Alternate current biosusceptometry for the assessment of gastric motility after proximal gastrectomy in rats: a feasibility study

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Causas da desnutrição pós-gastrectomia

Racional A retirada total ou parcial do estômago resulta em conseqüências nutricionais, agudas ou crônicas, perfeitamente prognosticáveis, mas nem sempre ponderadas na terapia pós-operatória. Objetivo - Rever as participações mecânicas e químicas do estômago no aproveitamento do nutriente dietético, e as conseqüências nutricionais da gastrectomia. Resultados - A deficiência energética, com conseqüente perda de peso, acompanha inversamente o volume gástrico remanescente e o tempo pós-operatório; tem a anorexia e diarréia (má absorção) como principais causas, sendo a primeira decorrente de fatores emocionais ou de mediadores químicos de ação hipotalâmica. A diarréia pode ser decorrente da maior motilidade ou do supercrescimento bacteriano intestinais, com o agravante da insuficiência pancreática exócrina e maior esvaziamento da vesícula biliar. A má absorção traz conseqüências não apenas energética-protéica com a perda fecal de gordura e nitrogênio, como também vitamínico-mineral pelo menor aproveitamento da vitamina D e cálcio dietéticos. A anemia verificada no gastrectomizado é conseqüente à diminuição da produção de HCl (e menor solubilização do ferro) e do fator intrínseco (com menor absorção da vitamina B12). Conclusão - Perda de peso e anemia são os sinais de desnutrição mais comumente observados nestes pacientes, em intensidade e duração variáveis dependentes do tipo de cirurgia e do tempo e tratamento nutricional pós-operatório, sendo recomendável o tratamento dietético supervisionado.

Desnutrição protéico-energética no paciente gastrectomizado

Racional - A gastrectomia traz conseqüências nutricionais inevitáveis mas atenuáveis, dependendo da dietoterapia pós-operatória. Embora observada, essa desnutrição protéico-energética é pouco dimensionada, provavelmente, pela falta de consenso metodológico. Objetivo - Avaliar o grau de desnutrição protéico-energética do paciente gastrectomizado, utilizando-se de indicadores isolados ou combinados. Pacientes e Métodos - Foram estudados 71 pacientes com gastrectomia parcial (n = 53) ou total (n =18) em pós-operatório de 6 a 24 meses e 24-60 meses. Os dados dietéticos, composição corporal e bioquímicos foram analisados de acordo com o tipo de gastrectomia e tempo pós-operatório. Resultados - A cirurgia foi conseqüência de complicações de úlcera péptica (68%) ou a câncer gástrico (32%). A perda de peso foi referida por 70% dos pacientes, sendo maior no grupo gastrectomia total (16 ± 5 kg) do que no grupo gastrectomia parcial (10 ± 6 kg). em geral, os pacientes apresentaram déficit antropométrico, albuminemia normal e baixa ingestão calórica, sugerindo deficiência energética crônica. A redução de hemoglobina, hematócrito e ferro ocorreu em maior intensidade e mais precocemente no grupo gastrectomia total. Assim, quando se associou hemoglobina aos indicadores albumina, linfócitos circunferência do braço e prega cutânea subescapular, a prevalência de desnutrição protéico-energética foi maior e em maior intensidade do que na ausência da hemoglobina. Conclusão - A gastrectomia resultou em desnutrição protéico-energética do tipo marasmática, acompanhada de anemia, mais intensa e precoce na gastrectomia total e gradativa na gastrectomia parcial, assemelhando-se à gastrectomia total no pós-operatório tardio.

REVERSIBILITY OF ADENOMATOUS HYPERPLASIA IN THE GASTRIC STUMP AFTER DIVERSION OF BILE REFLUX IN RATS

Morphological and phenotypical patterns of proliferative epithelial lesions induced in the gastric stump mucosa by duodenal content reflux after Billroth II partial gastrectomy (BII) were evaluated in rats. Control animals were either sham-operated or submitted at different times after BII to Roux-en-Y (RY) surgical procedure which prevents duodenal reflux. The lesions were analysed using routine haematoxylin and eosin staining, immunohistochemical staining for pepsinogen isoenzyme 1 and histochemical procedures for mucins (paradoxical Concanavalin A, galactose oxidase Schiff and sialidase galactose oxidase Schiff reactions). Mucosal hyperplasia (H) was observed in the group submitted to BII procedure 6 weeks after surgery. Adenomatous hyperplasia (AH) also appeared 6 weeks after induction of the reflux and its incidence and size increased until the 54th week of the experiment. RY procedure performed in the normal animals at the beginning of the experiment or at the 24th week after BII gastrectomy led to a significantly lower incidence of AH which was related to the moment of surgery. Most of H was due to pyloric mucosal hyperplasia. AH consisted mainly of gastric type glands but in some animals glands of the intestinal type Were present probably originating from the intestinal mucosa. Six mucinous adenocarcinomas were observed, all of them of intestinal type. This study demonstrates that AH induced by BII procedure is a reversible lesion and that the anomalous epithelial proliferation in the stoma may lead to adenocarcinomas.

REDUCTION OF CELL PROLIFERATIVE ACTIVITIES OF GASTRIC STUMP ADENOMATOUS HYPERPLASIAS AFTER BILE REFLUX DIVERSION IN RATS

Previously we reported the majority of lesions induced hy bile reflux, in the absence of chemical carcinogens, in the rat remnant stomach to consist primarily of gastric type and secondarily of intestinal type cells, and that they are reversible after diversion of bile reflux. The present study was designed to evaluate changes in proliferative activities in cells of each type under these conditions. The frequency of adenomatous hyperplasia (AH) induced in the gastric stump mucosa by duodenal content reflux after Billroth II partial gastrectomy (BII) increased until the 54th week of the experiment. Roux-en-Y (RY) surgical procedure which prevents duodenal reflux performed at the 24th or 36th week after BII led to a decrease in AH. Cell content of the lesions was analyzed using routine H&E staining, immunohistochemical staining for pepsinogen isoenzyme 1 and histochemical procedures for mucins (paradoxical concanavalin A, galactose oxidase Schiff and sialidase galactose oxidase Schiff reactions) and proliferation in each compartment evaluated by an immunohistochemical method using bromodeoxyuridine (BrdU) and a monoclonal antibody against BrdU. At the 54th week the number of BrdU-labeled cells per normal pyloric column was significantly (P < 0.05) increased to 10.63/pit after the BII operation, while it diminished to 5.23/pit after RY diversion, this being the same level as with the RY procedure alone. AH maintained a high rate of BrdU incorporation at 12.7% after BII operation, which was also significantly reduced (P < 0.01) to 7.0% by the RY surgery. The intestinal type cell showed highest (22.2%), the surface mucous type cell showed the next (16.5%) and the pyloric gland type cell showed lowest (5.2%) BrdU labeling indices after BII operation. All the cell types in AH showed similar proportional decreases in BrdU incorporation after RY diversion. Thus surgical intervention reverses the cell proliferation caused by bile reflux in the gastric stump.

Raquianestesia contínua em paciente submetido à gastrectomia parcial. Relato de caso

BACKGROUND AND OBJECTIVES: Due to the high incidence of technical and neurological complications, continuous spinal blocks were not performed for several years. With the advent of intermediate catheters the technique has been used more often and gaining acceptance among anesthesiologists. The objective of this report was to demonstrate the usefulness of the technique as a viable alternative for medium and major size surgeries. CASE REPORT: This is a 58 years old female patient, weighing 62 kg, physical status ASA I, with a history of migraines, low back pain, and prior surgeries under spinal block without intercurrence. The patient was scheduled for exploratory laparotomy for a probable pelvic tumor. After venoclysis with an 18G catheter, monitoring with cardioscope, non-invasive blood pressure and pulse oximetry was instituted; she was sedated with 2 mg of midazolam and 100 μg of fentanyl, and placed in left lateral decubitus. The patient underwent continuous spinal block through the median approach in L 3-L 4; 9 mg of 0.5% hyperbaric bupivacaine and 120 μ g of morphine sulfate were administered. Inspection of the abdominal cavity revealed a gastric stromal tumor that required an increase in the incision for a partial gastrectomy. A small dose of hyperbaric solution was required for the entire procedure, which was associated with complete hemodynamic stability. Postoperative admission to the ICU was not necessary; the patient presented a good evolution without complaints and with a high degree of satisfaction. She was discharged from the hospital after 72 hours without intercurrence. CONCLUSIONS: Intermediate catheters used in continuous spinal blocks have shown the potential to turn it an attractive and useful technique in medium and large size surgeries and it can even be an effective alternative in the management of critical patients to whom hemodynamic repercussions can be harmful.

Avaliação da atividade de contração e evaziamento gástrico em ratos gastretomizados por biosusceptometria AC

Pós-graduação em Biologia Geral e Aplicada - IBB

Detecção de mutação no gene supressor de tumor p53 e associação e cepas patogênicas do Helicobacter pylori em câncer gástrico

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Alterations of the gastric stump and not resected stomach mucosa after truncal vagotomy in rats

PURPOSE:To evaluate morphological changes of the gastric stump and not resected stomach mucosa after the completion of truncal vagotomy.METHODS:Eighty male Wistar rats were divided into four groups: CT, TV, RY and RYTV. In CT group, abdominal viscera were manipulated and the abdominal cavity was closed, in TV vagal trunks were isolated and sectioned, in RY a partial Roux-en-Y gastrectomy was performed and in RYTV the vagal trunks were sectioned and a partial Roux-en-Y gastrectomy was performed. At the 54th week after surgery, the rats were euthanized. The findings were submitted to histological analyses.RESULTS:None macroscopic or histological alterations in groups TV and CT was observed. Specimens from RY and RYTV groups did not show alterations in the gastric stump mucosa. At the jejunal side of the gastroenterostomy we found shallow ulcerative lesions always single, well-defined and with variable diameter 3 to 6 mm, six times in the RY group and none in the RYTV group (RY>RYTV, p=0.008). Neoplastic or preneoplastic lesions were not diagnosed in all groups.CONCLUSION:Truncal vagotomy is a safe and non-carcinogenic method in not resected and partially resected stomach.

Avaliação do efeito da gastrectomia na motilidade e no esvaziamento gástrico em ratos por biosusceptometria de corrente alternada

The study of gastrointestinal tract (GIT) functions is necessary due to the increasing number of pathologies associated with it. Directly influencing the quality of life, the gastrointestinal tract provides a number of parameters that, when analyzed, allow us to describe its dysfunctions. Thus, many techniques can be combined to obtain these properties related to the GIT. However, these techniques are often invasive, require surgery, catheter insertion, or to build a temporal model of these functions, require the sacrifice of animals in a series of data collection. The technique used in this study has the advantage of having a low operating cost, being free of ionizing radiation, non-invasive and is known as biosusceptometry AC (BAC), used to evaluate the properties of the GI tract by monitoring the position and concentration of materials magnetically marked. The sensor consists of two pairs of coils, one reference and one for detection. A fixed base line separates the sensing and reference coils, and also functions as support for the instrumentation. It is also important to note that the detection coils are arranged in a first order (subtraction) gradiometric way. The objective of this study was to analyze the effects of gastrectomy in gastric emptying and gastrointestinal transit time of solid food in rats using a BAC system associated with magnetic markers. To realize this study was constructed a dedicated BAC sensor, built to analyze these GIT properties. Data acquisition was obtained by aligning the magnetic sensor with the stomach and colon of the animal at pre-determined intervals. Thus, when approaching the magnetic material of the sensor, the balance created between the two sides of the sensor is broken. This imbalance can be measured, digitized and acquired. Tracer was used as a ration magnetically marked with ferrite... (Complete abstract click electronic access below)