Does age influence in endoscopic therapeutic success on the biliary tract? / A idade influencia no sucesso terapêutico endoscópico sobre a via biliar?

ABSTRACT Background: Retrograde endoscopic cholangiopancreatography (ERCP) effectively treats biliary and pancreatic disorders. Its indications are limited and precise, since its misuse delays adequate treatment, increases costs and to patient´s adverse events. Aim: To compare clinical, radiological and exploratory characteristics in relation to therapeutic success in patients undergoing ERCP in relation to age. Method: 421 patients who underwent the method were retrospectively studied; those who were not able to access the duodenal papilla were excluded. The patients were divided into two age groups: <60 years (group 1) and >60 years (group 2), and the variables of gender, examination indications, radiological findings, therapeutic success, diagnosis and the occurrence of immediate adverse events were analyzed. Results: 177 patients were allocated to group 1 and 235 to group 2. The main indication found in both groups was choledocholithiasis. In group 2, the number of cases of acute cholangitis (p=0.001), biliary stenosis (p=0.002) and papilla cancer (p=0.046) was higher. In this group, urgent indication for ERCP was higher (p=0.042), as well as the diagnosis of biliary tract dilatation (p<0.001). The placement of prostheses was the most common procedure performed in both groups, but the greatest number of patients in absolute quantity occurred in group 2. In group 1, the success in catheterization and the chance of achieving clearing of the biliary tract was significantly higher in compared to group 2 (p=0.016, OR=2.1). Conclusion: The success of catheterization and complete clearance of the bile duct was significantly higher in the group of young patients.

RESUMO Racional: A colangiopancreatografia endoscópica retrógrada (CPRE) trata eficazmente afecções biliares e pancreáticas. Suas indicações são limitadas e precisas, uma vez que seu uso indevido atrasa o tratamento adequado, aumenta os custos e submete pacientes a eventos adversos. Objetivo: Comparar as características clínicas, radiológicas e exploratórias em relação ao sucesso terapêutico em pacientes submetidos à CPRE com relação à idade. Método: Foram estudados retrospectivamente 421 pacientes submetidos ao método sendo excluídos aqueles onde não foi possível ao acesso a papila duodenal. Os pacientes foram divididos em dois grupos etários: <60 anos (grupo 1) e >60 anos (grupo 2) e analisadas as variáveis gênero, indicações do exame, achados radiológicos, sucesso terapêutico, diagnóstico e a ocorrência de eventos adversos imediatos. Resultados: 177 pacientes foram alocados no grupo 1 e 235 no grupo 2. A principal indicação encontrada em ambos os grupos foi coledocolitíase. No grupo 2, o número de casos de colangite aguda (p=0,001), estenose biliar (p=0,002) e neoplasia de papila (p=0,046) foi superior. Nesse grupo a indicação da CPRE em caráter de urgência foi superior (p=0,042), bem como o diagnóstico de dilatação da via biliar (p<0,001). A colocação de próteses foi o procedimento mais comumente realizado nos dois grupos, mas o maior número de doentes em quantidade absoluta ocorreu no grupo 2. No grupo 1, o sucesso na cateterização e a chance de conseguir o clareamento da via biliar foi significativamente superior em relação ao grupo 2 (p=0,016, OR=2,1). Conclusão: O sucesso da cateterização e o clareamento completo da via biliar foi significativamente superior no grupo de pacientes jovens.

Behavior of chromed catgut and polyglecaprone 25 sutures in the urinary bladder of rats, with special reference to stone formation

In order to determine and compare the behavior of chromed catgut and polyglecaprone 25 sutures, 49 female rats anesthetized with ether were submitted to laparotomy, cystotomy and cystorrhaphy with separate stitches using catgut for group C and polyglecaprone 25 for group E. When the bladders were observed 3, 7, 15, 30 and 50 days after suture application, stone formation was observed in 6 group C animals (p = 0.0058), with two stones (one per stitch) in 3 of them. No stones were detected in group E bladders. Microscopy revealed a similar course for the healing process and crystals were observed only in group C (p = 0.0159). We conclude that: 1) the tissue behavior of chromed catgut and polyglecaprone 25 sutures is similar, 2) catgut suture produce lithiasis in 46.15 per cent of the bladders sutured with it up to 50 days after surgery (p = 0.0058), and 3) polyglecaprone 25 sutures do not produce lithiasis up to 50 days after surgery.

Prospective, randomized trial of biofragmentable anastomosis ring and handsewn suture in colorectal anastomosis below the peritoneal reflection in dogs

This comparative, prospective, randomized tiral was made with the purpose of studying the techniques of handsewn suture, in one layer, seromuscular, interrupted stiches, with polyglatin 910 and the biofragmentable anastomotic ring in colorectal anastomosis below the peritoneal reflection. Forty-eight mongrel dogs were used, distributed in two groups of 24 animals. Each group was distributed in 3 subgroup. The subgroups were sacrificed on postoperative day 5, 15 and 30, repectively. The study evaluated mortality, morbidity, suture complications, macroscopic aspects, bursting strength, microscopic aspects and hydroxyproline concentration at the site of colorectal anastomosis. This analysis led to the the followin conclusions: There was no diference between anastomosis through macroscopic aspects, mortality and anastomotic leaks, fistula, stenosis and bleeding. The subgroups of animals with the biofragmentable anastomotic ring had on postoperative day 5 and 15 significant higher bursting when compared to the groups of handsewn technique at the same period. The subgroups of animals with the biofragmentable anastomotic ring had on postoperative day 15 and 30 significant less hydroxyproline concentration, when compared to the groups of handsewn rechnique at the same period. Both techniques of suture were valid and safe for low rectum anastomosis in dogs

Aspectos morfológicos da reaçäo tecidual da película celulósica inserida em esplenectomia parcial, hepatectomia parcial e no jejuno: estudo experimental em cäes / Morphological aspects of the tissue reaction from celulosic pellicle inserted into a partial splenectomy, partial hepatectomy and into jejunum: experimental study in dogs

O intuito desta pesquisa foi o de estudar a capacidade de hemostasia e as reaçöes teciduais morfológicas à inclusäo da película celulósica (BioFIill) suturada sobre a área cruenta de uma esplenectomia parcial, hepatectomia parcial e retirada de uma porçäo sero-muscular do jejuno. Foram utilizados 18 cäes, divididos em 3 grupos. Os animais foram sacrificados no 7§, 14§, e 28§ dia de Pós-operatório. A avaliaçäo imediata foi de boa contençäo hemostática após a sutura da película sobre os leitos cruentos. Houve formaçäo de abundantes aderências serosas, principalmente com omento, alças e parede abdominal. O estudo histopatológico demonstrou que a película provocou invariavelmente uma reaçäo inflamatória aguda, exsudativa exuberante. Com a evoluçäo da observaçäo houve uma diminuiçäo da extensäo do processo inflamatório e aparecimento de células gigantes e reparaçäo conjuntiva. O quadro foi semelhante a uma reaçäo granulomatosa tipo corpo estranho