Cirurgia ambulatorial em proctologia: análise retrospectiva de 437 casos

RACIONAL: O número de cirurgias ambulatoriais realizadas em hospitais, como em clínicas particulares, cresce a cada dia. Hoje, em alguns países, como a França, há predomínio das cirurgias ambulatoriais em relação às hospitalares. OBJETIVO: Avaliar retrospectivamente os pacientes operados no Serviço de Cirurgia Ambulatorial do Hospital das Clínicas da Faculdade de Medicina de Botucatu, SP. CASUÍSTICA E MÉTODO: Foram estudados retrospectivamente 437 casos clínicos de patologias orificiais, analisando a distribuição por faixa etária, por sexo, por patologias e as complicações pós-operatórias. RESULTADOS: Notou-se predomínio de pacientes com idade inferior a 45 anos (62,8%), prevalência do sexo feminino (56%), sendo a doença hemorroidária (45,1%) a principal patologia e a dor e sangramento as complicações mais freqüentes (9,8% e 7,3%). CONCLUSÕES: Os resultados satisfatórios observados demonstram a possibilidade de realização, em ambulatório, de diversos procedimentos simples em patologias anorretais freqüentes, a baixo custo e poucas complicações, sendo estas não superiores às observadas em cirurgia hospitalar.

Avaliação do extrato de Momordica charantia em Salmonella typhimurium: Mutagenicidade e antimutagenicidade

In the last years some natural products has been described as supressors of the mutagenic process in bacteria, the antimutagenics. The literature reference that in most of the countries, the population makes use of medicinal plants. The plant Momordica charantia (Cucurbitaceae) is original from Africa being used popularly as purgative, antirheumatic and for skin problems, burns and hemorrhoids. The present work had as objective to evaluate the mutagenic and antimutagenic activities of the ethanolic extract of M. charantia in Salmonella/microsome assays using TA100, TA98 and TA102 strains. It was verified that the extract did not present mutagenic activity when evaluated in different concentrations (0.64, 1.27, 2.55 and 3.84 mg/plate) but acted as antimutagenic agent against the mutations induced by the sodium azide (TA100,-S9), 4-nitro-phenylenediamine (TA98, -S9), daunomycin (TA102, +S9) 2-anthramine (TA100 and TA98, +S9) and 2-aminofluorene (TA102, +S9). When the metabolic activation (+S9) was used, the percentage of inhibition of the mutagenicity varied in the range of 31%-96%, while in absence of metabolizing system (-S9), the maximum percentage of inhibition of the mutagenicity was 44%. In that way, we can conclude that the metabolites found in the extract has potential to protect the genetic material against the damages induced by different chemical agents.

Efeito alelopático de extratos de parte aérea de barbatimão [Stryphnodendron adstringens (Mart.) Coville] na germinação e desenvolvimento da plântula de pepino

Stryphnodendron adstringens (Mart.) Coville (barbatimão), belonging to Mimosaceae family; it is used as ornamental and the wood is used in civil buildings, edification in wet places, lathe and joinery jobs, being very used also in home-made medicine against hemorrhage, diarrhea, hemorrhoids, conjunctivitis, injury cleaning, uterus hemorrhage, ulcerous hurt and excessive oily skin. The objective of this research was to determine the allelopathic potential of an aqueous extract, boiled or not of S. adstringens (Mart.) Coville, in the Cucumis sativus germination and initial development. Thus, the aqueous vegetable extract was extracted from the shoot, which was triturated in 1L of distilled water to 100g of leaf, being the extract filtrated and separated in boiled and not boiled. The treatments used were distilled water (0%) and boiled and not boiled extracts, in the concentrations of 50 and 100%. The cucumber seeds were put to germinate in Gerbox, having filter paper as substrate, which was wet with 25mL from different treatments, in constant temperature of 25°C. The reading germination was accomplished in breaks of 24 hours, for a period of five consequently days after the beginning of the experiment, considering germinated the seeds that showed 2mm of root, approximately. To dry matter determination, the seedlings with five days after the germination were separated in shoot and root, dried during three days to a constant weight in a 60°C forced draft oven. Through results, it can be concluded that the extract of S. adstringens affected more the Cucumis sativus seedling development than the germination, and it didn't show difference if boiled or not.

Modificação no posicionamento do paciente para o procedimento para prolapso e hemorroidas (PPH): Decúbito ventral com coxim e membros inferiores afastados

Our aim is to present a modification in patient placement on surgical table for the treatment of prolapsed hemorrhoids by using PPH technique. We propose a modified jackknife position for PPH procedure where the surgeon stays between patient's legs. The modified jackknife position may provide better surgical field with better view of the dentate line which facilitates pursestring confection. In Brazil, the majority of the surgeons prefer lithotomic position for PPH technique based on Longo's first reports. In our opinion, modified jackknife position provides both better surgical field for pursestring placement and better view of the staple line after PPH firing.