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The inflammatory/immune response at the site of peripheral nerve injury participates in the pathophysiology of neuropathic pain. Nevertheless, little is known about the local regulatory mechanisms underlying peripheral nerve injury that counteracts the development of pain. Here, we investigated the contribution of regulatory T (Treg) cells to the development of neuropathic pain by using a partial sciatic nerve ligation model in mice. We showed that Treg cells infiltrate and proliferate in the site of peripheral nerve injury. Local Treg cells suppressed the development of neuropathic pain mainly through the inhibition of the CD4 Th1 response. Treg cells also indirectly reduced neuronal damage and neuroinflammation at the level of the sensory ganglia. Finally, we identified IL-10 signaling as an intrinsic mechanism by which Treg cells counteract neuropathic pain development. These results revealed Treg cells as important inhibitory modulators of the immune response at the site of peripheral nerve injury that restrains the development of neuropathic pain. In conclusion, the boosting of Treg cell function/activity might be explored as a possible interventional approach to reduce neuropathic pain development after peripheral nerve damage.
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Neuralgia , Traumatismos dos Nervos Periféricos , Linfócitos T Reguladores , Animais , Hiperalgesia , Camundongos , Camundongos Endogâmicos C57BL , Traumatismos dos Nervos Periféricos/complicações , Nervo Isquiático , Células Th1RESUMO
BACKGROUND: Laparoscopic liver resections (LLR) have been increasingly performed in recent years. Most of the available evidence, however, comes from specialized centers in Asia, Europe and USA. Data from South America are limited and based on single-center experiences. To date, no multicenter studies evaluated the results of LLR in South America. The aim of this study was to evaluate the experience and results with LLR in South American centers. METHODS: From February to November 2019, a survey about LLR was conducted in 61 hepatobiliary centers in South America, composed by 20 questions concerning demographic characteristics, surgical data, and perioperative results. RESULTS: Fifty-one (83.6%) centers from seven different countries answered the survey. A total of 2887 LLR were performed, as follows: Argentina (928), Brazil (1326), Chile (322), Colombia (210), Paraguay (9), Peru (75), and Uruguay (8). The first program began in 1997; however, the majority (60.7%) started after 2010. The percentage of LLR over open resections was 28.4% (4.4-84%). Of the total, 76.5% were minor hepatectomies and 23.5% major, including 266 right hepatectomies and 343 left hepatectomies. The conversion rate was 9.7%, overall morbidity 13%, and mortality 0.7%. CONCLUSIONS: This is the largest study assessing the dissemination and results of LLR in South America. It showed an increasing number of centers performing LLR with the promising perioperative results, aligned with other worldwide excellence centers.
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Laparoscopia , Neoplasias Hepáticas , Argentina , Ásia , Brasil , Chile , Colômbia , Europa (Continente) , Hepatectomia , Humanos , Fígado , Neoplasias Hepáticas/cirurgia , PeruRESUMO
The ST2 receptor is a member of the Toll/IL-1R superfamily and interleukin-33 (IL-33) is its agonist. Recently, it has been demonstrated that IL-33/ST2 axis plays key roles in inflammation and immune mediated diseases. Here, we investigated the effect of ST2 deficiency in Staphylococcus aureus-induced septic arthritis physiopathology. Synovial fluid samples from septic arthritis and osteoarthritis individuals were assessed regarding IL-33 and soluble (s) ST2 levels. The IL-33 levels in samples from synovial fluid were significantly increased, whereas no sST2 levels were detected in patients with septic arthritis when compared with osteoarthritis individuals. The intra-articular injection of 1 × 107 colony-forming unity/10 µl of S. aureus American Type Culture Collection 6538 in wild-type (WT) mice induced IL-33 and sST2 production with a profile resembling the observation in the synovial fluid of septic arthritis patients. Data using WT, and ST2 deficient (-/-) and interferon-γ (IFN-γ)-/- mice showed that ST2 deficiency shifts the immune balance toward a type 1 immune response that contributes to eliminating the infection due to enhanced microbicide effect via NO production by neutrophils and macrophages. In fact, the treatment of ST2-/- bone marrow-derived macrophage cells with anti-IFN-γ abrogates the beneficial phenotype in the absence of ST2, which confirms that ST2 deficiency leads to IFN-γ expression and boosts the bacterial killing activity of macrophages against S. aureus. In agreement, WT cells achieved similar immune response to ST2 deficiency by IFN-γ treatment. The present results unveil a previously unrecognized beneficial effect of ST2 deficiency in S. aureus-induced septic arthritis.
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Artrite Infecciosa/imunologia , Artrite Infecciosa/microbiologia , Proteína 1 Semelhante a Receptor de Interleucina-1/genética , Infecções Estafilocócicas/imunologia , Líquido Sinovial/imunologia , Animais , Feminino , Humanos , Interferon gama/genética , Interferon gama/imunologia , Interleucina-33/imunologia , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Camundongos Knockout , Osteoartrite do Joelho/imunologia , Staphylococcus aureusRESUMO
BACKGROUND: Epidemiologic studies have highlighted the association of environmental factors with the development and progression of autoimmune and chronic inflammatory diseases. Among the environmental factors, smoking has been associated with increased susceptibility and poor prognosis in rheumatoid arthritis (RA). However, the immune and molecular mechanism of smoking-induced arthritis aggravation remains unclear. The transcription factor aryl hydrocarbon receptor (AHR) regulates the generation of Th17 cells, CD4 T cells linked the development of autoimmune diseases. AHR is activated by organic compounds including polycyclic aromatic hydrocarbons (PAHs), which are environmental pollutants that are also present in cigarette smoke. In this study, we investigated the role of AHR activation in the aggravation of experiment arthritis induced by exposure to cigarette smoke. METHODS: Mice were exposed to cigarette smoke during the developmental phase of antigen-induced arthritis and collagen-induced arthritis to evaluate the effects of smoking on disease development. Aggravation of articular inflammation was assessed by measuring neutrophil migration to the joints, increase in articular hyperalgesia and changes in the frequencies of Th17 cells. In vitro studies were performed to evaluate the direct effects of cigarette smoke and PAH on Th17 differentiation. We also used mice genetically deficient for AHR (Ahr KO) and IL-17Ra (Il17ra KO) to determine the in vivo mechanism of smoking-induced arthritis aggravation. RESULTS: We found that smoking induces arthritis aggravation and increase in the frequencies of Th17 cells. The absence of IL-17 signaling (Il17ra KO) conferred protection to smoking-induced arthritis aggravation. Moreover, in vitro experiments showed that cigarette smoke can directly increase Th17 differentiation of T cells by inducing AHR activation. Indeed, Ahr KO mice were protected from cigarette smoke-induced arthritis aggravation and did not display increase in TH17 frequencies, suggesting that AHR activation is an important mechanism for cigarette smoke effects on arthritis. Finally, we demonstrate that PAHs are also able to induce arthritis aggravation. CONCLUSIONS: Our data demonstrate that the disease-exacerbating effects of cigarette smoking are AHR dependent and environmental pollutants with AHR agonist activity can induce arthritis aggravation by directly enhancing Th17 cell development.
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Artrite Experimental/metabolismo , Receptores de Hidrocarboneto Arílico/metabolismo , Fumaça/efeitos adversos , Células Th17/metabolismo , Animais , Artrite Experimental/etiologia , Artrite Experimental/genética , Compostos Azo/farmacologia , Masculino , Camundongos Endogâmicos C57BL , Camundongos Endogâmicos DBA , Camundongos Knockout , Pirazóis/farmacologia , Receptores de Hidrocarboneto Arílico/antagonistas & inibidores , Receptores de Hidrocarboneto Arílico/genética , Receptores de Interleucina-17/genética , Receptores de Interleucina-17/metabolismo , Nicotiana/químicaRESUMO
Rheumatoid arthritis is a chronic inflammatory disease that leads to significant changes in metabolic activity. Succinate, an intermediate of the tricarboxylic acid cycle, has emerged as a metabolic mediator of the innate immune response. However, the involvement of succinate in the generation of the adaptive immune response and establishment of autoimmune response has not been addressed thus far. Here we demonstrated that the succinate-sensing receptor (Sucnr1/GPR91) plays a critical role in the development of immune-mediated arthritis. We found that Sucnr1 acts as a chemotactic gradient sensor that guides dendritic cells (DCs) into the lymph nodes, orchestrating the expansion of the T helper (Th)17-cell population and the development of experimental antigen-induced arthritis. Sucnr1-/- mice show reduced articular hyperalgesia, neutrophil infiltration and inflammatory cytokines in the joint, and reduced frequency of Th17 cells in draining lymph nodes. Adoptive transfer of wild-type (WT) DCs into Sucnr1-/- mice restored the development of arthritis. Moreover, DC-depleted mice transferred with Sucnr1-/- DCs developed less arthritis than mice transferred with WT DCs. In contrast, succinate given together with the immunization boosted the recruitment of DCs and the frequency of Th17 cells in draining lymph nodes, increasing arthritis severity. Therefore, the blockade of Sucnr1 may represent a novel therapeutic target of arthritis.-Saraiva, A. L., Veras, F. P., Peres, R. S., Talbot, J., de Lima, K. A., Luiz, J. P., Carballido, J. M., Cunha, T. M., Cunha, F. Q., Ryffel, B., Alves-Filho, J. C. Succinate receptor deficiency attenuates arthritis by reducing dendritic cell traffic and expansion of Th17 cells in the lymph nodes.
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BACKGROUND: Bone marrow multipotent mesenchymal stromal cells (MSCs) are a diverse subset of precursors that contribute to the homeostasis of the hematopoietic niche. MSCs can be isolated and expanded in vitro and have unique immunomodulatory and regenerative properties that make them attractive for the treatment of autoimmune diseases, including type 1 diabetes (T1D). Whether autologous or allogeneic MSCs are more suitable for therapeutic purposes has not yet been established. While autologous MSCs may present abnormal function, allogeneic cells may be recognized and rejected by the host immune system. Thus, studies that investigate biological characteristics of MSCs isolated from T1D patients are essential to guide future clinical applications. METHODS: Bone marrow-derived MSCs from recently diagnosed type 1 diabetes patients (T1D-MSCs) were compared with those from healthy individuals (C-MSCs) for morphological and immunophenotypic characteristics and for differentiation potential. Bioinformatics approaches allowed us to match absolute and differential gene expression of several adhesion molecules, immune mediators, growth factors, and their receptors involved with hematopoietic support and immunomodulatory properties of MSCs. Finally, the differentially expressed genes were collated for functional pathway enrichment analysis. RESULTS: T1D-MSCs and C-MSCs were similar for morphology, immunophenotype, and differentiation potential. Our absolute gene expression results supported previous literature reports, while also detecting new potential molecules related to bone marrow-derived MSC functions. T1D-MSCs showed intrinsic abnormalities in mRNA expression, including the immunomodulatory molecules VCAM-1, CXCL12, HGF, and CCL2. Pathway analyses revealed activation of sympathetic nervous system and JAK STAT signaling in T1D-MSCs. CONCLUSIONS: Collectively, our results indicate that MSCs isolated from T1D patients present intrinsic transcriptional alterations that may affect their therapeutic potential. However, the implications of these abnormalities in T1D development as well as in the therapeutic efficacy of autologous MSCs require further investigation.
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Células da Medula Óssea/metabolismo , Diabetes Mellitus Tipo 1/genética , Células-Tronco Mesenquimais/metabolismo , RNA Mensageiro/genética , Transcriptoma , Adolescente , Adulto , Células da Medula Óssea/patologia , Estudos de Casos e Controles , Quimiocina CCL2/genética , Quimiocina CCL2/metabolismo , Quimiocina CXCL12/genética , Quimiocina CXCL12/metabolismo , Diabetes Mellitus Tipo 1/metabolismo , Diabetes Mellitus Tipo 1/patologia , Feminino , Perfilação da Expressão Gênica , Fator de Crescimento de Hepatócito/genética , Fator de Crescimento de Hepatócito/metabolismo , Humanos , Janus Quinase 1/genética , Janus Quinase 1/metabolismo , Masculino , Células-Tronco Mesenquimais/patologia , Pessoa de Meia-Idade , RNA Mensageiro/metabolismo , Fatores de Transcrição STAT/genética , Fatores de Transcrição STAT/metabolismo , Molécula 1 de Adesão de Célula Vascular/genética , Molécula 1 de Adesão de Célula Vascular/metabolismoRESUMO
Wireless sensor networks (WSNs) are made up of nodes with limited resources, such as processing, bandwidth, memory and, most importantly, energy. For this reason, it is essential that WSNs always work to reduce the power consumption as much as possible in order to maximize its lifetime. In this context, this paper presents SITRUS (semantic infrastructure for wireless sensor networks), which aims to reduce the power consumption of WSN nodes using ontologies. SITRUS consists of two major parts: a message-oriented middleware responsible for both an oriented message communication service and a reconfiguration service; and a semantic information processing module whose purpose is to generate a semantic database that provides the basis to decide whether a WSN node needs to be reconfigurated or not. In order to evaluate the proposed solution, we carried out an experimental evaluation to assess the power consumption and memory usage of WSN applications built atop SITRUS.
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Hepatocellular carcinoma is an infection of variable incidence that can be caused by hepatitis B virus (HBV), which is endemic in the Amazon region. The diagnosis of HBV can be performed through the use of serum markers such as the hepatitis B surface antigen. The chronic HBV can cause mutagenesis and carcinogenesis, being the susceptibility of infection due to allele human leukocyte antigen (HLA). Thus, we evaluated the clinical, molecular and laboratory profile (histocompatibility complex) of HBV in 22 patients with hepatocellular carcinoma in Amazonia, including 18 males and 4 females, using a blood sample for generic HLA class II. The results showed increased frequency of disease evolution in adults between 25 and 64 years old, who comprised 19 of the 22 patients studied. Most patients (16/22) presented high levels of alpha-fetoprotein and transaminases (14/22). The most common HLA alleles were DRB1 04 (8/44), DRB1 08 (9/44), DRB 03 (16/44), and DQB1 04 (9/44). When we compared specific phenotype frequencies of HLA-DRB1 between patients and controls, we found that patients had a significantly higher frequency of allele DRB1 08 and a significantly lower frequency of DRB1 07 and DRB1 12 compared to previous studies on Asian and Amazonian populations suggesting ethnic differences. We suggest that alleles HLA-DRB 08, HLA-DRB 03 and HLA-DQB1 04 may be risk factors for hepatocellular carcinoma in Amazon.
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Carcinoma Hepatocelular/genética , Antígenos de Histocompatibilidade Classe II/genética , Neoplasias Hepáticas/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Alelos , Brasil , Carcinoma Hepatocelular/imunologia , Estudos de Casos e Controles , Feminino , Frequência do Gene , Vírus da Hepatite B/imunologia , Antígenos de Histocompatibilidade Classe II/imunologia , Humanos , Neoplasias Hepáticas/imunologia , Masculino , Pessoa de Meia-Idade , Fenótipo , Fatores Sexuais , Adulto JovemRESUMO
BACKGROUND: Experience with advanced techniques has increased the indications for laparoscopic liver resection. This video demonstrates technical aspects of a pure laparoscopic mesohepatectomy using intrahepatic Glissonian technique. To the best of our knowledge, this is the first case of anatomic laparoscopic mesohepatectomy using the Glissonian approach published in the English literature. METHODS: A 62-year-old man with colorectal liver metastasis occupying central liver segments was referred for surgical treatment. The first step is the control of segment 4 pedicle. Using the round ligament as a guide, one incision is performed on its right margin and another is made at the bottom of segment 4. A vascular clamp is introduced through those incisions to occlude segment 4 Glissonian sheath. The next step is to control the right anterior pedicle. The first incision is made in front of the hilum and another is performed on the right edge of gallbladder bed. Laparoscopic clamp is introduced through these incisions and closed producing ischemic discoloration of segments 5 and 8. Vascular clamp is replaced by an endoscopic vascular stapling device and stapler is fired. Line of liver transection is marked along the liver surface following ischemic area. Liver transection is accomplished with bipolar vessel sealing device and endoscopic stapling device as appropriate. Specimen was extracted through a suprapubic incision. Liver raw surfaces were reviewed for bleeding and bile leaks. RESULTS: Operative time was 200 min with minimum blood loss and no need for blood transfusion. Recovery was uneventful, and the patient was discharged on the fifth postoperative day. Histological examination revealed clear surgical margins. CONCLUSIONS: Mesohepatectomy can be safely performed laparoscopically in selected patients and by surgeons with expertise in both liver surgery and laparoscopic techniques. The use of the intrahepatic Glissonian approach may help to identify the exact limits of the mesohepatectomy to avoid ischemic injury of the remnant liver.
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Hepatectomia/métodos , Laparoscopia/métodos , Neoplasias Hepáticas/cirurgia , Neoplasias Colorretais/patologia , Humanos , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-IdadeRESUMO
A favorable attitude of health professionals to organ donation can positively influence the decision of families of potential donors. By increasing health professionals knowledge about donation and transplantation and qualifying them to disseminate information, education has produced a positive response to increase the insufficient number of donors. Educating students early in their careers may become crucial in this setting. In order to supply the necessary information about the process of donation and transplantation, a medical school in association with the Hospital Transplant Coordination Department created an educational program of organ donation and transplantation. This course is intended for medical, biomedical, and nutrition students. The objective of our program is to supply basic knowledge about organ donation and transplantation to students of medicine, nutrition, and biomedicine and to enhance their commitment to this process. Each semester, 50 to 90 students are enrolled in the course, which involves a total of 25 hours. Various aspects are approached such as brain death, donor management, political and legal aspects of donation, and skin, lung, bone marrow, heart, pancreas, liver, and kidney transplantation. Between March 2006 and June 2007, three courses were carried out and 200 students were trained. The students evaluated the course and rated it as excellent, concluding that it contributed to their education. Their attitude toward organ donation and transplantation was strongly positive at the end of the course. This project aims to educate and stimulate students in the process of organ donation and transplantation and should be implemented in other medical schools.
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Educação de Graduação em Medicina , Obtenção de Tecidos e Órgãos/normas , Morte Encefálica , Currículo , Família , Educação em Saúde , Humanos , Faculdades de Medicina , Imunologia de TransplantesRESUMO
The aim was to evaluate the effect of control selection on risk factor analysis for extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-KP) infections. Four contemporaneous case-control studies were conducted prospectively with 372 patients: Study 1 (ESBL-KP-infected vs non-infected); Study 2 (ESBL-KP-infected vs non-ESBL-KP-infected); Study 3 (all KP-infected vs non-infected); Study 4 (non-ESBL-KP-infected vs non-infected). Time at risk (TAR, i.e. duration of hospital stay) was the most significant risk factor [Study 1: odds ratio (OR): 5.74 (95% CI: 2.26-14.59; P<0.001); Study 2: 3.52 (1.47-8.43; P=0.005); Study 3: 2.68 (1.57-4.58; P<0.001)]; central venous catheterisation (CVC) was a risk factor in Study 1: 5.31 (1.67-16.82; P=0.005) and Study 3: 2.10 (1.04-4.27; P=0.04). Prior use of cephalosporins (PUC) was a risk factor only in studies with non-infected patients as controls [Study 1: 5.64 (1.90-16.72; P=0.002) and Study 3: 4.60 (2.09-10.13; P<0.001)]. The ORs were uniformly lower with 'non-ESBL-KP-infected' (TAR: 3.52; CVC: 2.07; PUC: 1.97) compared with 'non-infected' patients (TAR: 5.74; CVC: 5.31; PUC: 5.64) as control groups. Selection of control patients has a crucial role in the evaluation of risk factors for ESBL-KP infections. A consistent underestimation of the magnitude of the risk factors is observed when the control group is defined by the non-ESBL-KP-infected patients.
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Grupos Controle , Infecção Hospitalar/epidemiologia , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/enzimologia , Seleção de Pacientes , Antibacterianos/uso terapêutico , Viés , Brasil/epidemiologia , Estudos de Casos e Controles , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/microbiologia , Contaminação de Equipamentos , Humanos , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/isolamento & purificação , Tempo de Internação , Modelos Logísticos , Estudos Prospectivos , Fatores de Risco , Inquéritos e Questionários , beta-Lactamases/biossínteseRESUMO
Esophagectomy is the main option for treatment of esophageal cancer. Among the subjects of surgical interest is the use of anterior versus posterior mediastinum to permit reconstruction of the alimentary tract. We performed postmortem measurements in order to analyze the lengths of both routes. For each route (anterior and posterior) we performed two measurements. The first one was called anatomical route and the second was named as surgical route. Both routes begin at the cricoid cartilage. The anatomical route goes to the celiac axis and the surgical route goes to the gastroduodenal artery. Our results show that in both routes the posterior mediastinum is a shorter way to reach the cervical region.
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Esofagectomia , Mediastino/anatomia & histologia , Adulto , Cadáver , Feminino , Humanos , MasculinoRESUMO
The present study was undertaken to determine the effect of ischemia and reperfusion on oxidative stress in hepatic cirrhosis induced by carbon tetrachloride (CCl4) in rats by the evaluation of lipid peroxidation products (LPO). Cirrhosis of the liver was induced by CCl4 administration. This drug was dissolved in mineral oil and the control group received only mineral oil intraperitoneally. Forty-five minutes of ischemia followed by one hour of reperfusion were performed. LPO products were evaluated by the thiobarbituric acid reactive substances method (TBARS) and chemiluminescence initiated by tert-butyl hydroperoxide technique (CL). The liver was submitted to histologic evaluation to check whether cirrhosis was present. The results demonstrated that ischemia-reperfusion caused an increase of LPO products in cirrhotic rats when compared to the control group (p < 0.05). Hepatic cirrhosis was present in all animals treated with CCl4 and no significant histologic alterations were observed in the control group. According to this study, we can conclude that the effect of ischemia and reperfusion in a rat model of hepatic cirrhosis caused a significant increase of the hepatic-levels of LPO products when compared to the noncirrhotic livers.
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Isquemia/complicações , Circulação Hepática , Cirrose Hepática/complicações , Cirrose Hepática/metabolismo , Estresse Oxidativo , Traumatismo por Reperfusão/complicações , Animais , Tetracloreto de Carbono , Peróxidos Lipídicos/metabolismo , Fígado/metabolismo , Fígado/patologia , Cirrose Hepática/induzido quimicamente , Cirrose Hepática/patologia , Masculino , Ratos , Ratos WistarRESUMO
A prospective study to evaluate the selective or routine use of intraoperative cholangiography on elective cholecystectomy was performed. 178 patients were studied, listing criteria to explore the biliary tract with the cholangiography aspects. The criteria showing choledocholithiasis were the alkaline phosphatase and/or bilirubin increase, dilated common bile duct, large cystic duct, small stones and pancreatitis or jaundice on the past history. The patients were divided in 4 groups: 1) no criteria: 61 (34.3%); 2) one criterion: 53 (30%); 3) two criteria: 22 (12.3%); 4) more than two criteria: 42 (23.4%). The false-positive was 1.6% to the first group, 3.8% to the group 2 and 0% to the other groups. We concluded that the intraoperative cholangiography must be achieved on patients that have at least one choledocholithiasis criterion.
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Doenças dos Ductos Biliares/cirurgia , Colangiografia , Colecistectomia , Estudos de Avaliação como Assunto , Humanos , Período IntraoperatórioRESUMO
A pancreatic sarcoma of nerve sheath origin is reported in a 28-year-old female patient, who presented with melaena. Preoperative imaging showed an 8.5 cm diameter mass in the head of pancreas. There was bleeding from the papilla of Vater at endoscopy and a highly vascular lesion on arteriography. The patient was submitted to proximal pancreatoduodenectomy and remains symptom-free at 1 year follow-up.
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Neoplasias de Tecido Nervoso/cirurgia , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia , Adulto , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Neoplasias de Tecido Nervoso/complicações , Neoplasias de Tecido Nervoso/diagnóstico , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/diagnósticoRESUMO
The authors used Penrose drains around intraperitoneal portion of Silastic tubes to prevent subphrenic collections in transhepatic intubation. In 31 cases of benign stenosis of the biliary tree, this peritoneal drainage was employed in 18 and no collections were observed. In the other group, 3 patients developed subphrenic abscess. Even with a result not statistically significant (P less than 0.05), the authors consider the procedure useful in transhepatic intubation.
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Doenças do Ducto Colédoco/cirurgia , Drenagem/métodos , Adulto , Idoso , Constrição Patológica/cirurgia , Drenagem/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
In a consecutive surgical series of 70 patients with chronic calcifying pancreatitis, 18 presented with fixed stenosis of the terminal common bile duct. Nine patients presented with jaundice and two had a palpable gallbladder. The most relevant laboratory datum in the series was a persistently high serum alkaline phosphatase level. Long tapering of the terminal common bile duct was the characteristic radiological sign in 45 of our patients. In five of the 18 cases compression of the terminal bile duct was due to cephalic pseudocysts. Hepaticojejunostomy-en-Y was the type of drainage chosen in 16 cases, and an end-to-side technique was used in 15 patients. Side-to-side choledochoduodenostomy was performed in two cases. In 14 patients, biliary drainage was associated with other surgical procedures on the pancreatic parenchyma. No postoperative complications due to the biliary drainage occurred in this series.
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Doenças do Ducto Colédoco/cirurgia , Pancreatite/cirurgia , Adulto , Colangiopancreatografia Retrógrada Endoscópica , Colestase/etiologia , Doença Crônica , Doenças do Ducto Colédoco/diagnóstico por imagem , Doenças do Ducto Colédoco/etiologia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite/complicaçõesRESUMO
Acute histidinemia was provoked in 30-d-old male Wistar rats by injecting intraperitoneally either histidine alone (0.5 mg/g body wt) or histidine (0.25 mg/g body wt) plus the histidase inhibitor nitromethane (0.73 mg/g body wt). Histidase activity was approximately 90% inhibited in rats receiving nitromethane. Serum histidine in both groups reached levels similar to those of histidinemic patients. Rats were subjected to the open field behavioral task, and the number of rearings and crossings were counted. A consistently lower locomotor activity was observed in the histidinemic rats. It is proposed that reduced locomotor activity and its relationship to psychomotor development should be investigated in histidinemic children.