Julio Cesar Uili Coelho

Effect of pantoprazole administered subcutaneously on the healing of sutured gastric incisions in rats

Background: The properties of proton pump inhibitors most investigated are related to peptic diseases and upper gastrointestinal bleeding, but their influence on the healing of sutured gastric incisions has not been assessed. In the present study we evaluated the effect of subcutaneously administered pantoprazole on the healing of sutured gastric incisions in rats. Methods: Sixty rats were divided into a pantoprazole group and a control group. All rats were submitted to gastric suture in the gastric body and in the gastric fundus and had their gastric pH measured. The pantoprazole group received 20 mg/kg pantoprazole and the control group received 0.9% isotonic NaCl, both subcutaneously t.i.d. Healing analysis was carried out using collagen picrosirius red F3BA staining, and breaking strength was measured on the 4th and 7th postoperative days in all groups. Results: Gastric pH was higher in the pantoprazole group. In the fundus, the pantoprazole group had a higher measurement of breaking strength and a higher proportion of type-I over type-III collagen on the 7th postoperative day. In the body, the pantoprazole group had a higher proportion of type-I over type-III collagen on the 4th and 7th postoperative days. Conclusions: Pantoprazole given subcutaneously promoted a reduction in gastric acid secretion and was associated with improved healing of the sutured gastric incision in the fundus (squamous epithelium) of rats. These findings suggest that pantoprazole has healing properties in sutured gastric incisions with potential benefits in gastric surgery.

Custo do transplante hepático no Hospital de Clínicas da Universidade Federal do Paraná

A bi-directional scanning unit, a driving method and a gate driving circuit are provided. The bi-directional scanning unit includes a first stage subunit and a second stage subunit. The bi-directional scanning unit outputs a scanning signal stage by stage in a direction from the first stage subunit to the second stage subunit and outputs a scanning signal stage by stage in a direction from the second stage subunit to the first stage subunit. During the scanning, the first stage subunit and the second stage subunit cooperate with each other, so that one of the stage subunits does not output a scanning signal while the other one outputs a scanning signal. With the technical solutions according to the embodiments, the bi-directional scanning unit can output two-stage scanning signals stage by stage, have a simplified structure, and satisfy diverse demands on the gate driving circuit.

LAPAROSCOPIC REPAIR OF LUMBAR HERNIA (GRYNFELT): TECHNICAL DESCRIPTION

ABSTRACT Background: Lumbar hernias are rare. Usually manifest with reducible volume increase in the post-lateral region of the abdomen and may occur in two specific anatomic defects: the triangles of Grynfelt (upper) and Petit (lower). Despite controversies with better repair, laparoscopic approach, following the same principle of the treatment of inguinal hernias, seems to present significant advantages compared to conventional/open surgeries. However, some technical and anatomical details of the region, non usual to general surgeons, are fundamental for proper repair. Aim: To present systematization of laparoscopic transabdominal technique for repair of lumbar hernias with emphasis on anatomical details. Method : Patient is placed in the lateral decubitus. Laparoscopic access to abdominal cavity is performed by open technique on the left flank, 1.5 cm incision, followed by introduction of 11 mm trocar for a 30º scope. Two other 5 mm trocars, in the left anterior axillary line, are inserted into the abdominal cavity. The peritoneum of the left paracolic gutter is incised from the 10th rib to the iliac crest. Peritoneum and retroperitoneal is dissected. Reduction of all hernia contents is performed to demonstrate the hernia and its size. A 10x10 cm polypropylene mesh is introduced into the retroperitoneal space and fixed with absorbable staples covering the defect with at least 3-4 cm overlap. Subsequently, is carried out the closure of the peritoneum of paracolic gutter. Results: This technique was used in one patient with painful increased volume in the left lower back and bulging on the left lumbar region. CT scan was performed and revealed left superior lumbar hernia. Operative time was 45 min and there were no complications and hospitalization time of 24 h. Conclusion: As in inguinal hernia repair, laparoscopic approach is safe and effective for the repair of lumbar hernias, especially if the anatomical details are adequately respected.

Hernioplastia incisional laparoscópica: experiência de 45 casos

INTRODUCAO: Hernia incisional e uma complicacao frequente da laparotomia. O reparo por sutura simples tem elevadas taxas de recorrencia, e apesar do uso de protese diminuir o risco de recidiva, ainda e elevado. Na decada de 1990, o reparo laparoscopico da hernia incisional ganhou popularidade. Os beneficios incluem reducao no risco de complicacoes, menos dor e rapido retorno as atividades. Alem disso, pode diminuir a taxa de recorrencia. OBJETIVO: Apresentar experiencia com o tratamento laparoscopico das hernias incisionais. METODO: Entre janeiro de 2007 e julho de 2010, 45 pacientes foram submetidos a reparo laparoscopico de hernia incisional. Indicacoes incluiram espaco suficiente para posicionamento dos trocarteres e adequada sobreposicao da protese em relacao ao defeito herniario. As contra-indicacoes foram: co-morbidades severas que limitavam o uso de pneumoperitonio e/ou anestesia geral, assim como historico de peritonite difusa devido ao risco elevado de aderencias intra-abdominais. RESULTADOS: O tempo operatorio medio foi de 76 minutos. Houve apenas uma (2,2%) complicacao intra-operatoria. Nao houve nenhuma conversao. O tempo de internamento hospitalar foi igual ou inferior a 24 horas em 38 pacientes (84,4%). Quinze pacientes (33%) apresentaram complicacoes. Entretanto, 14 foram complicacoes menores (11 seromas indolores e 3 dor prolongada) e apenas uma complicacao maior (perfuracao tardia de ceco). Houve apenas uma recidiva (2,2%) apos seguimento medio de 24,6 meses. CONCLUSOES: O reparo laparoscopico das hernias incisionais e alternativa segura, viavel e eficaz. Parece estar associado a menores taxas de complicacoes perioperatorias e tempo de internamento quando comparado ao reparo aberto.

Análise informatizada dos resultados obtidos pela aplicação de protocolo eletrônico na microcirurgia endoscópica transanal (TEM)

RACIONAL: A informacao obtida pelos registros feitos em prontuario de papel, de maneira geral, nao e de boa qualidade, pois os dados sao perdidos ou coletados precariamente. A informatica possibilita a coleta dos dados na forma prospectiva melhorando a assistencia ao paciente e o acesso a informacao, servindo, tambem, como base para elaboracao de pesquisas cientificas. OBJETIVOS: 1) Apresentar estudos de mineracao de dados (verificacao de padroes e tendencias nao visiveis pela coleta de dados); 2) apresentar estudos analiticos dos resultados comparados entre grupos de pacientes do protocolo da TEM. METODO: Apos a coleta de dados no protocolo eletronico do TEM no SINPE©, efetuou-se estudo descritivo com interpretacao das informacoes pelo modulo SINPE© Analisador. Primeiro, executou-se estudos de mineracao de dados com verificacao de padroes e tendencias nao visiveis pela coleta de dados. Segundo, analise comparativa, comprovadas estatisticamente, dos resultados entre grupos de pacientes submetidos a TEM obtidos pelo protocolo eletronico em relacao a incidencia do carcinoma incidental, complicacoes pos-operatorias e estadiamento pre-operatorio e pos-operatorio. RESULTADOS: A mineracao de dados demonstrou as seguintes tendencias: 1) Adenomas maiores que 4 cm de aspecto sessil como fatores de risco de carcinoma incidental; 2) Tumores maiores que 5 cm, invasao angiolinfatica, tipo histologico viloso e margens cirurgicas comprometidas como fatores de risco para recidiva da neoplasia. Os estudos analiticos comparados concluiram que nao houve diferencas estatisticas significativas em relacao a incidencia do carcinoma incidental, em adenomas menores e maiores que 4 cm e, tambem, em relacao a presenca de complicacoes pos-operatorias entre portadores de adenoma e adenocarcinoma. Comprovou-se, ainda, que a margem de erro em tumores com estadiamento ultrassonografico de uT1, uT2 e uT3, em relacao ao estadiamento patologico, e muito maior que em tumores uT0. CONCLUSOES: Foi possivel realizar estudos de mineracao doa dados coletados pelo uso do SINPE©. Foi possivel realizar estudos analiticos dos resultados comparados entre grupos de pacientes do protocolo da TEM, sendo realizadas analises em relacao ao carcinoma incidental, estadiamento pre e pos-operatorio e complicacoes pos-operatorias.

Biópsia hepática e peritoneal por laparoscopia ou por notes em suínos: comparação de parâmetros operatórios e evolução pós-operatória

OBJECTIVE To evaluate the impact of NOTES compared to laparoscopic surgery, through the analysis of physiological parameters as well as surgical complications and postoperative outcome, for liver biopsy. METHODS 12 female pigs were divided into two groups: laparoscopy group (GLap) and NOTES group (GNote). The animals underwent liver biopsy by peritoneal laparoscopy or transvaginal endoscopy. The respiratory rate, heart rate, O2 saturation and expiratory concentrations of CO2 were recorded every 10 minutes. In the seventh postoperative day, the animals underwent laparotomy for evaluation of intra-abdominal complications. RESULTS Most of the animals showed weight loss after the procedure, however in no case more than 5%. There was no difference in percentage change in weight between the groups (p = 0.7535). Also, no differences were observed when comparing the averages of ETCO2 (p = 0.4762), and average heart rate (p = 0.6035). However, the GLap showed higher respiratory rate than the GNote (p = 0.0043), as well as the average O2 saturation (p = 0.0080). However, no animal showed SatO2 less than 87% and this difference was not considered clinically significant. Only one GNote animal presented with an operative complication. CONCLUSION NOTES is associated with physiological parameters similar to those found in operative laparoscopy. Performing transvaginal peritonioscopy is not associated with increased postoperative complications when compared to laparoscopy.

Prevenção de isquemia hepática normotérmica durante perfusão hepática in situ com três diferentes soluções de preservação: análise experimental através de termografia por radiação infravermelha em tempo real

OBJECTIVE: To establish the usefulness of infrared radiation thermography on monitoring in situ liver perfusion with different preservation solutions during liver harvesting. METHODS: Twenty-four adult male Wistar rats, weighing 385.31g were randomly divided into four groups of six animals each according to the solution used to perfuse the liver (Euro-Collins® solution - EC group; Custodiol® solution - CUST group; Celsior® solution - CEL group and Ringer-Lactate solution - RL group). Under inhalatory ether anesthesia, animals were submitted to upper transversal laparotomy, exposure of median and left-lateral hepatic lobes, heparin injection (500 UI/Kg) through infrahepatic vena cava, portal vein infusion through 18G catheter of cold (4°C) solution according to the group of study. Infrared images, with respective temperature avaliations from hepatic surface, were picked up in real time by Therma CAM SC500® infrared camera positioned at constant distance from three fixed points of the diaphragmatic surface of median and left lateral lobes at the following moments regarding liver perfusion: immediately after laparotomy; after portal vein cannulation and immediately before solution infusion; at each minute from the beginning of liver perfusion during five minutes. Mean temperatures of each moment were compared intra and intergroups with the difference between means test with normal distribution, with significance level of 5% (p=0.05). RESULTS: There was statistically significant difference of means temperatures between the moment of laparotomy and immediately after cannulation; between this later and after the first minute of perfusion; and between the first and fifth minutes of infusion in all groups of study in a similar way. CEL group showed additional difference between the first and second minutes means temperatures. Intergroup comparison showed Euro-Collins solution with significant less cooling power when compared to all others solutions. CONCLUSION: It was possible to follow the liver cooling process during preservation solutions perfusion using infrared radiation images. Preservation solutions had similar behaviors, with Celsior® solution showing additional cooling power until the second minute of perfusion. Euro-Collins solution had less cooling power than other solutions studied.

Mesh Displacement After Bilateral Inguinal Hernia Repair With No Fixation

Background and Objectives: About 20% of patients with inguinal hernia present bilateral hernias in the diagnosis. In these cases, laparoscopic procedure is considered gold standard approach. Mesh fixation is considered important step toward avoiding recurrence. However, because of cost and risk of pain, real need for mesh fixation has been debated. For bilateral inguinal hernias, there are few specific data about non fixation and mesh displacement. We assessed mesh movement in patients who had undergone laparoscopic bilateral inguinal hernia repair without mesh fixation and compared the results with those obtained in patients with unilateral hernia. Methods: From January 2012 through May 2014, 20 consecutive patients with bilateral inguinal hernia underwent TEP repair with no mesh fixation. Results were compared with 50 consecutive patients with unilateral inguinal hernia surgically repaired with similar technique. Mesh was marked with 3 clips. Mesh movements were measured by comparing initial radiography performed at the end of surgery, with a second radiographic scan performed 30 days later. Results: Mean movements of all 3 clips in bilateral nonfixation (NF) group were 0.15–0.4 cm compared with 0.1–0.3 cm in unilateral NF group. Overall displacement of bilateral and unilateral NF groups did not show significant difference. Mean overall displacement was 1.9 cm versus 1.8 cm in the bilateral and unilateral NF groups, respectively (P = .78). Conclusions: TEP with no mesh fixation is safe in bilateral inguinal repairs. Early mesh displacement is minimal. This technique can be safely used in most patients with inguinal hernia.