Intravascular and intraparenchymatous hepatic segmentary sclerosis

Abstract Purpose: To evaluate the morphological effects of injected sclerosing agents into the liver. Methods: This study was performed on twenty dogs, distributed into five groups: Group 1 (n = 5) - control, Group 2 (n = 5) - injection of 50% glucose solution inside hepatic parenchyma and animals followed during seven days, Group 3 (n = 10) - injection of ethanol inside hepatic parenchyma and animals distribution into two subgroups Subgroup 3A (n = 5) - followed during 24 hours and subgroup 3B (n = 5) - followed during seven days (group 3B), Group 4 (n = 5) - ethanol injection inside left portal vein branch and followed during 24 hours. Livers were macroscopically evaluated, submitted to hepatic arteriography and portography, then histology. Results: All animals in Group 4 died within 23 hours due to diffuse hepatic necrosis. The animals of groups 2 and 3 had a satisfactory evolution. Fibrosis formed in the segment reached by the sclerosant solution and interruption of the contrast flow injected into the portal system. Conclusion: Intrahepatic parenchymal ethanol injection is well tolerated and causes sclerosis restricted to a specific segment; however, intraportal ethanol injection causes massive hepatic necrosis and can lead to death.

Doença de Caroli tratada com derivação interna / Carolis disease treated with internal bypass

A doença de Caroli é uma moléstia rara, de apresentação clínica variável, caracterizada por dilatações císticas da árvore biliar. O escopo é relatar o caso de um paciente masculino, 80 anos, internado com icterícia, prurido, dor epigástrica e hepatomegalia. A propedêutica de imagem definiu o acometimento do lobo esquerdo do fígado e da via biliar principal. Após avaliação multidisciplinar, diante das alterações clínicas e laboratoriais do paciente, foi optado pela realização de colédoco-jejuno e hepáticojejuno anastomose em Y de Roux. O pós-operatório transcorreu com melhora clínica e laboratorial; o paciente permanece assintomático após seis meses de acompanhamento. O tratamento proposto pelos autores se mostrou eficiente e não inviabiliza uma ressecção hepática futura.

Carolis desease is a rare illness, has a variable clinical presentation, characterized for expand cystic biliar tract. The goal is report a case of a man, 80 year old, admitted with jaundice, itch, epigastric pain and enlarged liver. Imaging findings showed dilatations in left hepatic lobe and principal biliar tree. After multidisciplinary evaluation, against clinical and laboratorial changes of the patient, have done coledocojejunal and hepaticojejunal anastomosis in Y and Roux. The postoperative course was uneventful and the patient has been six mounths without changes. The treatment proposed for authors were efficient and dont unfeasible a hepatic resection in the future.

Avaliação funcional do transplante autólogo heterotópico de ovários: estudo experimental em ratas / Functional assessment of autologous heterotopic transplant of ovaries: An experimental study on female mice

Introduction: Two facts have been constantly reported in the literature over the lastdecades, namely: the increased number of reproductive-age women with cancer and theincreased age of primiparas. Both facts have encouraged studies on strategies to preserve women?s fertility. Objectives: To perform vaginal swab and morphological study to assess the functional viability of transplanted ovarian tissue. Methods: 30 female Wistar ablbinus mice with preserved hormonal function were randomly distributed in six groups: G1. Control ? laparotomy; G2. Bilateral oophorectomy. G3. Bilateral oophorectomy with intact ovarian implant in the femoral region; G4. Bilateral oophorectomy, with sliced ovarian implant in the femoral region; G5. Bilateral oophorectomy with intact ovarian implant in the great epiploon; G6. Bilateral oophorectomy with sliced ovarian implantat in the great epiploon. Vaginal swab and removal for morphological study of the transplanted ovaries were carried out on the 35th and 120th days after surgery. Groups G3 and G6 were submitted to new vaginal swab on the 150th day. Results: All G1 mice had hormonal function. All G2mice remained in diestrus. The patterns of four G3 mice were consistent with estrus on the 35th day, and one mouse ovulated on the 120th day. Only one G4 mouse remained in diestrus after transplantation. All G5 had functioning ovary. Four G6 mice manifested hormonal function on the 35th day and only three on the 120th day. All the 150th-day swabs were classified as diestrus.Conclusions: Autologous ovarian transplant is technically feasible in female mice as much as vaginal swab for hormonal function assessment.

Kidney function after left renal vein ligation in the dog

The ligature of the left renal vein is an alternative whenever this vessel is injured. The purpose of this study was to evaluate the capacity of the affluents of the left renal vein, proximal to the ligature, to maintain tissue vitality and function of the left kidney. Fifteen mongrel male dogs were divided in 3 groups of 5 dogs: Group I (control) - a laparotomy was performed, and the abdominal structures were only identified; Group II - the left renal vein was tied, close to vena cava; Group III - the same procedure as for Group II and a right nephrectomy. Blood urea nitrogen and serum creatinine levels were measured before the procedure, and every 3 days during 4 weeks in the postoperative period. Renal arteriography and an excretory urogram were performed on the animals that survived 60 days. Thereafter, or immediately after precocious death, the kidneys were removed for histological examination. All the animals of Group III died before two months (mean = 10.5 +-3.2 days), while the animals of Group II survived during that period. There was a complete exclusion of the left kidney in all dogs that underwent renal vein ligature. In the animals of Group II, the renal cortico-medullary limits could not be identified. At microscopy, the aspect was suggestive of nephrosclerosis. In the animals of Group III, the left kidney was enlarged, and a great amount of intravascular and intrapelvic blood clots were observed. At microscopy, extensive areas of necrosis, inflammatory infiltration, and hemorrhage were identified. In conclusion, the tributaries of the renal vein were not sufficient to maintain the tissue vitality and function of the left kidney after ligature of its main vein

Diagnóstico e estadiamento de tumores primarios do figado através da biópsia hepática dirigida por laparoscopia / Diagnosis and staging of primary liver carcinoma by laparoscopic guided liver biopsy

Apesar da ultra-sonografia e da tomografia computadorizada serem utilizadas como guias da biópsia hepatica,suas limitaçoes de resoluçao nao possibilitam um estadiamento pre-operatorio seguro das neoplasias primarias do figado.Foram estudados 72 pacientes com suspeita clinica de carcinoma hepatocelular que foram submetidos à biópsia hepatica guiada por laparoscopia.A biópsia foi positiva para neoplasia em 63 casos(87 por cento)Nesses casos o estadiamento oncologico relativo à ressecabilidade cirurgica foi correto.

Diagnóstico laparoscópico no abdome agudo / Laparoscopic diagnosis in acute abdomen

Foram estudadas 197 laparoscopias realizadas em pacientes com quadros abdominais agudos de etiologia näo estabelecida por outros métodos propedêuticos. As afecçöes ginecológicas (104 casos - 52,8%) e as apendiculares (51 casos - 25,9%) foram responsáveis pela maior parte dos exames. A laparoscopia no abdome agudo permitiu o diagnostico preciso e facilitou a escolha terapêutica. Este método é seguro, de fácil realizaçäo e apresentou baixa morbidade, podendo ser utilizado com sucesso em serviço médico de urgência.

Uso da laparoscopia na avaliaçäo de tumores intra-abdominais / Using of laparoscopy to avaliate intraabdominal tumors

Foram estudadas retorspectivamente 693 laparoscopias em pacientes com suspeita ou diagnóstico confirmado de neoplasia maligna. Os exames foram indicados principalmente para diagnóstico de massas abdominais (274 casos) e para estadiar neoplasias já diagnosticadas por outros métodos (241 casos). Os resultados mais encontrados foram carcinomatose peritoneal (221 - 31,89 por cento) e metástases hepáticas (144 casos). Em 55 casos (7,93 por cento) nao foi encontrada neoplasia abdominal. Houve complicaçoes óbito decorrente do exame. Concluindo, a laparoscopia é um método propedêutico de fácil realizaçao, seguro e permite o diagnóstico e o estadiamento de neoplasias, poupando muitas vezes o paciente da necessidade de uma laparotomia.

Ressuscitaçäo no choque hipovolêmico com soluçäo hipertônica de NaCl a 7,5/ 6. Dextran 70: revisäo de 7 casos / Hipovolemic shock resuscitation with hypertonic solution of 7,5

Foram estudados os efeitos imediatos da utilizaçäo da soluçäo de NaCl à 7,5% associada a Dextran 70, em sete pacientes com quadro de choque hipovolêmico grave. Obteve-se resposta satisfatória em seis pacientes, com um tempo médio de resposta de nove minutos. Esses pacientes foram acompanhados por 24 horas com exames clínicos e laboratoriais periódicos. Houve dois óbitos decorrentes da gravidade das lesöes apresentadas. Apesar de pequena casuística, a utilizaçäo da soluçäo hipertônica no choque hipovolêmico grave apresentou uma elevaçäo pressórica em um curto tempo, tornando possível sua ressuscitaçäo antes de ocorrerem efeitos sistêmicos decorrentes da hipovolemia.