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OBJECTIVE: The purpose of this study was to investigate how a scanner device would improve the outcome of laser hemorrhoidectomy regarding pain, healing, secretion, and hemostasis. BACKGROUND DATA: The technology of the laser has been applied since the 1960s in several clinical and surgical specialties. The inherent advantages, due to the biological characteristics of this instrument are: (1) it does not affect the neighborning tissues, (2) it is hemostatic, (3) it favors healing, (4) it is bactericidal, and (5) it presents less postoperative pain. Several authors have questioned these supposed advantages. After scanners were introduced, better results were accomplished, including in proctological surgery. METHODS: A total of 350 patients, consecutively, went through a laser hemorrhoidectomy using a CO2 laser coupled to a scanner device in a 3-year period. Patients were monitored for pain, healing, bleeding, and local secretion for up to 36 months. RESULTS: Almost 13% of the patients required bondage of arteries during the operation; 96% used analgesics for up to 3 days; and 5 patients (1.42%) complained of strong pain for several days. Only 2 patients (0.6%) reported intense pain for more than 7 days. All patients presented complete healing between the 30th and the 40th POD. In the 90th POD tissue regeneration appeared healthy. The immediate complications included 2 cases of nipple hemorrhage that demanded a review. Stenosis occurred in 4 patients. Residual "plicoma" was often present with the laser technique (20%). Return to work, regardless of its nature, was an average, on the 3rd postoperative day. CONCLUSIONS: Our evaluation of the results led to the conclusion that the scanner coupled to the CO2 laser was fundamental for better postoperative outcome in our patients, at least compared to other laser techniques.

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Several morbid conditions may necessitate extensive intestinal resection, leading to short-bowel syndrome. When clinical treatment becomes inefficient, a surgical approach is necessary. Distal colon interposition is one of the viable techniques. The interposition of colon segments between remnants of the small bowel improved lifestyle, increased transit time, and diminished diarrhea. The aim of this study is to observe the longitudinal muscular contractions after distal colon interposition. Sixteen male Wistar rats (EPM-1) were submitted to an 80% small bowel resection associated with a partial colectomy of the distal colon immediately after the bifurcation of the middle colic artery followed by a 3-cm isoperistaltic distal colon interposition. After 70 days, the animals were submitted to euthanasia and segments of the jejunum, ileum, remnant colon, and interposed colon were prepared for pharmacological tests. The isometric contractions were measured by a polygraph. After 30 minutes, the dose/effect curves were obtained for both metacholine and barium chloride stimulation through the extraluminal surface (serosa). After this period, we observed a significant increase in the length, diameter, and thickness of the intestinal wall. Regarding the sensibility (pD(2)), no difference was found (interposed colon = 7.21 +/- 0.2; remnant colon = 7.65 +/- 0.1; remnant jejunum 7.46 +/- 0.1; and remnant ileum 7.57 +/- 0.1), even though the animals were submitted to different procedures. In relation to the maximal effect (E(max)), the longitudinal muscle contraction responses (interposed colon = 11.79 +/- 0.1; remnant jejunum = 15.42 +/- 0.2; and remnant ileum = 11.48 +/- 0.2) were lower than those of the remnant colon (E(max) = 22.42 +/- 0.1). This means that there was a possible adaptation of colonic segments to their new location.

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Energy balance of female rats that were either injected daily with ethanol or received the alcohol by gavage was determined and the results compared with saline animals. Food intake, feces elimination, and body weight were recorded daily. After a 20-day period of treatment the animals were sacrificed and the energy content of the carcasses and feces was determined by bomb calorimetry. The results indicated that ethanol-injected animals underwent an impairment in the energy balance, with losses in body weight and body energy. Also, there was a decrease in metabolized energy intake. The results of a group of saline rats pair-fed to alcohol-injected rats showed that the impairment of the energy balance was not only a consequence of the decreased energy intake, because the ethanol-fed animals had an energy balance that was worse than the one of the pair-fed rats, even though both had eaten the same amount of food. Nevertheless, when alcohol was given by gavage, no alteration in the energy balance parameters was detected. Macroscopic observation of the abdominal cavity showed adherences in the gut of the alcohol-injected animals. It is concluded that the ethanol by itself does not alter the energy balance; however, depending on the route of administration it could indirectly impair the energy balance.

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One of the proposed surgical treatments of Short Bowel Syndrome is the interposition of a distal colon segment between two portions of the remnant small intestine. This method proved to reverse the nutritional disorders caused by this morbid entity. Surgical technique consisted in an 80% small bowel resection and the interposition of a 3 cm segment of distal colon between the remaining jejunum and ileum. After 70 days, the animals were reoperated and the interposed and the distal colon were isolated and tied. By using the method of rapid and successive absorptions of a glucose solution through the intestinal lumen, the relations between the absorption curves of the interposed and the normal colon could be drawn. Results show that the interposed colon segment absorbs more glucose (mean = 1.43 +/- 1.16 mg/dl) than the distal colon (mean = 0.37 +/- 0.29 mg/dl) and that its absorption pattern is similar to the small bowel rather than the colon. These results allow the use of this method for further studies in which the interposed colon adaptation is studied with other nutrients and/or under specific conditions.

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An adaptation of the Sols and Ponz method for the study of glucose intestinal absorption was developed by considering the special conditions of our line research. The glucose absorption was studied in proximal jejunum, distal ileum and distal colon in Wistar rat. The main adaptations in the method for successive absorptions with intestinal perfusions in vivo were the length of the intestinal segment and the change of the pumping system. The results are very similar to those obtained with the original method.

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As implicacoes clinicas decorrentes das grandes resseccoes intestinais sao hoje assunto de grande interesse para os cirurgioes, devido o numero crescente de pacientes que sobrevivem ao ato operatorio. Os diversos recursos para o tratamento da sindrome do intestino curto incluem a alimentacao parenteral e varios metodos cirurgicos que visam aumentar o tempo de transito intestinal e, portanto, a absorcao dos nutrientes. A interposicao de um segmento de colon distal entre os cotos de intestino delgado remanescente, vem mostrando resultados alentadores no campo experimental. As transformacoes da mucosa deste segmento de colon interposto vem sendo estudadas e se constituem em uma etapa de uma linha de pesquisa iniciada em 1974 na Escola Paulista de Medicina...

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