168 resultados para Endoscopic retrograde cholangiopancreatography.


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The esophagitis associated with chagasic megaesophagus is commonly attributed to food and secretion stasis, thereby its name of stasis esophagitis. The present work suggests instead that in some chagasic patients the clinical, endoscopic and histological findings are more compatible with a true reflux esophagitis.

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1. The protection offered by intermittent perfusion of of cardioplegic solution through the coronary sinus was investigated in isovolumic blood-perfused dog heart preparations submitted to 60 min of ischemia and 45 min of reperfusion.2. The preparations were divided into three treatment groups: a) coronary sinus, consisting of preparations (N = 10) perfused through the coronary sinus under 40 cm water pressure; b) aortic, consisting of preparations (N = 10) perfused through the aortic stump under 100 mmHg pressure; c) control, consisting of hearts (N = 9) that were not perfused with cardioplegic solution.3. Properties of contractile capacity and relaxation were markedly impaired in the control group but were preserved to a comparable extent in the groups perfused with cardioplegic solution through the aorta and coronary sinus. Developed pressure decreased in the control group (before ischemia: 70 +/- 5.5 mmHg; after reperfusion: 35 +/- 12 mmHg; P < 0.05) and didn't vary in the aortic group (from 69 +/- 4 mmHg to 65 +/- 13 mmHg; P > 0.05) and coronary sinus group (from 69 +/- 4.6 mmHg to 60 +/- 10 mmHg; P > 0.05). Myocardial relaxation was evaluated by the +/- dp/dt ratio. In the control group there was impairment of myocardial relaxation as indicated by an increase of this index after reperfusion (from 1.05 +/- 0.05 to 1.46 +/- 0.23; P < 0.05), whereas in the aortic (from 1.10 +/- 0.13 to 1.15 +/- 0.20; P > 0.05) and the coronary sinus (from 1.03 +/- 0.14 to 1.08 +/- 0.16; P > 0.05) groups there was no variation. Ultrastructural changes in the myocardium were negligible in all three groups at the end of reperfusion.4. We conclude that intermittent perfusion of a hypothermic cardioplegic solution through the coronary sinus is effective for the protection of the myocardium during total ischemia.

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In a previous work, Vieira Neto & Winter (2001) numerically explored the capture times of particles as temporary satellites of Uranus. The study was made in the framework of the spatial, circular, restricted three-body problem. Regions of the initial condition space whose trajectories are apparently stable were determined. The criterion adopted was that the trajectories do not escape from the planet during an integration of 10(5) years. These regions occur for a wide range of orbital initial inclinations (i). In the present work it is studied the reason for the existence of such stable regions. The stability of the planar retrograde trajectories is due to a family of simple periodic orbits and the associated quasi-periodic orbits that oscillate around them. These planar stable orbits had already been studied (Henon 1970; Huang & Innanen 1983). Their results are reviewed using Poincare surface of sections. The stable non-planar retrograde trajectories, 110 degrees less than or equal to i < 180, are found to be tridimensional quasi-periodic orbits around the same family of periodic orbits found for the planar case (i = 180 degrees). It was not found any periodic orbit out of the plane associated to such quasi-periodic orbits. The largest region of stable prograde trajectories occurs at i = 60 degrees. Trajectories in such region are found to behave as quasi-periodic orbits evolving similarly to the stable retrograde trajectories that occurs at i = 120 degrees.

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The architecture and musculotopic organization of the facial motor nucleus in the Cebus apella monkey (a New World primate) were investigated using histological techniques and a multiple labelling strategy, in which horseradish peroxidase-conjugated neuroanatomical tracers (CTB-HRP and WGA-HRP) and fluorescent tracers were injected into individual facial muscles. The facial motor nucleus was formed by multipolar motoneurons and had an ovoid shape, with its rostrocaudal axis measuring on average 1875 mum. We divided the nucleus into four different subnuclei: medial, intermediate, dorsal and lateral. Retrograde labelling patterns revealed that individual muscles were innervated by longitudinal functional columns of motoneurons. The columns of the orbicularis oculi, zygomaticus, orbicularis oris, auricularis superior, buccinator and platysma muscles were located in the dorsal, intermediate, lateral, medial, lateral and intermediate subnuclei, respectively. However, the motoneuron columns of the levator labii superioris alaeque nasi muscle and frontalis muscle could not be associated with a specific subnucleus. The present results confirm previous studies regarding the musculotopic organization of the facial motor nucleus. However, we observed some particularities in terms of the relative size of each column in C. apella, which might be related to the functional and behavioral importance of each muscle in the particular context of this primate.

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This paper describes tectonic and metamorphic features of Precambrian rocks from the Guaxupe Complex and Varginha Shear Zone (VSZ) near the city of Guaxupe in the southern part of the Sao Francisco Craton, southeastern Brazil. The VSZ separates the metasediments of Araxa Group to the north from the granulites of Guaxupe Complex to the south. The sinistral transcurrent VSZ crosses the entire area striking approximately E-W, bending towards SE in the eastern part. Because of this bend, transpressional movement occurred, facilitating the exhumation of the garnet-rich rocks of the deepest exposed part of the granulite-facies terrane.In the garnet granulites the highest pressure-temperature conditions recorded are approximately 1040 degreesC and 14.4 kbar. The rocks underwent decompression from 14.0 kbar to 8.0 kbar, cooling from 980 degreesC to 710 degreesC, the retrograde path following the boundary between the kyanite and sillimanite stability fields. This interval is interpreted to record the uplift of the lower crustal granulite-facies terrane and re-equilibration during magmatic intrusions. For the felsic granulites an interval of 700-810 degreesC and 8.0-11.5 kbar was attained, also pointing to regional decompression.The granulites of the Guaxupe Complex comprise a medium- to high-pressure lower-crustal terrane, with local occurrences of higher-pressure garnet-rich gneisses, which were uplifted along a transpressional segment of the VSZ. Copyright (C) 2000 John Wiley & Sons, Ltd.

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In this paper, numerical simulations are made, using the three-dimensional restricted three-body problem as the mathematical model, to calculate the effects of a swing-by with the planet Saturn in the orbit of a comet. To show the results, the orbit of the comet is classified in four groups: elliptic direct, elliptic retrograde, hyperbolic direct and hyperbolic retrograde. Then, the modification in the orbit of the comet due to the close approach is shown in plots that specify from which group the comet's orbit is coming and to which group it is going. Several families of orbits are found and shown in detail. An analysis about the trends as parameters (position and velocity at the periapse) vary is performed and the influence of each of them is shown and explained. The result is a collection of maps that describe the evolution of the trajectory of the comet due to the close approach. Those maps can be used to estimate the probability of some events, like the capture or escape of a comet. An example of this technique is shown in the paper. (C) 2005 COSPAR. Published by Elsevier Ltd. All rights reserved.

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The irregular satellites of Jupiter are believed to be captured asteroids or planetesimals. In the present work is studied the direction of capture of these objects as a function of their orbital inclination. We performed numerical simulations of the restricted three-body problem, Sun-Jupiter-particle, taking into account the growth of Jupiter. The integration was made backward in time. Initially, the particles have orbits as satellites of Jupiter, which has its present mass. Then, the system evolved with Jupiter losing mass and the satellites escaping from the planet. The reverse of the escape direction corresponds to the capture direction. The results show that the Lagrangian points L1 and L2 mainly guide the direction of capture. Prograde satellites are captured through these two gates with very narrow amplitude angles. In the case of retrograde satellites, these two gates are wider. The capture region increases as the orbital inclination increases. In the case of planar retrograde satellites the directions of capture cover the whole 360 degrees around Jupiter. We also verified that prograde satellites are captured earlier in actual time than retrograde ones.

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

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The knowledge of the normal anatomy and variations regarding the management of tumors of the sellar region is paramount to perform safe surgical procedures. The sellar region is located in the center of the middle cranial fossa; it contains complex anatomical structures, and is the site of various pathological processes: tumor, vascular, developmental, and neuroendocrine. We review the microsurgical anatomy (microscopic and endoscopic) of this region and discuss the surgical nuances regarding this topic, based on anatomical concepts.

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

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

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The authors studied the early lesions of laryngotracheal mucosa following intubation in 30 dogs who were intubated with high complacent canula during the period of 4 hours. After this period, biopsies of vocal cord, aritenois, cricoid and tracheal rings were performed. The most frequent histological findings were neutrophils and mononuclear inflammatory cell infiltration into the corion, vascular congestion and necrosis of epithelial cells. Based in these findings the authors recommend the use of canula with balonets of high complacence and the endoscopic follow up of the patients after extubation.

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The authors report a case of a patient with complaint of progressive disphagia. Stenoses of lower third of esophagus was revealed by radiological and endoscopic examinations. Fungi were showed in biopsy of lesion, with demonstration of Histoplasm capsulate by tissue culture. Endoscopic dilatation was performed because especific medical treatment failed but esophageal rupture was observed. Partial esophagectomy was performed with symptoms remission.

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The accurate investigation of the oropharyngeal dysphagia demands a systematic sequence of physical examinations. The aim of the present work is to propose a practical rule to facilitate the clinical investigation and the management of dysphagic patients. After a detailed anamnesis, an endoscopic examination is carried out and several manouvers to observe the oral, pharyngeal and laryngeal functions are performed by the patient. Following, a second endoscopy is performed during swallows of several consistencies of food, to verify the impairment of the laryngeal and or pharyngeal activities. The elevation of the laryngeal cartilage is also evaluated.

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Objective: The present study was performed to investigate the influence of different routes of perfusion on the distribution of the preservation solutions in the lung parenchyma and upper airways. Methods: Pigs were divided into four groups: control (n = 6), pulmonary artery (PA) (n = 6), simultaneous PA + bronchial artery (BA) (n = 8), and retrograde delivery (n = 6). After preparation and cannulation, cardioplegia solution and Euro- Collins solution (ECS) for lung preservation were given simultaneously. After removal of the heart, the double lung bloc was harvested. Following parameters were assessed: total and regional perfusion (dye-labeled microspheres), tissue water content, PA, aorta, left atrial and left ventricular pressures, cardiac output and lung temperature. Results: Our data show that flow of the ECS in lung parenchyma did not reach control values (9.4 ± 1.0 ml/min per g lung wet weight) regardless of the route of delivery (PA 6.3 ± 1.5, PA + BA 4.8 ± 0.9, retrograde 2.7 ± 0.9 ml/min per g lung wet weight). However, flow in the proximal and distal trachea were significantly increased by PA + BA delivery (0.970 ± 0.4, respectively, 0.380 ± 0.2 ml/min per g) in comparison with PA (0.023 ± 0.007, respectively, 0.024 ± 0.070 ml/min per g), retrograde (0.009 ± 0.003, respectively, 0.021 ± 0.006 ml/min per g) and control experiments (0.125 ± 0.0018, respectively, 0.105 ± 0.012 ml/g per min). Similarly the highest flow rates in the right main bronchus were achieved by PA + BA delivery (1.04 ± 0.4 ml/min per g) in comparison with 0.11 ± 0.03 in control, 0.033 ± 0.008 in PA, and 0.019 ± 0.005 ml/min per g in retrograde group. Flows in the left main bronchus were 0.09 ± 0.02 ml/min per g in control, 0.045 ± 0.012 ml/min per g in PA, and 0.027 ± 0.006 ml/min per g in retrograde group. The flow rates were significantly (P = 0.001) increased by PA + BA delivery of the storage solution (0.97 ± 0.3 ml/min per g). Conclusions: Our data show that the distribution of ECS for lung preservation is significantly improved in airway tissues (trachea and bronchi) if a simultaneous PA + BA delivery is used.