Acta cirurgica brasileira最新文献

[This corrects the article doi: 10.1590/acb400525].

[This corrects the article doi: 10.1590/acb401325].

Purpose: To identify and describe the most used surgical repair methods for traumatic injuries to peripheral nerves, as well as highlight the causes of trauma to peripheral nerves and the most prevalent traumatized nerves.

Methods: This is a systematic literature review using the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The searches were carried out in PubMED, in the time window from January 2018 to December 2022.

Results: In total, 3,687 articles were collected, of which, after applying the inclusion and exclusion filters and analyzing the risk of bias, 34 articles remained. It was observed that the age of the injury and type of nerve repair strongly influence the recovery of patients. The most identified trauma repair procedures were neurolysis, direct suturing, grafting, and nerve transfer. Among these four procedures, direct suturing is currently preferred.

Conclusion: Several repair methods can be used in peripheral nerve injuries, with emphasis on direct suturing. However, nerve transfer proves to be a differential in those cases in which repair is delayed or the first treatment options have failed, which shows that each method will be used according to the indication for each case.

Purpose: Approximately 10% of breast cancer patients with localized operable disease experience recurrence. This study aimed to evaluate patients with early-stage breast cancer (TNM I and II) who underwent surgery without the need for neoadjuvant therapy.

Methods: The total of 117 patients was included in the study: 104 without recurrence and 13 with recurrence. We analyzed various clinicopathological parameters, including body mass index, age at diagnosis, menopausal status, pesticide exposure, and tumor characteristics such as HER2 amplification, Ki67 index, molecular subtype, and histological grade.

Results: Two primary subsets were identified as being associated with disease recurrence. The first subset (PC1) was characterized by HER2 amplification and metastatic disease, while the second subset (PC2) comprised premenopausal young women exposed to pesticides who had triple-negative tumors. While some of these factors are well-documented in the literature, pesticide exposure emerged as a notable regional factor contributing to poor outcomes in breast cancer patients.

Conclusion: These findings underscored the significance of identifying local and regional risk factors when assessing recurrence risk in women with breast cancer, particularly in cases in which surgery is the primary treatment approach.

Purpose: To identify the prognostic variables related to the survival of patients operated on for adenocarcinoma of the rectum who underwent preoperative radiochemotherapy (RCT).

Methods: We studied 70 patients from the Discipline of Surgical Gastroenterology at Escola Paulista de Medicina from 2000 to 2019, with rectal cancer located up to 10 cm from the anal verge and with stages II or III, submitted to preoperative RCT and curative surgery (R0) and with follow-up of at least 12 months. Clinical restaging was performed four to six weeks after the end of neoadjuvant treatment to characterize the degree of clinical tumor regression. Surgery by laparotomy or videolaparoscopy was performed six to 12 weeks after RCT. Primary endpoint were: overall survival (OS), disease-free survival (DFS), metastasis-free survival (MSS), and neoplasm-specific survival (SEN). These were compared with gender, age, carcinoembryonic antigen (CEA) dosage, distance from the tumor to the anal verge, radiation dose, radiotherapy-surgery interval, clinical regression, type of surgery, pT and pN TNM stage tumor, number of nodes, circumferential resection margin, and complete pathological response. Survival was assessed by Kaplan-Meier curves. Univariate and multivariate Cox analyses were calculated to identify factors associated with survival outcomes.

Results: The mean follow-up time was 62 months. The pathological complete response rate was 18.6%. Univariate cox regression showed a significant relationship of CEA equal to or greater than 4 ng/mL with DFS and MFS, pT3/pT4 staging with DFS, MFS and SEN, pN1/N2 with DFS, MFS and SEN and stages II and III with DFS and MFS. Multivariate regression found that CEA, pT, and pN staging are independent prognostic factors for DFS, MFS, and SEN.

Conclusion: Carcinoembryonic antigen level prior to radiotherapy, pT staging and pN staging were independent prognostic factors for survival in patients with rectal adenocarcinoma who are treated with preoperative radiochemotherapy.

Purpose: To establish a profile of the inflammatory response in the preoperative and postoperative period of pulmonary resection of patients without postoperative complications, in order to trace the inflammatory profile of lung resection surgery.

Methods: Six collections of arterial and venous blood were performed for data analysis, one sample in the preoperative, immediate postoperative, 4, 8, 24, and 48 hours after surgery. Twenty-seven patients with a median age of 63 years old, ranging from 29 to 80 years old, were included.

Results: The leukocyte count showed a significant increase in the times: immediate postoperative and 4 hours after surgery, in relation to the preoperative period. Concomitantly, there was an increase in lactate, heart rate, interleukin (IL)-6 and IL-8 after 4 hours of surgery. The platelet count showed a significant decrease in 48 h, associated with an increase in IL-1β and tumor necrosis factor-α. A significant increase in IL-10 was observed in the immediate postoperative.

Conclusion: The study may contribute to the search for more specific and adequate alternatives for controlling the inflammatory response. In this way, the intervention would be specific to that cytokine that causes the greatest harm to the patient, as well as to the moment of the intervention.

Purpose: To evaluate the effect of the topical application of the ethanol extract (EESL) and the hydroethanolic fraction (HFSL) of ripe Solanum lycocarpum fruit on the healing of experimentally-induced wounds in mice.

Methods: The EESL and HFSL obtained from ripe fruit of the species S. lycocarpum were obtained by percolation with ethanol. They were tested in the healing of excisional wounds in mice, which were induced in anesthetized animals using a 7-mm dermatological punch. They were divided according to the treatment period and group, n = 6, and received topical application of the EESL or HFSL daily or saline solution for one, five, seven, or 21 days. At the end of this period, the animals were euthanized, and the lesions were subjected to histopathological processing and analysis to evaluate macroscopic area of the wound and microscopic analysis by morphometry of the number of leukocytes, mast cells, fibroblasts, re-epithelialization, and matrix deposition.

Results: The application of the EESL and HFSL reduced the number of leukocytes after one, five, and seven days of treatment. EESL improved re-epithelialization and tissue proliferation in wound healing from day 7.

Conclusion: The study demonstrated that daily administration of EESL and HFSL exhibit wound healing activity, with this effect being more pronounced by EESL. To our knowledge, this is the first report of the anti-inflammatory and healing activity of this species through topical application.

Purpose: To evaluate whether the effectiveness of topical antiseptic solutions in restoring skin continuity solutions is related to their antimicrobial action or to their action in maintaining moisture, in dogs undergoing elective surgeries.

Methods: Forty dogs, 20 males and 20 females, underwent orchiectomy and oophorectomy, respectively. Thereafter, the animals were allocated into four groups (n = 5) and treated with different topical solutions: polyhexanide 0.1% (G1), chlorhexidine digluconate 0.05% (G2), povidone-iodine 0.1% (G3), and sodium chloride 0.9% (control). Macroscopically evaluation of wounds on days 1, 5, and 10 after procedures, and hematological parameters were performed. Data were subjected to statistical analysis (p 0.05).

Results: No significant differences in the macroscopic evaluation of the wounds and hematological parameters were observed among groups, in the healing of clean elective surgical wounds. However, applying a topical solution dressing to maintain a moist wound promoted adequate tissue healing.

Conclusion: In our experimental conditions, moisture provided by topical antiseptic solutions is an important factor compared to the antiseptic activity of these solutions, for skin wound healing in post-surgical dressings resulting from clean, short-term elective surgeries in male and female dogs. Moreover, the type of topical antiseptic solution used does not influence the development of post-surgical infection.

Purpose: To create tridimensional (3D) anatomical models of diaphyseal fractures in dogs (3D AMDFD) and to evaluate the models from their radiographs.

Methods: The study consisted of six stages: preparation of femur from a healthy dog cadaver; digitalization of the bone through a 3D scanner and creation of the base model; creation of a 3D AMDFD based on the image of the base model, 3D modeling carried out to reproduce five different types of diaphyseal fractures; printing the models produced on a 3D printer with a thermoplastic material; insertion of neodymium magnets in the fracture line to allow the assembly and disassembly of the parts; and radiography of 3D AMDFD in lateromedial and craniocaudal positions.

Results: The base model and 3D AMDFD had high precision in the replication of bone structures, like the bone in natura. The radiopacity and radiolucency of the 3D AMDFD did not necessarily correspond to the bone densities found in the radiography of the natural canine femur.

Conclusion: The 3D AMDFD and their respective radiographs accurately reproduced the anatomical structures and fracture lines.

Purpose: To evaluate the molecular evolution of endoplasmic reticulum (ER) stress during colorectal cancer carcinogenesis.

Methods: Fifty-six hairless mice were divided into two groups: control (no intervention); and carcinogenesis (treated with two doses of azoxymethane at 10 mg/kg during the third and the fourth week and dextran sodium sulfate at 2.5% for seven days in the second, fifth, and eighth week). Euthanasia occurred at the fifth, 10th, 15th, and 20th week. Colons were collected, and gene expression of ER stress markers (IRE1-α, PERK, ATF6, and CHOP) was assessed via real-time quantitative polymerase chain reaction.

Results: ERN1 expression was significantly higher than the control at the 10th week (1.39 ± 0.16, p 0.05) and the 20th week (1.15 ± 0.04, p 0.01). ATF6 also showed elevated expression, significantly different at the 10th week (1.71 ± 0.29, p 0.05) and the 20th week (1.14 ± 0.06, p 0.05). PERK and CHOP expressions were significantly higher than the control in the 15th (PERK = 1.30 ± 0.12, CHOP = 1.48 ± 0.23) and 20th weeks (PERK = 1.63 ± 0.20, CHOP = 1.67 ± 0.22, p 0.05).

Conclusion: Upregulation of IRN1, PERK, ATF6, and CHOP demonstrates a strong ER stress response during colorectal cancer development.