Estudo histológico do fígado e bioquímico do sangue de ratos após ligadura do ducto hepático direito

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde. Programa de Pós-Graduação em Ciências Médicas

The real impact of colonic transit time and anorectal manometry in the diagnosis of adult patients with chronic constipation

Introduction: Anorectal physiology tests are indicated for patients who have refractory symptoms of constipation, but the best sequence of investigation remains controversial. Objective: To evaluate the influence of colonic transit time and anorectal manometry in the diagnosis of chronic constipation in adults. Method: This was a study of adult patients with constipation at a private clinic in a city in southern Brazil, from January 1, 2009 to December 31, 2018. Those who showed warning signs were referred for colonoscopy and those with any anatomical alterations were excluded. The patients received 10 g of psyllium and those who remained symptomatic after three weeks were referred for functional assessment with colonic transit time (CTT). Those who presented outlet obstruction in the colonic transit time were referred to anorectal manometry. Results: Of the 889 adult patients surveyed, 227 were included. Of the 216 who completed the study, 167 responded to primary treatment. Forty-nine underwent CTT. In these, 16 had normal colonic transit time and 33 were altered. In those with altered colonic transit time, eight had a pattern of colonic inertia and 25 had an obstruction pattern. The 25 patients with an outlet obstruction pattern underwent anorectal manometry. Eighteen had signs of paradoxical contracture of the puborectal muscle (PPRC) and seven did not. Conclusion: This study concluded that anorectal physiology exams contribute to the diagnosis of constipation, often changing the behavior. These exams should be performed whenever the patient does not respond to hygienic changes and fiber replacement. Resumo: Introdução: Os exames de fisiologia anorretal estão indicados nos pacientes que mantém sintomas refratários de constipação, porém uma sequência desejada de investigação permanece contraditória. Objetivo: Avaliar a influência do tempo de trânsito colônico e da manometria anorretal no diagnóstico da constipação crônica de adultos. Método: Estudamos os pacientes adultos de uma clínica privada em uma cidade do sul do Brasil, no período de 01 de Janeiro de 2009 a 31 de Dezembro de 2018 apresentando constipação. Aqueles que apresentassem sinais de alerta, eram encaminhados a colonoscopia e com qualquer alteração anatômica eram excluídos. Foram prescritos 10 g de Psyllium e aqueles que permaneceram sintomáticos após três semanas foram encaminhados à avaliação funcional com tempo de trânsito colônico (TTC). Os que apresentavam obstrução de saída ao tempo de trânsito colônico foram encaminhados a manometria anorretal. Resultados: Dos 889 pacientes adultos levantados, 227 foram incluídos. Dos 216 que concluíram o estudo, 167 responderam ao tratamento primário. Quarenta e nove realizaram TTC. Nestes, 16 tiveram tempo de trânsito colônico normal e 33 alterado. Naqueles com tempo de trânsito colônico alterado: oito tinham padrão de inércia colônica e 25, padrão de obstrução de saída. Os 25 pacientes com padrão de obstrução de saída foram submetidos à manometria anorretal. Dezoito tinham sinais de Contratura Paradoxal do músculo Puborretal (CPPR) e sete não. Conclusão: Concluímos que os exames de fisiologia anorretal contribuem para o diagnóstico da constipação, muitas vezes alterando a conduta. Estes exames devem ser realizados sempre que o paciente não responder as alterações higienodietéticas e a reposição de fibras

Intestinal preparations for colonoscopy. Comparative study: mannitol, picosulphate and macrogol

Bowel preparation is mandatory prior to elective colonoscopy and their effectiveness is closely related to the quality of the examination. There are many preparations on the market and there is no consensus on which is best. This study aimed to compare three solutions for colon preparation in patients undergoing colonoscopy. We conducted a prospective study with 61 patients divided randomly into three groups: one that received a standard dose of macrogol, another received a standard dose of 10% mannitol and another received a standard dose of sodium picosulphate. Patients and examining endoscopists responded to questionnaires for compiling data. In the results we noticed that 10% mannitol, despite being less tolerated by the patient when compared to sodium picosulphate, presents better results in colonic cleaning, being therefore superior in this regard. Macrogol was considered as an intermediate in relation to the other two preparations. As for tolerability, preference is given to sodium picosulphate as best tolerated, followed by mannitol and by macrogol, which is poorly tolerated by the patient. We conclude that as the main objective of bowel preparation in colonoscopy is the quality of colonic cleaning, 10% mannitol was superior to the other preparations studied. Resumo: O preparo intestinal é mandatório antes da realização das colonoscopias eletivas e sua eficácia está intrinsecamente relacionada à qualidade do exame. Existem diversos preparos no mercado e não há consenso sobre qual é melhor. Este estudo teve como objetivo comparar três soluções para preparo de cólon em pacientes submetidos à colonoscopia. Foi realizado um estudo prospectivo com 61 pacientes distribuídos de forma randomizada em três grupos: um recebeu macrogol, outro manitol a 10% e outro picossulfato de sódio em doses padrão. Os pacientes e os endoscopistas examinadores responderam a questionários para compilação de dados. Nos resultados notamos que o manitol a 10%, apesar de ser menos tolerado pelo paciente quando comparado ao picossulfato de sódio, apresenta melhores resultados na limpeza colônica, sendo, portanto, superior neste quesito. O macrogol foi considerado como intermediário em relação aos outros dois preparos. Quanto à tolerabilidade, a preferência recai sobre o picosulfato de sódio como o mais bem tolerado, seguido pelo Manitol; macrogol foi o menos tolerado pelo paciente. Concluímos que, como o principal objetivo do preparo intestinal na colonoscopia é a qualidade da limpeza colônica, o manitol a 10% mostrou-se superior aos demais preparos estudados. Keywords: Colonoscopy, Bowel preparation, Mannitol, Sodium Picosulfate, Macrogol, Palavras-chave: Colonoscopia, Preparo intestinal, Manitol, Picossulfato de sódio, Macrogo

Histological study of the liver and biochemistry of the blood of Wistar rats following ligature of right hepatic duct Estudo histológico do fígado e bioquímico do sangue de ratos após ligadura do ducto hepático direito

PURPOSE: To observe the histological alterations in the liver and biochemistry in the blood that can happen in Wistar rat, after the ligature of right hepatic duct. METHODS: In this study were used rats (n=46) of Wistar pedigree. The animal groups (n=46) were distributed in 6 experimented sub-groups (n=6). It was held a ligature surgery of the right hepatic duct and euthanasia in 7, 14, 21, 28, 60 and 90 days and the biochemistry control group (n=10), that animals had 2ml of their blood taken by cardiac puncture for biochemistry study with value analyses of bilirubins, transaminasis, lactic desidrogenasis, alkaline phophatase and gamma-glutamil-transferase. Given the expected time of each group, the animals were submitted to anesthesia procedure and cavity re-opening, being held intra-cardiac puncture and with 2ml blood collected for biochemistry analyses. It was proceeded the liver resection, being the liver putted in formol solution to 10% for a period of 24 hours and taken to the histology. RESULTS: It was not possible to identify results that express significant differences as the existence of alterations histological and biochemistrily between the different groups. CONCLUSION: At the end of the study, it was not possible to identify histological and biochemistrily alterations that express significant differences between livers of the animals from the right linked hepatic duct and the animals of the control group.<br>INTRODUÇÃO: a colestase é uma situação grave e geralmente letal. Habitualmente a obstrução do fluxo da secreção biliar ocorre por lesão iatrogênica. Cerca de 80% das lesões das vias OBJETIVO: Observar as alterações histológicas que possam ocorrer no fígado e bioquímicas no sangue de ratos Wistar, após ligadura do ducto hepático direito. MÉTODOS: Neste estudo foram utilizados ratos (n=46) da linhagem Wistar. O grupo de animais (n=46) foi dividido em 2 grupos: A experimento (n=36) e B controle bioquímico (n=10), sendo o grupo A subdividido em 6 subgrupos experimento (n=6). Foi realizada cirurgia para a ligadura do ducto hepático direito e eutanásia em 7, 14, 21, 28, 60 e 90 dias. No grupo B controle bioquímico (n=10), os animais tiveram 2ml de seu sangue retirado por punção cardíaca para estudo bioquímico com análise dos valores de bilirrubinas, transaminases, desidrogenase láctica, fosfatase alcalina e gama-glutamil-transferase. Dado o prazo de espera de cada grupo, os animais foram submetidos a procedimento anestésico e reabertura da cavidade, sendo realizada punção intracardíaca, com coleta de 2ml de sangue para análise bioquímica. Foi realizada a retirada do fígado, sendo o fígado fixado em solução de formol a 10 % por um período de 24 horas e encaminhado ao laboratório de histologia. RESULTADOS: Não foram encontrados resultados estatisticamente significantes quanto a existência de alterações histológicas e bioquímicas entre os diversos grupos. CONCLUSÃO: Ao final do estudo não se conseguiu identificar histológica e bioquimicamente, alterações que expressassem diferenças significativas entre os animais do grupo com o ducto hepático direito ligado e os animais do grupo controle

Exploring the Relationship between Biologics and Postoperative Surgical Morbidity in Ulcerative Colitis: A Review

Background: With the paradigm shift related to the overspread use of biological agents in the treatment of inflammatory bowel diseases (IBD), several questions emerged from the surgical perspective. Whether the use of biologicals would be associated with higher rates of postoperative complications in ulcerative colitis (UC) patients still remains controversial. Aims: We aimed to analyze the literature, searching for studies that correlated postoperative complications and preoperative exposure to biologics in UC patients, and synthesize these data qualitatively in order to check the possible impact of biologics on postoperative surgical morbidity in this population. Methods: Included studies were identified by electronic search in the PUBMED database according to the PRISMA (Preferred Items of Reports for Systematic Reviews and Meta-Analysis) guidelines. The quality and bias assessments were performed by MINORS (methodological index for non-randomized studies) criteria for non-randomized studies. Results: 608 studies were initially identified, 22 of which were selected for qualitative evaluation. From those, 19 studies (17 retrospective and two prospective) included preoperative anti-TNF. Seven described an increased risk of postoperative complications, and 12 showed no significant increase postoperative morbidity. Only three studies included surgical UC patients with previous use of vedolizumab, two retrospective and one prospective, all with no significant correlation between the drug and an increase in postoperative complication rates. Conclusions: Despite conflicting results, most studies have not shown increased complication rates after abdominal surgical procedures in patients with UC with preoperative exposure to biologics. Further prospective studies are needed to better establish the impact of preoperative biologics and surgical complications in UC

Exploring the Relationship between Biologics and Postoperative Surgical Morbidity in Ulcerative Colitis: A Review

Background: With the paradigm shift related to the overspread use of biological agents in the treatment of inflammatory bowel diseases (IBD), several questions emerged from the surgical perspective. Whether the use of biologicals would be associated with higher rates of postoperative complications in ulcerative colitis (UC) patients still remains controversial. Aims: We aimed to analyze the literature, searching for studies that correlated postoperative complications and preoperative exposure to biologics in UC patients, and synthesize these data qualitatively in order to check the possible impact of biologics on postoperative surgical morbidity in this population. Methods: Included studies were identified by electronic search in the PUBMED database according to the PRISMA (Preferred Items of Reports for Systematic Reviews and Meta-Analysis) guidelines. The quality and bias assessments were performed by MINORS (methodological index for non-randomized studies) criteria for non-randomized studies. Results: 608 studies were initially identified, 22 of which were selected for qualitative evaluation. From those, 19 studies (17 retrospective and two prospective) included preoperative anti-TNF. Seven described an increased risk of postoperative complications, and 12 showed no significant increase postoperative morbidity. Only three studies included surgical UC patients with previous use of vedolizumab, two retrospective and one prospective, all with no significant correlation between the drug and an increase in postoperative complication rates. Conclusions: Despite conflicting results, most studies have not shown increased complication rates after abdominal surgical procedures in patients with UC with preoperative exposure to biologics. Further prospective studies are needed to better establish the impact of preoperative biologics and surgical complications in UC