Effects of circular myotomy on the healing of esophageal suture anastomosis: an experimental study

For esophageal reconstruction in newborns with esophageal atresia, esophageal reunion with an end-to-end anastomosis is the ideal procedure, although it may result in leaks and strictures due to tension on the suture line, mainly in cases with a wide gap between the ends. Circular myotomy (Livaditis' procedure) is the best method to elongate the proximal esophageal pouch and reduce anastomotic tension. This experimental investigation in dogs was undertaken to attempt to verify that circular myotomy decreases the anastomotic leak rate in newborns with wide gap esophageal atresia, and to analyze whether the technique promotes morphologic changes in the anastomotic scar. A pilot study demonstrated that it is necessary to resect more than 8 cm (40% of the total esophageal length) in order to obtain high leak rates. In the experimental project, such resection was performed in dogs divided into two groups (control group, anastomosis only, and experimental group, anastomosis plus circular myotomy in the proximal esophageal segment). The animals were killed in the 14th postoperative day, submitted to autopsy, and were evaluated as to the presence of leaks and strictures, as well as to the features (macroscopic and microscopic aspects) of the anastomosis. Leak rates were the same in both groups. Morphometric analysis revealed that in animals in the experimental group, the anastomotic scar was thinner than the control animals, and the isolated muscular manchette distal to the site of myotomy was replaced by fibrous tissue. Correspondingly, a decreased number of newly formed small vessels were noted in the experimental animals, compared to control animals. We concluded that circular myotomy does not decrease the incidence of anastomotic leaks, and it also promotes deleterious changes in anastomotic healing.

Short- and long-term outcomes of ileal pouch-anal anastomosis for ulcerative colitis

Ileal pouch-anal anastomosis was an important advancement in the treatment of ulcerative colitis. The aim of this study was to determine whether early complications of ileal pouch-anal anastomosis in patients with ulcerative colitis are associated with poor late functional results. PATIENTS AND METHODS: Eighty patients were operated on from 1986 to 2000, 62 patients with ileostomy and 18 without. The early and late complications were recorded. Specific emphasis has been placed on the incidence of pouchitis with prolonged follow-up. RESULTS: The ileostomy was closed an average of 9.2 months after the first operation. Fourteen patients were excluded from the long-term evaluation; 6 patients were lost to regular follow-up, 4 died, and 4 patients still have the ileostomy. Of the 4 patients that died, 1 died from surgical complications. Early complications after operation (41) occurred in 34 patients (42.5%). Late complications (29) occurred in 25 patients as follows: 16 had pouchitis, 3 associated with stenosis and 1 with sexual dysfunction; 5 had stenosis; and there was 1 case each of incisional hernia, ileoanal fistula, hepatic cancer, and endometriosis. Pouchitis occurred in 6 patients (9.8%) 1 year after ileal pouch-anal anastomosis, 9 (14.8%) after 3 years, 13 (21.3%) after 5 years, and 16 (26.2%) after more than 6 years. The mean daily stool frequency was 12 before and 5.8 after operation. One pouch was removed because of fistulas that appeared 2 years later. CONCLUSIONS: Ileal pouch-anal anastomosis is associated with a considerable number of early complications. There was no correlation between pouchitis and severe disease, operation with or without ileostomy, or early postoperative complications. The incidence of pouchitis was directly proportional to duration of time of follow-up.

Results of microsurgical anastomosis in men with seminal tract obstruction due to inguinal herniorrhaphy

The incidence of vasal injury during inguinal herniorrhaphy is estimated at 0.5%. We sought to assess the patency rates and long-term fertility outcome after microsurgical repair of vasal obstruction related to prior inguinal herniorrhaphy. METHODS: Twenty procedures were performed on 13 men diagnosed with infertility and vasal injury secondary to previous inguinal herniorrhaphy. Eight of these men had undergone bilateral and 5 unilateral inguinal herniorrhaphy. Twelve procedures were vasovasostomies, 3 were crossover vasovasostomies, 2 were vasoepididymostomies, and 3 were crossover vasoepididymostomies. Eight patients were azoospermic, 2 were severely oligospermic (<1 M/mL), 1 was oligospermic, and 2 were asthenospermic. Patency data was obtained on all 13 patients, and pregnancy data was available for 10 couples (77%), with a mean follow-up of 69.5 months. RESULTS: The overall patency rate was 65%. In the vasovasostomy group, the patency rate was 60% (9/15), and in the vasoepididymostomy group it was 80% (4/5). Among the azoospermic patients, 13 procedures were performed. The patency rate was 42.9% for the vasovasostomy (3/7), and 100% for the vasoepididymostomy procedure (4/4). The overall pregnancy rate was 40%. Of the men who underwent vasoepididymostomy, 80% (4/5) established a pregnancy. CONCLUSIONS: Microsurgical vasovasostomy after inguinal vas injury results in a reasonable patency rate but a lower pregnancy rate than that after vasectomy reversal. When microsurgical vasoepididymostomy was possible, it resulted in high patency and pregnancy rate. Crossover vasoepididymostomy, when appropriate, can be a useful alternative to inguinal vasovasostomy.

Classificação de água de coco processada e natural por meio de HCA, PCA e teores de íons metálicos determinados por ICP OES

Inductively Coupled Plasma Optical Emission Spectrometry was used to determine Ca, Mg, Mn, Fe, Zn and Cu in samples of processed and natural coconut water. The sample preparation consisted in a filtration step followed by a dilution. The analysis was made employing optimized instrumental parameters and the results were evaluated using methods of Pattern Recognition. The data showed common concentration values for the analytes present in processed and natural samples. Principal Component Analysis (PCA) and Hierarchical Cluster Analysis (HCA) indicated that the samples of different kinds were statistically different when the concentrations of all the analytes were considered simultaneously.

Classificação de refrigerantes através de análise de imagens e análise de componentes principais (PCA)

This paper describes an approach for the colour-based classification of RGB (red-green-blue) images, acquired using a common scanner, of commercial carbonated soft drinks. Mean histograms of image colour channels were evaluated for the PCA classification of 29 brands of Guaraná, Cola, and orange flavors. Loadings for principal component axes resulted in different patterns for sample grouping on score plots according to RGB histograms. pH, sorbic acid and sucrose measurements were also correlated to the analyzed brands through PCA score plots of the digitalized images.

Avaliação da qualidade do corpo hídrico do rio Tibagi na região de Ponta Grossa utilizando análise de componentes principais (PCA)

The aim of this paper was to evaluate alterations in the quality of the water of the Tibagi River caused by the urban and industrial activities in the region of Ponta Grossa. The study involved the monitoring of physico-chemical and microbiological parameters of the water body, which were evaluated by a principal components analysis routine. Sample collections were carried out monthly during one year (October of 2005 to September of 2006), at 3 sampling points: upstream and downstream of the industrial district and downstream from the city of Ponta Grossa. The principal components analysis showed the effect of point sources associated with industrial activity, which contribute to the rise of total concentration of amoniacal nitrogen and the reduction of dissolved oxygen in the studied region.

PCA: uma ferramenta para identificação de traçadores químicos para água de formação e água de injeção associadas à produção de petróleo

This study describes the use of Principal Component Analysis to evaluate the chemical composition of water produced from eight oil wells in three different production areas. A total of 609 samples of produced water, and a reference sample of seawater, were characterized according to their levels of salinity, calcium, magnesium, strontium, barium and sulphate (mg L-1) contents, and analyzed by using PCA with autoscaled data. The method allowed the identification of variables salinity, calcium and strontium as tracers for formation water, and variables magnesium and sulphate as tracers for seawater.

Investigação da qualidade de farinhas enriquecidas utilizando Análise por Componentes Principais (PCA)

Alguns países, incluindo o Brasil (RDC 344, 2002), instituíram uma regulamentação indicando que farinhas de milho e trigo devem ser enriquecidas com ácido fólico e ferro. O principal objetivo deste trabalho foi a avaliação de algumas características de farinhas enriquecidas usando a Análise por Componentes Principais (PCA). Parâmetros como o teor de ácido fólico, ferro, proteína, lipídios, umidade, cinzas e carboidratos foram avaliados em 30 embalagens de farinhas adquiridas em comércio local. As farinhas de trigo e milho apresentaram, em média, composição centesimal aceitável de acordo com a Legislação Brasileira. Para as farinhas de trigo, a concentração de ácido fólico estava, em média, próxima ao esperado. As farinhas de milho continham quantidade superior da vitamina. Para os dois tipos de farinha, constatou-se teor de ferro acima do valor declarado no rótulo dos produtos. Uma matriz com 30 linhas (amostras) e 7 colunas (variáveis) foi organizada e os dados foram autoescalados. A primeira informação observada foi uma clara diferenciação entre os tipos de farinhas. As farinhas de trigo foram caracterizadas por maior quantidade de proteínas, umidade e cinzas. Por outro lado, as farinhas de milho apresentaram maior concentração de ferro, lipídios, carboidratos e ácido fólico. Foi possível notar também que farinhas acondicionadas em embalagens de plástico apresentaram menor quantidade de ácido fólico (152 µg.100 g-1, em média), quando comparadas às amostras armazenadas em embalagens de papel (259 µg.100 g-1, em média). Esse estudo pode fornecer ferramentas importantes para a avaliação dos programas de enriquecimento de alimentos com ácido fólico, principalmente, por apontar, preliminarmente, para a importância do tipo de embalagem para o acondicionamento das farinhas enriquecidas com a vitamina.

Anaphylaxis with Schistosoma mansoni extracts in normal and infected mice

Methods generally utilized for studies on anaphylaxis to protein antigens such as determination of histamine release to the blood, hemoconcentration, histamine release from peritoneal mast cells and passive cutaneous anaphylaxis (PCA) were used to investigate some aspects of the anaphylaxis to parasite antigens in Schistosoma mansoni infected mice. The release of histamine to the blood and significant rates of hemoconcentration were induced by intravenous injection of schistosomula or cercarial extracts into 10-13 weeks infected mice. Cercarial, schistosomula, worm tegument and soluble egg antigens were able to trigger histamine release from peritoneal mast cells from chronically infected mice. In spite of the PCA reaction beeing detected within 2 hours of sensitization (IgG1antibodies) in 6 of 8 tested sera from chronically infected mice, no detectable reactions were obtained after 48 hours sensitization (IgE antibodies). Although IgE was not detected in the circulation, by the PCA technique, the results indicate that the infected mice contained IgE antibodies bound to their mast cells.

Clinical use of growth hormone and glutamine in short bowel syndrome

Growth hormone (GH) and glutamine (GLN) are considered bowel trophic factors and are used experimentally after bowel resection. Their clinical uses in short bowel syndrome (SBS) are still not standardized. It is of interest to verify metabolic, nutritional and side effects of the association of GH and GLN in SBS. Three patients, 39 (A), 33 (B), and 01 years old (C) underwent bowel resection with jejunum anastomosis 15 cm (A) and 60 cm (B) distant from the Treitz angle, and 40 cm (C) preserving the ileo cecal valve. GH Saizen (Serono - A), Genotropin (Pharmacia - B), and Norditropin (Novonordisk C) were administered in doses of 0.14 mg /kg/day. GLN (0.4 g/kg/day) was given orally for 10 days (A), 30 days (B) and 60 days to patient C (0.28 g/kg/day). Central TPN and adequate oral diet was administered according to the bowel adaptation phase. On the first day after beginning treatment patient A exhibited symptoms of hypoglycemia. There were no other side effects. After treatment, body weight was higher and analysis by bioelectrical impedance showed more lean mass and less fat mass compared to pre-treatment measurements. Nitrogen retention was progressively higher with treatment. Simultaneous treatment with GH and GLN does not cause significant side effects, and is associated with a favorable distribution of the body compartments and nitrogen retention in patients with the short bowel syndrome.

Pouchitis: extracolonic manifestation of ulcerative colitis?

Pouchitis is the most frequent complication of ileal pouch-anal anastomosis for treatment of ulcerative colitis. There are several possible explanations. Among them, we focus on the one that considers pouchitis as an extracolonic manifestation of ulcerative colitis. The aim of this study was to investigate the association between pouchitis and extra-intestinal manifestations (EIM), which are frequent in these patients. Sixty patients underwent restorative proctocolectomy with an ileal J pouch (IPAA) from September 1984 to December 1998. Pouchitis was defined by clinical, endoscopic, and histologic criteria. The following extra-intestinal manifestations were studied: articular, cutaneous, hepatobiliary, ocular, genitourinary, and growth failure. Thirteen patients, of which 10 were female (76.9%), developed one or more episodes of pouchitis. Twelve patients of this group (92.3%) presented some kind of extra-intestinal manifestation, 4 pre-operatively (exclusively), 2 post-operatively (exclusively), and 6 both pre- and post-operatively (1.7 per patient). Twenty patients (42.7%) of the 47 without pouchitis did not present extra-intestinal manifestations; 10/35 (28.5%) of females had pouchitis, compared to 3/35 (12.0%) of men. Pouchitis was more frequent among females, though not statistically significant. EIM increases the risk of pouchitis. Pouchitis is related to EIM in 92.3 % of cases, corroborating the hypothesis that it could be an extracolonic manifestation of ulcerative colitis.

Concomitant involvement of the small intestine and the distal esophagus in an infant with massive necrotizing enterocolitis

Necrotizing enterocolitis is a disease of the newborn that may involve the small intestine and/or the colon, and the stomach. To our knowledge, massive necrosis of the small intestine with concomitant involvement of the esophagus has never been reported. A case of a 6-month-old boy with necrotizing enterocolitis and pan-necrosis of the small intestine, cecum, and the lower third of the esophagus is presented. After 70 days of treatment, intestinal transit was established by an anastomosis between the first centimeter of jejunum and the ascending colon. Finally, esophageal transit was established by a total gastric transposition with cervical esophagogastric anastomosis. The patient was maintained under total parenteral nutrition, and after 19 months he developed fulminant hepatic failure due to parenteral nutrition; he then underwent combined liver and small bowel transplantation. After 2 months, the patient died due to undefined neurologic complications, probably related to infection or immunosuppressive therapy.

Determinação dos elementos-traço (Zn, Co e Ni) em sedimentos da Plataforma Continental Amazônica sob influência da descarga do rio Amazonas

Esta pesquisa foi desenvolvida na Plataforma Continental Amazônica (PCA) no trecho compreendido entre os cabos Orange (AP) e Maguari (PA), para determinar os teores de Zn, Co e Ni nos sedimentos superficiais, identificando o papel dos sedimentos como fonte ou reserva de elementos-traço. A concentração dos elementos metálicos apresentou a seguinte associação: Zn > Ni > Co. Os sedimentos localizados na PCA podem ser considerados como sítio de ocorrência natural dos elementos metálicos, não havendo influência de fontes poluidoras na liberação destes para o sistema.

Estudo de metais pesados (Co, Cu, Fe, Cr, Ni, Mn, Pb e Zn) na Bacia do Tarumã-Açu Manaus (AM)

Os resíduos gerados em domicílios incluem diversos produtos, como pesticidas, produtos farmacêuticos, detergentes, óleos de cozinha, metais pesados contidos em baterias e outros utensílios. Esses resíduos são lançados continuamente em aterro sanitário ou lixões em cidades como Manaus. O chorume produzido nesses aterros, quando não tratados, contamina recursos hídricos superficiais e subterrâneos. Neste estudo foi feita uma avaliação das conseqüências da liberação do chorume no sistema hídrico da bacia do Tarumã-Açu. Amostras de água e sedimento foram coletadas nos igarapés Matrinxã, Acará, Bolívia, bacia do Tarumã-Açu e dentro do aterro sanitário (Manaus - Amazonas - Brasil) em março 2001. As amostras de água foram filtradas em filtro Milipore (0,45 mm de poro) e, em seguida, tratadas com HNO3 concentrado. As amostras de sedimento foram peneiradas em malha de 0,053 mm e digeridas com HCl:HNO3 (1:3) a 150ºC. As concentrações de alguns metais pesados (Co, Cu, Fe, Cr, Ni, Mn, Pb e Zn) foram determinadas nas amostras de água e sedimento por espectrometria de absorção atômica de chama. Os resultados revelaram que a concentração dos metais pesados é muito acima dos permitidos pela resolução 357/2005 do CONAMA em praticamente todos os locais amostrados, mostrando que o Aterro Sanitário é um dos principais responsáveis pelo impacto ambiental observado nos corpos hídricos estudados. As análises dos componentes principais (PCA) e hierárquica de cluster (HCA), revelam que os pontos de coleta localizados dentro do aterro sanitário apresentam características diferentes dos outros locais amostrados. Além disso, o HCA e PCA mostraram que existe uma similaridade entre os pontos de coleta localizados fora do aterro o que permite afirmar que o chorume do aterro se dissolve por todo corpo hídrico estudado.

Gradiente florístico das florestas secundárias do Nordeste Paraense

O presente estudo descreve um gradiente florístico de uma cronosequência de florestas secundárias do Nordeste Paraense, a partir de 19 sítios de diferentes idades, avaliados em diferentes anos. Foram usados os dados de densidade e realizada análise de regressão para riqueza, diversidade, densidade, densidade relativa máxima e equibilidade em relação à idade. Foi usado o método de análise de agrupamento hierárquico, sendo a distância euclidiana utilizada como medida de dissimilaridade e aplicada uma Análise de Componente Principal (PCA) para confirmação dos grupos. Após a definição dos grupos, foi feita a análise indicadora de espécies (IndVal) sobre a mesma matriz utilizada para análise de agrupamento. Encontrou-se um gradiente geográfico na cronosequência analisada e as espécies Tapirira guianensis, Vismia guianensis, Inga alba, Lacistema aggregatum, Croton maturensis, Abarema jupunba, Inga rubiginosa, Guateria poepigiana e Thyrsodium paraense, são indicadoras das florestas secundárias do Nordeste Paraense analisadas neste estudo.