RESUMO
Purpose To investigate the effects of induction of selective liver hypothermia in a rodent model. Methods Seven male Wistar rats were subjected to 90 minutes of partial 70% liver ischemia and topic liver 26°C hypothermia (H group). Other seven male Wistar rats were subjected to 90 minutes of partial 70% normothermic liver ischemia (N group). Five additional rats underwent a midline incision and section of liver ligaments under normothermic conditions and without any liver ischemia (sham group). All animals were sacrificed 24-h after reperfusion, and livers were sampled for analyses. Pathology sections were scored for sinusoidal congestion, ballooning, hepatocelllular necrosis and the presence of neutrophilic infiltrates. Results At the end of the experiment, liver tissue expressions of TNF-É, IL-1ß, iNOS and TNF-É/IL-10 ratio were significantly reduced in the H group compared to N group, whereas IL-10 and eNOS were significantly increased in H group. Histopathological injury scores revealed a significant decrease in ischemia/reperfusion (I/R) injuries in H group. Conclusion Selective liver hypothermia prevented I/R injury by inhibiting the release of inflammatory cytokines, preserves microcirculation, prevents hepatocellular necrosis and leukocyte infiltration, allowing maintenance of the liver architecture.
Assuntos
Lesão Pulmonar Aguda/prevenção & controle , Hipotermia Induzida/métodos , Fígado/irrigação sanguínea , Traumatismo por Reperfusão/prevenção & controle , Lesão Pulmonar Aguda/patologia , Animais , Temperatura Corporal , Citocinas/metabolismo , Modelos Animais de Doenças , Mediadores da Inflamação/metabolismo , Isquemia/patologia , Fígado/patologia , Masculino , Necrose/patologia , Óxido Nítrico/metabolismo , Óxido Nítrico Sintase/metabolismo , Ratos , Ratos Wistar , Traumatismo por Reperfusão/metabolismo , Traumatismo por Reperfusão/patologia , Fator de Necrose Tumoral alfaRESUMO
PURPOSE: To develop a new 24 hour extended liver ischemia and reperfusion (LIR) model analyzing the late biochemical and histopathological results of the isolated and combined application of recognized hepatoprotective mechanisms. In addition, we used a new stratification with zoning to classify the histological lesion. METHODS: A modified animal model of severe hepatic damage produced through 90 minutes of segmental ischemia (70% of the organ) and posterior observation for 24 hours of reperfusion, submitted to ischemic preconditioning (IPC) and topical hypothermia (TH) at 26ºC, in isolation or in combination, during the procedure. Data from intraoperative biometric parameters, besides of late biochemical markers and histopathological findings, both at 24 hours evolution time, were compared with control (C) and normothermic ischemia (NI) groups. RESULTS: All groups were homogeneous with respect to intraoperative physiological parameters. There were no losses once the model was stablished. Animals subjected to NI and IPC had worse biochemical (gamma-glutamyl transpeptidase, alkaline phosphatase, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, direct bilirubin, and total bilirubin) and histopathological scores (modified Suzuki score) compared to those of control groups and groups with isolated or associated TH (p < 0.05). CONCLUSION: The new extended model demonstrates liver ischemia and reperfusion at 24 hour of evolution and, in this extreme scenario, only the groups subjected to topical hypothermia, combined with ischemic preconditioning or alone, had better outcomes than those subjected to only ischemic preconditioning and normothermic ischemia, reaching similar biochemical and histopathological scores to those of the control group.
Assuntos
Isquemia/patologia , Precondicionamento Isquêmico , Fígado/irrigação sanguínea , Traumatismo por Reperfusão/patologia , Animais , Modelos Animais de Doenças , Hipotermia Induzida , Isquemia/etiologia , Fígado/patologia , Fígado/fisiopatologia , Masculino , Ratos , Ratos Wistar , Traumatismo por Reperfusão/etiologia , Fatores de TempoRESUMO
Abstract Purpose: To develop a new 24 hour extended liver ischemia and reperfusion (LIR) model analyzing the late biochemical and histopathological results of the isolated and combined application of recognized hepatoprotective mechanisms. In addition, we used a new stratification with zoning to classify the histological lesion. Methods: A modified animal model of severe hepatic damage produced through 90 minutes of segmental ischemia (70% of the organ) and posterior observation for 24 hours of reperfusion, submitted to ischemic preconditioning (IPC) and topical hypothermia (TH) at 26ºC, in isolation or in combination, during the procedure. Data from intraoperative biometric parameters, besides of late biochemical markers and histopathological findings, both at 24 hours evolution time, were compared with control (C) and normothermic ischemia (NI) groups. Results: All groups were homogeneous with respect to intraoperative physiological parameters. There were no losses once the model was stablished. Animals subjected to NI and IPC had worse biochemical (gamma-glutamyl transpeptidase, alkaline phosphatase, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, direct bilirubin, and total bilirubin) and histopathological scores (modified Suzuki score) compared to those of control groups and groups with isolated or associated TH (p < 0.05). Conclusion: The new extended model demonstrates liver ischemia and reperfusion at 24 hour of evolution and, in this extreme scenario, only the groups subjected to topical hypothermia, combined with ischemic preconditioning or alone, had better outcomes than those subjected to only ischemic preconditioning and normothermic ischemia, reaching similar biochemical and histopathological scores to those of the control group.
Assuntos
Animais , Masculino , Ratos , Traumatismo por Reperfusão/patologia , Precondicionamento Isquêmico , Isquemia/patologia , Fatores de Tempo , Traumatismo por Reperfusão/etiologia , Ratos Wistar , Modelos Animais de Doenças , Hipotermia Induzida , Isquemia/etiologia , Fígado/fisiopatologia , Fígado/irrigação sanguínea , Fígado/patologiaRESUMO
PURPOSE: To evaluate the effects of the topical liver hypothermia and IPC combination against I/R injury after initial reperfusion. METHODS: In 32 Wistar rats, partial liver ischemia was induced for 90 minutes in normothermia (IN), ischemic preconditioning (IPC), 26ºC topical hypothermia (H) and 26ºC topical hypothermia plus IPC (H+IPC). MAP, body temperature and bile flow were recorded each 15 minutes. Plasmatic injury markers and tissue antioxidant defenses were assessed after 120 minutes of reperfusion. RESULTS: MAP and body temperature remained constant during all experiment. Bile flow returned to levels similar to controls after 45 minutes of reperfusion in the H and H+IPC groups and increased significantly in comparison to the NI and IPC groups after 105 and 120 minutes. AST and ALT increased significantly in the normothermic groups in comparison to controls. TBARS levels decreased significantly in the H+IPC group in comparison to the other groups whereas Catalase levels increased significantly in the IPC group. SOD levels were significantly higher in the H group in comparison to all groups. CONCLUSION: The induction of 26ºC topical hypothermia associated or not to IPC protected the ischemic liver against ischemia/reperfusion injuries and allowed an early recovery of the hepatic function.
OBJETIVO: Avaliar os efeitos da hipotermia hepática tópica combinada ao pré-condicionamento isquêmico na proteção dos danos iniciais de isquemia e reperfusão. MÉTODOS: Trinta e dois ratos Wistar foram submetidos à isquemia hepática parcial durante 90 minutos em Normotermia (IN), Pré-condicionamento Isquêmico (IPC), Hipotermia a 26ºC (H) e Hipotermia a 26ºC mais PCI (H+PCI). A PAM, a temperatura corporal e o fluxo biliar foram aferidos em intervalos de 15 minutos. Marcadores plasmáticos de danos hepáticos e as defesas antioxidantes foram avaliados após 120 minutos de reperfusão. RESULTADOS: A PAM e a temperatura corporal permaneceram constantes durante o experimento. O fluxo biliar retornou a valores semelhantes ao grupo C nos grupos H e H+PCI após 45 minutos de reperfusão e aumentou significativamente nos grupos H e H+PCI em comparação aos grupos IN e PCI após 105 e 120 minutos. Os níveis plasmáticos da AST e ALT demonstraram aumento significativo no grupo IN em comparação ao grupo C. Os níveis de TBARS diminuíram significativamente no grupo H+PCI em comparação aos grupos IN, PCI e H. Os níveis de Catalase aumentaram significativamente no grupo PCI em comparação aos grupos C, IN e H+PCI. Os níveis de SOD foram significativamente maiores no grupo H em comparação aos grupos C, IN, PCI e H+PCI. CONCLUSÃO: A hipotermia tópica protegeu o fígado isquêmico contra os danos de isquemia e reperfusão e permitiu uma recuperação precoce da função hepática.
Assuntos
Ratos , Hipotermia , Ratos/classificação , Rim/anatomia & histologiaRESUMO
PURPOSE: To evaluate the effects of the topical liver hypothermia and IPC combination against I/R injury after initial reperfusion. METHODS: In 32 Wistar rats, partial liver ischemia was induced for 90 minutes in normothermia (IN), ischemic preconditioning (IPC), 26ºC topical hypothermia (H) and 26ºC topical hypothermia plus IPC (H+IPC). MAP, body temperature and bile flow were recorded each 15 minutes. Plasmatic injury markers and tissue antioxidant defenses were assessed after 120 minutes of reperfusion. RESULTS: MAP and body temperature remained constant during all experiment. Bile flow returned to levels similar to controls after 45 minutes of reperfusion in the H and H+IPC groups and increased significantly in comparison to the NI and IPC groups after 105 and 120 minutes. AST and ALT increased significantly in the normothermic groups in comparison to controls. TBARS levels decreased significantly in the H+IPC group in comparison to the other groups whereas Catalase levels increased significantly in the IPC group. SOD levels were significantly higher in the H group in comparison to all groups. CONCLUSION: The induction of 26ºC topical hypothermia associated or not to IPC protected the ischemic liver against ischemia/reperfusion injuries and allowed an early recovery of the hepatic function.
Assuntos
Bile/metabolismo , Hipotermia Induzida/efeitos adversos , Precondicionamento Isquêmico/efeitos adversos , Fígado/irrigação sanguínea , Traumatismo por Reperfusão/prevenção & controle , Alanina Transaminase/sangue , Animais , Aspartato Aminotransferases/sangue , Catalase/metabolismo , Modelos Animais de Doenças , Fígado/enzimologia , Fígado/patologia , Fígado/fisiopatologia , Masculino , Ratos , Ratos Wistar , Traumatismo por Reperfusão/etiologia , Traumatismo por Reperfusão/patologia , Traumatismo por Reperfusão/fisiopatologia , Substâncias Reativas com Ácido Tiobarbitúrico/metabolismoRESUMO
PURPOSE: Evaluation of the Mean Arterial Pressure (MAP) and body temperature changes in a new model of liver ischemia-reperfusion applying topical Hypothermia and Ischemic Preconditioning (IPC). METHODS: Rats (n= 32) were divided in 5 groups: Control (C), Normothermic Ischemia (NI), Ischemic Preconditioning (IPC), Hypothermia 26 degrees C plus IPC (H+IPC) and Hypothermia 26 degrees C (H). MAP and body temperature were recorded at 30 minutes intervals throughout the entire experiment. The study groups underwent 90 minutes partial hepatic ischemia followed by 120 minutes of reperfusion. The median and lateral left lobes were isolated and topical 26 degrees C hypothermia was induced by superfusion of cooled saline solution in H+IPC and H groups. A 10 minutes protocol of ischemia and reperfusion was applied in the IPC and H+IPC groups before the major ischemic insult. RESULTS: There was no significant difference in MAP and body temperature means between the groups throughout the experiments. CONCLUSION: The present model allows the induction of topical hepatic hypothermia associated or not to IPC. New studies to evaluate the possible synergistic effects of these tools can be reproduced without significant changes in macrohemodynamics and body temperature, or in other words, under stable conditions.
Assuntos
Pressão Sanguínea/fisiologia , Temperatura Corporal/fisiologia , Hipotermia Induzida/métodos , Isquemia/fisiopatologia , Precondicionamento Isquêmico , Fígado/irrigação sanguínea , Análise de Variância , Animais , Modelos Animais de Doenças , Masculino , Ratos , Ratos WistarRESUMO
PURPOSE: Evaluation of the Mean Arterial Pressure (MAP) and body temperature changes in a new model of liver ischemia-reperfusion applying topical Hypothermia and Ischemic Preconditioning (IPC). METHODS: Rats (n= 32) were divided in 5 groups: Control (C), Normothermic Ischemia (NI), Ischemic Preconditioning (IPC), Hypothermia 26°C plus IPC (H+IPC) and Hypothermia 26°C (H). MAP and body temperature were recorded at 30 minutes intervals throughout the entire experiment. The study groups underwent 90 minutes partial hepatic ischemia followed by 120 minutes of reperfusion. The median and lateral left lobes were isolated and topical 26°C hypothermia was induced by superfusion of cooled saline solution in H+IPC and H groups. A 10 minutes protocol of ischemia and reperfusion was applied in the IPC and H+IPC groups before the major ischemic insult. RESULTS: There was no significant difference in MAP and body temperature means between the groups throughout the experiments. CONCLUSION: The present model allows the induction of topical hepatic hypothermia associated or not to IPC. New studies to evaluate the possible synergistic effects of these tools can be reproduced without significant changes in macrohemodynamics and body temperature, or in other words, under stable conditions.
OBJETIVO: Avaliar as variações de temperatura corporal, pressão arterial média (PAM) em um novo modelo de isquemia e reperfusão hepático que utiliza Pré-condicionamento isquêmico e Hipotermia tópica. MÉTODOS: Ratos (n= 32) da raça Wistar foram divididos em 5 grupos: Controle (C), Isquemia normotérmica (IN), Hipotermia a 26°C (H), Pré-condicionamento isquêmico (PCI) e Hipotermia a 26°C com Pré-condicionamento isquêmico com hipotermia (H+PCI). As aferições da PAM e temperatura corporal foram realizadas em intervalos de 30 minutos. Os animais foram submetidos à isquemia hepática de 90 minutos e 120 minutos de reperfusão. Nos grupos H e H+PCI, o fígado foi isolado e resfriado por superfusão de solução fisiológica gelada. Nos grupos com PCI e H+PCI foram aplicados 10 minutos de isquemia e 10 minutos de reperfusão antes do insulto isquêmico maior. RESULTADOS: Não houve diferença na PAM e temperatura corporal entre os grupos durante todo o experimento. CONCLUSÃO: O presente modelo permite a aplicação de hipotermia local associada ou não ao PCI. Novos estudos para avaliar os possíveis efeitos sinergísticos destas ferramentas podem ser reproduzidos sem alterações significativas na macrohemodinâmica e temperatura corporal, ou seja, sob condições estáveis.
Assuntos
Animais , Masculino , Ratos , Pressão Sanguínea/fisiologia , Temperatura Corporal/fisiologia , Hipotermia Induzida/métodos , Precondicionamento Isquêmico , Isquemia/fisiopatologia , Fígado/irrigação sanguínea , Análise de Variância , Modelos Animais de Doenças , Ratos WistarRESUMO
OBJETIVO: Comparar a eficácia de dois esquemas terapêuticos de antibióticos em vítimas de trauma penetrante de abdome com lesão gastrintestinal. MÉTODO: O estudo selecionou de forma prospectiva e randomizada, vítimas de trauma abdominal penetrante com lesão gastrintestinal, dividindo-os em dois grupos, conforme o esquema terapêutico: cefoxitina perioperatória exclusivamente (Grupo 1) e associação de gentamicina e metronidazol por cinco dias (Grupo 2). Os grupos foram estratificados em três níveis de acordo com o Abdominal Trauma Index (ATI) e os desfechos analisados foram complicações infecciosas em nível de sitio cirúrgico e não cirúrgico. Escores de trauma e diversas variáveis foram coletadas, como mecanismo e intervalo trauma - tratamento, choque à admissão, volume transfundido, tempo cirúrgico e lesões de cólon. RESULTADOS: Ambos os grupos foram semelhantes e perfeitamente comparáveis, demonstrando não haver diferença na eficácia entre os esquemas antibióticos. CONCLUSÃO: Para vítimas de trauma abdominal penetrante com lesão gastrintestinal, o uso de cefoxitina restrito ao perioperatório é perfeitamente válido.
BACKGROUND: To compare the effectiveness of two antibiotics schemes in victims of penetrating abdominal trauma with gastrointenstinal lesions. METHOD: In this prospective and randomized trial, victims of penetrating abdominal trauma with gastrointestinal lesions were distributed into two groups: peroperative cefoxitin only (Group 1) and five days treatment with gentamicin associated to metronidazol (Group 2). The groups were stratified in three levels, in agreement with the Abdominal Trauma Index (ATI). End points were infectious complications at surgical and non surgical sites. Additional trauma scores and data regarding the mechanism of trauma, treatment interval, incidence of shock at the admission, transfused blood volume, surgical time and trans-operative data were collected. RESULTS: Both groups were similar and perfectly comparable, demonstrating that there was no difference in the effectiveness between the antibiotic schemes. CONCLUSIONS: For victims of penetrating abdominal trauma with gastrointestinal lesions, the use of the restricted peroperative cefoxitin scheme is valid.
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The authors report two cases of MALT (Mucosa Associated Lymphoid Tissue) lymphoma of the colon, describing their peculiarities related to diagnosis, treatment and imunopathology. Both had no signs of systemic disease and were submitted to colectomy. Follow-up was uneventful . It's emphasized about raising the possibility of a MALT neoplasm whenever investigating a colonic tumor and the value of imunocitochemistry in the correct diagnosis of these lesions. We also discuss about the pathogens of this lesion.
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Digestive fistulas are associated with significant morbidity and mortality, representing mayor challenges regarding diagnosis and the requiring management according physiopathologic basis, including hydroeletrolytic therapy, antibiotics, nutritional support, selected surgical handling and skin care. Most of these lesions are postoperative complications, especially in urgency and traumatic situations. Our objective is to revise importants aspects regarding gastrointestinal tract fistulas secondary to trauma, emphasizing classification, physiopathology, diagnosis, complications and treatment
Assuntos
Fístula do Sistema Digestório/diagnóstico , Complicações Pós-Operatórias , Fístula Biliar , Fístula Esofágica , Fístula do Sistema Digestório/etiologia , Fístula do Sistema Digestório/terapia , Fístula Gástrica , Fístula Intestinal , Fístula PancreáticaRESUMO
The authors report a case of Reexpansion Pulmonary Edema (RPE) seen at Hospital de Pronto Socorro de Porto Alegre 3 hours after drainage of spontaneous pneumothorax. The patient presented a unilateral pneumothorax with one-week duration. After pleural drainage respiratory failure occured being managed at the Intensive Care Unit with non-invasive positive pressure ventilation through facial mask. The patient had favorable outcome and was discharged asymtomatic after 72 hours.
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The authors present a case report of a victim of high power electric shock. The main electric lesion was a penetrating abdominal wound with loss of substance of the abdominal wall and an electric lesion of the hepatic segment and of the gallbladder. The surgical treatment included hepatic segmentectomy, cholecystectomy, repair of the abdominal wall with Marlex prosthesis and skin graft, besides the debridment of the lesions of extremities. The postoperative evolution was satisfactory and the follow-up for 6 months didn't show any sequelae.
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A videolaparoscopia (VL) vem contribuindo de forma crescente, para diagnóstico e terapêutica de várias afecções cirúrgicas abdominais, introduzindo profundas mudanças na cirurgia contemporânea. Esse avanço incorporou-se também às urgências traumáticas, fazendo parte da avaliação diagnóstica e, às vezes, da terapêutica do trauma abdominal. Os autores apresentam uma revisão concisa da literatura sobre a VL no trauma, atualizando o tema e discutindo os aspectos mais relevantes das indicações, limitações e complicações do método
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Traumatismos Abdominais/diagnóstico , Laparoscopia/classificação , Traumatismos Abdominais/complicações , Traumatismos Abdominais/terapiaRESUMO
Os tumores neuroendócrinos (TNE) já foram considerados raridades. Atualmente, através de novas técnicas para seu reconhecimento, tem-se identificado um número crescente destas neoplasias, sendo possível estratificá-las em subgrupos, expandindo o espectro dos neoplasmas neuroendócrinos e sua importância na prática cirúrgica atual. A imunocitoquímica, a dosagem de peptídeos e os modernos métodos de imagem proporcionam informações imprescindíveis para um diagnóstico acurado e o tratamento adequado. Este artigo tem por objetivo revisar aspectos referentes aos tumores neuroendócrinos do trato gastrointestinal relativos à história, fisiopatologia, classificação atualizada, diagnóstico e tratamento
Assuntos
Neoplasias Duodenais , Neoplasias Esofágicas , Neoplasias Gastrointestinais , Tumores Neuroendócrinos/diagnóstico , Neoplasias Pancreáticas , Tumores Neuroendócrinos/classificaçãoRESUMO
The papiloduodenectomy is a procedure that, although accomplished rarely, has its validity in selected cases of papillary tumors. It is included in this group the patients with important diseases that doesn`t have conditions of supporting the surgery of Whipple, the standard procedure for these pathologies. The authors review its experience with four patient carriers of malign neoplasia of the duodenal papila submitted to papiloduodenectomy. All the patients came jaundiced to the admission. The age varied of 62 to 82 years. The ultrassonography, the computed tomography and the endoscopy with biopsy were used for diagnosis and staging, and all the patients presented with initial stages (T1 or T2). Two patients were classified as ASA3 and the other two as ASA4, according to the American Society of Anesthesiology. All the diagnoses were proven by the pathological exam of the surgical piece. It is ended that this procedure facilitates to obtain appropriate margins and satisfactory results when indicated of appropriate way