupos. A média de seguimento global foi 37,6 meses (5-96). Complicações tardias foram similares entre os grupos. Conclusão: Ambas as técnicas foram superponíveis, entretanto a PDLE apresentou respectivamente maiores sangramento intraoperatório, tempo cirúrgico e número de linfonodos ressecados. Não foram observadas diferenças de infecções ou neoplasias relacionadas com esplenectomia durante o período de seguimento. Manutenção do baço evitou imunizações periódicas na PDLPEVE. Ela pode ser indicada em lesões pancreáticas pequenas com curso indolente.

ABSTRACT Background: Laparoscopic distal pancreatectomy (LDP) is the preferred approach for resection of tumors in the distal pancreas because of its many advantages over the open approach. Aim: To analyse and compare short and long-term outcomes from LDP performed through two different techniques: with splenectomy vs. spleen preservation and splenic vessel preservation. Method: Fifty-eight patients were operated and subsequently divided between two groups: Group 1, LDP with splenectomy (LDPS); and Group 2, LDP with spleen preservation and preservation of splenic vessels (LDPSPPSV). Results: The epidemiological characteristics were statistically similar between the two groups (age, gender, BMI and lesion size). Both the mean of operative time (p=0.04) and the mean of intra-operative blood loss (p=0,03) were higher in Group 1. The mean of resected lymph nodes was also higher in Group 1 (p<0.000). There were no statistic differences between the groups in relation to open conversion, morbidity or early postoperative mortality. The mean hospital stay was similar between groups. Pancreatic fistula (grade B and C) was similar between the groups. The mean of overall follow-up was 37.6 months (5-96). Late complications were similar between the groups. Conclusion: Both techniques were superimposable; however, LDPS presented, respectively, higher intra-operative bleeding, longer duration of the operation and higher number of lymph nodes resected. No differences were observed in the studied period in relation to the appearance of infections or neoplasm related to splenectomy during follow-up. Maintenance of the spleen avoided periodic immunizations in patients in LDPSPSV. It is indicated in small pancreatic lesions with indolent course.

Abstract Silicone breast implant is associated with complications inherent to the surgical procedure. Prosthesis coating with polyurethane, however, commonly reduces the incidence of such complications. In this paper, the authors evaluated the inflammatory histomorphometric profile and oxidative damage associated to the implant of polyester urethane sheets. Forty-eight Wistar rats were divided into Sham or polyester urethane groups (n = 8/group) and underwent a polyester urethane implant in the dorsal skinfold. Tissue samples were collected on days seven, 30, and 90 after surgery and subjected to histomorphometric analysis and biochemical tests. Results were analyzed by one-way ANOVA (p ≤ 0.05). Peri-implant tissue samples exhibited characteristic inflammatory response associated with the biomaterial, with increased vascularization on day seven and augmented levels of IL1-b and TNF-a after 30 days. Peri-implant fibrocystic population was small on day seven, but increased considerably after 90 days. A rise in the carbonyl group levels of skin samples in the polyester urethane group was observed on day seven. Findings suggest that polyester urethane sheets undergo biodegradation at an early stage after implantation, followed by increased vascularity and microencapsulation of biomaterial fragments, without persistent oxidative damage. Fiber arrangement inside the collagen matrix results in a fibrotic scar because of polyester urethane degradation.

Foi estudada a recente evolução do estado nutricional de menores de 5 anos nas aldeias Parakanã, Maroxewara e Paranatinga. Dados antropométricos (peso, altura) foram obtidos em três estudos transversais para avaliação da prevalência de desnutrição e acompanhamento da evolução nutricional pelo incremento médio do índice peso/idade de 70 crianças (87,5% dos menores existentes). A desnutrição nas aldeias foi proporcional ao tempo de contato com nossa cultura e atribuível a fatores socioculturais relatados. Na Paranatinga, os valores médios dos indicadores antropométricos - peso/idade, altura/idade e peso/altura - foram os menores, principalmente nas crianças entre o sexto e o 24º mês. Reduziu-se em 76, 1 % a prevalência de desnutrição global no grupo estudado, não havendo mais casos de desnutrição aguda na última avaliação. O incremento do indicador peso/idade foi proporcional à severidade do caso, não havendo diferença significante entre as aldeias. Medidas de natureza preventiva adotadas foram eficazes em reduzir a prevalência de desnutrição infantil entre os Parakanã.

The evolution of the nutritional status of children under 5 years of age living in two Indian settlements of the Parakanã tribe, Maroxewara and Paratininga, situated in the southest of Pará State (Brazil), with less than 20 years of direct contact with our society, was studied. The main purpose of this study was to register the effects of the preventive and curative health activities of the "Parakanã Program" (created by an agreement between the National Indian Foundation- FUNAI and Northern Hydroelectric Project- ELETRONORTE), undertaken with the technical cooperation of the Tropical Medicine Center (Federal University of Pará). Anthropometric data were obtained in there cross-sectional studies (April 89; January 90 and October 91) for the purpose of evaluating the prevalence of malnutrition by means of Gomez's, Waterlow's and WHO criteria. The evolution of nutritional status was evaluated in the light of the rate of growth and accepting weight increments superior to those expected among well-nourished children as a goal. Seventy children (87.5% of all the 0-5 years-olds living there) were followed through throughout the studies. Prevalence of malnutrition was greater in Paranatinga than in Maroxewara, possibly because the former was more populous and had had longer inter-racial contact. Paranatinga's anthropometric indices (wt/age, ht/age and wt/ht) were the lower. Most of the severe forms of malnutrition were found there too. Children between six months and 2 years old were the most affected. There had occurred an overall 76.1% decrease in the prevalence of malnutriotion. The primary health care given has been successful after eight months of activities, mainly in Paratininga. The increase of the wt/age index was proportional to the initial severity of the malnutrition various of the socio-cultural features observed might explain the differences in prevalences reported in this paper.

Foi estudada a recente evolução do estado nutricional de menores de 5 anos nas aldeias Parakanã, Maroxewara e Paranatinga. Dados antropométricos (peso, altura) foram obtidos em três estudos transversais para avaliação da prevalência de desnutrição e acompanhamento da evolução nutricional pelo incremento médio do índice peso/idade de 70 crianças (87,5% dos menores existentes). A desnutrição nas aldeias foi proporcional ao tempo de contato com nossa cultura e atribuível a fatores socioculturais relatados. Na Paranatinga, os valores médios dos indicadores antropométricos - peso/idade, altura/idade e peso/altura - foram os menores, principalmente nas crianças entre o sexto e o 24º mês. Reduziu-se em 76, 1 % a prevalência de desnutrição global no grupo estudado, não havendo mais casos de desnutrição aguda na última avaliação. O incremento do indicador peso/idade foi proporcional à severidade do caso, não havendo diferença significante entre as aldeias. Medidas de natureza preventiva adotadas foram eficazes em reduzir a prevalência de desnutrição infantil entre os Parakanã.

The evolution of the nutritional status of children under 5 years of age living in two Indian settlements of the Parakanã tribe, Maroxewara and Paratininga, situated in the southest of Pará State (Brazil), with less than 20 years of direct contact with our society, was studied. The main purpose of this study was to register the effects of the preventive and curative health activities of the "Parakanã Program" (created by an agreement between the National Indian Foundation- FUNAI and Northern Hydroelectric Project- ELETRONORTE), undertaken with the technical cooperation of the Tropical Medicine Center (Federal University of Pará). Anthropometric data were obtained in there cross-sectional studies (April 89; January 90 and October 91) for the purpose of evaluating the prevalence of malnutrition by means of Gomez's, Waterlow's and WHO criteria. The evolution of nutritional status was evaluated in the light of the rate of growth and accepting weight increments superior to those expected among well-nourished children as a goal. Seventy children (87.5% of all the 0-5 years-olds living there) were followed through throughout the studies. Prevalence of malnutrition was greater in Paranatinga than in Maroxewara, possibly because the former was more populous and had had longer inter-racial contact. Paranatinga's anthropometric indices (wt/age, ht/age and wt/ht) were the lower. Most of the severe forms of malnutrition were found there too. Children between six months and 2 years old were the most affected. There had occurred an overall 76.1% decrease in the prevalence of malnutriotion. The primary health care given has been successful after eight months of activities, mainly in Paratininga. The increase of the wt/age index was proportional to the initial severity of the malnutrition various of the socio-cultural features observed might explain the differences in prevalences reported in this paper.