Antônio Alves Júnior

Hipertensão portal esquistossomótica: influência do fluxo sangüíneo portal nos níveis séricos das enzimas hepáticas

AIM To evaluate relation between the portal blood flow and the laboratory hepatic screening in patients with schistosomal portal hypertension. PATIENTS AND METHODS Sixty-four patients with schistosomal portal hypertension had studied, being 19 not operated, 23 submitted to esophagogastric devascularization with splenectomy and 22 submitted to distal splenorenal shunt. Evaluated the laboratory hepatic screening through the dosage of albumin, aspartate aminotransferase, alanine aminotransferase, direct bilirubin and indirect bilirubin, alkaline phosphatase, gamma-glutamil transferase and prothrombin time. The portal flow was evaluated for Doppler. The results have been analyzed through linear regression, Pearson correlation coefficient, chi-square and one-way analysis of variance with Tukeys test. RESULTS It was proven that only gamma-glutamil transferase had significant correlation with the portal flow. In compare of the quartiles, also only gamma-glutamil transferase showed resulted significant, it was evidenced that the fourth quartile, that is bigger portal flow and formed in its majority for patients not operated, also was bigger average of gamma-glutamil transferase and significantly bigger value than first and the third quartiles. CONCLUSIONS 1. The portal blood flow was bigger in patients that the serum level of GGT was bigger; 2. the gamma-glutamil transferase is the variable of the hepatic screening evaluation more representative of the portal flow influence in hepatic functional activity in patients with hepatosplenic schistosomiasis, and 3. probably, the different surgeries through hemodynamics modifications, are beneficial in to diminish the degree of cholestasis or in decrease the microssomal induction.

Pressão intra-abdominal em pacientes com trauma abdominal

OBJETIVOS: Pacientes com trauma abdominal tratados cirurgicamente sao muito suscetiveis ao desenvolvimento de hipertensao intra-abdominal e sindrome do compartimento abdominal, cujo diagnostico e baseado na medicao da pressao intraabdominal associada a parâmetros clinicos. Este estudo teve por objetivos avaliar prospectivamente o comportamento da pressao intra-abdominal de pacientes com trauma abdominal cirurgicamente tratados e identificar se ha relacao entre tal comportamento e parâmetros clinicos destes pacientes. METODO: A tecnica de Kron foi utilizada para medir a pressao intra-abdominal. A casuistica foi composta por 17 homens e tres mulheres com media de idade de 36,9 anos (D.P. 12,943). O mecanismo de trauma mais frequente foi contusao abdominal 12 (60%) contra oito (40%) pacientes com ferimentos penetrantes. Os dados foram coletados em 6 e 18 horas de pos-operatorio. RESULTADOS: As medias de pressao intra-abdominal foram 10,4 cmH2O (D.P. 3,939) em 6 horas e 10,263 cmH2O (D.P. 3,445) em 18 horas de pos operatorio. A analise dos resultados mostrou correlacao estatisticamente significante entre o volume de coloides infundidos e a pressao intra-abdominal em 6 e 18 horas pos-operatorias (p = 0,0380 e p = 0,0033 respectivamente). E provavel que tal correlacao se deva ao edema visceral causado pelo extravasamento capilar de solucoes, aumentando a pressao intra-abdominal. CONCLUSOES: Os achados deste estudo ratificam a ideia de relacao entre grandes volumes de infusao venosa, sobretudo coloides, e o aumento da pressao intra-abdominal e destacam a importância da avaliacao da pressao intra-abdominal em pacientes com trauma abdominal submetidos a grandes reposicoes volemicas, sobretudo as solucoes coloidais.

Prevalência e gravidade de asma brônquica em adultos obesos com indicação de cirurgia bariátrica

OBJECTIVE To determine the prevalence of asthma in a group of obese adult candidates for bariatric surgery and to evaluate the severity of asthma in this group of patients. METHODS This was a cross-sectional study involving 363 obese adults (body mass index > 35 kg/m²) evaluated by a pulmonologist, using clinical evaluation as a diagnostic tool for asthma. All patients underwent clinical evaluation and spirometry and were divided into two groups (asthma and control). The patients with asthma were stratified by the severity of asthma. RESULTS The prevalence of asthma in the obese population studied was 18.5% (95% CI: 14.5-22.4). That prevalence was 20.4% (95% CI: 16.2-24.5) and 13.7% (95% CI: 10.1-17.2) in the women and the men, respectively. Asthma symptoms in the last twelve months were present in 8.0% (95% CI: 5.2-10.7), and the initial manifestation of asthma symptoms occurred during childhood/adolescence in 17.4% (95% CI: 13.5-21.3). In the asthma group, intermittent asthma was present in 29 patients (43.3%), mild persistent asthma in 7 (10.4%), moderate asthma in 25 patients (37.3%), and severe persistent asthma in 6 (9.0%). CONCLUSIONS Using clinical evaluation as the diagnostic criterion, we found the prevalence of asthma to be high in this group of obese adults. Asthma was more common in females, and the initial manifestation of asthma symptoms more commonly occurred during childhood/adolescence. The severity of asthma in this group of obese adults was within the range of mean values predicted for the general population. Intermittent asthma, mild persistent asthma, and moderate persistent asthma predominated.

Estresse pré-operatório: comparação entre pacientes do SUS e conveniados

This research compared the rates of stress in 60 patients interned for undergoing cholecystectomy surgery. 30 were treated by the National Health System (BR) and 30 by private health care plans. The instruments used for the research were the Lipps Inventory of Stress Symptoms for Adults and two questionnaires: a social-demographic questionnaire and one on clinical variables related to the surgery. The results showed that more patients from the National Health System (BR) group were under stress (93.3%) in comparison to those from private health care plans (33.3%) (p<0.05). The variables which showed statistical differences in terms of stress were: being female, not having attended to preanesthetic evaluation and not having a basic school education level. Those factors had a relation to stress in the overall sample (p<0.05), highlighting the fact that all of those factors had a higher incidence in the National Health System (BR) group (p<0.05).

Hipertensão portal esquistossomótica avaliação do fluxo sangüíneo portal antes e após tratamento cirúrgico

OBJETIVO: Avaliar o fluxo sanguineo portal na esquistossomose hepato-esplenica e o efeito tardio do tratamento cirurgico na hemodinâmica portal. METODO: Foram estudados 64 pacientes por Doppler duplex: grupo I (pacientes com hipertensao portal esquistossomotica); grupo II (pacientes submetidos a desconexao azigo-portal com esplenectomia) e grupo III (pacientes submetidos derivacao esplenorrenal distal). RESULTADOS: O fluxo da veia porta foi maior no grupo I (1954,46 ± 693,73ml/min) e foi menor no grupo III (639,55 ± 285,86ml/min), neste correlacionou-se com o tempo pos-operatorio (r=-0,67, p=0,0005). O fluxo sanguineo portal do grupo II (1097,18 ± 342,12ml/min) foi semelhante ao de individuos normais. As mesmas alteracoes foram verificadas com relacao ao diâmetro da veia porta nos grupos I, II, e III (cm): 1,46 ± 0,23; 1,12 ± 0,22; 0,93 ± 0,20, respectivamente. CONCLUSOES: Estes dados sugerem que: 1) Existe hiperfluxo portal na fisiopatologia da hipertensao portal esquistossomotica; 2) o tratamento cirurgico interferiu na hemodinâmica portal, diminuindo o fluxo sanguineo da veia porta; 3) Esta reducao do fluxo sanguineo portal correlacionou-se com o tempo de seguimento pos-operatorio no grupo III mas nao no grupo II.