Laying performance and egg quality of Japanese quails fed diets containing castor meal and enzyme complex

The objective of this study was to evaluate the effect of diets formulated with corn plus soybean meal (CSM) or with 21% autoclaved castor meal (ACM), with the addition of two enzyme complexes (EC1 and EC2), on the performance and egg quality of laying quail. Two hundred and sixteen quails were selected by egg production and weight uniformity and distributed in a completely randomized design with six treatments (in a 2 × 3 cross-factorial arrangement) and six replicates with six birds each. Three CSM and three ACM diets supplemented with EC1, EC2, or unsupplemented were established. The trial lasted three cycles of 21 days. Feed intake, laying rate, egg mass, feed conversion per egg mass, and feed conversion per dozen eggs did not differ. The use of ACM diet reduced egg (EW), yolk (YW), and eggshell (SW) weights, egg specific gravity and increased yolk color. However, EW and YW were similar among quails fed diets containing CSM and ACM when supplemented with CE1.The use of enzyme complex containing xylanase, b-glucanase, and phytase is recommended when 21% autoclaved castor mealis included in the diet of laying quails.(AU)

Laying performance and egg quality of Japanese quails fed diets containing castor meal and enzyme complex

The objective of this study was to evaluate the effect of diets formulated with corn plus soybean meal (CSM) or with 21% autoclaved castor meal (ACM), with the addition of two enzyme complexes (EC1 and EC2), on the performance and egg quality of laying quail. Two hundred and sixteen quails were selected by egg production and weight uniformity and distributed in a completely randomized design with six treatments (in a 2 × 3 cross-factorial arrangement) and six replicates with six birds each. Three CSM and three ACM diets supplemented with EC1, EC2, or unsupplemented were established. The trial lasted three cycles of 21 days. Feed intake, laying rate, egg mass, feed conversion per egg mass, and feed conversion per dozen eggs did not differ. The use of ACM diet reduced egg (EW), yolk (YW), and eggshell (SW) weights, egg specific gravity and increased yolk color. However, EW and YW were similar among quails fed diets containing CSM and ACM when supplemented with CE1.The use of enzyme complex containing xylanase, b-glucanase, and phytase is recommended when 21% autoclaved castor mealis included in the diet of laying quails.

Metabolizabilidade da energia de farinhas mistas contendo silagem de peixes para frangos de corte / Energy metabolizability of mixed flour containing fish silage for broiler chicken

Objetivou-se com este trabalho determinar o valor nutricional e os valores de energia metabolizável aparente (EMA) e EMA corrigida para o balanço de nitrogênio (EMAn) de quatro farinhas mistas contendo silagem de resíduo de filetagem de tilápia para frangos de corte do tipo crescimento lento com 28 a 38 dias de idade. Analisou-se a composição físico-química das silagens e, em seguida, realizou-se um ensaio de metabolismo pelo método de coleta total de excretas com 180 pintos machos da linhagem Vermelho Pesadão Francês, distribuídos em um delineamento inteiramente ao acaso, com cinco tratamentos, seis repetições e seis aves por unidade experimental. Os tratamentos consistiram de uma ração referência (RR) e quatro dietas teste compostas de 70% da (RR), com a inclusão de 30% de farinha mista contendo silagem de peixes produzida com o farelo de algaroba (SFA), com a farinha de varredura de mandioca (SFVM), com o farelo de milho (SFM) e com a casca da mandioca (SCM). Os valores para composição físico-química das SFA, SFVM, SFM, SCM foram de 20,63, 20,76, 21,99 e 14,54% de proteína bruta; 17,04, 23,22, 21,97 e 20,27% de extrato etéreo; 7,53, 7,79, 8,65 e 8,83% de matéria mineral; 23,07, 10,55, 16,81 e 12,34% de fibra bruta; 1,79, 2,30, 1,57 e 2,72% de cálcio; 1,12, 1,72, 1,45 e 1,94% de fósforo; 532, 528, 598 e 508 densidade, g/L; 4,5, 4,0, 4,4 e 4,4 de pH. Quanto aos valores de EMA e EMAn das farinhas mistas contendo silagem de peixes em base de matéria seca, foram, respectivamente, 3560kcal/kg e 3402kcal/kg para a SFA, 3574kcal/kg e 3415kcal/kg para a SFVM, 3570kcal/kg e 3412kcal/kg para a SFVM e 3571kcal/kg e 3413kcal/kg para a SCM, com a SFA apresentando menor valor (P=0,01). Com base nos resultados, as silagens contendo restos de peixe podem ser utilizadas em dietas para frangos de corte.(AU)

The objective of this study was to determine the nutritional value and the values of Apparent Metabolizable Energy (AME) and AME corrected for nitrogen balance (AMEn) of four mixed meals containing fish silage for slow growth type broiler chickens at 28-38 days of age. The physicochemical composition of the silage was analyzed and then a metabolism trial was performed using total excreta collection method with 180 male chicks of Red French Pesadão lineage distributed in a completely randomized design with five treatments and six replicates of six birds per experimental unit. Treatments consisted of a basal diet (RR) and four test diets containing 70% (RR), with the inclusion of 30% of mixed flour containing fish silage produced with mesquite meal (SFA) with flour of cassava meal (SFVM), with corn meal (SFM), and dehydrated cassava peel (SCM). The values for physico-chemical composition of the SFA, SFVM, SFM, SCM, were 20,63, 20.76, 21.99, and 14.54% of crude protein; 17.04, 23.22, 21.97 and 20.27% of ethereal extract; 7.53, 7.79, 8.65, and 8.83% of mineral matter; 23,07, 10,55, 16,81, and 12,34% of crude fiber; 1.79, 2.30, 1.57, and 2.72% of calcium; 1.12, 1.72, 1.45, and 1.94% of phosphorus; 532, 528, 598, and 508 of density, g / L; 4.5, 4.0, 4.4, and 4.4 of pH. As for AME and AMEn of the flours containing fish silage on dry matter basis, values were of, respectively, 3560 kcal/kg and 3402 kcal/kg for the SFA, 3574 kcal/kg and 3415 kcal/kg for SFVM, 3570 kcal/kg and 3412 kcal/kg for SFVM, and 3571 kcal/kg and 3413 kcal/kg for SCM, with the SFA showing lowest value. Based on the results, silage containing fish waste can be used in diets for broilers.(AU)

Metabolizabilidade da energia de farinhas mistas contendo silagem de peixes para frangos de corte / Energy metabolizability of mixed flour containing fish silage for broiler chicken

Objetivou-se com este trabalho determinar o valor nutricional e os valores de energia metabolizável aparente (EMA) e EMA corrigida para o balanço de nitrogênio (EMAn) de quatro farinhas mistas contendo silagem de resíduo de filetagem de tilápia para frangos de corte do tipo crescimento lento com 28 a 38 dias de idade. Analisou-se a composição físico-química das silagens e, em seguida, realizou-se um ensaio de metabolismo pelo método de coleta total de excretas com 180 pintos machos da linhagem Vermelho Pesadão Francês, distribuídos em um delineamento inteiramente ao acaso, com cinco tratamentos, seis repetições e seis aves por unidade experimental. Os tratamentos consistiram de uma ração referência (RR) e quatro dietas teste compostas de 70% da (RR), com a inclusão de 30% de farinha mista contendo silagem de peixes produzida com o farelo de algaroba (SFA), com a farinha de varredura de mandioca (SFVM), com o farelo de milho (SFM) e com a casca da mandioca (SCM). Os valores para composição físico-química das SFA, SFVM, SFM, SCM foram de 20,63, 20,76, 21,99 e 14,54% de proteína bruta; 17,04, 23,22, 21,97 e 20,27% de extrato etéreo; 7,53, 7,79, 8,65 e 8,83% de matéria mineral; 23,07, 10,55, 16,81 e 12,34% de fibra bruta; 1,79, 2,30, 1,57 e 2,72% de cálcio; 1,12, 1,72, 1,45 e 1,94% de fósforo; 532, 528, 598 e 508 densidade, g/L; 4,5, 4,0, 4,4 e 4,4 de pH. Quanto aos valores de EMA e EMAn das farinhas mistas contendo silagem de peixes em base de matéria seca, foram, respectivamente, 3560kcal/kg e 3402kcal/kg para a SFA, 3574kcal/kg e 3415kcal/kg para a SFVM, 3570kcal/kg e 3412kcal/kg para a SFVM e 3571kcal/kg e 3413kcal/kg para a SCM, com a SFA apresentando menor valor (P=0,01). Com base nos resultados, as silagens contendo restos de peixe podem ser utilizadas em dietas para frangos de corte.(AU)

The objective of this study was to determine the nutritional value and the values of Apparent Metabolizable Energy (AME) and AME corrected for nitrogen balance (AMEn) of four mixed meals containing fish silage for slow growth type broiler chickens at 28-38 days of age. The physicochemical composition of the silage was analyzed and then a metabolism trial was performed using total excreta collection method with 180 male chicks of Red French Pesadão lineage distributed in a completely randomized design with five treatments and six replicates of six birds per experimental unit. Treatments consisted of a basal diet (RR) and four test diets containing 70% (RR), with the inclusion of 30% of mixed flour containing fish silage produced with mesquite meal (SFA) with flour of cassava meal (SFVM), with corn meal (SFM), and dehydrated cassava peel (SCM). The values for physico-chemical composition of the SFA, SFVM, SFM, SCM, were 20,63, 20.76, 21.99, and 14.54% of crude protein; 17.04, 23.22, 21.97 and 20.27% of ethereal extract; 7.53, 7.79, 8.65, and 8.83% of mineral matter; 23,07, 10,55, 16,81, and 12,34% of crude fiber; 1.79, 2.30, 1.57, and 2.72% of calcium; 1.12, 1.72, 1.45, and 1.94% of phosphorus; 532, 528, 598, and 508 of density, g / L; 4.5, 4.0, 4.4, and 4.4 of pH. As for AME and AMEn of the flours containing fish silage on dry matter basis, values were of, respectively, 3560 kcal/kg and 3402 kcal/kg for the SFA, 3574 kcal/kg and 3415 kcal/kg for SFVM, 3570 kcal/kg and 3412 kcal/kg for SFVM, and 3571 kcal/kg and 3413 kcal/kg for SCM, with the SFA showing lowest value. Based on the results, silage containing fish waste can be used in diets for broilers.(AU)

Determinação da energia metabolizável do farelo residual do milho com e sem enzima em dietas para frangos de corte / Determination of the metabolizable energy of residual corn bran with and without enzyme in diets for broilers

O objetivo deste trabalho foi avaliar o valor nutricional e determinar a energia metabolizável do farelo residual de milho (FRM) sem e com o uso da enzima alfa- amilase. Foi realizado um experimento de metabolismo com 180 pintos machos Cobb com 14 dias, distribuídos em um delineamento inteiramente ao acaso, com seis tratamentos, cinco repetições e seis aves por parcela. As dietas experimentais foram: T1: ração referência (RR), T2: 60% T1 + 40% de FRM, T3: RR + enzima, T4: 60% T1 + 40% de FRM com adição de enzima, T5: RR com substituição de 100% do milho pelo FRM e T6: RR com substituição de 100% do milho pelo FRM com adição de enzima. A composição química do FRM foi: 88,33% de matéria seca (MS), 10,23% de proteína bruta (PB), 15,44% de extrato etéreo (EE), 4,33% de cinzas (CZ) e 4555kcal/kg de energia bruta (EB). Os valores dos coeficientes de metabolizabilidade aparente para o FRM sem e com adição de enzima foram, respectivamente, de 73,37% e 76,33% para MS (p=0,0136), 70,44% e 70,39% para PB (p=0,9595) e de 74,79% e 76,77% para EB (p=0,0128). Os valores da energia metabolizável aparente (EMA) e da EMA corrigida para retenção de nitrogênio (EMAn) para o FRM (na base natural) foram de 3322±19 e 3241±18kcal/kg e de 3334±16 e 3261±17kcal/kg, respectivamente, sem e com adição de enzima. A adição da enzima não teve efeito estatístico significativo sobre os valores de EMA e EMAn, entretanto houve efeito positivo no coeficiente de metabolização da energia.(AU)

The aim of this study was to evaluate the nutritional value and the metabolizable energy of residual corn bran (FRM) with and without the use of alpha amylase enzyme. One metabolism assay was done using 180 Ross male broilers at 14 days of age distributed in an entirely randomized design with six treatments, five replications and six broilers per plot. The assay treatments established were: T1: reference diet (RR), T2: 60% T1 + 40% of FRM, T3: T1 (RR) + enzyme addition, T4: 60% T1 + 40% of FRM with enzyme addition, T5: T1 (RR) with 100% replacement of corn by FRM and T6: T1 (RR) with 100% replacement of corn by FRM with enzyme addition. FRM chemical composition was: 88.33% of dry matter (MS), 10.23% of crude protein (PB), 15.44% of crude fat (EE), 4.33% of ashes (CZ) and 4555Kcal/kg of Gross Energy (EB). The FRM apparent metabolizability coefficients with and without the enzyme addition were, respectively, 73.37% and 76.33% for MS (p=0.0136), 70.44% and 70.39% for PB (p=0.9595) and 74.79% and 76.77% for EB (p=0.0128). The apparent metabolizable energy (EMA) and EMA corrected for nitrogen retention values (as is basis) were 3322±19 and 3241±18Kcal/kg and 3334±16 and 3261±17Kcal/kg, respectively, for with and without the enzyme addition to FRM. The enzyme addition had no statistical significance on the EMA and EMAn values, however, a significant effect on energy metabolizability coefficient was observed.(AU)

Determinação da energia metabolizável do farelo residual do milho com e sem enzima em dietas para frangos de corte / Determination of the metabolizable energy of residual corn bran with and without enzyme in diets for broilers

O objetivo deste trabalho foi avaliar o valor nutricional e determinar a energia metabolizável do farelo residual de milho (FRM) sem e com o uso da enzima alfa- amilase. Foi realizado um experimento de metabolismo com 180 pintos machos Cobb com 14 dias, distribuídos em um delineamento inteiramente ao acaso, com seis tratamentos, cinco repetições e seis aves por parcela. As dietas experimentais foram: T1: ração referência (RR), T2: 60% T1 + 40% de FRM, T3: RR + enzima, T4: 60% T1 + 40% de FRM com adição de enzima, T5: RR com substituição de 100% do milho pelo FRM e T6: RR com substituição de 100% do milho pelo FRM com adição de enzima. A composição química do FRM foi: 88,33% de matéria seca (MS), 10,23% de proteína bruta (PB), 15,44% de extrato etéreo (EE), 4,33% de cinzas (CZ) e 4555kcal/kg de energia bruta (EB). Os valores dos coeficientes de metabolizabilidade aparente para o FRM sem e com adição de enzima foram, respectivamente, de 73,37% e 76,33% para MS (p=0,0136), 70,44% e 70,39% para PB (p=0,9595) e de 74,79% e 76,77% para EB (p=0,0128). Os valores da energia metabolizável aparente (EMA) e da EMA corrigida para retenção de nitrogênio (EMAn) para o FRM (na base natural) foram de 3322±19 e 3241±18kcal/kg e de 3334±16 e 3261±17kcal/kg, respectivamente, sem e com adição de enzima. A adição da enzima não teve efeito estatístico significativo sobre os valores de EMA e EMAn, entretanto houve efeito positivo no coeficiente de metabolização da energia.(AU)

The aim of this study was to evaluate the nutritional value and the metabolizable energy of residual corn bran (FRM) with and without the use of alpha amylase enzyme. One metabolism assay was done using 180 Ross male broilers at 14 days of age distributed in an entirely randomized design with six treatments, five replications and six broilers per plot. The assay treatments established were: T1: reference diet (RR), T2: 60% T1 + 40% of FRM, T3: T1 (RR) + enzyme addition, T4: 60% T1 + 40% of FRM with enzyme addition, T5: T1 (RR) with 100% replacement of corn by FRM and T6: T1 (RR) with 100% replacement of corn by FRM with enzyme addition. FRM chemical composition was: 88.33% of dry matter (MS), 10.23% of crude protein (PB), 15.44% of crude fat (EE), 4.33% of ashes (CZ) and 4555Kcal/kg of Gross Energy (EB). The FRM apparent metabolizability coefficients with and without the enzyme addition were, respectively, 73.37% and 76.33% for MS (p=0.0136), 70.44% and 70.39% for PB (p=0.9595) and 74.79% and 76.77% for EB (p=0.0128). The apparent metabolizable energy (EMA) and EMA corrected for nitrogen retention values (as is basis) were 3322±19 and 3241±18Kcal/kg and 3334±16 and 3261±17Kcal/kg, respectively, for with and without the enzyme addition to FRM. The enzyme addition had no statistical significance on the EMA and EMAn values, however, a significant effect on energy metabolizability coefficient was observed.(AU)

Digestible Threonine Levels in the Starter Diet of Broilers Derived from Breeders of Different Ages

The aim of this study was to evaluate the effect of digestible threonine supplementation in the starter diet on the performance, intestinal parameters, and nutrient metabolism of broilers derived from breeders of different ages. In total, 480 one-day-old Cobb chicks, derived from 38-or 49-week-oldbreeders, were housed in experimental battery cages until 21 days of age and fed four different threonine levels (800, 900, 1,000, or 1,100 mg/kg) in the starter feed. A completely randomized experimental design in a 2x4 factorial arrangement (breeder age x threonine levels) was applied, totaling eight treatments with five replicates of 12 birds each. Broilers from older breeders fed 800 mg digestible threonine/kg of diet presented higher weight gain, with a positive linear effect. There was also an interaction between breeder age and threonine levels for the weight gain of 21-d-old broilers supplemented at maximum level of 1,003 mg Thr/kg diet during the starter phase. There was no effect of breeder age or threonine levels on nutrient metabolism during the period of 17-21 days. There was no influence of breeder age or threonine levels in the starter diet on intestinal morphometric measurements, absorption area, or percentage of goblet cells.

Digestible Threonine Levels in the Starter Diet of Broilers Derived from Breeders of Different Ages

The aim of this study was to evaluate the effect of digestible threonine supplementation in the starter diet on the performance, intestinal parameters, and nutrient metabolism of broilers derived from breeders of different ages. In total, 480 one-day-old Cobb chicks, derived from 38-or 49-week-oldbreeders, were housed in experimental battery cages until 21 days of age and fed four different threonine levels (800, 900, 1,000, or 1,100 mg/kg) in the starter feed. A completely randomized experimental design in a 2x4 factorial arrangement (breeder age x threonine levels) was applied, totaling eight treatments with five replicates of 12 birds each. Broilers from older breeders fed 800 mg digestible threonine/kg of diet presented higher weight gain, with a positive linear effect. There was also an interaction between breeder age and threonine levels for the weight gain of 21-d-old broilers supplemented at maximum level of 1,003 mg Thr/kg diet during the starter phase. There was no effect of breeder age or threonine levels on nutrient metabolism during the period of 17-21 days. There was no influence of breeder age or threonine levels in the starter diet on intestinal morphometric measurements, absorption area, or percentage of goblet cells.(AU)

Mutirões de colecistectomia por videolaparoscopia em regime de cirurgia ambulatorial

Introduction: The growing list of patients awaiting cholecystectomy, together with the great demand for beds and operating rooms at University Hospitals have encouraged the adoption of different solutions. Objective: To evaluate the process of organization and the clinical results of intensive programs of cholecystectomy by videolaparoscopy on an ambulatory surgery basis. Methods: Among the 314 patients with symptomatic cholelithiasis who were waiting for surgery at HCFMRP-USP, 160 were selected for treatment on an ambulatory basis. A multiprofessional team consisting of surgeons, anesthesiologists, nurses and social workers scheduled 4 intensive programs to be performed on weekends according to the availability of the surgical block and of the post-anesthesia recovery room. In a retrospective evaluation, the authors analyzed 79 medical records of patients operated upon in the intensive programs I and II (Group A) and 79 records of the 80 patients operated upon in the intensive programs III and IV (Group B). Statistical analysis was concluded using the Wilcoxon and Fisher's exact tests, with the level of significance of p=0.05. Results: Co-morbidities were recorded for 48 patients of Group A (60.8%) and for 31 of Group B (39.8%), p=0.007. Acute inflammation and scleroatrophy of the gallbladder were observed in 10 patients of group A (12.7%) and in 2 patients of group B (2.6%). The mean duration of surgery was 90 minutes (25-240) for group A and 68.2 minutes (20-180) for group B, p=0.002. There was one conversion in each group (1.3%). Prophylaxis for pain and vomiting was performed in 13 (16.4%) and 2 (2.5%) patients of group A, respectively. In group B, 63 patients (79.7%) received prophylaxis with analgesics and 73 (92.5%) with anti-emetics. Abdominal pain, vomiting and cardiorespiratory symptoms during post-anesthetic recovery involved 34 (43%), 18 (22.6%) and 10 (12.6%) of the patients in group A and 18 (22.8%), 14 (17.7%) and 3 (3.8%) of the patients in group B. The need for an overnight stay was greater in group A: 45 patients (50.7%) with a mean hospital stay of 18.3 hours (2.2-26), while in group B 5 patients stayed overnight and the mean permanence time was 7.8 hours (4-24), p=0.000. Five hospital admissions occurred in group A (6.3%) and 2 in group B (2.5%). Medical re-evaluation during the first week was necessary for 8 patients of group A (10.2%) and resulted in 3 readmissions (3.8%). In group B, 2 patients (2.6%) sought health services but did not require readmission. In group A, 2 patients presented coliperitoneum and 1 was re-operated upon. No death occurred in either group. Conclusion: As experience was gained in these programs, the process of patient selection and the offer of preoperative care were improved, demonstrating that intensive programs of videolaparoscopic cholecystectomy are a possible strategy for the reduction of waiting lists.

Introdução: As listas de espera para colecistectomia, associadas à elevada demanda dos leitos e salas cirúrgicas dos Hospitais Universitários, são incentivos para adoção de novos programas de assistência. Objetivo: Avaliar o processo de organização e os resultados clínicos dos Mutirões de Colecistectomia por Videolaparoscopia, em regime de Cirurgia Ambulatorial. Pacientes e Métodos: Dentre os 314 pacientes portadores de colelitíase sintomática que aguardavam cirurgia no HCFMRP-USP, 160 foram selecionados para tratamento em regime ambulatorial. Uma equipe multiprofissional, formada por cirurgiões, anestesistas, enfermeiros e assistentes sociais, programou 4 mutirões para serem realizados em fins de semana, em função da disponibilidade do bloco cirúrgico e da sala de recuperação pós-anestésica. Mediante avaliação retrospectiva, foram analisados 79 prontuários dos pacientes operados nos Mutirões I e II (Grupo A) e 79 dos 80 operados nos Mutirões III e IV (Grupo B). Análise estatística: teste de Wilcoxon e exato de Fisher (p 0,05). Resultados: As co-morbidades foram registradas em 48 pacientes do Grupo A - (60,8%) e em 31 do Grupo B (39,8%) (p=0,007). A inflamação aguda e a escleroatrofia da vesícula foram observadas em 10 pacientes do Grupo A (12,7%) e em 2 do Grupo B (2,6%). A duração média das operações, em minutos, foi de 90 (25-240) no Grupo A e de 68,2 (20-180) no Grupo B (p=0,002). Houve uma conversão em cada Grupo (1,3%). A profilaxia da dor e dos vômitos foi realizada, respectivamente, em 13 (16,4%) e em 2 (2,5%) pacientes do Grupo A. No Grupo B, 63 pacientes (79,7%) receberam analgésicos e 73 (92,5%) antieméticos de forma profilática. A dor abdominal, os vômitos e os sintomas cardiorespiratórios, na recuperação pós-anestésica, acometeram, respectivamente, 34 (43%), 18 (22,6%) e 10 (12,6%) dos pacientes do Grupo A e 18 (22,8%), 14 (17,7%) e 3 (3,8%) do Grupo B. A necessidade de pernoite foi maior no Grupo A: 45 pacientes (50,7%) com permanência hospitalar média de 18,3 horas (8,2-26), enquanto no Grupo B houve 5 pernoites e a média de permanência foi de 7,5 horas (4-24) (p=0,000). Ocorreram 5 internações no Grupo A (6,3%) e 2 no Grupo B (2,5%). A reavaliação médica, na primeira semana, foi necessária em 8 pacientes do Grupo A (10,2%) e redundou em 3 readmissões (3,8%). No Grupo B, 2 pacientes (2,6%) procuraram o serviço de saúde e a readmissão não foi necessária. No Grupo A, 2 pacientes apresentaram coleperitônio e 1 foi reoperado; não houve óbitos em nenhum Grupo. Conclusão: O aprimoramento no processo de seleção e nos cuidados perioperatórios para colecistectomia videolaparoscópica, em regime ambulatorial, assegura o tratamento, na forma de mutirões, como estratégia eventual de redução das listas de espera.

MUTIRÕES DE COLECISTECTOMIA POR VIDEOLAPAROSCOPIA EM REGIME DE CIRURGIA AMBULATORIAL

Introduction: The growing list of patients awaiting cholecystectomy, together with the great demand for beds and operating rooms at University Hospitals have encouraged the adoption of different solutions. Objective: To evaluate the process of organization and the clinical results of intensive programs of cholecystectomy by videolaparoscopy on an ambulatory surgery basis. Methods: Among the 314 patients with symptomatic cholelithiasis who were waiting for surgery at HCFMRP-USP, 160 were selected for treatment on an ambulatory basis. A multiprofessional team consisting of surgeons, anesthesiologists, nurses and social workers scheduled 4 intensive programs to be performed on weekends according to the availability of the surgical block and of the post-anesthesia recovery room. In a retrospective evaluation, the authors analyzed 79 medical records of patients operated upon in the intensive programs I and II (Group A) and 79 records of the 80 patients operated upon in the intensive programs III and IV (Group B). Statistical analysis was concluded using the Wilcoxon and Fisher's exact tests, with the level of significance of p=0.05. Results: Co-morbidities were recorded for 48 patients of Group A (60.8%) and for 31 of Group B (39.8%), p=0.007. Acute inflammation and scleroatrophy of the gallbladder were observed in 10 patients of group A (12.7%) and in 2 patients of group B (2.6%). The mean duration of surgery was 90 minutes (25-240) for group A and 68.2 minutes (20-180) for group B, p=0.002. There was one conversion in each group (1.3%). Prophylaxis for pain and vomiting was performed in 13 (16.4%) and 2 (2.5%) patients of group A, respectively. In group B, 63 patients (79.7%) received prophylaxis with analgesics and 73 (92.5%) with anti-emetics. Abdominal pain, vomiting and cardiorespiratory symptoms during post-anesthetic recovery involved 34 (43%), 18 (22.6%) and 10 (12.6%) of the patients in group A and 18 (22.8%), 14 (17.7%) and 3 (3.8%) of the patients in group B. The need for an overnight stay was greater in group A: 45 patients (50.7%) with a mean hospital stay of 18.3 hours (2.2-26), while in group B 5 patients stayed overnight and the mean permanence time was 7.8 hours (4-24), p=0.000. Five hospital admissions occurred in group A (6.3%) and 2 in group B (2.5%). Medical re-evaluation during the first week was necessary for 8 patients of group A (10.2%) and resulted in 3 readmissions (3.8%). In group B, 2 patients (2.6%) sought health services but did not require readmission. In group A, 2 patients presented coliperitoneum and 1 was re-operated upon. No death occurred in either group. Conclusion: As experience was gained in these programs, the process of patient selection and the offer of preoperative care were improved, demonstrating that intensive programs of videolaparoscopic cholecystectomy are a possible strategy for the reduction of waiting lists.

Introdução: As listas de espera para colecistectomia, associadas à elevada demanda dos leitos e salas cirúrgicas dos Hospitais Universitários, são incentivos para adoção de novos programas de assistência. Objetivo: Avaliar o processo de organização e os resultados clínicos dos Mutirões de Colecistectomia por Videolaparoscopia, em regime de Cirurgia Ambulatorial. Pacientes e Métodos: Dentre os 314 pacientes portadores de colelitíase sintomática que aguardavam cirurgia no HCFMRP-USP, 160 foram selecionados para tratamento em regime ambulatorial. Uma equipe multiprofissional, formada por cirurgiões, anestesistas, enfermeiros e assistentes sociais, programou 4 mutirões para serem realizados em fins de semana, em função da disponibilidade do bloco cirúrgico e da sala de recuperação pós-anestésica. Mediante avaliação retrospectiva, foram analisados 79 prontuários dos pacientes operados nos Mutirões I e II (Grupo A) e 79 dos 80 operados nos Mutirões III e IV (Grupo B). Análise estatística: teste de Wilcoxon e exato de Fisher (p 0,05). Resultados: As co-morbidades foram registradas em 48 pacientes do Grupo A - (60,8%) e em 31 do Grupo B (39,8%) (p=0,007). A inflamação aguda e a escleroatrofia da vesícula foram observadas em 10 pacientes do Grupo A (12,7%) e em 2 do Grupo B (2,6%). A duração média das operações, em minutos, foi de 90 (25-240) no Grupo A e de 68,2 (20-180) no Grupo B (p=0,002). Houve uma conversão em cada Grupo (1,3%). A profilaxia da dor e dos vômitos foi realizada, respectivamente, em 13 (16,4%) e em 2 (2,5%) pacientes do Grupo A. No Grupo B, 63 pacientes (79,7%) receberam analgésicos e 73 (92,5%) antieméticos de forma profilática. A dor abdominal, os vômitos e os sintomas cardiorespiratórios, na recuperação pós-anestésica, acometeram, respectivamente, 34 (43%), 18 (22,6%) e 10 (12,6%) dos pacientes do Grupo A e 18 (22,8%), 14 (17,7%) e 3 (3,8%) do Grupo B. A necessidade de pernoite foi maior no Grupo A: 45 pacientes (50,7%) com permanência hospitalar média de 18,3 horas (8,2-26), enquanto no Grupo B houve 5 pernoites e a média de permanência foi de 7,5 horas (4-24) (p=0,000). Ocorreram 5 internações no Grupo A (6,3%) e 2 no Grupo B (2,5%). A reavaliação médica, na primeira semana, foi necessária em 8 pacientes do Grupo A (10,2%) e redundou em 3 readmissões (3,8%). No Grupo B, 2 pacientes (2,6%) procuraram o serviço de saúde e a readmissão não foi necessária. No Grupo A, 2 pacientes apresentaram coleperitônio e 1 foi reoperado; não houve óbitos em nenhum Grupo. Conclusão: O aprimoramento no processo de seleção e nos cuidados perioperatórios para colecistectomia videolaparoscópica, em regime ambulatorial, assegura o tratamento, na forma de mutirões, como estratégia eventual de redução das listas de espera.

Evolução da fibrose biliar secundária em ratos tratados mediante derivação bílio-duodenal ou bílio-jejunal com alça de roux medindo 5, 10 e 15 cm

The type of bile-digestive shunt used for the treatment of cholestasis can be affect the process of repair of liver damage. We evaluated the performance of bile-duodenal and Roux-en-Y bile-jejunal shunts with excluded loop of different lengths in the process of liver repair in rats with secondary biliary fibrosis. Thirty Wistar rats, after 15 days of biliary obstruction (BO), were divided into 5 groups of 6 animals: the BO group, duodenal shunt group (BDS) and with jejunal shunt, with excluded loop of 5 cm (BJS5 group), 10 cm (BJS10 group) and 15 cm (BJS15 group), and reevaluated 3 months later. Six animals were submitted to sham surgery (SHAM group). All animals were submitted to qualitative and morphometric histological evaluations of the liver, to blood biochemical and to microbiological bile analysis, and to a study of hepatic mitochondrial function. Liver and spleen weights (g/kg body weight) were also determined. In the statistical analysis, the level of significance was set at 5%. The animals of the BO group showed a significant increase in median values of total bilirubins (9.6 mg/dl), alkaline phosphatase (AP) (296 U/ml) and aminotransferases (133 U/ml for ALT and 419 U/ml for AST) compared to the SHAM group.with normalization after all the shunt modalities used. A significant increase in liver and spleen weight occurred in the BO group (medians of 49.85 and 5.71, respectively) compared to the SHAM group (medians of 30.0 and 3.04 g/kg). There was a significant regression of liver weight in all the treatments, whereas spleen weight regressed only in the animals treated with a BJS (median values of 2.53 for BJS5, 2.82 for BJS10 and 2.93 for BJS15). There was a significant increase in estimated weight (g/kg body weight) of bile ducts, of fibrosis and of hepatocytes in animals of BO group (medians of 1.30; 10.03 and 37.0, respectively) compared to animals of SHAM group (medians of 0.03; zero and 29.37). There was a significant regression of estimated weight of bile ducts and of fibrosis, with respective median values of 0.22 and 0.22 in BDS group, of 0.45 and 3.31 in BJS5 group, and of 0.22 and 5.0 in BJS15 group. There was a significant regression of estimated hepatocyte weight only in BJS5, BJS10 and BJS15 groups, with median values of 31.93, 24.46 and 28.52 g/kg body weight. In all types of treatment a mixed inflammatory infiltrate occurred in the portal spaces, associated with enterobiliary reflux and with bacterial contamination of the bile. There was a significant increase in oxygen consumption by hepatic mitochondria in states 3 and 4 in BO group (respective medians of 101.55 and 31.05 nanoatoms O2/mg protein/min) compared to SHAM group (medians of 57.22 and 15.51). The O2 consumption normalized only in the animals of BJS15 group (medians of 52.38 and 14.8). The performance of the BJS indicates the importance of the evaluation of alternatives that might minimize the contact of enteric content with the biliary tree.

A modalidade de derivação bílio-digestiva empregada no tratamento da colestase extra-hepática crônica pode influenciar na reparação das lesões hepáticas. Avaliou-se o desempenho das derivações bílio-duodenal e bílio-jejunal em Y de Roux com alça exclusa de diferentes comprimentos na reparação das lesões morfológicas e funcionais do fígado de ratos com fibrose biliar secundária. Foram utilizados ratos Wistar, com 15 dias de obstrução biliar, alocados em 5 grupos de 6 animais. O grupo OB caracterizou as alterações da fibrose biliar. Os animais remanescentes foram tratados mediante derivação com o duodeno (grupo DBD), e com o jejuno, em alça exclusa de 5cm (grupo DBJ5), 10cm (grupo DBJ10) e 15cm (grupo DBJ15), sendo reavaliados 3 meses depois. Outros 6 animais foram submetidos à intervenção simulada e considerados grupo controle (IS). Todos animais foram submetidos à avaliação morfométrica do fígado, análise bioquímica do sangue e microbiológica da bile, estudo da função mitocondrial hepática e verificação do peso úmido do fígado e do baço. Na análise estatística adotou-se o nível de significância de 5%. Houve aumento significativo do peso estimado, em g/Kg de peso corporal, dos ductos biliares, da fibrose e dos hepatócitos nos animais do grupo OB (medianas de 1,30; 10,03 e 37,0) em relação aos animais controles (IS) (medianas de 0,03; zero e 29,37). Após tratamento, ocorreu regressão significativa do peso estimado dos ductos biliares e da fibrose, com valores medianos de 0,22 e 0,22 para o grupo DBD, 0,45 e 3,31 para o grupo DBJ5 e 0,22 e 5,0 para o grupo DBJ15. Houve regressão significativa do peso estimado dos hepatócitos apenas nos grupos derivados com o jejuno, com valores medianos de 31,93; 24,46 e 28,52. Ocorreu aumento significativo do peso úmido do fígado e do baço no grupo OB (medianas em g/Kg de peso corporal de 49,85 e 5,71) em relação ao grupo IS (30,0 e 3,04). Houve regressão significativa do peso do fígado em todos os tratamentos e do peso do baço nos animais tratados com derivação bílio-jejunal, (valores medianos de 35,59 e 2,53 para DBJ5, 37,54 e 2,82 para DBJ10 e 32,73 e 2,93 para DBJ15). Após o tratamento, surgiram infiltrado inflamatório misto, nos espaços portais, refluxo enterobiliar e contaminação bacteriana da bile. Houve aumento significativo no consumo de oxigênio pela mitocôndrias hepáticas nos estados 3 e 4 no grupo OB (medianas de 101,55 e 31,05 nanoátomos de O2/mgprot./min), em relação ao grupo IS (medianas de 57,22 e 15,51). Após o tratamento, normalizou-se o consumo energético apenas nos animais do grupo DBJ15 (medianas de 52,38 e 14,8). O desempenho da derivação bíilio-jejunal indica a importância de avaliar alternativas que possam minimizar o contato do conteúdo entérico com a via biliar.

EVOLUÇÃO DA FIBROSE BILIAR SECUNDÁRIA EM RATOS TRATADOS MEDIANTE DERIVAÇÃO BÍLIO-DUODENAL OU BÍLIO-JEJUNAL COM ALÇA DE ROUX MEDINDO 5, 10 E 15 CM

The type of bile-digestive shunt used for the treatment of cholestasis can be affect the process of repair of liver damage. We evaluated the performance of bile-duodenal and Roux-en-Y bile-jejunal shunts with excluded loop of different lengths in the process of liver repair in rats with secondary biliary fibrosis. Thirty Wistar rats, after 15 days of biliary obstruction (BO), were divided into 5 groups of 6 animals: the BO group, duodenal shunt group (BDS) and with jejunal shunt, with excluded loop of 5 cm (BJS5 group), 10 cm (BJS10 group) and 15 cm (BJS15 group), and reevaluated 3 months later. Six animals were submitted to sham surgery (SHAM group). All animals were submitted to qualitative and morphometric histological evaluations of the liver, to blood biochemical and to microbiological bile analysis, and to a study of hepatic mitochondrial function. Liver and spleen weights (g/kg body weight) were also determined. In the statistical analysis, the level of significance was set at 5%. The animals of the BO group showed a significant increase in median values of total bilirubins (9.6 mg/dl), alkaline phosphatase (AP) (296 U/ml) and aminotransferases (133 U/ml for ALT and 419 U/ml for AST) compared to the SHAM group.with normalization after all the shunt modalities used. A significant increase in liver and spleen weight occurred in the BO group (medians of 49.85 and 5.71, respectively) compared to the SHAM group (medians of 30.0 and 3.04 g/kg). There was a significant regression of liver weight in all the treatments, whereas spleen weight regressed only in the animals treated with a BJS (median values of 2.53 for BJS5, 2.82 for BJS10 and 2.93 for BJS15). There was a significant increase in estimated weight (g/kg body weight) of bile ducts, of fibrosis and of hepatocytes in animals of BO group (medians of 1.30; 10.03 and 37.0, respectively) compared to animals of SHAM group (medians of 0.03; zero and 29.37). There was a significant regression of estimated weight of bile ducts and of fibrosis, with respective median values of 0.22 and 0.22 in BDS group, of 0.45 and 3.31 in BJS5 group, and of 0.22 and 5.0 in BJS15 group. There was a significant regression of estimated hepatocyte weight only in BJS5, BJS10 and BJS15 groups, with median values of 31.93, 24.46 and 28.52 g/kg body weight. In all types of treatment a mixed inflammatory infiltrate occurred in the portal spaces, associated with enterobiliary reflux and with bacterial contamination of the bile. There was a significant increase in oxygen consumption by hepatic mitochondria in states 3 and 4 in BO group (respective medians of 101.55 and 31.05 nanoatoms O2/mg protein/min) compared to SHAM group (medians of 57.22 and 15.51). The O2 consumption normalized only in the animals of BJS15 group (medians of 52.38 and 14.8). The performance of the BJS indicates the importance of the evaluation of alternatives that might minimize the contact of enteric content with the biliary tree.

A modalidade de derivação bílio-digestiva empregada no tratamento da colestase extra-hepática crônica pode influenciar na reparação das lesões hepáticas. Avaliou-se o desempenho das derivações bílio-duodenal e bílio-jejunal em Y de Roux com alça exclusa de diferentes comprimentos na reparação das lesões morfológicas e funcionais do fígado de ratos com fibrose biliar secundária. Foram utilizados ratos Wistar, com 15 dias de obstrução biliar, alocados em 5 grupos de 6 animais. O grupo OB caracterizou as alterações da fibrose biliar. Os animais remanescentes foram tratados mediante derivação com o duodeno (grupo DBD), e com o jejuno, em alça exclusa de 5cm (grupo DBJ5), 10cm (grupo DBJ10) e 15cm (grupo DBJ15), sendo reavaliados 3 meses depois. Outros 6 animais foram submetidos à intervenção simulada e considerados grupo controle (IS). Todos animais foram submetidos à avaliação morfométrica do fígado, análise bioquímica do sangue e microbiológica da bile, estudo da função mitocondrial hepática e verificação do peso úmido do fígado e do baço. Na análise estatística adotou-se o nível de significância de 5%. Houve aumento significativo do peso estimado, em g/Kg de peso corporal, dos ductos biliares, da fibrose e dos hepatócitos nos animais do grupo OB (medianas de 1,30; 10,03 e 37,0) em relação aos animais controles (IS) (medianas de 0,03; zero e 29,37). Após tratamento, ocorreu regressão significativa do peso estimado dos ductos biliares e da fibrose, com valores medianos de 0,22 e 0,22 para o grupo DBD, 0,45 e 3,31 para o grupo DBJ5 e 0,22 e 5,0 para o grupo DBJ15. Houve regressão significativa do peso estimado dos hepatócitos apenas nos grupos derivados com o jejuno, com valores medianos de 31,93; 24,46 e 28,52. Ocorreu aumento significativo do peso úmido do fígado e do baço no grupo OB (medianas em g/Kg de peso corporal de 49,85 e 5,71) em relação ao grupo IS (30,0 e 3,04). Houve regressão significativa do peso do fígado em todos os tratamentos e do peso do baço nos animais tratados com derivação bílio-jejunal, (valores medianos de 35,59 e 2,53 para DBJ5, 37,54 e 2,82 para DBJ10 e 32,73 e 2,93 para DBJ15). Após o tratamento, surgiram infiltrado inflamatório misto, nos espaços portais, refluxo enterobiliar e contaminação bacteriana da bile. Houve aumento significativo no consumo de oxigênio pela mitocôndrias hepáticas nos estados 3 e 4 no grupo OB (medianas de 101,55 e 31,05 nanoátomos de O2/mgprot./min), em relação ao grupo IS (medianas de 57,22 e 15,51). Após o tratamento, normalizou-se o consumo energético apenas nos animais do grupo DBJ15 (medianas de 52,38 e 14,8). O desempenho da derivação bíilio-jejunal indica a importância de avaliar alternativas que possam minimizar o contato do conteúdo entérico com a via biliar.

Characterization of the Bipolaris maydis: symptoms and pathogenicity in popcorn genotypes (Zea mays L.)

Abstract Southern corn leaf blight (SCLB) is one of the most important corn leaf diseases. Appropriate management strategies and the use of resistant cultivars allow disease control. Therefore, knowing the aspects related to the pathogen and the response of hosts makes it possible to design efficient strategies for selecting genotypes resistant to this disease. In this sense, the objective was to carry out the Bipolaris maydis isolate characterization, evaluating the pathogenicity in different popcorn lines and the symptoms generated in the host after inoculation. The isolate characterization consisted of the macromorphological evaluation of the colonies and the micromorphological evaluation of the conidia in the PDA medium. An experiment was carried out in a greenhouse to evaluate the pathogenicity of the isolate, using 20 inbred lines of popcorn in a randomized block design with four replicates. Inoculation was carried out by spraying leaves, with a suspension containing 1.0 x 104 conidia.ml-1 of the CF/UENF 501 isolate of B. maydis. An incidence assessment and three assessments of disease symptom severity were performed, with seven days intervals between evaluations. The morphological characterization data of the isolate were analyzed using descriptive statistics, and for disease severity, the linear regression model was applied the first-degree model. The variance analysis was performed for the linear and angular coefficients obtained for each treatment. When a difference was found, the Scott-Knott clustering algorithm at 5% significance was applied. The isolate had gray-green colonies, a cottony appearance, and an irregular shape. The lines L353, L354, and L624 show more resistance at the beginning and throughout the evaluations. The high virulence of the CF/UENF 501 isolate made it possible to differentiate the lines in terms of disease intensity and the pattern of symptoms presented.

Resumo Mancha-de-Bipolaris é uma das mais importantes doenças foliares do milho. Estratégias de manejo adequadas e o uso de cultivar resistente permitem o controle da doença, mas para tanto, conhecer os aspectos associados ao patógeno e a resposta do hospedeiro é necessário para traçar estratégias eficientes para seleção de genótipos resistentes a essa doença. Neste sentido, objetivou-se realizar a caracterização do isolado de Bipolaris maydis avaliando a patogenicidade em diferentes linhagens de milho-pipoca e os sintomas gerados no hospedeiro a partir da inoculação. A caracterização do isolado consistiu na avaliação macromorfológica das colônias e micromofológica dos conídios em meio nutritivo BDA. Para avaliação da patogenicidade do isolado foi conduzido um experimento em casa de vegetação utilizando 20 linhagens endogâmicas de milho-pipoca, com delineamento em blocos casualizados, com quatro repetições. A inoculação foi realizada por meio de pulverização em folhas, com uma suspensão contendo 1,0 x 104 conídios.ml-1 do isolado CF/UENF 501 de B. maydis. Foi realizada uma avaliação de incidência e três avaliações de severidade dos sintomas da doença, com o intervalo de sete dias para cada avaliação. Os dados da caracterização morfológica do isolado foram analisados por meio da estatística descritiva e para severidade da doença foi aplicado o modelo de regressão linear de primeiro grau. Realizou-se a análise de variância para o coeficiente linear e angular obtido para cada tratamento e quando constatada diferença aplicou-se o agrupamento de médias de Scott-knott a 5% de significância. O isolado apresentou colônias com coloração cinza esverdeado, aspecto algodonoso e forma irregular. As linhagens L353 e L354 e L624 estão entre as linhagens que apresentaram maior resistência no inicio e ao longo das avaliações. A elevada virulência do isolado CF/UENF 501 possibilitou diferenciar as linhagens quanto a intensidade da doença, bem como o padrão dos sintomas apresentados.

Characterization of the Bipolaris maydis: symptoms and pathogenicity in popcorn genotypes (Zea mays L. ) / Caracterização de Bipolaris maydis: sintomas e patogenicidade em genótipos de milho-pipoca (Zea mays L. )

Southern corn leaf blight (SCLB) is one of the most important corn leaf diseases. Appropriate management strategies and the use of resistant cultivars allow disease control. Therefore, knowing the aspects related to the pathogen and the response of hosts makes it possible to design efficient strategies for selecting genotypes resistant to this disease. In this sense, the objective was to carry out the Bipolaris maydis isolate characterization, evaluating the pathogenicity in different popcorn lines and the symptoms generated in the host after inoculation. The isolate characterization consisted of the macromorphological evaluation of the colonies and the micromorphological evaluation of the conidia in the PDA medium. An experiment was carried out in a greenhouse to evaluate the pathogenicity of the isolate, using 20 inbred lines of popcorn in a randomized block design with four replicates. Inoculation was carried out by spraying leaves, with a suspension containing 1.0 x 104 conidia.ml-1 of the CF/UENF 501 isolate of B. maydis. An incidence assessment and three assessments of disease symptom severity were performed, with seven days intervals between evaluations. The morphological characterization data of the isolate were analyzed using descriptive statistics, and for disease severity, the linear regression model was applied the first-degree model. The variance analysis was performed for the linear and angular coefficients obtained for each treatment. When a difference was found, the Scott-Knott clustering algorithm at 5% significance was applied. The isolate had gray-green colonies, a cottony appearance, and an irregular shape. The lines L353, L354, and L624 show more resistance at the beginning and throughout the evaluations. The high virulence of the CF/UENF 501 isolate made it possible to differentiate the lines in terms of disease intensity and the pattern of symptoms presented.

Mancha-de-Bipolaris é uma das mais importantes doenças foliares do milho. Estratégias de manejo adequadas e o uso de cultivar resistente permitem o controle da doença, mas para tanto, conhecer os aspectos associados ao patógeno e a resposta do hospedeiro é necessário para traçar estratégias eficientes para seleção de genótipos resistentes a essa doença. Neste sentido, objetivou-se realizar a caracterização do isolado de Bipolaris maydis avaliando a patogenicidade em diferentes linhagens de milho-pipoca e os sintomas gerados no hospedeiro a partir da inoculação. A caracterização do isolado consistiu na avaliação macromorfológica das colônias e micromofológica dos conídios em meio nutritivo BDA. Para avaliação da patogenicidade do isolado foi conduzido um experimento em casa de vegetação utilizando 20 linhagens endogâmicas de milho-pipoca, com delineamento em blocos casualizados, com quatro repetições. A inoculação foi realizada por meio de pulverização em folhas, com uma suspensão contendo 1,0 x 104 conídios.ml-1 do isolado CF/UENF 501 de B. maydis. Foi realizada uma avaliação de incidência e três avaliações de severidade dos sintomas da doença, com o intervalo de sete dias para cada avaliação. Os dados da caracterização morfológica do isolado foram analisados por meio da estatística descritiva e para severidade da doença foi aplicado o modelo de regressão linear de primeiro grau. Realizou-se a análise de variância para o coeficiente linear e angular obtido para cada tratamento e quando constatada diferença aplicou-se o agrupamento de médias de Scott-knott a 5% de significância. O isolado apresentou colônias com coloração cinza esverdeado, aspecto algodonoso e forma irregular. As linhagens L353 e L354 e L624 estão entre as linhagens que apresentaram maior resistência no inicio e ao longo das avaliações. A elevada virulência do isolado CF/UENF 501 possibilitou diferenciar as linhagens quanto a intensidade da doença, bem como o padrão dos sintomas apresentados.