Jacques Matone

Comparative study of inflammatory response and adhesions formation after fixation of different meshes for inguinal hernia repair in rabbits

OBJETIVO: Avaliar a resposta inflamatoria e a formacao de aderencias das proteses de polipropileno e polipropileno associado a poliglactina sintetica (Vypro®) implantadas no espaco pre-peritoneal de coelhos. METODOS: Foram utilizados 14 coelhos albinos linhagem Nova Zelândia com tres meses de idade, machos com peso variando de 2000 a 2500 gramas. O acesso a cavidade se deu por incisao mediana abaixo do apendice xifoide com oito centimetros de extensao. Realizou-se o implante da tela de polipropileno no flanco esquerdo com um ponto de polipropileno em cada extremidade da protese. No flanco direito a tela Vypro® foi fixada da mesma forma com pontos de polipropileno. A laparoscopia foi realizada 28 dias apos o primeiro procedimento para avaliacao de aderencias intracavitarias. As proteses juntamente com o peritonio, musculatura e aponeurose adjacente foram retiradas em blocos individuais. Cada peca foi imersa em solucao tamponada de formaldeido a 10% e encaminhada ao patologista. RESULTADOS: Todos os animais tiveram boa evolucao pos-operatoria nao havendo infeccao das incisoes cirurgicas ou obito dos coelhos. Das quatorze proteses Prolene implantadas no peritonio intacto de coelho, em onze (78,6%) houve formacao de aderencias Das quatorze proteses Vypro®implantadas no peritonio intacto de coelho, em doze (85,7%) houve formacao de aderencias. Comparando as duas proteses entre si nao houve diferenca significante quanto ao numero de aderencias formadas. Em relacao a avaliacao microscopica, nas proteses VYPRO® a reacao granulomatosa do tipo corpo estranho e a fibrose foram predominantemente moderadas. Ja a inflamacao inespecifica foi proporcionalmente leve e moderada A inflamacao inespecifica foi menos intensa nas proteses de polipropileno. CONCLUSAO: Ambas as proteses implantadas na cavidade peritoneal de coelhos promovem a formacao de aderencias de forma semelhante. As proteses de polipropileno e associado a poliglactina promovem maior fibrose, apresentando melhor incorporacao aos tecidos.PURPOSE Compare, in a rabbit model, the inflammatory response and adhesions formation following surgical fixation of polypropilene and Vypro mesh in the inguinal preperitoneal space. METHODS Fourteen male New Zealand rabbits, weighing between 2.000 to 2.500 g were used. A midline incision was made and the peritoneal cavity was exposed. The 2.0 x 1.0 cm polypropylene mesh was fixed in the left flank and secured to the margins with 3-0 prolene in a separate pattern. In the right flank, a 2.0 x 1.0 cm Vypro II mesh was sewn in the same way. After the post surgical period, the animals were again anesthetized and underwent laparoscopic approach, in order to identify and evaluate adhesions degree. Both fixed prosthesis were excised bilaterally with the abdominal wall segment, including peritoneum, aponeurosis and muscle and sent to a pathologist. RESULTS Operative time ranged from 15 to 25 minutes and no difficulties in applying the mesh were found. From the 14 polypropylene meshes fixed to the intact peritoneum, 11 had adhesions to the abdominal cavity (78.6%). Concerning Vypro mesh, 12 animals developed adhesions from the 14 with mesh fixation (85.7%). Histological examination of tissues harvested revealed fibroblasts, collagen, macrophages and lymphocytes between the threads of the mesh. CONCLUSION Polypropylene and Vypro mesh, when implanted in the peritoneal cavity of rabbits provoke similar amount of adhesions. Vypro mesh tissues had higher fibrosis resulting in better mesh incorporation to the abdominal wall.

Randomized trial of total fundoplication and fundal mobilization with or without division of short gastric vessels: a short-term clinical evaluation

PURPOSE Evaluate short results after fundoplication procedure, concerning the division of short gastric vessels. METHODS A prospective randomization of 90 patients with indication for hiatoplasty and total fundoplication with fundus mobilization was performed. They were divided into two groups: no SGV division (group A, n= 46) and with SGV division (Group B, n=44), although in both groups the gastric fundus was mobilized to perform a floppy valve. Early outcome with clinical follow up (1 year) was observed. RESULTS Both groups were similar regarding preoperative parameters and severity of gastroesophageal reflux disease (GERD). No difference in morbidity was observed during hospital stay. Nevertheless, the median operating time was 80,2 minutes in group A and 94,1 minutes (p=0,021) in Group B. Transitory dysphagia during the first year was significantly lower in group B (46,6% versus 23,2%, p=0,012). However, in 12 months clinical outcome was similar in both groups (clinical symptoms of GERD, persistent dysphagia and reoperations). CONCLUSION There was no improvement in routine division of SGV in total fundoplication procedure when the gastric fundus was mobilized.

Efeitos da tela de polipropileno no testículo, epidídimo e ducto deferente de cães

The aim of this study was to investigate the effects of the synthetic mesh on the ductus deferens and testicle of dogs. Ten adult male dogs were anesthetized and a 2,5X3,5 cm² polypropilene mesh was fixed in the inguinal region in direct contact with the ductus deferens, using metallic staples without dissection of the region and therefore, without manipulation. The right side, with no mesh was the control. . The operative time was 15 minutes. The animals were observed for 30 days and after that, they were again anesthetized and underwent new operation when the ductus deferens and the testicle were removed and sent to histological analysis. The histological sections of the testicle showed a focal reduction of the spermatogenesis in 20 % and a degenerative process in 20 % of the animals. In the epididimus, chronic inflammation and seminiferous tubules dilatation were observed in 70 %. A chronic inflammatory process was found in 60 % of the vas deferens. The polypropilene mesh in direct contact with the spermatic funiculus in dogs causes histological alterations with minimal reduction on spermatogenesis.

Obesity and Symptomatic Achalasia

Weight loss is a frequent finding in achalasia because of the difficulty in swallowing. Although manometric findings compatible with achalasia have been found in morbidly obese patients, all of them were asymptomatic. The authors report a case of symptomatic achalasia and morbid obesity in a 38-year-old woman. A mental disorder become manifested after the patient was submitted to an esophageal myotomy and fundoplication. With weight gain, postoperative gastroesophageal reflux developed. Drawbacks of further operative procedures in such a patient are discussed.

Endoscopic treatment of bleeding gastric varices using large amount of N-butyl-2-cyanoacrylate under fluoroscopic guidance.

Purpose We propose the use of fluoroscopic guidance for endoscopic injection of n-butyl-2-cyanoacrylate to treat gastric variceal hemorrhage to achieve placement of the safest quantity of tissue adhesive. Methods Ten patients with gastric varices were treated with n-butyl-2-cyanoacrylate endoscopic injection under fluoroscopic guidance for the purpose of hemostasis or prevention of recurrent bleeding. The glue was infused into the varices in the quantities needed to achieve complete obliteration of the gastric varices. Results The median quantity of tissue adhesive required in this series was 6.6 mL. The procedure was initially considered successful in all patients. There were no complications relating to the procedure. The mean duration of follow-up was 20 months. Conclusions Injection of suitable quantities of cyanoacrylate under fluoroscopic guidance seems to be safe and effective for controlling hemorrhagic gastric varices.

Experimental model of severe acute pancreatitis in rabbits

PURPOSE To develop an experimental model of severe acute pancreatitis in rabbits through a pancreatic ductal injection of sodium taurocholate. METHODS Twenty-four albino rabbits of the New Zealand lineage were distributed into four groups of six animals (A, B, C and S). The rabbits of three experimental groups (A, B and C) were submitted to a laparatomy and received a pancreatic ductal injection of 1 ml/kg sodium taurocholate 5%. Also, they were submitted to further laparatomies after 4h, 8h and 12h, respectively. The control group (S) was subdivided into two groups of three animals: in subgroup S1 only the pancreatic duct catheterization was performed whereas in subgroup S2 the pancreatic duct catheterization as well as an injection of 1 ml/kg physiologic solution 0.9% were carried out. After 12 hours, the rabbits were evaluated. In the re-intervention, blood was collected to determine the amylasemia and a pancreatectomy was carried out to investigate interstitial infiltration, steatonecrosis and necrosis of the organ, using an optical microscope. RESULTS There was an elevation of amylase in all groups thus proving the existence of acute pancreatitis. The size of the interlobular septum increased progressively with a greater variation between group S1 (0.13) and group C (0. 53) (p=0.035). While all the animals in group A exhibited focal cellular necrosis, it was more intense in the rabbits of group B and culminated with a high proportion of severe pancreatic necrosis in group C animals. The difference in the intensity of cellular necrosis showed statistic significance (p=0.001). CONCLUSION The proposed experimental model demonstrated its reproducibility and effectiveness in producing severe acute pancreatitis in rabbits.

Ethyl-pyruvate reduces lung injury matrix metalloproteinases and cytokines and improves survival in experimental model of severe acute pancreatitis

PURPOSE To investigate if the ethyl-pyruvate solution could reduce mortality in AP and/or diminish the acute lung injury. METHODS Forty male rats, weighing between 270 to 330 grams were operated. An experimental model of severe AP by injection of 0.1 ml/100g of 2.5% sodium taurocholate into the bilio-pancreatic duct was utilized. The rats were divided into two groups of ten animals each: CT - control (treatment with 50 ml/kg of Ringers solution, intraperitoneal) and EP (treatment with 50 ml/kg of Ringer ethyl-pyruvate solution, intra-peritoneal), three hours following AP induction. After six hours, a new infusion of the treatment solution was performed in each group. Two hours later, the animals were killed and the pulmonary parenchyma was resected for biomolecular analysis, consisting of: interleukin, myeloperoxidase, MDA, nitric oxide, metalloproteinases and heat shock protein. In the second part of the experiment, another, 20 rats were randomly divided into EP and CT groups, in order to evaluate a survival comparison between the two groups. RESULTS There were no significant differences in IL-1B,IL-10, MMP-9, HSP70, nitric oxide, MPO, MDA (lipidic peroxidation) concerning both groups. The levels of IL-6 were significantly diminished in the EP group. Furthermore, the MMP-2 levels were also reduced in the EP group (p<0.05). The animals from the EP treatment groups had improved survival, when compared to control group (p<0.05). CONCLUSION The ethyl-pyruvate diminishes acute lung injury inflammatory response in acute pancreatitis and ameliorates survival when compared to control group, in the experimental model of necrotizing acute pancreatitis.