Resumo O tratamento de escolha para pacientes com síndrome de compressão venosa sintomática é o implante de stent venoso. Entretanto, esse tratamento possui complicações bem documentadas e, embora rara, trombose venosa profunda contralateral é uma dessas complicações. Nosso objetivo é apresentar um caso de trombose venosa profunda da veia ilíaca contralateral como resultado do posicionamento do stent além do preconizado e o desafio terapêutico que é a recanalização da veia com reconstrução da confluência ilíaco-cava.

Background: Robot-assisted radical prostatectomy with intraoperative pelvic lymph node dissection is the criterion standard for surgical treatment of nonmetastatic intermediate-and high-risk prostate cancer. However, this method is associated with symptomatic lymphocele (SLC), which is an important morbidity factor. To overcome this complication, several modifications of the technique have been developed, including the peritoneal interposition flap (PIF). We performed an updated systematic review and meta-analysis to investigate the efficacy and safety of this technique for preventing SLC and lymphocele (LC) formation. Materials and methods: Searches were performed using databases and references from included studies and previous systematic reviews. Only randomized controlled trials and nonrandomized cohorts were included. Primary outcomes were the incidence of SLC and LC formation, and safety outcomes were defined as operation time, estimated blood loss, length of hospital stay, and urinary incontinence. Quality assessment was performed using the Newcastle-Ottawa Scale and Cochrane Collaboration's tool. Pooled treatment effects were estimated using odds ratios with 95% confidence intervals (CIs) for binary endpoints. Heterogeneity was examined using Cochran's Q test and I 2 statistics; p values < 0.10 and I 2 > 25% were considered significant for heterogeneity. We used Mantel-Haenszel fixed-effect models in the analyses with low heterogeneity. Otherwise, the DerSimonian and Laird random-effects model was used. Results: The initial search yielded 510 results. After the removal of duplicate records and application of the exclusion criterion, 9 studies were fully reviewed for eligibility. Three randomized controlled trials and 5 retrospective cohorts met all the inclusion criteria, comprising 2261 patients, of whom 1073 (47.4%) underwent PIF. Six studies reported a significant reduction in SLC in the PIF group, and 3 of the 4 studies reported LC formation yielded significant results in preventing this complication. The incidence of SLC and LC formation in a follow-up of ≥3 months was significantly different between the PIF and no PIF group (odds ratio, 0.34 [95% CI, 0.16-0.74; p = 0.006] and 0.48 [95% CI, 0.31-0.74; p = 0.0008]), respectively. The safety outcomes did not differ significantly between the 2 groups. Conclusions: These results suggest that PIF is an effective and safe technique for preventing LC and SLC in patients undergoing transperitoneal robot-assisted radical prostatectomy and pelvic lymph node dissection.

Resumo A ponte de tirofiban é uma alternativa à suspensão da terapia antiplaquetária dupla no perioperatório de pacientes com alto risco de trombose de stent e de sangramento. Objetivamos avaliar a eficácia e a segurança deste protocolo em pacientes submetidos à cirurgia em até 12 meses após intervenção coronária percutânea com stent. Realizamos uma revisão sistemática por meio de pesquisa nas bases PubMed, Web of Science, Cochrane, EMBASE, LILACS e SciELO e nas referências de artigos relevantes ao tema. Dos 107 trabalhos encontrados, cinco foram incluídos após análise dos critérios de elegibilidade e da qualidade metodológica, totalizando 422 pacientes, sendo 227 do grupo controle. Apesar das limitações reportadas, quatro dos cinco estudos incluídos indicam que a ponte de tirofiban é eficaz em reduzir eventos cardíacos adversos e segura ao não interferir no risco de eventos hemorrágicos ou sangramentos. Todavia, são necessários ensaios clínicos randomizados para evidências robustas.

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Objective To develop a low-cost simulator model and a colonoscope with materials that are easily accessible to offer training on colonoscopy skills during undergraduate studies. Since this is the procedure of choice for colorectal cancer screening, the general practitioner must be able to recognize its main indications, preparation, and complications. Methods Using materials such as a mannequin, a vehicle inspection camera, a conduit, polyvinyl chloride (PVC) pipe, acrylic, wood, and red paint, we built a simulator and a 150-cm long and 20-to-25-mm thick colonoscope. The colonoscope's handle and handhold were made of acrylic, the colonoscope's mobile end was made with articulated PVC rings, and the up and down movements were performed according to the traction of the steel cables. The camera attached to its distal end enables connection to a smartphone to view the image. In the simulator, the conduit was inserted into the mannequin to simulate the curvatures of the colon. Red spray paint was used to simulate the staining of the colonic mucosa in the inner region of the mannequin and the adventitial layer in the outer region. Results We were able to build a simulator and a colonoscope with a total amount of R$ 182.82 (roughly US$ 36.50). Both were tested and proved to be useful in the acquisition of psychomotor and cognitive skills in colonoscopy. Conclusion The simulator and colonoscope developed by us are cost-effective, useful in the acquisition of psychomotor and cognitive skills in colonoscopy, and can facilitate the structuring of a training program for undergraduate students.