Realidade virtual e a medicina

Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de CirurgiaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPM, Depto. de CirurgiaUNIFESP, EPMSciEL

Organização de laboratório de microcirurgia

Microsurgical techniques have been used in many surgical specialties as well as a broad application in surgical research.. It demands high technical skills and continued training. The microsurgical skills should be first mastered in the lab before to be employed in the clinical practice. The microsurgical lab has a dual role: the training of residents and specialized surgeons and the support for the high qualified scientific research in experimental surgery. Here, it is presented (showed) the organization of a microsurgical lab, including area and equipments, furthermore there is a proposal that school-hospitals that offer microsurgical procedures, should have a microsurgical laboratory.As técnicas microcirúrgicas têm sido usadas em várias especialidades cirúrgicas, assim como uma ampla aplicação na pesquisa cirúrgica. A realização de microcirurgia exige alta qualidade técnica e treinamento contínuo. O completo domínio das técnicas de microcirurgia deve ser obtido primeiro no laboratório antes de ser empregada na prática clínica. O laboratório de microcirurgia tem uma dupla função: o treinamento de residentes e cirurgiões especialistas e o suporte para a investigação científica em cirurgia experimental. Nesse artigo está apresentado um modelo de laboratório de microcirurgia, incluindo a área e os equipamentos, além da proposta de que os hospitais-escola, que ofereçam procedimentos microcirúrgicos, sejam equipados com laboratório de microcirurgia.Harvard Medical School Brigham and Women's Hospital Division of Transplant SurgeryFederal University of São Paulo Department of SurgeryUNIFESP, Department of SurgerySciEL

Local and remote ischemic preconditioning protect against intestinal ischemic/reperfusion injury after supraceliac aortic clamping

OBJECTIVES: This study tests the hypothesis that local or remote ischemic preconditioning may protect the intestinal mucosa against ischemia and reperfusion injuries resulting from temporary supraceliac aortic clamping. METHODS: Twenty-eight Wistar rats were divided into four groups: the sham surgery group, the supraceliac aortic occlusion group, the local ischemic preconditioning prior to supraceliac aortic occlusion group, and the remote ischemic preconditioning prior to supraceliac aortic occlusion group. Tissue samples from the small bowel were used for quantitative morphometric analysis of mucosal injury, and blood samples were collected for laboratory analyses. RESULTS: Supraceliac aortic occlusion decreased intestinal mucosal length by reducing villous height and elevated serum lactic dehydrogenase and lactate levels. Both local and remote ischemic preconditioning mitigated these histopathological and laboratory changes. CONCLUSIONS: Both local and remote ischemic preconditioning protect intestinal mucosa against ischemia and reperfusion injury following supraceliac aortic clamping

The effect of n-acetylcysteine on hepatic histomorphology during hypothermic preservation

PURPOSE:To evaluate the NAC effects on liver hypothermic preservation at different time intervals.METHODS:For this, we used livers of male Wistar rats weighing between 250 and 300g, undergoing preservation in Ringer solution at 4°C for up to 24 hours. Tissue samples were obtained at four moments of preservation for histological examination by hematoxylin and eosin staining: T0 = beginning of preservation, T12 = 12 hours, T18 = 18 hours and T24 = 24 hours. Will be analyzed vacuolation, hepatic apoptosis by optical microscopy and parenchymal.RESULTS: The results showed a progressive increase in hepatic injury in both groups and showed that NAC was effective at T0. The parenchyma preservation was better in the NAC group and no difference when vacuolization of the cells.CONCLUSION: Hypothermic preservation, over time, causes changes in the hepatic parenchyma with increased apoptosis, loss of architecture, vacuolization, culminating in severe injury. The administration of N-acetylcysteine protects against preservation liver injury.University City of São PauloSão Paulo University Medical SchoolFederal University of São Paulo Paulista Medicine SchoolUNIFESP, Paulista Medicine SchoolSciEL

Inhibition of mouse and rat lymphoproliferation by gangliosides

Our previous study have demonstrated that Glycosphingolipids (GSLs) have an immunosuppressive effect on murine lymphoproliferation and IL-2 production. In the present study we examined the effect of a pool of Gangliosides (Gang) on spleen lymphocyte proliferation from either isogeneic strains of Wistar rats or BALB/c mice. Two hundred-fifty grams adult female isogeneic Wistar rats and 8-week-old BALB/c mice were used. The animals were sacrificed and the spleen harvested aseptically for cellular assays. Spleen cells suspensions were obtained by homogenization in RPMI 1640 with a loose tissue grinder. After washing, the cells were suspended in RPMI 1640 supplemented. Cell viability was measured by Trypan blue exclusion. Cells were cultured in triplicate using increasing concentrations of Gang (1; 2; 5; 10; 15; 20 mug/well) and in the presence of Concanavalin A. The cells were incubated for 48 hours and were pulsed with [³H] thymidine 18 hours prior to harvesting on glass fiber paper for counting in a beta-counter. Data were presented as rate of inhibition, as previously described. At concentrations 1 and 2 mug/well, Gang stimulated lymphoproliferation (30% and 50%, rats and mice respectively), while at concentration from 5 to 20 mug/well an increasing inhibition was observed for spleen cells from both mouse and rat (from 40% up to 80%). In preliminary studies we observed inhibition of mixed lymphocyte reaction on spleen cells from rats treated with Gang for 10 days (data not shown). Our data suggest that Gang may be investigated as a immunosuppressive drug in organ transplantation.UNIFESP-EPM Departamento de CirurgiaUNIFESP-EPM Disciplina de Técnica Operatória e Cirurgia ExperimentalUNIFESP-EPM Disciplina de ParasitologiaUNIFESP, EPM, Depto. de CirurgiaUNIFESP, EPM Disciplina de Técnica Operatória e Cirurgia ExperimentalUNIFESP, EPM Disciplina de ParasitologiaSciEL

Revistas brasileiras publicadoras de artigos científicos em cirurgia: I - características estruturais e administrativas das revistas

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)USP Escola de Comunicação e ArtesUNIFESP-EPM Depto. de CirurgiaNCCCUNIFESP-EPM Biblioteca CentralUNIFESP, EPM, Depto. de CirurgiaUNIFESP, EPM Biblioteca CentralSciEL

O papel do precondicionamento isquêmico do músculo grácil de ratos na fase precoce da reperfusão

PURPOSE: Verify the role of ischemic preconditioning (IPC) in ischemia and reperfusion injury on gracilis muscle of rats. METHODS: Wistar rats (n=30) were distributed in three groups, I/R and IPC groups were subdivided concerning ischemia time. A near-amputation model of the posterior limb was produced by a hip joint level incision, preserving the vascular bundle and the femur bone and ischemia was induced for 2h and 4h, G-I 2h/R (n=6) and G-I 4h/R (n=6), followed by 1h of vascular reperfusion. The preconditioned groups, G-PCI 2h (n=6) and G-PCI 4h (n=6), were preceded by 3 cycles of 5min of ischemia followed by 5min of vascular reperfusion before sustained ischemia. In the Control Group, C-G (n=6) animals were subjected to regional approach. The analysis was done with Light Microscopy (LM). RESULTS: The levels of fibril fragmentation were progressive in the G-I 2h/R (67% of muscle preservation) and in the G-I4 h/R (0% of muscle preservation). However in the group of the precondition the lesion degree being in level similar to the group controls in the G-I 2h/R (100% of muscle preservation) while at G-I 4h/r occur less protection (67% of muscle preservation). The degree of tissue inflammatory reaction was worst at G-I 4h/R (0% without inflammation signals) than at G-I 2h/R (50% without inflammation signals); while in the precondition group G-IPC-2h (83% without inflammation signals) was better than the G-IPC-4h (67% without inflammation signals). The vascular stasis was absent only in 17% of the G-I 4h/R and in 33% of the G-I 2h/R. In precondition group, however, the vascular stasis was absent in 33% at G-IPC 2h and absent in 50% at G-IPC 4h. CONCLUSION: The IPC showed, in an earlier phase, a benefic role at I/R derived injury on gracilis muscle of rats, as proven for the largest preservation of the fibers muscular, smaller inflammatory reaction and smaller vascular stasis.OBJETIVO: Verificar o papel do precondicionamento isquêmico (PCI) na lesão de isquemia e reperfusão (I/R) do músculo grácil de ratos. MÉTODOS: Trinta ratos Wistar foram distribuídos em três grupos, sendo G-I/R e G-PCI subdivididos em relação ao tempo de isquemia. Produziu-se modelo de quase-amputação do membro posterior por meio de uma incisão, preservando o feixe vascular e o osso femoral, induzindo-se isquemia por 2h e 4h, G-I 2h/R (n=6) e G-I 4h/R (n=6), seguida por 1h de reperfusão. Os Grupos Precondicionados, G-PCI 2h (n=6) e G-PCI 4h (n=6), foram precedidos por 3 ciclos de 5min de isquemia seguidos de 5min de reperfusão, antes da isquemia sustentada. No Grupo Controle, G-C (n=6) realizou-se apenas a abordagem regional. As avaliações morfológicas foram realizadas por meio de Microscopia Óptica (MO) para avaliação da desestruturação miofibrilar, processo inflamatório e estase venosa no tecido do músculo grácil. Foram atribuídos escores semi-quantitativos às variáveis estudadas. RESULTADOS: Houve preservação miofibrilar de 76% em G-I2h/R e 0% em G-I4h/R; G-IPC 2h a preservação foi de 100% e de 67% em G-IPC 4h. A reação inflamatória foi mais acentuada em G-I 4h (100% com inflamação) do que em G-I2h (50%);G-IPC 2h apresentou 82% sem inflamação e G-IPC 4h apresentou 67% sem inflamação. A estase vascular esteve ausente em 17% do G-I 4h e em 33% do G-I 2h; em G-IPC 2h esteve ausente em33% e em G-IPC 4h em 50%. CONCLUSÃO: O PCI mostrou, em uma fase inicial, papel benéfico na lesão de I/R no músculo grácil de ratos, comprovado pela maior preservação das fibras musculares, menor reação inflamatória e menor estase venosa.Federal University of São Paulo EPMFederal University of São Paulo Surgery DepartmentFederal College Foundation of Porto AlegreLutheran University of Brazil Electronic Microscopy LaboratoryUNIFESP, EPMUNIFESP, Surgery DepartmentSciEL

Efeito da N-acetilcisteína na lesão hepática por isquemia e reperfusão após 30% de hepatectomia em camundongos

PURPOSE: Evaluate the effect of N-acetylcysteine in liver remnant after hepatectomy associated to ischemia-reperfusion injury in mice. METHODS: Male adult BALB/c mice, weighing 20-22g were used. Animals were anesthetized with ketamine (70 mg/kg) and xylazine (10 mg/kg); received N-acetylcysteine (150 mg/kg, H-IR-NAC group) or vehicle (H-IR group). Surgical procedures were performed under 10X magnification. Partial hepatectomy (30%) was followed by ischemia-reperfusion injury (30 minutes of ischemia and 60 minutes of reperfusion). Blood sample and liver tissue were removed before animal was euthanized. AST and ALT were evaluated in blood samples and histomorphological analyses were performed in remnant liver. Groups were compared by Mann-Whitney test, and it was considered significant when p<0.05. RESULTS: Biochemical evaluations showed reduced levels of ALT in NAC group (H-IR-NAC=376±127U/l vs H-IR=636±39U/l, p=0.023). AST was similar (p=0.456). H-IR group showed hepatic tissue with preserved architecture, large area of steatosis, vascular congestion and rare mitogenic activity. NAC group showed hepatic tissue with small area of steatosis, vascular congestion and elevated mitogenic activity, evidenced by increased binuclear cells (H-IR-NAC=15.88±0.52 vs H-IR=7.4±0.37, p<0.001). CONCLUSION: N-acetylcysteine promotes enzymatic and morphological protection against hepatectomy and ischemia-reperfusion injury.OBJETIVO: Investigar se a N-acetilcisteína promove proteção do remanescente hepático após ressecção associada à isquemia e reperfusão do fígado em camundongos. MÉTODOS: Foram utilizados 12 camundongos BALB/c, machos, pesando entre 20-22g. Os animais foram anestesiados com quetamina (70mg/kg) e xilazina (10mg/kg); receberam a N-acetilcisteína (150mg/kg, grupo H-IR-NAC) ou controle (grupo H-IR). Os procedimentos cirúrgicos ocorreram na magnificação de 10X. A lesão por isquemia e reperfusão (30 minutos de isquemia e 60 minutos de reperfusão) foi precedida pela hepatectomia de 30%. Foram utilizados como parâmetro de avaliação: a bioquímica sangüínea (AST e ALT) e a histologia do fígado (coloração de hematoxilina-eosina). Para avaliação estatística empregou-se o teste de Mann-Whitney e o nível de significância foi 5%. RESULTADOS: Na avaliação bioquímica houve redução no nível de ALT no grupo tratado (H-IR-NAC=376±127 U/l vs H-IR=636±39 U/l, p=0,023). AST foi similar (p=0,456). Na histologia, o grupo H-IR apresentou um tecido hepático com arquitetura preservada, com grandes áreas de infiltração gordurosa, presença de congestão vascular e de alguma atividade mitótica; o grupo com a N-acetilcisteína apresentou menor infiltração gordurosa e congestão vascular, maior atividade mitótica, evidenciada pela quantidade elevada de células binucleadas (H-IR-NAC=15,88±0,52 vs H-IR=7,4±0,37, p<0,001). CONCLUSÃO: A N-acetilcisteína promove proteção ao fígado, do ponto de vista morfológico e enzimático, após hepatectomia associada à isquemia e reperfusão.UNIFESP Division of Operative Technique and Experimental Surgery Department of SurgeryUniversidade Federal de São Paulo (UNIFESP) Department of SurgeryUNIFESP Division of Histology Department of MorphologySão Paulo University Faculty of Medicine Surgical PhysiopathologyUNIFESP, Division of Operative Technique and Experimental Surgery Department of SurgeryUNIFESP, Department of SurgeryUNIFESP, Division of Histology Department of MorphologySciEL

Remote ischemic preconditioning and tacrolimus in the fetal small bowel transplant in mice

PURPOSE: To evaluate the effect of remote ischemic preconditioning (IPC-R) in the fetal small bowel transplantation model. METHODS: Two groups were constituted: The Isogenic transplant (ISO, C57BL/6 mice, n=24) and the allogenic transplant (ALO, BALB/c mice, n=24). In each group, the animals were distributed with and without IPC-R. It was obtained the following subgroups: Tx, IPC-R, Fk, IPC-Fk, in both strains. Intestinal grafts were stained with hematoxylin and eosin and immunohistochemically. RESULTS: The graft development evaluation in ISO group showed that IPC-R reduced the development compared with ISO-Tx (5.2+/-0.4 vs 9.0+/-0.8) and IPC-R-Fk increased the graft development compared with IPC-R (11.2+/-0.7 and 10.2+/-0.8). In ALO group, IPC-Fk increased the development compared with ALO-Tx and ALO with IPC-R (6.0+/-0.8, 9.0+/-1.2, 0.0+/-0.0, 0.5+/-0.3). The PCNA expression was increased in ISO group treated with Fk and IPC-R compared to other groups (12.2+/-0.8 vs Tx: 8.8+/-0.9, IPC-R: 8.0+/-0.4 and Fk: 9.0+/-0.6). The graft rejection was lower in groups treated with IPC-R (-18%), Fk (-68%) or both (-61%) compared with ALO-Tx. CONCLUSION: Remote ischemic preconditioning showed benefic effect even associate with Tacrolimus on the development and acute rejection of the fetal small bowel graft in the Isogenic and Allogenic transplants.Univ Fed Sao Paulo UNIFESP, Sch Med, Operat Tech & Expt Surg Div, Sao Paulo, SP, BrazilUniv Sao Paulo, Fac Med, Lab Emergency Med LIM 51, Sao Paulo, BrazilUniv Fed Vale Sao Francisco UNIVASF, Sch Med, Petrolina, PE, BrazilFMUSP, Surg Physiopathol Lab LIM 62, Sao Paulo, SP, BrazilOperative Technique and Experimental Surgery Division, Medical School, Universidade Federal de São Paulo (UNIFESP), BrazilWeb of Scienc