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Background The use of unfractionated heparin in hypovolemic shock, aortic clamping, and visceral reperfusion is still not established, despite evidence of inhibition of early cell damage. This study investigated the potential protective effect of unfractionated heparin on hepatic and renal apoptosis in a porcine ischemia and reperfusion model. Methods Twenty-one male swine (Sus scrofa) were divided into 3 groups: sham (n = 5), heparin (n = 8), and nonheparin (n = 8). The heparin and nonheparin groups underwent hypovolemic shock for 30 min, supraceliac aortic clamping for 1 h and reperfusion for 3 h. Unfractionated heparin 200 mg/kg was administered to the heparin group during aortic clamping. Hemodynamic and laboratory parameters were monitored, including aminotransferase and serum urea. Histological lesion scores were applied to hematoxylin and eosin–stained liver and kidney sections. Apoptosis quantification was performed by caspase-3 immunohistochemistry. Results The proposed model caused a severe cardiocirculatory disturbance in the heparin and nonheparin groups, observed by the carotid-femoral pressure gradient and lactic acidosis. There was no significant difference in hemodynamic and laboratory parameters between these two groups. The mean values of liver and renal histological lesion scores did not present any significant differences. Caspase-3 immunoexpression was lower in the heparin than the nonheparin group for both liver and kidney. Conclusions Attenuation of liver and kidney cell apoptosis in pigs undergoing systemic heparinization suggests a potential use for heparin in modulating cell death under critical hemodynamic conditions.

Objective: due to the advantages of Laser Assisted Vascular Anastomosis (less occurrence of myointimal hyperplasia with better hemodynamic evolution, shorter surgical time, absence of diameter incompatibility, absence of anaphylaxis, easy execution) the evaluation of the ideal diode laser wavelength to perform anastomosis in elastic arteries, without solder, is a great advance in the surgical practice.

Purpose: To analyze the effects of ischemic preconditioning (IPC) in the expression of apoptosis-related genes in rat small intestine subjected to ischemia and reperfusion. Methods: Thirty anesthetized rats underwent laparotomy and were drive into five groups: control (CG); ischemia (IG); ischemia and reperfusion (IRG); IPC and ischemia (IG+IPC); IPC and ischemia and reperfusion (I/RG+IPC). Intestinal ischemia was performed by clamping the superior mesenteric artery for 60 minutes, whereas reperfusion lasted for 120 minutes. IPC was carried out by one cycle of 5 minutes of ischemia followed by 10 minutes of reperfusion prior to the prolonged 60-minutes-ischemia and 120-minutes-reperfusion. Thereafter, the rats were euthanized and samples of small intestine were processed for histology and gene expression. Results: Histology of myenteric plexus showed a higher presence of neurons presenting pyknotic nuclei and condensed chromatin in the IG and IRG. IG+IPC and I/RG+IPC groups exhibited neurons with preserved volume and nuclei, along with significant up-regulation of the anti-apoptotic protein Bcl2l1 and down-regulation of pro-apoptotic genes. Moreover, Bax/Bcl2 ratio was lower in the groups subjected to IPC, indicating a protective effect of IPC against apoptosis. Conclusion: Ischemic preconditioning protect rat small intestine against ischemia/reperfusion injury, reducing morphologic lesions and apoptosis.

Background The goal of this study was to investigate whether exogenous offer of L-arginine (LARG) modulates the gene expression of intestinal dysfunction caused by ischemia and reperfusion. Methods Eighteen Wistar-EPM1 male rats (250–300 g) were anesthetized and subjected to laparotomy. The superior mesenteric vessels were exposed, and the rats were randomized into 3 groups (n = 6): the control group (CG), with no superior mesenteric artery interruption; the ischemia/reperfusion group (IRG), with 60 minutes of ischemia and 120 minutes of reperfusion and saline injections; and the L-arginine group (IRG + LARG), with L-arginine injected in the femoral vein 5 minutes before ischemia, 5 minutes after reperfusion, and after 55 minutes of reperfusion. The total RNA was extracted and purified from samples of the small intestine. The concentration of each total RNA sample was determined by using spectrophotometry. The first-strand complementary DNA (cDNA) was synthesized in equal amounts of cDNA and the Master Mix SYBR Green qPCR Mastermix (SABiosciences, a Qiagen Company, Frederick, Md). Amounts of cDNA and Master Mix SYBR Green qPCR Mastermix were distributed to each well of the polymerase chain reaction microarray plate containing the predispensed gene-specific primer sets for Bax and Bcl2. Each sample was evaluated in triplicate, and the Student t test was applied to validate the homogeneity of each gene expression reaction (P Results The gene expression of Bax in IRG (+1.48) was significantly higher than in IRG-LARG (+9.69); the expression of Bcl2L1 in IRG (+1.01) was significantly higher than IRG-LARG (+22.89). Conclusions The apoptotic cell pathway of 2 protagonists showed that LARG improves the gene expression of anti-apoptotic Bcl2l1 (Bcl2-like 1) more than the pro-apoptotic Bax (Bcl2-associated X protein).

This study evaluated the morphology of the rat liver when hyperbaric oxygen (HBO) was used at various stages of ischemia and reperfusion.Thirty-two male Wistar rats, subjected to 30 minutes of hepatic ischemia and 30 minutes of reperfusion, were randomly assigned as follows: GIR (n = 8), control without HBO; GHBO/I (n = 8), in which HBO was applied only during ischemia; GHBO/R (n = 8), HBO only during reperfusion; and GHBO/IR (n = 8), HBO during both ischemia and reperfusion. Feasibility scores of hepatocytes were determined by assessing 8 items related to liver injury.The histologic injury score of the hepatic specimens was significantly lower in the GHBO/I group (79.0 ± 0.1) compared with the GIR group (135.0 ± 0.1). HBO was not effective when applied during reperfusion (GHBO/R, 151.3 ± 0.1) or during the ischemia plus reperfusion period (GHBO/IR, 131.0 ± 0.1). The sum was significantly higher (P .05) in HBO-treated animals during the reperfusion period (ie, in the GHBO/R group compared with any of the other groups).A favorable effect was obtained when HBO was administered early during ischemia. HBO given in later periods of reperfusion was associated with a more severe sum index percentage of liver damage.

To investigate the role of the exogenous supply of adenosine triphosphate (ATP) in the expression of Bax and Bcl2L1 genes in intestinal ischemia and reperfusion (IR) in rats.The study was designed as a randomized controlled trial with a blinded assessment of the outcome. Eighteen adult male Wistar-EPM1 rats were housed under controlled temperature and light conditions (22-23°C, 12 h light/dark cycle). The animals were randomly divided into 3 groups: 1. Sham group (SG): no clamping of the superior mesenteric artery; 2. Ischemia and reperfusion group (IRG): 3. Ischemia and reperfusion plus ATP (IRG + ATP). ATP was injected in the femoral vein before and after ischemia. Afterwards, intestinal segments were appropriately removed and processed for Endothelial Cell Biology Rat RT2 Profiler PCR Array.ATP promoted the upregulation of Bcl2L1 gene expression, whereas it did not have significant effects on Bax gene expression. In addition, the relation of Bax/Bcl2L1 gene expression in the IRG group was 1.39, whereas it was 0.43 in the IRG + ATP group. Bcl2L1 plays a crucial role in protecting against intestinal apoptosis after ischemia and reperfusion. Increased Bcl2L1 expression can inhibit apoptosis while decreased Bcl2L1 expression can trigger apoptosis.Adenosine triphosphate was associated with antiapoptotic effects on the rat intestine ischemia and reperfusion by upregulating of Bcl2L1 gene expression.

Purpose: To evaluate the effect of hyperbaric oxygenation (HBO) on the expression of the genes antioxidant glutathione peroxidase 4 (Gpx4) and lactoperoxidase (Lpo) in the lung of mice subjected to intestinal ischemia and reperfusion (IIR). Methods: Control group (CG) in which were subjected to anesthesia, laparotomy and observation for 120 minutes; an ischemia and reperfusion group (IRG) subjected to anesthesia, laparotomy, small bowel ischemia for 60 minutes and reperfusion for 60 minutes; and three groups treated with HBO during ischemia (HBOG + I), during reperfusion (HBOG + R) and during ischemia and reperfusion (HBOG + IR). Studied 84 genes of oxidative stress by the method (RT-qPCR). Genes with expression levels three times below or above the threshold cycle were considered significantly hypoexpressed or hyperexpressed, respectively (Student’s t-test p

Objective This study compares the results of an objective structured clinical examination (OSCE) between 2 groups of students before an internship and after 6 months of clinical practice in an internship. Methods Seventy-two students participated, with 36 students in each cohort. The OSCEs were performed in the simulation laboratory before the participants' clinical practice internship and after 6 months of the internship. Students were tested in 9 stations for clinical skills and knowledge. The same procedures were repeated for both cohorts. The t test was used for unpaired parametric samples and Fisher's exact test was used for comparison of proportions. Results There was no difference in the mean final score between the 2 groups (p = .34 for test 1; p = .08 for test 2). The performance of the students in group 1 was not significantly different when performed before and after 6 months of clinical practice, but in group 2 there was a significant decrease in the average score after 6 months of clinical practice. Conclusions There was no difference in the cumulative average score for the 2 groups before and after 6 months of clinical practice in the internship. There were differences within the cohorts, however, with a significant decrease in the average score in group 2. Issues pertaining to test standardization and student motivation for test 2 may have influenced the scores.

Objectives:The effectiveness of noninvasive positive-pressure ventilation in preventing reintubation due to respiratory failure in children remains uncertain. A pilot study was designed to evaluate the frequency of extubation failure, develop a randomization approach, and analyze the feasibility of

Purpose: To investigate the effects of hyperbaric oxygenation (HBO) on intestinal ischemia and reperfusion (IR) injury, we evaluated the expression of 84 genes related to oxidative stress and the antioxidant response in mouse hearts. Methods: Four groups were subjected to 60 minutes of intestinal ischemia followed by 60 minutes of reperfusion: IRG, ischemia and reperfusion group without HBO; HBO-IG, which received HBO during ischemia; HBO-RG, which received HBO during reperfusion; and HBO-IRG, which received HBO during ischemia and reperfusion. The control group (CG) underwent anesthesia and laparotomy and was observed for 120 minutes. The (RT-qPCR) method was applied. Genes with expression levels three times below or above the threshold cycle were considered significantly hypoexpressed or hyperexpressed, respectively (Student’s t-test p

PURPOSE: To evaluate the effect of a local application of simvastatin gel in repairing bone defects in the femurs of rabbits. METHODS: Two standard surgical cavities were created in the femoral epiphysis of 18 rabbits. In the simvastatin group (SG), the cavities were filled with a collagen sponge soaked in 0.5 ml of a simvastatin (1 mg) gel, and the cavities were covered with a biological membrane. The bone cavities in the second group (control group) were filled with a blood clot and covered with a biological membrane. On the 7th, 21st and 42nd days, six animals in each group were euthanized, and the femurs were subject to histological evaluation (vascularity, fibrosis, reactive bone formation, osteoblasts, and osteoclasts) and immunohistochemical (anti-VEGF and anti-osteocalcin) analysis. The results were analyzed using a Wilcoxon test (p

PURPOSE: To determine the gene expressions profile related to the oxidative stress and the antioxidant response in the kidneys of mice subjected to intestinal ischemia and reperfusion. METHODS: Twelve inbred mice (C57BL/6) were randomly assigned to one of two groups: the control group (CG) underwent anesthesia and was observed for 120 min and the ischemia/reperfusion group (IRG), animals were anesthetized and subjected to laparotomy and ischemia for 60 minutes followed by 60 minutes of reperfusion. The expressions of 84 genes from the kidney were determined by the Reverse Transcription qualitative Polymerase Chain Reaction (RT-qPCR). All genes that were up regulated by more than threefold using the algorithm [2(ΔΔCt)] were considered statically significant (p

INTRODUÇÃO: A oxigenação hiperbárica (OHB) tem por objetivo aumentar em pelo menos 10 vezes a pressão tecidual de oxigênio, diminuindo os efeitos deletérios da isquemia. O objetivo deste estudo é investigar o papel da oxigenação hiperbárica na expressão imuno-histoquímica da caspase 3 e do fator de crescimento endotelial vascular (VEGF) em retalhos randômicos em ratos. MÉTODO: Trinta e dois ratos Wistar machos foram divididos aleatoriamente em quatro grupos: grupo sham (GS), grupo N-acetilcisteína (GNAC), grupo OHB (GOHB) e grupo OHB + N-acetilcisteína (GHN). Um retalho de pele retangular (2 cm x 8 cm) foi dissecado a partir da camada muscular dorsal, preservando um pedículo cranial. Uma lâmina de polietileno foi colocada sobre a camada muscular e fixou-se o retalho no local original. No 8º dia, foram coletadas biópsias (2 cm x 1 cm) de espessura total das áreas proximal, média e cranial e de um local fora do retalho, que serviu como área de controle. RESULTADOS: A expressão de VEGF nas camadas da pele e nos vasos não apresentou diferenças significativas entre os grupos. As células apoptóticas estavam significativamente aumentadas na área central do retalho em todos os grupos. O maior aumento ocorreu nos grupos GS e GNAC. A OHB diminuiu significativamente o número de células caspase 3 positivas nas camadas da pele e nos vasos das três áreas. CONCLUSÕES: A OHB foi associada a expressão reduzida de apoptose. A expressão de VEGF em camadas da pele e vasos não demonstrou diferença significativa. Os resultados sugerem que a difusão do oxigênio através do espaço intersticial foi o fator determinante para os resultados mais favoráveis da OHB na diminuição da expressão de apoptose. BACKGROUND: Hyperbaric oxygenation (HBO) therapy aims to increase oxygen tissue pressure by at least 10 times and decrease the adverse effects of ischemia. The aim of this study was to investigate the effect of HBO on the immunohistochemical expressions of caspase 3 and vascular endothelial growth factor (VEGF) in random flaps in rats. METHODS: Thirty-two male Wistar rats were randomly divided into 4 groups: the sham group (GS), the N-acetylcysteine group (GNAC), the HBO group, and the HBO + N-acetylcysteine group. A rectangular skin flap (2 × 8 cm) was dissected from the dorsal muscle layer, and a cranial pedicle was preserved. A polyethylene film was placed on the muscle layer, and the flap was fixed in the original site. On the eighth day, biopsy samples (2 × 1 cm) of the entire thickness of the proximal, medial, and cranial areas as well as of the site outside the flap, which was used as a control, were collected. RESULTS: VEGF expression in the skin layers and vessels was not significantly different between the groups. The number of apoptotic cells was significantly increased in the area of the flap in all groups. The highest increase was noted in the GS and GNAC groups. HBO significantly reduced the number of caspase 3-positive cells in the skin layers and vessels of the 3 areas. CONCLUSIONS: HBO was associated with decreased apoptosis. VEGF expression in the skin layers and vessels did not differ significantly. The results suggest that oxygen diffusion through the interstitial space was the determining factor for the positive effect of HBO on the decrease in apoptosis. Sociedade Brasileira de Cirurgia Plástica Universidade Católica de Pelotas Departamento de Cirurgia Universidade Federal de São Paulo (UNIFESP) Departamento de Cirurgia Universidade Federal de Pelotas Universidade Federal de Pelotas Liga Acadêmica de Cirurgia Plástica UNIFESP, Depto. de Cirurgia SciELO

A oxigenacao hiperbarica tem favorecido a prevencao e o tratamento de afeccoes auditivas como a ototoxicidade. OBJETIVO: Estudar os efeitos da oxigenacao hiperbarica em lesao ototoxica promovida pela amicacina. Forma de estudo: Experimental. METODO: Avaliados aspectos funcionais de 12 cobaias albinas por meio das emissoes otoacusticas produtos de distorcao e do potencial evocado auditivo de tronco encefalico, antes e apos o uso de amicacina (600 mg/kg/dia) e das sessoes com oxigenacao hiperbarica (2 ATA, 60 minutos). Aspectos morfologicos foram avaliados por meio de microscopia eletronica de varredura. Grupos de estudo com tres animais: grupo 1 - solucao salina + oxigenacao hiperbarica; grupo 2 - amicacina 8 dias; grupo 3 - amicacina + 7 dias de repouso e grupo 4 - amicacina + oxigenacao hiperbarica. RESULTADOS: Grupo 1 apresentou preservacao da funcionalidade e da morfologia durante todo experimento. Grupo 2 demonstrou, ao final do experimento, lesoes estatisticamente significantes das celulas ciliadas com alteracoes funcionais. Grupos 3 e 4 apresentaram alteracoes estatisticamente significantes dos aspectos funcionais e morfologicos apos o uso da amicacina, mantendo estas alteracoes apos os procedimentos propostos. CONCLUSAO: A oxigenacao hiperbarica nao promoveu alteracoes na morfologia das celulas ciliadas da coclea e aos limiares eletrofisiologicos das cobaias submetidas a amicacina.

To study whether treatment with the beta-blocker atenolol (AT) attenuates intestinal dysfunction caused by ischemia (I) and reperfusion (R), rats were treated with AT (1.5 mg · kg −1 , intravenously) or saline solution (SS) prior to I (60 minutes), which was produced by occlusion of the superior mesenteric artery, and/or R (120 minutes). After I or I/R, 2-cm jejunal segments were mounted in an organ bath to study neurogenic contractions stimulated by electrical pulses or KCl using a digital recording system. Thin jejunal slices were stained with hematoxylin and eosin for optical microscopy analysis. Compared to the sham group, jejunal contractions were similar in the I + AT and the I/R + AT groups, but reduced in the I + SS and the I/R + SS groups. The jejunal enteric nerves were damaged in the I + SS and the I/R + SS groups, but not in the I + AT and the I/R + AT. These results suggest that AT may attenuate intestinal dysfunction caused by I and I/R.

To examine whether treatment with L-arginine (ARG), a substrate of nitric oxide biosynthesis, attenuated intestinal dysfunction caused by ischemia (I) and reperfusion (R), we treated rats with ARG (100 mg/kg intravenously) or saline solution (SS) before 60 minutes of I produced by occlusion of the superior mesenteric artery and/or during 120 minutes of R. After I or I/R, we isolated 2-cm jejunal segments for mounting in an organ bath to study neurogenic contractions stimulated by electrical pulses or KCl with the use of a digital recording system. Thin jejunal slices were stained with hematoxylin and eosin for optical microscopy. Jejunal contractions were similar in the sham and I+ARG, but reduced in I+SS, I/R+SS, and I/R+ARG groups. Jejunal enteric nerves were damaged in I+SS, IR+SS, and IR+ARG, but not in the I+ARG group, suggesting that ARG attenuate intestinal dysfunctions due to I but not to R.

To study whether ischemic preconditioning (IPC) attenuated intestinal dysfunction caused by ischemia (I) and reperfusion (R), rats were underwent 60 minutes of I which was produced by occlusion of the superior mesenteric artery, and/or 120 minutes R. The IPC group had the I procedure previously stimulated for 5 minutes and the R for 10 minutes. IPC and sham groups were injected with saline solution (SS) via the femoral vein 5 minutes before the I and R, and for R. After I or I/R, 2-cm jejunal segments were mounted in an organ bath to study neurogenic contractions stimulated by electrical pulses or KCl using a digital recording system. Thin jejunal slices were stained with hematoxylin and eosin for optical microscopy. Compared with the sham group, jejunal contractions were similar in the IPC + I and the IPC + I/R groups, but reduced in the I + SS and the I/R + SS groups. The jejunal enteric nerves were damaged in the I + SS and the I/R + SS groups, but not in the IPC groups. These results suggested that ischemic preconditioning attenuated intestinal dysfunction caused by I and I/R.

Objective: Our aim is to investigate the role of HBO (hyperbaric oxygen), NAC (N-acetylcysteine), and HBO plus NAC on the necrosis area of random rat′s skin flaps of a modified McFarlane flap design. Materials and Methods: Thirty-two male Wistar rats were randomly divided into four groups: G-S (sham: n = 8), G-NAC (NAC: n = 8), G-HBO (HBO: n = 8), and G-HN (HBO plus NAC: n = 8). A rectangular skin flap (2 × 8 cm 2 ) was dissected from the muscular dorsal layer, preserving the cranial pedicle. Polyethylene film was placed over the muscular layer and an interrupted 3.0 nylon suture was employed to fix the flap into the original place. On the eighth day, full-thickness biopsy samples (2 × 1 cm 2 ) were collected from the proximal, middle, and cranial areas of the skin flap, and in a site away from the flap labelled as the control area. Results: The measurements of necrotic areas in the groups were 18.3% in G-S, 24.3% in G-NAC, 12.6% in G-HBO, and 14.9% in G-HN. Significant difference was observed between the groups G-HBO and G-HN as well as G-NAC. Conclusion: HBO is associated with reduced area of necrosis of skin flap. The G-NAC group was associated with poor results when examined in isolation. The association between HBO and NAC did not produce favourable results with respect to the use of HBO alone. These findings suggest that the diffusion of oxygen through the interstitial space was the determining factor of more favourable results of HBO.

CONTEXTO: Deformidades congênitas da parede torácica anterior são caracterizadas pelo desenvolvimento anormal das cartilagens costais. Todas essas afecções são frequentemente associadas com as mais diferentes deformidades da mama. Várias técnicas cirúrgicas têm sido utilizadas para a correção desde as esternocondroplastias até, atualmente, técnicas minimamente invasivas e próteses de silicone. RELATO DE CASO: O presente artigo relata o caso de uma paciente jovem que apresentava ptose mamária bilateral e uma forma moderada de pectus excavatum que ocasionava uma protrusão entre a oitava e a décima costelas, tendo como consequencia a desarmonia estética. O tratamento cirúrgico proposto incluiu, além de implantes mamários sub-glandulares de poliuretano, ressecção de parte da cartilagem da costela e parte do segmento ósseo da oitava, nona e décima costelas por uma única incisão sub-mamária para tornar a cicatriz minimamente visível. A correção por meio de uma única incisão beneficiou a paciente, proporcionando excelente resultado estético. CONCLUSÕES: As técnicas utilizadas para reparação da ptose mamária bilateral e do pectus excavatum pelas equipes de cirurgia plástica e torácica, respectivamente, demonstraram-se eficazes para correção de ambas as deformidades. Foi obtido ótimo resultado estético e funcional com consequente retomada da auto-estima da paciente. CONTEXT: Congenital deformities of the anterior thoracic wall are characterized by unusual development of the costal cartilages. All these medical conditions are frequently associated with a variety of breast deformities. Several surgical techniques have been described for correcting them, going from sternochondroplasty to, nowadays, minimally invasive techniques and silicone prosthesis implantation. CASE REPORT: The present article reports the case of a young female patient who presented bilateral mammary ptosis and moderate pectus excavatum that caused a protrusion between the eighth and the tenth ribs and consequent esthetic disharmony. The proposed surgical treatment included not only subglandular breast implants of polyurethane, but also resection of part of the rib cartilage and a bone segment from the eighth, ninth and tenth ribs by means of a single submammary incision in order to make the scar minimally visible. Correction through a single incision benefited the patient and provided an excellent esthetic result. CONCLUSIONS: The techniques used to repair bilateral mammary ptosis and pectus excavatum by plastic and thoracic surgery teams, respectively, have been shown to be efficient for correcting both deformities. An excellent esthetic and functional result was obtained, with consequent reestablishment of the patient's self-esteem. Universidade Católica de Pelotas Universidade Federal de Pelotas Universidade Federal de São Paulo (UNIFESP) Department of Surgery Division of Operative Technique and Experimental Surgery UNIFESP, Department of Surgery Division of Operative Technique and Experimental Surgery SciELO

BACKGROUND: The reconstructive surgery of the lip, upper or lower, presents a variety of techniques and procedures. In reconstructive surgery of lip is important to evaluate the characteristics of tissue (skin color, texture), which wherever possible should be used near the site of injury to provide the least morbidity and best tissues in colors and texture. CASE REPORT: This article aims to describe the Bernard-Burow technique for reconstruction of lower lip, and review the anatomy of the lower third of the face, through the case report of a patient who was bitten by a horse and had avulsion of lower lip and mentoniane portion of the face.

Capsular contracture is a potential adverse effect of breast implants. An inflammatory reaction is most likely the origin of fibrosis around the implant. It is possible that some substances may act to prevent this inflammatory reaction. Thus, our goal was to evaluate the effectiveness of local depot prednisolone phosphate-liposomes (PPL) on fibrous capsule formation around textured silicone breast implants. Shell prostheses (2 mL) were implanted in the right (plus PPL group) and left (plus saline solution, saline group) subcutaneous dorsum of 18 rats. In another 18 rats, the implants were positioned in the left of the back without any drug instillation (control group). In the PPL group, the capsule thickness (microm) and density (%) of collagen were significantly (p

Purpose: The present paper aimed to investigate the role of hyperbaric oxygen treatment (HBO) and the apoptosis in rat liver ischemia-reperfusion injury (IRI). Methods: Thirty-seven male Wistar rats were subjected to 30 minutes of hepatic ischemia and 30 minutes of reperfusion and randomly distributed into six groups: G-I/R (n = 8), control without HBO; G-HBO/I (n = 8), HBO only during the ischemia period; G-HBO/R (n = 8), HBO only during the reperfusion period; G-HBO-I/R (n = 8), HBO during both the ischemia and reperfusion periods; G-Sh (n = 3), HBO without ischemia or reperfusion as sham group; G-C (n = 2) for control of current apoptosis expression on the normal liver tissue. HBO was carried out using a transparent, cylindrical acrylic chamber with a pressure of 2.0 ATA. Hepatic samples were stained for caspase-3 cleavage. Results: Apoptotic cells were identified in all groups. In the hepatic specimens of animals HBO-treated during ischemia (GHBO-I), there was a significant decrease (P < 0.001) in the number of cells undergoing apoptosis (1.62 ± 0.91). The apoptotic index showed no significant difference in the animals HBO-treated during ischemia/reperfusion (5.75 ± 1.28) compared with the G-I/R (3.5 ± 0.75), which had no HBO treatment. The apoptosis index (11.25 ± 1.90) was significantly higher (P < 0.01) in HBO-treated animals during the reperfusion period when compared with any of the other groups. Conclusion: A favorable effect was obtained when hyperbaric oxygen was administered early during ischemia. The hyperbaric oxygen in later periods of reperfusion was associated with a more severe apoptosis index. © 2009 Wiley-Liss, Inc. Microsurgery 2009.

PURPOSE: To create a feasible animal model of hernia that should be reliable to test the different types of mesh and/or surgical technique. METHODS: Thirty six male New Zealand albino rabbits were submitted to surgical procedure to provoke a standard hole in the abdominal wall. A metallic frame measuring 3 cm length and 1 cm width was allocated longitudinally on the umbilicus scar and the comprehensive three squared centimeters area was resected. A continuous 4.0 polyamide was performed to closure the subcutaneous and skin. RESULTS: During three weeks a score of signals/symptoms was performed to evaluate the wound and clinical conditions. No death or severe complications occurred. In the 3rd week the hernia ring and visceral adhesions were evaluated. Soft omental adherences were present in the hernial sac in all animals. The area of hernia ring ranged from 32.1±5.5 to 35.6±3.1 squared centimeter and the maximum was 39 cm² and the minimum was 30 cm². The model results in protrusion which was similar to a human incisional hernia with hernia sac, visceral adhesions and fibrous healing ring. CONCLUSION: The model was more reliable to test further techniques or mesh on hernia repair. OBJETIVO: Criação de um modelo animal de hérnia que seja confiável para testar as diferentes técnicas e tipos de telas. MÉTODOS: Trinta e seis coelhos foram submetidos a procedimento operatório que provocou uma falha na parede abdominal. Uma moldura metálica com 3 cm de comprimento e 1 cm de largura foi colocada longitudinalmente sobre a cicatriz umbilical e ressecada uma área de 3cm². Uma sutura contínua de poliamida 4.0 fechou a tela subcutânea e pele. RESULTADOS: durante três semanas o escore de sinais e sintomas foi coletado para avaliar as condições clínicas e da ferida operatória. Não ocorreram óbitos ou complicações graves. Na terceira semana o anel herniário e aderências peritoneais foram avaliadas. Aderências frouxas estavam presentes no saco herniário em todos os animais. A área do anel herniário variou de 32.1±5.5 a 35.6±3.1 cm², com um máximo de 39 cm² e um mínimo de 30 cm². O modelo resultou numa protrusão de vísceras semelhante ao que ocorre em hérnia incisional de humanos. CONCLUSÃO: O modelo é factível para testar técnicas operatórias ou telas na reconstrução de hérnias incisionais.

The main complication of transhiatal subtotal esophagectomy with esophagogastric reconstruction is anastomotic leak, which is responsible for a large number of postoperative deaths. It is believed that this complication is due to gastric fundus ischemia caused by the sectioning of the short gastric, left gastric, and left gastro-omental arteries. The literature, however, presents controversies. An experimental study was performed with the aim of evaluating the vascularization of the gastric fundus following sectioning of these arteries.Forty mongrel dogs were distributed into 2 groups: a control group consisting of 15 dogs subjected to surgical simulation and an experimental group consisting of 25 dogs that underwent sectioning of these arteries. Fluorescein testing, gastric mummification, and morphometric image analysis were performed on both groups.In comparison with the control group, fluorescein testing on the experimental group demonstrated time-delayed fluorescence in the gastric fundus and partial coloring, (P0.001). Image analysis on the mummified gastric samples demonstrated significant reduction in blood vessels in the gastric fundus of the experimental group (P0.001).We conclude that sectioning of the short gastric, left gastric, and left gastro-omental arteries causes reduction in blood circulation and in the quantity of blood vessels on the anterior side of the gastric fundus of dogs.

PURPOSE: To create an animal model of extensive longitudinal tracheal stenosis (TS) that can be useful to test different surgical techniques of tracheal reconstruction. METHODS: Twenty male mongrel dogs were submitted to standard TS and randomly distributed to observation for 3 weeks (n=10) or 6 weeks (n=10). Under general anesthesia, an elliptical area (major axis from 1st to 20th ring and minor axis 40% of tracheal diameter) was resected and the stumps were sutured. The internal and external diameters were measured (before and after the observation time) and the stenosis index was calculated. Blood samples were collected (gasometry, hematocrit and hemoglobin.) before and after the surgical proceedings. RESULTS: The weight was significant lower in the animals of 6 weeks (15,551±3286.2) in comparison with those of 3 weeks observation (17,250±3575.0). No significant differences were noted in the extension of the trachea on the 21st day (21.2± 1.8) or 42nd day (21.1±1.7). The mean (40.1) and the median (40.5) of rings counted on the 21st day were quite similar to mean (38.1) and median (39.0) that were counted on the 42nd day. In the animals of group A (3 weeks) the mean (46.8%) and the median (49.8%) of index stenosis showed no significant difference (Mann Whitney test p

RACIONAL: Não há ainda um método que mantenha adequadamente e por tempo prolongado a qualidade e a função do intestino delgado a ser transplantado, apesar da existência de várias modalidades de preservação. Há necessidade de se desenvolver e aprimorar novas opções técnicas. OBJETIVO: Recuperar os artigos que estudaram a aplicação da oxigenação hiperbárica (OHB) como técnica de preservação do intestino delgado destinado para transplante, procurando determinar qual a contribuição do método no prolongamento do tempo e qualidade dessa preservação. MÉTODOS: Utilizou-se a base de dados do Medline e da Scielo consultada nos sites www.pubmed.com e www.bireme.br tendo sido selecionados 58 trabalhos pertinentes. A revisão mostrou que a preservação intestinal está associada ao uso de soluções que fornecem substrato oxidativo para a célula assim como acrescentam substâncias que evitam ou reduzem a formação de espécies reativas de oxigênio. A hipotermia e a oxigenação destas soluções preservadoras é de uso corrente e consensual. Nove trabalhos ativeram-se ao uso específico da OHB. Não há consenso sobre sua utilização em trabalhos experimentais. Contudo os estudos não são comparáveis, pois utilizam metodologias diversas e diferentes tipos de avaliação. Discute-se também a complexidade e os custos da OHB. Apesar disto, há indicações que a OHB pode prevenir o edema da hipotermia, manter a oxigenação tecidual durante a preservação e impedir ou diminuir a formação de radicais livres. CONCLUSÃO: A OHB deve ser avaliada como alternativa exclusiva ou complementar às técnicas de preservação, sendo campo fértil de investigação.

Aim: Our aim was to assess the application of three currently used surgical adhesives in the tubal lumen of rabbits, to promote sterilization, using a transvaginal approach. Methods: Fifty-seven female albino New Zealand rabbits (114 uterine tubes), which became pregnant and delivered before the experiment, were divided into four groups: GS (sham-24 tubes), GEFIBRI (0.25 mL of fibrin adhesive in 30 tubes), GE-GRF (0.25 mL of resorcin adhesive in 30 tubes) and GEBUTYL (0.25 mL of n-butyl-2-cyanoacrylate adhesive in 30 tubes). The animals were mated with proven fertile males after the experiment and observed over 30, 90 and 180 days. Pregnancy and patency were macroscopically evaluated. The tubal diameter, tubal mucosa, myosalpinx, total optical density and inflammatory process were microscopically evaluated. The statistical analysis was performed by McNemar and Wilcoxon tests for the subgroups, and Fisher's exact test and Kruskal–Wallis test for the groups, the differences identified by Dunn's multiple comparisons test (P = 5%). Results: GS showed patency and pregnancies in all subgroups. GEFIBRI showed patency and pregnancies in all subgroups. GE-GRF did not show patency or pregnancies, but was associated with severe inflammatory process and tubal morphology alterations. GEBUTYL did not show patency, pregnancies or morphological tubal mucosa alterations. Conclusions: The n-butyl-2-cyanoacrylate adhesive effectively promoted tubal obstruction, did not cause tubal morphological alterations, nor did it impair the rabbit pregnancy. The fibrin adhesive failed to cause the occlusion. The GRF adhesive, in spite of producing tubal occlusion, caused severe uterine tubes damage.

OBJETIVO: Estudar os efeitos da modulação do inositol hexafosfato (IP6) na expressão imunoistoquímica de marcador biológico de sinalização celular de apoptose, em modelo de carcinogênese induzida pelo azoximetano (AOM). MÉTODOS: Ratos Wistar (N=112) distribuídos em 4 grupos (n=28): A, controle; B, AOM (5 mg Kg-1, 2x, a partir semana 3); C, IP6 (em água a 1%, seis semanas); D, IP6+AOM. Eutanásia semanal (n=7), a partir de semana três. Imunoistoquímica de colo ascendente com marcador biológico inositol 1,4,5 trisphosphate receptor type III (Itpr3). Quantificação da imunoexpressão com uso de processamento imagem assistida computador. Análise estatística da expressão média entre grupos, semanas em grupos e grupos em semanas, e estabelecido significância quando p

Our aim was to study the ultrastructural aspects in the genesis of blood capillaries in the lower limb skeletal muscle of rats submitted to ischemia under the action of intramuscular or endovenous prostaglandin E(1) (PGE(1)). Twelve Wistar-UEM rats were used, randomly distributed into three groups of four animals each, equally redistributed into two subgroups, observed at 7 and 14 days as follows: group only with ischemia was considered as control (I), group with ischemia and intramuscular injection of PGE(1) (IM), and group with ischemia and endovenous injection of PGE(1) (EV). Results were analyzed by transmission electronic microscopy (TEM). TEM analysis revealed evidence of new capillary formation. TEM permitted us to identify morphological structures and phenomena in vascular neoformation that might have occurred through angiogenesis and/or vasculogenesis.

El objetivo del presente trabajo consistio en estudiar los aspectos ultraestructurales en la formacion de capilares sanguineos en el musculo esqueletico de las extremidades posteriores de ratas sometidas a isquemia y a la accion de la prostaglandina E1 (PGE1) administrada por via intramuscular o intravenosa. Se usaron 12 ratas Wistar-UEM, distribuidas aleatoriamente en tres grupos de cuatro animales cada uno, redistribuidos a su vez en dos subgrupos, observados a los 7 y 14 dias del modo siguiente: el grupo solo sometido a isquemia se considero el control (I), grupo con isquemia e inyeccion intramuscular de PGE1 (IM) y grupo con isquemia e inyeccion intravenosa de PGE1 (IV). Los resultados se analizaron mediante microscopia electronica de transmision (MET). El analisis MET revelo pruebas de formacion de nuevos capilares. Este analisis nos permitio identificar estructuras morfologicas y fenomenos en la neoformacion vascular que podrian haber tenido lugar a traves de la angiogenesis y/o vasculogenesis.

Notre but etait d'etudier les aspects ultrastructuraux de la genese des capillaires sanguins dans le muscle squelettique des membres inferieurs de rats soumis a une ischemie sous l'action de la prostaglandine E 1 (PGE 1 ) intra-musculaire ou intra-veineuse. Douze rats Wistar-UEM ont ete utilises, distribues de facon randomisee en trois groupes de quatre animaux chacun, egalement redistribues en deux sous-groupes, observes a 7 et 14 jours comme suit : groupe I avec ischemie seule, considere comme groupe controle, groupe avec ischemie et injection intra-musculaire de PGE 1 (groupe IM) et groupe avec ischemie et injection intra-veineuse de PGE 1 (groupe IV). Les resultats ont ete analyses en microscopie electronique de transmission (MET). Les analyses en MET ont montre la formation de neocapillaires. La MET nous a permis d'identifier les structures et les phenomenes morphologiques de la neoformation vasculaire qui auraient pu survenir par angiogenese et/ou vasculogenese.

CONTEXTO: A angiogênese terapêutica é uma modalidade de tratamento para pacientes com insuficiência arterial crônica que não têm indicação para revascularização direta ou angioplastia e que não tiveram uma resposta satisfatória ao tratamento clínico. Entre as drogas utilizadas para essa finalidade está a prostaglandina E1 (PGE1). OBJETIVO: Estudar os aspectos morfológicos na gênese de capilares sanguíneos em músculo esquelético do membro caudal de ratos submetidos à isquemia sob a ação da PGE1, administrada por via intramuscular (IM) ou endovenosa (EV). MÉTODOS: Foram utilizados 48 ratos, linhagem Wistar-UEM, distribuídos aleatoriamente em três grupos de 16, redistribuídos igualmente em dois subgrupos, observados no 7º e 14º dias, sendo um grupo controle onde apenas foi provocada a isquemia no membro, outro com a isquemia e a injeção da PGE1 via IM e outro com a isquemia e a injeção da PGE1 EV. Para análise dos resultados, foram realizadas a coloração com hematoxilina e eosina (HE) e coloração imuno-histoquímica. RESULTADOS: Constatou-se um aumento estatisticamente significativo no número de capilares nos subgrupos com o uso da PGE1 IM e EV, através da contagem nos cortes corados com HE. A imunomarcação não foi eficiente para a quantificação dos capilares. CONCLUSÕES: A PGE1, administrada por via IM ou EV, promoveu, após 14 dias de observação, um aumento no número de capilares no músculo esquelético de ratos submetido à isquemia, identificáveis histologicamente com a coloração em HE. A imunocoloração não permitiu estabelecer uma correlação com o aumento de vasos encontrados na coloração com HE. BACKGROUND: Therapeutic angiogenesis is a treatment modality for patients with chronic arterial insufficiency who do not have indication for direct reconstruction or angioplasty and who were not successfully submitted to clinical treatment. Prostaglandin E1 (PGE1) is one of the drugs used for this purpose. OBJECTIVE: To study morphologic aspects in the genesis of blood capillaries in the lower limb skeletal muscle of rats submitted to ischemia under the action of intramuscular (IM) or endovenous (EV) PGE1. METHODS: Forty-eight Wistar-UEM rats were randomly distributed into three groups of 16, equally redistributed into two subgroups, observed at the 7th and 14th days as follows: one control group, which had only limb ischemia; one group with ischemia and IM injection of PGE1; and one group with ischemia and EV injection of PGE1. To analyze the results, hematoxylin-eosin (HE) and immunohistochemical staining were used. RESULTS: There was a statistically significant increase in the number of capillaries in the subgroups using IM or EV PGE1, through counting in the samples containing HE staining. Immunostaining was not efficient for the quantification of capillaries. CONCLUSIONS: IM or EV PGE1 resulted in an increase in number of capillaries in the skeletal muscle of rats submitted to ischemia after 14 days of observation, which was histologically identifiable through HE staining. Immunostaining was not successful in establishing a correlation with the increase in vessels found in HE staining.

CONTEXT AND OBJECTIVE: Association between neurological lesions and gastroesophageal reflux disease (GERD) in children is very common. When surgical treatment is indicated, the consensus favors the fundoplication technique recommended by Nissen, despite its high morbidity and relapse rates. Vertical gastric plication is a procedure that may have advantages over Nissen fundoplication, since it is less aggressive and more adequately meets anatomical principles. The authors proposed to compare the results from the Nissen and vertical gastric plication techniques. DESIGN AND SETTING: Randomized prospective study within the Postgraduate Surgery and Experimentation Program of Unifesp-EPM, at Hospital do Servidor Público Estadual (IAMSPE) and Hospital Municipal Infantil Menino Jesus. METHODS: Fourteen consecutive children with cerebral palsy attended between November 2003 and July 2004 were randomized into two groups for surgical treatment of GERD: NF, Nissen fundoplication (n = 7); and VGP, vertical gastric plication (n = 7). These were clinically assessed by scoring for signs and symptoms, evaluation of esophageal pH measurements, duration of the operation, intra and postoperative complications, mortality and length of hospital stay. RESULTS: The mean follow-up was 5.2 months; symptoms were reduced by 42.8% (NF) (p = 0.001) and 57.1% (VGP) (p = 0.006). The Boix-Ochoa score was favorable for both groups: NF (p < 0.001) and VGP (p < 0.042). The overall mortality was 14.28% in both groups and was due to causes unrelated to the surgical treatment. CONCLUSION: The two operative procedures were shown to be efficient and efficacious for the treatment of GERD in neuropathic patients, over the study period. CONTEXTO E OBJETIVO: A associação de crianças portadoras de lesão neurológica com doença do refluxo gastroesofágico (DRGE) é muito freqüente. Quando indicado o tratamento operatório, o consenso é pela técnica de fundoplicatura preconizada por Nissen, porém com alta taxa de morbidade e recidiva. A técnica de plicatura gástrica vertical é um procedimento que tem eventuais vantagens sobre a técnica consensual por ser menos agressiva e atender mais adequadamente aos princípios anatômicos. Os autores se propõem a comparar os resultados da técnica à Nissen com a de plicatura gástrica vertical. TIPO DE ESTUDO E LOCAL: Estudo prospectivo randomizado do Programa de Pós-graduação em Cirurgia e Experimentação da Universidade Federal de São Paulo (UNIFESP-EPM), Hospital do Servidor Público Estadual-Iamspe e Hospital Municipal Infantil Menino Jesus. MÉTODOS: 14 crianças consecutivamente internadas com paralisia cerebral no período de novembro de 2003 a julho de 2004 foram randomizadas em dois grupos para o tratamento cirúrgico da DRGE: Grupo FN (n = 7), fundoplicatura a Nissen, e Grupo PGV (n = 7), plicatura gástrica vertical. Foram avaliados clinicamente através de um escore de sinais e sintomas, a avaliação da pHmetria esofágica, o tempo operatório, complicações intra e pós-operatórias, mortalidade e a permanência hospitalar. RESULTADOS: O acompanhamento médio foi de 5,2 meses; redução dos sintomas em 42,8% (G-FN) (p = 0,001) e 57,1% (G-PGV) (p = 0,006). Escore de Boix-Ochoa foi favorável nos dois grupos G-FN (p < 0,001) e G-PGV (p < 0,042). A mortalidade global foi de 14,28% nos dois grupos e deveu-se a causas estranhas ao tratamento cirúrgico. CONCLUSÃO: Os dois procedimentos operatórios mostraram-se efetivos no tratamento da DRGE em pacientes neuropatas, no período de tempo estudado.

The effect of hyperbaric oxygen (HBO) on ischemia-reperfusion injury of skeletal muscle, applied during different periods, was studied in 56 male rats. Animals were subjected to 6-h ischemia by a tourniquet over the major femoral trocanter and 4 (A) or 24 (B) h of reperfusion. HBO was carried out during 1 h in an acrylic chamber at a pressure of 2.0 ATA (100% oxygen): in the last 60 min of ischemia (II), after ischemia, during 1-h reperfusion time (III), and during the last hour of ischemia plus 1-h reperfusion (IV). Group I was the control group. After 4- or 24-h reperfusion, samples of the soleus muscle were stained by H&E and analyzed immunohistochemically. No interstitial hemorrhage, neutrophil infiltrate, or cellular necrosis were induced by HBO. The apoptosis index did not differ among the groups. HBO reduced morphologic alterations and promoted better results when administered in the ischemia plus reperfusion period (GIV).

PURPOSE: To evaluate the performance of fibrin adhesive and absorbable suture thread in the repairing of hepatic injures in rabbits. METHODS: New Zealand albino rabbits (n=16), males and females, from 5 to 6 months old, average weight of 2500 g, were distributed randomly in Group A (n-8) - biological adhesive and Group B (n=8) - suture thread. After anesthesia with acepromazine (1mg/Kg), ketamine (50mg/Kg) and fentanyl EV (0,5ml/Kg), it was performed a supra-umbilical median laparotomy, the median hepatic lobe was isolated and subjected to severe standardized incision. In the group B the incision edges were sutured with simple 4-0 catgut, in separated stitches. It was evaluated the total time of the procedure, the hemostasis time and hemorrhage volume. In the 21st post-operative day it was evaluated the presence of adherences and signs of infection in the abdominal cavity, and it was followed by the resection of the median hepatic lobe for the histological evaluation. RESULTS: The calculated mean and standard deviation showed that the procedure time, hemostasis time and bleeding amount were significantly smaller in the group of animals subjected to the use of fibrin adhesive. The surgical abdominal incision was significantly more extensive in the animals of the suture group (average of 6,8 cm) in relation to the adhesive group (average of 3,8), as well as the number of occurrences of abscesses. The adherence of the intestinal ansas to the sutured incision (group B) occurred in five cases and the major omentum adhesion occurred in all animals. In the group A (adhesive) it occurred adherences of the major omentum in three cases. The microscopy of the hepatic incision repaired with the use of fibrin showed that the inflammatory infection is less intense, not associated with the formulation of secretion in the abscesses, and therefore has a more favorable later cicatricial aspect than a conventional suture with surgical thread. CONCLUSION: In agreement with other biomedical literature works, the fibrin adhesive is a viable option for the performance of hemostasis in a animal model (rabbit) with severe hepatic injury. OBJETIVO: Avaliar o desempenho do adesivo de fibrina e do fio de sutura absorvível no reparo de lesões hepáticas provocadas em coelhos. MÉTODOS: Coelhos (n=16),Nova Zelândia, albinos, machos e fêmeas, 5 a 6 meses de idade, peso médio de 2500 gramas, foram distribuídos aleatoriamente em Grupo A(n = 8) - adesivo biológico e Grupo B(n=8) - fio de sutura. Após anestesia com acepromazina (1mg/Kg), quetamina (50mg/Kg) e fentanylEV (0,5ml/Kg), realizou-se laparotomia mediana supra-umbilical, o lobo hepático médio foi isolado e submetido a uma lesão padronizada grave. No grupo A foi aplicado o adesivo de fibrina. No grupo B as bordas da lesão foram suturadas com categute 4-0 simples, em pontos separados. Avaliou-se o tempo total de procedimento, tempo de hemostasia e volume da hemorragia. No 21º dia de pós-operatório avaliou-se a presença de aderências e sinais de infecção na cavidade e procedeu-se a ressecção do lobo hepático médio para a avaliação histológica. RESULTADOS: A média e desvio-padrão calculados mostraram que o tempo de procedimento, tempo de hemostasia e quantidade de sangramento foram significantes menores no grupo de animais submetidos ao uso do adesivo de fibrina. A extensão da ferida operatória foi significativamente maior nos animais do grupo sutura (média de 6,8cm) em relação ao grupo adesivo (média de 3,8cm) assim como o número de vezes da ocorrência de abscessos. A aderência de alças intestinais à lesão suturada (grupo B) ocorreu em 5 casos e adesão do omento maior ocorreu em todos os animais. No grupo A (adesivo) foram observadas aderências do omento maior em três casos. A microscopia da lesão hepática reparada com o uso de fibrina mostrou que a reação inflamatória é menos intensa, não está associada à formação de secreção ou abscessos e com isso tem um aspecto cicatricial tardio mais favorável que uma sutura convencional com fio cirúrgico. CONCLUSÃO: Em concordância com outros trabalhos da literatura biomédica, o adesivo de fibrina é uma opção viável para realizar hemostasia em um modelo animal (coelho) com lesão hepática grave.

A pulsed ruby laser was used in an unstable environment to overcome the high stability requirements when a hologram is recorded. The images were recorded for the purpose of measurement applied to non-destructive inspection (NDI) and medical applications. High-resolution photographic film or plates coupled with wet processing was employed as the recording material, but other recording materials are considered. The paper also explores the potential of electronic and digitized processes currently being developed.

PURPOSE: To evaluate modulation in the expression of Transforming growth factor beta2 (TGF-beta2) in short-term colon carcinogenesis. METHODS: 64 male rats was used, comprising 4 groups of 16 animals each: group 1 received Inositol hexaphosphate (IP6) and azoxymethane (AOM); group 2, AOM alone; group 3, IP6 alone; group 4 was used as control. Groups 1 and 3 were given 1% IP6 in drinking water for 6 weeks. AOM was administered subcutaneously at weeks 3 and 4 of the experiment at 20 mg/kg of body weight each week. Immunohistochemical processing was performed with the use of anti-TGF-beta2 primary antibodies in right colon samples and quantitation of TGF-beta2 as percentage of expression, through computer-assisted image processing. RESULTS: mean values of TGF-beta2 expression were 9.0 ± 3.9% for group 4 (control), 12.7 ± 4.0% for group 3 (IP6), 19.3 ± 6.2% for group 2 (AOM), and 13.1 ± 5.3% for group 1 (IP6+AOM). The value of p was calculated as 0.0001 for a 5% or lower significance level. CONCLUSION: the experiment revealed a significant increase in TGF-beta2 expression in right colon with the administration of AOM, and a significant decrease in TGF-beta2 expression when IP6 was administered with AOM.

PURPOSE: To investigate the expression of superoxide dismutase (SOD), with use of antioxidant inositol hexaphosfate, in the presence of the carcinogen azoxymethane, in FCA of colon rats. METHODS: Wistar rats (n=48) were distributed in four groups of 12 mice. Divided in control (n=12); with azoxymethane administration AOM (n=12); administration of IP6 (n=12) and with administration of IP6/AOM (n=12). The subcutaneous administration of azoxymethane happened in the week 3 and 4 of the experiment, in dose 20mg/Kg, weekly; and administration of IP6 to 1% in water of drinking for 6 weeks in the group 3 and 4. The identification of the expression SOD-1 was accomplished through the quantification imunohistochemistry by the image processing attended by computer in crypts and focus of aberrant crypts in right colon. RESULTS: The group control presented expression of SOD1, on average 16,0%; group AOM, 26,7%; group IP6, 16,9%; group IP6/AOM, 20,9%. Variance analysis among the groups, was calculated 0,0078. CONCLUSION: The azoxymethane increase expression SOD1, while inositol hexaphosphate decreases in a significant way the expression of SOD1 promoted by the administration of the carcinogen azoxymethane.

OBJETIVO: Estudar anastomose coledocoduodenal término-lateral em plano único, com a eversão da mucosa do colédoco e sua implantação em segmento do intestino, confeccionando-se uma "neopapila" que estando recoberta por mucosa afastaria a possibilidade de estenose. MÉTODOS: Foram estudados 30 porcos, machos, distribuídos em 3 grupos de 10 animais: Grupo I- controle-colédocoduodeno anastomose convencional. Grupo II- experimento-coledocoduodeno-anastomose com eversão da parede do colédoco (neopapila). Grupo III - simulado - isolamento e mobilização das vias biliares sem coledocotomia. Os parâmetros analisados foram o fluxo biliar e manometria pré e pós - operatória, endoscopia com 15 dias de PO, e com 30 dias os animais reoperados e avaliados do ponto de vista macro e microscópicos. RESULTADOS: A fluxometria e a manometria mostraram diferenças entre o pré e o pós-operatória nos grupos I e II, mas não no III. Nos animais dos grupos I e II,ocorreu metaplasia intestinal e diminuição das fibras elásticas do colédoco. Todos os animais apresentaram dilatação coledociana. CONCLUSÃO: A técnica de realização de neopapila mostrou resultado semelhante à técnica convencional. PURPOSE: This article aims to study the one layer end to side choledochusduodenal anastomosis creating a "neopapila" which, because of the mucosa recovering it, would prevent stenosis. METHODS: Thirty male pigs were distributed within 3 equal groups = Group I (control) - conventional choledochusduodenal anastomosis. Group II (experiment)- one layer end to side anastomosis with evertion of the choledochus wall (neopapila). Group III (sham)- isolation and mobilization of the biliar tract with no choledocotomy. We got the biliar flow and pressure (pre and postoperative) monitorized on the 15 PO day the animals went trough an endoscopy and on the 30 PO day they were operated and the tissues were analysed under macro and microscopic view. RESULTS: Regarding to biliar flow and manometry there were differences between all groups but the III. Animals in groups I and II showed intestinal metaplasia and diminished elastic fibers in the choledochus. All animals showed choledoco dilation. CONCLUSION: The proposed technique allowed the same results as the standard technique.

Objetivo: Avaliar a ação do dimetil-sulfóxido (DMSO) na necrose distal de retalhos randômicos isquêmicos em ratos. Métodos: Foram utilizados 30 ratos machos, linhagem Wistar, peso entre 220 e 363g e idade média de 3 meses. O retalho cutâneo dorsal (8x2cm) com pedículo cranial foi descolado, reposto em seu leito e suturado com poliamida 4.0. O grupo controle-CT (n=10) não recebeu nenhuma medicação, o grupo simulado-SM (n=10) recebeu o volume de 1mL de solução salina subcutânea, dividida em dez aplicações ao longo do retalho, o grupo experimento-EX (n=10) recebeu a injeção de 1ml de DMSO 5%. Após sete dias foram avaliadas as áreas de necrose distal e colhido material para o estudo histológico. Resultados: As medidas das áreas de necrose (CT=47,99, SM=58,78, EX=41,57) e as porcentagens das áreas de necrose (CT=29,98, SM=36,73, EX=23,99) mostraram-se menores no grupo Ex (p< 0,05). O estudo histológico qualitativo mostrou, no grupo Ex, maior presença de neovascularização, menor desestruturação dos anexos e do estroma conjuntivo e presença de fibroblastos em período mais precoce que nos dois outros grupos. Conclusão: O DMSO teve ação benéfica sobre os retalhos cutâneos randômicos em ratos, expressos pela menor área de necrose distal e pelo aspecto histológico de reparação tecidual mais precoce. ABSTRACT - Purpose: To evaluate through the morphologic study (macro and microscopic) the effectiveness of DMSO in the genesis of the distal necrosis of random skin flaps in rats. Methods: 30 male rats were used, lineage Wistar, weight between 220 and 363g and 3 months medium age .The skin flap (8x2cm) with remained cranial vessels it was unstuck, restored at his bed and sutured with polyamide 4.0. The control-group CT (n=10) don t received any medication, the simulated group -SM (n=10) it received the volume of 1mL of subcutaneous saline solution, divided in ten applications along the skin flap, the experiment group (n=10) it received the injection of 1ml of DMSO5%. After seven days they were appraised the areas of distal necrosis and picked material for the histology study. Results: The measures of the necrosis areas (CT=47.99, SM=58.78, EX=41.57) and the percentages of the necrosis areas (CT=29.98, SM=36.73, EX =23.99) they were shown smaller in the EX group (p < 0,05). The qualitative histology study showed, in the group EX, larger angiogenic presence, smaller destruction of the enclosures and of the conjunctive stroma and presence of fibroblasts in more precocious period than in the two other groups. Conclusion: The analysis of the collected data can infer that DMSO had beneficial action on the random skin flaps, expressed by the smallest area of distal necrosis and for the histology aspect of repairing tissue more precocious.

OBJETIVO: Avaliar a exeqüibilidade do condicionamento isquêmico por videolaparoscopia e o seu efeito funcional, na parede gástrica de ratos. MÉTODOS: Vinte ratos machos, EPM-1 Wistar foram submetidos a desvascularização gástrica proximal, por videolaparoscopia, com pressão intra-abdominal de pneumoperitônio de 4mmHg através da colocação de três trocartes na parede abdominal. Os animais foram distribuídos em dois grupos de 10 animais cada de acordo com a data de sacrifício, ou seja, 7 (G7) e 14 (G14) dias para avaliação da perfusão da parede gástrica com fluxometria por laser-Doppler antes da desvascularização, 10 minutos após e 7 ou 14 dias de acordo com o grupo a que pertenciam. RESULTADOS: A fluxometria revelou melhora progressiva da perfusão gástrica principalmente no G14, após a desvascularização. CONCLUSÕES: O modelo de condicionamento isquêmico do estômago é exeqüível por videolaparoscopia. O condicionamento isquêmico permite o restabelecimento da perfusão sangüínea na parede gástrica.

OBJETIVO: Verificar em animal de experimentação (coelho) a integração da poliuretana de mamona, aplicada na forma de biomassa moldável, como alternativa biológica para substituir o enxerto ósseo autógeno. MÉTODO: Foram utilizados vinte coelhos da raça Nova Zelândia submetidos a um defeito padrão condilar femoral, com dimensões de 6x10mm, e implantação de enxerto ósseo autógeno em um dos lados e poliuretana de mamona no outro, de forma aleatória. Os animais foram observados por período de 45 e 90 dias. Aos resultados da avaliação dos aspectos macro e microscópicos aplicaram-se testes estatísticos de McNemar, Fisher, "t" de Student e quiquadrado (p< 0,05). RESULTADOS: Na análise macroscópica, a presença de fratura femoral não foi significante em nenhum dos grupos. Em 100% dos enxertos ósseos autógenos houve a presença de cicatrização cortical (p = 0,0010), tanto aos 45 quanto aos 90 dias, enquanto nos fêmures que receberam poliuretana esta cicatrização estava ausente aos 45 dias. Em relação à presença do tecido ósseo maduro na zona de transição entre o implante e o osso receptor, a observação microscópica mostrou que ele estava completamente ausente, aos 45 dias. Aos noventa dias ele estava presente em todos os animais que receberam enxerto ósseo autógeno (p = 0,0010) e em nenhum dos que receberam poliuretana de mamona, que mostravam a presença apenas de tecido ósseo imaturo. CONCLUSÕES: Concluiu-se que a poliuretana de mamona integra-se ao osso receptor mais lentamente que o enxerto ósseo autógeno. No entanto a proposta do uso de uma massa moldável, para preencher a falha óssea, mostrou-se factível e promissora na pesquisa do polímero de mamona como substituto ósseo biológico. ABSTRACT - BACKGROUND: The aim was to verify the integration of the castor oil plant polyurethane, applied in the form of handmade biomass, as a biological alternative substitute of the autogenous bone graft in rabbits. METHODS: Twenty rabbits (New Zealand) were submitted to a standard femoral condilar defect, with dimensions of 6x10mm, and ramdomly assigned for implantation of autogenous bone graft in one side and castor oil plant polyurethane in the other. The animals were observed for a period of 45 and 90 days. Evaluation of the macro and microscopic studies were analysed with statistical tests (p < 0.05). RESULTS: Macroscopic analysis showed that the presence of femoral fractures were not significant in both groups. In all autogenous bone grafts there were the presence of cortical healing (p = 0.0010), at 45 and at 90 days, while in the femurs that received polyurethane, this healing was absent at 45 days. Regarding the presence of ripe bone in the transition area between the implant and the receiving bone, the microscopic observation showed that it was completely absent, at 45 days. At 90 days, it was present in all animals that received autogenous bone graft (p = 0.0010) and in none of those who received polyurethane of castor oil plant, showing the presence of only immature bone. CONCLUSION: Castor oil plant polyurethane becomes complete to the receiving bone in a slower fashion than autogenous bone graft. However the proposal for the use of a handmade biomass to fill out the bone flaw, was shown feasible and promising in the research of the castor oil plant polymer as biological bone substitute.

BACKGROUND: A new procedure for the treatment of esophageal fistula, mainly associated to the ebb esophagojejunal in patients submitted to the total gastrectomy and reconstruction with loop jejunal Rouxen-Y anastomosis is present. METHODS: The method is based in the use of "probe standard enteral prolongated with drain to laminate adapted in extremity", which results in advanced positioning inside the jejunum, making the administration of enteral nutrition possible and impeding ebb esophagojejunal. RESULTS: The authors discuss the theoretical advantages of the procedure and they suggest that the treatment of esofagic fistula with probe prolonged enteral would be suitable in the treatment of the fistula esophagojejunal by preventing the ebb esophagojejunal, which would result in smaller period of duration of the fistula esophagojejunal and it would prevent the high mortality rate. CONCLUSIONS: Preliminary studies demonstrated that this is a technically easy, low cost procedure through the endoscopic use. A prospective evaluation for morbility and mortality related to the method is needed.

Occult ischemia of the mobilized stomach is usually related to the dehiscence of an esophagogastric anastomosis. The principle of ischemic conditioning was studied to verify its clinic use. This study aims to evaluate progressively the tissue perfusion of the stomach in ischemic conditioning, establishing the best moment for gastric transposition. Twenty-four male EPM-1 Wistar rats were used, which also underwent partial desvacularization of the stomach by ligature of the left gastric vessels. Tissue perfusion was measured through flowmetry by laser Doppler (tissue perfusion unit; TPU) in the antrum (10 mm distal from the cardiac region). This measurement was done before (baseline) and immediately after the ligature, and on different postoperative days (POD) (days 3, 7, 10, and 14). A statistical analysis was done with nonparametric tests (Por= 0.05). The mean value (+/-SD) of the gastric perfusion, during the whole study period, was 88 +/- 6 (baseline), 23 +/- 5 (postligature), 31 +/- 5 (3rd POD), 55 +/- 4 (7th POD), 71 +/- 16 (10th POD), and 84 +/- 6 (14th POD), respectively. Perfusion immediately after the artery ligature was significantly lower (74%) than the baseline of the gastric perfusion; therefore, in the following days, tissue perfusion increased progressively (35%, 63%, 81%, and 96%, respectively). The flowmetry of the stomach reached basal values in the 14th POD of desvascularization, suggesting that this would the best day to perform a gastric transposition. However, on the 10th POD, good tissue perfusion was observed. The extrapolation from these data to the clinic could improve the results of esophagogastric anastomosis.

Objective: To evaluate the influence of the CO2 pneumoperitoneum in the glomerular filtration in a rat model with a 2/3 reduction of renal parenchyma. Methods: Adult Wistar male rats (n = 50) were subjected to right nephrectomy and a 2/3 ligature of the renal left vascular branch. Animals were randomly distributed as follows: GI (n = 10) - simulated, GII (n = 20) –8 mm Hg pneumoperitoneum, and GIII (n = 20) –15 mm Hg pneumoperitoneum. After two (GIIA and GIIIA) and three (GIIB and GIIIB) hours of insufflation, and one hour of disinsufflation, they were evaluated for the following aspects: mean blood pressure (MBP), microhematocrit, urinary volume and inulin clearance. Results: The microscopic aspects showed signs of glomerulosclerosis that caused proteinuria. Renal function with8 mm Hg pneumoperitoneum after two hours of disinsufflation (Δ% = 202.68) was better than after three hours (Δ% = 10.89). With15 mm Hg pneumoperitoneum, the renal function was damaged by both procedures, that is, two (Δ% = -3.57) and three hours (Δ% = -3.25). Conclusion: Inulin clearance evidenced renal insufficiency in the model with a 2/3 reduction of renal mass, and depending on both the increase of the exposure time and the pressure intensity, it can be more intensified.

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) PURPOSE: To investigate if expression of genes encoding pro and anti-apoptotic proteins in the rat enteric endothelial cells stimulated by intestinal ischemia followed by reperfusion (IR) can be modified by treatment with heparin (HP).METHODS: Eighteen adult Wistar rats were divided in three groups: sham group submitted to laparotomy only (SG), ischemia followed by reperfusion group (IRG); ischemia followed by reperfusion plus pretreatment with HP 100 mg.kg-1 (IRG+HP). Ischemia was performed by clamping of the superior mesenteric artery. After 60 min of ischemia, metal clamps were removed for reperfusion for 120 min. Gene expression of encoding pro (Casp1, Casp6, Casp3, Cflar, Fas and Pgl) and anti-apoptotic (Bcl2, Bcl2l1 and Naip2) proteins in rat enteric endothelial cells was evaluated by PCR microarray method.RESULTS: Compared to rat endothelial cells of SG, the expression of pro-apoptotic genes was up-regulated in IRG while anti-apoptotic genes were down-regulated. In contrast, the expression of anti-apoptotic genes in IRG+HP was up-regulated while pro-apoptotic genes was down-regulated compared to SG.CONCLUSION: The attenuation by heparin of intestinal ischemia-reperfusion previously demonstrated in rodents could be related with ability of this drug to stimulate and reduce gene expression of encoding anti and pro-apoptotic proteins, respectively. Federal University of São Paulo Department of Surgery UNIFESP Pharmacology Department UNIFESP Gynecology Department Universidade Federal de São Paulo (UNIFESP) Department of Biochemistry Universidade Federal de São Paulo (UNIFESP) Department of Surgery UNIFESP, Department of Surgery UNIFESP, Pharmacology Department UNIFESP, Gynecology Department UNIFESP, Department of Biochemistry UNIFESP, Department of Surgery SciELO

Facial aging is a natural biological process with symptoms such as sagging tissue, accentuated lines, furrows, wrinkles, dyschromias, and loss of facial volume. Rhytidectomy alone often fails to achieve a patient's expected goals, which is why there is a high demand for adjunct laser skin treatment.From January 2007 to February 2013, a total of 80 patients with skin types Fitzpatrick I-IV underwent large undermined cutaneous flap rhytidectomy and superficial muscular aponeurotic system (SMAS) plicature plus hyaluronic acid injection on the nasolabial folds and lips and concomitant Lumenis UltraPulse CO2 Active FX total ablation mode resurfacing of nonundermined skin. The undermined skin was treated with a fractional laser using different energies depending on the type of skin. Patients were evaluated at 5, 10, 15, 30, 60, and 90 days after the operation. At the last evaluation patients completed a specific questionnaire about satisfaction.Complications included expansive hematomas (5 %), partial necrosis (1.25 %), bacterial infection (1.25 %), herpetic infection (1.25 %), hypertrophic scar (1.25 %), and spot hyperchromia (1.25 %). 95 % of patients were extremely satisfied, 3.75 % were satisfied, and only 1.25 % were unsatisfied.The combination of subcutaneous flap rhytidectomy and SMAS plicature with fractional laser resurfacing plus hyaluronic acid injection is a safe procedure with low incidence of major complications and improves patient satisfaction.