Assessing the level of evidence of presented studies at the Brazilian Congress of Coloproctology

Introduction: Scientific studies in Brazil grew around 10.7% compared to previous years. However, the level of quality of evidence has been decreasing. The aim in our study is to examine the meeting abstracts of the Brazilian congress of coloproctology and analyze the level of evidence in trends and variables. Methods: A descriptive bibliometric study, working with secondary data to review scientific abstracts in the annals of the coloproctology congress from 2015 to 2019. Results: A total of 1756 abstracts of the Brazilian Congress of Coloproctology were analyzed for 5 years (2015-2019). There was a higher trend of abstracts presented with lower levels of evidence (level of evidence 5: 52.3% and 3: 30%), being the majority composed of case reports (49.4%) and retrospective studies (30.4%). The last two years analyzed (2018: 55.2% and 2019: 59.3%) had a predominance above average of case reports. From 2017 to 2019 there was a significant decrease in the number of level 2 evidence studies (18.10%,11.80% and 5.50%), while the number of studies with level 5 evidence showed an increase (45.60%, 56.60% and 61.40%). Statistical analysis occurred in only 17%, with an important decrease for the last two years (2018: 13.6%; 2019: 12.1%). Conclusions: Although the data of this study is from the Brazilian coloproctology point of view, they are important for the global scientific community, as they allow a quantitative evaluation of the relative contribution from the level of evidence of Brazilian coloproctology researchers to the scientific scenario. (AU)

Discrepancies of abstracts presented in coloproctology congresses and later publish as full manuscripts: a Brazilian perspective

Introduction: The purpose of this retrospective bibliometric study was to assess the discrepancies between coloproctology surgery meeting abstracts and subsequent full-length manuscript publications. Methods: Abstracts presented at the Brazilian Congress of Coloproctology Surgery from 2015 to 2019 were compared with matching manuscript publications. Discrepancies between the abstract and therefore the subsequent manuscript were categorized as major (changes within the purpose, methods, study design, sample size, statistical analysis, results, and conclusions) and minor (changes within the title, authorship, and number of female authors) variations. Results: The conversion rate of abstracts in published manuscripts was 6,9% (121 abstracts). There were inconsistencies between the study title (66,1%), authorship (69,5%), study design (3,3%), sample size (39,2%), statistical analysis (24,8%), results (25,6%), and conclusions (12,4%) of manuscripts compared with their corresponding meeting abstracts. Conclusion: As changes occur before manuscript publication of coloproctology surgery meeting abstracts, caution should be exercised in referencing abstracts or altering surgical practices based on abstracts content. (AU)

An American and Brazilian perspective on abstracts presented in coloproctology conferences converted into published manuscripts

Introduction: The presentation of abstracts in a congress is an important step for the dissemination of scientific information. The American Congress of Coloproctology is promoted by the American Society of Colon & Rectal Surgeons (ASCRS), and it is the largest in number of participants within the specialty, followed by the Brazilian Congress of Coloproctology. The present study aims to evaluate variables related to the quality of the scientific production of the abstracts presented in these two events and their conversion rate to published manuscripts. Materials and Methods: The present bibliometric study assesses secondary data from the review of abstracts presented in these 2 important conferences in 2016, followed by a research of the publications from these congress presentations. Results: The total number of abstracts evaluated was 854. The rate of articles containing statistical analyses was of 73.7% in the American congress, and of 34.1% in the Brazilian congress. Multicentric studies were more prevalent in the American congress (23.1%). Regarding study design, the most common were case reports in the Brazilian (44.8%) congress and retrospective studies in the American congress (67.7%). As for the works presented, the rate of conversion into full manuscripts in the American congress was of 24.2% compared with 10.6% in the Brazilian congress. Most papers from the American congress (93.7%) have citations compared with 68.6% of the other event evaluated. Conclusion: The scientific performance demonstrated by the conversion rate of abstracts into publications is below ideal, mainly in relation to the Brazilian meeting; yet, there were significant differences between the two events in terms of the profile of the presentations and several variables analyzed. (AU)

Lower 25-hydroxyvitamin D (25OHD) levels, diabetes and age are associated with foot and ankle fracture treatment complications

ABSTRACT Objective: This study investigated the nutritional status, 25-hydroxyvitamin D (25OHD), albumin and risk factors associated with complications in patients with foot and ankle fragility fractures. Subjects and methods: Prospective study, developed with patients who suffered fractures due to fragility of the foot and ankle (n = 108); the type of fractured bone, fracture mechanisms and classification were studied and also pseudoarthrosis, treatment, surgical dehiscence, anthropometry, 25OHD and albumin. The Chi-square or Fisher's exact test, Mann-Whitney and Kruskal-Wallis tests were used in the statistical analysis and the multiple logistic regression analysis was used to identify the risk factors associated with complications. Results: The factors that, together, were associated with treatment complications were the level of 25OHD (p = 0.0055; OR = 0.868 [1,152]; 95% CI = 0.786; 0.959 [1.043;1.272]) and diabetes (p = 0.0034; OR = 30,181; 95% CI = 3.087; 295.036). The factors that, together, were associated with the presence of any complication, were age (p = 0.0139; OR = 1.058; 95% CI = 1.011; 1,106) and 25OHD level (p = 0.0198; OR = 0.917; 95% CI = 0.852; 0.986). There was a complication probability above 0.40 associated with lower 25OHD levels (values below 20 ng/mL) and older age (over 50 years). Conclusion: Lower or abnormal levels of 25OHD were associated with pseudoarthrosis, and age and 25OHD were both risk factors for treatment complications in patients with foot and ankle fractures.

Is calf circumference associated with clinical and nutritional outcome in older patients? / A circunferência da panturrilha está associada ao desfecho clínico e nutricional em pacientes idosos?

ABSTRACT BACKGROUND: Previous studies have shown a relationship between calf circumference (CC) and outcomes in hospitalized patients. AIMS: To investigate the relationship between CC and clinical and nutritional outcomes in older in-patients (OiP) in a surgery ward. METHODS: This was a cross-sectional study with 417 OiP in a surgery ward. Clinical variables, anthropometry, and nutritional screening instruments such as subjective global assessment (SGA), mini nutritional assessment (MNA), and nutritional risk screening (NRS) were used in the investigation. The tests Pearson's chi-square, Mann-Whitney, Kruskal-Wallis, and Spearman's coefficient, and multiple linear regression analyses were used to review the factors associated with CC. RESULTS: Lower CC values were found in the age group 80 years and over (p<0.0001), presence of complications (p=0.0269), NRS (p<0.0001), SGA (p<0.0001), and MNA (p<0.0001). Gender (p=0.0011; partial R2=0.01151), age (p=0.0002; partial R2=0.06032), body mass index (p≤0.0001; partial R2=0.40820), and arm circumference (p≤0.0001; partial R2=0.11890) are variables that together were associated with CC. There was also a relationship between SGA (p=0.0166; partial R2=0.00605) and absence of complications during hospitalization (p=0.0047; R2=0.01154) with CC. CONCLUSIONS: Gender, age, body mass index, and arm circumference were jointly associated with CC, in addition to SGA and absence of complications. The CC is a relevant indicator for OiP in the clinical practice.

RESUMO RACIONAL: Estudos anteriores mostraram uma relação entre a circunferência da panturrilha (CP) e desfechos em pacientes hospitalizados. OBJETIVOS: Investigar a relação entre CP e desfecho clínico e nutricional em pacientes idosos hospitalizados (PIH) em uma enfermaria cirúrgica. MÉTODOS: Este foi um estudo transversal com 417 PIH em uma enfermaria de cirurgia. Variáveis clínicas, antropometria e instrumentos de triagem nutricional como avaliação subjetiva global (ASG), mini avaliação nutricional (MAN) e triagem de risco nutricional (NRS) foram utilizados na investigação. Qui-quadrado, Mann-Whitney, Kruskal-Wallis, coeficiente de Spearman e análise de regressão linear múltipla foram usados para analisar os fatores associados a CP. RESULTADOS: Menores valores de CP foram encontrados na faixa etária de 80 anos (p<0,0001), complicações (p=0,0269), risco nutricional pelo NRS (p<0,0001), ASG (p<0,0001) e MAN (p<0,0001). Sexo (p=0,0011; R2 parcial=0,01151), idade (p=0,0002; R2 parcial=0,06032), IMC (p≤0,0001; R2 parcial=0,40820) e circunferência do braço (CB) (p≤0,0001; R2 parcial=0,11890) foram variáveis que juntas estiveram associadas com a CP. Também houve relação entre ASG (p=0,0166; R2 parcial=0,00605) e ausência de complicações durante a internação (p=0,0047; R2= 0,01154) com a CP. CONCLUSÕES: Sexo, idade, IMC e CB associaram-se conjuntamente com CP, ASG e ausência de complicações. CP é um indicador relevante em PIH na prática clínica.

Concordância entre instrumentos de triagem nutricional em idosos hospitalizados / Agreement between nutritional screening instruments in hospitalized older patients

ABSTRACT Background The prevalence of hospitalized elderly patients has grown substantially and has impacted the hospital health services. Thus, it is believed that an investigation of the nutritional status associated with different clinical situations in elderly patients could contribute to multidisciplinary hospital intervention and nutritional care actions suitable for this population. Objective To investigate the relationship between two nutritional screening instruments in hospitalized older patients and to compare clinical variables between these two instruments. Methods Retrospective study with hospitalized older patients (n=277), investigating the agreement between two nutritional screening instruments. The data were analyzed using the McNemar, chi-square, Fisher, Mann-Whitney tests and the kappa coefficient for the agreement assessment. Results There was a significant difference (P=0.0002) between the nutritional risk classifications of the two nutritional screening instruments and moderate agreement (k=0.5430) between them. The association between nutritional risk screening and age (P=0.0255), length of hospital stay (P<0.0001), gender (P=0.0365) and illness (P=0.0001) were assessed. There was an association between Mini Nutritional Assessment and length of stay (P<0.0001), illness (P=0.0001) and body weight evolution (P=0.0479). Conclusion The nutritional risk screening and Mini Nutritional Assessment showed moderate agreement in the assessment of elderly patients.

RESUMO Contexto A prevalência de pacientes idosos hospitalizados tem crescido substancialmente e impactado os serviços de saúde hospitalar. Desta forma, acredita-se que uma investigação do estado nutricional, associado a situações clínicas variadas em pacientes idosos, poderia contribuir para ações de intervenção hospitalar multidisciplinares e de cuidado nutricional adequadas para esta população. Objetivo Investigar a relação entre dois instrumentos de triagem nutricional em pacientes idosos hospitalizados e comparar variáveis clínicas entre estes dois instrumentos. Métodos Estudo retrospectivo com pacientes idosos hospitalizados (n=277), sendo investigado a concordância entre dois instrumentos de triagem nutricional. Os dados foram analisados pelos testes McNemar, qui-quadrado, Fisher, Mann-Whitney e o coeficiente kappa para a avaliação de concordância. Resultados Houve diferença significativa (P=0,0002) entre as classificações de risco nutricional pelos dois instrumentos de triagem nutricional e concordância moderada (k=0,5430) entre eles. Verificou-se associação entre triagem de risco nutricional e idade (P=0,0255), tempo de internação (P<,0001), sexo (P=0,0365) e doenças (P=0,0001). Houve associação entre a Mini Avaliação Nutricional e tempo de internação (P<0,0001), doenças (P=0,0001) e evolução do peso corporal (P=0,0479). Conclusão Triagem de risco nutricional e a Mini Avaliação Nutricional apresentam concordância moderada para a avaliação de pacientes idosos.

Prognostic analysis of lymph node ratio of patients with disease recurrence previously submitted to cervical dissection surgery for head and neck cancer / Análise prognóstica da densidade linfonodal de pacientes recidivados previamente submetidos à cirurgia de esvaziamento cervical por neoplasia de cabeça e pescoço

ABSTRACT Introduction: the variable lymph node ratio has recently been studied as a possible influencer in the survival of patients diagnosed with head and neck cancer. Objective: to analyze the correlation between lymph node density and survival of recurred disease patients previously submitted to cervical dissection surgery due to head and neck squamous cell carcinoma. Method: we retrospectively analyzed 71 medical records of patients treated at the Head and Neck Surgery Service of the Pontifícia Universidade Católica de Campinas who had undergone cervical dissection surgery and presented tumor recurrence between 2006 and 2019. Patient and tumor data such as age, gender, skin color, smoking, alcohol consumption, location of the primary tumor, anatomopathological characteristics and lymph node status were correlated with the survival time. Results: we found a predominance of males and the mean age was 59.5 years. The most frequent primary site was the oral cavity followed by the larynx and oropharynx. The mortality rate was 53.52% and the mean lymph node ratio 0.28. We found influence on survival with statistical significance for the parameters: lymph node ratio, number of dissected and affected lymph nodes, T and N staging, type of treatment proposed (palliative or surgical), presence of compromited margins in the primary tumor and lymph node extravasation. Conclusion: the calculation of lymph node density in patients with recurred disease after cervical dissection surgery by head and neck squamous cell carcinoma should be taken into account during therapeutic planning and prognostic evaluation due to its direct influence on the survival.

RESUMO Introdução: recentemente tem-se estudado a variável densidade linfonodal como possível influenciador na sobrevida de pacientes com diagnóstico de câncer de cabeça e pescoço. Objetivo: analisar a relação entre a densidade linfonodal e a sobrevida de pacientes recidivados previamente submetidos a cirurgia de esvaziamento cervical por carcinoma espinocelular de cabeça e pescoço. Método: foram analisados retrospectivamente 71 prontuários pacientes atendidos no Serviço de Cirurgia de Cabeça e Pescoço da Pontifícia Universidade Católica de Campinas que tinham sido submetidos a cirurgia de esvaziamento cervical e apresentaram recidiva tumoral entre os anos de 2006 e 2019. Dados relativos ao paciente e ao tumor tais como: idade, sexo, cor da pele, tabagismo, etilismo, localização do tumor primário, características anatomopatológicas e status linfonodal foram correlacionados ao tempo de sobrevida dos indivíduos. Resultados: encontramos predominância do sexo masculino e a média de idade foi de 59,5 anos. O sítio primário mais frequente foi a cavidade oral seguido da laringe e orofaringe. A taxa de mortalidade foi de 53,52% e a densidade linfonodal média 0,28. Encontramos influência na sobrevida com significância estatística para os parâmetros: densidade linfonodal, número de linfonodos dissecados e acometidos, estadiamento T e N, tipo de tratamento proposto (paliativo ou cirúrgico), presença de margens comprometidas no tumor primário e extravasamento linfonodal. Conclusão: o cálculo da densidade linfonodal em pacientes recidivados após cirurgia de esvaziamento cervical por carcinoma espinocelular de cabeça e pescoço deve ser levado em consideração durante o planejamento terapêutico e na avaliação prognóstica devido à sua direta influencia na sobrevida dos indivíduos.

Evaluation of the serrated lesions detection rate and its role as a colonoscopy quality criteria

Objectives: To evaluate the serrated lesion detection rate in colonoscopy at a specialized clinic and its role as quality criteria for endoscopic examination. Methods: This is an observational cross-sectional study with all patients that underwent colonoscopy between October 2018 and May 2019, performed by an experimented physician. A questionnaire was answered before the examination by the patient, and another questionnaire after the colonoscopy was answered by themedical team. All polyps identified were removed and sent to the same pathologist for analysis. Results: A total of 1,000 colonoscopies were evaluated. The average age of the patients was 58.9 years old, and most of them were female (60.6%). In 62.5% of the procedures, polyps were removed, obtaining a total of 1,730 polyps, of which 529 were serrated lesions, being 272 sessile serrated lesions (SSL). This data resulted in a serrated lesion detection rate (SDR) of 29.2%, and of 14% when considering only the SSL detection rate (SSLDR). The right colon had higher rates, with 22.3% SDR and 15.3% SSLDR. Screening colonoscopies also presented a higher serrated detection rate, of 20%, followed by diagnostics and follow-up exams. Smoking was the only risk factor associated with higher serrated detection rate. Conclusions: The serrated lesion detection rate is higher than the ones already previously suggested and the have the higher rates were stablished in the right colon and on screening exams. (AU)

Prognosis of hospitalized children under 2 years of age with co-detection of influenza A and respiratory syncytial virus at the healthcare facility / Prognóstico de crianças hospitalizadas menores de 2 anos com codetecção de influenza A e vírus sincicial respiratório no local de atendimento

Abstract Objectives: the aim of this study is to evaluate the impact of co-detection of Flu A and RSV using rapid immunochromatographic tests at the point of care, in pediatric patients under 2 years of age in a general hospital. Methods: a retrospective cohort study was conducted to analyze clinical outcomes in hospitalized infants with viral respiratory disease with positive results of rapid immunochromatographic test for RSV and/or Flu-A, from 2013 to 2018. A logistic regression model was adjusted to analyze predictors of orotracheal intubation during hospitalization. Results: we analyzed 220 cases: RSV (192), Flu-A (9), co-detection (19). Lethality rate was 1.8% (2 cases), and 88% (194) were under 1 year of age. Mean time of hospitalizations was higher in patients with co-detection. Variables significantly associated with orotracheal intubation were: younger age in months, comorbidities, RSV and Flu-A co-detection, and bacterial pneumonia during hospitalization. Conclusions: RSV and Flu-Aco-detection was associated with the least favorable clinical prognoses in this study. Rapid test diagnosis may provide important information at the point of care, because molecular panels are not widely accessible in general hospitals. Rapid diagnosis allows timely evaluation and treatment.

Resumo Objetivos: avaliar o impacto da codetecção de Influenza A (FluA) e Vírus Sincicial Respiratório (VSR) por meio de testes imunocromatográficos rápidos em tempo real, em pacientes menores de 2 anos em hospital público e universitário. Métodos: estudo de coorte retrospectivo foi conduzido para analisar os desfechos clínicos de crianças hospitalizadas com doença respiratória viral com resultados positivos do teste rápido imunocromatográfico para VSR e/ou FluA, de 2013 a 2018. Um modelo de regressão logística foi ajustado para analisar preditores de intubação orotraqueal durante a internação. Resultados: foram analisados 220 casos: RSV (192), FluA (9) eco-detecção (19). A letalidade foi de 1,8% (2 casos) e 88% (194) casos em menores de 1 ano. O tempo médio de internação foi maior nos pacientes com codetecção. As variáveis significativamente associadas à intubação orotraqueal foram: menor idade em meses, comorbidades, codetecção de VSR e Flu-A e pneumonia bacteriana durante a internação. Conclusões: codetecção VSR e FluA foi associada a prognósticos clínicos desfavoráveis. O teste rápido fornece informações importantes a beira-leito, pois os painéis moleculares não são amplamente acessíveis em hospitais públicos. O diagnóstico rápido permite a avaliação e tratamento oportunos.

Alterações gastrointestinais durante o acompanhamento nutricional de pacientes oncológicos em acompanhamento ambulatorial de quimioterapia / Gastrointestinal changes during nutritional follow-up of cancer patients undergoing outpatient chemotherapy

ABSTRACT BACKGROUND: Cancer patients may have gastrointestinal changes that influence nutritional status. OBJECTIVE: To investigate the occurrence of gastrointestinal changes resulting from outpatient chemotherapy treatment in cancer patients. METHODS: In a retrospective longitudinal study, the nutritional status and chemotherapy gastrointestinal changes (nausea, vomit, diarrhea, constipation, mucositis, dysphagia, xerostomia, inappetence, dysgeusia and heartburn) in cancer patients (n=187) were investigated in an outpatient follow-up. For the study of the parameters over time, the generalized estimating equation (GEE) method was used. Kruskal-Wallis, Mann-Whitney tests and Spearman coefficient, at a significance level of 5% were also used. RESULTS: The majority of the patients were female (63.64%) and the mean age was 57.5±12.1 years. The most frequent symptoms were nausea (18.54%); inappetence (18.31%); intestinal constipation (11.58%); diarrhea (7.98%); xerostomia (7.59%) and vomiting (7.43%). The nutritional status did not exhibit any relevant changes (P=0.7594). However, a higher prevalence of eutrophy was observed, followed by overweight; vomiting exhibited a significant difference (P=0.0211). The nausea symptom exhibited a significant difference with a higher prevalence of colorectal neoplasia when compared to breast neoplasia (P=0.0062); as well as vomiting in lung and colorectal neoplasias (P=0.0022), and dysphagia, in head and neck neoplasia, when compared to other neoplasms (P<0.001). There was a statistically significant difference between the number of medical appointments and gender (P=0.0102) and between dysphagia and gender (P<0.0001). CONCLUSION: The study findings enhance the need for signs and symptoms follow up, as well as nutritional status follow up of patients undergoing outpatient chemotherapy.

RESUMO CONTEXTO: Pacientes oncológicos podem apresentar alterações gastrointestinais que influenciam o estado nutricional. OBJETIVO: Investigar a ocorrência de alterações gastrointestinais decorrentes do tratamento ambulatorial de quimioterapia, em pacientes oncológicos. MÉTODOS: Num estudo longitudinal retrospectivo, investigou-se o estado nutricional e as alterações gastrointestinais (náuseas, vômito, diarreia, constipação, mucosite, disfagia, xerostomia, inapetência, disgeusia e pirose) de pacientes oncológicos (n=187), em acompanhamento ambulatorial de quimioterapia. Para o estudo dos parâmetros ao longo do tempo, utilizou-se o método das equações de estimação generalizadas (EEG). Também foram utilizados os testes de Kruskal-Wallis, Mann-Whitney e o coeficiente de Spearman, com nível de significância de 5%. RESULTADOS: A maioria dos pacientes era do sexo feminino (63,64%) e a média de idade foi 57,5±12,1 anos. Os sintomas mais frequentes foram náuseas (18,54%); inapetência (18,31%); constipação intestinal (11,58%); diarreia (7,98%); xerostomia (7,59%) e vômito (7,43%). O estado nutricional não apresentou alterações relevantes (P=0,7594). No entanto, observou-se maior prevalência de eutrofia, seguido do sobrepeso e o vômito apresentou diferença significativa (P=0,0211). O sintoma de náusea apresentou diferença significativa com maior prevalência na neoplasia colorretal, quando comparado à neoplasia de mama (P=0,0062); assim como o vômito nas neoplasias de pulmão e colorretal (P=0,0022). E a disfagia, na neoplasia de cabeça e pescoço, quando comparada às demais neoplasias (P<0,001). Houve diferença estatisticamente significante entre o número de consultas médicas e sexo (P=0,0102) e entre disfagia e sexo (P<0,0001). CONCLUSÃO: Os achados encontrados no estudo permitem reforçar a necessidade do acompanhamento de sinais e sintomas, bem como do estado nutricional, de pacientes em acompanhamento ambulatorial de quimioterapia.

Ultrasound-guided foam sclerotherapy for chronic venous disease with ulcer. A prospective multiple outcome cohort study / Escleroterapia ecoguiada com espuma para doença venosa crônica com úlcera: coorte prospectiva de múltiplos desfechos

Abstract Background Chronic Venous Disease (CVD) is the main cause of chronic leg ulcers. Varicose veins are the most frequent cause of venous leg ulcers (VLU). 50.9% of Brazilian women have varicose veins and ulcer prevalence is as high as 4%. Ultrasound-guided foam sclerotherapy (UGFS) is a low-cost treatment option for varicose veins. Objectives To analyze UGFS outcomes in patients with VLU. Methods Prospective consecutive single center cohort study. Patients with great saphenous vein (GSV) reflux and VLU were treated and followed-up for 180 days. The following were studied: quality of life (QoL), disease severity, healing, and elimination of GSV reflux. The Aberdeen questionnaire, a venous clinical severity score, and Duplex scanning (DS) results were analyzed. Results 22 patients aged 35 to 70 years were treated. There was improvement in quality of life, disease severity reduced, and ulcer diameter reduced (p < 0.001; ANOVA). 77.27% of VLU healed completely (95%CI: 59.76-94.78%). The dimensions of 20/22 VLU reduced (90.91%; 95%CI: 78.9-100%). GSV reflux was eliminated in 63.64% (95%CI: 43.54-83.74%). Men had greater QoL benefit and women had more complications. There were no severe complications. The VLU that had healed completely at the end of the study were smaller at baseline than those that did not completely heal. The GSV that were completely occluded at the end of the study were smaller at baseline than those that were not completely occluded (p < 0.05; Mann-Whitney). Conclusion The results suggest that most patients benefited from UGFS.

Resumo Contexto A doença venosa crônica (DVC) é a principal causa de úlceras crônicas em membros inferiores. As varizes dos membros inferiores são a causa mais frequente de úlcera venosa (UV). No Brasil, 50,9% das mulheres têm varizes e a prevalência da úlcera chega a 4%. A escleroterapia ecoguiada com espuma (EEE) é uma alternativa de baixo custo para tratamento de varizes de membros inferiores. Objetivos Analisar evolução de portadores de UV tratados com EEE. Métodos Coorte prospectiva e consecutiva em um único serviço. Portadores de UV com veia safena magna (VSM) insuficiente foram acompanhados por 180 dias após EEE. Foram estudadas: qualidade de vida, gravidade da doença, cicatrização e eliminação do refluxo. Foram utilizados questionário Aberdeen, escore clínico venoso e ultrassom Doppler. Resultados Foram tratados 22 pacientes com idade entre 35 a 70 anos. Houve melhora na qualidade de vida, redução da gravidade da doença, e redução dos diâmetros das úlceras (p < 0.001; ANOVA). Houve redução das dimensões em 90,91% das úlceras [intervalo de confiança de 95% (IC95%) 78,9-100%], e cicatrização completa em 77,27% (IC95% 59,76-94,78%). O refluxo foi eliminado em 63,64% (IC95% 43,54-83,74%) das VSM. Homens tiveram maior benefício em qualidade de vida, e mulheres apresentaram mais complicações. Não houve complicações graves. As UV completamente cicatrizadas e as VSM que apresentaram oclusão completa apresentavam dimensões inicialmente menores quando comparadas às das UV não completamente cicatrizadas e das VSM não completamente ocluídas (p < 0,05; Mann-Whitney). Conclusões Os resultados sugerem que EEE foi benéfica para a maioria dos pacientes.

Comparative analysis of late results of cervical esophagogastric anastomosis by manual and mechanical suture in patients submitted to esophageal mucosectomy through advanced megaesophagus / Análise comparativa dos resultados em longo prazo da anastomose esofagogástrica cervical pela sutura manual e mecânica em pacientes submetidos à mucosectomia esofágica por megaesôfago avançado

ABSTRACT Background: Among the anastomoses of the gastrointestinal tract, those of the esophagus are of special interest due to several anatomical or even general peculiarities. Aim: Evaluate retrospectively the results comparing mechanical vs. manual suture at cervical esophagogastric anastomosis in megaesophagus treatment. Methods: Were included 92 patients diagnosed with advanced megaesophagus with clinical conditions to undergo the surgery. All underwent esophageal mucosectomy, performing anastomosis of the esophagus stump with the gastric tube at the cervical level. In order to make this anastomosis, the patients were divided into two groups: group A (n=53) with circular mechanical suture, lateral end; group B (n=39) with manual suture in two sides, lateral end. In the postoperative period, an early evaluation was performed, analyzing local and systemic complications and late (average 5.6 y) analyzing deglutition. Results: Early evaluation: a) dehiscence of esophagogastric anastomosis n=5 (9.4%) in group A vs. n=9 (23.0%) in group B (p=0.0418); b) stenosis of esophagogastric anastomosis n=8 (15.1%) in group A vs. n=15 (38.4%) in group B (p=0.0105.); c) pulmonary infection n=5 (9.4%) in group A vs. n=3 (7.6%) in group B (p=1.0000.); d) pleural effusion n=5 (9.4%) in group A vs. n=6 (15.4%) in group B (p<0.518). Late evaluation showed that 86.4-96% of the patients presented the criteria 4 and 5 from SAEED, expressing effective swallowing mechanisms without showing significant differences among the groups. Conclusion: Cervical esophagogastric anastomosis by means of mechanical suture is more proper than the manual with lower incidence of local complications and, in the long-term evaluation, regular deglutition was acquired in both suture techniques in equal quality.

RESUMO Racional: Das anastomoses do trato gastrointestinal, as do esôfago têm especial interesse devido às varias peculiaridades anatômicas e mesmo sistêmicas. Objetivo: Avaliar retrospectivamente os resultados comparando a sutura mecânica e manual na anastomose esofagogástrica cervical no tratamento do megaesôfago. Métodos: Foram estudados 92 pacientes com diagnóstico de megaesôfago avançado com condições clínicas de serem submetidos à operação. Todos foram submetidos à mucosectomia esofágica, sendo realizada anastomose do coto esofágico com o tubo gástrico no nível cervical. Para a realização desta anastomose, foram divididos em dois grupos: grupo A (n=53) com sutura mecânica circular terminolateral; grupo B (n=39) com sutura manual em dois planos terminolateral. No período pós-operatório foi realizada avaliação precoce, com análise das complicações locais e sistêmicas, e tardia (média 5,6 anos) com análise da deglutição. Resultados: Avaliação precoce: a) deiscência da anastomose esofagogástrica, n=5 (9,4%) no grupo A vs. n=9 (23,0%) no grupo B (p=0.0418); b) estenose da anastomose esofagogástrica n=8 (15,1%) no grupo A vs. n=15 (38,4%) no grupo B (p=0.0105); c) infecção pulmonar n=5 (9,4%) no grupo A vs. n=3 (7,6%) no grupo B (p=1.000); d) derrame pleural n=5 (9,4%) no grupo A vs. n=6 (15,4%) no grupo B (p<0.518). A avaliação tardia demonstrou que 86,4 a 96,0% dos pacientes apresentaram critérios 4 e 5 de SAEED, demonstrando deglutição efetiva e sem diferença significante entre os grupos. Conclusão: A anastomose esofagogástrica pela sutura mecânica é mais adequada que a manual com pequena incidência de complicações locais e, na avaliação em longo prazo, a deglutição demonstrou ser adequada em ambos os grupos e com qualidade semelhante.

Meta, prescrição e infusão da terapia nutricional enteral de pacientes críticos em unidade de terapia intensiva / Target, prescription and infusion of enteral nutritional therapy of critical patients in intensive care unit

ABSTRACT BACKGROUND: Enteral nutritional therapy (ENT) is the best route for the nutrition of critically ill patients with improved impact on the clinical treatment of such patients. OBJECTIVE: To investigate the energy and protein supply of ENT in critically ill in-patients of an Intensive Care Unit (ICU). METHODS: Prospective longitudinal study conducted with 82 critically ill in-patients of an ICU, receiving ENT. Anthropometric variables, laboratory tests (albumin, CRP, CRP/albumin ratio), NUTRIC-score and Nutritional Risk Screening (NRS-2002), energy and protein goals, and the inadequacies and complications of ENT were assessed. Statistical analysis was performed using the Chi-square or Fischer tests and the Wilcoxon test. RESULTS: A total of 48.78% patients were at high nutritional risk based on NUTRIC score. In the CRP/albumin ratio, 85.37% patients presented with a high risk of complications. There was a statistically significant difference (P<0.0001) for all comparisons made between the target, prescription and ENT infusion, and 72% of the quantities prescribed for both calories and proteins was infused. It was observed that the difference between the prescription and the infusion was 14.63% (±10.81) for calories and 14.21% (±10.5) for proteins, with statistically significant difference (P<0.0001). In the relationship between prescription and infusion of calories and proteins, the only significant association was that of patients at high risk of CRP/albumin ratio, of which almost 94% received less than 80% of the energy and protein volume prescribed (P=0.0111). CONCLUSION: The administration of ENT in severely ill patients does not meet their actual energy and protein needs. The high occurrence of infusion inadequacies, compared to prescription and to the goals set can generate a negative nutritional balance.

RESUMO CONTEXTO: A terapia nutricional enteral (TNE) é a melhor via para a nutrição de pacientes críticos e com melhores impactos no tratamento clínico desses pacientes. OBJETIVO: Investigar a oferta energética e proteica da TNE em pacientes críticos, internados em uma unidade de terapia intensiva (UTI) de um hospital universitário. MÉTODOS: Um estudo prospectivo longitudinal foi conduzido com 82 pacientes críticos internados em uma UTI, recebendo TNE. Foram estudadas variáveis antropométricas, exames laboratoriais (albumina, PCR, relação PCR/albumina), NUTRIC-score e o Nutritional Risk Screening (NRS-2002), metas energéticas e proteicas e as inadequações e complicações da TNE. A análise estatística foi realizada utilizando-se os testes Qui-quadrado ou Fischer e o teste de Wilcoxon, com nível de significancia de P<0,05. RESULTADOS: Na avaliação pelo NUTRIC score, 48,78% apresentaram alto risco nutricional. Na relação PCR/albumina, 85,37% apresentaram alto risco de complicações. Verificou-se diferença estatisticamente significante (P<0,0001) para todas as comparações efetuadas entre a meta, prescrição e infusão da TNE, sendo infundido 72% do que foi prescrito tanto para caloria como para proteína. Observou-se que a diferença entre a prescrição e a infusão foi de 14,63% (±10,81) para caloria e de 14,21% (±10,5) para proteína, com diferença estatisticamente significante (P<0,0001). Na relação entre prescrição e infusão de calorias e proteínas, a única associação significativa foi a dos pacientes com alto risco para a relação PCR/albumina, destes; quase 94% receberam menos que 80% do volume energético e proteico prescrito (P=0,0111). CONCLUSÃO: A administração da TNE em pacientes graves, não supre suas reais necessidades energéticas e proteicas. A alta ocorrência de inadequações da infusão, comparadas à prescrição e às metas definidas podem gerar balanço nutricional negativo.

Is total lymphocyte count related to nutritional markers in hospitalized older adults? / A contagem de linfócitos totais apresenta alguma relação com marcadores nutricionais em idosos hospitali­zados?

ABSTRACT BACKGROUND Older patients are commonly malnourished during hospital stay, and a high prevalence of malnutrition is found in hospitalized patients aged more than 65 years. OBJECTIVE To investigate whether total lymphocyte count is related to other nutritional markers in hospitalized older adults. METHODS Hospitalized older adults (N=131) were recruited for a cross-sectional study. Their nutritional status was assessed by the Nutritional Risk Screening (NRS), anthropometry, and total lymphocyte count. The statistical analyses included the chi-square test, Fisher's exact test, and Mann-Whitney test. Spearman's linear correlation coefficient determined whether total lymphocyte count was correlated with the nutritional markers. Multiple linear regression determined the parameters associated with lymphocyte count. The significance level was set at 5%. RESULTS According to the NRS, 41.2% of the patients were at nutritional risk, and 36% had mild or moderate depletion according to total lymphocyte count. Total lymphocyte count was weakly correlated with mid-upper arm circumference (r=0.20507); triceps skinfold thickness (r=0.29036), and length of hospital stay (r= -0.21518). Total lymphocyte count in different NRS categories differed significantly: older adults who were not at nutritional risk had higher mean and median total lymphocyte count ( P =0.0245). Multiple regression analysis showed that higher lymphocyte counts were associated with higher triceps skinfold thicknesses and no nutritional risk according to the NRS. CONCLUSION Total lymphocyte count was correlated with mid-upper arm circumference, triceps skinfold thickness, and nutritional risk according to the NRS. In multiple regression the combined factors that remained associated with lymphocyte count were NRS and triceps skinfold thickness. Therefore, total lymphocyte count may be considered a nutritional marker. Other studies should confirm these findings.

RESUMO CONTEXTO Durante a hospitalização é comum que pacientes idosos se encontrem desnutridos, sendo observada alta prevalência de pacientes idosos hospitalizados acima de 65 anos de idade. OBJETIVO Investigar se a contagem de linfócitos totais apresenta alguma associação com outros marcadores nutricionais em pacientes idosos hospitalizados. MÉTODOS Pacientes idosos hospitalizados (N=131) foram recrutados em um estudo transversal. Investigou-se o estado nutricional por meio do Nutritional Risk Screening (NRS), antropometria e a contagem de linfócitos totais. A análise estatística foi realizada com os testes Qui-quadrado, Fischer e Mann-Whitney. Aplicou-se o coeficiente de correlação linear de Spearman para se investigar a presença de correlação entre a CLT e os marcadores nutricionais e para avaliação dos parâmetros associados à contagem de linfócitos foi utilizada a análise de regressão linear múltipla, com nível de significância de 5%. RESULTADOS O NRS mostrou 41,2% de pacientes com risco nutricional e 36% dos pacientes encontravam-se com depleção leve ou moderada na contagem de linfócitos totais. Houve correlação significativa, de fraca intensidade, entre a contagem de linfócitos totais e a circunferência de braço (r=0,20507); a prega cutânea triciptal (r=0,29036) e o tempo de internação (r= -0,21518). Verificou-se ainda diferença significativa na comparação da contagem de linfócitos totais com as categorias de risco nutricional pelo NRS; a contagem de linfócitos totais foi maior, em média ou mediana, entre os idosos que não apresentaram risco nutricional pelo NRS ( P =0,0245). A análise de regressão múltipla mostrou que a maior contagem de linfócitos foi associada a valores maiores de prega cutânea triciptal e à classificação de sem risco nutricional pelo NRS. CONCLUSÃO A contagem de linfócitos totais apresentou associação com a circunferência de braço, com a prega cutânea triciptal e com o NRS, podendo ser considerada como um marcador nutricional. Na regressão, os fatores que, em conjunto, mantiveram-se associados à contagem de linfócitos foram o NRS e a prega cutânea triciptal. Outras investigações devem ser realizadas para confirmar estes achados.

Early and late assessment of esophagocardioplasty in the surgical treatment of advanced recurrent megaesophagus / Avaliação precoce e tardia da esofagocardioplastia no tratamento cirúrgico do megaesôfago avançado e recidivado

ABSTRACT Background Since Chagas disease has esophageal manifestations with different degrees of involvement, the best surgical option is controversial, especially for patients with advanced chagasic megaesophagus and recurrent symptoms after previous treatment. Objective To assess the early and late outcomes of esophagocardioplasty in a series of patients with advanced recurrent chagasic megaesophagus. Methods This descriptive study included 19 older patients with recurrent megaesophagus grade III/IV and positive immunofluorescence for Chagas disease. They had undergone cardiomyotomy with anterior fundoplication a mean of 16.5 years ago. Serra-Doria esophagocardioplasty was selected to treat the recurrence. The patients were followed to assess postoperative and late complications and the incidence of symptom recurrence. Results In early assessment, five (26.3%) patients presented clinical complications. One (5.2%) patient had a gastrointestinal fistula secondary to esophagogastric anastomotic leak, which responded well to conservative treatment. In the one-year follow-up, 18 (94.7%) patients could swallow normally and had no vomiting. Three years after surgery, 10 (62.5%) of 16 patients could swallow normally, and 3 (19.3%) patients complained of vomiting. Five years after surgery, only 5 (38.4%) of 13 patients could swallow normally and 7 (53.8%) had vomiting. Conclusion Serra-Doria esophagocardioplasty for the treatment of advanced recurrent megaesophagus had mild postoperative complications and good success rate in the short-term follow-up. In the long-term follow-up, it proved to be a poor surgery choice because of the high incidence of symptom recurrence, compromising quality of life. This procedure should be indicated only for patients with advanced recurrent megaesophagus without clinical conditions to undergo esophageal resection.

RESUMO Contexto A doença de Chagas, por apresentar manifestações esofágicas com diferentes graus de acometimento, faz com que haja controvérsias quanto a melhor opção cirúrgica; principalmente para pacientes com megaesôfago chagásico avançado e com recidiva de sintomas após tratamento prévio. Objetivo Avaliar o resultado precoce e tardio da esofagocardioplastia em uma série de pacientes com megaesôfago chagásico avançado e recidivado. Métodos Estudo descritivo, com 19 pacientes idosos com megaesôfago Grau III/IV recidivado e com imunoflorescência positiva para doença de Chagas. A cirurgia prévia foi a cardiomiotomia com fundoplicatura anterior, com tempo médio de realização de 16,5 anos. A cirurgia de eleição para o tratamento da recidiva foi a esofagocardioplastia de Serra-Dória. Realizou-se avaliação precoce para estudar as complicações pós-operatórias e tardias, para avaliar a incidência de recidiva de sintomas. Resultados Na avaliação precoce, 5 (26,3%) pacientes apresentaram complicações clínicas. Um (5,2%) paciente apresentou fístula digestiva consequente a deiscência da anastomose esofagogástrica, mas com boa evolução com o tratamento conservador. Na avaliação de 1 ano de pós-operatório, 18 (94,7%) pacientes apresentavam deglutição normal e sem regurgitação. Com 3 anos de pós-operatório, de 16 pacientes analisados; 10 (62,5%) pacientes apresentavam deglutição normal e 3 (19,3%) se queixavam de regurgitação. Com 5 anos de pós-operatório, de 13 pacientes analisados; somente 5 (38,4%) apresentavam deglutição normal e 7 (53.8%) com regurgitação. Conclusão A esofagocardioplastia de Serra-Dória, no tratamento cirúrgico do megaesôfago avançado recidivado, apresentou complicações pós-operatórias de baixa morbidade e com boa resolutividade, na avaliação precoce. Na avaliação de longo prazo, demonstrou não ser um procedimento cirúrgico adequado, pela alta incidência de recidiva de sintomas, com comprometimento da qualidade de vida. Deve ser indicada somente em pacientes com doença avançada recidivada, sem condições clínicas de serem submetidas à ressecção esofágica.

Microsurgical head and neck reconstruction: retrospective analysis of 30 free flaps / Reconstrução microcirúrgica em cabeça e pescoço: análise retrospectiva de 30 retalhos livres

Introduction: Reconstructive head and neck surgery is a challenge for the plastic surgeon and requires a large technical arsenal, in which microsurgery plays an essential role. The objective to retrospectively analyze microsurgical head and neck reconstruction performed at the Pontifical Catholic University of Campinas over a period of 2 years. Methods: The medical charts of patients who underwent microsurgical reconstruction after head and neck surgery between June 2014 and October 2016 were reviewed to determine which flap was used, the length of the vascular pedicle, recipient vessels, microvascular anastomoses, surgical time, length of hospital stay, complications, and success rate. Results: Thirty microsurgical reconstructions were performed using 3 types of flaps: anterolateral thigh (n = 15), antebrachial radial (n = 8), and fibula (n = 7). Recipient vessels: facial artery (70%) and facial vein (50%), as 92.4% of microvascular anastomoses were end-to-end. The average operative time was 10.1 hours. The average length of hospital stay was 10.7 days. Two flaps were lost due to arterial thrombosis, resulting in a success rate of 93.3%. Conclusions: The microsurgical reconstructions were effective for the repair of complex defects as well as to partially restore the shape and function of the affected tissues. Complications were observed in less than 50% of the cases, although these presented with significant morbidity. The success rate was similar to that reported by major centers of reconstructive microsurgery. The learning curve is long, although it tends to improve with staff training and the acquisition of experience over time.

Introdução: Cirurgia reconstrutiva em cabeça e pescoço representa desafio ao cirurgião plástico e requer amplo arsenal técnico, no qual a microcirurgia figura papel essencial. O objetivo é analisar retrospectivamente as reconstruções microcirúrgicas em cabeça e pescoço realizadas na Pontifícia Universidade Católica de Campinas no período de dois anos. Métodos: Pacientes submetidos à reconstrução microcirúrgica após cirurgia de cabeça e pescoço, entre junho de 2014 e outubro de 2016, tiveram seus prontuários revisados para avaliação do retalho utilizado, comprimento do pedículo vascular, vasos receptores, anastomoses microvasculares, duração da cirurgia, tempo de internação, complicações e índice de sucesso. Resultados: Foram realizadas 30 reconstruções microcirúrgicas com três tipos de retalhos: anterolateral da coxa (n = 15), antebraquial radial (n = 8) e fíbula (n = 7). Vasos receptores: artéria facial (70%) e veia facial (50%), sendo que 92,4% das anastomoses microvasculares foram término-terminais. As cirurgias duraram, em média, 10,1 horas. O tempo médio de internação hospitalar foi de 10,7 dias. Houve perda de dois retalhos por trombose arterial, levando à taxa de sucesso de 93,3%. Conclusões: As reconstruções microcirúrgicas analisadas foram eficazes na reparação dos defeitos complexos, restaurando parcialmente forma e função dos tecidos acometidos. Foram observadas complicações em menos da metade dos casos, porém com morbidade elevada. O índice de sucesso foi semelhante ao de grandes centros de microcirurgia reconstrutiva. A curva de aprendizado é longa, mas tende a melhorar com o treinamento da equipe e aquisição de experiência ao longo do tempo.

ASSESSMENT OF MECHANICAL AND MANUAL SUTURE IN THE SURGICAL TREATMENT OF THE PHARYNGOESOPHAGEAL DIVERTICULUM / AVALIAÇÃO DA SUTURA MECÂNICA E MANUAL NO TRATAMENTO CIRÚRGICO DO DIVERTÍCULO FARINGOESOFÁGICO

Background: The occurrence of the pharyngoesophageal, or Zenker diverticulum is not frequent in the national scenario, and the technique of the diverticulectomy with cricomyotomy in medium and great dimension diverticula is still the most indicated. Because the resection of the diverticulum requires the suture of the pharynx, dehiscence can occur, thereafter delaying swallowing. Hence, the idea is to accomplish this surgical procedure, comparing the manual and mechanical suture, in order to evaluate the real benefit of the mechanical technique. Aim: To evaluate the results of the pharyngoesophageal diverticulectomy with cricomyotomy using manual and mechanical suture with regard to local and systemic complications. Method: Fifty-seven patients with pharyngoesophageal diverticula diagnosed through high digestive endoscopy and pharyngeal esophagogram were studied. The applied surgical technique was diverticulectomy with myotomy of the cricopharyngeal muscle, done in 24 patients (42.2%) the mechanical suture (group A) with the mechanical linear suture device and in 33 (57.8%) a manual closure of the pharynx (group B). Results: In the postoperative period, one patient of group A (4.1%) presented fistula caused by dehiscence of the pharyngeal suture, and three of group B (15.1%) presented the same complication, with a good outcome using a conservative treatment. In the same group, three patients (9.0%) presented stenosis of the suture of the pharynx, with good outcome and with endoscopic dilatations, and no patient from group A presented such complication. Lung infection was present in five patients, being two (8.3%) of group A and three (9.0%) on B, having good outcomes after specific treatment. In the late review, done with 43 patients (94.4%) of group A and 22 (88.0%) on B, the patients declared to be pleased with the surgical procedure, because they were able to regain normal swallowing. Conclusion: The diverticulectomy with myotomy and pharyngeal closure using mechanical suture was proven appropriate, for having restored regular swallowing in most of the patients, and the mechanical closure of the pharynx proved to be more effective in comparison to the manual one, because it provided a lower index of local post-surgical complications.

Racional: A ocorrência do divertículo faringoesofágico, ou de Zenker, é pouco frequente no cenário nacional, sendo que a técnica da diverticulectomia com cricomiotomia em divertículos de média e grandes dimensões ainda é a mais indicada. Devido à ressecção do divertículo necessitar de sutura da faringe ocorre possibilidade de deiscência, o que retarda o retorno da deglutição. Daí a ideia de realizar este procedimento cirúrgico, comparando a sutura manual com a mecânica, para avaliar o real benefício da técnica mecânica. Objetivo: Avaliar os resultados da diverticulectomia faringoesofágica com cricomiotomia utilizando à sutura manual e mecânica em relação às complicações locais e sistêmicas. Métodos: Foram estudados 57 pacientes com divertículos faringoesofágicos diagnosticados através da endoscopia digestiva alta e faringoesofagograma. A técnica cirúrgica empreendida foi a diverticulectomia com miotomia do músculo cricofaríngeo, sendo a sutura mecânica realizada em 24 pacientes (42,2%, grupo A) com o aparelho linear e em 33 (57,8%, grupo B) a manual para o fechamento da faringe. Resultados: Na avaliação do pós-operatório precoce, um paciente do grupo A (4,1%) apresentou fístula consequente à deiscência da sutura da faringe e três do grupo B (15,1%) ambos com boa evolução com tratamento conservador. Neste mesmo grupo, três pacientes (9,0%) apresentaram estenose da sutura da faringe, com boa evolução com dilatações endoscópicas sendo que nenhum do grupo A apresentou esta complicação. A infecção pulmonar esteve presente em cinco pacientes, dois (8,3%) do grupo A e três (9,0%) do grupo B, com boa evolução com tratamento específico. Na avaliação tardia, realizada em 43 pacientes, 17(94,4%) do grupo A e 22 (88,0%) do grupo B, os pacientes referiram estarem satisfeitos com o procedimento cirúrgico, pois conseguiram resgatar a deglutição normal. Conclusões: A diverticulectomia com a miotomia do cricofaríngeo demonstrou ser procedimento cirúrgico ...

Hidrocortisona reduz as concentrações séricas dos biomarcadores inflamatórios séricos em pacientes submetidos a endarterectomia de carótida / Hydrocortisone reduces serum concentrations of inflammatory biomarkers in patients subjected to carotid endarterectomy

A hidrocortisona pode reduzir a concentração dos biomarcadores inflamatórios séricos e teciduais.ObjetivoAnalisar a atividade inflamatória da proteína C-reativa ultrassensível (PCR-US), do fator de necrose tumoral (FNT)-alfa e do fator de crescimento do endotélio vascular (FCEV) séricos e teciduais, mediante administração intraoperatória de hidrocortisona, após endarterectomia de artéria carótida (EAC).MétodoVinte e dois pacientes foram divididos em Grupo Controle (5 assintomáticos e 6 sintomáticos) – não foi administrada hidrocortisona – e Grupo 1 (4 assintomáticos e 7 sintomáticos) – foram administrados 500 mg intravenoso de hidrocortisona. O PCR-US, o FNT-alfa e o FCEV séricos foram dosados no pré-operatório e em 1 hora, 6 horas e 24 horas após a EAC. Na placa carotídea, mensuramos os níveis de FNT-alfa e FCEV.ResultadosO grupo 1 exibiu menor concentração sérica de FNT-alfa em 1 hora (p=0,031), 6 horas (p=0,015) e 24 horas (p=0,017) após a EAC, e menor concentração de FCEV em 1 hora (p=0,006) e 6 horas (p=0,005) após a EAC, em relação ao grupo controle. Os pacientes sintomáticos do grupo 1 exibiram menor concentração de FNT-alfa em 1 hora e 6 horas após a EAC, e menor concentração de FCEV em 1 hora após a EAC, em relação ao grupo controle. Não houve diferença estatística entre as concentrações teciduais de FNT-alfa e FCEV entre o grupo controle e o grupo 1.ConclusãoA hidrocortisona reduz as concentrações séricas pós-operatórias de FNT-alfa e FCEV, em especial nos sintomáticos; porém, não reduz os níveis teciduais destes biomarcadores.

Hydrocortisone may reduce serum and tissue concentrations of inflammatory biomarkers.ObjectiveTo analyze the inflammatory activity of serum and tissue high-sensitivity C-reactive protein (hsCRP), tumor necrosis factor (TNF)-á and vascular endothelial growth factor (VEGF) after intraoperative administration of hydrocortisone, after carotid endarterectomy (CEA).MethodTwenty-two patients were allocated to a Control Group (5 asymptomatic and 6 symptomatic patients) and were not administered hydrocortisone or to Group 1 (4 asymptomatic and 7 symptomatic patients) and were administered 500 mg intravenous hydrocortisone. Serum levels of hsCRP, TNF-á and VEGF were tested for the preoperative period and at 1 hour, 6 hours and 24 hours after CEA. Levels of TNF-á and VEGF were also measured in carotid plaques.ResultsGroup 1 exhibited lower concentrations of serum TNF-á at 1 hour (p=0.031), 6 hours (p=0.015) and 24 hours (p=0.017) after CEA and lower concentrations of serum VEGF at 1 hour (p=0.006) and 6 hours (p=0.005) after CEA, relative to controls. Symptomatic patients in group 1 exhibited lower concentrations than controls for serum TNF-á at 1 hour and 6 hours after CEA and lower concentrations than controls for serum VEGF at 1 hour after CEA. There were no statistical differences in tissue concentrations of TNF-á or VEGF between the control group and group 1.ConclusionHydrocortisone reduces postoperative concentrations of serum TNF-á and VEGF, especially in symptomatic patients; but does not reduce tissue levels of these biomarkers.

Hydrocortisone supresses inflammatory activity of metalloproteinase - 8 in carotid plaque / Hidrocortisona suprime a atividade inflamatória da metaloproteinase - 8 presente na placa carotídea

AbstractObjective:Matrix metalloproteinases are inflammatory biomarkers involved in carotid plaque instability. Our objective was to analyze the inflammatory activity of plasma and carotid plaque MMP-8 and MMP-9 after intravenous administration of hydrocortisone.Methods:The study included 22 patients with stenosis ≥ 70% in the carotid artery (11 symptomatic and 11 asymptomatic) who underwent carotid endarterectomy. The patients were divided into two groups: Control Group - hydrocortisone was not administered, and Group 1 - 500 mg intravenous hydrocortisone was administered during anesthetic induction. Plasma levels of MMP-8 and MMP-9 were measured preoperatively (24 hours before carotid endarterectomy) and at 1 hour, 6 hours and 24 hours after carotid endarterectomy. In carotid plaque, tissue levels of MMP-8 and MMP-9 were measured.Results:Group 1 showed increased serum levels of MMP- 8 (994.28 pg/ml and 408.54 pg/ml, respectively; P=0.045) and MMP-9 (106,656.34 and 42,807.69 respectively; P=0.014) at 1 hour after carotid endarterectomy compared to the control group. Symptomatic patients in Group 1 exhibited lower tissue concentration of MMP-8 in comparison to the control group (143.89 pg/ml and 1317.36 respectively; P=0.003). There was a correlation between preoperative MMP-9 levels and tissue concentrations of MMP-8 (P=0.042) and MMP-9 (P=0.019) between symptomatic patients in the control group.Conclusion:Hydrocortisone reduces the concentration of MMP- 8 in carotid plaque, especially in symptomatic patients. There was an association between systemic and tissue inflammation.

ResumoObjetivo:As metaloproteinases são biomarcadores inflamatórios envolvidos na instabilidade da placa carotídea. O objetivo deste estudo foi analisar a atividade inflamatória da MMP-8 e MMP-9 plasmática e presente na placa carotídea, após administração intravenosa de hidrocortisona.Métodos:Participaram do estudo 22 pacientes portadores de estenose ≥ 70% em artéria carótida (11 sintomáticos e 11 assintomáticos), submetidos à endarterectomia de artéria carótida. Os pacientes foram divididos em dois grupos: Grupo Controle - não foi administrado hidrocortisona e Grupo 1 - foi administrado 500 mg intravenoso de hidrocortisona durante a indução anestésica. As dosagens plasmáticas de MMP-8 e MMP-9 foram efetuadas no pré-operatório (24 horas antes da endarterectomia de artéria carótida) e em 1 hora, 6 horas e 24 horas após endarterectomia de artéria carótida. Na placa carotídea foram mensurados os níveis teciduais de MMP-8 e MMP-9.Resultados:O grupo 1 exibiu elevação dos níveis séricos da MMP-8 (994,28 pg/ml e 408,54 pg/ml, respectivamente; P=0.045) e MMP-9 (106.656,34 e 42.807,69, respectivamente; P=0.014) em 1 hora após a endarterectomia de artéria carótida, em relação ao grupo controle. Os pacientes sintomáticos do grupo 1 exibiram menor concentração tecidual de MMP-8, em relação ao grupo controle (143,89 pg/ml e 1317,36, respectivamente; P=0.003). Houve correlação entre os níveis pré-operatórios de MMP-9 e as concentrações teciduais de MMP-8 (P=0.042) e MMP-9 (P=0.019) entre os pacientes sintomáticos do grupo controle.Conclusão:A hidrocortisona reduz a concentração de MMP-8 na placa carotídea, em especial nos pacientes sintomáticos. Houve associação entre a inflamação sistêmica e a tecidual.