Mário Jorge Jucá

Prospective study on the effects of a polypropylene prosthesis on testicular volume and arterial flow in patients undergoing surgical correction for inguinal hernia

PURPOSE To evaluate testicular volume and arterial flow in patients undergoing surgical correction for inguinal hernia, with polypropylene prosthesis. METHODS This was an observational prospective clinical study on 39 male patients with unilateral inguinal hernia of types III A and III B according to the Nyhus classification who underwent surgical correction with implantation of a polypropylene prosthesis by means of the Lichtenstein technique. The patients were evaluated using Doppler ultrasound before the operation and selectively at the third and sixth months after the operation. The variables studied were testicular volume, systolic and diastolic velocity, resistance index and pulsatility index. RESULTS No statistically significant alterations in the variables studied were observed over the course of time: testicular volume (p= 0.197); systolic velocity (p= 0.257); diastolic velocity (p= 0.554); resistance index (p= 0.998); and pulsatility index (p= 0.582). CONCLUSION No alteration in testicular volume and arterial flow over a six-month period was observed among patients who underwent surgical correction for inguinal hernia using a polypropylene prosthesis.

Correlation between the immunohistochemical expressions of MMP-1, MMP-7 and VEGF and prognostic factors in colorectal adenocarcinoma

PURPOSE To analyze the expression of metalloproteinase-1, metalloproteinase-7 and vascular endothelial growth factor (VEGF) in colorectal adenocarcinoma, and to correlate these with the clinical-pathological prognostic factors. METHODS Tumor tissue from 82 patients was fixed in formalin and embedded in paraffin blocks. These samples were analyzed by means of the streptavidin-biotin immunohistochemical method, using the tissue microarray technique. Marker positivity was evaluated using categorical scores that determined cutoff percentages of stained tumor cells. Protein tissue expression was correlated with the variables of degree of cell differentiation, staging, disease-free interval, recurrence, survival and specific mortality. The Fisher exact and Kaplan-Meier tests were used to assess associations between the markers and the study variables. The log-rank and Wilcoxon tests were used to assess the significance of differences between curves of disease-free interval and survival. RESULTS All tumors were positive for metalloproteinase-1; 50 (61%) were positive and 32 (39%) were negative for metalloproteinase-7; and 60 (74.1%) were positive and 21 (25.9%) were negative for VEGF. Correlation of marker expression, both in groups and individually, did not show statistical significance in relation to the degree of cell differentiation, staging, disease-free interval, survival or specific mortality. Recurrence showed a statistically significant correlation with positive expression of the three markers, when analyzed as a group (p = 0.038). CONCLUSION The associated expression of metalloproteinase-1, metalloproteinase-7 and VEGF in colorectal adenocarcinoma is related to the incidence of disease recurrence.

Association between visual impairment and depression in the elderly: a systematic review

A systematic review was conducted to investigate the relationship between visual impairment and depression in the elderly. We searched electronic databases (LILACS, SciELO, MEDLINE, and Cochrane Central Register of Controlled Trials) from inception to August 2014 and researched the described references. The search strategy used the following terms: (visual impairment or blindness) and (elderly) and (depression). Of the 641 electronics, 42 works were selected in full and another 20 were identified as being possibly relevant. Ten studies were included. The studies ranged in sample size from 31 to 21,995 participants. Depression was associated with visual impairment in all studies; however, without standardization of diagnostic tests, we could not conduct a meta-analysis or establish a relationship between visual impairment and depression in the elderly.

Chemoprevention by celecoxib in reflux-induced gastric adenocarcinoma in Wistar rats that underwent gastrojejunostomy.

PURPOSE To evaluate chemoprevention by celecoxib in cases of reflux-induced gastric adenocarcinoma, in Wistar rats that underwent gastrojejunostomy. METHODS Sixty male Wistar rats of average age three months underwent surgery and were distributed into three groups: group 1, exploratory laparotomy; group 2, gastrojejunostomy; and group 3, gastrojejunostomy and daily celecoxib administration. After 53 weeks, the animals were sacrificed. Changes in the mucosa of the gastric body of group 1 and in the gastrojejunal anastomosis of groups 2 and 3, observed in histopathological and immunohistochemical examinations, were compared. All statistical analyses were performed using Epi-Info, version 3.4.3. RESULTS Comparison between groups 2 and 3 relative to the presence of adenocarcinoma showed a statistically significant difference (p=0.0023). Analysis of the association between groups 2 and 3 relative to COX-2 expression also showed a statistically significant difference (p=0.0018). CONCLUSION Celecoxib had an inhibiting effect on gastric carcinogenesis induced by enterogastric reflux in an animal model.

Resultados imediatos da herniorrafia inguinal com anestesia local associada com sedação

OBJETIVO: Avaliar os resultados imediatos da herniorrafia inguinal com anestesia local associada com sedacao. METODOS: Foram operados 30 pacientes portadores de hernia inguinal, sendo 26 (86,6%) do sexo masculino e 4 (13,4) do sexo feminino. Os anestesicos utilizados foram lidocaina a 1% e bupivacaina a 0,5% sem adrenalina, tendo sido adicionado 1mL de bicarbonato de sodio para cada 9mL da solucao anestesica. A sedacao foi realizada com midazolan. As hernias mais frequentes, de acordo com a classificacao de Nyhus, foram as do tipo I, encontradas em 16 (53,3%) pacientes. Praticou-se o reparo da parede posterior a em 17 (56,6%) e em 13 (43,2%) o reparo com protese. Para a analise estatistica utilizou-se o teste de McNemar para avaliar a correlacao entre os escores de dor na escala E.V.A. agrupada. RESULTADOS: Em nenhum paciente houve necessidade de mudanca da tecnica anestesica. Entre as complicacoes, observaram-se: 1 (3,3%) hematoma; 1 (3,3%) sangramento e 1 (3,3%) infeccao da ferida operatoria. A deambulacao foi precoce em 28 (93,3%) pacientes, assim como a alimentacao oral. O tempo de internacao medio foi 18 horas, e o escore de dor na escala visual analogica (E.V.A.) foi menor ou igual a 3 em 80% dos pacientes. CONCLUSAO: A anestesia local com sedacao e um metodo seguro, eficaz, com baixos indices de complicacoes imediatas, e alto indice de satisfacao para pacientes selecionados, portadores de hernia inguinal.

Metaloproteinases 1 e 7 e câncer colorretal

The metalloproteinase-1 (MMP-1) and metalloproteinase-7 (MMP-7) are proteinases of the extracellular matrix (MEC), zinc-dependent, involved in the initial process of carcinogenesis, allowing the invasion by the tumor cell and promoting the process of metastasis. The polymorphism of these proteinases has been studied recently in order to validate its expression and / or activity as a marker prognosis. Evidence shows cumulative important role of MMPs 1 and 7 in different stages of carcinogenesis. The MMP-1 is direct action on the main protein of the MEC, which is the collagen of interstitial connective tissue. Its increased expression in this tissue may indicate high potential for spread in different tumor types of cancer, including colorectal. The association of this increase of expression also appears to be true for MMP-7.

Usos do sulfato de magnésio em obstetrícia e em anestesia

JUSTIFICATIVA E OBJETIVOS: O magnesio e um ion predominantemente intracelular. Seu efeito bloqueador do receptor NMDA lhe confere caracteristicas analgesicas e sedativas. O objetivo desse artigo foi revisar a fisiologia, a farmacologia e a diminuicao da concentracao plasmatica do magnesio, assim como algumas das suas aplicacoes em obstetricia e em anestesia. CONTEUDO: O magnesio e um cation intracelular que possui multiplas funcoes: e cofator de enzimas do metabolismo glicidico e de enzimas da degradacao dos acidos nucleicos, proteinas e acidos graxos; regula a passagem de ions transmembrana e intervem na atividade de varias enzimas. O paciente em estado critico apresenta tendencia a hipomagnesemia e o tratamento consiste em corrigir a causa quando possivel acompanhada da reposicao do magnesio. Ja foi demonstrada a reducao da concentracao alveolar minima (CAM) dos agentes inalatorios em animais e do uso de opioides em humanos sob anestesia. CONCLUSOES: O sulfato de magnesio vem sendo utilizado em obstetricia com boa efetividade para inibicao do trabalho de parto prematuro e para o tratamento das crises convulsivas associadas ao quadro de eclâmpsia. E um farmaco com potencial analgesico e sedativo que pode ser utilizado como coadjuvante durante a anestesia geral atenuando a resposta pressorica a intubacao traqueal e diminuindo a necessidade de anestesicos.

Avaliação da qualidade dos ensaios clínicos aleatórios em anestesia publicados na Revista Brasileira de Anestesiologia no período de 2005 a 2008

BACKGROUND AND OBJECTIVES A random clinical trial (RCT) is defined as a study involving intervention and control groups with random distribution of the participants. The objective of the present study was to assess the quality of RCT in anesthesiology published during a specific time. DESIGN OF THE STUDY descriptive. METHODS A manual search of the articles published by the Brazilian Journal of Anesthesiology between January 2005 and February 2008 was undertaken to identify studies with characteristics of RCTs. The quality of RCTs was the primary parameter; secondary parameters included: approval by the Ethics on Research Committee (ERC), use of the informed consent (IC), description of the source of the grant, the sample size was calculated, number of authors, place of origin, statistical tests used, level of significance adopted, and classification of the type of study. The quality scale, descriptive statistics, and calculation of the 95% confidence interval were used to evaluate the quality of the RCTs. RESULTS Out of 114 studies, 42 were identified as RCT. Only 3 (7.1%) of those were classified as having good methodological quality considering the random distribution, double blind, losses, and exclusions. One-hundred and seven out of 114 studies were submitted to the ERC, 67 used IC, none of them described the source of the grant, 17 calculated the size of the sample, the studies had a mean of 4.49 authors; 60 publications were from São Paulo; the Student t test was used more often (47.4%), a level of significance of 5% was adopted by 97 studies; and 42 were RCTs. CONCLUSIONS After the manual search, 7.1% of the random clinical assays were considered of good methodological quality.BACKGROUND AND OBJECTIVES: A random clinical trial (RCT) is defined as a study involving intervention and control groups with random distribution of the participants. The objective of the present study was to assess the quality of RCT in anesthesiology published during a specific time. Design of the study: descriptive. METHODS: A manual search of the articles published by the Brazilian Journal of Anesthesiology between January 2005 and February 2008 was undertaken to identify studies with characteristics of RCTs. The quality of RCTs was the primary parameter; secondary parameters included: approval by the Ethics on Research Committee (ERC), use of the informed consent (IC), description of the source of the grant, the sample size was calculated, number of authors, place of origin, statistical tests used, level of significance adopted, and classification of the type of study. The quality scale, descriptive statistics, and calculation of the 95% confidence interval were used to evaluate the quality of the RCTs. RESULTS: Out of 114 studies, 42 were identified as RCT. Only 3 (7.1%) of those were classified as having good methodological quality considering the random distribution, double blind, losses, and exclusions. One-hundred and seven out of 114 studies were submitted to the ERC, 67 used IC, none of them described the source of the grant, 17 calculated the size of the sample, the studies had a mean of 4.49 authors; 60 publications were from Sao Paulo; the Student t test was used more often (47.4%), a level of significance of 5% was adopted by 97 studies; and 42 were RCTs. CONCLUSIONS: After the manual search, 7.1% of the random clinical assays were considered of good methodological quality.

Metalloproteinase-1, metalloproteinase-7, and p53 immunoexpression and their correlation with clinicopathological prognostic factors in colorectal adenocarcinoma.

AIM The aim of this study was to analyze the immunoexpression of metalloproteinase-1, metalloproteinase-7, and p53 in colorectal adenocarcinoma, and to correlate this with clinicopathological prognostic factors. MATERIAL AND METHODS Formalin-fixed paraffin-embedded tumor tissue from 82 patients was analyzed by means of immunohistochemistry, using the streptavidin-biotin method and the tissue microarray technique. Protein tissue expression was correlated with the variables of the degree of cell differentiation, stage, relapse-free survival, recurrence, survival, and specific mortality. RESULTS All of the tumors were positive for metalloproteinase-1, while 50 (61%) were positive for metalloproteinase-7, and 32 (39%) were negative for the latter. For p53, 70 (85.4%) of the tumors were positive and 12 (14.6%) were negative. Correlation of the marker expressions separately and in conjunction did not produce any statistically significant data. CONCLUSION The immunoexpression of metalloproteinase-1, metalloproteinase-7, and p53 did not correlate with recurrence, mortality, relapse-free survival, survival, degree of cell differentiation, or staging of colorectal cancer.

Expressão da proteína P53 no adenocarcinoma gástrico: correlação clínica, anatomopatológica e significância prognostica

BACKGROUND: To study the expression of p53 protein in gastric adenocarcinoma and its relationship to clinicopathological parameters such as, age, sex, infiltration of the gastric wall (T), histological type of Laurens classification, histological differenciation, lymph node involvement, stage (TNM) and patient longevity. METHODS: Forty-five patients with the diagnosis of gastric carcinoma submitted to a sub-total gastrectomy or a total gastrectomy in the Surgical Oncology Department at the Santa Casa de Misericordia Hospital in Maceio, Alagoas and the University Hospital of the Federal University of Alagoas, Brazil during the period of January 1991 to May 2002 were analysed.The expression of the p53 protein was evaluated by an immunohistochemistry method, and compared to age, sex, infiltration of the gastric wall, histological type, histological differenciation, lymph node involvement, stage (TNM) and patient longevity. RESULTS: In the total number of patients, 27 were male (60%). The age range of all patients was 26 - 75 years (mean = 53.9 years). Forty patients (88.9%) were classified as well differenciated. As far as infiltration of the gastric wall, 28 patients (62.2%) were classified as having deep infiltration. In 25 patients (55.6%) the lymph nodes were free of disease. The histological study revealed that 29 patients (64.4%) were classified as the intestinal type of Laurens classification. The stage (TNM) showed that 33 patients (73.3%) presented an advanced tumor. In the immunohistochemistry analysis, 18 patients (40%) were considered positive.The follow-up varied between 63 to 3920 days, with the average time being 1020.4 days. The statistical method of univariate analysis of Mantel identified the variables: age, stage, lymph node involvement and the tumor infiltration of the gastric wall as prognostic factors related to the patient with a significant statistical longevity (p<0.05). Multivariate analysis showed that only lymph node involvement was an independent prognostic factor. CONCLUSION: The author concluded that 18 (40%) of the total number of 45 patients with gastric carcinoma showed an immunohistochemistry reaction. There was no significant statistical relationship between expression of p53 protein and prognostic factors studied. Expression of p53 protein was not an independent prognostic factor.