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Background: The medical procedure of Laparoscopic adrenalectomy is common in human medicine; however, this is not true in veterinary medicine, where it isperformed rarely. The current treatment of choice for adrenal neoplasms is total adrenalectomy, unless there is a pre-operativediagnosis of metastasis that precludes surgery. The laparoscopic approach option becomes an interesting alternative because, through this technique,it has shown good results. In this report, we demonstrate the experience of a case in which we performed unilateral laparoscopic right adrenalectomy, without caudal vena cava invasion, in a dogsuffering from hyperadrenocorticism caused by adrenocortical carcinoma. Case: A 9-year-old beagle bitch, 12 kg in weight, showedpolyphagia, polydipsia, polyuria, pendular abdomen, thin and dark skin, lumbar alopecic areas and lethargy. The team carried out Complete Blood Count (CBC), blood chemistry (liver and renal functions) and urine sampling by cystocentesis for urinalysis and bacterial culture. All exams had normal results, except for ALP, which reached levels higher than 150 UIL-1. On abdominal radiographic examination, we noted mild adrenal enlargement, and by ultrasonography, it was possible to identify adrenal asymmetry and right adrenal enlargement (2.8x2x2.15 cm) in relation to the left gland (2x1x1.5 cm). As a treatment for adrenal neoplasm-dependent HAC [...](AU)

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Background: The medical procedure of Laparoscopic adrenalectomy is common in human medicine; however, this is not true in veterinary medicine, where it isperformed rarely. The current treatment of choice for adrenal neoplasms is total adrenalectomy, unless there is a pre-operativediagnosis of metastasis that precludes surgery. The laparoscopic approach option becomes an interesting alternative because, through this technique,it has shown good results. In this report, we demonstrate the experience of a case in which we performed unilateral laparoscopic right adrenalectomy, without caudal vena cava invasion, in a dogsuffering from hyperadrenocorticism caused by adrenocortical carcinoma. Case: A 9-year-old beagle bitch, 12 kg in weight, showedpolyphagia, polydipsia, polyuria, pendular abdomen, thin and dark skin, lumbar alopecic areas and lethargy. The team carried out Complete Blood Count (CBC), blood chemistry (liver and renal functions) and urine sampling by cystocentesis for urinalysis and bacterial culture. All exams had normal results, except for ALP, which reached levels higher than 150 UIL-1. On abdominal radiographic examination, we noted mild adrenal enlargement, and by ultrasonography, it was possible to identify adrenal asymmetry and right adrenal enlargement (2.8x2x2.15 cm) in relation to the left gland (2x1x1.5 cm). As a treatment for adrenal neoplasm-dependent HAC [...]

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BACKGROUND: Bisegmentectomy 7-8 is feasible even in the absence of a large inferior right hepatic vein. To our knowledge, this operation has never been performed by laparoscopy. This study was designed to present video of pure laparoscopic bisegmentectomy 7-8 and bisegmentectomy 2-3 in one-stage operation for bilateral liver metastasis. METHODS: A 67-year-old man with metachronous bilobar colorectal liver metastasis was referred for surgical treatment after neoadjuvant chemotherapy. CT scan disclosed two liver metastases: one located between segments 7 and 8 and another one in segment 2. At liver examination, another metastasis was found on segment 3. We decided to perform a bisegmentectomy 7-8 along with bisegmentectomy 2-3 in a single procedure. The operation began with mobilization of the right liver with complete dissection of retrohepatic vena cava. Inferior right hepatic vein was absent. Right hepatic vein was dissected and encircled. Upper part of right liver, containing segment 7 and 8, was marked with cautery. Selective hemi-Pringle maneuver was performed and right hepatic vein was divided with stapler. At this point, liver rotation to the left allowed direct view and access to the superior aspect of the right liver. Liver transection was accomplished with harmonic scalpel and endoscopic stapling device. Bisegmentectomy 2-3 was performed using the intrahepatic Glissonian approach. The specimens were extracted through a suprapubic incision. Liver raw surfaces were reviewed for bleeding and bile leaks. RESULTS: Operative time was 240 minutes with no need for transfusion. Recovery was uneventful. Patient was discharged on the fifth postoperative day. Patient is well with no evidence of disease 14 months after liver resection. Tumor markers are within normal range. CONCLUSIONS: Bisegmentectomy 7-8 may increase resectability rate in patients with bilateral lesions. This operation can be performed safely by laparoscopy. Preservation of segments 5 and 6 permitted simultaneous resection of segments 2 and 3 with adequate liver remnant.

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INTRODUCTION: The present report describes the technique for "inverted L" upper ministernotomy with central canulation for the treatment of simple congenital cardiopathies and presents the initial results. METHODS: Ten patients (mean age: 7 +/- 4.2 years; mean weight 29.1 +/- 13.5 kg) were operated on between January 2006 and July 2007. RESULTS: All defects were corrected. No death was observed and no complication that required reintervention occurred. CONCLUSION: The described technique showed to be feasible and safe for the correction of certain congenital cardiopathies, with less surgical trauma, besides the aesthetic benefit and an expectation of diminished thoracic deformity in the future.

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The outcomes of total and bicaval heart transplantation techniques are better than those of the biatrial technique; however, the latter is still considered the gold-standard. The objective of this study was to determine whether the total and bicaval heart transplantation techniques are, in fact, better than the biatrial technique. A systematic review with meta-analysis was carried out. Studies were retrieved from Pubmed, Lilacs, Web of Science, Scirus, Scopus, Google Scholar, and Scielo databases, identified by sensitive strategy. Randomized, prospective, and retrospective controlled studies were selected for inclusion. Intra and postoperative parameters were assessed. A total of 11,602 studies were identified and 36 were included in our review. The number of atrial arrhythmias, tricuspid valve regurgitation, deaths, and embolic events, as well as bleeding volume; temporary and permanent pacemaker requirement; and length of stay in the intensive care unit are significantly lower for the total and bicaval techniques than for the biatrial technique. Also, hemodynamic variables such as pulmonary capillary pressure, mean pulmonary artery pressure, and right atrial pressure are lower in total and bicaval transplantation. In prognostic terms, total and bicaval orthotopic heart transplantations are better, than the biatrial transplantation. Therefore, indication of the biatrial technique for transplantation should be the exception, not the rule.

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INTRODUÇÃO: Descreveremos a técnica com a miniesternotomia superior em "L invertido" com canulação central para o tratamento de cardiopatias congênitas simples e apresenta os resultados iniciais. MÉTODOS: Foram operados 10 pacientes (idade média: 7 ± 4,2 anos; peso médio: 29,1 ± 13,5 kg), entre janeiro de 2006 e julho de 2007. RESULTADOS: Todos os defeitos foram corrigidos sem a necessidade de conversão para esternotomia total. Não ocorreu nenhum óbito ou complicação que necessitasse de reintervenção. CONCLUSÃO: A referida técnica demonstrou ser aplicável e segura na correção de determinadas cardiopatias congênitas com benefício estético e expectativa de menor deformidade torácica no futuro.

INTRODUCTION: The present report describes the technique for "inverted L" upper ministernotomy with central canulation for the treatment of simple congenital cardiopathies and presents the initial results. METHODS: Ten patients (mean age: 7 ± 4.2 years; mean weight 29.1 ± 13.5 kg) were operated on between January 2006 and July 2007. RESULTS: All defects were corrected. No death was observed and no complication that required reintervention occurred. CONCLUSION: The described technique showed to be feasible and safe for the correction of certain congenital cardiopathies, with less surgical trauma, besides the aesthetic benefit and an expectation of diminished thoracic deformity in the future.

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As técnicas de transplante cardíaco bicaval e total apresentam melhores resultados que a biatrial, porém esta ainda é considerada o padrão-ouro. O objetivo é determinar se as técnicas de transplante cardíaco bicaval e total são, de fato, melhores que a técnica biatrial. Realizou-se a revisão sistemática com metanálise. Os estudos foram provenientes das bases de dados da Pubmed®, Lilacs®, Web of Science®, Scirus®, Scopus®, Google Acadêmico® e Scielo®, identificados por estratégia sensível. Elegeram-se, para a inclusão, estudos aleatórios e estudos prospectivos e retrospectivos controlados. Parâmetros intra e pós-operatórios foram avaliados. Foram identificados 11.602 estudos, e 36 foram incluídos na revisão. O número de arritmias atriais, insuficiência valvar tricúspide, mortalidade, eventos embólicos, volume de sangramento, necessidade de marcapasso temporário e permanente e o tempo de estada em unidade de terapia intensiva são significativamente menores nas técnicas bicaval e total do que na biatrial. Além disso, variáveis hemodinâmicas como a pressão capilar pulmonar, pressão média de artéria pulmonar e pressão de átrio direito são menores nos transplantes bicaval e total. Os transplantes cardíacos ortotópicos bicaval e total são melhores, em termos de prognóstico, que o biatrial. Portanto, a indicação da técnica biatrial para transplante deve ser a exceção e não a regra.

The outcomes of total and bicaval heart transplantation techniques are better than those of the biatrial technique; however, the latter is still considered the gold-standard. The objective of this study was to determine whether the total and bicaval heart transplantation techniques are, in fact, better than the biatrial technique. A systematic review with meta-analysis was carried out. Studies were retrieved from Pubmed™, Lilacs™, Web of Science™, Scirus™, Scopus™, Google Scholar™, and Scielo™ databases, identified by sensitive strategy. Randomized, prospective, and retrospective controlled studies were selected for inclusion. Intra and postoperative parameters were assessed. A total of 11,602 studies were identified and 36 were included in our review. The number of atrial arrhythmias, tricuspid valve regurgitation, deaths, and embolic events, as well as bleeding volume; temporary and permanent pacemaker requirement; and length of stay in the intensive care unit are significantly lower for the total and bicaval techniques than for the biatrial technique. Also, hemodynamic variables such as pulmonary capillary pressure, mean pulmonary artery pressure, and right atrial pressure are lower in total and bicaval transplantation. In prognostic terms, ...

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Este estudo apresenta resultados preliminares obtidos com um novo filtro permanente de veia cava, baseado no desenho de Greenfield, com três hastes prolongadas de um total de seis, para dar estabilidade central ao filtro na luz da veia cava. Neste artigo, relatamos sua avaliação clínica preliminar quanto à aplicabilidade, eficácia e segurança. De agosto de 2004 a dezembro de 2006, 15 filtros foram implantados em nove homens e seis mulheres, com idades variando de 38 a 79 anos (média de 57,8 anos). O acesso foi feito sempre por via transjugular. As indicações foram: trombose venosa proximal, com contra-indicação de anticoagulação em 12 pacientes; complicações hemorrágicas com anticoagulação em dois pacientes; e embolia pulmonar, apesar de anticoagulação adequada, em um paciente. Os filtros foram avaliados quanto à liberação, inclinação, mau posicionamento e perfuração de cava. No seguimento, avaliou-se trombose no local de acesso, tromboembolismo venoso recorrente, migração do filtro e trombose de cava pelo ultra-som. Nenhum paciente recebeu anticoagulantes no seguimento. O filtro foi liberado com sucesso em todos os casos sem mau posicionamento, inclinação, perfuração ou trombose de acesso. Os pacientes foram seguidos entre 3 e 23 meses (média de 11 meses). Nenhum paciente teve recorrência de tromboembolismo venoso. Não houve casos de trombose de veia cava ou migração do filtro. Óbito ocorreu em sete casos, todos relacionados com a moléstia de base. Os resultados preliminares indicam potencial eficácia e segurança do uso do novo filtro no período estudado.

This study presents preliminary results obtained from a new permanent filter, based on Greenfield's filter design, with prolongations on three of six struts to stabilize it centrally in the vena caval lumen. The preliminary clinical evaluation of the filter with regard to feasibility, efficacy and safety is reported. From August 2004 to December 2006, 15 vena cava filters were deployed in nine men and six women, who ranged in age from 38 to 79 years (mean, 57.8 years). The approach used was always transjugular. Indications for filter placement were proximal deep venous thrombosis with a contraindication to anticoagulation in 12 patients; hemorrhagic complications with anticoagulation in two patients; and pulmonary embolism, despite adequate anticoagulation in one patient. New vena cava filters were evaluated for releasing, tilting, malpositioning and caval perforation. Follow-up included assessment of access site thrombosis and filter migration, recurrent venous thromboembolism, and caval thrombosis by duplex ultrasound. No patient received anticoagulants in the follow-up. In all patients the filter was successfully released, with no malpositioning, tilting, perforation or access thrombosis. The patients were followed for 3 to 23 months (mean = 11 months). No patient developed recurrent venous thromboembolism. No other patients developed inferior vena cava thrombosis or filter migration. Death occurred in seven patients, all related to baseline illness. This preliminary study suggests good feasibility and safety of the new filter up to the observation period.

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BACKGROUND: We explored the angiographic and pathological effects of corticosteroids on the long-term outcome of radiofrequency (RF) ablation lesions in the swine caval veins. METHODS: Under fluoroscopy guidance, a single linear RF lesion (4-mm tip, 60 degrees C, 180 seconds) was created in each vena cava (from +/-2 cm into the vein to the venoatrial junction) of 20 anesthetized minipigs (35+/- 2 kg). Three groups were studied: acute (n = 4), killed 1 hour after RF; control (n = 8), sacrificed 83+/- 1 days after RF; and pigs (n = 8) receiving hydrocortisone (400 mg i.v. after RF) and prednisone (25 mg po for 30 days), killed 83+/- 1 days post-RF. Angiography was performed before, immediately after ablation, and at follow-up. Then, animals were sacrificed for histological analysis. RESULTS: Mild (<40%) or moderate (41-70%) acute luminal narrowing occurred in 19/20 (95%) inferior veins and in 13/20 (65%) superior veins. Severe (>70%) stenosis and occlusions were not noted. At follow-up, in both chronic groups, mean vessel diameters returned to baseline and progression of luminal narrowing did not occur in any vein. Of note, superior and inferior vena cava angiographic diameter for control and treated pigs did not differ. The same was observed for the cross-sectional luminal area. Acute lesions displayed transmural coagulative necrosis whereas chronic lesions revealed marked fibrosis. Histological findings were similar in controls and treated pigs. CONCLUSION: In this model, mild and moderate stenosis, occurring immediately after ablation, seems to resolve over time. Corticosteroids do not affect the long-term outcome of such RF lesions in the caval veins.

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Retroperitoneal primitive neuroectodermal tumour is an uncommon disease. The main treatment consists of surgical resection, which can require resection of great vessels, depending on the location. We present a single case of a 19-year-old male with a large tumour. To achieve R0 resection we needed to remove the vena cava. Venous flow reconstruction was performed with a cava prosthesis.

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