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Análise histopatológica e ultraestrutural do esôfago distal de ratos com lesão cáustica submetidos à aplicação tópica de mitomicina C /Bustamante, Thais França. January 2011 (has links)
Orientador: Erika V. Paiva Ortolan / Banca: Walmar Kerche de Oliveira / Banca: João Gilberto Maksound Filho / Resumo: A ingestão acidental de substâncias cáusticas constitui um grave problema de saúde pública, ocorrendo principalmente na faixa etária pediátrica, sendo a estenose do esôfago uma complicação frequente. A dilatação esofágica é o tratamento de escolha para estes casos. Várias substâncias já foram testadas nos casos refratários à dilatação, porém com resultados insatisfatórios. A mitomicina C, agente quimioterápico capaz de inibir a síntese protéica e a proliferação de fibroblastos, tem sido usada com sucesso em estenoses esofágicas refratárias às dilatações. No entanto, há poucos estudos experimentais descrevendo como a mitomicina C interage com o tecido lesado e qual o melhor momento para o seu uso após a lesão cáustica. Avaliar os efeitos do uso tópico da mitomicina C, associada ou não à dilatação esofágica, aplicada em diferentes momentos após a lesão cáustica do esôfago de ratos com soda cáustica (NAOH 10%). Para efeito de comparação, utilizou-se ratos nos quais se infundiu solução salina (SF0,9%) no esôfago. Quarenta e oito ratos foram divididos em 6 grupos com 8 ratos cada: grupo manipulado ou sham (Gs), grupo controle (Gc), grupo com lesão cáustica e não tratado (Gnt), grupo com lesão cáustica e aplicação de mitomicina C (MMC) logo após a lesão (GmmcD0), grupo com lesão cáustica e aplicação de MMC 14 dias após a lesão (GmmcD14) e grupo com lesão cáustica seguido de dilatação e aplicação de MMC 14 dias após a lesão (Gdil+mmcD14). A lesão cáustica foi produzida seguindo o modelo descrito por Gehanno & Guedon modificado pelo nosso grupo de pesquisa, com NaOH10%. Em 4 momentos de avaliação (7º, 14º, 21º, e 28º dias de pós operatório - PO), todos os animais foram pesados. No 7º e 21º dias de PO, 4 ratos de cada grupo foram submetidos ao exame contrastado de esôfago. No 28º dia de PO... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The accidental ingestion of caustic substances is an important problem of public health, occurring mainly in childhood. The esophageal stricture is a frequent complication and esophageal dilation is the treatment of choice. Many agents have been tested when esophageal dilation is unsatisfactory, although with poor results. Mitomycin C, a chemotherapeutic agent that inhibits protein synthesis and the proliferation of fibroblasts, has been used successfully in cases of esophageal stricture that are refractory to dilation. However, there are few experimental studies describing how this substance interacts with damaged tissue and the best time window for its use after caustic injury. The purpose of this study was to evaluate the effects of the topical application of MMC in rats, with or without associated esophageal dilatation, at different moments after the induction of a caustic esophageal lesion by NaOH10%. 48 Wistar rats were divided into 6 groups of 8 animals each: sham group (SG), control group (CG), injured group but not treated (NTG), injured group with mitomycin C application immediately after the caustic lesion (MMCD0G), injured group with MMC application 14 days after induction of caustic lesion (MMCD14G) and injured group with esophageal dilation and application 14 days after caustic lesion (MMCD14+DILG). The caustic injury was produced as described by Gehanno & Guedon, modified by our group, with NaOH10%. There were 4 moments of evaluation: 7°, 14°, 21° and 28° days after caustic injury, when rats were weighted. At 7° and 21° days after injury, it was performed the esophagograms of 4 rats of each group. On day 28 after caustic injury, all animals were sacrificed, and morphological and histopathological analyses were performed on the esophageal specimens, besides... (Complete abstract click electronic access below) / Mestre
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Análise histopatológica e ultraestrutural do esôfago distal de ratos com lesão cáustica submetidos à aplicação tópica de mitomicina CBustamante, Thais França [UNESP] 18 August 2011 (has links) (PDF)
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bustamante_tf_me_botfm.pdf: 3625249 bytes, checksum: 92a758c187e8eec63582c316baef9e88 (MD5) / Universidade Estadual Paulista (UNESP) / A ingestão acidental de substâncias cáusticas constitui um grave problema de saúde pública, ocorrendo principalmente na faixa etária pediátrica, sendo a estenose do esôfago uma complicação frequente. A dilatação esofágica é o tratamento de escolha para estes casos. Várias substâncias já foram testadas nos casos refratários à dilatação, porém com resultados insatisfatórios. A mitomicina C, agente quimioterápico capaz de inibir a síntese protéica e a proliferação de fibroblastos, tem sido usada com sucesso em estenoses esofágicas refratárias às dilatações. No entanto, há poucos estudos experimentais descrevendo como a mitomicina C interage com o tecido lesado e qual o melhor momento para o seu uso após a lesão cáustica. Avaliar os efeitos do uso tópico da mitomicina C, associada ou não à dilatação esofágica, aplicada em diferentes momentos após a lesão cáustica do esôfago de ratos com soda cáustica (NAOH 10%). Para efeito de comparação, utilizou-se ratos nos quais se infundiu solução salina (SF0,9%) no esôfago. Quarenta e oito ratos foram divididos em 6 grupos com 8 ratos cada: grupo manipulado ou sham (Gs), grupo controle (Gc), grupo com lesão cáustica e não tratado (Gnt), grupo com lesão cáustica e aplicação de mitomicina C (MMC) logo após a lesão (GmmcD0), grupo com lesão cáustica e aplicação de MMC 14 dias após a lesão (GmmcD14) e grupo com lesão cáustica seguido de dilatação e aplicação de MMC 14 dias após a lesão (Gdil+mmcD14). A lesão cáustica foi produzida seguindo o modelo descrito por Gehanno & Guedon modificado pelo nosso grupo de pesquisa, com NaOH10%. Em 4 momentos de avaliação (7º, 14º, 21º, e 28º dias de pós operatório - PO), todos os animais foram pesados. No 7º e 21º dias de PO, 4 ratos de cada grupo foram submetidos ao exame contrastado de esôfago. No 28º dia de PO... / The accidental ingestion of caustic substances is an important problem of public health, occurring mainly in childhood. The esophageal stricture is a frequent complication and esophageal dilation is the treatment of choice. Many agents have been tested when esophageal dilation is unsatisfactory, although with poor results. Mitomycin C, a chemotherapeutic agent that inhibits protein synthesis and the proliferation of fibroblasts, has been used successfully in cases of esophageal stricture that are refractory to dilation. However, there are few experimental studies describing how this substance interacts with damaged tissue and the best time window for its use after caustic injury. The purpose of this study was to evaluate the effects of the topical application of MMC in rats, with or without associated esophageal dilatation, at different moments after the induction of a caustic esophageal lesion by NaOH10%. 48 Wistar rats were divided into 6 groups of 8 animals each: sham group (SG), control group (CG), injured group but not treated (NTG), injured group with mitomycin C application immediately after the caustic lesion (MMCD0G), injured group with MMC application 14 days after induction of caustic lesion (MMCD14G) and injured group with esophageal dilation and application 14 days after caustic lesion (MMCD14+DILG). The caustic injury was produced as described by Gehanno & Guedon, modified by our group, with NaOH10%. There were 4 moments of evaluation: 7°, 14°, 21° and 28° days after caustic injury, when rats were weighted. At 7° and 21° days after injury, it was performed the esophagograms of 4 rats of each group. On day 28 after caustic injury, all animals were sacrificed, and morphological and histopathological analyses were performed on the esophageal specimens, besides... (Complete abstract click electronic access below)
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Acute emergency care and airway management of caustic ingestion in adultsStruck, Manuel F., Beilicke, André, Hoffmeister, Albrecht, Gockel, Ines, Gries, André, Wrigge, Hermann, Bernhard, Michael 20 June 2016 (has links) (PDF)
Background: Caustic ingestions are rare but potentially life-threatening events requiring multidisciplinary emergency approaches. Although particularly respiratory functions may be impaired after caustic ingestions, studies involving acute emergency care are scarce. The goal of this study was to explore acute emergency care with respect to airway management and emergency department (ED) infrastructures. Methods: We retrospectively evaluated adult patients after caustic ingestions admitted to our university hospital over a 10-year period (2005–2014). Prognostic analysis included age, morbidity, ingested agent, airway management, interventions (endoscopy findings, computed tomography (CT), surgical procedures), intensive care unit (ICU) admission, length of stay in hospital and hospital mortality. Results: Twenty-eight patients with caustic ingestions were included in the analysis of which 18 (64 %) had suicidal intentions. Ingested agents were caustic alkalis (n = 22; 79 %) and acids (n = 6; 21 %). ICU admission was required in 20 patients (71 %). Fourteen patients (50 %) underwent tracheal intubation and mechanical ventilation, of which 3
(21 %) presented with difficult airways. Seven patients (25 %) underwent tracheotomy including one requiring awake tracheotomy due to progressive upper airway obstruction. Esophagogastroduodenoscopy (EGD) was performed in 21 patients (75 %) and 11 (39 %) underwent CT examination. Five patients (18 %) required emergency surgery with a mortality of 60 %. Overall hospital mortality was 18 % whereas the need for tracheal intubation (P = 0.012), CT-diagnostic (P = 0.001), higher EGD score (P = 0.006), tracheotomy (P = 0.048), and surgical interventions (P = 0.005) were significantly associated with mortality. Conclusions: Caustic ingestions in adult patients require an ED infrastructure providing 24/7-availability of expertise in establishing emergent airway safety, endoscopic examination (EGD and bronchoscopy), and CT diagnostic, intensive care
and emergency esophageal surgery. We recommend that - even in patients with apparently stable clinical conditions - careful monitoring of respiratory functions should be considered as long as diagnostic work-up is completed.
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Acute emergency care and airway management of caustic ingestion in adults: single center observational studyStruck, Manuel F., Beilicke, André, Hoffmeister, Albrecht, Gockel, Ines, Gries, André, Wrigge, Hermann, Bernhard, Michael January 2016 (has links)
Background: Caustic ingestions are rare but potentially life-threatening events requiring multidisciplinary emergency approaches. Although particularly respiratory functions may be impaired after caustic ingestions, studies involving acute emergency care are scarce. The goal of this study was to explore acute emergency care with respect to airway management and emergency department (ED) infrastructures. Methods: We retrospectively evaluated adult patients after caustic ingestions admitted to our university hospital over a 10-year period (2005–2014). Prognostic analysis included age, morbidity, ingested agent, airway management, interventions (endoscopy findings, computed tomography (CT), surgical procedures), intensive care unit (ICU) admission, length of stay in hospital and hospital mortality. Results: Twenty-eight patients with caustic ingestions were included in the analysis of which 18 (64 %) had suicidal intentions. Ingested agents were caustic alkalis (n = 22; 79 %) and acids (n = 6; 21 %). ICU admission was required in 20 patients (71 %). Fourteen patients (50 %) underwent tracheal intubation and mechanical ventilation, of which 3
(21 %) presented with difficult airways. Seven patients (25 %) underwent tracheotomy including one requiring awake tracheotomy due to progressive upper airway obstruction. Esophagogastroduodenoscopy (EGD) was performed in 21 patients (75 %) and 11 (39 %) underwent CT examination. Five patients (18 %) required emergency surgery with a mortality of 60 %. Overall hospital mortality was 18 % whereas the need for tracheal intubation (P = 0.012), CT-diagnostic (P = 0.001), higher EGD score (P = 0.006), tracheotomy (P = 0.048), and surgical interventions (P = 0.005) were significantly associated with mortality. Conclusions: Caustic ingestions in adult patients require an ED infrastructure providing 24/7-availability of expertise in establishing emergent airway safety, endoscopic examination (EGD and bronchoscopy), and CT diagnostic, intensive care
and emergency esophageal surgery. We recommend that - even in patients with apparently stable clinical conditions - careful monitoring of respiratory functions should be considered as long as diagnostic work-up is completed.
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