César Orlando Peralta Bandeira

Effects of repeated extracorporeal shock wave on kidney apoptosis of normal and diabetic rat

OBJECTIVEnTo assess the effect of repeated extracorporeal shock waves (ESW) on the apoptosis of renal parenchyma in normal and diabetic rats by the caspase-3 expression.nnnMATERIALS AND METHODSn80 rats were assigned for ESW (Direx Tripter X1(R) - 14 KVA) to one of three groups with 50% rats with diabetes (A) and 50% normal (B) in each: G1 (n = 40): no ESW; G2 (n = 20): one ESW; G3 (n = 20): two ESWin an interval of 14 days. The animals were sacrificed 3 days after the ESW and samples of the renal parenchyma were histologically prepared, stained by the caspase-3 cleavage immunohistochemical method, and the apoptotic index (ApIn) was calculated by computer program Image Pro-Plus V 4,5,1 Media Cybernetics ( ApIn = number of apoptotic cells in the microscopic section / total cells in the microscopic section).nnnRESULTSnThere was no statistical difference in ApIn of normal rats with one ESW (8.4 +/- 0.2) or two ESW (9.1 +/- 0.3) and both were similar to the control group with no ESW (7.9 +/- 0.2). The ApIn of diabetic rats with one ESW (7.4 +/- 0.3) was similar to the normal rats with one or two ESW. On the other hand, the ApIn was statistically higher in diabetic rats with two ESW (11.9 +/- 0.4) than in diabetic rats with one ESW (7.4 +/- 0.3).nnnCONCLUSIONSnThe ApIn of normal rats with a single (2,000 SW) or repeated ESW (4,000 SW) was similar to the control animals without any ESW. In diabetic rats, the repeated ESW (4,000 SW) may result in an additional risk of tissue damage expressed by the higher ApIn.

Manometric and radiographic evaluation of transduodenal sphincteroplasty (papillary dilation) in dogs

PURPOSEnTo evaluate, in dogs, the functions of biliary sphincter subjected to dilation hydrostatic balloon by the point of view of the radiographic and manometric alterations.nnnMETHODSnTwenty dogs were submitted to laparotomy, duodenotomy, and enlargement of the major duodenal papilla- GA(n=10) - with balloon of 8mm inflated with pressure of 0,5atm, during 2 minutes or to the sham procedure - GB(n=10). The computerized manometry and the cholangiography were done before and immediately after the initial procedure, one and four weeks after the dilation or the sham. It was calculated from the radiographic images: the mean, standard deviation, absolute and percentual variation of the diameter measures of the papilla. It was measured: the basal pressure in the papilla region, the contraction amplitudes and the choledoc pressure in all observation times (t0, t7 and t28).nnnRESULTSnThere was not differences in the diameter measures of the papilla in t0 (GA=5,14 +/- 1,1) (GB=4,64 +/-0,9), as well as in the absolute (0,14 mm) or relative (-2,7%) variations. In the animals of GA the papilla basal pressure measure was found to be smaller in t28 (11,1) than in t0 (18,6) and t7 (16,2). The contraction amplitudes measures were significantly smaller in the postoperatory times (post-t0, t7 and t28) when comparing to the initial time (pre-t0), in the animals of groups A and B. The average pressure values in the choledoc were also smaller in t28 (7,5) than in t0 (17,8) and t7 (12,6) in the animals of GA.nnnCONCLUSIONnthe function of the major duodenal papilla is partially committed with the dilation, therefore it provoked the basal pressure decrease and compromising of the capacity of sphincter in its cyclical contractions up to the 28 days of observation.

Body temperature evaluation during induced pneumoperitoneum with CO2: an experimental study in pigs

BackgroundIn prolonged laparoscopic procedures, hypothermia is frequently observed. The possible influence of the vasodilating action of CO2, due to its increased levels in the blood during the laparoscopic procedures, has yet to be studied. The objective of this study was, therefore, to evaluate body temperature patterns in pigs subjected to pneumoperitoneum with CO2.MethodsThirty male pigs were allocated into three groups of ten animals each: group I, anesthetic procedure and abdominal puncture only; group II, the same as for group I and insufflation with CO2; and group III, the same as for group I and insufflation with medical grade compressed air. After anesthetic induction and surgical preparation, rectal and esophageal temperatures were measured every 10xa0min. Blood was collected during the experiment for the gasometric measurement of pCO2. Animals were insufflated with no gas loss and were kept anesthetized for 180xa0min. For statistical analysis, Friedman and Kruskal–Wallis tests were used at a level of significance of 95% (Pxa0<xa00.05).ResultsAnimals in groups I and II (Pxa0=xa00.000) had a statistically significant drop in both esophageal and rectal temperatures during the experiment, but not animals in group III. However, when the groups were compared among themselves, no statistically significant differences were found at any of the times measured. A statistically significant drop in pCO2 levels was observed for groups I and III, but not for animals in groups II.ConclusionsThe use of CO2 did not significantly affect body temperature variation in pigs subjected to pneumoperitoneum. However, CO2 produced a temperature drop pattern different than that of compressed air, indicating that CO2 may lead to thermoregulatory changes and influence the peripheral temperature drop.

The repeated extracorporeal shock waves and the renal parenchyma injury on normal and diabetic rats

PURPOSEnTo assess the effect of repeated extracorporeal shock waves (ESW) on renal parenchyma of normal and diabetic rats.nnnMETHODSn40 normal rats (A) and 40 diabetic rats (B) were assigned for ESW (Direx Tripter X1 - 14 KVA) as follow: A1/B1 and A3/B3 no ESW; A2/B2 one ESW (2,000 SW); A4/B4 two ESW (4,000 SW) in an elapsed 14 days. All the animals were sacrificed 3 days after the ESW and samples of renal parenchyma were histological prepared, stained by H&E. For each animal the frequency of hemorrhage focus (HF) in the subcapsular, interstitial and glomerulus area was calculated (percentage) on 20 randomly histological sections.nnnRESULTSnNo one HF was identified in all normal or diabetic animals without ESW (A1, A3 and B1, B3). In the normal rats the HF frequency was similar to one ESW (subcapsular =15%; interstitial =20% and glomerular =10%) or repeated ESW (subcapsular =25%; interstitial =20%; glomerular=10%). In diabetic rats the occurrence of HF with repeated ESW was more frequent (subcapsular =40%; interstitial =30% and glomerular =10%) than with a single ESW (subcapsular =25%; interstitial =15% and glomerular =15%).nnnCONCLUSIONnA single ESW or a repeated ESW caused a mild and similar damage on renal cortex of normal rats. In diabetic rats the repeated ESW may result in an accumulated damage, especially with focus of hemorrhage in subcapsular and interstitial tissue and glomerulus edema.

Evaluation of care for traffic accidents victims made by on duty emergency physicians and surgeons in the emergency room

OBJECTIVEnto evaluate the care for victims of traffic accidents by on call emergency physicians and/or surgeons in the emergency room.nnnMETHODSnwe conducted a retrospective, descriptive and exploratory study on the care for traffic accidents victims in the urban area of u200bu200bMaringá-PR, between July 2013 and July 2014 in reference hospitals. We assessed demographics and vocational training through a questionnaire sent to the attending physicians.nnnRESULTSnof the 688 records evaluated, 99% of patients had a prehospital Revised Trauma Score of 12. Statistical analysis showed that in the cases conducted by the emergency physicians (nu200b=187), the recording of the Glasgow Coma Scale and the performance of surgical procedures were less common, whereas the recording of blood pressure values u200bu200bwas performed in greater numbers when compared with cases led by surgeons (n=501). There was a statistically significant relationship (p<0.01) between the length of hospital stay and surgical specialty, with a greater chance (crude OR=28) in the period from one to six hours for the group treated by emergency doctors. Most physicians participating in the study were young, with emergency room time of up to one to two years, and with ATLS training. Among those who had attended the ATLS course, 60% did so in the last four years. Surgeons performed 73% of hospital treatments.nnnCONCLUSIONnin the care of traffic victims with minor injuries, the Glasgow Coma Scale, the blood pressure levels, the type of treatment in the emergency room and hospital stay had different approaches between emergency physicians and surgeons.

Effects of structural injure in the bile bacterial contamination after balloon transduodenal sphincteroplasty (papillary dilation) in dogs

PURPOSEnTo evaluate, in dogs, the biliary sphincter subjected to dilation by hydrostatic balloon by the point of view of structural alterations of the papilla and the biochemestry and bacterial contamination of the bile.nnnMETHODSnTwenty dogs were submitted to laparotomy, duodenotomy, and enlargement of the major duodenal papilla- GA(n=10) - with balloon of 8mm inflated with pressure of 0,5 atm, during 2 minutes or to the sham procedure - GB(n=10). Blood samples collected on times t(0 day), t(7 days) and t(28 days) were subjected to dosages of alkaline phosphatase (ALP) and gamma-glutamyltransferase (GGT) for cholestasis evaluation. The collected material from the gall bladder at the same times were registered and numbered to be submitted to culture in BHI, blood agar (rich, non-selective element) and Mac Conkey (selective element for Gram-negative bacillus. On the 28th day three fragments of the papilla were tranversally cut by the choledoc axis 3mm from the duodenal papilla and the cuts, stained with hematoxylin-eosin and Massons tricome, were evaluated according to their inflammatory reaction.nnnRESULTSnThe GGT and ALP averages on the three periods in the groups A and B did not show significant differences, not being characterizes the cholestasis. The bacterian contamination was significantly higher in GA (2,19) than in GB (1,96); the contamination was lower in the initial time compared with 7 and 28 days (t0<t7 and t 28) in GA and GB (t0<t 28). The chronic inflammatory alteration of the mucosa occurred in 60% of the GA animals and in 80% of the GB animals. There was not mural inflammation.nnnCONCLUSIONnThe duodenal papilla dilation or its simple manipulation leads to the bacterial contamination of the gall bladder, not associated with cholestasis. The morphologic lesions are more intense in the late phase, not associated with an eventual papilla esthenosis.