Ivana Duval Araújo

Effects of sildenafil on the viability of random skin flaps.

PURPOSE To assess the viability of McFarlane skin flaps in rats with administration of sildenafil. METHODS Twenty Wistar rats were distributed into two groups: Control (dorsal skin flap, subdermal application of saline solution at 0.9%) and Study (dorsal skin flap, subdermal application of sildenafil). Seven days after the surgery, flaps were photographed and graphically rendered. Then, they were analyzed with AutoCAD software. Three biopsies (proximal, medial and distal) of each flap were collected for histological analysis. RESULTS Macroscopic analysis showed that animals of the study group had greater necrotic areas (p=0.003) in the dorsal skin flaps. Additionally, histological analysis of the distal third of these flaps showed a tendency to less granulated tissue formation in animals treated with sildenafil. CONCLUSION Sildenafil subdermally was associated with lower viability of the random skin flap in rats.

Efeito do uso de povidine-iodine na cicatrização de anastomoses de cólon direito de ratos

BACKGROUND Anastomotic leakage is a major cause of mortality in colorectal surgery. Several methods have been evaluated in order to prevent anastomotic leakage, and was postulate that povidone-iodine irrigation of colon before anastomosis can improve anastomotic healing, prevent adhesion formation, and may be beneficial in patients undergoing gastrointestinal surgery. AIM To evaluates the efficacy of this agent in healing of colonic anastomosis in rats. MATERIAL AND METHODS Twenty Wistar rats were divided into two groups: Group A (n = 10), cleaning of anastomotic borders with saline solution, and group B (n = 10), cleaning of anastomotic borders with 5% povidone-iodine. The animals were submitted to laparotomy, section of colon and treatment according previously described. After anastomosis, the animals were observed, and killed in 7th postoperative day. Blood samples were collected to serum albumin measurement and anastomosis observed macroscopically in relation to presence of fistula, adhesion and dilatation. A 6 cm colonic segment with the anastomosis at the center was excised bursting pressure was determined. RESULT There was no fistula in any animal in both groups, and there was no difference in relation to obstruction, presence of adhesion or bursting pressure when compared group A and B. CONCLUSION The use of povidone-iodine was not able to improve anastomotic healing in rats.

A pilot prospective study to evaluate whether the bladder morphology in cystography and/or urodynamic may help predict the response to botulinum toxin a injection in neurogenic bladder refractory to anticholinergics

BackgroundWe have observed different clinical responses to botulinum toxin A (BTX-A) in patients who had similar urodynamic parameters before the procedure. Furthermore, some bladders evaluated by cystography and cystoscopy during the procedure had different characteristics that could influence the outcome of the treatment. The aim of this study was to assess whether cystography and urodynamic parameters could help predict which patients with neurogenic detrusor overactivity (NDO) refractory to anticholinergics respond better to treatment with injection of BTX-A.MethodsIn total, 34 patients with spinal cord injury were prospectively evaluated. All patients emptied their bladder by clean intermittent catheterization (CIC) and had incontinence and NDO, despite using 40 mg or more of intravesical oxybutynin and undergoing detrusor injection of BTX-A (300 IU). Pretreatment evaluation included urodynamic, and cystography. Follow-up consisted of urodynamic and ambulatory visits four months after treatment. The cystography parameters used were bladder shape, capacity and presence of diverticula. Urodynamic parameters used for assessment were maximum cystometric capacity (MCC), maximum detrusor pressure (MDP), compliance and reflex volume (RV).ResultsAfter injection of BTX-A, 70% of the patients had success, with 4 months or more of continence. Before the treatment, there were significant differences in most urodynamic parameters between those who responded successfully compared to those who did not. Patients who responded successfully had greater MCC (p = 0.019), higher RV (p = 0.041), and greater compliance (p = 0.043). There was no significant difference in the MDP (0.691). The cystography parameters were not significantly different between these groups bladder shape (p = 0.271), capacity (p > 0.720) and presence of diverticula (p > 0.999). Statistical analyses were performed using SPSS (version 20.0) and included Student’s t-test for two paired samples and Fisher’s exact test, with a significance threshold of 0.05.ConclusionsThis study suggests that the cystography parameters evaluated cannot be used to help predict the response to injection of BTX-A in the treatment of refractory NDO. However, the urodynamic parameters were significantly different in patients who responded to the treatment, with the exception of the MDP.

Treatment with Chlorhexidine Modifies the Healing of Colon Anastomosis in Rats

ABSTRACT Purpose: To investigate the effects of chlorhexidine on the healing of colon anastomosis in the presence of peritonitis. Methods: Peritonitis was induced in male Wistar rats by cecal ligation and puncture (CLP). The abdominal cavities of experimental animals were irrigated with warm solutions containing 0.9% saline (SAL group; n = 8) or 0.05% chlorhexidine (CHD group; n = 8), following which colon anastomosis was performed. Rats of the control group (n = 8) were submitted to colon anastomosis but not to CLP. Animals were euthanized seven days after surgery, and healing was assessed by histopathological examination and by measuring anastomotic burst pressure. Results: Post-operative survival rates were 100, 87.5 and 75% for the control, SAL, and CHD groups, respectively. The degree of inflammation was significantly lower (ρ = 0.01) in the CHD group compared with the other groups, whilst the anastomotic burst pressure within the CHD group (156.7 ± 53.2 mmHg) was lower than, but not significantly different from, those of the control and SAL groups (196.3 ± 49.8, 208.6 ± 72.7 mmHg, respectively). Conclusions: Peritoneal irrigation with chlorhexidine solution is effective in the control of inflammation promoted by peritonitis but does not improve healing of colon anastomosis in rats.

Use of the amniotic membrane to cover the peritoneal cavity in the reconstruction of the abdominal wall with polypropylene mesh in rats

OBJECTIVE to evaluate the efficacy of the amniotic membrane used with polypropylene mesh against the formation of adhesions and its influence on healing. METHODS twenty five female Wistar rats were anesthetized for creating a parietal defect in the anterior abdominal wall. Its correction was made with polypropylene mesh alone and associated with amniotic membrane. In the control group (n=11), the screen was inserted alone. In group A (n=7) we interposed the amniotic membrane between the screen and the abdominal wall. In group B, the amniotic membrane was placed on the mesh, covering it. After seven days, the animals were euthanized for macroscopic and microscopic evaluation of healing. RESULTS adhesions were observed in all animals except one in the control group. Severe inflammation was observed in all animals in groups A and B and in three of the control group, with significant difference between them (A and B with p=0.01). Pronounced angiogenic activity was noted in one animal in the control group, six in group A and four in group B, with a significant difference between the control group and group A (p=0.002) and group B (p=0.05). The scar collagen was predominantly mature, except in five animals of the control group, with significant difference between the control group and group A (p=0.05) and group B (p=0.05). CONCLUSION The amniotic membrane did not alter the formation of adhesions in the first postoperative week. There were also pronounced inflammation, high angiogenic activity and predominance of mature collagen fibers, regardless of the anatomical plane that it was inserted in.

Fractures of the distal clavicle: comparison between two surgical treatment methods

Objective To compare the clinical and radiographic results from osteosynthesis of fractures of the lateral third of the clavicle, using two methods: T plates or anchors together with Kirschner wires. Methods Fifteen patients of mean age 34.3 years (range: 19–57) and mean follow-up 22.7 months (range: 14–32) were evaluated. In nine cases, a T plate was used; and in six cases, coracoclavicular fixation was used with anchors in the coracoid process and Kirschner wires through the acromioclavicular joint. The evaluation included the Constant score, personal satisfaction and radiographic assessment. Results Both types of treatment achieved consolidation in all cases. Group 1 presented a higher Constant score (83.4) than that of Group 2 (76.4) (p = 0.029). Neither of the techniques presented any severe complications, and mild complications were only observed in Group 2 (80%), mostly consisting of migration of the Kirschner wire and superficial infection. Conclusion Surgical treatment of fractures of the distal clavicle using T plates provided the same consolidation rate as shown by coracoclavicular fixation with anchors in the coracoid process and Kirschner wires through the acromioclavicular joint, and better clinical results. Level of evidence Level III evidence was obtained. Comparative retrospective study and therapeutic study were performed.

Effects of the povidone-iodine (PVPI) in treatment of bacterial peritonitis induced in rats

PURPOSE To evaluate the effectiveness of the use of the povidone-iodine (PVI) added to the liquid of wash of the peritoneal cavity in the reduction of bacterial absorption and in the remainder non-phagocyted bacteria in the circulating blood of rat. METHODS Thirty four Wistar females rats were used, distributed in the following groups: A (n=10), non-treated; B (n=9), wash of the peritoneal cavity with solution of PVI to 1% in saline solution; C (n=15), wash of the cavity with saline solution. After anesthesia, it was made intraperitoneal infusion of solution of Escherichia coli labeled with 99mTc containing 10(8) CFU/ml. After 40 minutes, it was made the treatment, in the group A, manipulation of the viscera; in the group B, irrigation of the peritoneal cavity with warm solution of 1% PVPI to 37,5 degrees C, and in the group C irrigation with warm saline (37,5 degrees C). After 15 minutes of the treatment, blood samples and fragments of liver, spleen and lung was obtained for count of the radioactivity, and animals killed by abdominal aorta section. There were determined the bacterial absorption index and the remainder index in the bloodstream. RESULTS Of the total of bacteria infused in the peritoneum, there was absorption of 0,92% (0,14% to 2,13%) in the animals of the group A (controls), 0,49% (0,18% to 0,71%) after use of topical PVPI (group B) and 0,80% (0,04% to 3,8%) after wash with saline solution (group C). There was significant reduction of the absorption when compared the treated animals with PVPI and the controls (p=0,003). Of the total of bacteria absorbed for the circulatory current, the percentile amount of bacteria non-phagocyted in the outlying blood was of 2,9% (1,1% to 17,7%) in the control group, 15,2% (8,3% to 21,4%) in those treated with PVPI (group B) and 6,9% (0,8% to 29,7%) after wash with saline solution (group C), with difference among controls and treated with PVPI (p=0,01). CONCLUSION The wash of the cavity peritoneal of mice with solution containing PVPI showed to be capable to reduce the absorption of bacteria by peritoneum of rat; however it seems to interfere with the function of the phagocytic cells for the observation of the increase of viable bacteria in the outlying blood of those animals.

Perioperative fluorocholangiography with routine indication versus selective indication in laparoscopic cholecystectomy

BACKGROUND The use of routine or selective peroperatory cholangiography in cholecystectomy is a matter of controversy in literature. AIM To compare the efficacy of selective or routine fluorocholangiography in diagnostic of common bile duct stone in patients underwent to laparoscopic cholecystectomy based on selective indication criteria. METHOD Two hundred and fifty four patients with cholelithiasis were prospectively studied. The patients were divided in two groups: to the first 127 patients perioperative fluorocholangiography was indicated as routine (group 1), and to the other 127 patients perioperative fluorocholangiography indication followed clinical criteria (jaundice, choluria, fecal acholia and history of pancreatitis), laboratory criteria (increase in seric alkaline phosphatase, bilirubins, amylase) or ultra-sonographyc criteria (less than 6 mm diameter calculi, common bile duct stone, common bile duct diameter more than 6 mm). A comparative assessment of the difference in common bile duct stone diagnosis, fluorocholangiography success index and reliability of the selective criteria of indication for perioperative fluorocholangiography was compared between the two groups. RESULTS Perioperative fluorocholangiography was successfully performed in 102 of the 127 patients from group 1 (a rate of 80.3%), and in 59 of the 71 patients from group 2 (a rate of 83.1%). In the 102 patients of group 1 who underwent perioperative fluorocholangiography, 11 (10.8%) presented common bile duct stone, 4 (3.9%) presented common bile duct dilatation, and 1 (1%) had a false-positive image. In the 59 patients from group 2, 7 (11.7%) presented common bile duct stone and one (1.7%) presented a common bile duct diatation. In another situation, when application of selective indication criteria to perioperative fluorocholangiography was simulated in group 1 patients, we observed that only in one patient with common bile duct stone the diagnostic would not have been made. Fluorocholangiography selective indication criteria presented sensitivity of 90.9% and specificity of 46.2%. The main causes of fluorocholangiography failure were biliary pedicle inflammation and cystic duct size and caliber variations. CONCLUSION There was not a significant difference in common bile duct stone diagnostic through perioperative fluorocholangiography between the groups of patients with selective and routine indication, validating the examination selective indication criteria, with a sensitivity of 90.9%, despite the specificity of 46.2%--43 patients were selected to the flourocholangiography and common bile duct stone was not diagnosed.

Scintigraphic imaging with technetium-99M-labelled ceftizoxime is a reliable technique for the diagnosis of deep sternal wound infection in rats

PURPOSE To evaluate whether scintigraphy with technetium-99m-labeled ceftizoxime ((99m)Tc-CFT) can differentiate mediastinitis from aseptic inflammation associated with sternotomy. METHODS Twenty female Wistar rats were randomly distributed into four groups: S (control) -partial upper median sternotomy with no treatment; SW (control) - sternotomy and treatment of sternal wounds with bone wax; SB - sternotomy and infection with Staphylococcus aureus; SWB - sternotomy with bone wax treatment and bacterial infection. Scintigraphy with (99m)Tc-CFT was performed eight days after surgery and images were collected 210 and 360 min after infusion of the radiopharmaceutical. RESULTS No animals exhibited clinical signs of wound infection at the end of the experiment, although histological data verified acute inflammatory response in those experimentally infected with bacteria. Scintigraphic images revealed that tropism of (99m)Tc-CFT to infected sternums was greater than to their non-infected counterparts. Mean counts of radioactivity in bacteria-infected sternal regions (SB and SWB) were significantly higher (p = 0.0007) than those of the respective controls (S and SW). CONCLUSION Scintigraphy with technetium-99m-labeled ceftizoxime is a method that can potentially detect infection post sternotomy and differentiate from aseptic inflammation in animals experimentally inoculated with S. aureus.

Complicações precoces no tratamento ortopédico das metástases ósseas

OBJETIVO: Avaliar as complicacoes precoces do tratamento ortopedico de lesoes osseas metastaticas e os fatores associados a essas complicacoes. METODOS: Foram avaliados retrospectivamente 64 pacientes submetidos a tratamento cirurgico de metastases osseas, analisando as complicacoes ocorridas no peroperatorio e pos-operatorio precoce e associando-as com a origem do tumor, o tipo de procedimento realizado, a necessidade de reposicao de sangue no peroperatorio, necessidade de novos procedimentos cirurgicos e a mortalidade em decorrencia das complicacoes. RESULTADOS: Complicacoes precoces do tratamento foram observadas em 17 (26,6%); seis (35,2%) evoluiram para obito em decorrencia dessa complicacao. De acordo com o tipo, em 15 (23,8%) casos foram complicacoes cirurgicas, em quatro (6,3%), clinicas e tres (4,7%) pacientes apresentaram tanto complicacoes clinicas quanto cirurgicas. Nao houve diferenca significativa na frequencia das complicacoes ou mortalidade quando avaliados o tipo de reconstrucao ou o local acometido. Os tumores de origem renal necessitaram de maior reposicao sanguinea e tiveram maior frequencia de complicacoes (p = 0,0001). CONCLUSAO: As complicacoes ocorreram em 26,6%. As complicacoes nao estao associadas ao tipo de tratamento realizado, nem ao local acometido. Os tumores de origem renal apresentaram risco aumentado de hemorragia.