Luis Sérgio Leonardi

Estudos biomecânicos da ação de aderências sobre anastomose cólica: trabalho experimental em ratos

PURPOSE: To evaluate the influence of abdominal adhesions in the distal colonic anastomoses in rats using biomechanical tests. METHODS: Ninety Wistar-CEMIB (UNICAMP) rats were distributed in 3 groups. In group 1 the analysis was performed by bursting strength test, in group 2 by breaking strength test and in group 3 by final resultant tension test. In each group, 10 animals were characterized by the presence of adhesions in the anastomoses during the biomechanical test performance, 10 animals had the anastomoses adhesions removed before the test and 10 animals were free of adhesions in the anastomoses during the test (protection by P.V.C. sheet in the anastomoses area). RESULTS: Evaluations were made on the 5th post-operatory day and independent of the test performed, the results were similar. The mechanical resistence in the subgroups characterized by the presence of adhesions in anastomoses were higher than subgroups with anastomoses adhesions removed. The subgroups free of adhesions in the anastomoses (P.V.C. protection) demonstrated the lowest mechanical resistance in anastomoses breakdown (Group 1-p=0,0001, Group 2-p=0,0003 and Group 3-p=0,0001). CONCLUSION: Analysis of the results allowed to conclude that abdominal adhesions presented benefic influence in the distal colonic wound healing process in rats thus increasing mechanical resistance of the anastomoses.

Reservação da arcada vascular do cólon direito para o alongamento mesenterial na cirurgia do reservatório ileal

BACKGROUND: The aim of this study was to analyze the efficacy of the preserved vascular arcade of the right colon (MVA) on maintaining blood perfusion to the pouch following mesenteric lenghtening maneuvers. METHODS: Forty six patients submitted to total proctocolectomy and ileal pouch-anal anastomosis for the treatment of ulcerative colitis (UC) and adenomatous familial polyposis (AFP), from January 1990 to July 2000, were divided in two groups: Group With Preservation of the Arcade (WPA), 27 patients, mean age 34,0 (19-53) years, 15 (55,6%) were female, and 24 (88,9%) were white; and Group Without Preservation of the Arcade (WOPA), 19 patients, mean age 41,5 (13-62) years, 8 were female (42,1%), and 18 (94,8%) were white. Thirty patients (65,2%) had UC and 16 (34,7%) had AFP. Analyzes were made by the comparison of the incidence of complications due to blood perfusion failure or overtension in the ileoanal anastomosis, as well as the need of revision operation. RESULTS: In the group WPA, 4 patients (14.8%) had complications being related to ischemia or anastomosis overtension. In the group WOPA, it was seen in 7 patients (36,9%). Three patients (11,1%) of the Group WPA were submitted on to revision operation due to complications related to ischemia or anastomotic overtension and 5 (26,3%) in the Group WOPA, for the same reasons. CONCLUSIONS: Besides methodological limitations, it was possible to identify a tendency to less occurrence of ischemia or anastomotic overtension related complications in the Group WPA. To perform a ileal pouch pull through operation, placing the anastomosis at the level of the pectinate line, the preserved MVA is an important technical aspect, helping to maintaining the viability and function of the pouch.

Estudo da liberação renal de glicose em coelhos submetidos a hepatectomia total funcional e infusão de noradrenalina

AIM To study the possible endogenous sources of glucose in the absence of the liver (equivalent to the anhepatic period of liver transplantation). MATERIAL AND METHODS A experimental model of total functional hepatectomy in anesthetized rabbits was developed. The aorta and the right renal vein were catheterised in order to collect blood samples to measure glucose contents. The animals were divided into two groups: group 1, 5 animals underwent only norepinephrine infusion; group 2, 15 animals underwent norepinephrine infusion and submitted to total functional hepatectomy. RESULTS In group 2, before the hepatectomy, arterial glucose levels were higher than venous ones and after the liver removal, the venous levels became higher than the arterial ones. This pattern showed an inversion in the glycemic curves. In group 1 this pattern was not observed. CONCLUSION The glycemic curves behavior observed in group 2 its not due to norepinephrine infusion, but represents renal glucose release after total functional hepatectomy.