Effect of Obesity and/or Ligature-induced Periodontitis on Aortic Wall Thickness in Wistar Rats / Efeito da obesidade e/ou periodontite induzida por ligadura na espessura da parede da aorta em ratos wistar

ABSTRACT The purpose of this study was to evaluate aortic wall thickness after periodontal disease and/or obesity induction in a Wistar rat model. Sixty male Wistar rats were randomly divided into four groups: control (CT), periodontal disease (PD), obesity (OB), and obesity plus periodontal disease (OB+PD). Groups OB and OB+PD received cafeteria diet for 17 weeks. After they had acquired obesity (week 12), periodontal disease was induced by placing a silk ligature on the maxillary right second molar of groups PD and OB+PD. During the experimental period, body weight and Lee index were assessed. Mean alveolar bone loss (ABL) was evaluated, and aortas were prepared for histometric analysis of the aortic wall by ImageJ software. Body weight and Lee index increased in rats exposed to cafeteria diet. Mean ABL was higher in Groups PD and OB+PD than in control and OB (p<0.05). ABL was 18% higher in Group OB+PD than in Group PD, with statistically significant difference (p<0.001). Aortas were thicker in Groups OB and OB+PD than in control and PD groups, respectively (2.31mm ± 0.28 and 2.33 ± 0.29 vs. 2.18 ± 0.26 and 2.14 ± 0.27). Group OB differed significantly from the control group (p=0.036), and OB+PD and OB differed significantly from PD (p=0.004 and p= 0.001, respectively). Obesity alters aortic wall thickness in Wistar rats. However, the presence of periodontal disease did not affect the aortic wall thickness under the conditions of the present study.

RESUMO O objetivo deste estudo foi avaliar a espessura da parede da aorta após modelos de indução de doença periodontal e/ou obesidade em ratos Wistar. Sessenta ratos Wistar machos foram aleatoria mente divididos em quatro grupos: controle (CT), doença periodontal (DP), obesidade (OB), obesidade mais doença periodontal (OB+DP). Os grupos OB e OB+DP rece beram dieta de cafeteria por 17 semanas. Após de adquirirem obesidade, (semana 12), doença periodontal foi induzido pela colocação de ligaduras de seda no segundo molar superior direito dos grupos DP e OB+DP. Durante o período experi mental, o peso corporal e índice de Lee foram obtidos. Média de perda óssea alveolar (POA) foi avaliada e as aortas preparadas para análise histométrica da parede aórtica (em mm) pelo software ImageJ. Ratos expostos a dieta de cafeteria demonstraram um aumento do peso corporal e do índice de Lee. Uma POA media maior foi observada nos grupos DP e OB+DP comparado aos grupos controle e OB (p<0.05). O grupo OB+DP, quando comparado ao grupo DP, apresentou POA 18% maior e essa diferença foi estatisticamente significativa (p<0.001). Os grupos OB e OB+DP exibiram uma espessura de aorta maior comparado aos grupos DP e controle, respectivamente (2.31 ± 0.28 e 2.33 ± 0.29 vs. 2.18 ± 0.26 e 2.14 ± 0.27). Diferenças significativas foram observadas nas comparações dos grupos OB e controle (p=0,036), e OB+DP e OB comparado ao grupo DP (p=0.004 e p= 0.001, respectivamente). A obesidade parece afetar a espessura da parede da aorta em ratos Wistar. Entretanto, a presença de doença periodontal não afetou a espessura da parede da aorta sob as condições do presente estudo.

Sangrado tardío luego de tratamiento con macroligadura elástica de hemorroides / Late bleeding after hemorrhoid treatment with rubber macroband ligation

Objetivo: Presentar el caso infrecuente de sangrado tardío posterior al tratamiento con macroligadura elástica de hemorroides, tratamiento propuesto por A. Reis Neto. Caso Clínico: Mujer de 26 años con tratamiento de hemorroides con macroligadura elástica. A los 28 días es admitida en urgencia por proctorragia abundante sin signos de shock hipovolémico. Laboratorio: Hematocrito 27%, Hemoglobina 8,9 mg/dl. Se realiza colonoscopia evidenciando la cicatriz de macroligadura con signos de coágulo desprendido sin sangrado activo. Se decide conducta expectante con tratamiento de la hipovolemia incial y anemia. Evoluciona sin resangrado con control endoscópico a los 60 y 180 (sin sangrado y excelentes resultados). Discusión: La macroligadura es una técnica alternativa para el tratamiento de hemorroides con excelentes resultados anatómicos y funcionales. Presenta menor dolor postoperatorio, bajo índice de complicaciones (ninguna severa o propia del método). No existen comunicaciones sobre sangrado tardío grave tanto en ligaduras convencionales como macroligadura. Conclusiones: Se presenta el primer caso comunicado a la fecha de un sangrado tardío en macroligaduras que fue resuelto en forma conservadora.

Objetive: To present an infrequent clinical report of a case of late bleeding after rubber macroband ligation. Case report: A 28-year-old female with severe rectal bleeding but no associated shock was presented 28 days after rubber macroband ligation at emergency room. Blood samples showed acute anemia. An urgent colonoscopy was performed which showed a scar without acute bleeding. Medical treatment was settled. There was no secondary bleeding in follow up. Endoscopic control was done at 60 and 180 days. Discusion: Hemorrhoidal rubber macroband ligation is a modification of conventional rubber band ligation. It was proposed and developed by J.A. Reis Neto (Campinas, SP, Brazil). Morbidity is low and results are excellent. There is no previous report of delayed bleeding considering both rubber band and macroband ligation. Conclusion: The First case of late bleeding after rubber band ligation treated with conservative measures.

Complicaciones infecciosas graves luego de la ligadura con banda elástica para hemorroides: reporte de un caso y revisión de la literatura / Acute infectious complications after ligation with elastic band for hemorrhoids: a case report and literature review

Introducción: La ligadura con banda elástica es un procedimiento efectivo y de bajo costo, para el manejo de hemorroides grado I-III, que no requiere internación. Sus complicaciones, cuando presentes, son habitualmente leves. Aunque poco comunes, existen complicaciones graves asociadas a este procedimiento. El objetivo de este estudio es realizar una revisión de las complicaciones infecciosas pelvi-perineales de la ligadura con banda elástica, características comunes de presentación y alternativas de tratamiento en aquellos que sufren estas complicaciones. Descripción del caso: Se expone el caso de un hombre de 71 años de edad que presentó una sepsis pelviana severa posterior a la realización de una ligadura con banda elástica. A las 48 horas del procedimiento consulta por dolor perianal, dificultad miccional y fiebre. Se realiza el drenaje quirúrgico de ambas fosas isquiorrectales, luego de lo cual intercurre con shock séptico, realizándose una laparotomía, drenaje de retroperitoneo, colostomía sigmoidea. Posteriormente, debido al desarrollo de un síndrome compartimental abdominal, el abdomen se dejó abierto y contenido con una malla. Discusión: Se han descripto complicaciones sépticas posteriores a escleroterapia y crioterapia hemorroidal, ligadura con banda elástica, hemorroidectomia convencional y con sutura mecánica. Se exponen 20 casos de sepsis pelviana post-ligadura con banda elástica. La relación hombre:mujer fue de 3:1, con un amplio rango de edad (27-82 años). Sólo 2 tenían antecedentes de inmunosupresión. La progresión o la persistencia del dolor asociado a fiebre, dificultad miccional, edema perineal y/o genital fueron signos y síntomas comunes que se manifestaron dentro de los 14 días posteriores a la ligadura. Tal como en el caso aquí referido como en otros ya publicados, la realización de imágenes ayudó al diagnóstico y a la planificación quirúrgica. Todos recibieron antibioticoterapia de amplio espectro y 13 requirieron además cirugía. El espectro de tratamientos quirúrgicos fue desde el drenaje incisional hasta la amputación rectal. Ante la progresión del cuadro séptico, la realización de una ostomía fue la conducta más usual. Cinco pacientes requirieron más de una cirugía, y 8 fallecieron. Conclusión: Es importante conocer las complicaciones infecciosas mayores y su presentación clínica, para realizar un diagnóstico y tratamiento precoz de las mismas, con el fin de disminuir su elevada morbilidad o mortalidad. (AU)

Background: Rubber band ligation is an effective, low-cost procedure for grade I-III hemorrhoids, and does not require hospitalization. Its complications, when present, are usually mild. Although rare, there are serious complications associated with this procedure. The purpose of this review was to identify common presenting features and treatment alternatives in those who suffer pelviperineal infectious complications after rubber band ligation. Case Report: The present case is that of a 71-year-old man who presented severe pelvic sepsis after rubber band ligation. He complained of perianal pain, voiding difficulties and fever 48 hours after the procedure. Surgical drainage of both ischiorectal fossae was carried out. He developed septic shock. Laparotomy, retroperitoneal drainage and sigmoid loop colostomy were performed. In a subsequent operation due to abdominal compartment syndrome, the abdomen was left open and contained with a mesh. Discussion: Septic complications have been described after sclerotherapy, cryotherapy, rubber band ligation, conventional hemorrhoidectomy and stapled haemorrhoidopexy. We describe 20 cases of pelvic sepsis after rubber band ligation. The male: female ratio was 3: 1, with a wide age range (27- 82 years). Only 2 had a history of immunosuppression. The progression or persistence of pain associated with fever, voiding difficulties, perineal and / or genital edema were common signs and symptoms that appeared within 14 days after rubber band ligation. In the case here referred to as in others already published, imaging studies helped the diagnosis and surgical planning. All received broad spectrum antibiotic therapy and 13 required surgery. The spectrum of surgical treatments ranged from incisional drainage to rectal amputation. In view of the progression of the septic condition, performing an ostomy was the most usual conduct. Five patients required more than one surgery, and 8 died. Conclusion: It is important to acknowledge the major infectious complications and their clinical presentation, to help with an early diagnosis and treatment, in order to reduce their high morbidity and mortality. (AU)

Ligadura interesfinteriana del trayecto fistuloso (LIFT) como alternativa de tratamiento a una fístula perianal compleja / Ligation of intersphincteric fistula tract (LIFT) as an alternative treatment for complex perianal fistula

Resumen Introducción: Las técnicas quirúrgicas para la fístula perianal compleja han tenido altas tasas de recidiva asociado al riesgo de incontinencia fecal. La técnica de LIFT (Ligadura Interesfintérica del trayecto fistuloso) ha logrado menores tasas de recidiva con casi nulo riesgo de incontinencia según reportes inter-nacionales. Sin embargo, aún no está consolidada como técnica estándar para esta patología. Objetivo: Presentar los resultados (éxito clínico e incontinencia según escala de Wexner) de nuestros pacientes con fístula perianal compleja operados con técnica de LIFT. Materiales y Método: Estudio descriptivo de cohorte prospectiva no aleatoria, con pacientes operados por fístula perianal compleja en el Hospital del Salvador, entre los años 2015 al 2017. Resultados: Se incluyen 22 pacientes operados. En un 77% se obtiene éxito terapéutico en la primera cirugía y hasta un 90% con una segunda cirugía más simple. Ninguno de los pacientes modificó su Wexner preoperatorio. Conclusiones: En pacientes con fístula perianal compleja la técnica de LIFT es una alternativa que ofrece igual o mejores tasas de curación clínica con bajo riesgo de incontinencia fecal.

Introduction: Surgical techniques for complex perianal fistula have high recurrence and fecal incontinence rates. The technique of LIFT (ligation of the intersphincteric fistula tract) has achieved lower rates of recurrence with almost no risk of incontinence according to international reports. However, it is not yet consolidated as a standard technique for this pathology. Objective: To present the results (clinical success and incontinence according to the Wexner scale) of our patients with complex perianal fistula operated with the LIFT technique. Materials and Method: Descriptive study of a non-randomized prospective cohort, with patients operated for complex perianal fistula at the Hospital del Salvador, between 2015 and 2017. Results: 22 operated patients are included. In 77%, therapeutic success is obtained in the first surgery and up to 90% with a second surgery. None of this patients modified their preoperative Wexner. Conclusions: In patients with complex perianal fistula, the LIFT technique is an alternative that offers high cure rates with low risk of fecal incontinence.

Post esophageal variceal band ligation pain, another insult to injury

Objective: To measure and characterize pain in post esophageal variceal band ligation patients

Study Design: Cross sectional observational study

Place and Duration of Study: This study was carried out in Combined Military Hospital Kharian which is a tertiary care hospital, from Dec 2014 to Aug 2015

Material and Methods: All patients of esophageal varices due to any underlying pathology requiring esophageal variceal band ligation [EVBL] were included in this study. Patients unwilling for EVBL were excluded from the study

Their EVBL was done with the help of Upper Gastrointestinal Pentax High definition 90i series Video Endoscope and subsequently they were inquired about the details of pain till next session of banding

Results: Out of 86 patients 63 [73%] were males and 23 [27%] were females. Their mean age was 54 years with SD +/- 12. Pain was present in 47 [54%] patients and 39 [46%] were pain free. It was severe in 3 [7%], moderate in 34 [72%] and mild in 10 [21%] patients. Out of post EVBL pain group 30 [65%] patients experienced pain after first EVBL session, 12 [25%] in subsequent and 5 [10%] after all the sessions

Conclusion: Post EVBL pain is a common complication. Mostly it is mild to moderate in intensity and needs attention in almost half of the patients to relief the suffering

Experimental models of renal dysfunction in female rats. Functional and histological aspects after unilateral nephrectomy or ligation of right renal vein with kidney preservation

ABSTRACT PURPOSE: To compare renal dysfunction after right nephrectomy and ligation of the right renal vein with preservation of kidney. METHODS: Animals' weight, pH, density, protein in urine and histological samples of the kidneys were evaluated. Fifteen female rats (Wistar) were divided into three groups. In the control group, right renal vein dissections were performed. In the second group, the right nephrectomy was performed. In the third group, the right renal vein was ligated and the kidney was preserved. Urine samples were taken before, three and seven days after the procedure. On the seventh postoperative day the kidneys were removed to histopathological study. Analysis by Student's t test was performed. RESULTS: weight loss, alterations of urine pH (p<0.05), in specific gravity, proteinuria (p<0.05) were found in groups 2 and 3; hemorrhagic infarction and edema were found after ligation of the right renal vein; changes in the left kidney were also observed on the seventh day. CONCLUSIONS:.

Avaliação da degradação da força liberada por ligaduras elásticas convencionais e temáticas / Force degradation assessment released by conventional and thematic orthodontic elastic ties

As ligaduras elásticas são consideradas importantes fontes de força na movimentação ortodôntica. No entanto, apresentam a desvantagem de não serem capazes de liberar níveis de forças constantes no meio bucal, por sofrerem alterações em suas propriedades físicas (dimensão, características individuais), prejudicando suas propriedades mecânicas. O objetivo deste trabalho foi avaliar a degradação de força das ligaduras elásticas ortodônticas convencionais e temáticas. Dezoito grupos experimentais foram avaliados (n=10), tendo como fatores em estudo o formato das ligaduras, temática (Orthosource) e convencional (Morelli); o tempo de armazenagem em saliva artificial a 37°C (24 horas e 30 dias) e a cor (vermelho, rosa e azul). Para a determinação da intensidade das forças liberadas, todas as ligaduras elásticas foram distendidas quatro vezes o valor do seu comprimento original (1 mm), em máquina de ensaio universal Instron 5965 à velocidade constante de 5,08 mm/min, sendo a resistência máxima à tração registrada em N. Os dados foram analisados pelos testes Anova e Tukey para comparações entre os grupos (α=0,05). Os resultados demonstraram que a degradação de força após 24 horas foi muito superior nas ligaduras elásticas convencionais (24,09%, 18,90% e 14,45%) do que nas ligaduras temáticas (1,31%, 2,55% e 2,99%) nas cores vermelho, rosa e azul, respectivamente. Após 30 dias, a degradação de força continuou sendo superior nas ligaduras elásticas convencionais (33,20%, 27,23% e 21,87%), embora a degradação nas ligaduras temáticas tenha aumentado drasticamente neste período (11,89%, 15,55% e 18,53%) nas cores vermelho, rosa e azul, respectivamente...

Elastic ties are considered an important source of force for orthodontic movement. However, they present the disadvantage of not being able to release constant force levels overtime in the oral environment due to changes in their physical properties (dimension, individual characteristics) affecting their mechanical properties. The purpose of this study was to evaluate the force degradation of conventional and thematic orthodontic elastic ties. Eighteen experimental groups were evaluated (n=10) having as variables the elastic tie format of two commercial brands, thematic (Orthosource) and conventional (Morelli), the storage time in artificial saliva at 37°C (immediate, 24 hours and 30 days) and color (red, pink and blue). To determine the magnitude of the forces released, all elastic ties were stretched four times their original size (1 mm) in a universal testing machine (Instron 5965) at a constant speed rate of 5.08 mm/min with the tensile strength measured in N. The data were analyzed by Anova and Tukey statistical tests for multiple comparisons among the groups (α=0.05). The results demonstrated that force degradation after 24h was much greater for the conventional (24,09%, 18,90% and 14,45%) than for the thematic elastic ties (1,31%, 2,55% and 2,99%) in red, pink and blue colors, respectively. After 30 days, force degradation continued to be greater with the conventional elastic ties (33,20%, 27,23% and 21,87%) although force degradation with the thematic elastic ties increased dramatically (11,89%, 15,55% and 18,53%) in red, pink and blue colors, respectively...

Hemorroidectomía con Ligasure vs diatermia convencional: análisis retrospectivo monocéntrico / [Ligasure vs conventional diathermy in excisional haemorrhoidectomy: a retrospective study of a single center].

INTRODUCTION: Hemorrhoids are a prolapse of vasculopathic structures that cushion the anal canal and haemorrhoidectomy is the most effective treatment for grades III and IV In this retrospective study we compare the outcome after haemorrhoidectomy with Ligasure or with conventional diathermy. METHODS: From June 2005 to March 2009 we analyzed 75 patients affected by hemorrhoids (grades III and IV) who underwent haemorrhoidectomy in the University Hospital Arnau de Vilanova in Lleida. We evaluated the technique, the age and the sex, and compared the post-operative hospital stay, the post-operative pain and the complications with each of the techniques. RESULTS: We used Ligasure technique in 49 patients (65

) and conventional diathermy technique in 26 (35

). The mean age was 50.3 years. There was no significant difference in both postoperative length ofstay, with an average of2.13 days (P = 0.60), and postoperative pain in the first 15 days (P = 0.275). On the contrary, we found a significant difference in the rate of postoperative complications (P = 0.032) and in the post-surgical pain at one month (P = 0.03). CONCLUSIONS: In our experience the Ligasure haemorrhoidectomy has shown to have fewer complications and post-operative pain when compared with conventional diathermy haemorrhoidectomy.

Spontaneous Healing of Gastric Perforation after Endoscopic Ligation for Gastric Varices

Endoscopic variceal ligation (EVL) can be performed as an optional therapy for gastric variceal bleeding if endoscopic sclerotherapy (ES) is not readily available or if practitioners lack experience. EVL using an endoscopic pneumo-activated ligating device was performed on a 53-year-old male patient with liver cirrhosis who presented with hematemesis. Follow-up esophagogastroduodenoscopy (EGD) performed two days after the EVL showed gastric perforation at the EVL-procedure site on the gastric fundus. However, the patient refused emergency surgery, and therefore received only supportive management, including intravenous antibiotics. EGD 10 days later showed healing of the perforation site. This is the first report of a case of gastric variceal bleeding with development of a gastric perforation soon after EVL, which showed complete recovery with conservative therapy and without surgical intervention.

Esplenectomia e ligadura da veia gástrica esquerda na esquistossomose mansônica: efeitos sobre pressão das varizes do esôfago e indicadores endoscópicos de risco de sangramento por varizes esofagogástricas / Splenectomy and gastric vein ligature in hepatosplenic schistosomiais: effects upon esophageal variceal pressure and endoscopic risk factors of esophageal variceal bleeding

RACIONAL: Expressivo contingente de pacientes esquistossomóticos com a forma hepatoesplênica e hipertensão portal apresentam hemorragia causada pela ruptura de varizes esofagogástricas, principal causa de alta morbidade e mortalidade da doença. OBJETIVO: Investigar os efeitos da esplenectomia e ligadura da veia gástrica esquerda sobre fatores de risco de sangramento por varizes esofagogástricas em portadores de esquistossomose mansônica, forma hepatoesplênica, com antecedente de hemorragia digestiva alta. MÉTODO: Estudaram-se, de forma prospectiva, 34 pacientes, com idade entre 1 e 74 anos (média 44,14), sendo 18 (53%) mulheres. Analisaram-se: 1) pressão das varizes do esôfago, aferida pela técnica endoscópica do balão pneumático; 2) tamanho, local, cor e sinais de cor vermelha nas varizes do esôfago; 3) varizes gástricas e gastropatia da hipertensão portal. Realizaram-se avaliações no pré-operatório, no pós-operatório imediato e no sexto mês após a ligadura da veia gástrica esquerda. RESULTADOS: A pressão das varizes do esôfago diminuiu de 22,3+/-2,6 mmHg, antes da operação, para 16,0+/-3,0 mmHg no pós-operatório imediato (p<0,001), caindo para 13,3+/-2,6 mmHg no pós-operatório do sexto mês (p<0,001). A proporção de varizes de grosso calibre, varizes no esôfago superior, varizes de cor azul, varizes com sinais de cor vermelha e de gastropatia da hipertensão portal decresceu de forma significante apenas no sexto mês de pós-operatório. CONCLUSÃO: A ligadura da veia gástrica esquerda, em esquistossomóticos hepatoesplênicos, com antecedente de hemorragia digestiva alta, revelou-se eficaz em diminuir alguns dos principais fatores de risco de hemorragia por varizes esofagogástricas, indicando boa perspectiva no controle definitivo do sangramento.

BACKGROUND: A significant number of patients with schistosomiasis develop the hepatosplenic form, with portal hypertension, in which bleeding caused by rupture of esophagogastric varices emerged as the leading cause of morbidity and mortality. AIM: To investigate the effects of splenectomy and ligature of the left gastric vein on risk factors for bleeding of esophagogastric varices in patients with schistosomiasis mansoni, hepatosplenic form, with a history of upper gastrointestinal bleeding. METHODS: The main risk factors of bleeding from esophagogastric varices were studied in 34 patients. The following parameters were investigated: 1) esophageal variceal pressure, measured by the endoscopic pneumatic balloon technique; 2) size, fundamental color, extension and red signs of esophageal varices, gastric varices and gastropathy of portal hypertension. The evaluations were performed in the preoperative period, immediate postoperative period (between the sixth and eighth postoperative days) and the sixth month of follow-up. RESULTS: The variceal pressure has fallen from 22.3+/-2.6 mmHg before surgery to 16.0+/-3.0 mmHg in the immediate postoperative period (p<0.001), reaching 13.3+/- 2.6 mmHg in the sixth month of follow-up. A significant reduction of the frequency of the parameters associated with a greater risk of hemorrhage was observed between the preoperative period and six-month follow-up, when the proportion of large esophageal varices (p<0.05), varices extending to the upper esophagus (p<0.05), bluish varices (p<0.01), varices with red signs (p<0.01) and gastropathy (p<0.05) decreased. CONCLUSION: In patients with hepatosplenic schistosomiasis with a previous history of variceal hemorrhage, splenectomy and gastric vein ligation was effective in reducing the main hemorrhagic risk factors until the sixth month of follow-up, indicating a good way to control the bleeding episodes.

Prospective study of bacteremia rate after elective band ligation and sclerotherapy with cyanoacrylate for esophageal varices in patients with advanced liver disease / Estudo de bacteriemia relacionada à ligadura elástica versus injeção de cianocrilato para varizes esofágicas em pacientes com doença hepática avançada

CONTEXT: Band ligation (BL) is the most appropriate endoscopic treatment for acute bleeding or prophylaxis of esophageal variceal bleeding. Sclerotherapy with N-butyl-2-cyanoacrylate (CY) can be an alternative for patients with advanced liver disease. Bacteremia is an infrequent complication after BL while the bacteremia rate following treatment with CY for esophageal varices remains unknown. OBJECTIVES: To evaluate and compare the incidence of transient bacteremia between cirrhotic patients submitted to diagnostic endoscopy, CY and BL for treatment of esophageal varices. METHODS: A prospective study comprising the period from 2004 to 2007 was conducted at Hospital of Universidade Federal de São Paulo, UNIFESP, SP, Brazil. Cirrhotic patients with advanced liver disease (Child-Pugh B or C) were enrolled. The patients were divided into two groups according treatment: BL Group (patients undergoing band ligation, n = 20) and CY Group (patients receiving cyanoacrylate injection for esophageal variceal, n = 18). Cirrhotic patients with no esophageal varices or without indication for endoscopic treatment were recruited as control (diagnostic group n = 20). Bacteremia was evaluated by blood culture at baseline and 30 minutes after the procedure. RESULTS: After 137 scheduled endoscopic procedures, none of the 58 patients had fever or any sign suggestive of infection. All baseline cultures were negative. No positive cultures were observed after CY or in the control group - diagnostic endoscopy. Three (4.6 percent) positive cultures were found out of the 65 sessions of band ligation (P = 0.187). Two of these samples were positive for coagulase-negative staphylococcus, which could be regarded as a contaminant. The isolated microorganism in the other case was Klebsiella oxytoca. The patient in this case presented no evidence of immunodeficiency except liver disease. CONCLUSIONS: There was no significant difference in bacteremia rate between these three groups. BL or CY injection for non-bleeding esophageal varices may be considered as low-risk procedures regarding bacteremia even when performed on patients with advanced liver disease.

CONTEXTO: A ligadura elástica é considerada o melhor tratamento endoscópico para o sangramento agudo por varizes esofágicas ou para profilaxia do sangramento varicoso, sendo a escleroterapia com N-2-butil-cianoacrilato uma alternativa para os pacientes com doença hepática avançada e distúrbio de coagulação. Bacteriemia é uma complicação rara associada à ligadura elástica, por outro lado, a incidência de bacteriemia relacionada com o uso de N-2-butil-cianoacrilato permanece desconhecida. OBJETIVOS: Avaliar e comparar a incidência de bacteriemia transitória entre os pacientes cirróticos submetidos a endoscopia digestiva alta diagnóstica, escleroterapia com N-2-butil-cianoacrilato ou ligadura elástica para tratamento das varizes esofágicas. MÉTODOS: Estudo prospectivo realizado entre 2004 e 2007 foi conduzido no Hospital da Universidade Federal de São Paulo, UNIFESP, Brasil. Cirróticos com doença hepática avançada (Child B ou C) foram incluídos. Os pacientes foram divididos em dois grupos de acordo com o tratamento: grupo ligadura elástica (pacientes submetidos a ligadura elástica, n = 20) e grupo N-2-butil-cianoacrilato (pacientes submetidos a injeção de N-2-butil-cianoacrilato, n = 18). Cirróticos sem varizes esofágicas ou com varizes esofágicas sem indicação de tratamento endoscópico foram recrutados como controles (grupo endoscopia diagnóstica, n = 20). Bacteriemia foi avaliada por hemocultura basal e 30 minutos após o procedimento. RESULTADOS: Dos 137 procedimentos endoscópicos realizados, nenhum dos 58 pacientes apresentou febre ou qualquer sinal sugestivo de infecção. Todas as hemoculturas de base foram negativas. Nenhuma cultura positiva foi observada após o uso de N-2-butil-cianoacrilato ou no grupo controle. Três (4,6 por cento) culturas positivas foram encontradas após as 65 sessões de ligadura elástica (P = 0,187). Duas dessas foram positivas para Staphylococcus coagulase-negativo, provavelmente relacionadas à contaminação. O microorganismo isolado no terceiro caso foi Klebsiella oxytoca. Nesse caso, o paciente apresentava a própria doença hepática como única situação relacionada à imunodeficiência. CONCLUSÕES: Não houve diferença significante na incidência de bacteriemia entre os três grupos de pacientes. Ligadura elástica ou injeção de N-2-butil-cianoacrilato para profilaxia do sangramento varicoso podem ser considerados procedimentos de baixo risco quanto ao surgimento de bacteriemia, mesmo em pacientes com doença hepática avançada.

Methodological model of chronic stress associated with ligature-induced periodontitis in rats: a radiographic study

This study evaluated the time efficiency of stress associated with ligature-induced periodontitis in rats. Sixty adult Wistar rats, housed in temperature-controlled rooms and receiving water and food ad libitum, were randomly separated into stress (n = 30) or control groups (n = 30). All animals were anesthetized, and nylon ligatures were placed at the gingival margin level of the maxillary right second molars. After the induction of periodontitis, rats in the stress group were subjected to physical restraint for 12 hours daily. The animals were euthanized after 7, 15 and 30 days by anesthetic overdose (10 animals per group per period). The right hemimaxillae were stored in formalin solution for 48 hours. Parallel radiographic images of the hemimaxillae were taken and processed following standard procedures. Radiographic examination was performed by a blinded and previously calibrated investigator. Bone height level was measured, and data were submitted to analysis of variance and post hoc Bonferroni tests (p < 0.05). Rats in the stress group had greater bone loss than those in the control group at 7 and 15 days post-induction (p < 0.05). After 30 days, there was no statistically significant difference between the groups (p > 0.05). Restraint stress modulates the short-term progression of periodontal disease in rats. Therefore, the 12-hour daily physical restraint stress model in rats applied for up to 15 days is suitable for the investigation of the combined effect of ligation and restraint stress on periodontal degradation.

Percentual de degradação das forças liberadas por ligaduras elásticas / Force decay rate of orthodontic elastomeric ligatures

OBJETIVO: avaliar ligaduras elásticas da marca Morelli, dos tipos modular e bengala, nas cores cinza e cristal para determinação do percentual de degradação das forças geradas pelas mesmas. METODOLOGIA: as ligaduras elásticas foram estiradas em estiletes de aço inoxidável com diâmetro de 4mm, imersas em solução de saliva artificial a 37ºC, sendo a intensidade das forças liberadas medidas nos tempos de zero hora, 24 horas, 1 semana, 2 semanas, 3 semanas e 4 semanas, em máquina de ensaios de tração. RESULTADOS E CONCLUSÕES: as ligaduras do tipo bengala liberaram, em média e no período de 4 semanas, maior intensidade de força que as do tipo modular. O percentual de degradação das forças liberadas por todas as ligaduras aumentou de forma acentuada entre zero e 24 horas e de forma gradativa após este período, com exceção do 28º dia quando, provavelmente, houve perda das propriedades elásticas das ligaduras. Não foi observado um comportamento constante das ligaduras bengala e modular em relação às cores cinza e cristal.

PURPOSE: to evaluate gray and clear module and cane-loaded elastomeric ligatures of the brand Morelli to determine the percentage of decay of the forces they deliver. METHODS: the elastomeric ligatures were stretched over 4mm diameter stainless steel dowels and placed in synthetic saliva bath at 37ºC. The intensity of the forces delivered were taken at start, after 24 hours, one week, two weeks, three weeks and four weeks at a tensile test machine. RESULTS AND CONCLUSIONS: the cane-loaded ligatures delivered, in a period of 4 weeks, in average, greater force intensity than the modules. The percentage of force decay of all ligatures increased rapidly between zero and 24 hours and gradually after that period, except for the 28th day, when probably there was a loss of elastic properties of the ligatures. The researchers did not note any constant behavior in the cane-loaded and module ligatures in relation to the colors: gray and clear.

Rubber band ligation and infrared photocoagulation for the outpatient treatment of hemorrhoidal disease

PURPOSE: To compare the results of rubber band ligation and infrared photocoagulation for the treatment of hemorrhoidal disease through the analysis of the incidence of complications after each treatment and respective success rate. METHODS: Forty-eight patients with first, second or third degree hemorrhoidal disease were randomized to recieve treatment with either rubber band ligation (n=23) or infrared photocoagulation (n=25). Each patient was assessed at 1 week and 4 week intervals after treatment. We compared the incidence of complications and efficiency of each treatment modality and Qui-square, Fisher's Exact Test and Student's t Test were used to statistical analysis. RESULTS: Bleeding occured in eigth (34,7 percent) patients treated with rubber band ligation and in four (16,0 percent) after infrared photocoagulation (p=0,243). Thirteen (52,0 percent) patients felt pain during infrared photocoagulation and 9 (39,1 percent) after rubber band ligation (p=0,546). After rubber band ligation, 14 (60,8 percent) required medication for pain relief. One patient (4,0 percent) required medication after infrared photocoagulation (p<0,001). Three (13,0 percent) patients treated with rubber band ligator and 1 (4,0 percent) treated with infrared photocoagulation had symptomatic mucosal ulcers. Perianal dermatitis occured in two (8,0 percent) patients treated with infrared photocoagulation and one patient (4,3 percent) was observed to have prolapsed thrombosed piles after rubber band ligation. One month after treatment, 17 of 23 patients treated with rubber band ligation (73,9 percent) and 18 of 25 patients treated with infrared photocoagulation were asymptomatic. Rubber band ligation treated bleeding and prolapse in 90,0 percent and 82,4 percent respectively. Infrared photocoagulation treates bleeding and prolapse in 93,7 percent and 87,5 percent respectively. Those differences are not significant. CONCLUSION: Rubber band ligation causes significantly...

OBJETIVO: Comparar os resultados da ligadura elástica com os da fotocoagulação com radiação infravermelha no tratamento da doença hemorroidária através da análise de suas respectivas morbidades e eficácia. MÉTODOS: Foi realizado ensaio clínico casualisado com 48 pacientes portadores de doença hemorroidária graus I, II e III. Após randomização, os pacientes foram submetidos à ligadura elástica (n=23) ou fotocoagulação com radiação infravermelha (n=25). Os pacientes compareceram para consulta ambulatorial 1 semana e 4 semanas após o procedimento. A avaliação foi feita através da análise da incidência de morbidades após cada procedimento e eficácia, com quatro semanas de acompanhamento. As análises estatísticas foram realizadas através do teste do Qui-quadrado, Teste Exato de Fisher e Teste t de Student. RESULTADOS: Dos pacientes submetidos à ligadura elástica, 34,7 por cento (8/23) apresentou sangramento após o procedimento. Após fotocoagulação, 16,0 por cento (4/25) tiveram sangramento (p=0,243). A incidência de pacientes com dor no momento da aplicação do procedimento foi de 52,0 por cento (13/25) após fotocoagulação com radiação infravermelha e 39,1 por cento (9/23) após ligadura elástica (p=0,546). No entanto, ligadura elástica foi mais dolorosa após 48 horas do procedimento (p=0,044). Após ligadura elástica, 60,8 por cento (14/23) dos pacientes necessitaram de analgésicos contra 4,0 por cento (1/25) após fotocoagulação com radiação infravermelha (p<0,001). Um paciente submetido à ligadura elástica (4,3 por cento) evoluiu com trombose dos mamilos ligados. Três pacientes submetidos à ligadura elástica (13,0 por cento) e 1 (4,0 por cento) submetido à fotocoagulação com radiação infravermelha apresentaram úlceras sintomáticas após a aplicação dos tratamentos. Dois pacientes (8,0 por cento) submetidos à fotocoagulação com radiação infravermelha tiveram dermatite perianal. Em relação aos resultados terapêuticos 73,9 por cento dos pacientes...

effect of proton pump inhibitors on post endoscopic variceal band ligation complications

The study was done to evaluate the effect of proton pump inhibitors on the complications of variceal band ligation [EVL] and ulcer formation. It was conducted on 46 patients with esophageal varices [EV] asking for secondary prevention. Patients were randomly classified into group I of 22 patients received PPI [pantoprazole 40 mg] and group II of 24 patients received Placebo. Band ligation was done to all patients. Patients contacted after one week to assess for complications and adverse reactions. They re-endoscoped after 2 weeks and at that time the size and number of formed ulcer, chest pain and dysphagia all were assessed. EVL has a greater efficacy and fewer side effects for eradication of large EV with decrease in size and extent of varices. Post band ligation ulcer formation is of low incidence and risk. There is no significant difference in the number [13:15] or the size of the formed ulcer [4.8mm:5.6mm] between the two groups. The post band ligation rebleeding were more in group II than group I. Band ligation has no harmful effect on fundal varices or congestive gastropathy. Post band ligation administration of PPI has no significant effect on post band ulcer formation but associated with low risk of rebleeding

Iatrogenic injury to the internal iliac vein: a life threatening complication of internal iliac artery ligation

Bilateral internal iliac artery ligation is an invaluable tool in the management of obstetric haemorrhage. However complications could occur and if not properly managed it could result in morbidity or even mortality. We report a case of iatrogenic injury to the left internal iliac vein during internal iliac artery ligation for severe post partum haemorrhage following Abruptio Placentae, which was successfully managed and the patient did well post operatively

Macroligaduras hemorroidales. Un nuevo concepto / Hemorrhoidal macroligations. A new concept

Introducción: El tratamiento alternativo de las hemorroides comprende una amplia variedad de procedimientos. Entre ellos se destaca por multiples ventajas las ligaduras elásticas convencionales. Surge un nuevo concepto, tal es la aplicación de las macroligaduras hemorroidales altas. Objetivo: Analizar los resultados, morbilidad y recidiva de la enfermedad hemorroidal interna sintomática tratada con macroligaduras altas. Diseño: Estudio prospectivo no randomizado. Pacientes y Métodos: Entre abril de 2005 y mayo de 2006, en una institución privada y un hospital universitario se evaluaron los pacientes tratados por enfermedad hemorroidal grado III o IV sintomática. Exclusión: enfermedad anoperineal asociada, tratamiento alternativo o quirúrgico previo o concomitante. Se registraron las complicaciones inmediatas y alejadas y la recidiva de los síntomas. Resultados: Fueron 236 pacientes ambulatorios (170 varones y 66 mujeres). Se trataron 3 paquetes hemorroidarios en el 66,1 por ciento. Se realizó sólo una sesión en 211 casos. En 4 casos se registró disconfort leve, 9 pacientes tuvieron dolor moderado y 2 casos requirieron analgésicos vía parenteral. En 69 casos hubo tenesmo rectal y en el 82 por ciento hemorragia durante la evacuación. En 2 pacientes (0,8 por ciento) se registró una hemorragia con necesidad de internación pero sin necesidad de transfusión. Otras complicaciones: 4 hematomas perianales, 3 trombosis y 1 tromboflebitis local. Sólo el 3,4 por ciento requirió de la resección local de plicomas previos. Hubo recidiva en el 6,3 por ciento, todos tratados con una nueva sesión de macroligadura. No se registró ninguna hemorragia ni dolor intenso o infección. Seguimiento mínimo: 12 meses. Conclusión: El procedimiento propuesto tiene baja morbilidad y no presenta complicaciones severas. El índice de recidiva de los síntomas es bajo y puede ser tratado nuevamente con el mismo método. Son necesarios estudios comparativos con otras técnicas para establecer su in...

Evolução de 31 crianças submetidas à ressecção bilateral das glândulas submandibulares e ligadura dos ductos parotídeos para controlar a sialorréia / Drooling: analysis and evaluation of 31 children who underwent bilateral submandibular gland excision and parotid duct ligation

OBJETIVOS: Avaliar a segurança da ressecção bilateral das glândulas submandibulares e ligadura dos ductos parotídeos em crianças para reduzir a saliva, a eficácia e as complicações em médio e longo prazo no tratamento da sialorréia. FORMA DE ESTUDO: Coorte longitudinal. MATERIAL E MÉTODO: Trinta e uma crianças, com idades entre 6 e 13 anos (média de 7,6 anos), com múltiplas deficiências de etiologia neurológica foram submetidas à ressecção bilateral das glândulas submandibulares e ligadura dos ductos parotídeos, para controle da sialorréia, entre dezembro de 1999 a dezembro de 2005, e seguimento médio de 36 meses. RESULTADOS: O critério de sucesso foi o estabelecido por Wilkie, e 87 por cento das crianças tiveram resultados excelentes e bons, sendo a morbidade insignificante e a principal complicação foi o edema temporário na região parotídea. CONCLUSÃO: A ressecção bilateral das glândulas submandibulares e a ligadura dos ductos parotídeos constituem técnica segura e eficaz para ser realizada em crianças, com 87 por cento de sucesso no controle da sialorréia.

AIM: To evaluate the safety of bilateral submandibular gland excision and parotid duct ligation in order to control drooling in children; to assess its long-term efficacy and complications. STUDY DESIGN: longitudinal cohort. MATERIALS AND METHODS: Thirty-one children aged 6 to 13 years (7.6 years old in average), with multiple neurological disabilities were submitted to a bilateral submandibular gland excision with parotid duct ligation in order to control ptyalism between December 1999 and December 2005, mean follow up of 36 months. RESULTS: According to WilkieÆs success criteria, 87 percent of children had excellent or good results and insignificant morbidity was insignificant; with temporary parotid edema as the major complication. CONCLUSION: Bilateral submandibular gland excision with parotid duct ligation were safe to be performed in children, with 87 percent of success in drooling control.

effect of portal vein branch plus heterochronous hepatic artery branch ligation on liver regeneration [Experimental study]

The proliferative capacity of non-ligated liver lobes was designned experimental study on dogs in which portal vein and hepatic artery ligation was done either simultaneously or heterochronously. Dogs were divided into four groups: G I [control G]; laparotomy was performed without vascular ligation, G II; dogs were subjected to ligation of the right lateral and median branches of portal vein alone, G III, dogs were subjected to hepatic artery branches ligation 48h after portal vein branches ligation. G IV, dogs were subjected to ligation of the same branches of the portal vein and hepatic artery simultaneously. Dogs from each group were subjected to a liver biopsy before and 24, 48, 72, and 168h [one week] after surgery. Standard serum liver functions were tested before ligation, 72 hs and one week after ligation. Hepatic regeneration in the non-ligated lobe was assessed through histopathological study, DNA quantitation of the hepatic nuclei by the computerized image analysis system and estimation of proliferation marker in hepatic tissue. In this study, the labeling index of the nuclear factor NF Kappa B [PI05], a novel monoclonal antibody specific for PI05 protein, was determined immunohistochemically. Results showed induction of the NK kappa B [P105] labeling index showed maximum levels G III. Quantitative determination of serum glutamicoxaloacetate transaminase [GOT] showed peak levels in G IV at 24h after surgery. Our finding for this index that heterochronous partial portal vein and hepatic artery ligation [i.e., G III] is effecttive, because this procedure leads to an increase in the compensatory hypertrophy of the nonligated liver lobes that depends on the regenerative capacity of the lobes themselves. In contrast, in G IV [i.e., synchronous ligation of portal vein and hepatic artery branches] liver regeneration did not occur due to the severe systemic damage induced by infectious necrosis in the ligated lobe. The serial changes in liver function in G III indicate that the use of this technique may minimize dysfunction in the remaining hypertrophied liver lobes, similar to findings in G II. So, the PVBL plus heterochronous HABL procedure is safer and more effective than PVBL alone, or PVBL plus simultaneous HABL. A better knowledge of the events following such heterochronous ligation should improve the clinical outcome of hepatic resection for liver diseases