Osvaldo Malafaia

Prognostic evaluation of severe sepsis and septic shock: Procalcitonin clearance vs Δ Sequential Organ Failure Assessment

PURPOSE The purpose of the study is to compare the clearance of procalcitonin (PCT-c) in the first 24 and 48 hours of treatment of severe sepsis and septic shock with another early prognostic marker represented by the 48-hour Δ Sequential Organ Failure Assessment (SOFA). MATERIALS AND METHODS Prospective, observational cohort study conducted in a general intensive care unit including patients with severe sepsis and septic shock. The PCT-c was determined at the diagnosis of sepsis and after 24 and 48 hours. The SOFA score was determined at the time of intensive care unit admission and after 48 hours. RESULTS One hundred thirty adult patients with severe sepsis and septic shock were studied over an 18-month period. The 24- and 48-hour PTC-c scores were significantly higher in survivors (P < .0001). In nonsurvivors, the initial SOFA was significantly higher, and the 48-hour Δ SOFA was significantly smaller (P = .01). The area under the receiver operating characteristic curve was 0.68 for Δ SOFA and 0.76 for 24- and 48-hour PCT-c. CONCLUSIONS The 48-hour Δ SOFA score and the clearance of 24- and 48-hour PCT are useful markers of prognosis in patients with severe sepsis and septic shock. A decrease in PCT-c in the first 24 hours of treatment should prompt the reassessment of the appropriateness and adequacy of treatment.

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.

Effects of a highly concentrated platelet-rich plasma on the bone repair using non-critical defects in the calvaria of rabbits

PURPOSE To verify the effect of highly concentrated platelet-rich plasma (hPRP) in the pathways of bone repair using non-critical defects in the calvaria of rabbits. METHODS The hPRP was produced from collected venous blood of 21 rabbits. Four non-critical defects of 8 mm in diameter were created on the calvaria of each animal. The defects were all treated differently: autogenous particled bone (APB, group 1), autogenous particled bone associated with hPRP (APB + hPRP, group 2), isolated hPRP (group 3), and blood clot (control, group 4). Animals were submitted to euthanasia on the 2nd, 4th and 6th week postoperatively. Histological and histomorphometric analysis were carried through. RESULTS After two weeks, groups 1 and 2 were in more advanced stage of repair than 3 and 4. At this period, comparing the groups 1 and 2, no significant differences were found between both, which also happened between the groups 3 and 4. However, after four and six weeks, the group 1 showed a more advanced stage of repair among all the other studied groups, while group 2 was in more advanced signs of bone repair than groups 3 and 4. Comparing groups 3 and 4, after four and six weeks, the least advanced stage of bone repair was found to be within group 3. CONCLUSION The use of a highly concentrated PRP was considered prejudicial to the repair of non-critical defects in the calvaria of rabbits, either in the association of autogenous particled bone, when compared to autogenous particled bone alone, or in its isolated form, when compared to blood clot (control).

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 de deficiência de vitamina D em pacientes com úlceras de perna de etiologia venosa

OBJECTIVE To study if the prevalence of vitamin D deficiency in patients with venous leg ulcer is higher than in the control population. METHODS Serum levels of 25 hidroxi (OH)-vitamin D3 was studied by chemiluminescence in 27 patients with chronic venous ulcer and 58 controls at the Evangelical Hospital of Curitiba. RESULTS The levels of 25 OH-vitamin D3 were below 8 ng/dl in 11.1% of ulcer patients and 3.4% of controls; between 8 and 20 ng/dl in 46.1% of ulcer patients and 25.8% of controls; between 21 and 30 ng/dl in 22.2% of ulcer patients and 27.5% of controls and above 30 ng/dl in 43.1% of controls and 18.5% of ulcer patients (p=0.04). CONCLUSION There is an increased prevalence of vitamin D deficiency in patients with chronic venous leg ulcers.

Tracheal suture in rats with hypothyroidism: wound healing study

PURPOSE To evaluate the influence of hypothyroidism in tracheal wound healing process. METHODS A controlled study was designed with 48 male Wistar rats, divided into two groups: study and control groups. In the first one hypothyroidism was surgically induced and 10 weeks after, a tracheal opening followed by suture was performed in both groups, subdivided into 7, 14, and 21 days in accordance with the date of animals death. A laboratorial evaluation was performed to prove the decreased in thyroid function in the study group. Also a macroscopic evaluation through a stablished protocol and a microscopic analysis with Hematoxylin-eosin and Sirius-Red staining methods were done. RESULTS The laboratorial evaluation certified suppressed thyroid function in the study group. The macroscopic evaluation showed the presence of suture blockade in the study group in all the evaluated days. Microscopic analysis showed a prolongated inflammatory process and less collagen with delay in organization in the study group comparing to control group. All these data were statistic significant. CONCLUSION Hypothyroidism had an influence in tracheal wound healing process, promoting delay in the inflammatory and organization processes and diminished tissue collagen quantity.

Microcirurgia endoscópica transanal no tratamento dos tumores do reto: estudo prospectivo em 50 pacientes

BACKGROUND The medical literature accepts local resection as a valuable option in selected cases of rectal tumors. Selection of patients requires an exact perioperative estimation of risks with clinical and histopathological examination. Transanal endoscopic microsurgery aims a safe resection of the tumoral area which leads up to the cure. AIM To evaluate transanal endoscopic microsurgery results in a follow-up time of 18 months. METHODS From April 2002 to April 2006, 50 patients with rectal tumors were submitted to transanal endoscopic microsurgery, chosen by clinical history and lesion characteristics. The inclusion criteria were: sessile adenomas larger than 3 cm and smaller than 8 cm, not circumferentially distributed; intra epithelial neoplasia of high degree; and rectal carcinoma pT1, and special cases of pT2. All these rectal tumors were submitted to the same surgical act. RESULTS The final histopathological results reveal 9 adenoma, 26 intra-epithelial neoplasia of high degree, 13 carcinoma (9 pT1-4 pT2) and 2 carcinoid. The lowest age was 25 and the higher, 92 years-old. The smallest resected tumor had 64 mm(2) (carcinoid) and the largest (adenoma), 90 cm(2). Operating time was in average 90 minutes and the overall time statement, 5 days. There was one death not related with the method. One patient with low risk carcinoma pT1 presented recurrence 18 months after transanal endoscopic microsurgery and was submitted to curative rectosigmoidectomy. It was proven a residual tumor after local surgery in two patients and the most important complication was one recto-vaginal fistula. The overall complications rate was 9%. CONCLUSION Today transanal endoscopic microsurgery is chosen as the ideal technique for the treatment of sessile adenomas, intraepithelial neoplasia of high degree and rectal carcinoma pT1.

Effect of pantoprazole administered subcutaneously on the healing of sutured gastric incisions in rats

Background: The properties of proton pump inhibitors most investigated are related to peptic diseases and upper gastrointestinal bleeding, but their influence on the healing of sutured gastric incisions has not been assessed. In the present study we evaluated the effect of subcutaneously administered pantoprazole on the healing of sutured gastric incisions in rats. Methods: Sixty rats were divided into a pantoprazole group and a control group. All rats were submitted to gastric suture in the gastric body and in the gastric fundus and had their gastric pH measured. The pantoprazole group received 20 mg/kg pantoprazole and the control group received 0.9% isotonic NaCl, both subcutaneously t.i.d. Healing analysis was carried out using collagen picrosirius red F3BA staining, and breaking strength was measured on the 4th and 7th postoperative days in all groups. Results: Gastric pH was higher in the pantoprazole group. In the fundus, the pantoprazole group had a higher measurement of breaking strength and a higher proportion of type-I over type-III collagen on the 7th postoperative day. In the body, the pantoprazole group had a higher proportion of type-I over type-III collagen on the 4th and 7th postoperative days. Conclusions: Pantoprazole given subcutaneously promoted a reduction in gastric acid secretion and was associated with improved healing of the sutured gastric incision in the fundus (squamous epithelium) of rats. These findings suggest that pantoprazole has healing properties in sutured gastric incisions with potential benefits in gastric surgery.

Análise biomecânica da solidarização de tendões para reconstrução do ligamento cruzado anterior

OBJECTIVE:To evaluate the difference of the mechanical behavior of bended tied (sewed) and not tied hamstring tendons in order to evaluate if it has any effective function. METHODS: Twenty-four fresh bovine digital tendons had been used. Alginate to determine the area of the tendon transversal section was used. Ten bovine tendons had been bended and tied following the manufacturer orientation, ten others pairs had not been tied. Claws had been developed for the grafts fixation to the universal machine, for the setting simulation. The superior one was characterized to be bipartite and to have controlled passage for the pins and the inferior claw is characterized to have alternating teeth. RESULTS: The maximum load of the not tied samples of the test was 849,4 N ± 386,8 the area was 30,4 mm2 ± 7,7, and 29 ± 17 Mpa of tension. The tied ones had gotten maximum load of 871,8 N ± 484,9, area of 35 mm2 ± 5,8, and 24 ± 10 Mpa of tension. It did not have statistical difference between the two groups (p>0,05). CONCLUSION: The probability distribution showed that with 400 N the not tied tendons represents 83,8% of trustworthiness and the tied ones represents 78,5%.

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.