McKittrick-Wheelock syndrome secondary to rectal adenocarcinoma

Introduction: McKittrick-Wheelock syndrome is a rare condition that arises from a hypersecretory state secondary to large colorectal tumors, mainly villous adenomas, leading to an electrolytic disorder associated with chronic diarrhea that usually persists for years. It is a relatively unknown disease that can lead to severe complications such as acute kidney injury, severe hyponatremia, and hypokalemia. In fact, it causes death in most untreated cases. Surgical removal of the tumor is the most successful treatment, and symptoms tend to disappear after proper management. Case Report: A 62-year-old man with a 2-year history of mucoid diarrhea preceded by abdominal pain presented with acute kidney injury, hyponatremia, and hypokalemia. A digital rectal examination and sigmoidoscopy were performed, and revealed a large laterally-spreading tumor in the rectum. Further investigation showed a rectal tubulovillous adenoma with secondary McKittrick-Wheelock syndrome. An anterior resection of the rectum with a colonic J-pouch and a diverting ileostomy were performed, and the patient improved with the resolution of the renal failure and electrolyte disturbances. The histopathological analysis revealed an invasive rectal adenocarcinoma. Discussion: McKittrick-Wheelock syndrome is a condition with a low incidence that needs early intervention and proper diagnosis. It is of extreme importance that this disease is included in the differential diagnoses for chronic diarrhea associated with an electrolytic disorder. (AU)

Does CO2 pneumoperitoneum in laparoscopy interfere with collagen deposition in abdominal surgical wounds?

Abstract Purpose To determine by histomorphometric analysis whether CO2 pneumoperitoneum interferes with collagen deposition in surgical wounds in the aponeurosis of rats. Methods This experiment involved 80 male Wistar rats, randomly allocated into four groups according to pneumoperitoneum period (PRE: 30 min preoperatively; POST: 30 min postoperatively; PP: 30 min pre- and postoperatively; C: control group). CO2 pneumoperitoneum was insufflated to 5 mmHg of pressure. A laparotomy was performed; 1 cm of the left colon was then resected, and an end-to-end anastomosis was performed to simulate surgical trauma, after which the abdominal wall was closed. On postoperative days 7 or 14, a sample of the abdominal wall was collected, stained with picrosirius red and observed under polarized light in an optical microscope. The amount of collagen was estimated by computerized histomorphometric analysis. Results There were no significant differences in collagen deposition between the control and experimental groups on postoperative days 7 (p=0.720) or 14 (p=0.933). The amount of collagen increased as expected in all groups between postoperative days 7 and 14 (p=0.0003). Conclusion At 5 mmHg, CO2 pneumoperitoneum does not interfere with collagen deposition in abdominal wall surgical wounds in rats.

Improving reproducibility and external validity. The role of standardization and data reporting of laboratory rat husbandry and housing

Abstract Purpose: To identify the most relevant flaws in standardization in husbandry practices and lack of transparency to report them. This review proposes some measures in order to improve transparency, reproducibility and eventually external validity in experimental surgery experiments with rat model. Methods: We performed a search of scientific articles in PUBMED data base. The survey was conducted from august 2016 to January 2017. The keywords used were "reproducibility", "external validity", "rat model", "rat husbandry", "rat housing", and the time frame was up to January 2017. Articles discarded were the ones which the abstract or the key words did not imply that the authors would discuss any relationship of husbandry and housing with the reproducibility and transparency of reporting animal experiment. Reviews and papers that discussed specifically reproducibility and data reporting transparency were laboriously explored, including references for other articles that could fulfil the inclusion criteria. A total of 246 articles were initially found but only 44 were selected. Results: Lack of transparency is the rule and not the exception when reporting results with rat model. This results in poor reproducibility and low external validity with the consequence of considerable loss of time and financial resources. There are still much to be done to improve compliance and adherence of researchers, editors and reviewers to adopt guidelines to mitigate some of the challenges that can impair reproducibility and external validity. Conclusions: Authors and reviewers should avoid pitfalls of absent, insufficient or inaccurate description of relevant information the rat model used. This information should be correctly published or reported on another source easily available for readers. Environmental conditions are well known by laboratory animal personnel and are well controlled in housing facilities, but usually neglected in experimental laboratories when the rat model is a novelty for the researcher.

Effect of Hevea brasiliensis latex sap gel on healing of acute skin wounds induced on the back of rats / Efeito do gel da seiva do látex da Hevea brasiliensis na cicatrização de lesões cutâneas agudas induzidas no dorso de ratos

Objective : to evaluate the effect of topical delivery of latex cream-gel in acute cutaneous wounds induced on the back of rats. Methods : we subjected sixteen rats to dermo-epidermal excision of a round dorsal skin flap, with 2.5cm diameter. We divided the animals into two groups: Latex Group: application of cream-gel-based latex throughout the wound bed on postoperative days zero, three, six and nine; Control group: no treatment on the wound. Photographs of the lesions were taken on the procedure day and on the 6th and 14th postoperative days, for analyzing the area and the larger diameter of the wound. We carried out euthanasia of all animals on the 14th postoperative day, when we resected he dorsal skin and the underlying muscle layer supporting the wound for histopathological study. Results : there was no statistically significant difference in the percentage of wound closure, in the histopathological findings or in the reduction of the area and of the largest diameter of the wounds among the groups studied on the 14th postoperative day. Conclusion : according to the experimental conditions in which the study was conducted, latex cream-gel did not interfere in the healing of acute cutaneous wounds in rats.

Objetivo : avaliar o efeito da administração tópica do gel-creme de látex em feridas cutâneas agudas induzidas no dorso de ratos. Métodos : dezesseis ratos foram submetidos à excisão dermoepidérmica de retalho cutâneo dorsal, circular com 2,5cm de diâmetro. Os animais foram distribuídos em dois grupos, um experimental e outro controle: Grupo Látex- aplicação em todo o leito da ferida do látex em base gel-creme no período zero, no terceiro, no sexto e no nono dias pós-operatórios; Grupo Controle- sem nenhum tratamento sobre a ferida. Foram feitas fotografias das lesões no dia da operação, no sexto e no 14º dia pós-operatório, para análise de área e do maior diâmetro da ferida. Realizou-se a eutanásia de todos os animais no 14º dia pós-operatório. Ressecou-se a pele dorsal e o plano muscular subjacente contendo a ferida para estudo histopatológico. Resultados : não houve diferença estatisticamente significante no percentual de fechamento, nos achados histopatológicos ou na redução da área e do maior diâmetro das feridas, entre os grupos estudados no 14º dia pós-operatório. Conclusão : nas condições experimentais em que o estudo foi realizado, o gel-creme de látex não interferiu na cicatrização de feridas cutâneas agudas em ratos.

Effects of metoclopramide on the expression of metalloproteinases and interleukins in left colonic anastomoses. An experimental study

PURPOSE : To evaluate the effects of metoclopramide on metalloproteinases (MMP) and interleukins (IL) gene expression in colonic anastomoses in rats. METHODS : Eighty rats were divided into two groups for euthanasia on the 3rd or 7th postoperative day (POD), then into two subgroups for sepsis induction or not, and then into subgroups to receive either metoclopramide or saline solution. Left colonic anastomosis were performed and then analyzed. RESULTS : On the 3rd POD, metoclopramide was associated with increased expression of MMP-1a, MMP-13, and TNF-α. On the 7th POD, the transcripts of all MMPs, TNF-α, IL-1β, IFN-γ, and IL-10 of the treated animals became negatively modulated. In the presence of sepsis, metoclopramide did not change MMPs and decreased IL-6, IL-1β, IFN-γ and IL-10 gene expression on the 3rd POD. On the 7th POD, increased expression of all MMPs, IFN-γ and IL-10 and negative modulated TNF-α and IL-6 gene expression. CONCLUSION : Administration of metoclopramide increased metalloproteinases and interleukins gene expression on the 3rd postoperative day and negatively modulated them on the 7th POD. In the presence of abdominal sepsis, metoclopramide did not change MMPs and decreased ILs gene expression on the 3rd POD. On the 7th POD, the drug increased expression of all MMPs.

Effect of glutamine supplementation on left colon healing in rats with extrahepatic biliary obstruction

PURPOSE: To evaluate the influence of glutamine and obstructive jaundice on left colon healing in rats. METHODS: Sixteen male rats were allocated across four groups: LG - Common bile duct ligation followed by colotomy and bowel suture on postoperative day 7. Supplementation with glutamine 2% from day 4 after duct ligation until euthanasia. L - Common bile duct ligation followed by colotomy and bowel suture on postoperative day 7. No glutamine supplementation. M - Common bile duct manipulation followed by colotomy and bowel suture on postoperative day 7. No glutamine supplementation. MG - Common bile duct manipulation followed by colotomy and bowel suture on postoperative day 7. Supplementation with glutamine 2% from day 4 after duct manipulation until euthanasia. On the day of euthanasia, bursting pressure of the sutured bowel segment was measured and samples were collected for histopathological analysis. RESULTS: There were no differences in bursting pressure among groups : LG vs. M (110 ± 28 vs. 173 ± 12; p = 0.08). Groups L and MG were not different from group M (156 ± 12 and 118 ± 22. Glutamine supplementation was associated with less edema, polymorphonuclear lymphocyte infiltration, bacterial colonies, and abscess formation, as well as with increased collagen formation. CONCLUSION: Obstructive jaundice had no negative effect and glutamine supplementation had no positive effect on colonic scar strength in rats. .

The effect of pelvic floor muscle training in urinary incontinent elderly women: a sistematic review / Efeito do treinamento dos músculos do assoalho pélvico na incontinência urinária de mulheres idosas: revisão sistemática

Introduction The International Continence Society (ICS) determines that the pelvic floor muscles training (PFMT) is the first-choice treatment of urinary symptoms in women. Objective The aim of this study was to systematize randomized controlled clinical trials that address the effects of PFMT in the treatment of urinary symptoms in older women using objective outcome measures. Method Systematic review search was performed eletronic the following databases: Medline, Pubmed, Lilacs, PEDro and manual research conducted in the references of the studies. Were considered eligible women aged over 60 years who performed PFMT in isolation, without the involvement of another technique. The PFMT performed in clinic or at home, with or without the supervision of a therapist and with or without the use of biofeedback as an adjunct. Considered as outcome measures urodynamic studies, voiding diary that assesses daytime urinary frequency, nocturnal urinary frequency, urinary incontinence and exchange absorbent, and, finally, the absorbent test that quantifies loss urinary grams. The assessment of methodological quality of the studies was conducted by PEDro scale. Results Three studies were reviewed in full. Only one trial was rated high methodological quality. There was significant improvement in urinary symptoms after treatment proposed in the three selected studies. Conclusion Considering the studies available so far are weak the evidence for the use of PFMT in the treatment of urinary symptoms in elderly women.

Introdução A Sociedade Internacional de Continência (SIC) determina que o treinamento dos músculos do assoalho pélvico (TMAP) seja considerado como primeira opção de tratamento dos sintomas urinários nas mulheres. Objetivo O objetivo deste estudo foi sistematizar ensaios clínicos randomizados e controlados que abordam os efeitos do TMAP no tratamento dos sintomas urinários em mulheres idosas utilizando medidas de desfecho objetivas. Método Revisão sistemática no qual foi feita uma busca eletrônica nas seguintes bases de dados: Medline, Pubmed, Lilacs, PEDro e pesquisa manual realizada nas referências bibliográficas dos estudos. Consideraram-se elegíveis mulheres idosas acima de 60 anos, que realizaram o TMAP de forma isolada, sem envolvimento de outra técnica. O TMAP realizado em ambulatório ou em domicílio, com ou sem a supervisão de um terapeuta e com ou sem o uso do biofeedback como adjuvante. Considerou-se como medidas de desfecho o estudo urodinâmico, o diário miccional que avalia a frequência urinária diurna, a frequência urinária noturna, perda urinária aos esforços e a troca de absorventes, e, por fim, o teste do absorvente que quantifica a perda urinária em gramas. A avaliação da qualidade metodológica dos estudos foi realizada pela escala PEDro. Resultados Três estudos foram revisados na íntegra. Apenas um artigo foi classificado como de alta qualidade metodológica. Houve melhora significativa dos sintomas miccionais após o tratamento proposto nos três estudos selecionados. Conclusão Considerando os estudos disponíveis até o momento são fracas as evidências favoráveis à utilização do TMAP no tratamento dos sintomas urinários de mulheres idosas.

Influence of patient age and colorectal polyp size on histopathology findings / Influência da idade do paciente e do tamanho dos pólipos colorretais nos achados histopatológicos

BACKGROUND: Colorectal cancer is a major cause of morbidity and mortality and can arise through the adenoma-carcinoma sequence. Colonoscopy is considered the method of choice for population-wide cancer screening. AIM: To assess the characteristics of endoscopically resected polyps in a consecutive series of patients who underwent colonoscopy at a university hospital and compare histopathology findings according to patient age and polyp size. METHODS: Retrospective, cross-sectional of 1950 colonoscopy reports from consecutively examined patients. The sample was restricted to reports that mentioned colorectal polyps. A chart review was carried out for collection of demographic data and histopathology results. Data were compared for polyps sized ≤0.5 cm and ≥0.6 cm and then for polyps sized ≤1.0 cm and ≥1.1 cm. Finally, all polyps resected from patients aged 49 years or younger were compared with those resected from patients aged 50 years or older. RESULTS: A total of 272 colorectal polyps were resected in 224 of the 1950 colonoscopies included in the sample (11.5%). Polyps >1 cm tended to be pedunculated (p=0.000) and were more likely to exhibit an adenomatous component (p=0.001), a villous component (p=0.000), and dysplasia (p=0.003). These findings held true when the size cutoff was set at 0.5 cm. Patients aged 50 years or older were more likely to have sessile polyps (p=0.023) and polyps located in the proximal colon (p=0.009). There were no significant differences between groups in histopathology or presence of dysplasia. CONCLUSION: Polyp size is associated with presence of adenomas, a villous component, and dysplasia, whereas patient age is more frequently associated with sessile polyps in the proximal colon. .

RACIONAL: O câncer colorretal é causa importante de morbimortalidade e pode desenvolver-se pela sequência adenoma-carcinoma. A videocolonoscopia é considerada método de escolha para rastreamento populacional para esta neoplasia. OBJETIVO: Avaliar as características de pólipos endoscopicamente ressecados em uma série consecutiva de pacientes submetidos à videocolonoscopia em um hospital universitário e comparar os achados histopatológicos de acordo com a idade do paciente e o tamanho dos pólipos. MÉTODO: Estudo retrospectivo transversal baseado na análise dos laudos de 1950 videocolonoscopias realizadas consecutivamente. Foram selecionados aqueles em que foram evidenciados pólipos no cólon ou reto. Procedeu-se a revisão dos prontuários para coleta de dados demográficos e da avaliação histopatológica dos espécimes. Foram comparados os achados relativos aos pólipos de até 0,5 cm com os acima de 0,6 cm. Posteriormente, foram comparados pólipos de até 1 cm com os acima de 1,1 cm. Em um terceiro momento foram realizadas comparações dos achados dos pólipos ressecados de pacientes com idade até 49 anos com aqueles retirados de pacientes acima de 50 anos. RESULTADOS: Foram ressecados pólipos colorretais em 224 dos 1950 exames avaliados (11,5%), com retirada total de 272 pólipos. Pólipos maiores de 1 cm tenderam a ser pediculados (p=0,000) e tiveram maior chance de apresentarem componente adenomatoso (p=0,001), componente viloso (p=0,000) e displasia (p=0,003). Os mesmos achados foram observados com ponto de corte de 0,5 cm. Pacientes com 50 anos ou mais apresentaram mais frequentemente pólipos sésseis (p=0,023) e localizados no cólon proximal (p=0,009). Não houve diferença significante entre os grupos em relação à histopatologia ...

Effect of vitamin K1 supplementation on left colon healing in rats with extrahepatic biliary obstruction

PURPOSE: To evaluate the effects of vitamin K1 on wound healing in the left colon of rats with experimental biliary obstruction. METHODS: Sixteen male rats, divided into four groups of four animals each (L, M, LK, and MK), underwent colostomy followed by bowel suture in the left colon. Seven days before, animals in the L and LK groups had undergone common bile duct ligation. The animals in groups MK and LK received vitamin K1 supplementation. On day 7 after bowel suture, repeat laparotomy was performed for evaluation of colonic healing by burst pressure measurement and collection of samples for histopathological analysis. Changes in body weight were evaluated in the four groups. RESULTS: Weight loss was lower in animals supplemented with vitamin K. No significant differences were observed in burst pressure among the four groups (p>0.05). Histological analysis showed more hemorrhage and congestion in the biliary obstruction groups. Supplemented animals exhibited increased collagen formation and less edema and abscess formation. CONCLUSION: Vitamin K supplementation attenuated weight loss and improved colonic wound healing in rats. .

Avaliação manométrica anorretal de mulheres adultas com diagnóstico clínico e urodinâmico de bexiga hiperativa / Anorectal manometry evaluation in adult women with clinical and urodynamic diagnostics of overactive bladder

RACIONAL: A manometria anorretal é método diagnóstico empregado na prática clínica para avaliação de distúrbios funcionais anorretais e do assoalho pélvico. As disfunções miccionais, anorretais e do assoalho pélvico tem sido consideradas como fatores contribuintes dos sintomas de bexiga hiperativa. OBJETIVO: Avaliar os resultados obtidos com manometria anorretal em mulheres adultas com diagnóstico clínico e urodinâmico de bexiga hiperativa. MÉTODOS: Vinte e cinco mulheres adultas (média de idade de 45.5±11.9 anos) com diagnóstico clínico e urodinâmico de bexiga hiperativa submeteram-se à manometria anorretal e os resultados obtidos nesta avaliação foram comparados aos de um grupo controle de 18 mulheres (média de idade de 33.9 ±10.7 anos) assintomáticas do ponto de vista urinário e sem critérios clínicos para diagnóstico de bexiga hiperativa. O grupo de mulheres com bexiga hiperativa foi denominado BH e controle C. RESULTADO: Ocorreram seis (24%) casos de contração paradoxal do puborretal no grupo BH e nenhuma no Grupo C. Houve 13 (52%) ocorrências de hipertonia de repouso isolada ou associada à hipertonia de contração no Grupo BH e sete (39%) no Grupo C. A média de pressão de repouso foi de 80.1 mmHg no Grupo BH e 67.6 mmHg no Grupo C. O total de ocorrência de hipertonia de contração no Grupo BH foi de 7(28%) e 11(61%) no Grupo C. A média de pressão de contração foi de 182.2 mmHg no Grupo BH e 148.1 mmHg no Grupo. Com relação ao reflexo inibitório retoanal, a sensibilidade e a capacidade retal máxima não houve diferença estatisticamente significante entre os dois grupos. CONCLUSÃO: As mulheres com bexiga hiperativa apresentaram maior ocorrência de contração paradoxal do puborretal em relação às do grupo controle.

BACKGROUND: Anorectal manometry is a diagnostic method often used in clinical practice for assessing functional anorectal disorders and pelvic floor. The dysfunctional voiding, anorectal and pelvic floor has been considered as contributing factors of the symptoms of overactive bladder. AIM:To evaluate the results with anorectal manometry in adult women with clinical and urodynamic diagnostics of overactive bladder. METHODS: Twenty-five adult women (mean age 45.5±11.9 years) with clinical and urodynamic diagnostic of overactive bladder underwent anorectal manometry and the results of this assessment were compared to a control group of eighteen women (mean age 33.9±10.7 years) with no urinary or intestinal disorders and without clinical criteria for diagnosis of overactive bladder. RESULTS: Paradoxical puborectalis contraction occurred in six patients in the overactive bladder group and none of the controls. There were no significant between group differences in the following manometric parameters: rectoanal inhibitory reflex, rectal sensitivity, maximum tolerable volume, resting pressure, and hypertonia at rest. Mean squeeze pressure was 182.2 mmHg in the overactive bladder group versus 148.1 mmHg in the control group. CONCLUSION: Women with overactive bladder had increased incidence of paradoxical puborectalis contraction than women in the control group.

What are the risk factors for readmission in patients with an ileostomy? / Quais são os fatores de risco para readmissão em pacientes com ileostomia?

PURPOSE: the aim of this study was to identify the risk factors for readmission among patients submitted to colorectal surgery. METHODS: a single-center colorectal quality-assessment database was queried for patients undergoing colorectal procedures with ileostomy during 2009. The sample was divided into readmitted vs. non-readmitted. Readmission was defined as admission within the first 30 days after the index procedure. Groups were compared by pre, intra and postoperative characteristics. A multivariate analysis was performed to identify the risk factors for readmission. RESULTS: the query returned 496 patients, [267 (54%) males, median age 48 years (IQR: 34-60)]. Eighty-three (17%) were readmitted; 296 patients (60%), were operated due to inflammatory bowel disease, 89 (18%) for cancer, 16 (3%) for diverticular disease and 95 (19%) for other diagnosis. The three most common procedures were total proctocolectomy with ileal pouch-anal anastomosis (IPAA) in 103 patients (21%), total colectomy with end ileostomy in 117 (24%) and small bowel resections (including enterocutaneous fistula takedown and J-pouch excision) in 149 (30%). The following variables were significantly more common in readmitted patients: current smoking (24% vs. 14%, p = 0.02), postoperative DVT/PE (10% vs. 4%, p = 0.04), wound infection (20% vs. 10% p = 0.01), sepsis (22% vs. 8% p < 0.001) and organ or space surgical site infection (OrgSSI) (35% vs. 5%, p < 0.001). Postoperative OrgSSI was the only independent factor associated with readmission in a multivariate analysis (p < 0.001). CONCLUSION: colorectal surgeons should be alert for OrgSSI when facing an ileostomy patient readmitted after a colorectal procedure. (AU)

OBJETIVO: o objetivo deste estudo foi identificar os fatores de risco para readmissão em pacientes submetidos à cirurgia colorretal. MÉTODOS: um banco de dados de avaliação da qualidade colorretal em um único centro foi consultado para pacientes submetidos à procedimentos colorretais com ileostomia em 2009. A amostra foi dividida em readmitidos versus não readmitidos. A readmissão foi definida como a admissão dentro dos primeiros 30 dias após o procedimento índice. os grupos foram comparados em relação à características pré, intra e pós-operatórias. A análise multivariada foi realizada para identificar os fatores de risco para readmissão. RESULTADOS: a consulta identificou 496 pacientes, [267 (54%) do sexo masculino, idade média de 48 anos (VIQ: 34 -60)]. oitenta e três (17%) foram readmitidos; 296 pacientes (60%) foram operados por doença inflamatória intestinal, 89 (18%) por câncer, 16 (3%) por doença diverticular e 95 (19%) devido a outro diagnóstico. os três procedimentos mais comuns foram proctocolectomia total com anastomose anal e bolsa ileal (IPAA) em 103 pacientes (21%), colectomia total com ileostomia final em 117 (24%) e ressecções do intestino delgado (incluindo a remoção de fístula enterocutânea e excisão da bolsa em J) em 149 (30%). As seguintes variáveis foram significativamente mais comuns em pacientes readmitidos: tabagismo atual (24 % vs. 14%, p = 0,02), TVP/EP pós-operatório (10% vs. 4 %, p = 0,04), infecção da ferida cirúrgica (20 % vs. 10% p = 0,01), sepse (22% vs. 8%, p < 0,001) e infecção de órgão/espaço do sítio cirúrgico (IOSC) (35 % vs. 5%, p < 0,001). A infecção do IOSC pós-operatório foi o único fator independente associado com a readmissão na análise multivariada (p < 0,001). CONCLUSÃO: os cirurgiões colorretais devem estar alertas para IOSC diante de um paciente com ileostomia readmitido após um procedimento colorretal. (AU)

Does acute alcohol intoxication interfere with colonic anastomosis wound healing?: a rat model of nondestructive colon trauma

PURPOSE: To evaluate the effects of acute alcohol intoxication on healing of colonic anastomosis. METHODS: Thirty-six rats were allocated into two groups. Animals in the alcohol (A) were given 2 mL of ethanol diluted in 0.9% saline solution to a concentration of 40% by gavage immediately before anesthesia, whereas control (C) animals received 2 mL of 0.9% saline solution via the same route. A colonic anastomosis was then performed in all animals. On postoperative days 1, 3, and 7, anastomotic breaking strength was assessed and histopathological examination was performed. Change in body weight and mortality were also evaluated. RESULTS: The median of anastomotic tensile strength on the postoperative day 1 was 0.09 Newtons for group A and 0.13 for group C. (p>0.05). The median of anastomotic tensile strength on the postoperative day 3 was 0.13 Newtons for group A and 0.17 for group C. (p>0.05). The median of anastomotic tensile strength on the postoperative day 7 was 0.30 Newtons for group A and 0.35 for group C. (p>0.05). There was no significant difference between the groups A and C, in the first, third or seventh POD (p>0.05), in any of the analyzed parameters. There were no statistical differences between groups in the weight. Three animals died, all from the group A. CONCLUSION: Acute alcohol intoxication did not interfere with wound healing of colonic anastomoses, although it caused early postoperative mortality.

The effect of carbon dioxide pneumoperitoneum on the healing colonic anastomosis in rats

PURPOSE: To investigate the effects of pneumoperitoneum on colonic anastomosis healing. METHODS: Colonic anastomosis was performed in 120 rats divided into four groups: Group I - pneumoperitoneum before laparotomy, Group II - pneumoperitoneum after laparorrhaphy, Group III - pneumoperitoneum before laparotomy and after laparorrhaphy, Group IV - no pneumoperitoneum (control group). Pneumoperitoneum pressure was 5 mmHg. Animals were killed on the 3rd, 7th and 14th postoperative day. Hhistopathological features, anastomosis breaking strength, collagen histomorphometry and hydroxyproline concentration were assessed. RESULTS: Breaking strength between groups: (day 3, p=0.165; day 7, p=0.219; day 14, p=0.539). Histopathology revealed that group II had, on day 7, less infiltration of mononuclear cells (p=0.006), greater infiltration of polymorphonuclear cells (p=0.001) and greater necrosis (p=0.001); and on day 14, less fibrosis. Histomorphometry revealed a decrease in collagen in groups I and III (p<0.001) on day 7 and an increase in groups I and II on day 14 (p<0.001). Hydroxyproline concentration was similar for groups on days 3 (p=0.152), 7 (p=0.913) or 14 (p=0.981). CONCLUSION: Carbon dioxide does not impair the healing of colonic anastomosis in rats.

The effect of carbon dioxide therapy on composite graft survival

PURPOSE: To investigate the effect of carboxytherapy in auricular composite grafts in rabbits. METHODS: An experimental study was conducted using 20 rabbits randomly assigned to a treatment group of carboxytherapy or a control group of saline solution. In each ear, a circular graft with 1.5 cm or 2 cm of diameter was amputated and reattached. Animals underwent carbon dioxide or saline injection four times during the experiment. We analyzed clinical evolution of the animals, grafts survival, histopathology features and histomorphometry of collagen. RESULTS:The treated group had a significantly lower weight gain (p=0.038). Histopathology was not significantly different between groups. There was an increase in amount of collagen in 2 cm grafts submitted to carbon dioxide therapy (p=0.003). Carboxytherapy didn't influence graft survival rate for 1.5 cm grafts or 2 cm grafts (p=0.567 and p=0.777, respectively). CONCLUSIONS:Carbon dioxide therapy increased the amount of collagen in 2 cm grafts. CO2 was not significantly different from saline infusion on composite grafts survival, but this study suggests that there is a mechanical effect caused by distension which favored graft survival.

Effects of pneumoperitoneum with carbon dioxide and helium on renal function and morphology in rats

PURPOSE: To evaluate the effects of pneumoperitoneum with carbon dioxide and helium on renal function and morphology in a rat model. METHODS: Twenty four rats were randomized into three groups (n=8): gasless insufflation ('open', Pressure=0 mmHg), carbon dioxide pneumoperitoneum at 12 mmHg, and helium pneumoperitoneum at 12 mmHg; all lasting 90 minutes.. A cystostomy was performed and the bladder was emptied. At the end of the experiment, the urine produced, a blood sample and the left kidney of each animal were collected. The following variables were obtained: serum sodium, potassium, urea and creatinine, urine volume and creatinine. The creatinine clearance was estimated for each animal. The kidneys were stained with hematoxylin and eosin (HE) and evaluated by a pathologist blinded to the groups. RESULTS: The CO2 and Helium groups did not differ in the variables evaluated. Both developed oliguria (p<0.001 vs. gasless). The CO2 group presented hyperkalemia compared to gasless (p=0.05), which did not attain significance in the helium group. Histopathological analysis revealed mild hydropic degeneration and congestion in the three groups, with no significant difference among them. CONCLUSIONS: The type of gas resulted in no difference in the variables of renal function and morphology assessed. The increase in serum potassium was only observed with CO2 insufflation suggests a combined effect of elevated intra-abdominal pressure and metabolic effects of pneumoperitoneum.

Gossipiboma após operação abdominal é situação clínica desafiadora e sério problema médico legal / Gossypiboma after abdominal surgery is a challenging clinical problem and a serious medicolegal issue

INTRODUÇÃO: O termo gossipiboma refere-se à matriz que contém material têxtil e à reação tecidual formada ao redor deste corpo estranho. As gazes e as compressas cirúrgicas são os materiais mais frequentemente retidos após laparotomias. OBJETIVO: Estudar a incidência e as causas de gossipiboma abdominal, além das medidas preventivas para reduzir a sua frequência e morbimortalidade. MÉTODO: Foi realizada revisão da literatura na língua inglesa no Medline / Pubmed. A pesquisa envolveu os últimos 10 anos, selecionando os seguintes descritores - gossipiboma, textiloma, corpo estranho retido e cirurgia abdominal.Trinta artigos foram considerados para a revisão. RESULTADOS: A incidência é subestimada, principalmente pelas implicações legais decorrentes de tal achado, mas também porque muitos pacientes permanecem assintomáticos. Ocorrem em 1/1000 a 1/1500 operações abdominais. A apresentação clínica é variável e depende da localização do corpo estranho e do tipo de reação inflamatória apresentado pelo hospedeiro. A migração transmural é rara. O tratamento recomendado é a excisão, realizado por via endoscópica, laparoscópica ou por laparotomia, com o objetivo de evitar as complicações que podem atingir alta mortalidade. A abordagem mais importante é a prevenção. As medidas preventivas incluem o uso de material têxtil com marcadores radiopacos, exploração detalhada da cavidade abdominal ao final do procedimento operatório e contagem meticulosa do material cirúrgico. CONCLUSÃO: Gossipiboma é problema médico-legal antigo, cuja incidência aparentemente está aumentando e que precisa ser reabordado para que medidas preventivas efetivas sejam adotadas na sala de operação.

INTRODUCTION: The term "gossypiboma" refers to a textile matrix surrounded by foreign body reaction. Gauze and surgical dressings are the most commonly retained materials after laparotomy. AIM: To evaluate the incidence of abdominal gossypiboma, its causes and the preventive measures to reduce the frequence and morbimortality. METHOD: Was conducted a literature review in Medline/Pubmed in english. The survey was about the last 10 years, selecting the headings: gossypiboma, textiloma, retained foreign body and abdominal surgery. Thirty articles were considered in this review. RESULTS: The incidence of gossypiboma is underreported, mostly due to the legal implications of their detection but also because many patients remain asymptomatic. Occur in 1/1000 to 1/1500 of intra-abdominal operations. Clinical presentation is variable, and depends on the location of the foreign body and on the type of inflammatory reaction presented by the host. The recommended course of treatment is excision, which can be accomplished endoscopically, laparoscopically, or via the open route, and seeks to prevent the complications that lead to a high mortality rate. The most important approach is prevention. Preventive measures required include exploration of the abdominal cavity at the end of the procedure, use of textiles with radiopaque markers and a meticulous account of surgical materials. CONCLUSION: Gossypiboma is a former medical-legal problem, whose incidence is apparently increasing. Therefore needs to be revised to take preventive measures in the operating room.

Correlation between bursting pressure and breaking strength in colonic anastomosis

PURPOSE: To investigate the correlation between bursting pressure and breaking strength on the 7th postoperative day following left colonic anastomosis in rats. METHODS: Seventy rats were randomly divided into seven groups of ten animals each. All of the animals underwent segmental resection of the left colon and end-to-end anastomosis. The animals in groups I to VI underwent surgical laparoscopies with pneumoperitoneums using carbon dioxide or helium at pressures of 5, 12 or 20 mmHg. In Group VII, open laparotomy was performed. The animals were reoperated on postoperative day 7 to measure the bursting pressure and the breaking strength of the anastomosis. RESULTS: The anastomosis bursting pressure in 70 animals was 193.10±55.56 mmHg. There was no significant difference between the groups (p=0.786). The breaking strength of the anastomosis was 0.26±0.12 N. There was no significant difference between the groups (p=0.356). Pearson's correlation test showed a low correlation (r=0.231) lacking statistical significance (p=0.054). CONCLUSION: There was no correlation between the bursting pressure and breaking strength of left colonic anastomoses in rats on the 7th postoperative day.

Effects of carbon dioxide therapy on the healing of acute skin wounds induced on the back of rats

PURPOSE: To evaluate the healing effect of carbon dioxide therapy on skin wounds induced on the back of rats. METHODS: Sixteen rats underwent excision of a round dermal-epidermal dorsal skin flap of 2.5 cm in diameter. The animals were divided into two groups, as follows: carbon dioxide group - subcutaneous injections of carbon dioxide on the day of operation and at three, six and nine days postoperatively; control group - no postoperative wound treatment. Wounds were photographed on the day of operation and at six and 14 days postoperatively for analysis of wound area and major diameter. All animals were euthanized on day 14 after surgery. The dorsal skin and the underlying muscle layer containing the wound were resected for histopathological analysis. RESULTS: There was no statistically significant difference between groups in the percentage of wound closure, in histopathological findings, or in the reduction of wound area and major diameter at 14 days postoperatively. CONCLUSION: Under the experimental conditions in which this study was conducted, carbon dioxide therapy had no effects on the healing of acute skin wounds in rats.

A new proposal for laparoscopic left colectomy in a rat model

PURPOSE: To evaluate the feasibility and safety of a new technique for laparoscopic segmental colectomy and primary anastomosis in the left colon of rats. METHODS: Thirty rats were randomly assigned to three groups of ten animals each. All animals underwent segmental resection of the left colon and end-to-end anastomosis. In Group I, the animals underwent laparoscopic surgery with carbon dioxide pneumoperitoneum at a pressure of 5 mmHg. In Group II, the animals underwent pneumoperitoneum with carbon dioxide at a pressure of 12 mmHg. In Group III, the control group, the animals underwent open surgery. All animals were reopened on the 7th postoperative day and were evaluated for peritonitis, abscesses, anastomotic dehiscence and bowel obstruction, and the anastomosis bursting pressure was measured. RESULTS: No obstructions, peritonitis or abscesses were found in any of the animals. An animal in Group I exhibited a blocked anastomosis leakage. The average anastomosis bursting pressure in the 30 animals was 187.02 ± 68.35 mmHg. There was no significant difference in the anastomosis bursting pressure among the groups (p = 0.503) CONCLUSION: The laparoscopic experimental model was feasible and safe for segmental colectomy and anastomosis of the left colon in rats.

Laparoscopic training in colorectal surgery: can we do it safely? / Colectomia videolaparoscópica: é seguro treinar o residente?

OBJECTIVE: Laparoscopic approach should be offered for most patients requiring colectomy, as it is a safe procedure, associated with shorter hospitalization, better cosmetic results, and does not affect negatively the oncological outcomes of patients with colon cancer. However, there is no consistent data on the safety of laparoscopic surgery training during residency. Therefore, the aim of this study was to assess whether or not the resident participation in laparoscopic colectomy affected the postoperative outcomes. METHODS: The database of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was searched for patients undergoing laparoscopic colectomies between 2005 and 2007. We excluded patients with no data regarding whether or not there was a resident participation in the operation. The study population was divided into 2 groups (resident and nonresident), according to residents participation in the surgical procedure. Perioperative variables and postoperative complications were compared between groups. A multivariate analysis was performed to evaluate the association between postoperative complications and resident participation in the operation. RESULTS: The search yielded 5,912 patients with a median age of 63 years. Of these, 3,112 (53%) were female and 3.887 (66%) had a resident involved in their operation. The resident group had a significantly longer mean operative time (163 ± 64 min vs 138 ± 58 min, p < 0.0001). Other variables did not differ significantly between groups. Moreover, multivariate analysis showed no association between resident participation and the occurrence of postoperative complications. CONCLUSION: Laparoscopic training during residency may be safely performed without threatening the patient's integrity. (AU)

OBJETIVO: Cirurgia videolaparoscópica é a via preferencial para colectomias eletivas por ser um procedimento seguro, associado à menor tempo de internação, melhores resultados estéticos e por não influenciar negativamente os resultados oncológicos dos pacientes com câncer de cólon. Entretanto, ainda não existem dados consistentes sobre a segurança do treinamento em cirurgia laparoscópica durante a residência. Sendo assim, o objetivo deste estudo foi avaliar se a participação do residente em colectomias laparoscópicas afetou os resultados pós-operatórios. MÉTODOS: A base de dados do American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) foi pesquisada para colectomias laparoscópicas entre os anos de 2005 e 2007. A população do estudo foi dividida em dois grupos de acordo com a participação ou não do residente na cirurgia: residente vs. não residente. Os grupos foram comparados em relação às variáveis perioperatórias e complicações pós-operatórias. Uma análise multivariada foi realizada para investigar possível associação entre complicações pós-operatórias e o envolvimento de residentes na operação. A pesquisa retornou 5.912 pacientes, com mediana de idade de 63 anos. Em 3.887 casos (66%) o residente estava envolvido na operação. O grupo Residente apresentou tempo operatório mediano significantemente maior que o grupo Não Residente (163 ± 64 min vs. 138 ± 58 min, p < 0.0001). Todas as outras variáveis estudadas não diferiram significativamente entre os grupos. Além disso, a análise multivariada não demonstrou nenhuma associação entre o envolvimento do residente na operação e a ocorrência de complicações pós-operatórias. CONCLUSÃO: O treinamento laparoscópico durante a residência pode ser realizado com segurança sem colocar em risco a integridade do paciente operado. (AU)