Carlos Augusto Mathias

Effects of Propranolol on Human Postoperative Ileus

Background: The sympathetic nervous hyperactivity present in response to surgical stress has been implicated as an important component of the postoperative paralytic ileus. A randomized and prospective study was conducted, evaluating the effects of the preoperative beta-adrenergic blockade with propranolol in schistosomotic patients during the period of postoperative ileus. Methods: The study compared schistosomotic patients submitted, or not, to beta-adrenergic blockade. Basal cardiac frequency was determined and propranolol was used in a dose of 40 mg twice a day. The dose was adjusted weekly until a minimum decrease of 20% in cardiac frequency was achieved. Three coupled bipolar electrodes were placed in the left colon in both groups, and registration of myoelectric activity of the left colon was made twice a day during the period of postoperative ileus using a system of data collection (DATA Q Series 200). The electric signals were previously amplified, filtered and separated into Electric Control Activity (ECA) and Electric Response Activity (ERA). Results: The dose of propranolol varied from 80 to 160 mg/day. The proportional decrease in basal heart frequency varied from 20 to 33%, with an average of 25.4 ± 3.9% in the propranolol group, maintaining a mean of 24.3 ± 3.6% decrease in the postoperative period. Differences on clinical recovery of the postoperative ileus were not found. Significant differences on electromyographic patterns were not observed between the groups, except for the presence of a greater number of short-duration contractions in the second postoperative day in the beta-blocked group. Conclusion: The authors suggest that the preoperative beta-adrenergic blockade with propranolol does not determine myoelectric activity changes that could contribute to an earlier resolution of postoperative ileus.

Influência da cola Bioglue® na deiscência de anastomose colônica: estudo experimental

The great part of the morbimortality associated with the colorretal surgery, is related with the anastomotic dehiscence. Experimental trials on the utility of tissue adhesives in the colonic anastomosis are controversial, as well as prospective randomized clinical studies are absent. BioGlue® Surgical Adhesive(BSA) is a two-component surgical adhesive composed of purified bovine serum albumin and glutaraldehyde. The glutaraldehyde molecules covalently bond (cross-link) the BSA molecules to each other and, upon application, to the tissue proteins at the repair site. The aim of this study is to evaluate the effectiveness of the BioGlue® in the prevention of the anastomotic colonic dehiscence in rats. Thirty male Wistar rats had been used. The colocolonic anastomosis was confectioned with separate stitches with polypropylene 5-0 (group 1) and the application of the BioGlue® Surgical Adhesive (group 2). The formation and extension of the adhesions, the histological alterations and the rupture pressure had been evaluated. In the group 1, we have only 7% of mortality (01 animal), being evidenced in the autopsy, intestinal obstruction with major bowel distension. The mortality in group 2, on the other hand, was 67% (10 animals), being observed: bowel distension, anastomotic dehiscence and, in some situations, fecal peritonitis because of anastomotic total dehiscence. We concluded in the present study that, the use of BioGlue® Surgical Adhesive in colonic anastomosis in rats, is associated with an increase of the morbimortality in comparison with conventional suture which was statistically significant.

Avaliação experimental da recuperação o do íleo paralítico pós-operatório após colectomia convencional e laparoscopica

Laparoscopic surgery has gained a wide acceptance, determining a review in many surgical dogmas. One of those dogmas is the apparent lack of postoperative ileus. The patterns and lhe difference between laparoscopic assisted colectomy and the traditional open colectomy, of colonic motility were determined experimentally. Ten, healthy, dogs, weighting 20 to 30 kg, were instrumented with bipolar electrodes. Each animal was instrumented with 8 bipolar recording electrodes, 4 on the small bowel and 4 on the colon. Dogs were allowed to recover for ten days, when baseline myoelectric recordings were obtained. Then, the dogs were randomized to open or laparocopic colectomy. Operations were carried out after an overnight fast, under sterile conditions and general anesthesia. Myoelectric recording resumed immediately following operations and was continued until the complete resolution of lhe postoperative ileus. None of lhe dogs received analgesics. There were no significant differences between the groups regarding the end of the colectomy and the first Migrating Myoelectric Complex (MMC), the end of the colectomies and the return of the phase lI, the time division between the end of the colectomies and the first Migrating Colonic Contraction, the end of the colectomies and the first Giant Migrating Colonic Contraction, and the relation between the end of the colectomy and the first evacuation. The authors concluded that laparoscopic assisted colectomy produces postoperative ileus and there was no difference between the groups, relating the period of time of recovery from postoperative paralytic ileus.

Padrão mioelétrico do cólon esquerdo no reflexo gastrocólico

Our aim in this study was to settle the patterns of the myoelectric activity on the left colon ( sigmoid) regarding the gastrocolic reflex by analysing the Electric Control Activity (ECA), the Electric Response Activity (ERA), the Migrating Colonic Contractions. We included 15 patients, with no gastrointestinal tract complaints, who underwent histerectomy. The mean age was 40,2 years. Patients were control of themselves and registers were compared with each other before, during and after meal. Bypolar electrodes covered with teflon were implanted on the anterior left colon taenia. After postoperative recovery, data collection was put together. There was taken a DATA Q 200 system for the collection data which reaches frequencies between 0,02 and 10Hz and a software that runs in the Windows environment. Our results showed that there was no significant difference neither in the ECA nor in the short duration ERA ( number/hour) between the groups. The long duration ERA showed a significant decrease regarding its number/hour. There was a statistically significant difference in the Migrating Motor Complex between the registers before and during meal. Regarding the left colon, we concluded that while the electric activity decreased, the motor activity increased after meal.

Cystic dilatation of the common bile duct in adults: report of five cases and review of literature

Os autores apresentam cinco casos de dilatacao cistica do ducto biliar comum do Tipo I (classificacao de Todani) em adultos, anteriormente nao relatados, num periodo de 25 anos no Servico de Cirurgia Geral de um Hospital Universitario, entre 16.057 operacoes, no periodo de 1974 e 1999. O diagnostico dos cistos foi realizado atraves de colangiografia operatoria (CO) no primeiro, por colangiografia transparietohepatica no segundo (CTPH) e por ultra-sonografia (US), colangiopancreatografia endoscopica retrograda (CPER) and colangiografia operatoria (CO), respectivamente, nos tres ultimos casos. Em um dos pacientes, foi detectado adenocarcinoma localizado na parede posterior do cisto, associado a metastases peritoniais. Os dois primeiros casos foram tratados atraves de derivacao cistoenterica, sendo nos tres ultimos realizada a excisao do cisto, seguida de hepaticojejunostomia em Y de Roux. Foram revisados classificacao, incidencia, etiologia, diagnostico, malignizacao e tratamento cirurgico da doenca cistica biliar (DCB), concluindo-se que a terapeutica cirurgica de escolha deve ser a resseccao, quando possivel, sobretudo devido ao risco significativo de malignizacao.