INTRODUÇÃO: O câncer da vesícula biliar é a lesão maligna mais comum da árvore biliar e pouco se sabe sobre a sua carcinogênese. O possível caráter pré-neoplásico das alterações histológicas da vesícula biliar vem sendo estudado recentemente. O objetivo deste estudo foi identificar e quantificar as alterações histológicas da vesícula biliar no nosso meio e correlacioná-las com dados clínicos, e correlacionar as alterações metaplásicas, em separado, com as demais alterações encontradas. MÉTODOS: Neste estudo retrospectivo realizado entre novembro de 1999 a dezembro de 2006, foram avaliados 1.689 prontuários de doentes submetidos a colecistectomia laparoscópica por colecistolitíase. Os doentes foram divididos em relação à idade em doentes com até 60 anos e com mais de 60 anos. Em relação ao tempo de sintomas antes da cirurgia foram agrupados em doentes sem sintomas, doentes com sintomas até 1 ano, e doentes com sintomas por mais de 1 ano antes da cirurgia. Em relação ao tamanho e número dos cálculos foram agrupados em doentes com cálculos de até 10 mm, e aqueles com cálculos maiores que 10 mm, e em doentes com cálculos únicos ou múltiplos. RESULTADOS: Eram mulheres 1.238 doentes (73,3%) e 451 eram homens (26,7%). Apresentaram idade de até 60 anos 1.192 doentes (70,6%) e 497 (29,4%) apresentaram mais de 60 anos. Apresentaram cálculos menores que 10 mm 1.319 doentes (78,1%) e 370 doentes (21,9%) apresentaram cálculos maiores que 10 mm. Foi observado inflamação aguda em 174 doentes (10,3%), gangrena em 23 (1,4%), abscesso em 8 (0,4%), colesterolose em 305 (18,1%), adenomiomatose em 40 (2,4%), colecistite xantogranulomatosa em 29 (1,7%), fibrose em 12 (0,7%), escleroatrofia em 20 (1,2%), pólipo hiperplásico em 3 (0,2%), pólipo de colesterol em 17 (1,0%), metaplasia pilórica em 72 (4,3%), metaplasia intestinal em 18 (1,1%), displasia em 4 (0,2%), câncer em 2 (0,1%). Não foram observados pólipos adenomatosos. CONCLUSÕES: O sexo masculino apresenta maior freqüência de complicações inflamatórias que o feminino. Não há relação entre o tempo de sintomas e uma maior ocorrência das alterações histológicas estudadas, excetuando-se a colecistite xantogranulomatosa. Nos doentes idosos há maior ocorrência de adenomiomatose, gangrena e abscesso. Há aumento progressivo de idade para a ocorrência de metaplasia pilórica, metaplasia intestinal, displasia e câncer. O tamanho dos cálculos não guarda relação com a ocorrência das alterações estudadas, exceto para colecistite aguda que se associou com cálculos pequenos e múltiplos. Há associação entre a ocorrência de metaplasia pilórica e adenomiomatose, metaplasia pilórica e displasia, metaplasia pilórica e câncer. Há também associação entre a ocorrência de metaplasia intestinal e metaplasia pilórica, metaplasia intestinal e adenomiomatose, metaplasia intestinal e displasia, metaplasia intestinal e câncer. / INTRODUCTION: Gallbladder cancer is the most common malignant lesion of the biliary tree; yet, little is known about its carcinogenesis. The possible preneoplastic character of histological gallbladder alterations has been studied in recent medical literature. The purpose of this study was to identify and quantify histological gallbladder alterations in our population, to correlate them with clinical data, and to correlate the metaplastic alterations, separately, with the other histological alterations found. METHODS: In this retrospective study conducted between November,1999 and December, 2006, the medical records of 1.689 patients who were submitted to laparoscopic cholecystectomy by cholecystolithiasis were analyzed. The patients were classified according to age: 60 years or younger, and older than 60. In relation to the duration of symptoms before the surgery, they were grouped according to: patients without symptoms, patients with symptoms for 1 year or less, and patients with symptoms for over 1 year before the surgery. In relation to the size and number of the gallstones, they were grouped according to: patients with gallstones of 10 mm or less, and those with gallstones over 10 mm, and those with single or multiple gallstones. RESULTS: There were 1,238 (73.3%) female and 451 (26.7%) male patients. In relation to age, 1,192 patients were 60 or younger (70.6%) and 497 (29.4%) were older than 60. There were 1.319 (78.1%) patients with gallstones smaller than 10 mm and 370 patients (21.9%) with gallstones larger than 10mm. Acute choelcystitis was observed in 174 patients (10.3%), gangrene in 23 (1.4%), abscess in 8 (0.4%), cholesterolosis in 305 (18.1%), adenomyomatosis in 40 (2.4%), xanthogranulomatous cholecystitis in 29 (1.7%), fibrosis in 12 (0.7%), sclero-atrophic gallbladder in 20 (1.2%), hyperplasic polyp in 3 (0.2%), cholesterol polyp in 17 (1.0%), pyloric metaplasia in 72 (4.3%), intestinal metaplasia in 18 (1.1%), dysplasia in 4 (0.2%), and cancer in 2 (0.1%). No adenomatous polyp was found. CONCLUSIONS: Male patients have more inflammatory complications than females. With the exception of xanthogranulomatous cholecystitis, there is no correlation between symptom duration and an increased occurrence of the histological alterations studied. In the elderly patients, the occurrence of adenomyomatosis, gangrene and abscess is more frequent. The size of gallstones has no relationship with the occurrence of the histological alterations studied, except for acute cholecystitis, which is associated with small and multiple gallstones. There is an association between pyloric metaplasia and the following: adenomyomatosis, dysplasia, and cancer. There is also an association between intestinal metaplasia and the following: pyloric metaplasia, adenomyomatosis, dysplasia, and cancer.

INTRODUÇÃO: O câncer da vesícula biliar é a lesão maligna mais comum da árvore biliar e pouco se sabe sobre a sua carcinogênese. O possível caráter pré-neoplásico das alterações histológicas da vesícula biliar vem sendo estudado recentemente. O objetivo deste estudo foi identificar e quantificar as alterações histológicas da vesícula biliar no nosso meio e correlacioná-las com dados clínicos, e correlacionar as alterações metaplásicas, em separado, com as demais alterações encontradas. MÉTODOS: Neste estudo retrospectivo realizado entre novembro de 1999 a dezembro de 2006, foram avaliados 1.689 prontuários de doentes submetidos a colecistectomia laparoscópica por colecistolitíase. Os doentes foram divididos em relação à idade em doentes com até 60 anos e com mais de 60 anos. Em relação ao tempo de sintomas antes da cirurgia foram agrupados em doentes sem sintomas, doentes com sintomas até 1 ano, e doentes com sintomas por mais de 1 ano antes da cirurgia. Em relação ao tamanho e número dos cálculos foram agrupados em doentes com cálculos de até 10 mm, e aqueles com cálculos maiores que 10 mm, e em doentes com cálculos únicos ou múltiplos. RESULTADOS: Eram mulheres 1.238 doentes (73,3%) e 451 eram homens (26,7%). Apresentaram idade de até 60 anos 1.192 doentes (70,6%) e 497 (29,4%) apresentaram mais de 60 anos. Apresentaram cálculos menores que 10 mm 1.319 doentes (78,1%) e 370 doentes (21,9%) apresentaram cálculos maiores que 10 mm. Foi observado inflamação aguda em 174 doentes (10,3%), gangrena em 23 (1,4%), abscesso em 8 (0,4%), colesterolose em 305 (18,1%), adenomiomatose em 40 (2,4%), colecistite xantogranulomatosa em 29 (1,7%), fibrose em 12 (0,7%), escleroatrofia em 20 (1,2%), pólipo hiperplásico em 3 (0,2%), pólipo de colesterol em 17 (1,0%), metaplasia pilórica em 72 (4,3%), metaplasia intestinal em 18 (1,1%), displasia em 4 (0,2%), câncer em 2 (0,1%). Não foram observados pólipos adenomatosos. CONCLUSÕES: O sexo masculino apresenta maior freqüência de complicações inflamatórias que o feminino. Não há relação entre o tempo de sintomas e uma maior ocorrência das alterações histológicas estudadas, excetuando-se a colecistite xantogranulomatosa. Nos doentes idosos há maior ocorrência de adenomiomatose, gangrena e abscesso. Há aumento progressivo de idade para a ocorrência de metaplasia pilórica, metaplasia intestinal, displasia e câncer. O tamanho dos cálculos não guarda relação com a ocorrência das alterações estudadas, exceto para colecistite aguda que se associou com cálculos pequenos e múltiplos. Há associação entre a ocorrência de metaplasia pilórica e adenomiomatose, metaplasia pilórica e displasia, metaplasia pilórica e câncer. Há também associação entre a ocorrência de metaplasia intestinal e metaplasia pilórica, metaplasia intestinal e adenomiomatose, metaplasia intestinal e displasia, metaplasia intestinal e câncer. / INTRODUCTION: Gallbladder cancer is the most common malignant lesion of the biliary tree; yet, little is known about its carcinogenesis. The possible preneoplastic character of histological gallbladder alterations has been studied in recent medical literature. The purpose of this study was to identify and quantify histological gallbladder alterations in our population, to correlate them with clinical data, and to correlate the metaplastic alterations, separately, with the other histological alterations found. METHODS: In this retrospective study conducted between November,1999 and December, 2006, the medical records of 1.689 patients who were submitted to laparoscopic cholecystectomy by cholecystolithiasis were analyzed. The patients were classified according to age: 60 years or younger, and older than 60. In relation to the duration of symptoms before the surgery, they were grouped according to: patients without symptoms, patients with symptoms for 1 year or less, and patients with symptoms for over 1 year before the surgery. In relation to the size and number of the gallstones, they were grouped according to: patients with gallstones of 10 mm or less, and those with gallstones over 10 mm, and those with single or multiple gallstones. RESULTS: There were 1,238 (73.3%) female and 451 (26.7%) male patients. In relation to age, 1,192 patients were 60 or younger (70.6%) and 497 (29.4%) were older than 60. There were 1.319 (78.1%) patients with gallstones smaller than 10 mm and 370 patients (21.9%) with gallstones larger than 10mm. Acute choelcystitis was observed in 174 patients (10.3%), gangrene in 23 (1.4%), abscess in 8 (0.4%), cholesterolosis in 305 (18.1%), adenomyomatosis in 40 (2.4%), xanthogranulomatous cholecystitis in 29 (1.7%), fibrosis in 12 (0.7%), sclero-atrophic gallbladder in 20 (1.2%), hyperplasic polyp in 3 (0.2%), cholesterol polyp in 17 (1.0%), pyloric metaplasia in 72 (4.3%), intestinal metaplasia in 18 (1.1%), dysplasia in 4 (0.2%), and cancer in 2 (0.1%). No adenomatous polyp was found. CONCLUSIONS: Male patients have more inflammatory complications than females. With the exception of xanthogranulomatous cholecystitis, there is no correlation between symptom duration and an increased occurrence of the histological alterations studied. In the elderly patients, the occurrence of adenomyomatosis, gangrene and abscess is more frequent. The size of gallstones has no relationship with the occurrence of the histological alterations studied, except for acute cholecystitis, which is associated with small and multiple gallstones. There is an association between pyloric metaplasia and the following: adenomyomatosis, dysplasia, and cancer. There is also an association between intestinal metaplasia and the following: pyloric metaplasia, adenomyomatosis, dysplasia, and cancer.

INTRODUÇÃO: A litíase biliar é uma doença do trato digestivo que apresenta prevalência variada em diferentes grupos étnicos e que gera altos gastos aos sistemas de saúde. A possibilidade de aplicação de tratamento não invasivo medicamentoso está direcionada a presença de cálculo de colesterol o que leva a necessidade de identificar corretamente os pacientes que podem beneficiar-se com o tratamento. No Brasil estima-se uma prevalência da doença em 9,3% da população em geral. Porém, ainda não há estudos que demonstrem a composição de cálculo de colesterol e pigmentos nos pacientes, bem como não há estudos de análise dos lipídios biliares e sua relação com os mecanismos fisiopatológicos da doença. Nossos objetivos foram analisar a composição do cálculo e da bile e compará-la com fatores pré-dispositivos da doença como tempo de nucleação e hiper saturação de colesterol em pacientes brasileiros. MÉTODOS: Foram analisadas 72 amostras de bile vesicular e cálculo biliar de pacientes com litíase biliar submetidos a procedimento cirúrgico laparoscópico em diferentes hospitais da grande São Paulo. Quatorze amostras de bile vesicular de pacientes que foram submetidos à laparoscopia por problemas gastrointestinais, mas que não apresentavam litíase biliar foram usadas como controle. Foram realizadas análises bioquímicas para avaliar a composição dos cálculos e da bile. Os cálculos foram analisados de acordo com a porcentagem de colesterol e bilirrubina em relação ao peso total do cálculo. A concentração dos ácidos biliares foi determinada pela técnica HPLC. O índice de saturação do colesterol foi calculado de acordo com a metodologia descrita por Carey. O tempo de nucleação foi avaliado através de microscopia de luz polarizada durante 21 dias. RESULTADOS: No grupo de pacientes com litíase biliar, 48 eram do sexo feminino (66,7%) e a média de idade foi 54,1 anos ± 13,1 (mínima de 18 anos e máxima de 75 anos). Do total de cálculos analisados (n=72) 75% foram classificados como cálculo de colesterol e 25% como cálculo de bilirrubina. A bile dos pacientes com cálculo de colesterol apresentou menor concentração de fosfolipídios p<0,05), maior índice de saturação de colesterol (p<0,001), menor tempo de nucleação (p<0,05) e maior concentração de ácido deoxicólico (p<0,05) quando comparada com a bile de pacientes controle. CONCLUSÕES: Os nossos resultados mostraram que a composição dos cálculos não foi homogênea na nossa amostra. Análise da bile mostrou-se semelhante aos trabalhos encontrados na literatura, os fatores litogênicos estavam presentes na bile dos pacientes com cálculo de colesterol e mostraram-se precursores eficientes para formação do cálculo / Introduction: Gallstone disease represents a prevalent and costly health problem. The changing epidemiology and the emerging non-surgical interventions for gallstone disease necessitate the definition of target populations for future therapies. The prevalence of biliary lithiasis in Brazil is around 9,3% of the general population with more than 20 years old, however it is necessary investigative studies to determine the composition of the gallstones and the correlation between bile lipids and disease physiopathology factors. Objectives: This study aimed to define patterns of gallstone composition and evaluate the biliary predictors factors of gallstone disease as nucleation time and cholesterol saturation index in Brazilian patients. Methods: Seventy two post- cholecystectomy gallstone specimens and gallbladder bile were obtained from different hospitals of the city of Sao Paulo. Fourteen gallbladder bile samples were obtained as control samples, from patients who underwent laparoscopic surgery due to gastrointestinal symptoms without gallbladder disease. Biochemistry analyses were performed to determine the composition of the gallstones and bile. Gallstones were classified according to their cholesterol and bilirrubin content linked with their dry weight. The concentration of bile salts was evaluated by HPLC technique. The cholesterol saturation index (CSI) was calculated in accordance with Carey methods. The nucleation time was evaluated by polarized light microscopy during 21 days. Results: There were 48 women and 22 men in the Gallbladder disease patients group. The mean age of the patients were 54,1 ± 13,1 years old (range 18 75 years old). Cholesterol stones were found in 75% of the stones. The bile of the cholesterol gallstone patients presented lower concentration of phospholipids (p<0,05), higher CSI (p<0,001), lower nucleation time (p<0,05) and higher concentration of deoxicholic acid (p<0,05) when compared with control group. Conclusions: Our results showed the composition of gallstones in our samples was not homogeneous. The analysis of bile is in accordance with literary findings and the lithogenic factors were presented in the bile of patients with cholesterol gallstones and they seem to be effective predictors factors for the gallstone formation in our population

Background and aims: Laparoscopic technique was quickly adopted in general surgery because of less pain, quicker recovery and shorter hospital stay. In the 1990´s several reports on port site metastases restrained the enthusiasm to use laparoscopic surgery in malignant diseases. The numerous reports on port site metastases initiated a debate whether laparoscopic surgery would increase the risk of tumour spread and growth. Personal experience of two patients who devloped port site metastases from an incidental gall bladder cancer (GBC) after laparoscopic cholecystectomy (LC), encouraged us to study the incidence of wound metastases from GBC after laparoscopic and open cholecystectomy (OC). Experimentally we examined whether pneumoperitoneum would increase the risk of tumour development. Several studies had demonstrated that minimally invasive procedures exert a less negative influence on the immune system and may have beneficial effects for cancer patients. We wanted to compare the long term survival after OC and LC and if the occurence of port site metastases had any impact on survival. Material and methods: A questionnaire was sent out to all major hospitals in Sweden requesting information obout the number of port site metastases encountered 1991-94. Data on all pateints with verfied GBC were obtained from the Swedish Oncological Centres. Data on all patients with GBC registered with surgical codes for cholecystectomy were collected from the National Board of Health and Welfare (EpC). The patient files were scrutinized and long term survival data was achieved (EpC). In the first experiment on Wistar Fu rats, adenocarcinoma cells were injected intraperitoneally in animals insufflated with air, CO2 and not insufflated controls. In the following studies, rats were similarly insufflated with air,CO2 and compared to not insufflated controls. Laser Doppler blood flow in the abdominal wall was concomitantly measured. To study the effect of reduced blood flow, one rectus muscle was clamped and the other not and laser Doppler Blood flow was measured in both rectus muscles. Adenocarcinoma cells were injected into the rectus muscles in all animals at the induction of pneumoperitoneum/clamping. Results: 14 of 55 patients developed wound metastases from GBC after LC and 12 of 187 after OC. Gallbladder perforation was overrepresented in patients with wound metastases. Improved survival was noted after LC in patients with T3 tumours. Experimentally, air and CO2 equally increased intraperitoneal tumour development, Insufflation with air,CO2 and clamping decreased blood flow in the abdominal wall and increased tumour growth at the same site. Conclusion: Despite a high rate of wound metastases, LC does not seem to worsen the prognosis of GBC and may even have a positive effect on survival. Perforation of the malignant gallbladder seems to be associated with an increased risk of metastatic formation. In the experimental setting, pneumoperitoneum seems to increase tumour development. Other features of laparoscopic surgery such as decreased blood flow in the abdominal wall may contribute to increased risk of tumour progress.

名古屋大学博士学位論文 学位の種類 : 博士(医学)(課程) 学位授与年月日:平成7年3月27日 金子健一朗氏の博士論文として提出された

Diss. (sammanfattning) Linköping : Linköpings universitet, 2005. / Härtill 6 uppsatser.

INTRODUÇÃO: A litíase biliar é uma doença do trato digestivo que apresenta prevalência variada em diferentes grupos étnicos e que gera altos gastos aos sistemas de saúde. A possibilidade de aplicação de tratamento não invasivo medicamentoso está direcionada a presença de cálculo de colesterol o que leva a necessidade de identificar corretamente os pacientes que podem beneficiar-se com o tratamento. No Brasil estima-se uma prevalência da doença em 9,3% da população em geral. Porém, ainda não há estudos que demonstrem a composição de cálculo de colesterol e pigmentos nos pacientes, bem como não há estudos de análise dos lipídios biliares e sua relação com os mecanismos fisiopatológicos da doença. Nossos objetivos foram analisar a composição do cálculo e da bile e compará-la com fatores pré-dispositivos da doença como tempo de nucleação e hiper saturação de colesterol em pacientes brasileiros. MÉTODOS: Foram analisadas 72 amostras de bile vesicular e cálculo biliar de pacientes com litíase biliar submetidos a procedimento cirúrgico laparoscópico em diferentes hospitais da grande São Paulo. Quatorze amostras de bile vesicular de pacientes que foram submetidos à laparoscopia por problemas gastrointestinais, mas que não apresentavam litíase biliar foram usadas como controle. Foram realizadas análises bioquímicas para avaliar a composição dos cálculos e da bile. Os cálculos foram analisados de acordo com a porcentagem de colesterol e bilirrubina em relação ao peso total do cálculo. A concentração dos ácidos biliares foi determinada pela técnica HPLC. O índice de saturação do colesterol foi calculado de acordo com a metodologia descrita por Carey. O tempo de nucleação foi avaliado através de microscopia de luz polarizada durante 21 dias. RESULTADOS: No grupo de pacientes com litíase biliar, 48 eram do sexo feminino (66,7%) e a média de idade foi 54,1 anos ± 13,1 (mínima de 18 anos e máxima de 75 anos). Do total de cálculos analisados (n=72) 75% foram classificados como cálculo de colesterol e 25% como cálculo de bilirrubina. A bile dos pacientes com cálculo de colesterol apresentou menor concentração de fosfolipídios p<0,05), maior índice de saturação de colesterol (p<0,001), menor tempo de nucleação (p<0,05) e maior concentração de ácido deoxicólico (p<0,05) quando comparada com a bile de pacientes controle. CONCLUSÕES: Os nossos resultados mostraram que a composição dos cálculos não foi homogênea na nossa amostra. Análise da bile mostrou-se semelhante aos trabalhos encontrados na literatura, os fatores litogênicos estavam presentes na bile dos pacientes com cálculo de colesterol e mostraram-se precursores eficientes para formação do cálculo / Introduction: Gallstone disease represents a prevalent and costly health problem. The changing epidemiology and the emerging non-surgical interventions for gallstone disease necessitate the definition of target populations for future therapies. The prevalence of biliary lithiasis in Brazil is around 9,3% of the general population with more than 20 years old, however it is necessary investigative studies to determine the composition of the gallstones and the correlation between bile lipids and disease physiopathology factors. Objectives: This study aimed to define patterns of gallstone composition and evaluate the biliary predictors factors of gallstone disease as nucleation time and cholesterol saturation index in Brazilian patients. Methods: Seventy two post- cholecystectomy gallstone specimens and gallbladder bile were obtained from different hospitals of the city of Sao Paulo. Fourteen gallbladder bile samples were obtained as control samples, from patients who underwent laparoscopic surgery due to gastrointestinal symptoms without gallbladder disease. Biochemistry analyses were performed to determine the composition of the gallstones and bile. Gallstones were classified according to their cholesterol and bilirrubin content linked with their dry weight. The concentration of bile salts was evaluated by HPLC technique. The cholesterol saturation index (CSI) was calculated in accordance with Carey methods. The nucleation time was evaluated by polarized light microscopy during 21 days. Results: There were 48 women and 22 men in the Gallbladder disease patients group. The mean age of the patients were 54,1 ± 13,1 years old (range 18 75 years old). Cholesterol stones were found in 75% of the stones. The bile of the cholesterol gallstone patients presented lower concentration of phospholipids (p<0,05), higher CSI (p<0,001), lower nucleation time (p<0,05) and higher concentration of deoxicholic acid (p<0,05) when compared with control group. Conclusions: Our results showed the composition of gallstones in our samples was not homogeneous. The analysis of bile is in accordance with literary findings and the lithogenic factors were presented in the bile of patients with cholesterol gallstones and they seem to be effective predictors factors for the gallstone formation in our population

Made available in DSpace on 2014-08-20T14:38:46Z (GMT). No. of bitstreams: 1 dissertacao_leonardo_merlo_da_silva.pdf: 1300864 bytes, checksum: 70a88ad09eab6afb574e9dd990e9cf3b (MD5) Previous issue date: 2012-06-29 / This study aimed to investigate the effect of soybean oil, boldo leaves essence infusion and a cholesterol absorption-inhibiting substance in the storage of bile in the gallbladder during fasting in Cobb broilers. A total of three trials were run using a completely randomized design. Treatments consisted: T1 control (1,6 mL water); T2 0,4 mL soybean oil; T3 0,8 mL soybean oil; T4 1,2 mL soybean oil; T5 1,6 mL soybean oil (offered by gavage bird/hour). A total of 100 broilers were equally distributed into five treatments (20 birds/treatment). Each bird was taken as a replicate. In the second trial, the infusion of boldo leaves essence efficiency was examined. A total of 76 broilers were equally divided into two groups: with boldo leaves essence (1.6 ml) and without boldo leaves essence (1.6 ml water), offered by gavage. In the third trial, the inclusion of soybean oil was offered in combination with a cholesterol absorption inhibiting substance. A total of 216 broilers were equally distributed into four treatments: T1-control; T2- 1.6 ml soybean oil + cholesterol inhibiting substance; T3- 1.6 ml soybean oil + cholesterol inhibiting substance and T4- cholesterol-inhibiting substance. Carcass weight loss and gallbladder weight were examined. The results indicated that offering increasing levels of soybean oil up to 1.6 ml/hour, during 6 fasting hours does not decrease the gallbladder weight, but alters the bile density and decreases linearly the broiler weight at the slaughtering time. There is a linear decrease in the broilers live weight as the preharvesting fasting period increases up to six hours, regardless of the application of soybean oil or boldo leaves essence infusion. Offering boldo leaves essence (1.6 ml/hour, during 6 hours), during the fasting period does not decrease the gallbladder weight. Soybean oil alone decreases gallbladder weight bring about a reduction one hour following its offering to the birds. The use of cholesterol absorption-inhibiting substance does not reduce the gallbladder weight if offered 4 hours preharvesting. / Objetivou-se avaliar a eficiência de óleo de soja, infusão de boldo e um medicamento inibidor da absorção de colesterol no acúmulo de bile durante o jejum alimentar em frangos de corte da linhagem Cobb. Para isso, foram realizados três experimentos num delineamento completamente casualizado. No primeiro foram avaliados os seguintes tratamentos: T1 controle (1,6 mL de água); T2 0,4 mL de óleo de soja; T3 0,8 mL de óleo de soja; T4 1,2 mL de óleo de soja; T5 1,6 mL de óleo de soja (administrados por gavagem ave/hora). Foram utilizados como modelo biológico 100 frangos, distribuídos em cinco tratamentos com 20 repetições cada. No segundo experimento foi avaliada a eficiência de infusão de boldo, na dosagem de 1,6 mL, comparado a um grupo controle (1,6 mL de água), ambos administrados por gavagem. Foram utilizados 76 frangos, distribuídos em dois tratamentos com 38 repetições cada. No terceiro experimento foi avaliada a inclusão de óleo de soja em combinação com um medicamento inibidor de colesterol, conforme os tratamentos a seguir: T1 controle (1,6 mL de água); T2 1,6 mL de óleo de soja; T3 1,6 mL de óleo de soja + inibidor de colesterol T4 inibidor de colesterol. Foram utilizados 216 frangos, distribuídos em quatro tratamentos com 54 repetições cada. As variáveis analisadas foram perda de peso de carcaça e peso de vesículas de frangos. Os dados analisados permitem concluir que a administração de doses de óleo de soja em níveis crescentes de até 1,6 mL por hora durante seis horas de jejum alimentar não reduz o peso de vesícula mas altera a densidade da bile e reduz linearmente o peso vivo de frangos de corte no momento do abate. Há uma redução linear no peso vivo das aves conforme aumenta o tempo de jejum préabate por até seis horas, independentemente da aplicação de óleo de soja ou infusão de boldo. A administração de infusão de boldo na dose de 1,6 mL por hora durante seis horas de jejum alimentar não reduz o peso de vesícula. O óleo de soja aplicado isoladamente reduz o peso de vesículas uma hora após ser administrado às aves. O uso de substância inibidora da absorção de colesterol não se mostra efetivo para reduzir o peso de vesícula se aplicado quatro horas antes do abate.

Abstract Acute acalculous cholecystitis (AAC) is an insidious and increasingly recognized complication of critical illness, whose pathogenesis is poorly understood and clinical picture obscure. Diagnosis is difficult and there is no consensus on treatment. The medical records of all ICU patients who had undergone open cholecystectomy due to AAC during the years 2000–2001 and 2003–2004 were examined for clinical and organ failure data. The indication for open cholecystectomy was a suspicion of AAC based on clinical signs and symptoms of sepsis or deteriorating multiple organ dysfunction without other obvious foci and/or radiological (computed tomography or ultrasound) findings indicative of cholecystitis. A total of 73 patients had operatively treated AAC during the study periods, giving an incidence of 0.9% of all admissions (73/8184) and an incidence of 6.7% among the long-stayers (ICUstay >5 days). The hospital mortality of these patients was 43%. Infection was the most common admission diagnosis followed by cardiovascular surgery. The patients were severely ill, the mean (SD) APACHE II score being 25.5 (6.4) and the mean (SD) SOFA score 10.2 (3.5) on admission. In those patients who had AAC as the only intra-abdominal complication of multiple organ dysfunction, cholecystectomy was followed by a remarkable improvement of individual and total SOFA scores by the seventh postoperative day. The AAC gallbladders were histologically and immunohistologically compared to normal gallbladders and to gallbladders of patients with acute calculous cholecystitis (ACC). The ACC patients were admitted into hospital because of primary acute gallbladder disease, were treated on a normal ward and did not have severe sepsis or multiple organ dysfunction. The typical histopathological features of AAC (34 cases) in the gallbladder wall were bile infiltration, lymphatic dilatation and leucocyte margination of blood vessels, while epithelial degeneration and defects, widespread occurrence of inflammatory cells and extensive and deep muscle layer necrosis were typical features of ACC (28 cases). Tight junction proteins (claudin-1, -2, -3, -4, occludin, ZO-1 and E-cadherin) were uniformly expressed in normal gallbladder epithelium, with the exception of claudin-2, which was present in less than half of the cells. In AAC, the expression of cytoplasmic occludin and claudin-1 was decreased compared to control group. In ACC, the expression of claudin-2 was increased, but the expression of claudin-1, -3 and -4, occludin and ZO-1 was decreased compared to normal or AAC gallbladders. In conclusion, AAC is associated with severe illness, infection, long intensive care unit stay and deteriorating multiple organ dysfunction. Open cholecystectomy is one important contributing factor to reverse the course of multiple organ dysfunction in these patients. Histological and immunohistological studies suggest that AAC is a manifestation of systemic inflammatory disease, while ACC is a local inflammatory and often infectious disease.

Das Fettgewebe sezerniert hormonähnliche Proteine, sogenannte Adipozytokine oder Adipokine. Es sind zahlreiche Zusammenhänge zwischen Adipokinen und dem Auftreten von Adipositas und adipositasassoziierten Erkrankungen beschrieben. Gallensteine sind mit Adipositas assoziiert und stellen aufgrund der Häufigkeit des Auftretens und der damit verbundenen Kosten ein großes gesundheitsökonomisches Problem dar. Ziel dieser Arbeit war es zu prüfen, ob eine Assoziation der Cholelithiasis mit den Serumspiegeln von Adiponectin, Chemerin, Vaspin, Progranulin, FGF21 und AFABP vorliegt. Dazu wurde eine Kohorte von 1022 Sorben, einer nationalen Minderheit aus der Oberlausitz, statistisch ausgewertet. Für Chemerin, Vaspin, FGF21 und AFABP konnte kein Zusammenhang ermittelt werden. Bei den männlichen Gallensteinträgern war im Vergleich zu der Kontrollgruppe der Serumporgranulinspiegel signifikant erhöht, wobei unklar bleibt, wie die Serumkonzentration mit der Konzentration in der Gallenblase korreliert und wie die geschlechtsspezifischen Unterschiede zustande kommen. Für Adiponectin bestätigten sich bereits vorliegende Aussagen, dass dieses Adipokin einen protektiven Effekt auf die Gallensteinentstehung hat. Es sind weitere longitudinale und funktionelle Studien notwendig, um die Pathomechanismen weiter zu klären.