SOLID PSEUDOPAPILLARY NEOPLASM OF THE PANCREAS.

BACKGROUND: The solid pseudopapillary neoplasm is a rare tumor of the pancreas. However, it´s etiology still maintain discussions. AIM: To analyze it´s clinical data, diagnosis and treatment. METHODS: A retrospective study of medical records of all patients treated from January 1997 until July 2015. RESULTS: Were identified 17 cases. Most patients were women (94.11%) and the average age was 32.88 years. The main complaint was abdominal mass (47.05%). The most frequent location was in the body/tail of the pancreas (72.22%) and the most frequently performed surgery was distal pancreatectomy with splenectomy (64.70%). No patient had metastases at diagnosis. Conservative surgery for pancreatic parenchyma was performed in only three cases. The rate of complications in the postoperative period was 35.29% and the main complication was pancreatic fistula (29.41%). No patient underwent adjuvant treatment. CONCLUSIONS: The treatment is surgical and the most common clinical presentation is abdominal mass. Distal pancreatectomy with splenectomy was the most frequently performed surgery for its treatment.

RACIONAL: A neoplasia sólida pseudopapilar é tumor raro de pâncreas de tratamento cirúrgico. No entanto, sua causa ainda gera discussões. OBJETIVO: Analisar os dados clínicos, do diagnóstico e do tratamento da dessa neoplasia. MÉTODOS: Estudo retrospectivo com dados médicos de pacientes tratados entre janeiro de 1997 a julho de 2015. RESULTADOS: Foram identificados 17 casos. A maioria era de mulheres (94,11%) e a média de idade foi de 32,88 anos. A principal queixa era massa abdominal (47,05%). A localização mais frequente era no corpo/cauda do pâncreas (72,22%) e a operação mais realizada foi a pancreatectomia corpocaudal com esplenectomia (64,70%). Nenhum caso apresentou metástase no momento do diagnóstico. Operação conservadora de parênquima pancreático foi realizada em apenas três casos. A taxa de complicações no pós-operatório foi de 35,29% e a principal complicação foi fístula pancreática (29,41%). Nenhum paciente realizou adjuvância no seguimento. CONCLUSÕES: A mais comum apresentação clínica da neoplasia sólida pseudopapilar é de massa abdominal. Ela é de tratamento cirúrgico e pancreatectomia corpocaudal com esplenectomia é o procedimento mais realizado para seu tratamento.

H. Pylori infection, endoscopic, histological aspects and cell proliferation in the gastric mucosa of patients submitted to roux-en-y gastric bypass with contention ring: a cross sectional endoscopic and immunohistochemical study

ABSTRACT Background Morbid obesity treatment through vertical gastroplasty Roux-en-Y gastric bypass initially used a contention ring. However, this technique may create conditions to the development of potentially malign alterations in the gastric mucosa. Although effective and previously performed in large scale, this technique needs to be better evaluated in long-term studies regarding alterations caused in the gastric mucosa. Objective To analyze the preoperative and postoperative endoscopic, histological and cell proliferation findings in the gastric antrum and body mucosa of patients submitted to the Roux-en-Y gastric bypass with a contention ring. Methods We retrospectively evaluated all patients submitted to Roux-en-Y gastric bypass with a contention ring with more than 60 months of postoperative follow-up. We compared the preoperative (gastric antrum and body) and postoperative (gastric pouch) gastric mucosa endoscopic findings, cell proliferation index and H. pylori prevalence. We evaluated cell proliferation through Ki-67 antibody immunohistochemical expression. Results In the study period, 33 patients were operated with the Roux-en-Y gastric bypass using a contention ring. We found a chronic gastritis rate of 69.7% in the preoperative period (gastric antrum and body) and 84.8% in the postoperative (gastric pouch). H. pylori was present in 18.2% of patients in the preoperative period (gastric antrum and body) and in 57.5% in the postoperative (gastric pouch). Preoperative cell proliferation index was 18.1% in the gastric antrum and 16.2% in the gastric body, and 23.8% in the postoperative gastric pouch. The postoperative cell proliferation index in the gastric pouch was significantly higher (P=0.001) than in the preoperative gastric antrum and body. Higher cell proliferation index and chronic gastritis intensity were significantly associated to H. pylori presence (P=0.001 and P=0.02, respectively). Conclusion After Roux-en-Y gastric bypass with contention ring, there was a higher chronic gastritis incidence and higher cell proliferation index in the gastric pouch than in the preoperative gastric antrum and body. Mucosa inflammation intensity and cell proliferation index in the postoperative gastric pouch were associated to H. pylori presence and were higher than those found in the preoperative gastric antrum and body mucosa.

RESUMO Contexto O tratamento da obesidade mórbida através da gastroplastia vertical com derivação gastrojejunal em Y de Roux inicialmente utilizou o anel de contenção. No entanto, essa técnica pode criar condições para o desenvolvimento de alterações potencialmente malignas na mucosa gástrica. Apesar de eficaz e realizada anteriormente em grande escala, essa técnica precisa ser melhor avaliada em estudos de longo prazo em relação às alterações causadas na mucosa gástrica. Objetivo Analisar os achados endoscópicos, histológicos e da proliferação celular na mucosa do antro e corpo gástricos no pré-operatório e no pós-operatório de pacientes submetidos à derivação gastrojejunal em Y de Roux com anel de contenção. Métodos Avaliamos retrospectivamente todos os pacientes submetidos à derivação gastrojejunal em Y de Roux com anel de contenção e mais de 60 meses de seguimento pós-operatório. Comparamos os achados endoscópicos da mucosa gástrica, o índice de proliferação celular e a prevalência do H. pylori no pré-operatório (antro e corpo gástricos) e no pós-operatório (bolsa gástrica). Avaliamos a proliferação celular pela expressão imuno-histoquímica do anticorpo Ki67. Resultados No período do estudo, 33 pacientes foram operados com a derivação gastrojejunal em Y de Roux usando anel de contenção. Encontramos a taxa de gastrite crônica de 69,7% no período pré-operatório (antro e corpo gástrico) e 84,8% no pós-operatório (bolsa gástrica). O H. pyloriestava presente em 18,2% dos pacientes no período pré-operatório (antro e corpo gástrico) e em 57,5% no pós-operatório (bolsa gástrica). O índice de proliferação celular pré-operatório foi de 18,1% no antro gástrico e 16,2% no corpo gástrico, e de 23,8% na bolsa gástrica no pós-operatório. O índice de proliferação celular pós-operatório na bolsa gástrica foi significantemente maior (P=0,001) do que no antro e corpo gástrico no pré-operatório. O maior índice de proliferação celular e a intensidade da gastrite crônica na bolsa gástrica associaram-se significantemente à presença do H. pylori(P=0,001 e P=0,02, respectivamente). Conclusão Após a derivação gastrojejunal em Y de Roux com anel de contenção, houve maior incidência de gastrite crônica e maior índice de proliferação celular na bolsa gástrica do que no antro e corpo gástricos no pré-operatório. A intensidade da inflamação da mucosa e o índice de proliferação celular encontrados na bolsa gástrica no pós-operatório associaram-se à presença doH. pylori e foram maiores do que os encontrados na mucosa gástrica do antro e corpo gástricos no pré-operatório.

Solid pseudopapillary neoplasm of the pancreas / Neoplasia sólida pseudopapilar de pâncreas

ABSTRACT Background: The solid pseudopapillary neoplasm is a rare tumor of the pancreas. However, it´s etiology still maintain discussions. Aim: To analyze it´s clinical data, diagnosis and treatment. Methods: A retrospective study of medical records of all patients treated from January 1997 until July 2015. Results: Were identified 17 cases. Most patients were women (94.11%) and the average age was 32.88 years. The main complaint was abdominal mass (47.05%). The most frequent location was in the body/tail of the pancreas (72.22%) and the most frequently performed surgery was distal pancreatectomy with splenectomy (64.70%). No patient had metastases at diagnosis. Conservative surgery for pancreatic parenchyma was performed in only three cases. The rate of complications in the postoperative period was 35.29% and the main complication was pancreatic fistula (29.41%). No patient underwent adjuvant treatment. Conclusions: The treatment is surgical and the most common clinical presentation is abdominal mass. Distal pancreatectomy with splenectomy was the most frequently performed surgery for its treatment.

RESUMO Racional: A neoplasia sólida pseudopapilar é tumor raro de pâncreas de tratamento cirúrgico. No entanto, sua causa ainda gera discussões. Objetivo: Analisar os dados clínicos, do diagnóstico e do tratamento da dessa neoplasia. Métodos: Estudo retrospectivo com dados médicos de pacientes tratados entre janeiro de 1997 a julho de 2015. Resultados: Foram identificados 17 casos. A maioria era de mulheres (94,11%) e a média de idade foi de 32,88 anos. A principal queixa era massa abdominal (47,05%). A localização mais frequente era no corpo/cauda do pâncreas (72,22%) e a operação mais realizada foi a pancreatectomia corpocaudal com esplenectomia (64,70%). Nenhum caso apresentou metástase no momento do diagnóstico. Operação conservadora de parênquima pancreático foi realizada em apenas três casos. A taxa de complicações no pós-operatório foi de 35,29% e a principal complicação foi fístula pancreática (29,41%). Nenhum paciente realizou adjuvância no seguimento. Conclusões: A mais comum apresentação clínica da neoplasia sólida pseudopapilar é de massa abdominal. Ela é de tratamento cirúrgico e pancreatectomia corpocaudal com esplenectomia é o procedimento mais realizado para seu tratamento.

Tamoxifen decreases the myofibroblast count in the healing bile duct tissue of pigs.

OBJECTIVE: The aim of this study was to evaluate the effect of oral tamoxifen treatment on the number of myofibroblasts present during the healing process after experimental bile duct injury. METHODS: The sample consisted of 16 pigs that were divided into two groups (the control and study groups). Incisions and suturing of the bile ducts were performed in the two groups. Tamoxifen (20 mg/day) was administered only to the study group. The animals were sacrificed after 30 days. Quantification of myofibroblasts in the biliary ducts was made through immunohistochemistry analysis using anti-alpha smooth muscle actin of the smooth muscle antibody. Immunohistochemical quantification was performed using a digital image system. RESULTS: In the animals treated with tamoxifen (20 mg/day), there was a significant reduction in immunostaining for alpha smooth muscle actin compared with the control group (0.1155 vs. 0.2021, p = 0.046). CONCLUSION: Tamoxifen reduced the expression of alpha smooth muscle actin in the healing tissue after bile duct injury, suggesting a decrease in myofibroblasts in the scarred area of the pig biliary tract. These data suggest that tamoxifen could be used in the prevention of biliary tract stenosis after bile duct surgeries.

Tamoxifen decreases the myofibroblast count in the healing bile duct tissue of pigs

OBJECTIVE: The aim of this study was to evaluate the effect of oral tamoxifen treatment on the number of myofibroblasts present during the healing process after experimental bile duct injury. METHODS: The sample consisted of 16 pigs that were divided into two groups (the control and study groups). Incisions and suturing of the bile ducts were performed in the two groups. Tamoxifen (20 mg/day) was administered only to the study group. The animals were sacrificed after 30 days. Quantification of myofibroblasts in the biliary ducts was made through immunohistochemistry analysis using anti-alpha smooth muscle actin of the smooth muscle antibody. Immunohistochemical quantification was performed using a digital image system. RESULTS: In the animals treated with tamoxifen (20 mg/day), there was a significant reduction in immunostaining for alpha smooth muscle actin compared with the control group (0.1155 vs. 0.2021, p = 0.046). CONCLUSION: Tamoxifen reduced the expression of alpha smooth muscle actin in the healing tissue after bile duct injury, suggesting a decrease in myofibroblasts in the scarred area of the pig biliary tract. These data suggest that tamoxifen could be used in the prevention of biliary tract stenosis after bile duct surgeries.

Severe acute pancreatitis: results of treatment.

OBJECTIVE: To evaluate the results of the Protocol for treatment of patients with severe acute pancreatitis. METHODS: We consecutively analyzed age, gender, etiology, length of hospital stay, type of treatment and mortality of 37 patients with severe acute pancreatitis from January 2002. RESULTS: The patients' ages ranged from 20 to 88 years (average 50 years), 27% were female and 73% male. Mean overall hospital stay was 47 days. Thirteen patients were treated surgically, the average operations per patient was two. There were six deaths among patients undergoing surgical treatment (46%) and two deaths in the group submitted to medical treatment alone (8.3%). The overall mortality was 21%. CONCLUSION: After modification in the form of management of patients with severe acute pancreatitis, there was a decrease in mortality and a trend for conservative management.

Resultados do tratamento da pancreatite aguda grave / Severe acute pancreatitis: results of treatment

OBJETIVO: Avaliar os resultados do Protocolo de Atendimento de pacientes com diagnóstico de pancreatite aguda grave. MÉTODOS: Foram analisados, consecutivamente, a partir de janeiro de 2002, idade, sexo, etiologia, tempo de internação, tipo de tratamento e mortalidade de 37 pacientes portadores de pancreatite aguda grave. RESULTADOS: A idade dos pacientes variou de 20 a 88 anos (média de 50 anos); 27% foram do sexo feminino e 73% do masculino. O tempo médio global de internação foi 47 dias. Treze pacientes foram tratados cirurgicamente; a média de operações realizadas foi duas por paciente. Ocorreram seis óbitos dentre os pacientes submetidos ao tratamento cirúrgico (46%) e dois óbitos no grupo submetido somente ao tratamento clínico (8,3%). A mortalidade global foi 21% CONCLUSÃO: Após a modificação na forma de abordagem dos pacientes com pancreatite aguda grave, houve diminuição da mortalidade e uma tendência para a conduta expectante.

OBJECTIVE: To evaluate the results of the Protocol for treatment of patients with severe acute pancreatitis. METHODS: We consecutively analyzed age, gender, etiology, length of hospital stay, type of treatment and mortality of 37 patients with severe acute pancreatitis from January 2002. RESULTS: The patients' ages ranged from 20 to 88 years (average 50 years), 27% were female and 73% male. Mean overall hospital stay was 47 days. Thirteen patients were treated surgically, the average operations per patient was two. There were six deaths among patients undergoing surgical treatment (46%) and two deaths in the group submitted to medical treatment alone (8.3%). The overall mortality was 21%. CONCLUSION: After modification in the form of management of patients with severe acute pancreatitis, there was a decrease in mortality and a trend for conservative management.

The repercussions of spinal cord injury on the action of the diaphragmatic crura for gastroesophageal reflux containment.

STUDY DESIGN: Cross-sectional and nonexperimental. OBJECTIVE: To detect and compare functional abnormalities in the esophagus and esophagogastric junction in 2 groups with chronic spinal injuries, 1 with injuries at the phrenic innervation level and the other at upper thoracic levels, and to relate these to gastroesophageal reflux containment. SUMMARY OF BACKGROUND DATA: There are no studies on esophageal manometry with pH metering among spinal cord injury patients. Worldwide statistics reveal that the prevalence of gastroesophageal reflux disease among spinal cord injury patients is greater than among the general population, at around 22% to 27%. The "diaphragmatic crura" has been recognized as an important antireflux barrier and should functionally be considered to be a muscle separated from the costal diaphragm. However, doubts remain regarding whether this difference relates to its innervation. METHODS: This was a cross-sectional study on 29 patients with complete spinal cord injuries: 14 quadriplegics (level C4) and 15 paraplegics (levels T1-T7). Functional abnormalities of the esophagogastric junction, esophagus, and diaphragm were investigated using esophageal manometry and diaphragmatic video fluoroscopy. Presence of gastroesophageal reflux was investigated subjectively (pyrosis and regurgitation) and objectively (pH metering and endoscopy). RESULTS: The incidence of gastroesophageal reflux disease was 27.6%, without difference between the groups. This became statistically significant when the mean diaphragmatic crural pressures were compared (quadriplegics: 37.5 +/- 17.8; paraplegics: 26.6 +/- 7.2; P = 0.048). It was also significant in relation to the prevalence of at least one of the objective and/or subjective reflux findings and/or esophageal peristaltism (quadriplegics: 85.7%; paraplegics: 40.0%; P = 0.011). CONCLUSION: Spinal injury at the level of the phrenic innervation did not predispose the quadriplegics toward greater risk of developing gastroesophageal reflux disease. Paradoxically, manometry showed significantly greater crural contractility among the quadriplegics.

Endoscopic treatment of bleeding gastric varices using large amount of N-butyl-2-cyanoacrylate under fluoroscopic guidance.

PURPOSE: We propose the use of fluoroscopic guidance for endoscopic injection of n-butyl-2-cyanoacrylate to treat gastric variceal hemorrhage to achieve placement of the safest quantity of tissue adhesive. METHODS: Ten patients with gastric varices were treated with n-butyl-2-cyanoacrylate endoscopic injection under fluoroscopic guidance for the purpose of hemostasis or prevention of recurrent bleeding. The glue was infused into the varices in the quantities needed to achieve complete obliteration of the gastric varices. RESULTS: The median quantity of tissue adhesive required in this series was 6.6 mL. The procedure was initially considered successful in all patients. There were no complications relating to the procedure. The mean duration of follow-up was 20 months. CONCLUSIONS: Injection of suitable quantities of cyanoacrylate under fluoroscopic guidance seems to be safe and effective for controlling hemorrhagic gastric varices.

Complicações especificas em pós-operatórios de cirurgia de Nissen por via laparoscópica: ensaio iconográfico / Specific complications after laparoscopic Nissen fundoplicaton: iconographic essay

O objetivo do presente estudo é demonstrar, por meio de radiografias contrastadas, os aspectos de imagem de complicações específicas da cirurgia de Nissen realizada por via laparoscópica. Foram selecionados pacientes do setor de radiologia contrastada de um hospital universitário. Os pacientes foram submetidos a seriografias esôfago-estômago-duodeno, realizadas por residentes e sob a supervisão de um mesmo médico radiologista com experiência em trato digestivo. O tempo de pós-operatório e os sintomas apresentados eram variáveis. Apresentamos as seguintes imagens radiológicas descritas no pós-operatório de cirurgia de Nissen por via laparoscópica: formação de pseudotumor, estômago em ampulheta, migração da válvula e recidiva da hérnia. A fundoplicatura de Nissen é o tratamento cirúrgico mais utilizado para a doença do refluxo gastroesofágico. Diversas complicações têm sido observadas no pós-operatório desta cirurgia, podendo estar relacionadasou não a sintomas específicos. Os radiologistas devem estar familiarizados com o aspecto dessas complicações e aptos a reconhecê-las através da radiografia contrastada, método já consagrado na demonstração dessas alterações.

The purpose of this study is to demonstrate, through radiographicbarium swallow upper tract studies, radiographic aspect of specific complications of laparoscopic Nissen fundoplication. We selected patients from the radiology section of a university hospital. The patients underwent esophagus-stomach-duodenum seriographies. The examinations were conducted by residents under the supervision of a radiologist with experience in digestive tract. Time between surgery and examination and the patients' symptoms were variable. We present radiographic images described in patients after Nissen fundoplication: pseudo-tumor formation, hourglass stomach, migration of the wrap and recurrent hernia. Nissenfundoplication is the most used surgical treatment in the gastroesophagicreflux disease. Many complications have been reported after the surgery. They may be or may not be related to specificsymptoms. Radiologist should be familiar with the image aspect of these complications and should be able to recognize them using an upper gastrointestinal tract study.

Emergencia y Trayecto de las Arterias Epigástricas Superiores: Aplicación en los Abcesos Quirúrgicos Abdominales / Emergency and Trajectory of the Superior Epigastric Arteries: Aplication on the Assessement Abdominal Surgery

El conocimiento de la vascularización de la pared anterior del abdomen es un importante instrumento para la realización de incisiones y punciones abdominales, contribuyendo a evitar algunas complicaciones reurrentes de este procedimiento. Con el propósito de estudiar la emergencia y el trayecto de las arterias epigástricas superiores, fueron disecados 32 cadáveres adultos, del sexo masculino, no fijados, blancos y no blancos, con edades entre 18 y 65 años. Se observó el trayecto de las arterias epigástricas superiores, su emergencia y su forma de distribución. Las arterias epigástricas superiores emergieron por atrás del 7 cartílago costal en todos los casos. En el 75% de los casos las arterias epigástricas se presentaron como un tronco único y en 15 casos (23,44%) bifurcadas, siendo 11 a la derecha y 4 a la izquierda y en 1 caso (1,56%) a la izquierda. En este último, caso dio origen a tres ramos principales. Cuando era un tronco único, su trayecto fue descendente de medial para lateral en relación al margen lateral del músculo recto del abdomen. Cuando era bifurcada, sus ramos se separaron uno del otro luego de su emergencia, volviendo a convergir próximo a la cicatriz umbilical.

The knowledge of the vascularization of the anterior abdominal wall is very important on the incisions and abdominal punctures, contributing to avoid the injuries of this vessels during this procedures. With the goal to study the emergency and the trajectory of the superior epigastric arteries, 32 adult not preserved cadavers, of the masculine sex, white and not white, with age between 18 and 65 years were studied. The trajectory of the superior epigastric arteries, your emergency and distribution form were observed. The superior epigástric arteries emerged behind to 7th costal cartilage in all the cases. In 75% of the cases they appeared like an only trunk and in 15 cases (23,44%) they appeared forked, being 11 to the right and 04 to the left and in 01 case (1,56%) to the left, it'd origin three main branches. When in an only trunk, your trajectory went descending of medial for lateral in relationship to the lateral margin of the rectus abdominal muscle. When forked, your branches separated one of the other immediatelly after your emergency, back converging close to the umbilical scar.

Hypertonic glucose solution 10 percent - 25 percent on the mesenterium and peritoneum of the rat: macroscopic and microscopic study

OBJETIVO: Investigar as alterações macroscópicas e microscópicas do mesentério e do peritônio parietal quando se administra a solução aquosa de glicose hipertônica a 10% e a 25% na cavidade peritoneal de rato.MÉTODOS: 90 ratos fêmeas (n=90), adultos, "Wistar", jovens, com peso variando de 180 a 250 gramas foram divididos em 3 sub-grupos (A, B e C) contendo cada um 30 animais com procedimentos idênticos, diferindo apenas no período de observação. Os números de 1 a 30 constituem o grupo A ou grupo-controle (NaCl 0,9%), os números de 31 a 60 constituem o grupo B ou grupo-glicose a 10% e os números de 61 a 90 constituem o grupo C ou grupo- glicose a 25%. Realizando-se posteriormente laparotomia com incisão mediana longitudinal de pele a 2 cm abaixo do processo Xiphoideus sterni, estendendo-se por 3 cm caudalmente na linha média ventral. A escolha do procedimento a ser realizado para introdução na cavidade peritoneal de 2 ml de uma solução de cloreto de sódio 0,9% (controle), de glicose hipertônica a 10% e de glicose hipertônica a 25%. Em períodos correspondentes às 6h, 24h e 48h de pós-operatório, os animais de cada grupo foram reoperados, sendo realizada avaliação macroscópica e microscópica além dos registros das alterações histológicas do mesentério e peritônio parietal.RESULTADOS: Na microscopia do mesentério observou-se que 30 animais (33,4%) apresentaram linfonodos hiperplásicos; 6 animais (6,6%) com fibrose reacional; 10 animais (11,1%) com intensa congestão vascular; 16 animais (17,8%) com inflamação crônica inespecífica; 28 casos (31,1%) sem alteração. A microscopia do peritônio revelou 6 casos com fibrose reacional (3,3%) 174 casos (96,7%) sem alteração histológica. CONCLUSÃO: As soluções de glicose a 10% e a 25% não causam necrose tecidual quando introduzidas na cavidade peritoneal. O processo reacional inflamatório é de igual intensidade tecidual comparando-se ao uso da solução de NaCl a 0,9%.

Hypertonic glucose solution 10%-25% on the mesenterium and peritoneum of the rat: macroscopic and microscopic study.

PURPOSE: The objective of the experimental study is to detect the macroscopic and microscopic alterations of the mesenterium and parietal peritoneum when hypertonic glucose aqueous solution 10%-25% is administrated into the peritoneal cavity of the rat. METHODS: 90 Wistar females young rats adults were used weighing between 180-250 g, numbered 1 to 90, establishing unique group and divided in three groups (A, B, C) of 30 animals chosen aleatory manner. 0.9% saline solution was used called control group, or group A, 10% glucose solution named group B, and in the others 30 was used 25% glucose solution named group C, differing in the observation period, (06 h, 24 h and 48 h), but with the same procedure. A midline abdominal wall laparotomy was made and in the animals of the control group was injected 2 ml of a 0.9% saline solution into the peritoneal cavity. After, we made a suture in mass without to include the peritoneum. For the others groups (B, C) the rats received 10% glucose solution and 25% glucose solution injected into the peritoneal cavity respectively. All groups were kept under observation and the results were submitted to statistical analysis by a longitudinal and transversal comparative study. RESULTS: A new surgery was done in 6 h, 24 h and 48 h, and we observed in macroscopic evaluation, the presence of fluid, serous uniform and rosy all over the cavity. Vascular congestion was present. We dried out 90 fragments of mesenterium and 90 fragments of parietal peritoneum bilateral. In the microscopic study, necrosis was not present. For the mesenterium histological study we observed 16 cases (17.8%) unspecific chronic inflammation, 30 cases (33.4%) hyperplasc linfonod, 10 cases (11.1%) high vascular congestion, 6 cases (6.6%) reaction fibrosis and 28 cases (31.1%) no alteration. For the parietal peritoneum histological study we observed 6 cases (3.3%) reaction fibrosis and 174 cases (96.7%) no alteration. Giant cell was not present. In the statistical analysis statistic there is no significance between the groups (p>0.05). CONCLUSION: Hypertonic glucose solution and NaCl 0.9% on the mesenterium and parietal peritoneum do not produce tissue necrosis in a rat and the inflammation process has the same intensity.

Prevalência e fatores associados à bacteremia nos portadores de colecistite aguda litiásica / Bacteremia - prevalence and associated factors in patients with acute calculous cholecystitis

OBJETIVO: Determinar a prevalência de bacteremia e os fatores associados no período pré-operatório em portadores de colecistite aguda litiásica e analisar comparativamente as complicações e mortalidade nos pacientes com e sem bacteremia, que foram submetidos a colecistectomia de urgência. MÉTDODOS: Foram estudados, prospectivamente, 51 pacientes com diagnóstico histopatológico de colecistite aguda litiásica. O sistema Bactec foi o método utilizado para a detecção de bacteremia. As médias dos grupos foram analisadas quanto às variáveis clínicas e laboratoriais, relacionando-as com a bacteremia. RESULTADOS: A prevalência de bacteremia no pré-operatório foi de 15,68 por cento, e a idade (p=0,024), a freqüência cardíaca (p=0,026), a freqüência respiratória (p=0,028), a creatinina (p=0,028) e a presença da SIRS (Síndrome da Resposta Inflamatória Sistêmica, p=0,016) associaram-se positivamente com a bacteremia. Nos portadores de bacteremia verificou-se um óbito, maior número de complicações gerais (p=0,045) e infecciosas (p=0,039) e maior tempo de internação (p<0,005). CONCLUSAO: Nessa amostra, utilizando-se o sistema Bactec, a prevalência de bacteremia foi considerável. Fatores clínicos e laboratoriais estão associados à bacteremia e a sua presença associa-se à maior gravidade dos pacientes e pior prognóstico em relação às complicações no pós-operatório nos portadores de colecistite aguda litiásica.

[Bacteremia -- prevalence and associated factors in patients with acute calculous cholecystitis]. / Prevalência e fatores associados à bacteremia nos portadores de colecistite aguda litiásica.

BACKGROUND: Bacteremia seems to increase the morbidity and mortality in clinical and surgical conditions, however the importance and factors associated with it during acute calculous cholecystitis are not well established. The purpose of this study was to determine pre-operative prevalence, associated factors and prognosis of bacteremia in patients with acute calculous cholecystitis submitted to an emergency cholecystectomy. METHODS: A prospective study of 51 patients with histological diagnosis of acute calculous cholecystitis was designed. The Bactec System was used to detect bacteremia. Mean results of clinical and laboratory analyses were related to the presence of bacteremia. RESULTS: The pre-operative prevalence of bacteremia was of 15.68%. Age (P=0.024), heart rate (P=0.026), respiratory rate (P=0.028), serum creatinine (P=0.028) and presence of systemic inflammatory response syndrome (P=0.016) were positively associated with bacteremia. Bacteremic patients had statistically higher overall (P=0.045) and infectious (P=0.039) complication rates and longer hospitalization (P<0.005) including one death. CONCLUSIONS: Patients with acute calculous cholecystitis have a considerable prevalence of bacteremia in the pre-operative period. It is associated with old age, heart rate, respiratory rate, serum creatinine and systemic inflammatory response syndrome. In patients with acute calculous cholecystitis, presence of bacteremia may be associated to severity of the condition and poor outcome related to pos-operative complications.

Aspecto endoscópico da papila amior do duodeno em portadores de pancreatite aguda biliar / Endoscopic aspect of the greater duodenal papila in patients with acute bilary pancreatitis

A junçäo biliopancreática ocupa posiçäo estratégica na etiopatogenia da pancreatite aguda biliar(PAB). Opie(1901) fundamenta a teoria do canal comum para explicar a etiopatogenia dessa doença, na ocorrência de obstruçäo do óstio da papila maior do duodeno ou da ampola de Vater, como agente desencadeante da doença. Em decorrência disso, muitos autores indicam a realizaçäo da papilotomia endoscópica de rotina na PAB. Objetivo: O objetivo deste estudo é detectar por via endoscópica, as alteraçöes macroscópicas da papila de Vater em portadores de PAB. Casuística e método: Foram submetidos à duodenoscopia (fibroendoscopia ou viedoendoscopia) 62 pacientes portadores de PAB, nas primeiras 24 horas da sua admissäo ao PS do Hospital Säo Paulo. resultados: o orifício papilar foi identificado em 60 (98,4 por cento) pacientes e a presença de cálculo retido na regiäo ocorreu em 10 (16,70 por cento). Em 31 (51,7 por cento) o óstio encontrava-se pérvio e em 19 (31,7 por cento) impéervio, com aspecto puniforme. A mucosa periostial apresentava-se sem alteraçöes em 28 (45,2 por cento). Conclusäo: A duodenoscopia em portadores de PAB, detecta alteraraçöes importantes na papila maior do duodeno, que podem ser levadas em consideraçäo na indicaçäo da papilotomia endoscópica

Glucagonoma: relato de caso e revisäo de literatura / Glucagonoma: case report and literature review

Glucagonoma é um tumor neuroendócrino de células alfa pancreáticas que se manifesta através de eritema necrolítico migratório, hiperglucagonemia, intolerância à glicose, emagrecimento, anemia e hipoaminoacidemia. Relata-se caso de glucagonoma em paciente de 38 anos, diagnosticado através da presença de tumoraçao em pâncreas, metástases hepáticas, emagrecimento, intolerância à glicose, eritema necrolítico migratório, hiperglucagonemia (1400 pg/ml; normal < 200 pg/ml) e histologia, demonstrando reaçao ao glucagon e enolase neurônio-específica pela imunohistoquímica. A terapêutica atual do glucagonoma inclui cirurgia, quimioterapia, somatostatina ou octreotide para controle dos sintomas e, mais recentemente, a utilizaçao do alpha-interferon.

Pode a pancreatocolangiografia contribuir para a propedêutica de doentes que já têm o diagnóstico clínico-laboratorial de icterícia obstrutiva? / Can cholangiopancreatography contribute to the propedeutics of patients with clinico-laboratory diagnosis of obstructive jaundice?

De um total de 359 pancreatocolangiografias retrógradas por via endoscópica (PCRE) realizadas no período de 1980 a 1986, analisam-se 99 doentes cuja indicaçäo do exame havia sido a icterícia obstrutiva comprovada por meios clínicos e laboratoriais. Aplicado com finalidade diagnóstica, o exame foi considerado conclusivo em 88,9% das vezes, total que inclui 78,8% de doentes nos quais a PCRE permitiu confirmar o diagnóstico da obstruçäo e 10,1% de casos em que se afastou qualquer processo obstrutivo extra-hepático como causa de icterícia. Ocorreram duas intercorrências (2,0%). Os índices de acuidade (88,9%), de sensibilidade (100,0%) e de especificidade (100,0%) reafirmam a utilidade da PCRE nas situaçöes analisadas e contribuem para apurar o diagnóstico etiológico e topográfico da obstruçäo, bem como identificam os casos nos quais o tratamento cirúrgico näo deve ser indicado

Recidiva de carcinoma esofagiano transposto pós-esofagectomia sem toracotomia / Esophageal carcinoma recidivation in transposed stomach postesophagectomy without thoracotomy

Säo apresentados cinco doentes com carcinoma espinocelular de esôfago, recidivado no estômago transposto ao tórax, pelo mediastino posterior, após ressecçäo esofágica sem toracotomia. A infiltraçäo dos bordos da ressecçäo é motivo conhecido de recidiva na anastomose, como ocorreu em um dos doentes. A recidiva do carcinoma no corpo gástrico, com a anastomose preservada, manifestada por sangramento digestivo alto, parece ser ocorrência rara e pode ser explicada pelo crescimento do tumor residual no mediastino, invadindo por contiguidade a parede do estômago transposto. Dessa maneira, enfatiza-se a falta de radicalidade oncológica quando se realiza a ressecçäo sem toracotomia e a inconveniência de se utilizar o leito esofagiano (mediastino posterior) para a reconstruçäo do trânsito