Quantitative and qualitative analysis of collagen types in the fascia transversalis of inguinal hernia patients.

BACKGROUND: Inguinal hernia is the second most common surgical case in our field. The anatomical factors alone are not enough to explain the inguinal hernia. Studies show changes in the proportion and quantity of collagen fibers in the developing of inguinal hernia. The greater production of collagen type III compared to the type I could justify the thinning of the fascia transversalis and its weakness. AIM: To determine the quantitative and qualitative changes of collagen in the fascia transversalis in inguinal hernia patients and compare them to findings from corpses without inguinal hernia. METHOD: Prospective case-control study based on the biopsy of fascia transversalis of 27 patients and 24 corpses. The technique used was hematoxylin-eosin and picrosirius colorimetry. RESULTS: The medium percent area of collagen (types I + III) and collagen type I, in both groups, show no statistic difference. The quantity of collagen type III was greater in the patients. Patients classified with Nyhus IIIa presented greater quantity of collagen type III. CONCLUSION: There is no significant difference in the quantity of collagen in the fascia transversalis of patients compared to the controls. An increase in the quantity of collagen type III was found in patients with inguinal hernia and a greater quantity in those patients classified with Nyhus IIIa.

Induced hypothermia using large volume, ice-cold intravenous fluid in comatose survivors of out-of-hospital cardiac arrest: a preliminary report.

STUDY HYPOTHESIS: Recent studies have shown that induced hypothermia for twelve to twenty four hours improves outcome in patients who are resuscitated from out-of-hospital cardiac arrest. These studies used surface cooling, but this technique provided for relatively slow decreases in core temperature. Results from animal models suggest that further improvements in outcome may be possible if hypothermia is induced earlier after resuscitation from cardiac arrest. We hypothesized that a rapid infusion of large volume (30 ml/kg), ice-cold (4 degrees C) intravenous fluid would be a safe, rapid and inexpensive technique to induce mild hypothermia in comatose survivors of out-of-hospital cardiac arrest. METHODS: We enrolled 22 patients who were comatose following resuscitation from out-of-hospital cardiac arrest. After initial evaluation in the Emergency Department (ED), a large volume (30 ml/kg) of ice-cold (4 degrees C) lactated Ringers solution was infused intravenously over 30 min. Data on vital signs, arterial blood gas, electrolyte and hematological was collected immediately before and after the infusion. RESULTS: The rapid infusion of large volume, ice-cold crystalloid fluid resulted in a significant decrease in median core temperature from 35.5 to 33.8 degrees C. There were also significant improvements in mean arterial blood pressure, renal function and acid-base analysis. No patient developed pulmonary odema. CONCLUSION: A rapid infusion of large volume, ice-cold crystalloid fluid is an inexpensive and effective method of inducing mild hypothermia in comatose survivors of out-of-hospital cardiac arrest, and is associated with beneficial haemodynamic, renal and acid-base effects. Further studies of this technique are warranted.

Radiographic study of patients submitted to total gastrectomy using Safatle reconstruction technique.

BACKGROUND: Ever since the first total gastrectomy, there has always been a great concern in increasing the survival of patients, and with the advance of techniques, in improving the quality of life of these patients. The most common reconstruction technique of the gastrointestinal transit is the Roux-en-Y. The reposition of a functional pouch in place of the resected stomach was proposed to minimize the postprandial symptoms, improve the nutritional grade and consequently, the quality of life. The Safatle reconstruction of the gastrointestinal transit technique consists of, in short, in the association of the interposition of the jejunal loop with partial transit through the duodenum, with an inverted Roux-en-Y and with the creation of a pouch which resembles the dynamics of the stomach, achieved by duodenojejunal segment which has an antiperistalsis emptying. AIM: To assess, by radiographic means, the emptying of the duodenojejunal pouch in patients submitted to total gastrectomy using the Safatle reconstruction technique. METHOD: Twelve patients submitted to total gastrectomy using the Safatle technique due to gastric cancer were studied. They were summoned to perform contrasted radiographies of the esophagus-duodenum-jejunum by the videofluoroscopic method during the months of July and August, 2005. RESULTS: All the patients presented satisfactory movement of the duodenojejunal pouch and an adequate emptying in antiperistalsis without food stasis. There has been an average 25-minute drainage time of the duodenojejunal pouch. CONCLUSION: The duodenojejunal pouch, in the patients submitted to total gastrectomy using the Safatle reconstruction, presented adequate emptying and movement.

Hemorragia digestiva baixa devido a melanoma maligno metastático / Lower gastrointestinal bleeding due to metastatic malignant melanoma

A case of lower gastrointestinal bleeding due to metastatic malignant melanoma in a man, in which the final diagnosis was made only on surgery, is reported. The patient underwent a segmentary enterectomy with primary anastomosis and he was discharged on tenth postoperative day.

Efeito da vagotomia troncular em ratos injetados na fase neonatal com glutamato monossódico: estudo biométrico / Effect of truncal vagotomy in rats neonatally injected with monosodium glutamate: biometry study

Obesidade hipotalâmica pode ocorrer em humanos e pode ser reproduzida, experimentalmente, por lesão do VMH em ratos. Esta obesidade pode ser revertida por vagotomia troncular (VT), devido à redução da ingestão alimentar e da insulinemia mediada pelo nervo vago. Experimentalmente, a injeção de MSG causa lesão em nível de ARC. O objetivo deste trabalho é avaliar os efeitos do MSG em ratos e se VT os altera. Estudou-se 52 ratos Wistar machos, divididos em dois grupos de 26 animais, um submetido à injeção de MSG na fase neonatal e outro à de solução salina. Aos 30 dias de vida, após nova divisão, obteve-se: grupo MSG, submetido à VT (VTMSG), e outro à laparotomia (LAPMSG); grupo SALINA, submetido à VT (VTSAL), e outro à laparotomia (LAPSAL). Obteve-se peso, CNA e índice de Lee. O consumo alimentar foi obtido dos 30 aos 90 dias de vida. Aos 90 dias, após eutanásia, mensurou-se peso, CNA, índice de Lee e gordura perigonadal. Análise estatística foi realizada pelo "t de Student". Constatou-se que o MSG provoca redução do CNA e aumento do índice de Lee aos 30 dias de vida, e provoca redução do peso e do CNA, aumento do índice de Lee e da gordura perigonadal aos 90 dias e aumento do consumo alimentar dos 30 aos 90 dias de vida. A VT provoca redução do peso, do índice de Lee e da gordura perigonadal, e tendência à redução do CNA no rato injetado com MSG. A VT provoca redução de consumo alimentar nos primeiros 30 dias de pós-operatório, mas com tendência a maior consumo nos 30 dias subseqüentes. Conclui-se que o MSG injetado na fase neonatal provoca aumento do consumo alimentar e da adiposidade e causa redução da estatura e do peso do animal dos 30 aos 90 dias de vida. E que a VT, realizada aos 30 dias de vida, provoca redução do consumo alimentar nos primeiros 30 dias de pós-operatório, da adiposidade e do peso.