Obstrução intestinal no idoso

RACIONAL: O envelhecimento da população é realidade sentida na vivência diária, levando à necessidade associada de prover cuidados médicos eletivos e de emergência a um número cada vez maior de idosos. OBJETIVO: Avaliar os aspectos clínicos, terapêuticos e evolutivos de pacientes idosos com obstrução intestinal atendidos no Hospital das Clínicas da Faculdade de Medicina de Botucatu - UNESP. MÉTODOS: Análise retrospectiva de pacientes internados no período de janeiro de 2002 a dezembro de 2006. Foram estudados 50 pacientes, 24 homens e 26 mulheres, com idade média de 74,7 ± 7,4 anos, analisando-se a diferenciação entre obstrução funcional e orgânica; a freqüência das causas obstrutivas; a mortalidade; a incidência dos sinais e sintomas; e correlação laboratorial. RESULTADOS: O quadro obstrutivo intestinal teve as seguintes causas: brida (38%), câncer de colon (24%), hérnias (12%), impactacão fecal (12%), carcinomatose (10%) e volvo da sigmóide (4%). A mortalidade foi de 18% associada à complicações infecciosas em todos os pacientes. CONCLUSÕES: a) A distinção entre a obstrução intestinal funcional e orgânica oferece dificuldade no idoso; b) o câncer do colon constitui-se em importante causa de obstrução intestinal com quadro obstrutivo já na primeira manifestação clínica desse tumor; c) bridas e hérnias são igualmente importantes na etiologia da obstrução intestinal; d) os sinais clínicos obstrutivos são poucos evidentes no idoso e a leucometria é mais fidedigna para este diagnóstico.

Obstrução nasolacrimal congênita: fatores relacionados com a possibilidade de cura

OBJETIVO: Avaliar a chance de cura da obstrução nasolacrimal congênita de acordo com a idade em que se deu o início da epífora e o tratamento efetuado. MÉTODOS: Quarenta crianças portadoras de obstrução nasolacrimal congênita, atendidas no período de 1997 a 1999, foram estudadas retrospectivamente, avaliando-se: idade do início da epífora, tratamento efetuado e possibilidade de cura. Os dados foram submetidos à análise estatística e usou-se o teste de proporções binomiais para contrastes entre e dentro de populações. RESULTADOS: A proporção de cura foi menor quando a epífora se iniciou em idade superior a 4 meses de vida, havendo possibilidade de cura com massagem e/ou sondagem em mesmas proporções, sendo possível obter cura também em crianças com idade superior a 3 anos de vida. CONCLUSÃO: Os resultados mostram que a possibilidade de cura sofre a influência da época do início da epífora e que o tratamento com massagem ou sondagem pode ser efetivo, mesmo em crianças com idade superior a 3 anos de idade.

Obstrução nasolacrimal congênita: fatores relacionados com a melhora após sondagem terapêutica

OBJETIVO: Avaliar em crianças portadoras de obstrução nasolacrimal congênita (ONLC) os índices de cura com a sondagem das vias lacrimais e os fatores relacionados com o insucesso do procedimento. MÉTODO: Estudo retrospectivo observacional, incluindo 80 crianças portadoras de obstrução nasolacrimal congênita, submetidas à sondagem terapêutica da via lacrimal. As crianças foram avaliadas quanto ao sexo, faixa etária e resultado da sondagem. Os dados obtidos foram avaliados por estatística descritiva, teste de Goodman e pelo teste não paramétrico de Mann-Whitney, com nível de significância de 5%. RESULTADOS: A cura ocorreu igualmente em ambos os sexos. A média de idade das crianças que se beneficiaram da sondagem foi de 19,95±11,4 meses e a das crianças que não se curaram foi de 23,37±15,2 meses. A possibilidade de cura ocorreu igualmente nas faixas etárias acima dos 6 meses. Observou-se nas crianças que não se curaram com a sondagem a existência de alterações nasais como rinite, hipertrofia de adenóide ou de cornetos, desvio de septo e sinusopatia. CONCLUSÃO: A possibilidade de cura com a sondagem não varia significativamente mesmo nas idades acima dos 12 meses. Entre as causas de insucesso com o procedimento devem ser incluídas as alterações da cavidade nasal.

Effects of muscarinic receptor antagonists on acetylcholine-induced contractions of jejunal smooth muscle in horses

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Obstrução intestinal e enterotomia em tigre d’água (Trachemys dorbignyi)

Intestinal obstruction occurs in chelonian mainly due parasitism and foreign bodies, as stones and sand. An intestinal compaction was described in a five year-old male d'orbigny's slider which was taken to the Veterinary Medical Teaching Hospital of the UNICASTELO, at Fernandopolis, SP, Brazil, presenting anorexia for a week, severe dehydration and stupor. Definitive diagnostic was performed by radiographic exam and great amount of intestinal radiopac substance was detected. The animal went through emergency celiotomy for removing the intestinal foreign bodies. Inhalatory anesthesia with isofluorane was used for anesthesia induction and manutention. After local antisepsy, a 4cm(2) oblique opening was conducted on plastron by using a vibratory saw. Peritoneum was cut, intestines exteriorized and enterotomy performed. During the surgery, the animal was radiographed to confirm the complete taken out of the foreign bodies. Mononylon 4-0 strand was applied for intestinal suture in two planes. The plastron piece that was taken out was replaced and set with epoxy resine and gaze on the surgical window, making it waterproof. In the postoperative time, animal was medicated with analgesics for two days and pentabiotics for five days. Oral creamy diet was used with oral tube from the second to tenth day, what provided a great clinicosurgical recovering.

Obstrução intestinal congênita em cão por aderência de alça em osso púbico

Atendeu-se uma cadela, sem raça definida, com aproximadamente cinco meses de idade, apresentando anamnese com queixa de apatia e hiporexia associadas a vômitos e emagrecimento progressivo com início incerto. Ao exame físico era evidente distensão abdominal com dilatação intestinal e aumento de peristaltismo. O animal apresentava-se emaciado e subdesenvolvido, com acentuado grau de desidratação, pulso filiforme e nível de consciência reduzido. Minutos após o início do atendimento a cadela foi a óbito. À necropsia, pôde-se observar um segmento do intestino delgado atravessando o púbis e com lúmen reduzido. Tal apresentação se faz relevante por se tratar de um caso nunca antes descrito na literatura veterinária.

EFFECTS OF PROTEIN-DEFICIENCY AND NATURAL INTESTINAL INFECTION WITH GIARDIA-LAMBLIA ON JEJUNAL INTRAEPITHELIAL LYMPHOCYTES IN RATS OF DIFFERENT AGES

1. The interaction between experimental protein deprivation and natural intestinal infection by Giardia lamblia was studied in terms of its effects on the intraepithelial lymphocyte (IEL) population and morphology of the jejunal mucosa of rats of different ages.2. Young, adult and old male Wistar rats received a protein-deficient diet (2% casein) or a control diet (20% casein) for 42 days. Mucosal height and the number of lymphocytes located among 500 consecutive epithelial cells (EC) along the villi or crossing the basement membrane were determined in PAS-stained jejunal fragments.3. The number of IEL increased progressively with animal age, from 14 to 25 per 100 epithelial cells, with significant differences between age ranges. However, the number of IEL did not differ between control and protein-deficient rats in any of the age groups. The proportion of lymphocytes crossing the basement membrane was approximately two-fold greater in young (2.8/100 EC) and adult (5.8/100 EC) protein-deficient animals than in their respective controls (1.6 and 2.8/100 EC). The intensity of parasite colonization was moderate, from 3 to 5/100 EC and did not differ between groups. The pattern of morphologic changes of jejunal mucosa in protozoal infection did not differ between control and protein-deficient animals in any of the three age groups.4. We conclude that intestinal infection with Giardia lamblia probably stimulated the local immune response, masking the reduction of the IEL population induced by protein deficiency. The increase in lymphocyte numbers with age may be related to prolonged antigenic stimulation promoted by infection.

Cinética do transporte jejunal de glicose em ratos com deficiência de niacina.

The kinetic of jejunal glucose transport was studied using perfused rat jejunum in vivo. Ninety rats were fed a diet deficient in niacin and 90 a control diet. The jejunal loops of 7 groups of animal were infused each group with one of following solutions of glucose: 5, 10, 20, 40, 80, 160 and 300 mM/l. The Vmax and Km values were determined. The results showed that the vitamin-deficient rats absorbed less glucose independently of the amount infused and these animals had lower Vmax (133.7 microM/15 min/15 cm) and Km (192.1 mM/l) than control groups (294.1 microM/15 min/15 cm and 171.8 mM/l, respectively). In conclusion one can assume that niacin deficiency leads to a decreased glucose absorption in the jejunal loops, when tested as in our experimental model.

Obstrução nasolacrimal congênita - Diagnóstico e tratamento

Patients with congenital nasolacrimal obstruction (CNLO) were evaluated at the Lacrimal Apparatus Service of Botucatu Faculty of Medicine - UNESP from 1990 to 1993. 45 children were seen at this period with CNLO. The diagnosis was confirmed by dacryocystography (DCG). Obstruction was unilateral in 77,7% of the patients; 68,1% at Arlt Sinus and 43,6% had lacrimal sac grade 1. Probing was made in children older than 6 months, under general anaesthesia, after DCG was performed. Cure was greater in children age 6 to 12 months with obstruction at Hasner's Valve and without dilation of lacrimal sac.

Transporte jejunal eletrogênico da glicose em ratos com deficiência de niacina.

The active electrogenic absorption of glucose was studied in 12 niacin deficient rats using a method for measuring changes in transmural potential difference across jejunal mucosa. The glucose was infused in 6 different concentrations (2.5; 5.0; 10.0; 20.0; 50.0 and 100.0 mM/L) at a constant rate of 1.7 ml per minute. The apparent kinetic parameters (Km and Pdmax) of active electrogenic transport were obtained graphically from curves of glucose transfer potentials. The results were compared with that obtained in a control group. The curve of glucose transfer potential in niacin deficient group was significantly lower than that of the control group. The apparent Km of niacin deficient group was greater than in the control group (16.1 x 12.7 mM/L). Furthermore, the Pdmax of the deficient group was lower than that of the control group (12.5 x 19.4 mV). The results showed that in niacin deficiency occurs a decreasing of the active electrogenic glucose absorption. One of the possible interpretation of the differences in the kinetic characteristics of electrogenic glucose transport would be a depleted energy supplement for the active transport in the enterocyte of the niacin deficient rats.

Obstrução nasolacrimal congênita - Diagnóstico e tratamento

This article assembled the congenital lacrimal obstruction according embryology, clinical presentation, propedeutic exams and other differential anomalies.

Edema agudo pulmonar associado à obstrução das vias aéreas. Relato de caso

BAKGROUND AND OBJECTIVES: Negative pressure pulmonary edema has been defined as non-cardiogenic edema, with transudation of fluid to the interstitial space of the lungs due to an increase in negative intrathoracic pressure secondary to obstruction of the upper airways. This is the case of a healthy patient who underwent general anesthesia and developed acute pulmonary edema after extubation. CASE REPORT: A 23-year old female patient, physical status ASA II, underwent gynecologic videolaparoscopy under general anesthesia. The procedure lasted 3 hours without intercurrence. After extubation the patient developed laryngeal spasm and reduction in oxygen saturation. The patient improved after placement of an oral cannula and administration of oxygen under positive pressure with a face mask. Once the patient was stable she was transferred to the recovery room where, shortly after her arrival, she developed acute pulmonary edema with elimination of bloody serous secretion. Treatment consisted of elevation of the head, administration of oxygen via a face mask, furosemide and fluid restriction. Chest X-ray was compatible with acute pulmonary edema and normal cardiac area. Electrocardiogram (ECG), echocardiogram and cardiac enzymes were normal. The condition of the patient improved and she was discharged from the hospital the following day, asymptomatic. CONCLUSIONS: Acute pulmonary edema associated with obstruction of the upper airways can aggravate surgical procedures with low morbidity, affecting mainly young patients. Early treatment should be instituted because it has a fast evolution and, in most cases, resolves without lasting damages. © Sociedade Brasileira de Anestesiologia, 2008.

Indicadores bioquímicos séricos e do líquido peritoneal de equinos submetidos à obstrução intestinal

Twenty-four horses were distributed into four different groups, instrumented control (GI), duodenum obstruction (GII), ileum obstruction (GIII) and large colon obstruction (GIV). Serum and peritoneal fluid analysis of aspartate aminotransferase, creatine kinase, lactate dehydrogenase, alkaline phosphatase, inorganic phosphorus and lactate were measured. Samples were collected one hour before the surgical procedure (T0); 3 hours after the obstruction (T3ob), 1, 3, 12, 24, 120 and 168 hours after the beginning of reperfusion/deobstruction. Duodenal (GII) and ileum (GIII) obstructions changed serum and peritoneal fluid biochemical analysis. However, only lactate, lactate dehydrogenase, creatine kinase and inorganic phosphorus concentrations were abnormal in peritoneal fluid three hours after the obstruction. The biochemical analysis of peritoneal fluid allowed a faster diagnostic of intestinal alterations than the serum analysis; hence it should be prioritized when pre-operatory colic assessment is carried out.

Efeitos do tramadol no modelo de dor induzida por obstrução intestinal em eqüinos

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

Análise perceptivo-auditiva e acústica da voz em crianças de 4 a 12 anos com obstrução nasal crônica

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