Pedro Roberto de Paula

Os significados da sexualidade para a pessoa com estoma intestinal definitivo

Estudo exploratorio, descritivo, e qualitativo a luz do referencial da Representacao Social (RS). OBJETIVO: identificar a RS da pessoa com estoma intestinal sobre a sexualidade. METODOS: Participaram 15 estomizados, oito (F) e sete (M), com idade media 57,9 anos, assistidos no Ambulatorio Regional de Especialidades de Taubate, periodo agosto-setembro/2005. Os dados foram obtidos por entrevistas, as quais foram transcritas e submetidas a analise de conteudo, originando a Unidade Tematica: Os significados da sexualidade, sub-temas: sexualidade necessidade fisica, emocional e de partilha, lembrancas desagradaveis, nao pratica e negacao da sexualidade. CONSIDERACOES FINAIS: A qualidade dos relacionamentos apareceu como elemento central do significado atribuido a sexualidade, determinando sistemas de referencia para a vivencia da mesma no pos-estoma. Conhecer o significado da sexualidade para a pessoa estomizada e necessidade para complementar e implementar acoes assistenciais que contribuam para melhorar qualidade de vida e assistencia prestada.

Bacteriology of the anal wound after open hemorrhoidectomy

The purpose of this study is to analyze the size of the bacterial colonies in anal wounds after open hemorrhoidectomy. Twenty patients were studied during predetermined postoperative time periods. Material was collected from the surface and from within the tissue of each patients three open wounds, intraoperatively, on the 6th, 13th and 20th postoperative days for bacteriologic examination in aerobic, microaerophilic, and anaerobic media. The bacterium most commonly identified wasEscherichia coli,followed byStaphylococcus aureusandStaphylococcus epidermidis. Pseudomonas aeruginosa, Enterococcus faecalis, Klebsiella pneumoniae, Proteus vulgaris,andProteus mirabiliswere also identified. Critical indexes of colonization were present since the intraoperative stage (>105bacteria/g of tissue and >106bacteria/ml); obligate anaerobic bacteria were not identified; neither the species nor the number of bacteria, even when critical indexes were present, prevented proper healing. The same bacteria were not necessarily present on the surface and in the tissue; the bacterial load observed among the three wounds (left lateral, right posterior, and right anterior), was the same.

Why Do Anal Wounds Heal Adequately? A Study of the Local Immunoinflammatory Defense Mechanisms

PURPOSEThe aim of this study was to identify the tissue defense immunoinflammatory mechanisms present in the healing process of anal region wounds resulting from hemorrhoidectomy by the open technique.METHODSImmunohistochemical techniques were applied to biopsies of anal wounds obtained on Day 0 and Day 6 after surgery from 20 patients with hemorrhoid disease to characterize and quantify macrophages, T and B lymphocytes, and natural killer cells in high-power fields (400×). These techniques were also used to identify cells showing immunoexpression of cytokines (transforming growth factor beta 1, transforming growth factor beta 2, transforming growth factor beta 3) and constitutive and induced nitric oxide synthase. Plasma cells were quantified on slides stained with hematoxylin and eosin and the presence of immunoglobulin G, immunoglobulin M, and immunoglobulin A secreting cells was investigated by direct immunofluorescence.RESULTSAn acute nonspecific inflammation with no lymphomononuclear-plasmacytic component was observed on Day 0. On Day 6, an inflammatory cellular infiltration rich in macrophages and lymphoplasmacytic cells was detected, which documented the participation of innate defense mechanisms and the adaptive tissue response. On Day 6, the mean number of immunoinflammatory cells were as follows: macrophages (CD68+) = 190.3; macrophages (HAM56+) = 184.3; T lymphocytes (CD3+) = 59.6; T lymphocytes (CD45RO+) = 47.7; helper T lymphocytes (CD4+) = 89.2; cytotoxic T lymphocytes (CD8+) = 29.4; B lymphocytes (CD20+) = 64.4; plasma cells = 1.7; natural killer cells (NK1+) = 12.9. Macrophages (HAM56+ and CD68+) were present in significantly higher amounts than those of the remaining ones. B lymphocytes (CD20+) predominated over T lymphocytes (CD3+), although the difference between the two cell types was not significant. Participation of the humoral immune system was characterized by the presence of immunoglobulin G–secreting cells. The cellular immune system was characterized by the identification of T lymphocytes (CD3+ and CD45RO+), most of them belonging to the T helper cell subpopulation (CD4+). These predominated in a significant manner over cytotoxic T lymphocytes (CD8+). Natural killer cells were present in small amounts. There was immunoexpression of constitutive nitric oxide synthase on Day 0 and on Day 6. Induced nitric oxide synthase was not identified on Day 0 but was present on Day 6. Transforming growth factor beta 2 and transforming growth factor beta 3 were expressed in endothelial cells on Day 0 and on Day 6, and transforming growth factor beta1 was also expressed in macrophages, endothelial cells, and fibroblasts on Day 6. Transforming growth factor beta 1 and transforming growth factor beta 2 were expressed significantly in macrophages, whereas transforming growth factor beta 3 occurred at similar proportions in the three cell types.CONCLUSIONSThe host developed locally innate and immunologic defense adaptive mechanisms. The predominant local defense response involved macrophages. Natural killer cells and immunoexpression of constitutive nitric oxide synthase in endothelial cells were components of the noninduced innate response. In the induced innate response, in addition to neutrophils, there were large numbers of macrophages that were the major cells showing immunoexpression of transforming growth factor beta and induced nitric oxide synthase. The adaptive immunologic response was characterized by T and B lymphocytes. Helper T cells and cytotoxic T cells predominated in the cellular immune response and cytotoxic T cells and natural killer cells were present in small numbers. Secretory immunoglobulin G plasma cells were present in small numbers as a component of the humoral immune system.

MODELO DE DISPOSITIVO PARA TREINAMENTO E AVALIAÇÃO DAS HABILIDADES EM TÉCNICA OPERATÓRIA

Com o objetivo de facilitar o aprendizado da tecnica operatoria, em especial na realizacao de nos e suturas cirurgicas, foi desenvolvido um modelo experimental nao biologico, contendo dispositivos simples que simulam diversas situacoes encontradas no procedimento cirurgico fundamental

Efeito da nifedipina gel 0,2% nas pressões de canal anal e na dor pós-operatória: estudo após hemorroidectomia pela técnica aberta

INTRODUCTION: Hemorrhoids are very common and pain following their surgical treatment causes great suffering. Various alternatives have been studied for reducing postoperative pain. Among these is surgical sphincterotomy, which may in some cases cause some degree of fecal incontinence. For this reason, several studies have used chemical sphincterotomy, with nifedipine, diltiazem, glycerin trinitrate or botulinum toxin. The objective of the present study was to investigate the effects of topical nifedipine for reducing anal canal pressures and consequently reducing postoperative pain. MATERIAL AND METHOD: Topical gels of 0.2% nifedipine plus 2% lidocaine (Group 1) and 2% lidocaine alone (Group 2) were used following hemorrhoidectomy. Pressures were measured before the operation and on the first, fourth and seventh days after the operation. Pain was also evaluated on all of the first seven postoperative days using a visual analog scale. RESULTS: There were no differences in relation to anal canal pressures, but lower pain levels were reported in the group that received nifedipine. CONCLUSION: Nifedipine gel was efficient for postoperative analgesia, but did not alter anal canal pressures.

Bariatric surgery: impact on sexuality of the obese person.

OBJECTIVE To assess the impact of surgical treatment in the sexuality of the obese. METHODS We conducted a qualitative / quantitative research with 30 patients who had undergone Fobi-Capella Roux-Y gastric bypass for at least one year. We collected data through individual interviews using a questionnaire with 10 mixed questions and one open, between May and June 2011. The objective data were quantified in absolute numbers and percentages, and the subjective ones were analyzed using the Discourse of the Collective Subject (DCS) and discussed in view of reference published on the subject. RESULTS 30 patients were enrolled, with a mean age 44 ± 12 years, 24 (80%) were female and six (20%) were male, 23 (77%) were married, 23 (96%) were hypertensive and eight (33%) were diagnosed with Diabetes Mellitus. After the operation, 11 (37%) individuals reported no change in the number sexual intercourses, but 19 (63%) reported that this number was altered, 16 (53%) informed increased frequency, one (3%) reported a decrease in frequency, one (3%) did not practice sexual intercourse anymore and one (3%) did not report the frequency. The central ideas (CI) raised originated four DCSs: Experience of female sexuality; No experience of female sexuality; Experience of male sexuality; and improvements of comorbidities and psychological factor. CONCLUSION there are positive repercussions of physical and emotional orders of the surgical treatment of obesity, favoring the quality of life, including sexuality.

Avaliação manométrica anal pré e pós tratamento da fissura anal crônica com nifedipina tópica 0,2%

In the treatment of the anal fissure, calcium channel blockers are among the new drugs which have been used. The objective of this research was the manometric evaluation of patients with chronic anal fissure after topic treatment with 0.2% nifedipine and correlation with the healing and pain. This is a prospective study of patients from Coloproctology Clinic of the University of Taubate Hospital. The patients had been submitted to a manometric examination before and after 30 days of the use of topic 0.2% nifedipine gel three times a day in the anus and anal edge. For the statistics analysis Mann-Whitney test was applied to a significance of p= 0,05. Ten patients did not exihibit manometric alteration associated with nifedipina treatment, however 50% of them reported improvement of the symptoms and 40% depicted healing of the fissure. The results demonstrated that nifedipine was effective and safe for anal fissure treatment and considering the functional point of view it did not cause injuries as well. The manometric evaluation did not demonstrate alterations in the anal pressure; however, it was observed that 50% of the patients had improvement in pain and 40% in healing.

Neoplasia no sítio da colostomia: relato de três casos e revisão da literatura

Carcinomas rarely occur at the site of a colostomy. Colostomies are risk for malignancy, just as in any other portion of the colon. If the initial resection was for cancer, then the risk of metachronous colon adenocarcinoma is significantly higher than for the general population. Metachronous colorectal carcinoma occurs from 0.1 to 3.6 percent of patients who undergo surgery for colorectal carcinoma and the recurrence of the primary bowel malignancy that necessitated the stoma may present with signs of bleeding or obstruction. We report three cases of this rare neoplasia occurring at the site of a colostomy, and we review the literature.

Sigmoidoanal intussusception with exteriorization of sigmoid adenocarcinoma

A intussuscepcao intestinal e uma doenca rara em adultos, sendo na maior parte dos casos causada por neoplasia maligna. Os sintomas sao geralmente inespecificos e cronicos, na maioria das vezes sugerindo obstrucao intestinal. O tratamento consiste na remocao oncologica do tumor. Este artigo relata o caso de uma paciente com quadro de hematoquezia e exteriorizacao de massa atraves do ânus que foi submetido a retossigmoidectomia anterior alta em bloco e confirmado o diagnostico de adenocarcinoma de sigmoide.

Hidradenite supurativa crônica perianal e glútea: tratamento cirúrgico com ressecção ampla e rotação de retalho dermogorduroso

OBJECTIVE: To evaluate the use of skin flaps neighborhood in a single step in the repair of the area from the resection of lesions of Suppurative Hidradenitis. METHODS: Retrospective cross-sectional epidemiological study of patients with chronic extensive Suppurative Hidradenitis in perianal and gluteal regions underwent extensive resection and skin flap rotation of the neighborhood, from January 2000 to November 2008. RESULTS: The skin flaps allowed in single step, the total coverage of the area resected in eight patients. There was no necrosis or infection in any cases. Following, six patients attended all scheduled outpatient consultations. All were satisfied with the result. CONCLUSIONS: The treatment of suppurative perianal hidradenitis and / or gluteal should be individualized according to the extent, severity and degree of interference in the quality of life. Surgical resection with plastic procedures such as rotation of retail in the neighborhood in one step is safe and has satisfactory results and should be considered for chronic cases, extensive and refractory to medical treatment and with large areas resected.