Edson Yuzur Yasojima

Effect of copaiba oil on correction of abdominal wall defect treated with the use of polypropylene/polyglecaprone mesh

PURPOSE To evaluate the effects of copaiba oil on the correction of abdominal defect treated with the use of polypropylene/polyglecaprone mesh in rats. METHODS A defect in the abdominal wall was created and corrected with polypropylene/polyglecaprone mesh in 36 rats. They were randomly distributed into three groups: control, copaiba by oral administration (gavage) and copaiba oil dip in the mesh. Euthanasia was performed after seven, 14 and 21 post-operative days. The healing process was analyzed regarding the meshes and macroscopic and microscopic aspects. RESULTS All animals had abdominal adhesions, which were smaller in the copaiba (gavage) group (p<0.05). In microscopy, all animals had an acute inflammation stage and the inflammatory response was best characterized by foreign body-type granulomas around the mesh fragments, which was not found in the mesh fragments within the copaiba dip group. There was a greater area of necrosis and fibrosis in the copaiba dip group compared to the control group (p<0.05). The copaiba (gavage) group had a greater quantity of collagen fibers compared to the control group. CONCLUSION Copaiba oil administered by gavage decreased the amount of abdominal adhesions, besides accelerating the process of collagen fibers formation, without damages within the early stages of healing. However, when used by dip directly on the mesh, it had corrosive effects compromising the healing process of the abdominal wall.

COPAIBA OIL INFLUENCES VENTRAL HERNIA REPAIR WITH VICRYL® MESH?

Background: The use of meshes in hernia surgical repair promoted revolution in the surgical area; however, some difficulties had come, such as a large area of fibrosis, greater postoperative pain and risk of infection. The search for new substances that minimize these effects should be encouraged. Medicinal plants stand out due possible active ingredients that can act on these problems. Aim: To check the copaiba oil influence in the repair of abdominal defects in rats corrected with Vicryl(c) mesh. Method: Twenty-four Wistar rats were submitted to an abdominal defect and corrected with Vicryl(c) mesh. They were distributed into two groups: control and copaíba via gavage, administered for seven days after surgery. The analysis of the animals took place on 8, 15 and 22 postoperative days. It analyzed the amount of adhesions and microscopic analysis of the mesh. Results: There was no statistical difference regarding the amount of adhesions. All animals had signs of acute inflammation. In the control group, there were fewer macrophages in animals of the 8th compared to other days and greater amount of necrosis on day 8 than on day 22. In the copaiba group, the number of gigantocytes increased compared to the days analyzed. Conclusion: Copaiba oil showed an improvement in the inflammatory response accelerating its beginning; however, did not affect the amount of abdominal adhesions or collagen fibers.

Colangiografia peroperatória sistemática em colecistectomia videolaparoscópica

OBJETIVO: Analisar os resultados de colangiografias peroperatorias (CPO), realizadas sistematicamente durante colecistectomias videolaparoscopicas (CVL). METODO: No periodo de janeiro de 1998 a dezembro de 1999, foram realizadas CVL em 250 pacientes nao selecionados, 65 (26%) do sexo masculino e 185 (74%) do sexo feminino, independente da presenca ou nao de sinais clinicos, laboratoriais, ultra-sonograficos ou de outros metodos diagnosticos, indicativos de coledocolitiase ou outras doencas da via biliar principal. RESULTADOS: A CPO pode ser realizada em 237 (94,6%) pacientes. Foram encontradas 31 (13%) alteracoes, entre as quais seis (2,5%) casos de coledocolitiase e 25 (10,5%) casos de anomalias anatomicas. CONCLUSAO: A CPO, durante a CVL, mostrou-se um procedimento seguro, sem complicacoes relacionadas ao exame, definindo a anatomia, prevenindo as lesoes biliares e permitindo a deteccao de coledocolitiase insuspeitada.

Sigilo e confidencialidade na relação médico-paciente: conhecimento e opinião ética do estudante de medicina

Given that the medical secrecy is a moral characteristic of medicine and basis of the doctor-patient relationship, and the physician’s ethical thought reflect their academic background, it was necessary to research the ethical knowledge of medical students at the University of Para State. The study is characterized by a questionnaire with situations where the student should judge situations in which confidentiality could be broken. It was also asked whether they had read the Code of Medical Ethics and the Hippocratic Oath. 207 medical students were interviewed, from 1 st to 4 th year of University of the State of Para. It was observed that 25 students showed high-knowledge about medical confidentiality, with 135 as regular-knowledge and 27 showed low-knowledge about the issue. The ethical orientation to medical students becomes extremely important seeking to have graduates capable of practicing and respecting the patient confidentiality.Considerando que el secreto medico es una caracteristica moral obligatoria de la medicina y el pilar de la relacion medico-paciente y el pensamiento etico del medico, el reflejo de su formacion academica, se vio la necesidad de investigar el conocimiento etico de los estudiantes de medicina de la Universidad del Estado de Para. El estudio se caracteriza por un cuestionario con situaciones en las que el alumno debe juzgar en cuales la confidencialidad puede ser rota. Tambien se pregunto si estos hubieran leido el Codigo de Etica Medica y el juramento de Hipocrates. Fueron entrevistados 207 estudiantes de medicina, del 1er a 4o ano de la Universidad del Estado de Para, Brasil. Se observo que 25 estudiantes mostraron el dominio de la confidencialidad medica, 135 poseian pobre conocimiento y 27 mostraron desconocimiento del tema. Es de fundamental importancia la formacion y la orientacion etica de los estudiantes de medicina, para formar graduados capaces de rendir culto, practicar y respetar el sigilo del paciente.

Apendicectomia videolaparoscópica: análise prospectiva de 300 casos

RACIONAL: A apendicectomia e o tratamento de escolha para os casos de apendicite aguda e a evolucao das tecnicas operatorias faz da videocirurgia boa opcao terapeutica. OBJETIVO: Analisar os achados clinicos e demograficos de 300 pacientes com apendicite aguda, bem como a viabilidade e evolucao intra e pos-operatoria das apendicectomias videolaparoscopicas neles realizadas. METODOS: Foram estudados todos os pacientes com diagnostico confirmado de apendicite submetidos a cirurgia videolaparoscopica no Hospital da Beneficencia Nipo-Brasileira da Amazonia, no periodo de agosto de 2000 a julho de 2008, com a utilizacao de protocolo para a coleta de dados. Ele incluia dados demograficos, aspectos clinicos e de achados fisicos para o diagnostico, resultados do leucograma, aspectos tecnicos do procedimento cirurgico, posicao do apendice, fase de inflamacao apendicular, operacoes associadas realizadas, tempo operatorio, complicacoes pos-operatorias e a recuperacao pos-operatoria. RESULTADOS: Observou-se que a maioria dos pacientes encontrava-se entre a segunda e terceira decadas e a apendicite era mais comum nos homens. Dor em fossa iliaca direita, febre, nauseas e vomitos ocorreu em 65,44% e 84,29% apresentaram leucocitose. A disposicao anatomica apendicular mais encontrada foi pelvica em 84,29% dos casos, seguida da retrocecal com 7,14%, da retrocecal-subserosa com 5,71% e da subserosa com 2,86%. Em 10% dos casos foram realizadas operacoes associadas. A media de tempo operatorio foi de 55 minutos, com taxa de conversao de 2%. Nao foram observadas complicacoes intra-operatorias e as pos-operatorias foram de 7,1%. O tempo de internacao ficou na media de 48,5 horas. O retorno as atividades habituais ocorreu em media de 5 dias. CONCLUSAO: A apendicectomia videocirurgia e procedimento seguro, eficaz com restabelecimento rapido dos pacientes, devendo ser sempre pensada quando for tratado quadro de apendicite aguda em qualquer idade.

Development of a laparoscopic training model using a smartphone

OBJECTIVE to develop a model of training in video-surgery, of low cost and that uses a smartphone as an image-generating source. METHODS We developed a 38cm high, 40cm wide, 40cm long hexagonal-shaped training box, with a front opening of 12x8 cm for coupling the smartphone. The internal illumination is made with LED lamps and for the support of the smartphone, we used a selfie stick, fixed in the upper part of the box, that allows control of height, distance, angulation, and the coupling of devices with different formats. We selected 20 undergraduate students without previous training in video-surgery, who performed four exercises in the box, with assessment of the time and amount of errors in the execution of the tasks. Each student completed the training for three consecutive weeks. We collected the data in spreadsheets for later analysis. RESULTS Nineteen students completed the training program, with significant improvement in the times and in the number of errors. CONCLUSION the developed model was feasible and promoted the acquisition of skills in this group of students. In addition, it presents low cost, is portable and uses common equipment, such as smartphones.

Kidney ischemia and reperfunsion syndrome: effect of lidocaine and local postconditioning

Objective: to evaluate the effects of blocking the regulation of vascular tone on the ischemia and reperfusion syndrome in rats through the use of lidocaine in the postconditioning technique. Methods: we randomized 35 rats into seven groups of five animals: Group 1- Control; Group 2- Ischemia and Reperfusion; Group 3- Ischemia, Reperfusion and Saline; Group 4- Ischemic Postconditioning; Group 5- Ischemic Postconditioning and Saline; Group 6- Lidocaine; Group 7- Ischemic Postconditioning and Lidocaine. Except for the control group, all the others were submitted to renal ischemia for 30 minutes. In postconditioning groups, we performed ischemia and reperfusion cycles of five minutes each, applied right after the main ischemia. In saline and lidocaine groups, we instilled the substances at a rate of two drops per minute. To compare the groups, we measured serum levels of urea and creatinine and also held renal histopathology. Results: The postconditioning and postconditioning + lidocaine groups showed a decrease in urea and creatinine values. The lidocaine group showed only a reduction in creatinine values. In histopathology, only the groups submitted to ischemic postconditioning had decreased degree of tubular necrosis. Conclusion: Lidocaine did not block the effects of postconditioning on renal ischemia reperfusion syndrome, and conferred better glomerular protection when applied in conjunction with ischemic postconditioning. Objetivo: avaliar os efeitos do bloqueio da regulação do tônus vascular por meio do uso da lidocaína na técnica de pós-condicionamento isquêmico na síndrome de isquemia e reperfusão renal em ratos. Métodos: trinta e cinco ratos foram randomizados em sete grupos de cinco animais: Grupo 1- Controle; Grupo 2- Isquemia e Reperfusão; Grupo 3- Isquemia, Reperfusão e Solução Salina; Grupo 4- Pós-condicionamento Isquêmico; Grupo 5- Pós-condicionamento Isquêmico e Solução Salina; Grupo 6- Lidocaína; Grupo 7- Pós-condicionamento Isquêmico e lidocaína. Com exceção do grupo controle, todos os demais foram submetidos à isquemia renal de 30 minutos. Nos grupos de pós-condicionamento, foi realizado o ciclo de isquemia e reperfusão de cinco minutos cada, aplicado logo após a isquemia principal. Nos grupos salina e lidocaína foram instiladas as substâncias numa taxa de duas gotas por minuto. Para comparar os grupos, foram dosados os níveis séricos de ureia e creatinina e análise histopatológica renal. Resultados: os grupos pós-condicionamento e pós-condicionamento + lidocaína apresentaram uma redução nos valores de ureia e creatinina. O grupo lidocaína apresentou apenas uma redução nos valores de creatinina. Na análise histopatológica, apenas os grupos submetidos ao pós-condicionamento isquêmico apresentaram redução do grau de necrose tubular. Conclusão: a lidocaína não bloqueou os efeitos do pós-condicionamento na síndrome de isquemia e reperfusão renal, mas conferiu melhor na proteção glomerular quando aplicada em conjunto com o pós-condicionamento isquêmico.

Diclofenac topical gel in excisional wounds maintain heal quality and reduce phlogistic signals1

PURPOSE To investigate diclofenac topical gel as an alternative to reduce phlogistic signals and maintain quality of wound repair. METHODS Fifteen Wistar rats were used in this study; four excisional wounds were performed on the dorsum of each animal. Once in a day, cranial wounds received topical diclofenac gel administration and caudal wounds were washed with isotonic saline. After seven, 14 and 21 postoperative days, five animals were randomly chosen for macroscopic and microscopic wound analysis. RESULTS On the 7th day: diclofenac wounds showed significant higher scab formation, however showed less phlogistic signal; diclofenac wounds had larger area and had less neutrophil invasion. On the 14th day: No area difference was noted and diclofenac wounds showed less hyperemia and phlogistic signals; diclofenac wounds showed greater keratinocytes invasion. On the 21st day: Almost all wounds were closed and there were no difference regarding the type of scar formation; diclofenac wounds showed greater monocytes invasion and lower angiogenesis level. No difference was noted in any postoperative day regarding fibroblast invasion, collagen deposit quantity and quality. CONCLUSION Diclofenac topical gel is capable of reducing phlogistic signals and do not cause fibroblast or keratinocyte downregulation thus do not lead to excisional wound healing impairment.

New experimental model of exposure to environmental tobacco smoke

PURPOSE To describe a new model to passive smoking for rodents. METHODS Twenty rats were distributed into two study groups (N=10): control group (CG), that was not exposed to tobacco smoke and used as normal standard for biochemical and histological analysis; Experimental Group (EG), that Animals were exposed to the passive smoking; Euthanasia was performed after 14 days of exposure. The serum level of nicotine and histological analysis were performed. RESULTS There was a statistical difference on the nicotine serum levels between Experimental and Control group, with level of 286 ± 23 nanograma/mL in the EG and undetectable on CG (p<0.01). The histological study suggested the model efficacy producing alveolar destruction and emphysema in the EG compared with the insignificant lesions in the CGs lung. CONCLUSION The model of exposure to environmental tobacco smoke for rodents induced easily the changes related to secondhand smoke.

Cisto de mesentério

Mesenteric cyst is a rare abdominal disease, with a higher incidence among women and 1: 250.000 incidence among hospitalized adults and 1: 200.000 among hospitalized children. Thereby, we report a case of a 10 years old child, male, presenting a large mesenteric cyst, which occupied almost all the abdominal and pelvic cavities and treated by resection during laparotomy.