Perda de peso e o comprimento do intestino delgado na cirurgia de fobi-capella: há relação? / Weight loss and the length of the small intestine in the fobi-capella surgery: is there a relationship?

RESUMO - RACIONAL: Os fatores relacionados à perda de peso nos pacientes obesos submetidos à cirurgia bariátrica sempre foram exaustivamente estudados na tentativa de propor a melhor técnica cirúrgica com maior perda de peso e resolução as comorbidades à longo prazo. Os pacientes apresentam variações anatômicas no que tange o comprimento do intestino delgado. Há estudos que demonstram alterações de peso nos pacientes que apresentam diferentes comprimentos das alças intestinais na técnica do by-pass em Y de Roux. O presente trabalho realizou um estudo entre a influência do IMC, a perda de peso e o comprimento da alça comum nos resultados cirúrgicos à longo prazo. MÉTODOS: Estudo transversal descritivo pela análise retrospectiva de 112 prontuários de pacientes submetidos à cirurgia bariátrica aberta pela técnica do bypass gástrico no Hospital de Clínicas -UFPR. Os dados foram correlacionados em programas estatísticos para este fim. RESULTADOS: Dos 112 pacientes, 83,03% eram do sexo feminino, média de idade de 41,52 anos. O comprimento médio do intestino delgado total dos pacientes foi de 5,02 metros. Houve uma relação diretamente proporcional entre o comprimento do intestino delgado e a perda de peso (p=0,0428). CONCLUSÃO: Há uma ampla gama de variáveis relacionadas à perda de peso nos pacientes submetidos à cirurgia bariátrica, tais como a técnica utilizada, o comprimento das alças no by-pass gástrico em Y de Roux e a rotina de acompanhamento nutricional e físico do paciente. É importante considerar os detalhes técnicos do procedimento cirúrgico, e verificar a perda de peso avaliando-se o paciente como um todo e outras variáveis.

ABSTRACT - BACKGROUND: Factors related to weight loss in obese patients undergoing bariatric surgery have always been exhaustively studied in an attempt to propose the best surgical technique with greater weight loss and long-term resolution of comorbidities. Patients present anatomical variations regarding the length of the small intestine. Some studies demonstrate weight changes in patients with different lengths of the intestinal loops in the Roux-en-Y bypass technique. The present work carried out a study on the influence of body mass index, weight loss, and common loop length on long-term surgical outcomes. METHODS: This is a descriptive cross-sectional study by retrospective analysis of 112 medical records of patients undergoing open bariatric surgery using the gastric bypass technique at University Hospital - UFPR. The data were correlated in statistical programs for this purpose. RESULTS: Out of 112 patients, 83.03% were women, with mean age of 41.52 years. The mean length of the total small bowel of the patients was 5.02 m. There was a directly proportional relationship between the length of the small intestine and weight loss (p=0.0428). CONCLUSION: There is a wide range of variables related to weight loss in patients undergoing bariatric surgery, such as the technique used, the length of the loops in the Roux-en-Y gastric bypass, and the routine of nutritional and physical monitoring of the patient. It is important to assess the technical details of the surgical procedure and to verify the weight loss by evaluating integrally the patient and other variables.

Evisceración del intestino delgado estrangulado en una anciana con douglascele / Evisceration of the impacted small bowel in an elderly with douglascele

Se presenta el caso clínico de una anciana de 86 años de edad con evisceración del intestino delgado a través del periné. Se efectuó la exploración quirúrgica urgente del abdomen y se observó la perforación del fondo del saco de Douglas y la salida de 50 cm de intestino delgado estrangulado, de manera que se realizó la resección intestinal de todo el segmento afectado y anastomosis termino-terminal. Luego se reparó el defecto del fondo del saco de Douglas con una plastia perineal, para lo cual se utilizó una malla de polipropileno. Este proceder es una buena alternativa para el tratamiento quirúrgico en quienes presentan hernias perineales, pues permite un cierre mejor, disecar el saco herniario y reducirlo adecuadamente.

The case report of a 86 years elderly is presented with evisceration of the small bowel through the perineum. The urgent surgical exploration of the abdomen was carried out and it was observed the perforation of the Douglas pouch and the 50 cm prominence of impacted small bowel, so that the bowel resection of the whole affected segment and end to end anastomosis was carried out. Then the Douglas pouch defect was repaired with a perineal plasty, for which a polypropylene mesh was used. This procedure is a good alternative for the surgical treatment in those who present perineal hernias, because it allows a better closing, to dissect the hernial sack and to reduce it appropriately.

Hernia paracecal / Paracecal hernia

RESUMEN Las hernias internas son una causa poco frecuente de obstrucción del intestino delgado (representan menos del 5 %). La hernia pericecal ocupa alrededor de la décima parte de las hernias internas; mientras que, la hernia paracecal constituye una de sus cuatro variantes, las que a su vez, pueden ser congénitas o adquiridas. Se presentó un paciente masculino de 98 años de edad, operado por obstrucción intestinal debido a hernia paracecal, que requirió resección de intestino y anastomosis, con evolución favorable. En la búsqueda realizada en Cochrane no se encontró ningún otro caso publicado por autores cubanos. Se revisó la literatura al respecto y se insistió en la necesidad de tener presente dicho diagnóstico en el actuar diario del cirujano, ya que se comporta con una alta mortalidad sino se sospecha, debido a que cursa generalmente con compromiso vascular.

ABSTRACT Internal hernias are an uncommon cause of small bowel obstruction (they represent less than 5%). The pericaecal hernia occupies about a tenth of the internal hernias while the paracaecal hernia is one of its four variants, which in turn can be congenital or acquired. We present a 98-year-old male patient operated on bowel obstruction due to paracaecal hernia, which required bowel resection and anastomosis, with favourable evolution. No other case published by Cuban authors was found when searching in Cochrane Library. Literature on this subject was also reviewed, insisting on the need for surgeons to bear this diagnosis in mind in their daily work, since it is manifested with a high mortality if it is not suspected, because it generally involves vascular compromise.

Tissue fusion technology versus suture and staple in porcine bowel anastomosis: an in vivo study

The aim of this study was to make a comparison between the tissue fusion technique and conventional methods for sealing bowel anastomosis. Eighteen female domestic pigs (Suidae, Sus) were used in our study. Tissue-fused anastomoses (LigaSure groups) were made in 13 animals (5 anastomoses per animal), which were subdivided into 4 groups according to different manufacturing settings: "LigaSure-L-1" and "LigaSure-L-2", with low energy output level with 1 or 2 device-activated tissue sealing times, and "LigaSure-M" and "LigaSure-H", with medium or high energy output level. As controls, automatically stapled (GIA group) and hand-sewn (suture group) anastomoses were utilized in 3 and 2 animals, respectively. There was no statistical difference in the overall leakage rate between the GIA group (6.7%) and the LigaSure groups (15%) (P=1.000). There was less proliferating epithelium covering the anastomosis gap in the LigaSure groups compared with the other two groups. The gap between the two extremities of muscular layers of the anastomosis in the LigaSure groups was filled with collagen fibers. More proliferating cell nuclear antigen (PCNA)-positive cells were found in the anastomoses of the LigaSure groups compared with the other two groups (P=0.010). Our results showed that the tissue fusion technology was a feasible and safe method for anastomoses.

The effect of ileocecal valve removal in a model of short bowel syndrome / Efeito da remoção da válvula ileocecal em modelo de síndrome do intestino curto

ABSTRACT Background : Short bowel syndrome is a harmful condition that needs experimental research. Aim: To assess the impact of the ileocecal valve removal in a model of short bowel syndrome, in order to investigate the evolution of the colon under this circumstance. Method: Fifteen Wistar rats were equitable divided into: Control (Sham), Group I (70% enterectomy preserving ileocecal valve) and Group II (70% enterectomy excluding ileocecal valve). After enterectomy was performed jejunoileal or jejunocecal anastomosis and sacrificed the animals on 30th postoperative day for histomorphometric study of the colon. During this period, was observed the clinical evolution of the animals weekly including body weight measurement. Results: Group I and II presented progressive loss of weight. In Group I was observed diarrhea, perineal hyperemia and purple color of the colon during autopsy. Histomorphometry assay showed hypertrophy and hyperplasia of colon mucosa in Group I. In Group II the colon wall was thicker due to hypertrophy and muscular hyperplasia, and in mucosa vascular proliferation and inflammatory infiltrate were intense. Conclusion : This short bowel syndrome model is relevant and achieve 100% of survival. Animal's weight loss was not altered by the presence or exclusion of the ileocecal valve. Animals with 70% of small bowel removal and presence of the ileocecal valve attained a better clinical evolution and histological colon adaptation than those without ileocecal valve.

RESUMO Racional: Síndrome do intestino curto é condição clínica crítica e que precisa de pesquisa experimental. Objetivo: Avaliar o impacto da remoção da válvula ileocecal em um modelo de síndrome do intestino curto para investigar o comportamento do cólon nesta circunstância. Método: Quinze ratos Wistar foram divididos em três grupos de cinco: Controle (Sham), grupo I (enterectomia de 70% com preservação da válvula ileocecal), e grupo II (70% enterectomia de 70% excluindo a válvula ileocecal). Após a enterectomia foi restabelecido o trânsito com anastomose jejunoileal no grupo I e jejunocecal no grupo II. Os animais foram sacrificados no 30º dia do pós-operatório para histomorfometria do cólon. Durante este período, observou-se a evolução clínica semanal, incluindo a medição do peso corporal. Resultados: Grupos I e II apresentaram perda progressiva de peso. No grupo I houve diarreia, períneo hiperemiado e cor violácea do cólon durante a autópsia. A histomorfometria mostrou hipertrofia e hiperplasia da mucosa do cólon no grupo I. No grupo II a parede do cólon estava mais espessa devido à hipertrofia e hiperplasia das camadas muscular e mucosa onde a proliferação vascular e infiltração inflamatória foi intensa. Conclusão: Este modelo é factível e atingiu 100% de sobrevida. A perda de peso não foi alterada pela presença ou exclusão da válvula ileocecal. Animais com remoção de 70% do intestino delgado e presença da válvula ileocecal apresentaram melhor evolução clínica e adaptação histológica do cólon que os sem válvula ileocecal.

Report of a rare case and review of adult intestinal duplication at the opposite side of mesenteric margin

ABSTRACT CONTEXT: To study the previously discovered clinical entity of adult intestinal duplication and its treatment, and propose an extension to its existing classification. CASE REPORT: We report the case of an adult male with abdominal pain, constipation and vomiting. This patient underwent surgical separation of adhesions, reduction of torsion and intestinal decompression. Postoperative pathological findings confirmed the rare diagnosis of intestinal duplication. CONCLUSION: Adult intestinal duplication is quite rare. Its clinical manifestations are nonspecific. From this finding of intestinal duplication originating at the opposite side of the mesenteric margin, a further extension of the existing anatomical classification is proposed.

Differences between polydioxanone and poliglactin in intestinal anastomoses - a comparative study of intestinal anastomoses / Diferenças entre polidioxanona e poliglactina em anastomoses intestinais - estudo comparativo de anastomoses intestinais

ABSTRACT Introduction: Intestinal anastomosis is a surgical practice constantly realized by surgeons worldwide. When the option is to perform manual anastomosis, which is still widely used for its low cost, the question arises as to the best material to be applied. Objective: To compare polydioxanone and polyglactin threads for healing and tensile strength in intestinal anastomosis in rats. Method: We used 25 rats Wistar; after anesthesia, in groups A and B (10 rats each), laparotomy was performed, transection of the ileum at 5 and 10 cm proximally to the ileocecal valve; in group A, anastomosis was performed with 4 separate extra mucosal sutures with polidioxanone; in group B, anastomosis was performed with polyglactin; in group C (5 rats), laparotomy and manipulation of the ileum were performed. After 21 days, the animals were anesthetized and submitted to euthanasia. The specimens were sent for histopathological study and tensile strength analysis. Statistical analysis was performed using the Turkey and Student's t tests, with a significance of p < 0.05. Results: The results showed that in the tensile strength analysis, there were no significant differences between them. The histological analysis showed significant differences between the cicatrization pattern, where polydioxanone caused less fibrosis than polyglactin. Conclusion: Polydioxanone caused less fibrosis than polyglactin in intestinal anastomoses of rats.

RESUMO Introdução: Anastomose intestinal é uma prática cirúrgica constantemente realizada pelos cirurgiões em todo o mundo. Quando a opção é a anastomose manual - um procedimento ainda amplamente empregado, graças a seu baixo custo - coloca-se o problema de saber qual é o melhor material a ser aplicado. Objetivo: Comparar fios de polidioxanona e poliglactina quanto à cicatrização e resistência à tração em anastomoses intestinais em ratos. Método: Utilizamos 25 ratos Wistar; depois da anestesia, foi realizada laparotomia nos grupos A e B (10 ratos cada), com transecção do íleo a 5 e 10 centímetros proximalmente à válvula ileocecal; no grupo A, a anastomose foi realizada com 4 suturas de mucosa separadas com uso de polidioxanona; no grupo B, a anastomose foi realizada com poliglactina; no grupo C (5 ratos), foi realizada apenas a laparotomia e manipulação do íleo. Transcorridos 21 dias, os ratos foram anestesiados e submetidos à eutanásia. Os espécimes foram enviados para estudo histopatológico e análise de resistência à tração. A análise estatística foi efetuada com a aplicação dos testes de Tukey e de t de Student, com significância de p < 0,05. Resultados: Os resultados demonstraram que, na análise de resistência à tração, não foram observadas diferenças significativas entre os materiais. A análise histológica revelou diferenças significativas entre padrões de cicatrização, em que polidioxanona causou menos fibrose versus poliglactina. Conclusão: Polidioxanona causou menos fibrose versus poliglactina em anastomoses intestinais realizadas em ratos.

Tratamiento médico o quirúrgico de la obstrucción intestinal alta / Medical or surgical treatment of small bowel obstruction

Introducción: La obstrucción intestinal (OI) es una causa frecuente de consulta en los servicios de urgencia. Los avances en los métodos de diagnósticos y la implementación de unidades de paciente crítico han logrado disminuir la morbimortalidad de esta afección. El proceso diagnóstico incluye desde la anamnesis y examen físico al uso de exámenes de laboratorio e imagenológicos para definir el mejor tratamiento en cada caso, ya sea médico o quirúrgico. Objetivo: Describir la respuesta al tratamiento médico o quirúrgico en pacientes con diagnóstico de OI alta en nuestro hospital.Materiales y métodos: Serie de casos retrospectiva de todos los casos egresados con diagnóstico de OI alta (parcial o completa) como diagnóstico primario, atendidos en el hospital desde enero de 2012 hasta mayo de 2014. Resultados: Hubo 134 casos incluidos, con 101 OI completas, 81 de ellas se resolvieron de forma quirúrgica. En las 20 restantes se decidió tratamiento médico, sin presentar este subgrupo mayor morbimortalidad asociada; sin embargo dada la evolución de estos pacientes se requirió en un 75% de los casos cirugía definitiva. Todas las OI parciales (33 casos), se resolvieron de forma conservadora, sin requerir cirugía. Conclusión: El tratamiento conservador de la OI no presentó mayores complicaciones que el tratamiento quirúrgico, por lo que se mantiene como una posibilidad válida de tratamiento teniendo en cuenta que es necesaria una vigilancia estricta para evitar mayor morbimortalidad. Sin embargo, esto no significa que operar o no operar sea lo mismo, siendo importante considerar la etiología de la OI.

Background: Small bowel intestinal obstruction (IO) is a frequent problem presenting in emergency rooms. Advances in diagnostic methods and the creation of intensive case units have diminished the morbidity and mortality of this disease. The diagnostic tool includes a careful clinical examination, the use of laboratory tests plus radiological procedures, which together allow to define the best treatment option for each patient wit IO. Aim: To report the response to medical or surgical treatment of patients with a small bowel IO. Material and methods: Review of a retrospective case series of 134 patients discharged from a clinical hospital with the primary diagnosis of small bowel intestinal obstruction between 2012 and 2014. Results: One hundred and one patients had a complete obstruction and 81 of these were treated surgically. In the remaining 20, a medical treatment was chosen, without observing a higher frequency of complications. However, 75% of these patients required surgery during their evolution. All partial obstructions were treated conservatively, without requiring surgery. Conclusion: Conservative treatment of intestinal obstruction is not associated with a higher rate of complications but requires a close clinical follow up. The etiology of the obstruction must be taken in consideration for decision making.

The influence of nicotine in healing of small bowel anastomoses in rats: angiogenesis and miofibroblasts / A influência da nicotina na cicatrização de anastomoses do intestino delgado em ratos: angiogênese e miofibroblastos

ABSTRACT Objective: to know the effect of nicotine on angiogenesis and myofibroblast formation in anastomoses of the small bowel of rats. Methods: we randomly divided 60 Wistar rats into the groups Nicotine (N) and control (C), according to the proposed treatment. Each group was subdivided into three subgroups according to the time interval used for the evaluation (7, 14 or 28 days). The N group with 30 animals received nicotine subcutaneously at a dose of 2mg/kg body weight, diluted in 0.3ml of 0.9% saline, twice daily for 28 days prior to the operation, and for more 7, 14 or 28 days, depending on the subgroup. The C group (also 30 animals) received only saline on the same conditions and time intervals. After 28 days we carried out an end-to-end anastomosis 10cm distal to the duodenojejunal flexure in each rat. After 7, 14 or 28 days after surgery, we euthanized ten animals of each group, sent specimens of the anastomosis areas, 1cm proximal to 1cm distal, to counting of blood vessels and myofibroblasts through immunohistochemical staining by the application of monoclonal anti-factor VIII antibodies and anti-smooth muscle alpha-actin. Results: the administration of nicotine led to the decrease in the number of blood vessels measured on the 28th postoperative day and the number of myofibroblasts measured on the seventh day following completion of the anastomoses. Conclusion: administration of nicotine was deleterious on angiogenesis and myofibroblast formation in rats' small intestine anastomoses.

RESUMO Objetivo: conhecer o efeito da nicotina sobre a angiogênese e formação de miofibroblastos em anastomoses do intestino delgado de ratos. Métodos: sessenta ratos Wistar foram divididos de maneira aleatória em grupos Nicotina(N) e Controle (C), conforme o tratamento proposto. Cada grupo foi subdividido em três subgrupos, de acordo com o intervalo de tempo utilizado para a avaliação (7, 14 ou 28 dias). O grupo N, com 30 animais, recebeu nicotina por via subcutânea, na dose de 2mg/Kg de peso, diluída em 0,3ml de solução salina a 0,9%, em duas aplicações diárias, durante 28 dias prévios à operação e por mais 7, 14 ou 28 dias, conforme o subgrupo. O grupo C (igualmente com 30 animais) recebeu somente a solução salina nas mesmas condições e intervalos de tempo. Após 28 dias efetuou-se, em cada rato, anastomose término-terminal a 10cm da flexura duodenojejunal. Após 7, 14 ou 28 dias da cirurgia, os dez animais de cada subgrupo foram eutanasiados, sendo que as áreas anastomosadas, 1cm proximal a 1cm distal, foram encaminhadas para contagem de vasos sanguíneos e miofibroblastos, através de coloração imuno-histoquímica por aplicação dos anticorpos monoclonais antifator VIII e anti-alfa-actina muscular lisa. Resultados: a administração de nicotina levou à diminuição do número de vasos sanguíneos aferidos no 28o dia pós-operatório e do número de miofibroblastos aferidos no sétimo dia após a realização das anastomoses. Conclusão: a administração de nicotina foi deletéria sobre a angiogênese e formação de miofibroblastos em anastomoses do intestino delgado de ratos.

Ascorbate Oxidase Minimizes Interference by High-Concentration Ascorbic Acid in Total Cholesterol Assays

No abstract available.

Experience report on teaching surgical technique without animal use

PURPOSE: To report the experience of the school in implementing the 3 Rs replace, reduce and refine; showing time and assembling cost of the experimental models used in the teaching of Surgical Technique and Experimental Surgery. METHODS: Assembly time and costs of models: grafts and flaps performed in pork belly, model of intestinal anastomosis and jejunostomy done in Bahiana box and black box model for training videosurgery. RESULTS: Average time and cost estimate: ten minutes-pork belly, cost $ 6.00 per kilogram; two minutes-Bahiana box, cost $ 27.2; Black box-3.6 hours for manufacturing, cost $ 100.00. The repetition of each practice the cost is $ 3.20 for Bahiana box and at no cost to the black box. CONCLUSION: The experimental models presented are easily reproducible and of low cost. .

Accuracy of the Timed Up and Go test for predicting sarcopenia in elderly hospitalized patients

OBJECTIVES: The ability of the Timed Up and Go test to predict sarcopenia has not been evaluated previously. The objective of this study was to evaluate the accuracy of the Timed Up and Go test for predicting sarcopenia in elderly hospitalized patients. METHODS: This cross-sectional study analyzed 68 elderly patients (≥60 years of age) in a private hospital in the city of Salvador-BA, Brazil, between the 1st and 5th day of hospitalization. The predictive variable was the Timed Up and Go test score, and the outcome of interest was the presence of sarcopenia (reduced muscle mass associated with a reduction in handgrip strength and/or weak physical performance in a 6-m gait-speed test). After the descriptive data analyses, the sensitivity, specificity and accuracy of a test using the predictive variable to predict the presence of sarcopenia were calculated. RESULTS: In total, 68 elderly individuals, with a mean age 70.4±7.7 years, were evaluated. The subjects had a Charlson Comorbidity Index score of 5.35±1.97. Most (64.7%) of the subjects had a clinical admission profile; the main reasons for hospitalization were cardiovascular disorders (22.1%), pneumonia (19.1%) and abdominal disorders (10.2%). The frequency of sarcopenia in the sample was 22.1%, and the mean length of time spent performing the Timed Up and Go test was 10.02±5.38 s. A time longer than or equal to a cutoff of 10.85 s on the Timed Up and Go test predicted sarcopenia with a sensitivity of 67% and a specificity of 88.7%. The accuracy of this cutoff for the Timed Up and Go test was good (0.80; IC=0.66-0.94; p=0.002). CONCLUSION: The Timed Up and Go test was shown to be a predictor of sarcopenia in elderly hospitalized patients. .

Comparison of Single Layer Versus Double Layer Continuous Anastomotic Technique for Small Bowel Resection and Anastomosis.

Small intestinal resection and anastomosis is an important surgical procedure. Aims and Objectives : To study efficacy and safety of single layer intestinal anastomosis using non absorbable suture material against conventional double layer anastomosis. Single layer anastomosis will decrease surgery time and minimize incorporation of foreign body [sutures]. Materials and Methods : Present study carried out in Pravara rural hospital, Loni. It is a prospective study of 50 patients who underwent elective and emergency resection and anastomosis of small intestine from May 2004 to Oct 2006. Observations : Majority of patients were in the age group of 40-50 yrs and children. Intestinal obstruction with gangrene was the most common indication for anastomosis. Significant difference was found in recovery and complications between two methods after applying Z-test. Discussion : Forty seven patients required resection and anastomosis and 3 patients operated for ileostomy closure. Single layer anastomosis has superior results as compared to double layer anastomosis of small intestine. Conclusion : Arithmetical means of these endpoints suggest that single layer method offers same or better results than double layer method.

Duplicación de intestino delgado / Small bowel duplicity

Las duplicaciones intestinales son malformaciones congénitas poco frecuentes. Pueden localizarse desde la boca al ano. En general son asintomáticas, aunque pueden complicarse y manifestarse como hemorragia digestiva o abdomen agudo en aquellos casos en que se localiza a nivel abdominal. Esto obliga a tenerlo en cuenta como diagnóstico diferencial ante estos cuadros. En adultos, el diagnóstico suele darse de manera casual en el acto operatorio. Si bien la conducta es quirúrgica, con resección de la duplicación, ya sea total o parcial, en casos asintomáticos no complicados, esta conducta es controversial. Se presentan tres casos asintomáticos no complicados, diagnosticados casualmente en operaciones abdominales por otras causas, en la que se optó por tratamiento conservador. Dos de los casos fueron operados en el Hospital Regional del Luque y el tercero en el Instituto Nacional del Cáncer. Se hace una revisión del tema.

Intestinal duplications are infrequent congenital malformations. They can be located since the mouth to the anus. Generally they are asymptomatic, although they can be complicated and manifest themselves as a gastrointestinal bleeding or an acute abdomen in those cases that they are located in an abdominal level. These cases compel us to think in them as a differential diagnosis. In adults, the diagnosis usually occurs by chance during the surgical procedure. Although the behavior is surgical, with a partial or total resection of the duplication, it is controversial in those asymptomatic or not complicated cases. It is presented three asymptomatic and not complicated cases which were diagnosed by chance during abdominal surgeries for other causes, and where we chose a conservative treatment. Two out of the three cases were operated in the Hospital Regional de Luque and the third case was operated in the Instituto Nacional del Cáncer. It is made a review of the subject.

Persistent Vitellointestinal Duct Causing Small Bowel Obstruction - A Rare Entity.

Vitellointestinal {omphalo-mesenteric (OMD)} duct connects the developing mid-gut to the primitive yolk sac, provides nutrition to the embryo and remains patent and connected to the intestines until the fifth to ninth week of gestational period. Varied remnants of the vitellointestinal duct have been reported. The present case report describes a completely obliterated fibrous remnant of the duct. The remnant presented as a thick cord extending from the umbilicus towards the terminal part of ileum with a Meckel’s diverticulum. Herein, we report a case of 20 yr old male who presented with the features of small bowel obstruction due to completely obliterated fibrous remnant of the duct which is a rare entity. Although persistent omphalomesentric duct is an extremely infrequent cause of small bowel obstruction in adult patients, it should be taken into consideration in patients without any previous surgical history.

Peritonite séptica em fêmea canina - relato de caso / Septic peritonitis in female canine - case report

A inflamação do peritônio é denominada peritonite e pode ser classificada d e acordo com a origem (primária ou secundária), com o grau de contaminação (asséptica, séptica ou mista) e com a extensã o (localizada ou generalizada) (ZIMMERMANN et al., 2006). A peritonite generalizada bacteriana é a forma predominante em cães e geralmente surge por contaminação pelo trato gastrointestinal, secundária a uma deiscênc ia de ferida cirúrgica (FOSSUM, 2008) , ma s também por perfurações do trato gastrintestinal, neoplasias, ulcerações, ferimentos por armas de fogo e intussuscepção ( ZIMMERMANN et al., 200 6). O diagnóstico de peritonite basea - se na anamnese, nos sinais clínicos, nos dados laboratoria is e no diagnóstico por imagem . Este trabalho tem o objetivo de relatar o caso de uma peritonite séptica, ocorrida após enterectomia, realizada devido a um caso de intu ssuscepção, em uma fêmea canina.

Cyclic parenteral nutrition does not change the intestinal microbiota in patients with short bowel syndrome / Nutrição parenteral cíclica não altera a microbiota intestinal em pacientes com a síndrome do intestino curto

PURPOSE: To characterize of the intestinal microbiota of patients with short bowel syndrome (SBS) admitted to the Metabolic Unit of a University Hospital. METHODS: Fecal samples were evaluated, and biochemical tests were conducted only in the case of SBS patients. The nutritional status was assessed via anthropometric measurements and evaluation of food intake by means of a food questionnaire. The pathogenic strains were detected with the aid of cultures and specific biochemical tests in aerobic medium, for determination of species belonging to the Family enterobacteriaceae. Anti-sera were applied to each isolated E. coli strain, for determination of their possible pathogenicity. Molecular methodology was employed for establishment of the intestinal bacterial microbiota profile RESULTS: A lower amount of microorganisms of the family enterobacteriaceae per gram of stool was observed in the case of patients with SBS. However, molecular analysis showed maintenance of the bacterial species ratio, which is equivalent to a healthy intestinal microbiota. CONCLUSION: Despite the massive removal of the small bowel, frequent use of antibiotics, immune system depression, presence of non-digested food in the gastrointestinal tract, and accelerated intestinal transit, the ratio between intestinal bacterial species remain similar to normality.

OBJETIVO: Caracterizar a microbiota intestinal de pacientes com síndrome do intestino curto (SIC) internados na Unidade Metabólica do Hospital Universitário. MÉTODOS: Foram avaliadas amostras de fezes e exames bioquímicos, estes últimos somente dos pacientes. A avaliação do estado nutricional foi feita a partir de medidas antropométricas e a avaliação do consumo alimentar por meio de inquérito alimentar. Para detecção de cepas patogênicas foram realizados cultivos e testes bioquímicos específicos em meio aeróbico para determinação de espécies da família enterobacteriaceae. Em cada cepa de E. coli isolada foram aplicados anti-soros para determinação de possível patogenicidade. Metodologia molecular também foi utilizada para determinação do perfil da microbiota intestinal bacteriana. RESULTADOS: Observou-se menor quantidade de microorganismos da família enterobacteriaceae por grama de fezes em pacientes com SIC. Porém a análise molecular mostrou a manutenção na proporção de espécies bacterianas, equivalente a microbiota intestinal saudável. CONCLUSÃO: Nossos resultados sugerem que apesar da retirada maciça do intestino delgado, uso freqüente de antibióticos, depressão do sistema imune, presença de alimentos não digeridos no trato gastrintestinal e trânsito intestinal acelerado, a proporção entre as espécies bacterianas intestinais permanecem similares à normalidade.

Oxidative stress gene expression profile in inbred mouse after ischemia/reperfusion small bowel injury / Perfil da expressão gênica do estresse oxidativo em camundongos isogênicos após lesão de isquemia e reperfusão intestinal

PURPOSE: To determine the profile of gene expressions associated with oxidative stress and thereby contribute to establish parameters about the role of enzyme clusters related to the ischemia/reperfusion intestinal injury. METHODS: Twelve male inbred mice (C57BL/6) were randomly assigned: Control Group (CG) submitted to anesthesia, laparotomy and observed by 120min; Ischemia/reperfusion Group (IRG) submitted to anesthesia, laparotomy, 60min of small bowel ischemia and 60min of reperfusion. A pool of six samples was submitted to the qPCR-RT protocol (six clusters) for mouse oxidative stress and antioxidant defense pathways. RESULTS: On the 84 genes investigated, 64 (76.2%) had statistic significant expression and 20 (23.8%) showed no statistical difference to the control group. From these 64 significantly expressed genes, 60 (93.7%) were up-regulated and 04 (6.3%) were down-regulated. From the group with no statistical significantly expression, 12 genes were up-regulated and 8 genes were down-regulated. Surprisingly, 37 (44.04%) showed a higher than threefold up-regulation and then arbitrarily the values was considered as a very significant. Thus, 37 genes (44.04%) were expressed very significantly up-regulated. The remained 47 (55.9%) genes were up-regulated less than three folds (35 genes - 41.6%) or down-regulated less than three folds (12 genes - 14.3%). CONCLUSION: The intestinal ischemia and reperfusion promote a global hyper-expression profile of six different clusters genes related to antioxidant defense and oxidative stress.

OBJETIVO: Determinar o perfil de expressão dos genes associados com estresse oxidativo e contribuir para estabelecer parâmetros sobre o papel das familias de enzimas relacionadas com a lesão de isquemia / reperfusão intestinal. MÉTODOS: Doze camundongos machos isogênicos (C57BL/6) foram distribuídos aleatoriamente: Grupo Controle (CG) submetido à laparotomia anestesia, e observado por 120min; Grupo isquemia/reperfusão (IRG) submetido à anestesia, laparotomia, 60min de isquemia do intestino delgado e 60min de reperfusão. Um pool dos seis camundongos de cada grupo foi submetido ao protocolo de qPCR-RT (seis famílias) para o estresse oxidativo e defesa antioxidante. RESULTADOS: Dos 84 genes investigados, 64 (76,2%) tiveram expressão estatística significante e 20 (23,8%) não apresentaram diferença estatística com o grupo controle. Dos 64 genes expressos de forma significante, 60 (93,7%) foram hiper-expressos e 04 (6,3%) foram hipo-expressos. Do grupo sem expressão estatisticamente significante, 12 genes foram hiper e 8 genes foram hipo-expressos. Surpreendentemente, 37 (44,04%) apresentaram expressão três maior que o limiar de normalidade e arbitrariamente os valores foram considerados como altamente significantes. Assim, 37 genes (44,04%) foram hiper-expressos de modo muito significante. Nos demais, 47 (55,9%) dos genes foram hiper-expressos menos de três vezes (35 genes - 41,6%) ou hipo-expressos menos de três vezes(12 genes - 14,3%). CONCLUSÃO: A isquemia e reperfusão intestinal promoveu um perfil de hiper-expressão global das seis familias de genes relacionados com estresse oxidativo antioxidante e defesa antioxidante.

Incomplete small bowel obstruction caused by idiopathic diaphragm disease of the proximal ileum

Diaphragm disease is a rare pathology and describes the phenomenon of circumferential, concentric mucosal lesions of the bowel which can cause progressive narrowing of the bowel lumen and bowel obstruction. The etiology in significant majority of cases is previous or concurrent ingestion of non-steroidal anti-inflammatory drugs [NSAID]. A 55-year-old Caucasian man with no history of prior ingestion of NSAID presented with a three week history of progressive abdominal pain, distension and subsequent absolute constipation. He failed a trial of conservative management and subsequently underwent a laparotomy and small bowel resection for small bowel obstruction. Histopathological analysis revealed diaphragm disease of the small bowel. This case emphasizes the complexities in the management of patients with incomplete small bowel obstruction and highlights the possibility of diaphragm disease of the bowel in the absence of known risk factors