Estudo da cicatrização de anastomoses realizadas no íleo terminal e cólon distal de ratos normais e diabéticos: análise morfométrica e ultraestrututral do colágeno

O presente trabalho teve por objetivo investigar se o diabetes experimental aloxânico poderia provocar alterações qualitativas nas anastomoses intestinais realizadas em íleo terminal e cólon distal de ratos, em relação a ratos controles normais, submetidos à mesma abordagem cirúrgica. Foram efetivamente avaliados 192 ratos da raça Wistar, machos, sadios ao exame clínico, pesando entre 200 e 300g, distribuídos em quatro grupos experimentais de 48 animais cada, sendo um grupo controle normal com anastomoses realizadas no ileo (GI), um grupo controle normal com anastomoses realizadas no cólon (G2), um grupo diabético com anastomoses realizadas no íleo (G3), e um grupo diabético com anastomoses realizadas no cólon (G4). Após três meses de seguimento (GI e G2), ou de diabetes (G3 e G4), os animais dos quatro grupos experimentais foram operados sendo realizadas anastomoses no íleo terminal (Cl e G3) ou no cólon distal (G2 e G4) e subsequentemente avaliados em quatro momentos de pós-operatório (40, 14°, 21° e 300 dias), onde foram analisados os seguintes parâmetros: evolução clínica (peso corporal, ingestão hídrica, ingestão alimentar, diurese), exames laboratoriais (glicemia de jejum e glicosúria). Em cada um dos momentos mencionados os animais foram sacrificados, sendo retirados fragmentos de intestino delgado e de intestino grosso, envolvendo as anastomoses realizadas, sendo espécimes de 6 animais utilizados para análise ultraestrutural das fibras colágenas, à microscopia eletrônica de varredura, com posterior cálculo da dimensão fractal, e outros 6 para o estudo histopatológico à microscopia óptica pelo método de coloração do pricrosirius. A indução do diabetes foi feita por meio da injeção endovenosa de aloxana a 2%, em dose única. Foram incluídos no experimento somente animais com diabetes grave....The purpose of this study was to investigate if experimental aloxanic diabetes could cause qualitative changes in intestinal anastomoses of the terminal ileum and distai colon in rats, when compared to normal control rats submitted to the sarne surgicai approach. 192 male Wistar rats were weighing between 200 and 300 g were spiit into four experimental groups of 48 animais each. One normal controi group was submitted to ileum anastomoses (Gi), one normal control group was submitted to coion anastomoses (G2), one diabetic group was submitted to anastomoses of the ileum (G3) and the fourth diabetic group was submitted to anastomoses of the coion (G4). Normal (GI and G2) and diabetic (G3 and G4) rats were foliowed up for three months and then submitted to anastomoses of the terminal iieum (Gi and G3) or of the distai coion (G2 and G4). Animais were evaiuated on days 4, 14, 21 and 30 after surgery and the foiiowing parameters were assessed: clinical evolution (body weight, fluid intake, food ingestion and diuresis), laboratory tests (glycemia and glycosuria). Animais were sacrificed on each of these days and fragments of the small and large intestine where the anastomoses were performed were removed. Samples from 6 animais were submitted to ultrastructurai analysis of the collagen fibers using a scanning electron microscope and using these images, the fractal dimension of the collagen structure was calculated. Sampies from another 6 animais were submitted to histopathology at opticai microscopy stained by picrosirius red and the area of the coilagen in the anastomoses were calcuiated using these digitized images. Diabetes was induced with a singie intravenous injection of alioxan 2%. The study ínciuded oniy animais with severe diabetes characterized by progressive weight loss,... (Complete abstract, click electronic address below).Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Anastomotic healing in ileum and colon of alloxan-induced diabetic rats Cicatrização de anastomoses realizadas no íleo e cólon de ratos diabéticos induzidos pela aloxana

PURPOSE: To investigate if diabetes mellitus may alter breaking strength (BS) and collagen content in ileum and colon anastomoses in rats. METHODS: Three-hundred Wistar rats were randomly assigned to 5 experimental groups, 60 per group: normal controls surgically manipulated (G1); normal controls submitted to ileum (G2) and colon (G3) anastomotic construction; diabetic rats submitted to ileum (G4) and colon (G5) anastomotic construction. Each group was further divided into 6 subgroups with 10 rats each for sacrifice at 0, 4, 7, 14, 21, and 30 days after surgery. All surgical procedures were performed 3 months after alloxan diabetes induction. BS was measured in all intestinal anastomoses. Fragments of ileum and colon anastomoses were taken for hydroxyproline concentration (HP) and total tissue protein (TP) dosages. RESULTS: Anastomotic BS was significantly decreased (P<0.05) in ileum and colon of G4 and G5 diabetic groups up to 7 and 14 days after surgery, respectively, compared with G2 and G3 normal control groups. Anastomotic HP and TP content did not significantly differ between diabetic and normal control operated groups in ileum or colon at all evaluation times. CONCLUSION: Experimental diabetes leads to impaired intestinal anastomotic strength during early surgical wound repair, but does not appear to be implicated with collagen synthesis capacity.<br>OBJETIVO: Investigar se o diabetes mellitus pode alterar a força de ruptura (FR) e o conteúdo de colágeno em anastomoses realizadas no íleo e cólon de ratos. MÉTODOS: 300 ratos Wistar foram distribuídos por sorteio em 5 grupos experimentais com 60 animais cada: controle normal manipulado cirurgicamente (G1); normais controles submetidos a anastomoses no íleo (G2) e cólon (G3); ratos diabéticos submetidos a anastomoses no íleo (G4) e cólon (G5). Cada grupo foi dividido em 6 subgrupos com 10 ratos cada para sacrifícios com 0, 4, 7, 14, 21 e 30 dias após as operações. Os procedimentos cirúrgicos foram realizados 3 meses após a indução do diabetes com aloxana. A FR foi medida em todas anastomoses intestinais. Fragmentos de anastomoses do íleo e cólon foram retirados para dosagens de hidroxiprolina (HP) e proteína tecidual total (PT). RESULTADOS: A FR teve significante redução (P<0,05) nos grupos diabéticos G4 e G5, até 7 e 14 dias após a operação, respectivamente, quando comparada à observada nos grupos controles G2 e G3. Não foram observadas diferenças significantes nas dosagens de HP e PT em ratos diabéticos e controles, tanto operados no íleo como no cólon, em todos os momentos de avaliação. CONCLUSÃO: O diabetes conduz a alterações da força de ruptura de anastomoses intestinais durante a fase inicial da reparação da ferida cirúrgica, porém, este fato parece não estar relacionado à capacidade de sintetizar colágeno

Upper gastrointestinal histopathological findings in children and adolescents with nonulcer dyspepsia with helicobacter pylori infection

Objectives: The aim of the study was to investigate the histopathological lesions in the upper gastrointestinal mucosa associated with Helicobacter pylori infection in children with nonulcer dyspepsia.Methods: A cross-sectional case-control study was performed on 185 Brazilian children and adolescents (4-17 years, mean 9.5 +/- 2.7 years), 63.2% girls, submitted to upper gastrointestinal endoscopy. The histopathological lesions of the esophageal and gastric mucosa were analyzed in biopsy samples.Results: H pylori infection was identified in 96 children (51.8%). Moderate to severe chronic active gastritis was present in antrum (70.5%) and corpus (45.2%), with higher grading in antrum than in corpus (P<0.05). The topographic distribution of inflammation was pangastritis (61.9%), followed by antral (32.1%) and corpus (5.9%). H pylori density was higher in antrum than in corpus. Intestinal metaplasia was not found in the H pylori-infected group, nor was significant gastric atrophy. The scores for esophagitis were significantly higher (P<0.05) in the noninfected group (1.4 +/- 0.8) than in the H pylori-infected group (1.07 +/- 0.9), with significant negative correlation (r = 0.29; P<0.05) with the scores of gastric inflammation.Conclusions: The prevalence of H pylori infection was high among children with dyspepsia and associated with moderate/severe degrees of gastric inflammation. The high scores of esophagitis in the noninfected group point to 2 distinct groups of pathological conditions sharing similar clinical patterns

Resultados do tratamento cirúrgico da doença do refluxo gastroesofágico em crianças com e sem afecções neurológicas concomitantes

RACIONAL: Crianças portadoras de distúrbios neurológicos têm maior incidência de refluxo e, em geral, não apresentam melhora da sintomatologia com tratamento clínico, necessitando de intervenção cirúrgica. OBJETIVO: Comparar os resultados da operação antirefluxo em crianças normais e com comprometimento neurológico, identificando as principais complicações e causas de reoperação. MÉTODOS: Cento e vinte crianças portadores de refluxo foram distribuídas em dois grupos de estudo: Grupo I - 60 crianças normais; Grupo II - 60 crianças com comprometimento neurológico. Exame contrastado do esôfago, estômago e duodeno, endoscopia digestiva alta com biópsia, pHmetria esofágica de 24 horas e cintilografia foram os exames utilizados no diagnóstico e na avaliação da eficácia da operação antirefluxo. Todos os pacientes operados eram refratários ao tratamento clínico. O procedimento cirúrgico antirefluxo realizado foi predominantemente a fundoplicatura de Lind, sendo associada à gastrostomia em 55% dos pacientes do Grupo II. RESULTADOS: No Grupo II a indicação cirúrgica foi significantemente mais precoce que no Grupo I. A principal causa de indicação cirúrgica entre neuropatas foi o alto comprometimento do desenvolvimento neuropsíquico-motor e as pneumonias de repetição. O tempo de internação, as reoperações e a necessidade de dilatações esofágicas no pós-operatório foi maior no Grupo II (p<0,01). Ocorreram três óbitos no pós-operatório tardio no Grupo II (sepse e infecção respiratória grave). CONCLUSÃO: O tratamento cirúrgico adotado foi satisfatório para o tratamento cirúrgico do refluxo nos dois grupos de pacientes. Porém, torna-se necessário o aprofundamento dos estudos acerca da população de crianças neuropatas portadoras de refluxo, uma vez que estas respondem de forma menos favorável ao procedimento cirúrgico, principalmente no que se refere às taxas de mortalidade, recorrência dos sintomas respiratórios, índice de reoperações e gravidade das complicações pós-operatórias.BACKGROUND: Children with neurological disorders present a higher incidence of reflux, and generally symptoms do not get better with clinical treatment, making surgical interventions a necessary action. AIM: To compare the results of the anti-reflux surgery in normal children and in those with neurological disorders, identifying the leading complications and causes of re-operation. METHODS: One hundred and twenty children with gastroesophageal reflux were distributed into two groups of study: Group I - 60 normal children; Group II - 60 children with neurological disorders. Barited contrast of aesophagus, stomach and duodenum, high endoscopy with biopsy, 24 hours esophageal pHmetry and cintilography were the tests utilized in the diagnosis and evaluation of the efficacy of the surgery. All operated patients were refractory to clinical treatment prior to surgery. The anti-reflux surgery performed was Lind fundoplication, being associated to gastrostomy in 55% of the Group II patients. RESULTS: In Group II, surgery was indicated earlier than Group I. Among neuropaths, their highly affected neural psyquic motor development and repeated pneumonia were the main causes of surgery indication. Hospitalization time, number of re-operations and the need for post-operation esophageal dilatation were greater in Group II (p<0.01). Three deaths occurred in Group II during late post-operative period (sepsis and severe respiratory infection). CONCLUSION: The procedure performed is satisfactory for surgical reflux treatment. However, further studies of neuropath children population with reflux are imperative as they respond less favorably to surgery with regard to mortality rates, recurrence of respiratory symptoms, re-operation rates and severity of post-operative complications

Pancreas transplantation prevents cellular oxidative stress in kidneys of alloxan-induced diabetic rats

Purpose. Oxidative stress is one of the most important mechanisms to explain genesis of the complications in the chronic progression of diabetes. In this investigation we studied the effects of pancreas transplantation (PT) on the imbalance caused by excessive production of free oxygen radicals by antioxidant defenses of rats with serious chronic hyperglycemia induced by alloxan.Methods. Ninety inbred male Lewis rats were randomly distributed into three groups: NC-30 nondiabetic controls; DC-30 diabetic controls without any treatment; PT-30 diabetic rats undergoing syngeneic PT from normal donor Lewis rats. Each experimental group was then split into three subgroups of 10 animals for sacrifice after 1, 3, or 6 months. Clinical and laboratory parameters from all rats as well as lipid hydroperoxide (LPO) concentrations and renal tissue enzyme activities of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GSH-Px) were recorded for all rats.Results. Successful PT corrected clinical and laboratory alterations in diabetic rats with sustained normoglycemia throughout the study. A significant increase in LPO concentration and a marked reduction in SOD and CAT enzyme activity were observed in DC rats; there was no significant variation in renal tissue GSH-Px in this group. However, alterations in DC rats were completely restored from 1st month after PT; all evaluated enzyme levels did not significantly differ (P < .01) from those in NC controls.Conclusion. Successful PT controlled cellular oxidative stress in diabetic kidneys, which may prevent chronic lesions

Análisis de la vocación, motivación y burnout en el profesorado de un centro educativo de la Comunidad de Madrid

La motivación de los alumnos de Educación Secundaria (ESO) y Bachillerato en las clases de Educación Física es fundamental para asegurar la adherencia a la actividad física y el desarrollo de un estilo de vida saludable. En esa motivación es esencial el papel del profesor y su motivación, menos estudiada que la de los alumnos. Este estudio se propone investigar la motivación de los docentes de Educación Física de ESO y Bachillerato, y su relación con la vocación y el agotamiento emocional, así como compararla con la de los profesores de esta asignatura de Educación Primaria y de otras asignaturas de ESO y Bachillerato. Se administró un cuestionario con preguntas sobre motivación, burnout y vocación a 31 profesores (6 Educación Física de ESO y Bachillerato, 7 de Educación Física de Educación Primaria y 18 de otras asignaturas de ESO y Bachillerato). No obtenemos correlaciones significativas entre la vocación y la motivación, ni entre la motivación y el burnout. Tampoco obtenemos diferencias significativas en la motivación de los tres grupos de estudio, lo que nos sugiere que el nivel de impartición y/o asignatura impartida en un centro no parece ser un elemento determinante en la motivación del profesorado. ----------ABSTRACT---------- Secondary Education and Baccalaureate student’s motivation to face Physical Education is important to make them practice physical activity by their own and to develop a healthy way of living. Teacher’s attitude is essential to motivate these students, but their motivation, which is even more important, has not been widely studied. Our study aims to research Physical Education teachers’ motivation, and it relation with vocation and burnout syndrome. We want to compare this motivation with Primary Education teacher’s one and with that of other teachers who teach different subjects in the same academic level. We use a motivation questionnaire with 31 teachers (6 teach Physical Education in Secondary Education and Baccalaureate, 7 teach Physical Education in Primary Education and 18 teach other subjects in Secondary Education). We do not get significant correlations between vocation and motivation and neither between motivation and burnout. Moreover, we do not find significant differences in the motivation of our three groups of teachers what suggest us that subjects or level of education taught do not seem to determinate teacher’s motivation

Microscopic, morphometric and ultrastructural analysis of anastomotic healing in the intestine of normal and diabetic rats

The purpose of this study was to investigate if experimental alloxanic diabetes could cause qualitative changes in intestinal anastomoses of the terminal ileum and distal colon in rats, as compared to controls. 192 male Wistar rats, weighing ± 300g were split into four experimental groups of 48 animals each, after 3 months of follow-up: a control group with ileum anastomoses (G1), a control group with colon anastomoses (G2), a diabetic group with ileum anastomoses (G3) and a diabetic group with colon anastomoses (G4). Animals were evaluated and sacrificed on days 4, 14, 21 and 30 after surgery, and fragments of the small and large intestine where the anastomoses were performed were removed. Samples from 6 animals from each sacrifice moment were submitted to ultrastructural analysis of the collagen fibers using a scanning electron microscope and samples from another 6 animals were submitted to histopathology and optical microscopy studies using picrosirius red-staining. Histopathological analysis of picrosirius red-stained anastomosis slides using an optical microscope at 40x magnification showed that the distribution of collagen fibers was disarranged and also revealed a delay in scar tissue retraction. The morphometric study revealed differences in the collagen filled area for the ileum anastomoses 14 days post surgery whereas, in the case of colon anastomoses, differences were observed at days 4 and 30 post surgery, with higher values in the diabetic animals. Ultrastructure analysis of the ileum and colon anastomoses using a scanning electron microscope revealed fewer wide collagen fibers, the presence of narrower fibers and a disarranged distribution of the collagen fibers. We conclude that diabetes caused qualitative changes in scar tissue as well as in the structural arrangement of collagen fibers, what could explain the reduced wound strength in the anastomosis of diabetic animals. © J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart

Does Calretinin Immunohistochemistry Reduce Inconclusive Diagnosis in Rectal Biopsies for Hirschsprung Disease?

Many difficulties occur during the evaluation of rectal biopsies for the diagnosis of Hirschsprung disease. We investigated whether the introduction of calretinin (CR) immunohistochemistry in a diagnostic panel could decrease the rate of inconclusive results. Data from 82 patients undergoing rectal biopsies before and after CR introduction were analyzed. Inconclusive results were obtained in 17 of 45 rectal biopsies (37.8%) in the series of cases before CR introduction and in 5 of 42 rectal biopsies (11.9%) in the series of cases after CR (P < 0.006). The inclusion of CR in the histopathologic panel may improve the diagnostic accuracy of Hirschsprung disease

A useful panel for the diagnosis of Hirschsprung disease in rectal biopsies: calretinin immunostaining and acetylcholinesterase histochesmistry

The pathological evaluation of rectal biopsies for the diagnosis of Hirschsprung disease has been a challenging issue. We analyzed prospectively the usefulness of calretinin immunostaining and acetylcholinesterase (AChE) histochesmistry in rectal biopsies for the diagnosis of Hirschsprung disease. Frozen tissue samples from 43 patients were used for AChE histochemistry and paraffin-embedded sections for calretinin immunohistochemistry and conventional histology (hematoxylin and eosin [H&E]). Activity for AChE, was demonstrated in 13 of 43 cases, and the absence of immunoreactivity for calretinin was observed in 14 of 43 cases. Conventional histology (H&E) did not reveal ganglion cells in 24 of 43 cases. The results on calretinin were in good agreement with AChE according to the κ index (0.946; P < .001) and presented significantly higher specificity (96.7 × 63.3; P < .002) and accuracy (97.6 × 74.4; P < .003) when compared with conventional histology (H&E). The final diagnosis of Hirschsprung disease was confirmed in 13 of 43 patients who were submitted to surgical treatment. The results of the present study indicate that calretinin can be a good tool in ruling out the diagnosis of Hirschsprung disease, by showing positive staining in ganglion cells and intrinsic nerve fibers, whereas AChE is useful in confirming the diagnosis of Hirschsprung disease, by revealing activity of this enzyme in hypertrophied nerve fibers. The association between calretinin and AChE can be a useful panel for the histopathologic evaluation of rectal biopsies for the diagnosis of Hirschsprung disease. © 2013 Elsevier Inc. All rights reserved