Efeitos da lesão estrutural na contaminação bacteriana biliar após a esfincteroplastia transduodenal (dilatação papilar) em cães

PURPOSE: To evaluate, in dogs, the biliary sphincter subjected to dilation by hydrostatic balloon by the point of view of structural alterations of the papilla and the biochemestry and bacterial contamination of the bile. METHODS: Twenty dogs were submitted to laparotomy, duodenotomy, and enlargement of the major duodenal papilla- GA(n=10) - with balloon of 8mm inflated with pressure of 0,5atm, during 2 minutes or to the sham procedure - GB(n=10). Blood samples collected on times t(0day), t(7days) and t(28days) were subjected to dosages of alkaline phosphatase (ALP) and gamma-glutamyltransferase (GGT) for cholestasis evaluation. The collected material from the gall bladder at the same times were registered and numbered to be submitted to culture in BHI, blood agar (rich, non-selective element) and Mac Conkey (selective element for Gram-negative bacillus. On the 28th day three fragments of the papilla were tranversally cut by the choledoc axis 3mm from the duodenal papilla and the cuts, stained with hematoxylin-eosin and Masson's tricome, were evaluated according to their inflammatory reaction. RESULTS: The GGT and ALP averages on the three periods in the groups A and B did not show significant differences, not being characterizes the cholestasis. The bacterian contamination was significantly higher in GA (2,19) than in GB (1,96); the contamination was lower in the initial time compared with 7 and 28 days (t0<t7 and t28) in GA and GB (t0<t28). The chronic inflammatory alteration of the mucosa occurred in 60% of the GA animals and in 80% of the GB animals. There was not mural inflammation. CONCLUSION: The duodenal papilla dilation or its simple manipulation leads to the bacterial contamination of the gall bladder, not associated with cholestasis. The morphologic lesions are more intense in the late phase, not associated with an eventual papilla esthenosis.OBJETIVO: Avaliar, em cães, a papila duodenal maior submetida à dilatação por balão hidrostático sob o ponto de vista das alterações estruturais da papila e da bioquímica e contaminação bacteriana da bile. MÉTODOS: Vinte cães foram submetidos a laparotomia, duodenotomia, dilatação da papila maior GA (n=10) - com balão de 8mm insuflado com pressão de 0,5atm, durante 2 minutos ou ao procedimento simulado - GB(n=10). Amostras de sangue coletadas nos tempos t(0dia), t(7dias) e t(28dias) foram submetidas às dosagens da fosfatase alcalina (FA) e gama-glutamil-transferase (GGT) para avaliação da colestase. Material colhido da vesícula biliar nos mesmos tempos foi registrado e numerado para ser submetido à cultura em BHI, ágar sangue (meio rico não seletivo), e Mac Conkey (meio seletivo para bacilos Gram-negativos). No 28º. dia três fragmentos da papila forma cortados transversalmente ao eixo do colédoco a 3mm da papila duodenal e os cortes corados em hematoxilina-eosina e tricômio de Masson e avaliados quanto a reação inflamatória. RESULTADOS: As médias da GGT e da FA nos três períodos nos grupos A e B não mostraram diferenças significantes, não sendo caracterizada a colestase. A contaminação bacteriana foi significante maior em GA(2,19) que no GB(1,96); a contaminação foi menor no tempo inicial em relação aos 7 e 28 dias( t0<t7 e t28) no GA e no GB (t0<t28). A alteração inflamatória crônica da mucosa ocorreu em 60% dos animais do GA e em 80% do GB. Não houve inflamação mural. CONCLUSÃO: A dilatação da papila duodenal ou a sua simples manipulação leva a contaminação bacteriana da vesícula biliar, não associada à colestase. As lesões morfológicas são mais intensas na fase aguda e não correspondem a lesões crônicas mais extensas na fase tardia, não estando associadas a uma eventual estenose da papila.State University of Maringá Surgery DepartmentUNIFESPUNIFESPSciEL

Effects of repeated extracorporeal shock wave on kidney apoptosis of normal and diabetic rat

OBJECTIVE: To assess the effect of repeated extracorporeal shock waves (ESW) on the apoptosis of renal parenchyma in normal and diabetic rats by the caspase-3 expression. MATERIALS AND METHODS: 80 rats were assigned for ESW (Direx Tripter X1® - 14 KVA) to one of three groups with 50% rats with diabetes (A) and 50% normal (B) in each: G1 (n = 40): no ESW; G2 (n = 20): one ESW; G3 (n = 20): two ESWin an interval of 14 days. The animals were sacrificed 3 days after the ESW and samples of the renal parenchyma were histologically prepared, stained by the caspase-3 cleavage immunohistochemical method, and the apoptotic index (ApIn) was calculated by computer program Image Pro-Plus V 4,5,1 Media Cybernetics® ( ApIn = number of apoptotic cells in the microscopic section / total cells in the microscopic section). RESULTS: There was no statistical difference in ApIn of normal rats with one ESW (8.4 + 0.2) or two ESW (9.1 + 0.3) and both were similar to the control group with no ESW (7.9 + 0.2). The ApIn of diabetic rats with one ESW (7.4 + 0.3) was similar to the normal rats with one or two ESW. On the other hand, the ApIn was statistically higher in diabetic rats with two ESW (11.9 + 0.4) than in diabetic rats with one ESW (7.4 + 0.3). CONCLUSIONS: The ApIn of normal rats with a single (2,000 SW) or repeated ESW (4,000 SW) was similar to the control animals without any ESW. In diabetic rats, the repeated ESW (4,000 SW) may result in an additional risk of tissue damage expressed by the higher ApIn.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Department of SurgeryUNIFESP, EPM, Department of SurgerySciEL

Comparação da anastomose traqueal suturada com fio de náilon monofilamentar e categute cromado em coelhos submetidos a ação do diclofenaco sódico

BV UNIFESP: Teses e dissertaçõe

Comparação da anastomose traqueal saturada com fio de poligalactina 910, polidioxanona, polipropileno e poliéster: estudo experimental em coelhos

BV UNIFESP: Teses e dissertaçõe

Manometric and radiographic evaluation of transduodenal sphincteroplasty (papillary dilation) in dogs Avaliação manométrica e radiográfica da esfincteroplastia transduodenal (dilatação papilar) em cães

PURPOSE: To evaluate, in dogs, the functions of biliary sphincter subjected to dilation hydrostatic balloon by the point of view of the radiographic and manometric alterations. METHODS: Twenty dogs were submitted to laparotomy, duodenotomy, and enlargement of the major duodenal papilla- GA(n=10) - with balloon of 8mm inflated with pressure of 0,5atm, during 2 minutes or to the sham procedure - GB(n=10). The computadorized manometry and the cholangiography were done before and immediately after the initial procedure, one and four weeks after the dilation or the sham. It was calculated from the radiographic images: the mean, standard deviation, absolute and percentual variation of the diameter measures of the papilla. It was measured: the basal pressure in the papilla region, the contraction amplitudes and the choledoc pressure in all observation times (t0, t7 and t28). RESULTS: There was not differences in the diameter measures of the papilla in t0 (GA=5,14 +/- 1,1) (GB=4,64 +/-0,9), as well as in the absolute (0,14 mm) or relative (-2,7%) variations. In the animals of GA the papilla basal pressure measure was found to be smaller in t28 (11,1) than in t0 (18,6) and t7 (16,2). The contraction amplitudes measures were significantly smaller in the postoperatory times (post-t0, t7 and t28) when comparing to the initial time (pre-t0), in the animals of groups A and B. The average pressure values in the choledoc were also smaller in t28 (7,5) than in t0 (17,8) and t7 (12,6) in the animals of GA. CONCLUSION: the function of the major duodenal papilla is partially commited with the dilation, therefore it provoked the basal pressure decrease and compromising of the capacity of sphincter in its cyclical contractions up to the 28 days of observation.<br>OBJETIVO: Avaliar, em cães, a função da papila duodenal maior submetidas à dilatação por balão hidrostático sob o ponto de vista das alterações radiográficas e manométricas. MÉTODOS: Vinte cães foram submetidos a laparotomia, duodenotomia, dilatação da papila maior - GA(n=10) - com balão de 8mm insuflado com pressão de 0,5atm, durante 2 minutos ou ao procedimento simulado - GB(n=10). A manometria computadorizada e a colangiografia foram efetuadas antes e imediatamente após o procedimento inicial, uma e quatro semanas após a dilatação ou a simulação. Foram calculadas à partir das imagens radiográficas: a média, desvio-padrão, mediana, variação absoluta e porcentual das medidas do diâmetro da papila. Foram medidas: a pressão basal na região da papila, a amplitude das contrações e a pressão do colédoco em todos tempos de observação(t0, t7 e t28). RESULTADOS: Não houve diferença nas medidas do diâmetro da papila em t0 (GA=5,14 e DP=1,1) (GB=4,64 e DP=0,9), assim como nas variações absolutas (0,14mm) ou relativas (-2,7%). Nos animais do GA a medida da pressão basal da papila, mostrou-se menor no t28 (11,1) que nos tempos t0 (18,6) e T7 (16,2). As médias das amplitudes de contração foram significantemente inferiores nos tempos pós-operatórios (pós-t0, t7 e t28) em relação ao tempo inicial (pré-t0), nos animais dos grupos A e B. Os valores médios da pressão no colédoco também foram inferiores em t28 (7,5) que nos tempos t0 (17,8) e t7 (12,6) nos animais do GA. CONCLUSÃO: A função da papila duodenal está comprometida parcialmente com a dilatação, pois provocou diminuição da pressão basal e comprometimento da capacidade do esfíncter em suas contrações cíclicas até aos 28 dias de observação

Effects of structural injure in the bile bacterial contamination after balloon transduodenal sphincteroplasty (papillary dilation) in dogs

PURPOSE: To evaluate, in dogs, the biliary sphincter subjected to dilation by hydrostatic balloon by the point of view of structural alterations of the papilla and the biochemestry and bacterial contamination of the bile. METHODS: Twenty dogs were submitted to laparotomy, duodenotomy, and enlargement of the major duodenal papilla- GA(n=10) - with balloon of 8mm inflated with pressure of 0,5atm, during 2 minutes or to the sham procedure - GB(n=10). Blood samples collected on times t(0day), t(7days) and t(28days) were subjected to dosages of alkaline phosphatase (ALP) and gamma-glutamyltransferase (GGT) for cholestasis evaluation. The collected material from the gall bladder at the same times were registered and numbered to be submitted to culture in BHI, blood agar (rich, non-selective element) and Mac Conkey (selective element for Gram-negative bacillus. On the 28th day three fragments of the papilla were tranversally cut by the choledoc axis 3mm from the duodenal papilla and the cuts, stained with hematoxylin-eosin and Masson's tricome, were evaluated according to their inflammatory reaction. RESULTS: The GGT and ALP averages on the three periods in the groups A and B did not show significant differences, not being characterizes the cholestasis. The bacterian contamination was significantly higher in GA (2,19) than in GB (1,96); the contamination was lower in the initial time compared with 7 and 28 days (t0<t7 and t28) in GA and GB (t0<t28). The chronic inflammatory alteration of the mucosa occurred in 60% of the GA animals and in 80% of the GB animals. There was not mural inflammation. CONCLUSION: The duodenal papilla dilation or its simple manipulation leads to the bacterial contamination of the gall bladder, not associated with cholestasis. The morphologic lesions are more intense in the late phase, not associated with an eventual papilla esthenosis

Comparação da anastomose traqueal suturada com fio absorvível e inabsorvível em coelhos

Morphological and morphometric aspects of tracheal anastomosis in rabbits sutured with two absorbable synthetic threads and two nonabsorbable synthetic threads were compared in this study. The animals were divided into three equal groups of twenty-four individuals (A, B, C), for post-operation studies on the 7th, 14th and 28th day. Each group was subdivided into four equal subgroups of six animals. After the excision of three cartilaginous rings, the tracheal anastomosis was sutured with polygalactine 910, polydioxan, polypropylene and polyester thread. The macroscopic examination verified a tracheal fistula on the seventh postoperation day in the anastomosis sutured with polyester. Cicraticial stenosis was most intensive and frequent with polyester and polydioxan threads in all the periods observed. On the fourteenth and twenty-eighth post-operation days, the optical microscopy revealed a chronic inflammatory reaction with higher intensity in sutures with polyester, polydioxan and polypropylene with a clear correlation between intense chronic inflammatory reaction and the macroscopic bad results observed in the anastomoses sutured with such threads. The final results lead to the conclusion that polygalactine 910 provided the best cicratization for tracheal anastomosis in rabbits, followed by polypropylene. Polydioxan and polyester threads provided the worst anastomosis cicratizationNeste trabalho foram comparados aspectos mofológicos e morfométricos da anastomose traqueal em coelhos, com a sutrua realizada por dois fios sintéticos absorvíveis e dois fios sintéticos inabsorvíveis. Os animais foram separados em três grupos iguais de 24 animais (A, B e C), estudos nos 7º, 14º e 28º dias de pós-operatório. Cada grupo foi dividido em quatro subgrupos iguais de seis animais. Após a excisão de três anéis cartilaginosos, a anastomose traqueal foi realizada com o fio de poligalactina 910, polidioxanona, polipropileno ou poliéster. Ao exame macroscópico, verificou-se que ocorreu uma fístula traqueal no 7º dia de pós-operatório na anastomose suturada com o fio de poliéster. A estenose cicatricial ocorreu com maior intensidade e freqüência com os fios de poliéster e polidioxanona, em todos os períodos de observação. No 14º e 28º dias de pós-operatório, verificou-se, à microscopia óptica, reação inflamatória crônica com intensidade maior nas suturas com os fios de poliéster, polidioxanona e polipropileno, nesta ordem, com nítida correlação entre a resposta inflamatória crônica intensa e os maus resultados macroscópicos observados nas anastomoses onde foram utilizados estes fios. Os resultados obtidos permitiram concluir que o fio de poligalactina 910 apresentou os melhores resultados cicatriciais para a anastomose traqueal dos coelhos, seguido pelo fio de polipropileno. Os fios de polidioxanona e poliéster apresentaram os piores resultados para a cicatrização da anastomos

Herniorrafia inguinal: anestesia local ou regional?

Inguinal herniorrhaphy is one of the most frequent surgical procedures around the world. Therefore its optimization has been tried to reduce expenses, hospitalization time and complications resulting from surgical and anesthetic procedures. This experiment compared regional and local anesthesia in herniorrhaphy of 32 patients divided into two groups. Regional anesthesia was applied to group one patients and local anesthesia was applied to group two patients. Regional anesthesia showed to be more effective in terms of trans-surgical discomfort while local anesthesia showed to be more efficient in reducing post-surgical complications and hospitalization time.A herniorrafia inguinal é um dos procedimentos cirúrgicos mais realizados no mundo. Devido a isso tem-se procurado otimizar o procedimento, diminuindo custos, tempo de internamento e complicações decorrentes do ato operatório e da anestesia. Neste trabalho, fizemos uma análise comparativa entre anestesia regional e anestesia local na herniorrafia de 32 pacientes divididos em dois grupos. No grupo 1, foi utilizada anestesia regional e, no grupo 2, anestesia local. Em relação ao desconforto transoperatório, o método de anestesia regional se mostrou mais efetivo. Já em relação a incidência de complicações pós-operatórias e diminuição do tempo de internamento, a anestesia local se mostrou mais eficiente