Roux-en-Y gastric bypass in rat reduces mu-opioid receptor levels in brain regions associated with stress and energy regulation.

Roux-en-Y gastric bypass surgery (RYGB) is the most common and effective weight loss procedure for severe obesity. However, a significant increase in addictive behaviors and new-onset substance use disorder (SUD) are sometimes observed post-surgery. The endogenous opioid system is known to play a major role in motivated behavior and reward, as well as the abuse of substances, including alcohol, tobacco, opioids and highly palatable foods. Here, we examined the effects of RYGB on mu-opioid receptor levels in the brain. Male Sprague-Dawley rats were assigned to one of four groups: standard diet with sham surgery (control), ad libitum high-energy high-fat (HF) diet with sham surgery, calorie restricted HF diet with sham surgery (Sham-FR), or HF diet with RYGB surgery. Control and HF groups were fed their respective diets for 8 weeks, with surgery performed on the eighth week. After 9 weeks on their respective diets post-surgery, animals were sacrificed for mu-opioid receptor autoradiography using the [3H] [D-Ala2,N-Me-Phe4-Gly5-ol]- enkephalin (DAMGO) ligand. Rats with RYGB showed reduced DAMGO binding in the central amygdala compared to sham-operated HF diet controls, and in the hypothalamus compared to high-fat fed Sham-FR. Diet alone did not change [3H] DAMGO binding in any region. These findings show that RYGB surgery, independent of diet or caloric restriction, decreases mu opioid signaling in specific regions important for stress and energy regulation. Thus, RYGB surgery may lead to greater stress sensitivity via downregulated mu opioid signaling in the central amygdala, which may contribute to the observed increased risk in some subjects for addictive behavior.

The antidepressant effect of bone marrow mononuclear cell transplantation in chronic stress.

BACKGROUND: Inflammation could be a risk factor for the development of depression and change the outcome of this common chronic-recurrent mental disorder. AIMS: This study aimed to investigate if bone marrow mononuclear cell (BMMC) transplantation is effective in restoring sucrose preference in rats subjected to chronic stress (CS), if it has an anti-inflammatory effect and is able to restore damaged DNA. METHODS: The effect of BMMC transplantation was studied in a controlled protocol (compared with a control group and a selective serotonin reuptake inhibitor escitalopram group) involving sucrose preference in CS in rats. Measurements were taken of the amygdala, hippocampus, frontal cortex, and other brain areas, the spleen and blood pro-inflammatory cytokines, namely interleukin-1ß, interleukin-6, tumor necrosis factor-alpha, and interferon-gamma, as well as anti-inflammatory cytokine interleukin-10. Finally, 8-hydroxy-2'-deoxyguanosine (a DNA damage marker) was determined. RESULTS: BMMC transplantation was as effective as escitalopram in restoring sucrose preference. It also had an anti-inflammatory effect and slightly improved damaged DNA after one week. CONCLUSIONS: These findings suggest administration of BMMC in rats subjected to CS restores sucrose preference, resolves inflammation in both the peripheral and central nervous system, as well as diminishes DNA damage. This effect was similar to that of escitalopram, which is effective in the treatment of depressive patients.

Statistical Analysis of Influences on the Psychosocial Status of Children With Hemangiomas and Their Families.

The psychologic stress on the child and family, which arise from hemangiomas, the most common neoplasm of childhood, cannot be overestimated. This study determined the preoperative and postoperative psychosocial status and variation among Oriental children with hemangiomas and their families by questionnaire. Thirty patients who underwent surgery for hemangiomas were assessed for preoperative and postoperative psychosocial status by questionnaire. The distribution of the total mean score and variation between the preoperative and postoperative status was estimated. Based on these results, the significance was statistically analyzed according to variable determinants. This study showed that hemangiomas have harmful effects on psychosocial status of patients and families. After corrective surgery, an improvement in psychosocial status was noted with respect to the self-esteem category or categories related to social activity, and in the following variables, women, face, and dissatisfaction with appearance. When the authors care for patients with hemangiomas and their families, the psychosocial health must be presumed to be at particular risk. Earlier surgical interventions with esthetic concerns have permitted the patient and family the opportunity to reduce the psychologic impact that the hemangioma may otherwise have.

Perioperative humoral stress response to laparoscopic versus open aortobifemoral bypass surgery.

Minimally invasive surgery seems to reduce hormonal stress response to surgery, but has not previously been examined in major abdominal vascular surgery. Aortic cross-clamping time and operation time is known to be longer in the totally laparoscopic aortobifemoral bypass (LABF) as compared to open aortobifemoral bypass (OABF). The main objective of our study was to measure the hormonal stress response during surgery and aortic cross-clamping in patients undergoing a totally laparoscopic versus an open aortobifemoral bypass. This was a sub-study of a larger randomized controlled multicentre trial. Thirty consecutive patients with severe aortoiliac occlusive disease were randomized to either a laparoscopic (LABF) or an open (OABF) procedure. The surgical stress response was measured by perioperative monitoring of adrenocorticotropic hormone (ACTH), aldosterone, metanephrine and cortisol at eight different time-points. During surgery. there was an increase in all humoral stress markers in both groups. The analysis of covariance showed increased levels of cortisol and ACTH in open group at 24 h time-point as compared to the baseline and this difference was statistically significant between the two groups, which indicate an earlier return to baseline levels in the laparoscopic group. Results from the General Estimated Equations (GEE) model indicate that LABF generates a lower level of metanephrine and higher level of aldosterone as compared to OABF. In conclusion, although they have higher levels of ACTH, aldosterone and cortisol during surgery, the patients operated with a laparoscopic aortobifemoral bypass achieve earlier hormonal homeostasis after surgery compared to open aortobifemoral bypass.

Uso exclusivo de fios absorvíveis em fendas labiopalatais / Exclusive use of absorbable suture threads in cleft lip and palate

INTRODUÇÃO: O tratamento de fendas labiopalatais tem etapas que podem trazer traumas psicológicos consideráveis aos pacientes e familiares. O uso de fios absorvíveis pode eliminar um destes momentos desconfortáveis. Contudo, a utilização exclusiva deste tipo de material de síntese ainda não é a preferência de todos os cirurgiões, principalmente em planos musculares. MÉTODOS: Levantados os dados dos pacientes operados no Hospital Universitário da Universidade Federal do Rio de Janeiro, submetidos à correção de fendas labiais ou palatais, nas quais foram utilizados somente fios absorvíveis (poliglecaprona 25 - Monocryl® ou poliglactina 910 - Vicryl Rapide®) em todos os panos de sutura (mucosa, músculo, pele). O período avaliado foi de 2007 a 2014. RESULTADOS: Encontramos 360 pacientes que se enquadraram no estudo. Não observamos diferenças quanto ao aspecto local das feridas durante o processo de absorção dos fios. A incidência de deiscências ou fístulas se manteve abaixo de 1% e não houve complicações relacionadas ao objetivo do estudo. As cicatrizes não se mostraram, a longo prazo, diferentes das obtidas com o uso de fios inabsorvíveis, utilizados em outros tipos de cirurgias. CONCLUSÕES: O uso exclusivo destes fios absorvíveis se mostrou uma opção eficaz e segura. Proporcionou cicatrizes de boa qualidade, força tênsil adequada (mesmo em planos musculares) e não observamos complicações relacionadas ao processo de absorção dos materiais empregados.

INTRODUCTION: The treatment of orofacial clefts comprises steps that may result in considerable psychological trauma for patients and their caregivers. The use of absorbable sutures may help to eliminate these uncomfortable situations. However, the exclusive use of this synthetic material is still not preferred by surgeons, particularly in the muscle planes. METHODS: Data from patients who underwent surgery at the University Hospital of the Federal University of Rio de Janeiro from 2007 to 2014 were used. The patients underwent correction of cleft lip or palate, using only absorbable sutures (poliglecaprone 25 - Monocryl® or polyglactin 910 - Vicryl Rapide®) in all suture planes (mucosa, muscle, skin). RESULTS: We found 360 patients who met the inclusion criteria for this study. We did not observe differences in terms of the local appearance of the wounds during the suture absorption process. The incidence of dehiscence or fistula cases was below 1%, and there were no complications regarding the objectives of the study. In the long term, the scars did not differ from those obtained with non-absorbable sutures used in other types of surgeries. CONCLUSIONS: The exclusive use of absorbable sutures was shown to be an efficient and safe option. These resulted in good quality scars and adequate tensile strength (even in muscle planes), and we did not observe complications related to the absorption process of the material used.

[Dependence of the operation stress degree from the kind of operative intervention for an acute cholecystitis in the patients with high operative-anesthesiological risk].

The results of comparison between the operation stress degree in various kinds of surgical interventions, performed for an acute cholecystitis, using determination of cortizol, prolactin and glucose content before the operation, intraoperatively and postoperatively in 50 patients, are adduced. There was established, that the largest (in 5.3 times) and the most durable (more than 24 hours) intr erative raising of the cortizol level in the blood serum was noted in patients, to whom open cholecystectomy (OCH) was done, and the minimal (in 2.2 times) and the least durable (up to 1 hour)--while performing transcutaneous transhepatic draining (TTD) of gallbladder under ultrasonographic control. While performance of laparoscopic cholecystectomy (LCH) there was noted the most pronounced intraoperative raising of prolactin level (in 3.6 times) and more rapid its lowering (during 24 hours) in comparison with such while the OCH performance (during 72 hours). In TTD there was observed the minimal intraoperative inhancing of the prolactin level (in 2.3 times) and its duration (during 1 hour) postoperatively. The above mentioned have witnessed, that while TTD of gallbladder performance stimulation of the anterior hypophysis is significantly lesser, than while LCH and OCH.

Psychological aspects of scoliosis surgery in children.

Children in the scoliosis surgery ward rarely have the possibility of meeting a psychologist to get support in this difficult situation. As we know, not all children can manage their pain on their own and discharge anger born out of the situation in a constructive way. The purpose of the study is to estimate the strength of individual beliefs conditioning the management of pain (internally), the influence of staff on the management of pain (the influence of others) as well as accidental factors. Also, the objective is to estimate the level of internal and external expression of anger and to estimate the mood of a child before and after the surgery. 52 children between the age of 12.5-17 years old (35 girls and 17 boys) were examined with the Pain Control Beliefs questionnaire by Suzanne Skevington and the Expression of Anger Scale by Oginska. Children who believed their pain was an accidental occurrence reported their mood as being at its lowest, before and after the procedure. Their estimation of the pain experience was the highest. The group taking part in the examination (except for one person) showed a much higher internal expression of anger than that of external which could suggest that they cannot discharge their anger arising out of this difficult situation. It is recommended to expand this research on a bigger group of children and to include psychological support as a standard procedure before and after the surgery for spinal deformity in order to decrease the level of fear and to work with constructive anger discharge.

The impact of cochlear implantation on tinnitus, stress and quality of life in postlingually deafened patients.

Tinnitus is a common complaint in the candidates for cochlear implantation (CI). Tinnitus-related distress has often been measured in these patients using categorical ratings, which lack information about tinnitus severity, stress and health-related quality of life or their correlation. Here, using 4 validated questionnaires, we evaluated psychometric parameters and the quality of life of 32 postlingually deafened patients before and after CI. The data regarding pre-CI were collected retrospectively. Of all patients included in this study, 28 (87.5%) suffered from tinnitus before implantation. Following a mean of 24 months after surgery, these patients reported a significant decrease (39.2%) of tinnitus impairment, as measured by the Tinnitus Questionnaire. In none of the 28 patients has tinnitus worsened. Moreover, the 4 tinnitus-free patients remained so after the CI surgery. In addition, the implant supply resulted in 36.7% reduction in perceived stress and in 15.4% reduction in evasive coping. In addition, the focus on positive coping has improved by 12.3%, whereas the health-related quality of life improved by 53.4% in all patients. Tinnitus impairment and stress were reduced more strongly in patients who had initially higher scores. Interestingly, a significant correlation between the psychometric scores was found mainly after CI. Our results indicate that patients with higher tinnitus-related distress have a lower quality of life, lesser coping abilities and perceive more stress, but before implantation it is masked by deafness. We conclude that tinnitus-related screening of patients before and after CI is an important step in the identification of individuals who would benefit from specific fitting and/or tinnitus therapy after implantation.

Restoring dignity: social reintegration after obstetric fistula repair in Ukerewe, Tanzania.

This study explores barriers and facilitating factors women experience re-integrating into society after treatment of an obstetric fistula in rural Tanzania. A total of 71 women were interviewed in the Mwanza region of Tanzania, including a community control group. The majority of the women who received successful surgical repairs reported that, over time, they were able to resume many of the social and economic activities they engaged in prior to the development of a fistula. Familial support facilitated both accessing repair and recovery. For 60% of the women recovering from an obstetric fistula, work was the most important factor in helping them feel 'normal again'. However, physical limitations and other residual problems often hampered their ability to continue working. All of the treated women expressed interest in follow-up discussions with health care providers regarding their health and concerns about future pregnancies. Special attention is needed for women who are not completely healed and/or for those who experience other related medical or emotional problems after repair, especially if they lack a social network.

Assessing the impact adenotonsilectomy has on the lives of children with hypertrophy of palatine and pharyngeal tonsils.

UNLABELLED: The hypertrophy of the palatine and pharyngeal tonsils is extremely common in children, being one of the most frequent causes of visits to otolaryngologists and such problem can impair the child's quality of life. AIM: to evaluate the impact of adenotonsillectomy on the lives of children with hypertrophied tonsils. MATERIALS AND METHODS: Contemporary longitudinal cohort study. A specific questionnaire used to evaluate the quality of life - OSD-6, was given to seventy five parents or guardians of children previously submitted to adenotonsillectomy, before the surgery and thirty days afterwards. RESULTS: The adenotonsillectomy provided a significant reduction in the questionnaire score. DISCUSSION: Snoring and nasal obstruction were the symptoms with the highest scores. There is a great concern from the parents with the snoring of the children and a poor statistic correlation between the degree of obstruction degree and a worse quality of life. CONCLUSION: Adenotonsillectomy causes a relevant impact in the quality of life of children with tonsil hypertrophy.

Avaliação do impacto da adenotonsilectomia sobre a qualidade de vida em crianças com hipertrofia das tonsilas palatinas e faríngeas / Assessing the impact adenotonsilectomy has on the lives of children with hypertrophy of palatine and pharyngeal tonsils

A hipertrofia das tonsilas palatinas e faríngeas é extremamente comum na infância, sendo um dos problemas mais freqüentes do consultório do otorrinolaringologista, podendo prejudicar a qualidade de vida das crianças. OBJETIVO: Avaliar o impacto da adenotonsilectomia sobre a qualidade de vida das crianças que apresentam aumento do volume das tonsilas. MATERIAL E MÉTODOS: Estudo de coorte contemporâneo longitudinal. Foi aplicado a setenta e cinco pais ou responsáveis por crianças submetidas a adenotonsilectomia um questionário específico para a avaliação da qualidade de vida, OSD-6, antes do procedimento cirúrgico e trinta dias após. RESULTADOS: A adenotonsilectomia proporcionou significativa diminuição na pontuação obtida no questionário. DISCUSSÃO: Ronco e a obstrução nasal foram os sintomas responsáveis pelas maiores pontuações nos questionários. Existe grande preocupação dos pais com o ronco das crianças e pobre correlação estatística entre o grau de obstrução e a pior qualidade de vida. CONCLUSÃO: A adenotonsilectomia apresenta impacto relevante na qualidade de vida das crianças com hipertrofia das tonsilas.

The hypertrophy of the palatine and pharyngeal tonsils is extremely common in children, being one of the most frequent causes of visits to otolaryngologists and such problem can impair the child's quality of life. AIM: to evaluate the impact of adenotonsillectomy on the lives of children with hypertrophied tonsils. MATERIALS AND METHODS: Contemporary longitudinal cohort study. A specific questionnaire used to evaluate the quality of life - OSD-6, was given to seventy five parents or guardians of children previously submitted to adenotonsillectomy, before the surgery and thirty days afterwards. RESULTS: The adenotonsillectomy provided a significant reduction in the questionnaire score. DISCUSSION: Snoring and nasal obstruction were the symptoms with the highest scores. There is a great concern from the parents with the snoring of the children and a poor statistic correlation between the degree of obstruction degree and a worse quality of life. CONCLUSION: Adenotonsillectomy causes a relevant impact in the quality of life of children with tonsil hypertrophy.

Avaliação do estresse psíquico em pacientes submetidos a operações de grande porte sob anestesia geral / Assessment of psychic stress in patients submitted to big surgical procedures under general anaesthesia

INTRODUÇÃO: Estudo realizado em clínicas cirúrgicas de dois hospitais de Belo Horizonte com 100 pacientes adultos de ambos os sexos, distribuídos em dois grupos: Grupo 1 - 22 pacientes sem experiência com cirurgia; Grupo 2 - 78 pacientes submetidos previamente a outras operações de médio e grande porte. OBJETIVO: Avaliar o impacto do estresse psíquico em pacientes submetidos a operações de grande porte sob anestesia geral, relacionando suas reações físicas e psíquicas com as diferentes fases do estresse. MÉTODO: Para investigação do estresse, utilizou-se o Inventário de Sintomas de Stress para Adultos, desenvolvido por Lipp, um dia antes e dois dias e sete dias após a operação. A comparação dos grupos quanto às variáveis "sexo", "dor" e "percentual de estresse" foi realizada pelo teste do qui ao quadrado e para a variável idade foi utilizado o teste t de Student. As diferenças foram consideradas significativas para p < 0,05. RESULTADOS: Os grupos não foram homogêneos quanto ao percentual geral de estresse nas três mensurações. O Grupo 1 diminuiu e o Grupo 2 aumentou o estresse no pós-operatório. Prevaleceram sintomas psíquicos do estresse em ambos os grupos. CONCLUSÃO: O fato de ter sido operado previamente reduziu a tensão pré-operatória, porém não interferiu nos distúrbios emocionais pós-operatórios.

INTRODUCTION: One hundred adult patients hospitalized in the surgical wards of two hospitals of Belo Horizonte city, Brazil, were separated into two groups: group 1, 22 patients who had no previous experience with surgeries; and group 2, 78 patients who had been previously submitted to major surgical procedures. OBJECTIVE: To evaluate the impact of psychical stress on patients submitted to major operations under general anesthesia and to correlate physical and psychological reactions to different stages of stress. METHOD: The Stress Symptoms Inventory for Adults was used one day before and two and seven days after the operation. The groups were compared with regard to sex, level of pain and stress percentage with the chi-square test and for age with the Student t test. The level of significance was set at p < 0.05. RESULTS: The groups were not homogeneous regarding the general percentage of stress on the occasion of the three measurements. The level of stress was decreased in Group 1 and increased in Group 2. Psychic stress symptoms prevailed in both groups. CONCLUSION: Previous experience with surgery under general anesthesia reduces preoperative stress, but does not affect postoperative stress.

Evaluación del efecto de la actuación de los payasos de hospital sobre la ansiedad, en los niños sometidos a una intervención quirúrgica / Evaluation of the effect of hospital clown´s performance about anxiety in children subjected to surgical intervention

Introducción. Ser hospitalizado es un acontecimiento altamente angustioso para los niños. Actualmente un recurso usado en España y otros países para reducir la ansiedad de los niños en el contexto sanitario son los payasos de hospital. Estudiamos el efecto de los payasos de hospital sobre la ansiedad en los niños que van a ser operados. Método. Reclutamos a 60 niños de entre 6 y 10 años de edad, que iban a ser sometidos a una cirugía electiva. 30 niños tendrían payasos antes de la cirugía (grupo de casos) y 30 no los tendrían (grupo control).En el grupo de casos, 2 payasos actuaron para los niños. Medimos la ansiedad con distintas escalas (STAIC, CCPH, escala de caras), después de la actuación y hasta 7 días después de la cirugía. Resultados. Los resultados muestran que ambos grupos tienen una tendencia a incrementar la ansiedad, pero los niños del grupo de casos mostraron menos incremento en la puntuación de ansiedad. El grupo control mostró que los niños están más alterados a los siete días del alta. Conclusiones. Los niños que reciben la atención de los payasos tienen tendencia a estar menos estresados y con menos miedo que los otros, medido por el STAIC y la escala de caras, y estos resultados se mantienen siete días después del alta (AU)

Objective. To be hospitalized is a highly distressing event for children. At present, a resort used in Spain and other countries to reduce children’s anxiety in the health context are hospital’s clown. We studied the effect of the hospital’s clowns about the anxiety in children that going to be operated. Methods. We recruited 60 children aged 6 to 10 years scheduled to undergo elective surgery. 30 children would have clowns before the surgery (case group) and 30 would not have them (control group).In the case group, two clowns performed for children. We measured the anxiety with several scales (STAIC, CCPH, faces scale), after the performance and until 7 days after the surgery. Results. The outcomes show both groups a tendency to increase anxiety but the children of the case group showed less increase at the anxiety’s score. In the control group is showed that the children are more alterated at seven days from the discharge. Conclusions. Children that receive the clown’s care, have tendency to be less distressing and with less fear that another ones, measurement by STAIC and faces scale, and these results are maintained seven days after the discharge (AU)

Behavioral response to emotional stress in rabbits: role of serotonin and serotonin2A receptors.

Exposure to a novel environment is a stressor which modulates behavior, increases stress hormones and enhances the release of several neurotransmitters including serotonin (5-HT). Exposing rabbits to a novel environment significantly increases head-bob behavior but fails to alter either grooming or wet dog shakes compared with those observed in the home-cage. The goal of this study was to determine the role of 5-HT and its receptors in mediating novelty-elicited head-bob behavior. Reduction of central 5-HT levels after treatment with the serotonergic neurotoxin 5,7-DHT significantly decreased novelty-elicited head bobs by 40% compared with those in sham-lesioned rabbits, indicating that 5-HT mediates, in part, this behavior. Additionally, pretreatment with the 5-HT1A partial agonist and clinically used anxiolytic buspirone also significantly attenuated novelty-elicited head bobs. Pretreatment with the selective 5-HT2A antagonist M 100,907 significantly reduced novel environment-elicited head bobs by 40%. Furthermore, agonist-induced reduction of cortical 5-HT2A receptor density resulted in a significant 40% reduction in the number of head bobs elicited by the novel environment. These data demonstrate that rabbit head-bob behavior, an index of the response to novelty stress, is mediated, in part, by 5-HT activation of 5-HT2A receptors.

Psychoneurological applications of endoscopic sympathetic blocks (ESB).

In addition to more widely and longer known indications of ETS, various neurological disorders and psychologically stressful situations in their worst expressions might be alleviated by the reversible ESB procedure. The patients with social phobia, especially those who have also blushing and/or stage fright type of heart racing, benefit from the ESB. The disturbances of the sympathetic nervous system, e. g. in Parkinson's disease and multiple system atrophy might be alleviated with sympathetic block, especially the extrapyramidal symptoms in these diseases. In migraine, sympathetic surgery has been noted to give some help. The unilateral left-sided block has been effective in long QT-syndrome type arrhythmias. In schizophrenia, the phobic, paranoic or confusional reactions have been tentatively treated by the sympathetic block.