Theses / Dissertations 2014

 

MASTER

Author: Christian Lamar Scheibe
Original Title: Schinus terebinthifolius raddi (Aroeira) and Orbignya phalerata mart. (Babassu) effect in cecorrahphy healing in rats

Background: The healing consists in a perfect and coordinated cascade of cellular and molecular events (phases) interacting with objective of restoring damaged tissue. The medicinal plants use in the healing of cecum injuries, as well as others tissues and organs, has been showed in many experimental studies. Objective: To evaluate the effect of Schinus terebinthifolius Raddi (aroeira) and Orbignya phalerata Mart. (babassu) in the healing process of cecorraphies in rats. Material and Methods: Fifty four rats, adults, male were divided into three groups randomly: aroeira, babassu and control, which were divided into three subgroups of six animals according to the time of the deaths (7, 14 and 21 days). All underwent the same surgical procedure cecostomy and cecorraphy differing only to the animals in group aroeira and babassu that received a daily dose of 100 mg/kg of hydroalcoholic extract and 50 mg/kg of aquous extract, by gavage, while the control group received normal saline. The parameters evaluated were: macroscopic changes, test of resistance to air insufflations and histological changes. In all tests the level of statistical significance (α) was 5%. Results: All animals showed good healing without infection. All groups present adhesions between cecum and neighboring organs. The resistance test by insufflations of atmospheric air showed progressive increase of pressure means according to the days in the aroeira group and decrease in babassu group, without reveal significant difference. Concerning the microscopy, showed significant difference in the polymorphonuclears, hyperemia, angiogenesis, fibroblast proliferation and collagen histological variables in the 14º day. Conclusion: Against the macroscopic analysis, the aroeira and babassu groups, didn’t favor the cicatricial process. Concerning the tensiometric analysis, as far as the rupture area, the aroeira group in the 21º day, showed better healing with significant difference. Among the histological analysis, could be inferred that in the 14º day the babassu group showed better healing in the polymorphonuclear and hyperemia variables  (acute inflammatory process) and the aroeira group in the angiogenesis, fibroblast proliferation and collagen variables (chronic inflammatory process).

Download File

 Artigo: http://www.ncbi.nlm.nih.gov/pubmed/27355748

 

 

 

Author: Letícia Elizabeth Augustin Czeczko Rutz
Original Title: Correlation between pre and postoperative upper digestive endoscopy in patients who underwent roux-en-y gastrojejunal bypass

Introduction: Obesity is an increasing comorbidity worldwide and leads to a significant increase in morbidity and mortality. Searching for a treatment bariatric surgeries are currently performed, particularly Roux-en-Y gastric bypass. Study and correlate the pre and postoperative Roux-en-Y gastric bypass is critical to optimize the conduct and follow-up of bariatric patients. Objectives: To evaluate a sample of obese patients undergoing Roux-en-Y gastric bypass studying: age, sex, preoperative body mass index, dyslipidemia, diabetes / impaired glucose tolerance and correlate the findings of pre and postoperative upper digestive endoscopy Methods: 110 patients that underwent Roux-en-Y gastric bypass of January 2011 to June 2012 were evalueted. Inclusion criteria were: formal statement bariatric surgery, have pre and postoperative upper digestive endoscopy. Exclusion criteria were: patients undergoing bariatric surgery previously , undergoing other types of bariatric surgery, who did not possess endoscopy pre or postoperative. Endoscopy was routinely performed preoperatively and were required postoperatively when there were symptoms or one year after surgery in asymptomatic patients. Results: Woman were prevalent in 73.6% of the sample, the mean age was 37.3 years and the body mass index was 40.3 kg / m2. Diabetes / impaired glucose tolerance was diagnosed in 38.2% (n = 42) and patients with dyslipidemia were found in 53.6% (n = 59) of patients. The preoperative upper digestive endoscopy was normal in 26.4% (n = 29) patients, among endoscopic alterations found the hiatal hernia was the most prevalent with 32.7% (n = 36) of the sample, followed by non-erosive gastritis 27.3% (n = 30). The postoperative upper digestive endoscopy was normal in 40.9% (n = 45) of patients, and among endoscopic alterations stenosis was the most prevalent in 35.5% (n = 39) of the sample, followed by the marginal ulcer with 8.2 % (n = 9). Correlating the pre and postoperative upper digetstive endoscopy  a reduction of 100% of hiatus hérnias and 88% of esophagitis was found. Conclusions: The correlation between pre and postoperative endoscopic findings indicated the significant decrease of hiatal hernia, erosive esophagitis, non-erosive esophagitis, erosive gastritis and non-erosive gastritis. Stenosis of the gastrojejunostomy was the most prevalent postoperative complications in patients without significant correlation with preoperative variables: age, sex, body mass index, dyslipidemia, type 2 diabetes mellitus or impaired glucose tolerance, erosive esophagitis, non-erosive esophagitis, erosive gastrites and non-erosive gastritis.

Download File

 Artigo: https://www.ncbi.nlm.nih.gov/pubmed/27120737

 

 

Author: Paola Zarur Varella
Original Title: Study of contaminated meshes in correction of ventral abdominal wall defect in wistar rats

Introduction: The incisional hernia is a common complication of abdominal surgery. Surgical treatment has reasonable recurrence rates. The use of prostheses is a consensus. What is not defined is how the best prostheses for use in contaminated surgical sites. Objective: Determine whether there are differences between Marlex® mesh and Dynamesh PP-Light® in the abdominal wall defect correction of rats, in contaminated surgical site. Material and Method: 28 rats divided into two groups of 14 animals anf four groups of 7 animals, euthanized at 7nd and 14nd days for evaluation. All subgroups underwent similar surgical procedure defective production in the ventral abdominal wall while maintaining the integrity of the parietal peritoneum. A subgroup received the Marlex® mesh and the other to Dynamesh PP-Light® to correct the defect. Before being deployed, the meshes passed a contamination process, which used a standard solution containing 108 UFC of Escherichia coli. Fragments of abdominal wall of the animals were submitted to macroscopic, microscopic and microbiological analysis. Results: in Marlex-7 subgroups and Dynamesh-7 there were an animal with wound necrosis, an abscess and two seromas in each subgroup. In Marlex-14 subgroup there was an abscess and Dynamesh-14 subgroup, one dehiscence of the surgical wound and abscess. There was no statistical significance in the analysis of the macroscopic variables. The inflammation score was intense in all subgroups. The foreign body reaction was mild in all subgroups except Dynamesh-14 which was moderate, with no statistical significance. Microbiological testing of the screens was also similar between the groups, with p = 1. Conclusion: in this study there was no difference between the meshes of Marlex® and Dynamesh PP-Light® in the defect correction in the ventral abdominal wall of rats, in contaminated surgical site.

Download File

Artigo: https://www.ncbi.nlm.nih.gov/pubmed/27828602

 

 

Author: Liz Ribeiro Wallim
Original Title: Study on the integrity of the aparently sound skin of patients with eritematosous lupus. manose lighting lectin paper

Introduction: Mannose binding lectin (MBL) disfunction and the presence in the tissues have been linked to predisposition to systemic lupus erythematosus (SLE) and to disease activity. Some studies found deposits of MBL in glomerular tissue of patients with lupus nephritis but there is no research about the participation of MBL in skin disease. Objective: to study the existence of traces of complement and MBL in the skin with lesion and in the skin without lesion on patients with SLE and DLE. Cases and Methods: Skin biopsies from lesional and non lesional skin of 4 discoid lupus erythematosus (DLE) and 10 SLE patients were submitted to immunofluorescence staining for IgG, IgA, IgM, C3, C4, C1q, C5b-9 and MBL. Charts were reviewed for demographic, clinical and serological data. Patients with SLE had disease activity measured in the same day of the biopsy by SLEDAI score. Results: MBL was found only in SLE lesional skin and its presence showed an association trend towards higher disease activity. Deposition of C5b-9 occurred in vessels only in patients with SLE (70%), being stronger in the patients with kidney disease. Conclusions: MBL deposition was found in the lesional skin of SLE patients but not in SLE non lesional skin nor in DLE patients.

Download File

Artigo: https://www.ncbi.nlm.nih.gov/pubmed/?term=liz+ribeiro+wallim

 

 

Author: Luis Eduardo Durães Barboza
Original Title: Holmium Laser enucleation of the prostate (HoLEP) versus Transurethral Resection of the Prostate (TURP)

INTRODUCTION: Benign prostatic hyperplasia is one of the most frequent diseases in men. Many ways of surgical treatment have been developed. Transurethral resection of the prostate remains as the gold standard and Holmium laser enucleation of the prostate appears as an alternative with lower morbidity. OBJECTIVE:  Evaluate wound healing caractheristics, effectiveness and applicability of Holmium laser enucleation of the prostate (HoLEP) comparing it to Transurethral resection of the prostate (TURP). PATIENTS AND METHODS: Patients with symptomatic BPH and candidates for surgical treatment were selected. Both procedures were explained and they had choosen HoLEP or TURP. At hospital stay were collected: age, date of birth, international prostate symptom score (IPSS), peak urinary flow rate, prostate volume, post-voiding residual urine, GV and serum PSA. At the procedure: operating time, morcellating time (HoLEP), bladder mucosal injury and intercorrences. At the first day postoperative: GV and sodium. Besides that: catheter indwelling time and hospital stay. After 90 days, peak urinary flow rate and IPSS. Statistical analisys have been done partially by Sinpe® and also by a professional team. RESULTS: From June 2011 to May 2012 were operated 20 patients in HoLEP group and 21 at TURP. Baseline  peak urinary flow rate (8 ml/s in both groups) and preoperative IPSS (22 -HoLEP and 20 -RTUp) were very similar. Operating time, 85 minutes at HoLEP and 60 minutes at TURP, p<0.05. Hospital stay was 47 hours for HoLEP and 48 hours to TURP, p<0.05. At 90 day assessing peak urinary flow rate has raised to 21,5 ml/s in HoLEP group and to 20 ml/s in TURP and the median of IPSS has reduced to three in both groups. CONCLUSION: HoLEP is  an effective technique on BPH surgical treatment and has outcomes – considering wound healing, efficacy and feasibility – comparable to TURP.

Download File

Artigo: https://www.ncbi.nlm.nih.gov/pubmed/?term=Luis+Eduardo+Dur%C3%A3es+Barboza

 

 

Author: Adham do Amaral e Castro
Original Title: Use of ultrasonography to study the prevalence of carpal tunnel syndrome before and after bariatric surgical treatment

INTRODUCTION: The carpal tunnel syndrome (STC) is the most common entrapment neuropathy and the obesity is one of its risk factors. Its diagnosis is predominantly clinical, but the ultrasonography (US) is an important diagnostic tool in this context, highlighting its rapidity and low cost. The calculation of the cross sectional area of the median nerve (ANM) is the most important diagnostic criteria for STC when using the US. OBJECTIVES: To study the prevalence of STC in candidates for bariatric surgery comparing it with the non-obese population. To study the influence of bariatric treatment in the prevalence of STC. METHODS: The study was conducted at the bariatric and metabolic surgery ambulatory and at the image sector of the Curitiba University Evangelic Hospital. Three groups of individuals were studied: individuals with bariatric surgery indication (preoperative); individuals already undergoing the banded Roux-en-Y gastric bypass (postoperative); and a control group (non obese patients). In the 3 groups was collected: demographic and anthropometric data, comorbidities, clinical data regarding STC (pain and paresthesia in the median nerve distribution ; Phalen and Tinel maneuvers). We also applied the Boston carpal tunnel questionnaire (BCTQ), which constitutes a specific questionnaire of the evaluation of the STC. Measurement of ANM was done by US and considered suggestive of STC when greater or equal to 9mm2. RESULTS: we included 329 individual: 114 patients in the preoperative group, 90 patients in the postoperative group and 125 controls. We observed higher prevalence of STC diagnosed by US between the pre operative and control groups (p<0.00001) with no significant difference in the prevalence of STC between the pre and post operative groups. It was found significant difference between the preoperative and postoperative groups (p=0.05) in those who performed non-manual work. There was an association of postoperative days and value of ANM (p=0.014) and postoperative days and the presence of STC (p=0.03). CONCLUSION: There was a higher prevalence of STC among individuals of the preoperative group compared to the control. No significant difference in prevalence was observed when comparing the pre and postoperative group.

Download File

Artigo: https://www.ncbi.nlm.nih.gov/pubmed/25742409

 

 

 

Author: Sebastião Vieira de Morais
Original Title: Osteoarthritis model induced by intra-articular monosodium iodoacetate in the knee of rats

Introduction: Osteoarthritis is the most common chronic disease in elderly patients. There is an imbalance between the formation and resorption of the components of the joint, the most common symptom is pain. Nowadays, the treatment of this disease is limited to the use of analgesics. In the experimental field, the study of pain in osteoarthritis using animals as models has led to great frustration because huge gains in science knowledge obtained from animal experiments do not lead to development of effective new clinical compounds. monosodium iodoacetate when injected intra-articular inhibits glycolysis and destroys the chondrocytes, for it is already being used as an experimental model reproducing the characteristics of human osteoarthritis. Objectives: Studying an experimental model of osteoarthritis in the knees of rats by inducing intra articular monosodium iodoacetate, evaluating disability and joint pain through clinical trials, radiological changes of the knee joint that occur during the development of osteoarthritis and microscopic changes of the synovial membrane. Material and Method: During the study, we evaluated 48 rats divided into two groups randomly. After general anesthesia, the first group of animals received 0.9% saline in the joint and served as control. The other was subjected to experimental osteoarthritis of the right knee joint to induce intra monosodium iodoacetate. All animals were subjected to comparative tests of forced ambulation, inability to articulate and tactile allodynia on day 1 of the experiment. Following induction of osteoarthritis were divided into subgroups of 6 tests were repeated on days: 7, 14, 21 and 28 and these same days were euthanized still being subjected to radiographic examination of the knee joints, arthrotomy and collection of synovial membrane to study microscopic. Results: Animals receiving monosodium iodoacetate intra-articular showed significant differences when compared to the control group in the day 7:14 in rotarod. In the past two weeks showed similar marches. In weight bearing and Von Frey tests there were significant pain behavioral changes in all the days that were evaluated. In radiological evaluation, after the 14th day, important osteoarthritic changes with significant differences were presented. Microscopic examination of the synovial membrane showed abnormalities of inflammatory character at all stages. Conclusion: Monosodium iodoacetate injected intra-articular in mice causes knee osteoarthritis, evolving with changes in motion of the joint (Rotarod test and Weight Bering) and tactile allodynia (von Frey test) evaluated in steps, with radiologically significant degeneration and progressive from the second week and microscopic inflammation of the synovial membrane in the study period.

Download File

Artigo: https://www.ncbi.nlm.nih.gov/pubmed/27982265

 

 

Author: Cícero Evandro Soares Silva
Original Title: Effect of Carapa guianensis Aublet (Andiroba) and Orbignya phalerata (Babassu) in colonic healing in rats

OBJECTIVE: to evaluate the healing effect of the babassu aqueous extract and andiroba oil on open wounds in the cecum of rats. METHODS: fifty-four Wistar rats were divided into three groups of 18: 1) babassu group with application of aqueous extract of babassu; 2) andiroba group with application of the oil; and 3) control group, with application of saline solution. All procedures were done by gavage. Each group was divided into three subgroups of six animals according to the observation period of 7, 14 or 21 days. From each animal was removed caecum fragment of 1.5cm² diameter. The areas of the lesions were analyzed macroscopically and resected specimens by light microscopy using hematoxylin-eosin and Masson's trichrome. RESULTS: abscess and infection were observed in two aroeira group animals, and in one only hematoma. In relationship to adhesions degree, babassu group had higher incidence of grade II while in the control and aroeira groups predominated adhesions grade I. On microscopic examination on day 7 fibroblast proliferation was greater in aroeira and lower in babassu group (p=0.028). On the 14th day polymorphonuclear were less pronounced in babassu (p=0.007). As for the resistance test of air insufflation, it was observed that in all andiroba group in all tested days showed be higher. As for collagen, on the 7th day it was present in 100% of animals of aroeira group. On the 14th day was more pronounced in the control group and at day 21 similar results were found in the control and aroeira groups. CONCLUSION: animals in babassu and andiroba groups showed better cecum healing compared to the control group.

Download File

Artigo: https://www.ncbi.nlm.nih.gov/pubmed/?term=C%C3%ADcero+Evandro+Soares+Silva

 

 

Author: Claudio Luciano Franck
Original Title: Evaluation of the intensity of fibrosis and neovascularization in second intention healings on the back of rats with human fat graft.

INTRODUCTION: The tissue injury triggers a spontaneous sequence of physiological and biochemical events, which intends to recover the organic integrity and promote tissue regeneration bound by the steps of the healing process, which were systematized in inflammatory, fibroblastic and remodeling phases. Several motivating factors lead to chronic scarring as well as to serious damage to the body, and social damage, triggering a continue search for an effective method for the recovery of the wounds. OBJECTIVE: This study aims to determine the intensity of fibrosis and neovascularization in healing processes resolved by second intention in rats subjected human fat xenografting by using immunohistochemical and histochemical methods. MATERIAL AND METHODS: In this experimental study forty rats were divided into equal number in the control group (CG) and experiment group (EG). In both groups the rats under general anesthesia underwent longitudinal incisions three centimeters long on their back two centimeters from the middle to the right side, which reached the maximum depth of the dermis line. These incisions suffered one centimeter bilateral dislocation of the skin and subcutaneous tissue, so that the edges remain apart early in the healing process. After ten days, anesthetized again, all twenty animals of GE underwent three milliliters of fat human decanted injection, below the scar tissue. After 30 days of completion of surgical incisions, the two groups were sacrificed for the resection of the scar samples. The scar tissue was prepared for microscopic evaluation by Picrosirius stain to assess differences between the groups regarding the intensity of fibrosis, and the CD34 immunohistochemical method to assess differences between the groups of neovascularization. The results of the samples of GC and GE microscopy were described by mild/moderate or moderate/severe variables by Fisher's exact test or the assessment of ordinal variables using the nonparametric Mann-Whitney. RESULTS: The considerations of microscopic evaluation of groups in relation to the intensity of fibrosis by Picrosirius staining found on GC 40% of mild/moderate fibrosis, compared with 70% in GE, but no statistical significance results by Fisher’s exact test (p=0,111), in return for the same sample, the Mann-Whitney test showed statistical significance results (p=0,009). Regarding neovascularization, the CD34 found 20% GC with moderate/severe neovascularization against 75% GE, which showed statistical significance results in both the Mann-Whitney test (p=0,001) as the Fisher’s exact test (p=0,001). CONCLUSION: The evaluation of Picrosirius revealed that in GE compared to the GC to the thirty day of healing, there was a lesser degree of fibrosis, with statistical significance results by the quantitative method, but no significance by the qualitative method. Assessment of CD34 showed that in GE compared to the GC to the thirty day of healing, there was an increase of neovascularization with a difference of statistical significance by the quantitative and qualitative methods.

Download File

 

 

 

Author: Giuliano Peixoto Campelo
Original Title: Effect of Schinus Terebinthifolius Raddi (Aroeira) and Carapa Guianensis Aublet (Andiroba) on the cicatrization process of cecorrafia in rats

Introduction: The cicatrization represents a complex phenomenon. Inappropriate reparation of the tissue may lead to severe complications, which requires studies about substances that may make this process better. Objective: Evaluating the healing effect of the hydroalcoholic extract of aroeira and the oil of andiroba in rats’ cecum. Material and Method: 54 wistar rats were submitted to suture of the cecum, and then they were distributed into 3 groups of 18 participants, called: control group, aroeira and andiroba. Each group was divided in three subgroups of 6 animals based on the moment of the death: 7, 14 e 21 days, being submitted to macroscopic analyses, resistance to insufflation test and microscopy. In the macroscopy, presence of infection, dehiscence, abscess, fistula, hematoma and adhesions were evaluated; in the resistance to insufflation test, the pressure of rupture of the cecum was measured; and in the microscopy, using the hematoxylin-eosin (HE) and Masson (TM), the presence of acute and chronic inflammatory infiltrate was evaluated, as well the density of the collagen. The level of statistical significance (α) used in all the tests was 5% (p < 0,05). Results: All the animals presented good postoperative evolution, with adequate healing of abdominal wall and cecum, with just one case of partial dehiscence of the skin and two cases of infection of the abdominal wall, represented by abscess. Only four animals didn´t present formation of adhesions. Based on the resistance to insufflation test, the mean pressure of rupture in the 7º and 21º days was bigger in the aroeira group, and in the 14º day, it was bigger in the andiroba group (p > 0,05). The histologic evaluation showed statistical differential in favor of the tested groups in the variables vascular congestion in the 14º day, and presence of mononuclear cells in the 7º day. Conclusion: The macroscopic and tensiometric evaluations didn´t present advantage in tissue reparation in the tested groups. The animals of the aroeira and andiroba groups presented better healing of the cecum, related to a presence of less congestion in the 14º day and presence of more mononuclear cells in the 7º postoperative day.

Download File

 

 

Author: Klayton Henrique Morais Ribeiro
Original Title: Patients epidemiological study of tumor stromal gastrointestinal and its expression immunohistochemistry

Introduction: Gastrointestinal stromal tumors (GIST) are derived from Cajal interstitial cells located at the level of the myenteric plexus, between longitudinal and circle muscle layer of the gastrointestinal tract. The Cajal cells are responsible for intestinal motility, being called pacemaker cells of the gastrointestinal tract. These cells have immunophenotypic features and ultra structural both smooth muscle as neural differentiation, and express the Kit receptor (CD117 or cKIT). The GIST has annual prevalence around 20-40 cases per million populations, differing among populations and an estimated annual incidence of 4-5 cases per million inhabitants. Objectives: To study epidemiologically a sample of patients with GIST and evaluation of immunohistochemical expression of tumors with cKIT markers, CD34 and S100 protein. Methods: We evaluated epidemiological data of 34 patients diagnosed with GIST and immunostaining of cKIT, CD34 and S100 protein of referred patients to define systemic cancer treatment to specialized services in oncology São Luís, Maranhão, Brazil, in the period 2006 to 2014. Results: the male sex (52.9%) and the age group of 50 to 59 years were the most frequent. Stomach observed as more location (64.7%), followed by small intestine (23.4%). Abdominal pain was the most frequent symptom (23.5%). The spindle cell prevailed as histology most frequente (94.1%) as well as tumors in size between 2 and 5 centimeters (38.2%) and non-metastatic (64.7%). When metastatic, liver was the most affected organ (32.4%). Surgical treatment was the most used (89.4%). High-risk tumors (38.2%). The positive expression in immunohistochemistry of cKIT occurred in 94.1% and was negative in 4.9%. CD34 was positive in 100%. Protein S100 negative in all patients. 82.4% of patients were alive. Conclusions: There was a higher frequency of GIST in men, the most affected age group was 50 to 59 years, stomach as the most frequent anatomical site. Abdominal pain, bleeding in the digestive tract, palpable mass and early satiety were the most common symptoms. Size between 2 and 5 cm was the most common. Localized tumors was the most common, as well as histology and spindle classified as high risk. The overall survival was 82.4%. The immunohistochemical expressions of cKIT, S100 protein and CD34 confirmed the diagnosis of GIST. The cKIT was positive in 94.1% and negative 5.9%. The CD 34 was positive in 100% of patients and S100 protein was negative in all cases.

Download File

 

 

 

Author: Antonio Machado Alencar Junior
Original Title: Analysis of the Ki-67 immunostaining and its relation with other prognostic factors in breast cancer

Introduction: the Ki-67 immunostaining have been assessed extensively as a prognostic factor in breast cancer. Although it has not been validated, many studies have demonstrated its potential. The association of Ki-67 with other prognostic factors can increase the amount of available information for a better prognostic evaluation in breast cancer patients. Objective: to evaluate the Ki-67 immunostaining in breast cancer patients and its association with age at diagnosis, size of primary tumor, nodal involviment histologic grade, estrogen receptors, progesterone receptors and HER 2. Method: in 69 breast cancer patients, we evaluated the association among high and low immunostaining Ki-67 index and the age at diagnosis, primary tumour size, nodal involvement, histologic grade, estrogen receptors, progesterone receptors and HER 2. The cutoff point used to define the groups with high and low Ki-67 immunostaining index was 20%. Results: we found 50 patients (72.5%) with Ki-67 > 20% and 19 (27.5%) with Ki-67 < 20%, 61 patients (88.4%) with age > 35 years, 49 (71%) with primary tumour > 2 cm, 32 (46.3%) with nodal involvement and 4 patients (5.8%) with distant metastasis at the time of diagnosis. Histologic grade 3 was identified in 23 (33.3%) patients, HER 2 positive in 20 (29%), RE positive in 45 (65.2%) e RP positive in 39 (56.5%) patients. Compared to the Ki-67 < 20% group, the Ki-67 > 20% group had a higher incidence of primary tumour > 2 cm (78% vs. 52.6%, P = 0.038), histologic grade 3 (42% vs. 10.5%, P = 0.0014), RE negative (42% vs. 15.8%, P= 0.0412) e HER 2 positive (36% x 10.5%, P= 0.0372). There was no statistically difference between the Ki-67< 20% and Ki-67 > 20% group considering the age at diagnosis (P = 0.2749), nodal involvement (P = 0.4249), presence of distant metastasis at diagnosis (P = 0.6458) and RP immunostaining (P = 0.0763). Conclusions: the results of this study demonstrate that the Ki-67 immunostaining is associated with size of primary tumor, histologic grade, estrogen receptors and HER 2, but not with age at diagnosis, nodal involviment and progesterone receptors.

Download File

 

 

Author: Silvia Carmen da Silva Gonçalves Tefilli
Original Title: Evaluation of fibrosis intensity and neovascularization in rat skin sutures after human fat grafting

INTRODUCTION: The search for an effective method for wound recovery stimulated the progresses in cellular and molecular biology that may lead to a great impact in the hole understanding of this process, mainly the researches with fat and steem cells. OBJECTIVE: Verify the intensity of fibrosis and neovascularization in skin sutures in rats after human fat grafting using immunohistochemical and histochemical methods. MATERIAL AND METHODS: In this experimental study forty rats were divided into equal number in the control group (GC) and experiment group (GE). The animals underwent longitudinal incisions of three centimeters long on their back, two centimeters from the middle to the left side, which reached the maximum depth of the dermis. Those incisions were closed with a continuous suture. After ten days, all animals of GE underwent three milliliters of human fat decanted injection, below the scar tissue. After 30 days, the two groups were sacrificed for the resection of the scar samples. They were prepared for microscopic evaluation by Picrosirius stain to assess differences between the groups regarding the intensity of fibrosis, and the CD34 immunohistochemical method to assess differences of neovascularization. The results of the samples of GC and GE microscopy were described by low level or high level variables by Fisher's exact test or the assessment of ordinal variables using the nonparametric Mann-Whitney. RESULTS: The considerations of microscopic evaluation in relation to the intensity of fibrosis by Picrosirius staining demonstrated on GC 55% of high level of fibrosis, compared with 25% in GE, but no statistical significance was found in both Fisher’s exact test (p=0,105) and Mann-Whitney test (p=0,077). Regarding neovascularization, the CD34 found 20% GC with high level neovascularization against 30% GE, but no statistical significance results was found in both Fisher’s exact test (p=0,716) and Mann-Whitney test (p=0,096). CONCLUSION: The evaluation of Picrosirius revealed that in GE compared to the GC to the thirty day of healing, there was a lesser degree of fibrosis, with no statistical significance results by both quantitative and qualitative method. Assessment of CD34 showed that in GE compared to the GC to the thirty day of healing, there was an increase of neovascularization with no statistical significance by the quantitative and qualitative methods.

Download File

 

 

 

DOCTORATE

Author: José Raimundo Araujo de Azevedo
Original Title: Prognostic evaluation of severe sepsis and septic shock: Clearance of Procalcitonin versus Delta Sofa

Objective: To compare the clearance of procalcitonin (PCT-c) in the first 24 and 48 hours of treatment of severe sepsis and septic shock with another early prognostic marker represented by the Δ SOFA 48 hours. Methods: Prospective, observational cohort study conducted in a general intensive care unit including patients with severe sepsis and septic shock. The clearance of procalcitonin was determined at diagnosis of sepsis and after 24 and 48 hours. The SOFA score was determined at the time of ICU admission and after 48 hours. Results: One hundred and thirty adult patients with severe sepsis and septic shock were studied in an 18 months period. The initial PCT concentration was not significantly different between survivors and non-survivors groups, but the PCT-c 24 hours and 48 hours were significantly higher in survivors (p< 0.0001). The initial SOFA was significantly higher and the Δ SOFA 48hours significantly smaller in non-survivors (p=0.01). The AUROC was 0.68 (95% CI, 0.56 – 0.79, p = 0.004) for Δ SOFA; 0.76 (95% CI, 0.66 – 0.86, p < 0.0001) for PCT-c 24 hours and 0.76 (95% CI, 0.66-0.86, p < 0.0001) for PCT-c 48 hours. Conclusions: This study showed that both the Δ SOFA score 48 hours and the clearance of PCT 24 and 48 hours are useful markers of prognosis in patients with severe sepsis and septic shock. A decrease in PCT-c in the first 24 hours of treatment should alert to reassessment of the appropriateness and adequacy of treatment.

Download File

Artigo: https://www.ncbi.nlm.nih.gov/pubmed/25241933

 

 

 

Author: Ozimo Pereira Gama Filho
Original Title: Comparative study between sleeve gastrectomy and gastric plication in obese rats

INTRODUCTION: Obesity results from a prolonged imbalance between energy intake and energy expenditure. Studies with experimental models of bariatric surgery provided a fundamental contribution to the understanding of morphological and functional changes in obesity and after bariatric surgery. The techniques of restrictive bariatric surgery currently in use are gastric banding, sleeve gastrectomy and the gastric plication. The latter remains an experimental technique and has therefore not yet enough studies that shed light on the postoperative rates of weight loss, surgical complications, resolution of comorbidities and the mechanisms responsible for weight loss. The aim of this study was to conduct a comparative evaluation between gastric plication and sleeve gastrectomy in rats with obesity induced by cafeteria diet. The late postoperative variation of in body weight, plasma biochemistry and gastric alterations on gross and microscopic effects of surgery were compared. MATERIAL AND METHOD: 28 male wistar rats were randomized into three groups after induction period of obesity by cafeteria diet and underwent sleeve gastrectomy (GV group), gastric plication (GP group) and sham operation (control group). The animals were assessed daily postoperatively and the variables were recorded: body weight (initial seven days, 14 and 21 days) and presence of complications until day 21 postoperatively. In this time, they were euthanized and evaluated: biochemistry (glucose, insulin, HDL, total cholesterol, triglycerides, AST, ALT and serum ghrelin), degree of intra-abdominal adhesions, atmospheric air insufflation test in the stomach and microscopic evaluation of the gastric mucosa. RESULTS: In relation to body weight variation of animals GV group (initial weight: 318 ± 7,89 g / Final weight: 213 ± 9,03g) was significantly decreased (p<0,05) at 21 post-surgery day compared to the GP group (initial weight: 314,11 ± 20,79 g / final weight: 239,16 ± 14,71 g) and control group (initial weight: 315,16±17,54g / final weight: 317,91±16,06 g). The animals in the GV group had a significant decrease (p<0,001) in blood glucose, insulin, transaminases, serum HDL and ghrelin levels compared to animals in GP group and control group. Was also significantly lower the burst pressure of the stomach in the atmospheric air insufflation test in the GV group to the GP group and control group. The GP and GV groups showed the same degree of inflammation (subacute inflammation) and different of control group (chronic inflammation). CONCLUSIONS: The sleeve gastrectomy is more effective than gastric plication in reducing body weight, metabolic control and reduction of serum ghrelin in obesity rats, and presents the same rates of postoperative complications (adhesions, deaths and grade inflammation).

Download File

 

Contact / Directions

POSTGRADUATE PROGRAM IN THE PRINCIPLES OF SURGERY

 

  • 1980 Alameda Algusto Stellfeld
    Curitiba / PR
    Zip-Code: 80730-150
  • Phone: +55 41 3240-5488

Local Time

Sunday, 12 July 2020

Weather Forecast

Scattered Thunderstorms

28°C

Curitiba

Scattered Thunderstorms

Humidity: 62%

Wind: 40.23 km/h

  • 03 Jan 2019

    Thunderstorms 30°C 21°C

  • 04 Jan 2019

    Thunderstorms 28°C 20°C

Topo