RESUMO
INTRODUCTION: Trauma primarily affects the economically active population, causing social and economic impact. The non-operative management of solid organ injuries aims to preserve organ function, reducing the morbidity and mortality associated with surgical interventions. The aim of study was to demonstrate the epidemiological profile of patients undergoing non-operative management in a trauma hospital and to evaluate factors associated with mortality in these patients. METHODS: This is a historical cohort of patients undergoing non-operative management for solid organ injuries at a Brazilian trauma reference hospital between 2018 and 2022. Included were patients with blunt and penetrating trauma, analyzing epidemiological characteristics, blood transfusion, and association with the need for surgical intervention. RESULTS: A total of 365 patients were included in the study. Three hundred and forty-three patients were discharged (93.97%), and the success rate of non-operative treatment was 84.6%. There was an association between mortality and the following associated injuries: hemothorax, sternal fracture, aortic dissection, and traumatic brain injury. There was an association between the need for transfusion and surgical intervention. Thirty-eight patients required some form of surgical intervention. CONCLUSION: The profile of patients undergoing non-operative treatment consists of young men who are victims of blunt trauma. Non-operative treatment is safe and has a high success rate.
Assuntos
Ferimentos não Penetrantes , Humanos , Masculino , Feminino , Adulto , Brasil/epidemiologia , Pessoa de Meia-Idade , Adulto Jovem , Ferimentos não Penetrantes/mortalidade , Ferimentos não Penetrantes/terapia , Ferimentos não Penetrantes/epidemiologia , Adolescente , Estudos Retrospectivos , Transfusão de Sangue/estatística & dados numéricos , Ferimentos Penetrantes/mortalidade , Ferimentos Penetrantes/terapia , Idoso , Centros de TraumatologiaRESUMO
ABSTRACT Introduction: Trauma primarily affects the economically active population, causing social and economic impact. The non-operative management of solid organ injuries aims to preserve organ function, reducing the morbidity and mortality associated with surgical interventions. The aim of study was to demonstrate the epidemiological profile of patients undergoing non-operative management in a trauma hospital and to evaluate factors associated with mortality in these patients. Methods: This is a historical cohort of patients undergoing non-operative management for solid organ injuries at a Brazilian trauma reference hospital between 2018 and 2022. Included were patients with blunt and penetrating trauma, analyzing epidemiological characteristics, blood transfusion, and association with the need for surgical intervention. Results: A total of 365 patients were included in the study. Three hundred and forty-three patients were discharged (93.97%), and the success rate of non-operative treatment was 84.6%. There was an association between mortality and the following associated injuries: hemothorax, sternal fracture, aortic dissection, and traumatic brain injury. There was an association between the need for transfusion and surgical intervention. Thirty-eight patients required some form of surgical intervention. Conclusion: The profile of patients undergoing non-operative treatment consists of young men who are victims of blunt trauma. Non-operative treatment is safe and has a high success rate.
RESUMO Introdução: O trauma atinge principalmente a população economicamente ativa, causando impacto social e econômico. O tratamento não operatório das lesões de órgãos sólidos tem como objetivo preservar a função do órgão, diminuindo a morbimortalidade envolvida nos tratamentos cirúrgicos. O objetivo do estudo foi demonstrar o perfil epidemiológico dos pacientes submetidos ao tratamento não operatório em um hospital de trauma, bem como avaliar o fatores associados ao óbito nesses pacientes. Métodos: Trata-se de uma coorte histórica de pacientes submetidos à tratamento não operatório de lesão de órgãos sólidos, em um hospital referência de trauma brasileiro, entre 2018 e 2022. Foram incluídos pacientes vítimas de trauma contuso e penetrante, analisando as características epidemiológicas, hemotransfusão e associação ou não com necessidade de abordagem cirúrgica. Resultados: Foram incluídos 365 pacientes no estudo. Trezentos e quarenta e três pacientes receberam alta (93,97%) e a taxa de sucesso no tratamento não operatório foi de de 84,6%. Houve associação entre o desfecho óbito e as seguintes lesões associadas: hemopneumotorax, fratura de esterno, dissecção de aorta e traumatismo crânio encefálico. Houve associação entre necessidade de transfusão e abordagem cirúrgica. Trinta e oito pacientes necessitaram de alguma abordagem cirúrgica. Conclusão: O perfil dos pacientes submetidos a TNO são homens jovens, vítimas de trauma contuso. O tratamento não operatório é seguro e apresenta alta taxa de sucesso.
RESUMO
PURPOSE: To evaluate the effect of preoperative intravenous chemotherapy with 5-fluorouracil on liver regeneration in an experimental model of major hepatectomy in rats. METHODS: Wistar rats were divided into two groups of 20 animals each and submitted to 70% hepatectomy 24 h after intravenous injection of 5-fluorouracil 20 mg/kg (fluorouracil group, FG) or 0.9% saline (control group, CG). After hepatectomy, each group was subdivided into two subgroups of 10 animals each according to the day of sacrifice (24 h or 7 days). Liver weight during regeneration, liver regeneration rate using Kwon formula, and the immunohistochemical markers proliferating cell nuclear antigen (PCNA) and Ki-67 were used to assess liver regeneration. RESULTS: At early phase (24 h after hepatectomy) it was demonstrated the negative effect of 5-fluorouracil on liver regeneration when assessed by Kwon formula (p < 0.0001), PCNA analysis (p = 0.02). With regeneration process complete (7 days), it was possible to demonstrate the sustained impairment of chemotherapy with 5-fluorouracil on hepatocytes regeneration phenomenon when measured by Kwon formula (p = 0.009), PCNA analysis (p = 0.0001) and Ki-67 analysis (0.001). CONCLUSIONS: Preoperative chemotherapy with intravenous 5-fluorouracil negatively affected the mechanisms of liver regeneration after major hepatectomy in rats.
Assuntos
Hepatectomia , Regeneração Hepática , Ratos , Animais , Antígeno Nuclear de Célula em Proliferação , Antígeno Ki-67 , Ratos Wistar , Fluoruracila/farmacologiaRESUMO
Purpose: To evaluate the effect of preoperative intravenous chemotherapy with 5-fluorouracil on liver regeneration in an experimental model of major hepatectomy in rats. Methods: Wistar rats were divided into two groups of 20 animals each and submitted to 70% hepatectomy 24 h after intravenous injection of 5-fluorouracil 20 mg/kg (fluorouracil group, FG) or 0.9% saline (control group, CG). After hepatectomy, each group was subdivided into two subgroups of 10 animals each according to the day of sacrifice (24 h or 7 days). Liver weight during regeneration, liver regeneration rate using Kwon formula, and the immunohistochemical markers proliferating cell nuclear antigen (PCNA) and Ki-67 were used to assess liver regeneration. Results: At early phase (24 h after hepatectomy) it was demonstrated the negative effect of 5-fluorouracil on liver regeneration when assessed by Kwon formula (p < 0.0001), PCNA analysis (p = 0.02). With regeneration process complete (7 days), it was possible to demonstrate the sustained impairment of chemotherapy with 5-fluorouracil on hepatocytes regeneration phenomenon when measured by Kwon formula (p = 0.009), PCNA analysis (p = 0.0001) and Ki-67 analysis (0.001). Conclusions: Preoperative chemotherapy with intravenous 5-fluorouracil negatively affected the mechanisms of liver regeneration after major hepatectomy in rats.
Assuntos
Animais , Ratos , Quimioprevenção/métodos , Fluoruracila/uso terapêutico , Hepatectomia/reabilitação , Regeneração Hepática/efeitos dos fármacosRESUMO
Introdução: A hepatite C está associada ao desenvolvimento do carcinoma hepatocelular (CHC). O regime terapêutico baseado em interferon vem sendo substituído pelos antivirais de ação direta (AAD) para tratamento da infecção pelo vírus da hepatite C (HCV). Contudo, estudos recentes evidenciaram um aumento inesperado da recorrência do CHC em pacientes tratados com AAD para resolução da hepatite C. Objetivo: Avaliar o risco de recorrência de hepatocarcinoma após uso de AAD em pacientes com infecção por HCV. Método: Realizou-se um levantamento nas bases de dados PubMed, MEDLINE e LILACS de acordo com os descritores DeCS/MeSH ((hepatocellular carcinoma) AND recurrence) AND Direct-acting antiviral. A revisão obedeceu ao protocolo PRISMA e está cadastrada na plataforma PROSPERO. A análise estatística dos dados foi realizada no software RStudio. Resultados: Sete artigos foram selecionados resultando em 847 pacientes. Entre os tratados com AAD, a taxa de recorrência variou entre 11,1% e 42,1% e, no grupo controle, ocorreu em 5% a 65,6% dos pacientes. O risco relativo (RR) de recorrência do CHC no grupo de pacientes que recebeu AAD foi menor do que o risco evidenciado no grupo controle, apesar de não haver significância estatística (RR 0,71 95% IC [0,55;0,93] I²=38%, p=0,14). O tempo até o diagnóstico da recorrência teve uma média de 9,35 meses no grupo exposto à terapia e 13,42 meses no grupo controle. Conclusão: Sugere-se que a terapia com AAD não aumenta o risco de recorrência do CHC em comparação com grupos controle. Nos pacientes que desenvolveram recorrência, ocorreu com maior frequência dentro do primeiro ano após introdução dos AAD.
Introduction: Hepatitis C is associated with the development of hepatocellular carcinoma (HCC). The interferon-based therapeutic regimen has been replaced by direct-acting antivirals (AAD) to treat HCV virus infection. However, recent studies have shown an unexpected increase in HCC recurrence in patients treated with AAD to resolve hepatitis C. Objective: To assess the risk of hepatocarcinoma recurrence after using AAD in patients with HCV infection. Method: A survey was carried out in PubMed, MEDLINE, and LILACS databases according to the descriptors DeCS/MeSH ((hepatocellular carcinoma) AND recurrence) AND Direct-acting antiviral. The review followed the PRISMA protocol and is registered on the PROSPERO platform. The data statistical analysis was performed through RStudio software. Results: Seven articles were selected resulting in 847 patients. Among those treated with AAD, the recurrence rate varied between 11.1% to 42.1% and, in the control group, it occurred in 5% to 65.6% of the patients. The relative risk (RR) of recurrence of HCC in the group of patients who received AAD was less than the risk evidenced in the control group, although there is no statistical significance (RR 0.71 95% CI [0.55; 0.93] I²=38%, p=0.14). The mean time until the diagnosis of recurrence was 9.35 months in the group exposed to therapy and 13.42 months in the control group. Conclusion: It is suggested that therapy with AAD does not increase the risk of HCC recurrence compared to control groups. In patients who developed recurrence, it occurred more frequently within the first year after the introduction of AAD.
Introducción: La hepatitis C está asociada con el desarrollo de carcinoma hepatocelular (CHC). El régimen terapéutico basado en interferón ha sido reemplazado por antivirales de acción directa (AAD) para tratar la infección por VHC. Sin embargo, estudios recientes han mostrado un incremento inesperado en la recurrencia del CHC en pacientes tratados con AAD para resolución de la hepatitis C. Objetivo: Evaluar el riesgo de recurrencia del hepatocarcinoma después de usar AAD en pacientes con infección por VHC. Método: Se realizó una pesquisa en las bases de datos PubMed, MEDLINE y LILACS según los descriptores DeCS/MeSH ((carcinoma hepatocelular) AND recurrencia) AND antiviral de acción directa. La revisión siguió el protocolo PRISMA y está registrada en la plataforma PROSPERO. El análisis estadístico de los datos se realizó mediante el software RStudio. Resultados: Fueron seleccionados 7 artículos resultando en 847 pacientes. Entre los tratados con AAD, la tasa de recurrencia varió entre el 11,1% y el 42,1% y, en el grupo de control, ocurrió entre el 5% y el 65,6% de los pacientes. El riesgo relativo (RR) de recurrencia del CHC en el grupo de pacientes que recibieron AAD fue inferior que el riesgo evidenciado en el grupo control, aunque no hay significación estadística (RR 0,71; IC del 95% [0,55; 0,93] I²=38%, p=0,14). El tiempo hasta el diagnóstico de recidiva fue de 9,35 meses en el grupo expuesto a terapia y de 13,42 meses en el grupo control. Conclusión: Se sugiere que la terapia con AAD no aumenta el riesgo de recurrencia del CHC en comparación con los grupos control. En los pacientes que desarrollaron recurrencia, esta ocurrió con mayor frecuencia durante el primer año después de la introducción de los AAD.
Assuntos
Humanos , Neoplasias Hepáticas/etiologia , Antivirais/uso terapêutico , Hepatite C/complicações , Carcinoma Hepatocelular/etiologia , Recidiva Local de NeoplasiaRESUMO
Introdução: A hepatite C está associada ao desenvolvimento do carcinoma hepatocelular (CHC). O regime terapêutico baseado em interferon vem sendo substituído pelos antivirais de ação direta (AAD) para tratamento da infecção pelo vírus da hepatite C (HCV). Contudo, estudos recentes evidenciaram um aumento inesperado da recorrência do CHC em pacientes tratados com AAD para resolução da hepatite C. Objetivo: Avaliar o risco de recorrência de hepatocarcinoma após uso de AAD em pacientes com infecção por HCV. Método: Realizou-se um levantamento nas bases de dados PubMed, MEDLINE e LILACS de acordo com os descritores DeCS/MeSH ((hepatocellular carcinoma) AND recurrence) AND Direct-acting antiviral. A revisão obedeceu ao protocolo PRISMA e está cadastrada na plataforma PROSPERO. A análise estatística dos dados foi realizada no software RStudio. Resultados: Sete artigos foram selecionados resultando em 847 pacientes. Entre os tratados com AAD, a taxa de recorrência variou entre 11,1% e 42,1% e, no grupo controle, ocorreu em 5% a 65,6% dos pacientes. O risco relativo (RR) de recorrência do CHC no grupo de pacientes que recebeu AAD foi menor do que o risco evidenciado no grupo controle, apesar de não haver significância estatística (RR 0,71 95% IC [0,55;0,93] I²=38%, p=0,14). O tempo até o diagnóstico da recorrência teve uma média de 9,35 meses no grupo exposto à terapia e 13,42 meses no grupo controle. Conclusão: Sugere-se que a terapia com AAD não aumenta o risco de recorrência do CHC em comparação com grupos controle. Nos pacientes que desenvolveram recorrência, ocorreu com maior frequência dentro do primeiro ano após introdução dos AAD.
Introduction: Hepatitis C is associated with the development of hepatocellular carcinoma (HCC). The interferon-based therapeutic regimen has been replaced by direct-acting antivirals (AAD) to treat HCV virus infection. However, recent studies have shown an unexpected increase in HCC recurrence in patients treated with AAD to resolve hepatitis C. Objective: To assess the risk of hepatocarcinoma recurrence after using AAD in patients with HCV infection. Method: A survey was carried out in PubMed, MEDLINE, and LILACS databases according to the descriptors DeCS/MeSH ((hepatocellular carcinoma) AND recurrence) AND Direct-acting antiviral. The review followed the PRISMA protocol and is registered on the PROSPERO platform. The data statistical analysis was performed through RStudio software. Results: Seven articles were selected resulting in 847 patients. Among those treated with AAD, the recurrence rate varied between 11.1% to 42.1% and, in the control group, it occurred in 5% to 65.6% of the patients. The relative risk (RR) of recurrence of HCC in the group of patients who received AAD was less than the risk evidenced in the control group, although there is no statistical significance (RR 0.71 95% CI [0.55; 0.93] I²=38%, p=0.14). The mean time until the diagnosis of recurrence was 9.35 months in the group exposed to therapy and 13.42 months in the control group. Conclusion: It is suggested that therapy with AAD does not increase the risk of HCC recurrence compared to control groups. In patients who developed recurrence, it occurred more frequently within the first year after the introduction of AAD.
Introducción: La hepatitis C está asociada con el desarrollo de carcinoma hepatocelular (CHC). El régimen terapéutico basado en interferón ha sido reemplazado por antivirales de acción directa (AAD) para tratar la infección por VHC. Sin embargo, estudios recientes han mostrado un incremento inesperado en la recurrencia del CHC en pacientes tratados con AAD para resolución de la hepatitis C. Objetivo: Evaluar el riesgo de recurrencia del hepatocarcinoma después de usar AAD en pacientes con infección por VHC. Método: Se realizó una pesquisa en las bases de datos PubMed, MEDLINE y LILACS según los descriptores DeCS/MeSH ((carcinoma hepatocelular) AND recurrencia) AND antiviral de acción directa. La revisión siguió el protocolo PRISMA y está registrada en la plataforma PROSPERO. El análisis estadístico de los datos se realizó mediante el software RStudio. Resultados: Fueron seleccionados 7 artículos resultando en 847 pacientes. Entre los tratados con AAD, la tasa de recurrencia varió entre el 11,1% y el 42,1% y, en el grupo de control, ocurrió entre el 5% y el 65,6% de los pacientes. El riesgo relativo (RR) de recurrencia del CHC en el grupo de pacientes que recibieron AAD fue inferior que el riesgo evidenciado en el grupo control, aunque no hay significación estadística (RR 0,71; IC del 95% [0,55; 0,93] I²=38%, p=0,14). El tiempo hasta el diagnóstico de recidiva fue de 9,35 meses en el grupo expuesto a terapia y de 13,42 meses en el grupo control. Conclusión: Se sugiere que la terapia con AAD no aumenta el riesgo de recurrencia del CHC en comparación con los grupos control. En los pacientes que desarrollaron recurrencia, esta ocurrió con mayor frecuencia durante el primer año después de la introducción de los AAD.
Assuntos
Antivirais/uso terapêutico , Hepatite C/complicações , Carcinoma Hepatocelular/etiologia , Neoplasias Hepáticas/etiologia , Recidiva Local de NeoplasiaRESUMO
PURPOSE: To evaluate the influence of the cyclosporine in liver regeneration in rats submitted to an experimental model of 70% hepatectomy. METHODS: Forty male rats were randomly divided in four subgroups (C.24h, C.7d, E.24h, E.7d), according to the drug used and the day of sacrifice (24 hours and 7 days). Cyclosporine (10 mg/Kg/day) was given to the study subgroup and 1 ml of 0.9% sodium chloride was to the control subgroup. Resection of left lateral lobe and median lobe performing 70% of liver mass. During the animals' death, KWON formula was applied. Counting of mitotic figures and percentage of positive nucleus with PCNA and Ki-67 were evaluated. RESULTS: In the 2nd, 4th PO and death days, E.7d lose more weight than C.7d. Regarding to the KWON formula, the C.7d regenerated more than the C.24h and the same with the E.7d. Comparing between the groups, only E7d subgroup was statistically significant compared with C.7d, showing the stimulating effect of cyclosporine in liver regeneration. Immunohistochemestry had significant results between the study subgroups. The mitotic index revealed statistical differences in the control subgroups. CONCLUSION: Cyclosporine, in spite of being an immunosuppressive drug, has a positive effect in liver regeneration, although reduce the animal's body weight.
Assuntos
Ciclosporina/farmacologia , Hepatectomia/métodos , Imunossupressores/farmacologia , Regeneração Hepática/efeitos dos fármacos , Animais , Peso Corporal , Contagem de Células , Proliferação de Células , Modelos Animais de Doenças , Imuno-Histoquímica , Masculino , Índice Mitótico , Antígeno Nuclear de Célula em Proliferação/análise , Distribuição Aleatória , Ratos Wistar , Reprodutibilidade dos Testes , Fatores de Tempo , Resultado do TratamentoRESUMO
PURPOSE: To evaluate the influence of the cyclosporine in liver regeneration in rats submitted to an experimental model of 70% hepatectomy. METHODS: Forty male rats were randomly divided in four subgroups (C.24h, C.7d, E.24h, E.7d), according to the drug used and the day of sacrifice (24 hours and 7 days). Cyclosporine (10mg/Kg/day) was given to the study subgroup and 1 ml of 0.9% sodium chloride was to the control subgroup. Resection of left lateral lobe and median lobe performing 70% of liver mass. During the animals' death, KWON formula was applied. Counting of mitotic figures and percentage of positive nucleus with PCNA and Ki-67 were evaluated. RESULTS: In the 2nd, 4th PO and death days, E.7d lose more weight than C.7d. Regarding to the KWON formula, the C.7d regenerated more than the C.24h and the same with the E.7d. Comparing between the groups, only E7d subgroup was statistically significant compared with C.7d, showing the stimulating effect of cyclosporine in liver regeneration. Immunohistochemestry had significant results between the study subgroups. The mitotic index revealed statistical differences in the control subgroups. CONCLUSION: Cyclosporine, in spite of being an immunosuppressive drug, has a positive effect in liver regeneration, although reduce the animal's body weight. .
Assuntos
Animais , Masculino , Ciclosporina/farmacologia , Hepatectomia/métodos , Imunossupressores/farmacologia , Regeneração Hepática/efeitos dos fármacos , Peso Corporal , Contagem de Células , Proliferação de Células , Modelos Animais de Doenças , Imuno-Histoquímica , Índice Mitótico , Antígeno Nuclear de Célula em Proliferação/análise , Distribuição Aleatória , Ratos Wistar , Reprodutibilidade dos Testes , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: To evaluate the influence of sirolimus on liver regeneration triggered by resection of 70% of the liver of adult rats. METHODS: we used 40 Wistar rats randomly divided into two groups (study and control), each group was divided into two equal subgroups according to the day of death (24 hours and seven days). Sirolimus was administered at a dose of 1mg/kg in the study group and the control group was given 1 ml of saline. The solutions were administered daily since three days before hepatectomy till the rats death to removal of the regenerated liver, conducted in 24 hours or 7 days after hepatectomy. Liver regeneration was measured by the KWON formula, by the number of mitotic figures (hematoxylin-eosin staining) and by the immunohistochemical markers PCNA and Ki-67. RESULTS: there was a statistically significant difference between the 24h and the 7d groups. When comparing the study and control groups in the same period, there was a statistically significant variation only for Ki-67, in which there were increased numbers of hepatocytes in cell multiplication in the 7d study group compared with the 7d control group (p = 0.04). CONCLUSION: there was no negative influence of sirolimus in liver regeneration and there was a positive partial effect at immunohistochemistry with Ki-67.
Assuntos
Imunossupressores/farmacologia , Regeneração Hepática/efeitos dos fármacos , Sirolimo/farmacologia , Animais , Hepatectomia , Masculino , Distribuição Aleatória , Ratos , Ratos WistarRESUMO
OBJECTIVE: To evaluate the influence of sirolimus on liver regeneration triggered by resection of 70% of the liver of adult rats. METHODS: we used 40 Wistar rats randomly divided into two groups (study and control), each group was divided into two equal subgroups according to the day of death (24 hours and seven days). Sirolimus was administered at a dose of 1mg/kg in the study group and the control group was given 1 ml of saline. The solutions were administered daily since three days before hepatectomy till the rats death to removal of the regenerated liver, conducted in 24 hours or 7 days after hepatectomy. Liver regeneration was measured by the KWON formula, by thenumber of mitotic figures (hematoxylin-eosin staining) and by the immunohistochemical markers PCNA and Ki-67. RESULTS: there was a statistically significant difference between the 24h and the 7d groups. When comparing the study and control groups in the same period, there was a statistically significant variation only for Ki-67, in which there were increased numbers of hepatocytes in cell multiplication in the 7d study group compared with the 7d control group (p = 0.04). CONCLUSION: there was no negative influence of sirolimus in liver regeneration and there was a positive partial effect at immunohistochemistry with Ki-67. .
OBJETIVO: avaliar a influência do sirolimo sobre a regeneração hepática desencadeada pela ressecção de 70% do fígado de ratos adultos. MÉTODOS: utilizaram-se 40 ratos Wistar que foram divididos aleatoriamente em dois grupos (estudo e controle), cada grupo foi subdividido em dois subgrupos iguais conforme o dia da morte (24 horas e sete dias). O sirolimo foi administrado na dose de 1mg/kg/dia no grupo de estudo e no grupo controle foi administrado 1ml de solução salina. As soluções foram administradas diariamente, desde três dias precedentes à hepatectomia até a morte dos ratos, para a retirada do fígado regenerado, realizada em 24h ou 7d após a hepatectomia. A análise da regeneração hepática foi mensurada pela fórmula de KWON, número de figuras de mitose pela técnica de hematoxilina-eosina e pelos marcadores imunoistoquímicos PCNA e Ki-67. RESULTADOS: demonstrou-se variação estatisticamente significativa quando comparado os grupos 24h com os grupos 7d através dos métodos de análise. Ao comparar os grupos de estudo e controle no mesmo período demonstrou-se variação estatisticamente significativa apenas pelo Ki-67 no qual foi verificado aumento do número de hepatócitos em multiplicação celular no grupo de estudo de 7d quando comparado com o grupo controle de 7d (p=0,04). . CONCLUSÃO: não demonstramos influência negativa do sirolimo na regeneração hepática e houve efeito parcial positivo pela análise imunoistoquímica utilizando Ki-67. .
Assuntos
Animais , Masculino , Ratos , Imunossupressores/farmacologia , Regeneração Hepática/efeitos dos fármacos , Sirolimo/farmacologia , Hepatectomia , Distribuição Aleatória , Ratos WistarRESUMO
OBJECTIVE: To analyze, during two different moments of liver regeneration, the effect of the immunosuppressant Tacrolimus on the 70% hepatectomy model-induced liver regeneration in adult rats. METHODS: Forty Wistar adult rats, weighing 510.08 + 11.66 g were randomly divided into two groups, each group divided into two subgroups according to the death day after 70% hepatectomy . According to the group of study, rats received 0.1 mg/kg/day of Tacrolimus or the same volume of saline solution, by gavage. After three days of pre-therapy, all animals were submitted to 70% hepatectomy by resection of median and left lateral hepatic lobes which were weighed for posterior calculation of liver regeneration by Kwon's formula. Twenty four hours or seven days after hepatectomy ten rats of each group were killed; the remaining liver (regenerated) was entirely resected, weighed and sampled for mitotic index on hematoxylin-eosin staining and immunohistochemical assays with PCNA and Ki-67 markers. Data were statistically analyzed by Mann-Whitney or Student "t" tests, with significance level of 5% (p<0.05). RESULTS: Rats receiving tacrolimus showed statistically significant higher levels of liver regeneration when compared to placebo according to Kwon's formula, mitotic index and PCNA marker. Identical trend was found with Ki-67 marker, but without statistical significance. CONCLUSION: Tacrolimus-based immunossuppression has stimulatory effect on liver regeneration process induced by 70% hepatectomy in adult Wistar rats.
Assuntos
Hepatectomia , Imunossupressores/farmacologia , Regeneração Hepática/efeitos dos fármacos , Tacrolimo/farmacologia , Animais , Hepatectomia/métodos , Masculino , Ratos , Ratos WistarRESUMO
OBJETIVO: Avaliar em dois momentos distintos da regeneração hepática a influência do Tacrolimus sobre o fenômeno da regeneração hepática desencadeada pela ressecção de 70 por cento do parênquima hepático em ratos plenamente desenvolvidos. MÉTODOS: Utilizaram-se 40 ratos Wistar com peso médio de 510,08 g ± 11.66 g distribuidos aleatoriamente em dois grupos de 20, cada grupo subdividido em dois subgrupos conforme o dia da morte após a hepatectomia. De acordo com o grupo os animais receberam por gavagem solução aquosa de Tacrolimus 0,1 mg/kg/dia ou solução salina no mesmo volume. Após três dias de pré-terapia todos foram submetidos à hepatectomia de 70 por cento pela ressecção dos lobos hepáticos mediano e lateral esquerdo que foram pesados para posterior cálculo da regeneração hepática pela fórmula de Kwon. Vinte e quatro horas ou sete dias após a hepatectomia, 10 animais de cada grupo foram mortos, os fígados remanescentes (regenerados) foram pesados e amostrados para realização de índice mitótico por hematoxilina-eosina e estudo imunoistoquímico com os marcadores PCNA e Ki-67. RESULTADOS: Os animais que receberam tacrolimus mostraram índice maior de regeneração hepática, atingindo significância estatística quando comparado ao subgrupo de animais mantidos com placebo quando analisados pelos parâmetros: fórmula de Kwon, índice mitótico e marcador PCNA. A tendência para o marcador Ki-67 foi idêntica aos outros parâmetros mas não alcançou significância estatística. CONCLUSÃO: A imunossupressão com tacrolimus possui efeito estimulatório no processo de regeneração hepática desencadeado pela hepatectomia 70 por cento em ratos Wistar adultos, plenamente desenvolvidos.
OBJECTIVE: To analyze, during two different moments of liver regeneration, the effect of the immunosuppressant Tacrolimus on the 70 percent hepatectomy model-induced liver regeneration in adult rats. METHODS: Forty Wistar adult rats, weighing 510.08 + 11.66 g were randomly divided into two groups, each group divided into two subgroups according to the death day after 70 percent hepatectomy . According to the group of study, rats received 0.1mg/Kg/day of Tacrolimus or the same volume of saline solution, by gavage. After three days of pre-therapy, all animals were submitted to 70 percent hepatectomy by resection of median and left lateral hepatic lobes which were weighed for posterior calculation of liver regeneration by Kwon´s formula. Twenty four hours or seven days after hepatectomy ten rats of each group were killed; the remaining liver (regenerated) was entirely resected, weighed and sampled for mitotic index on hematoxylin-eosin staining and immunohistochemical assays with PCNA and Ki-67 markers. Data were statistically analyzed by Mann-Whitney or Student "t" tests, with significance level of 5 percent (p<0.05). RESULTS: Rats receiving tacrolimus showed statistically significant higher levels of liver regeneration when compared to placebo according to Kwon's formula, mitotic index and PCNA marker. Identical trend was found with Ki-67 marker, but without statistical significance. CONCLUSION: Tacrolimus-based immunossuppression has stimulatory effect on liver regeneration process induced by 70 percent hepatectomy in adult Wistar rats.
Assuntos
Animais , Masculino , Ratos , Hepatectomia , Imunossupressores/farmacologia , Regeneração Hepática/efeitos dos fármacos , Tacrolimo/farmacologia , Hepatectomia/métodos , Ratos WistarRESUMO
RACIONAL: A regeneração hepática representa o resultado de respostas fisiológicas que ocorrem após perdas de parênquima, como consequência de agressões tóxico-medicamentosas, infecciosas, traumáticas ou cirúrgicas. OBJETIVO: Avaliar, em dois momentos distintos da regeneração hepática, a influência do tacrolimus sobre o fenômeno da regeneração hepática desencadeada pela ressecção de 70
do parênquima hepático em ratos plenamente desenvolvidos. MÉTODO: Utilizaram-se 40 ratos Wistar com peso médio de 510,08 g ± 11.66 g divididos aleatoriamente em dois grupos de 20 (Estudo e Controle), cada grupo subdividido em dois subgrupos conforme o dia da morte após a hepatectomia (24 horas e 7 dias). De acordo com o grupo os animais receberam por gavagem, diariamente, iniciando três dias antes da hepatectomia e prolongando-se por todo o período de observação, solução aquosa de tacrolimus 0,1 mg/kg/dia ou solução salina no mesmo volume. Após três dias de pré-terapia todos foram submetidos à hepatectomia de 70
pela ressecção dos lobos hepáticos mediano e lateral esquerdo que foram pesados para posterior cálculo da regeneração hepática pela fórmula de Kwon. Vinte e quatro horas ou sete dias após a hepatectomia, 10 animais de cada grupo foram mortos, os fígados remanescentes (regenerados) foram pesados e amostrados para realização de índice mitótico por hematoxilina-eosina e estudo imunoistoquímico com os marcadores PCNA e Ki-67. RESULTADOS: Os animais que receberam tacrolimus mostraram índice maior de regeneração hepática, atingindo significância estatística quando comparado ao subgrupo de animais mantidos com placebo quando analisados pelos parâmetros: fórmula de Kwon, índice mitótico e marcador PCNA. A tendência para o marcador Ki-67 foi idêntica aos outros parâmetros, mas não alcançou significância estatística...
BACKGROUND: Liver regeneration is the result of physiological responses that occur after loss of parenchyma, as a consequence of drug abuse-toxic, infection, trauma or surgical procedure. AIM: To analyze, during two different moments of liver regeneration, the effect of the immunosuppressant tacrolimus on the 70
hepatectomy model-induced liver regeneration in adult rats. METHODS: Forty Wistar adult rats, weighing 510.08+11.66 g were randomly divided into two groups (Study or Control), each group divided into two subgroups according to the death day after 70
hepatectomy (24 hours or 7 days). According to the group of study, rats received 0.1mg/Kg/day of tacrolimus or the same volume of saline solution, by gavage, daily, starting three days before hepatectomy until the end of observation (animal death´s day). After three days of pre-therapy, all animals were submitted to 70
hepatectomy by resection of median and left lateral hepatic lobes which were weighed for posterior calculation of liver regeneration by Kwon´s formula. Twenty four hours or seven days after hepatectomy 10 rats of each group were killed; the remaining liver (regenerated) was entirely resected, weighed and sampled for mitotic index on hematoxylin-eosin staining and immunohistochemical assays with PCNA and Ki-67 markers. Data were statistically analyzed by Mann-Whitney or Student "t" tests, with significance level of 5
(P<0.05). RESULTS: Rats receiving tacrolimus showed statistically significant higher levels of liver regeneration when compared to placebo according to Kwon's formula, mitotic index and PCNA marker. Identical trend was found with Ki-67 marker, but without statistical significance. CONCLUSION: Tacrolimus-based immunossuppression has stimulatory effect on liver regeneration process induced by 70
hepatectomy in adult Wistar rats.
Assuntos
Animais , Masculino , Adulto , Ratos , Imuno-Histoquímica , Hepatectomia , Terapia de Imunossupressão/efeitos adversos , Laparotomia , Ratos Wistar/cirurgia , Regeneração HepáticaRESUMO
Foi estudada a vascularizaçäo arterial hepática em peças anatômicas obtidas em necropsias no IML, avaliando-se os vasos, a sua origem e distribuiçäo. Pode-se concluir que: a incidência das artérias hepáticas direita e esquerda aberrantes encontradas na amostra estudada é semelhante à literatura consultada; a incidência das artérias hepáticas direita eesquerda aberrantes como vaso nutridor principal da regiäo hepática correspondente é maior que na literatura consultada; a combinaçäo da origem da artéria hepática esquerda aberrante originada da artéria gástrica esquerda como a artéria hepática direita aberrante, originada da artéria mesentérica superior, teve uma incidência maior que na literatura consultada; näo houve observaçöes da artéria hepática comum, originando-se da artéria mesentérica superior, e a incidência do modelo padräo do tronco celíaco apresentou-se como descrito na literatura estudada
Assuntos
Artéria Hepática/anatomia & histologia , DissecaçãoRESUMO
Patients with dermatomyositis (DM) or polymyositis (PM) were studied retrospectively. The patients were divided into four groups: definite PM 24, probable PM 19, definite DM 34 and mild-early DM 25 cases. PM patients complained more often proximal muscle weakness [p <0.01]. DM patients complained more arthralgia [p <0.05], dysphagia [p <0.03] and weight loss [p <0.04]. Five patients had a malignant neoplasm and 9 had other connective-tissue disease. DM presented higher ESR than PM [p <0.002]. PM presented more significant increase in creatine kinase (CK) [p <0.02] and in alanine aminotransferase (ALT) [p <0.001] levels. Electromyography showed myopathic pattern in 76 percent. Muscle biopsy was the definitive test. Perifascicular atrophy was more frequent in definite DM than in mild-early DM group [p <0.03]. CONCLUSION: A small association with connective-tissue diseases and neoplasms was found. DM and PM are clinically different. DM presents systemic involvement affecting the skin, developing more severe arthralgia, dysphagia and weight loss and presenting higher values of ESR. PM presents a restricted and more significant involvement of muscles generating more weakness complaints and higher levels of serum muscle enzymes