Nelson Adami Andreollo

Rat's age versus human's age: what is the relationship?

BACKGROUND Millions of mice are used annually in research and teaching. The exact relationship between age of the animals compared with the age of humans is still subject to discussion and controversy. OBJECTIVE Literature review analyzing the age of rats in comparison with men age. METHODS Were reviewed the existing publications on the subject contained in Medline / PUBMED, SciELO, The Cochrane Database of Systematic Reviews and Lilacs crossing the headings rats, experimental surgery and physiology. RESULTS Rats rapidly develop during childhood and become sexually mature at about six weeks old, but reach social maturity five to six months later. In adulthood, every month of the animal is approximately equivalent to 2.5 human years. Several authors performed experimental studies in rats and estimated 30 days of human life for every day life of the animal. CONCLUSION The differences in anatomy, physiology, development and biological phenomena must be taken into consideration when analyzing the results of any research in rats when age is a crucial factor. Special care is necessary to be taken when the intention is to produce correlation with human life. For this, special attention is needed to verify the phase in days of the animal and its correlation with age in years of humans.BACKGROUND: Millions of mice are used annually in research and teaching. The exact relationship between age of the animals compared with the age of humans is still subject to discussion and controversy. OBJECTIVE: Literature review analyzing the age of rats in comparison with men age. METHODS: Were reviewed the existing publications on the subject contained in Medline / Pubmed, Scielo, The Cochrane Database of Systematic Reviews and Lilacs crossing the headings rats, experimental surgery and physiology. RESULTS: Rats rapidly develop during childhood and become sexually mature at about six weeks old, but reach social maturity five to six months later. In adulthood, every month of the animal is approximately equivalent to 2.5 human years. Several authors performed experimental studies in rats and estimated 30 days of human life for every day life of the animal. CONCLUSION: The differences in anatomy, physiology, development and biological phenomena must be taken into consideration when analyzing the results of any research in rats when age is a crucial factor. Special care is necessary to be taken when the intention is to produce correlation with human life. For this, special attention is needed to verify the phase in days of the animal and its correlation with age in years of humans

Gastric polyps: a retrospective analysis of 26,000 digestive endoscopies

BACKGROUND Gastric polyps are small gastric lesions, asymptomatic in most cases and are generally discovered inadvertently during upper digestive endoscopy. AIM To retrospectively review the characteristics and frequency of gastric polyps, derived from the gastric mucosal epithelium in a large series of endoscopies. METHODS One hundred and fifty three patients in a series of 26,000 consecutive upper digestive endoscopies done over a 5-year period, being that each patient had only one examination were analyzed and their histological and Yamada classification, as well as their location, size, histopathological findings and treatment studied. All patients had at least one gastric polyp, as confirmed by histological examination. RESULTS The polyps were classified as hyperplastic, adenomatous and fundic gland polyps. The most of them measure less than 1 cm (hyperplastic polyps - 60,5%; adenomatous polyps - 73,6%; fundic gland polyps - 72%). Hyperplastic polyps were the most frequent and accounted for 71.3% of the cases, whereas fundic gland polyps accounted for 16.3% and adenomatous polyps for 12.4%. Hyperplastic and adenomatous polyps were primarily single, whereas fundic gland polyps tended to be multiple. A carcinoma was detected in one hyperplastic polyp (0.9%) and in two adenomatous polyps (10.5%). High grade dysplastic foci were found in four adenomatous polyps (21%). CONCLUSIONS The digestive endoscopy is the safest and efficient method for the diagnosis of the gastric polyps, that in most of the patients does not show characteristic symptoms. The histopathological definition is not possible to the endoscopic glance being needed the pathologists aid, once the conduct to be adopted will depend on the result of the biopsy.

HPV infection in Brazilian patients with esophageal squamous cell carcinoma: Interpopulational differences, lack of correlation with surrogate markers and clinicopathological parameters

The role of HPV in esophageal squamous cell carcinoma (ESCCs) is controversial. Therefore, we determined, through different methodologies, the prevalence of HPV in 264 ESCC samples from Brazil, and correlated it with the presence of surrogate markers and clinicopathological characteristics. HPV is present in 13% of ESCC, and with a 3-fold variation between high and medium incidence areas. Most HPV positive tumors were infected with HPV16, but this was not associated with p16 expression, TP53 mutation status, patient age, amount of tobacco or alcohol consumption, or overall survival. We conclude that HPV infection may not have a role in ESCC.

Use of corticosteroids after esophageal dilations on patients with corrosive stenosis: prospective, randomized and double-blind study

OBJECTIVE To determine triancinolone intralesional injections effects in association with esophageal dilations in corrosive stenosis cases, by means of a double-blind and randomized study. METHOD Fourteen adults patients (6 men and 8 women) with severe esophageal corrosive stenosis were randomized in two groups: Group A: treated by esophageal dilations and posterior triancinolone 10 mg/ml intralesional injection; Group B: treated by esophageal injections and posterior saline solution 0,9% injection (placebo). New applications were made based on the patient symptomatology. It had been analysed dilation frequency, obtained diameters and dysphagia before and after the research, for 12 months. RESULTS Eleven patients had ingested sodium hydroxide, two had ingested ammoniac and one had taken muriatic acid. There was no statistic difference (p > 0.05) in dilation frequency and dysphagia between the groups. However, an improvement in obtained diameter was observed in the corticosteroids group in comparison with control group (p < 0.05). By comparing groups before and after steroids, the final results were very favorable in group A CONCLUSION: Multiple intralesional injections of triancinolone hexacetonide 10 mg/ml in association with esophageal dilations increase obtained diameters in succeeding sessions.

Alterations in epidermal growth factor receptors 1 and 2 in esophageal squamous cell carcinomas

A bstractBackgroundEsophageal squamous cell carcinoma (ESCC) shows a 5-year survival rate below 10%, demonstrating the urgency in improving its treatment. Alterations in epidermal growth factor receptors are closely related to malignancy transformation in a number of tumors and recent successful targeted therapies have been directed to these molecules. Therefore, in this study, we analyzed the expression of EGFR and HER2 and evaluated EGFR mutation profile as well as the presence of mutations in hotspots of KRAS and BRAF in ESCC patients.MethodsWe performed RT-qPCR, immunohistochemistry and Fluorescent in situ hybridization to determine EGFR and HER2 expression in ESCC patients, and direct sequencing and PCR-RFLP for mutations and polymorphism analysis.ResultsOur results showed an increased EGFR mRNA expression in tumors compared to surrounding tissue (p <0.05), with 11% of the cases presenting at least a four-fold difference between tumor and paired adjacent mucosa. EGFR protein overexpression was present only in 4% of the cases. The median expression of HER2 mRNA was not different between tumors and adjacent mucosa. Still, 7% of the tumors presented at least a 25-fold higher expression of this gene when compared to its paired counterpart. Immunohistochemical analysis revealed that 21% of the tumors were positive for HER2 (scores 2+ and 3+), although only 3+ tumors presented amplification of this gene. Mutation analysis for EGFR (exons 18-21), KRAS (codons 12 and 13) and BRAF (V600E) showed no mutations in any of the hotspots of these genes in almost 100 patients analyzed. EGFR presented synonymous polymorphisms at codon 836 (C>T) in 2.1% of the patients, and at codon 787 (G>A) in 79.2% of the cases. This last polymorphism was also evaluated in 304 healthy controls, which presented a similar frequency (73.7%) in comparison with ESCC patients. The absence of mutations of EGFR, KRAS and BRAF as well as the overexpression of EGFR and HER2 in less than 10% of the patients suggest that this signaling pathway is altered in only a small proportion of patients with ESCC.ConclusionHER receptors target therapies may have the potential to be effective in only a minor fraction of patients with ESCC.

Lower expression of p14ARF and p16INK4a correlates with higher DNMT3B expression in human oesophageal squamous cell carcinomas

Oesophageal squamous cell carcinoma (ESCC) is one of the most common malignancies and is the sixth cause of cancer-related death in the world. Inactivation of cell-cycle regulating genes, such as p14ARF and p16INK4a, and cell adhesion genes, such as E-cadherin, is common in cancer, and results from genetic and/or epigenetic alterations. Therefore, we have analysed the mRNA expression of p14ARF, p16INK4a and E-cadherin in 17 matched ESCC and normal mucosal samples obtained from Brazilian patients by semi-quantitative RT-PCR. The expression of p14ARF and p16INK4a was absent or reduced in several ESCC samples. Hypermethylation of CpG islands, caused by the action of DNA methyltransferases (DNMTs), is a major form of epigenetic inactivation of the p14ARF and p16INK4a genes in tumours. Hence, we also investigated the mRNA expression of the human DNA methyltransferases in normal oesophageal mucosa and in the tumour matched samples. All DNMTs were constitutively expressed in the normal oesophageal mucosa but a significantly higher expression of DNMT3B was observed in the tumours. Data analysis by the Spearman rank test showed that the expression of DNMT3B was inversely correlated with that of p14ARF and p16INK4a. Our results suggest that DNMT3B over-expression may be involved in the suppression or lower expression of p14ARF and p16INK4a observed in ESCC.

Foregut caustic injuries: results of the world society of emergency surgery consensus conference

IntroductionLesions of the upper digestive tract due to ingestion of caustic agents still represent a major medical and surgical emergency worldwide. The work-up of these patients is poorly defined and no clear therapeutic guidelines are available.Purpose of the studyThe aim of this study was to provide an evidence-based international consensus on primary and secondary prevention, diagnosis, staging, and treatment of this life-threatening and potentially disabling condition.MethodsAn extensive literature search was performed by an international panel of experts under the auspices of the World Society of Emergency Surgery (WSES). The level of evidence of the screened publications was graded using the Oxford 2011 criteria. The level of evidence of the literature and the main topics regarding foregut caustic injuries were discussed during a dedicated meeting in Milan, Italy (April 2015), and during the 3rd Annual Congress of the World Society of Emergency Surgery in Jerusalem, Israel (July 2015).ResultsOne-hundred-forty-seven full papers which addressed the relevant clinical questions of the research were admitted to the consensus conference. There was an unanimous consensus on the fact that the current literature on foregut caustic injuries lacks homogeneous classification systems and prospective methodology. Moreover, the non-standardized definition of technical and clinical success precludes any accurate comparison of therapeutic modalities. Key recommendations and algorithms based on expert opinions, retrospective studies and literature reviews were proposed and approved during the final consensus conference. The clinical practice guidelines resulting from the consensus conference were approved by the WSES council.ConclusionsThe recommendations emerging from this consensus conference, although based on a low level of evidence, have important clinical implications. A world registry of foregut caustic injuries could be useful to collect a homogeneous data-base for prospective clinical studies that may help improving the current clinical practice guidelines.

O megaesôfago tratado cirurgicamente: perfil epidemiológico dos pacientes operados no Hospital de Clínicas da Universidade Estadual de Campinas entre 1989 e 2005

Megaesophagus is one of the manifestations of Chagas disease and surgical treatment is the approach that presents the best results. In this retrospective study, the epidemiological profile of patients operated in the Clinical Hospital of University of Campinas between 1989 and 2005 was evaluated with regard to: place of birth, place of residence, probable place of infection, age, degree of megaesophagus, etiology, duration and evolution of dysphagia, other diseases in association and the type of surgery chosen. The method used was to analyze the 390 medical files of these patients, at the hospitals medical archive service. The results made it possible to establish the endemic regions, place of birth and place of residence of the patients with Chagas disease attended at our clinic, and to characterize the group. After detailed analysis, it was found that the mean age was 47 years and the mean duration of dysphagia was 9.47 years. It was observed that: a) in 84.4% of the patients, dysphagia took hold progressively; b) 306 (78.5%) patients presented Chagas disease etiology; c) grade 2 was prevalent in 48%; d) 89.8% of the patients underwent cardiomyotomy; and e) there were frequent associations with gastritis, esophagitis, megacolon, arterial hypertension and cardiopathy.

Studies of distribution and recurrence of Helicobacter spp. gastric mucosa of dogs after triple therapy

Purpose: To analyze the triple antimicrobial therapy in positive Helicobacter spp. dogs and to investigate recurrence. Methods: A total of 20 dogs underwent endoscopy followed by gastric biopsy using the rapid urease test and histopathology stained with Giemsa. Ten animals were treated with triple therapy recommended for humans and divided into control and experimental group. The control group was kept in isolation while the experimental group was placed in contact with positive animals during 60 days. Results: The prevalence of infection in animals in this experiment was 100%, and more frequent in the fundus and the gastric body. Therapy for 7 days using clarithromycin, amoxicillin and lansoprazole was effective in 100% of the animals. Recurrence of the infection in 80% of dogs in the experimental group, while the control group remained eradicated after 60 days. Conclusion: Crowded environments associated with close contact with dogs infected with helicobacter are a determinant for transmission of Helicobacter spp. between canines. Key works: Helicobacter infections. Endoscopy. Gastric Mucosa. Dogs. RESUMO Objetivo: Avaliar a eficacia da terapia triplice em caes naturalmente infectados pelo Helicobacter spp. e investigar a recorrencia da infeccao pelo contato com animais infectados. Metodos: Foram utilizados 20 caes, submetidos a endoscopia digestiva alta seguida de biopsia gastrica usando teste rapido da urease e histopatologia corada pelo Giemsa. Dez animais foram tratados com terapia triplice preconizada para humanos e divididos em grupo controle e experimental. O grupo controle foi mantido em isolamento enquanto que o grupo experimento foi colocado em contato com os animais positivos durante 60 dias. Resultados: A prevalencia da infeccao nos animais deste experimento foi de 100%, e mais frequente no fundo e corpo gastrico. A terapia durante 7 dias empregando claritromicina, amoxicilina e lansoprazol foi eficaz em 100% dos animais. Houve recorrencia da infeccao em 80% dos caes do grupo experimental, enquanto que o grupo controle manteve-se erradicado apos 60 dias. Conclusao: Ambientes aglomerados associado a intimo contato com caes infectados por helicobacterias e fator determinante para transmissao do Helicobacter spp. entre caninos. Descritores: Infeccao por Helicobacter . Endoscopia. Mucosa Gastrica. Caes.PURPOSE To analyze the triple antimicrobial therapy in positive Helicobacter spp. dogs and to investigate recurrence. METHODS A total of 20 dogs underwent endoscopy followed by gastric biopsy using the rapid urease test and histopathology stained with Giemsa. Ten animals were treated with triple therapy recommended for humans and divided into control and experimental group. The control group was kept in isolation while the experimental group was placed in contact with positive animals during 60 days. RESULTS The prevalence of infection in animals in this experiment was 100%, and more frequent in the fundus and the gastric body. Therapy for 7 days using clarithromycin, amoxicillin and lansoprazole was effective in 100% of the animals. Recurrence of the infection in 80% of dogs in the experimental group, while the control group remained eradicated after 60 days. CONCLUSION Crowded environments associated with close contact with dogs infected with helicobacter are a determinant for transmission of Helicobacter spp. between canines.

The use of pyloric exclusion for treating duodenal trauma: case series.

CONTEXT AND OBJECTIVES Significant controversy exists regarding the best surgical treatment for complex duodenal injuries. The aims of this study were to report on a series of eight cases of duodenal repairs using pyloric exclusion and to describe reported complications or improvements in clinical outcomes among patients with complex duodenal trauma. DESIGN AND SETTING Cross-sectional study followed by a case series in a university hospital. METHODS Data on eight patients with duodenal trauma who underwent pyloric exclusion over a 17.5 year period were collected and analyzed. RESULTS The causes of the injuries included penetrating gunshot wounds (GSW) in five patients and motor vehicle accidents (blunt trauma) in three patients. The time elapsed until surgery was longer in the blunt trauma group, while in one patient, the gunshot injury was initially missed and thus the procedure was carried out 36 hours after the original injury. The injuries were grade III (50%) or IV (50%) and the morbidity rate was 87.5%. Four patients (50%) died during the postoperative period from complications, including hypovolemic shock (one patient), sepsis (peritonitis following the missed injury) and pancreatitis with an anastomotic fistula (two patients). CONCLUSIONS Pyloric exclusion was associated with multiple complications and a high mortality rate. This surgical technique is indicated for rare cases of complex injury to the duodenum and the surgeon should be aware that treatment with a minimalistic approach, with only primary repair, may be ideal.