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2.
Rev. méd. Urug ; 37(supl.1): s43-s43, jun. 2021.
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1361663
3.
Rev. cuba. cir ; 60(2): e989,
Article in Spanish | LILACS, CUMED | ID: biblio-1280220

ABSTRACT

Introducción: El cáncer de colon constituye un grave problema sanitario debido a su alta incidencia y mortalidad. Objetivo: Describir algunos aspectos epidemiológicos, etiopatogénicos, diagnósticos, terapéuticos y evolutivos del cáncer de colon con metástasis hepáticas. Métodos: Revisión documental en bases de datos bibliográficos biomédicas sobre el tema durante el período 2015-2020. Se seleccionaron 31 artículos relacionados con el objetivo propuesto. Desarrollo: Los pacientes con cáncer de colon con metástasis hepáticas sincrónicas son tratados mediante tres estrategias: la tradicional o clásica consiste en la resección quirúrgica del tumor primario y posteriormente, quimioterapia, radioterapia o ambas, para proceder a la resección de las lesiones hepáticas tres a seis meses después; la simultánea, consistente en la resección de la lesión tumoral primaria y de las metástasis hepáticas en un mismo acto quirúrgico, seguida de quimioterapia, radioterapia o ambas y la inversa, que administra de tres a seis ciclos de quimioterapia sistémica, seguidos por la resección de las metástasis hepáticas y en un segundo tiempo resecar el tumor primario, todo esto con quimioterapia durante el intervalo entre ambas cirugías. Conclusiones: El único tratamiento con potencial curativo en los pacientes con metástasis hepáticas debe ser la resección de todo el volumen tumoral hepático con márgenes adecuados y la suficiente preservación del parénquima sano (25 - 30 por ciento), según criterios oncológicos y anatómicos establecidos, lo que incide en la calidad de vida y la supervivencia de estos enfermos(AU)


Introduction: Colon cancer is a serious health concern due to its high incidence and mortality. Objective: To describe some epidemiological, etiopathogenic, diagnostic, therapeutic and evolutionary aspects of colon cancer with hepatic metastases. Methods: Documentary review about the subject carried out in biomedical bibliographic databases, during the period 2015-2020. Thirty-one articles related to the proposed objective were selected. Development: Colon cancer patients with synchronous hepatic metastases are treated using three strategies: the traditional, or classic, strategy consists in surgical resection of primary tumor and, subsequently, chemotherapy, radiotherapy or both, before proceeding then to resection of liver lesions three to three six months later; the simultaneous strategy consists in resection of primary tumor lesion and hepatic metastases in the same surgical procedure, followed by chemotherapy, radiotherapy or both; and the reverse strategy, in which three to six cycles of systemic chemotherapy are administered, followed by resection of hepatic metastases and, in a second stage, resection of primary tumor, all this with chemotherapy during the interval between both surgeries. Conclusions: The only treatment with curative potential in patients with hepatic metastases should be the resection of the entire hepatic tumor volume with adequate margins and sufficient preservation of the healthy parenchyma (25-30 percent), according to established oncological and anatomical criteria, which has an incidence on the quality of life and survival of these patients(AU)


Subject(s)
Humans , Quality of Life , Databases, Bibliographic , Colonic Neoplasms/surgery , Colonic Neoplasms/epidemiology , Neoplasm Metastasis/therapy , Survivorship , Liver/injuries
4.
Article in English | WPRIM | ID: wpr-921368

ABSTRACT

OBJECTIVES@#To investigate the effect of peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α) on liver injury induced by periodontitis in rats.@*METHODS@#Twenty-four male Wistar rats were randomly divided into two groups: control group and periodontitis group, twelve per group. In periodontitis group, the periodontitis models were established for the maxillary first molars in rats by means of "wire ligation+vaccinationwith @*RESULTS@#The probing depth, tooth mobility and sulcus bleeding index in periodontitis group were significantly higher than that in control group. HE staining showed in periodontitis group, hepatic cords ranged disorderly and there were vacuoles in cells and inflammatory cells infiltrated in liver tissues of rats, and there was no obvious abnormality in control group. The qRT-PCR results showed that the mRNA expression levels of @*CONCLUSIONS@#PGC-1α may be involved in the process of periodontitis-induced liver injury in rats.


Subject(s)
Animals , Liver/injuries , Male , PPAR gamma , Periodontitis/pathology , Rats , Rats, Wistar
5.
Rev. Col. Bras. Cir ; 48: e20202784, 2021. tab
Article in English | LILACS | ID: biblio-1155372

ABSTRACT

ABSTRACT Objective: the aim of this study was to identify associated factors with the increased length of hospital stay for patients undergoing surgical treatment for liver trauma, and predictors of mortality as well as the epidemiology of this trauma. Methods: retrospective study of 191 patients admitted to the Cajuru University Hospital, a reference in the treatment of multiple trauma patients, between 2010 and 2017, with epidemiological, clinicopathological and therapeutic variables analyzed using the STATA version 15.0 program. Results: most of the included patients were men with a mean age of 29 years. Firearm injury represents the most common trauma mechanism. The right hepatic lobe was injured in 51.2% of the cases, and hepatorraphy was the most commonly used surgical correction. The length of hospital stay was an average of 11 (0-78) days and the length of stay in the intensive care unit was 5 (0-52) days. Predictors for longer hospital stay were the mechanisms of trauma, hemodynamic instability at admission, number of associated injuries, degree of liver damage and affected lobe, used surgical technique, presence of complications, need for reoperation and other surgical procedures. Mortality rate was 22.7%. Conclusions: the study corroborated the epidemiology reported by the literature. Greater severity of liver trauma and associated injuries characterize patients undergoing surgical treatment, who have increased hospital stay due to the penetrating trauma, hemodynamic instability, hepatic packaging, complications and reoperations.


RESUMO Objetivo: identificar fatores associados ao aumento do tempo de hospitalização de pacientes submetidos a tratamento cirúrgico por trauma hepático e descrever preditores de mortalidade, assim como a epidemiologia desse trauma. Métodos: estudo retrospectivo de 191 pacientes admitidos no Hospital Universitário Cajuru, referência no atendimento de politraumatizados, no período entre 2010 e 2017, com variáveis epidemiológicas, clinicopatológicas, terapêuticas analisadas por meio do programa STATA versão 15.0. Resultados: maioria dos pacientes incluídos eram homens com média de idade de 29 anos. Ferimento por arma de fogo representou o mecanismo de trauma mais comum. O lobo hepático direito foi lesado em 51,2% dos casos e hepatorrafia foi a correção cirúrgica mais empregada. O tempo de internamento hospitalar foi em média de 11(0-78) dias e o tempo de internação em unidade de terapia intensiva de 5 (0-52) dias. Preditores de maior tempo de hospitalização foram mecanismo de trauma, instabilidade hemodinâmica à admissão, número de lesões associadas, grau da lesão hepática e lobo acometido, técnica cirúrgica empregada, presença de complicações, necessidade de reoperação e outros procedimentos cirúrgicos. Taxa de mortalidade foi de 22,7%. Conclusões: o estudo corroborou a epidemiologia descrita na literatura. Maior gravidade do trauma hepático e das lesões associadas caracterizam os pacientes submetidos ao tratamento cirúrgico, que apresentam aumento de tempo de hospitalização devido a trauma penetrante, instabilidade hemodinâmica, tamponamento hepático, complicações e reoperações.


Subject(s)
Humans , Male , Adult , Wounds, Gunshot , Firearms , Trauma Centers , Injury Severity Score , Retrospective Studies , Hospitalization , Length of Stay , Liver/surgery , Liver/injuries
6.
Autops. Case Rep ; 9(4): e2019107, Oct.-Dec. 2019.
Article in English | LILACS | ID: biblio-1023992
7.
Arch. argent. pediatr ; 116(6): 778-781, dic. 2018. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-973697

ABSTRACT

Las lesiones hepáticas y de las vías biliares por causa traumática son poco usuales en la edad pediátrica. Del total de pacientes con trauma abdominal cerrado, menos del 9 % presentan lesión hepática, y la frecuencia varía entre el 2 % y el 3 % de la lesión de las vías biliares. Actualmente, el tratamiento recomendado para el trauma abdominal cerrado con lesión hepática sin repercusión hemodinámica es conservador; en caso de presentar lesión de la vía biliar intra- o extrahepática, los abordajes de preferencia son mínimamente invasivos, como la cirugía percutánea o endoscópica, y se utiliza la laparotomía en casos seleccionados. Se presenta el caso de un paciente con trauma abdominal cerrado y trauma hepático, inicialmente laparotomizado en 2 ocasiones por inestabilidad hemodinámica y hemoperitoneo; presentó un bilioma subdiafragmático y coleperitoneo, en el que se realizó un manejo mínimamente invasivo por drenaje percutáneo bajo control tomográfico.


Hepatic and biliary tract injuries due to traumatic causes are rare in pediatric patients. Of the total number of patients with closed abdominal trauma, less than 9 % have liver injury, and the frequency varies between 2 and 3 % of biliary tract lesions. Currently, the recommended treatment for closed abdominal trauma with liver injury without hemodynamic repercussion is conservative. In case of presenting intra or extrahepatic biliary tract lesion, the preferred approaches are minimally invasive, such as percutaneous or endoscopic surgery, using laparotomy in selected cases. We present the case of a patient with closed abdominal trauma and liver trauma, initially laparotomized on 2 occasions due to hemodynamic instability and hemoperitoneum; presented a subdiaphragmatic and coleperitoneal bilioma; it was performed minimally invasive percutaneous drainage under tomographic control.


Subject(s)
Humans , Male , Child, Preschool , Wounds, Nonpenetrating/therapy , Biliary Tract/injuries , Drainage/methods , Abdominal Injuries/therapy , Wounds, Nonpenetrating/complications , Tomography, X-Ray Computed , Hemoperitoneum/etiology , Hemoperitoneum/therapy , Laparotomy/methods , Abdominal Injuries/complications , Liver/injuries
8.
Autops. Case Rep ; 8(4): e2018048, Oct.-Dec. 2018. ilus
Article in English | LILACS | ID: biblio-986469

ABSTRACT

The differential diagnosis of hepatic focal lesions is challenging because the etiology can be inflammatory, infectious, and even neoplastic. A rare cause of metastatic liver nodules is cardiac angiosarcoma. We report a case of this tumor, which was diagnosed only after autopsy. A 26-year-old Caucasian man was admitted for progressive dyspnea and cough over the past 3 weeks. Physical examination showed only hypophonetic heart sounds. Laboratory analysis demonstrated anemia and elevated inflammatory markers, despite normal biochemical parameters and liver function. Transthoracic echocardiography revealed massive pericardial effusion. Abdomen computed tomography (CT) showed multiple hepatic nodules, the largest of which measured 3 cm, but the percutaneous biopsy revealed only lobular necrosis and perisinusoidal fibrosis without granulomas or neoplastic cells. During hospitalization, the patient had fever and night sweats with weight loss, and empiric treatment for extrapulmonary tuberculosis associated with corticosteroids was initiated. The outpatient follow-up revealed complete improvement of the pericardial effusion, but maintenance of the liver lesions. After 2 months of hospital discharge, the patient was readmitted with hemorrhagic shock due to bleeding liver lesions, which were evidenced by CT. Embolization of the right hepatic artery was performed, but the patient soon died. The autopsy revealed a primary cardiac angiosarcoma with multiple hepatic metastases, rupture of the Glisson's capsule and laceration of the liver. The case shows how important and difficult the diagnosis of focal liver lesions is, since it may result in an unexpected fatal outcome.


Subject(s)
Humans , Male , Adult , Heart Neoplasms/complications , Hemangiosarcoma/complications , Liver/injuries , Liver Neoplasms/diagnosis , Autopsy , Fatal Outcome , Neoplasm Metastasis
10.
Pesqui. vet. bras ; 38(1): 65-70, Jan. 2018. tab, ilus
Article in English | LILACS, VETINDEX | ID: biblio-895536

ABSTRACT

Histopathological evaluation of liver from 33 pigs slaughtered for human consumption in Amazon region, previously tested by serology and molecular techniques for hepatitis E virus infection (HEV), was analysed in three groups: Group 1, negative for both HEV-RNA and anti-HEV IgG (n=10); Group 2, positive for HEV-RNA (n=13); Group 3, positive for anti-HEV IgG (n=10). Group 2 showed a significant difference among the groups for liver lesions such as lobular activity (P=0.007), periportal interface hepatitis (P=0.004), portal inflammation (P=0.028) hepatitis with lobular, portal and periportal interface activity (P=0.001). HEV detection by immunohistochemistry was performed and 3 of 6 samples of group 2 were positive. Pigs naturally infected by HEV genotype 3 present microscopic necroinflammatory liver lesions similar to HEV in humans. Liver histopathology showed be important in the diagnosis of active asymptomatic HEV infection in pigs slaughtered for human consumption because hepatic liver lesions may present distinct profiles according to molecular and serological diagnosis and in this sense, histopathology and immunohistochemistry may be an important complementary diagnostic tool.(AU)


A avaliação histopatológica hepática de 33 suínos abatidos para consumo humano na região amazônica, previamente testados para infecção pelo vírus da hepatite E (HEV) por sorologia e técnicas moleculares, foi realizada em três grupos: Grupo 1, animais negativos para HEV-RNA e anti-HEV IgG (n=10); Grupo 2, positivos para HEV-RNA (n=13); e Grupo 3, positivos para anti-HEV IgG (n=10). O grupo 2 apresentou diferenças estatísticas significantes entre os grupos em relação à presença de atividade lobular (P=0,007), hepatite periportal de interface (P=0,004), inflamação portal (P= 0.028) e atividade lobular acompanhada por inflamação portal e periportal de interface (P=0,001). A detecção imunohistoquímica do HEV foi realizada e três de seis amostras do Grupo 2 foram positivas. Suínos naturalmente infectados pelo genótipo 3 do HEV apresentam lesões necroinflamatórias no fígado similares a lesão em humanos. A histopatologia hepática demonstrou ser importante no diagnóstico de infecção ativa e assintomática por HEV em suínos abatidos para consumo humano, pois as lesões no fígado apresentaram perfis diferenciados de acordo com o diagnóstico sorológico e molecular da infecção e, neste sentido, a histopatologia e imunohistoquímica podem representar importantes ferramentas complementares de diagnóstico.(AU)


Subject(s)
Animals , Swine/virology , Hepatitis E virus , Genotype , Liver/cytology , Liver/injuries , Immunohistochemistry/veterinary
11.
ABCD arq. bras. cir. dig ; 31(1): e1342, 2018. graf
Article in English | LILACS | ID: biblio-885756

ABSTRACT

ABSTRACT Background Obtaining effective hemostasis either in the traumatic or surgical lesions of parenchymal viscera, especially the liver, has always been a challenge. Aim: Comparative study between the use of different hemostatic sponges in hepatic wound and their capacity of integration to cells in a short period. Methods: Fifteen Wistar rats were divided into three groups. Through laparotomy a standardized wound in hepatic right lobe was made. The animals were treated with three sponges, being gelatin in group I, equine collagen in group II, and oxidized cellulose in group III. The hemostatic capacity was analysed. On the 7º day after surgery samples for histology analysis (H&E and picrosirius) were collected for inflammatory evaluation and collagen quantification (types I and III) with polarized microscopy. Results: All materials used had similar haemostatic effects, with no significant difference in hemostasis time. In the assessment of tissue repair and adhesions provoked, as well as analysis of the inflammatory process, the gelatin sponge presented greater inflammation and adhesions to the contiguous structures to the procedure in relation to the other groups. Conclusion: Animals which had their wounds treated with collagen and regenerated cellulose sponges presented better results in relationship to the ones treated with gelatin sponge.


RESUMO Racional A obtenção de hemostasia eficaz nas lesões traumáticas ou cirúrgicas de vísceras parenquimatosas, em especial do fígado, sempre foi desafiante. Objetivo: Comparar o uso de hemostáticos absorvíveis em ferimento hepático quanto à capacidade hemostática e de integração aos tecidos em curto prazo. Métodos: Foram utilizados 15 ratos Wistar separados em três grupos. Foi realizada laparotomia e ferimento padronizado em lobo hepático direito. Os animais do grupo I foram tratados com esponja de gelatina sobre os ferimentos; os do grupo II com esponja de colágeno equino, e os do grupo III com celulose regenerada oxidada. Na ocasião foi estudada a capacidade hemostática. No 7º dia de pós-operatório nova laparotomia foi realizada e foram coletadas amostras para estudos histológicos (H&E e picrosirius) avaliando os processos por microscopia ótica e de polarização para quantificação de colágeno (tipos I e III). Resultados: Todos os materiais usados apresentaram efeitos hemostáticos semelhantes, não havendo diferença significativa no tempo de hemostasia. Na avaliação da reparação tecidual e aderências provocadas, assim como análise do processo inflamatório, os tratados com esponja de gelatina apresentaram maior inflamação e aderências às estruturas contíguas ao procedimento em relação aos outros grupos. Conclusão: Os animais tratados com a esponja de colágeno e celulose regenerada apresentaram resultados melhores que aqueles com esponja de gelatina.


Subject(s)
Animals , Rats , Hemostatics/therapeutic use , Cellulose, Oxidized/therapeutic use , Hemostatic Techniques/instrumentation , Collagen/therapeutic use , Gelatin/therapeutic use , Liver/injuries , Wound Healing , Surgical Sponges , Rats, Wistar
12.
Pesqui. vet. bras ; 37(10): 1172-1176, out. 2017. tab, ilus
Article in English | LILACS, VETINDEX | ID: biblio-895347

ABSTRACT

Pulsed Doppler ultrasound was used to evaluate portal blood flow, portal velocity and portal congestion index in 24 healthy sheep divided into groups (lambs, yearlings and ewes), according to age. Measurements were performed at the 11th right intercostal space using ideal insonation angle and uniform insonation method. Mean values obtained in each group were compared with one-way ANOVA, followed by Tukey post-hoc test. Portal velocity and portal blood flow were statistically similar between the groups (P>0.05). Mean portal velocity were 17.75; 17.13 and 16.75; while mean portal blood flow were 26.65; 31.04 and 24.32 for lambs, yearlings and ewes, respectively. Portal congestion index was statistically distinct between the groups and values for lambs, yearlings and ewes were 0.009; 0.058 and 0.09, respectively (P<0.01). Statistical differences were observed in portal vein diameter, portal vein area and portal congestion index between the groups, presumably due to influence of weight and not to age.(AU)


A ultrassonografia com Doppler pulsado foi utilizado para avaliar o fluxo sanguíneo portal, velocidade portal e índice de congestão portal em 24 ovinos saudáveis divididos em grupos (cordeiros, borregos e ovelhas), de acordo com a idade. As medições foram realizadas no 11o espaço intercostal direito utilizando ângulo de insonação ideal e método de inclusão uniforme. Os valores médios obtidos em cada grupo foram comparados com ANOVA, seguido pelo teste post-hoc de Tukey. A velocidade portal e o fluxo de sangue portal foram estatisticamente semelhantes entre os grupos (P>0,05). A velocidade portal média foram 17,75; 17,13 e 16,75; enquanto o fluxo de sangue portal médios foram 26,65; 31,04 e 24,32 para cordeiros, borregos e ovelhas, respectivamente. O índice de congestão portal foi estatisticamente diferente entre os grupos e os valores para cordeiros, novilhos e ovelhas foram 0,009; 0,058 e 0,09, respectivamente (P<0.01). Observaram-se diferenças estatísticas nos diâmetros da veia porta, na área da veia porta e nos índices de congestão portal entre os grupos, provavelmente devido à influência do peso e não pela idade.(AU)


Subject(s)
Animals , Sheep/physiology , Portal Pressure/physiology , Ultrasonography, Doppler, Pulsed/veterinary , Liver Circulation/physiology , Liver/injuries
13.
Hig. aliment ; 31(266/267): 123-129, 30/04/2017.
Article in Portuguese | LILACS | ID: biblio-833407

ABSTRACT

Objetivou-se verificar a ocorrência e as causas de condenação de fígados de bovinos em um frigorífico na cidade de Condor, na região Noroeste do Estado do Rio Grande do Sul, sob regime de Inspeção Estadual, através da análise macroscópica e microscópica dos fígados condenados pelo SIE. Para isso, em um período de nove meses foram colhidas 196 amostras de lesões de fígado de bovinos. O material foi fotografado e fragmentos de fígado foram colhidos e fixados em formalina neutra a 10%, e processados rotineiramente para exame histopatológico. De acordo com o SIE, as razões para condenação foram: cirrose (26,54%), fasciolose (25,52%), peri-hepatite (15,81%), abscessos (14,79%), esteatose (10,71%), telangiectasia (3,06%) hidatidose (2,03%) e outras causas (1,54%). No exame microscópico, os fígados mostraram esteatose (26,54%), fasciolose (25,52%), abscessos (14,79%), sem alterações (13,77%), fibrose capsular (11,22%), telangiectasia (3,06%), peri-hepatite (3,06%), calcificação focal (1,02%) e hidatidose (1,02%). No presente estudo houve diferenças em alguns diagnósticos macroscópicos realizados pelos inspetores quando comparados com os diagnósticos microscópicos, demonstrando que há falta de aperfeiçoamento dos inspetores na linha de inspeção, corroborando com estudos já realizados.


Subject(s)
Animals , Cattle , Cattle Diseases , Food Inspection , Food Samples , Liver Diseases/veterinary , Liver/injuries , Meat/analysis , Abattoirs/standards , Quality Control
14.
Pesqui. vet. bras ; 37(1): 8-16, jan. 2017. ilus.
Article in Portuguese | LILACS, VETINDEX | ID: biblio-837443

ABSTRACT

Intoxicações por plantas do gênero Senecio representam uma importante causa de morte em bovinos no Rio Grande do Sul e estima-se que mais de 50% das mortes causadas por plantas tóxicas devem-se à intoxicação por Senecio spp. Nesse trabalho, são descritos os aspectos epidemiológicos, clínicos e anatomopatológicos de um surto de intoxicação natural por Senecio brasiliensis em bezerros e a caracterização e evolução das lesões hepáticas durante o surto. Um lote com 206 bovinos, fêmeas, sem raça definida, foi desmamado com aproximadamente quatro meses de idade e soltos em campo nativo com 25 hectares, contendo grande quantidade de Senecio brasiliensis em diferentes estágios. Os bovinos permaneceram nesse campo durante três meses e posteriormente foram transferidos para outra área. Na nova área, seis bezerras, com idades entre sete a oito meses, começaram a apresentar sinais clínicos de emagrecimento, fraqueza, diarreia e edema subcutâneo de declive na região submandibular. Os seis bovinos morreram em um período de 15 dias e um deles foi necropsiado. Macroscopicamente, foi visualizado o primeiro dos três padrões distintos de lesão hepática dos bovinos desse surto, que se caracterizava por um fígado aumentado de tamanho, com os bordos arredondados e com superfície capsular e de corte alaranjada. Histologicamente havia acentuada degeneração vacuolar hepatocelular difusa, bilestase, megalocitose e leve proliferação de ductos biliares e fibrose periportal. Dois meses após o início do surto, constatou-se que em um período de 20 dias adoeceram mais 28 bezerras e, dessas, 14 morreram. Os bovinos acometidos nessa segunda visita tinham idades entre nove a 10 meses. O principal sinal clínico observado foi fotossensibilização, e incluía graus variados de fotofobia, lacrimejamento, salivação excessiva, descarga ocular mucopurulenta, secreção nasal e glossite diftérica ventral. Das 14 bezerras mortas, realizou-se a necropsia de duas delas, sendo visualizado o segundo padrão de lesão hepática nesse surto (Padrão 2). Os fígados estavam com a superfície capsular lisa e esbranquiçada e moderadamente diminuídos de tamanho. Ao corte observou-se leve irregularidade do parênquima e áreas mais claras intercaladas com áreas avermelhadas. O aspecto histológico incluía acentuada fibrose periportal, marcada proliferação de ductos biliares, megalocitose, áreas multifocais de necrose de hepatócitos, hemorragia e lesões veno-oclusivas. A atividade sérica da GGT foi avaliada em 15 bovinos afetados nessa segunda visita à propriedade. Desses, 13 bezerras testadas apresentaram alterações nos valores, que variaram de 26-175 U/L. Em uma terceira visita à propriedade, sete meses após o início do surto, mais 27 bezerras adoeceram em um período de 40 dias e, dessas, 23 morreram, sendo três submetidas à necropsia. Evidenciou-se o terceiro padrão de lesão hepática. O fígado dos três bovinos estava diminuído de tamanho e acentuadamente firme. A superfície capsular era lisa e esbranquiçada, e a superfície de corte apresentava-se difusamente acastanhada. Lesões histológicas semelhantes ao segundo padrão foram também constatadas no fígado dessas três bezerras. Na quarta visita à propriedade, realizaram-se biópsias hepáticas nos 163 bovinos restantes do lote. Lesões hepáticas características da intoxicação estavam presentes em 103 dos 163 bovinos submetidos à biopsia hepática. Os bovinos afetados foram classificados em grupos de acordo com a severidade e os aspectos morfológicos observados. O diagnóstico de intoxicação nos bovinos desse estudo baseou-se nos achados epidemiológicos, clínicos e anatomopatológicos, associados ao histórico do consumo da planta e evolução das lesões.(AU)


Poisoning by Senecio spp. plants are an important cause of death in cattle in the State of Rio Grande do Sul, Brazil. It is estimated that over 50% of deaths caused by toxic plants are due to the ingestion of Senecio spp. The epidemiological, clinical and anatomopathological aspects of a spontaneous outbreak of Senecio brasiliensis in calves are described here. Characterization and evolution of liver lesions during the outbreak are also described. Two hundred and six 4-month-old female calves were weaned and placed in a 25-hectare pasture heavily infested by S. brasiliensis at of varying growth stages. The calves remained in this pasture for three months and were later transferred to another area where six calves aged 7-8- month-old developed clinical signs including unthriftiness, diarrhea, and subcutaneous dependent edema in the submandibular region. All these six affected calves died within 15 days from the onset of clinical signs and one of those was necropsied. Grossly the first of three patterns of hepatic lesions described in this report was observed and it was characterized by an enlarged liver, with round borders and an orange hue to the capsular and cut surfaces. Histologically there was marked diffuse vacuolar hepatocellular degeneration, bilestasis, hepatocellular megalocytosis, and mild bile duct proliferation and periportal fibrosis. Two months after the onset of the outbreak, in another visit to the farm, it was observed that an additional 28 calves got sick and 14 died. Affected calves observed in this second on-site visit were 9-10 month-old and their main clinical sign was photosensitization characterized by varying degrees of photophobia, tearing from the eyes, marked drooling, mucopurulent ocular discharge, increased nasal secretion, and ventral diphtheric glossitis. Two of the fourteen calves that died were necropsied and displayed the second pattern of hepatic lesions observed in the outbreak. Liver had smooth and whitish capsular surfaces and a moderate decrease in size. There was moderate irregularity to the cut surface of hepatic parenchyma and pale areas intercalated with red ones. Histologically there was marked periportal fibrosis, marked bile duct proliferation, hepatocellular megalocytosis, focal areas of hepatocellular necrosis, and hemorrhage and veno-occlusive changes. In this second on-site visit, GGT serum activity was determined in 15 affected calves and 13 of them had increased values (26-175 U/L). Seven months after the onset of the outbreak, a third visit was made to the farm when was learned that and additional 27 calves have been affected, 23 of which died within a period of 40 days. At the necropsy of three of these calves the third pattern of hepatic lesions were observed. The liver was decreased in size and markedly firm. The capsular surface was smooth and whitish and the capsular surface was diffusely tan. Histological lesions similar to those observed in the second pattern were seen in in the liver of these three calves. A fourth on-site visit to the farm was made and a liver biopsy was performed in each of the 163 calves remaining in the herd and hepatic lesions characteristic of Senecio poisoning were observed in the liver biopsy of 103 of them. Affected calves were classified in groups according to the severity and morphologic aspects of the observed hepatic lesions. The diagnosis of Senecio poisoning in calves of this study was based on epidemiology, clinical and anatomopathological findings associated with the history of consumption of the plant, and on the chronological development of the lesions.(AU)


Subject(s)
Animals , Cattle , Liver/growth & development , Liver/injuries , Plant Poisoning/epidemiology , Plant Poisoning/veterinary , Senecio/toxicity , Photosensitivity Disorders/veterinary , Pyrrolizidine Alkaloids
15.
Rev. chil. pediatr ; 88(4): 470-477, 2017. ilus, tab
Article in Spanish | LILACS | ID: biblio-900005

ABSTRACT

Introducción: El manejo no operatorio (MNO) es el manejo estándar del trauma cerrado esplénico y hepático en el paciente pediátrico. Se han identificado como fallas a este manejo inestabilidad hemodinámica y transfusiones masivas. Pocos trabajos evalúan si existen factores que permitan una anticipación a estos eventos. El objetivo fue determinar la existencia de factores asociados a la falla en MNO de las lesiones esplénicas y/o hepáticas secundarias al trauma abdominal cerrado. Pacientes y Método: Análisis retrospectivo 2007 a 2015 de los pacientes que ingresaron al servicio de Cirugía infantil del Hospital Universitario San Vicente Fundación con trauma hepático y/o esplénico cerrado. Resultados: Ingresaron 70 pacientes con trauma cerrado de abdomen, 3 fueron excluidos por cirugía inmediata (2 inestabilidad hemodinámica y 1 irritación peritoneal). De 67 pacientes que recibieron MNO, 58 tuvieron éxito y 9 presentaron falla (8 inestabilidad hemodinámica y 1 lesión de víscera hueca). Encontramos 3 factores asociados a la falla MNO: presión arterial (PAS) < 90 mmHg al ingreso (p=0,0126; RR =5,19), caída de la Hemoglobina (Hb) > 2 g/dl en las primeras 24 h (p=0,0009; RR= 15,3), y transfusión de 3 o más unidades de glóbulos rojos (UGR) (0,00001; RR= 17,1). Mecanismo del trauma, severidad e Índice de Trauma Pediátrico no se asociaron con fallo MNO. Conclusiones: Los niños con trauma cerrado hepático o esplénico responden al MNO. Los factores como PA menor de 90 al ingreso, caída de la Hb >2 g/dl en las primeras 24 h y la transfusión de 3 o más UGR pueden asociarse con la falla en el MNO.


Introduction: The non operative management (NOM) is the standard management of splenic and liver blunt trauma in pediatric patients.Hemodynamic instability and massive transfusions have been identified as management failures. Few studies evaluate whether there exist factors allowing anticipation of these events. The objective was to identify factors associated with the failure of NOM in splenic and liver injuries for blunt abdominal trauma. Patients and Method: Retrospective analysis between 2007-2015 of patients admitted to the pediatric surgery at University Hospital Saint Vincent Foundation with liver trauma and/or closed Spleen. Results: 70 patients were admitted with blunt abdominal trauma, 3 were excluded for immediate surgery (2 hemodynamic instability, 1 peritoneal irritation). Of 67 patients who received NOM, 58 were successful and 9 showed failure (8 hemodynamic instability, 1 hollow viscera injury). We found 3 factors associated with failure NOM: blood pressure (BP) < 90 mmHg at admission (p = 0.0126; RR = 5.19), drop in hemoglobin (Hb) > 2 g/dl in the first 24 hours (p = 0.0009; RR = 15.3), and transfusion of 3 or more units of red blood cells (RBC) (0.00001; RR = 17.1). Mechanism and severity of trauma and Pediatric Trauma Index were not associated with failure NOM. Conclusions: Children with blunted hepatic or splenic trauma respond to NOM. Factors such as BP < 90 mmHg at admission, an Hb fall > 2 g/dl in the first 24 hours and transfusion of 3 or more units of RBC were associated with the failure in NOM.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Spleen/injuries , Wounds, Nonpenetrating/diagnosis , Wounds, Nonpenetrating/therapy , Conservative Treatment , Liver/injuries , Prognosis , Wounds, Nonpenetrating/physiopathology , Retrospective Studies , Follow-Up Studies , Treatment Failure
16.
Bahrain Medical Bulletin. 2017; 39 (1): 47-49
in English | IMEMR | ID: emr-185653

ABSTRACT

The liver is commonly injured through blunt abdominal trauma in children. Transaction of the hepatic artery and subsequent angioembolization is well reported in the adult population; however, the evidence of its effectiveness is lacking in pediatrics. We report a case of a child who sustained a grade 3/4 liver injury with contrast blush as evidenced on CT scan. The case was treated by super-selective angioembolization with no major or minor complications. To our knowledge, this is the first case report of pediatric hepatic angioembolization in the Middle East


Subject(s)
Child, Preschool , Humans , Male , Hepatic Artery/injuries , Liver/injuries , Child, Preschool , Accidents, Traffic
17.
Rev. argent. cir ; 108(4): 1-10, dic. 2016. tab
Article in Spanish | LILACS, BINACIS | ID: biblio-957885

ABSTRACT

Antecedentes: existe una tendencia creciente hacia el tratamiento no operatorio (TNO) en el trauma-tismo cerrado de abdomen (TCA), en pacientes estables hemodinámicamente, sin abdomen agudo peritoneal. No hay consenso sobre: momento de inicio de la dieta, deambulación, proflaxis anttrom-bótica, seguimiento y control, y reinicio de la actividad fisica. Objetivo: describir los resultados del manejo de pacientes con TCA, admitidos en nuestro Servicio de Cirugía. Material y métodos: incluimos pacientes mayores de 15 años internados desde enero de 2011 hasta septembre de 2014, con TCA sometidos a TNO. Se recabaron las variables analizadas de una base de datos electrónica de fichaje prospectivo. Resultados: del total de pacientes 31 TCA, 15 se intervinieron quirúrgicamente al ingreso y 16 pacientes se someteron a TNO. El 73,3% presentó lesiones asociadas extraabdominales. A todos se les realizó ecografa abdominal, donde se encontró líquido libre en el 80% y se identificó lesión de órgano sólido en el 60%. En 11 pacientes se realizó TC confrmando lesión objetivada en la ecografa e iden-tificando 3 no evidenciadas previamente. Se diagnosticaron 5 traumatismos hepáticos, 2 asociados a traumatismo renal; 6 traumatismos esplénicos, 4 renales y un paciente con hemoperitoneo. En 7 pacientes se utlizó tromboproflaxis. El TNO fue exitoso en todos los casos. Tres pacientes presentaron complicaciones. No se registró mortalidad. Conclusiones: los pacientes sometidos a TNO en nuestro hospital fueron tratados exitosamente en todos los casos. No se registró mortalidad en la serie analizada.


Background: there is a growing trend towards non-operative management (NOM) in the blunt abdominal trauma (BAT) in hemodynamically stable patentis without peritoneal acute abdomen. However, there is stll no consensus on: tme of onset of diet, ambulaton, antthrombotic prophylaxis, follow-up, and resumpton of physical activity. Objective: to describe the management of patentis with BAT, admited to the Department of Surgery of our insttuton. Material and methods: we included patentis age 15 and older admited from January 2011 to Sept-ember 2014, with BAT who underwent NOM. The variables analyzed were collected from an electronic database of prospective signing. Resultis: 31 TCA were identifed, 15 were operated on at admission and 16 patentis underwent NOM. 75% were men; mean age of 29 (range 18-58). In 100% abdominal ultrasound was performed, finding free fuid in 80% and identifying organ damage in 60% of the total. In 11 patentis CT scan was perfor-med confrming identifed organ injury on ultrasound and diagnosing three not evidenced previously. We included 5 patentis with liver trauma, 2 associated renal trauma; 6 splenic trauma; 4 kidney trauma and 1 patent with hemoperitoneum. Thromboprophylaxis was used in 7 patentis. NOM was successful in all cases. Three patentis presented complicatons, not associated with trauma. No mortality was recorded. Conclusions: patentis undergoing NOT in our hospital were successfully treated in all cases. There were no complicatons associated with management of the NOT. No mortality was recorded.


Subject(s)
Humans , Male , Adolescent , Adult , Middle Aged , Young Adult , Abdominal Injuries/therapy , Argentina , Epidemiology, Descriptive , Cross-Sectional Studies , Ultrasonography , Kidney/injuries , Abdominal Injuries/diagnostic imaging , Liver/injuries
18.
Rev. Col. Bras. Cir ; 43(2): 110-116, Mar.-Apr. 2016. tab, graf
Article in English | LILACS | ID: lil-782924

ABSTRACT

ABSTRACT Objective: to evaluate the effectiveness of an collagen-based adhesive associated with fibrinogen and thrombin in experimental liver injuries in rats. Methods: we randomly divided 30 Wistar rats into three groups: A, B and C. All underwent a standard liver traumatic injury. In group A, the lesion was treated with the adhesive; in group B, with conventional, absorbable suture; group C received no treatment. We analyzed the time of hemostasis, mortality, occurrence of adhesions and any histological changes. Results: there was no statistical difference in relation to mortality (p=0.5820). The adhesive treated group showed the lowest hemostasis times (p=0.0573, odds ratio 13.5) and lower incidence of adhesions (p=0.0119). The histological alterations of the Groups A and B were similar, with foreign body granuloma formation separating the adhesive material and the hepatic stroma suture. Conclusion: the collagen adhesive associated with fibrinogen and thrombin was effective in treating experimental hepatic injury, providing a lower incidence of adhesions between the liver and surrounding structures.


RESUMO Objetivo: avaliar a eficácia de um adesivo a base de colágeno associado ao fibrinogênio e trombina, no trauma hepático experimental em ratos. Métodos: toram incluídos no estudo 30 ratos Wistar, igualmente divididos aleatoriamente em três grupos: A, B e C. Todos foram submetidos à lesão traumática hepática padronizada. No grupo A, a lesão foi tratada com o adesivo, no grupo B, com sutura convencional com fio absorvível, e no grupo C, não houve tratamento da lesão. Foram analisados o tempo de hemostasia, mortalidade, ocorrência de aderências e eventuais alterações histológicas. Resultados: os resultados mostraram que não houve diferença estatística em relação à mortalidade (p=0,5820). O grupo tratado com adesivo apresentou os menores tempos de hemostasia (p=0,0573 e odds ratio 13,5) e menor ocorrência de aderências (p=0,0119). Microscopicamente as alterações histológicas dos grupos A e B foram semelhantes, com a formação de granuloma de corpo estranho separando o material do adesivo e do fio de sutura do estroma hepático. Conclusão: o adesivo de colágeno associado ao fibrinogênio e trombina foi eficaz no tratamento do trauma hepático experimental, proporcionado menor ocorrência de aderências entre o fígado e as estruturas vizinhas.


Subject(s)
Animals , Male , Rats , Tissue Adhesives , Fibrinogen , Thrombin , Collagen , Liver/surgery , Liver/injuries , Hemostatics , Random Allocation , Rats, Wistar
19.
Rev. Col. Bras. Cir ; 43(1): 22-27, Jan.-Feb. 2016. tab
Article in English | LILACS | ID: lil-779031

ABSTRACT

Objective : to evaluate the epidemiological variables and diagnostic and therapeutic modalities related to hepatic trauma patients undergoing laparotomy in a public referral hospital in the metropolitan region of Vitória-ES. Methods : we conducted a retrospective study, reviewing charts of trauma patients with liver injuries, whether isolated or in association with other organs, who underwent exploratory laparotomy, from January 2011 to December 2013. Results : We studied 392 patients, 107 of these with liver injury. The male: female ratio was 6.6 : 1 and the mean age was 30.12 years. Penetrating liver trauma occurred in 78.5% of patients, mostly with firearms. Associated injuries occurred in 86% of cases and intra-abdominal injuries were more common in penetrating trauma (p <0.01). The most commonly used operative technique was hepatorrhaphy and damage control surgery was applied in 6.5% of patients. The average amounts of blood products used were 6.07 units of packed red blood cells and 3.01 units of fresh frozen plasma. The incidence of postoperative complications was 29.9%, the most frequent being infectious, including pneumonia, peritonitis and intra-abdominal abscess. The survival rate of patients suffering from blunt trauma was 60%, and penetrating trauma, 87.5% (p <0.05). Conclusion : despite technological advances in diagnosis and treatment, mortality rates in liver trauma remain high, especially in patients suffering from blunt trauma in relation to penetrating one.


Objetivo : avaliar as variáveis epidemiológicas e as modalidades diagnósticas e terapêuticas relacionadas ao trauma hepático de pacientes submetidos à laparotomia exploradora em um hospital público de referência da Região Metropolitana de Vitória-ES. Métodos: estudo retrospectivo de revisão de prontuários dos pacientes vítimas de trauma com lesão hepática isolada ou associada a outros órgãos, submetidos à laparotomia exploradora, no período de janeiro de 2011 a dezembro de 2013. Resultados: foram estudados 392 pacientes submetidos à laparotomia, dos quais 107 com lesões hepáticas. A relação masculino:feminino foi 6,6:1 e a média de idade dos pacientes foi 30,12 anos. O trauma hepático penetrante ocorreu em 78,5% dos pacientes, principalmente por arma de fogo. Lesões associadas ocorreram em 86% dos casos e as lesões intra-abdominais foram mais comuns no trauma penetrante (p<0,01). A técnica operatória mais utilizada foi a hepatorrafia, e a cirurgia para controle de danos foi feita em 6,5% dos pacientes. A quantidade média de hemoderivados utilizados foi 6,07 unidades de hemoconcentrado e 3,01 unidades de plasma fresco. A incidência de complicações pós-operatórias foi 29,9%, e as mais frequentes foram as infecciosas, incluindo pneumonia, peritonite e abscesso intra-abdominal. A taxa de sobrevida dos pacientes acometidos de trauma contuso foi 60% e de trauma penetrante, 87,5% (p<0,05). Conclusão: apesar dos avanços tecnológicos de diagnósticos e tratamentos, as taxas de morbimortalidade nos traumas hepáticos permanecem elevadas, especialmente nos pacientes acometidos de trauma hepático contuso em relação ao trauma penetrante.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Wounds, Nonpenetrating/surgery , Wounds, Nonpenetrating/epidemiology , Wounds, Penetrating/surgery , Wounds, Penetrating/epidemiology , Liver/surgery , Liver/injuries , Epidemiologic Studies , Retrospective Studies , Laparotomy , Middle Aged
20.
Int. j. med. surg. sci. (Print) ; 3(1): 753-758, 2016. ilus
Article in Spanish | LILACS | ID: lil-790602

ABSTRACT

Una cirugía exitosa no puede efectuarse sin un adecuado conocimiento de la anatomía quirúrgica, sobre todo en el trauma hepático, donde el conocimiento anatómico juega un rol fundamental ala hora de tomar rápidas decisiones que permitirán salvar la vida de los pacientes con esta patología en la urgencia. Evaluar el conocimiento anatómico del hígado y estructuras relacionadas en la realización de abordajes quirúrgicos de urgencia para la movilización y control vascular del mismo. Programa de entrena-miento de tres años de maniobras de control vascular y movilización hepática, para 11 residentes de cirugía general cursando su 2do, 3ro y 4to año. Se utilizaron tres cadáveres frescos y 20 cadáveres formolizados al 10%. Las diferentes maniobras de movilización y control vascular del hígado fueron realizadas a partir del 2do año de residencia por tres años consecutivos. Se observó una disminución del 57 % en los tiempos de realización de las maniobras y reconocimiento de estructuras en los residentes de 2do año que hicieron esta práctica por 3 años consecutivos, y del 38 % en los residentes de 2do y 3er año que lo realizaron por 2 años consecutivos con resultados similares. El conocimiento anatómico en etapa de formación permite mejorar el abordaje quirúrgico del paciente traumatizado, disminuyendo el tiempo de realización de las maniobras y el riesgo de complicaciones.


A successful surgery cannot be done without adequate knowledge of the surgical anatomy, especially in liver trauma, where anatomical knowledge plays a key role when it comes to making quick decisions that will allow saving the life of patients with this pathology in the emergency. Assess liver anatomical knowledge and related structures for conducting emergency surgical approaches mobilization maneuvers and vascular control. A 3-year training program for vascular control maneuvers and liver mobilization, for 11 surgical residents during their second, third and fourth year, while 3 fresh corpses and 20 formolized at 10 percent corpses were used. Different maneuvers of liver mobilization and vascular control were performed from the second year onward for three consecutive years. A decrease of 57 percent was observed in the time of realization of the maneuvers and recognition of structures in second year residents who conducted this test for three consecutive years, and a decrease of 38 percent in second and third year residents who performed it for two consecutive years with similar results. Anatomical knowledge in stage training improves the surgical approach to trauma patients, decreasing the time of realization of the maneuvers and the risk of complications.


Subject(s)
Humans , General Surgery/education , Liver/anatomy & histology , Liver/surgery , Liver/injuries , Cadaver , Mentoring , Liver/blood supply , Internship and Residency , Emergencies
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