Assuntos
Íleo/lesões , Perfuração Intestinal/etiologia , Migração de Dispositivo Intrauterino , Dispositivos Intrauterinos/efeitos adversos , Adulto , Feminino , Humanos , Íleo/diagnóstico por imagem , Íleo/cirurgia , Perfuração Intestinal/diagnóstico por imagem , Perfuração Intestinal/cirurgia , Laparoscopia , Útero/lesõesRESUMO
In this study, we investigated the potential role of high-mobility group box 1 (HMGB1) in severe acute pancreatitis (SAP) and the effects of growth hormone (G) and somatostatin (S) in SAP rats. The rats were randomly divided into 6 groups of 20 each: sham-operated, SAP, SAP+saline, SAP+G, SAP+S and SAP+G+S. Ileum and pancreas tissues of rats in each group were evaluated histologically. HMGB1 mRNA expression was measured by reverse transcription-PCR. Levels of circulating TNF-α, IL-1, IL-6, and endotoxin were also measured. In the SAP group, interstitial congestion and edema, inflammatory cell infiltration, and interstitial hemorrhage occurred in ileum and pancreas tissues. The levels of HMGB1, TNF-α, IL-1, IL-6 and endotoxin were significantly up-regulated in the SAP group compared with those in the sham-operated group, and the 7-day survival rate was 0%. In the SAP+G and SAP+S groups, the inflammatory response of the morphological structures was alleviated, the levels of HMGB1, TNF-α, IL-1, IL-6, and endotoxin were significantly decreased compared with those in the SAP group, and the survival rate was increased. Moreover, in the SAP+G+S group, all histological scores were significantly improved and the survival rate was significantly higher compared with the SAP group. In conclusion, HMGB1 might participate in pancreas and ileum injury in SAP. Growth hormone and somatostatin might play a therapeutic role in the inflammatory response of SAP.
Assuntos
Animais , Masculino , Hormônio do Crescimento/metabolismo , Proteína HMGB1/metabolismo , Pâncreas/patologia , Pancreatite Necrosante Aguda/etiologia , Somatostatina/metabolismo , Edema/patologia , Endotoxinas/sangue , Expressão Gênica , Proteína HMGB1/genética , Hematoma/patologia , Íleo/lesões , Íleo/patologia , Interleucina-1beta/sangue , /sangue , Microscopia Eletrônica de Transmissão , Infiltração de Neutrófilos/fisiologia , Pâncreas/lesões , Pâncreas/metabolismo , Pancreatite Necrosante Aguda/metabolismo , Pancreatite Necrosante Aguda/patologia , Distribuição Aleatória , Ratos Sprague-Dawley , Reação em Cadeia da Polimerase Via Transcriptase Reversa , RNA Mensageiro/isolamento & purificação , Taxa de Sobrevida , Fator de Necrose Tumoral alfa/sangueRESUMO
In this study, we investigated the potential role of high-mobility group box 1 (HMGB1) in severe acute pancreatitis (SAP) and the effects of growth hormone (G) and somatostatin (S) in SAP rats. The rats were randomly divided into 6 groups of 20 each: sham-operated, SAP, SAP+saline, SAP+G, SAP+S and SAP+G+S. Ileum and pancreas tissues of rats in each group were evaluated histologically. HMGB1 mRNA expression was measured by reverse transcription-PCR. Levels of circulating TNF-α, IL-1, IL-6, and endotoxin were also measured. In the SAP group, interstitial congestion and edema, inflammatory cell infiltration, and interstitial hemorrhage occurred in ileum and pancreas tissues. The levels of HMGB1, TNF-α, IL-1, IL-6 and endotoxin were significantly up-regulated in the SAP group compared with those in the sham-operated group, and the 7-day survival rate was 0%. In the SAP+G and SAP+S groups, the inflammatory response of the morphological structures was alleviated, the levels of HMGB1, TNF-α, IL-1, IL-6, and endotoxin were significantly decreased compared with those in the SAP group, and the survival rate was increased. Moreover, in the SAP+G+S group, all histological scores were significantly improved and the survival rate was significantly higher compared with the SAP group. In conclusion, HMGB1 might participate in pancreas and ileum injury in SAP. Growth hormone and somatostatin might play a therapeutic role in the inflammatory response of SAP.
Assuntos
Hormônio do Crescimento/metabolismo , Proteína HMGB1/metabolismo , Pâncreas/patologia , Pancreatite Necrosante Aguda/etiologia , Somatostatina/metabolismo , Animais , Edema/patologia , Endotoxinas/sangue , Expressão Gênica , Proteína HMGB1/genética , Hematoma/patologia , Íleo/lesões , Íleo/patologia , Interleucina-1beta/sangue , Interleucina-6/sangue , Masculino , Microscopia Eletrônica de Transmissão , Infiltração de Neutrófilos/fisiologia , Pâncreas/lesões , Pâncreas/metabolismo , Pancreatite Necrosante Aguda/metabolismo , Pancreatite Necrosante Aguda/patologia , RNA Mensageiro/isolamento & purificação , Distribuição Aleatória , Ratos Sprague-Dawley , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Taxa de Sobrevida , Fator de Necrose Tumoral alfa/sangueRESUMO
OBJECTIVE: to evaluate the impact of the new technology of multidetector computed tomography (MDCT) in improving the accuracy and early diagnosis of BSBI. METHODS: patients with blunt small bowel injuries (BSBI) grade> I were identified retrospectively and their CT scans reviewed by an experienced radiologist. Clinical and tomographic findings were analyzed and patients grouped as "pre-MDCT" and "post-MDCT", according to the time of implementation of a 64-slice MDCT. RESULTS: of the 26 patients with BSBI 16 had CT scans. Motor vehicle collision (62.5%) was the most frequent mechanism of injury. In the pre-MDCT period, five of the 13 patients (38.5%) had abdominal CT, and in the post-MDCT, 11 of 13 patients (84.6%) had the exam. During pre-MDCT, all CT scans were abnormal with findings of pneumoperitoneum (60%), free fluid (40%) and bowel wall enhancement (20%). In the post-MDCT group, all exams but one were abnormal and the most frequent findings were free fluid (90.9%), bowel wall enhancement (72.7%), and pneumoperitoneum (54.5%). However, the rate of delayed laparotomy did not change. The mortality rate in both groups were similar, with 20% during pre-MDCT and 18.2% during post-MDCT. CONCLUSION: the use of MDCT in abdominal trauma in our service has increased the sensibility of the diagnosis, but has had no impact on outcome so far.
Assuntos
Íleo/diagnóstico por imagem , Íleo/lesões , Jejuno/diagnóstico por imagem , Jejuno/lesões , Tomografia Computadorizada Multidetectores , Traumatismo Múltiplo/diagnóstico por imagem , Ferimentos não Penetrantes/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
OBJECTIVE: to evaluate the impact of the new technology of multidetector computed tomography (MDCT) in improving the accuracy and early diagnosis of BSBI. METHODS: patients with blunt small bowel injuries (BSBI) grade> I were identified retrospectively and their CT scans reviewed by an experienced radiologist. Clinical and tomographic findings were analyzed and patients grouped as "pre-MDCT" and "post-MDCT", according to the time of implementation of a 64-slice MDCT. RESULTS: of the 26 patients with BSBI 16 had CT scans. Motor vehicle collision (62.5%) was the most frequent mechanism of injury. In the pre-MDCT period, five of the 13 patients (38.5%) had abdominal CT, and in the post-MDCT, 11 of 13 patients (84.6%) had the exam. During pre-MDCT, all CT scans were abnormal with findings of pneumoperitoneum (60%), free fluid (40%) and bowel wall enhancement (20%). In the post-MDCT group, all exams but one were abnormal and the most frequent findings were free fluid (90.9%), bowel wall enhancement (72.7%), and pneumoperitoneum (54.5%). However, the rate of delayed laparotomy did not change. The mortality rate in both groups were similar, with 20% during pre-MDCT and 18.2% during post-MDCT. CONCLUSION: the use of MDCT in abdominal trauma in our service has increased the sensibility of the diagnosis, but has had no impact on outcome so far. .
OBJETIVO: avaliar se o avanço tecnológico dos aparelhos de tomografia computadorizada (TC) melhorou a acurácia e rapidez no diagnóstico dessas lesões. MÉTODOS: pacientes com lesão de intestino delgado grau>I (AAST-OIS) por trauma contuso foram identificados e suas imagens de TC analisadas por especialista. Foram analisados achados clínicos e tomográficos agrupando os pacientes em antes e após o uso da TC multislice 64 canais, incorporada em nosso Serviço em abril de 2009. RESULTADOS: Dentre os 26 pacientes identificados entre 2005 e 2012, 16 realizaram TC. Acidente automobilístico (62,5%) foi o principal mecanismo de trauma. No período pré-multislice, cinco dentre 13 pacientes (38,5%) realizaram TC e no pós-multislice 11 de 13 (84,6%). No grupo pré-multislice todos os exames foram alterados, sendo os principais achados pneumoperitônio (60%), liquido livre (40%) e espessamento da parede intestinal (20%). No grupo pós-multislice apenas um exame foi considerado normal e os achados mais frequentes nos outros 10 casos foram: líquido livre (90,9%), espessamento da gordura do mesentério (72,7%) e pneumoperitônio (54,5%). Não foi observada mudança no intervalo de tempo entre a realização de TC e a laparotomia. A mortalidade em ambos os grupos foi semelhante (20% no pré-multislice e 18,2% no pós-multislice). CONCLUSÃO: O uso de tomografia multislice aumentou a sensibilidade do diagnóstico, porém sem alteração na evolução dos pacientes. .
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Íleo/lesões , Íleo , Jejuno/lesões , Jejuno , Tomografia Computadorizada Multidetectores , Traumatismo Múltiplo , Ferimentos não PenetrantesRESUMO
Percutaneous iliosacral screw fixation is a useful technique for fixation of posterior pelvis ring injuries but it has potential complications. We describe a surgical technique modification of the original technique described by Routt etal. Using the surface of the C-arm as a guide in the inlet and outlet views, exact positioning of the guide wire is easier and surgical time as radiation exposure are decreased. We hope that this modification, in addition to a better understanding of sacral anatomical variations and risk factors for misplacement of iliosacral screws would reduce complications related to this procedure.
La fijación percutánea con tornillos sacroilíacos es una técnica de utilidad demostrada para la fijación de las fracturas de la pelvis posterior, sin embargo, no está exenta de riesgos. Describimos una modificación de la técnica quirúrgica original descrita por Routt et al. Utilizando las superficies del fluoroscopio como referencia en las vistas inlet y outlet, se facilita la orientación de la aguja guía disminuyendo el tiempo operatorio y el tiempo de radiación necesaria para la colocación de este tipo de osteosíntesis. Esperamos que esta modificación, asociado a un mejor conocimiento de la anatomía del sacro y los factores asociados a mal posición de los tornillos sacroilíacos permita disminuir los riesgos asociados a este procedimiento.
Assuntos
Humanos , Parafusos Ósseos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Ossos Pélvicos/lesões , Fluoroscopia , Íleo/cirurgia , Íleo/lesões , Modelos Biológicos , Sacro/cirurgia , Sacro/lesõesRESUMO
Body packing is one method of smuggling cannabis across international borders. The practice is prevalent in Jamaica. There has been one reported death from this practice in medical literature. We report a second fatal case of cannabis body packing, reinforcing the dangerous nature of this practice.
Assuntos
Cannabis , Colo Sigmoide/lesões , Crime , Embalagem de Medicamentos , Perfuração Intestinal/etiologia , Viagem , Abscesso Abdominal/etiologia , Abscesso Abdominal/patologia , Abscesso Abdominal/cirurgia , Colectomia , Colo Sigmoide/patologia , Colo Sigmoide/cirurgia , Evolução Fatal , Feminino , Humanos , Íleo/lesões , Íleo/patologia , Íleo/cirurgia , Perfuração Intestinal/patologia , Pessoa de Meia-Idade , Sepse/etiologia , Bexiga Urinária/lesões , Bexiga Urinária/patologia , Bexiga Urinária/cirurgiaRESUMO
Indoor wounds in infants probably represent widest range of minor lesions. However, there are casualties as consequence of falls, burns and ingestion of foreign bodies. Intestinal rupture due to ingested magnetic device is a very unusual event. We report the case of a four-month old female patient with this complication is presented. During first laparotomy intestinal rupture and magnetic buttons of cellular telephone as causal agent was found. Three days after operation, she required a second look due to cecum rupture. Primary reparation was performed. In order to demonstrate a pathogenic hypothesis, the bottom was put in a porcine bowel segment surrounding for a metallic jail, resulting in bowel rupture. We concluded that the ingested magnetic devices can produce intestinal rupture.
Assuntos
Corpos Estranhos/complicações , Íleo/lesões , Ingestão de Alimentos , Feminino , Humanos , Lactente , Fenômenos Magnéticos , Ruptura/etiologiaRESUMO
Meckel's diverticulum (MD) is a congenital disorder that results from an incomplete obliteration of the vitelline duct. MD may give rise to bleeding, intestinal obstruction and inflammation; however its perforation by a foreign body is an extremely rare life-threatening complication. We report on a 52 years-old Brazilian Amazon man presenting symptoms and signs of acute abdomen with an initial suspicion of acute appendicitis. However, the right diagnosis was made only during exploratory laparotomy when the appendix was found to be normal, whereas MD was found to be inflamed and perforated by a chicken bone. The patient was treated successfully with resection of a segment of the ileum, including the perforated diverticulum, and had an uncomplicated postoperative course.
Assuntos
Apendicite/diagnóstico , Doenças do Íleo/etiologia , Íleo/lesões , Perfuração Intestinal/etiologia , Divertículo Ileal/diagnóstico por imagem , Dor Abdominal/etiologia , Animais , Osso e Ossos , Galinhas , Diagnóstico Diferencial , Humanos , Doenças do Íleo/cirurgia , Perfuração Intestinal/cirurgia , Laparotomia , Masculino , Carne/efeitos adversos , Divertículo Ileal/cirurgia , Pessoa de Meia-Idade , RadiografiaRESUMO
PURPOSE: To study the effect of protein malnutrition on the intestinal wall of rats by evaluating alterations in the rupture force and dosing tissue collagen in the ileum and distal colon. METHODS: One hundred and twenty rats, that had an average weight of 100g, were used. They received water and a standard diet with 20 percent protein during 7 days for adaptation to the diet itself and to environmental conditions. After that period, the animals were randomly distributed in two groups of 60 rats each: Group 1 - the animals received a control diet with 20 percent casein for 21 days; Group 2 - hypoprotein diet with 2 percent casein for 21 days. After the adaptation period, 12 animals of each group were sacrificed at 5 moments: the beginning of experimental period (M0), 4° day (M1), 7° day (M2), 14° day (M3) and 21° day (M4). The diet to the other rats was maintained until the last sacrifice. The following variables were evaluated: body weight, blood albumin rate, tissue's hydroxyproline, hydroxyproline/total protein ratio and rupture strength in the intestinal wall of the ileum and the distal colon. RESULTS: It was observed that the rupture strength in the ileum segment and distal colon was lower in malnourished animals (Group 2); the loss of mechanical resistance was higher in the distal colon segment than in the ileum probably due to the smaller concentration of tissue collagen in the distal colon. CONCLUSION: Protein malnutrition induces the loss of mechanical resistance of the ileum and distal colon and may be associated with a smaller percentage of collagenous tissue formation in the intestinal wall.
OBJETIVO: Avaliar o efeito da desnutrição protéica na parede intestinal do rato através da medida de força de ruptura e dosagem do colágeno tecidual no íleo e cólon distal. MÉTODOS: Foram utilizados 120 ratos, pesando em média 100g, que receberam durante 07 dias uma dieta padrão, contendo 20 por cento de caseína para adaptação dos animais as condições do biotério. Após esse período os animais foram divididos em dois grupos de 60, o controle denominado grupo um que recebeu a dieta padrão, e o grupo teste denominado grupo dois, que recebeu dieta hipoprotéica contendo 2 por cento de caseína. Os dois grupos receberam suas respectivas dietas por um período de 21 dias. Após esse período iniciou-se o sacrifício seqüencial dos animais em ambos os grupos, em número de 12 animais em cada momento, correspondendo ao dia Zero (MO), 4º dia (M1), 7º dia (M2), 14º dia (M3), e 21º dia (M4) sendo mantida a mesma dieta até o final do sacrifício. Em cada momento foram avaliados o peso corpóreo, albumina sanguínea, hidroxiprolina tecidual, relação hidroxiprolina/proteína tecidual e a força de ruptura no segmento ileal e cólico dos animais. RESULTADOS: Observou-se que a força de ruptura do segmento ileal e do cólon distal foi menor nos animais desnutridos (Grupo 2). A perda da resistência mecânica foi maior no segmento do cólon distal do que no segmento ileal, provavelmente pela menor concentração do colágeno tecidual no cólon distal. CONCLUSÃO: A desnutrição protéica induz a diminuição da resistência mecânica no íleo e no cólon distal associado a diminuição do colágeno tecidual na parede intestinal.
Assuntos
Animais , Ratos , Colágeno/análise , Colo/metabolismo , Íleo/metabolismo , Mucosa Intestinal/metabolismo , Desnutrição Proteico-Calórica/metabolismo , Resistência à Tração/fisiologia , Peso Corporal , Colo/lesões , Colo/fisiopatologia , Hidroxiprolina/análise , Íleo/lesões , Íleo/fisiopatologia , Mucosa Intestinal/química , Mucosa Intestinal/fisiopatologia , Desnutrição Proteico-Calórica/fisiopatologia , Proteínas/análise , Distribuição Aleatória , Ratos Wistar , Ruptura/fisiopatologia , Albumina Sérica/análise , Fatores de TempoRESUMO
PURPOSE: To study the effect of protein malnutrition on the intestinal wall of rats by evaluating alterations in the rupture force and dosing tissue collagen in the ileum and distal colon. METHODS: One hundred and twenty rats, that had an average weight of 100g, were used. They received water and a standard diet with 20% protein during 7 days for adaptation to the diet itself and to environmental conditions. After that period, the animals were randomly distributed in two groups of 60 rats each: Group 1 - the animals received a control diet with 20% casein for 21 days; Group 2 - hypoprotein diet with 2% casein for 21 days. After the adaptation period, 12 animals of each group were sacrificed at 5 moments: the beginning of experimental period (M0), 4 degrees day (M1), 7 degrees day (M2), 14 degrees day (M3) and 21 degrees day (M4). The diet to the other rats was maintained until the last sacrifice. The following variables were evaluated: body weight, blood albumin rate, tissue's hydroxyproline, hydroxyproline/total protein ratio and rupture strength in the intestinal wall of the ileum and the distal colon. RESULTS: It was observed that the rupture strength in the ileum segment and distal colon was lower in malnourished animals (Group 2); the loss of mechanical resistance was higher in the distal colon segment than in the ileum probably due to the smaller concentration of tissue collagen in the distal colon. CONCLUSION: Protein malnutrition induces the loss of mechanical resistance of the ileum and distal colon and may be associated with a smaller percentage of collagenous tissue formation in the intestinal wall.
Assuntos
Colágeno/análise , Colo/metabolismo , Íleo/metabolismo , Mucosa Intestinal/metabolismo , Desnutrição Proteico-Calórica/metabolismo , Resistência à Tração/fisiologia , Animais , Peso Corporal , Colo/lesões , Colo/fisiopatologia , Hidroxiprolina/análise , Íleo/lesões , Íleo/fisiopatologia , Mucosa Intestinal/química , Mucosa Intestinal/fisiopatologia , Desnutrição Proteico-Calórica/fisiopatologia , Proteínas/análise , Distribuição Aleatória , Ratos , Ratos Wistar , Ruptura/fisiopatologia , Albumina Sérica/análise , Fatores de TempoRESUMO
PURPOSE: The objective of this study was to compare patients with "isolated" blunt small bowel injury (SBI) to patients with multiple intra-abdominal injuries and analyze whether delayed laparotomy affected outcome. METHODS: Medical records of patients that suffered a blunt SBI between 1994 and 2005 were reviewed. The patients were divided into two groups: those with isolated SBI and those with other associated intra-abdominal injuries ("non-isolated"). The method of diagnosis, time to operation, small bowel Organ Injury Scale (OIS) assessment (grade >or= 2), injury severity score (ISS), morbidity, and mortality were analyzed. RESULTS: A total of 90 patients met the inclusion criteria, including 62 (68.9%) isolated cases and 28 (31.1%) non-isolated cases. Isolated cases required more supplementary diagnostic methods than the non-isolated cases. Non-isolated cases had a shorter diagnosis to treatment period (p < .01) and a higher ISS (mean 22.5 vs. 17.2 in "isolated" group). Morbidity (51.6% and 53.6%) and mortality (16.1% and 28.6%) did not differ significantly between the isolated and non-isolated groups. Delays in diagnosis were common in the isolated group, but this did not affect outcome. Patients with associated injuries, and higher ISS, had higher mortality. CONCLUSIONS: The presence of associated intra-abdominal injuries significantly affected the presentation and time to diagnosis of patients with SBI, but not morbidity or mortality. Delayed surgical treatment in the isolated cases was not associated with an increased incidence of complications. Patients inflicted with more severe associated injuries were less likely to survive the trauma.
Assuntos
Traumatismos Abdominais/complicações , Íleo/lesões , Jejuno/lesões , Ferimentos não Penetrantes/complicações , Traumatismos Abdominais/mortalidade , Traumatismos Abdominais/cirurgia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Íleo/cirurgia , Jejuno/cirurgia , Laparotomia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Índices de Gravidade do Trauma , Ferimentos não Penetrantes/mortalidade , Ferimentos não Penetrantes/cirurgia , Adulto JovemRESUMO
PURPOSE: The objective of this study was to compare patients with "isolated" blunt small bowel injury (SBI) to patients with multiple intra-abdominal injuries and analyze whether delayed laparotomy affected outcome. METHODS: Medical records of patients that suffered a blunt SBI between 1994 and 2005 were reviewed. The patients were divided into two groups: those with isolated SBI and those with other associated intra-abdominal injuries ("non-isolated"). The method of diagnosis, time to operation, small bowel Organ Injury Scale (OIS) assessment (grade > 2), injury severity score (ISS), morbidity, and mortality were analyzed. RESULTS: A total of 90 patients met the inclusion criteria, including 62 (68.9 percent) isolated cases and 28 (31.1 percent) non-isolated cases. Isolated cases required more supplementary diagnostic methods than the non-isolated cases. Non-isolated cases had a shorter diagnosis to treatment period (p < .01) and a higher ISS (mean 22.5 vs. 17.2 in "isolated" group). Morbidity (51.6 percent and 53.6 percent) and mortality (16.1 percent and 28.6 percent) did not differ significantly between the isolated and non-isolated groups. Delays in diagnosis were common in the isolated group, but this did not affect outcome. Patients with associated injuries, and higher ISS, had higher mortality. CONCLUSIONS: The presence of associated intra-abdominal injuries significantly affected the presentation and time to diagnosis of patients with SBI, but not morbidity or mortality. Delayed surgical treatment in the isolated cases was not associated with an increased incidence of complications. Patients inflicted with more severe associated injuries were less likely to survive the trauma.
OBJETIVO: Comparar pacientes com lesão "isolada" de intestino delgado com pacientes com lesões abdominais "associadas" e analisar o quanto o retardo para indicação de laparotomia influenciou na evolução dos pacientes. MÉTODOS: Foram revisados os prontuários de pacientes com trauma abdominal fechado e lesão de intestino delgado no período de 1994 a 2005, sendo os pacientes divididos em dois grupos: lesão "isolada" e lesões abdominais "associadas". Foram analisados os métodos diagnósticos, intervalo de tempo para a cirurgia, gravidade da lesão de delgado (grau > 2), ISS e morbimortalidade dos pacientes. RESULTADOS: Noventa pacientes preencheram os critérios de inclusão, 62 (68,9 por cento) no grupo "isolada" e 28 (31,1 por cento) no "associada". Pacientes do grupo "isolada" necessitaram mais de métodos diagnósticos complementares. O tempo de diagnóstico até o tratamento foi significantemente menor no grupo "associada", e estes pacientes apresentavam ISS mais elevado (média de 22,5 versus 17,2 no grupo "isolada"). A morbidade e mortalidade nos grupos foram, respectivamente, 51,6 por cento e 16,1 por cento no grupo "isolada", e 53,6 por cento e 28,6 por cento no "associada", sem diferença estatística. Demora para o diagnóstico foi comum no grupo "isolada", porém sem agravar a evolução dos pacientes. Pacientes com lesões "associadas", quantificadas pelo ISS, tiveram maior mortalidade. CONCLUSÃO: A presença de lesões abdominais "associadas" significativamente interferiu no quadro clínico e momento do diagnóstico em pacientes com lesão de delgado, porém não influenciou na morbimortalidade. No grupo "isolada" a demora para tratamento cirúrgico foi freqüente, porém sem interferir nas complicações. A elevada mortalidade foi reflexo da gravidade de lesões associadas.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Traumatismos Abdominais/complicações , Íleo/lesões , Jejuno/lesões , Ferimentos não Penetrantes/complicações , Traumatismos Abdominais/mortalidade , Traumatismos Abdominais/cirurgia , Estudos de Casos e Controles , Íleo/cirurgia , Jejuno/cirurgia , Laparotomia , Estudos Retrospectivos , Fatores de Tempo , Índices de Gravidade do Trauma , Ferimentos não Penetrantes/mortalidade , Ferimentos não Penetrantes/cirurgia , Adulto JovemRESUMO
Intestinal ischemia/reperfusion (I/R) may induce bacterial translocation (BT). Glutamine (GLN)-enriched nutrition decreases BT. However, little is known about the effect of glucan (GL) in BT. This study investigated the combined effect of GL/GLN on BT, intestinal damage, and portal blood cytokines in animals under I/R. Four groups of 10 rats each were subjected to 60 min of intestinal ischemia and 120 min of reperfusion. The control group (group 1) received only rat food/water, group 2 received glutamine via gavage, group 3 received subcutaneuos soluble (1, 3)-d-glucan, and group 4 received GL + GLN. A sham group (group 5) served as a normal control. Bacterial cultures of ileum, mesenteric lymph nodes (MLN), liver and lung biopsies, histological changes of ileum, and serum cytokines variables were examined after I/R. Data were analyzed by analysis of variance (ANOVA) and the Newman-Keuls test. Results showed that GLN, GL, and GL/GLN significantly reduced BT to MLN, liver, and lung. BT was more attenuated after GL treatment than GLN (P < .05). Rats treated with both GL and GLN exhibited lower bacterial colony counts than the ones treated only with GLN or GL. Severe mucosal damage on histological findings was shown in group 1, but these findings were significantly ameliorated (P < .05) in groups 3 and 4. Tumor necrosis factor (TNF)-a and interleukin (IL)-6 levels in portal serum were significantly reduced and IL-10 was increased by GL and GLN treatment. In conclusion, the use of GL was more effective than GLN in reducing BT, intestinal damage, and cytokine levels after I/R. Additionally, the combination of GL and GLN improved results.
Assuntos
Glucanos/farmacologia , Glutamina/farmacologia , Íleo/irrigação sanguínea , Íleo/lesões , Traumatismo por Reperfusão/tratamento farmacológico , Traumatismo por Reperfusão/microbiologia , Animais , Citocinas/sangue , Enterobacteriaceae/isolamento & purificação , Íleo/efeitos dos fármacos , Íleo/microbiologia , Masculino , Ratos , Ratos Wistar , Traumatismo por Reperfusão/patologiaAssuntos
Íleo/lesões , Perfuração Intestinal/etiologia , Laparoscópios , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Polipropilenos , Complicações Pós-Operatórias/etiologia , Implantação de Prótese , Telas Cirúrgicas , Incontinência Urinária por Estresse/cirurgia , Idoso , Remoção de Dispositivo , Feminino , Humanos , Íleo/cirurgia , Agulhas , Retocele/cirurgia , Reoperação , Aderências Teciduais , Doenças da Bexiga Urinária/cirurgiaRESUMO
A 51-year-old woman with a history of stone disease sustained two 3 x 2-mm ileal perforations during SWL (6000 shockwaves; 0.33-0.42 mJ/mm2) for a 14 x 8-mm left-sided midureteral stone. Low energy levels should be applied when ureteral stones are treated by SWL with the patient prone.
Assuntos
Íleo/lesões , Perfuração Intestinal/etiologia , Litotripsia/efeitos adversos , Cálculos Ureterais/terapia , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Jejunostomy is widely acknowledged in the literature as a means for enteral nutrition. Complication rates range from 16% to 46% for the classical open technique and from 11% to 70% for the several mini-invasive techniques currently in use, including the laparoscopic techniques. The most probable complications are abscess, intestinal obstruction, abdominal wall infection, intraperitoneal leakage, enterocutaneous fistula, and loss, elbowing, or even rupture of the enteral probe. The authors report the case of a patient with severe malnutrition concomitant with advanced gastric cancer who underwent jejunostomy because of an incapacity for normal oral feeding. Previous attempts to pass a nasal enteral probe were not successful, even with the aid of endoscopy. Videolaparoscopy was indicated for adequate staging of the neoplasm and for performance of video-assisted jejunostomy. During the procedure, an extensive carcinomatous process was observed that rendered comprehension of the abdominal anatomy extremely difficult. Consequently, while attempting jejunal catheterization, unintentional catheterization of the terminal ileum took place. The authors discuss this first reported case of unintentional ileostomy and review the literature.
Assuntos
Nutrição Enteral/efeitos adversos , Íleo/lesões , Complicações Intraoperatórias , Laparoscopia/efeitos adversos , Idoso , Evolução Fatal , Feminino , Humanos , Laparoscopia/métodos , Masculino , Cirurgia VídeoassistidaRESUMO
Os autores estudaram 31 crianças portadoras de ruptura do jejuno-íleo, por contusäo, tratadas no Hospital Joäo XXIII, em 10 anos. Houve prevalência do sexo masculino 25 (80 por cento). Acidentes de trânsito foram as causas das lesöes em 14 (51,8 por cento). A indicaçäo de laparotomia foi feita exclusivamente pela clínica, em 15 (48,5 por cento), em 9 (29 por cento) pela clínica e radiologia e 7 (22,5 por cento) pelo lavado peritoneal. Lesäo isolada ocorreu em 27 casos (87,1 por cento). A lesäo ocorreu no jejuno proximal em 20 casos, íleo terminal em 10 e ambos em um caso. Em 14 casos (45,1 por cento), a operaçäo foi realizada nas primeiras seis horas, em cinco casos (16,1 por cento) entre 7 e 12 horas e em 11 casos (35,4 por cento) mais de 12 horas. O tempo entre a lesäo e a cirurgia näo modificou a conduta, ou seja, em todos os pacientes foi feita correçäo primária da lesäo (sutura e/ou anastomose). Houve um óbito (3,2 por cento) consequente à lesäo associada de fígado, veia cava e hepática direita.