Acta cirurgica brasileira最新文献

Purpose: To evaluate the peritoneal histopathological changes and culture after the use of intravenous meropenem and intra-abdominal inoculation of 10% aqueous extract of anacardiaceae, in elderly rat model after autogenous fecal peritonitis induced.

Methods: Thirty 18-month-old Wistar rats received induction of autogenous fecal peritonitis and then were stratified into two groups: study I, treated with meropenem (40 mg/kg); and study II, treated with meropenem (40 mg/kg) and intraperitoneal 10% aqueous extract of anacardiaceae. Animals were monitored for 15 days until euthanasia. Peritoneal fragments were collected for histopathological and culture. The study was approved by Ethics Committee.

Results: None study-II animals died, while in study I, one died before euthanasia. In study II, 20% of the animals showed histopathological changes, none positive peritoneal culture, but one blood culture was positive (10%). In study I, 50% of the animals presented histopathological changes, 40% positive peritoneal cultures, and 50% positive blood cultures. All results when evaluated in the morbidity score showed better outcome for study-II group (p = 0,175).

Conclusion: The use of meropenem associated with intraperitoneal 10% aqueous anacardiaceae extract after induction of autogenous fecal peritonitis in elderly rats showed better outcome in the set of histopathological changes, negative peritoneal and blood cultures, when compared with the use of meropenem isolated.

Purpose: This study aimed to ascertain the efficacy and safety of remimazolam besylate and ciprofol in elderly patients undergoing painless gastrointestinal endoscopy.

Methods: Patients in the control group (n = 31) were anesthetized with ciprofol, and those in the observation group (n = 31) were anesthetized with remimazolam besylate. The anesthetic effect, analgesic effect, hemodynamics, cognitive function, and adverse reactions between the two groups were compared.

Results: The observation group had shorter anesthesia onset time, recovery time, as well as anesthesia recovery room stay time and a higher effective rate of analgesia. At T1, T2, and T3, the mean arterial pressure and heart rate of the observation group were higher versus the control group; at T1 and T2, SpO2 in the observation group was higher versus the control group. The simple mental state scale score of the observation group was higher than that of the control group (all p 0.05). The total incidence of adverse reactions exhibited no difference between the two groups (p> 0.05).

Conclusion: Versus ciprofol, remimazolam besylate has better anesthetic and analgesic effects, more stable hemodynamics, less impact on patients' cognitive function, and good safety in elderly patients undergoing painless gastrointestinal endoscopy.

Purpose: The surgical glue is widely used in closing cutaneous surgical wounds. Corticosteroids are indicated for their anti-inflammatory and immunomodulatory properties. The present work evaluated the pharmacological effects of triamcinolone (AT) incorporated into surgical glue (C) on the initial phase of the wound healing process in Wistar rats.

Methods: Through in-vivo studies, the effects of the healing process, C or C+AT in the same rat were evaluated for seven and 14 days post-surgery.

Results: The C+AT association did not change the physicochemical properties of the polymer. This association in wound healing confirmed the anti-inflammatory and immunomodulatory effects of the corticosteroid, with less neovascularization and fibrosis, in addition to the remodeling of the extracellular matrix carried out by the balance of myofibroblasts and less dense collagen fibers, culminating in tissue regeneration and possible reduction of side effects.

Conclusion: This association is a powerful and innovative pharmacological tool, promising in translational medicine.

Purpose: To compare the indicators, postoperative pneumoretroperitoneum-related complications, and postoperative recovery of laparoscopic preperitoneal inguinal hernia repair under different CO2 pneumoperitoneum pressures.

Methods: The total of 187 adult patients with primary inguinal hernia who successfully underwent transabdominal preperitoneal prosthesis (TAPP) from September 2021 to September 2023 in the Department of General Surgery, Haimen People's Hospital affiliated to Nantong University, were collected. These patients were randomly divided into low abdominal pressure group (group A: pneumoperitoneum pressure = 8 mmHg), sub-low abdominal pressure group (group B: pneumoperitoneum pressure = 10 mmHg), moderate abdominal pressure group (group C: pneumoperitoneum pressure = 12 mmHg), and standard pressure group (group D: pneumoperitoneum pressure = 14 mmHg), with 40 patients each.

Results: The operation time in group C (43.90 ± 9.75) was significantly lower than group A (51.98 ± 12.65, p 0.001), group B (46.70 ± 10.59, p 0.001), and was higher than that in group D without significant statistical differences (38.15 ± 7.98, P = 0.05). The peritoneal suturing time in group C (5.03 ± 1.07) was significantly higher than group A (4.23 ± 0.70, p 0.001), group B (4.55 ± 0.85, p = 0.03), and was significantly lower than that in group D (6.95 ± 1.96, p 0.001).

Conclusion: Selecting sub-low abdominal pressure (12 mmHg) can help to have a shorter operation time, with less blood loss, and it did not add pneumoretroperitoneum-related complications. Changing the pneumoperitonium pressure during different phases of the surgery is also an optimal option.

Purpose: To assess the cytotoxicity and wound healing properties of an alginate hydrogel containing calendula glycolic extract.

Methods: Cell viability in murine fibroblasts (3T3 cells) was evaluated using MTT and SRB assays. The wound healing effect was tested in an incisional wound model on 50 female Wistar rats, divided into two groups: rats treated with alginate hydrogel (n = 25), and rats treated with calendula-alginate hydrogel. Wound healing was assessed by measuring wound retraction rate and histological analysis of lesion tissues over a 28-day period. Histological analyses were performed on days 2, 7, 14, 21, and 28 post-surgery to examine inflammatory infiltrate, macrophage count, and angiogenesis. Picrosirius red staining was used to compare the relative abundance of collagen types I and III fibers.

Results: Cytotoxicity tests on 3T3 cells revealed increased cell viability with the calendula-alginate hydrogel. The calendula-alginate hydrogel also demonstrated a significant improvement in wound closure, supported by histopathological analysis, showing reduced inflammation, increased macrophage activity, and enhanced collagen deposition.

Conclusions: These findings evidenced the therapeutic potential of combining calendula extract and alginate for promoting enhanced wound healing.

Purpose: To evaluate the association of collagen gel with F18 bioactive glass (BG) in the healing of non-contaminated cutaneous wounds induced in healthy Wistar rats.

Methods: One hundred twelve adult and healthy Wistar rats were randomly divided into four groups (n = 28): saline solution (0.9%); healing ointment based on allantoin and zinc oxide; collagen gel; and association of F18 BG powder and collagen gel. All the rats underwent the creation of a 3-cm diameter wound in their dorsal region. Macroscopic, thermographic, and tensiometric evaluations of the wound were performed.

Results: The presence of granulation tissue varied significantly in and between the groups. The surface temperature assessed through thermography of wounds treated with saline solution (0.9%) increased significantly over time and between the groups. No difference was identified regarding tensiometry.

Conclusions: Collagen gel associated with F18 BG induced beneficial healing effects on non-contaminated cutaneous wounds in Wistar rats, which included the induction of increased blood perfusion as assessed through thermography.

Purpose: To evaluate the gender distribution of first and last authors with Brazilian surgical affiliations in PubMed-indexed surgical journals.

Methods: Data from eligible surgical journals were retrieved using Scimago Journal & Country Rank 2021 and manually reviewed. Manuscripts published from 2018 to 2022 were included if at least one author was affiliated with a Brazilian institution and a surgical specialty.

Results: Data from 340 eligible surgical journals were included. We analyzed first and last authors' forenames of 1,881 manuscripts. Women comprised 16.7% of the first and 12.4% of the last authors. Analyzing the differences in gender trends in authorship across the five Brazilian regions, we found that the South had the highest representation, while the Midwest and North showed the lowest, respectively. Obstetrics and gynecology featured the highest percentage of women-first authors, whereas orthopedics had the lowest. For the last authorship, pediatric surgery showed the highest, with hand surgery having the lowest representation. Male first authors were 1.9 times more likely to engage in international collaborations.

Conclusions: This study suggests the persistent underrepresentation of Brazilian women in surgical journal authorship. Local policy changes should be considered to encourage greater diversity and inclusivity in surgical research.

Purpose: This study investigated the hypothesis of early dehiscence of hysterorrhaphy as the initial stage of post-cesarean uterine scar defects, examining the possible influence of barbed suture in this process.

Methods: This longitudinal, prospective, double-blind study included 54 pregnant women with no history of cesarean section, randomized into two suture groups: #0 polyglactin or #1 barbed PDS threads. Sutures were continuous, unlocked, involved the entire myometrium in a single layer, and included the endometrium. Tridimensional transvaginal ultrasonography was performed on the second day postpartum to investigate scar dehiscence and measure its maximal width.

Results: The groups had 29 and 25 participants, respectively. Ages: 18-37 (mean 25.80 ± standard error of the mean 0.69) years old. Groups were homogeneous for labor duration, cervical thickness, edge-to-os distance, retroversion, amniotic sac rupture, and additional hemostatic sutures required. Uterine retroversion accounted for 7.4% of cases. Dehiscence was observed in 68.5% (3.98 ± 0.57 mm). The only factor correlating (positively) with dehiscence width was myometrial thickness, whether proximal or distal.

Conclusions: Suture type had no influence on early dehiscence, which occurred at the same rate as published niche formation rates. Tridimensional ultrasound proved effective for evaluating dehiscence.

Purpose: Research in high-income countries has extensively documented the non-operative management of spleen injuries in children, resulting in low splenectomy rates (5%). However, there is a lack of literature on this topic in low- and-middle-income countries (LMICs), including Brazil. This scoping review analyzed pediatric spleen trauma research trends in Brazil and the United States of America (USA).

Methods: Search strategy was conducted across five databases, considering articles published in English or Portuguese from January 1968 to 2023 that reported spleen injury in patients younger than 18 years old in Brazil or the USA. Two pairs of independent reviewers screened the title and the abstract, followed by a full-text review.

Results: The total of 7,150 studies was identified, of which 295 were eligible for data extraction. Most papers (98.64%, 301) originated from the USA, while only 1.36% (4) were from Brazil. In addition, 46.44% (137) articles reported intrabdominal injury, including splenic trauma, 16.27% (48) liver and spleen injury, and 37.29% (110) reported isolated spleen injury. The operative rate for spleen injury was 11.33% in American studies (40,812/359,926) compared to 98.57% (137/139) in Brazilian studies.

Conclusions: Brazil contributed only with four studies on pediatric splenic trauma over two decades. Future studies should explore the incidence and management of splenic trauma in LMICs.

Purpose: To evaluate the effects of platelet-rich fibrin (PRF) on the healing of intestinal sutures in rats.

Methods: Forty rats were distributed into four groups. Two groups were treated with a standard diet and considered nourished (I and II). Two other groups were treated with cornmeal and considered malnourished (III and IV). All animals underwent cecotomy and cecorrhaphy. Groups II and IV had sutures overlapped with human PRF membrane. The following parameters were evaluated: animal weight, death, rupture site, rupture pressure, collagen, and reticulin dosage in the suture line.

Results: The use of PRF did not influence deaths, rupture pressure or rupture location. For malnourished animals, a significant difference was observed in relation to the rupture site, corresponding to the suture line (p = 0.038) and reticulin dosage (p = 0.040), when PRF was used. There was no difference in relation to burst pressures.

Conclusions: The use of PRF did not influence intestinal healing in nourished rats. In the group of malnourished animals, its use favored healing.