Pedro Ernesto Caron

Ação do tacrolimus na pancreatite aguda experimental induzida pela arginina

OBJECTIVE To determine whether tacrolimus administered to rats, in the presence of pancreatitis induced by L-Arginine, interferes with the serum levels of amylase and glucose and the histological pattern of the pancreatic parenchyma. METHODS Forty Wistar rats were divided into four groups with 10 rats each: control group (C), tacrolimus group (T), pancreatitis group (P) and pancreatitis-tacrolimus group (PT). We evaluated serum levels of amylase, glucose, and tacrolimus and made histological assessments of the pancreas. Induction of pancreatitis was made by inoculation of L-Arginine at a dose of 500 mg/100g body weight intraperitoneally, and tacrolimus treatment at a dose of 1ìg/kg subcutaneously for four days. RESULTS Serum amylase was higher (p = 0.0000) in groups PT, P and T than in the control group. The PT group mean was higher (p = 0.0009) than in the T group, but did not differ (p = 0.6802) from the average of the P group. There was no difference between groups P and T (p = 0.2568). Neither in mean blood glucose between the groups (p = 0.4920); serum levels of tacrolimus were similar in PT and T groups (p = 0.7112). There were no histological changes in groups T and C and no hemorrhage in the pancreas of rats in groups P and PT. In group P, there was no edema in 30%, mild edema in 20% and in 50%, moderate; as for inflammatory infiltration, it was moderate in 80% and absent in 20%, and atrophy of the parenchyma was moderate in 60% and severe in 40%. In the PT group, there was edema, inflammatory infiltration or atrophy in the pancreas in all rats. CONCLUSION Treatment with Tacrolimus induced an increase in serum amylase in normal mice, but did not affect blood glucose or the histological pattern of the pancreatic parenchyma. In the presence of pancreatitis induced by L-Arginine tacrolimus induced edema, inflammatory infiltration and more severe atrophy in the pancreatic parenchyma.

Influência do pneumoperitônio nas funções hepática e renal e na liberação de citocinas pró-inflamatórias em modelo experimental de endotoxemia induzida por lipopolissacarídeo de Escherichia coli

BACKGROUND: Videosurgery can bring complications with it´s manipulation and among them the hyperpression into the abdominal cavity is important factor. AIM: To analyze the pneumoperitoneum effects in an endotoxemia experimental model caused by lipopolyssacharide. METHOD: Thirty-two Wistar rats were utilized, from which blood was collected 24 hours prior to the experiment for the initial evaluations of the renal function, the hepatic function and the endotoxic state (total counts and differential of leukocytes, platelet count and dosages of lipopolyssacharide, TNFα, IL6). The rats were then separated into four groups of eight: control groups inoculated with lipopolyssacharide (10 mg/kg via intraperitoneum) and kept for four and 11 hours (C-LPS4 and C-LPS11). Group C-PP, control of pneumoperitoneum by carbon dioxide at 10 mmHg for one hour and kept under observation for six hours. Experiment group (E) in which the rats were inoculated with 10 mg/kg of lipopolyssacharide via intraperitoneum and after four hours were submitted to pneumoperitoneum by carbon dioxide at 10 mmHg for one hour and kept under observation for six hours. At the end of these periods, blood samples were collected for the same initial evaluations. The T-student method was utilized for statistical comparisons of results, with a significance level of 0.05. RESULTS: Compared to the initial values and the control groups, Group E had higher values in the renal function tests (creatinine=0.85 ± 0.24 and urea=106.38 ± 37.61 mg/dL). In the hepatic function tests, there were higher values in the dosages of direct bilirubin (0.34 ± 0.09mg/dL), ALT (390,38 ± 351.88) and TAP (17.01 ± 2.18). The endotoxic state was confirmed by the dosages of IL6 (36.0 ± 11.23 pg/mL), TNFα (518.36 ± 203.39 pg/mL) and by the hematological alterations: reduction of platelets, increased leukocytes and band neutrophils and the detection of circulating endotoxin (0.21 ± 0.08 UE/mL). CONCLUSION: Pneumoperitoneum by carbon dioxide induces increase of TNFα, IL6, worsens the hepatic and renal function in the experimental endotoxemia model induced by lipopolyssacharide.

Resultados do transplante pancreático em um centro brasileiro

BACKGROUND: Pancreatic transplantation (PT) is the only treatment available to keep long term normoglicemic state and insulin independence in type 1 diabetic patients. We present the results of PT performed in a center at the State of Parana. METHODS: From January 2001 until april 2003, 24 patients received simultaneous pancreas-kidney transplant (SPK) and one isolated pancreatic transplant at Hospital Angelina Caron. RESULTS: With a mean follow-up of 8,2 months (range 1-27), the pancreas and kidney success rate was 74%. Patient survival was 76%. Leading cause of pancreas and kidney losses was thrombosis in three pancreas (12%) and two kidneys (8%). No episode of rejection occurred in any of the transplanted patients. All patients with successful grafts are insulin-free since transplantation. CONCLUSIONS : This series confirms that SPK is a highly successful procedure for diabetic patients with renal failure.

Derivação bíleo-digestiva com o ducto do segmento III do fígado em obstrução hilar maligna

Cholangiocarcinoma of the hepatic hilum is a seldom curable lesion. Those patients are often managed with prostheses. Cholangiojejunostomy on the third segment of the liver seems to offer effective biliary drainage with better quality of life compared to other forms of palliation. The aim of this paper is to report a successful case of a patient with irressectable biliary tumor submitted to a surgical biliary drainage.

Transplante hepático sem transfusão sanguínea

Orthotopic liver transplantation (OLT) usually requires large amounts of blood transfusion. Reports of OLT without transfusion are scarce and often associated to religious reasons. Herein we report two cases of OLT successfully managed without blood transfusion and not related to religious beliefs.

Proposta de um novo modelo experimental de indução de doença inflamatória intestinal

PURPOSE: To evaluate the bowel lesions of rats after immunization against self intestinal proteins. METHODS: A 40% colonic solution was made in pH 7,4 PBS, followed by maceration, purification, inactivation and SDS-PAGE electrophoresis. Twenty Wistar rats were submitted to the following immunization schedule: Subcutaneous and intramuscular sensibilization with antigen solution emulsified in Freunds complete adjuvant. Intramuscular booster with pure antigen suspension. In this phase, were investigated anti-intestinal antibodies by single radial immunodiffusion and histologic evaluation of colon samples. Challenge by intraperitoneal route with antigenic solution and clinical observation. The animals were sacrificed and had collected colon samples for histologic evaluation. RESULTS: The antigenic suspension presented eight protein with molecular weight between 80 and 420 kD. After six days of the intraperitoneal challenge they had presented: blepharitis, diarrhea, alopecia, apathy and hematochezia. Histological evaluation of this immunological IBD animal model showed ulceration of distal colon, mucosa leucocyte infiltration, edema in submucosa layer and significant crypts degeneration. Anti-intestinal antibodies were present in all of animals. CONCLUSION: It was concluded that was possible to reproduce IBD in rats, as well as the presence of anti-intestinal antibodies was related to histologic features of colon in immunizated rats.

Ressecção isolada do segmento I sob exclusão vascular hepática total

An isolated hepatic caudate lobectomy was performed in a fifty-seven-year-old white woman presenting a colo-rectal metastasis to hepatic segment I. The resection was performed under total liver vascular exclusion due to the proximity to hepatic veins. The patient presented an uneventful hospitalization being discharged on day seven.