RESUMO
OBJECTIVE: To verify the effect of longitudinal abdominal incisional herniorrhaphy on respiratory muscle pressure. METHOD: The technique of incisional herniorrhaphy used was proposed by Lázaro da Silva. To measure the pressure, we used a water manometer in 20 patients, median age 48.5 years (range 24 70). We analyzed the maximum inspiratory pressure at the level of residual volume (IP-RV) and functional residual capacity (IP-FRC) and the maximum expiratory pressure of functional residual capacity (EP-FRC) and total lung capacity (EP-TLC) in the preoperative and late postoperative (40 90 days) periods, in 13 patients with large incisional hernias and in 7 patients with medium incisional hernias. RESULTS: There was a significant increase in IP-FRC (p = 0.027), IP-RV (p = 0.011) and EP-TLC (p = 0.003) in patients with large incisional hernias. EP-FRC increased, but not significantly. In patients with medium incisional hernias, the changes were not significant. CONCLUSION: Surgical correction of large incisional hernias improves the function of the breathing muscles; however, surgery for medium incisional hernias does not alter this function.
Assuntos
Hérnia Ventral/cirurgia , Herniorrafia/métodos , Hérnia Incisional/cirurgia , Respiração , Músculos Respiratórios , Abdome/cirurgia , Adulto , Idoso , Feminino , Humanos , Capacidade Inspiratória , Masculino , Manometria , Fluxo Expiratório Máximo , Pessoa de Meia-Idade , Período Pós-Operatório , Cuidados Pré-Operatórios , Testes de Função Respiratória , Adulto JovemRESUMO
PURPOSE: To elaborate an animal model with the objective of studying the continence of the biological valves surgically performed in the left colon of rats. METHODS: Thirty four rats were operated on and divided into three groups (G). G1 (sham) animals which underwent laparotomy only; G2 (perineal amputation without valves): animals which underwent amputation of the anal sphincter complex combined with a perineal colostomy; G3 (abdominoperineal amputation combined with valves): animals which underwent abdominoperineal amputation combined with three, equidistant and circumferential (360 degrees), extra-mucosal seromyotomies, of the descending colon, which were sutured to create biological valves combined with perineal colostomy. Animals were euthanized in the late postoperative period and surgical valves were saved for histopathological study. RESULTS: Surgical procedure provoked intestinal dilation, as well as segmented chambers along the descending colon. Retained fecalomas between the valves and proximal to them were also noted. Six rats died of intestinal obstruction due to fecal impaction at the surgical site. The sequence of events was: stasis, obstruction, distention, perforation, peritonitis and death. Histopathology showed inflammation due to foreign body type reaction around the sutured colon causing partial concentric stenosis, capable of interfering normal mechanical activity of the distal colon. This process resulted in retardation of the intestinal transit. CONCLUSION: Extra-mucosal seromyotomies, with seromuscular suture, can be used as an operative procedure capable of causing retardation in the intestinal transit of rats.
Assuntos
Colo Descendente/patologia , Colo Descendente/cirurgia , Colostomia/métodos , Impacção Fecal/etiologia , Esvaziamento Gástrico/fisiologia , Anastomose Cirúrgica/métodos , Animais , Colo Descendente/ultraestrutura , Colostomia/efeitos adversos , Modelos Animais de Doenças , Incontinência Fecal/patologia , Fibrose/patologia , Reação a Corpo Estranho/patologia , Células Gigantes de Corpo Estranho/ultraestrutura , Linfócitos do Interstício Tumoral , Masculino , Complicações Pós-Operatórias/mortalidade , Ratos , Ratos Wistar , Técnicas de SuturaRESUMO
BACKGROUND AND OBJECTIVES: Based on the knowledge of the anti-inflammatory and anti-bacterial actions of local anesthetics (LA), the objective of this study was to determine the effects of peritoneal lavage with bupivacaine on survival of mice with fecal peritonitis. METHODS: Forty-eight Wistar mice, weighing between 300 and 330 g (311.45 +/- 9.67 g), undergoing laparotomy 6 hours after induction of peritonitis were randomly divided in 4 groups: 1--Control, without treatment (n = 12); 2--Drying of the abdominal cavity (n = 12); 3--Lavage with 3 mL NS and posterior drying of the abdominal cavity (n = 12); and 4--Lavage with 8 mg x kg(-1) (+/- 0.5 mL) of 0.5% bupivacaine added to 2.5 mL of NS followed by drying out of the abdominal cavity (n = 12). Animals that died underwent necropsy and the time of death was recorded. Surviving animals were killed on the 11th postoperative day and underwent necropsy. RESULTS: Group 1 presented a 100% mortality rate in 52 hours, 100% mortality rate in Group 2 in 126 hours, and Group 3 presented a 50% mortality rate in 50 hours. Animals in Group 4 survived. Survival on the 11th day was greater in groups 3 and 4 than in Groups 1 and 2 (p < 0.001) and greater in Group 4 than in Group 3 (p< 0.01). CONCLUSIONS: Peritoneal lavage with a solution of bupivacaine diluted in NS was effective in preventing death for 11 days in 100% of animals with fecal peritonitis.
Assuntos
Anestésicos Locais/uso terapêutico , Bupivacaína/uso terapêutico , Lavagem Peritoneal , Peritonite/mortalidade , Peritonite/terapia , Animais , Fezes , Camundongos , Ratos , Ratos Wistar , Taxa de SobrevidaRESUMO
OBJECTIVE: To investigate the effects of splenic artery and vein ligation and the influence of hyperbaric oxygen after the double vascular ligation on the viability of spleen tissue. METHODS: Sixty nine adult male Wistar rats (285-375 g) were randomly separated in three groups: group 1, four rats, sham operated, group 2, 34 rats, submitted to simultaneous splenic artery and vein ligation and group 3, 31 rats, submitted to hyperbaric oxygen during 11 days, after double vascular ligation. All animals were killed on day 12 after surgery. The spleen was removed and paraffin embedded for microscopic examination. RESULTS: In the groups submitted to vascular ligation, the spleen was normal in 8.82% of rats not treated with hyperbaric oxygen and in 45.16% of rats that received hyperbaric oxygen after vascular ligation (p=0.01). In the spleens with white infarct, the mass of preserved splenic tissue in relation to the total body mass did not differ between the groups treated or not with hyperbaric oxygen. The preserved splenic tissue had normal histology in both groups. The healing process was more accelerated in the group of rats treated with hyperbaric oxygen. CONCLUSION: Results demonstrate that exposure to hyperbaric oxygen increased the frequency of total spleen mass preservation after simultaneous ligation of the splenic artery and vein but did not alter the percentage of the spleen's viable area, however the healing process in necrotic areas was accelerated.
Assuntos
Oxigenoterapia Hiperbárica , Baço/irrigação sanguínea , Artéria Esplênica , Infarto do Baço/patologia , Veia Esplênica , Animais , Ligadura/métodos , Masculino , Ratos , Ratos Wistar , Baço/patologia , Infarto do Baço/etiologia , Infarto do Baço/prevenção & controleRESUMO
PURPOSE: To study the fragment of the autologous tissue, built by a peritoneum-fascia-muscle, implanted on the level of the wall of inguinal canal and the spermatic cord of rats aiming to verify the histological behavior of the survive and the tissue incorporation. METHODS: Thirty-six rats were distributed into four groups. The rats of the group A, B, C and D were submitted to the median laparotomy to obtain the species to be implanted. On the group A, was implanted a tissue compounded by peritoneum and transversal fascia on the wall of the inguinal canal. On the B, the tissue implanted was added a part of rectum muscle of the abdomen and implanted on the wall of the inguinal canal. On the C, the tissue grafted was similar to the groupA, now grafted into the spermatic cord. On the D, the tissue was similar to the group B, now grafted into the spermatic cord. RESULTS: After 21 days of implant, these tissues presented the following histological alteration: the group A and C, fibroadipous tissue with dilated vessel, Focus of fibrosis' and limphoplasmocitary infiltrated and the groups B and D, fibroadipous tissue with dilated vessels, skeletal muscle and focus of fibrosis. The fibrosis displayed on the groups B and D was more intensive. On the group B, we almost always find the skeletal muscle, while on the group D this tissue was presented in six animals, almost replaced by fibrosis in two and not present in one. CONCLUSION: All the implanted grafts displayed survive and local incorporation, what could be useful on the correction of defects on the inguinal canal, on situations when the autologous tissue was indicated.
Assuntos
Fáscia/transplante , Canal Inguinal/cirurgia , Músculo Esquelético/transplante , Peritônio/transplante , Animais , Canal Inguinal/patologia , Ratos , Ratos Sprague-DawleyRESUMO
PURPOSE: To investigate if ultrasonic therapy is effective in avoidance of incisional hernia (IH), once the ideal technique for repair of IH is still a non-solved problem, in despite of prostheses usage. METHODS: IH was created by linea alba opening over 20 male Wistar rats, distributed in two groups: one group received the ultrasound, over the wound, during 14 days (5 animals) and the other for 28 days (5 animals), each one with the same number of animals as controls. The ultrasound was applied using a small probe, 1:5 pulse mode, 3.0 MHz frequency and 0.5W/cm2 intensity, for 5 minutes daily, from the first postoperative day. The width of the linea alba scar or the hernia ring was measured at the end of every period. The IH was defined when these openings were over 2mm wide. Some specimens from hernia sac or linea alba scar were obtained for vessels, fibroblasts, and colagen fibers density. Standard deviation and medians were obtained by variation analysis and Tukey-Kramer multi-comparison test. RESULTS: The ultrasound group showed a linea alba scar in 60%. The other 40% presented the hernia ring smaller than the non treated group (p < 0.0001). The ultrasound increased density of blood vessels (p = 0.0031), fibroblasts (p < 0.0001), and collagen fibers (p = 0.0015). There was no difference between the two treated groups. CONCLUSION: The ultrasound avoided the IH to appear or reduced its width. Fourteen days of treatment were sufficient for this purpose.
Assuntos
Hérnia Abdominal/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Terapia por Ultrassom , Animais , Hérnia Abdominal/patologia , Masculino , Complicações Pós-Operatórias/patologia , Ratos , Ratos WistarRESUMO
BACKGROUND: The jejunal pouch interposition between the gastric body and the duodenum after the gastrectomy, although not frequent in the surgical practice today, has been successfully employed for the prevention and treatment of the postgastrectomy syndromes. In the latter, it is included the dumping syndrome, which affects 13-58% of the patients who undergo gastrectomy. AIM: Retrospective assessment of the results of this procedure for the prevention of the dumping syndrome. METHODS: Fourty patients were selected and treatetd surgically for peptic ulcer, between 1965 and 1970. Of these, 29 underwent vagotomy, antrectomy, gastrojejunalduodenostomy at the lesser curvature level, and the 11 remaining were submitted to vagotomy, antrectomy, gastrojejunal-duodenostomy at the greater curvature level. The gastro-jejuno-duodenal transit was assessed in the immediate or late postoperative with the contrasted study of the esophagus, stomach and duodenum. The clinical evolution was assessed according to the Visick grade. RESULTS: Of the 40 patients, 28 were followed with the contrast evaluation in the late postoperative. Among those who were followed until the first month (n=22), 20 (90%) had slow gastro-jejuno-duodenal transit and in two (10%) the transit was normal. Among those who were followed after the first month (n=16), three (19%) and 13 (81%) had slow and normal gastric emptying, respectively. None had the contrasted exam compatible with the dumping syndrome. Among the 40 patients, 22 underwent postoperative clinical evaluation. Of these, 19 (86,5%) had excellent and good results (Visick 1 and 2, respectively). CONCLUSIONS: The jejunal pouch interposition showed to be a very effective surgical procedure for the prevention of the dumping syndrome in gastrectomized patients.
Assuntos
Síndrome de Esvaziamento Rápido/prevenção & controle , Duodeno/fisiologia , Duodeno/cirurgia , Trânsito Gastrointestinal , Jejuno/fisiologia , Jejuno/cirurgia , Estômago/fisiologia , Estômago/cirurgia , Adulto , Anastomose Cirúrgica , Síndrome de Esvaziamento Rápido/etiologia , Feminino , Gastrectomia/efeitos adversos , Humanos , Masculino , Estudos RetrospectivosRESUMO
ABSTRACT Objective: To verify the effect of longitudinal abdominal incisional herniorrhaphy on respiratory muscle pressure. Method: The technique of incisional herniorrhaphy used was proposed by Lázaro da Silva. To measure the pressure, we used a water manometer in 20 patients, median age 48.5 years (range 24 70). We analyzed the maximum inspiratory pressure at the level of residual volume (IP-RV) and functional residual capacity (IP-FRC) and the maximum expiratory pressure of functional residual capacity (EP-FRC) and total lung capacity (EP-TLC) in the preoperative and late postoperative (40 90 days) periods, in 13 patients with large incisional hernias and in 7 patients with medium incisional hernias. Results: There was a significant increase in IP-FRC (p = 0.027), IP-RV (p = 0.011) and EP-TLC (p = 0.003) in patients with large incisional hernias. EP-FRC increased, but not significantly. In patients with medium incisional hernias, the changes were not significant. Conclusion: Surgical correction of large incisional hernias improves the function of the breathing muscles; however, surgery for medium incisional hernias does not alter this function.
RESUMO Objetivo: verificar o efeito da herniorrafia incisional abdominal longitudinal na pressão dos músculos da respiração. Método: a técnica de herniorrafia incisional utilizada foi a proposta por Lázaro da Silva. Para aferir a pressão foi utilizado manômetro de água, em 20 pacientes, idade mediana 48,5 anos (mínimo 24, máximo 70). Foram analisadas a pressão máxima inspiratória no nível do volume residual (PIVR) e da capacidade residual funcional (PICRF) e a pressão máxima expiratória da capacidade residual funcional (PECRF) e da capacidade pulmonar total (PECPT), no pré-operatório e pós-operatório tardio (entre 40 e 90 dias), em 13 pacientes com hérnias incisionais grandes e em 7 pacientes com hérnias incisionais médias. Resultados: houve aumento significante da PICRF (p=0.027), da PIVR (p=0.011), da PECPT (p=0.003) nos pacientes com hérnias incisionais grandes. A PECRF aumentou, porém de forma não significante. Nos pacientes com hérnias incisionais médias as alterações não foram significantes. Conclusão: a correção cirúrgica da hérnia incisional grande melhora a função dos músculos da respiração, porém a cirurgia da hérnia incisional média não altera a referida função.
Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Adulto Jovem , Respiração , Músculos Respiratórios , Herniorrafia/métodos , Hérnia Incisional/cirurgia , Hérnia Ventral/cirurgia , Período Pós-Operatório , Testes de Função Respiratória , Cuidados Pré-Operatórios , Capacidade Inspiratória , Fluxo Expiratório Máximo , Abdome , Manometria , Pessoa de Meia-IdadeRESUMO
BACKGROUND: The most common injury to indicate definitive stoma is rectal cancer. Despite advances in surgical treatment, the abdominoperineal resection is still the most effective operation in radical treatment of malignancies of the distal rectum invading the sphincter and anal canal. Even with all the effort that surgeons have to preserve anal sphincters, abdominoperineal amputation is still indicated, and a definitive abdominal colostomy is necessary. This surgery requires patients to live with a definitive abdominal colostomy, which is a condition that modify body image, is not without morbidity and has great impact on the quality of life. AIM: To evaluate the technique of abdominoperineal amputation with perineal colostomy with irrigation as an alternative to permanent abdominal colostomy. METHOD: Retrospective analysis of medical records of 55 patients underwent abdominoperineal resection of the rectum with perineal colostomy in the period 1989-2010. RESULTS: The mean age was 58 years, 40 % men and 60 % women. In 94.5% of patients the indication for surgery was for cancer of the rectum. In some patients were made three valves, other two valves and in the remaining no valve at all. Complications were: mucosal prolapse, necrosis of the lowered segment and stenosis. CONCLUSION: The abdominoperineal amputation with perineal colostomy is a good therapeutic option in the armamentarium of the surgical treatment of rectal cancer.
Assuntos
Colostomia/métodos , Doença de Crohn/cirurgia , Períneo/cirurgia , Neoplasias Retais/cirurgia , Abdome , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: The intestinal interpositions are important in various operations of the digestive tract. However, they are capable to produce serious immediate and late complications. AIM: To compare clinical and surgical outcomes, as well as intestinal pathological findings, in dogs submitted to jejunum and colon interposition. METHODS: Forty male mongreal dogs were immunized and dewormed, between 36 and 72 months old and weighting from 6 to 16 kg divided into two groups of 20 (G1=gastrojejunoduodenal and G2=gastrocoloduodenal). They were anesthetized and submitted to laparotomy with jejunum and colon interposition between the gastric antrum and the duodenum. On the 120th postoperative day, a relaparotomy was performed with removal of the jejunun/colon segments for evaluation. The segments were processed using Bouin and tissue were stained with H&E for histological analysis. Clinical and surgical outcomes analyzed were weight, diarrhea, fistula, infection, suture dehiscence and incisional hernia. The pathological analysis involved neutrophilic infiltration, increase in number of goblet cells and villous and crypts hypotrophy. Mann-Whitney and Fisher Exact tests were used for groups comparisons. RESULTS: Dogs that underwent gastrocoloduodenal interposition had a higher weight loss (p<0.05) and more diarrhea (p<0.001). Clinically, controlled fistula rates were 20% in G1 and 100% in G2. Complications occurred in 20% in G1 and in all animals in G2 (p<0.001). Pathological alterations were also more prevalent in G2 (p<0.001). CONCLUSION: There is a high morbidity and complication rates involving intestine interposition and higher in G2 where colon segments were used.
Assuntos
Colo/cirurgia , Duodeno/cirurgia , Jejuno/cirurgia , Estômago/cirurgia , Anastomose Cirúrgica , Animais , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Cães , Humanos , MasculinoRESUMO
We discuss the reasons why Defensive Medicine is widely used in Brazil and worldwide. The Defensive Medicine is characterized by excessive use of complementary tests, the use of supposedly safer therapeutic procedures, the frequent referral of patients to other specialists and by the refusal to care for critically ill patients and with greater potential for complications. This is a practice that aims to defend the doctor from legal suits. The way the processes are conducted by the judiciary certainly contributes to the consolidation of this foolish practice. The slow pace of justice in our country, associated with the unpreparedness of judges and legal experts in the analysis of cases, leads to an emotional exhaustion of the parties involved. Furthermore, poor training of doctors in our country values the use of sophisticated diagnostic and treatment methods, rather than a thorough clinical examination and appropriate communication with the patient. Besides inefficient in protecting the doctor, Defensive Medicine has severe consequences to the patient and to society, since it generates an additional invaluable cost to medical practice, determines greater suffering to the patient and causes deterioration of the doctor-patient relationship, which has always been marked by trust, respect and personhood.
Assuntos
Medicina Defensiva , Padrões de Prática Médica , Humanos , Consentimento Livre e Esclarecido , Responsabilidade LegalRESUMO
INTRODUCTION: For a few decades the long-term use of proton pump inhibitors has had wide application in the treatment of several gastrointestinal diseases. Since then, however, several studies have called attention to the possible development of anatomical and pathological changes of gastric mucosa, resulting from the long term use of this therapeutic modality. Recent experimental and clinical studies suggest that these changes have connection not only to the development of precancerous lesions, but also of gastric tumors. OBJECTIVE: To present a qualitative analysis of anatomical and pathological changes of gastric mucosa resulting from the long-term use of proton pump inhibitors. METHOD: The headings used were: proton pump inhibitors, precancerous lesions and gastric neoplasms for a non systematic review of the literature, based on Medline, Lillacs and Scielo. Twelve articles were selected from clinical (9) and experimental (3) studies, for qualitative analysis of the results. RESULTS: The gastric acid suppression by high doses of proton pump inhibitors induces hypergastrinemia and the consequent emergence of neuroendocrine tumors in animal models. Morphological changes most often found in these experimental studies were: enterochromaffin-like cell hyperplasia, neuroendocrine tumor, atrophy, metaplasia and adenocarcinoma. In the studies in humans, however, despite enterochromaffin-like cell hyperplasia, the other effects, neuroendocrine tumor and gastric atrophy, gastric metaplasia and or adenocarcinoma, were not identified. CONCLUSION: Although it is not possible to say that the long-term treatment with proton pump inhibitors induces the appearance or accelerates the development of gastric cancer in humans, several authors have suggested that prolonged administration of this drug could provoke the development of gastric cancer. Thus, the evidence demonstrated in the animal model as well as the large number of patients who do or will do a long-term treatment with proton pump inhibitors, justifies the maintenance of this important line of research.
Assuntos
Mucosa Gástrica/efeitos dos fármacos , Mucosa Gástrica/patologia , Inibidores da Bomba de Prótons/farmacologia , Animais , Estudos de Avaliação como Assunto , Humanos , Neoplasias Gástricas/induzido quimicamente , Fatores de TempoRESUMO
BACKGROUND AND OBJECTIVES: After exposure to indomethacin, human umbilical vein endothelial cells have shown increased procoagulant activity. Thrombosis in rabbit auricular veins has been observed after injection of tenoxicam with its diluent or of the diluent alone. Human studies evaluating venous endothelium after tenoxican injection were not found in the literature. This study aimed at evaluating whether tenoxicam with 0.9% sodium chloride changes the venous endothelium of rabbits as it is observed when associated to its diluent (bidistilled water). METHODS: The study involved 90 rabbits (2000 and 3500 grams) divided in two groups: Control group, which received 0.9% NaCl; Experimental group, which received tenoxicam (20 mg) with bidistilled water or with 0.9% NaCl. A constant volume of 2 ml was administered to both groups. Anesthesia was induced with acepromazine maleate, ketamine hydrochloride and xylazine hydrochloride, and the puncture of right and left caudal auricular veins was performed with a 27G butterfly needle. Animals were confined for 6 hrs, 12 hrs, and 24 hrs, when they were once more anesthetized and sacrificed, with extraction of the auriculae at their base, followed by microscopic venous study. RESULTS: Thrombosis was observed in 19.4% of the Experimental Group after the administration of tenoxicam with bidistilled water and in 22.2% after the administration of tenoxicam with 0.9% sodium chloride. In the Control group, which has only received 0.9% sodium chloride, no thrombosis was observed. CONCLUSIONS: It was possible to conclude that tenoxicam, either with bidistilled water or 0.9% sodium chloride, has induced thrombosis in the veins it was injected.