Comparative evaluation of three laparoscopic cholecystectomy techniques in rabbit's model.

PURPOSE: The aim of this randomized study was to compare the complications and perioperative outcome of three different techniques of laparoscopic cholecystectomy (LC). Changes in the liver function test after LC techniques were investigated. Also, we compared the degree of postoperative adhesions and histopathological changes of the liver bed. METHODS: Thirty rabbits were divided into three groups: group A) Fundus-first technique by Hook dissecting instrument and Roeder Slipknot applied for cystic duct (CD) ligation; group B) conventional technique by Maryland dissecting forceps and electrothermal bipolar vessel sealing (EBVS) for CD seal; group C) conventional technique by EBVS for gallbladder (GB) dissection and CD seal. RESULTS: Group A presented a longer GB dissection time than groups B and C. GB perforation and bleeding from tissues adjacent to GB were similar among tested groups. Gamma-glutamyl transferase and alkaline phosphatase levels increased (p ≤ 0.05) on day 3 postoperatively in group A. By the 15th postoperative day, the enzymes returned to the preoperative values. Transient elevation of hepatic transaminases occurred after LC in all groups. Group A had a higher adherence score than groups B and C and was associated with the least predictable technique. CONCLUSIONS: LC can be performed using different techniques, although the use of EBVS is highly recommended.

Comparative evaluation of three laparoscopic cholecystectomy techniques in rabbit's model

Purpose: The aim of this randomized study was to compare the complications and perioperative outcome of three different techniques of laparoscopic cholecystectomy (LC). Changes in the liver function test after LC techniques were investigated. Also, we compared the degree of postoperative adhesions and histopathological changes of the liver bed. Methods: Thirty rabbits were divided into three groups: group A) Fundus-first technique by Hook dissecting instrument and Roeder Slipknot applied for cystic duct (CD) ligation; group B) conventional technique by Maryland dissecting forceps and electrothermal bipolar vessel sealing (EBVS) for CD seal; group C) conventional technique by EBVS for gallbladder (GB) dissection and CD seal. Results: Group A presented a longer GB dissection time than groups B and C. GB perforation and bleeding from tissues adjacent to GB were similar among tested groups. Gamma-glutamyl transferase and alkaline phosphatase levels increased (p ≤ 0.05) on day 3 postoperatively in group A. By the 15th postoperative day, the enzymes returned to the preoperative values. Transient elevation of hepatic transaminases occurred after LC in all groups. Group A had a higher adherence score than groups B and C and was associated with the least predictable technique. Conclusions: LC can be performed using different techniques, although the use of EBVS is highly recommended.

Correlation of serum acute-phase proteins with bone repair in rabbits (Oryctolagus cuniculus) submitted to partial radio ostectomy / Correlação do proteinograma sérico com a reparação óssea em coelhos (Oryctolagus cuniculus) submetidos à ostectomia parcial do rádio

ABSTRACT: Bone trauma triggers an acute inflammatory response, which can alter the serum concentration of acute-phase proteins (PFA). We aimed to evaluate the effectiveness of PFA measurement as a laboratory biomarker for inflammation related to bone regeneration. A partial ostectomy of the right radius was performed on 22 young male rabbits. The complete blood count, albumin, ceruloplasmin, haptoglobin, C-reactive protein, and transferrin levels were recorded and correlated with the radiographic evolution of bone healing. Statistically the best correlations with the inflammatory process and radiological findings were reported with haptoglobin and transferrin compared to the other measured PFAs. Haptoglobin and transferrin showed a maximum peak 24 and 36 hours after surgery, respectively. Transferrin displayed signs of decrease in the first 6 hours after surgery, in advance of the leukocyte response. The measurement of acute-phase proteins proved to be viable, considering the conditions in which the present study was carried out. Among all variables studied, haptoglobin and transferrin showed best correlation with the inflammatory process of bone healing. Additional studies are needed to determine the sensitivity of acute-phase proteins as predictors of complications in the treatment of fractures.

RESUMO: Os traumas ósseos desencadeiam resposta inflamatória aguda e consequentemente alteram a concentração sérica das proteínas de fase aguda (PFA), podendo essas representarem um parâmetro para avaliação da evolução do processo inflamatório relacionado à cicatrização óssea, assim como complicações. Objetivou-se avaliar a inter-relação da mensuração de PFAs com a repação óssea em coelhos submetidos à ostectomia parcial do rádio. Foram utilizados 22 coelhos, machos, jovens (160 a 180 dias) e peso médio (3,8 ± 0,3). Para acompanhamento da evolução do processo inflamatório foram realizados hemograma completo e mensuração de albumina, ceruloplasmina, haptoglobina, proteína C reativa e transferrina, além do acompanhamento radiológico. Foi observado a melhor correlação da haptoglobina e da transferrina junto ao processo inflamatório e achados radiológicos frente às demais PFAs mensuradas. A haptoglobina apresentou pico máximo 24 horas do pós-operatório e a transferrina após 36 horas, entretanto, essa última já mostrou indícios de diminuição nas primeiras 6 horas do pós-cirúrgico, antecipadamente à resposta leucocitária. Nas condições em que o presente estudo foi realizado, a mensuração das proteínas de fase aguda mostrou-se factível. Das proteínas estudadas, a haptoglobina e transferrina foram as que mostraram maior correlação com o processo inflamatório da cicatrização óssea. Estudos adicionais são necessários para determinar a sensibilidade das proteínas de fase aguda como previsores de complicações do tratamento das fraturas.

Postoperative pain behaviours in rabbits following orthopaedic surgery and effect of observer presence.

Rabbits are widely used in studies focusing on pain. However, pain is undertreated in this species and one possible factor to explain this is the lack of evaluation methods. The objective of this study was to identify behaviours related to orthopaedic pain in rabbits and to evaluate the influence of the presence of an observer on these behaviours. Twenty-eight rabbits undergoing orthopaedic surgery and filmed 24 hours before surgery, and 1 hour (before rescue analgesia), 4 hours (3 hours after rescue analgesia), and 24 hours post-recovery were observed in the presence and absence of an observer. The frequency and/or duration of behaviours were compared over time and between the presence and absence of the observer using the Friedman and Wilcoxon tests respectively. Data are expressed as median and interquartile range and a significant difference was considered when p<0.05. At 1 hour post-recovery, the rabbits showed reduced activity, hopping, change posture, position in the cage, explore, and open eyes in both the presence and absence of the observer. In the absence of the observer, quadrupedal posture, interact with pinecone, and eat carrot also decreased, while wince behaviour increased. In the presence of the observer, before surgery, the rabbits were less active (Presence-280; 162-300, Absence-300; 300-300) and presented a lower duration of explore (Presence-3; 0-32, Absence-40; 4-63). Post-recovery the rabbits flinched less (Presence-0; 0-0, Absence-0; 0-1) and suspended the affected limb less (Presence-0; 0-0, Absence-0; 0-65). After rescue analgesia the rabbits put weight on and raised the affected limb less (Presence-0; 0-0, Absence-0; 0-2) and licked the affected area less (Presence-0; 0-0, Absence-0; 0-2). These findings demonstrate that the presence of the observer inhibited pain-free behaviours in the rabbits, leading to a false impression of pain, and after the surgery the rabbits masked some pain signs related to the affected area.

Burnout e fadiga por compaixão: o mal dos tempos modernos? / Burnout and compassion fatigue: is it the modernity´s illness?

Apesar de ser um assunto que começou a ser discutido no final do século XX, pode-se dizer que a síndrome da exaustão profissional, ou burnout, teve início com a Revolução Industrial. O burnout não é um problema do indivíduo, mas do ambiente social no qual trabalha, que pode afetar negativamente o bem-estar, além de prejudicar a qualidade do serviço prestado. Pesquisas apontam que mais de 40% dos médicos podem apresentar queda no desempenho profissional devido a síndrome, a qual é mais comum naqueles envolvidos com emergências, doenças infecciosas e oncologia. Em relação à Medicina Veterinária, 14% dos veterinários demonstraram fortes evidências de burnout. Esta síndrome também pode ocorrer em estudantes, portanto não é restrita apenas ao trabalhadores. A fadiga por compaixão, também conhecida por distúrbio pós-traumático secundário, ocorre com a exaustão física, emocional, psicológica e espiritual do profissional. Seu desenvolvimento está relacionado ao grau de exposição do indivíduo aos eventos traumáticos sofridos por terceiros e à sua personalidade. O risco de ocorrer fadiga por compaixão em médicos veterinários é elevado, pois eles desenvolvem grande afeição por seus pacientes. Não há tratamento para estas duas síndromes, mas elas podem ser evitadas a partir do equilíbrio entre vida pessoal e profissional. Deste modo é possível concluir que os médicos veterinários estão no grupo de risco para desenvolvimento de burnout e fadiga por compaixão.

Despite professional exhaustion syndrome, or burnout, began to be discussed in the late twentieth century, it can be said that it started with Industrial Revolution. The burnout is not an individual problem but the social environment in which it works, that can negatively affect well-being, besides damaging the quality of service performed. Researches indicates that more than 40% of physicians can present a drop in professional performance due to syndrome, which is more common in those involved with emergencies, infectious diseases and oncology. Regarding Veterinary Medicine, 14% of veterinarians demonstrated strong evidence of burnout. This syndrome may also occur in students, thus it is not restricted only to workers. The compassion fatigue, also known as secondary posttraumatic stress disorder, is physical, emotional, psychological and spiritual exhaustion. Its development is related to the degree of personal exposure to traumatic events suffered by the others and your personality. The risk of veterinarians develop compassion fatigue is high, because they usually have great affection for their patients. There is no treatment for these syndromes, but they can be avoided from the healthy balance between work and personal life. Thus, it can be concluded that veterinarians are at the risk group to develop burnout and compassion fatigue.