Object Anterior cervical discectomy and fusion had been considered a safe and effective procedure for radiculopathy and myelopathy in the cervical spine, but degeneration in adjacent spinal levels has been a problem in some patients after fusion. Since 2002, cervical disc arthroplasty has been established as an alternative to fusion. The objective of this study was to review data concerning the role of cervical arthroplasty in reducing adjacent-level degeneration. Methods A systematic review was performed using the MEDLINE, EMBASE, Cochrane, and LILACS databases, focusing on a structured question involving the population of interest, types of intervention, types of control, and outcomes studied. Results No study has specifically compared the results of arthroplasty with the results of fusion with respect to the rate of postoperative development of adjacent-segment degenerative disease. One paper described a rate for adjacent-level surgery. The level of evidence of that paper was classified 2b, and although its authors found a statistically significant between-groups difference (arthroplasty vs fusion) using log-rank analysis, re-analysis according to number needed to treat (in the current paper) did not reveal statistical significance. Conclusions Adjacent-level degeneration has not been adequately studied in a review of the available randomized controlled trials on this topic, and there is no clinical evidence of reduction in adjacent-level degeneration with the use of cervical arthroplasty.

Introduction. Agenesis of the right lobe of the liver is a rare finding and was defined as the absence of liver tissue on the right side, with preservation of the middle hepatic vein, without previous disease or surgery. It is usually an incident finding reveled by imaging exams or during abdominal surgery. Case Report. A 32-year-old male patient was admitted to the hospital for abdominal discomfort and loss of appetite. Imaging studies revealed the absence of the right hepatic lobe and hypertrophied left hepatic segments. Discussion. Anomalies of hepatic morphology are rare and correspond to developmental defects during embryogenesis, are a rare diagnosis, and are generally diagnosed incidentally based on imaging. Agenesis or hypoplasia of the right lobe may predispose the patient to the development of portal hypertension and esophageal varices. Surgical knowledge of such anatomical agenesis is necessary for surgical planning, for the appropriate identification of intraoperative surgical findings, and for the design of the postoperative approach to therapy. Conclusion. Agenesis of the right hepatic lobe is a rare condition. We want to highlight the importance of understanding the condition. Surgeons must recognize the entity in order to deal appropriately with the findings.

Background:The anterior cervical discectomy (ACD) is often used to treat spinal cord and nerve root compressions and the frequent use of interbody fusion (ACDF) has popularized it as a common practice associated or not with cages or plates for maintaining the intervertebral disc height.Objective:The aim of this study is to clarify the effectiveness of ACD compared with ACDF, with or without the use of anterior cervical spacer (Cage) or instrumentation with plate fixation (ACDFI).Methods:randomized controlled trials or quasi-randomized trials were selected for analysis in one segmental level. The comparison criteria were the rates of success and failure with surgery (Odom’s’ criteria), fusion rates and kyphosis rates. Electronic search was made in the MEDLINE database (Pubmed), in the Central Registry of randomized trials of Cochrane database and EMBASE.Results:Seven studies were selected for analysis.Conclusion:Implications for practice: There is moderate evidence that clinical results of ACD and ACDF are not significant different. There is moderate evidence that addition of intervertebral cage enhance clinical results.There is moderate evidence that anterior cervical plate does not change the clinical results of ACD.There is moderate evidence that ACD produce more segmental kyphosis than ACDF and ACDFI, with use of cage or plate.There is moderate evidence that ACD produce lower rate of fusion than ACDF and than the cages. There is limited evidence of the lower capacity of PMMA to produce fusion. There is limited evidence that fused patients have better outcome than non fused patients.

Purpose. Ascites, esophageal varicose veins, and acute digestive bleeding are unusual in the clinical presentation of chronic pancreatitis; however, these symptoms are frequently observed in patients with liver cirrhosis. Moreover, it is unlikely to observe chylous ascites in both presentations. Method. We report a patient who presented with chronic pancreatitis with splenic vein thrombosis, necrosis of the pancreatic neck and tail, esophageal varicose veins with previous bleeding, and chylous ascites. After partial pancreatectomy, his treatment was based on low-fat oral diet with medium-chain triglycerides with remarkable resolution of the chylous ascites. After 3 years, he presented with decompensated chronic pancreatitis and underwent plexus alcoholization and biliary-enteric deviation with an unremarkable postoperative course. Conclusion. Ascites is rarely associated with chronic pancreatitis, and chylous ascites is even rarer. The treatment of atraumatic chylous ascites is based on resolution of the obstructive causes and should include drainage and a low-fat diet with medium-chain triglycerides.

Resumo Contexto: Estudos da percepção da qualidade de vida no trabalho (QVT) permitem estimar a percepção de uma classe profissional inteira, identificar desequilíbrios específicos e proporcionar políticas de desenvolvimento profissional. Objetivo: Avaliar a percepção da QVT dos neurocirurgiões que trabalham em Serviços de Emergência em São Paulo usando instrumentos de validação disponíveis na língua portuguesa. Método: A percepção da QVT dos neurocirurgiões da cidade de São Paulo (Capital) foi estudada com questionário validado para língua portuguesa. Resultados: Cinquenta e oito neurocirurgiões responderam ao questionário. A análise revelou fortes tendências negativas na maioria das áreas de QVT. As áreas com forte tendência negativa deveriam ser tratadas com políticas específicas. Conclusão: Há fortes tendências negativas em quase todos os domínios da QVT.