Leticia Elizabeth Augustin Czeczko

Estudo das telas cirúrgicas de polipropileno/poliglecaprone e de polipropileno/polidioxanona/celulose oxidada regenerada na cicatrização de defeito produzido na parede abdominal de ratos

BACKGROUND: The use of surgical meshes for the repair of abdominal wall defects has been increasing its share in surgeries worldwide. AIM: To study two different surgical meshes (Proceed® and Ultrapro®) on the healing of defects produced in abdominal wall of rats evaluating the macroscopic, microscopic and tensiometric parameters. METHOD: Thirty two Wistar rats were divided into two groups of 16 animals and four groups of eight animals euthanized within 15 and 30 days for evaluation. The macroscopic variables were: the presence of hematoma at the edges of the sutures of the surgical mesh in the abdominal wall; the knitting of the surgical mesh and the edge of the wound; presence of infection at the surgical site; presence of viscera fistulas on the surgical mesh; presence of adhesions in the abdominal cavity; presence of incisional hernia. During microscopy the stages of the inflammatory process of healing where evaluated, and tensiometry evaluated the tensile force required to rupture the material. RESULTS: The knitting of the mesh and the edge of the surgical wound was better in the 15 days Ultrapro subgroup than in the 15 days Proceed subgroup; within 30 days the knitting was similar in both subgroups. There was no significant difference for the variable of macroscopy. Both groups in both periods had the same proportion of cases with chronic inflammation, but there were higher scores of inflammation in the 15 days Ultrapro subgroup than the 30 days Ultrapro subgroup. The subgroup 15 days Ultrapro showed greater rupture strength than the subgroup 15 days Proceed, but in 30 days there were no difference. Ultrapro showed equal rupture strength in both periods, but 30 days Proceed showed greater rupture strength than 15 days Proceed. CONCLUSION: The meshes are similar in variables.

Neoplasias uroteliais papilíferas superficiais da bexiga (pTa e pT1): correlação da expressão do p53, KI-67 E CK20 com grau histológico, recidiva e progressão tumoral

OBJECTIVE To investigate the immunohistochemical expressions of p53, ki67, CK20 in superficial papillary urothelial neoplasms of the bladder and correlate them with histological grade, tumor progression and recurrence. METHODS We selected samples of 43 patients with superficial transitional cell carcinoma of the bladder. They were divided into two groups, one called Recurrent (R), with 18 individuals, and other Non-Recurrent (NR), with 25. Multi-sampling blocks were prepared. The immunohistochemical technique employed was immunoperoxidase, and the antibodies were: p53: Novocastra (clone DO7) at a dilution of 1/100; Ki67: Spring (clone SP6) at a dilution of 1/100; and CK20: Dako (clone K20 .8) at a dilution of 1/50. RESULTS The expression of p53 was observed in 11 cases, six in the Recurrent group and five in the Non-Recurrent, all high-grade tumors (p = 0.0001). The histological progression occurred in six patients (p = 0.0076). Of the 18 Recurrent cases, six showed immunoreactivity for p53 and 12 were negative for this antibody (p = 0.1715). Ki67 was positive in 17 of the 18 cases from the Recurrent group (p = 0.0001) and, from 20 high-grade tumors, 18 showed reaction to this antibody (p = 0.0001). Of the 18 individuals who had recurrence, 13 showed anomalous expression for CK20 (p = 0.0166). In high-grade carcinomas, of the 20 cases, 16 showed anomalous expression for this antibody, while 18 of the 23 patients with low-grade tumors showed normal expression for CK20 (p = 0.0002). CONCLUSION The p53 showed good correlation with histological progression and histologic grade. Ki67 was strongly associated with recurrence and histological grade, and CK20 was also associated with these variables.

Estudo comparativo do uso de extrato de Pfaffia glomerata e do laser de baixa potência (Hélio-Neônio) na cicatrização de feridas em ratos

BACKGROUND: Pfaffia glomerata is a plant used in folk medicine as tonic, antidiabetic, to improve the healing process, neutralize stomach upset and antirheumatic. AIM: To compare the wound contraction and the neovascularization with the use of plant extract of Pfaffia glomerata (Spreng.) Pedersen, Amaranthaceae, and low power laser in rats. METHODS: It was used 40 Wistar rats in which surgical wounds with a punch of 3 mm in diameter at the top right of the back and no substance was applied at this site, and similar wounds in the lower left side had applicated extract of P. glomerata (Spreng.) Pedersen, Amaranthaceae, control groups and plants in the same animal. Another 40 animals had the low power laser application. On dates scheduled within 48 hours, one, two and three weeks measures were taken and wound contraction observed. Microscopic results were analyzed using immunohistochemistry with Factor VIII to observe the vascular density. RESULTS: It was possible to observe macroscopically no statistic significant difference with respect to the contraction of the wound between the groups plant and laser, both getting better results than the control group. This variable showed a statistical significance with the laser group when was compared the subgroups 48 hours X one week (p=0,008). Statistical analysis of Factor VIII showed an statistic significance in subgroup one week of the plant with the laser (p=0.09). CONCLUSIONS: There was no statistic significant difference between the plant and laser groups with respect to contraction of the wound. On microscopic analysis, the group plant earned more than the laser group with relation to neovascularization in subgroup one week, and after that occured a balance between them.

CORRELATION BETWEEN PRE AND POSTOPERATIVE UPPER DIGESTIVE ENDOSCOPY IN PATIENTS WHO UNDERWENT ROUX-EN-Y GASTROJEJUNAL BYPASS.

Background: Bariatric operations have variable range of complications and postoperative benefits. Gastroesophageal reflux is considered potential factor that may result in damage to the esophageal mucosa and this subject is quite controversial in the literature. Aim : To evaluate patients who underwent to Roux-en-Y gastrojejunal bypass correlating epidemiologic and endoscopic findings in pre and postoperative periods. Method : A retrospective, paired study which evaluated 110 patients. Inclusion criteria were formal indication for bariatric surgery and patients with pre and postoperative endoscopy. Exclusion criteria were previous bariatric surgery, patients subjected to other types of bariatric surgery and those who had no pre or postoperative upper digestive endoscopy. The epidemiological variables were: sex, age, body mass index, type 2 diabetes mellitus or impaired glucose tolerance, and preoperative dyslipidemia. Results : The preoperative upper endoscopy was normal in 26.4% of the patients. Among endoscopic alterations, the hiatus hernia was the most prevalent followed by non-erosive gastritis. The postoperative upper endoscopy was normal in 40.9% and stenosis was the most prevalent followed by marginal ulcer. Correlation on pre and postoperative endoscopies, was found 100% reduction of hiatal hernias and 88% of esophagitis. There was no statistical significance in relationship to anastomotic stenosis with preoperative other variables. Conclusions: There was significant decrease in postoperative hiatus hernia, erosive esophagitis, non-erosive esophagitis, erosive gastritis and non-erosive gastritis with the operation. Stenosis of the gastrojejunostomy anastomosis was the most prevalent postoperative complication with no correlation with preoperative variables.

A utilização da Pfaffia glomerata no processo de cicatrização de feridas da pele

BACKGROUND: When tissue loss occurs in the skin comes the need for reconstruction and many devices and medication are proposed to increase the healing process. The use of herbal medicine, such as Pfaffia glomerata, aims to play an active role in the scar formation. AIM: To evaluate the results of the use of Pfaffia glomerata on healing process of surgical wounds in rats. METHODS: A total of 40 rats, which were held surgical wounds with a punch of 3 mm in diameter at the upper right back where no substance was applied and another in the lower region, where the herbal extract was used. They were divided into four subgroups of 48 hours, one, two and three weeks in relation to sacrifice. Measures were taken on the circumference to analyze the macroscopic contraction of the wound. Microscopic data were analyzed using the hematoxylin-eosin staining to verify the inflammatory process; immunohistochemistry, factor VIII, to observe the vascular density, and Masson trichrome to study fibrosis. RESULTS: Macroscopic plant group achieved better results than the control group. The analysis of factor VIII showed statistical significance in a week of herbal medicine. In fibrosis, it was found that during the 48 hours the control group showed 70% of cases with minimal fibrosis, whereas the plant, 90%. In one week, the control group showed 10% of cases with no fibrosis, 60% with minimal fibrosis and 30% with moderate fibrosis, while the group plant showed 70% of cases with minimal fibrosis and 30% with moderate fibrosis. In the period of two weeks, the control group maintained 60% of cases with minimal fibrosis and increased to 40% of those with moderate fibrosis, while the plant maintained its group average presented in the previous group. In three weeks both groups, control and plan, kept the percentages presented in the previous period. CONCLUSION: In relation to wound contraction, plant group showed better results than the control group. In regard to histological analysis, HE staining showed a greater presence of inflammation in the animals of control groups. The immunohistochemical technique showed a vascular density, higher in the plant during the period of one week and Massons trichrome staining showed no significant changes

Prevalência de alterações proliferativas gástricas em pacientes com uso crônico de inibidores de bomba de prótons

RACIONAL: As medicacoes mais frequentemente prescritas e usadas de forma cronica por pacientes com queixas dispepticas pertencem ao grupo dos inibidores de bomba de protons cujo principal representante e o omeprazol, utilizado clinicamente a cerca de 20 anos. Estudos recentes tem postulado a relacao entre o uso cronico desta medicacao e alteracoes proliferativas macroscopicas e microscopicas da mucosa do fundo e corpo gastrico, principalmente os polipos de glândulas fundicas. OBJETIVO: Analisar a frequencia e o tipo de alteracoes proliferativas gastricas em usuarios cronicos de inibidores de bomba de protons e sua associacao com idade, dose utilizada, tempo de uso, sintomatologia e infeccao pelo Helicobacter pylori. METODO: Estudo transversal de prevalencia realizado no Servico de Endoscopia Digestiva do Hospital de Clinicas da Universidade Federal do Parana. Aplicado questionario com informacoes quanto ao uso destas drogas e realizada endoscopia digestiva alta em sujeitos em uso continuo desta classe de medicamentos ha pelo menos 12 meses. Realizadas biopsias de fundo, corpo e antro gastrico em todos os pacientes. Polipos eram retirados ao serem identificados, para analise histopatologica. Realizada pesquisa do Helicobacter pylori por teste de urease e analise histopatologica. RESULTADOS: Vinte e dois individuos foram incluidos sendo que seis (27,3%) apresentaram alteracoes proliferativas da mucosa oxintica. Destes, dois (9,1%) apresentavam polipos fundicos esporadicos e quatro apresentavam exclusivamente alteracao proliferativa microscopica como formacao cistica glandular. Houve significância estatistica (p 60 anos e estas alteracoes. Nao houve associacao entre dose de uso, tempo de uso, sintomatologia e infeccao pelo Helicobacter pylori. CONCLUSOES: Ocorrem alteracoes proliferativas de mucosa oxintica em individuos em uso cronico de inibidores de bomba de protons. A associacao entre idade e alteracoes proliferativas apresentou significância estatistica.

Expressão citofotométrica do fator de proliferação celular ki-67 no bócio colóide e no carcinoma papilífero da tireóide

OBJECTIVE To compare the cytophotometric quantitative expression of Ki-67 cellular proliferation factor in the colloid goiter with papillary carcinoma of the thyroid. METHODS The protein Ki-67 was studied with immunohistochemistry in 20 cases of papillary carcinoma of the thyroid and 12 cases of colloid goiter. The immunomarked cell nuclei were quantified through the software SAMBA 4000 and analyzed by software IMMUNO, considering variables index marker and optical density. The coefficient of the Spearman rank correlation and the non-parametric test of Mann-Whitney were estimated. RESULTS There is significant difference between the goiter colloid and the papillary carcinoma of the thyroid in Ki-67 measurements, being bigger in papillary carcinomas. No difference was found in optical density. The correlation coefficient between the index marker and the optic density was 0,78. In colloid goiter, there was positive and significant association between the index marker and the optic density. For the papillary carcinoma of the thyroid the correlation between index marker and optic density was 0,18 (p = 0,572). There was no association between the index marker and the optic density in the carcinoma papillary of the thyroid. CONCLUSION The cytophotometric expression of the Ki-67 showed higher cellular proliferation in the papillary carcinoma of the thyroid in comparison with in the colloid goiter.

Tratamento cirúrgico em paciente com situs inversus totalis após ferimento por arma de fogo: relato de caso

intercostal space, without outlet.On physical examination, patent airway, spontaneous ventilation wearing a neck collar on rigid board. Pulmonary auscultation presented vesicular murmur in the left hemithorax and decreased in the right lung base. Hemodynamically unstable. Had Glasgow coma scale 15 and pupils isochoric. The abdomen was distended with signs of peritoneal irritation. The patient had no other injury.The initial procedure was fluid replacement, blood transfusion, bladder catheterization of delay-sealed tube drainage water to the right. Then, revealed presence of about 1000 mL of blood intra-cavity with lots of clots, visualization of situs inversus totalis (Figures 1 and 2), grade V splenic