Effect of a selective nonsteroidal anti-inflammatory inhibitor of cyclooxygenase-2 on the small bowel of rats

The pathogenesis of nonsteroidal anti-inflammatory drug (NSAID) enteropathy is a complex process involving the uncoupling of mitochondrial oxidative phosphorylation and inhibition of cyclooxygenase (COX). Rofecoxib, a selective inhibitor of COX-2, has shown less gastric damage, but the same beneficial effect is not clear in the case of the small bowel. Fifty-seven male Wistar rats (250-350 g) were divided into three groups (N = 19 each) to evaluate the effect of this NSAID on the rat intestine. The groups received 2.5 mg/kg rofecoxib, 7.5 mg/kg indomethacin or water with 5 percent DMSO (control) given as a single dose by gavage 24 h before the beginning of the experiment. A macroscopic score was used to quantify intestinal lesions and intestinal permeability was measured using [51Cr]-ethylenediaminetetraacetic acid ([51Cr]-EDTA). The extent of intestinal lesion, indicated by a macroscopic score, was significantly lower when rofecoxib was administered compared to indomethacin (rofecoxib = 0.0 vs indomethacin = 63.6 ± 25.9; P < 0.05) and did not differ from control. The intestinal permeability to [51Cr]-EDTA was significantly increased after indomethacin (control = 1.82 ± 0.4 vs indomethacin = 9.12 ± 0.8 percent; P < 0.0001), but not after rofecoxib, whose effect did not differ significantly from control (control = 1.82 ± 0.4 vs rofecoxib = 2.17 ± 0.4 percent; ns), but was significantly different from indomethacin (indomethacin = 9.12 ± 0.8 vs rofecoxib = 2.17 ± 0.4 percent; P < 0.001). In conclusion, the present data show that rofecoxib is safer than indomethacin in rats because it does not induce macroscopic intestinal damage or increased intestinal permeability.

Redondogastropexia associada a valvula anti-refluxo no tratamento de hernia hiatal de deslizamento. Estudo de 33 casos. / Redondogastropexy associated with antireflux valve in the treatment of sliding hiatal hernia.Study of 33 cases

Os autores apresentam 33 casos de hernia hiatal por deslizamento, sem reducao do calibre do esofago, tratados cirurgicamente pela associacao da redondocardiopexia a valvula anti-refluxo, confeccionada pelo envolvimento parcial do esofago abdominal pelo fundo gastrico, cuja tecnica e descrita. No seguimento continuo dos pacientes verificou-se a cura da doenca em todos os casos. Apenas um paciente, apos dois anos, embora assintomatico, persistiu apresentando refluxo gastroesofagico discreto a esofagogastroscopia. Concluem os autores pela eficiencia da associacao das operacoes, que sao bastante rapidas e seguras

Vesicula biliar em porcelana. Consideracoes a respeito de dois casos. / Porcelain gallbladder. Considerations apropos of 2 cases

Os autores apresentam dois casos de calcificacao da parede da vesicula biliar. Discutem os mecanismos etiopatogenicos desta rara afeccao e ressaltam a necessidade do tratamento cirurgico uma vez que a associacao com o carcinoma do orgao e grande e frequentemente oligossintomatica

Enfisema retroperitoneal, mediastinal e cervical apos perfuracao traumatica do reto subperitoneal. / Retroperitoneal, mediastinal and cervical emphysema following traumatic perforation of the subperitoneal rectum

Os autores apresentam um raro caso de enfisema retroperitoneal, mediastinal e cervical desenvolvido a partir de uma perfuracao traumatica do reto subperitoneal. O mecanismo e modo de difusao dos gases colonicos para o mediastino sao discutidos. O diagnostico foi feito pelo achado radiologico de pneumoretroperitoneo, pneumomediastino e enfisema cervical. A evolucao foi favoravel sob tratamento cirurgico