Valdinaldo Aragão de Melo

Hipertensão portal esquistossomótica: influência do fluxo sangüíneo portal nos níveis séricos das enzimas hepáticas

AIM To evaluate relation between the portal blood flow and the laboratory hepatic screening in patients with schistosomal portal hypertension. PATIENTS AND METHODS Sixty-four patients with schistosomal portal hypertension had studied, being 19 not operated, 23 submitted to esophagogastric devascularization with splenectomy and 22 submitted to distal splenorenal shunt. Evaluated the laboratory hepatic screening through the dosage of albumin, aspartate aminotransferase, alanine aminotransferase, direct bilirubin and indirect bilirubin, alkaline phosphatase, gamma-glutamil transferase and prothrombin time. The portal flow was evaluated for Doppler. The results have been analyzed through linear regression, Pearson correlation coefficient, chi-square and one-way analysis of variance with Tukeys test. RESULTS It was proven that only gamma-glutamil transferase had significant correlation with the portal flow. In compare of the quartiles, also only gamma-glutamil transferase showed resulted significant, it was evidenced that the fourth quartile, that is bigger portal flow and formed in its majority for patients not operated, also was bigger average of gamma-glutamil transferase and significantly bigger value than first and the third quartiles. CONCLUSIONS 1. The portal blood flow was bigger in patients that the serum level of GGT was bigger; 2. the gamma-glutamil transferase is the variable of the hepatic screening evaluation more representative of the portal flow influence in hepatic functional activity in patients with hepatosplenic schistosomiasis, and 3. probably, the different surgeries through hemodynamics modifications, are beneficial in to diminish the degree of cholestasis or in decrease the microssomal induction.

Voice Quality in Short Stature With and Without GH Deficiency

OBJECTIVE The aim of this study was to analyze the individual impact of short stature (SS) or untreated isolated growth hormone deficiency (IGHD) on voice quality and the influence of IGHD on voice aging. METHODS A cross-sectional study was carried out on 73 adults: 33 IGHD, 10 SS, and 30 normal controls (CO), by evaluating vocal perception using Voice-Related Quality-of-Life (V-RQOL) scores and fundamental frequency (ƒ0). Analysis of variance with Bonferroni post-test was used to compare groups, and the Student t test was used to verify the influence of aging. RESULTS Stature of the SS and IGHD groups was similarly reduced in comparison to CO. Cephalic perimeter (CP) in SS males was larger than CO (P<0.05), and this was larger than in IGHD (P<0.0001). CP was similar in SS and CO females, and both were larger than in IGHD (P<0.0001). V-RQOL scores were lower in IGHD than in SS and CO. ƒ0 (Hz) was similar in IGHD females and SS and higher than in CO (P<0.05). f0 of IGHD males was higher than in SS (P=0.01) and CO (P=0.001). IGHD abolished the effect of aging on ƒ0 exhibited by CO. CONCLUSIONS Lower vocal perception and higher ƒ0 were found in IGHD in comparison to CO in both genders; in comparison to SS, higher ƒ0 was only found in IGHD males. Because SS males have higher CP than IGHD, this suggests that CP and craniofacial growth can influence voice in IGHD. Finally, IGHD seems to abolish the effects of aging on voice.

Effects of progressive increase in body weight on lung function in six groups of body mass index

OBJECTIVE To evaluate the effects of the progressive increase in body weight on lung function by oxygen peripheral saturation, spirometry and maximal respiratory pressures in different degrees of obesity. METHODS Cross-sectional study including 140 patients in clinical and surgical evaluation for obesity treatment. The selected patients were divided into six groups of body mass index (BMI), including a control group of non-obese and a subdivision for the morbidly obese into three subgroups. RESULTS Significant differences were demonstrated between the groups regarding oxygen peripheral saturation (SpO2) (p < 0.001), forced vital capacity (FVC) (p < 0.002, p < 0.02) and forced expiratory volume in one second (FEV1) (p < 0.001, p < 0.03) in relative and absolute values, respectively. Group VI (BMI > 50.9 kg/m²) showed significant differences (SpO2, FVC and FEV1) when compared with the other groups (except group V) and group V (BMI > 45 to 49.9 kg/m²) with the group control. The other variables (FEV1/FVC ratio, forced expiratory flow 25-75 [FEF25-75] and maximal respiratory pressure) did not show any statistical differences. CONCLUSION Lung function is influenced by the progressive increase in BMI, with changes in lung function better demonstrated when BMI > 45 kg/m²; these changes are more evident when BMI > 50.9 kg/m².

Enhancement of liver regeneration by the association of Hyptis pectinata with laser therapy.

Since new molecules that normally would accelerate regeneration can also be potentialized by light, the use of new substances combined with laser therapy seems to be a natural type of experiment. Therefore, the purpose of this study was to assess the effects of Hyptis pectinata leaves on liver regeneration after partial hepatectomy (PH) associated with laser therapy. Twenty-four rats were divided into four groups—PH(control), PHL (laser therapy), PH200 (200 mg/kg of Hyptis pectinata), and PHL200 (200 mg/kg of the plant and laser)—which were submitted to 67% hepatectomy. Laser treatment consisted of focusing the light on the remaining liver after hepatectomy. The data analyzed were serum levels of aminotransferases, liver regeneration, and mitochondrial function. Group PH200 showed a statistically significant decrease in AST levels, and PHL200 disclosed an augmentation in ALT levels. The liver regeneration index was significantly increased in group PHL200. Concerning liver mitochondrial respiratory assay, groups PH200 and PHL200 showed lower state 3 levels than groups PH and PHL. Group PHL showed an increase in state 4 levels and a reduction in membrane potential and RCR. The present study shows that the association of the aqueous extract of Hyptis pectinata leaves at 200 mg/kg with intraoperative laser therapy can stimulate liver regeneration and cause a reduction in liver mitochondrial respiratory function without altering its phosphorylative activity.

Tuberculosis of the cystic duct lymph node

Tuberculosis of the cystic duct lymph node associated with cholelithiasis is rare. We report a case of a 40 year-old woman with this pathology. She presented with anorexia, biliary colic, postprandial fullness and fever. Imaging studies revealed cholelithiasis and several visible portal lymph nodes. Cholecystectomy was performed and histopathological examination showed tuberculosis of the cystic duct lymph node without affecting the gallbladder. The presence of gallstones and lymphadenopathy in computed tomography, associated with persistent fever and symptoms that resemble cholecystitis, should cause suspicion of tuberculosis. However, diagnosis is usually achieved by microscopic appearance of caseating granulomas and isolation of Mycobacterium tuberculosis. The treatment in this case consisted of cholecystectomy and antitubercular chemotherapy.

Efeitos do aumento progressivo do peso corporal na função pulmonar em seis grupos de índice de massa corpórea

OBJECTIVE: To evaluate the effects of the progressive increase in body weight on lung function by oxygen peripheral saturation, spirometry and maximal respiratory pressures in different degrees of obesity. METHODS: Cross-sectional study including 140 patients in clinical and surgical evaluation for obesity treatment. The selected patients were divided into six groups of body mass index (BMI), including a control group of non-obese and a subdivision for the morbidly obese into three subgroups. RESULTS: Significant differences were demonstrated between the groups regarding oxygen peripheral saturation (SpO2) (p 50.9 kg/m2) showed significant differences (SpO2, FVC and FEV1) when compared with the other groups (except group V) and group V (BMI > 45 to 49.9 kg/m2) with the group control. The other variables (FEV1/FVC ratio, forced expiratory flow 25-75 [FEF25-75] and maximal respiratory pressure) did not show any statistical differences. CONCLUSION: Lung function is influen- ced by the progressive increase in BMI, with changes in lung function better demonstrated when BMI > 45 kg/m2; these changes are more evident when BMI > 50.9 kg/m2.

Falciform ligament abscess: report of a case

Falciform ligament abscess is rare. We report a case of a 65-year-old man who presented with right upper quadrant abdominal pain, postprandial fullness, and fever. Computed tomography disclosed a cylindrical mass in the anterior abdomen that aroused suspicion of a hepatic abscess. At laparoscopic surgery, an abscess of the falciform ligament was found and drained. Two months later, the patient developed recurrence of the abscess secondary to acute calculous cholecystitis. Abscess drainage and cholecystectomy were performed. The presence of right uppper quadrant abdominal pain, epigastric tenderness, fever, leukocytosis, and a mass in the anterior abdomen should arouse suspicion of falciform ligament abscess. Its treatment consists of abscess drainage.

Cisto mesentérico: aspectos clínicos e anátomopatológicos

OBJECTIVE To evaluate epidemiologic, clinical, pathologic and therapeutic characteristics of the mesenteric cysts in hospitals of Sergipe, Brazil. METHODS Mesenteric cysts were assessed by a non-interventional cross-sectional study from the archives of the Pathology Laboratory of Federal University of Sergipe between 1995 and 2007. The charts of the patients were reviewed in order to find out: gender, age, clinical findings, complementary exams and therapeutic approach. RESULTS Eighteen cases of mesenteric cysts were found. Females were more affected (72.2%). Mean of age of the patients was 30.46. More frequent symptoms were pain and abdominal mass. Ultrasonography of abdomen, performed in all patients, was not conclusive in half of the cases. CTscan of abdomen with contrast was performed in six cases, being cystic tumor well identified in all of them. Regarding histopathology, 6 lymphangiomas, 8 mesotheliomas, 1 hemorrhagic cyst in organization and 1 mucinous cyst were found. Surgical treatment was performed in all cases. Intracystic bleeding was the main complication in 3 cases. CONCLUSION The mesenteric cysts presented clinically with unspecific symptoms. CTscan was more effective than ultrasonography for the diagnosis. Lymphangiomas and mesothelioma had been found in equal ratios. The complete resection of the cyst was the treatment of election. There were no deaths in postoperative period.

Efeito do omeprazol e do pantoprazol sobre a regeneração hepática após hepatectomia parcial em ratos

PURPOSE: To assess the effects of omeprazole and pantoprazole on liver regeneration after partial hepatectomy. METHODS: Fifty eight male Wistar rats were divided into 4 groups: SHAM, HP, PANTO and OMEP Groups. They were submitted to 67% partial hepatectomy (HP, PANTO and OMEP Groups) or laparotomy (SHAM Group). Their livers were removed 32 and 56 hours after the operation. Then, the animals were sacrificed. In all groups, the substances (saline solution, omeprazole and pantoprazole) were injected once daily from the moment they were operated on until the time of sacrifice. RESULTS: In SHAM Group the mitotic index was not significant. Thirty two hours after hepatectomy, the mitosis index was 1.2 ± 1.09 in HP Group, 1.2 ± 1.6 in OMEP Group and 2.6 ± 3.2 in PANTO Group. Concerning the 56-hour analysis, the values were 1.6 ± 0.89 in HP Group, 2 ± 1.8 in OMEP Group and 2.6 ± 0.54 in PANTO Group. These results were not statistically significant. CONCLUSION: Omeprazole and pantoprazole, proton pump inhibitors (H+, K+-ATPase), do not cause any change on liver regeneration 32 and 56 hours after 67% partial hepatectomy in rats.

Cirurgia bariátrica: existe necessidade de internação em unidade de terapia intensiva?

OBJETIVOS: Determinar o local de internacao no pos-operatorio de cirurgia bariatrica primaria e verificar as complicacoes clinicas-cirurgicas que justificassem internacao em unidade de terapia intensiva, inclusive morte. METODOS: Estudo transversal, prospectivo, aberto, sendo avaliados 120 pacientes submetidos a cirurgia bariatrica primaria por videolaparoscopia no periodo de maio de 2007 a abril de 2008 em um hospital terciario. Utilizou-se o indice de Aldrete e Kroulik para liberacao da sala de recuperacao pos-anestesica e definicao do local de encaminhamento no pos-operatorio. RESULTADOS: Entre os 120 pacientes, havia 83 mulheres e 37 homens, com media de idade 35,4 ± 10,5 anos (18 a 66 anos), indice de massa corporea medio 45,6 ± 10,5. O tempo entre admissao hospitalar e inicio da cirurgia foi de 140,7 ± 81,8 minutos, o tempo cirurgico 105,0 ± 28,6 minutos, o tempo de permanencia na sala de recuperacao pos-anestesica foi 125,0 ± 38,0 minutos e tempo de internacao hospitalar 47,7 ± 12,4 horas, com 100% dos pacientes deambulando em 24 horas. O indice de Aldrete e Kroulik da sala de recuperacao pos-anestesica alcancou pontuacao de 10 com 120 minutos em todos os pacientes, com sobrevida de 100%. CONCLUSAO: Com o uso do indice Aldrete e Kroulik na sala de recuperacao pos-anestesica de bypass gastrico por videolaparoscopia em cirurgia bariatrica primaria, nenhum paciente foi internado em unidade de terapia intensiva e nenhuma complicacao maior foi observada.