Laparoscopic pyeloplasty proficiency during a residency program after adoption of a standardized simulation training program is maintained during the COVID pandemic despite reduced surgery volume

ABSTRACT Purpose: To evaluate the effect of the standardized laparoscopic simulation training program in pyeloplasty, following its implementation and during the COVID-19 pandemic. Material and Methods: A retrospective chart review was performed at Hospital de Clínicas de Porto Alegre, a tertiary referral center in south Brazil, in which 151 patients underwent laparoscopic pyeloplasty performed by residents between 2006-2021. They were divided into three groups: before and after adoption of a standardized laparoscopic simulation training program and during the COVID-19 pandemic. The main outcome was a combined negative outcome of conversion to open surgery, major postoperative complications (Clavien-Dindo III or higher) or unsuccessful procedure, defined as need for redo pyeloplasty. Results: There was a significant reduction in the combined negative outcome (21.1% vs 6.3%), surgical time (mean 200.0 min vs 177.4 min) and length of stay (median 5 days vs 3 days) after the adoption of simulation training program. These results were maintained during the COVID-19 pandemic (combined negative outcome of 6.3%, mean surgical time of 160.1 min and median length of stay of 3 days) despite a reduction in 55.4% of the surgical volume. Conclusion: A structured laparoscopic simulation program can improve outcomes of laparoscopic pyeloplasty during the learning curve.

Laparoscopic pyeloplasty proficiency during a residency program after adoption of a standardized simulation training program is maintained during the COVID pandemic despite reduced surgery volume.

PURPOSE: To evaluate the effect of the standardized laparoscopic simulation training program in pyeloplasty, following its implementation and during the COVID-19 pandemic. MATERIAL AND METHODS: A retrospective chart review was performed at Hospital de Clínicas de Porto Alegre, a tertiary referral center in south Brazil, in which 151 patients underwent laparoscopic pyeloplasty performed by residents between 2006-2021. They were divided into three groups: before and after adoption of a standardized laparoscopic simulation training program and during the COVID-19 pandemic. The main outcome was a combined negative outcome of conversion to open surgery, major postoperative complications (Clavien-Dindo III or higher) or unsuccessful procedure, defined as need for redo pyeloplasty. RESULTS: There was a significant reduction in the combined negative outcome (21.1% vs 6.3%), surgical time (mean 200.0 min vs 177.4 min) and length of stay (median 5 days vs 3 days) after the adoption of simulation training program. These results were maintained during the COVID-19 pandemic (combined negative outcome of 6.3%, mean surgical time of 160.1 min and median length of stay of 3 days) despite a reduction in 55.4% of the surgical volume. CONCLUSION: A structured laparoscopic simulation program can improve outcomes of laparoscopic pyeloplasty during the learning curve.

Selective Suturing or Sutureless Technique in Robot-assisted Partial Nephrectomy: Results from a Propensity-score Matched Analysis.

BACKGROUND: Despite efforts aimed at preserving renal function, the functional decline after robot-assisted partial nephrectomy (RAPN) is not negligible. To address the risk of intraparenchymal vessel injuries during renorrhaphy, with consequent loss of functional renal parenchyma, we introduced a new surgical technique for RAPN. OBJECTIVE: To compare perioperative patient outcomes between selective-suturing or sutureless RAPN (suRAPN) and standard RAPN (stRAPN). DESIGN, SETTING, AND PARTICIPANTS: Ninety-two consecutive patients undergoing RAPN for a renal mass performed by a high-volume surgeon at a European tertiary center were included. Propensity-score matching was used to account for baseline differences between suRAPN and stRAPN patients. INTERVENTION: RAPN using a selective-suturing or sutureless technique versus standard RAPN. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Perioperative outcomes included operative time, blood loss, length of stay, and intraoperative and 30-d postoperative complications. We also evaluated trifecta achievement (warm ischemia time ≤25 min, negative surgical margins, and no perioperative complications) and the incidence of postoperative acute kidney injury (AKI). We applied χ2 tests, t tests, and Kruskal-Wallis tests to assess differences in perioperative outcomes between suRAPN and stRAPN. RESULTS AND LIMITATIONS: Overall, 29 patients (31%) were treated with suRAPN. Only one suRAPN patient experienced intraoperative complications (p = 0.9). Two suRAPN patients (6.9%) and four stRAPN patients (13.8%) experienced 30-d postoperative complications (p = 0.3). Operative time (110 vs 150 min; p < 0.01) and length of stay (2 vs 3 d; p = 0.02) were shorter for suRAPN than for stRAPN. The trifecta outcome was achieved in 25 suRAPN patients (86%) and 20 stRAPN patients (70%; p = 0.1). Only one suRAPN patient (3.4%) versus five stRAPN patients (17%) experienced postoperative AKI (p = 0.2). Finally, the decrease in the estimated glomerular filtration rate at 6-mo follow-up was lower in the suRAPN (-5.2%) than in the stRAPN group (-9.1%; p < 0.01). Lack of randomization represents the main study limitation. CONCLUSIONS: A selective-suturing or sutureless technique in RAPN is feasible and safe. Moreover, suRAPN is a lower-impact surgical procedure. We obtained promising results for trifecta and functional outcomes, but prospective randomized trials are needed to validate the impact of selective suturing or a sutureless technique on long-term functional outcomes. PATIENT SUMMARY: We assessed a new technique in robotic surgery to remove part of the kidney because of kidney cancer. Our new technique involves selective suturing or no suturing of the area from where the tumor is removed. We found that the rate of complications did not increase and the operating time and length of hospital stay were shorter using this new technique.

Urology Residents Simulation Training Improves Clinical Outcomes in Laparoscopic Partial Nephrectomy.

BACKGROUND: Partial nephrectomy (PN) is the preferred modality of treatment for small renal masses. Laparoscopic partial nephrectomy (LPN) has been adopted worldwide and a fundamental role is played by surgical skills. The need for skill instruction outside the operating room is well recognized in the modern models of surgery residency training. We aim to investigate the impact of residents' laparoscopic surgical skills training on the successful implementation of LPN in a reference public teaching hospital in southern Brazil. METHODS: We accessed all patients undergoing LPN by senior's urology residents at Hospital de Clínicas de Porto Alegre. Patients were stratified in 2 periods of time named 'LPN eras' 1 and 2, to report the training impact on the outcome. LPN era 1 was from October 2012 to February 2017 and LPN era 2 from March 2017 to June 2019. All the senior residents of LPN era 2 followed a simulation training divided into 4 years with a total training time of 244 hours before performing the LPN. Residents from LPN era 1 did not have simulation training. RESULTS: 124 patients underwent LPN during the study period, 53 (42.7%) of those were performed in LPN era 1 and 71 (57.3%) in LPN era 2. Baseline characteristics of the patients in the two groups were similar. The training performed by LPN era 2 residents was able to significantly reduce estimated blood loss, ischemia time and LOS with p value respectively 0.007, 0.001 and 0.001. LPN era 2 group also reached Trifecta in 77.5% of patients, being significantly more than in the LPN era 1 (p = 0.007). CONCLUSIONS: Simulation in residents surgical training was able to improve clinical outcomes in LPN. These data reinforce the fundamental importance of adequate residents training before performing surgery on a patient.

The impact of 5-alpha-reductase inhibitors on mortality in a prostate cancer chemoprevention setting: a meta-analysis.

PURPOSE: This study aims to evaluate the impact of 5-alpha-reductase inhibitors (5ARI) for prostate cancer (PCa) primary prevention on specific and overall mortality (primary outcomes), the incidence of PCa diagnosis and disease aggressiveness (secondary outcomes). METHODS: We searched MEDLINE, EMBASE, Cochrane, ClinicalTrials and BVS through April 2018 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement to identify randomized clinical trials (RCT) and cohort studies (CS). We included articles with data on mortality or PCa incidence for men using 5ARI previously to PCa diagnosis. RESULTS: Regarding the included studies, nine had data on mortality, 16 on PCa incidence and 12 on Gleason scores (GS). We found that the use of 5ARI had no impact on overall mortality (RR 0.93 95% CI 0.78-1.11) and PCa-related mortality (RR 1.35 95% CI 0.50-3.94), nor on high-grade PCa diagnosis (RR 1.06 95% CI 0.72-1.56). We identified a relative risk reduction of 24% in moderate-grade PCa diagnosis (RR 0.76 95% CI 0.59-0.98) and low-grade PCa diagnosis (RR 0.76 95% CI 0.59-0.97) Also, a reduction of 26% in overall PCa diagnosis was observed in the RCT subgroup analysis (RR 0.74 95% CI 0.65-0.84). CONCLUSION: 5ARI significantly reduced the risk of being diagnosed with PCa, not increasing high-grade disease, overall or cancer-specific mortality. Due to the relatively short mean follow-up of most studies, the mortality analysis is limited.

Laparoscopic ureteral reconstruction in infant with congenital mid ureteric valve.

Congenital mid ureteric valve (MUV) stenosis is a very rare cause of ureteric obstruction and hydronephrosis (HN) in children. We describe how we manage laparoscopically one case of a patient with congenital MUV. We describe a 6-month-old boy born with antenatal left HN, with an anteroposterior diameter (APD) of 1,5 cm. Follow-up renal ultrasound at 3 months of age showed an increase in left kidney HN, approximately 2.5 cm below the PUJ associated with distal stenosis. Renal scintigraphy with DTPA showed an obstructive pattern. Urography scan showed an abrupt reduction in the caliber of the mid left ureter Based on a preoperative diagnosis of MUV stenosis, we performed a laparoscopic left ureteroplasty. Abrupt tapering of the left ureter at 3 cm from the PUJ was identified. Proximal ureter repair was performed before the resection of the narrowing segment. The two edges of the ureter were spatulated and continuous anastomosis was performed without tension. An antegrade JJ stent was inserted after the posterior part of the anastomosis was done. Patient made an uneventful recovery and was discharged on the first postoperative day. Laparoscopic ureteroplasty is a complex but feasible option to treat patients with congenital MUV stenosis.

Laparoscopic ureteroplasty with gonadal vein graft for long ureteral stenosis: A step by step video.

Strictures of the ureter may occur from iatrogenic injury or impacted kidney stones. Complications from ureteroscopy may result in ureteral stricture in 0,5-2% of patients. New techniques are being described in order to minimize the morbidity associated with classic approaches. This is a step-by-step video of this novel technique: a successful laparoscopic ureteroplasty with gonadal vein graft for a iatrogenic long ureteral stenosis. A 16 year old female patient, with multiple previous ureteroscopies for ureteral stones, presented with severe left lumbar pain. An abdominal CT and a pyelography were performed showing a 3 cm left mid-proximal ureteral stricture with proximal hydronephrosis. The stenotic area was identified and an anterior left ureteral incision was made. Gonadal vein was removed and prepared, being sutured in the anterior surface of the ureter. Patient was discharged in the second post operative (PO). JJ stent was removed after 1 month. A 3 month PO pyelography was performed, showing no fistula and resolution of the stricture. Twelve months after surgery, the patient was painless with symptom resolution. The use of gonadal vein as a graft for ureteral strictures is a new possible approach, although more cases are necessary to evaluate its results.

Garrahan U-Stitch laparoscopic appendicovesicostomy - Making surgery easier.

Appendicovesicostomy is an established continent urinary conduit. The development of minimally invasive techniques and the reduction of operative time instigated the search for new techniques. In this video we show the laparoscopic transabdominal technique for appendicovesicostomy using U-stitch technique as proposed by Santiago Weller et al. We present a case of a teenager with neurogenic bladder and intolerance for urethral catheterization. The procedure was performed using a transperitoneal approach. The appendix was detached from the colon preserving its pedicle. The proximal appendix was spatulated and pulled through a hiatus created in the distal vesical mucosa into the bladder using a U-stitch, on a Shanfield fashion anastomosis in the anterior wall of the bladder. Detrusor was approximated over the appendix creating an antireflux mechanism. The tip of the appendix was brought out to the right iliac fossa and ostomy was fashioned. The operative time was 180 min. A Foley catheter was placed through the conduit. The case was done without any intraoperative or postoperative complications. Laparoscopic appendicovesicostomy with U-stitch technique is feasible and can be easily done in a short operative time in centers with expertise in laparoscopic surgeries with low complexity and high reproducibility.

Trauma de Cólon: experiência de um centro de referência em Porto Alegre/RS / Colon trauma: the experience of a reference center in Porto Alegre/RS

Introdução: As lesões de cólon são comuns em pacientes vítimas de trauma. Seu tratamento é bastante variável e muito discutido. Objetivo: Analisar a experiência com trauma de cólon de um centro de referência em trauma por aproximadamente 4 anos, avaliando o perfil dos pacientes, mecanismo de trauma, lesões, evolução e desfecho. Métodos: Estudo retrospectivo em que foram incluídos todos os pacientes com trauma de cólon no período de setembro de 2009 a dezembro de 2013. Resultados: Foram identificadas 101 vítimas com trauma de cólon, sendo 92 casos (91%) devido a trauma penetrante. Os ferimentos abdominais foram preponderantes (85,1%), seguidos por ferimentos em dorso em 15,8% e em transição toracoabdominal em 9,9%. Apenas 6,9% apresentavam-se com PAS < 90 mmHg e 23,8% com FC > 100 bpm na admissão. Noventa e nove por cento dos pacientes foram levados ao bloco cirúrgico para laparotomia exploradora imediatamente após o atendimento na sala de emergência. Setenta e três (72,3%) apresentaram lesões de outros órgãos abdominais associadas, a mais comum foi de intestino delgado (49,5%). A mortalidade da série foi de 1%, e as complicações mais frequentes foram a pneumonia em 16,8%, a infecção de ferida operatória em 11,9% e a infecção urinária em 7,9%. Conclusões: O diagnóstico e tratamento precoce das lesões de cólon são fundamentais para uma boa evolução e para prevenção das complicações, principalmente infecciosas, que são responsáveis pela morbidade e mortalidade nesses pacientes. Os dados apresentados estão de acordo com os encontrados na literatura atual(AU)

Background: Colon lesions are common in trauma patients. Their treatment is very variable and much discussed. Objective: To analyze the experience with colon trauma of a reference center for trauma for about 4 years, evaluating patient profile, mechanism of trauma, injury, evolution and outcome. Methods: A retrospective study which included all patients with colon trauma from September 2009 to December 2013. Results: A series of 101 victims with colon trauma were identified, of which 92 cases (91%) were due to penetrating trauma. Abdominal injuries were prevalent (85.1%), followed by back (15.8%) and thoracoabdominal transition (9.9%) injuries. Only 6.9% presented with SBP 100 bpm at admission. Ninety-nine percent of patients were taken to the operating room for exploratory laparotomy immediately after evaluation in the emergency room. Seventythree (72.3%) had associated injuries to other abdominal organs, the most common being small intestine (49.5%). The mortality in this series was 1%, and the most frequent complications were pneumonia in 16.8%, wound infection in 11.9%, and urinary infection in 7.9%. Conclusions: Early diagnosis and treatment of colon lesions are critical for a good outcome and prevention of complications, mainly infectious diseases, which are responsible for morbidity and mortality in these patients. The data presented are consistent with the current literature(AU)

Technique for implanting intramuscular electrodes in the diaphragm by videolaparoscopy in pigs.

PURPOSE: To describe a novel approach for implanting intramuscular electrodes in the diaphragm through videolaparoscopy. METHODS: We used twelve pigs for this videolaparoscopic technique, which permits at the same time to explore the diaphragm, to locate its motor points and to fix the electrodes in the diaphragm bilaterally. In this technique we used three trocars: one portal for a 10-mm 0° viewing angle laparoscope, one portal for the manipulation of structures and another for electrode implantation. RESULTS: All animals survived the procedure without pneumothorax/capnothorax or other complication. Implanted electrodes provided an appropriate interface between the muscle and the electrical current generator, and electroventilation was satisfactorily generated in all animals. CONCLUSION: This videolaparoscopic technique with three trocars enables the exploration and identification of motor points and an efficient fixation of one or two electrodes in each hemidiaphragm.

Total testosterone levels are correlated to metabolic syndrome components.

INTRODUCTION: Metabolic syndrome (MetS) is a constellation of interrelated risk factors of metabolic origin. Some studies suggest a possible link between low total testosterone (TT) levels and the presence of MetS. AIM: To analyze the strength and independence of associations between TT and MetS components in non-diabetic men. METHODS: In this cross-sectional study, 143 non-diabetic men older than 40 were analyzed. MAIN OUTCOMES MEASURE: Blood samples were collected to evaluate metabolic profile and TT levels. MetS was defined as the presence of three or more of the following characteristics: fasting blood glucose levels ≥ 100 mg/dL, triglyceride ≥ 150 mg/dL, HDL-c < 40 mg/dL, hypertension or blood pressure ≥ 130/85 mmHg, and waist girth > 102 cm. RESULTS: Mean age of the study population was 61.5 ± 8.61 years old. MetS was present in 47.9% of the individuals. Thirty-four men had low TT and MetS was observed in 23 (70%) against 50 (46%) in those with normal TT (≥ 300 ng/dL) (OR 4.94, p < 0.01), adjusted to confounder's factors. In multiple linear regression analysis, only waist circumference (Beta: -0.395; p = 0.03) and HDL-c (Beta: 0.19; p = 0.04) remained significantly correlated with TT levels. CONCLUSIONS: Low TT levels were associated with MetS diagnosis. Abdominal obesity was the MetS component independently correlated to low TT levels.

Technique for implanting intramuscular electrodes in the diaphragm by videolaparoscopy in pigs

PURPOSE: To describe a novel approach for implanting intramuscular electrodes in the diaphragm through videolaparoscopy. METHODS: We used twelve pigs for this videolaparoscopic technique, which permits at the same time to explore the diaphragm, to locate its motor points and to fix the electrodes in the diaphragm bilaterally. In this technique we used three trocars: one portal for a 10-mm 0° viewing angle laparoscope, one portal for the manipulation of structures and another for electrode implantation. RESULTS: All animals survived the procedure without pneumothorax/capnothorax or other complication. Implanted electrodes provided an appropriate interface between the muscle and the electrical current generator, and electroventilation was satisfactorily generated in all animals. CONCLUSION: This videolaparoscopic technique with three trocars enables the exploration and identification of motor points and an efficient fixation of one or two electrodes in each hemidiaphragm.

N-acetylcysteine administration confers lung protection in different phases of lung ischaemia-reperfusion injury.

OBJECTIVES: To verify the effects of N-acetylcysteine (NAC) administered before and after ischaemia in an animal model of lung ischaemia-reperfusion (IR) injury. METHODS: Twenty-four Wistar rats were subjected to an experimental model of selective left pulmonary hilar clamping for 45 min followed by 2 h of reperfusion. The animals were divided into four groups: control group (SHAM), ischaemia-reperfusion, N-acetylcysteine-preischaemia (NAC-Pre) and NAC-postischaemia (NAC-Post). We recorded the haemodynamic parameters, blood gas analysis and histology. We measured the thiobarbituric acid reactive substances concentration; the expression of superoxide dismutase (SOD), inducible nitric oxide synthase (iNOS), nitrotyrosine, cleaved caspase 3, nuclear factor κB (NF-κB), NF-kappa-B inhibitor alpha (IκB-α), tumour necrosis factor alpha (TNF-α) and interleukin-1 beta (IL-1ß); myeloperoxidase activity (MPO). RESULTS: No significant differences were observed in the haemodynamic parameters, blood gas analysis and SOD activity among the groups. Lipid peroxidation was significantly higher in the IR and NAC-Pre groups (P < 0.01). The expression of nitrotyrosine, cleaved caspase 3, NF-κB, IκB-α, TNF-α and IL-1ß were significantly higher in the IR group when compared with the SHAM and NAC groups (P < 0.01). The NAC-Pre group showed a significantly higher expression of these proteins when compared with the SHAM and NAC-Post groups (P < 0.05). After reperfusion, the expression of iNOS increased almost uniformly in all groups when compared with the SHAM group (P < 0.01). The histological analysis showed fewer inflammatory cells in the NAC groups. CONCLUSIONS: The intravenous administration of NAC demonstrated protective properties against lung IR injury. The use of NAC immediately after reperfusion potentiates its protective effects.

Análise epidemiológica dos adenocarcinomas gástricos ressecados em um serviço de cirurgia oncológica / Epidemiological analysis of resected gastric adenocarcinomas in a oncologic surgery service

Introdução: O adenocarcinoma de estômago é a quarta neoplasia mais incidente no mundo e a segunda causa de morte relacionada ao câncer. O objetivo deste estudo é determinar o perfil epidemiológico e patológico dos pacientes intervidos cirurgicamente por adenocarcinoma gástrico e sua sobrevida relacionada à classificação TNM. Métodos:Estudo de coorte histórica de 216 pacientes submetidos à gastrectomia por adenocarcinoma gástrico. Foram analisados dados epidemiológicos, patológicos e a sobrevida. Resultados: A média de idade foi de 61,84 anos. Foram 76 (35,2%) pacientes do gênero feminino e 140 (64,8%), masculino. Quanto à localização, 79 (36,6%) no antro, 45 (20,8%) na cárdia, 70 (32,4%) no corpo. Em relação à diferenciação celular, 5 (2,3%) bem diferenciados, 71 (32,9%) moderadamente diferenciados, 133 (61,6%) pouco diferenciados e 7 (3,2%) eram indeterminados. O estadiamento clínico demonstrou 11 (5,1%) pacientes com estádio 0, com sobrevida de 100%; 23 (10,6%) no estádio I, com sobrevida de 82%; 55 pacientes (25,5%), com sobrevida de 60% no estádio II; 101 pacientes (46,7%), com sobrevida de 25% no estádio III e 26 pacientes (12%), com sobrevida de 15% no estádio IV. Em relação às complicações pós-operatórias, 52,3% dos pacientes não tiveram complicações e 7,9% (17 pacientes) com óbito no período pós-operatório. Conclusões: Aproximadamente 70% das neoplasias eram distais, enquanto cerca de 30% eram proximais. A grande parte dos pacientes era de estádios mais avançados, o que conferiu um pior prognóstico, refletindo a necessidade de uma revisão das políticas públicas para câncer gástrico do Brasil, visando aprimorar o diagnóstico e tratamento, melhorando o prognóstico desses pacientes.

Introduction:The gastric adenocarcinoma is the fourth most frequent cancer worldwide and the second leading cause of cancer-related death. The aim of this study is to determine the epidemiological and pathological profile of gastric adenocarcinoma patients and their survival regarding the TNM classification. Methods: A historical cohort study of 216 patients undergoing gastrectomy for gastric adenocarcinoma. Epidemiological, pathological and survival data were analyzed. Results: The mean age was 61.84 years. There were 76 (35.2%) females and 140 (64.8%) males. Regarding location, 79 (36.6%) cases were in the antrum, 45 (20.8%) in the cardia, and 70 (32.4%) in the body. Regarding cell differentiation, 5 cases (2.3%) were well differentiated, 71 (32.9%) moderately differentiated, 133 (61.6%) poorly differentiated, and 7 (3.2%) were indeterminate. Clinical staging showed 11 (5.1%) patients with stage 0 with a survival rate of 100%, 23 (10.6%) in stage I with a survival rate of 82%, 55 patients (25.5%) in stage II with a survival rate of 60%,101 patients (46,7%) in stage III with a survival rate of 25% and 26 patients (12%) in stage IV with a survival rate of 15%. Regarding postoperative complications, 52.3% of the patients had no complications and 7.9% (17 patients) died in the postoperative period. Conclusions: Approximately 70% of tumors were distal, while approximately 30% were proximal. The majority of patients had more advanced stages, which conferred a worse prognosis, reflecting the need for a revision of public policies for gastric cancer in Brazil, aiming to improve the diagnosis and treatment and determining a better prognosis for these patients.

Effect of the systemic administration of methylprednisolone on the lungs of brain-dead donor rats undergoing pulmonary transplantation.

OBJECTIVE: Most lung transplants are obtained from brain-dead donors. The physiopathology of brain death involves hemodynamics, the sympathetic nervous system, and inflammatory mechanisms. Administering methylprednisolone 60 min after inducing brain death in rats has been shown to modulate pulmonary inflammatory activity. Our objective was to evaluate the effects of methylprednisolone on transplanted rat lungs from donors treated 60 min after brain death. METHODS: Twelve Wistar rats were anesthetized, and brain death was induced. They were randomly divided into two groups (n=6), namely a control group, which was administered saline solution, and a methylprednisolone group, which received the drug 60 min after the induction of brain death. All of the animals were observed and ventilated for 2 h prior to being submitted to lung transplantation. We evaluated the hemodynamic and blood gas parameters, histological score, lung tissue levels of thiobarbituric acid-reactive substances, level of superoxide dismutase, level of tumor necrosis factor-alpha, and level of interleukin-1 beta. RESULTS: After transplantation, a significant reduction in the levels of tumor necrosis factor-alpha and IL-1ß was observed in the group that received methylprednisolone (p=0.0084 and p=0.0155, respectively). There were no significant differences in tumor necrosis factor-alpha and superoxide dismutase levels between the control and methylprednisolone groups (p=0.2644 and p=0.7461, respectively). There were no significant differences in the blood gas parameters, hemodynamics, and histological alterations between the groups. CONCLUSION: The administration of methylprednisolone after brain death in donor rats reduces inflammatory activity in transplanted lungs but has no influence on parameters related to oxidative stress.

Effect of the systemic administration of methylprednisolone on the lungs of brain-dead donor rats undergoing pulmonary transplantation

OBJECTIVE: Most lung transplants are obtained from brain-dead donors. The physiopathology of brain death involves hemodynamics, the sympathetic nervous system, and inflammatory mechanisms. Administering methylprednisolone 60 min after inducing brain death in rats has been shown to modulate pulmonary inflammatory activity. Our objective was to evaluate the effects of methylprednisolone on transplanted rat lungs from donors treated 60 min after brain death. METHODS: Twelve Wistar rats were anesthetized, and brain death was induced. They were randomly divided into two groups (n = 6), namely a control group, which was administered saline solution, and a methylprednisolone group, which received the drug 60 min after the induction of brain death. All of the animals were observed and ventilated for 2 h prior to being submitted to lung transplantation. We evaluated the hemodynamic and blood gas parameters, histological score, lung tissue levels of thiobarbituric acid-reactive substances, level of superoxide dismutase, level of tumor necrosis factor-alpha, and level of interleukin-1 beta. RESULTS: After transplantation, a significant reduction in the levels of tumor necrosis factor-alpha and IL-1β was observed in the group that received methylprednisolone (p = 0.0084 and p = 0.0155, respectively). There were no significant differences in tumor necrosis factor-alpha and superoxide dismutase levels between the control and methylprednisolone groups (p = 0.2644 and p = 0.7461, respectively). There were no significant differences in the blood gas parameters, hemodynamics, and histological alterations between the groups. CONCLUSION: The administration of methylprednisolone after brain death in donor rats reduces inflammatory activity in transplanted lungs but has no influence on parameters related to oxidative stress. .

Barium swallow study in routine clinical practice: a prospective study in patients with chronic cough / Estudo radiografico com ingestao de bario na rotina clinica: um estudo prospectivo em pacientes com tosse cronica

OBJECTIVE: To assess the routine use of barium swallow study in patients with chronic cough. METHODS: Between October of 2011 and March of 2012, 95 consecutive patients submitted to chest X-ray due to chronic cough (duration > 8 weeks) were included in the study. For study purposes, additional images were obtained immediately after the oral administration of 5 mL of a 5% barium sulfate suspension. Two radiologists systematically evaluated all of the images in order to identify any pathological changes. Fisher's exact test and the chi-square test for categorical data were used in the comparisons. RESULTS: The images taken immediately after barium swallow revealed significant pathological conditions that were potentially related to chronic cough in 12 (12.6%) of the 95 patients. These conditions, which included diaphragmatic hiatal hernia, esophageal neoplasm, achalasia, esophageal diverticulum, and abnormal esophageal dilatation, were not detected on the images taken without contrast. After appropriate treatment, the symptoms disappeared in 11 (91.6%) of the patients, whereas the treatment was ineffective in 1 (8.4%). We observed no complications related to barium swallow, such as contrast aspiration. CONCLUSIONS: Barium swallow improved the detection of significant radiographic findings related to chronic cough in 11.5% of patients. These initial findings suggest that the routine use of barium swallow can significantly increase the sensitivity of chest X-rays in the detection of chronic cough-related etiologies. .

OBJETIVO: Investigar o uso rotineiro do estudo radiográfico com ingestão de bário em pacientes com tosse crônica. MÉTODOS: Entre outubro de 2011 e março de 2012, 95 pacientes consecutivos submetidos a radiografia de tórax devido a tosse crônica (duração > 8 semanas) foram incluídos no estudo. Como propósito do estudo, radiografias de tórax adicionais foram obtidas imediatamente após a administração oral de 5 mL de uma suspensão de sulfato de bário a 5%. Dois radiologistas avaliaram todas as imagens de forma sistemática para identificar alterações patológicas. O teste exato de Fisher e o teste do qui-quadrado para dados categóricos foram utilizados nas comparações. RESULTADOS: As imagens obtidas imediatamente após a ingestão de bário revelaram patologias significativas potencialmente relacionadas a tosse crônica em 12 (12,6%) dos 95 pacientes. Essas patologias, incluindo hérnia diafragmática, neoplasia de esôfago, acalasia, divertículo esofágico e dilatação anormal do esôfago, não foram detectadas nas imagens obtidas sem a administração do contraste. Após o tratamento adequado, os sintomas desapareceram em 11 pacientes (91,6%), enquanto o tratamento foi ineficaz em 1 (8,4%). Não foram observadas complicações relacionadas à ingestão de bário, como aspiração. CONCLUSÕES: A ingestão de bário melhorou a detecção de achados radiológicos significantes relacionados a tosse crônica em 11,5% dos pacientes. Esses resultados iniciais sugerem que a utilização rotineira da ingestão de bário aumenta significantemente a sensibilidade de radiografias de tórax na detecção de etiologias relacionadas a tosse crônica. .

Effectiveness of diaphragmatic stimulation with single-channel electrodes in rabbits.

Every year, a large number of individuals become dependent on mechanical ventilation because of a loss of diaphragm function. The most common causes are cervical spinal trauma and neuromuscular diseases. We have developed an experimental model to evaluate the performance of electrical stimulation of the diaphragm in rabbits using single-channel electrodes implanted directly into the muscle. Various current intensities (10, 16, 20, and 26 mA) produced tidal volumes above the baseline value, showing that this model is effective for the study of diaphragm performance at different levels of electrical stimulation.