Caracterização histológica, bioquímica e farmacológica da musculatura gástrica na doença de Chagas

PURPOSE: To assess in vitro the correlation between the number of neurons and the sensitivity to cholinergic drugs and acetylcholinesterase activity in chagasic patients. METHODS: A 3x1 cm strip of the muscle layer of the anterior part of the stomach, always close to the angular incisure, was removed from 10 chronic chagasic patients (6 men) submitted to megaesophagus or megacolon surgery and from 10 non-chagasic patients (4 men) submitted to other types of surgery (control group), aged on average 52.3 and 50.1 years, respectively, for histological and pharmacological studies. The action of cholinergic drugs was investigated in isolated preparations according to the superfusion method of Ferreira and Costa, and acetylcholinesterase activity was determined by the method of Ellman. For neuron count, the strips were cut into 8 µm sections according to the method standardized by Alcântara. RESULTS: There was a difference in number of neurons between the chagasic (5,6) and control (7,3) groups. Acetylcholinesterase activity, in moles of hydrolyzed substrate per minute per gram tissue, was reduced in chagasic patients (4,32) compared to the controls (7,30). No hypersensitivity of the gastric musculature to cholinergic drugs was detected, with a reduced maximum response to carbachol and betanechol in the chagasic group. CONCLUSIONS: The reduction of neurons in the myenteric plexus of the stomach of chronic chagasic patients can be demonstrated even in the absence of clinical chagasic gastropathy. The hypersensitivity of the gastric musculature to cholinergic drugs probably depends on intense denervation. The reduced acetylcholinesterase activity demonstrates the involvement of the cholinergic innervation in the stomach of chronic chagasic patients. There was no correlation between number of neurons, sensitivity to cholinergic drugs and acetylcholinesterase activity in the gastric musculature of chagasic and non-chagasic patients.OBJETIVO: Avaliar in vitro a correlação entre o número de neurônios e a sensibilidade a drogas colinérgicas e a atividade da acetilcolinesterase em pacientes chagásicos. MÉTODOS: Em 10 pacientes chagásicos crônicos (6 homens) submetidos à cirurgia de megaesôfago ou de megacólon e em 10 pacientes não chagásicos (4 homens) submetidos a outros tipos de cirurgia (grupo controle), respectivamente com idade média de 52,3 e 50,1 anos, retirou-se uma tira de 3x1 cm da camada muscular da parede anterior do estômago, sempre junto á cisura angular, que serviu para os estudos histológicos e farmacológicos. A ação de drogas colinérgicas foi feita em preparação isolada de acordo com o método de superfusão de Ferreira e Costa, e a determinação da atividade da acetilcolinesterase pelo método de Ellman. Para a contagem de neurônios a tira muscular foi submetida a cortes de 8 micra segundo método padronizado por Alcântara. RESULTADOS: Houve diferença do número de neurônios entre os grupos chagásico (5,6) e controle (7,3). A atividade da acetilcolinesterase mostrou-se diminuída nos chagásicos (4,32) expressa como número de moles do substrato hidrolisado por minuto por grama de tecido, em relação aos controles (7,30). Não se encontrou hipersensibilidade da musculatura gástrica a drogas colinérgicas, encontrando-se inclusive efeito máximo reduzido ao carbacol e betanecol no grupo chagásico. CONCLUSÕES: A redução de neurônios no plexo mioentérico do estômago de pacientes chagásicos crônicos pode ser demonstrada mesmo na ausência de gastropatia chagásica clínica. A hipersensibilidade da musculatura gástrica a drogas colinérgicas provavelmente depende de desnervação intensa. A redução da atividade da acetilcolinesterase demonstra o comprometimento da inervação colinérgica no estômago de pacientes chagásicos crônicos. Não houve correlação entre número de neurônios, sensibilidade a drogas colinérgicas e atividade da acetilcolinesterase na musculatura gástrica de pacientes chagásicos ou não chagásicos

O PACIENTE CIRÚRGICO - RELAÇÃO MÉDICO PACIENTE

A good medical assistance requires a profound cognitive, technical, conscious, affective, and ethical preparation of the physician. Besides his knowledge about and the necessary know-how of surgical techniques, every surgeon should be aware of the patient's psychosocial situation, as well as of the fact that a relationship between the doctor and the patient, which involves all the above mentioned features, is crucial for the success of any therapy.O bom exercício da medicina exige preparo cognitivo, técnico, afetivo e ético do médico. O cirurgião, além do conhecimento das doenças e de habilidade na técnica cirúrgica, deve entender que o paciente está inserido em um contexto psico-social amplo e que o sucesso da terapêutica está baseado na boa relação médico-paciente, relacinada a todos esses fatores

EQUILÍBRIO HIDROELETROLÍTICO E HIDRATAÇÃO NO PACIENTE CIRÚRGICO

A fundamental basis of clinical surgery is the patients' hydroelectrolytic balance. In conjunction with this topic, the distribution of electrolytes aming the hydric compartments, the relation between water gain and water loss, and the main hydroelectrolytic disturbances are discussed. Furthermore, both the hydration and the electrolytic replacement in surgery patients are emphasized.O equilíbrio hidroeletrolítico no paciente cirúrgico é um dOs principais fundamentos em clínica cirúrgica. Neste tópico são apresentadas a distribuição eletrolítica dos compartimentos hídricos, a relação entre entrada e perda de água e os principais distúrbios hidroeletrolíticos.Ao final é abordada a hidratação e reposição eletrolítica do paciente cirúrgico

CIRURGIA BARIÁTRICA E APNÉIA DO SONO

Obesity is an important medical and social problem due to its severity and its already high and increasing prevalence. It has epidemic proportions and can cause or worsen arterial hypertension, type 2 diabetes mellitus, degenerative arthropathies, sleep apnea, as well as respiratory and cardiovascular dysfunctions. The impairment of the quality of life, reduction of life expectancy and the high failure rates of medical treatment are factors which reinforce the indication of surgical treatment for morbid obesity. The surgical indication is based on the analysis of multiple clinical aspects, including conservative treatment failure and psychological evaluation. Body mass index higher than 40 kg/m2 or over 35 kg/m2 with the presence of illness associated with obesity are important parameters to define the surgical indication. Surgical techniques involve modalities that are restrictives, malabsortives or a combination of both. As is the case for other comorbidities, an adequate pre and postoperative preparation of obese patients with severe obstructive sleep apnea is important. Besides special care concerning ventilation, it is recommended that the patient looses 10 to 15% of his original weight before the surgical operation. The preferencial surgical technique for morbid obesity in Brazil is the vertical gastroplasty with bandage and Roux-en-Y gastric bypass (Fobi-Capella operation) as it obtains a long-term weight loss of 40% of the original body weight, without significant nutritional and metabolic alterations. Bariatric surgery cures or improves most of the obese patients suffering from sleep apnea.  A obesidade constitui um problema médico-social importante por sua prevalência alta e crescente e sua gravidade. Tem características epidêmicas e pode favorecer ou agravar hipertensão arterial, diabetes mellitus, artropatias degenerativas, apnéia do sono, e disfunções respiratórias e cardiovasculares. A piora da qualidade de vida, a redução da expectativa de vida e a alta taxa de fracasso dos tratamentos conservadores são fatores que reforçam a indicação de tratamento cirúrgico da obesidade mórbida. A indicação cirúrgica baseia-se na análise conjunta de múltiplos aspectos clínicos, incluindo a falha do tratamento conservador e a avaliação psicológica. São parâmetros importantes o índice de massa corpórea acima de 40 kg/m2 ou acima de 35 kg/m2 na presença de doença agravada ou causada pela obesidade. As modalidades cirúrgicas, de acordo com seu objetivo fundamental, são: restritivas, disabsortivas e mistas. Como para outras co-morbidades, é importante o preparo pré-e pós operatório adequado dos obesos com apnéia obstrutiva do sono (AOS) grave. Além de cuidados especiais relativos à ventilação é recomendado que o paciente perca de 10 a 15% de seu peso antes da intervenção cirúrgica. Redução de 10% do peso original corresponde geralmente à diminuição de cerca de 25% no índice de apnéia e hipopnéia. Os efeitos sobre a AOS são tanto melhores quanto maiores forem a redução do peso e a manutenção dessa perda. Resultados de meta-análise demonstram que a perda efetiva de peso após cirurgia bariátrica resolve as co-morbidades na maioria dos pacientes , com cura ou melhora da AOS em 86,3% dos pacientes. No Brasil dá-se preferência à gastroplastia vertical com bandagem e derivação gástrica em Y de Roux (técnica de Fobi-Capella) por conseguir perda de 40% do peso inicial, mantida a longo prazo e por não produzir alterações nutricionais e metabólicas importantes. 

Handgrip strength

The basic function of the human hand is the manipulation and grasping of various objects in all daily activities, including work activities. This is greatly influenced by strength and manual dexterity. However age, gender and other contexts such as work or leisure activities could influence strength. Handgrip strength, a measure of maximum voluntary force of the hand, has proved to be reliable and valid as an objective parameter to evaluate the functional integrity of the hand as part of the musculoskeletal system. It correlates highly with strength in other muscular groups and is therefore considered as a good indicator of overall muscular strength and functional stress and could be used as a predictor of physical disability. Handgrip strength assessment is simple and reliable and used commonly by several investigators and health professionals, in different contexts (medical, nutritional, rehabilitation, professional settings, engineering, etc.) and with different purposes (research, diagnostic, assessment, etc.). In clinical and rehabilitation settings is of vital importance in the determination of effectiveness of several interventions and for monitoring evolution of diseases. Various ways (methods, techniques and equipments) of collecting information on grip strength have been reported. This chapter will review basic concepts on handgrip function, methodologies of assessment, contexts of application and correlates, such as physical activity, health or nutritional status. Several populations and reference values as also the relationships between handgrip and clinical status, aging, risk of disability and diseases, will be discussed

Assessment of oral conditions and quality of life in morbid obese and normal weight individuals: a cross-sectional study

The aim of this study was to identify the impact of oral disease on the quality of life of morbid obese and normal weight individuals. Cohort was composed of 100 morbid-obese and 50 normal-weight subjects. Dental caries, community periodontal index, gingival bleeding on probing (BOP), calculus, probing pocket depth, clinical attachment level, dental wear, stimulated salivary flow, and salivary pH were used to evaluate oral diseases. Socioeconomic and the oral impacts on daily performances (OIDP) questionnaires showed the quality of life in both groups. Unpaired Student, Fisher’s Exact, Chi-Square, Mann-Whitney, and Multiple Regression tests were used (p<0.05). Obese showed lower socio-economic level than control group, but no differences were found considering OIDP. No significant differences were observed between groups considering the number of absent teeth, bruxism, difficult mastication, calculus, initial caries lesion, and caries. However, saliva flow was low, and the salivary pH was changed in the obese group. Enamel wear was lower and dentine wear was higher in obese. More BOP, insertion loss, and periodontal pocket, especially the deeper ones, were found in obese subjects. The regression model showed gender, smoking, salivary pH, socio-economic level, periodontal pocket, and periodontal insertion loss significantly associated to obesity. However, both OIDP and BOP did not show significant contribution to the model. The quality of life of morbid obese was more negatively influenced by oral disease and socio-economic factors than in normal weight subjects107CNPQ - CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICOCAPES - COORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL E NÍVEL SUPERIORFAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO558366/2010-4Sem informação2014/09550-

Hepatic alterations in the obstructive jaundice

The alterations in the hepatic function of patients with obstructive jaundice are described in this chapter, correlating them with the operative morbidity and mortality.The various pathophysiologic alterations the lead to&nbsp;hepatocelular damage and the immune system disfunction are analysed as well.As alterações na função hepática de pacientes com icterícia obstrutiva são descritas nesta revisão, correlacionando-as com a morbidade e a mortalidade operatória. As várias alterações fisiopatológicas que levam ao dano hepatocelular e a disfunção do sistema imune também são analisadas