Nicolau Gregori Czeczko

Avaliação do extrato hidroalcoólico de Aroeira (Schinus terebinthifolius Raddi) no processo de cicatrização de feridas em pele de ratos

PURPOSE: To evaluate the healing effect of the topic administration of the hydroalcoholic extract of aroeira in open wounds in the dorsocostal region of rats. METHODS: Sixty Wistar rats, males, were used. In all animals one skin fragment was removed, with two centimeters in diameter. Inhalatory anesthesia with ethyl ether was done, The rats were divided in two groups of 30 animals: aroeira group, submitted to an topic application of the hydralcoholic extract of the plant, and control group, with the same process but with 0.9% saline solution. Each group was divided in three sub-groups of 10 animals according to the period of observation: 7, 14 and 21 days. The areas of the injuries were analyzed by the macrocospic aspect and digital planimetry, and the resected segments of the wounds were studied by optic microscopy stainned with hematoxilin-eosine and trichromium of Masson. RESULTS: The macrocospic findings showed early complete reepitelization in the control group by the 14th day. According to the digital planimetry the average wound areas of the rats from the control group (0.5278 cm2) had been smaller than those from the wounds of the rats of the aroeira group (0.6897 cm2), with statistical significance to the 14th day (p=0.036). The hystologic study showed statistical difference (p=0.023) regarding the mononuclear cells in 14th day of evaluation, with larger number in the aroeira group, without significant differences regarding other parameters in all the remaining days. CONCLUSION: The topic use of the hydralcoholic extract of aroeira delayed the reepitelization of the skin wounds in rats.

Avaliação da ação da Aroeira (Schinus terebinthifolius Raddi) na cicatrização de feridas cirúrgicas em bexiga de ratos

PURPOSE: To evaluate the hydroalcoholic aroeira extract in the healing process of surgical incisions in the bladder of rats in an experimental comparative study. METHODS: Forty male Wistar rats were used. All of them underwent a median abdominal incision, with an 1cm cistotomy, followed by one plan suture with separated stitches of poliglactine 910 5-0. The animals were then divided into two groups of 20 rats each, and named the aroeira group (GA) and the control group (GC). In the first one, 80% hydro-alcoholic plant extract was injected in the peritoneal cavity, in a one dose of 100mg/kg. The second group, a 0.9% saline solution was injected in place of aroeira extract. Each group was divided into two subgroups (SGA and SGC) of 10 animals. According to their scheduled death, they were named subgroups SGA3 and SGC3 when killed in the 3th day after surgery and subgroups SGA7 and SGC7 in the 7th day. The abdominal cavity and the bladder suture were macroscopically evaluated. RESULTS: The microscopic analysis of the surgical incision in the bladder was performed by means of the hematoxilin-eosine stain and the trichrome of Masson. The macroscopic analysis showed an infection in the surgical incision in three rats of the SGC group and in one of the SGA, and peritoneal adhesion in the 26 rats belonging nine to SGC and 17 in the SGA. The microscopic evaluation revealed a more severe acute inflammation process in the SGC on the 3th (p=0.045) and in the 7th (0=0.002) days. In the SGA, a more significant colagenization (p=0.001) could be seen, as far as the evidence of vascular neoformation (p=0.002) on the 3th day. Chronic inflammatory reaction (p=0.006) and a more intense vascular neoformation (p=0.001) were observed in the 7th day. CONCLUSION: The hydroalcoholic aroeira extract have a favorable effect in the healing process of cystotomies done in rats.

Avaliação do extrato de Aroeira (Schinus terebinthifolius Raddi) no processo de cicatrização de gastrorrafias em ratos

PURPOSE: To evaluate the healing process of gastric suture in rats using hydroalcoholic aroeira (Schinus terebinthifolius Raddi) extract. METHODS: Forty adult male rats, divided into two groups of 20 animals were operated and named as follows: aroeira group (Ga), and the control group (Gc). Each group was divided into two subgroups (SG) of 10 animals (SGa and SGc) according to the time of provoked death (three and seven days). The same surgical procedure was performed in all animals consisting in incision and simple suture of the stomach (Prolene® 6-0). The only difference was on the type of medical treatment. The aroeira group received a single 100mg/kg of aroira extract in an intraperitoneal dose and the animals from the control group received the same quantity in milliliters (ml) of the isotonic saline solution. The evaluated parameters were: macroscopic alterations, microscopic healing process and toleration to atmospheric air insufflation. RESULTS: All animals had good healing process of abdominal wall with no clinical evidence of infection, dehiscence, abscesses and peritonitis. Both groups presented adherences to gastric suture line area with surrounding organs, mainly the liver, lower intestines and the abdominal wall. Microscopic analysis showed only chronic inflammation significant difference between the aroeira and control groups on the third day of observation. Resistance tests did not present significant statistical differences in the studied groups. CONCLUSION: The use of aroeira (Schinus terebinthifolius Raddi) hydro-alcoholic extract did not alter the stomach healing process, considered on macroscopic, tensiometric and microscopic assessment.

Procalcitonin as a prognostic biomarker of severe sepsis and septic shock

OBJETIVO: Avaliar a tendencia da concentracao plasmatica e do clearance de procalcitonina (PCT-c) como biomarcadores de prognostico de pacientes com sepse grave e choque septico, comparado a um outro marcador precoce de prognostico representado pelo numero de criterios de SIRS no momento do diagnostico da sepse. METODOS: Estudo de coorte prospectivo observacional onde foram incluidos pacientes com sepse grave e choque septico. A concentracao serica de procalcitonina foi determinada no momento do diagnostico da sepse e apos 24 e 48 horas. Foram coletados dados demograficos, escore APACHE IV, escore SOFA na chegada, numero de criterios de SIRS no momento do diagnostico, sitio da infeccao e resultados microbiologicos. RESULTADOS: Vinte e oito pacientes foram incluidos, 19 clinicos e nove cirurgicos. Em 13 (46,4%) a fonte da sepse foi pulmonar, em sete abdominal (25,0%), em cinco urinaria (17,9%) e de partes moles em tres casos (10,7%). Quinze pacientes tinham sepse grave e 13 choque septico. A mortalidade global foi cinco pacientes (17,9%), tres deles com choque septico. Vinte e oito determinacoes de PCT foram realizadas no momento do diagnostico da sepse, 27 apos 24 horas e 26 apos 48 horas. A concentracao inicial nao se mostrou expressivamente diferente entre os grupos sobreviventes e nao sobreviventes, mas as diferencas entre os dois grupos apos 24 e 48 horas alcancaram significância estatistica expressiva. Nao se observou diferenca em relacao ao numero de criterios de SIRS. O clearance de procalcitonina de 24 horas mostrou-se expressivamente mais elevado no grupo de sobreviventes (-3,0 versus -300,0, p=0,028). Embora o clearance de procalcitonina de 48 horas tenha mostrado resultado mais elevado no grupo de sobreviventes comparado aos nao sobreviventes, a diferenca nao alcancou significância estatistica. CONCLUSAO: Concentracoes persistentemente elevadas de procalcitonina no plasma, assim como, reducao do PCT-c 24 horas, associaram-se a elevacao expressiva da mortalidade de pacientes com sepse grave e choque septico.

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.

Avaliação do uso do extrato bruto de Jatropha gossypiifolia L. na cicatrização de feridas cutâneas em ratos

INTRODUCTION: Phytotherapy is one of the research branches in the healing process of surgical wounds. PURPOSE: To analyze the morphological aspects of the healing process occurring in open skin lesions in rats under administration of raw extract from Jatropha Gossypiifolia L. METHOD: Sixty Wistar rats were utilized. A 2cm wound in diameter was done in each animal at the dorsal region. The animals were divided into two groups, each one consisting of 30 animals. Each group was subdivided into three subgroups of ten. They were analyzed in the 7th, 14th and 21st post-operative day. The two groups were compared through macroscopic analysis using digital planigraphy and histological examination. The microscopic parameters considered were the vascular proliferation, polymorph and mononuclear cells, fibroblastic proliferation, collagen and epithelium formation. RESULTS: Epitelization occurred in a same amount in all animals. There was no chronic inflamation on 21st day in the Jatropha group and also no difference in polimorphonuclear cells between the groups. The fibroblastic reaction was better on the 7th day in the Jatropha group and equal in the remaining ones. Colagenization was greater on 7th and 14th days in Jatropha and better re-epitelization occurred in the same group in the 7th day. CONCLUSION: Although with hystologic aspects favoring the Jatropha, no significant differences concerning to the macroscopic and microscopic aspects were observed among the skin wounds receiving raw extract Jatropha and those that received no treatment in the final evaluation.

Reparo intraperitoneal de defeitos da parede ventral do abdome com telas de poliéster com colágeno e polipropileno com ácido poliglicólico

OBJECTIVE To compare the clinical and histological outcomes of the repair of induced abdominal wall defects with Parietex and Optilene Mesh Elastic + Safil in direct contact with abdominal viscera (intraperitoneal position, IPOM). METHODS Sixteen rabbits were allocated into two groups with 8 animals each, corresponding to evaluation on the 30th and 60th postoperative days. All animals were submitted to two standardized symmetric abdominal wall defects, comprising all muscular layers and the peritoneum, followed by repair through the intraperitoneal placement of two different meshes. The experimental design allowed each animal to be its own control. Macroscopic aspects evaluated were: surgical site infection, mesh erosion, suture insufficiency, fistulae, intra-abdominal infection and adhesion formation. Microscopic parameters analyzed consisted of collagen deposition and the immunohistochemical healing process. RESULTS The formation of intraperitoneal adhesions and the other macroscopic outcome measures evaluated did not present significant statistical differences between the two meshes, neither did type I and III collagen deposition and MMP-1 and MMP-8 antibody expression. MMP-13 antibody exhibited significantly higher expression on the 30th postoperative day with Optilene+Safil and on the 60th day with Parietex. CONCLUSION Due to the similar results obtained, both macroscopically and microscopically, the meshes can be considered equivalent with respect to the healing of surgical wounds in abdominal wall defects in rabbits.

Prevalência ultra-sonográfica de litíase biliar em pacientes ambulatoriais

BACKGROUND: The aim of this study is to determine the sonographic prevalence of gallstone disease in out-patients. METHODS: From July 2001 to March 2002, five hundred patients who underwent an ultra-sonografic exam for non-biliary disease were evaluated. There were 250 male and 250 female with age range from 19 to 72 years old. RESULTS: The prevalence of cholelitiasis or patients who had been underwent to cholecystectomy due to cholelithiasis was 18.4%. Gallstones prevalence increased with age (sixty years old or over), female sex, more than four pregnancies and body mass index (BMI) over 30. CONCLUSION: The prevalence of gallstones increased in patients with risk factors.

Escolha do material da tela para disposição intra-peritoneal na correção cirúrgica de defeitos herniários da parede abdominal

INTRODUCTION: The use of meshes to surgical repair of abdominal wall defects has contributed increasingly to reduce the number of incisional hernias. This use, however, in the intraperitoneal position leads to adhesion formation and a great number of complications, as bowel obstruction. METHODS: Twenty seven articles were selected from PubMed and Medline publications with important information about the meshes properties (material, pore size, spacial surface area, molecular weight) and its alocation in intraperitoneal position, preventing adhesion formation and incisional hernia. CONCLUSION: Nowadays, the composite meshes are the most specified to use in the intraperitoneal position. They are composed in one side with a material (macroporous and reticular) that must be in contact with the muscle and has the purpose to maintain the abdominal wall resistence. In the other side, another kind of material (microporous and laminar) that must be in contact with the intra-abdominal organs, however without inducing adhesion formation.

Healing reaction to mammary prostheses covered by textured silicone and silicone foam in rats

PURPOSE To compare the capsular reaction to two different coverings of silicone prosthesis through the biophysical characteristic of adherence and microscopical aspects of the inflammatory reaction and collagen formation. METHODS Thirty two Wistar rats were used. In the dorsum of each animal a silicone elastomer with a smooth superficies and another coated with texturized silicone (Mentor) was implanted. Another one, with the same smooth superficies and other coated with silicone foam (Lifesil), making up in each side, of the dorsum, the texturized and silicone foam group respectively. The animals were split into four groups to be evaluated at 7, 14, 30 and 60 days. On the evaluation dates the implant adherence was verified witch a tensiometer and the values in kgf were obtained. The material was sent to histological analysis with hematoxilin-eosin and picrosirius colorations, to evaluate the inflammatory reaction and collagen synthesis, respectively. The obtained data were submitted to statistical treatment. RESULTS There was more adherence of the tissue to the silicone foam (P<0,001). The inflammatory reaction was more intense in the same group, but without statistical significance. The number of giant cells and granulomas were more frequent in the silicone foam group. There was statistical significance at the 60 days for granulomas (P<0,028) and for all subgroups about number of giant cells (P< 0,012 to P<0,036). The thickness of the capsule in the silicone foam group was bigger, with statistical significance at seven days (P<0,028) and 60 days (P<0,012). The collagen deposition showed no difference in statistical analysis. CONCLUSION The capsular reaction to the silicone foam showed stronger adherence, bigger thickness and had more number of granulomas and giant cells. No difference was observed in the intensity of inflammatory reaction in relation to type I and III collagen, when compared to the texturized cover.