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In the present study the age-related changes of the striated muscle elastic fiber system were investigated in the diaphragm and rectus abdominis muscles of 1-, 4-, 8- and 18-month-old rats. The activation patterns of these muscles differ in that the diaphragm is regularly mobilized tens of times every minute during the entire life of the animal whereas the rectus abdominis, although mobilized in respiration, is much less and more irregularly activated. The elastic fibers were stained by the Verhoeff technique for mature elastic fibers. Weigert stain was used to stain mature and elaunin elastic fibers, and Weigert-oxone to stain mature, elaunin and oxytalan elastic fibers. The density of mature and elaunin elastic fibers showed a progressive increase with age, whereas the amount of oxytalan elastic fibers decreased in both diaphragm and rectus abdominis muscles and their muscular fasciae. These age-related quantitative and structural changes of the elastic fiber system may reduce the viscoelastic properties of the diaphragm and rectus abdominis muscles, which may compromise the transmission of tensile muscle strength to the tendons and may affect maximum total strength.

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In the present study the age-related changes of the striated muscle elastic fiber system were investigated in the diaphragm and rectus abdominis muscles of 1-, 4-, 8- and 18-month-old rats. The activation patterns of these muscles differ in that the diaphragm is regularly mobilized tens of times every minute during the entire life of the animal whereas the rectus abdominis, although mobilized in respiration, is much less and more irregularly activated. The elastic fibers were stained by the Verhoeff technique for mature elastic fibers. Weigert stain was used to stain mature and elaunin elastic fibers, and Weigert-oxone to stain mature, elaunin and oxytalan elastic fibers. The density of mature and elaunin elastic fibers showed a progressive increase with age, whereas the amount of oxytalan elastic fibers decreased in both diaphragm and rectus abdominis muscles and their muscular fascias. These age-related quantitative and structural changes of the elastic fiber system may reduce the viscoelastic properties of the diaphragm and rectus abdominis muscles, which may compromise the transmission of tensile muscle strength to the tendons and may affect maximum total strength

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In order to evaluate age related changes of the elastic fiber system in the interfoveolar ligament, we studied the deep inguinal ring from 33 male cadavers aged from stillborn to 76 years. Selective and alternated staining methods for elastic fibers were performed to differentiate oxytalan, elaunin, and mature elastic fibers. We confirmed quantitative changes of the elastic fiber system with aging. There was a significant and progressive reduction of the oxytalan fibers (responsible for tissue resistance) and a significant increment in the mature elastic and elaunin fibers (responsible for tissue elasticity). Furthermore, there were structural changes in the thickness, shortness and curling of these mature elastic fibers. These changes induced loss of the elastic fiber function and loss of the interfoveolar ligament compliance. These factors predispose individuals to the development of indirect inguinal hernias that frequently emerge in adults and aged individuals, especially above the fifth decade.

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OBJECTIVE: To compare late results (recurrence) of three different techniques for treatment of inguinal hernias in the adult: Bassini, Shouldice and McVay. PATIENTS AND METHODS: The operative late results of three surgical techniques: Bassini, Shouldice and McVay in 119 adult patients with inguinal hernias (some with bilateral pathology, totalizing 136 hernias) were analyzed. The majority of patients were males (93.3%). The analysis was prospective, randomized, with uniform distribution of all three types of inguinal hernia (direct, indirect and combined) among the three groups of operative techniques. The number of recurrences was submitted to an actuarial analysis for a period of 4 years. The results underwent statistical analysis by the Kaplan-Mayer test with actuarial survival curves. RESULTS: Eight hernia operations by the Bassini technique recurred in this time span, 3 in the Shouldice group and 2 in McVay. Among the Bassini recurrences, the worst results were observed with direct hernias (29% recurrence) when compared with indirect ones (16% recurrence). Overall recurrence rates plotted in an actuarial survival curve for 4 years, revealed statistically significant differences between Bassini and Shouldice: 35.7% versus 23.7%; the same happened when comparing Bassini to McVay: 35.7% versus 8.5%. The differences between Shouldice and McVay were not significant. CONCLUSION: A recurrence rate of 35.7% for inguinal herniorraphy with the Bassini technique in a General Surgery University Clinic was surprising and obliged us to interrupt the trial. Our observations point to a prohibitive high failure rate when dealing with the Bassini technique, which was, over a century, the most popular treatment of inguinal hernia all over the world. Shouldice and McVay techniques, even though more complex, should be preferred whenever one makes the choice for "conventional" hernia treatment.

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Objetivo. Comparar os resultados tardios (recidivas) obtidos com o emprego de trêstécnicas operatórias para correçao das Hérnias Inguinais no adulto: Bassini, Shouldice e Mc Vay. Casuística e Método. Foram analisados os resultados obtidos em 119 pacientes adultos portadores de hérnias inguinais, alguns com hérnias bilaterais (totalizando 136 hérnias), operados por uma das três técnicas seguintes: Bassini, Shouldice e McVay. A maioria dos pacientes foi do sexo masculino (93,3 por cento). O estudo foi prospectivo, randomizado, com distribuiçao uniforme dos três tipos de hérnias (indireta, direta e mista) entre os três grupos de técnicas operatórias. Foi avaliado o número de recidivas observadas durante um período de quatro anos. Estes resultados foram submetidos à análise estatística através de curvas de sobrevida de Kaplan-Mayer. Resultados. Oito hérnias operadas pela técnica de Bassini recidivaram neste período, três no grupo Shouldice e duas operadas a McVay. Dentre os operados a Bassini, os piores resultados foram observados nas hérnias diretas (29 por cento de recorrência) quando comparados aos obtidos com as hérnias indiretas (16 por cento). Os resultados gerais projetados para quatro anos de seguimento, mostram diferenças estatisticamente significantes entre Bassini e Shouldice: 35,7 por cento vs 23,7 por cento. O mesmo foi observado na comparaçao entre Bassini e McVay: 35,7 por cento vs 8,5 por cento. As diferenças entre os grupos Shouldice e McVay nao foram significantes. Conlcusao. O índice de recidiva de 35,7 por cento para as hérnias operadas pela técnica de Bassini foi surpreendente, obrigando-nos a suspender o estudo. Há um índice excessivamente alto de insucesso após a utilizaçao da técnica de Bassini, que foi durante um século o método mais usado para correçao de hérnias inguinais no mundo inteiro. Os métodos de Shouldice e de McVay, embora de execuçao técnica mais complexa, devem ser as preferidos quando se opta pela utilizaçao de técnicas convencionais de herniorrafia.

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The treatment of penetrating injuries of the neck is still controversial nowadays, especially when there is doubt concerning the existence of any anatomic structure lesion. The delay to indicate surgical cervical exploration may predispose the patient to have serious sequels when the esophagus or the trachea are injured. The infection which may occur in this eventuality progresses rapidly to the mediastinum, determining the patient's death. The purpose of this work was to identify and to analyze the parameters which suggest the best treatment indicated for patients with penetrating injuries of the neck. This is a non-randomized prospective study which gathered 53 patients, victims of penetrating wounds of the neck, treated at the Emergency Surgical Service of the Hospital das Clínicas, University of São Paulo School of Medicine, during a three-year period, starting in October, 1990. All the patients were evaluated by the surgical team on call who elected the selective exploration approach for the cases that did not present clear evidence of injuries in the cervical structures nor hemodynamic alterations. For the fifteen carriers of evident injuries, immediate surgical exploration was the treatment adopted. All the patients had epidemiologic data, evaluation results, hospitalization period, complications, morbidity and mortality rates, besides trauma indexes, collected. For patients whose clinical observation was allowed, endoscopic studies were also performed and compared. In order to evaluate variable correlations, statistical analysis were performed using Q square test, Student test and Z statistics, which leaded to the following conclusions: 1. Penetrating wounds of the neck were most frequent in white people aged from 20 to 30 years. They were mostly located in the right side of cervical zone II and were caused by gunshot. 2. Trauma indexes correlated with patients' clinical evolution. 3. In cases when there was doubt about the effective presence of injuries, complementary digestive and respiratory evaluations were indicated. These exams contributed for reducing the rate of unnecessary surgical explorations.

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The authors describe diagnosis and surgical treatment of a patient with iatrogenic diaphragmatic hernia following esophagogastrofundoduplication by Nissen's operation. The patient had presented a hiatal hernia with esophagitis chronic regurgitation and was submitted to esophagogastrofundoduplication. On the third postoperative day, the patient showed signs of dysphagia and intense dyspnea. The computerized tomography showed the presence of the gastric fundus and it's contents inside the leftpleural cavity. The patient was submitted to a left posterolateral thoractomy and an ischemic peptic ulcer in the gastric fundus, blocked by lung parenchyma was sutured. Then, the stomach was reduced into the abdominal cavity with diaphragmatic suture associated with esophageal and gastric fundus fixation to the right diaphragmatic pilar. The patient presented satisfactory immediate and late postoperative follow-up (1 year). The authors discuss and document aspects of diagnosis as well as surgical indication.

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Gallstone ileus, a mechanical intestinal obstruction caused by the passage of a gallstone into the intestinal lumen through a fistula, although not common, deserves to more carefully studied due to its morbidity and mortality. Its incidence among older-age groups explains its association with chronic and degenerative diseases, which increase the complexity of the treatment choice. The need and appropriateness of a surgical approach to a cholecystenteric fistula to solve the obstructive emergency, in a one or two stage procedure, has been discussed in the literature. It has also been reported that gallstone ileus is an uncommon cause of upper intestinal obstruction. Intestinal obstruction is seen more frequently after a gallstone impacts at the ileocecal valve. The authors report a case of gallstone ileus as a cause of upper intestinal obstruction and discuss its diagnosis and treatment.

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Age-related changes of muscle fiber and collagen content of the diaphragm (DIA) and rectus abdominis (RA) muscles were examined in rats aged 1, 4, 8 and 18 months. The cross-sectional areas of all muscle fiber types (I, IIa, IIb) and the amount of collagen in both DIA and RA increased up to the age of 8 months after which a decrease in growth following a parabolic curve was found. The older DIA showed an increase in the percentage of type I fibers while in RA there was a high percentage of type IIb fibers. The aged DIA became more resistant to fatigue but at the expense of slow contraction while older RA is faster and stronger. Aged DIA and RA muscles showed a low amount of collagen with great concentration of cross-linkings leading to a tissue with low viscoelastic properties and reduced compliance.

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Thirty-two morphologically normal spleens from adult corpses were excised and immersed into a graduated water tank and the water volume displaced was considered as the actual spleen volume. After that, the splenic maximal height, width, and breadth were determined by a pachimeter. All the reference points were marked with a metal clip. Utilizing the metal clip references ultrasound maximal height, width, and breadth were determined. It was assumed that the ultrasound spleen volume was the result of the multiplication of the three ultrasonographic measurements previously obtained. There was no significant difference between pachimeter and ultrasound determinations. The mean actual spleen volume was 147.5 cm3 (SD = 81.46). The mean ultrasound spleen volume was 283.8 cm3 (SD = 168.27). A roughly linear correlation between actual spleen volume (y) and ultrasound spleen volume (x) was found, y = 14.23 + 0.469 x (R2 = 0.94, P < 0.01).

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Mechanic intestinal obstruction, caused by the passage of biliary calculus from vesicle to intestine, through fistulization, although not frequent, deserve study due to the morbi-mortality rates. Incidence in elder people explains the association with chronic degenerative diseases, increasing complexity in terms of therapy decision. Literature discusses the need and opportunity for the one or two-phase surgical attack of the cholecyst-enteric fistule, in front of the resolution on the obstructive urgency and makes reference to Gallstone Ileus as an exception for strong intestinal obstruction. The more frequent intestinal obstruction observed is when it occurs a Gallstone Ileus impacting in terms of ileocecal valve. The authors submit a Gallstone Ileus manifestation as causing strong intestinal obstruction, discussing aspects regarding diagnostic and treatment.

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A correlaçäo entre a varicocele e a esterilidade masculina levou-nos a estudar a arquitetura das veias testiculares. Foram utilizados 12 cadáveres, com idade variando entre 23 e 64 anos. Isoladas as veias testiculares em toda sua extensäo e fixadas em soluçäo de formol a 10//, foram obtidos cortes seriados espessos e corados para evidenciar os tecidos muscular e fibroso. O arranjo dos feixes de fibras musculares mostra disposiçäo diferente ao nível das desembocaduras à direita e à esquerda. O arranjo do tecido fibroso é semelhante ao do tecido muscular. A análise micromesoscópica mostra sistemas músculo-fibrosos adaptados a regulaçäo do fluxo sanguíneo nas junçöes venosas cavo e renotesticular

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The correlation between varicocele and male sterility, mentioned by several authors, led us to study the disposition of the testicular veins, especially at the level of their ending, trying to provide an anatomical description, which may contribute with new etiopathogenic information, in order to interpret that pathologic entity. The arrangements of the muscular fiber bundles show a different disposition in the right and left side, mainly in their distinct orientation. The collagen and elastic tissue show an arrangement similar to the muscular fibers, in order to improve the blood flow, sometimes in the reno-testicular and sometimes in the cavo-testicular junction.

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A series of 110 muscle and 40 skin biopsy specimens were examined using direct immunofluorescence aiming to identify features that may differentiate the myopathy of connective tissue disease from other muscle diseases. The skeletal muscle fluorescence was positive in 75% of the patients with muscle diseases. The sarcolemmal staining was higher in mitochondrial encephalomyopathy. Fiber and vascular staining occurred in all muscle diseases, except in cases of myasthenia. Our results showed that 42% of patients with polymyositis and 43% of patients with peripheral motor neuron diseases have vascular deposits of immune complexes suggesting that these two diseases could result from an immune-complex-induced vasculopathy. The IF test in skin specimens was positive in 60% of the patients with muscular diseases. The absence of immunoglobulin deposit at the dermoepidermal junction and at epidermal nuclei in cases of peripheral motor neuron disease suggest that this skin test may be useful in the differentiation of muscle diseases.

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PURPOSE: Analysis the fibrous elements of the transition between the inferior vena cava and right atrium. METHODS: Twenty adult (20-40 ys) were used. Properly preserved samples were analysed macro and microscopically. Fragments were excised from the inferior cavo-atrial transition and analysed under stereomicroscopic. RESULTS: The inferior vena cava valve was disposed at the wall of the vein. Insertions of striated muscular cardiac fibers bundles are seen at the anterior wall of inferior vena cava. These muscular bundles are directed towards the intima of the vein. There were at the venous posterior wall insertions of the cardiac muscular bundles, originated from the crista terminalis and from the interatrial septum, these bundles show an orientation predominantly oblique, with tendency to become circular. At the transition level, the bundles of smooth muscular fibers of the inferior vena cava, presented an oblique disposition, becoming predominantly circular. CONCLUSION: As the disposition of muscular cardiac fibers presents a predominantly circular direction and, the bundles of smooth muscular fibers of the inferior vena cava present the same direction, we could postulate that, when the atrial systole occurs, these muscular bundles would obliterate the cavo-atrial transition, preventing, this way, the venous reflux.

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Gallbladder lesions by blunt abdominal trauma are rare, due to the organ's anatomical particularities. Diagnosis is difficult, and it generally occurs during surgery. The trauma is usually associated with other lesions and is related to very serious traumas or to deceleration. Due to the scarcity of publications on this topic and to its reduced incidence, we present here a report of five patients who had suffered blunt abdominal trauma with gallbladder lesion and who were attended at the General Hospital (of the University of São Paulo Medical School) Emergency Service between 1986 and 1991. Furthermore, we analyze the incidence of this trauma, presence of associated lesion, treatment, morbidity and mortality of the patients, as well as a review of the literature.

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The authors studied experimentally the electromagnetic pulsing field effects in an experimental model in rats, for evaluation of the velocity of consolidation of tibial and fibular fractures. The animals were followed for a period of three weeks under continuous stimulation and there were done radiological evaluation weekly and histological study at the end of the study. There were no histological, clinical or radiological differences between the group of rats submitted to electromagnetic pulsing fields and the control group.

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A young female patient had a recurrence of severe spherocytic anemia there years after having been submitted to splenectomy. The presence of two accessory spleens with a size of 3.5 cm and 4.0 cm, was demonstrated by technetium scanning and ultrasound images. Surgical removal of these noduli resulted again in prompt recovery. The development of the spleen beings in the fifth week of intrauterine life at the dorsal mesogastrium. The lack of fusion of splenic lobuli is responsible for the occurrence of accessory spleens. A surgeon performing splenectomy for the treatment of hemolytic anemia should always search for possible existences of accessory spleens.

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The fine structural changes and the reactivity for acid phosphatase (AcPase) and thiamine pyrophosphatase (TPPase) were studied in thin sections from rat pancreatic acinar cells exposed to dl-ethionine for 2-10 days. The cells from ad libitum and pair-fed controls exhibit occasionally 0.2-0.6 microns circular profiles showing reaction for AcPase and considered as presumptive lysosomes. At days 2 and 4 of dl-ethionine treatment the acinar cells exhibit presumptive lysosomes, autophagosomes and membrane-bounded cytoplasmic areas devoid of electron density and AcPase activity, containing scattered membranous elements. These regions were named lesioned areas. On 6th, 8th and 10th days a membrane bound anomalous cytoplasmic structure that represents a dense pile of layered membrane-like material (multilayered bodies, MB) was seen. The MBs consistently show AcPase activity and in rare instances TPPase activity. Freeze fracture studies reveal that the limiting membrane of the MBs has intramembranous particles whereas the multilayered membranous contents are devoid of such particles. The structure and disposition of the lamellae of the MBs seen in the replicas are similar to those of artificially prepared phospholipidic membranes.

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