Macroscopic and histological analysis on endoscopically resected rectal lesions / Análise macroscópica e histológica de lesões retais endoscopicamente ressecadas

ABSTRACT BACKGROUND: Colorectal cancer is among the most common malignancies worldwide. Colonoscopy is the examination of choice for the prevention of CRC because of its great diagnostic and, especially, therapeutic capacity in relation to adenomatous lesions. AIMS: This study aimed to analyze the prevalence, macroscopic, and histological characteristics of polypoid rectal lesions resected through endoscopic techniques and assess whether endoscopic therapy is safe and efficient for treating lesions located in the rectum. METHODS: This is a retrospective observational study with an analysis of the medical records of all patients undergoing resection of rectal polyps. RESULTS: A total of 123 patients with rectal lesions were evaluated, with 59 men and 64 women of mean age 56 years. All patients underwent endoscopic resection: 70% with polypectomy and 30% with wide mucosectomy. Complete colonoscopy with removal of the entire rectal lesion occurred in 91%, while in 5% the preparation was inadequate and poor clinical conditions were an impeditive factor, and in 4% surgical treatment was indicated because there was an infiltrative lesion with central ulceration. Histological evaluation showed adenomas in 3.25%, hyperplasia in 7.32%, and hamartoma in 0.81%; low-grade dysplasia was identified in 34.96%, high-grade dysplasia in 51.22%, and adenocarcinoma in 1.63%, while one case (0.81%) was classified as erosion. CONCLUSIONS: Polyps in the rectum are common and were found in 37% of these colonoscopies. Adenomas with dysplasia were the most common form of Colorectal cancer . Therapeutic colonoscopy proved to be a safe and efficient method for the complete treatment of rectal lesions.

RESUMO RACIONAL: O câncer colorretal (CCR) está entre as neoplasias mais comuns em todo o mundo. A colonoscopia é o exame de escolha para prevenção por sua grande capacidade diagnóstica e, principalmente, terapêutica em relação às lesões adenomatosas. OBJETIVOS: Analisar a prevalência, as características macroscópicas e histológicas das lesões polipoides retais ressecadas por técnicas endoscópicas e avaliar se a terapia endoscópica é segura e eficaz para o tratamento de lesões localizadas no reto. MÉTODOS: Estudo observacional retrospectivo com análise dos prontuários de todos os pacientes submetidos à ressecção de pólipos retais. RESULTADOS: Foram avaliados 123 pacientes com lesões retais: 59 homens e 64 mulheres com idade média de 56 anos. Todos os pacientes foram submetidos à ressecção endoscópica: 70% com polipectomia e 30% com mucosectomia ampla. A colonoscopia completa com retirada de toda a lesão retal ocorreu em 91%, enquanto em 5% o preparo foi inadequado e as más condições clínicas foram fator impeditivo, e em 4% o tratamento cirúrgico foi indicado por haver lesão infiltrativa com ulceração central. A avaliação histológica mostrou adenomas em 3,25%, hiperplasia em 7,32% e hamartoma em 0,81%; displasia de baixo grau foi identificada em 34,96%, displasia de alto grau em 51,22% e adenocarcinoma em 1,63%, enquanto um caso (0,81%) foi classificado como erosão. CONCLUSÕES: Pólipos no reto são comuns e foram encontrados em 37% das colonoscopias. Adenomas com displasia foram a forma mais comum de câncer colorretal. A colonoscopia terapêutica mostrou-se método seguro e eficiente para o tratamento completo das lesões retais.

Platelet-rich fibrin improves the osteoneogenesis in non-critical defects in calvaria: a histological and histometric study

ABSTRACT Purpose: The aim of this study was to evaluate the effect of platelet-rich fibrin (PRF) and autograft on non-critical bone repair. Methods: Four bone defects (8.3 × 2 mm) were produced on the calvarium of 15 rabbits. The surgical defects were treated with either autograft, autograft associated to PRF, PRF alone, and sham. Animals were euthanized on the second, fourth or sixth posteoperative week. Histological analyses for presence of bone development on deffect was evaluated comparing the groups treated with autograft and without the autograft separately within the same period. Mann-Whitney's tests were used to compare the percentage of bone repair in each post-operative period for autograft × autograft + PRF groups and also for control × PRF groups (α = 5%). Results: No differences were observed between the groups that received autograft and autograft associated to PRF on the second and fourth postoperative week, but areas treated with PRF demonstrated significant osteogenesis when compared to sham group on the fourth and sixth weeks. The groups that received PRF (with autograft or alone) demonstrated an enlarged bone deposition when compared to their control group. Conclusions: The use of PRF may influence bone repair and improve the bone deposition in late period of repair demonstrating osteoconductive and osteogenic properties.

Comparative analysis of tissular response after abdominal wall repair using polypropylene mesh and bovine pericardium mesh / Análise comparativa da resposta tecidual após reparo da parede abdominal utilizando tela de polipropileno e de pericárdio bovino

ABSTRACT Background: The use of polypropylene meshes for surgical repair of the abdominal wall contributes to a reduction of the of recurrence rates of hernias or defects. However, its intra-abdominal use comes along with the formation of adhesions and several complications. The study and the search for alternative materials, including bovine pericardium, have been regarded as an option for the correction and treatment of resulting hernias with better adaptations and effectiveness. Aim: Evaluating the inflammatory process of the bovine pericardium in comparison with the inflammatory process of synthetic polypropylene mesh. Method: Bovine pericardium mesh and polypropylene mesh were placed, both on the same animal. The first group had the mesh removed for analysis on day 20, and the second group on day 40. The variables congestion, granulation, giant cells, necrosis, acute inflammation, chronic inflammation and collagen were analyzed. Results: All variables were found in greater numbers as a response to the polypropylene mesh, except for the collagen, which, on day 40, was greater in response to the bovine pericardium mesh. Conclusion: The data in this study suggest that there is less inflammatory reaction in response to bovine pericardium mesh when compared to polypropylene mesh.

RESUMO Racional: O uso de telas de polipropileno para a correção cirúrgica da parede abdominal contribui para redução dos índices de recidiva das hérnias ou defeitos. No entanto, o seu uso intra-abdominal cursa com a formação de aderências e diversas complicações. O estudo e a busca por materiais alternativos, como pericárdio bovino, têm se mostrado uma opção na correção e tratamento de hérnias que resultem com melhores adaptações e efetividades. Objetivo: Avaliar o processo inflamatório do pericárdio bovino em comparação ao processo inflamatório da tela sintética de polipropileno. Método: Foi realizada a colocação de tela de pericárdio bovino e polipropileno, ambas no mesmo animal. O primeiro grupo as teve retiradas para análise no dia 20, e o segundo grupo no dia 40. Foram analisadas as variáveis congestão, granulação, células gigantes, necrose, inflamação aguda, inflamação crônica e colágeno. Resultados: Todas as variáveis foram encontradas em maior número como resposta a tela de polipropileno, exceto a variável colágeno, que no dia 40 apresentou-se em maior quantidade em resposta à tela de pericárdio bovino. Conclusão: Há menor reação inflamatória em resposta a tela de pericárdio bovino, quando comparada com a de polipropileno.

Are stem cell marker expression and cd133 analysis relevant to differentiate colorectal cancer? / A expressão de marcadores de células-tronco e a análise do cd133 são relevantes na diferenciação do câncer colorretal?

ABSTRACT Background: CD133 and AXL have been described as cancer stem cell markers, and c-MYC as a key regulatory cellular mechanism in colorectal cancer (CRC). Aim: Evaluate the prognostic role of the biomarkers CD133, AXL and c-MYC and their association with clinicopathologic characteristics in colorectal adenocarcinomas and adenomas. Methods: A total of 156 patients with UICC stage I-IV adenocarcinomas (n=122) and adenomas (n=34) were analyzed. Tissue microarrays (TMA) from primary tumors and polyps for CD133, c-MYC and AXL expression were performed and analyzed for their significance with clinicopathologic characteristics. Results: Poorly differentiated adenocarcinomas and disease progression were independent risk factors for poor overall survival. The median overall survival time was 30 months. Positive CD133 expression (35.9% of all cases), particularly of right-sided CRCs (44.8% of the CD133+ cases), was negatively correlated with death in the univariate analysis, which did not reach significance in the multivariate analysis. c-MYC (15.4% of all cases) was predominantly expressed in advanced-stage patients with distant (non-pulmonary/non-hepatic) metastasis. AXL expression was found only occasionally, and predominantly dominated in adenomas, with less penetrance in high-grade dysplasia. Conclusions: CD133 expression was not associated with inferior overall survival in CRC. While AXL showed inconclusive results, c-MYC expression in primary CRCs was associated with distant metastasis.

RESUMO Racional: CD133 e AXL são descritos na literatura como marcadores de células-tronco tumorais, e c-MYC cumpre papel chave como mecanismo de regulação celular no câncer colorretal (CCR). Objetivo: Avaliar o papel prognóstico dos biomarcadores CD133, AXL e c-MYC e sua associação com características clinicopatológicas de adenocarcinomas e adenomas colorretais. Métodos: Um total de 156 pacientes com adenocarcinomas de estádio UICC I-IV (n=122) e adenomas (n=34) colorretais foram avaliados. Microarranjos teciduais (TMA) dos tumores primários e adenomas foram realizados em busca de expressão de CD133, c-MYC e AXL, com posterior análise de relação significativa com características clinicopatológicas. Resultados: Adenocarcinomas pobremente diferenciados e progressão de doença foram fatores de risco independentes para má sobrevida global. A taxa mediana de sobrevida global foi de 30 meses. Expressão positiva de CD133 (35,9% dos casos), particularmente em cânceres de cólon direito (44,8% dos casos CD133+), correlacionou-se negativamente com óbito na análise univariada, sem significância estatística na análise multivariada. c-MYC (15,4% dos casos) teve predomínio de expressão em pacientes com estádio avançado com metástases distantes (não-pulmonares/não-hepáticas). Expressão de AXL foi pouco encontrada, com predomínio em adenomas, com menor penetrância em displasia de alto grau. Conclusão: Expressão de CD133 não se associou com sobrevida global inferior em CCR. Enquanto AXL demonstrou resultados inconclusivos, expressão de c-MYC em tumores primários se associou-se à metástases à distância.

Is there neural and functional recovery after clip removal in cervical experimental sympathectomy? / Existe recuperação neural e funcional após a retirada de clipe quando da indução de simpatectomia cervical experimental?

ABSTRACT Background: The surgical treatment of hyperhidrosis by thoracic sympathectomy has brought, in addition to symptomatic relief for many, its main adverse effect: compensatory or reflex sweating. The clipping technique in place of the sympathetic nerve section gave rise to the hope of reversibility, but the positive results showed to be quite divergent, evidencing the academic deficiency regarding the study of this phenomenon. Aim: To observe micro and macroscopic damage caused by the polymer clip on sympathetic nerve of rabbits seven days after their clipping and the findings after three weeks of clip removal. Method: In this experimental study, 20 rabbits were divided into two groups of 10, group 1 (clipping) and group 2 (de-clipping). The right cervical sympathetic nerve of all animals was clamped with polymeric clip, and in group 2 the nerve was unclipped seven days later. Group 1 rabbits were induced to death on the 7th postoperative day, and group 2 on the 21st after removal of the polymer clip. Macroscopic variables were: clip appearance, presence of discontinuity lesion, infection and adhesions around the nerve. H&E was used in the evaluation of the phases and degree of the inflammatory process and presence of necrosis, and picrosirius red F3BA for quantification of collagen. Results: The cervical sympathetic nerve was intact, without necrosis or infection in all animals of the experiment; there were adhesions in both groups, being minimal in eight animals of each group and moderate or intense in two; the clip was completely closed in all animals at the 7th postoperative day; the inflammatory process shown was chronic, with monomorphonuclear predominance. There was no significant difference between groups regarding the intensity the inflammatory process, but the amount of collagen type I and type III was significantly higher in group 2. Conclusions: The injury caused by the polymer clip on the sympathetic nerve may be reversible, allowing functional return in the areas involved in the simulated cervical sympathectomy. Clipping of the cervical sympathetic nerve using a polymer clip does not cause discontinuity injury.

RESUMO Racional: O tratamento cirúrgico da hiperidrose pela simpatectomia torácica trouxe além do alívio sintomático para muitos, também seu principal efeito adverso: o suor compensatório ou reflexo. A técnica de clipagem do nervo simpático no lugar de sua secção deu margem à esperança de reversão do procedimento; porém, os resultados mostram-se bastante divergentes e pouco conclusivos Objetivo: Observar a lesão provocada pelo clipe de polímero em nervo simpático de coelhos sete dias após sua clipagem, comparando-a com os achados após três semanas da retirada do clipe. Método: Estudo experimental, com amostra formada por 20 coelhos, divididos em dois grupos de 10, sendo o grupo 1 chamado clipagem e o 2, desclipagem. Todos foram submetidos à clipagem do nervo simpático cervical direito com clipe polimérico, e no grupo 2 realizou-se a desclipagem sete dias após. Os coelhos do grupo 1 foram submetidos à eutanásia no 7º dia de pós-operatório, e os do grupo 2 no 21º dia após a remoção do clipe. Observou-se na macroscopia o aspecto do clipe, a presença de lesão de descontinuidade, infecção e aderências ao redor do nervo. Para estudo microscópico utilizou-se a coloração H&E na avaliação das fases, grau do processo inflamatório e presença de necrose, e a de picrosirius red F3BA para quantificação de colágeno. Resultados: O nervo simpático cervical foi identificado íntegro, sem necrose ou infecção em todos os animais do experimento; havia aderências em ambos os grupos, sendo mínimas em oito de cada grupo e moderadas ou intensas em dois; em toda a amostra o clipe encontrava-se completamente fechado no 7º dia de pós-operatório; o processo inflamatório presente foi do tipo crônico, com predomínio monomorfonuclear, não se observando diferença significativa em relação ao grau do processo inflamatório entre os grupos; porém, a quantidade de colágeno tanto do tipo I quanto do tipo III foi significativamente maior no grupo 2. Conclusões: A lesão provocada pelo clipe de polímero em nervo simpático pode ser reversível possibilitando o retorno funcional nas áreas envolvidas na simpatectomia cervical simulada. A clipagem do nervo simpático cervical com uso de clipe de polímero não causa lesão de descontinuidade.

Between prolene®, ultrapro® and bard soft® meshes which presents the best performance in the repair of the abdominal wall? / Dentre as telas prolene®, ultrapro® ebard soft® qual apresenta melhor desempenho no reparo da parede abdominal?

ABSTRACT Background: In the definition of the mesh to be used to correct hernias, porosity, amount of absorbable material and polypropylene should be considered in the different stages of healing process. Aim: To evaluate the inflammatory reaction in the use of macro and microporous meshes of high and low weight in the repair of defects in the abdominal wall of rats. Methods: Ninety Wistar rats (Rattus norvegicus albinus) were used. The animals were submitted to similar surgical procedures, with lesion of the ventral abdominal wall, maintaining the integrity of the parietal peritoneum and correction using the studied meshes (Prolene®, Ultrapro® and Bard Soft®). Euthanasia was performed at 30, 60 and 120 days after surgery. The abdominal wall segments were submitted to histological analysis using H&E, Masson's trichrome, immunohistochemistry, picrosirius red and tensiometric evaluation. Results: On the 120th day, the tensiometric analysis was superior with Ultrapro® macroporous mesh. The inflammatory process score showed a significant prevalence of subacute process at the beginning and at the end of the study. Microporous meshes showed block encapsulation and in macroporous predominance of filamentous encapsulation. Conclusion: The Ultrapro® mesh showed better performance than the others in healing process of the abdominal wall.

RESUMO Racional: Na definição da tela a ser utilizada na correção das hérnias deve-se considerar a porosidade, quantidade de material absorvível e polipropileno ou inabsorvível nas diversas fases da cicatrização. Objetivo: Avaliar a reação inflamatória das telas macro e microporosas de alta e baixa gramatura no reparo de defeito da parede abdominal de ratos. Método: Foram utilizados 90 ratos da raça Wistar (Rattus norvegicus albinus). Os animais foram submetidos a procedimentos cirúrgicos semelhantes, com lesão da parede abdominal ventral, mantendo a integridade do peritônio parietal e correção utilizando as telas Prolene®, Ultrapro® e Bard Soft®. Realizou-se a eutanásia aos 30, 60 e 120 dias de pós-operatório. Os segmentos da parede abdominal foram submetidos à análise histológica com H&E, tricômio de Masson, imunoistoquímica, picrosirius red e análise tensiométrica. Resultado: No 120º dia a análise tensiométrica mostrou superioridade da tela macroporosa Ultrapro®. O escore do processo inflamatório demonstrou prevalência significativa de processo subagudo no início e no final do estudo. As telas microporosas mostraram encapsulamento em bloco e as macroporosas encapsulamento predominantemente filamentar. Conclusão: A tela Ultrapro® mostrou melhor desempenho em relação às demais na cicatrização da parede abdominal.

Could the intestinal epithelial alterations promoted by roux-en-y gastric bypass explain higher tendency for colonic diseases in bariatric patients? / As alterações epiteliais intestinais promovidas pelo bypass em y-de-roux podem explicar maior tendência a doenças colônicas em pacientes bariátricos?

ABSTRACT Background: Intestinal diversions have revolutionized the treatment of morbid obesity due to its viability and sustained response. However, experimental studies suggest, after these derivations, a higher risk of colon cancer. Aim: To analyze the histological and immunohistological changes that the jejunojejunal shunt can produce in the jejunum, ileum and ascending colon. Method: Twenty-four male Wistar rats were randomly divided into two groups, control (n=12) and experiment (n=12) and subdivided into groups of four. Nine weeks after the jejunojejunal shunt, segmental resection of the excluded jejunum, terminal ileum and ascending colon was performed. Histological analysis focused on the thickness of the mucosa, height of the villi, depth of the crypts and immunohistochemistry in the expression of Ki-67 and p53. Results: Significant differences were found between the experiment and control groups in relation to the thickness of the mucosa in the jejunum (p=0.011), in the ileum (p<0.001) and in the colon (p=0.027). There was also a significant difference in relation to the height of the villus in the ileum (p<0.001) and the depth of the crypts in the jejunum (p0.001). The results indicated that there is a significant difference between the groups regarding the expression of Ki-67 in the colon (p<0.001). No significant differences were found between the groups regarding the expression of Ki-67 in the jejunum and ileum. In the P53 evaluation, negative nuclear staining was found in all cases. Conclusion: The jejunojejunal deviation performed in the Roux-in-Y gastrojejunal bypass, predispose epithelial proliferative effects, causing an increase in the thickness of the mucosa, height of the villi and depth of the crypts of the jejunum, ileum and ascending colon.

RESUMO Racional: As derivações intestinais revolucionaram o tratamento da obesidade mórbida pela sua viabilidade e resposta sustentada. Porém, estudos experimentais sugerem, após estas derivações, risco maior de câncer de cólon. Objetivo: Analisar as alterações histológicas e imunoistológicas que a derivação jejunojejunal possa produzir no jejuno, íleo e cólon ascendente. Método: Foram utilizados 24 ratos Wistar machos randomicamente divididos em dois grupos, controle (n=12) e experimento (n=12) e subdivididos em grupos de quatro. Nove semanas após a derivação jejunojejunal procedeu-se a ressecção segmentar do jejuno excluso, íleo terminal e cólon ascendente. Análise histológica focou na espessura da mucosa, altura dos vilos, profundidade das criptas e a imunoistoquímica na expressão do Ki-67 e p53. Resultados: Foram encontradas diferenças significativas entre os grupos experimento e controle em relação à espessura da mucosa no jejuno (p=0,011), no íleo (p<0,001) e no cólon (p=0,027). Também houve diferença significativa em relação à altura dos vilos no íleo (p<0,001) e profundidade das criptas no jejuno (p<0,001). Os resultados indicaram que existe diferença significativa entre os grupos em relação à expressão do Ki-67 no cólon (p<0,001). Não foram encontradas diferenças significativas entre os grupos em relação à expressão do Ki-67 no jejuno e no íleo. Na avaliação do P53, foi encontrada coloração nuclear negativa em todos os casos. Conclusão: O desvio realizado na derivação gastrojejunal em Y-de-Roux, predispõem efeitos proliferativos epiteliais, causando aumento da espessura da mucosa, altura dos vilos e profundidade das criptas do jejuno, íleo e cólon ascendente.

Are stem cell marker expression and cd133 analysis relevant to differentiate colorectal cancer? / A expressão de marcadores de células-tronco e a análise do cd133 são relevantes na diferenciação do câncer colorretal?

ABSTRACT Background: CD133 and AXL have been described as cancer stem cell markers, and c-MYC as a key regulatory cellular mechanism in colorectal cancer (CRC). Aim: Evaluate the prognostic role of the biomarkers CD133, AXL and c-MYC and their association with clinicopathologic characteristics in colorectal adenocarcinomas and adenomas. Methods: A total of 156 patients with UICC stage I-IV adenocarcinomas (n=122) and adenomas (n=34) were analyzed. Tissue microarrays (TMA) from primary tumors and polyps for CD133, c-MYC and AXL expression were performed and analyzed for their significance with clinicopathologic characteristics. Results: Poorly differentiated adenocarcinomas and disease progression were independent risk factors for poor overall survival. The median overall survival time was 30 months. Positive CD133 expression (35.9% of all cases), particularly of right-sided CRCs (44.8% of the CD133+ cases), was negatively correlated with death in the univariate analysis, which did not reach significance in the multivariate analysis. c-MYC (15.4% of all cases) was predominantly expressed in advanced-stage patients with distant (non-pulmonary/non-hepatic) metastasis. AXL expression was found only occasionally, and predominantly dominated in adenomas, with less penetrance in high-grade dysplasia. Conclusions: CD133 expression was not associated with inferior overall survival in CRC. While AXL showed inconclusive results, c-MYC expression in primary CRCs was associated with distant metastasis.

RESUMO Racional: CD133 e AXL são descritos na literatura como marcadores de células-tronco tumorais, e c-MYC cumpre papel chave como mecanismo de regulação celular no câncer colorretal (CCR). Objetivo: Avaliar o papel prognóstico dos biomarcadores CD133, AXL e c-MYC e sua associação com características clinicopatológicas de adenocarcinomas e adenomas colorretais. Métodos: Um total de 156 pacientes com adenocarcinomas de estádio UICC I-IV (n=122) e adenomas (n=34) colorretais foram avaliados. Microarranjos teciduais (TMA) dos tumores primários e adenomas foram realizados em busca de expressão de CD133, c-MYC e AXL, com posterior análise de relação significativa com características clinicopatológicas. Resultados: Adenocarcinomas pobremente diferenciados e progressão de doença foram fatores de risco independentes para má sobrevida global. A taxa mediana de sobrevida global foi de 30 meses. Expressão positiva de CD133 (35,9% dos casos), particularmente em cânceres de cólon direito (44,8% dos casos CD133+), correlacionou-se negativamente com óbito na análise univariada, sem significância estatística na análise multivariada. c-MYC (15,4% dos casos) teve predomínio de expressão em pacientes com estádio avançado com metástases distantes (não-pulmonares/não-hepáticas). Expressão de AXL foi pouco encontrada, com predomínio em adenomas, com menor penetrância em displasia de alto grau. Conclusão: Expressão de CD133 não se associou com sobrevida global inferior em CCR. Enquanto AXL demonstrou resultados inconclusivos, expressão de c-MYC em tumores primários se associou-se à metástases à distância.

Are cdx2, beta-catenin and wnt immunomarchers useful for evaluating the chance of disease progression or evolution to death in patients with colorectal cancer? / Os imunomarcadores cdx2, beta-catenina e wnt são úteis para avaliar a chance de progressão de doença ou a evolução para óbito em pacientes com câncer colorretal?

ABSTRACT Background: Colorectal cancer (CRC) is one of the most common types of cancer in the world. Over time, intestinal epithelial cells undergo mutations that may lead to proliferative advantage and the emergence of cancer. Mutations in the beta-catenin pathway are amongst those described in the development of CRC. Aim: To verify the existence of a relation between the presence of Wnt3, beta-catenin and CDX2 in colorectal cancer samples and clinical outcomes such as disease progression or death. Method: Wnt3a, beta-catenin and CDX2 immunohistochemistry was performed on CRC tissue microarray samples (n=122), and analysis regarding the relation between biomarker expression and disease progression or death was performed. Results: No significant difference was found between the presence or absence of CDX2, beta-catenin or Wnt3a expression and clinical stage, tumor grade, disease progression or death. Conclusion: CDX2, beta-catenin and Wnt3a are not useful to predict prognosis in patients with CRC.

RESUMO Racional: O câncer colorretal (CCR) é um dos tipos mais comuns no mundo. As células epiteliais intestinais podem sofrer mutações que ocasionam vantagem proliferativa e culminam com o surgimento do câncer. Mutações da via da beta-catenina foram descritas entre as que podem ocasioná-lo. Objetivo: Verificar a existência de relação entre a expressão de Wnt3, beta-catenina e CDX2 em amostras de câncer colorretal com os eventos clínicos progressão de doença e óbito. Método: Foi realizada análise imunoistoquímica de Wnt3a, beta-catenina e CDX2 em blocos multiamostrais de CRC (n=122), e avaliada a relação entre a expressão dos biomarcadores e os desfechos progressão de doença e óbito. Resultados: Não foram encontradas diferenças significativas entre a expressão ou ausência de CDX2, beta-catenina ou Wnt3a e estádio clínico, grau de diferenciação tumoral, presença de progressão de doença ou evolução ao óbito. Conclusão: Os marcadores CDX2, beta-catenina e Wnt3a não são úteis para predizer prognóstico em pacientes com CCR.

Is there a relation between helybacter pylori and intestinal metaplasia in short column epitelization up to 10 mm in the distal esophagus? / Existe relação entre o helicobacter pylori e metaplasia intestinal nas epitelizações colunares curtas até 10 mm no esôfago distal?

ABSTRAT Background: The presence of intestinal metaplasia in the distal esophagus (Barrett's esophagus) is an important precursor of adenocarcinoma. Knowledge of the risk factors and the process by which the Barrett develops is very important and Helicobacter pylori (HP) can contribute to this development. Aim: To analyze the impact of HP in the gastric mucosa with intestinal metaplasia in the distal esophagus in areas of columnar epithelialization smaller than 10 mm in length and epidemiological data on prevalence Method: A retrospective study in which were included 373 consecutive patients diagnosed with columnar epithelium in the distal esophagus was done. In all, HP was investigated by urease and histology, exclusion and inclusion factors were applied and patients were divided into two groups: the first grouping the ones without histological diagnosis of Barrett's esophagus (235-63%) and the second with it (138-37%). Results: There was no significant difference between HP and non-HP patients in relation to the probability of having intestinal metaplasia (p=0.587). When related to the general group, there was an inverse association between the bacterium and the columnar epithelia in the distal esophagus. Age (p=0.031), gender (p=0.013) and HP (p=0.613) when related together to intestinal metaplasia showed no significant relation. In isolation, when related to age and gender, regardless of HP, results confirmed that patients in more advanced age and women present a higher incidence of intestinal metaplasia. Conclusion: There is an inverse relation between HP and the areas of columnar epithelization in the distal esophagus, regardless of the presence or absence of intestinal metaplasia. Age and gender, regardless of HP, showed higher prevalence in women and in older the number of cases with intestinal metaplasia in the distal esophagus.

RESUMO Racional: A presença de metaplasia intestinal no esôfago distal (esôfago de Barrett) é importante doença precursora do adenocarcinoma. O conhecimento sobre os fatores de risco e o processo pelo qual ela se desenvolve é importante e o Helicobacter pylori (HP) pode contribuir para esse desenvolvimento. Objetivo: Analisar o impacto do HP na mucosa gástrica sobre a metaplasia intestinal no esôfago distal em áreas de epitelização colunar menores que 10 mm de extensão e dados epidemiológicos de prevalência. Método: Estudo retrospectivo com inclusão de 373 pacientes consecutivos, com diagnóstico de epitélio colunar no esôfago distal. Em todos foi pesquisado o HP pela urease e histologia, aplicados os fatores de exclusão e inclusão e divididos em dois grupos: o primeiro agregando os pacientes sem diagnóstico histológico de esôfago de Barrett (235-63%) e o segundo com ele (138-37%). Resultados: Não houve diferença significativa entre os portadores ou não do HP em relação à probabilidade de ter metaplasia intestinal (p=0,587). Quando relacionado ao grupo geral, houve associação inversa entre a bactéria e a epitelização colunar em esôfago distal. A idade (p=0,031), gênero (p=0,013) e HP (p=0,613) quando relacionados juntos à metaplasia intestinal não mostraram relação significativa. Isoladamente, quando relacionados idade e gênero, independente do HP, surgiram resultados confirmando que pacientes de idade mais avançada e mulheres apresentam maior incidência de metaplasia intestinal. Conclusão: Existe relação inversa entre HP e as áreas de epitelização colunar em esôfago distal, independente da presença ou não de metaplasia intestinal. Já em relação à idade e gênero, independente do HP, notou-se que em mulheres e com maior a idade há aumento no número de casos com metaplasia intestinal no esôfago distal.

Tadalafil protector effect during ischemia-reperfusion in rats

Abstract Purpose: To evaluate histological parameters in rat renal tissue after tadalafil use during hot ischemia for 45 minutes and reperfusion for 24 hours. Methods: Twenty rats were divided into 2 groups. In the experimental group 10 mg/kg of tadalafil was used per gavage before the procedure. All cases underwent left partial nephrectomy, followed by 45 minutes of warm ischemia. Left nephrectomy of the remaining kidney was performed after 24 hours from the initial procedure. The histological parameters analyzed were: detachment of tubular cells, accumulation of desquamated cells in the proximal tubule, loss of brush border, tubular cylinders, interstitial edema, leukocyte infiltration, capillary congestion, vacuolization, tubular dilatation, necrosis and collapse of the capillary tuft. Results: Two rats from each group died and were excluded from the study. Tadalafil significantly reduced leukocyte infiltration (p = 0.036). The remaining histological parameters did not show statistical difference between the groups. Conclusion: The use of tadalafil during warm ischemia and reperfusion demonstrates statistically significant reduction of leukocyte infiltration in the renal interstitium.

Histological evaluation of capsules formed by silicon implants coated with polyurethane foam and with a textured surface in rats

ABSTRACT PURPOSE: To assess the capsules formed by silicone implants coated with polyurethane foam and with a textured surface. METHODS: Sixty-four Wistar albinus rats were divided into two groups of 32 each using polyurethane foam and textured surface. The capsules around the implants were analyzed for 30, 50, 70 and 90 days. Were analyzed the following parameters: foreign body reaction, granulation tissue, presence of myofibroblasts, neoangiogenesis, presence of synovial metaplasia, capsular thickness, total area and collagen percentage of type I and III, in capsules formed around silicone implants in both groups. RESULTS: The foreign body reaction was only present in the four polyurethane subgroups. The formation of granulation tissue and the presence of myofibroblasts were higher in the four polyurethane subgroups. Regarding to neoangiogenesis and synovial metaplasia, there was no statistical difference between the groups. Polyurethane group presented (all subgroups) a greater capsule thickness, a smaller total area and collagen percentage of type I and a higher percentage area of type III, with statistical difference. CONCLUSION: The use of polyurethane-coated implants should be stimulated by the long-term results in a more stable capsule and a lower incidence of capsular contracture, despite developing a more intense and delayed inflammatory reaction in relation to implants with textured surface.

Osteoarthritis model induced by intra-articular monosodium iodoacetate in rats knee

ABSTRACT PURPOSE: To evaluate the usefulness of a knee osteoarthritis model through functional, radiological and microscopic changes of the synovial membrane. METHODS: Forty eight rats were divided randomly into two groups. The first received 0.9% saline in the joint and corresponded to the control group. The second was submitted to experimental osteoarthritis of the right knee induced by monosodium iodoacetate and corresponded to the osteoarthritis group. All animals were subjected to comparative tests of forced ambulation and joint movements, inability to articulate and tactile allodynia on day 1 post-experiment by forced ambulation (Roto-rod test), joint assessment of disability (weight bearing test) and assessment of tactile allodynia (Von Frey test). After inflammatory induction they were divided into four sub-groups corresponding to the scheduled death in 7, 14, 21 and 28 days when they were submitted to radiographic examination of the knee, arthrotomy and collection of the synovial membrane. RESULTS: The osteoarthritis group showed significant differences compared to control group on days 7 and 14 in Roto-rod, in weight bearing and Von Frey tests in all days, and in radiological evaluation. Microscopic examination of the synovial membrane showed abnormalities of inflammatory character at all stages. CONCLUSION: The osteoarthritis induced by intra-articular monosodium iodoacetate in rats knee is a good model to be used in related research, because it provides mensurable changes on joint movements, tactile allodynia, progressive radiological degeneration and microscopic inflammation of the synovial membrane, that represent markers for osteoarthritis evaluation

Influence of chlorpromazine on renal histology of rats submitted to ischemia and reperfusion injury

ABSTRACT PURPOSE: To analyze the influence of chlorpromazine on renal histology of rats submitted to ischemia and reperfusion injury. METHODS: Sixteen Wistar rats - split in two groups - have been used: control group, receiving 3 mg/kg isotonic saline solution through caudal vein, and, the chlorpromazine group, receiving 3 mg/kg-IV of such medication. The nephrectomy of the left kidney lower third was carried out; immediately, the test-drug was administrated. After 15 minutes of test-drug administration, the renal pedicle was clamped; in 60 minutes of ischemia it was released. After 24 hours of the renal reperfusion, the rats were, once more, anesthetized and submitted to total left nephrectomy, and, afterwards, to euthanasia. Histological findings regarding ischemia have been evaluated and compared between the groups. RESULTS: There was no statistical difference related to inferior renal pole histological analysis. Regarding 60-minute renal ischemia, chlorpromazine has statistically reduced the accrual of leucocytes within the vasa recta renis (p=0.036) and the congestion of peritubular capillaries (p=0.041). When conducting joint analysis of histological patterns, the control group showed a median score of 11 and chlorpromazine group of 5.5 (p=0.036). CONCLUSION: Chlorpromazine significantly reduced the occurrence of secondary damage to ischemia and reperfusion process in the overall histological analysis.

Ventral abdominal wall defect correction in rats with contaminated meshes

ABSTRACT PURPOSE: To investigate whether there is a difference between Marlex(r) and Dynamesh PP-light Marlex(r) meshes, in the abdominal wall defect correction, on rats in contaminated surgical site. METHODS: Twenty-eight Wistar rats were divided into two groups of 14, and four subgroups of seven animals. All subgroups underwent similar surgical procedure. One group received the mesh Marlex(r) and the other Dynamesh PP-light(r) for correction of the defect. Before implanting, the meshes went through a contamination process, on which was used standard solution containing 10 UFC of Escherichia coli. Fragments of the animal's abdominal wall received macroscopic, microscopic and microbiological analysis. RESULTS: There was no statistical significance in the analysis of macroscopic variables. Accentuated inflammatory process was shown in all subgroups. The foreign body type reaction was mild in all subgroups, except Dynamesh(r)-14, which was moderate with no statistical significance. The microbiological analysis of the meshes was also similar between the subgroups. CONCLUSION: There was no difference between the meshes of Marlex(r) and Dynamesh PP-light(r) in the ventral abdominal wall defect correction on rats in contaminated surgical site.

Prevalence of helicobacter pylori ten years ago compared to the current prevalence in patients undergoing upper endoscopy / Prevalência do helicobacter pylori há dez anos comparada com a atual em pacientes submetidos à endoscopia digestiva alta

ABSTRACT Background: Helicobacter pylori has been extensively studied since 1982 it is estimated that 50% of the world population is affected. The literature lacks studies that show the change of its prevalence in the same population over time. Aim: To compare the prevalence of H. pylori in 10 years interval in a population that was submitted to upper endoscopy in the same endoscopy service. Method: Observational, retrospective and cross-sectional study comparing the prevalence of H. pylori in two samples with 10 years apart (2004 and 2014) who underwent endoscopy with biopsy and urease. Patients were studied in three consecutive months of 2004, compared to three consecutive months of 2014. The total number of patients was 2536, and 1406 in 2004 and 1130 in 2014. Results: There were positive for H. pylori in 17 % of the sample as a whole. There was a significant decrease in the prevalence from 19.3% in 2004 to 14.1% in 2014 (p<0.005). Conclusion: There was a 5.2% reduction in the prevalence of H. pylori comparing two periods of three consecutive months with 10 years apart in two equivalent population samples.

RESUMO Racional: Helicobacter pylori vem sendo amplamente estudado desde 1982 estimando-se que 50% da população mundial esteja afetada. A literatura carece de estudos que mostrem a mudança de sua prevalência em uma mesma população ao longo do tempo. Objetivo: Comparar a prevalência do H.pylori no intervalo de 10 anos em população que realizou endoscopia digestiva alta no mesmo serviço de endoscopia. Método: Estudo observacional, retrospectivo e transversal, comparando a prevalência de H. pylori em duas amostras com intervalo de 10 anos (2004 e 2014) que realizaram endoscopia digestiva alta com biópsias e teste da urease para a pesquisa de H. pylori. Foram estudados pacientes em três meses consecutivos de 2004, comparados aos de três meses consecutivos de 2014. O número total de pacientes avaliados foi 2536, sendo 1406 em 2004 e 1130 em 2014. Resultados: Constatou-se resultado positivo para H.pylori em 17% da amostra como um todo. Houve queda significativa da prevalência de H.pylori de 19,3% em 2004 para 14,1% em 2014 (p<0.005). Conclusão: Houve redução de 5,2% da prevalência de H. pylori comparando-se dois períodos de três meses consecutivos com intervalo de 10 anos em duas amostras populacionais equivalentes.

Schinus terebinthifolius raddi (Aroeira) and Orbignya phalerata mart. (Babassu) effect in cecorrahphy healing in rats

ABSTRACT PURPOSE: To evaluate the effect of Schinus terebinthifolius Raddi (aroeira) and Orbignya phalerata Mart. (babassu) in the healing process of cecorrhaphy in rats. METHODS : Fifty four rats were used, distributed into three groups randomly: aroeira, babassu and control, which were divided into three subgroups (six animals) according to the time of the deaths (7, 14, 21 days). All underwent the same surgical procedure, cecotomy and cecorrhaphy. The animals in group aroeira and babassu received daily dose of 100 mg/kg of hydroalcoholic extract and 50 mg/kg of aquous extract respectively, by gavage. The control group received only saline solution. The parameters evaluated were: macroscopic changes, ,resistance test to air insufflations and histological changes. RESULTS : All animals showed good healing without infection. All groups presented adhesions between cecum and neighboring organs. The resistance test insufflating of atmospheric air showed progressive increase of pressure according to the days in the aroeira group, and decrease in babassu group, without significant difference. Microscopy showed significant difference in the polymorphonuclear, hyperemia, angiogenesis, fibroblast proliferation and collagen histological variables in the 14th day. CONCLUSION : Hydroalcoholic extract of aroeira and the aqueous extract of babassu favored the healing process in cecorrhaphy in rats.