Orlando de Castro e Silva Junior

Intervenção educativa para candidatos ao transplante de fígado

Objetivo: o estudo teve como objetivo analisar o conhecimento de candidatos sobre o processo de transplante de figado, antes e depois da implementacao de intervencao educativa. Metodos: trata-se de estudo com delineamento de pesquisa quase-experimental, do tipo grupo unico, antes e depois. A amostra final foi composta por 15 sujeitos. A coleta de dados da investigacao, cuja duracao foi de janeiro a marco de 2010, ocorreu em tres etapas, a saber: pre-teste, implementacao da intervencao educativa (dois encontros) e pos-teste. Resultados: os resultados evidenciaram ganho cognitivo significativo apos a intervencao, com melhora no desempenho dos participantes. Conclusoes: o estudo traz evidencias de que a implementacao de estrategia direcionada para educacao de paciente pode aumentar o conhecimento de candidatos sobre o processo de transplante de figado e, consequentemente, contribuir para o sucesso do tratamento.

Determination of post-mortem interval using in situ tissue optical fluorescence

In this study we have used fluorescence spectroscopy to determine the post-mortem interval. Conventional methods in forensic medicine involve tissue or body fluids sampling and laboratory tests, which are often time demanding and may depend on expensive analysis. The presented method consists in using time-dependent variations on the fluorescence spectrum and its correlation with the time elapsed after regular metabolic activity cessation. This new approach addresses unmet needs for post-mortem interval determination in forensic medicine, by providing rapid and in situ measurements that shows improved time resolution relative to existing methods.

Aspectos morfológicos da utilização intraperitoneal de prótese de dupla face na inguinoplastia em cães

OBJECTIVE: To asses the morphological features of the behavior of a double-sided prostheses using inguinoplasty laparotomy in dogs with latex side turned to the visceras. METHODS: Twenty dogs were divided into two groups of 10 and submitted into infraumbilical laparotomy with double-sided prostheses fixed in an inguinal area and in the other side area a control prostheses of polipropilene (PPL). Macroscopics itens were studied on the 14th and 28th day post-operatory, and they were related to obstruction and intestinal fistulas, encystation, fusion and especially sticker. The microscopic analysis covered the inflammatory process in its acute, chronic and restored phase RESULTS: Infectious process, obstruction or intestinal fistula did not happen. The prostheses presented good accommodation and incorporation. The stickers happened with more prevalent and intensity with the PPL (p 0,05). CONCLUSION: The double-sided prostheses in its parietal side adds the advantages of the incorporations potential to the noticed material with PPL to the biocompatibility from the latex in its visceral side. The little distance between the PPL disc and the edge of the double-sided prostheses (2 cm) allied to its sticking with just five staples is not enough to avoid gaps, through which the epiploon migrated towards to the inflammatory process provoked by PPL in the parietal side.

Educational intervention for liver transplantation candidates

Objetivo: o estudo teve como objetivo analisar o conhecimento de candidatos sobre o processo de transplante de figado, antes e depois da implementacao de intervencao educativa. Metodos: trata-se de estudo com delineamento de pesquisa quase-experimental, do tipo grupo unico, antes e depois. A amostra final foi composta por 15 sujeitos. A coleta de dados da investigacao, cuja duracao foi de janeiro a marco de 2010, ocorreu em tres etapas, a saber: pre-teste, implementacao da intervencao educativa (dois encontros) e pos-teste. Resultados: os resultados evidenciaram ganho cognitivo significativo apos a intervencao, com melhora no desempenho dos participantes. Conclusoes: o estudo traz evidencias de que a implementacao de estrategia direcionada para educacao de paciente pode aumentar o conhecimento de candidatos sobre o processo de transplante de figado e, consequentemente, contribuir para o sucesso do tratamento.

Efeitos do laser sobre a cirrose hepática

O presente estudo relata os efeitos da aplicacao de LASER sobre figados cirroticos de ratos Wistar. A cirrose hepatica foi induzida atraves da ligadura do ducto biliar. Aproximadamente vinte e cinco dias apos a cirurgia inicial, os animais foram submetidos a irradiacao LASER com exposicao hepatica direta. O experimento compos-se da analise morfometrica dos constituintes do figado apos 24 horas da irradiacao. Os resultados revelaram maior proliferacao vascular nos animais irradiados sem alteracao dos demais componentes.

Considerations about a thematic Supplement containing papers related to Translational Research in Surgery.

The present supplement was conceived and prepared starting in August 2015. There were papers already written which had not been submitted to other journals. Two had been submitted to and accepted on merit by two other other journals but at a cost exceeding 2,000.00 dollars each. Obviously we refused to pay this amount despite the high impact of the journals. Without controversy, it is our policy to pay for the publication of scientific papers only when we see that the amount is destined to cover the costs inherent to the editing of articles, and therefore not abusive, as collaboration with the journal involved. At a meeting, Acta Cirurgica Brasileira was the journal chosen for the submission of our papers that are part of this Supplement. Within six months we wrote the results obtained and we are now submitting them for possible publication. They are six papers in the coloproctology area, one in the area of digestive surgery, one in the area of urology and two in the cardiovascular area, all of them dealing with current topics of relevance in the area of surgery. In general, we may consider this supplement to be thematic, dealing with cancer in different areas of surgery involving the introduction of new surgical techniques and studies on laser, methylene blue and hyperbaric oxygen therapy and their effects on the disease. Current sophisticated study methods were used in the various investigations, with relevant results and rich discussions, rendering the present supplement an excellent medium for consultation within the medical literature. Regarding the use of laser, one of the papers specifically deals with the laser/hepatic tissue interaction in livers not submitted to any type of partial resection. The liver is a quiescent organ regarding cell proliferation: only 0.0012 to 0.01% of the hepatocytes are in mitosis at any given momemt2,3. The literature shows that toxic or surgical injuries in experimental models can alter this low cell turnover, leading to massive hepatocyte proliferation and consequently to the the total reestablishment of the hepatic mass within approximately two weeks after the loss of up to two thirds of the organ.. Several studies have shown an effective interaction of light with biological tissues, the liver in particular. Conventional light as well as LED (Light-Emitting Diode) and laser, with their different optical properties, have similar effects on the cell organelles, leading to increased efficiency of wound healing, of the hepatocellular mitochondrial energy cpacity and of hepatic regeneration. The tissue loss of part of the liver rapidly triggers the regenerative process until the originl weight is recovered. The observation of the response of the liver to various challenges such as hepatitis, intoxication, hepatic resection and liver transplantation is mythological and raises extremely interesting aspects regarding the hepatic coherence in overcoming challenges and obstacles. In particular, in this Supplement the authors studied the effect of laser light at two wavelengths on intact livers aiming at the possible application of a rational dose of laser light to the liver in various therapeutic modalities in the future. We wish to thank Prof. Goldenberg for giving us the opportunity to publish this Supplement.

How to do liver transplantation in situs inversus totalis: a simple technique

Situ inversus totalis (SIT), a defect in the global situs orientation resulting in a complete mirror image of the normal arrangement of internal organs, occurs in one out of 4000–20 000 newborns.1 Due to its rarity and complexity, SIT presents a unique technical challenge. The main problems for orthotopic liver transplantation in SIT are: (i) having to place the greater right lobe of the graft over the right-sided stomach; and (ii) the presence of a large empty space in the left upper quadrant predisposing to lateral displacement of the graft leading to kinking of the hepatic veins. Raynor et al. reported the first successful liver transplant in a recipient with SIT in 1988.2 Though different successful approaches have been proposed, agreement on a standard technique has not been achieved. They are: (i) plication of the left diaphragm together with stabilization of the graft with an inflated gastric balloon of the Sengstaken–Blakemore tube inserted percutaneously;3 (ii) segmental living donor liver transplantation (i.e. reduced size);4 (iii) varying degrees (15–90°) of lateral rotation (clockwise in SIT recipients or counterclockwise in donor SIT) of the graft with standard piggy-back, end-to-side or side-to-side cavo-caval anastomosis;5 and (iv) 180° flip (retroversus or backward facing) of the graft.6 Here we describe simple technical aspects of a successful orthotopic cadaveric donor liver transplant in a patient with SIT, which we consider optimal for such cases. A 44-year-old man with cryptogenic cirrhosis, previously diagnosed with complete SIT (Child-Pugh score B; Model for End-Stage Liver Disease, 24), was submitted to liver transplantation in 2010. The liver was procured in the standard fashion with the University of Wisconsin solution. The native liver weighed 825 g and the donor liver 1295 g. Back-table preparation of the donor liver involved an arterial reconstruction (an accessory left hepatic artery was anastomosed to the gastroduodenal artery) and closing of the suprahepatic vena cava with a running suture. While placing the graft in the cavity, it was rotated 90° clockwise. This allowed perfect alignment of the recipient and donor hila. The donor infrahepatic vena cava was anastomosed end-to-side to the recipient inferior vena cava. The artery and portal vein were anastomosed end-to-end. A choledococholedocostomy was established over a number 8 T-tube. The triangular and falciform ligaments were fixed to the abdominal wall. Figure 1 shows the schematic representation of the final graft placement. Figure 1 Schematic representation: final placement of the graft in the abdominal cavity. T-L, termino-lateral; IVC, inferior vena cava. The patient was discharged on the 24th postoperative day. At 3 months, due to a narrow native biliary tree, the choledococholedocal anastomosis was converted to a Roux-en-Y choledochojejunostomy. Magnetic resonance imaging 3 months after the transplant showed adequate graft placement and venous drainage of the graft. Currently, the patient is doing fine 3 years after orthotopic cadaveric donor liver transplantation, has normal graft function and is asymptomatic. SIT per se is not a contraindication for liver transplantation. Preoperative evaluation of the native vascular and biliary anatomy is essential. In hindsight, a Roux-en-Y bilio-enteric anastomosis at the outset would have been beneficial and should always be considered while planning the surgery. This technique in our opinion is most suited for this anatomical variation. It has several advantages: there is no risk of kinking of the venous outflow; the hepatic hilum is aligned and allows a choledococholedocostomy (if the recipient anatomy permits); the hepatic veins drain medially and there is no stagnant pool of blood in the outflow; and there is no need for a reduced size graft, as the larger graft in this case clearly demonstrates. And finally, the same technique can also be used when the donor presents SIT.

Effects of plastic stenting in commom bile duct of rats: a quantitative reaction analysis using collagen and elastin morphometry

Purpose: To evaluate the effects of biliary stenting in rats through analysis of collagen and elastin deposition in the bile ducts. Methods: Twenty male rats underwent midline laparotomy, duodenotomy and transampullary stenting of the common bile duct with a 22Fr plastic stent. Animals were randomized in 4 groups, with 5 components in each: (I) control, (II) biliary stenting for 7 days, (III) biliary stenting for 14 days, and (IV) biliary stenting for 30 days. Sections of the common bile duct were stained using Hematoxylin Eosin; Sirius Red to quantitate the amount of collagen present; and Weigert’s Resorcin-fuchsin to quantitate the amount of elastin present. Results: The percentage of area stained for collagen was 13.4; 21.5; 29.5 and 32.8, for groups I to IV, respectively. The percentage of area stained for elastin fibers was 7.0; 5.2; 4.0 and 2.9, for groups I to IV, respectively. Collagen/Elastin ratio was 2.4; 5.1; 11.0 and 14.4 for groups I to IV, respectively. Conclusions: The biliary stenting leads to collagen and elastin deposition in the bile ducts; and collagen deposition and collagen/elastin ratio are proportional to the period of stenting.