Background: Elective laparoscopic cholecystectomy has very low risk for infectious complications, ranging the infection rate from 0.4% to 1.1%. Many surgeons still use routine antibiotic prophylaxis Aim: Evaluate the real impact of antibiotic prophylaxis in elective laparoscopic cholecystectomies in low risk patients. Method: Prospective, randomized and double-blind study. Were evaluated 100 patients that underwent elective laparoscopic cholecystectomy divided in two groups: group A (n=50), patients that received prophylaxis using intravenous Cephazolin (2 g) during anesthetic induction and group B (n=50), patients that didn't receive any antibiotic prophylaxis. The outcome evaluated were infeccious complications at surgical site. The patients were reviewed seven and 30 days after surgery. Results: There was incidence of 2% in infection complications in group A and 2% in group B. There was no statistical significant difference of infectious complications (p=0,05) between the groups. The groups were homogeneous and comparable. Conclusion: The use of the antibiotic prophylaxis in laparoscopic cholecystectomy in low risk patients doesn't provide any significant benefit in the decrease of surgical wound infection.

Introduction: Endoscopic evaluation, particularly the macroscopic mucosal and histological results of ileocolic biopsies, is essential for the management of inflammatory bowel disease. Endoscopic appearance is not always sufficient to differentiate Crohn’s disease and ulcerative colitis, but there are some characteristics that favor one or another diagnosis. Both diseases have an increased incidence of colorectal carcinoma; so, surveillance colonoscopy is important for detecting early neoplastic lesions. Objective: To update the importance of endoscopy in the evaluation, diagnosis and prognosis of inflammatory bowel disease. Method: Search was done in the scientific literature of the TRIP database, chosen from clinical questions (PICO) with the following descriptors: “inflammatory bowel disease”, “endoscopy/colonoscopy”, “Crohn’s disease”, “ulcerative colitis” and “diagnosis/treatment”. Results: Endoscopic investigation in patients with chronic colitis is quite accurate for the differential diagnosis between ulcerative colitis and Crohn’s disease. Endoscopy is indicated for ulcerative colitis during severe crisis due to its prognostic value. Another accepted indication for endoscopy in inflammatory bowel disease is its use in the screening for dysplastic lesion. Conclusion: Ileocolonoscopy allows an accurate diagnosis of Crohn’s disease or ulcerative colitis in up to 90% of cases. The healing of the mucosa assessed by endoscopy after treatments despite not being consensus is still the gold-standard in the evaluation of remission of the disease. Colonoscopy is essential for long-term cancer surveillance and in the future the implementation of Confocal Laser Endomicroscopy seems to be very promising in assessing the initial dysplasia.

As fístulas biliares internas espontâneas são comunicações estabelecidas entre qualquer segmento da árvore biliar e dos órgãos abdominais. Elas constituem uma afecção rara apesar de compreender uma complicação da colecistite, patologia freqüente da prática cirúrgica. As fístulas bilioentericas ocorrem em 3-5% dos doentes com colelitíase, sendo 68% destas bilioduodenais. O objetivo desse manuscrito é relatar um caso de fístula bilioduodenal complicada com hemobilia e hemorragia digestiva, descrevendo a conduta adotada. Os dados foram coletados entre dezembro/2015 a abril/2016 através da analise de prontuário fornecido pelo Hospital Universitário Sul Fluminense (HUSF). Trata-se de um paciente masculino, 75 anos, atendido no HUSF-Vassouras/RJ com diagnóstico sindrômico de abdome agudo inflamatório por colecistite aguda, submetido a tratamento conservador para regressão da inflamação peri-colecística, diminuindo assim, o risco de lesões iatrogênicas da árvore biliar em posterior cirurgia. Evoluiu com melena, que foi investigada por endoscopia digestiva alta onde foi observada úlcera de bulbo duodenal com drenagem de secreção purulenta pela sua luz; e tomografia computadorizada de abdome que evidenciou presença de aerobilia indicando presença de fístula bileodigestiva. O tratamento conservador consistiu-se em antibioticoterapia e reposição volêmica, optado devido à remissão do quadro de colecistite após desobstrução pela fístula, devido à hemorragia que cessou espontaneamente e também pelo risco da realização do procedimento cirúrgico em paciente idoso com intensa resposta inflamatória sistêmica. Não é comum na literatura médica a ocorrência de fístulas biliodigestivas com sinais e sintomas hemorrágicos. O quadro clínico geralmente é inespecífico e frequentemente atrasado devido à falta de sinais e sintomas patognomônicos.

Funding Acknowledgements Type of funding sources: None. Background Platypnea-orthodeoxia syndrome (POS) is an uncommon condition characterized by dyspnoea and hypoxemia in the upright position that improves with recumbency.1 Possible causes are intracardiac shunt, pulmonary arteriovenous shunt, and V/Q mismatch.1,2 Echocardiography is the cornerstone of POS diagnosis, with special focus on atrial septal defect (ASD) morphology and right-to-left shunt confirmation.3 Purpose To evaluate the clinical and echocardiographic features of patients presenting with POS due to a cardiac cause. Methods We performed a retrospective analysis of patients diagnosed with POS in our centre between 2015 January and 2021 August. Routine blood tests and transthoracic echocardiogram (TTE) were performed in all patients. Demographics, clinical presentation, blood test results, TTE information, and PFO closure procedure details were recorded. Results Seven patients were included, 85.7% female (n = 6). The median (IQR) age was 78 (72-85) years. The most prevalent cardiovascular risk factors were hypertension (100%; n = 7) and overweight/obesity (85.7%; n = 6). Two patients (28.6%) had chronic pulmonary disease. The most common symptoms were fatigue and exercise intolerance (n= 5; 71.4%) and the most frequent sign was persistent hypoxemia (n = 7; 100%), although 28.6% (n = 2) patients did not present the typical positional changes in peripheral oxygen saturation. Haemoglobin levels [14.1 (13.3-15.2)] were within the normal range and serum NTproBNP levels [656 (287-1196)] were slightly elevated. Left ventricle function was preserved in all patients; right ventricle morphology and function were normal in 85.7% (n = 6) patients, low probability of pulmonary hypertension in TTE was found in 85.7% (n = 6), and exuberant Eustachian valve was observed in 14.3% (n = 1). All patients presented atrial septal hypermobility, 87.5% (n = 6) meeting atrial septal aneurysm criteria. Patent foramen ovale was found in 85.7% of patients (n = 6) and ostium secundum ASD in 14.3% (n = 1). POS precipitating factors were aortic root dilation (28.6%; n = 2), chest trauma (14.3%; n = 1), right hip arthroplasty (14.3%; n = 1), atrial septal stretching regarding right volume overload (14.3%; n = 1). The underlying mechanism was unknown in 28.6% (n = 2) of patients. ASD closure was performed in 57.1% (n = 4) of patients: 75% (n = 3) showed residual shunt, but clinical improvement was reported by all. No acute complications were described, except for paroxysmal atrial fibrillation (14.3%; n = 1). Conclusion POS diagnosis depends on high clinical suspicion: the most common manifestations are fatigue and persistent hypoxemia. Typical positional changes in oxygen saturation are not present in all patients. Polycythaemia, right chambers dilation, and pulmonary hypertension are not common. Echocardiography is fundamental for diagnosis, allowing right-to-left shunt confirmation and ASD morphology evaluation to outline a successful closure procedure.

O câncer de próstata de pequenas células (CPPC), ou neuroendócrino, é um raro tumor e apresenta alta mortalidade,com sobrevida média de 10 meses após o diagnóstico. Representa cerca de 1% de todos os cânceres de próstata. Amaioria dos casos de CPPC têm doença avançada com baixos níveis de antígeno prostático específico (PSA) aodiagnóstico, mostrando a importância do exame físico correto na suspeição precoce. Seu tratamento é baseadocom quimioterapia, principalmente, sendo o etoposídeo e a cisplatina os mais utilizados. Nós relatamos um casosintomático ao diagnóstico sendo tratado com etoposídeo e cisplatina, com óbito após 10 meses de início dos sintomas.