Ricardo Costa-Val

Efeitos da oxigenoterapia hiperbárica em ratos submetidos à ligadura das veias hepáticas: avaliação da mortalidade e da histologia do fígado e baço

PURPOSE To evaluate the effects of hyperbaric oxygen therapy in rats submitted to instantaneously hepatic vein obstruction. METHODS 30 Holtzman adult male rats were utilised, distributed into two groups: 1) hepatic vein obstruction; 2) hepatic vein obstruction associated with hyperbaric oxygen therapy. General anaesthesia was utilized by a solution composed of ketamine chloride (40 mg/ml) and meperidine chloride (10 mg/ml) in a dose of 50/mg/weight, applied into the right gluteus muscle. The animals belonged to group 2 were submitted to hyperbaric oxygen therapy, 8 hours after the operations, in a 2,5 atmosphere, which lasts 120 minutes per day, in consecutive 20 days. The statistical analysis was made in relation to mortality and histological study of livers and spleens utilizing the Fisher test, and the results were considered statistically significant when p < 0.05. RESULTS Occurred seven (46.67%) deaths between animals belonged to group 1 and no deaths in the animals belonged to group 2. The histological studies made in the livers and spleens of the animals belonged to group 1 showed many alterations in the following percentages: thrombosis of hepatic, portal and center-lobular veins in five (33.3%), very extensive necrosis of liver cells in seven (46.7%), and light in eight (53.3%), Kupffer cells developed and hypertrophied in 14 (93.3%), high congestion of the spleen purple in six (40.0%) and moderate and severe hemossiderinosis spleen in 14 (93.3%). The analysis of this parameters in the group 2 only showed light necrosis of liver cells, Kupffer cells light developed and hypertrophied, moderated congestion of the spleen purple and light hemossiderinosis spleen. All these parameters analysed showed significantly difference (p < 0.05) between these two groups. CONCLUSIONS It could be concluded that the hyperbaric oxygen therapy applied in rats, with instantaneously hepatic vein obstruction decreased their post-surgical mortality and their early deleterious effects in the liver and spleen.

A produção científica do J Vasc Bras: conquistas e desafios

CONTEXTO: Sucessor da revista Cirurgia Vascular e Angiologia, o Jornal Vascular Brasileiro (J Vasc Bras) e o orgao cientifico oficial da Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV) e vem, ao longo dos anos, progredindo e conquistando importantes metas. No entanto, tais conquistas remetem ao comprometimento ininterrupto capaz de manter um alto padrao de qualidade e implicam constantes desafios, nao apenas para que novas conquistas acontecam, mas tambem para que o mesmo se perpetue. OBJETIVO: Avaliar criticamente todas as publicacoes do J Vasc Bras nas versoes impressas e/ou eletronicas entre os anos de 2002 a 2007. METODOS: Trata-se de uma revisao sistematica sobre todas as publicacoes do J Vasc Bras, tanto impressas quanto eletronicas, ocorridas no referido periodo. Os manuscritos foram subdivididos em 12 categorias e analisados em cinco aspectos, a saber: a) tipos de publicacoes; b) grandes areas tematicas; c) niveis de evidencias cientificas; d) citacoes bibliograficas; e) paises de origens das citacoes bibliograficas. Usaram-se os programas estatisticos SPSS®, versao 13.0 e Microsoft Excel® 2003 para as analises estatisticas. Nao ha conflito de interesse neste estudo. RESULTADOS: Foram avaliadas 26 edicoes e quase 400 manuscritos que se enquadraram em todos os niveis de evidencias cientificas, abrangendo desde editoriais, artigos originais, de revisao, consensos e/ou foruns cientificos e relatos de casos ate cartas ao editor e resumos de trabalhos de conclusao. Os textos abordaram todas as grandes areas tematicas da angiologia e cirurgia vascular, alem da bioetica, sociologia, filosofia e inovacao tecnologica. No entanto, e apesar de uma paulatina mudanca de paradigma, percebeu-se que os autores nacionais ainda deixam a desejar no que diz respeito a valorizacao da producao cientifica nacional e a do proprio J Vasc Bras, atitude que necessita ser repensada. CONCLUSAO: Apesar de jovem, o J Vasc Bras vem galgando obstaculos e cumprindo seu papel, seja como orgao oficial da SBACV, seja como revista cientifica. Suas conquistas permitem deduzir que o mesmo esta no caminho certo; entretanto, ainda existem desafios a vencer, particularmente em relacao aos proprios autores nacionais, os quais, sem duvida, foram e sempre serao parte de todas as conquistas. Mais do que estimular, a palavra de ordem e crescer, e de forma conjunta.

Reflexões sobre o trauma cardiovascular civil a partir de um estudo prospectivo de 1000 casos atendidos em um centro de trauma de nível I: a prospective study from 1000 cases

BACKGROUND: To analyze the demographics and outcomes, from a large number of civilian cardiovascular (CCV) trauma cases, prospectively registered at a level I Brazilian Trauma Center. METHODS: This paper deals with cardiovascular traumas studied in a prospective, descriptive and analytic way registered between 1998 through 2005. RESULTS: Over 7-year period, 1000 patients were surgically approached. Most patients were young males with gunshot, stab wound/glasses and blunt trauma, distributed at the abdomen, neck, torso and more frequent at the limbs. The three main syndromes observed at admission were: hemorrhagic, ischemic and hemorrhagic/ischemic. Severe shock at admission was present in 34.6% of the patients, and non cardiovascular associated injuries were present in 85% of the cases. Most of the patients were operated on without preoperative tests. A second operation was required in 14%, because of the following reasons: peripheral compartmental syndrome, acute arterial thrombosis or major hemorrhage. The amputation rate was 5.5% and mortality rate was 7.5% at discharge. Severe hemorrhagic shock and multiple organ failure were the main causes of death. Isolated CCV lesion was present in 15%, with a global lethality of 41 %. Deaths were attributed to the following causes: venous (22%), arterial (47%) and cardiac (81%) with statistical significance between cardiac lesions versus arterial plus venous lesions (p = 0.01; odds ratio = 7.37) and arterial lesions versus venous lesions (p = 0.01; odds ratio 3.17). CONCLUSION: This large number of cases showed that the main victims were young men, involved on personal violence or vehicle crash accidents, with lesions more frequently found at the extremities with high association with non cardiovascular injuries. The negative prognostic predictive factors were severe shock, large artery lesions or cardiac injuries.

Altos custos financeiros do trauma vascular

OBJECTIVE To analyze all expenses paid to the first surgical approached for vascular lesion patients admitted at Hospital João XXIII/FHEMIG, between years 2004 until 2006. METHOD It is about an ethical approved study, retrospective and descriptive from audit over 70 eligible patients enrolled by Cardiovascular Service. RESULTS Five (7.14%) patients files were excluded for bad quality records. The costs were R

O papel da oxigenação hiperbárica na estrutura do fígado e baço após ligadura das veias hepáticas: estudo em ratos

103,614.96 (US

Reflexões sobre o trauma cardiovascular civil a partir de um estudo prospectivo de 1000 casos atendidos em um centro de trauma de nível I

60,949.97) and R

A iminente mudança de paradigma na relação entre a indústria farmacêutica e a medicina

185,888.21 (US

Persistência da artéria isquiática: relato de caso

109,346.0), a 44% sliding scale for endowment from Brazilian Public System and private medical assistance estimate, respectively. Indeed, the data showed direct relationship between costs and anatomic topographic and exponential increased expenses when blood and/or vascular prosthesis were utilized. CONCLUSION Audit in health system is a must to making decision and evidences the expensive therapy for vascular lesions.

Inhibition of rats extramedullary liver erytropoiesis by hyperbaric oxygen therapy

OBJECTIVE: Liver and spleen morphologic evaluation of rats submitted to hyperbaric oxygen therapy after hepatic vein ligation. METHOD: Thirty Holtzman adult male rats were used, distributed into two groups of 15 animals: group 1 - hepatic vein ligation; group 2 - hepatic vein ligation associated with hyperbaric oxygen therapy. All animals received general anesthesia by a solution composed of ketamine chloride (40 mg/ml) and meperidine chloride (10 mg/ml) in a dose of 50/mg/weight, and were submitted to median laparotomy and hepatic vein ligation. Group 2 animals were submitted to hyperbaric oxygen therapy, 8 hours after the operation, 90 minutes at 2.5 atmosphere pressure and 15 minutes at the onset and end of the therapy, in a total of 120 minutes, in order to promote the gradual compression and decompression in 20 consecutive days. On the 21st preoperative day, the animals were sacrificed by ether inhalation and submitted to laparotomy and stripping of liver and spleen for histological study. The results of the histological study of livers and spleens were compared using Fishers exact test. Statistically significant difference was considered when P < 0.05. RESULTS: The histological studies made in the livers and spleens of animals from both groups showed the following alterations: presence of thrombosis of hepatic, portal and central lobular veins in five (33.3%) group 1 animals and absence in group 2 animals; very extensive necrosis of liver cells in seven (46.7%) group 1 animals, and light in eight (53.3%), whereas for all group 2 animals such alteration was considered light; Kupffer cells developed and hypertrophied in 14 (93.3%) group 1 animals and slightly developed and hypertrophied in all group 2 animals; high congestion of the spleen purple in six (40%) and moderate in nine (60%) group 1 animals, whereas all group 2 animals had moderate congestion; moderate or severe hemosiderosis in 14 (93.3%) group 1 animals and mild hemosiderosis in all group 2 animals. The statistical analyses performed between both groups showed significant differences (P < 0.05) for all variables. CONCLUSIONS: The hyperbaric oxygen therapy applied in rats submitted to hepatic vein ligation mitigated its early deleterious effects on the liver and spleen, which was confirmed by the histological study.