A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment for the degree Master of Medicine (Surgery) / Aim: The aim of this research report is to assess which local epidemiological and clinical factors determine impact on the morbidity and mortality of intussusception, expressed as defined clinical outcomes. Methods: A retrospective hospital record review of paediatric intussusception admitted to Chris Hani Baragwanath (CHBH) and Charlotte Maxeke Johannesburg Academic Hospitals (CMJAH) for the period of January 2007 to April 2010 was undertaken. The four determining factors evaluated are: Duration of symptoms, weight, palpable rectal intussusceptum, admission serum C-­‐reactive protein, against seven possible clinical outcomes: Failed pneumatic reduction, perforation during attempted pneumatic reduction, intestinal resection, ileostomy, relook laparotomy, intensive care unit admission and mortality. A total of 108 cases were found of which 11 were excluded from data analysis. Results: Sixty eight percent of cases were from CHBH and a total of 57% of cases were referred from surrounding medical facilities. 62 of 97 cases had an attempted pneumatic reduction with a 51.6% (32/62) success rate and an overall success rate of 32/97, 33%. Seven cases developed pneumoperitoneum during pneumatic reduction. A total of 65 cases underwent surgical management. Of those 81.5% (53/65) underwent intestinal resection. Ileostomy diversion was necessary in 13.8% (9/65) of operative cases and 11% (7/65) needed a second surgical procedure during the initial presenting admission. An overall mortality rate of 9.3% (9/97) is noted. Conclusion: Intussusception in Johannesburg is associated with significant morbidity and mortality. Duration of symptoms and C -­‐ reactive protein levels are predictive for clinical outcomes in paediatric intussusception.

No description available.

A obstrução intestinal mecânica representa uma condição de urgência, necessitando diagnóstico precoce e terapêutica adequada, em virtude do seu elevado grau de morbidade e de mortalidade. Desta forma, o objetivo deste estudo foi avaliar o efeito da N-acetilcisteína associada ao Ringer lactato ou à solução salina hipertônica na resposta inflamatória, histologia e translocação bacteriana em modelo experimental de obstrução e isquemia intestinal. Para tanto, Foram constituídos quatro grupos experimentais, com 10 ratos Wistar em cada, além do grupo de referência: OI - Submetidos a obstrução e isquemia intestinal e enterectomia com anastomose intestinal, sem reanimação volêmica; RL - Submetidos a obstrução e isquemia intestinal, reanimação volêmica com Ringer lactato (32ml/kg, i.v., em 10 minutos) e enterectomia com anastomose intestinal; RLNAC - Submetidos a obstrução e isquemia intestinal, reanimação volêmica com Ringer lactato associado a NAC (32ml/kg + 150 mg/kg i.v. em 10 minutos) e enterectomia com anastomose intestinal; SHNAC - Submetidos a obstrução e isquemia intestinal, reanimação volêmica com solução salina hipertônica a 7,5% associado com NAC (4ml/kg + 150 mg/kg i.v., em 10 minutos) e enterectomia com anastomose intestinal. Grupo Referência (n=5): Animais anestesiados, submetidos a coleta de materiais para cultura e histologia e sacrificados por exsanguinação. Os animais receberam uma associação anestésica de cetamina e xilazina intramuscular em membro posterior direito, na dose de 60mg/kg e 10mg/kg, respectivamente. Decorridas 24 h do tratamento, a eutanásia foi realizada por exanguinação, sob anestesia, após a coleta dos tecidos / Mechanical intestinal obstruction represents a condition of urgency, necessary early diagnosis and appropriate therapy, due to their high degree of morbidity and mortality. In this way, the objective of this study was to evaluate the effect of N-acetylcysteine associated with lactated Ringer\'s or hypertonic saline solution in the inflammatory response, histology and translocation in an experimental model of intestinal obstruction and ischemia. For Four experimental groups were constituted with 10 Wistar rats each, in addition to the reference group: OI - submitted to obstruction and ischemia intestinal and enterectomy with intestinal anastomosis, without volume resuscitation; RL - Undergoing intestinal obstruction and ischemia, volume resuscitation with Ringer\'s lactate (32ml / kg, i.v., within 10 minutes) and anastomosis enterectomy intestinal; RLNAC - Undergoing obstruction and intestinal ischemia, resuscitation with lactated Ringer\'s lactating NAC (32 ml / kg + 150 mg / kg i.v. in 10 minutes) and enterectomy with intestinal anastomosis; SHNAC - Submitted to obstruction and intestinal ischemia, volume resuscitation with saline solution hypertension at 7.5% associated with CAP (4 ml / kg + 150 mg / kg i.v., in 10 minutes) and enterectomy with intestinal anastomosis. Reference Group (n = 5): Anesthetized animals, submitted to collection of materials for culture and histology and sacrificed by exsanguination. The animals received a anesthetic association of ketamine and intramuscular xylazine in limb posterior right, at the dose of 60mg / kg and 10mg / kg, respectively. After 24 h of treatment, euthanasia was performed by exsanguination, under anesthesia, after collection of tissues

INTRODUCTION Internal abdominal hernias are infrequent but an increasing cause of bowel obstruction still often underdiagnosed. Among adults its usual causes are congenital anomalies of intestinal rotation, postsurgical iatrogenic, trauma or infection diseases. PRESENTATION OF CASE We report the case of a 63-year-old woman with history of chronic constipation. The patient was hospitalized for two days with acute abdominal pain, abdominal distension and inability to eliminate flatus. The X-ray and abdominal computerized tomography scan (CT scan) showed signs of intestinal obstruction. Exploratory laparotomy performed revealed a trans-mesenteric hernia containing part of the transverse colon. The intestine was viable and resection was not necessary. Only the hernia was repaired. DISCUSSION Internal trans-mesenteric hernia constitutes a rare type of internal abdominal hernia, corresponding from 0.2 to 0.9% of bowel obstructions. This type carries a high risk of strangulation and even small hernias can be fatal. This complication is specially related to trans-mesenteric hernias as it tends to volvulize. Unfortunately, the clinical diagnosis is rather difficult. CONCLUSION Trans-mesenteric internal abdominal hernia may be asymptomatic for many years because of its nonspecific symptoms. The role of imaging test is relevant but still does not avoid the necessity of exploratory surgery when clinical features are uncertain. / Revisión por pares

Made available in DSpace on 2014-06-11T19:22:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-02-22Bitstream added on 2014-06-13T20:09:23Z : No. of bitstreams: 1 lopes_mcs_me_jabo.pdf: 1425980 bytes, checksum: ec77cfbfaaacc7792256be3564bbc255 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Avaliaram-se os efeitos clínico e comportamental da injeção intravenosa do tramadol no controle da dor induzida experimentalmente, por obstrução intestinal extraluminal, com dreno de Pen Rose. Foram utilizados 24 cavalos distribuídos em quatro grupos: controle (GC, n=6); obstrução duodenal (GD, n=6); obstrução de íleo (GI, n=6) e obstrução de flexura pélvica (GFP, n=6). Após medicação pré-anestésica com a associação de acepromazina (0,025 mg.kg-1 IV), xilazina (0,5 mg.kg-1 IV) e meperidina (4 mg.kg-1 IM), o tramadol foi administrado nas doses de 1,0 mg.kg-1 e 1,5 mg.kg-1, por via intravenosa (IV), imediatamente após a obstrução intestinal, em três cavalos de cada grupo. Avaliaram-se as freqüências cardíaca (FC) e respiratória (f), temperatura retal (TºC), tempo de preenchimento capilar (TPC), motilidade intestinal, comportamento relacionado à dor (olhar para o flanco, cavar, deitar e rolar) hemograma e hemogasometria venosa, nos intervalos: M0 (basal) a cada 0,5 hora de M1 a M6 , na fase de obstrução, e até três horas após a reversão do processo obstrutivo (M7 a M12). Os resultados demonstraram que não houve diferença significativa entres as doses utilizadas dentro de cada grupo, assim como entre os grupos. Houve aumento da FC em M11 no GD e em M12 no GFP. Os sinais de dor abdominal e atonia intestinal iniciaram-se em M5 no GFP e em M6 no GI. Nos animais do GD, os sinais de desconforto não progrediram. No leucograma foi observado um quadro característico de estresse e na hemogasometria os animais do GD tendenciaram à alcalose metabólica com compensação respiratória. Clinicamente, observou-se que a dose de 1,5 mg.kg-1 de tramadol proporcionou melhor conforto para os animais, porem sem significado estatístico, quando comparado coma dose de 1,0 mg.kg-1... / The clinical and behavioral effects of the intravenous injection of tramadol were evaluated during the control of pain induced experimentally due to intestinal extraluminal obstruction using “Pen Rose” drain. A total of 24 horses were used and distributed in four groups: control (GC, n=6); duodenal obstruction (GD, n=6); ileum obstruction (GI, n=6) and pelvic flexure obstruction (GFP, n=6). After administration of pre-anesthetic medications using association of acepromazine (0.025 mg.kg-1 IV), xylazine (0.5 mg.kg-1 IV) and meperidine (4 mg.kg-1 IM), tramadol was administered at doses of 1.0 mg.kg-1 and 1.5 mg.kg-1 intravenously (IV), immediately after the intestinal obstruction in three horses of each group. Evaluations were performed, including heart rate (HR), respiratory rate (RR), rectal temperature (RT), capillary refill time (CRT), gut motility, pain-related behaviour (look for the sidewall, dig down and roll) and blood gases from venous blood at the time: M0 (baseline) and every 0.5 hours from M1 to M6, during obstruction process and also until three hours after the obstructive process be reverted (M7 to M12). The results showed no significant difference among the doses used in the same group as among groups. There was an increase in HR in the GD M11 and M12 of GFP. Signs of abdominal pain and intestinal atony began at M5 in GFP and at M6 in GI. In animals from GD, the discomfort signs did not showed progress. On the leucogram was observed a typical stress and on the blood gas analysis the animals from GD showed a tendency to metabolic alkalosis with respiratory compensation. Clinically, was observed that the dose of 1.5 mg.kg-1 of tramadol provided better comfort to the animals, but there was not statistical significance, compared with the dose 1.0 mg.kg-1... (Complete abstract click electronic access below)

Made available in DSpace on 2014-06-11T19:31:08Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-02-27Bitstream added on 2014-06-13T18:41:44Z : No. of bitstreams: 1 uribediaz_ap_dr_jabo.pdf: 327728 bytes, checksum: 95978c4b4ea30b83afc2bcabbfd833d4 (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Trabalhos recentes relatam a eficácia do azul de metileno na prevenção dos danos impostos por espécies reativas de oxigênio aos tecidos de vários órgãos, em vários modelos de isquemia/reperfusão. Este estudo foi concebido com o fito de avaliar o efeito do azul de metileno sobre as respostas clínico-laboratoriais, na obstrução experimental do jejuno em equinos, associada à exposição de lipopolissacarídeo. Dois grupos de animais foram submetidos à indução da endotoxemia e à obstrução experimental do jejuno em período anterior. Posteriormente administrou-se em um deles, infusão de azul de metileno (3 mg/kg I.V), 15 minutos antes da obstrução experimental, e no outro, a mesma infusão 15 minutos antes da desobstrução do jejuno. Foi realizada avaliação clínica, hematológica e bioquímico-sérica, e perfil bioquímico e citológico do líquido peritoneal a partir de aferições em oito tempos durante 12 horas, também foram caracterizadas as lesões intestinais. Após 3 horas de isquemia, verificou-se hemorragia, edema, infiltração de neutrófilos e desprendimento da mucosa. Essas lesões manifestaram-se predominantemente após a reperfusão, e de forma concomitante com o aumento dos componentes celulares e moleculares da inflamação, tanto no sangue quanto no líquido peritoneal. Contudo, todos os achados foram discretamente menos evidentes nos animais que receberam o azul de metileno antes da fase de reperfusão. Não é possível afirmar efeito benéfico do azul de metileno sobre a resposta dos equinos na obstrução experimental do jejuno. / Intestinal ischemia is one of the most serious intra-abdominal alterations and reflects extremely elevated morbility and mortality. Reoxygenation on the ischemic tissue produces deleterious inflammatory events with consequences even more severe than the ischemia itself. Methylene blue, due to this action as an inhibitor of free-radical formation. The objective of this test was to study the effects of methylene blue on the clinical and laboratory response before and after the experimental obstruction of the jejunum, associated to the exposition of lypopolysacharide. Two groups of animals were submitted to endotoxemia and experimental obstruction of the jejunum. After, in one group was administered, intravenously, a solution of methylene blue (3 mg/kg), immediately before the experimental obstruction, in the other group, the solution was administered immediately before interrupt the obstructive process in the intestinal segment. The horses were submitted to the evaluation of clinical signs and laboratory response during the 12 hours of study. Based on the clinical and laboratory findings we concluded that, the administration of methylene blue was not able to avoid the clinical and laboratory responses in the experimental model proposed for this study.

Orientador: Carlos Augusto Araújo Valadão / Banca: Juan Carlos Duque Moreno / Banca: Paulo Sérgio Patto dos Santos / Resumo: Avaliaram-se os efeitos clínico e comportamental da injeção intravenosa do tramadol no controle da dor induzida experimentalmente, por obstrução intestinal extraluminal, com dreno de Pen Rose. Foram utilizados 24 cavalos distribuídos em quatro grupos: controle (GC, n=6); obstrução duodenal (GD, n=6); obstrução de íleo (GI, n=6) e obstrução de flexura pélvica (GFP, n=6). Após medicação pré-anestésica com a associação de acepromazina (0,025 mg.kg-1 IV), xilazina (0,5 mg.kg-1 IV) e meperidina (4 mg.kg-1 IM), o tramadol foi administrado nas doses de 1,0 mg.kg-1 e 1,5 mg.kg-1, por via intravenosa (IV), imediatamente após a obstrução intestinal, em três cavalos de cada grupo. Avaliaram-se as freqüências cardíaca (FC) e respiratória (f), temperatura retal (TºC), tempo de preenchimento capilar (TPC), motilidade intestinal, comportamento relacionado à dor (olhar para o flanco, cavar, deitar e rolar) hemograma e hemogasometria venosa, nos intervalos: M0 (basal) a cada 0,5 hora de M1 a M6 , na fase de obstrução, e até três horas após a reversão do processo obstrutivo (M7 a M12). Os resultados demonstraram que não houve diferença significativa entres as doses utilizadas dentro de cada grupo, assim como entre os grupos. Houve aumento da FC em M11 no GD e em M12 no GFP. Os sinais de dor abdominal e atonia intestinal iniciaram-se em M5 no GFP e em M6 no GI. Nos animais do GD, os sinais de desconforto não progrediram. No leucograma foi observado um quadro característico de estresse e na hemogasometria os animais do GD tendenciaram à alcalose metabólica com compensação respiratória. Clinicamente, observou-se que a dose de 1,5 mg.kg-1 de tramadol proporcionou melhor conforto para os animais, porem sem significado estatístico, quando comparado coma dose de 1,0 mg.kg-1... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The clinical and behavioral effects of the intravenous injection of tramadol were evaluated during the control of pain induced experimentally due to intestinal extraluminal obstruction using "Pen Rose" drain. A total of 24 horses were used and distributed in four groups: control (GC, n=6); duodenal obstruction (GD, n=6); ileum obstruction (GI, n=6) and pelvic flexure obstruction (GFP, n=6). After administration of pre-anesthetic medications using association of acepromazine (0.025 mg.kg-1 IV), xylazine (0.5 mg.kg-1 IV) and meperidine (4 mg.kg-1 IM), tramadol was administered at doses of 1.0 mg.kg-1 and 1.5 mg.kg-1 intravenously (IV), immediately after the intestinal obstruction in three horses of each group. Evaluations were performed, including heart rate (HR), respiratory rate (RR), rectal temperature (RT), capillary refill time (CRT), gut motility, pain-related behaviour (look for the sidewall, dig down and roll) and blood gases from venous blood at the time: M0 (baseline) and every 0.5 hours from M1 to M6, during obstruction process and also until three hours after the obstructive process be reverted (M7 to M12). The results showed no significant difference among the doses used in the same group as among groups. There was an increase in HR in the GD M11 and M12 of GFP. Signs of abdominal pain and intestinal atony began at M5 in GFP and at M6 in GI. In animals from GD, the discomfort signs did not showed progress. On the leucogram was observed a typical stress and on the blood gas analysis the animals from GD showed a tendency to metabolic alkalosis with respiratory compensation. Clinically, was observed that the dose of 1.5 mg.kg-1 of tramadol provided better comfort to the animals, but there was not statistical significance, compared with the dose 1.0 mg.kg-1... (Complete abstract click electronic access below) / Mestre

Orientador: Áureo Evangelista Santana / Banca: Raquel Yvonne Arantes Baccarin / Banca: Rafael Resende Faleiros / Banca: Marcia Rita Fernandes Machado / Banca: Juliana Regina Peiró / Resumo: Trabalhos recentes relatam a eficácia do azul de metileno na prevenção dos danos impostos por espécies reativas de oxigênio aos tecidos de vários órgãos, em vários modelos de isquemia/reperfusão. Este estudo foi concebido com o fito de avaliar o efeito do azul de metileno sobre as respostas clínico-laboratoriais, na obstrução experimental do jejuno em equinos, associada à exposição de lipopolissacarídeo. Dois grupos de animais foram submetidos à indução da endotoxemia e à obstrução experimental do jejuno em período anterior. Posteriormente administrou-se em um deles, infusão de azul de metileno (3 mg/kg I.V), 15 minutos antes da obstrução experimental, e no outro, a mesma infusão 15 minutos antes da desobstrução do jejuno. Foi realizada avaliação clínica, hematológica e bioquímico-sérica, e perfil bioquímico e citológico do líquido peritoneal a partir de aferições em oito tempos durante 12 horas, também foram caracterizadas as lesões intestinais. Após 3 horas de isquemia, verificou-se hemorragia, edema, infiltração de neutrófilos e desprendimento da mucosa. Essas lesões manifestaram-se predominantemente após a reperfusão, e de forma concomitante com o aumento dos componentes celulares e moleculares da inflamação, tanto no sangue quanto no líquido peritoneal. Contudo, todos os achados foram discretamente menos evidentes nos animais que receberam o azul de metileno antes da fase de reperfusão. Não é possível afirmar efeito benéfico do azul de metileno sobre a resposta dos equinos na obstrução experimental do jejuno. / Abstract: Intestinal ischemia is one of the most serious intra-abdominal alterations and reflects extremely elevated morbility and mortality. Reoxygenation on the ischemic tissue produces deleterious inflammatory events with consequences even more severe than the ischemia itself. Methylene blue, due to this action as an inhibitor of free-radical formation. The objective of this test was to study the effects of methylene blue on the clinical and laboratory response before and after the experimental obstruction of the jejunum, associated to the exposition of lypopolysacharide. Two groups of animals were submitted to endotoxemia and experimental obstruction of the jejunum. After, in one group was administered, intravenously, a solution of methylene blue (3 mg/kg), immediately before the experimental obstruction, in the other group, the solution was administered immediately before interrupt the obstructive process in the intestinal segment. The horses were submitted to the evaluation of clinical signs and laboratory response during the 12 hours of study. Based on the clinical and laboratory findings we concluded that, the administration of methylene blue was not able to avoid the clinical and laboratory responses in the experimental model proposed for this study. / Doutor

A obstrução intestinal mecânica representa uma condição de urgência, necessitando diagnóstico precoce e terapêutica adequada, em virtude do seu elevado grau de morbidade e de mortalidade. Desta forma, o objetivo deste estudo foi avaliar o efeito da N-acetilcisteína associada ao Ringer lactato ou à solução salina hipertônica na resposta inflamatória, histologia e translocação bacteriana em modelo experimental de obstrução e isquemia intestinal. Para tanto, Foram constituídos quatro grupos experimentais, com 10 ratos Wistar em cada, além do grupo de referência: OI - Submetidos a obstrução e isquemia intestinal e enterectomia com anastomose intestinal, sem reanimação volêmica; RL - Submetidos a obstrução e isquemia intestinal, reanimação volêmica com Ringer lactato (32ml/kg, i.v., em 10 minutos) e enterectomia com anastomose intestinal; RLNAC - Submetidos a obstrução e isquemia intestinal, reanimação volêmica com Ringer lactato associado a NAC (32ml/kg + 150 mg/kg i.v. em 10 minutos) e enterectomia com anastomose intestinal; SHNAC - Submetidos a obstrução e isquemia intestinal, reanimação volêmica com solução salina hipertônica a 7,5% associado com NAC (4ml/kg + 150 mg/kg i.v., em 10 minutos) e enterectomia com anastomose intestinal. Grupo Referência (n=5): Animais anestesiados, submetidos a coleta de materiais para cultura e histologia e sacrificados por exsanguinação. Os animais receberam uma associação anestésica de cetamina e xilazina intramuscular em membro posterior direito, na dose de 60mg/kg e 10mg/kg, respectivamente. Decorridas 24 h do tratamento, a eutanásia foi realizada por exanguinação, sob anestesia, após a coleta dos tecidos / Mechanical intestinal obstruction represents a condition of urgency, necessary early diagnosis and appropriate therapy, due to their high degree of morbidity and mortality. In this way, the objective of this study was to evaluate the effect of N-acetylcysteine associated with lactated Ringer\'s or hypertonic saline solution in the inflammatory response, histology and translocation in an experimental model of intestinal obstruction and ischemia. For Four experimental groups were constituted with 10 Wistar rats each, in addition to the reference group: OI - submitted to obstruction and ischemia intestinal and enterectomy with intestinal anastomosis, without volume resuscitation; RL - Undergoing intestinal obstruction and ischemia, volume resuscitation with Ringer\'s lactate (32ml / kg, i.v., within 10 minutes) and anastomosis enterectomy intestinal; RLNAC - Undergoing obstruction and intestinal ischemia, resuscitation with lactated Ringer\'s lactating NAC (32 ml / kg + 150 mg / kg i.v. in 10 minutes) and enterectomy with intestinal anastomosis; SHNAC - Submitted to obstruction and intestinal ischemia, volume resuscitation with saline solution hypertension at 7.5% associated with CAP (4 ml / kg + 150 mg / kg i.v., in 10 minutes) and enterectomy with intestinal anastomosis. Reference Group (n = 5): Anesthetized animals, submitted to collection of materials for culture and histology and sacrificed by exsanguination. The animals received a anesthetic association of ketamine and intramuscular xylazine in limb posterior right, at the dose of 60mg / kg and 10mg / kg, respectively. After 24 h of treatment, euthanasia was performed by exsanguination, under anesthesia, after collection of tissues

Introduction: Intestinal obstruction is a common cause of hospital admissions and carries a mortality rate around 5%. We hypothesized that surgical intervention reduces mortality among these patients. Methods: We conducted a retrospective cohort study using the 2006 Nationwide Inpatient Sample (NIS) to analyze patients with a diagnosis of intestinal obstruction without hernia. We used multiple variable logistic regression to calculate the odds ratio for surgery as a predictor of death after adjusting for illness severity. Results: Among 38,931 patients, 17,544 (45.1%) underwent operative intervention for intestinal obstructions. Surgical patients were slightly younger than non-surgical patients (65 vs. 68 years), and had more severe illness, as measured by the disease staging: mortality scale (115.45 vs. 97.95, p<0.001). After adjusting for illness severity, surgery was protective from mortality (adjusted odds ratio 0.617, 95% CI 0.535-0.710, p<0.001). This finding was validated with 2 other methods of severity adjustment. Among surgery patients, there were fewer days to surgery among survivors (1 day) than non-survivors (2 days), p<0.001. The risk of bowel necrosis increased as time from admission to surgery increased. A greater percentage of surgical patients (77.5%) were discharged home compared to non-surgical patients (76.3%), p=0.007. Conclusion: Surgery is associated with a reduced odds of in-hospital mortality among patients urgently or emergently admitted with intestinal obstruction without hernia. Delaying operative intervention is associated with an increased odds of bowel necrosis and death in these patients. / Clinical Research and Translational Medicine