SUMMARY One hundred and twenty seven patients were treated by nasobiliary drainage, or stenting, to prevent biliary obstruction after endoscopic failure to clear stones from the common bile duct. At presentation, 91 (72%) patients were jaundiced and 39 (31%) had cholangitis. Placement of either a nasobiliary drain or stent was successful in 124 (98%) patients. One hundred and twenty one (95%) patients were followed up. Clearance was ultimately achieved endoscopically in 52 and surgically in 25 patients after (mean) 2.4 months. Thirty day mortality was 3%. There were no complications of nasobiliary drainage, but two of 39 patients treated by temporary stents developed cholangitis, both successfully managed by endoscopic duct clearance. Forty two patients unfit for surgery or further endoscopic attempts at duct clearance were followed with stents in situ for a mean 15.9 months (range 2.5-37.5). Cholangitis developed in four patients and was successfully managed by stent change. These results indicate that longterm stenting can be useful for poor risk surgical patients and that nasobiliary drainage or temporary stenting permits further elective rather than urgent endoscopic or surgical treatment.Endoscopic sphincterotomy and stone extraction were introduced by Kawai' and Demling2 in 1974. Since then, most series have reported successful endoscopic duct clearance in around 85% of patients.3 Failure to clear the duct renders a patient at risk from recurrent obstruction, cholangitis, and pancreatitis.7 Indeed, a recent estimate of the increased risk to patients whose bile duct was not cleared of stones showed a statistically significant three-fold increase in morbidity, with major complications occurring in 32% of patients.7 Treatment of retained stones after a failed attempt at endoscopic extraction is often urgent laparotomy with exploration of the bile duct done in patients initially considered at high risk from surgery and referred specifically for endoscopic clearance. Two alternative procedures are available to prevent the complications of retained common duct stones, namely nasobiliary drains89 and biliary stents.'0`The former provides biliary drainage as well as enabling biliary solvents to be perfused to reduce the size of stones, and so

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Introduction: In Portugal, the number of neurosurgery residents has been rising steadily. However, there are no robust studies assessing the level of satisfaction and quality of the current training programs. The aim of this study was to describe and quantify the level of satisfaction about Neurosurgery residency in 2019, in Portugal.Material and Methods: Quantitative observational cross-sectional study based on an original questionnaire about the level of satisfaction of neurosurgical training in Portugal in 2019, sent electronically to residents and young consultants between October and December 2019.Results: A total of 37 responses were obtained from physicians aged around 29.0 (± 4.0) years old, of which 78.4% were men and 54.1% from centers in the center/south of the country/islands. Overall, 51.4% of the answers came from first three years’ residents. As for the theoretical training, there was dissatisfaction with the morbidity and mortality meetings (59.5%), existence of sessions/anatomical lab (89.2%), participation in medical education (64.9%) and in research (64.9%). As for practical training, there was dissatisfaction only towards outpatient clinics (56.8%). There is a tendency for the first surgery to occur in the first month of residency and, in ascending order, firstly a cranial trauma surgery (5.09 ± 4.59 months), then for cerebrospinal fluid diseases (5.95 ± 4.3 months), peripheral nerves (6.0 ± 7.0 months), craniotomy (6.59 ± 3.88 months) and lumbar spine diseases (11.41 ± 1.5 months). Pediatric surgery was the last type of surgery to begin (19.36 ± 20.0 months). There seems to be a generalized satisfaction with the annual (59.5%) but not with thefinal examination (37.8%).Conclusion: This study has succeed at being a better description of the Portuguese neurosurgical centers and of the level of satisfaction about neurosurgical training in Portugal.

Introdução: Os adenomas não funcionantes (ANF) são lesões hipofi sárias comuns, diagnosticadas principalmente na quinta e sexta década de vida, sem predomínio no sexo, e incidentalmente num terço dos casos. O objectivo do estudo foi caraterizar os ANF acompanhados no nosso centro e avaliar a sua história natural. Métodos: Estudo observacional, retrospetivo e longitudinal em doentes seguidos na Consulta de Hipófi se no período entre 01-01-2016 e 01-01-2018 (2 anos). Resultados: Foram avaliados 30 doentes com ANF incidentais, 17 (56,7%) macroadenomas e 13 (43,3%) microadenomas. A idade média no diagnóstico era 60 ± 20 anos, sendo na sua maioria mulheres (66,7%). Os macroadenomas foram diagnosticados em idade média mais tardia (68 ± 14 anos) do que os microadenomas (45 ± 20 anos), p = 0,001. A maioria dos macroadenomas foram diagnosticados por tomografi a computorizada, e dos microadenomas por ressonância magnética (RM) (p = 0,03). O diâmetro máximo inicial pela RM foi em média de 18 ± 8 mm (11-43 mm) nos macroadenomas e 5 ± 2 mm nos microadenomas (2,5-8 mm). O tempo médio de seguimento foi de 65 ± 57 meses e 67 ± 51 meses para os macro e microadenomas respetivamente. Verifi cou-se diminuição das dimensões em 4 (13%), um macroadenoma e três microadenomas e crescimento em 14 lesões. Constatou-se uma diferença estatisticamente signifi cativa entre a média dos diâmetros máximos inicial e fi nal nas lesões que mostraram crescimento (teste-t, p < 0,001). Este aumento evidenciou-se, ao fi m do primeiro ano de seguimento, em 60% (n = 3) dos microadenomas mas apenas em 44% (n = 4) dos macroadenomas. Dos macroadenomas, 47% tinham componente suprasselar, 41% contacto/compressão quiasmática suspeita, 41% extensão a (pelo menos um) seio cavernoso e 12% extensão parasselar. O hipopituitarismo estava presente inicialmente num doente e instalou-se durante o seguimento noutro doente, ambos com macroadenomas. Foram registados 5 doentes (16,7% do total) com alterações oftalmológicas, todos com macroadenomas, 4 dos quais apresentavam suspeita imagiológica de contacto/compressão quiasmática. Conclusão: O seguimento dos ANF incidentais permitiu identifi car alterações oftalmológicas subclínicas, crescimento destas lesões e/ou alterações endocrinológicas ao longo do tempo. Ao longo de 5,5 anos, 47% das lesões aumentaram de dimensões (cerca de 0,55 mm/ano) e 3,3% revelaram disfunção endócrina de novo, que foi independente do crescimento. Introduction: Non-functioning adenoma (NFA) are common pituitary lesions, mainly diagnosed in the fi fth or sixth decade, without gender predominance, and incidentally in 30% of cases. The objective of the study was a characterization of NFA cases followed in our medical center and evaluation their natural history. Methods: Observational, retrospective and longitudinal study on selected patients from pituitary pathology appointments between 01-01-2016 e 01-01-2018 (2 years).

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