Should preconditioning hyperbaric oxygenation protect the liver against ischemia-reperfusion injury? An experimental study in a rat model.

OBJECTIVES: We designed studies to test the hypotheses that hyperbaric oxygen (HBO) therapy should protect liver against subsequent ischemia/reperfusion (I/R) injury are scarce and controversial. The purpose of this study was to clarify some questions about the association of HBO with the processes of liver I/R. METHODS: We divided Wistar rats into 5 groups: (1) SHAM operation, (2) I/R, rats submitted to total pedicle ischemia for 30 minutes followed by 5 minutes of reperfusion; (3) HBO60I/R and (4) HBO120I/R, rats respectively submitted to 60 and 120 minutes of HBO therapy at 2 absolute atmospheres and immediately after submitted to the experimental protocol of I/R; (5) HBO120, rats submitted to 120 minutes of HBO therapy at 2 absolute atmospheres and then immediately after humanely killed. The experimental protocol included (1) serum levels of aspartate and alanine aminotransferase; (2) mitochondrial function; (3) tissue malondialdehyde (MDA); and (4) plasma nitrite/nitrate. Data were analyzed using the Mann-Whitney test and were considered significant P < 5%. RESULTS: The processes of liver ischemia/reperfusion caused tissue injury with hepatic mitochondrial functional impairment. A single exposure to 120 minutes of HBO caused an increase of tissue MDA. The time of HBO exposure as preconditioning before hepatic I/R is critical in the prevalence of beneficial or deleterious effects. Sixty minutes of hyperoxic preconditioning before liver I/R presents systemic benefits, but no significant tissue preservation. One hundred twenty minutes of hyperoxic preconditioning tissue liver benefits predominate compared with systemic benefits. CONCLUSIONS: The HBO preconditioning therapeutic benefits to liver I/R injury are time dependent, suggesting a therapeutic window that needs to be clearly defined in future studies.

Anal canal mucinous adenocarcinoma with invasion of gluteus and perineum treated with surgery and hyperbaric oxygen therapy.

The case of a 66-year-old female patient with late diagnosis of giant anal canal mucinous adenocarcinoma invading the gluteal and vulvar regions is reported. Because of the patient's severe clinical status and disease morbidity, surgical resection of the lesion was accomplished, with no adjuvant chemo- or radiotherapy. In the postoperative period, the patient received hyperbaric oxygen therapy, which facilitated and even accelerated local healing. Total closure of the raw flesh area was achieved, with no recurrence signals of cancer being detected after one-year follow-up. We are convinced that, in this difficult case, hyperbaric oxygen therapy played a crucial role in patient recovery and wound healing, allowing for early closure with good progression.

A new proctoscope for transanal endoscopic operations.

Transanal access is one of many currently used procedures for rectal cancer treatment. The techniques used for local excision include conventional transanal excision, posterior access, therapeutic colonoscopy and transanal endoscopic approaches. The aim of the present study was to present a new surgical proctoscope for the endoscopic transanal excision of rectal lesions. A cylindrical proctoscope with a diameter of 4 cm was devised and built. The end inserted into the anus has a bevelled aspect and rounded borders, allowing correct exposure of the anal lesion. The rectoscope is fixed to the anal border with surgical thread through perforations in the external end. A base screw holds a fibre-light which illuminates the operative field. Part of the equipment is a guide which is positioned inside the rectoscope on insertion into the anus. In operations utilizing this proctoscope, 17 adenomas, 25 adenocarcinomas, 1 carcinoid and 1 endometrioma were excised. The diameter of the lesions varied from 1 to 6 cm. The range of procedures that are possible with this new proctoscope are similar to those achieved with conventional techniques which, however, require more expensive equipment. Hence, the present study demonstrates that this newly devised low-cost proctoscope is an efficient tool for the transanal endoscopic excision of rectal lesions.

Therapeutic effect of hyperbaric oxygen in hepatic artery thrombosis and functional cholestasis after orthotopic liver transplantation.

Among the postoperative complications, hepatic artery thrombosis can occur in up to 10% of adult orthotopic liver transplants and intervention is indicated when this occurs within 30 days by retransplantation. Primary graft dysfunction, which can occur in up to 30% of the cases and is another potential complication, although reversible, has a relatively high mortality rate. Hyperbaric therapy, an efficient mode of tissue oxygenation, is being used in an increasing number of clinical situations. We report here two cases where hyperbaric oxygen therapy greatly benefited patients with complications after orthotopic liver transplantation: one with hepatic artery thrombosis and the other with primary graft dysfunction. Both patients showed rapid clinical recovery with gradual reduction of liver and canalicular enzymes soon after commencing hyperbaric oxygen therapy.

Effect of hyperbaric oxygen on liver regeneration in a rat model.

Hyperbaric oxygen therapy is a treatment that has been gradually implemented for the treatment of several pathologic conditions. The present study evaluated the effect of hyperbaric oxygen therapy for hepatic regeneration and its relationship to mitochondrial function. Male Wistar rats underwent partial hepatectomy (70%) and subsequently underwent two sessions of hyperbaric oxygen (90 minutes each, at a pressure of 2 ATA). The animals were sacrificed at 24 and 48 hours after surgery. Hepatic regeneration was evaluated by the dry weight of the remaining liver, the hepatic regeneration rate, the hepatic DNA content, and the hepatocyte proliferation rate using the "proliferating cell nuclear antigen" (PCNA) content. Function of the mitochondria was evaluated by its oxygen consumption during respiratory states 3 and 4, its respiratory control ratio (RCR), its membrane potential, as well as its osmotic swelling. We also measured serum levels of aminotransferases. The results revealed an increased dry weight of the remaining liver, regeneration rate, and DNA content at 24 and 48 hours after hepatectomy. The hepatocyte proliferation rate was significantly higher among animals treated with hyperbaric oxygen therapy at 48 hours after surgery. There was no significant difference in aminotransferase levels. Mitochondrial respiration revealed reduced oxygen consumption in state 3 after 48 hours. These results demonstrated that hyperbaric oxygen stimulates hepatic regeneration at 24 and 48 hours after 70% hepatectomy. The effect of hyperbaric oxygen on hepatic tissue occurs without tissue damage and protects mitochondria after 48 hours.

The role of mechanical bowel preparation for colonic resection and anastomosis: an experimental study.

BACKGROUND AND AIMS: To evaluate the effect of mechanical bowel preparation (MBP) on colonic resection and anastomosis. PATIENTS AND METHODS: Mongrel dogs were divided into two groups of 20 animals each. During the preoperative period (24 h) group A was not subjected to MBP, and group B was fasted and ingested 20 ml magnesium hydroxide plus 15 ml/kg 10% mannitol orally. All animals underwent segmental colectomy followed by end-to-end anastomosis. The survivors of both groups were reoperated upon on the 7th postoperative day. RESULTS: Mortality before reoperation was significantly higher in group A (45%) than in group B (10%; P<0.05). Upon reoperation on surviving animals the incidence of localized anastomotic leakage, leakage with peritonitis, and healed anastomoses was 72.72%, 9.09%, and 18.8% in group A, and 66.66%, 22.22%, and 11.11% in group B, respectively (P>0.05). Aerobic and anaerobic bacterial cultures showed similar growth in the two groups. CONCLUSION: We conclude that the omission of MBP increased the mortality due to early anastomotic leakage with peritonitis; MBP did not change the rate of localized anastomotic leakage, leakage with peritonitis, or intact anastomoses on the 7th day; no quantitative or qualitative differences were observed in the bacteria isolated from the two groups.

Apendicite crônica e apendicite recorrente: artigo de revisäo e apresentaçäo de casuística / Chronic and recurrent appendicitis: review article and cases report

A apendicite crônica e a apendicite recorrente säo condiçöes patológicas que diferem da apendicite aguda, a afecçäo mais comum do apêndice vermiforme. O propósito desse artigo é decifrar com critério os aspectos clínicos, o diagnóstico e a histopatologia da apendicite crônica e da apendicite recorrente. Os dados da literatura e as experiências clínica e cirúrgica dos autores, demonstradas por 10 pacientes com idade média entre 40 e 45 anos, com distribuiçäo similar quanto ao sexo, sendo 6 pacientes com apendicite recorrente e 4 com apendicite crônica, permitem concluir que a apendicite crônica e a recorrente já näo devem ser mais uma controvérsia ou dúvida, mas um fato inequívoco de importâncias clínica e acadêmica. Portanto, seus conceitos merecem difusäo na literatura científica e nas escolas médicas.

Proctossigmoidectomia via perineal no tratamento do prolapso retal / Perineal proctosigmoidectomy in treatment of rectal prolapse

A técnica cirúrgica mais utilizada no tratamento do prolapso retal é a sacropromontofixaçäo do reto por via abdominal, porém nos últimos anos a proctossigmoidectomia via perineal tem sido retomada como alternativa para pacientes idosos com comorbidades. Revisamos 14 casos operados pela proctossigmoidectomia via perineal (cirurgia de Altemeier), sendo 13 mulheres e 1 homem. Destes pacientes havia 50 por cento de obstipados, 14,2 por cento tinham diarréia crônica e 64,2 por cento eram previamente incontinentes. Idade média de 72,2 anos, 64,2 por cento com anastomose manual e 35,8 por cento mecânica, além de 42,9 por cento com reparo anal posterior no mesmo tempo operatório. O tempo médio de internaçäo foi de 3,8 dias, näo houve complicaçöes imediatas ou precoces e apenas ocorreu recidiva em 01 paciente, 7,1 por cento. Pelos bons resultados, baixa morbi-mortalidade e recidiva aceitável e de acordo com a literatura nos encorajamos à utilizaçäo desta técnica para correçäo do prolapso retal.

Apendicite crônica e apendicite recorrente: artigo de revisão e apresentação de casuística

Chronic and recurrent appendicitis are pathologic conditions that differ from acute appendicitis, the most common affection of the vermiform appendix. The purpose of the present study was to describe in detail the clinical features, diagnosis and pathology of those conditions.

A apendicite crônica e a apendicite recorrente são condições patológicas que diferem da apendicite aguda, a afecção mais comum do apêndice vermiforme. O propósito desse artigo é decifrar com critério os aspectos clínicos, o diagnóstico e a histopatologia da apendicite crônica e da apendicite recorrente. Os dados da literatura e as experiências clínica e cirúrgica dos autores, demonstradas por 10 pacientes com idade média entre 40 e 45 anos, com distribuição similar quanto ao sexo, sendo 6 pacientes com apendicite recorrente e 4 com apendicite crônica, permitem concluir que a apendicite crônica e a recorrente já não devem ser mais uma controvérsia ou dúvida, mas um fato inequívoco de importâncias clínica e acadêmica. Portanto, seus conceitos merecem difusão na literatura científica e nas escolas médicas.

Proctossigmoidectomia via perineal no tratamento do prolapso retal

The most used surgical technic for treatment of rectal prolapse is the rectal promontofixation by laparotomy. In the last years, the perineal rectossigmoidectomy has been widely performed again, as alternative for old pacients, particulary for these who have other severe diseases. We've studied 14 pacients operated on perineal rectosigmoidectomy (Altemeier procedure ), 13 women and only 01 man. There were 50% constipated ,also 14,2% had chronic diarrhoea and 64,2% were incontinent. The medium age was of 72,2 years, 64,2% had manual anastomosis and 35,8% mechanic and 42,9% had posterior anal repair (Parks) at the same surgical time. The pacients were hospitalized for 3,8 days (mean time), there were no imediate or recent complications and just 01 recurrence (7,1%). As wehad good results, low morbimortality and acceptable recurrence, we have performed that technique more usually, specially for old patients.

A técnica cirúrgica mais utilizada no tratamento do prolapso retal é a sacropromontofixação do reto por via abdominal, porém nos últimos anos a proctossigmoidectomia via perineal tem sido retomada como alternativa para pacientes idosos com comorbidades. Revisamos 14 casos operados pela proctossigmoidectomia via perineal (cirurgia de Altemeier), sendo 13 mulheres e 1 homem. Destes pacientes havia 50% de obstipados, 14,2% tinham diarréia crônica e 64,2% eram previamente incontinentes. Idade média de 72,2 anos, 64,2 % com anastomose manual e 35,8% mecânica, além de 42,9% com reparo anal posterior no mesmo tempo operatório. O tempo médio de internação foi de 3,8 dias, não houve complicações imediatas ou precoces e apenas ocorreu recidiva em 01 paciente, 7,1%. Pelos bons resultados, baixa morbi-mortalidade e recidiva aceitável e de acordo com a literatura nos encorajamos à utilização desta técnica para correção do prolapso retal .

Quilotórax traumático en el niño / Traumatic chilothorax in children

Se relata el caso de una niña de cuatro años víctima de un politraumatismo por maltrato familiar.Ingresa con un trauma craneoencefálico y renal,dos días después se constata un hemotórax,el que se drena.Al cuarto día,coincidiendo con la realimentación oral se comprobó la presencia de un quilotoráx.El tratamiento fue conservador,con drenaje torácico y el uso de dieta con triglicéridos de cadena media.Seis días después hubo resolución completa del quilotórax.La terapéutica frente a esta afección puede ser clínica o quirúrgica.Cerca de 50 por ciento de los casos como en el descripto son tratados con éxito en forma conservadora.La opción quirúrgica se reserva para aquellas situaciones de falla del tratamiento clínico realizado por lo menos durante 4 a 6 semanas.Encontramos solo dos casos citados en la literatura de quilotórax traumático por apaleamiento

Massive lower gastrointestinal hemorrhage caused by pseudocyst of the pancreas ruptured into the colon. Report of two cases.

We report two cases of massive lower gastrointestinal (LGI) bleeding occurring in young adult men, as the first manifestation of pseudocyst of the pancreas. Despite the rarity of such a complication, pancreatic pseudocyst should be kept in mind as a possible source of massive LGI bleeding requiring immediate surgical treatment.