Laparoscopic bariatric surgery in adolescents: early and five- year clinical and laboratory assessment / Cirurgia bariátrica videolaparoscópica em adolescentes: avaliação clínica e laboratorial precoce e após cinco anos

ABSTRACT BACKGROUND: Obesity has reached epidemic proportions among adolescents. Methods, such as bariatric surgery, have become the most effective treatment for patients with classes III and IV obesity. AIM: To evaluate weight loss, comorbidity remission, and long-term results of bariatric surgery in adolescents. METHODS: Study with adolescent patients undergoing bariatric surgery, evaluating laboratory tests, comorbidities, and the percentage of excess weight loss in the preoperative period and at one, two, and five years postoperatively. RESULTS: A total of 65 patients who met the inclusion criteria, with a mean age of 18.6 years, were included in the analysis. In the preoperative period, 30.8% of hypercholesterolemia, 23.1% of systemic arterial hypertension, and 18.4% of type 2 diabetes were recorded, with remission of these percentages occurring in 60, 66.7 and 83.4%, respectively. The mean percentage of excess weight loss was 63.48% after one year of surgery, 64.75% after two years, and 57.28% after five years. The mean preoperative total cholesterol level was 180.26 mg/dL, and after one, two, and five years, it was 156.89 mg/dL, 161.39 mg/dL, and 150.97 mg/dL, respectively. The initial mean of low-density lipoprotein was 102.19mg/dL and after five years the mean value reduced to 81.81 mg/dL. The mean preoperative glycemia was 85.08 mg/dL and reduced to 79.13 mg/dL after one year, and to 76.19 mg/dL after five years. CONCLUSIONS: Bariatric surgery is safe and effective in adolescents, with low morbidity, resulting in a loss of excess weight and long-term stability, improving laboratory tests, and leading to remission of comorbidities, such as diabetes mellitus, hypercholesterolemia, and systemic arterial hypertension.

RESUMO RACIONAL: A obesidade tomou proporções epidêmicas entre adolescentes, e procedimentos como a cirurgia bariátrica tornou-se o tratamento mais efetivo em pacientes com obesidade grau III e IV. OBJETIVOS: Avaliar a perda peso, a remissão de comorbidades, e resultados a longo prazo da cirurgia bariátrica em adolescentes. MÉTODOS: Estudo com pacientes adolescentes submetidos à cirurgia bariátrica, avaliando exames laboratoriais, comorbidades e o percentual de perda de excesso de peso, nos períodos pré-operatório e com 1, 2 e 5 anos de pós-operatório. RESULTADOS: Foram incluídos no estudo 65 pacientes que preencheram os critérios de inclusão, com a média de idade de 18,6 anos. No pré-operatório foram registrados: 30,8% hipercolesterolemia, 23,1% hipertensão arterial sistêmica e 18,4% diabetes tipo 2, ocorrendo remissão destes porcentuais em 60, 66,7 e 83,4%, respectivamente. O percentual médio de perda de excesso de peso após 1 ano foi de 63,48%, após 2 anos foi de 64,75% e após 5 anos foi 57,28%. O valor médio do colesterol total no pré-operatório era de 180,26mg/dL, e após 1 ano, 2 anos e 5 anos foram de 156,89mg/dL,161,39mg/dL e de 150,97mg/dL, respectivamente. A média inicial de lipoproteína de baixa densidade era 102,19mg/dL e após 5 anos o valor médio reduziu para 81,81 mg/dL. O valor médio da glicose pré-operatório era 85,08 mg/dL, após um ano uma média 79,13mg/dL, e com 5 anos 76,19 mg/dL. CONCLUSÕES: A cirurgia bariátrica é segura e eficaz em adolescentes, com baixa morbidade, resultando em uma perda do excesso de peso e estabilidade a longo prazo, melhorando exames laboratoriais e levando a remissão de comorbidades como diabetes mellitus, hipercolesterolemia e hipertensão arterial sistêmica.

A importância do uso de pericárdio bovino para reconstruções cirúrgicas: uma revisão sistemática / The importance of the use of bovine pericardium for surgical reconstructions: a systematic review

Introdução: O uso de pericárdio bovino teve início em 1972 nas cirurgias cardiovasculares. A partir da evolução da engenharia de tecidos com os cuidados na preparação do material, minimizando os riscos de rejeição e facilitando a utilização para diversos tipos de cirurgias, o pericárdio bovino tornou-se ferramenta importante em procedimentos cirúrgicos reconstrutivos. Objetivos: Nessa casuística, o presente estudo propõe avaliar o atual cenário da utilização do pericárdio bovino em procedimentos cirúrgicos de diversas especialidades e os resultados pósoperatórios encontrados. Métodos: Assim, foi realizada uma revisão sistemática da literatura e a base de dados consultada foi a MEDLINE, utilizando a palavra-chave "bovine pericardium", elencando estudos publicados nos últimos cinco anos em inglês e português, e que não utilizavam outro tipo de "patch". Resultados: Foram selecionados 14 artigos que totalizam 507 pacientes, submetidos a cirurgias em diversas áreas, tais quais, cardiologia, neurologia, vascular, pediatria, urologia e oftalmologia. Conclusão: Depreende-se que o uso de pericárdio bovino como remendo cirúrgico é seguro, tendo em vista que existem poucos casos de rejeição do hospedeiro, além de fácil e rápido de ser manuseado, possuindo benefícios frente a próteses mecânicas. Faz-se relevante, portanto, ampliar o número de estudos sobre o tema, visando o grande potencial que esse tipo de material possui para a medicina regenerativa.

Introduction: The use of bovine pericardium started in 1972 in cardiovascular surgeries. From the evolution of tissue engineering with care in the preparation of the material, minimizing the risk of rejection and facilitating the use for various types of surgeries, the bovine pericardium has become an important tool in reconstructive surgical procedures. Purpose: In this series, the present study proposes to evaluate the current scenario of the use of bovine pericardium in surgical procedures of different specialties, and the postoperative results found. Methods: Thus, a systematic literature review was carried out and the database consulted was MEDLINE, using the keywords "bovine pericardium", listing studies published in the last five years in English and Portuguese and that did not use another type of patch. Results: 14 articles were selected, totaling 507 patients, who underwent surgery in several areas, such as cardiology, neurology, vascular, pediatrics, urology, and ophthalmology. Conclusion: It appears that the use of bovine pericardium as a surgical patch is safe, given that there are few cases of host rejection, in addition to being easy and quick to handle, with benefits compared to mechanical prostheses. It is relevant, therefore, to expand the number of studies on the subject, aiming at the great potential that this type of material has for regenerative medicine.

Tacrolimus action pathways in an ointment base for hypertrophic scar prevention in a rabbit ear model

Abstract Background: Tacrolimus is used to prevent unaesthetic scars due to its action on fibroblast activity and collagen production modulation. Objectives: To evaluate the action pathways, from the histopathological point of view and in cytokine control, of tacrolimus ointment in the prevention of hypertrophic scars. Methods: Twenty-two rabbits were submitted to the excision of two 1-cm fragments in each ear, including the perichondrium. The right ear received 0.1% and 0.03% tacrolimus in ointment base twice a day in the upper wound and in the lower wound respectively. The left ear, used as the control, was treated with petrolatum. After 30 days, collagen fibers were evaluated using special staining, and immunohistochemistry analyses for smooth muscle actin, TGF-β and VEGF were performed. Results: The wounds treated with 0.1% tacrolimus showed weak labeling and a lower percentage of labeling for smooth muscle actin, a higher proportion of mucin absence, weak staining, fine and organized fibers for Gomori's Trichrome, strong staining and organized fibers for Verhoeff when compared to controls. The wounds treated with 0.03% tacrolimus showed weak labeling for smooth muscle actin, a higher proportion of mucin absence, strong staining for Verhoeff when compared to the controls. There was absence of TGF-β and low VEGF expression. Study limitations: The analysis was performed by a single pathologist. Second-harmonic imaging microscopy was performed in 2 sample areas of the scar. Conclusions: Both drug concentrations were effective in suppressing TGF-β and smooth muscle actin, reducing mucin, improving the quality of collagen fibers, and the density of elastic fibers, but only the higher concentration influenced elastic fiber organization.

Taxa de detecção de pólipos serrilhados proximais: um indicador de qualidade complementar para a taxa de detecção de adenomas? / Proximal serrated polyp detection rate: a complementary quality indicator for adenoma detection rate?

ABSTRACT BACKGROUND: The effectiveness of colonoscopy for colorectal cancer (CRC) screening depends on quality indicators, which adenoma detection rate (ADR) being the most important. Proximal serrated polyp detection rate (pSPDR) has been studied as a potential quality indicator for colonoscopy. OBJECTIVE: The aim is to analyze and compare the difference in ADR and pSPDR between patients undergoing screening colonoscopy and an unselected population with other indications for colonoscopy, including surveillance and diagnosis. METHODS: This is a historical cohort of patients who underwent colonoscopy in the digestive endoscopy service of a tertiary hospital. Out of 1554 colonoscopies performed, 573 patients were excluded. The remaining 981 patients were divided into two groups: patients undergoing screening colonoscopy (n=428; 43.6%); patients with other indications including surveillance and diagnosis (n=553; 56.4%). RESULTS: Adenoma detection rate of the group with other indications (50.6%) was higher than that of the screening group (44.6%; P=0.03). In regarding pSPDR, there was no difference between pSPDR in both groups (screening 13.6%; other indications 13.7%; P=0.931). There was no significant difference in the mean age (P=0.259) or in the proportion of men and women (P=0.211) between both groups. CONCLUSION: Proximal serrated polyp detection rate showed an insignificant difference between groups with different indications and could be used as a complementary indicator to adenoma detection rate. This could benefit colonoscopists with low colonoscopy volume or low volume of screening colonoscopies.

RESUMO CONTEXTO: A efetividade da colonoscopia no rastreamento do câncer colorretal (CCR) depende de indicadores de qualidade, sendo a taxa de detecção de adenoma (TDA) a mais importante. A taxa de detecção de pólipos serrilhados proximais (TDPSp) tem sido estudada como um potencial indicador de qualidade para a colonoscopia. OBJETIVO: O objetivo é analisar e comparar a diferença de TDA e TDPSp entre pacientes submetidos à colonoscopia de rastreamento e uma população não selecionada com outras indicações para colonoscopia, incluindo vigilância e diagnóstico. MÉTODOS: Esta é uma coorte histórica de pacientes submetidos à colonoscopia no serviço de endoscopia digestiva de um hospital terciário. Das 1554 colonoscopias realizadas, 573 pacientes foram excluídos. Os 981 pacientes restantes foram divididos em dois grupos: pacientes submetidos à colonoscopia de rastreamento (n=428; 43,6%); pacientes com outras indicações, incluindo vigilância e diagnóstico (n=553; 56,4%). RESULTADOS: A taxa de detecção de adenoma do grupo com outras indicações (50,6%) foi superior à do grupo de rastreamento (44,6%; P=0,03). Em relação ao TDPSp, não houve diferença entre os dois grupos (triagem 13,6%; outras indicações 13,7%; P=0,931). Não houve diferença significativa na idade média (P=0,259) ou na proporção de homens e mulheres (P=0,211) entre os grupos. CONCLUSÃO: A taxa de detecção proximal de pólipos serrilhados mostrou uma diferença insignificante entre os grupos com diferentes indicações para colonoscopia e poderia ser utilizada como um indicador complementar a TDA. Isso beneficiaria colonoscopistas com baixo volume de colonoscopias ou baixo volume de colonoscopias de rastreamento.

Etiopathogenic, epidemiologic and clinical-therapeutic comparison of non-hodgkins lymphoma and kaposis sarcoma / Comparação etiopatogênica, epidemiológica e clinicoterapêutica de linfoma não hodgkin e sarcoma de kaposi

ABSTRACT Background: Non-Hodgkin's lymphomas (NHL) are primary neoplasms derived from lymphocytes, and Kaposi's sarcoma (SK) is a multicentric disease of viral etiology and is associated with HIV. Aim: To study the etiopathogenesis and clinical characteristics of NHL and KS, describing their mutual factors. Methods: This retrospective investigation was performed on 101 medical charts. The patients were studied according to their age, gender, and HIV-positivity, following the PRISMA guidelines. The characteristics of the tumors and comorbidities were analyzed according to their age and lymphatic metastasis. Results: The mean age of the patients ranged between 15-87 years for NHL and between 25-54 for KS, but the age of patients with NHL associated with HIV did not surpass 34 years. The ratio male: female was 1,8:1 for NHL, but only men presented KS. HIV-positivity was found in five patients with NHL and in 14 with KS. The stages of NHL were: I (21%), II (18,4%), III (26,3%), and IV (34,2%), but KS were found only at III (40%) and IV (60%) stages. The lymphatic metastases were positive in 62 patients NHL and in four with KS. HIV-positivity occurred in 60% of patients with NHL and in 50% with KS. Conclusion: The HIV seropositivity was revealed for most of patients during the NHL and SK propaedeutic and none of them present clinical manifestations of AIDS. NHL associated with HIV was found only in young patients. NHL and KS patients have similar epidemiological, clinical, and therapeutic characteristics.

RESUMO Racional: Os linfomas não Hodgkin (LNH) são neoplasias primárias derivadas de linfócitos e o sarcoma de Kaposi (SK) é doença multicêntrica de etiologia viral, ambas associadas ao HIV. Objetivo: Avaliar características clínicas dos LNH e SK, relacionando fatores etiopatogênicos mútuos. Métodos: Foram avaliados retrospectivamente 101 prontuários. Os doentes foram analisados quanto a idade, sexo e soropositividade para o HIV, de acordo com o PRISMA guidelines. Os tumores foram classificados por estadiamento, presença de linfonodos regionais invadidos e tipo celular. Resultados: A idade variou entre 15 e 87 anos para o LNH e 25 a 54 anos para o SK, mas a idade dos pacientes com LNH associado com o HIV não ultrapassou 34 anos. A proporção homem: mulher foi de 1,8:1 para o LNH, enquanto SK foi registrado apenas em homens. A soropositividade para o HIV ocorreu em cinco pacientes com LNH e 14 com SK. A invasão de linfonodos regionais foi positiva em 62 com LNH e quatro com SK. Os linfomas foram 27,9% de baixo grau, 17,4% de grau intermediário e 12,8% de alto grau. A soropositividade para HIV, foi diagnosticada durante a propedêutica do tumor em 60% dos pacientes com LNH e 50% dos com SK. Conclusão: A maioria dos pacientes portadores de HIV descobriram a soropositividade durante propedêutica para LNH e SK, sem manifestações clínicas de AIDS. Todos os pacientes com LNH associado com o HIV eram jovens. Pacientes com LNH e com SK apresentam características epidemiológicas, clínicas e terapêuticas semelhantes entre si.

Evaluation of Clinical and Radiographic Results of Cemented Total Hip Arthroplasty in 477 Patients / Avaliação dos resultados clínicos e radiográficos da artroplastia total cimentada do quadril em 477 pacientes

Abstract Objective The purpose of the present study was to evaluate retrospectively the clinical and radiographic results of total hip arthroplasty (THA) performed with the Exeter technique and using the Exeter prosthesis. Methods Between March 2000 and December 2006, 504 THAs were performed in 477 patients, with several etiological diagnoses. A total of 260 surgeries were performed on the right side, 244 on the left side, and 27 were performed bilaterally. The mean age of the patients was 58.9 (17.7-86.8) years old, with a median of 69.0 years old. The preoperative planning was performed with appropriate templates. All of the surgeries were performed through the posterolateral approach with the patient placed on lateral decubitus. The clinical evaluation was performed according to the Harris hip score (HHS). In the radiographic evaluation, the bone cement interface in the three zones of DeLee and Charnley on the acetabular side and in the seven zones of Gruen on the femoral side were studied. Subsidence of the femoral component, presence of diaphyseal hyperthrophy, and heterotopic ossification were also observed. Results The mean follow-up of 441 surgeries (87.5%) was of 7.2 (1.0-16.6) years, with a median of 7.1 years. The incidence of complications was: dislocation, 3.2%; infection, 2.2%; peripheral nerve disorders 2.0%; thromboembolism 2.7%, acetabular cup loosing 2.0%; diaphyseal hypertrophy, 1.26%; distal migration of the femoral component between 2,0 mm and 2.9 mm, 0.5%; 1 case of aseptic loosing of the femoral component and 9 (1.8%) of the acetabular component. The mean HHS was mean 92.3 (50-100) points. Conclusion Cemented THA, with themethodology applied, proved to be an effective treatment for this group of patients. The results were satisfactory with acceptable complication rates.

Resumo Objetivo Avaliar os resultados da artroplastia total do quadril (ATQ) cimentada, coma utilização da técnica e prótese da escola Exeter. Metódo Entre março de 2000 e dezembro de 2006, foram realizadas 504 ATQs em 477 pacientes, com diversos diagnósticos etiológicos, 260 à direita e 244 à esquerda, 27 bilaterais,. A idade média foi de 58,9 (17,7-86,8) anos, com mediana de 69,0 anos. O planejamento radiográfico foi feito utilizando-se gabaritos apropriados. O acesso cirúrgico foi o posterolateral com o paciente em decúbito lateral. Para a avaliação clínica, foi utilizado o escore do quadril de Harris (EQH). Na avaliação radiográfica, foi estudada a interface osso-cimento acetabular, nas três zonas de DeLee e Charnley e nas sete zonas de Gruen do lado femoral, a presença de migração distal do componente femoral, hipertrofia diafisária, e ossificação heterotópica. Resultados O seguimento médio de 441 cirurgias (87,5%) foi de 7,2 (1,0-16,6) anos, com mediana de 7,1 anos. A incidência de complicações foi: luxação, 3,2%; infecção ,2,2%; tromboembolismo, 2,1%; disfunção de nervos periféricos 1,1%; hipertrofia diafisária, 1,5%; soltura do componente acetabular, 1,8%; migração distal do componente femoral entre 2,0mm e 2,9 mm, 0,45%; 1 caso de soltura asséptica do componente femoral; e 1 caso de fratura da haste femoral. A pontuação média com o EQH foi de 92 pontos. Conclusão A ATQ cimentada, com a metodologia utilizada, constituiu-se em uma opção eficaz para o tratamento deste grupo de pacientes, comresultados satisfatórios, com este tempo de seguimento.

Evaluation of the use of tacrolimus ointment for the prevention of hypertrophic scars in experimental model

Abstract BACKGROUND: Tacrolimus, for its activity on modulation of collagen production and fibroblast activity, may have a role in the prevention of hypertrophic scars. OBJECTIVES: Evaluate macroscopic, microscopic, metabolic, laboratory effects and side effects of the use of topical tacrolimus ointment, in different concentrations, in the prevention of hypertrophic scars. METHODS: Twenty-two rabbits were submitted to the excision of 2 fragments of 1 cm of each ear, 4 cm apart, down to cartilage. The left ear of the animals was standardized as control and Vaseline applied twice a day. The right ear received tacrolimus ointment, at concentrations of 0.1% on the upper wound and 0.03% on the lower wound, also applied twice a day. Macroscopic, microscopic, laboratory criteria and the animals' weight were evaluated after 30 days of the experiment. RESULTS: Wounds treated with tacrolimus, at concentrations of 0.1% and 0.03%, when compared to control, showed a lower average degree of thickening (p = 0.048 and p <0.001, respectively). The average of scar thickness and lymphocyte, neutrophil and eosinophil concentrations are lower in the treated wounds compared to the control (p <0.001, p=0.022, p=0.007, p=0.044, respectively). The mean concentration of lymphocytes is lower in wounds treated with a higher concentration of the drug (p=0.01). STUDY LIMITATIONS: experiment lasted only 30 days. CONCLUSIONS: Tacrolimus at the 2 concentrations evaluated reduced the severity of inflammatory changes and positively altered the macroscopic aspect of the scar in the short term. Its use was shown to be safe, with no evidence of systemic or local adverse effects.

Comparison of the efficacy of losartan, hydrocortisone and acetylsalicylic acid (ASA) in preventing the development of fibrous scar tissue in skeletal muscle / Comparação da eficácia de losartana, hidrocortisona e ácido acetilsalicílico (AAS) na prevenção do desenvolvimento de tecido cicatricial fibroso nos músculos esqueléticos / Comparación de la eficacia de losartán, hidrocortisona y ácido acetilsalicílico (AAS) en la prevención del desarrollo de tejido cicatricial fibroso en los músculos esqueléticos

OBJECTIVE: To analyze fibrous scar tissue inhibition capacity with the use of losartan, hydrocortisone and acetylsalicylic acid. METHOD: The sample consisted of 120 male heterogeneic Wistar rats with a muscle laceration model. The rats were divided into four groups of 30 animals each: control group, losartan group, ASA group and hydrocortisone group. The animals were anesthetized and a 2.5 cm longitudinal incision was made in the left thoracolumbar paravertebral region. The muscles were subjected to a Grade III lesion caused by applying Kelly hemostatic forceps for 60 seconds, followed by sectioning with scissors. The skin was sutured with 3-0 nylon monofilament thread. The animals were placed in individual cages with plenty of food and water. The losartan group received losartan diluted in water at a dose of 0.1 mg/mL (10 mg/kg/day), the ASA Group received a 3 mg/mL ASA solution (300 mg/kg/day), and the hydrocortisone group received a 0.2 mg/mL hydrocortisone solution (20 mg/kg/day). RESULTS: The control, losartan, hydrocortisone and aspirin groups had a fibrotic area of 0.95 ± 0.35 mm, 0.55 ± 0.34 mm, 0.93 ± 0.33 mm, and 0.66 ± 0.36 mm, respectively. We observed a significantly smaller fibrotic area in the losartan group compared to the control (p=0.01) and hydrocortisone (p=0.01) groups. There were no significant differences among the other groups. CONCLUSION: The healing of striated skeletal muscle produced less fibrous scar tissue when exposed to losartan in comparison to the control group or the hydrocortisone group. Level of Evidence I; Randomized double-blind placebo-controlled study.

OBJETIVO: Analisar a capacidade de inibição de formação de tecido cicatricial fibroso com losartana, hidrocortisona e AAS. MÉTODOS: A amostra consistiu em 120 ratos Wistar heterogênicos machos com modelo de laceração muscular. Os ratos foram distribuídos em quatro grupos de 30 animais: grupo controle, grupo losartana, grupo AAS e grupo hidrocortisona. Os animais foram anestesiados e submetidos a uma incisão em sentido longitudinal de 2,5 cm de extensão na região paravertebral toracolombar esquerda, e os músculos sofreram uma lesão grau III com pinça hemostática de Kelly durante 60 segundos e posterior secção com tesoura. A pele foi suturada com nylon monofilamentar 3-0. Os animais foram colocados em gaiolas individuais, com água e alimento à vontade. O grupo losartana recebeu losartana diluída em água na dose de 0,1 mg/ml (10 mg/kg/dia), o grupo AAS recebeu solução de AAS 3 mg/ml (300 mg/kg/dia), o grupo hidrocortisona recebeu solução de hidrocortisona 0,2 mg/ml (20 mg/kg/ dia). RESULTADOS: Os grupos controle, losartana, hidrocortisona e AAS apresentaram área fibrótica de0,95 ± 0,35 mm, 0,55 ± 0,34 mm, 0,93 ± 0,33 mm, 0,66 ± 0,36 mm, respectivamente. Observou-se área fibrótica significativamente menor do grupo losartana em comparação com o grupo controle (p = 0,01) e hidrocortisona (p = 0,01). Nos demais grupos não houve diferença significativa. CONCLUSÃO: A cicatrização do músculo estriado esquelético produziu menos tecido cicatricial fibroso quando exposto à losartana do que quando comparado com o grupo controle ou o grupo hidrocortisona. Nível de Evidência I; Estudo duplo-cego randomizado controlado por placebo.

OBJETIVO: Analizar la capacidad de inhibición de formación de tejido cicatricial fibroso con losartán, hidrocortisona y AAS (ácido acetilsalicílico). MÉTODOS: La muestra consistió en 120 ratas Wistar heterogéneas machos con modelo de laceración muscular. Las ratas fueron distribuidas en cuatro grupos de 30 animales: grupo control; grupo losartán; grupo AAS y grupo hidrocortisona. Los animales fueron anestesiados y sometidos a una incisión longitudinal de 2,5 cm de extensión en la región paravertebral toracolumbar izquierda y los músculos sufrieron una lesión de grado III con pinza hemostática de Kelly durante 60 segundos y posterior sección con tijera. La piel se suturó con monofilamento de nylon 3-0. Los animales fueron dispuestos en jaulas individuales con abundante comida y agua. El grupo losartán recibió losartán diluido en agua a una dosis de 0,1 mg/ml (10 mg/kg/día), el grupo AAS recibió solución de AAS de 3 mg/ml (dosis 300 mg/kg/día), el grupo hidrocortisona recibió solución hidrocortisona de 0,2 mg/ml (20 mg/kg/día). RESULTADOS: Los grupos control, losartán, hidrocortisona y AAS mostraron área fibrótica de 0,95 ± 0,35 mm, 0,55 ± 0,34 mm, 0,93 ± 0,33 mm, 0,66 ± 0,36 mm, respectivamente. Se observó área fibrótica significativamente menor del grupo losartán en comparación con el grupo control (p = 0,01) e hidrocortisona (p = 0,01). En los demás grupos no hubo diferencias significativas. CONCLUSIÓN: La cicatrización del músculo estriado esquelético produjo menos tejido cicatricial fibroso cuando fue expuesto a losartán que cuando fue comparado con el grupo control o el grupo hidrocortisona. Nivel de Evidencia I; Estudio doble ciego aleatorio controlado por placebo.

Effects of different periods of gastric ischemia on liver as a remote organ

Abstract Purpose: To evaluate the hepatic changes associated with gastric ischemia. Methods: Thirty male rabbits were studied, distributed in 3 groups (n=10). Group 1: ligature and section of the gastric vasculature and removal of the liver after three hours; Group 2: ligature and section of the gastric vasculature and removal of the liver after 6 hours; Group 3: ligature and section of the gastric vasculature and removal of the liver after 12 hours. Blood samples were collected immediately before surgery and after the determined time of ischemia in each group to evaluate the hepatic function. After the death of the rabbits, the liver was removed for macro and microscopic study. Results: An increase in aminotransferases and bilirubin occurred in groups 2 and 3. Total protein and albumin diminished in all of the animals. All of the rabbits from groups 2 and 3 presented hepatocellular necrosis. Conclusion: The devascularization of the stomach for a period of above three hours is associated with hepatic morphological and functional disorders.

Comparative study of intraperitoneal adhesions related to light-weight polypropylene mesh and type I polymerized and purified bovine collagen coated light-weight polypropylene mesh in rabbits

Abstract Purpose: To compare the effectiveness of light-weight polypropylene mesh coated with polymerized and purified bovine type I collagen (Surgidry HNB) in the treatment of abdominal wall defect and the degree of adhesion formation. Methods: Two types of polypropylene mesh were implanted after creation of defect measuring 6.0cm X 5.5cm in the anterior abdominal wall of 32 male New Zealand breed rabbits, divided in two groups (n = 32): (1) light-weigh macroporous polypropylene, (2) type I polymerized and purified bovine collagen coated light-weigh macroporous polypropylene. These animals were further accessed for adhesions, histological evaluation of inflammation and wall's thickness. Results: The percentage of the area adhered in group 1 (62.31 ± 16.6) was higher compared to group 2 (22.19 ± 14.57) (p <0.05). There was an association between the percentage of the covered area by adhesions and the type of adhesion, toughness and the scores obtained by the adhesion score by correlation analysis (p <0.05). There was no difference between the groups in any variables in relation to the degree of inflammation. Conclusion: The purified type I bovine collagen coated light-weigh polypropylene mesh showed to be effective in the repair of abdominal wall defects and reducing adhesion formation.

Effects of chronic consumption of green tea on weight and body fat distribution of Wistar rats evaluated by computed tomography

Abstract Purpose: To evaluate the effects of chronic consumption of green tea on body weight and distribution of visceral fat by Computed tomography in female Wistar rats. Methods: Wistar rats were divided into control group (n = 5), which received water and feed ad libitum, and green tea group (n = 8), in which water has been replaced by green tea. The animals were weighed weekly and Computed Tomography was used at the beginning (1st week) and end (18th week) of the experiment for evaluating the distribution of visceral fat. The animals were followed for 18 weeks. Results: There was no significant difference in body weight between the groups. However, there was significant difference in visceral fat area. The green tea group had less visceral fat area at the end of the experiment, 3.67 ± 1.2 cm2, while the control group showed an area of 6.25 ± 2.2 cm (p = 0.00). Conclusions: Chronic consumption of green tea leads to decreased visceral adipose tissue area.

Relação entre câncer, alergia e imunomediadores / Relationship between cancer, allergy and immunometers

Introdução: Vários estudos verificaram que pacientes com câncer apresentam menor incidência de alergia, enquanto outros não encontraram tal associação. Esses achados conflitantes decorrem de diferentes métodos utilizados e conceitos para definir alergia. Objetivos: Verificar se existe relação entre câncer e alergia. Métodos: Este estudo caso-controle incluiu pacientes maiores de 18 anos com diagnóstico de câncer, comparados com indivíduos sadios, pareados por sexo e idade. Realizou-se anamnese, testes percutâneos para alergia e dosagem sérica de eosinófilos. Ambos os grupos foram pareados quanto às variáveis de interesse e ajustaram-se eventuais desvios por análise multivariada. Resultados: Relato de alergia ocorreu em 30% dos pacientes no grupo com câncer e em 53% no grupo sem câncer (p = 0,001), já para os testes cutâneos ocorreu maior positividade no grupo com câncer (69%) do que no sem câncer (51%), (p = 0,01). Não houve diferença entre os valores dos eosinófilos. Conclusão: Pessoas com câncer apresentaram menor relato de alergia. Por outro lado, em indivíduos com câncer houve testes cutâneos positivos para alergia sem correspondência clínica. Portanto, em cancerosos, o teste cutâneo positivo para alergia não corresponde à presença de alergia clínica. (AU)

Introduction: Many studies have found patients with cancer present less allergy, while others did not found this association. The conflicting findings from prior studies are due to differences in the research methods, and in definitions of allergy. Objective: To identify a relation between cancer and allergy. Methods: This case-control study included patients older than 18 years of age, who presented a diagnosis of cancer, as compared to healthy individuals, paired by sex and ages. Anamnesis, allergy percutaneous test and a blood sample was collected to evaluate the eosinophils. Both groups were paired according to interest variables, and eventual deviations were adjusted by means of multivariate analysis. Results: Reports of allergies occurred in 30% of the patients with cancer, as compared to 53% in the non-cancer group (p = 0.001), whereas in the cutaneous tests, a greater positivity occurred in the cancer group (69%) than in the non-cancer group (51%), p = 0.01. No difference in the eosinophil values was observed within these groups. Conclusion: Patients with cancer present lower level of allergies. By contrast, in these cases, positive cutaneous tests detected allergies with no correspondence to clinical findings. Therefore, in presence of cancer, the positive cutaneous test for allergies is not related with clinical manifestation of allergy. (AU)

Treatment of abdominal wall hernia with suture, or polypropylene, or collagen prosthesis

ABSTRACT PURPOSE: To develop an experimental model for incisional hernias and to compare morphological and functional aspects of hernia repairs by suture, polypropylene mesh and collagen mesh. METHODS: A defect measuring 7cm x 2cm was created in the anterior abdominal of 28 New Zealand male rabbits, divided into four groups (n = 7): (1) control, (2) suture of the anterior sheath of the rectus abdominal muscle, (3) setting of polypropylene mesh, and (4) setting of collagen mesh. On the 90th postoperative day, the animals were examined to verify the presence of incisional hernia. Samples of abdominal wall and scar were collected for histological study. RESULTS: Incisional hernia was identified in 85.7% of the control group, 57.1% of the suture group, 42.9% of the collagen mesh group, and none in the polypropylene mesh group (p = 0.015). Mesh exposure could be identified in 71.4% of the animals in group 3 and in no animal in group 4 (p = 0.021). The polypropylene mesh is effective in the treatment of abdominal wall defects, causing an intense inflammatory reaction. CONCLUSION: The collagen mesh is biocompatible, producing a minimal inflammatory reaction, but fails in the treatment of abdominal wall defects.

CLINICAL, EPIDEMIOLOGIC, AND ENDOSCOPIC PROFILE IN CHILDREN AND ADOLESCENTS WITH COLONIC POLYPS IN TWO REFERENCE CENTERS

Background - The main goal of this paper is to investigate the frequency, clinical profile, and endoscopic findings of children and teenagers submitted to colonoscopies. Methods - Patients of below 18 years of age, diagnosed with polyps by means of colonoscopies at two reference centers of pediatric endoscopy were followed-up between 2002 and 2012. The clinical variables evaluated in this study included: gender, recommendation of colonoscopy, associated signs and symptoms, age of onset of symptoms, age at identification of the polyp, interval of time between the onset of symptoms and the endoscopic diagnosis of colonic polyps, and family history of intestinal polyposis and/or colorectal cancer. The characteristics of the polyps also included: number, morphological type, histology, and distribution. Polyposis syndromes were also investigated. Results - From the 233 patients submitted to colonoscopies, polyps were found in 74 (31.7%) patients, with a median age of 6.6 years, of which 61% were male. Juvenile polyps were identified in 55 (74%) patients, with 7 (9%) characterized within the criteria for juvenile polyposis. Patients with intestinal polyposis syndromes were diagnosed in 35% of the patients. The most frequent clinical presentation was hematochezia. Abdominal pain with acute episodes of intestinal partial obstruction or intussusception with emergency laparotomy was observed in the majority of Peutz-Jeghers syndrome patients leading to an increased morbidity. Conclusions - Even though juvenile colonic polyps are the most frequent type of diagnosed polyps, the present study identified a significant level of children with polyposis syndromes (35%), associated with a higher morbidity of these individuals.

Objetivos - Conhecer a frequência, o perfil clínico, os achados endoscópicos, de crianças e adolescentes submetidos à colonoscopia em dois centros de referência em gastroenterologia e endoscopia pediátrica. Métodos - Foram avaliados e acompanhados pacientes com idade menor ou igual a 18 anos com diagnóstico de pólipos identificados à colonoscopia em dois centros de referência em endoscopia pediátrica no período de 2002 a 2012. As variáveis clínicas avaliadas foram: gênero, indicação da colonoscopia, sinais e sintomas associados, idade de início dos sintomas, idade à identificação do pólipo, intervalo de tempo entre início dos sintomas e diagnóstico endoscópico do pólipo colônico, história familiar de polipose intestinal e/ou câncer coloretal. Em relação às características dos pólipos foram descritos: número, tipo morfológico, histológico e distribuição. Foram estudadas também as síndromes poliposas (síndrome de Peutz-Jeghers, síndrome juvenil poliposa, síndrome poliposa adenomatosa familiar). Resultados - Dos 233 pacientes submetidos à colonoscopia, foram encontrados 74 (31,7%) pacientes com pólipos, com mediana de idade de 6,6 anos, 61% do gênero masculino. Pólipos juvenis foram identificados em 55 (74%) dos pacientes, sendo 7 (9%) com critérios diagnósticos de polipose juvenil. Pacientes com síndromes poliposas intestinais foram diagnosticados em 35% dos pacientes. Destes, 12% com diagnóstico de polipose adenomatosa familiar, 9% com síndrome juvenil poliposa e 8% com diagnóstico de Síndrome de Peutz-Jeghers. A apresentação clínica mais frequente foi o sangramento retal indolor. Nos pacientes com polipose adenomatosa familiar o principal motivo da indicação da colonoscopia foi para rastreamento da doença devido história familiar da síndrome poliposa. Um paciente apresentou adenocarcinomacoloretal, simultâneo ao diagnóstico da polipose adenomatosa aos 15 anos de idade. Dor abdominal com episódios agudos de semiobstrução ou intussuscepção intestinal com laparotomia de urgência foi observado nos pacientes com Peutz-Jeghers. Conclusões - Embora os pólipos colônicos juvenis sejam os mais frequentemente diagnosticados, foi observado um percentual significativo de crianças com síndromes poliposas (35%) associado a uma maior morbidade destas crianças. Desta forma concluímos ser importante estabelecimento de um protocolo de diagnóstico e seguimento dos pacientes afetados e familiares de risco.

Characteristics of motorcyclists involved in accidents between motorcycles and automobiles / Características dos motociclistas envolvidos em acidentes entre motocicleta e automóvel

Introduction: traffic accidents are one of the main causes of death and disability, with motorcyclists representing the great majority of both the victims and the perpetrators. Objective: this work studied the characteristics of motorcyclists injured in accidents involving motorcycles and automobiles. Method: this study sought to interview 100 motorcyclists who had been injured in collisions between motorcycles and automobiles, and who were undergoing emergency hospital treatment in the region of Belo Horizonte, Brazil. The questionnaires included demographic information (age, gender, skin color, education level, profession) and questions about years of licensed driving practice, how often they would drive an automobile, how long they had had a motorcycle driver’s license, how often they would ride a motorcycle, the number of prior accidents involving a car, and the number of prior accidents not involving a car. Results: of the 100 consecutive accidents studied, 91 occurred with men and 9 with women, aged between 16 and 79 (m = 29 ± 11) years. Regarding their reason for using a motorcycle, 83% reported using it for transport, 7% for work, and 10% for leisure. Most of these accident victims had secondary or higher education (47%). Of the motorcyclists who held a car driver’s license, 68.3% drove the vehicle daily or weekly and held the license for more than one year. Sixty-seven percent of the accident victims used a motorcycle daily and had a motorcycle driver’s license for at least one year. Conclusion: among the motorcyclists injured, most were men aged 20 years or older, with complete secondary education, and experienced in driving both motorcycles and cars, indicating that recklessness while driving the motorcycle is the main cause of traffic accidents. .

Introdução: os acidentes de trânsito são uma das principais causas de morte e invalidez, sendo os motociclistas a maior parte de suas vítimas e seus causadores. Objetivo: estudar as características dos motociclistas envolvidos em acidentes entre motocicletas e automóveis. Métodos: foram entrevistados 100 motociclistas feridos em colisões entre motocicleta e automóvel que se encontravam em tratamento hospitalar de urgência no município de Belo Horizonte. O questionário continha sua identificação (idade, sexo, cor da pele, escolaridade, profissão) e perguntas sobre tempo de habilitação para dirigirem automóvel, frequência com que dirigiam automóvel, tempo de habilitação para conduzirem motocicleta, frequência com que dirigiam motocicleta, número de acidentes prévios envolvendo automóvel e número de acidentes prévios sem relação com automóvel. Resultados: dos 100 acidentados consecutivos estudados, 91 eram homens e 9 eram mulheres com idade de 16 a 79 anos (M=29±11). Quanto à finalidade do uso da motocicleta, 83% a empregavam para transporte, 7% para trabalho e 10% para lazer, tendo a maior parte dos acidentados pelo menos o ensino médio completo (47%). Dos motociclistas que possuíam habilitação para automóvel, 68,3% dirigiam o veículo diária ou semanalmente e possuíam a habilitação por período superior a 1 ano; 67% dos acidentados conduziam motocicleta diariamente e tinham pelo menos 1 ano de habilitação para motocicleta. Conclusão: entre os 100 acidentados, predominaram homens com idade superior a 20 anos, ensino médio completo, experiência em conduzir motocicletas e automóveis, indicando que a imprudência ao conduzir a motocicleta tenha sido a principal causa de acidentes de trânsito. .

Closure of large wounds using rubber bands in rabbits / Fechamento de grandes feridas com fita elástica de borracha em coelhos

OBJECTIVE: To verify the effectiveness of the rubber elastic band in the treatment of large wounds of the body wall of rabbits by means of traction of its edges. METHODS: we studied 30 New Zealand rabbits, divided into three groups (n=10): Group 1- healing by secondary intention; Group 2- removal and eutopic repositioning of skin as full thickness skin graft; Group 3- Approximation of wound edges with elastic rubber band. In all animals, we removed a segment of the back skin and subcutaneous tissue down to the fascia, in accordance with an acrylic mold of 8cm long by 12cm wide. All animals were observed for 21 days. RESULTS: two animals of groups 1 and 2 had wound abscess. In Group 2, there was partial or total graft loss in 90% of animals. The complete closure of the wounds was observed in four animals of Group 1, six of Group 2 and eight of Group 3. There was no difference between the scar resistance values of groups 2 and 3, which were higher than those in Group 1. The scars of the three groups were characterized by the presence of mature connective tissue mixed with blood vessels and inflammatory infiltration, predominantly polymorphonuclear. CONCLUSION: the tensile strength of the wound edges with rubber elastic band is as efficient as the skin graft to treat rabbits' large body wounds.

OBJETIVOS: Verificar a eficácia da fita elástica de borracha no tratamento de grandes feridas de parede corpórea de coelhos por meio da tração de suas bordas. MÉTODOS: foram estudados 30 coelhos da raça Nova Zelândia, distribuídos em três grupos (n=10): Grupo 1. Cicatrização por segunda intenção. Grupo 2. Retirada e reposicionamento eutópico da pele como enxerto de pele total. Grupo 3. Aproximação das bordas da ferida com fita elástica de borracha. Em todos os animais, foi retirado segmento de pele e tecido subcutâneo até a fáscia musculoaponeurótica do dorso, de acordo com um molde de acrílico, com 12cm de comprimento por 8cm de largura. Todos os animais foram acompanhados durante 21 dias. RESULTADOS: dois animais dos grupos 1 e 2 apresentaram abscesso na ferida. No Grupo 2, houve perda parcial ou total do enxerto em 90% dos animais. O fechamento completo das feridas foi observado em quatro animais do Grupo 1, seis do Grupo 2 e oito do Grupo 3. Não houve diferença entre os valores de resistência cicatricial dos grupos 2 e 3, que foram maiores do que os do Grupo 1. As cicatrizes dos três grupos caracterizaram-se pela presença de tecido conjuntivo maduro entremeado por vasos sanguíneos e infiltrado inflamatório, predominantemente polimorfonuclear. CONCLUSÃO: a tração das bordas da ferida com fita elástica de borracha constitui método tão eficaz quanto o enxerto de pele para tratar grandes feridas de parede corpórea de coelhos.

Does a previous surgical experience interfere on psychic stress in patients submitted to major surgery? / A experiência cirúrgica prévia interfere no estresse psíquico em pacientes submetidos à operações de grande porte?

OBJECTIVE: to evaluate the impact of stress in patients undergoing major surgeries under general anesthesia, relating their physical and psychic reactions to the different stages of stress. METHODS: we studied 100 adult patients of both genders, who were divided into two groups: Group 1 - 22 patients without experience with surgery; Group 2 - 78 patients previously submitted to medium and major surgery. To investigate the stress, we used the Inventory of Stress Symptoms for Adults, developed by Lipp, the day before the procedure and two days and seven days after the operation. The comparison of groups with respect to gender, pain, and percentage of stress were performed using the Chi-square test, and for the age variable the Student's t test was used. Differences were considered significant at p<0.05. RESULTS: the groups were not homogeneous as for the overall percentage of stress on the three measurements. G1 had decreased postoperative stress, whilst in G2 it increased. Psychological symptoms of stress prevailed in both groups. CONCLUSION: previous surgery reduced preoperative stress but did not affect postoperative emotional disorders. .

OBJETIVO: avaliar o impacto do estresse em pacientes submetidos à operações de grande porte, sob anestesia geral, relacionando suas reações físicas e psíquicas com as diferentes fases do estresse. MÉTODOS: foram estudados 100 pacientes adultos de ambos os sexos, distribuídos em dois grupos: Grupo 1- 22 pacientes sem experiência com cirurgia; Grupo 2- 78 pacientes submetidos previamente a outras operações de médio e grande porte. Para investigação do estresse, utilizou-se o Inventário de Sintomas de Stress para Adultos, desenvolvido por Lipp, um dia antes, dois dias, e sete dias após a operação. A comparação dos grupos quanto às variáveis sexo, dor, e percentual de estresse, foi realizada pelo teste qui-quadrado e para a variável idade foi utilizado o teste t Student. As diferenças foram consideradas significativas para p<0,05. RESULTADOS: os grupos não foram homogêneos quanto ao percentual geral de estresse nas três mensurações. O G1 diminuiu e o G2 aumentou o estresse no pós-operatório. Prevaleceram sintomas psíquicos do estresse em ambos os grupos. CONCLUSÃO: O fato de ter sido operado previamente reduziu a tensão pré-operatória, porém não interferiu nos distúrbios emocionais pós-operatórios. .

Ocorrência de enteroparasitoses em crianças de creches na região do Vale do Aço? MG, Brasil / Occurrence of intestinal parasites in children from daycare centers at Vale do Aço? MG, Brazil

Parasitoses intestinais constituem um importante problema de saúde pública e, dentre os indivíduos acometidos, as crianças constituem um grupo de grande relevância. Este estudo teve como objetivo avaliar a prevalência das parasitoses intestinais em 93 crianças matriculadas em creches municipais do Vale do Aço ? MG. As amostras foram obtidas no segundo semestre de 2010 e submetidas à técnica de sedimentação espontânea de Lutz. A prevalência global de enteroparasitoses foi de 36,6% (34 crianças). Os parasitos mais prevalentes foram Giardia intestinalis (24,7%) e Entamoeba histolytica (6,5%). Os parasitos menos frequentes foram Hymenolepis nana, Ascaris lumbricoides e Taenia sp. com prevalência de 1,1%. Não houve diferença estatística significante entre as creches avaliadas quanto à prevalência de parasitose intestinal. A maioria das crianças parasitadas não apresentava diarreia. Os resultados apontam que ainda há uma prevalência importante de parasitoses intestinais em crianças na faixa etária de até seis anos, principalmente giardíase. Tal fato corrobora para a importância do papel do diagnóstico e da prevenção através das melhorias de saneamento básico e de educação em saúde.

Intestinal parasites are a major public health problem and children are the group most affected. The aim of this study was to evaluate the prevalence of intestinal parasites in 93 children of daycare centers in the Vale do Aço ? MG. Samples were obtained in the second half of 2010 and submitted to sedimentation method of Lutz. The overall prevalence of intestinal parasites was of 36.6 %. The most prevalent parasites were Giardia intestinalis (24.7%) and Entamoeba histolytica (6.5%). The less common parasites found were Hymenolepis nana, Ascaris lumbricoides and Taenia sp. with a prevalence of 1.1%. No statistically significant difference in prevalence was observed among daycare centers. The majority of parasitized children had no diarrhea. The results show that there is still an important prevalence of intestinal parasites in children aged up to six years, especially giardiasis. This fact confirms the importance of the diagnosis and prevention by improved sanitation and health education.

Ejaculação precoce: revisão de literatura sobre novos tratamentos / Premature ejaculation: a literature review about new treatment options

Ejaculação precoce é o problema sexual masculino mais comum, com prevalência de 2% a 23%. Este estudo é uma revisão do tratamento de ejaculação precoce em artigos de relevância publicados nas bases de dados PubMed, Lilacs e SciELO no período de 2006 a 2012. Discute-se sobre abordagens tópicas, medicações por via oral, acupuntura e drogas injetáveis. Os resultados mostram que a ejaculação precoce é problema de origem multifatorial e que diversos estudos estão sendo conduzidos sobre abordagens terapêuticas diferentes. O acompanhamento em longo prazo é fundamental para o tratamento e, em alguns casos, é importante que se realize terapia combinada. Ressalta-se que se deve aguardar os resultados de estudos que estão sendo desenvolvidos com novas drogas e terapias. Enquanto não houver novas conclusões, deve-se utilizar terapia medicamentosa por via oral e, em casos selecionados, terapia tópica.

Premature ejaculation is the most common sexual problem in men, with prevalence from 2% to 23%. This study is a review of relevant articles about the treatment of premature ejaculation published in the PubMed, Lilacs and SciELO databases between 2006 and 2012. We discuss topical approaches, oral medication, acupuncture and injectable drugs. The results of this study show that premature ejaculation is a multifactorial problem. In fact, many studies are being conducted on different therapeutic approaches to treat this condition. Long term follow-up is critical to treatment and, in some cases, combined therapy is important. We emphasize the relevance of waiting for the results of studies that are being conducted about new drugs and therapies. Oral medication and, in special cases, topical drugs, should be used while new conclusions are not reached.