Carlos Henrique Marques dos Santos

The ischemic preconditioning and postconditioning effect on the intestinal mucosa of rats undergoing mesenteric ischemia/reperfusion procedure

PURPOSE To evaluate the effect of the ischemic preconditioning and the ischemic postconditioning over the tissue injury in the intestinal mucosa of rats undergoing the procedure of mesenteric ischemia and reperfusion. METHODS Thirty Wistar rats were studied, divided in three groups: group A, undergoing mesenteric ischemia (30 minutes) and reperfusion (60 minutes); group B, mesenteric ischemia and reperfusion preceded by ischemic preconditioning; group C, mesenteric ischemia and reperfusion and, before the beginning of reperfusion, the ischemic postconditioning was performed. At the end, a segment of the small intestine was dissected for histological analysis. The results were evaluated using the CHIU et al.6 classification followed by the statistic treatment. RESULTS The mean values of the tissue injury levels were: group A, 3.5; group B, 1.2; and group C, 1. The difference between the result of group A with the results of groups B and C was considered statistically significant (p < 0,05). CONCLUSION The ischemic preconditioning and postconditioning are able to minimize the tissue injury in the intestines of rats that underwent the procedure of mesenteric ischemia and reperfusion.

Evaluation of ischemic postconditioning effect on mesenteric ischemia treatment: experimental study in rats

OBJECTIVE To assess the preconditioning and postconditioning effect on intestinal mucosal lesions in rats undergone mesenteric ischemia and reperfusion procedure. METHODS Thirty Wistar rats were studied and divided into three groups: Group A, 10 rats undergone mesenteric ischemia (30 minutes) and reperfusion (60 minutes); Group B, 10 rats undergone mesenteric ischemia and reperfusion preceded by ischemic preconditioning for three cycles of ischemia and reperfusion for two minutes each; Group C, 10 rats undergone mesenteric ischemia and reperfusion and, preceding the beginning of reperfusion, ischemic postconditioning was performed for three cycles of reperfusion and ischemia for two minutes each. Then, a segment of small intestine was resected for histological analysis. We assessed the results by Chiu et al. score and the statistical analysis was performed. RESULTS According to Chiu et al. score, the means of lesion degree were: In the group A, 3.5; Group B, 1.2; Group C, 1. The difference between group A with the groups B and C was considered statistically significant (P < 0.05). CONCLUSION Ischemic pre- and postconditioning were capable of minimizing - in a similar intensity - the tissue injury on the intestinal mucosa of rats undergone mesenteric ischemia and reperfusion process.

Perfil do paciente ostomizado e complicações relacionadas ao estoma

ABSTRACT: OBJECTIVE: To elaborate the profile of the patients with permanent ostomies and the complications related to thestoma. MATERIAL AND METHODS: This is a retrospective study based on the database of the patients with permanent ostomies,registered in the ‘Programa de Ostomizados do Centro de Especialidades Medicas’ of the City Hall of Campo Grande, MS.RESULTS: It was evaluated 178 handbooks of these patients (56,7% men and 43,3% women). The average age was 46,8 years forthe male group and 54.6 years for the female group. It was found 152 colostomies (85,4%), 21 ileostomies (11,8%) and 5urostomies (2,8%). The main indication for the stomas was the cancer (46,6%). The second indication was abdominal trauma(7,3%), and third was patients with decubitus ulcer (6,7%). Inadequate pouch placement was found in 90 patients (50,6%). Stomalcomplications had been found in 103 patients (57,9%), including skin irritation (28,7%), plain stoma (18,6%), peristomal hernia(10,7%) and stomal retraction (10,1%). CONCLUSIONS: It was concluded that, in the group evaluated, the major indication forstomal confection was the rectosigmoid cancer and the anal cancer. The most common was the peristomal dermatitis.Key words:

Terapêutica medicamentosa na isquemia e reperfusão mesentérica: revisão da literatura

Ate pouco tempo atras se acreditava que na isquemia mesenterica todas as alteracoes orgânicas desta afeccao eram devidas a obstrucao total ou parcial do fluxo arterial intestinal. Recentes descobertas quanto a fisiopatologia do processo de isquemia e reperfusao mesenterica demonstraram que os radicais livres, principalmente, atuam durante a reperfusao, levando a lesao tecidual muito mais importante do que as lesoes que ocorrem na fase de isquemia isoladamente. Assim, surge uma nova possibilidade terapeutica alem do tratamento cirurgico, em que uma determinada substância poderia atuar de modo a inibir ou minimizar a cascata de alteracoes no nivel celular que culminam na lesao e morte celular. Realizamos uma ampla revisao da literatura medica atual pelos bancos de dados LILACS e MEDLINE, visando verificar quais os farmacos estudados para este fim e os resultados obtidos nas pesquisas. Constatamos que inumeras substâncias tem sido avaliadas em estudos experimentais, em sua maioria utilizando ratos e a maioria nao apresentou resultados satisfatorios a ponto de permitirem seu emprego na pratica clinica; algumas, entretanto, apresentaram resultados promissores, necessitando ainda de novos estudos a fim de se descobrir uma substância que possa ser empregada em seres humanos em situacoes de isquemia e reperfusao mesenterica, a fim de se evitar tratamentos intervencionistas com altos indices de morbi-mortalidade.

Avaliação do pós-condicionamento isquêmico no tratamento da isquemia mesentérica: estudo experimental em ratos

OBJECTIVE To assess the preconditioning and postconditioning effect on intestinal mucosal lesions in rats undergone mesenteric ischemia and reperfusion procedure. METHODS Thirty Wistar rats were studied and divided into three groups: Group A, 10 rats undergone mesenteric ischemia (30 minutes) and reperfusion (60 minutes); Group B, 10 rats undergone mesenteric ischemia and reperfusion preceded by ischemic preconditioning for three cycles of ischemia and reperfusion for two minutes each; Group C, 10 rats undergone mesenteric ischemia and reperfusion and, preceding the beginning of reperfusion, ischemic postconditioning was performed for three cycles of reperfusion and ischemia for two minutes each. Then, a segment of small intestine was resected for histological analysis. We assessed the results by Chiu et al. score and the statistical analysis was performed. RESULTS According to Chiu et al. score, the means of lesion degree were: In the group A, 3.5; Group B, 1.2; Group C, 1. The difference between group A with the groups B and C was considered statistically significant (P < 0.05). CONCLUSION Ischemic pre- and postconditioning were capable of minimizing - in a similar intensity - the tissue injury on the intestinal mucosa of rats undergone mesenteric ischemia and reperfusion process.

Uso do propofol (2,6 diisopropilfenol) como inibidor da lesão tecidual na isquemia e reperfusão mesentérica: estudo experimental em ratos

PURPOSE: Evaluate the effects of propofol as inhibitor of tissue lesion in mesenteric ischemia and reperfusion in rats. METHODS: Forty rats Wistar were submitted to anesthesia and middle laparotomy. Intestinal ischemia was obtained by false ligature of cranial mesenteric artery by thirty minutes. Then, the tissue was reperfused for sixty minutes. The half of the animals received physiologic solution 0,9% 10 ml/kg/h (control group) by intravenous infusion; the other half received propofol 20 mg/kg/h by same way (propofol group). At the end, a segment of intestine was taken for histologycal analysis. The results were analyzed in agreement with CHIU et al 80 classification and the statistical analysis was done. RESULTS: In the control group was founded 5 rats with classification grade 2; 8 with classification grade 3; 3 with classification grade 4 and 4 rats with grade. In the propofol group was found 6 rats with classification grade 1; 11 with classification grade 2 and 3 with classification grade 3. The classification media was 3,3 for control group and 1,85 for the propofol group. The variation in the two groups was considered statistically significant (P < 0,05). CONCLUSION: The propofol minimize the tissue lesion in mesenteric ischemia and reperfusion in rats.

Postconditioning effect in the hepatic ischemia and reperfusion in rats

PURPOSE To evaluate the effect of postconditioning protection in liver tissue of rats submitted to ischemia and reperfusion. METHODS 25 Wistar male rats were randomized in three groups: Group A (ischemia and reperfusion - I/R), with 10 rats, which was made ischemia by vascular clamp application in hepatic hilum for 30 minutes and reperfusion for 60 minutes by removal of the clamp; Group B (Postconditioning - IPo), with 10 rats, with same procedure plus postconditioning (3 cycles of reperfusion inserted by 3 cycles of ischemia, 30 seconds for each phase, between ischemia and reperfusion phases); and Group C (Sham), with 5 rats, which took place only laparotomy and manipulation of the hepatic hilum. Specimens were examined (histological evaluation) and dosage of serum AST and ALT was made. The statistical analysis was made with t Student test, with significant difference when p<0.05. RESULTS In the Sham group there was no histological or enzymatic changes; In group A the mean tissue lesion was 1.6 and in group B 1.1 (p=0.014). In group A the mean ALT level was 355U/l and in group B was 175.9U/l (p=0.016). The mean of AST was 828.8U/l in group A and 295.5U/l in group B (p=0.001). CONCLUSION The postconditioning was able to minimize the severity of liver injury in rats submitted to ischemia and reperfusion.

Association and management of Crohn's disease plus hidradenitis suppurativa

Crohn’s disease (CD) and hidradenitis suppurativa (HS) are both chronic inflammatory diseases in organs inhabited by commensal microorganisms, related to smoking and genetic etiologic compounds. Although the former affects primarily the gastrointestinal tract (GIT) and the latter concerns the skin, their probable association suggests a common treatment. Anti-tumor necrosis factor alpha (TNF-a) has been used in patients with CD and some reports show remission of HS with it; therefore, it was tried in our patient, a 26-year-old woman, Brazilian, nonsmoker, with a 6-year diagnosis of fistulizing rectovaginal CD. At first an advancement flap technique was tried, unsuccessfully. Then infliximab treatment was initiated (standard dose), closing the fistula. One year later, she developed a perineal HS, confirmed by histopathologic exam, successively treated with ciprofloxacin, cephalexin, and sulfamethoxazole/trimethoprim, presenting partial response only to the latest association. A surgical resection of the lesions was performed but they relapsed on two other occasions, requiring new resections. Although the rectovaginal fistula remained closed, the history of relapsing HS led to increasing the infliximab dose to 10 mg/kg. After 6 months without improvement, adalimumab was chosen (standard dose), with persistence of the abscesses (Figs. 1, 2). CD is an inflammatory bowel disease of unknown cause. It is more frequent in American or European white women, smokers, between 20–40 years old, in urban areas. Adding to the epidemiology, there are a few other factors: genetic (NOD2 gene mutation in 15%–20% of the patients, HLADR1/DQw5, HLA-A2, and HLADRB3*0301 carriers are more likely to develop the disease), intraluminal (greater amount of bacteria in the GIT), intestinal permeability (increased and with a minor tissue repair rate), and immunoregulation failure (antigen presentation directed to Th1 response rather than suppressor T response). HS consists of recurrent nodules, abscesses, or sinus tract in apocrine gland-bearing areas, such as the axilla, groin, and perineum. Its prevalence is estimated around 1%, and its pathogenesis is based on infundibular hyperkeratosis leading to pilosebaceous follicular occlusion, with posterior dilatation and rupture, occasionally forming granuloma. The disease etiology might be FIGURE 1. Hidradenitis suppurativa lesion and scar from previous resection. [Color figure can be viewed in the online issue, which is available at wileyonline library.com.]

Principais achados de colonoscopias realizadas em caráter de urgência e eletivas

Since 1960 it there was a great technological breakthrough, including the observation of the digestive system with the advent of flexible endoscopy. Initially used to the upper digestive tract and subsequently to the colon, allowing more accurate diagnoses and, in some cases, the complete treatment. Even in urgency situations, colonoscopy can be used as first choice and work as a diagnostic tool or eve the therapeutic procedure. AIM: This study analyzed the results of colonoscopy held in the Digestive Endoscopy unit at the Hospital Regional Rosa Pedrossian in Mato Grosso do Sul. MATERIALS AND METHODS: It was performed a colonoscopy in 290 patients at the unit of Digestive Endoscopy in the Hospital Regional of Mato Grosso do Sul, in during november 2006 until august 2007. The results were analyzed and verified the following variables: sex, age, solicitation as elective or emergency and diagnosis. RESULTS: The age of the patients ranged from 15 to 92 years old and the mean age was 52 years. Most of the patients were female (56.5%). The colonoscopy tests showed that 48.5% (n=141) were normal. Among the abnormal there were a prevalence of colon diverticulum (n = 56), followed by polyps (n = 37), inflammatory diseases (n = 31), cancer (n = 18) and angiodisplasy (n = 7). Polyps most usual place were in colorectal sigmoid (n = 18) followed by colorectal downward and rectum. The inflammatory diseases were shown as actinic colitis (n = 11) followed by actinic proctitte (n = 7) and nonspecific proctite (n = 7). There was a higher prevalence of procedures from the ambulatory 73%, interns 20% and from the emergency room 7%. CONCLUSION: The predominant diagnosis was diverticulum disease, followed by polyps. Digestive hemorrhage was the main signal noticed by the doctors who asked for the exam. With a high incidence of polyps, and mostly in sigmoid, just evidenced the how important the retosigmoidoscopy is. It is a relatively safe and cheaper procedure in comparison to the colonoscopy and can be performed during the simple consultation. The low incidence of angiodisplasia could be explained by a relatively low average age, differing from literature.

Utilização de adesivos de cianoacrilatos em suturas de pele

INTRODUCTION: Cyanoacrylates are liquid monomers that polymerizes, resulting in a strong hold when applied to skin. Applicable in lots of areas in Medicine and promising results in emergency rooms. DISCUSSION: The majority of the revised studies about these adhesives demonstrate results comparable to the traditional methods of suture. It is indicated for clean injuries, after adequate hemostasia, in not humid places and low tension and, especially in young people. Some advantages are the decreasing of surgery time proportionally to the size of the suture, easy application, anesthesia not needed, do not require removal, minor risk of needle sticks, painless and probably biocide activity of some CA. The disadvantages are the high cost of the adhesive, minor resistance to tension and humidity, sensation of burn in the application area, tack of the adhesive to the clothes and contact with the interior of the injury. Related complications are the higher index of dehiscence of sutures according to only one author and worse approach of the edges of the injury. CONCLUSION: When correctly indicated CA are a good alternative to suture wires and have aesthetic and functional results equivalent to traditional methods and acceptable risk of complications. More clinical assays with low cost glue are necessary to demonstrate its security and applicability in the practical, mainly in developing countries as Brazil.