Deomir Germano Bassi

Bacteriology of the anal wound after open hemorrhoidectomy

The purpose of this study is to analyze the size of the bacterial colonies in anal wounds after open hemorrhoidectomy. Twenty patients were studied during predetermined postoperative time periods. Material was collected from the surface and from within the tissue of each patients three open wounds, intraoperatively, on the 6th, 13th and 20th postoperative days for bacteriologic examination in aerobic, microaerophilic, and anaerobic media. The bacterium most commonly identified wasEscherichia coli,followed byStaphylococcus aureusandStaphylococcus epidermidis. Pseudomonas aeruginosa, Enterococcus faecalis, Klebsiella pneumoniae, Proteus vulgaris,andProteus mirabiliswere also identified. Critical indexes of colonization were present since the intraoperative stage (>105bacteria/g of tissue and >106bacteria/ml); obligate anaerobic bacteria were not identified; neither the species nor the number of bacteria, even when critical indexes were present, prevented proper healing. The same bacteria were not necessarily present on the surface and in the tissue; the bacterial load observed among the three wounds (left lateral, right posterior, and right anterior), was the same.

Why Do Anal Wounds Heal Adequately? A Study of the Local Immunoinflammatory Defense Mechanisms

PURPOSEThe aim of this study was to identify the tissue defense immunoinflammatory mechanisms present in the healing process of anal region wounds resulting from hemorrhoidectomy by the open technique.METHODSImmunohistochemical techniques were applied to biopsies of anal wounds obtained on Day 0 and Day 6 after surgery from 20 patients with hemorrhoid disease to characterize and quantify macrophages, T and B lymphocytes, and natural killer cells in high-power fields (400×). These techniques were also used to identify cells showing immunoexpression of cytokines (transforming growth factor beta 1, transforming growth factor beta 2, transforming growth factor beta 3) and constitutive and induced nitric oxide synthase. Plasma cells were quantified on slides stained with hematoxylin and eosin and the presence of immunoglobulin G, immunoglobulin M, and immunoglobulin A secreting cells was investigated by direct immunofluorescence.RESULTSAn acute nonspecific inflammation with no lymphomononuclear-plasmacytic component was observed on Day 0. On Day 6, an inflammatory cellular infiltration rich in macrophages and lymphoplasmacytic cells was detected, which documented the participation of innate defense mechanisms and the adaptive tissue response. On Day 6, the mean number of immunoinflammatory cells were as follows: macrophages (CD68+) = 190.3; macrophages (HAM56+) = 184.3; T lymphocytes (CD3+) = 59.6; T lymphocytes (CD45RO+) = 47.7; helper T lymphocytes (CD4+) = 89.2; cytotoxic T lymphocytes (CD8+) = 29.4; B lymphocytes (CD20+) = 64.4; plasma cells = 1.7; natural killer cells (NK1+) = 12.9. Macrophages (HAM56+ and CD68+) were present in significantly higher amounts than those of the remaining ones. B lymphocytes (CD20+) predominated over T lymphocytes (CD3+), although the difference between the two cell types was not significant. Participation of the humoral immune system was characterized by the presence of immunoglobulin G–secreting cells. The cellular immune system was characterized by the identification of T lymphocytes (CD3+ and CD45RO+), most of them belonging to the T helper cell subpopulation (CD4+). These predominated in a significant manner over cytotoxic T lymphocytes (CD8+). Natural killer cells were present in small amounts. There was immunoexpression of constitutive nitric oxide synthase on Day 0 and on Day 6. Induced nitric oxide synthase was not identified on Day 0 but was present on Day 6. Transforming growth factor beta 2 and transforming growth factor beta 3 were expressed in endothelial cells on Day 0 and on Day 6, and transforming growth factor beta1 was also expressed in macrophages, endothelial cells, and fibroblasts on Day 6. Transforming growth factor beta 1 and transforming growth factor beta 2 were expressed significantly in macrophages, whereas transforming growth factor beta 3 occurred at similar proportions in the three cell types.CONCLUSIONSThe host developed locally innate and immunologic defense adaptive mechanisms. The predominant local defense response involved macrophages. Natural killer cells and immunoexpression of constitutive nitric oxide synthase in endothelial cells were components of the noninduced innate response. In the induced innate response, in addition to neutrophils, there were large numbers of macrophages that were the major cells showing immunoexpression of transforming growth factor beta and induced nitric oxide synthase. The adaptive immunologic response was characterized by T and B lymphocytes. Helper T cells and cytotoxic T cells predominated in the cellular immune response and cytotoxic T cells and natural killer cells were present in small numbers. Secretory immunoglobulin G plasma cells were present in small numbers as a component of the humoral immune system.

Efeito da nifedipina gel 0,2% nas pressões de canal anal e na dor pós-operatória: estudo após hemorroidectomia pela técnica aberta

INTRODUCTION: Hemorrhoids are very common and pain following their surgical treatment causes great suffering. Various alternatives have been studied for reducing postoperative pain. Among these is surgical sphincterotomy, which may in some cases cause some degree of fecal incontinence. For this reason, several studies have used chemical sphincterotomy, with nifedipine, diltiazem, glycerin trinitrate or botulinum toxin. The objective of the present study was to investigate the effects of topical nifedipine for reducing anal canal pressures and consequently reducing postoperative pain. MATERIAL AND METHOD: Topical gels of 0.2% nifedipine plus 2% lidocaine (Group 1) and 2% lidocaine alone (Group 2) were used following hemorrhoidectomy. Pressures were measured before the operation and on the first, fourth and seventh days after the operation. Pain was also evaluated on all of the first seven postoperative days using a visual analog scale. RESULTS: There were no differences in relation to anal canal pressures, but lower pain levels were reported in the group that received nifedipine. CONCLUSION: Nifedipine gel was efficient for postoperative analgesia, but did not alter anal canal pressures.

Bariatric surgery: impact on sexuality of the obese person.

OBJECTIVE To assess the impact of surgical treatment in the sexuality of the obese. METHODS We conducted a qualitative / quantitative research with 30 patients who had undergone Fobi-Capella Roux-Y gastric bypass for at least one year. We collected data through individual interviews using a questionnaire with 10 mixed questions and one open, between May and June 2011. The objective data were quantified in absolute numbers and percentages, and the subjective ones were analyzed using the Discourse of the Collective Subject (DCS) and discussed in view of reference published on the subject. RESULTS 30 patients were enrolled, with a mean age 44 ± 12 years, 24 (80%) were female and six (20%) were male, 23 (77%) were married, 23 (96%) were hypertensive and eight (33%) were diagnosed with Diabetes Mellitus. After the operation, 11 (37%) individuals reported no change in the number sexual intercourses, but 19 (63%) reported that this number was altered, 16 (53%) informed increased frequency, one (3%) reported a decrease in frequency, one (3%) did not practice sexual intercourse anymore and one (3%) did not report the frequency. The central ideas (CI) raised originated four DCSs: Experience of female sexuality; No experience of female sexuality; Experience of male sexuality; and improvements of comorbidities and psychological factor. CONCLUSION there are positive repercussions of physical and emotional orders of the surgical treatment of obesity, favoring the quality of life, including sexuality.

Avaliação manométrica anal pré e pós tratamento da fissura anal crônica com nifedipina tópica 0,2%

In the treatment of the anal fissure, calcium channel blockers are among the new drugs which have been used. The objective of this research was the manometric evaluation of patients with chronic anal fissure after topic treatment with 0.2% nifedipine and correlation with the healing and pain. This is a prospective study of patients from Coloproctology Clinic of the University of Taubate Hospital. The patients had been submitted to a manometric examination before and after 30 days of the use of topic 0.2% nifedipine gel three times a day in the anus and anal edge. For the statistics analysis Mann-Whitney test was applied to a significance of p= 0,05. Ten patients did not exihibit manometric alteration associated with nifedipina treatment, however 50% of them reported improvement of the symptoms and 40% depicted healing of the fissure. The results demonstrated that nifedipine was effective and safe for anal fissure treatment and considering the functional point of view it did not cause injuries as well. The manometric evaluation did not demonstrate alterations in the anal pressure; however, it was observed that 50% of the patients had improvement in pain and 40% in healing.

Gist-induced upper gastrointestinal bleeding

Gastrointestinal stromal tumors (GIST) are rare neoplasms that mostly affect patients over the age of 50, with no gender predilection1,2. The diagnosis of GIST is made by means of immunohistochemistry testing for CD117 (c-kit), and combination treatment with surgical intervention and adjuvant chemotherapy has produced good outcomes3. We report a case of gastric GIST diagnosed after an episode of upper gastrointestinal bleeding and successfully treated by subtotal gastrectomy.

Neoplasia no sítio da colostomia: relato de três casos e revisão da literatura

Carcinomas rarely occur at the site of a colostomy. Colostomies are risk for malignancy, just as in any other portion of the colon. If the initial resection was for cancer, then the risk of metachronous colon adenocarcinoma is significantly higher than for the general population. Metachronous colorectal carcinoma occurs from 0.1 to 3.6 percent of patients who undergo surgery for colorectal carcinoma and the recurrence of the primary bowel malignancy that necessitated the stoma may present with signs of bleeding or obstruction. We report three cases of this rare neoplasia occurring at the site of a colostomy, and we review the literature.

Hérnia de amyand

Amyands hernia is an extremely rare surgical event. It is characterized by the presence of acute appendix in an incarcerated inguinal hernia. Its clinical presentation varies, depending on the extent of appendicular inflammation. The authors report a case of Amyands hernia, in an 89 years-old male who had the diagnosis made intraoperatively.

Esôfago de barrett após gastrectomia total com reconstrução em Y de roux

Reflux esophagitis and Barretts esophagus after total gastrectomy is related to reconstructive procedure of intestinal continuity. The Roux-en-Y operation with length of limb of 40 cm occasionally is not enough to prevent biliary reflux to distal esophagus. Barretts esophagus is thought to develop as a consequence of biliary reflux and has a malignant potential. Symptoms of retroesternal burning and dysphagia that does not improve with conservative management has to be treated by an operative procedure. To prevent biliary reflux to distal esophagus after total gastrectomy the lenght of limb of Roux-en-Y should be at lest 60 cm.