Complications of laparoscopic inguinal herniorrhaphy including one case of atypical mycobacterial infection.

BACKGROUND: Although laparoscopic inguinal herniorrhaphy is considered safe, several complications may occur. This study aimed to evaluate the complications observed in 780 laparoscopic inguinal herniorrhaphies at the authors' hospital. METHODS: All the patients who underwent laparoscopic inguinal herniorrhaphy at the authors' hospital during a period of 11 years were enrolled retrospectively in this study. Patient demographics, operative data, and intra- and postoperative complications were evaluated. RESULTS: A total of 569 patients underwent 780 laparoscopic inguinal herniorrhaphies. The male-to-female ratio was 8.8 to 1, and the mean age was 54.8 ± 15.7 years. Hernia recurrence was recognized in 14 patients (2.5%). Intra- and postoperative complications were diagnosed in 28 (4.9%) and 35 (6.2%) patients respectively. There was no mortality. The most common intraoperative complication was extensive subcutaneous emphysema. Two patients with extensive subcutaneous emphysema had cardiac arrhythmia. Small bowel perforation and bladder perforation occurred in one patient each. One patient had extensive preperitoneal infection caused by Mycobacterium massiliense, which required mesh removal, tissue debridement, and prolonged antibiotic therapy. CONCLUSIONS: Although the mortality rate is low, potentially life-threatening complications such as small bowel and bladder perforation may be experienced by patients subjected to laparoscopic herniorrhaphy.

A novel approach to intraoral mandibular nerve anesthesia: changing reference planes in the Gow-Gates block technique.

PURPOSE: The Gow-Gates technique is said to have several advantages over traditional techniques to achieve mandibular nerve anesthesia; however, its routine use is quite limited, mainly due to complications during visual alignment of reference landmarks. The purpose of this study was to verify the validity and accuracy of a new method to reach the injection site. MATERIAL AND METHODS: Fifteen magnetic resonance images were captured. Distances from the ideal injection point in the condylar neck (puncture ideal) to the injection points located in the alpha and beta plane intersection (puncture Gow-Gates and puncture modified) were measured and compared. RESULTS: Positive and significant (P

Influence of leukotriene inhibitor montelukast on wound contraction and cutaneous healing process in rats.

BACKGROUND: Wound contractures can cause severe deformities and disabilities. Recent studies have suggested that leukotriene receptor antagonists have an inhibitory effect on the healing contraction process. This study aimed to evaluate the influence of the leukotriene inhibitor montelukast on the cutaneous healing process and the wound contraction phenomenon in rats. METHODS: For this study, 60 male rats were randomly divided into four groups (MK-7d, SF-7d, MK-14d, and SF-14d) according to the drug given through a rigid orogastric tube (MK group: montelukast 10 mg/kg/day; SF group: normal saline solution) and the day the animals were killed (7d: postoperative day 7; 14d: postoperative day 14). An excisional wound (2 x 2 cm) was created on the dorsum of each rat. The wounds were left open to heal spontaneously and documented by standard digital photographs on different postoperative days. Wound contraction rates were calculated with specific software, and specimens were histologically evaluated using picrosirius red stain. Results were analyzed using the Aspin-Welch, Mann-Whitney, and t tests, assuming a significance level of 5%. RESULTS: The wound contraction rates were similar between the control and study groups (p > 0.05). On postoperative day 7, the wounds showed a marginally significant reduction in collagen maturation in the study group (40.1% +/- 6.88% vs 61.2% +/- 8.02%; p = 0.0607). On postoperative day 14, this reduction was statistically significant in the MK group (26% +/- 5.66% vs 68.3% +/- 7.76%; p = 0.0001). CONCLUSIONS: Montelukast does not alter the contraction rate of excisional wounds in rats but has a significant and progressive inhibitory effect on collagen maturation.

FOOD INTAKE EVALUATION DURING THE FIRST YEAR OF POSTOPERATIVE OF PATIENTS WITH TYPE 2 DIABETES MELLITUS OR GLYCEMIC ALTERATION SUBMITTED TO ROUX-EN-Y GASTRIC BYPASS.

BACKGROUND: : Obesity is one of the main causes of glycemic change. Failure of clinical obesity treatment may lead to an increase in bariatric surgery. Dietary guidance, in conjunction with disabsorptive and hormonal factors resulting from the anatomical and physiological changes provoked by the surgery, is associated with changes in food intake. AIM: To analyze food intake evolution during the first postoperative year of Roux-en-y gastric bypass in patients with type 2 diabetes mellitus or glycemic alteration. METHODS: : This was a longitudinal and retrospective observational study. For food intake evolution analysis, linear regression models with normal errors were adjusted for each of the nutrients. RESULTS: At 12 months, all patients presented improvement in glycemic levels (p<0.05). During the first postoperative year, there was a reduction in energy intake, macronutrients, consumption of alcoholic beverages and soft drinks. Conversely, there was an increase in fiber intake and diet fractionation. It was observed that, despite gastric restrictions, the micronutrient intake specifically recommended for glycemic control was greater up to six months postoperatively. CONCLUSION: There was change in the quantity and quality of food intake. It was the most prevalent glycemic control contributor up to six months postoperatively. At the end of one year, the diet underwent a change, showing a similar tendency to the preoperative food intake pattern.

Holographic interferometry method for assessment of static load stress distribution in dog mandible.

This study compared the transmission of tensions in fresh, fixed and macerated dog mandibles in order to clarify the diversity of behavior of bone tissues under dry and moist conditions. Double-exposure holographic interferometry was applied and holograms were obtained from 12 fresh hemi-mandibles under static load (control group), which were randomly assigned to 2 groups: 6 were fixed in 10% formalin and 6 were macerated. The specimens were submitted to the same initial force and their respective holograms were obtained. Analysis of the holograms showed that the fresh specimens transmitted significantly less tension than the fixed and macerated ones (p<0.05), and the tension direction was different. An average two-fold tension increment was observed in the experimental conditions. The holographic interferometry method was efficient in quantifying and qualifying tension transmission. However, depending on the type of analysis, the anatomical specimens must be fresh because macerated specimens will produce different results.

Umbilical hernia in patients with liver cirrhosis: A surgical challenge.

Umbilical hernia occurs in 20% of the patients with liver cirrhosis complicated with ascites. Due to the enormous intraabdominal pressure secondary to the ascites, umbilical hernia in these patients has a tendency to enlarge rapidly and to complicate. The treatment of umbilical hernia in these patients is a surgical challenge. Ascites control is the mainstay to reduce hernia recurrence and postoperative complications, such as wound infection, evisceration, ascites drainage, and peritonitis. Intermittent paracentesis, temporary peritoneal dialysis catheter or transjugular intrahepatic portosystemic shunt may be necessary to control ascites. Hernia repair is indicated in patients in whom medical treatment is effective in controlling ascites. Patients who have a good perspective to be transplanted within 3-6 mo, herniorrhaphy should be performed during transplantation. Hernia repair with mesh is associated with lower recurrence rate, but with higher surgical site infection when compared to hernia correction with conventional fascial suture. There is no consensus on the best abdominal wall layer in which the mesh should be placed: Onlay, sublay, or underlay. Many studies have demonstrated several advantages of the laparoscopic umbilical herniorrhaphy in cirrhotic patients compared with open surgical treatment.

Neuropeptide Y, alpha-melanocyte-stimulating hormone, and monoamines in food intake regulation.

Obesity is increasing in severity and prevalence in the United States and represents a major public health issue. No effective pharmacologic treatment leading to sustained weight loss currently exists. The growing interest in the regulation of food intake stems from the current drug treatments for obesity, almost all of which interfere with the monoamine system. Our knowledge of potential interactions between the orexigenic and anorexigenic pathways is limited and fragmented, making the development of targeted drug therapy for obesity difficult. The present review of the interaction of neuropeptides and monoamines emphasizes the complexity of the central mechanisms that regulate feeding behavior. Two main systems are implicated in food intake regulation: neuropeptide Y (NPY) and pro-opiomelanocortin. alpha-Melanocyte-stimulating hormone is a tridecapeptide cleaved from pro-opiomelanocortin that acts to inhibit food intake. The predominant NPY orexigenic receptors are NPY-Y1 and NPY-Y5, and the two anorexigenic melanocortin receptors involved in hypothalamic food intake control are MC3-R and MC4-R. Both neuropeptides interact with monoamines in the hypothalamus to control physiologic states such as hunger, satiation, and satiety. Serotonin suppresses food intake and body weight, acting mainly through the serotonin 1B receptor. Dopamine regulates hunger and satiety by acting in specific hypothalamic areas, through the D1 and D2 receptors. Noradrenaline activation of alpha1- and beta2-adrenoceptors decreases food intake, and stimulation of the alpha2-adrenoceptor increases food intake. A better understanding of the detailed mechanisms underlying the pathogenesis of hyperphagia and hypophagia is needed to develop new therapeutic approaches to obesity.

Oral glutamine does not prevent bacterial translocation in rats subjected to intestinal obstruction and Escherichia coli challenge but reduces systemic bacteria spread.

OBJECTIVE: We investigated whether oral glutamine prevents bacterial translocation. METHODS: Male Wistar rats were fed with isocaloric and isoproteic standard rat chow and randomly assigned to receive glutamine (GLN) or glycine administered through an orogastric tube at 1.5 g.kg(-1).d(-1) for 7 d. On day 8 of the study, the animals were anesthetized and intestinal obstruction was produced by ligature of the terminal ileum. A suspension containing 10(9) colony-forming units per milliliter of Escherichia coli ATCC 25992 was injected into the lumen of the ileum. Twenty-four hours later, blood was withdrawn, and mesenteric lymph nodes and fragments of spleen, liver, and lung were sent for microbiological analysis. Cultures were done on blood agar and MacConkey agar. Student's t test and analysis of variance between two proportions were used. P < 0.05 was considered significant. RESULTS: Rats in both groups lost body weight during the experiment (not significant). Mesenteric lymph node cultures were positive in both groups. The GLN group had a smaller percentage of E. coli in blood and organ cultures (65.45% versus 82.67% in the glycine group; P = 0.027). Positive cultures of blood, spleen, liver and lung also were higher on glycine group, although not significantly. CONCLUSIONS: Oral GLN does not prevent bacterial translocation in rats after intestinal obstruction and E. coli challenge. No specific organ was protected by GLN. Nevertheless, its use was associated with a reduced number of positive E. coli cultures in blood and remote organs, and thus diminished bacteria spread. This association suggests a role for GLN in gut barrier protection, possibly by immune system enhancement.

In utero malnutrition influences wound healing of newborn rats as measured by tensile strength and collagen deposition.

BACKGROUND: Studies have investigated the consequences of intrauterine malnutrition on birth weight and overall survival but not on wound healing. This study aims to assess the influence of in utero malnutrition on wound healing of newborn rats. METHODS: Pregnant Wistar rats were divided into 2 groups. Study rats were given 50% of the food intake of controls throughout pregnancy in a pair-fed manner. The body weight and length of the newborns were measured. Newborns were breast-fed until day 21, when a laparotomy was performed. The effect of the laparotomy was assessed by measure of the wound strength and collagen deposition at postoperative day (POD) 7 (n = 15) and POD 21 (n = 15). RESULTS: The body weight and length of newborns of malnourished mothers were significantly smaller at birth compared with controls (respectively, 4.5 +/- 0.1 g vs 5.8 +/- 0.1 g, p = .0003 and 4.6 +/- 0.1 cm vs 5.2 +/- 0.1 cm, p = .0003). Maximum, rupture, and tensile strength of malnourished newborns were smaller than controls on POD 7 (0.281 +/- 0.031 vs 0.470 +/- 0.031, p = .0061, 0.112 +/- 0.06 kgf vs 0.173 +/- 0.08 kgf, p = .0495 and 0.019 +/- 0.002 kgf/mm2 vs 0.024 +/- 0.003 kgf/mm2, p = .050, respectively). On POD 21, only tensile strength remained lower (0.044 +/- 0.003 kgf/mm2 vs 0.058 +/- 0.003 kgf/mm2, p = .0477). Type I collagen deposition of malnourished newborns was similar to controls on POD 7 (57.69 +/- 10.06 vs 48.34 +/- 15.65, p = .3187) and on POD 21 (75.6 +/- 7.21 vs 80.0 +/- 9.92, p = .4212). CONCLUSIONS: In utero malnutrition decreases the abdominal wound strength of newborn rats but not the collagen deposition, suggesting that breast-feeding nutrition is effective in recovering the collagen deposition but not overall wound strength.

Complications of laparoscopic fundoplication in the elderly.

Our objective was to assess the complications of laparoscopic fundoplication in 77 patients older than 70 years of age. The indications for surgery were (1) complications of reflux esophagitis (n = 17), (2) large hiatal hernia (n = 10), (3) asthma and bronchitis (n = 7), (4) the need for other surgery (n = 13), and (5) a patient's desire to discontinue medical treatment that was controlling reflux esophagitis (n = 30). Operative time varied from 34 to 250 minutes (mean [standard deviation], 116 +/- 20). Hospital stay varied from 12 hours to 19 days (mean, 1.2). No patient needed conversion to open operation. Intraoperative complications were observed in 4 patients (5.2%): left pneumothorax in 2, major operative bleeding in 1, and minor spleen lesion in 1. The most common postoperative complications were gas-bloating syndrome and dysphagia. Gastric ulcer was diagnosed in two. Other postoperative complications included acute delirium, acute urinary retention, and acute ischemia of the lower extremity. One patient died of congestive heart failure. It is concluded that laparoscopic fundoplication is an effective procedure for treating geriatric patients with reflux esophagitis and may be performed with low morbidity and mortality rates.

Food intake evaluation during the first year of postoperative of patients with type 2 diabetes mellitus or glycemic alteration submitted to roux-en-y gastric bypass / Avaliação da ingestão alimentar durante o primeiro ano de pós-operatório de pacientes com diabete melito tipo 2 ou alteração glicêmica submetidos ao bypass gástrico em y-de-roux

ABSTRACT Background : Obesity is one of the main causes of glycemic change. Failure of clinical obesity treatment may lead to an increase in bariatric surgery. Dietary guidance, in conjunction with disabsorptive and hormonal factors resulting from the anatomical and physiological changes provoked by the surgery, is associated with changes in food intake. Aim: To analyze food intake evolution during the first postoperative year of Roux-en-y gastric bypass in patients with type 2 diabetes mellitus or glycemic alteration. Methods : This was a longitudinal and retrospective observational study. For food intake evolution analysis, linear regression models with normal errors were adjusted for each of the nutrients. Results: At 12 months, all patients presented improvement in glycemic levels (p<0.05). During the first postoperative year, there was a reduction in energy intake, macronutrients, consumption of alcoholic beverages and soft drinks. Conversely, there was an increase in fiber intake and diet fractionation. It was observed that, despite gastric restrictions, the micronutrient intake specifically recommended for glycemic control was greater up to six months postoperatively. Conclusion: There was change in the quantity and quality of food intake. It was the most prevalent glycemic control contributor up to six months postoperatively. At the end of one year, the diet underwent a change, showing a similar tendency to the preoperative food intake pattern.

RESUMO Racional: Obesidade é uma das maiores causas de alteração glicêmica. O insucesso no seu tratamento clínico pode levar ao aumento de operações bariátricas. Orientação dietética, em conjunto com fatores disabsortivos e hormonais resultantes das alterações anatômicas e fisiológicas provocadas pela operação, está associada à mudanças na ingestão alimentar. Objetivo : Analisar a evolução da ingestão alimentar durante o primeiro ano pós-operatório de bypass gástrico em Y-de-Roux de pacientes com diabete melito tipo 2 ou alteração glicêmica no pré-operatório. Métodos : Estudo observacional longitudinal e retrospectivo. Para análise da evolução da ingestão alimentar, modelos de regressão linear com erros normais foram ajustados para cada nutriente. Resultados: Aos 12 meses, todos os pacientes apresentaram melhora nos níveis de glicemia (p<0,05). Durante o primeiro ano pós-operatório, houve redução na ingestão de energia, macronutrientes, consumo de bebidas alcoólicas e refrigerantes. Por outro lado, houve aumento na ingestão de fibras e fracionamento de dieta. Observou-se que, apesar das restrições gástricas, a ingestão de micronutrientes recomendados especificamente para o controle glicêmico foi maior até seis meses do pós-operatório. Conclusão: Houve mudança na quantidade e na qualidade da ingestão alimentar, sendo o consumo de alimentos que contribuem para o controle glicêmico mais prevalente até o sexto mês de pós-operatório. No pós-operatório em até um ano, a dieta sofre alteração, apresentando inadequações em relação à pirâmide específica, com tendência ao padrão alimentar do pré-operatório.

Assessment and nutritional aspects of wound healing.

PURPOSE OF REVIEW: The aim of this study is to review the physiopathology and the nutritional aspects of wound healing. RECENT FINDINGS: Wound healing consists of a perfect and coordinated cascade of events that result in tissue reconstitution. The healing process is common to all wounds, independent of the agent that has caused it. It is divided didactically into three phases: inflammation, proliferation, and remodeling or maturation. Collagen is the most abundant protein in the human body and is also the main component of the wound matrix. It is organized in a thick and dynamic net, resulting from constant collagen deposition and reabsorption. Wound scar is the result of the interaction between collagen synthesis, degradation, and remodeling. There are several ways to evaluate wound healing: tensiometry, collagen morphometry, immunohistochemistry, and, more recently, the dosage of growth factors. Malnutrition adversely affects wound healing. On the contrary, the healing process can be stimulated by preoperative feeding and by certain nutrients such as glutamine, arginine, butyrate, and antioxidants. SUMMARY: Wound healing is a complex process that started to be fully understood only in recent years. Recent research has been directed to act in the nutrition modulation of the healing process.

Long-term use of a diabetes-specific oral nutritional supplement results in a low-postprandial glucose response in diabetes patients.

BACKGROUND: To determine the effect of 12 weeks supplementation with a high-MUFA, high-fibre diabetes-specific oral nutritional supplement (ONS) on postprandial glucose response in type 2 diabetic patients at risk for malnutrition. METHODS: Forty patients participated in this randomised, controlled, double-blind, parallel-group study. Subjects consumed 2 x 200 ml of diabetes-specific ONS (Diasip) or standard ONS per day in addition to their normal diet. At baseline, after 6 and 12 weeks postprandial glucose responses and secondary parameters were assessed. RESULTS: Postprandial glucose responses (incremental area under curve) (p<0.01) and delta postprandial peak glucose concentration (p<0.01) were significantly lower in the diabetes-specific ONS group compared with the standard ONS group at all visits. In time, iAUC glucose (p=0.074, t=0 week vs. t=12 weeks) and delta postprandial peak plasma glucose concentration (p<0.05, t=0 week vs. t=12 weeks) were decreased within the diabetes-specific ONS group, but not in the standard ONS group. No significant differences in fasting glucose, insulin, HbA1c, lipid profile, hs-CRP, oxidized LDL and malondialdehyde, laboratory safety parameters and nutritional status parameters were found between both groups at either of the visits. CONCLUSIONS: These data demonstrate that diabetic patients at risk for malnutrition benefit from use of this diabetes-specific ONS to improve postprandial blood glucose control.

The nasogastric feeding tube as a risk factor for aspiration and aspiration pneumonia.

PURPOSE OF REVIEW: Aspiration is one of the most common complications in enterally fed patients. The source of aspiration is due to the accumulation of secretions in the pharynx of reflux gastric contents from the stomach into the pharynx. The true prevalence of aspiration is difficult to determine because of vague definitions, poor assessment methods, and varying levels of clinical recognition. RECENT FINDINGS: There is evidence in the literature showing that the presence of a nasogastric feeding tube is associated with colonization and aspiration of pharyngeal secretions and gastric contents leading to a high incidence of Gram-negative pneumonia in patients on enteral nutrition. However, other aspects may be equally important and should also be considered when evaluating a patient suspected of having aspiration and aspiration pneumonia. The mechanisms responsible for aspiration in patients bearing a nasogastric feeding tube are (1). loss of anatomical integrity of the upper and lower esophageal sphincters, (2). increase in the frequency of transient lower esophageal sphincter relaxations, and (3). desensitization of the pharyngoglottal adduction reflex. SUMMARY: Sometimes it is possible to differentiate whether the aspirate is gastric or pharyngeal. The kind of bacterial contamination is, however, more difficult to establish. Oral or dental disease, antibiotic therapy, systemic illness or malnutrition and reduction of salivary flow are responsible for colonization of Gram-negative bacteria in oral and pharyngeal flora in nasogastric-tube-fed patients. The use of a nasogastric feeding tube and the administration of food increase gastric pH and lead to colonization of gastric secretions. It has also been suggested that gastric bacteria could migrate upward along the tube and colonize the pharynx.

Nutritional aspects of liver transplantation.

Most adult and pediatric liver transplantation candidates present several metabolic disturbances that lead to malnutrition. Because malnutrition may adversely affect morbidity and mortality of orthotopic liver transplantation, it is very important to carefully assess the nutritional status of the waiting list patients. Pretransplant nutritional therapy -- enteral or parenteral -- may positively influence liver metabolism, muscle function, and immune status. Nutrition therapy should continue in the short- and also in the long-term post-transplant periods. For malnourished patients, early post-transplant enteral or parenteral nutrition have been useful in improving nutritional status. Finally, the metabolic and nutritional care of the liver transplant donor must be considered to reduce allograft dysfunction indices.

Diagnostic methods for the detection of anterograde aspiration in enterally fed patients.

PURPOSE OF REVIEW: The diagnosis of aspiration and its origin in patients on enteral tube feeding is challenging to the physician and provides an important means to prevent pneumonia. This review examines the most recent studies and developments in the field with an approach to the technical aspects of diagnostic methods. RECENT FINDINGS: The methods more commonly used to detect anterograde aspiration in clinical practice are fiberoptic endoscopic evaluation of swallowing and modified barium swallowing. Recent studies have shown that although these methods may provide the diagnosis of aspiration, their use for clinical monitoring is not appropriate. The studies comparing fiberoptic endoscopic evaluation of swallowing and modified barium swallowing have demonstrated that both tests present similar sensitivity, specificity and predictive values. SUMMARY: The different methods used to diagnose anterograde aspiration are appropriate for clinical practice, with a low complication rate and few contraindications. In most instances, the early diagnosis of aspiration and evaluation of other factors such as laryngeal sensibility, may predict the occurrence of aspiration pneumonia.

Holographic interferometry method for assessment of static load stress distribution in dog mandible

This study compared the transmission of tensions in fresh, fixed and macerated dog mandibles in order to clarify the diversity of behavior of bone tissues under dry and moist conditions. Double-exposure holographic interferometry was applied and holograms were obtained from 12 fresh hemi-mandibles under static load (control group), which were randomly assigned to 2 groups: 6 were fixed in 10 percent formalin and 6 were macerated. The specimens were submitted to the same initial force and their respective holograms were obtained. Analysis of the holograms showed that the fresh specimens transmitted significantly less tension than the fixed and macerated ones (p<0.05), and the tension direction was different. An average two-fold tension increment was observed in the experimental conditions. The holographic interferometry method was efficient in quantifying and qualifying tension transmission. However, depending on the type of analysis, the anatomical specimens must be fresh because macerated specimens will produce different results.

Frente à diversidade de comportamento do tecido ósseo, nas condições seca e úmida, este trabalho comparou a transmissão de tensões em mandíbulas de cães nas seguintes condições: frescas, fixadas e maceradas. Aplicou-se a interferometria holográfica de dupla exposição e os hologramas foram obtidos de 12 hemi-mandíbulas, sob carregamento estático (grupo controle). Em seguida, foram randomizadas em 2 grupos: 6 hemi-mandíbulas foram fixadas em solução de formol a 10 por cento e 6 foram maceradas. As amostras foram submetidas à mesma carga inicial e os respectivos hologramas foram obtidos. A análise dos hologramas mostrou que as amostras frescas transmitiram menos tensão que as amostras fixadas e as maceradas (p<0,05), e também houve diferença na direção percorrida pelas tensões. Em média, os grupos experimentais apresentaram o dobro de tensões em relação ao grupo controle. O método da interferometria holográfica mostrou-se eficiente para avaliar quantitativa e qualitativamente a transmissão das tensões geradas. Entretanto, dependendo do tipo de análise, a peça anatômica deve ser fresca, uma vez que os resultados podem diferir das amostras secas.

Long-term use of a diabetes-specific oral nutritional supplement results in a low-postprandial glucose response in diabetes patients

Background: To determine the effect of 12 weeks supplementation with a high-MUFA, high-fibre diabetes-specific oral nutritional supplement (ONS) on postprandial glucose response in type 2 diabetic patients at risk for malnutrition. Methods: Forty patients participated in this randomised, controlled, double-blind, parallelgroup study. Subjects consumed 2 200 ml of diabetes-specific ONS (Diasip1) or standard ONS per day in addition to their normal diet. At baseline, after 6 and 12 weeks postprandial glucose responses and secondary parameters were assessed. Results: Postprandial glucose responses (incremental area under curve) ( p < 0.01) and delta postprandial peak glucose concentration ( p < 0.01) were significantly lower in the diabetesspecific ONS group compared with the standard ONS group at all visits. In time, iAUC glucose ( p = 0.074, t = 0 week vs. t = 12 weeks) and delta postprandial peak plasma glucose concentration ( p < 0.05, t = 0 week vs. t = 12 weeks) were decreased within the diabetes-specific ONS group, but not in the standard ONS group. No significant differences in fasting glucose, insulin, HbA1c, lipid profile, hs-CRP, oxidized LDL and malondialdehyde, laboratory safety parameters and nutritional status parameters were found between both groups at either of the visits. Conclusions: These data demonstrate that diabetic patients at risk for malnutrition benefit from use of this diabetes-specific ONS to improve postprandial blood glucose control.

Transplante hepático no Hospital de Clínicas da Universidade Federal do Paraná: descriçäo dos cinco casos iniciais / Hepatic transplantation at the Hospital de Clinicas of the Universidade Federal do Parana: report of the first five cases

O primeiro transplante hepático com sucesso foi realizado em 1967. A introduçäo da ciclosporina em 1979 possibilitou que o transplante hepático tornasse em uma opçäo terapêutica para o paciente portador de doença hepática irreversível. O programa de transplante hepático do Hospital de Clínicas da Universidade Federal do Paraná teve início em setembro de 1991. Desde entäo cinco pacientes receberam transplante hepático em nosso serviço. As indicaçöes foram cirrose biliar primária em dois pacientes, doença de Wilson em dois pacientes e fibrose hepática congênita associada a doença de Caroli em um paciente. A idade dos nossos pacientes variou de 9 a 52 anos. Um paciente foi a óbito no pós-operatório devido a um quadro de pancreatite aguda viral necro-hemorrágica. Em um período de seguimento de 1 a 15 meses a sobrevida é de 80%. Nossos resultados iniciais säo similares a aqueles observados na literatura mundial