Prospective ultrasonographic study of blood flow and testicular volume in patients submitted to surgical repair of inguinal hernia without using prosthesis

Purpose: To evaluate the behavior of arterial circulation and testicular volume in patients submitted to conventional inguinal hernia repair without the use of a synthetic prosthesis to reinforce the posterior wall. Methods: A prospective observational clinical trial was performed on 26 male patients with unilateral inguinal hernia types I and II by the Nyhus classification, who underwent surgical correction using the modified Bassini technique. Bilateral Doppler ultrasonography was performed preoperatively, at the third and at the sixth postoperative month. The studied variables were: systolic peak velocity (SPV), diastolic peak velocity (DPV), resistance index (RI), pulsatility index (PI) and testicular volume. Results: There were no statistically significant changes over time in the variables studied on the operated side: SPV (p = 0.916), DPV (p = 0.304), RI (p = 0.879), PI (p = 0.475), and testicular volume (p = 0.100). The variables on the control side also did not change statistically until the sixth postoperative month: SPV (p = 0.784), DPV (p = 0.446), RI (p = 0.672), PI (p = 0.607), and testicular volume (p = 0.413). Conclusion: Surgical correction of the inguinal hernia without the use of a prosthesis does not cause alterations in vascularization and testicular volume in the first six months postoperatively.(AU)

Use of fibrinogen and thrombin sponge in pediatric split liver transplantation

Purpose: To analyze the use of this sponge in pediatric patients undergoing split-liver transplantation. Methods: Retrospective study, including 35 pediatric patients undergoing split-liver transplantation, divided into two groups according to the use of the sponge: 18 patients in Group A (no sponge) and 17 in Group B (with sponge). Results: The characteristics of recipients and donors were similar. We observed greater number of reoperation due to bleeding in the wound area in Group A (10 patients - 55.5%) than in Group B (3 patients - 17.6%); p = 0.035. The median volume of red blood cells transfused in Group A was significantly higher (73.4 ± 102.38 mL/kg) than that in Group B (35.1 ± 41.67 mL/kg); p = 0.048. Regarding bile leak there was no statistical difference. Conclusion: The use of the human fibrinogen and thrombin sponge, required lower volume of red blood cell transfusion and presented lower reoperation rates due to bleeding in the wound area.(AU)

Evaluating the best time to intervene acute liver failure in rat models induced by d-galactosamine

PURPOSE:To describe an animal model for acute liver failure by intraperitoneal d-galactosamine injections in rats and to define when is the best time to intervene through King's College and Clichy´s criteria evaluation.METHODS:Sixty-one Wistar female rats were distributed into three groups: group 1 (11 rats received 1.4 g/kg of d-galactosamine intraperitoneally and were observed until they died); group 2 (44 rats received a dose of 1.4 g/kg of d-galactosamine and blood and histological samples were collected for analysis at 12 , 24, 48 , 72 and 120 hours after the injection); and the control group as well (6 rats) .RESULTS:Twelve hours after applying d-galactosamine, AST/ALT, bilirubin, factor V, PT and INR were already altered. The peak was reached at 48 hours. INR > 6.5 was found 12 hours after the injection and factor V < 30% after 24 hours. All the laboratory variables presented statistical differences, except urea (p = 0.758). There were statistical differences among all the histological variables analyzed.CONCLUSION:King's College and Clichy´s criteria were fulfilled 12 hours after the d-galactosamine injection and this time may represent the best time to intervene in this acute liver failure animal model.(AU)

An evaluation of the protective effect of an infusion of chilled glucose solution on thermal injury of the bile ducts caused by radiofrequency ablation of the liver

PURPOSE: To evaluate the protective effects of chilling the bile ducts with cold (5°C) 5% glucose solution (GS) during radiofrequency (RF) administration. METHODS: Twenty male pigs (3 mos. old; 25–30 kg) were subjected to RF delivery with chilling (experimental group, N=10) or without chilling (control group, N=10). Half of the animals in each group were euthanized immediately after the operation, and half were euthanized one week later. The following histological variables in relation to the bile ducts were evaluated by a pathologist (blind examiner): degenerative changes to the epithelium; epithelial necrosis; ulceration, regenerative changes of the epithelium; polymorphonuclear neutrophil infiltration; and thermal effects. RESULTS: The experimental group (88 bile ducts examined) showed reduced thermal damage relative to the control group (86 bile ducts examined) as demonstrated by significant differences in the following histopathological parameters: epithelial detachment of biliary epithelium (84.1% vs. 59.3%; p<0.006); elongation/palisade arrangement of nuclei (65.1% vs. 87.5%; p<0.001); pseudo-goblet cells (32.9% vs. 56.8%; p<0.001). CONCLUSION: Infusion of 5% glucose solution (5°C) has a protective effect on bile ducts subjected to heat (95–110°C, 12 min) from radiofrequency thermal ablation device.(AU)

Comparative efficacy of Belzer or Euro-Collins solutions for pancreatic preservation during cold ischemic storage in rats

To compare the efficacy of different types of solutions (Belzer or Euro-Collins) for the preservation of rat pancreas during cold ischemia. METHODS: Thirty Wistar rats were divided into three groups according to the perfusion or storage solution: Group E (perfusion and storage in Euro-Collins solution); Group B (perfusion and storage in Belzer solution) and Group BE (Perfusion in Belzer solution and storage in Euro-Collins solution). After perfusion, the pancreas was excised and stored at 4˚C for 18 hours. Amylase was measured at 6, 12 and 18h, and histological analysis of the pancreas was performed after 18h of cold storage. RESULTS: Amylase was elevated and comparable in Groups E and BE after 12 and 18 hours of ischemia (p<0.05). In the exocrine pancreas, histological differences in the amount of necrosis (p=0.049), lymphocytic infiltrate (p<0.001) and neutrophilic infiltrate (p=0.004) were observed, with more favorable features present in Group B. In the endocrine pancreas, Group B showed less edema (p<0.001), but other parameters were similar among all groups. CONCLUSION: The Euro-Collins solution is inferior to the Belzer solution for the preservation of rat pancreas during cold ischemia.(AU)

Ethyl-pyruvate reduces lung injury matrix metalloproteinases and cytokines and improves survival in experimental model of severe acute pancreatitis

PURPOSE: To investigate if the ethyl-pyruvate solution could reduce mortality in AP and/or diminish the acute lung injury. METHODS: Forty male rats, weighing between 270 to 330 grams were operated. An experimental model of severe AP by injection of 0.1ml/100g of 2.5% sodium taurocholate into the bilio-pancreatic duct was utilized. The rats were divided into two groups of ten animals each: CT - control (treatment with 50ml/kg of Ringer's solution, intraperitoneal) and EP (treatment with 50ml/kg of Ringer ethyl- pyruvate solution, intra-peritoneal), three hours following AP induction. After six hours, a new infusion of the treatment solution was performed in each group. Two hours later, the animals were killed and the pulmonary parenchyma was resected for biomolecular analysis, consisting of: interleukin, myeloperoxidase, MDA, nitric oxide, metalloproteinases and heat shock protein. In the second part of the experiment, another, 20 rats were randomly divided into EP and CT groups, in order to evaluate a survival comparison between the two groups. RESULTS: There were no significant differences in IL-1B,IL-10, MMP-9, HSP70, nitric oxide, MPO, MDA (lipidic peroxidation) concerning both groups. The levels of IL-6 were significantly diminished in the EP group. Furthermore, the MMP-2 levels were also reduced in the EP group (p<0.05). The animals from the EP treatment groups had improved survival, when compared to control group (p<0.05). CONCLUSION: The ethyl-pyruvate diminishes acute lung injury inflammatory response in acute pancreatitis and ameliorates survival when compared to control group, in the experimental model of necrotizing acute pancreatitis.(AU)

Adhesion prevention in reabsorbable polyethylene glycol hydrogel (Coseal®) coated polypropylene mesh in rabbits

PURPOSE: To evaluate of postoperative adhesion prevention and inflammatory response to polypropylene mesh, coated with reabsorbable hydrogel of polyethylene glycol (Coseal®) in contact with small bowel in an experimental model in rabbits. METHODS: Twenty female rabbits underwent laparotomy to implant two polypropylene meshes, 2x1cm, in the right and left flanks. The right mesh was protected with Coseal® spray (Group 1) and the left mesh received no treatment after implantation (Group 2). Thirty days after implantation, the rabbits underwent laparoscopy for adhesion analysis; the prosthesis were removed en bloc with the adjacent tissue for microscopic analysis of inflammation. Statistical analysis used the Mann-Whitney test. RESULTS: There was adhesion formation in five meshes (36%) from Group 1 and in 14 meshes (100%) from Group 2, with statistical significance (p<0.01). There were no differences in the inflammatory response, fibrosis, foreign body reaction, presence of collagen and type of inflammatory cells between the two groups. CONCLUSION: Polypropylene mesh coated with Coseal® showed a significantly lower rate of adhesion formation when compared with uncoated meshes, without interfering with inflammatory response.(AU)

May titanium spiral tacks contribute to intra-abdominal adhesion formation? / Grampos espirais de titânio podem contribuir para a formação de aderências intra-abdominais?

PURPOSE: To verify if titanium spiral tacks may contribute to intra-abdominal adhesion formation in rabbits. METHODS: Ten New Zealand white rabbits were used. Through videolaparoscopic surgery two titanium spiral tacks (ProTack®, Covidien®) were applied in the right flank. After 30 days the animals were submitted to evaluate peritoneal cavity by videolaparoscopy. RESULTS: No adhesion was found where the titanium spiral tacks were placed. CONCLUSION: Titanium spiral tacks for fixation do not cause adhesions in rabbits.(AU)

OBJETIVO: Verificar se grampos espirais de titânio podem contribuir para a formação de aderências intra-abdominais em coelhos. MÉTODOS: Foram utilizados 10 coelhos albinos linhagem Nova Zelândia. Por meio de vídeo laparoscopia foram aplicados dois grampos metálicos espirais de titânio (ProTack®, Covidien®) na região do flanco direito. Após 30 dias, os animais foram submetidos à laparoscopia para avaliação da cavidade peritoneal. RESULTADOS: Não foi encontrada nenhuma aderência aos grampos aplicados. CONCLUSÃO: Os grampos em espiral de titânio para a fixação não causam aderências em coelhos.(AU)

Parenteral nutrition versus enteral nutrition in severe acute pancreatitis / Nutrição parenteral versus enteral em pacientes com pancreatite aguda grave

PURPOSE: To compare the effect of parenteral versus enteral nutritional support in severe acute pancreatitis, with respect to efficacy, safety, morbidity, mortality and length of hospitalization. METHODS: The study was comprised of 31 patients, divided into a parenteral group (n=16) and an enteral group (n=15), who met severity criteria for abdominal tomography (Balthazar classes C, D, and E). The patients were compared by demographics, disease etiology, antibiotic prophylaxis, use or not of somatostatin, nutritional support, complications and disease progression. RESULTS: There was no statistical difference in the average duration of nutritional support, somatostatin, or antibiotics in the two groups. Imipenem was the drug of choice for prophylaxis of pancreatic infections in both groups. More complications occurred in the parenteral group, although the difference was not statistically significant (p=0.10). Infectious complications, such as catheter sepsis and infections of the pancreatic tissue, were significantly more frequent in the parenteral group (p=0.006). There was no difference in average length of hospitalization in the two groups. There were three deaths in the parenteral group and none in the enteral group. CONCLUSION: Enteral nutritional support is associated with fewer septic complications compared to parenteral nutritional support.(AU)

OBJETIVO: Comparar o efeito do suporte nutricional parenteral versus enteral, em pancreatite aguda grave, com relação à eficácia, à segurança, à morbi-mortalidade e ao tempo de internação. MÉTODOS: Foram estudados 31 pacientes distribuídos em grupo parenteral (n=16), no período de 1995 a 1998 e grupo enteral (n=15), no período de 1999 a 2002, que preencheram os critérios de gravidade pela tomografia de abdome (Balthazar C,D,E). Os pacientes foram comparados quanto aos dados demográficos, etiologia, antibioticoprofilaxia, somatostatina, suporte nutricional, complicações e evolução. RESULTADOS: A maioria dos pacientes era Balthazar E, principalmente no grupo enteral, porém sem significado estatístico (p=0,21). Também não houve diferença estatística nos dois grupos em relação ao tempo médio de uso de suporte nutricional, somatostatina e antibiótico. O imipenem foi a droga de escolha para profilaxia da infecção pancreática nos dois grupos. Houve mais complicações gerais no grupo parenteral, sem significado estatístico (p=0,10). As complicações infecciosas do tipo sépsis do cateter e infecção do tecido pancreático foram mais frequentes no grupo parenteral, com significância estatística (p=0,06). Não houve diferença na média de internação nos dois grupos. Houve três óbitos no grupo parenteral e nenhum no enteral. CONCLUSÃO: O suporte nutricional enteral está associado à menor taxa de complicações sépticas do que o parenteral.(AU)

Evaluation of the efficacy and reproducibility of cholangiopancreatography by magnetic resonance for detecting biliary complications following orthotopic liver transplantation / Estudo da eficácia e da reprodutibilidade da colangiopancreatografia por ressonância magnética na detecção das complicações biliares pós-transplantes hepáticos

PURPOSE: To evaluate the accuracy and reproducibility of magnetic resonance cholangiopancreatography (MRCP) in the detection of biliary complications in liver transplanted patients. METHODS: A study was conducted, with blinded review of 28 MRCP exams of 24 patients submitted to liver transplantation. The images were reviewed by two independent observers, at two different moments, regarding the degree of biliary tree visualization and the presence or absence of biliary complications. The MRCP results were compared, when negative, to at least 3 months of clinical and biochemical follow-up, and when positive, to the findings at surgery or endoscopic retrograde cholangiopancreatography (ERCP). RESULTS: The degree of intrahepatic biliary tree visualization was considered good or excellent in 78.6 percent and 82.1 percent of the exams by the two observers and visualization of the donor duct, recipient duct and biliary anastomosis was considered good or excellent in 100 percent of the exams, by both observers. Six biliary complications were detected (21.4 percent), all of them anastomotic strictures. Intra and interobserver agreement were substantial or almost perfect (kappa k values of 0.611 to 0.804) for the visualization of the biliary tree and almost perfect (k values of 0.900 to 1.000) for the detection of biliary complications. MRCP achieved 100 percent sensitivity, 95.45 percent specificity, 85.7 percent positive predictive value and 100 percent negative predictive value for the detection of biliary complications. CONCLUSIONS: MRCP is an accurate examination for the detection of biliary complications after orthotopic liver transplantation and it is a highly reproducible method in the evaluation of the biliary tree of liver transplanted patients.(AU)

OBJETIVO: Medir a acurácia e reprodutibilidade da colangiopancreatografia por ressonância magnética (CPRM) na avaliação da visibilização de complicações biliares em pacientes submetidos a transplantes hepáticos ortotópicos. MÉTODOS: Realizado estudo retrospectivo de 28 exames de CPRM de 24 pacientes submetidos a transplantes hepáticos. Os exames foram interpretados por dois observadores independentes, em dois momentos distintos, quanto ao grau de visibilização das estruturas estudadas e quanto à presença ou ausência de alterações nas vias biliares. Os resultados da CPRM foram comparados, nos casos de CPRM negativa, à evolução clínico-laboratorial por pelo menos 3 meses e, nos casos de CPRM alterada, aos achados de colangiopancreatografia retrógrada endoscópica (CPRE) e cirurgia, quando indicados. RESULTADOS: A visibilização das vias biliares intra-hepáticas foi considerada boa ou excelente em 78,6 por cento e 82,1 por cento dos exames pelos dois observadores. A visibilização da via biliar extra-hepática do doador e do receptor, bem como da anastomose biliar, foi considerada boa ou excelente em 100 por cento dos casos por ambos os observadores. Foram detectadas seis complicações biliares (21,4 por cento dos casos), todas elas estenoses anastomóticas. A concordância intra e intra-observador foi substancial ou quase perfeita (índices de kappa- k de 0,611 a 0,804) para a visualização das estruturas estudadas e quase perfeita (k de 0,900 a 1,000) para a detecção das complicações biliares. A CPRM apresentou sensibilidade de 100 por cento, especificidade de 95,45 por cento, valor preditivo positivo de 85,7 por cento e valor preditivo negativo de 100 por cento para a detecção de complicações biliares. CONCLUSÕES: A colangiopancreatografia por ressonância magnética (CPRM) é um exame acurado para a detecção de complicações biliares em pacientes submetidos a transplantes hepáticos ortotópicos por CPRM. Este exame configura-se como um método eficiente ...(AU)

Prospective study on the effects of a polypropylene prosthesis on testicular volume and arterial flow in patients undergoing surgical correction for inguinal hernia / Estudo prospectivo dos efeitos da prótese de polipropileno sobre o volume e o fluxo arterial testicular em pacientes submetidos à correção cirúrgica de hérnia inguinal

PURPOSE: To evaluate testicular volume and arterial flow in patients undergoing surgical correction for inguinal hernia, with polypropylene prosthesis. METHODS: This was an observational prospective clinical study on 39 male patients with unilateral inguinal hernia of types III A and III B according to the Nyhus classification who underwent surgical correction with implantation of a polypropylene prosthesis by means of the Lichtenstein technique. The patients were evaluated using Doppler ultrasound before the operation and selectively at the third and sixth months after the operation. The variables studied were testicular volume, systolic and diastolic velocity, resistance index and pulsatility index. RESULTS: No statistically significant alterations in the variables studied were observed over the course of time: testicular volume (p= 0.197); systolic velocity (p= 0.257); diastolic velocity (p= 0.554); resistance index (p= 0.998); and pulsatility index (p= 0.582). CONCLUSION: No alteration in testicular volume and arterial flow over a six-month period was observed among patients who underwent surgical correction for inguinal hernia using a polypropylene prothesis.(AU)

OBJETIVO: Avaliar o volume testicular e o fluxo na artéria testicular em pacientes operados de inguinal com prótese de polipropileno. MÉTODOS: Estudo clínico prospectivo observacional em 39 pacientes do sexo masculino portadores de hérnia inguinal tipo III A e III B na classificação de Nyhus os quais foram submetidos a hernioplastia inguinal com implantação de prótese de polipropileno com a técnica de Lichtenstein. Os pacientes foram avaliados com ultra-sonografia Doppler no pré-operatório; no 3º mês e no 6º mês de pós-operatório. As variáveis estudadas foram: volume testicular; velocidade sistólica e diastólica, o índice de resistividade e o índice de pulsatilidade. RESULTADOS: Não se observou alterações estatisticamente significantes nas variáveis ao longo do tempo: volume testicular (p=0,197); velocidade sistólica (p=0,257); velocidade diastólica (p=0,554); índice de resistividade (p=0,998); índice de pulsatilidade (p=0,582). CONCLUSÃO: Não se observou alteração no volume testicular e no fluxo sanguíneo da artéria testicular após seis meses nos pacientes submetidos à correção cirúrgica de hérnia inguinal com prótese de polipropileno..(AU)

Prospective study on the effects of a polypropylene prosthesis on testicular volume and arterial flow in patients undergoing surgical correction for inguinal hernia / Estudo prospectivo dos efeitos da prótese de polipropileno sobre o volume e o fluxo arterial testicular em pacientes submetidos à correção cirúrgica de hérnia inguinal

PURPOSE: To evaluate testicular volume and arterial flow in patients undergoing surgical correction for inguinal hernia, with polypropylene prosthesis. METHODS: This was an observational prospective clinical study on 39 male patients with unilateral inguinal hernia of types III A and III B according to the Nyhus classification who underwent surgical correction with implantation of a polypropylene prosthesis by means of the Lichtenstein technique. The patients were evaluated using Doppler ultrasound before the operation and selectively at the third and sixth months after the operation. The variables studied were testicular volume, systolic and diastolic velocity, resistance index and pulsatility index. RESULTS: No statistically significant alterations in the variables studied were observed over the course of time: testicular volume (p= 0.197); systolic velocity (p= 0.257); diastolic velocity (p= 0.554); resistance index (p= 0.998); and pulsatility index (p= 0.582). CONCLUSION: No alteration in testicular volume and arterial flow over a six-month period was observed among patients who underwent surgical correction for inguinal hernia using a polypropylene prothesis.

OBJETIVO: Avaliar o volume testicular e o fluxo na artéria testicular em pacientes operados de inguinal com prótese de polipropileno. MÉTODOS: Estudo clínico prospectivo observacional em 39 pacientes do sexo masculino portadores de hérnia inguinal tipo III A e III B na classificação de Nyhus os quais foram submetidos a hernioplastia inguinal com implantação de prótese de polipropileno com a técnica de Lichtenstein. Os pacientes foram avaliados com ultra-sonografia Doppler no pré-operatório; no 3º mês e no 6º mês de pós-operatório. As variáveis estudadas foram: volume testicular; velocidade sistólica e diastólica, o índice de resistividade e o índice de pulsatilidade. RESULTADOS: Não se observou alterações estatisticamente significantes nas variáveis ao longo do tempo: volume testicular (p=0,197); velocidade sistólica (p=0,257); velocidade diastólica (p=0,554); índice de resistividade (p=0,998); índice de pulsatilidade (p=0,582). CONCLUSÃO: Não se observou alteração no volume testicular e no fluxo sanguíneo da artéria testicular após seis meses nos pacientes submetidos à correção cirúrgica de hérnia inguinal com prótese de polipropileno..

Experimental model of severe acute pancreatitis in rabbits / Modelo experimental de pancreatite aguda grave em coelhos

PURPOSE: To develop an experimental model of severe acute pancreatitis in rabbits through a pancreatic ductal injection of sodium taurocholate. METHODS: Twenty-four albino rabbits of the New Zealand lineage were distributed into four groups of six animals (A, B, C and S). The rabbits of three experimental groups (A, B and C) were submitted to a laparatomy and received a pancreatic ductal injection of 1ml/kg sodium taurocholate 5 percent. Also, they were submitted to further laparatomies after 4h, 8h and 12h, respectively. The control group (S) was subdivided into two groups of three animals: in subgroup S1 only the pancreatic duct catheterization was performed whereas in subgroup S2 the pancreatic duct catheterization as well as an injection of 1ml/kg physiologic solution 0.9 percent were carried out. After 12 hours, the rabbits were evaluated. In the re-intervention, blood was collected to determine the amylasemia and a pancreatectomy was carried out to investigate interstitial infiltration, steatonecrosis and necrosis of the organ, using an optical microscope. RESULTS: There was an elevation of amylase in all groups thus proving the existence of acute pancreatitis. The size of the interlobular septum increased progressively with a greater variation between group S1 (0.13) and group C (0. 53) (p=0.035). While all the animals in group A exhibited focal cellular necrosis, it was more intense in the rabbits of group B and culminated with a high proportion of severe pancreatic necrosis in group C animals. The difference in the intensity of cellular necrosis showed statistic significance (p=0.001). CONCLUSION: The proposed experimental model demonstrated its reproducibility and effectiveness in producing severe acute pancreatitis in rabbits.(AU)

OBJETIVO: Desenvolver modelo experimental de pancreatite aguda grave em coelhos por meio da injeção de taurocolato de sódio no ducto pancreático. MÉTODOS: Vinte e quatro coelhos albinos da linhagem Nova Zelândia foram distribuídos em quatro grupos de seis animais (A, B, C e S). Os coelhos dos três grupos experimentais (A, B e C) foram submetidos a laparotomia e injetou-se taurocolato de sódio a 5 por cento, 1ml/Kg no ducto pancreático. Realizou-se nova laparotomia, respectivamente, após 4h, 8h e 12h. No grupo controle (S), subdividido em dois grupos de três animais, foi realizada no subgrupo S1 apenas cateterização do ducto pancreático e no subgrupo S2 cateterização do ducto pancreático e injeção de solução fisiológica 0,9 por cento, 1ml/Kg. Estes animais foram reavaliados após 12 horas. Na reintervenção coletou-se sangue para determinação da amilasemia e realizou-se pancreatectomia para análise histológica do infiltrado intersticial, da esteatonecrose e da necrose do órgão. RESULTADOS: Houve elevação da amilase em todos os grupos, demonstrando a presença da pancreatite aguda. O tamanho do septo interlobular aumentou progressivamente, observando-se maior diferença entre os grupos S1 (0,13) e C (0,53) (p=0,035). Todos os animais do grupo A apresentaram necrose celular focal que se tornou mais intensa nos coelhos do grupo B, culminando com o predomínio de necrose pancreática acentuada nos animais do grupo C. A diferença na intensidade da necrose celular apresentou significância estatística (p=0,001). CONCLUSÃO: O modelo experimental proposto se mostrou reprodutível e efetivo em provocar pancreatite aguda grave em coelhos.(AU)

Randomized trial of total fundoplication and fundal mobilization with or without division of short gastric vessels: a short-term clinical evaluation / Estudo prospectivo e randomizado da fundoplicatura total e mobilização do fundo gástrico com ou sem secção dos vasos gástricos curtos. Resultados de avaliação clínica em curto prazo

PURPOSE: Evaluate short results after fundoplication procedure, concerning the division of short gastric vessels. METHODS: A prospective randomization of 90 patients with indication for hiatoplasty and total fundoplication with fundus mobilization was performed. They were divided into two groups: no SGV division (group A, n= 46) and with SGV division (Group B, n=44), although in both groups the gastric fundus was mobilized to perform a floppy valve. Early outcome with clinical follow up (1 year) was observed. RESULTS: Both groups were similar regarding preoperative parameters and severity of gastroesophageal reflux disease (GERD). No difference in morbidity was observed during hospital stay. Nevertheless, the median operating time was 80,2 minutes in group A and 94,1 minutes (p=0,021) in Group B. Transitory dysphagia during the first year was significantly lower in group B (46,6 percent versus 23,2 percent, p=0,012). However, in 12 months clinical outcome was similar in both groups (clinical symptoms of GERD, persistent dysphagia and reoperations). CONCLUSION: There was no improvement in routine division of SGV in total fundoplication procedure when the gastric fundus was mobilized(AU)

OBJETIVO: Comparar os resultados imediatos e curto prazo segundo a secção ou não dos vasos gástricos curtos. MÉTODOS: Estudo prospectivo randomizado com 90 pacientes selecionados em dois grupos: 46 (grupo A) sem secção e 44 (Grupo B) com secção dos vasos gástricos curtos, seguidos de hiatoplastia e fundoplicatura total por laparoscopia. Analisaram-se os resultados até um ano de pós-operatório. RESULTADOS: Os dois grupos eram homogêneos quanto aos critérios demográficos e aos relacionados á doença do refluxo gastroesofágico. Não houve diferença quanto á morbidade ou tempo de internação, porém o tempo cirúrgico foi maior no Grupo B (80,2 minutos contra 94,1 minutos, p=0,021). Disfagia transitória foi mais freqüente no Grupo A (46,6 por cento versus 23,2 por cento,p=0,012), porém na avaliação final de primeiro ano do pós-operatório não existindo diferença quanto á disfagia persistente, reoperação ou recidiva. CONCLUSÃO: Não houve melhora quando da secção rotineira para a mobilização do fundo gástrico para a realização da fundoplicatura total por laparoscopia(AU)

Experimental model of gastroesophageal reflux in rats / Modelo experimental de refluxo gastroesofágico em ratos

OBJETIVO: Desenvolver um modelo experimental de refluxo gastroesofágico em ratos. MÉTODOS: Sessenta ratos, Wistar, foram operados e distribuídos em três grupos de vinte animais. Os animais foram submetidos a miectomia total do esôfago em um grupo(A), e em outro grupo foram submetidos a miectomia parcial(B). O terceiro grupo foi o grupo controle(C). Para avaliar o refluxo gastroesofágico realizou-se o estudo radiológico contrastado do esôfago. O estudo anátomo-patológico do esôfago foi utilizado para avaliar esofagite. RESULTADOS: Durante os 30 dias de pós-operatório, 14 animais do grupo A apresentaram refluxo de Bário no esôfago. Em 07 animais do grupo B e em 02 do grupo controle, foram observados a presença de Bário no esôfago. O resultado do histopatológico foi controverso. Observou-se perda ponderal importante nos ratos submetidos a miectomia total, porém não existiu diferença estatística. CONCLUSÃO: A miectomia total realizada no terço inferior do esôfago provocou refluxo gastroesofágico na maioria dos animais.(AU)

Analysis of the correlation between p53 and bcl-2 expression with staging and prognosis of the colorectal adenocarcinoma

PURPOSE: To analyze the correlation between p53 and bcl-2 expression and colorectal adenocarcinoma staging and prognosis. METHODS: This was a retrospective series of 125 colorectal adenocarcinoma patients (67 women and 58 men; ages 30-87 years) who underwent surgery with curative intent. The mean follow-up was 28.5 months (range: 2-96 months). TNM staging, tumor recurrence, survival and cancer-related mortality were analyzed. Immunoreactivity was evaluated using DO7 (Dako) for p53 and K492 (Dako) for bcl-2. Tumors with accumulation of staining for cytoplasmic bcl-2 or nuclear p53 in more than 10% of cells were considered positive. Statistical analysis utilized Pearson chi-squared, log-rank and Wilcoxon tests, and Kaplan-Meier survival estimation (significance level: p 0.05). RESULTS: p53+ was found in 11.8% (14/118), bcl-2+ in 50% (58/116) and associated p53+/bcl-2+ in 6.4% (7/109) of the tumors. There was no significant correlation between expression of these biomarkers and TNM I, II, III and IV staging (p=0.385 for p53; p=0.461 for bcl-2). For tumor recurrence, p53+ was found in 9.5% (2/21), bcl-2+ in 50% (11/22), and associated p53+/bcl-2+ in 5.2% (1/19) of the tumors (p=0.714, p=1.000 and p=0.960, respectively). For survival analysis, p53+: 57 months (45.0-68.0), bcl-2+: 78 (37.0-89.0), and p53+/bcl-2+: 62 (56.0-68.0) (p=0.319). For cancer-related mortality, p53+: 8.3% (3/36), bcl-2+: 47.2% (17/36), and p53+/bcl-2+: 5.9% (2/36) of the patients (p=0.432, p=0.688 and p=0.907, respectively). CONCLUSION: No correlation was found between tumor expression of p53 and bcl-2 and the TNM staging, recurrence, survival and cancer-related mortality in colorectal adenocarcinoma.

OBJETIVO: Analisar a correlação entre a expressão da p53 e do bcl-2 com o estadiamento e prognóstico do adenocarcinoma colorretal. MÉTODOS: Foi realizado o estudo de uma série retrospectiva de 125 doentes com adenocarcinoma colorretal (67 mulheres e 58 homens; 30 a 87 anos de idade), que se submeteram ao tratamento cirúrgico com intenção curativa. O tempo médio de seguimento foi de 28,5 meses (variação de 2 a 96 meses). O estadiamento TNM, a recidiva tumoral, a sobrevida e a mortalidade relacionada com o câncer foram analisados. A reação imunohistoquímica utilizada foi o DO& (Dako) para o p53 e o K492 (Dako) para o bcl-2. Tumores com intensidade de coloração citoplásmica para o bcl-2 e nuclear para o p53, acima de 10% de células foram considerados positivos. A análise estatística utilizada foi o teste qui-quadrado de Pearson, log-rank, Wilcoxon e estimativa de sobrevida de Kaplan-Meier (nível de significância : p 0,05). RESULTADOS: p53+ foi encontrado em 11.8% (14/118), bcl-2+ em 50% (58/116) e associados p53+/bcl-2+ em 6.4% (7/109) dos tumores. Não foi encontrado correlação significante entre a expressão tumoral destes marcadores e o estadiamento TNM I, II, III e IV (p=0.385 para a p53; p=0.461 para o bcl-2). Na recidiva tumoral, p53+ foi encontrado em 9.5% (2/21), bcl-2+ em 50% (11/22), e p53+/bcl-2+ associados em 5.2% (1/19) dos tumores (p=0.714, p=1.000 e p=0.960, respectivamente). Na análise de sobrevida, p53+: 57 meses (45.0-68.0), bcl-2+: 78 (37.0-89.0), e p53+/bcl-2+: 62 (56.0-68.0) (p=0.319). Para mortalidade relacionada com câncer, p53+: 8.3% (3/36), bcl-2+: 47.2% (17/36), e p53+/bcl-2+: 5.9% (2/36) dos pacientes (p=0.432, p=0.688 and p=0.907, respectivamente). CONCLUSÃO: Nenhuma correlação significante foi encontrada entre a expressão tumoral da p53 e do bcl-2 com o estadiamento TNM, recidiva, sobrevida e mortalidade relacionada com câncer.

Assessment of staging, prognosis and mortality of colorectal cancer by tumor markers: receptor erbB-2 and cadherins / Avaliação do estadiamento, prognóstico e mortalidade do câncer colorretal mediante marcadores tumorais: receptor erbB-2 e caderinas

OBJETIVO: Avaliação da expressão tumoral das proteínas c-erbB-2 e E-caderina e sua relação com o prognóstico, estadiamento e grau de diferenciação celular, em doentes com câncer colo-retal . MÉTODOS: O estudo incluiu 117 doentes com média de idade de 63.1 anos e com acompanhamento médio de 28.1 meses. O intervalo livre de doença, sobrevida, índice de recidiva e mortalidade específica foram os parâmetros avaliados. Anticorpos anti-oncoproteína c-erbB-2 (Dako) foram utilizados pela técnica da estreptavidiva-biotina. Considerou-se como positiva a presença desta proteína quando mais de 10% das células tumorais estivessem coradas. A proteína E-caderina foi estudada pelo anticorpo anti-E-caderina (Dako), sendo computada como positiva a amostra que apresentasse 50% ou mais das células coradas. A análise estatística utilizou o teste do qui-quadrado de Pearson, o teste exato de Fischer, a curva de Kaplan-Meier, o teste de log-rank e o teste de Wilcoxon ( variante de Breslow),sendo estabelecido nível de significância de 5%( p<0,05). RESULTADOS: 52 de 108 doentes estudados para c-erbB-2 foram positivos (48,1%), 47 de 93 doentes estudados para E-caderina foram negativos (50,5%). Estes dados não mostraram relação com estadiamento TNM (tumor, nódulo e metástase), com o grau de diferenciação celular e índice de recidiva tumoral. O intervalo livre de doença para os doentes positivos para c-erbB-2 e negativos para E-caderina foi de 68.0 meses e não diferiu daqueles que foram negativos para c-erbB-2 e positivos para E-caderina ( 55.0 meses - p = 0.5510). A sobrevida média para os doentes positivos para c-erbB-2 e negativos para E-caderina foi 75 meses sem diferença estatisticamente significante com o outro grupo de comparação( 61 meses - p = 0.5256). A mortalidade específica foi de 20.0% dos casos e não se correlacionou com a expressão do c-erbB-2 (p=0,446) ou da E-caderina(p=0,883). CONCLUSÃO: A expressão das proteínas c-erbB-2 e E-caderina em doentes portadores de adenocarcinoma colo-retal não apresentou correlação com o estadiamento e grau de diferenciação celular. Não houve da mesma forma relação com o prognóstico, no que diz respeito ao índice de recidiva da doença, intervalo livre de doença, sobrevida e mortalidade específica.(AU)