Maximum inspiratory and expiratory pressures in the pre and postoperative periods of patients with incisional abdominal hernia corrected by Lázaro da Silva technique / Pressões máximas inspiratórias e expiratórias no pré e pós-operatório de pacientes com hérnias incisionais abdominais corrigidas pela técnica de Lázaro da Silva

ABSTRACT Objective: To verify the effect of longitudinal abdominal incisional herniorrhaphy on respiratory muscle pressure. Method: The technique of incisional herniorrhaphy used was proposed by Lázaro da Silva. To measure the pressure, we used a water manometer in 20 patients, median age 48.5 years (range 24 70). We analyzed the maximum inspiratory pressure at the level of residual volume (IP-RV) and functional residual capacity (IP-FRC) and the maximum expiratory pressure of functional residual capacity (EP-FRC) and total lung capacity (EP-TLC) in the preoperative and late postoperative (40 90 days) periods, in 13 patients with large incisional hernias and in 7 patients with medium incisional hernias. Results: There was a significant increase in IP-FRC (p = 0.027), IP-RV (p = 0.011) and EP-TLC (p = 0.003) in patients with large incisional hernias. EP-FRC increased, but not significantly. In patients with medium incisional hernias, the changes were not significant. Conclusion: Surgical correction of large incisional hernias improves the function of the breathing muscles; however, surgery for medium incisional hernias does not alter this function.

RESUMO Objetivo: verificar o efeito da herniorrafia incisional abdominal longitudinal na pressão dos músculos da respiração. Método: a técnica de herniorrafia incisional utilizada foi a proposta por Lázaro da Silva. Para aferir a pressão foi utilizado manômetro de água, em 20 pacientes, idade mediana 48,5 anos (mínimo 24, máximo 70). Foram analisadas a pressão máxima inspiratória no nível do volume residual (PIVR) e da capacidade residual funcional (PICRF) e a pressão máxima expiratória da capacidade residual funcional (PECRF) e da capacidade pulmonar total (PECPT), no pré-operatório e pós-operatório tardio (entre 40 e 90 dias), em 13 pacientes com hérnias incisionais grandes e em 7 pacientes com hérnias incisionais médias. Resultados: houve aumento significante da PICRF (p=0.027), da PIVR (p=0.011), da PECPT (p=0.003) nos pacientes com hérnias incisionais grandes. A PECRF aumentou, porém de forma não significante. Nos pacientes com hérnias incisionais médias as alterações não foram significantes. Conclusão: a correção cirúrgica da hérnia incisional grande melhora a função dos músculos da respiração, porém a cirurgia da hérnia incisional média não altera a referida função.

Effects of inferior splenic lobe pole fixation and gastrosplenic peritoneal membrane section on the vitality of the remanent of subtotal splenectomy in rats

PURPOSE: To investigate the vitality of the spleen lower pole after subtotal splenectomy with suture to the stomach and after posterior peritoneal gastro-splenic membrane section, using macro and microscopic evaluations. METHODS: Sixty Wistar rats were used in this study and were randomly distributed in the three groups: Group 1: (n=20), subtotal splenectomy with lower pole preservation, Group 2: (n=20) subtotal splenectomy with lower pole preservation and suture to the stomach, Group 3: subtotal splenectomy with lower pole preservation and posterior peritoneal gastrosplenic ligament section. The animals were sacrificed 45 days after the surgery and the spleen lower poles were removed for macroscopic and microscopic examination. RESULTS: All animals in this series survived. No macroscopic differences were encountered between the groups. Microscopic evaluation observed statistic difference concerning fibrosis between group 1 and 3 (p≤0.05), but the analysis for necrosis and inflammation presented no differences. CONCLUSION: Vitality of the spleen lower pole after subtotal splenectomy is minimally modified when it is fixed to the stomach or when the posterior peritoneal gastrosplenic ligament is resected. .

Effect of total splenectomy in the lipid profile in mice

PURPOSE: To analyze total splenectomy effect on the lipid profile - total cholesterol, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), very-low-density lipoprotein cholesterol (VLDL) and triglycerides levels, in Balb/c mice. METHODS: Thirty Balb/c male mice, one (1) month old and average weight 26.2g ± 4.0 were used in the experiment. They were distributed into three groups of 10 animals each: a control group (non-operated), a simulation group (spleen manipulation) and the splenectomy group. The animals were subjected to blood sampling to measure plasma lipid levels, at three different times: before surgery, days 30 and 75 of the experiment. RESULTS: Increased total cholesterol and LDL were observed in the control group from the start to end of the experiment. The simulation group showed increased rates of VLDL and triglycerides at the 30th and 75th days. Splenectomized animals showed no significant change. CONCLUSION: Total splenectomy did not induce increased plasma lipids levels of in Balb/c mice. .

Micronucleus test in peripheral blood of rats treated with hyperbaric oxygen after subtotal splenectomy preserving the lower pole

PURPOSE: To assess the mutagenic potential of the oxygen inhalation therapy (HBO), by means of the micronucleus test, performed in peripheral blood of rats that underwent subtotal splenectomy with lower pole preservation (ESTPI), after HBO sessions or simulations. METHODS: Eighteen male Wistar rats, were distributed into three groups of six animals: group 1 - submitted to ESTPI and HBO sessions; group 2 - submitted to ESTPI and HBO simulations; group 3 - underwent cyclophosphamide administration. In groups 1 and 2, blood samples from the animals' tails were collected before surgery (T0) and immediately after the 13th HBO session or simulation (T1). In group 3, tail blood samples were collected from animals before (T0) and 24 hours after (T1) cyclophosphamide (CP) delivery. The number of micronucleated normochromatic erythrocytes (MNNCE) was determined by blind counting 2000 normochromatic erythrocytes (NCE) per animal. RESULTS: Micronuclei average after CP delivery in group 3 was higher than before its use, thus confirming the mutagenic activity of this drug (p=0.01). In groups 1 and 2, no significant difference in the average of Micronuclei was observed when comparing it to blood samples before and after the 13th HBO session or simulation. CONCLUSION: The treatment protocol used in this study did not induce Micronucleus formation in animals submitted to ESTPI and HBO treatment or simulation. .

Phagocytic function of lower spleen pole and autogenous splenic implants in rats

PURPOSE: To investigate whether there are differences between the phagocytic function of the remaining lower spleen pole after subtotal splenectomy and autogenous splenic implants. METHODS: Thirty-six male Wistar rats, weighting 364 ± 60g were used. They were subjected to subtotal splenectomy preserving the lower spleen pole and to autogenous splenic implant in the greater omentum. Its viability was assessed microscopically. Phagocytic function was assessed by splenic uptake of the radioisotope-labeled colloid and by macrophages counting. RESULTS: The viability of the autogenous splenic implant and of the lower spleen pole was found in 33 animals, with no difference between them. The weight of the implants was higher than the lower pole of animals from groups G1, G7, G30, G60 and G120. The implants phagocytic function by radioisotope uptake was higher than the lower pole in G7 and G120 groups and it did not differ from the other groups. The number of macrophages was higher in G1, G60, G90 and G120 and did not differ from the other groups. CONCLUSION: Until the 16th week, the phagocytic function was more pronounced in autogenous splenic implants when compared with the lower spleen pole, but it became similar thereafter. .

Effects of human chorionic gonadotropin on the normal testicular tissue of rats

PURPOSE: To investigate the effects of human chorionic gonadotropin (hCG) on the testicular tissue of young male rats. METHODS: Male Wistar rats were assigned to groups (10 rats/group).Control Group received subcutaneous saline solution; Group 1 received hCG 50UI/Kg/dose; and Group 2 received hCG 100UI/Kg/dose, daily for 15 days. Half was submitted to bilateral orchiectomy on the 16th day and the other half 45 days after the beginning of the hormone application. Testicles were weighed, measured and has their volumes determined. The diameter of the tubules and the thickness of the seminiferous epithelium were measured. RESULTS: Control Group presented the highest values of testicles volume and weight. Rats in the Control presented normal histology. In G1 and G2 atrophy of the seminiferous tubules, apoptosis of germ cells and multinucleated giant cells were observed. Comparing groups, in the first operation Control rats had higher diameter values. In the second operation, the Control was only different from G1. As for thickness, Control had higher values in both operations. Comparing the time of operation, the diameter values were higher in G1 and G2 in the second operation. For all groups, the thickness of the epithelium was higher in the second operation. CONCLUSIONS: Human chorionic gonadotropin is gonadotoxic in rats. This effect was temporary and can affect reproductive potential. The total recovery of testicular damage in the studied range could not be proved, and the effects were not dose-dependent. .

Epidural anesthesia with ropivacaine with or without clonidine and postoperative pain in hemorrhoidectomies

To determine the safety, pain intensity correlated with age and body mass index (BMI), epidural anesthesia with ropivacaine and clonidine in hemorrhoidectomy. METHODS: Eighty patients, both genders, 20-70 years old, ASA I or II, for hemorrhoidectomy were randomly divided into two groups: Control (n=38), epidural anesthesia with 14 mL of ropivacaine 0.75 % plus 0.0266 mL/kg of 0.9% saline solution; Experimental (n=42) epidural anesthesia with 14 mL of 0.75% ropivacaine plus 4.0 mcg/kg of clonidine. In preoperative and postoperative period were evaluated: systolic blood pressure (SBP), diastolic blood pressure (DBP ), heart rate (HR ), pulse oximetry (SpO2), electrocardiography (ECG), pain intensity (VAS ) in four, eight and, 12 hours and analgesic consumption. RESULTS: The VAS values differed between four, eight and 12 hours in the Experimental Group, where correlation of VAS 12h with age (p<0.05) occurred and not with BMI and more patients (p<0.05) did not receive analgesics. SBP, DBP, HR changed similarly in both groups at 15, 30 and 45 min. The ECG and SpO2 remained unchanged. CONCLUSIONS: Clonidine (4mcg/kg) in epidural anesthesia with ropivacaine 0.75% in hemorrhoidectomy showed safety and greater analgesia within four hours. The pain at 12 hours showed correlation with age and not with body mass index.

Resultados da herniorrafia inguinal bilateral simultânea pela técnica de Lichtenstein / Results of the simultaneous bilateral inguinal hernia repair by the Lichtenstein technique

OBJETIVO: analisar os resultados da herniorrafia inguinal bilateral pela técnica de Lichtenstein. MÉTODOS: estudo dos prontuários de 59 pacientes submetidos à herniorrafia inguinal bilateral simultânea, eletiva, no período entre 2003 e 2007. Foram analisados: sexo, idade, peso, tempo operatório, tempo total de internação, classificação de Nyhus, intercorrências no pós-operatório imediato e tardio, e recidiva. Esses dados foram submetidos à análise estatística descritiva. RESULTADOS: dos 59 pacientes, 95% eram homens; e 5%, mulheres. A idade variou de 40 a 60 anos, o peso de 50 a 103 kg, o tempo operatório de 60 a 180 minutos, o tempo de internação de um a seis dias. Trinta pacientes apresentavam hérnias do tipo IIIB; nove, do tipo II; dez, do tipo IIIA; sete, do tipo IV; um, do tipo II à esquerda e tipo IIIB à direita; um, tipo IIIA à direita e IIIB à esquerda; e um, do tipo IIIA à direita e do tipo II à esquerda. No pós-operatório imediato, a dor foi a manifestação mais importante em 30,5% dos casos. Em 94,92% dos casos, não houve complicações tardias. Ocorreram dois casos de inguinodinia e um de dor em queimação local. Observou-se uma recidiva, no 29º mês de pós-operatório. CONCLUSÕES: a herniorrafia inguinal bilateral simultânea pela técnica de Lichtenstein foi segura e eficaz, pois houve baixo índice de complicações, curta permanência hospitalar e, em um período médio de 48 meses de acompanhamento, houve apenas um caso de recidiva.

OBJECTIVE: To analyze the results of bilateral inguinal hernia repairs by the Lichtenstein technique. METHODS: We studied the charts of 59 patients who underwent elective simultaneous bilateral inguinal hernia repair between 2003 and 2007. We analyzed: gender, age, weight, operative time, length of hospital stay, Nyhus classification, complications in the immediate and late postoperative periods, and recurrence. These data were submitted to descriptive statistical analysis. RESULTS: Of the 59 patients, 95% were men. Age ranged from 40 to 60 years; weight, from 50 to 103 kg; operative time, from 60 to 80 minutes; and the length of stay, from one to six days. Thirty patients had type IIIB hernias; nine, type II; ten, type IIIA; seven, type IV; one, type II on the left and type IIIB on the right; one, type IIIA on the right and IIIB on the left; and one, type IIIA on the right and type II on the left. In the immediate postoperative period, pain was the most important manifestation, in 30.5% of subjects. In 94.92% of cases there were no complications. There were two cases of inguinodinia and one of burning pain in the surgical site. There was one recurrence 29 months after the procedure. CONCLUSIONS: Simultaneous bilateral inguinal hernia repair by Lichtenstein technique was safe and effective, with a low rate of complications, short hospital stay, and only one case of recurrence at an average of 48 months follow-up.

Immunoexpression of proliferating cell nuclear antigen (PCNA) in spleen of splenectomized rats with preservation of inferior pole, submitted to hyperbaric oxygenation

PURPOSE: To analyze PCNA immunoexpression on the inferior pole of the spleen of splenectomized rats submitted to hyperbaric oxygenation (HBO). METHODS: Were analyzed fragments of the inferior pole of the spleen of 20 male Wistar rats submitted to splenectomy with preservation of the inferior pole. The rats were divided in two groups: group A (n=10) without HBO and group B (n=10) submitted to HBO at 2, 5 atmospheres per 120 minutes, twice a day for three days and once a day for seven days. The groups were then subdivided in four subgroups: A15 (n=5), with euthanasia on the 15th day; A45 (n=5), with euthanasia on the 45th day; B15 (n=5) with euthanasia on the 15th day and B45 with euthanasia on the 45th day. Respectively on these days, fragments of the inferior pole of the spleen of all animals were collected and analyzed with the immunohistochemistry technique in order to evaluate PCNA expression. RESULTS: There was an expressive increase in PCNA immunoreactivity in the group B. The 45 day postoperative period resulted in a higher level of positivity than the 15 day postoperative period (p<0.01). CONCLUSION: The quantitative analysis of proliferating cell nuclear antigen positive suggests that hyperbaric oxygenation increases cellular proliferation, contributing to splenic regeneration.

Decompressive fasciotomy in testicular torsion of the spermatic cord in rats

PURPOSE: To evaluate the effect of decompression fasciotomy on testes undergoing torsion of the spermatic cord. METHODS: Spermatic cord torsion was induced in 40 Wistar testes for six and 12 hours. At the time of distortion, decompression fasciotomy was performed on half of the animals. After 42 days, the testicles were examined both macroscopically and microscopically. A non-parametric Mann- Whitney U- test was used for statistical analysis. The results were considered significant at p≤0.05. RESULTS: Testicular weight; volume and degree of histological alterations were evaluated. When the groups without and with fasciotomy were compared, a 12-hour torsion subgroup in the fasciotomy group was noted to present larger volume, heavier weight and superior histological classification when compared with the 12-hour subgroup in the without fasciotomy group. No differences between the two groups after six hours of torsion were found. No significant changes were noticed in the contralateral testis. CONCLUSIONS: Testicular fasciotomy (decompression) benefited the macroscopic and histological aspects of the testicles undergoing cord torsion for a 12-hour period. These results demonstrate the role played by compartment syndrome in the pathophysiology of spermatic cord torsion and the need for decompression.

A study of interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α) serum levels in rats subjected to fecal peritonitis and treated with intraperitoneal ropivacaine / Avaliação dos níveis séricos de interleucina 6 (IL-6) e fator de necrose tumoral (TNF-α) em ratos submetidos a peritonite fecal e tratado com ropivacaína intraperitoneal

PURPOSE: The objective of this study was to assess the cytokine serum levels of IL-6 and TNF-α in rats subjected to fecal peritonitis and treated with peritoneal lavage with 0.2% ropivacaine by peritoneal lavage. METHODS: We subjected 16 Wistar rats to laparotomy 6 hours after the induction of fecal peritonitis with autogenous stool and subsequently divided the rats randomly into 4 groups: I-control, no treatment; II- drying of the abdominal cavity; III- lavage of the abdominal cavity with 3 mL of 0.9% normal saline and drying; IV- lavage of the abdominal cavity with 3 mL of 0.2% ropivacaine and drying. Six hours following the laparotomy, the animals underwent cardiac puncture, and 1 mL of blood was collected for cytokine assessment before the animals were euthanized. RESULTS: The lavage with ropivacaine resulted in smaller TNF-α levels compared with those observed in the other treatment groups (p <0.05). Regarding IL-6, the ropivacaine group showed lower cytokine levels than those observed in groups I and II, but there was no significant difference (p> 0.05) between groups III and IV. CONCLUSION: Peritoneal lavage with 0.2% ropivacaine was shown to reduce plasma levels of IL-6 and TNF-α in the treatment of fecal peritonitis in rats.

OBJETIVO: O objetivo do presente estudo foi avaliar as dosagens séricas das citocinas Il-6 e TNF-α em ratos submetidos à peritonite fecal e tratados com lavagem peritoneal com ropivacaína a 0,2%. MÉTODOS: Utilizaram-se 16 ratos Wistar, submetidos à laparotomia 6 horas após a indução de peritonite fecal com fezes autógenas, distribuídos aleatoriamente em 4 grupos: I- Controle, nenhum tratamento; II- Enxugamento da cavidade abdominal; III- Lavagem da cavidade abdominal com 3 ml de solução salina 0,9% e enxugamento; IV- Lavagem da cavidade abdominal com 3 ml de ropivacaína a 0,2% e enxugamento. Seis horas após a laparotomia os animais foram submetidos à punção cardíaca com retirada de 1 mL de sangue para a dosagem das citocinas e, a seguir, eutanasiados. RESULTADOS: A lavagem com ropivacaína apresentou valores de TNF-α menores do que os observados com os outros tratamentos (p<0,05). Em relação aos valores da IL-6, o grupo da ropivacaína apresentou valores menores do que os observados com os grupos I e II, mas não houve diferença estatística (p>0,05) em relação ao grupo III. CONCLUSÃO: A lavagem peritoneal com ropivacaína a 0,2% no tratamento da peritonite fecal em ratos demonstrou reduzir os níveis plasmáticos de IL-6 e do TNF-α.

Atendimento pré-hospitalar à múltiplas vítimas com trauma simulado / Prehospital care to trauma victmis with multiple simulated

OBJETIVO: Analisar a qualidade do atendimento pré-hospitalar realizado pelas agências em Vitória-ES. MÉTODOS: Estudo retrospectivo realizado nos arquivos da Liga Acadêmica de Cirurgia e Atendimento ao Trauma do Espírito Santo (Lacates) dos dados de 40 vítimas de um acidente simulado entre um ônibus e dois automóveis. Os pacientes foram assistidos por quatro equipes: Corpo de Bombeiro Militar do Espírito Santo, Samu 192, Guarda Municipal e Defesa Civil. A atuação dessas equipes foi avaliada pela Lacates, através da análise do check-list com orientações pré-estabelecidas para cada vítima. RESULTADO: O Corpo de Bombeiros Militar do Espírito Santo (CBMES), que desencarcerou as vítimas, delimitou as zonas de perigo e realizou a triagem pelo método START atuou corretamente em 92,5% dos casos. O Samu 192 que atendeu as vítimas pelo método mnemônico (ABCDE) no posto médico avançado agiu corretamente em 92,5% dos casos, no quesito Via Aérea; 97,5%, no Respiração; 92,5%, no Circulação; 90%, no Avaliação Neurológica; e 50%, no Exposição e Controle do Ambiente. A análise conjunta do ABCDE mostrou que o atendimento foi correto em 42,5% dos casos. O transporte dos pacientes foi realizado corretamente em 95% dos casos. A Guarda Municipal garantiu a perviedade das avenidas para transporte dos pacientes, e a Defesa Civil coordenou eficazmente o trabalho das equipes envolvidas no posto de comando. CONCLUSÃO: A triagem e o transporte foram executados satisfatoriamente, entretanto, maior atenção deve ser dada à exposição e proteção contra hipotermia das vítimas, já que esse item comprometeu o tratamento.

OBJECTIVE: To assess the quality of prehospital care agencies conducted in Vitória, capital of Espírito Santo State, Brazil. METHODS: We conducted a retrospective study in the archives of the League of Academic Surgery and Trauma Care of Espírito Santo (Lacates) regarding 40 victims of a simulated crash between a bus and two cars. The patients were treated by four teams: Military Fire Department of Espírito Santo, Samu 192, County Guard and Civil Defense. The performance of these teams was evaluated by Lacates, through analysis of a check-list with pre-established guidelines for each victim. RESULT: The Fire Department of Espírito Santo (CBMES), which extricated victims, outlined the danger zones and carried out the screening by the method START, acted correctly in 92.5% of cases. The Samu 192 victims, which attended victims by the mnemonic method (ABCDE) in medical outposts, acted correctly in 92.5% of cases in the category Airway; 97.5% in breathing, 92.5% in circulation, 90% in Neurological Assessment, and 50% in the Exhibition and Environmental Control. The analysis showed that the ABCDE care was correct in 42.5% of cases. The transport of patients was performed correctly in 95% of cases. The County Guard secured the patency of the avenues for transportation of patients and Civil Defense successfully coordinated the work of teams involved in the command post. CONCLUSION: The triage and transport of victims have been performed satisfactorily. However, more attention should be given to exposure and hypothermia protection of victims, since this item compromised treatment.

Histological features of peritoneal lavage with ropivacaine in rats with fecal peritonitis / Características histológicas da lavagem peritoneal com ropivacaína em ratos com peritonite fecal

PURPOSE: To evaluate the histological features in lungs, peritoneum and liver of rats subjected to fecal peritonitis and treated with peritoneal lavage with 0.2 percent ropivacaine. METHODS: Twenty Wistar rats were subjected to laparotomy 6 h after the fecal peritonitis induction with autogenous stool. Rats were randomly distributed into 4 groups: I - (n=5) Control, no treatment; II - (n=5) Drying of the abdominal cavity; III - (n=5) Abdominal cavity lavage with 3 ml 0.9 percent saline solution and drying; and IV - (n=5) Abdominal cavity lavage with 3 ml 0.2 percent ropivacaine and drying. The animals that died underwent necropsy, and the surviving ones were subjected to euthanasia on the 11th day post-surgery. Fragments of liver, lungs and peritoneum were removed for histological evaluation. RESULTS: The animals that received peritoneal lavage (groups III and IV) showed greater survival than the drying and control groups. Lavage with ropivacaine prevented death during the observed period. Peritoneal lavage with ropivacaine maintained the architecture of the lung, peritoneum and liver without any important histological alterations. The histopathological findings analyzed correlated with greater survival of group IV. CONCLUSION: Treatment of fecal peritonitis in rats with peritoneal lavage using 0.2 percent ropivacaine demonstrated a reduction in histopathological alterations related to inflammatory response and sepsis.

OBJETIVO: Avaliar os aspectos histopatológicos em pulmões, peritônios e fígados de ratos submetidos à peritonite fecal e tratados com lavagem peritoneal com ropivacaína a 0,2 por cento. MÉTODOS: Utilizou-se 20 ratos Wistar, submetidos à laparotomia 6 horas após a indução de peritonite fecal com fezes autógenas, distribuídos aleatoriamente em quatro grupos: I- (n=5) Controle, nenhum tratamento; II- (n=5) Enxugamento da cavidade abdominal; III- (n=5) Lavagem da cavidade abdominal com 3 ml de solução salina 0,9 por cento e enxugamento ; IV- (n=5) Lavagem da cavidade abdominal com 3 ml de ropivacaína a 0,2 por cento e enxugamento. Os animais que morreram foram necropsiados e os sobreviventes foram eutanasiados no 11º dia do pós-operatório. Retirou-se fragmentos do fígado, pulmões e do peritônio dos animais para estudo histopatológico. RESULTADOS: Os animais que receberam lavagem peritoneal (grupos III e IV) apresentaram maior sobrevida que os grupos enxugamento e controle. A lavagem com ropivacaína impediu o óbito no período avaliado. A lavagem peritoneal com ropivacaína manteve a arquitetura do pulmão, peritônio e fígado sem alterações histológicas importantes. Os achados histopatológicos analisados foram condizentes com o maior tempo de sobrevida no grupo IV. CONCLUSÃO: A lavagem peritoneal com ropivacaína a 0,2 por cento no tratamento da peritonite fecal em ratos demonstrou reduzir as alterações histopatológicas relacionados à resposta inflamatória e sepse.

A new proposal to evaluate the healing of open skin wounds: volumetry / Nova proposta para avaliar cicatrização de ferida cutânea aberta: volumetria

PURPOSE: To present a new proposal to evaluate the healing of an open subcutaneous and skin wound, which we termed "volumetry". METHODS: A total of 32 circular wounds were performed in the subcutaneous tissues and skin of four feet of pigs (8 each). Each wound had about 1 cm in diameter and was 0.2 cm deep. Volume was calculated from the wound filled with saline and mass Xantopren. With the aid of a magnifying glass and local lighting, the liquid was dripped with a micropipette inside the wound until complete fullness. Volume repletion was calculated in microliters, corresponding to the volume of the wound. The mass of Xantopren was placed inside the wound to obtain a mold of the lesion. Mold volume was calculated using the formula of the volume of a cylinder closest resembling a geometric figure with mold. RESULTS: The calculation of wound volume was possible with both Xantopren and mold techniques. Volume as calculated by micropipette was 119.37 ± 30.87 microliters while the volume calculated by mold was 122.41 ± 33.90 mm3 (p=0.79). CONCLUSIONS: Volumetry in pig feet is simple and reproducible. Volumetry perfomed with saline did not differ from the volumetry with mass Xantopren. This method may be a useful tool to help evaluate the healing of open skin wounds in experimental and clinical research.

OBJETIVO: Apresentar nova proposta para avaliar a cicatrização de uma ferida cutânea aberta, denominada "volumetria." MÉTODOS: Foram provocadas 32 feridas circulares cutâneas, com cerca de 1 cm de diâmetro e 0.2 cm de profundidade, em quatro patas de suíno. O volume da ferida foi calculado com solução salina e massa de xantopren. O líquido foi gotejado com uma micropipeta no interior da ferida até sua completa repleção, o que foi auxiliado com uma lupa de aumento e iluminação local. O volume de repleção foi calculado em microlitros e correspondeu ao volume da ferida. A massa de xantopren foi colocada no interior da ferida para se obter um molde da lesão. O volume do molde foi calculado utilizando-se a fórmula do volume de um cilindro que foi a figura geométrica mais parecida com o molde. RESULTADOS: O cálculo do volume da ferida foi possível com as duas técnicas propostas. O volume calculado pela micropipeta foi 119.37 ± 30.8693 microlitros e o volume calculado pelo molde foi 122.4088 ± 33.8997 mm³ (p=0.79). CONCLUSÕES: A volumetria realizada em patas de suíno é um método simples, reprodutível. A volumetria realizada com líquido não diferiu da volumetria realizada com massa de Xantopren. Esse método poderá ser útil para auxiliar na análise da cicatrização da ferida cutânea aberta em trabalhos clínicos e experimentais.

Efeito da oxigenoterapia hiperbárica em ratos submetidos à esplenectomia subtotal com preservação do polo inferior / Effect of hyperbaric oxygen therapy in rats with subtotal splenectomy preserving the inferior pole

PURPOSE: To evaluate the effect of hyperbaric oxygen therapy on the survival and weight of rats submitted to subtotal splenectomy and on the viability and growth of the inferior pole. METHODS: Forty Wistar rats underwent subtotal splenectomy with preservation of the inferior pole and distributed into two groups: Group A (n=20) - not treated with hyperbaric oxygen, Group B (n=20) - treated with hyperbaric oxygen. These groups were divided into two subgroups of 10 animals each, according to the time of euthanasia, 15th and 45th days. The survival and weight of the animals were recorded. The inferior pole was measured, weighed and morphologically analyzed. RESULTS: All animals survived. The weight of the animals increased in all subgroups, but decreased on the 10th day in the subgroups treated with hyperbaric oxygen (p<0.001). The viability of the inferior pole was more evident in animals treated on the 15th day, but did not differ on the 45th day. The growth of the inferior pole has not occurred on the 15th day but on the 45th day after surgery in untreated animals (p<0.01) and treated animals (p<0.05). Vascular and cellular increase in treated animals was significantly higher than in untreated ones. CONCLUSION: Hyperbaric oxygen therapy did not affect the survival of animals but reduced their weight. It improved the viability of the inferior splenic pole, but did not interfere with their growth.

OBJETIVO: Avaliar o efeito da oxigenoterapia hiperbárica na sobrevida e peso de ratos submetidos à esplenectomia subtotal e na viabilidade e crescimento do polo inferior. MÉTODOS: Quarenta ratos Wistar foram submetidos à esplenectomia subtotal com preservação do polo inferior e distribuídos em dois grupos: A (n=20) v - não tratados com oxigênio hiperbárico, B (n=20) - tratados. Esses grupos foram divididos em dois subgrupos de 10 animais cada, de acordo com a época de eutanásia: 15º e 45º dias. A sobrevida e peso dos animais foram anotadas. O pólo inferior foi medido, pesado e analisado morfologicamente. RESULTADOS: Todos os animais sobreviveram. O peso aumentou em todos os subgrupos, porém diminuiu no 10º dia nos subgrupos tratados com oxigênio hiperbárico (p<0,001). A viabilidade do polo inferior foi mais evidente nos animais tratados no 15º dia, porém não diferiu no 45º dia. O crescimento do polo inferior não ocorreu no 15º e sim no 45º dia pós-operatório, nos animais não tratados (p<0,01) e tratados (p<0,05). O aumento celular e vascular nos animais tratados foi mais significativo do que nos animais não tratados. CONCLUSÃO: A oxigenoterapia hiperbárica não interferiu na sobrevida dos animais, porém diminuiu o peso. Melhorou a viabilidade do polo inferior do baço, mas não interferiu no seu crescimento.

Colecistectomia videolaparoscópica em 960 pacientes idosos / Laparoscopic cholecystectomy in 960 elderly patients

OBJETIVO: Analisar o tempo operatório, a permanência hospitalar, a taxa de conversão, a morbidade e a mortalidade de pacientes idosos submetidos à colecistectomia videolaparoscópica por doença da vesícula biliar. MÉTODOS: Estudo descritivo, retrospectivo, realizado no prontuário de 960 pacientes, de ambos os sexos, com idade entre 60 e 97 anos no período de janeiro de 1993 a agosto de 2009. RESULTADOS: O tempo operatório variou de nove a 180 minutos. O tempo de internação variou de 24 a 120 horas. A conversão ocorreu em 28 pacientes (2,92 por cento), dos quais 67,9 por cento eram mulheres e 28,6 por cento homens tendo sido em 11 casos (39,3 por cento) realizada minilaparotomia e em 17 (60,7 por cento) a via aberta convencional. As intercorrências no transoperatório foram duas rupturas da vesícula biliar, uma falha no pneumoperitônio e uma na clipagem do ducto cístico. No pós-operatório observaram-se cinco hérnias umbilicais incisionais. As complicações sistêmicas foram: nove arritmias cardíacas, uma icterícia pós-operatória, um infarto agudo do miocárdio e um infarto enteromesentérico. Mortalidade ocorreu em três pacientes (0,3 por cento), um por infarto agudo do miocárdio no transoperatório, uma sepse e um infarto enteromesentérico. CONCLUSÃO: Os pacientes idosos submetidos à colecistectomia videolaparoscópica apresentaram baixo tempo de internação hospitalar e baixa morbimortalidade. O tempo operatório e o de internação hospitalar foram curtos, demonstrando que a colecistectomia videolaparoscópica é procedimento seguro e eficaz nos idosos.

OBJECTIVE: to evaluate the operative time, hospital stay, conversion rate, morbidity and mortality in elderly patients undergoing laparoscopic cholecystectomy for gallbladder disease. METHODS: we conducted a descriptive, retrospective study with the chats of 960 patients, aged 60 and 97 years in the period from January 1993 to August 2009. RESULTS: operative time ranged from nine to 180 minutes. The length of stay ranged from 24 to 120 hours. Conversion occurred in 28 patients (2.92 percent), of whom 67.9 percent were women and 28.6 percent men, a minilaparotomy having been performed in 11 cases (39.3 percent) and in 17 (60.7 percent) the conventional open route. The perioperative complications were two ruptures of the gallbladder, one failure in the pneumoperitoneum and one in clipping the cystic duct. Postoperative complications were five umbilical incisional hernias. Systemic complications were: nine arrhythmias, one postoperative jaundice, one acute myocardial infarction and one mesenteric infarction. Mortality occurred in three patients (0.3 percent), one due to perioperative myocardial infarction, one due to sepsis and one because of mesenteric infarction. CONCLUSION: elderly patients undergoing laparoscopic cholecystectomy had low hospital stay and low morbimortality. The operative time and hospital stay were short, demonstrating that laparoscopic cholecystectomy is safe and effective in the elderly.

Subtotal laparoscopic splenectomy in rats with preservation of the inferior pole / Esplenectomia subtotal laparoscópica com preservação do polo inferior em ratos

Purpose: To evaluate the feasibility and safety of subtotal splenectomy by laparoscopy with inferior pole preservation and to determine the viability of the splenic remnant. Methods: Twenty male Wistar rats weighing between 365 g and 474 g (mean 417.92 ± 36.15g SD) were operated and randomly assigned to two groups : Group 1 rats were killed on postoperative day 10 (n = 10), and Group 2 on the postoperative day 80 (n = 10). Both the inferior splenic pole and the superior part of the spleen, which was used as a control to measure inferior pole viability, were weighed and morphologically examined. Results: The technique was feasible in all cases. There were two postoperative deaths on immediate postoperative and one not well defined. The average weight percentage of the inferior pole, measured indirectly on the 10th day, was 53.67 percent ± 11.59 percent and on the 80th day was 62.69 percent ± 6.89 percent. The inferior pole was necrotic, with abscess formation in one case (5.9 percent) and appeared normal in all other cases. Microscopy showed features that were compatible with normality. Conclusions: Subtotal splenectomy with preservation of the inferior pole by laparoscopy was feasible and safety. The lower splenic pole was viable in 94.1 percent of animals.

Objetivo: Avaliar a exequibilidade e a segurança da esplenectomia subtotal com preservação do polo inferior do baço por videolaparoscopia, e a viabilidade do referido polo. Métodos: 20 ratos Wistar, machos, pesando entre 365g e 474g (MA 417,92 ± 36,15g) foram operados e distribuídos em dois grupos de acordo com a época da retirada do polo inferior para estudo: grupo 1 do 10º dia, (n= 10), grupo 2, do 80º dia (n=10). A porção superior do baço que serviu de controle da viabilidade do pólo inferior e esse remanescente, retirados no término do experimento, foram medidos, pesados e enviados para exame morfológico. Resultados: A técnica foi exeqüível em todos os casos. O peso médio percentual do polo inferior avaliado de forma indireta no 10º dia foi 53,67 por cento ± 11,59 por cento, e no 80º dia 62,69 por cento ± 6,89 por cento. Houve dois óbitos após a cirurgia, provavelmente por mal condução da anestesia e/ou do pneumoperitônio, e um tardiamente por causa desconhecida. O exame macro e microscópico do polo inferior nos 17 animais sobreviventes e no que faleceu tardiamente mostrou necrose em um caso (5,9 por cento). Conclusões: A esplenectomia subtotal com preservação do pólo inferior por videolaparoscopia em ratos foi exequível e segura. O polo inferior do baço mostrou-se viável em 94,1 por cento dos animais.

Aspectos morfológicos e funcionais dos autoimplantes esplênicos em ratos tratados com oxigenio hiperbárico / Splenic autoimplant and hyperbaric oxygen therapy in rats

OBJETIVO: Estudar aspectos morfológicos e funcionais dos autoimplantes esplênicos de ratos submetidos ou não à oxigenioterapia hiperbárica (OHB). MÉTODOS: Foram estudados em dois períodos distintos 105 ratos Wistar. No período mediato (n= 56) os animais foram avaliados até o 11º dia de pós-operatório, e no período tardio (n= 49), até o 70º dia. Em cada período os ratos foram distribuídos nos grupos: A- Simulação, B- Autoimplante esplênico, tratados com oxigênio hiperbárico ou não. Nos animais do Grupo A realizou-se apenas manipulação do baço. Nos animais do Grupo B realizou-se esplenectomia total e a seguir quatro fragmentos do baço foram implantados no grande omento. Em todos os animais foram dosados os lípides e imunoglobulinas e contadas as plaquetas e os corpúsculos de Howell-Jolly no pré-operatório e no 11º ou 70º dia de pós-operatório. O baço dos animais do Grupo A e os autoimplantes dos animais do Grupo B foram retirados e enviados para avaliação morfológica. RESULTADOS: No grupo B11nt houve aumento do colesterol total, LDL-colesterol, VLDL-colesterol e triglicérides. No grupo B70nt houve aumento do colesterol total e LDL-colesterol. Nos grupos tratados não houve alterações lipídicas. A IgM caiu nos grupos B e não alterou nos grupos A. Os corpúsculos de Howell - Jolly foram menos freqüentes nos grupos Bt que nos grupos Bnt. As plaquetas aumentaram nos grupos B11t e B11nt e não se alteraram nos demais grupos. A viabilidade microscópica dos grupos Bt foi melhor que a dos grupos Bnt. CONCLUSÃO: Os autoimplantes esplênicos dos animais tratados com OHB apresentaram melhor função e viabilidade do que os autoimplantes dos animais não tratados.

OBJECTIVE: To study the functional and morphological features of splenic autoimplants in rats subjected, or not, to postoperative hyperbaric oxygen therapy. METHODS: One hundred and five male Wistar rats, weighing 251.6 g ± 29.5 g, were studied ot early (11th day) and late (70th day ) postoperative periods. For each period the animals were distributed in the following groups: A (n=40), splenic manipulation; B (n=65),splenic autoimplants, not treated (nt) (A11nt- n=10, B11nt- n=21, A70nt- n= 10, B70nt-n= 18) and treated with hyperbaric oxygen (t) ( A11t- n= 10, B11t- n=15, A70t - n=10, B70t- n=11). Blood was collected for measurement of lipids and immunoglobulins , platelet and Howell-Jolly body count before and after surgery. The spleen and autoimplants were removed for histologic analyses. RESULTS: There was an increase of total cholesterol (p=0.00068), LDL-cholesterol (p=0.002), VLDL-cholesterol and triglycerides (p=0.0033) in B11nt group. There was an increase of total cholesterol (p= 0.0007) and LDL-cholesterol (p=0.0000) in B70nt group, and no alterations were observed in the other groups. IgM decreased in B groups (p=0.0000) and no changes were observed in the splenic manipulation group. Number of Howell-Jolly bodies were lesser in Bt groups than in Bnt groups( p=0.03). Platelets were increased in B11t and B11nt groups (p=0.0000) and remained unchanged in the other groups. Autoimplants microscopic viability was better in Bt groups than in Bnt. CONCLUSION: The splenic autoimplants of rats treated with hyperbaric oxygen therapy showed a better functionality and viability than those subjected to other procedures.

Venous drainage from the tail of the pancreas to the lienal vein and its relationship with the distal splenorenal shunt selectivity / Drenagem venosa da cauda do pâncreas para a veia lienal e sua relação com a seletividade da anastomose esplenorrenal

PURPOSE: To identify the veins draining from the pancreatic tail to the lienal vein and its possible relationship with the loss of the distal splenorenal shunt selectivity. METHODS: Thirty eight human blocks including stomach, duodenum, spleen, colon and pancreas, removed from fresh corpses, were studied with the replenish and corrosion technique, using vinilic resin and posterior corrosion of the organic tissue with commercial hydrochloric acid, in order to study the lienal vein and its tributaries. RESULTS: The number of veins flowing directly to the splenic vein varied from seven to twenty two (14.52 ± 3.53). Pancreatic branches of the pancreatic tail flowing to the segmentary veins of the spleen were found in 25 of the anatomical pieces studied (65.79 percent). These branches varied from one to four, predominating one branch (60 percent) and two branches (24 percent). CONCLUSIONS: In 65.79 percent of the anatomical pieces studied, the veins of the pancreatic tail flowed in segmentary branches of the splenic vein. These branches could be responsible for the loss of distal splenorenal shunt selectivity. The complete disconnection of the pancreatic tail could increase the selectivity in this procedure.

OBJETIVO: Identificar as veias da cauda do pâncreas afluentes da veia lienal e a possível relação destes ramos com a perda de seletividade da derivação esplenorrenal distal. MÉTODOS: Foram estudadas 38 peças humanas, retiradas de cadáveres, contendo estômago, duodeno, baço, cólon e pâncreas, utilizando-se a técnica de repleção vascular com resina vinílica e posterior corrosão do tecido orgânico com o objetivo de se estudar o molde vascular da veia lienal e seus afluentes. RESULTADOS: O número de veias afluindo diretamente para a veia esplênica variou de sete a vinte dois (MA 14.52±3.53). Ramos pancreáticos da cauda do pâncreas afluindo para as veias segmentares do baço estavam presentes em 25 das peças estudadas (65,79 por cento). Estes ramos variaram de um a quatro, predominando um ramo (60 por cento) e dois ramos (24 por cento). CONCLUSÕES: Em 65,79 por cento das peças veias da cauda do pâncreas desembocavam em ramos segmentares da veia esplênica. Estes ramos poderiam ser responsáveis pela perda de seletividade da derivação esplenorrenal distal e a esqueletização completa da cauda do pâncreas poderia aumentar a seletividade neste procedimento.

Epidural anesthesia using a 0,75 percent ropivacaine and subarachnoid anesthesia with a 0,5 percent bupivacaine associated or not with clonidine in hemorroidectomies / Anestesia peridural com ropivacaína a 0,75 por cento e anestesia subaracnóidea com bupivacaína a 0,5 por cento associadas ou não à clonidina em hemorroidectomias

PURPOSE: To study the safety and efficiency of two anesthetic blockages in hemorroidectomy and the effect of clonidine on analgesia. METHODS: 80 patients were studied, randomly divided into four groups: l (n=19)- peridural with a 0,75 percent ropivacaine; 2 (n=21)-peridural with a 0,75 percent ropivacaine and 150 µg of clonidine; 3 (n=19)- subarachnoid with a 0,5 percent bupivacaine; 4 (n=21)- subarachnoid with a 0,5 percent bupivacaine and 50 µg of clonidine. The intensity of pain was evaluated by the visual analogical scale 8, 12 and 24 hours after surgery. The use of vasoconstrictors on the transoperatory and the amount of analgesics within the 24 hours were registered. RESULTS: The intensity of pain, 8 hours after surgery, was lesser on group 4, and much lesser on group 4 comparing with groups 1 and 2, 12 hours (p=0,022; p=0,001) and 24 hours (p=0,03; p=0,003). The frequency of vasoconstrictors usage on the transoperatory and the analgesics on the post-operatory showed no difference among the groups. There were no anesthetic complications. CONCLUSIONS: The subarachnoid anesthesia with a 0,5 percent bupivacaine with clonidine, showed better analgesia comparing with the peridural anesthesia with a 0,75 percent ropivacaine with or without clonidine, however all were safe and efficient. The clonidine aided on the decreasing of pain when subarachnoid anesthesia was used.

OBJETIVO: Verificar a segurança e a eficácia de dois bloqueios anestésicos na hemorroidectomia e o efeito da clonidina na analgesia. MÉTODOS: Foram estudados oitenta pacientes, distribuídos aleatoriamente em quatro grupos: 1 (n=19)- peridural com ropivacaína a 0,75 por cento; 2 (n=21)-peridural com ropivacaína a 0,75 por cento e 150 µg de clonidina; 3 (n=19)-subaranóidea com bupivacaína a 0,5 por cento; 4 (n=21)- subaracnóidea com bupivacaína a 0,5 por cento e 50 µg de clonidina. A intensidade da dor foi avaliada pela escala analógica visual 8, 12 e 24 horas após a cirurgia. O uso de vasoconstritores no transoperatório, o consumo de analgésicos em 24 horas foram anotados. RESULTADOS: A intensidade da dor, 8 horas após a cirurgia, foi menor no grupo 4, e significantemente menor no grupo 4 em relação aos grupos 1 e 2, 12 horas (p=0,022; p=0,001) e 24 horas (p=0,03; p=0,003). A freqüência do uso de vasoconstritores no transoperatório e de analgésicos no pós-operatório não diferiu entre os grupos. Não houve complicações anestésicas. CONCLUSÕES: A anestesia subaracnóidea com bupivacaína a 0,5 por cento, com clonidina, apresentou melhor analgesia que a anestesia peridural com ropivacaína a 0,75 por cento com ou sem clonidina, porém todas foram seguras e eficazes. A clonidina contribuiu para diminuir a dor na anestesia subracnóidea.