Antonio Dorival Campos

Correlação entre o consumo de oxigênio obtido pelo método de Fick e pela calorimetria indireta no paciente grave

OBJECTIVE To compare the oxygen consumption index measured by using indirect calorimetry (VO2I Delta) with a portable metabolic cart and calculated according to Ficks principle (VO2 I Fick) in critically ill patients. METHODS Fourteen patients (10 men and 4 women, mean age 39.4 +/- 5.4 years) were analyzed, 5 of them trauma victims and 9 sepsis victims. The following mean scores were obtained for these patients: APACHE II = 21.3+/-1.8, ISS = 24.8+/-6, and sepsis score = 19.6+/-2.3. The mortality risk (odds ratio), calculated from APACHE II, was 41.9+/-7.1%. All patients underwent mechanical ventilation and invasive hemodynamic monitoring with a Swan-Ganz catheter. VO2 was obtained using the 2 methods (VO2I Delta and VO2I Fick) at 4 different times (T1-T4). RESULTS A good correlation was found between the 2 methods (r=0.77) for the mean of the 4 serial measurements. No statistically significant differences were observed between indirect calorimetry and Ficks equation at T1 (VO2I Delta = 138+/-28 and VO2I Fick = 59+/-38 mL.min-2.m-2, P=0.10) and T3 (VO2I Delta = 144+/-26 and VO2I Fick = 158+/-35 mL.min-2.m-2, P=0.14), but a significant difference was observed at T2 (VO2I Delta = 141+/-27 and VO2I Fick = 155+/-26 mL.min-2.m-2, P=0.03) and T4 (VO2I Delta = 145+/-24 and VO2I Fick = 162+/-26 mL.min-2.m-2, P=0.01). CONCLUSION We may state that indirect calorimetry can be used for oxygen consumption analysis in critically ill patients and is as efficient as Ficks reverse equation, with the benefit of being a noninvasive and risk-free procedure.

Apresentação clínica de doença celíaca em crianças durante dois períodos, em serviço universitário especializado

BACKGROUND Several studies have demonstrated changes in the forms of clinical presentation of celiac disease in children and adults, with an increased occurrence of atypical forms. AIM To determine this fact in Clinical Hospital, Ribeirão Preto, SP, Brazil. METHODS Celiac patients were studied over two different periods of time, from January 1978 to December 1987 (group 1 = G1) and from January 1988 to December 1997 (group 2 = G2). Time of disease, age at diagnosis and nutritional status and clinical forms were investigated. The typical form was considered to be present if the patient had at least two of the following signs/symptoms: diarrhea, abdominal distention, and weight loss, associated or not with others. RESULTS Clinical forms (%) - G1: typical 57.14 and atypical 42.85. G2: typical 55.18 and atypical 44.82. Median age at diagnosis: 23 months (G1) and 21 months (G2). Interval between the onset of symptoms and the diagnosis: 13 months (G1) and 11 months (G2). Gomez nutritional status G1: Eutrophy = 23.8, DI = 47.61, DII = 23.8 and DIII = 4.76. G2: Eutrophy = 20.68, DI = 48.27, DII = 27.58 and DIII = 3.44. Waterloo G1: Eutrophy = 23.8, Wasting = 14.28, Stunting = 28.57 and Chronic = 33.33. G2: Eutrophy = 20.68, Wasting = 13.79, Stunting = 34.48 and Chronic = 31.03. No statistically significant differences occurred between the groups for any of these parameters. CONCLUSIONS No change in the forms of presentation or remaining clinical characteristics of celiac disease occurred in our service. This may be due to the population characteristics or to differences among health services, or to different periods of observation.

Anorectal manometry in children with chronic functional constipation

BACKGROUND The anorectal manometry is a very utilized and well recognized examination in children with chronic functional constipation. The major manometric findings in these children are: anal hypotonia, anal hypertonia, paradoxal contraction of the external anal sphincter, decreased ability of internal anal sphincter to relax during rectal distension and alterations in rectal contractility, sensibility and compliance. AIMS To evaluate the anal basal pressure and the relaxation reflex before and after standard treatment for a better understanding of the physiopathologic mechanisms involved in pediatric chronic functional constipation. METHODS Anorectal manometry was performed before treatment on 20 children with chronic functional constipation aged 4 to 12 years and the results were compared to those obtained after standard treatment, with a good outcome. RESULTS There was a reduction in anal basal pressure after treatment, but no differences were detected between the anorectal manometries performed before and after treatment in terms of amplitude and duration of relaxation, residual pressure, latency time, or descent and ascent angle. CONCLUSIONS We conclude that the anal basal pressure decreased in children recovering from chronic functional constipation, but the standard treatment did not provide all the conditions necessary for the relaxation reflex of constipated children to return to the values described in normal children.

Indirect calorimetry can be used to measure cardiac output in septic patients

PURPOSE The aim of this study was to compare two different cardiac output (CO) monitoring systems based on the thermodilution principle (Thermo-CO) and indirect calorimetry (Fick mixed-CO) in septic patients. METHODS Prospective study in septic patients admitted in an intensive care unit of a university hospital. Nineteen patients aged on average 45.4 +/- 21.5 years were enrolled in the study. Four series of hourly measurements by the two techniques were carried out simultaneously. RESULTS No significant differences were observed between Thermo-CO and Fick mixed-CO (7.0 +/- 1.8 L.min-1 and 6.4 +/- 1.7 L.min-1.). Parallel analysis of Fick mixed-CO and Fick atrial-CO was performed introducing a correction factor for the eight atrial samples in order to adjust the values of oxygen saturation obtained from atrial blood (Fick corrected atrial-CO) to those obtained from mixed venous blood. No significant differences could be detected between Fick mixed-CO and Fick corrected atrial-CO. The correlation coefficients of Thermo CO/Fick mixed-CO and Fick mixed-CO/Fick corrected atrial-CO were 0.84 and 0.94, respectively. CONCLUSION We observed that the agreement between the two methods was satisfactory on the basis of the decisions made for treatment. Indirect calorimetry is useful to measure CO in patients with septic shock.

Efeito da desnutrição na cicatrização de anastomoses colônicas: estudo experimental em ratos

Dehiscence of colonic anastomosis is one of the most severe complications after gastrointestinal surgery. The intestinal anastomosis healing complication is associated to several factors like malnutrition and hypoalbuminemia. This is an experimental study that aimed to evaluate the colonic anastomosis healing in malnutrition and hypoalbuminemia conditions. Animals were separated in two experimental groups: control and submitted to malnutrition (daily food intake as half of the control group per 20 days). Body weight, clinical outcome, serum albumin, abdominal cavity aspects, gross and microscopic aspects of the anastomosis, hepatic steatosis and tissue hydroxyproline dosage were compared between groups. Our results show that malnutrition development was efficient since a significant loss of body weight was observed in the experimental group. The malnutrition group of rats presented pathologic data all suggestive of lower prognostic and higher mortality rate. In conclusion, malnutrition interferes with the normal colonic anastomosis healing and increases the mortality rate.

The cytoprotective effect of a nitric oxide donor drug on gastric mucous membrane of rats treated with ketoprofen, a non-steroidal anti-inflammatory drug

BACKGROUND Non-steroidal anti-inflammatory drugs are considered today a very important group of medication, with a wide variety of therapeutic use, in different areas of modern medicine. Despite their beneficial effects on the patient, these drugs show a high incidence of side effects, mainly in the gastrointestinal tract. The physiopathological mechanisms of non-steroidal anti-inflammatory drugs induced lesions and the gastric mucosa defense mechanism became an important source for medical research, especially those which try to evaluate the role of nitric oxide as a cytoprotective agent. AIM To define a possible cytoprotective effect of a nitric oxide donor, isosorbide dinitrate, on the gastric mucous of rats submitted to non-steroidal anti-inflammatory drugs ketoprofen treatment. METHODS Adult male Wistar rats, previously submitted to starvation for 24 hours and divided in three groups: group I (standard): animals that received isotonic saline solution intragastric by gavage and intravenous. Group II (control-ketoprofen): animals that received isotonic saline solution intragastric by gavage and ketoprofen intravenous. Group III (nitrate/ketoprofen): animals that received 2mM solution of isosorbide dinitrate intragastric by gavage and ketoprofen intravenous. Later on, these animals were sacrificed and had their stomach removed and submitted to macroscopical, microscopical and biochemical studies. The evaluated parameters were: a) gastric lesion index; b) gastric mucous layer thickness; c) gastric tissue nitrate/nitrite (NOx) concentration and d) gastric tissue malondialdehyde concentration. RESULTS a) Gastric lesion index evaluation showed a smaller statistically significant incidence on the animals of group III; b) group III showed a thicker mucous layer, which also was statistically significant, when compared to group II; c) the variation on tissue nitrate/nitrite concentration was similar in all three groups, without statistical significance when compared to each other. CONCLUSION Isosorbide dinitrate has a cytoprotective activity on the gastric mucosa of rats submitted to ketoprofen action.

Estudo da isquemia e reperfusão em retalhos cutâneos de ratos

INTRODUCAO: Multiplos fatores tem sido implicados na patogenese da lesao de isquemia/reperfusao da pele, incluindo as especies reativas de oxigenio. OBJETIVO: Estudar a lesao de isquemia/reperfusao em retalhos cutâneos de ratos avaliando os niveis teciduais do malonildialdeido (MDA) e xantina oxidase (XO). METODOS: Foram utilizados 8 ratos Wistar, com peso entre 300 - 400g, sendo confeccionados 2 retalhos epigastricos por animal (controle e experimento), um deles submetido a 16h de isquemia (RI) seguida de 45 min de reperfusao (RR) e o outro controle (RC). Foram colhidas 3 biopsias de pele dos retalhos (RC, RI, RR) e encaminhadas para dosagem de MDA e XO. RESULTADOS: A analise bioquimica mostrou aumento significativo dos niveis teciduais de MDA e XO apos a reperfusao em relacao aos retalhos controles. CONCLUSAO: Retalhos epigastricos de ratos submetidos a 16h de isquemia e 45min de reperfusao apresentam elevacao dos niveis teciduais de MDA e XO, caracterizando a lipoperoxidacao da membrana celular.

Effect of thalidomide on the healing of colonic anastomosis, in rats

PURPOSE Thalidomide, because of its anti-inflammatory properties, as re-emerged as an option for the treatment of Crohns disease refractory to standard therapy. We studied the effect of thalidomide on the healing of colonic anastomosis. METHODS Sixty male rats (Rattus norvegicus), were divided into 3 groups of 20 animals each, respectively receiving 0.5 or 1.0 mg/kg thalidomide by the oral route for 7 days, or saline solution (control). All animals were submitted to continuous end-to-end anastomosis with 6-0 Prolene sutures. After sacrifice the anastomoses were analyzed macroscopically and submitted to determination of hydroxyproline, to histology and to immunohistochemistry for metalloproteinase 1, metalloproteinase 1 inhibitor and vascular endothelial growth factor (VEGF). RESULTS Statistical analysis of the data showed no significant difference in macroscopic aspect or hydroxyproline determination (p= 0.5403). In the immunohistochemical analysis, the following p values were obtained: p = 0.5817 for VEGF, p = 0.1854 for metalloproteinase 1, and p = 0.0023 for metalloproteinase 1 inhibitor, with this last value being considered statistically significant. CONCLUSION We conclude that thalidomide influenced collagen maturation. There was a stronger action of metalloproteinases, possibly indicating a negative tendency for the healing process.

Viability of a 12-ring complete tracheal segment transferred in the form of a compound flap: an experimental study in dogs.

Introduction: There is a lack of an ideal substitute for the injured tracheal tissues. Autologous or homologous grafts and prostheses are inadequate because of their unreliable and nonviable nature for the reconstruction of a complete tracheal segment (CTS).

Efeito da drenagem abdominal na cicatrização de anastomoses colônicas: estudo experimental em ratos

Anastomosis dehiscence is a main complication of the gastrointestinal surgical procedures. Different factors might influence the healing process, including the presence of an abdominal drain. The aim of the present study was to evaluate the role of different abdominal drains, on the colonic anastomosis healing, in rats. Forty rats, all submitted to a colonic resection followed by a local anastomosis, were divided into 4 groups. Group I was the control. Groups II, III and IV received and abdominal drain constituted of latex, PVC or silicone, respectively. One week after, animals were killed and had their abdominal cavity inspected macroscopically (peritonitis, adhesions, dehiscence, and abscesses). The anastomotic regions were submitted to histological and biochemical evaluations. In total, 4 macroscopic, 13 histological and 1 biochemical criteria were evaluated and some of them did not show statistical differences between groups. Group II showed a negative outcome in comparison to the others. Control groups had a positive healing condition in comparison to the others. In conclusion, the abdominal drain, independently of the constituting material, is a negative factor which interferes with anastomosis healing, compared to controls. The latex drain showed the worse effect on healing, when compared to other drains.