The Incidence of Winged Scapula after Thoracic Cancer Surgery: A Prospective Cohort Study.

BACKGROUND: Lung cancer is the leading cause of cancer-related deaths, and surgery is still the first treatment of choice in early and locally advanced cases. One of the iatrogenic complications is the serratus anterior palsy, which could lead to a winged scapula (WS). Unfortunately, the incidence of this deficit in thoracic surgery is unclear. Our primary aim was to determine the incidence of WS in lung cancer patients in a single-center experience. METHODS: We conducted a retrospective analysis of prospectively collected data with patients eligible for oncological thoracic surgery from March 2013 until January 2014. A physical evaluation of the WS was performed pre- and postoperatively, at the discharge and after 1 year of follow-up. RESULTS: A total of 485 patients were evaluated; 135 (27.8%) showed WS. Longer operative time (p < 0.0001), type of surgery (p < 0.0001), lymphadenectomy (p < 0.0001), and neoadjuvant treatment prior surgery (p = 0.0005) were significantly related to the WS injury. Multivariable analysis showed that type of surgery was significantly associated with WS (p < 0.0001). After 1 year, 41.6% still had WS. CONCLUSION: The incidence of WS was similar to the literature. As WS incidence is underdiagnosed, assessment and correct education about possible deficits or impairments should be improved. Moreover, when a minimally invasive approach is not planned, it is a good clinical practice to discuss surgical strategies with surgeons to reduce this deficit.

Effects of rosiglitazone on contralateral iliac artery after vascular injury in hypercholesterolemic rabbits.

BACKGROUND: The objective was to evaluate the effects of rosiglitazone on iliac arteries of hypercholesterolemic rabbits undergoing balloon catheter injury in the contralateral iliac arteries. METHODS: White male rabbits were fed a hypercholesterolemic diet for 6 weeks and divided into two groups as follows: rosiglitazone group, 14 rabbits treated with rosiglitazone (3 mg/Kg body weight/day) during 6 weeks; and control group, 18 rabbits without rosiglitazone treatment. All animals underwent balloon catheter injury of the right iliac artery on the fourteenth day of the experiment. RESULTS: There was no significant difference in intima/media layer area ratio between the control group and the rosiglitazone group. Rosiglitazone did not reduce the probability of lesions types I, II, or III (72.73% vs. 92.31%; p = 0.30) and types IV or V (27.27% vs. 7.69%; p = 0.30). There were no differences in the extent of collagen type I and III deposition or in the percentage of animals with macrophages in the intima layer. The percentage of rabbits with smooth muscle cells in the intima layer was higher in rosiglitazone group (p = 0.011). CONCLUSION: These findings demonstrate that rosiglitazone given for 6 weeks did not prevent atherogenesis at a vessel distant from the injury site.

Use of rosiglitazone before and after vascular injury in hypercholesterolemic rabbits: Assessment of neointimal formation.

OBJECTIVES: To analyse the effects of rosiglitazone administered at different times on neointimal formation in hypercholesterolemic rabbits following vascular injury. METHODS: Thirty-nine rabbits on a hypercholesterolemic diet were included. The animals underwent balloon catheter injury to the right iliac artery on day 14. They were divided into three groups as follows: control group, 13 rabbits without rosiglitazone; group I, 13 rabbits treated with rosiglitazone (3 mg/Kg body weight/day) for 28 days after the vascular injury; and group II, 13 rabbits treated with rosiglitazone (3 mg/Kg body weight/day) during all the experiment (42 days). Histological analysis was done by an experienced pathologist who was unaware of the rosiglitazone treatment. Histomorphometric parameters were performed by calculation of the luminal and intimal layer area, and intima/media layer area ratio (the area of the intimal layer divided by the area of the medial layer). RESULTS: Intimal area was significantly lower in group II vs. CG (p = 0.024) and group I (p = 0.006). Luminal layer area was higher in group II vs. CG (p < 0.0001) and group I (p < 0.0001). Intima/media layer area ratio was equal between CG and group I. Intima/media layer ratio area was significantly lower in group II vs. control group (p < 0.021) and group I (p < 0.003). There was a significant reduction of 65% and 71% in intima/media layer area ratio in group II vs. control group and group I, respectively. CONCLUSION: Pretreatment with rosiglitazone in hypercholesterolemic rabbits submitted to vascular injury significantly reduces neointimal formation.

The protective effect of methylene blue in lungs, small bowel and kidney after intestinal ischemia and reperfusion.

PURPOSE: To study the role of methylene blue as an inhibitor of superoxide production by xanthine oxidase. METHODS: Thirty-two Wistar rats were divided into 2 groups of 16 animals: the control group and the experimental group. All were submitted to a laparotomy for the occlusion of the cranial mesenteric artery during 60 minutes. The reperfusion was confirmed by the pulsation of the artery after the release of the temporary ligature and color change of the intestines. In the animals of the control group, 2 ml of saline were injected in the peritoneal cavity and in the animals of the experimental group, 2 ml of methylene blue were injected in the peritoneal cavity. After reperfusion for 4 hours, the animals were then sacrificed. The lungs were excised from all 32 rats. Simultaneously, the small intestine and kidneys were ressected in 20 animals (10 from the control group and 10 from the experimental group). Samples of the organs were taken to evaluate the action of xanthine-oxidase, for histopathology studies and for characterization of the edema. RESULTS: In the animals of the experimental group, the inflammatory lesion as well as the edema in the lung was greater than in the control group. The intestinal and renal lesions were similar in both groups, but the lung damage was superior to that observed in the intestines and kidneys. . CONCLUSION: Despite similar action of the xanthine oxidase in the control and the experimental group, after intestinal ischemia and reperfusion, the protective effect of methylene blue was observed only in the lungs of the experimental group.

Interleukin-6 (IL-6) influence on colonic anastomosis healing in rats.

PURPOSE: To observe the effect of pro-inflamatory citokin, Interleukin-6 (IL-6), administration on the healing of colonic anastomosis in rats. METHODS: Thirty Wistar rats were divided into 2 groups of 15 animals each: a control group and an experiment group. The animals of the experiment group were submitted to injection of 500microg/kg of IL-6 Recombinant (Sandoz Phamarceutical(R)) subcutaneously 24 and 12 hours preceding the surgery, and the control group, were submitted to the injection of saline solution, using the same volume of solution as well as the way of administration. The rats were submitted to an end to end colonic anastomosis, being sacrificed in the 7th post-operative day, the site of the anastomosis was evaluated regarding to the adhesions that was quantified and the presence of complications was observed. The colon containing the anastomosis was submitted to a tensiometric study and a sample were sent for histological studies with HE and Sirius Red dye. RESULTS: The macroscopic and the tensiometric study did not demonstrate any significant differences between the control and experiment group. Regarding the histological evaluation, there was a significant reduction of the chronic inflammatory process in the experiment group (p=0,0209) and a lesser granulation area (p=0,0099). The total amount of collagen was similar in both groups, however, the experimental group showed a predominant area of immature collagen (p=0.009). CONCLUSIONS: The longer persistence of the acute phase of wound healing in the experiment group, as well as a decreased of the mature collagen type I, demonstrating that the IL-6 was harmful to the colonic healing anastomosis in rats.

[Porcine submucosa graft for the treatment of duodenal injuries in dogs]. / Enxerto de submucosa porcina no tratamento de lesões duodenais em cães.

PURPOSE: To evaluate the biocompatibility and effectiveness of porcine SIS (small intestinal submucosa), when used as a patch to repair a defect on the anterior duodenal wall. METHODS: The experimental study was performed in 8 dogs. A segment of the anterior duodenal wall was removed and the defect was repaired with a patch of porcine intestinal submucosa. On the 120th post operative day the animals were sacrificed and the segment of duodenum containing the patch was removed to a macroscopic and microscopic evaluation. RESULTS: There was no infection, suture dehiscence or fistula. The microscopic evaluation showed complete re-epithelization in 75% of the cases, with moderate fibroblastic proliferation in 87.5% of the cases. CONCLUSION: The porcine SIS used as a patch acts as a tissue substitute for repairing induced lesions in duodenal wall of dogs.

Profile of the research activity returned to the Brazilian Congress of Thoracic Surgery--Chest 2009.

OBJECTIVE: To increase the knowledge of research activity in Thoracic Surgery in Brazil. METHODS: We carried out a prospective observational study of the abstracts published in the Annals of the Brazilian Congress of Thoracic Surgery - Thorax 2009, to quantitatively and qualitatively assess the geographic distribution and type of home institutions of abstracts, the types of studies and themes addressed. RESULTS: We published 182 abstracts, 174 (95.60%) of interventionist nature. There were three foreign abstracts, all from a single Italian institution. As for the types of studies, we observed 108 trials, 67 case reports and seven experimental studies. Pulmonary resection (14.29%) was the most frequent theme, followed by lung cancer, hyperhidrosis and tracheal disorders (10.44%), trauma (7.14%) and mediastinum (6.04%). Public institutions participated with 68.16% of the abstracts, private institutions with 11.17% and the philanthropic entities with 20.67%; the Pontifical Catholic Universities (11.00%) and the Santas Casas--Holy Homes (7.70 %)--had a significant involvement in Thoracic Surgery research in Brazil. CONCLUSION: Public institutions are mainly responsible for research activity in Thoracic Surgery in Brazil, which is more concentrated in the state of São Paulo (34.07%). One third of this activity is represented by case reports and, although there is wide variation in topics covered, pulmonary resection is the most frequent theme.

Rosiglitazone and vascular injury in hypercholesterolemic rabbits: neointimal formation assessment.

BACKGROUND: Rosiglitazone has been the focus of extensive discussion. OBJECTIVE: To evaluate the effects of rosiglitazone on iliac arteries, both at the injury site and the contralateral artery, of hypercholesterolemic rabbits undergoing balloon catheter injury. METHODS: White male rabbits were fed a hypercholesterolemic diet by oral gavage for 6 weeks and divided into two groups as follows: rosiglitazone group (14 rabbits treated with rosiglitazone during 6 weeks) and the control group (18 rabbits without rosiglitazone). Animals underwent balloon catheter injury of the right iliac artery on the 14th day. RESULTS: In the contralateral iliac artery, there was no significant difference in the intima/media layer area ratio (IMR) between the control and rosiglitazone groups. Rosiglitazone did not reduce the probability of type I, II, or III lesions (72.73% vs 92.31%; p=0.30) and type IV or V lesions (27.27% vs 7.69%; p=0.30). As for the homolateral iliac artery, the intimal area was significantly lower in the rosiglitazone group, as compared to the control group (p = 0.024). The luminal layer area was higher in the rosiglitazone group vs. the control group (p < 0.0001). There was a significant reduction of 65% in the IMR in the rosiglitazone group vs the control group (p = 0.021). None of the histological criteria for type I-V atherosclerotic lesions (American Heart Association) were found in the homolateral iliac artery. CONCLUSION: These findings demonstrate that rosiglitazone given for 6 weeks prevents atherogenesis at the injury site, but not in a vessel distant from the injury site.

Pectus excavatum surgery: sternochondroplasty versus Nuss procedure.

BACKGROUND: The repair of pectus excavatum (PE) by minimally invasive Nuss surgery is well established, but its complication rate is high and its indication is indiscriminate. Sternochondroplasty (SCP) provides good results with a low complication rate but requires a small transverse incision. METHODS: To compare SCP and Nuss, we analyzed 40 patients with PE who underwent surgery (SCP, n = 20; Nuss, n = 20). Thirty subjects (75.0%) were male and 10 (25.0%) were female. In the SCP group, 9 (45.0%) had symmetric PE, and 11 (55.0%) had asymmetric PE. In the Nuss group, 17 (85%) had symmetric PE, and 3 (15%) had asymmetric PE (p = 0.020). RESULTS: The mean duration of SCP was 229.5 minutes, and the mean duration of Nuss was 54.3 minutes. The average length of hospital stay was 4 days with SCP and 6.3 days with Nuss (p = 0.172). The SCP results were favorable in 18 subjects (90%) and fair in 2 subjects (10%). In the Nuss group, we observed 17 patients (85.0%) with favorable results and 3 (15.0%) with poor results. Patients with asymmetric PE exhibited severe pectus carinatum. No complications were found in 17 patients (85%) in the SCP group. In the Nuss group, 9 patients (45.0%) had 13 complications (65.0%; p = 0.004). CONCLUSIONS: Sternochondroplasty surgery yielded better results than the Nuss procedure and more patients with asymmetric PE, less pain, and fewer complications. Nuss surgery had shorter operating times than SCP, younger patients, more symmetric PE, and 3 patients who experienced severe postoperative asymmetric pectus carinatum. In summary, for asymmetric PE the best indication is SCP.

T3T4 endoscopic sympathetic blockade versus T3T4 video thoracoscopic sympathectomy in the treatment of axillary hyperhidrosis.

BACKGROUND: The use of endoscopic sympathetic blockade (ESB) in the treatment of axillary hyperhidrosis has grown because of its potential reversibility. But it is still not clear whether the rates of success, compensatory sweating, and satisfaction are better than those accomplished with video thoracoscopic sympathectomy (VTS). METHODS: Eighty-four patients were studied to compare the rates of success, satisfaction, and compensatory sweating in patients undergoing either ESB or VTS of the T3T4 ganglion after 2 years' follow-up. RESULTS: Thirty-five patients (83.3%) undergoing ESB and 39 patients (92.8%) undergoing VTS had remission of axillary hyperhidrosis (p = 0.315). Improvement was seen in 7 patients (16.7%) in the ESB group and 1 patient (2.4%) in the VTS group. Two patients (4.8%) had bad results in the VTS group. Absence of or minor compensatory sweating was observed in 25 patients (59.5%) in the ESB group and 28 patients (66.7%) in the VTS group, and moderate compensatory sweating occurred in 13 patients (31.0%) in the ESB group and 10 patients (23.8%) in the VTS group. Severe compensatory sweating was observed in 4 patients (9.5%) in the ESB group versus 4 patients (9.5%) in the VTS group (p = 0.905). In the ESB group, 28 patients (66.7%) were very satisfied, 11 patients (26.2%) were satisfied, and 3 patients (7.1%) were unsatisfied with treatment. In the VTS group, 35 patients (83.3%) were very satisfied, 6 patients (14.3%) were satisfied, and 1 patient (2.4%) was unsatisfied with VTS. CONCLUSIONS: Endoscopic sympathetic blockade and VTS of T3T4 ganglion are efficient in axillary hyperhidrosis treatment. We found no differences regarding therapeutic success, satisfaction rate, and incidence, severity, and location of compensatory sweating.

Perfil da atividade de pesquisa encaminhada ao Congresso Brasileiro de Cirurgia Torácica - Tórax 2009 / Profile of the research activity returned to the Brazilian Congress of Thoracic Surgery - Chest 2009

OBJETIVO: Contribuir para o melhor conhecimento da atividade de pesquisa em Cirurgia Torácica no Brasil. MÉTODOS: Estudo prospectivo observacional dos resumos publicados nos Anais do Congressos Brasileiro de Cirurgia Torácica - Tórax 2009, para descrição quantitativa e qualitativa da distribuição geográfica e do tipo das instituições de origem dos resumos, dos tipos de estudos e dos temas abordados. RESULTADOS: Foram publicados 182 resumos, sendo 174 (95,60%) intervencionistas. Houve três resumos provenientes de instituições estrangeiras, todos provindos de uma mesma instituição italiana. Quanto aos tipos de estudos, foram observados 108 estudos clínicos, 67 relatos de caso e sete estudos experimentais. No cômputo geral, a ressecção pulmonar (14,29%) é o tema mais freqüente, seguidos de câncer pulmonar, hiperidrose e afecções traqueais (10,44%), trauma torácico (7,14%) e mediastino (6,04%). As instituições públicas participaram com 68,16% dos resumos avaliados, as instituições privadas 11,17% e as chamadas institucionais com 20,67%, sendo que as Pontifícias Universidades Católicas (11,00%) e as Santas Casas (7,70%) tiveram participação significativa na pesquisa em Cirurgia Torácica no Brasil. CONCLUSÃO: As instituições públicas são as principais responsáveis pela atividade de pesquisa em Cirurgia Torácica no Brasil, a qual está mais concentrada no estado de São Paulo (34,07%). Um terço desta atividade é representada por relatos de caso e, embora haja grande variação de assuntos abordados, a ressecçãos pulmonar é o tema mais freqüente.

OBJECTIVE: To increase the knowledge of research activity in Thoracic Surgery in Brazil. METHODS: We carried out a prospective observational study of the abstracts published in the Annals of the Brazilian Congress of Thoracic Surgery - Thorax 2009, to quantitatively and qualitatively assess the geographic distribution and type of home institutions of abstracts, the types of studies and themes addressed. RESULTS: We published 182 abstracts, 174 (95.60%) of interventionist nature. There were three foreign abstracts, all from a single Italian institution. As for the types of studies, we observed 108 trials, 67 case reports and seven experimental studies. Pulmonary resection (14.29%) was the most frequent theme, followed by lung cancer, hyperhidrosis and tracheal disorders (10.44%), trauma (7.14%) and mediastinum (6.04%). Public institutions participated with 68.16% of the abstracts, private institutions with 11.17% and the philanthropic entities with 20.67%; the Pontifical Catholic Universities (11.00%) and the Santas Casas - Holy Homes (7.70 %) - had a significant involvement in Thoracic Surgery research in Brazil. CONCLUSION: Public institutions are mainly responsible for research activity in Thoracic Surgery in Brazil, which is more concentrated in the state of São Paulo (34.07%). One third of this activity is represented by case reports and, although there is wide variation in topics covered, pulmonary resection is the most frequent theme.

Rosiglitazona e lesão vascular em coelhos hipercolesterolêmicos: avaliação da formação neointimal / Rosiglitazone and vascular injury in hypercholesterolemic rabbits: neointimal formation assessment / Rosiglitazona y lesión vascular en conejos hipercolesterolémicos

FUNDAMENTO: O uso da rosiglitazona tem sido o objeto de extensas discussões. OBJETIVO: Avaliar os efeitos da rosiglitazona nas artérias ilíacas, no local da injúria e na artéria contralateral, de coelhos hipercolesterolêmicos submetidos à lesão por cateter-balão. MÉTODOS: Coelhos brancos machos receberam uma dieta hipercolesterolêmica através de gavagem oral por 6 semanas e foram divididos em 2 grupos: grupo rosiglitazona (GR - 14 coelhos tratados com rosiglitazona por 6 semanas) e grupo controle (GC - 18 coelhos sem rosiglitazona). Os animais foram submetidos a lesão por cateter-balão na artéria ilíaca direita no 14º dia. RESULTADOS: Na artéria ilíaca contralateral, não houve diferença significante na razão entre as áreas intimal e medial (RIM) entre os grupos GR e GC. A rosiglitazona não reduziu a probabilidade de lesões tipo I, II ou III (72,73 por cento vs 92,31 por cento; p=0,30) e lesões tipo IV ou V (27,27 por cento vs 7,69 por cento; p=0,30). Na artéria ilíaca homolateral, a área intimal era significantemente menor no GR quando comparado ao GC (p = 0,024). A área luminal era maior no GR quando comparado ao GC (p < 0,0001). Houve uma redução significante de 65 por cento na IMR no GR quando comparado ao GC (p = 0,021). Nenhum dos critérios histológicos para lesões ateroscleróticas tipos I a V (American Heart Association) foram encontrados na artéria ilíaca homolateral. CONCLUSÃO: Esses achados demonstram que a administração de rosiglitazona por 6 semanas impede a aterogênese no local da lesão, mas não em um vaso distante do sítio da lesão.

BACKGROUND: Rosiglitazone has been the focus of extensive discussion. OBJECTIVE: To evaluate the effects of rosiglitazone on iliac arteries, both at the injury site and the contralateral artery, of hypercholesterolemic rabbits undergoing balloon catheter injury. METHODS: White male rabbits were fed a hypercholesterolemic diet by oral gavage for 6 weeks and divided into two groups as follows: rosiglitazone group (14 rabbits treated with rosiglitazone during 6 weeks) and the control group (18 rabbits without rosiglitazone). Animals underwent balloon catheter injury of the right iliac artery on the 14th day. RESULTS: In the contralateral iliac artery, there was no significant difference in the intima/media layer area ratio (IMR) between the control and rosiglitazone groups. Rosiglitazone did not reduce the probability of type I, II, or III lesions (72.73 percent vs 92.31 percent; p=0.30) and type IV or V lesions (27.27 percent vs 7.69 percent; p=0.30). As for the homolateral iliac artery, the intimal area was significantly lower in the rosiglitazone group, as compared to the control group (p = 0.024). The luminal layer area was higher in the rosiglitazone group vs. the control group (p < 0.0001). There was a significant reduction of 65 percent in the IMR in the rosiglitazone group vs the control group (p = 0.021). None of the histological criteria for type I-V atherosclerotic lesions (American Heart Association) were found in the homolateral iliac artery. CONCLUSION: These findings demonstrate that rosiglitazone given for 6 weeks prevents atherogenesis at the injury site, but not in a vessel distant from the injury site.

FUNDAMENTO: El uso de rosiglitazona ha estado siendo el objeto de extensas discusiones. OBJETIVO: Evaluar los efectos de la rosiglitazona en las arterias ilíacas, en el local de la injuria y en la arteria contralateral, de conejos hipercolesterolémicos sometidos a la lesión por catéter-balón. MÉTODOS: Conejos blancos machos recibieron una dieta hipercolesterolémica a través de gavage oral por 6 semanas y se los dividieron en 2 grupos: grupo rosiglitazona (GR - 14 conejos tratados con rosiglitazona por 6 semanas) y grupo control (GC - 18 conejos sin rosiglitazona). Los animales se sometieron a lesión por catéter-balón en la arteria ilíaca derecha en el 14º día. RESULTADOS: En la arteria ilíaca contralateral, no hubo diferencia significativa en la razón entre las áreas íntima y media (RIM) entre los grupos GR y GC. La rosiglitazona no redujo la probabilidad de lesiones tipo I, II ó III (72,73 por ciento vs 92,31 por ciento; p=0,30) y lesiones tipo IV ó V (27,27 por ciento vs 7,69 por ciento; p=0,30). En la arteria ilíaca homolateral, el área intima era significantemente menor en el GR cuando comparado al GC (p = 0,024). El área luminal era mayor en el GR cuando comparado al GC (p < 0,0001). Hubo una reducción significante del 65 por ciento en la IMR en el GR cuando comparado al GC (p = 0,021). Ningún de los criterios histológicos para lesiones ateroscleróticas tipos I a V (American Heart Association) se encontraron en la arteria ilíaca homolateral. CONCLUSIÓN: Estos hallazgos demuestran que la administración de rosiglitazona por 6 semanas impide la aterogénesis en el local de la lesión, pero no en un vaso distante del sitio de la lesión.

The protective effect of methylene blue in lungs, small bowel and kidney after intestinal ischemia and reperfusion

PURPOSE: To study the role of methylene blue as an inhibitor of superoxide production by xanthine oxidase. METHODS: Thirty-two Wistar rats were divided into 2 groups of 16 animals: the control group and the experimental group. All were submitted to a laparotomy for the occlusion of the cranial mesenteric artery during 60 minutes. The reperfusion was confirmed by the pulsation of the artery after the release of the temporary ligature and color change of the intestines. In the animals of the control group, 2 ml of saline were injected in the peritoneal cavity and in the animals of the experimental group, 2 ml of methylene blue were injected in the peritoneal cavity. After reperfusion for 4 hours, the animals were then sacrificed. The lungs were excised from all 32 rats. Simultaneously, the small intestine and kidneys were ressected in 20 animals (10 from the control group and 10 from the experimental group). Samples of the organs were taken to evaluate the action of xanthine-oxidase, for histopathology studies and for characterization of the edema. RESULTS: In the animals of the experimental group, the inflammatory lesion as well as the edema in the lung was greater than in the control group. The intestinal and renal lesions were similar in both groups, but the lung damage was superior to that observed in the intestines and kidneys. . CONCLUSION: Despite similar action of the xanthine oxidase in the control and the experimental group, after intestinal ischemia and reperfusion, the protective effect of methylene blue was observed only in the lungs of the experimental group.

OBJETIVO: Estudar a ação do azul de metileno como supressor da produção de radicais livres de oxigênio, atuando como receptor alternativo de elétrons na enzima xantina-oxidase. MATERIAIS E MÉTODOS: Foram utilizados 32 ratos Wistar (Rattus norvegicus albinus, Rodentia mammalia) divididos em 2 grupos de 16 animais, os quais foram denominados grupos: experimento e controle. Todos os animais foram submetidos a laparotomia mediana e oclusão da artéria mesentérica cranial por 60 minutos. A reperfusão foi confirmada por meio da verificação do reaparecimento da pulsação da arcada mesentérica. Foi então administrado no grupo experimento 2 ml de azul de metileno 1 por cento intra-peritonealmente, enquanto que no grupo controle o mesmo volume de solução salina isotônica foi administrado pela mesma via. Após 4 horas de reperfusão, os animais foram sacrificados. Os pulmões foram ressecados nos 32 animais do estudo, ao passo que o intestino delgado e os rins em 20 animais (10 ratos do grupo controle e 10 ratos do grupo experimento). Amostras dos órgãos retirados foram obtidas para medição da xantina-oxidase, análise histopatológica e avaliação do edema. RESULTADOS: O dano pulmonar encontrado no grupo controle foi superior ao encontrado no grupo experimento. Observou-se uma maior formação de edema e uma maior atividade inflamatória nos pulmões do grupo controle. O dano intestinal e renal encontrado foi semelhante em ambos os grupos, mas não tão intenso quanto o dano pulmonar. A atividade da xantina-oxidase foi semelhante em ambos os grupos. CONCLUSÃO: A atividade protetora do azul de metileno foi evidenciada nos pulmões, todavia o mesmo efeito não foi demonstrado nos rins nem no intestino delgado.

Interleukin-6 (IL-6) influence on colonic anastomosis healing in rats

PURPOSE:To observe the effect of pro-inflamatory citokin, Interleukin-6 (IL-6), administration on the healing of colonic anastomosis in rats. METHODS: Thirty Wistar rats were divided into 2 groups of 15 animals each: a control group and an experiment group. The animals of the experiment group were submitted to injection of 500æg/kg of IL-6 Recombinant (Sandoz Phamarceutical®) subcutaneously 24 and 12 hours preceding the surgery, and the control group, were submitted to the injection of saline solution, using the same volume of solution as well as the way of administration. The rats were submitted to an end to end colonic anastomosis, being sacrificed in the 7th post-operative day, the site of the anastomosis was evaluated regarding to the adhesions that was quantified and the presence of complications was observed. The colon containing the anastomosis was submitted to a tensiometric study and a sample were sent for histological studies with HE and Sirius Red dye. RESULTS: The macroscopic and the tensiometric study did not demonstrate any significant differences between the control and experiment group. Regarding the histological evaluation, there was a significant reduction of the chronic inflammatory process in the experiment group (p=0,0209) and a lesser granulation area (p=0,0099). The total amount of collagen was similar in both groups, however, the experimental group showed a predominant area of immature collagen (p=0.009). CONCLUSIONS: The longer persistence of the acute phase of wound healing in the experiment group, as well as a decreased of the mature collagen type I, demonstrating that the IL-6 was harmful to the colonic healing anastomosis in rats.

OBJETIVO: Verificar a influência da administração da citocina pró-inflamatória, Interleucina-6 (IL-6), na cicatrização de anastomoses colônicas em ratos. MÉTODOS: Utilizaram-se 30 ratos Wistar, divididos em 2 grupos, controle e experimento, de 15 animais cada. Os animais do grupo experimento receberam nas 24 e 12 horas precedentes a cirurgia, 500æg/kg de IL-6 Recombinante (Sandoz Phamarceutical®) via subcutâneo, os animais do grupo controle, receberam a administração de soro fisiológico nesse mesmo período, pela mesma via. Foram submetidos à anastomose colônica término-terminal. No 7° dia pós-operatório foram realizadas a eutanásia, com quantificação macroscópica das aderências e visualização de complicações. Em seguida realizou-se o estudo tensiométrico, seguido do estudo histológico das lâminas coradas com Hematoxicilina Eosina e Sirius Red. RESULTADOS: O estudo macroscópico e tensiométrico não demonstraram diferenças significativas entre os grupos estudados. Na avaliação histológica, os resultados significativos demonstraram uma diminuição no grupo experimento do processo inflamatório crônico (p=0,0209) e uma menor área de granulação (p=0,0099) presente neste grupo. Na densitometria do colágeno houve um percentual significativamente maior de colágeno imaturo (tipo III) no grupo experimento (70,76 +-9,47), quando comparado ao grupo controle (56,31 +-11,29), p= 0,009. CONCLUSÕES: Os resultados analisados mostraram que houve um maior número de complicações relacionados à persistência da fase aguda da cicatrização no grupo experimento, com manutenção do processo inflamatório agudo neste grupo e que a Interleucina-6, mostrou-se ser prejudicial à cicatrização de anastomoses colônicas em ratos.

Trauma abdominal fechado: análise dos pacientes vítimas de trauma esplênico em um Hospital Universitário de Curitiba / Blunt abdominal trauma: analysis of the patients victims of splenic trauma in a University Hospital of Curitiba

OBJETIVO: determinar as características comuns referentes ao mecanismo de trauma e às lesões anatômicas e fisiológicas dos pacientes vítimas de trauma esplênico. MÉTODO: revisão dos prontuários de dezembro de 1999 a janeiro de 2003, sendo selecionados 524 vítimas de doença tóraco-abdominal e posteriormente internados. Desses prontuários, foram excluídos aqueles que não apresentavam mecanismo de trauma contuso e os menores de 16 anos. Resultando em uma amostra com N = 200. As variáveis de interesse no estudo foram: etiologia do trauma, órgão lesado, grau e segmento da lesão, pressão arterial sistólica e freqüência cardíaca na admissão hospitalar e fraturas de costela. RESULTADOS: a lesão esplênica isolada teve a maior incidência 39 por cento, já a lesão associada hepato-esplênica representou 14 por cento. Dos 116 pacientes com diagnóstico de lesão esplênica, a classificada anatomicamente em Grau IV foi a mais comum (44 pacientes). A maioria das lesões teve como mecanismo de trauma veículo auto-motor (VAM) 56 pacientes, entre os quais a lesão Grau III teve maior prevalência 33,93 por cento. Observou-se que 20 por cento dos pacientes com lesão Grau III, IV ou V não havia descrito dor abdominal em seus prontuários, já nas lesões Grau I ou II 30,13 por cento não se descreveu dor. Freqüência cardíaca média (FC média) e a Pressão arterial sistólica (PA sistólica) mostraram-se equivalentes entre as diferentes lesões. A maior incidência de lesão esplênica está relacionada com ausência de fratura dos arcos costais. Quando diagnosticada fratura há predomínio do grupo com arcos costais esquerdos, nos quais as lesões Grau III, IV ou V predominam com 62,50 por cento. CONCLUSÕES: os acidentes por veículo automotor foram a causa mais comum de trauma esplênico, sendo que a lesão Grau III foi a mais comum dentre as vítimas de VAM. Em 80 por cento dos pacientes com lesão Grau III, IV ou V havia sido descrito dor abdominal, revelando-se um parâmetro significativo. FC média e...

BACKGROUND: determining the common characteristics referring to the trauma mechanism and to the anatomic and physiological lesion of patients victim of splenic trauma. METHODS: The records of December/1999 to January/2003 were revised, being selected 524 of those by the Software TNVT Plus (version 2.0.0.213 - year 1996), admitted in the Emergency Service victims of thoracic-abdominal disease and subsequently interned. Of these records, were excluded those which did not present mechanism of contused trauma, the ones that deceased in the emergency room and the minors of 16 years of age. A sample with N=200 patients were studied. The variables of interest in the study were: etiology of the trauma, organ with the lesion, degree and segment of the lesion, systolic arterial pressure, cardiac frequency in the hospital admission and rib fracture. RESULTS: the splenic injury isolated had the greater incidence 39 percent, the hepatic-splenic associated lesion represented 14 percent. Of the 116 patients with diagnosis of splenic lesion, the classified anatomically in Degree IV was the most common (44 patients). The majority of the lesions had an auto-engine vehicle as the trauma mechanism - 56 patients, among which the lesion Degree III had greater prevalence 33,93 percent, standard comparable with the lesion Degree IV 32,14 percent. It was observed that 20 percent of the patients with lesion Degree III, IV or V had not described abdominal pain in their records, and in the lesions Degree I or II 30,13 percent did not describe pain. Medium Cardiac Frequency and Systolic Arterial Pressure were shown equivalent among different lesions. The greater incidence of splenic lesion was related to the absence of rib fracture. When diagnosed fracture, there was predominance of the group with isolated left ribs fractured, in which lesions Degree III, IV or V predominate with 62,50 percent. CONCLUSION: the accidents by automobile vehicle are the most common cause...

Trauma abdominal fechado: análise dos pacientes vítimas de trauma hepático em um Hospital Universitário de Curitiba / Blunt abdominal trauma: analysis of victims of hepatic trauma in na University Hospital of Curitiba

OBJETIVO: Determinar as características comuns referentes ao mecanismo de trauma, lesões anatômicas e fisiológicas, dor abdominal e à fratura de costelas das vítimas de trauma hepático contuso, no momento da admissão hospitalar. MÉTODO: Revisão dos prontuários de dezembro de 1999 a janeiro de 2003, e selecionados 524 através do Software TNVT Plus (versão 2.0.0.213 - ano 1996), admitidos no Serviço de Emergência, vítimas de trauma tóraco-abdominal contuso e posteriormente internados, que apresentavam hepatectomia parcial, hepatorrafia, laparotomia exploradora, redução de fratura de costelas ou tratamento conservador de fratura de costelas. Foram excluídos aqueles que apresentavam trauma penetrante, que foram a óbito na sala de emergência e os menores de 16 anos, restando 200 prontuários. RESULTADOS: Considerando todos os traumas hepáticos, 37,63 por cento foram causados por acidentes com veículo automotor, sendo que os traumas por esse mecanismo provocaram 54,29 por cento das lesões mais graves (grau III, IV e V). Estas lesões causaram dor abdominal em 75,86 por cento dos casos, e as mais leves (grau I e II), em 69,70 por cento. A freqüência cardíaca e a pressão arterial sistólica média dos pacientes com lesões grau I ou II, foram, respectivamente, 100,37 batimentos por minuto e 114,45 mmHg, e naqueles com lesões grau III, IV, ou V, foram 105,69 batimentos por minuto e 107,88 mmHg, respectivamente. A fratura de costela à direita associou-se à lesão hepática grau I ou II em 29,41 por cento dos casos. CONCLUSÃO: Acidentes por veículo automotor foram a causa mais comum de trauma hepático e o mecanismo de trauma que provocou as lesões mais graves. Estas lesões causaram dor abdominal com a mesma freqüência que as mais leves. A freqüência cardíaca e a pressão arterial sistólica média não possuíram relação com o grau da lesão hepática e a fratura de costelas à direita influenciou apenas na presença da lesão hepática.

Enxerto de submucosa porcina no tratamento de lesões duodenais em cães / Porcine submucosa graft for the treatment of duodenal injuries in dogs

OBJETIVO: Avaliar a biocompatibilidade e a eficiência da SID (submucosa de intestino delgado) porcina, quando usada como enxerto para reparar lesões duodenais. MÉTODOS: O estudo experimental foi realizado em oito cães. Um segmento da parede da segunda porção do duodeno foi ressecada e a lesão foi reparada com um enxerto de submucosa de intestino delgado porcina. No 120° dia de pós-operatório os animais foram submetidos a eutanásia e o segmento do duodeno com o enxerto foi retirado para avaliações macroscópica e microscópica. RESULTADOS: Não houve infecção, deiscência da sutura ou fístula. O estudo microscópico revelou completa re-epitelização em 75 por cento dos casos, com proliferação fibroblástica moderada em 87,5 por cento dos casos. CONCLUSÃO: A SID porcina é um enxerto eficaz para reparo de lesões com perda de substância em duodeno de cães.