[Healing process in bladder suture of rats with and without the administration of intraperitoneal Jatropha gossypiifolia L. gross extract]. / Estudo da cicatrização de suturas na bexiga urinária de ratos com e sem a utilização de extrato bruto de Jatropha gossypiifolia L. intraperitoneal.

INTRODUCTION: The suture of tissues and their healing process is one of the basic fundamentals of surgery, and the research on substances which could improve the process is an ongoing challenge. The use of plants has been tested but till nowadays without scientific demonstration. PURPOSE: To compare the macroscopic and histological alterations done by the use of intraperitoneal Jatropha gossypiifolia L. gross extract, in the healing process of sutures performed on the bladder of rats. METHODS: Forty adult, male, Wistar rats were distributed into two animal groups. One centimeter longitudinal incision on the bladder ventral wall, and single plane synthesis with separated polyglactine 910 5-0 (Ethicon) stitches was done in all the animals. In the control group an intraperitoneal cavity instillation of distilled water at a ratio of 1 ml/kg/weight, and a 1 ml/kg/weight of Jatropha gossypiifolia L. extract for the Jatropha group was done representing 200 mg of the substance. Each group was subdivided into two with 10 animals in each, being submitted to euthanasia on 3rd and 7th post-operative days. Comparative histological, macroscopic and statistical analysis were undertaken between the subgroups. RESULTS: Statistical significant difference was observed in the acute inflammation changes, vascular neoformation and bonding on day 3; the first one was greater in the control group, and the latter two greater in the Jatropha group; acute inflammation variables and fibroblastic proliferation presented to be more intense on day 7, with statistical significance favoring the control group. CONCLUSION: No favorable healing effect was observed with the administration of single intraperitoneal dose of Jatropha gossypiifolia L. gross extract on the sutures of bladder in rats.

[Evaluation of the aroreira (Schinus terebinthifolius Raddi) in the healing process of surgical incision in the bladder of rats]. / Avaliação da ação da Aroeira (Schinus terebinthifolius Raddi) na cicatrização de feridas cirúrgicas em bexiga de ratos.

PURPOSE: To evaluate the hydroalcoholic aroeira extract in the healing process of surgical incisions in the bladder of rats in an experimental comparative study. METHODS: Forty male Wistar rats were used. All of them underwent a median abdominal incision, with an 1cm cystotomy, followed by one plain suture with separated stitches of poliglactine 910 5-0. The animals were then divided into two groups of 20 rats each, and named the aroeira group (GA) and the control group (GC). In the first one, 80% hydro-alcoholic plant extract was injected in the peritoneal cavity, in a one dose of 100mg/kg. The second group, a 0.9% saline solution was injected in place of aroeira extract. Each group was divided into two subgroups (SGA and SGC) of 10 animals. According to their scheduled death, they were named subgroups SGA3 and SGC3 when killed in the 3th day after surgery and subgroups SGA7 and SGC7 in the 7th day. The abdominal cavity and the bladder suture were macroscopically evaluated. RESULTS: The microscopic analysis of the surgical incision in the bladder was performed by means of the hematoxilin-eosine stain and the trichrome of Masson. The macroscopic analysis showed an infection in the surgical incision in three rats of the SGC group and in one of the SGA, and peritoneal adhesion in the 26 rats belonging nine to SGC and 17 in the SGA. The microscopic evaluation revealed a more severe acute inflammation process in the SGC on the 3th (p=0.045) and in the 7th (0=0.002) days. In the SGA, a more significant collagenization (p=0.001) could be seen, as far as the evidence of vascular neoformation (p=0.002) on the 3rd day. Chronic inflammatory reaction (p=0.006) and a more intense vascular neoformation (p=0.001) were observed in the 7th day. CONCLUSION: The hydroalcoholic aroeira extract had a favorable effect in the healing process of cystotomies done in rats.

[Phytotherapeutic evaluation of Jatropha gossypiifolia L. on rats ventral abdominal wall wound healing]. / Avaliação fitoterápica da Jatropha gossypiifolia L. na cicatrização de suturas na parede abdominal ventral de ratos.

INTRODUCTION: The Jatropha gossypiifolia L., which is used in popular medicine is considered to have good diuretic effect in hypertension and is also used as a laxative drug. It seems to have a healing effect, although not proved till now. PURPOSE: To evaluate the influence of intraperitoneal administration of Jatropha Gossypiifolia L., in suture healing of ventral abdominal wall of rats, through tensiometric measurement, macro and microscopic aspect of post-operative period. METHODS: Forty Wistar male rats were allocated in two groups of 20 animals. After the incision and exposure of abdominal cavity 1 ml/kg/weight of 0,9% sodium chloride solution was injected in control group, and in the other one the injection was of 1 ml/kg/weight of a gross ethanol extract of Jatropha gossypiifolia L. The suture of the abdominal wall was than performed with polypropylene separated stitches. The animals were followed-up and killed in the third and seventh days. The ventral abdominal wall was macroscopically analyzed, the resistance strength to strain was measured and it was also studied the histological aspects. RESULTS: On macroscopic examination more intense adhesion was found on the group of Jatropha in both third and seventh post-operative days. The strain evaluation was meanly greater on Jatropha group also in third and seventh days. CONCLUSION: The histological comparative analysis between the different groups showed that the acute inflammatory process was meanly greater for the Jatropha group in third and seventh post-operative days. The vascular neoformation was significantly greater in third post-operative day of Jathopha group; the other histological parameters were just alike. The intraperitoneal injection of Jatropha extract did not have any significant improvement for the wound healing on ventral abdominal wall on the evaluated animals in this study, no matter if analyzed at the third or seventh post-operative days.

Small bowel volvulus after transabdominal preperitoneal hernia repair due to improper use of V-Loc™ barbed absorbable wire - do we always "read the instructions first"?

INTRODUCTION: Transabdominal preperitoneal endoscopic hernia repair (TAPP) is part of primary surgical health care. While both, the reported recurrence rate and procedure specific morbidity are consistently low, rare serious complications occur. PRESENTIATION OF CASE: A 36-year-old male patient developed bowel obstruction three days after both-sided TAPP for inguinal hernia repair. A computer tomography scan of the abdomen revealed a small bowel volvulus in the right lower quadrant of the abdomen requiring urgent revisional surgery. Intraoperatively, the small bowel and its mesenterial vessels were found to be twisted around a 5cm long V-Loc™ barbed absorbable suturing wire. After successful laparoscopic adhesiolysis, removal of the wire and detorquing of the bowel conglomerate, resection of small intestine was not necessary. The patient's further postoperative recovery was uneventful. DISCUSSION: Due to the barbed configuration of the V-Loc™ wire, a gapless continuous suturing of the peritoneum without laparoscopic knotting is easily and fast to accomplish. In this case the recommendation of the manufacturer to shorten the wire was not strictly followed and neither had the suture stump been extraperitonealized in order to avoid such rare complications. CONCLUSION: Surgeons need to be aware of relevant "tricks and traps" of routinely performed procedures and have to know all tools and material they use very well. This case may therefore increase our attention when it comes to little things which actually do matter.

[Antroduodenal motility and pH changes after partial gastrectomy including the pacemaker region of the dog's stomach]. / Alterações da motilidade antroduodenal e do pH gástrico após ressec o gástrica parcial incluindo a rea correspondente ao marca-passo do estômago de cães.

BACKGROUND: Functional alterations of antroduodenal motility are not well defined at present. The gastric pacemaker is located at the greater curvature, next to the fundus. PURPOSE: The aim was to evaluate the influence of the gastric pacemaker on the gastroduodenal motility in dogs. METHODS: The study was designed in three steps and performed with 20 dogs: first, construction of a cervical esophagostomy to measure the antroduodenal motility and gastric pH-metry as validation step. The manometry was performed by means of a six point electronic manometry probe and both manometry and pH-metry were recorded during 4 hours. Second, the stomach's pacemaker region and gastric reservoir were resected by videolaparoscopy. Third, the antroduodenal motility and gastric pH-metry were measured again. RESULTS: In the validation step, there was established a typical dogs' antroduodenal motility pattern, with a three-shaped interdigestive motility complex (IMC) (phases 1 to 3); the gastric pH-metry showed a baseline at pH 1,15. After partial gastric resection, overall there was an increase in contractions' frequency, an increase in phase 2 and a decrease in phase 3 participation on the IMC's. Regarding the gastric pH measurements, there was an increase in pH intervals 0-1 and 1-2 and a decrease in pH intervals 6-7; overall, there was a decrease in the stomach's pH and a decrease in the prandial time. CONCLUSION: The resection of the stomach's pacemaker region and gastric reservoir correlated with alterations in antroduodenal motility, maintaining however the typical IMC pattern.

Rapid prototyping of three-dimensional biomodels as an adjuvant in the surgical planning for intracranial aneurysms.

PURPOSE: To fabricate a three-dimensional biomodels of intracranial aneurysms, using rapid prototyping technology, to facilitate optimal anatomical visualization of aneurysms prior to and during surgery. METHODS: Four intracranial aneurysms cases were selected for this study. Using CT angiography images, the rapid prototyping process was completed using a PolyJet technology machine. The size and morphology of the prototypes were compared to brain digital subtraction arteriography of the same patients. RESULTS: The biomodels reproduced the exact location and morphology of the intracranial aneurysms, particularly the necks, in life-size dimensions and exactly the same as measured by digital subtraction arteriography. The arterial segments adjacent to the aneurysm and arteries anatomically known by the surgeon were also shown, which could guide the surgeon to the aneurysmal segment. The models showed an average unit cost of US$ 130 and each one took an average of 20 hours to be fabricated. CONCLUSIONS: It is possible to fabricate 3D physical biomodels of intracranial aneurysms from CT angiography images. These prototypes may be useful in the surgical planning for intracranial aneurysms to clarify the anatomy, define surgical techniques and facilitate the choice of suitable materials, such as clips and clip appliers.

Comparative study between polypropylene and polypropylene/poliglecaprone meshes used in the correction of abdominal wall defect in rats.

PURPOSE: To evaluate the healing process of a defect in the ventral abdominal wall of rats, comparing the polypropylene and polypropylene/poliglecaprone meshes on the 30(th) and 60(th) postoperative day. METHODS: Thirty two Wistar rats were submitted to a ventral abdominal wall defect, with integrity of the parietal peritoneum. In the repair, were used polypropylene (group A) and polypropylene/poliglecaprone (group B) meshes. The groups were subdivided into four subgroups of eight animals euthanized on the 30(th) (A30 and B30) and 60(th) postoperative day (A60 and B60). Fragments of the abdominal wall of the animals were submitted to macroscopic, tensiometric and histological evaluations. RESULTS: The tensiometry on subgroup A30 showed a mean average break point of 0.78 MPa and in A60, 0.66 Mpa. In subgroup B30 it was 0.84 MPa and in B60, 1.27 Mpa. The score of the inflammatory process showed subacute phase on A30 and B30 sub-groups and chronic inflammatory process in subgroups A30 and 60B. CONCLUSIONS: The tensile strength was higher on the wall repaired by polypropylene/poliglecaprone mesh in the 60(th) post-operative day. Histology showed higher concentration of fibrosis on the surface of the polypropylene mesh with a tendency to encapsulation. In polypropylene/poliglecaprone subgroups the histology showed higher concentration of fibrosis on the surface of mesh filaments.

Postoperative abdominal CT findings in patients submitted to Roux-en-y gastric bypass without ring.

OBJECTIVE: To evaluate by CT scan in patients undergoing laparoscopic Roux-en-Y gastric bypass without a ring for treatment of morbid obesity that looked for medical assistance after the operation. METHODS: We studied 40 CT exams from patients attended at the radiology service with the intention to clarify abdominal complains. The patients were in post-bariatric surgical follow-up and were operated in the same hospital. We excluded patients who had undergone bariatric surgery by other surgical techniques, operated by another surgical team and the ones who did not agree with the administration of oral or intravenous iodinated contrast media and exceeding the weight limit of the examination table. RESULTS: The patients were aged from 23 to 70 years, 11 male and 29 female. There were no extra-abdominal changes, and 30 of the 40 patients had CT findings within normal limits. The presence of stenosis at the gastrojejunal anastomosis was found in one patient, internal hernias occurred in five, anastomotic leak in one and the presence of abscess occurred in three of patients. CONCLUSION: Total abdominal CT failed to inform the cause of the symptoms in 87.5% of patients seeking medical re-evaluation for symptoms of post-operative bariatric surgery.

Comparative study between meshes of polyester with collagen and polytetrafluoroethylene in the repair of defects produced in abdominal wall of rats.

PURPOSE: To study the intraperitoneal use of polyester with collagen and polytetrafluoroethylene meshes in the correction of total ventral wall defects in rats. METHODS: Thirty two rats were evaluated and divided randomly into four groups and underwent laparotomy and preparation of total defects of the abdominal wall. Next, the correction of the defect with the intraperitoneal placement of the chosen mesh was performed. The rats were submitted to euthanasia at 30 and 90 days after surgery. Were analyzed the macroscopic adhesions and microscopic aspects, and applied stress rupture test RESULTS: All animals showed intraperitoneal adhesions in varying degrees, with no statistical significance difference. There was no difference also between groups in the evaluation of stress rupture tests. On the microscopic aspect, the A30 group had less inflammatory reaction and less formation of granulomas and foreign body reaction that the B30 group, with significant difference. CONCLUSIONS: There was no difference in intraperitoneal adhesion and tensile rupture strength among groups. Group B30 presented granulomatous inflammatory reaction at the site of mesh attachment to the wall significantly higher than the A30.

Action of tacrolimus on Wistar rat kidneys implanted with Walker 256 carcinosarcoma.

PURPOSE: To evaluate the development of Walker 256 tumor in male Wistar rats treated with tacrolimus using an experimental kidney tumor model. METHODS: 40 male Wistar rats were divided into four groups: Tumor group (TU) (n=10), Tacrolimus-Tumor group (TT) (n=10), Tacrolimus group (TC) (n=10) and Control group (C) (n=10). Treatment with tacrolimus was performed in groups TT and TC. Under anesthesia, the right kidney of each animal of TU and TT was accessed through a supraumbilical incision and inoculated with a 0.1 mL solution containing 2 x 10(6) tumor cells (Walker 256 carcinosarcoma tumor cells). Group TC was treated with a saline solution. All the animals of groups TC and TT were treated with tacrolimus (5mg/kg/day) by gavage for 15 days. TU group animals received saline by gavage for 15 days. On the 15th postoperative day, all animals were submitted to euthanasia and blood sampling for analysis of serum creatinine (Cr) and blood urea nitrogen (BUN). Abdominal gross examination was performed, the right kidney removed and prepared for histological analysis by hematoxylin-eosin staining. The resulting data were submitted to statistical analysis by ANOVA. RESULTS: Statistical significance was found when comparing creatinine level between groups TU, TT and TC -TT group culminated with a marked increased in creatinine levels (Cr=1.013 + or - 0.3028 mg/mL), TU group (Cr=0.5670 + or - 0.03536 mg/dL) P=0.00256, TC group (Cr =0.711 + or - 0.1653 mg/mL) P= 0.02832. Statistical significance was found when comparing BUN levels in TT group (71.32 + or - 17.14 mg/mL), compared with TU group (45.83 + or - 5.046 mg/dL), P=0.000318. There were no statistically significant differences between groups TT and TC (61.23 + or - 9.503 mg/mL) P=0.7242. Histological analysis showed a poor evolution in TT group with multiple foci of hemorrhage and cortical invasion by the Walker tumor. CONCLUSION: The Tacrolimus-treated group developed a more aggressive tumor and a drug-related nephrotoxic effect.

Evaluation of healing prosthetic materials polyester mesh resorbable film and collagen elastin matrix /polypropylene used in rabbits abdominal wall defects.

PURPOSE: To compare polyester with absorbable layer prosthesis with collagen-elastin/polypropylene prosthesis in the repair of abdominal wall defects. METHODS: The 16 studied rabbits were divided in groups A and B (euthanized on the 30th and 60th days, after the implant of the mesh). The animals underwent laparotomy and received a 2 cm wall 'defect' on each side of the Alba linea. The repair was made with the suture of a polyester mesh with absorbable film on the left side of the Alba Linea and with collagen-elastin/polypropylene mesh on the right side. Adherences were classified according to Nair Score and microscopic evaluation observing types I and III collagen formation and other immunohistochemical analyses. RESULTS: There were no significant differences in adhesion formation. The collagen type I showed higher deposition in polyester with absorbable layer. In group B, the difference between the meshes was significant, with higher collagen III deposition in polyester with absorbable layer (60 masculine P.O.). About the metalloproteinases, the presence of MMP -1 and MMP-8 were about the same; the expression of MMP-13 increased near to the 60th day. CONCLUSIONS: There is no significant difference between the two meshes in adhesion formation and immunohistochemical evaluation. The polyester mesh resorbable film presented a higher deposition of collagen.

Intraperitoneal meshes in the repair of abdominal wall defects: comparison of polyester with collagen versus polypropylene with polyglycolic acid.

OBJECTIVE: To compare the clinical and histological outcomes of the repair of induced abdominal wall defects with Parietex and Optilene Mesh Elastic + Safil in direct contact with abdominal viscera (intraperitoneal position, IPOM). METHODS: Sixteen rabbits were allocated into two groups with 8 animals each, corresponding to evaluation on the 30th and 60th postoperative days. All animals were submitted to two standardized symmetric abdominal wall defects, comprising all muscular layers and the peritoneum, followed by repair through the intraperitoneal placement of two different meshes. The experimental design allowed each animal to be its own control. Macroscopic aspects evaluated were: surgical site infection, mesh erosion, suture insufficiency, fistulae, intra-abdominal infection and adhesion formation. Microscopic parameters analyzed consisted of collagen deposition and the immunohistochemical healing process. RESULTS: The formation of intraperitoneal adhesions and the other macroscopic outcome measures evaluated did not present significant statistical differences between the two meshes, neither did type I and III collagen deposition and MMP-1 and MMP-8 antibody expression. MMP-13 antibody exhibited significantly higher expression on the 30th postoperative day with Optilene+Safil and on the 60th day with Parietex. CONCLUSION: Due to the similar results obtained, both macroscopically and microscopically, the meshes can be considered equivalent with respect to the healing of surgical wounds in abdominal wall defects in rabbits.

Rapid prototyping of three-dimensional biomodels as an adjuvant in the surgical planning for intracranial aneurysms

PURPOSE: To fabricate a three-dimensional biomodels of intracranial aneurysms, using rapid prototyping technology, to facilitate optimal anatomical visualization of aneurysms prior to and during surgery. METHODS: Four intracranial aneurysms cases were selected for this study. Using CT angiography images, the rapid prototyping process was completed using a PolyJet technology machine. The size and morphology of the prototypes were compared to brain digital subtraction arteriography of the same patients. RESULTS: The biomodels reproduced the exact location and morphology of the intracranial aneurysms, particularly the necks, in life-size dimensions and exactly the same as measured by digital subtraction arteriography. The arterial segments adjacent to the aneurysm and arteries anatomically known by the surgeon were also shown, which could guide the surgeon to the aneurysmal segment. The models showed an average unit cost of US$ 130 and each one took an average of 20 hours to be fabricated. CONCLUSIONS: It is possible to fabricate 3D physical biomodels of intracranial aneurysms from CT angiography images. These prototypes may be useful in the surgical planning for intracranial aneurysms to clarify the anatomy, define surgical techniques and facilitate the choice of suitable materials, such as clips and clip appliers.

Comparative study between polypropylene and polypropylene/poliglecaprone meshes used in the correction of abdominal wall defect in rats / Estudo comparativo entre as telas de polipropileno e polipropileno/poliglecaprone utilizadas na correção de defeito na parede abdominal ventral de ratos

PURPOSE: To evaluate the healing process of a defect in the ventral abdominal wall of rats, comparing the polypropylene and polypropylene/poliglecaprone meshes on the 30th and 60th postoperative day. METHODS: Thirty two Wistar rats were submitted to a ventral abdominal wall defect, with integrity of the parietal peritoneum. In the repair, were used polypropylene (group A) and polypropylene/poliglecaprone (group B) meshes. The groups were subdivided into four subgroups of eight animals euthanized on the 30th (A30 and B30) and 60th postoperative day (A60 and B60). Fragments of the abdominal wall of the animals were submitted to macroscopic, tensiometric and histological evaluations. RESULTS: The tensiometry on subgroup A30 showed a mean average break point of 0.78 MPa and in A60, 0.66 Mpa. In subgroup B30 it was 0.84 MPa and in B60, 1.27 Mpa. The score of the inflammatory process showed subacute phase on A30 and B30 sub-groups and chronic inflammatory process in subgroups A30 and 60B. CONCLUSIONS: The tensile strength was higher on the wall repaired by polypropylene/poliglecaprone mesh in the 60th post-operative day. Histology showed higher concentration of fibrosis on the surface of the polypropylene mesh with a tendency to encapsulation. In polypropylene/poliglecaprone subgroups the histology showed higher concentration of fibrosis on the surface of mesh filaments.

OBJETIVO: Avaliar a cicatrização de um defeito, na parede abdominal ventral de ratos, comparando-se as telas de polipropileno e polipropileno/poliglecaprone no 30º e 60º dia do pós-operatório. MÉTODOS: Trinta e dois ratos Wistar foram submetidos à produção de defeito na parede abdominal ventral, com integridade do peritônio parietal. Na correção foram utilizadas as telas de polipropileno (grupo A) e polipropileno/poliglecaprone (grupo B). Houve subdivisão em quatro subgrupos (A30, A60, B30 e B60) de oito animais que foram submetidos à eutanásia no 30º e 60º dia do pós-operatório. Fragmentos da parede abdominal foram submetidos à análise macroscópica, tensiométrica e histológica. RESULTADOS: A tensiometria no subgrupo A30 mostrou tensão média de ruptura de 0,78 Mpa e no subgrupo A60 de 0,66 MPa. No subgrupo B30 foi de 0,84 MPa e no B60 de 1,27 MPa. O escore do processo inflamatório mostrou fase subaguda nos subgrupos A30 e B30 e processo inflamatório crônico no subgrupo A60 e B60. CONCLUSÕES: A resistência à tensão foi maior na parede reparada pela tela de polipropileno/poliglecaprone no 60º dia pós-operatório. Na análise histológica houve maior concentração da fibrose na superfície da tela de polipropileno com tendência ao encapsulamento. Nos subgrupos polipropileno/poliglecaprone a análise histológica mostrou maior fibrose entre os filamentos da tela.

Achados tomográficos das alterações abdominais pós-operatórias dos pacientes submetidos ao derivação gastrojejunal em Y-de-Roux sem anel / Postoperative abdominal CT findings in patients submitted to Roux-en-y gastric bypass without ring

OBJETIVO: Avaliar por exame de tomografia computadorizada de pacientes submetidos à derivação gastrojejunal em Y-de-Roux, sem anel, para tratamento de obesidade mórbida. MÉTODOS: Estudaram-se 40 pacientes, encaminhados ao serviço de tomografia do Hospital Universitário Evangélico de Curitiba para avaliação diagnóstica. Encontravam-se em pós-operatório de cirurgia bariátrica tendo sido operados no mesmo hospital. Foram incluídos pacientes submetidos à operação laparoscópica com sintomas que necessitavam de avaliação tomográfica diagnóstica. Excluíram-se pacientes que tinham sido submetidos à cirurgia bariátrica por outras técnicas cirúrgicas; que tinham sido operados por outra equipe; que não concordassem com a administração de contraste iodado por via oral ou endovenosa; e que excediam o limite de peso da mesa de exame. Para análise estatística utilizou-se a média das variáveis. RESULTADOS: Os pacientes apresentaram-se com idade entre 23 a 70 anos e eram 11 homens e 29 mulheres. Não houve alterações extra-abdominais detectáveis pela tomografia de abdômen total; dos 40 pacientes avaliados, 30 apresentavam achados tomográficos dentro do limite da normalidade. A presença de estenose na anastomose gastrojejunal foi encontrada em um paciente; hérnia interna ocorreu em cinco; fístula anastomótica em um e abcesso em três dos pacientes estudados. CONCLUSÃO: A tomografia de abdome total não conseguiu informar a causa dos sintomas dos pacientes operados em 87,5% dos pacientes que procuraram re-avaliação médica por sintomas pós-operatórios da cirurgia bariátrica.

OBJECTIVE: To evaluate by CT scan in patients undergoing laparoscopic Roux-en-Y gastric bypass without a ring for treatment of morbid obesity that looked for medical assistance after the operation. METHODS: We studied 40 CT exams from patients attended at the radiology service with the intention to clarify abdominal complains. The patients were in post-bariatric surgical follow-up and were operated in the same hospital. We excluded patients who had undergone bariatric surgery by other surgical techniques, operated by another surgical team and the ones who did not agree with the administration of oral or intravenous iodinated contrast media and exceeding the weight limit of the examination table. RESULTS: The patients were aged from 23 to 70 years, 11 male and 29 female. There were no extra-abdominal changes, and 30 of the 40 patients had CT findings within normal limits. The presence of stenosis at the gastrojejunal anastomosis was found in one patient, internal hernias occurred in five, anastomotic leak in one and the presence of abscess occurred in three of patients. CONCLUSION: Total abdominal CT failed to inform the cause of the symptoms in 87.5% of patients seeking medical re-evaluation for symptoms of post-operative bariatric surgery.

Comparative study between meshes of polyester with collagen and polytetrafluoroethylene in the repair of defects produced in abdominal wall of rats / Estudo comparativo entre as telas de poliéster com colágeno e politetrafluoretileno no reparo de defeitos produzidos na parede abdominal de ratos

PURPOSE: To study the intraperitoneal use of polyester with collagen and polytetrafluoroethylene meshes in the correction of total ventral wall defects in rats. METHODS: Thirty two rats were evaluated and divided randomly into four groups and underwent laparotomy and preparation of total defects of the abdominal wall. Next, the correction of the defect with the intraperitoneal placement of the chosen mesh was performed. The rats were submitted to euthanasia at 30 and 90 days after surgery. Were analyzed the macroscopic adhesions and microscopic aspects, and applied stress rupture test RESULTS: All animals showed intraperitoneal adhesions in varying degrees, with no statistical significance difference. There was no difference also between groups in the evaluation of stress rupture tests. On the microscopic aspect, the A30 group had less inflammatory reaction and less formation of granulomas and foreign body reaction that the B30 group, with significant difference. CONCLUSIONS: There was no difference in intraperitoneal adhesion and tensile rupture strength among groups. Group B30 presented granulomatous inflammatory reaction at the site of mesh attachment to the wall significantly higher than the A30.

OBJETIVO: Estudar comparativamente o uso intraperitoneal das telas de poliéster com colágeno e politetrafluoretileno na correção de defeitos totais da parede ventral em ratos. MÉTODOS: Foram avaliados 32 ratos distribuídos em quatro grupos aleatórios e submetidos à laparotomia e confecção de defeitos totais da parede abdominal. Em seguida, foi realizada a correção do defeito com a colocação intraperitoneal das telas. A eutanásia ocorreu aos 30 e 90 dias do pós-operatório. Foram analisadas as aderências macroscópicas, aspectos microscópicos e aplicado teste de tensão de ruptura. RESULTADOS: Todos os animais apresentaram aderências abdominais intraperitoneais em vários graus, sem significância estatística. Não houve diferença entre os grupos na avaliação dos testes de tensão de ruptura. Na análise microscópica o grupo A30 teve menor reação inflamatória e formação de granulomas, e menor reação do tipo corpo estranho quando comparado ao grupo B30, com resultados significativos. CONCLUSÕES: Não houve diferença significativa entre os grupos tanto em relação à formação de aderências intraperitoneais quanto à tensão de ruptura. O grupo B30 apresentou reação inflamatória e formação granulomatosa no local de fixação na parede significativamente maior que o grupo A30.

Action of tacrolimus on Wistar rat kidneys implanted with Walker 256 carcinosarcoma / Estudo da ação do tacrolimus em rins de ratos Wistar implantados com carcinossarcoma de Walker

PURPOSE: To evaluate the development of Walker 256 tumor in male Wistar rats treated with tacrolimus using an experimental kidney tumor model. METHODS: 40 male Wistar rats were divided into four groups: Tumor group (TU) (n=10), Tacrolimus-Tumor group (TT) (n=10), Tacrolimus group (TC) (n=10) and Control group (C) (n=10). Treatment with tacrolimus was performed in groups TT and TC. Under anesthesia, the right kidney of each animal of TU and TT was accessed through a supraumbilical incision and inoculated with a 0.1mL solution containing 2x10(6) tumor cells (Walker 256 carcinosarcoma tumor cells). Group TC was treated with a saline solution. All the animals of groups TC and TT were treated with tacrolimus (5mg/kg/day) by gavage for 15 days. TU group animals received saline by gavage for 15 days. On the 15th postoperative day, all animals were submitted to euthanasia and blood sampling for analysis of serum creatinine (Cr) and blood urea nitrogen (BUN). Abdominal gross examination was performed, the right kidney removed and prepared for histological analysis by hematoxylin-eosin staining. The resulting data were submitted to statistical analysis by ANOVA. RESULTS: Statistical significance was found when comparing creatinine level between groups TU, TT and TC -TT group culminated with a marked increased in creatinine levels (Cr=1.013 ± 0.3028 mg/mL), TU group (Cr=0.5670 ± 0.03536 mg/dL) P=0.00256, TC group (Cr =0.711 ± 0.1653 mg/mL) P= 0.02832. Statistical significance was found when comparing BUN levels in TT group (71.32 ± 17.14 mg/mL), compared with TU group (45.83 ± 5.046 mg/dL), P=0.000318. There were no statistically significant differences between groups TT and TC (61.23 ± 9.503 mg/mL) P=0.7242. Histological analysis showed a poor evolution in TT group with multiple foci of hemorrhage and cortical invasion by the Walker tumor. CONCLUSION: The Tacrolimus-treated group developed a more aggressive tumor and a drug-related nephrotoxic effect.

OBJETIVO: Avaliar as alterações na evolução do carcinosarcoma 256 de Walker, inoculado no rim de ratos Wistar, sob tratamento imunossupressor com o tacrolimus. MÉTODOS: Foram utilizados 40 ratos Wistar, machos divididos em quatro grupos de 10: grupo Tumor (TU), Tumor-Tacrolimus (TT), Tacrolimus (TC) e Controle (C). Os ratos dos grupos TU e TT foram inoculados com 0,1 mL de solução contendo 2x10(6) células do tumor de Walker no parênquima do rim direito. Os dos grupos TC e TT receberam tratamento com tacrolimus na dose de 5mg/kg de peso, via gavagem orogástrica durante 15 dias. Os ratos do grupo TU receberam solução salina isotônica pH 7,2. Ao 15º dia de evolução, todos foram submetidos à eutanásia. Amostras de sangue eram coletadas para dosagem de creatinina (Cr) e uréia (Ur) e posteriormente realizada nefrectomia para avaliação histológica. RESULTADOS: As dosagens séricas de creatinina foram maiores no grupo TT (Cr = 1,013±0,3028 mg/mL), que diferiu significantemente dos grupos TU (Cr=0,5670 ± 0,03536 mg/dL) com p=0,00256 e do TC (Cr=0,711 ± 0,1653 mg/mL) com p=0,02832. As dosagens séricas de uréia foram maiores no grupo TT (71,32 ± 17,14 mg/mL), que diferiu significantemente do grupo TU (45,83 ± 5,046mg/dL) com p=0,000318, mas comparado ao grupo TC (61,23 ± 9,503 mg/mL) não houve diferença significante (p=0,7242). No inventário da cavidade abdominal dos grupos TU e TT, observou-se presença macroscópica de tumor em todos os rins direitos; não foram evidenciadas efusões ascíticas, formação de bridas ou metástases tumorais em outros órgãos ou tecidos adjacentes aos rins direitos. CONCLUSÃO: O tacrolimus exerceu efeito nefrotóxico e induziu exacerbação do crescimento do tumor de Walker 256, quando implantado no rim de ratos Wistar.

Estudo das telas cirúrgicas de polipropileno/poliglecaprone e de polipropileno/polidioxanona/celulose oxidada regenerada na cicatrização de defeito produzido na parede abdominal de ratos / Study of surgical meshes of polypropylene/polyglecaprone and polypropylene/polydioxanone/oxidized regenerated cellulose on the healing of defects produced in abdominal wall of rats

RACIONAL: O uso de telas cirúrgicas para a correção de defeitos da parede abdominal vem ocupando cada vez mais espaço nas operações no mundo todo. OBJETIVO: Estudar duas telas cirúrgicas distintas (Proceed® e Ultrapro®) na cicatrização de defeito produzido em parede abdominal de ratos avaliando-se macroscopia, tensiometria e microscopia. MÉTODO: A amostra foi constituída por 32 ratos Wistar, divididos em dois grupos de 16 animais e quatro subgrupos de oito, submetidos à eutanásia com 15 dias e 30 dias para avaliação. As variáveis macroscópicas foram: presença de hematoma nos bordos da sutura da tela cirúrgica na parede abdominal, união entre a tela e a borda da ferida, presença de infecção no sítio cirúrgico, presença de fístulas de vísceras com a tela cirúrgica, presença de aderências dentro da cavidade abdominal e presença de hérnia incisional. Na microscopia avaliaram-se as fases do processo inflamatório da cicatrização, e na tensiometria a força tênsil necessária para ruptura do material. RESULTADOS: A união entre a tela cirúrgica e a borda da ferida foi melhor no subgrupo Ultrapro 15 dias que no Proceed 15 dias; com 30 dias foi igual nos dois subgrupos. Não houve diferença significativa quanto às demais variáveis da macroscopia. Os dois grupos nos dois momentos tiveram a mesma proporção de casos com processo inflamatório crônico, mas houve maior escore de inflamação do Ultrapro 15 dias que do Ultrapro 30 dias. O subgrupo Ultrapro 15 dias mostrou força de ruptura maior que o subgrupo Proceed 15 dias, mas em 30 dias não houve diferença. Ultrapro mostrou força de ruptura igual para os dois momentos, mas Proceed 30 dias mostrou força de ruptura maior que Proceed 15 dias. CONCLUSÃO: As telas são semelhantes nas variáveis analisadas.

BACKGROUND: The use of surgical meshes for the repair of abdominal wall defects has been increasing its share in surgeries worldwide. AIM: To study two different surgical meshes (Proceed® and Ultrapro®) on the healing of defects produced in abdominal wall of rats evaluating the macroscopic, microscopic and tensiometric parameters. METHOD: Thirty two Wistar rats were divided into two groups of 16 animals and four groups of eight animals euthanized within 15 and 30 days for evaluation. The macroscopic variables were: the presence of hematoma at the edges of the sutures of the surgical mesh in the abdominal wall; the knitting of the surgical mesh and the edge of the wound; presence of infection at the surgical site; presence of viscera fistulas on the surgical mesh; presence of adhesions in the abdominal cavity; presence of incisional hernia. During microscopy the stages of the inflammatory process of healing where evaluated, and tensiometry evaluated the tensile force required to rupture the material. RESULTS: The knitting of the mesh and the edge of the surgical wound was better in the 15 days Ultrapro subgroup than in the 15 days Proceed subgroup; within 30 days the knitting was similar in both subgroups. There was no significant difference for the variable of macroscopy. Both groups in both periods had the same proportion of cases with chronic inflammation, but there were higher scores of inflammation in the 15 days Ultrapro subgroup than the 30 days Ultrapro subgroup. The subgroup 15 days Ultrapro showed greater rupture strength than the subgroup 15 days Proceed, but in 30 days there were no difference. Ultrapro showed equal rupture strength in both periods, but 30 days Proceed showed greater rupture strength than 15 days Proceed. CONCLUSION: The meshes are similar in variables.

Clinical correlation between the consumption of nicotine and cotinine concentrations in urine and serum by competitive enzyme-linked immunosorbent assay.

Different negative effects of smoking are known (e.g. postoperative complications), which lead, especially in plastic surgery, to unsatisfactory results. The aim of this study was to examine the appropriateness of a cotinine enzyme-linked immunosorbent assay (ELISA) for routine usage in operative disciplines. By correlation of smoking habits and concentration of cotinine in serum and urine, we tried to ascertain reference values for smokers, passive smokers and non-smokers. The reliability and sensitivity of the cotinine ELISA concerning nicotine exposure need to be proven. 165 (108 men, 57 women) test persons were examined by detecting cotinine in serum and urine by ELISA. The study shows a very good sensitivity, precision and reproducibility of the cotinine ELISA according to the laboratory criteria. The test shows significance of a good differentiation between smokers, passive smokers and non-smokers in urine. In serum, cotinines are excellent to differentiate between smokers and non-smokers/passive smokers. Urine and serum tests demonstrate valid and comparable results.

Processo cicatricial de sutura em ceco com os fios polipropilene, poliglecaprone 25 e glicomer 60 em ratos / Healing process with polipropilene, poliglecaprone 25 and glicomer 60 in cecorraphy in rats

RACIONAL: A despeito de grandes avanços na elucidação dos fatores locais e gerais que interferem na cicatrização, o estado atual ainda não permite dispensar o uso do fio de sutura em intervenções cirúrgicas e a busca pelo fio ideal ainda continua. OBJETIVO: Avaliar suturas em ceco de ratos realizadas com fio monofilamentar absorvível de glicomer 60 (Monosyn®), em relação aos fios polipropilene (Prolene®) e poliglecaprone 25 (Monocryl®). MÉTODO: Foram utilizados 72 ratos Wistar, divididos em três grupos de 24 denominados grupo polipropilene, poliglecaprone e glicomer. Os animais de cada grupo foram distribuídos em três subgrupos de oito e avaliados no 3º, 7º e 14º dias de pós-operatório. Os parâmetros estudados foram: teste de resistência à insuflação de ar atmosférico; aspectos macroscópicos; as características histológicas e taxa de hidroxiprolina tecidual. RESULTADOS: O teste de resistência à insuflação de ar atmosférico apresentou baixos valores no 3º dia, com elevação no 7º, mantendo-se nos mesmos níveis no 14º dia, sendo semelhantes em todos os fios estudados. Na análise estatística, não se observou diferença significativa entre os grupos no 3º, 7º e 14º dias de pós-operatório, porém houve aumento significativo da pressão auferida, comparando-se os dias 3 e 7, em todos os grupos. Na análise histológica, avaliada quanto aos aspectos de reação inflamatória, proliferação fibroblástica, colagenização, coaptação das bordas e reepitelização, houve no 7º dia significativamente mais animais do grupo polipropilene com colagenização moderada em relação aos grupos poliglecaprone e glicomer. Os demais resultados não diferiram entre os fios estudados. Na determinação da taxa de hidroxiprolina tecidual, obteve-se a menor taxa nos subgrupos de 3º dia de pós-operatório, de todos os três grupos estudados, observando-se assim paralelismo com o ganho de resistência tênsil à insuflação de ar...

BACKGROUND: Surgeons are still looking for the ideal suture material, although the progress during the last decades. AIM: To compare cecorrhaphy in rats with three different sutures: polypropylene (Prolene®), polyglecaprone 25 (Monocryl®) and glycomer 60 (Monosyn®). METHOD: Seventy-two Wistar rats were divided into three groups of 24 each (polypropylene, polyglecaprone and glycomer groups). Within each group, the animals were assigned to three subgroups and assessed on the 3rd, 7th and 14th postoperative day. The parameters studied were the bursting strength, macroscopic mucosal healing, histology and tissue hydroxyproline rate. RESULTS: The bursting strength had its lower values on the 3rd postoperative day, with significant higher values on the 7th and 14th; there was no difference among groups. In the overall, the histological analysis of the inflammatory reaction, fibroblast proliferation, collagen formation, border attachment and re-epithelization showed the same pattern among the three groups and sub-groups; only on day 7, there was seen a significant higher collagen formation in polypropylene group than polyglecaprone and glycomer groups. The tissue hydroxyproline rate was significant lower in the sub-groups of the 3rd postoperative day, in all of the three studies groups, with increase on days 7 and 14. There was a parallel gain in bursting strength and neo-collagen formation. CONCLUSION: There was no difference among glycomer 60, polypropylene and polyglecaprone sutures in performing cecorrhaphy in rats between days 3 and 14, according to the evaluated parameters.