RESUMO RACIONAL: O transplante de fígado é uma terapia complexa e valiosa. Entretanto, complicações que prejudicam a qualidade de vida pós-operatória, como a hérnia incisional, devem ser mais bem elucidadas, analisando os fatores de risco e medidas profiláticas. OBJETIVOS: Definir a taxa de hérnia incisional em pacientes submetidos a transplante de fígado em uma população do sul do Brasil, avaliar os fatores de risco relacionados, a fim de estabelecer futuramente medidas de otimização prévia e cuidados profiláticos específicos. MÉTODOS: Foram analisados, retrospectivamente, pacientes submetidos a transplante de fígado adultos, de janeiro de 2004 a novembro de 2020, avaliando suas características demográficas, resultados cirúrgicos e fatores predisponentes. RESULTADOS: Dentre os 261 pacientes transplantados hepáticos incluídos, a hérnia incisional foi diagnosticada em 71 (27,2%). Vinte e oito do total de 71 pacientes com hérnia incisional (39,4%) desenvolveram hérnia incisional durante o primeiro ano pós-transplante. A maioria era do sexo masculino [n=52, (73,2%)]; 52/71 (73,2%) apresentavam cirrose secundária ao vírus da hepatite C; 33/72 (46,5%) foram portadores de carcinoma hepatocelular. Sexo masculino (p=0,044), diabetes mellitus (p=0,008) e rejeição celular aguda (p<0,001) foram fatores de risco estatisticamente significantes para hérnia incisional. Vinte e oito pacientes (39,4%) foram submetidos à hernioplastia incisional com tela, com taxa de recidiva de 17,8%. CONCLUSÕES: Hérnia incisional após transplante de fígado é um problema relativamente comum, associado ao sexo masculino, diabetes e também a rejeição celular aguda. Este é um problema que não deve ser banalizado, já que pode levar à redução da qualidade de vida, comprometer os resultados tardios do transplante de fígado e pode levar a encarceramento ou estrangulamento.

ABSTRACT BACKGROUND: Liver transplantation is a complex and valuable therapy. However, complications that burden postoperative quality of life, such as incisional hernia, are to be better elucidated, such as risk factors and prophylactic measures. AIM: This study aimed to define the rate of incisional hernia in patients who underwent liver transplantation in a population in southern Brazil and to assess the related risk factors in order to establish measures for prior optimization and specific prophylactic care in the future. METHODS: Patients undergoing adult Liver transplantation from January 2004 to November 2020 were retrospectively analyzed, assessing demographic features, surgical outcomes, and predisposing factors. RESULTS: Among 261 liver transplantation patients included, incisional hernia was diagnosed in 71 (27.2%). Of the 71 incisional hernia patients, 28 (39.4%) developed IH during the first post-transplant. Majority of the patients were male (52/71, 73.2%); of the 71 patients, 52 had hepatitis C virus (HCV) and 33 (46.5%) had hepatocellular carcinoma (HCC). Male gender (p=0.044), diabetes mellitus (p=0.008), and acute cellular rejection (p<0.001) were risk factors for IH. In all, 28 (39.4%) patients were submitted for hernia repair with mesh, with a recurrence rate of 17.8%. CONCLUSION: Incisional hernia after liver transplantation is a relatively common problem associated with male gender, diabetes, and acute cellular rejection. This is a problem that should not be trivialized in view of the complexity of liver transplantation, as it can lead to a reduction in quality of life as well as jeopardize late liver transplantation results and lead to incarceration and strangulation.

Purpose To investigate the effects of induction of selective liver hypothermia in a rodent model. Methods Seven male Wistar rats were subjected to 90 minutes of partial 70% liver ischemia and topic liver 26°C hypothermia (H group). Other seven male Wistar rats were subjected to 90 minutes of partial 70% normothermic liver ischemia (N group). Five additional rats underwent a midline incision and section of liver ligaments under normothermic conditions and without any liver ischemia (sham group). All animals were sacrificed 24-h after reperfusion, and livers were sampled for analyses. Pathology sections were scored for sinusoidal congestion, ballooning, hepatocelllular necrosis and the presence of neutrophilic infiltrates. Results At the end of the experiment, liver tissue expressions of TNF-ɑ, IL-1β, iNOS and TNF-ɑ/IL-10 ratio were significantly reduced in the H group compared to N group, whereas IL-10 and eNOS were significantly increased in H group. Histopathological injury scores revealed a significant decrease in ischemia/reperfusion (I/R) injuries in H group. Conclusion Selective liver hypothermia prevented I/R injury by inhibiting the release of inflammatory cytokines, preserves microcirculation, prevents hepatocellular necrosis and leukocyte infiltration, allowing maintenance of the liver architecture.

Abstract Purpose: To develop a new 24 hour extended liver ischemia and reperfusion (LIR) model analyzing the late biochemical and histopathological results of the isolated and combined application of recognized hepatoprotective mechanisms. In addition, we used a new stratification with zoning to classify the histological lesion. Methods: A modified animal model of severe hepatic damage produced through 90 minutes of segmental ischemia (70% of the organ) and posterior observation for 24 hours of reperfusion, submitted to ischemic preconditioning (IPC) and topical hypothermia (TH) at 26ºC, in isolation or in combination, during the procedure. Data from intraoperative biometric parameters, besides of late biochemical markers and histopathological findings, both at 24 hours evolution time, were compared with control (C) and normothermic ischemia (NI) groups. Results: All groups were homogeneous with respect to intraoperative physiological parameters. There were no losses once the model was stablished. Animals subjected to NI and IPC had worse biochemical (gamma-glutamyl transpeptidase, alkaline phosphatase, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, direct bilirubin, and total bilirubin) and histopathological scores (modified Suzuki score) compared to those of control groups and groups with isolated or associated TH (p < 0.05). Conclusion: The new extended model demonstrates liver ischemia and reperfusion at 24 hour of evolution and, in this extreme scenario, only the groups subjected to topical hypothermia, combined with ischemic preconditioning or alone, had better outcomes than those subjected to only ischemic preconditioning and normothermic ischemia, reaching similar biochemical and histopathological scores to those of the control group.

Abstract Purpose: To evaluate whether combining hypothermia and remote ischemic preconditioning (RIPC) results in protection from ischemia-reperfusion (IR). Methods: Thirty-two Wistar rats underwent right nephrectomy and were randomly assigned to four experimental protocols on the left kidney: warm ischemia (group 1), cold ischemia (group 2), RIPC followed by warm ischemia (group 3), and RIPC followed by cold ischemia (group 4). After 240 minutes of reperfusion, histological changes in the left kidney, as well as lipid peroxidation and antioxidant enzyme activity, were analyzed. The right kidney was used as the control. Serum creatinine was collected before and after the procedures. Results: RIPC combined with hypothermia during IR experiments revealed no differences on interventional groups regarding histological changes (p=0.722). Oxidative stress showed no significant variations among the groups. Lower serum creatinine at the end of the procedure was seen in animals exposed to hypothermia (p<0.001). Conclusions: Combination of RIPC and local hypothermia provides no renal protection in IR injury. Hypothermia preserves renal function during ischemic events. Furthermore, RIPC followed by warm IR did not show benefits compared to warm IR alone or controls in our experimental protocol.

Abstract Purpose: To evaluate whether their combination was more effective than either alone in decreasing renal damage due to ischemia/reperfusion (I/R) injury in rats. Methods: Thirty-two Wistar rats were assigned to four groups. Following right nephrectomy, their left kidneys were subjected to warm ischemia (IR), cold ischemia (TH+IR), intraperitoneal injection of 10 mg/kg melatonin (MEL+IR), or injection of 10 mg/kg melatonin followed by cold ischemia (MEL+TH+IR). Eight randomly assigned right kidneys constituted the control group. After 240 min of reperfusion, left nephrectomy was performed for histopathological evaluation, lipid peroxidation, and measurement of antioxidant enzyme activity. Serum was collected to measure urea and creatinine concentrations. Results: Histopathological damage induced by ischemia and reperfusion was more attenuated in the MEL+TH+IR group than in the MEL+IR and TH+IR groups (p<0.037). Superoxide dismutase activity was significantly higher (p<0.029) and creatinine (p<0.001) and urea (p<0.001) concentrations were significantly lower in the MEL+TH+IR group than in the MEL+IR and TH+IR groups. Conclusion: The combination of melatonin (MEL) and topical hypothermia (TH) better protects against renal I/R injury than does MEL or TH alone.

RESUMO Racional: O adenocarcinoma pancreático apresenta alta taxa de mortalidade. Uma ferramenta que possa predizer adequadamente o seu prognóstico é fundamental para melhor estratificação de risco. A razão neutrófilos/linfócitos e suas adaptações e a razão plaquetas/linfócitos tem se mostrado promissores para este fim. Objetivo: Avaliar o valor prognóstico das razões neutrófilos/linfócitos, neutrófilos/linfócitos derivada e plaquetas/linfócitos, analisar os pontos de corte mais adequados e investigar sua utilidade como fator preditivo de ressecabilidade. Métodos: Foram coletados dados de pacientes com adenocarcinoma pancreático atendidos no Hospital de Clínicas de Porto Alegre entre 2003 e 2013. As razões estudadas foram determinadas com base nos hemogramas coletados na internação e após dois ciclos de quimioterapia paliativa. Resultados: As razões neutrófilos/linfócitos basal, neutrófilos/linfócitos derivada basal e plaquetas/linfócitos basal não tiveram impacto prognóstico na sobrevida (p=0,394, p=0,152, p=0,177 respectivamente). No subgrupo submetido a quimioterapia paliativa, as razões neutrófilos/linfócitos, neutrófilos/linfócitos derivada e plaquetas/linfócitos após dois ciclos de tratamento mostraram-se fatores prognósticos para sobrevida global (p=0,003, p=0,009 e p=0,001 respectivamente). Os pontos de corte encontrados foram 4,11 para neutrófilos/linfócitos (sensibilidade 83% e especificidade 75%), 362 para plaquetas/linfócitos (sensibilidade 91% e especificidade 62,5%) e 2,8 para neutrófilos/linfócitos derivada (sensibilidade 87% e especificidade 62,5%). As razões neutrófilos/linfócitos, neutrófilos/linfócitos derivada e plaquetas/linfócitos não se mostraram estatisticamente significativas como preditores para ressecabilidade (p=0,88; p=0,99 e p=0,64 respectivamente). Conclusões: As razões neutrófilos/linfócitos, neutrófilos/linfócitos derivada e plaquetas/linfócitos são úteis como marcadores prognósticos de sobrevida global em pacientes com adenocarcinoma pancreático submetidos à quimioterapia paliativa. Seu uso como preditor de ressecabilidade não foi demonstrado.

ABSTRACT Background: Pancreatic adenocarcinoma has a high mortality rate. A prognostic tool is essential for a better risk stratification. The neutrophil/lymphocyte ratio and adaptations and the platelet/lymphocyte ratio seem promising for this purpose. Aim: Evaluate the prognostic value of neutrophil/lymphocyte ratio, derived neutrophil/lymphocyte ratio and platelet/lymphocyte ratio, analyze the ideal cutoff values and investigate their utility in predicting resectability. Methods: Data were collected of patients with pancreatic adenocarcinoma in Hospital de Clínicas de Porto Alegre between 2003 and 2013. The studied ratios were determined by blood count collected at hospital admission and after two cycles of palliative chemotherapy. Results: Basal neutrophil/lymphocyte ratio, derived neutrophil/lymphocyte ratio and platelet/lymphocyte ratio did not have prognostic impact in survival (p=0.394, p=0.152, p=0.177 respectively). In subgroup analysis of patients submitted to palliative chemotherapy, neutrophil/lymphocyte ratio, derived neutrophil/lymphocyte ratio and platelet/lymphocyte ratio determined after two cycles of chemotherapy were prognostic for overall survival (p=0.003, p=0.009, p=0.001 respectively). The ideal cutoff values found were 4,11 for neutrophil/lymphocyte ratio (sensitivity 83%, specificity 75%), 2,8 for derived neutrophil/lymphocyte ratio (sensitivity 87%, specificity 62,5%) and 362 for platelet/lymphocyte ratio (sensitivity 91%, specificity 62,5%), Neutrophil/lymphocyte ratio, derived neutrophil/lymphocyte ratio and platelet/lymphocyte ratio were not able to predict resectability (p=0.88; p=0.99; p=0.64 respectively). Conclusions: Neutrophil/lymphocyte ratio, derived neutrophil/lymphocyte ratio and platelet/lymphocyte ratio are useful as prognostic markers of overall survival in patients with pancreatic adenocarcinoma submitted to palliative chemotherapy. Its use as resectability predictor could not be demonstrated.

RESUMO Objetivo: comparar tomografia computadorizada de abdome (TC) com exame clínico seriado (ECS) isolado na condução de ferimentos por arma branca na região anterior do abdome. Métodos: estudo prospectivo, randomizado, realizado no Hospital de Pronto Socorro de Porto Alegre em que pacientes com ferimentos por arma branca na parede anterior do abdome, sem indicação de laparotomia imediata, foram divididos em dois grupos: grupo TC e grupo ECS, No grupo ECS, os pacientes eram observados com exame clínico seriado de 6/6h, No grupo TC, eram submetidos à tomografia computadorizada de abdome após a avaliação inicial. Resultados: dos 66 pacientes estudados, 33 foram selecionados para cada grupo, Do total, seis foram submetidos à cirurgia, três de cada grupo, No grupo ECS, pacientes submetidos à cirurgia tiveram média de 12h entre a chegada e o diagnóstico, sem laparotomias não terapêuticas, Os 30 pacientes restantes deste grupo receberam alta após 24h de observação, No grupo TC, três pacientes apresentaram alterações na TC e foram submetidos à laparotomia, uma não terapêutica, Os demais receberam alta após observação de 24h, A tomografia computadorizada de abdome apresentou valor preditivo positivo (VPP) de 67% e valor preditivo negativo (VPN) de 100%, com acurácia de 96%, O exame clínico seriado isolado, teve VPP e VPN de 100%, com acurácia de 100%. Conclusão: o manejo seletivo para ferimentos por arma branca na parede abdominal anterior é seguro, caso obedeça a uma seleção rigorosa dos pacientes, O exame clínico seriado isolado pode ser realizado sem a necessidade de tomografia, sem aumento do tempo de internação ou da morbidade, o que reduz custos, exposição à radiação, morbimortalidade e laparotomias não terapêuticas.

ABSTRACT Objective: to compare abdominal computer tomography (CT) with isolated serial clinical exam (SCE) in the management of anterior abdominal stab wounds. Methods: randomized prospective study performed at Hospital de Pronto Socorro de Porto Alegre involving patients with anterior abdominal stab wounds without indication of immediate laparotomy; patients were divided in two groups: CT group and SCE group, In the SCE group, patients were followed up with serial clinical exam every 6 hours, Patients of CT group were submitted to abdominal computer tomography after initial evaluation. Results: 66 patients were studied and 33 were included in each group, Of total, six were submitted to surgery, three of each group, In the SCE group, patients submitted to surgery in media waited 12 hours from arrival to diagnosis without any non-therapeutic surgeries, The remaining 30 patients of this group were discharged from hospital after 24 hours of observation, In the CT group, three patients showed alteration at CT and were submitted to laparotomy, one non-therapeutic, The others were discharged from hospital after 24 hours of observation, Abdominal computer tomography had a positive predictive value (PPV) of 67% and negative predictive value (NPV) of 100%, with 96% of accuracy, Isolated serial clinical exam showed PPV and NPV of 100% and 100% of accuracy. Conclusion: selective management of anterior abdominal stabs is safe, when a rigorous selection of patients is observed, Isolated serial clinical exam may be performed without computer tomography, without increase of hospitalization time or morbidity, reducing costs, exposure to radiation, mortality and morbidity and non-therapeutic laparotomies.

Abstract Purpose: Topical hypothermia and local ischemic preconditioning have been shown to reduce renal ischemia-reperfusion (I/R) injury individually. We examined whether combination of both strategies lessens renal I/R injury. Methods: Post right nephrectomy, 40 male Wistar rats were randomly assigned to five experimental protocols performed in the left kidney: topical hypothermia without ischemia (TH), warm ischemia (IR), ischemic preconditioning followed by warm ischemia (IPC+IR), cold ischemia (TH+IR), and ischemic preconditioning followed by cold ischemia (IPC+TH+IR). Eight randomly assigned right kidneys constituted the control group. After 240 min of reperfusion, the left kidney was retrieved to evaluate histological changes, lipid peroxidation and antioxidant enzymes activity. Serum was collected to evaluate urea and creatinine. Results: IPC+TH+IR group revealed no difference to any other group subjected to ischemia in relation to histological changes, lipid peroxidation and antioxidant enzymes activity. Creatinine was lower in IPC+TH+IR group compared with IPC+IR, but showed no difference compared to TH+IR group. Conclusions: Combination of local ischemic preconditioning (IPC) and topical hypothermia conferred no protection in renal I/R injury. Moreover, local IPC solely followed by warm ischemia impaired renal function more than warm ischemia alone.

Resumo Objetivos: Estimar a prevalência de dor nas costas em adolescentes do sexo feminino no ano letivo e verificar se esta dor nas costas está associada com fatores socioeconômicos, demográficos, antropométricos e comportamentais. Métodos: Inquérito epidemiológico com amostra representativa de 495 estudantes do sexo feminino do ensino médio regular diurno, com idade de 14 a 18 anos, da cidade de São Leopoldo, RS, Brasil. Os dados foram coletados através de um questionário auto-aplicável composto por questões fechadas, padronizado, codificado e testado. A análise bivariada incluiu o teste do qui-quadrado (x2) e o cálculo das razões de prevalência (α<0,05). Resultados: A prevalência de dor nas costas foi de 75,2%. As regiões mais acometidas foram dorso-lombar (30,4%) e lombar (27,7%). Entre as alunas com dor, 60,5% apontaram uma intensidade de média a muita dor e 21,2% relataram que a dor as impediu de realizar suas atividades normais do dia a dia. Em relação aos fatores associados, a dor foi mais prevalente nas alunas com sobrepeso/obesidade (RP = 1,246; IC95%: 1,137 a 1,366), nas que relataram mochila/bolsa escolar pesadas (RP = 1,187; IC95%: 1,073 a 1,314) e nas que adotavam uma postura incorreta ao pegar objetos do chão (RP = 1,138; IC95%: 1,031 a 1,256). Conclusões: A prevalência de dor nas costas foi alta e esteve associada com IMC, com o peso relatado da mochila/bolsa escolar e com a postura ao pegar objetos do chão.

Abstract Objective: To estimate the prevalence of back pain in adolescent girls, and determine whether this pain is associated with socioeconomic, demographic, anthropometric, and behavioral factors. Methods: This was an epidemiological survey with a representative sample of 495 female high school students, aged 14 to 18 years, in the municipality of São Leopoldo in the southern Brazilian state of Rio Grande do Sul. Data were collected through a self-administered questionnaire with closed, standardized, coded, and tested questions. Bivariate analysis included the chi-square test (x2) and calculation of prevalence ratios (α<0.05). Results: The prevalence of back pain was 75.2%. The thoracic-lumbar (30.4%) and lumbar (27.7%) regions of the spine were most affected. Among the students with pain, 60.5% reported the severity of their pain to be moderate to severe, and 21.2% reported that the pain prevented them from performing activities of daily living. Regarding associated factors, the pain was more prevalent in overweight/obese students (RP = 1.246, 95% CI: 1.137 to 1.366), who reported carrying a heavy school backpack/bag (PR = 1.187, 95% CI: 1.073 to 1.314) and those who had incorrect posture when picking up objects from the floor (PR = 1.138, 95% CI: 1.031 to 1.256). Conclusions: There was a high prevalence of back pain associated with body mass index, reported weight of the student's school backpack/bag, and posture when picking up objects from the floor.

PURPOSE: To evaluate whether topical renal hypothermia (TRH) at different levels of temperature has protective effects on lung tissue after renal I/R, through an analysis of organ histology and inflammatory markers in lung tissue. METHODS: Twenty-eight male Wistar rats were randomly allocated across four groups and subjected to renal ischemia at different levels of topical renal temperature: normothermia (no cooling, 37°C), mild hypothermia (26°C), moderate hypothermia (15°C), and deep hypothermia (4°C). To induce I/R, the vessels supplying the left kidney of each animal were clamped for 40 minutes, followed by reperfusion. After four hours, another procedure was performed to harvest the tissues of interest. TNF-α, IL-1β and myeloperoxidase activity were measured in lung tissue. Histological analysis was performed in hematoxylin and eosin-stained lung specimens. RESULTS: Induction of renal I/R under deep topical hypothermia resulted in a significant decrease in lung concentrations of TNF-α compared with normothermic I/R (p<0.05). A trend toward significant correlation was found between lung IL-1β concentration and intensity of hypothermia (Spearman r=−0.37; p=0.055). No difference was found in myeloperoxidase activity or histologic injury between groups. CONCLUSION: Topical renal hypothermia reduces activation of the inflammatory cascade in the lung parenchyma. However, tissue-protective effects were not observed.

PURPOSE:To design an animal model of ischemia-reperfusion (I/R) in kidneys and evaluate the role that predetermined ranges of local hypothermia plays on markers of stress-oxydative as well as on histologic sections. METHODS: Twenty eight male rats Wistar, under general anesthesia, undergone right nephrectomy (G0, control group) followed by left kidney ischemia during 40 min. Four temperatures groups were designed, with seven animals randomized for each group: normothermic (G1, ±37ºC), mild hypothermia (G2, 26ºC), moderate hypothermia (G3, 15ºC) and deep hypothermia (G4, 4ºC). Left kidney temperature was assessed with an intraparenchymal probe. Left nephrectomy was performed after 240 min of reperfusion. After I/R a blood sample was obtained for f2-IP. Half of each kidney was sent to pathological evaluation and half to analyze CAT, SOD, TBARS, NO3, NO2. RESULTS:Histopathology showed that all kidneys under I/R were significantly more injured than the G0 (p<0.001). TBARS had increased levels in all I/R groups compared with the G0 (p<0.001). CAT had a significant difference (p<0.03) between G1 and G4. Finally, no difference was found on SOD, NO3, NO2 nor on f2-IP. CONCLUSION: This model of I/R was efficient to produce oxidative-stress in the kidney, showing that 4ºC offered significant decrease in free radicals production, although tissue protection was not observed.

OBJETIVO: Avaliar os efeitos da hipotermia hepática tópica combinada ao pré-condicionamento isquêmico na proteção dos danos iniciais de isquemia e reperfusão. MÉTODOS: Trinta e dois ratos Wistar foram submetidos à isquemia hepática parcial durante 90 minutos em Normotermia (IN), Pré-condicionamento Isquêmico (IPC), Hipotermia a 26ºC (H) e Hipotermia a 26ºC mais PCI (H+PCI). A PAM, a temperatura corporal e o fluxo biliar foram aferidos em intervalos de 15 minutos. Marcadores plasmáticos de danos hepáticos e as defesas antioxidantes foram avaliados após 120 minutos de reperfusão. RESULTADOS: A PAM e a temperatura corporal permaneceram constantes durante o experimento. O fluxo biliar retornou a valores semelhantes ao grupo C nos grupos H e H+PCI após 45 minutos de reperfusão e aumentou significativamente nos grupos H e H+PCI em comparação aos grupos IN e PCI após 105 e 120 minutos. Os níveis plasmáticos da AST e ALT demonstraram aumento significativo no grupo IN em comparação ao grupo C. Os níveis de TBARS diminuíram significativamente no grupo H+PCI em comparação aos grupos IN, PCI e H. Os níveis de Catalase aumentaram significativamente no grupo PCI em comparação aos grupos C, IN e H+PCI. Os níveis de SOD foram significativamente maiores no grupo H em comparação aos grupos C, IN, PCI e H+PCI. CONCLUSÃO: A hipotermia tópica protegeu o fígado isquêmico contra os danos de isquemia e reperfusão e permitiu uma recuperação precoce da função hepática.

PURPOSE: To evaluate the effects of the topical liver hypothermia and IPC combination against I/R injury after initial reperfusion. METHODS: In 32 Wistar rats, partial liver ischemia was induced for 90 minutes in normothermia (IN), ischemic preconditioning (IPC), 26ºC topical hypothermia (H) and 26ºC topical hypothermia plus IPC (H+IPC). MAP, body temperature and bile flow were recorded each 15 minutes. Plasmatic injury markers and tissue antioxidant defenses were assessed after 120 minutes of reperfusion. RESULTS: MAP and body temperature remained constant during all experiment. Bile flow returned to levels similar to controls after 45 minutes of reperfusion in the H and H+IPC groups and increased significantly in comparison to the NI and IPC groups after 105 and 120 minutes. AST and ALT increased significantly in the normothermic groups in comparison to controls. TBARS levels decreased significantly in the H+IPC group in comparison to the other groups whereas Catalase levels increased significantly in the IPC group. SOD levels were significantly higher in the H group in comparison to all groups. CONCLUSION: The induction of 26ºC topical hypothermia associated or not to IPC protected the ischemic liver against ischemia/reperfusion injuries and allowed an early recovery of the hepatic function.

OBJETIVO: Avaliar as variações de temperatura corporal, pressão arterial média (PAM) em um novo modelo de isquemia e reperfusão hepático que utiliza Pré-condicionamento isquêmico e Hipotermia tópica. MÉTODOS: Ratos (n= 32) da raça Wistar foram divididos em 5 grupos: Controle (C), Isquemia normotérmica (IN), Hipotermia a 26°C (H), Pré-condicionamento isquêmico (PCI) e Hipotermia a 26°C com Pré-condicionamento isquêmico com hipotermia (H+PCI). As aferições da PAM e temperatura corporal foram realizadas em intervalos de 30 minutos. Os animais foram submetidos à isquemia hepática de 90 minutos e 120 minutos de reperfusão. Nos grupos H e H+PCI, o fígado foi isolado e resfriado por superfusão de solução fisiológica gelada. Nos grupos com PCI e H+PCI foram aplicados 10 minutos de isquemia e 10 minutos de reperfusão antes do insulto isquêmico maior. RESULTADOS: Não houve diferença na PAM e temperatura corporal entre os grupos durante todo o experimento. CONCLUSÃO: O presente modelo permite a aplicação de hipotermia local associada ou não ao PCI. Novos estudos para avaliar os possíveis efeitos sinergísticos destas ferramentas podem ser reproduzidos sem alterações significativas na macrohemodinâmica e temperatura corporal, ou seja, sob condições estáveis.

PURPOSE: Evaluation of the Mean Arterial Pressure (MAP) and body temperature changes in a new model of liver ischemia-reperfusion applying topical Hypothermia and Ischemic Preconditioning (IPC). METHODS: Rats (n= 32) were divided in 5 groups: Control (C), Normothermic Ischemia (NI), Ischemic Preconditioning (IPC), Hypothermia 26°C plus IPC (H+IPC) and Hypothermia 26°C (H). MAP and body temperature were recorded at 30 minutes intervals throughout the entire experiment. The study groups underwent 90 minutes partial hepatic ischemia followed by 120 minutes of reperfusion. The median and lateral left lobes were isolated and topical 26°C hypothermia was induced by superfusion of cooled saline solution in H+IPC and H groups. A 10 minutes protocol of ischemia and reperfusion was applied in the IPC and H+IPC groups before the major ischemic insult. RESULTS: There was no significant difference in MAP and body temperature means between the groups throughout the experiments. CONCLUSION: The present model allows the induction of topical hepatic hypothermia associated or not to IPC. New studies to evaluate the possible synergistic effects of these tools can be reproduced without significant changes in macrohemodynamics and body temperature, or in other words, under stable conditions.

OBJETIVO: O estresse oxidativo é um importante mecanismo responsável pela disfunção dos enxertos após transplante de fígado (TF). Sabe-se que níveis baixos de Glutationa reduzida (GSH) deixam os enxertos vulneráveis aos danos de reperfusão. O objetivo deste estudo foi avaliar as concentrações de GSH e da Glutationa oxidada (GSSG), os danos hepatocelulares e a função em enxertos ótimos e subótimos após TF. MÉTODOS: Foram realizadas biópsias em 33 pacientes imediatamente antes do implante e duas horas após a reperfusão, permitindo a determinação do GSH, GSSG e o cálculo do índice de stress oxidativo (GSH/GSSG). Foram medidas as transaminases hepáticas e as atividades da Protrombina (TP) e do Fator V para avaliação dos danos hepatocelulares e da função do enxerto, respectivamente. O dano histopatológico foi avaliado através de um índice de cinco parâmetros. RESULTADOS: Houve uma diminuição nos níveis de GSH (p<0.01) 0.323 ± 0.062 ìmol/g to 0.095 ± 0.01 ìmol/g and 0.371 ± 0.052 ìmol/g to 0.183 ± 0.046 ìmol/g) e aumento nos níveis de GSSG (0.172 ± 0.038 ìmol/g to 0.278 ± 0.077 ìmol/g and 0.229 ± 0.048 ìmol/g to 0.356 ± 0.105 ìmol/g) (p<0.05). Houve diminuição do GSH/GSSG (2.23 ± 0.31 to 0.482 ± 0.042 and 2.47 ± 0.32 to 0.593 ± 0.068). Nenhuma diferença entre os grupos ótimo e subótimo foi vista após duas horas de reperfusão. Os escores de danos histopatológicos foram maiores no grupo subótimo (6.46 ± 0.4 vs. 5.39 ± 1.1) (p<0.05) e mostraram correlação com o TP e fator V no grupo Ótimo (p<0.05). A análise multivariada apontou a esteatose como um fator de risco independente para a ocorrência de danos histopatológicos (p<0.05). CONCLUSÃO: Houve uma significativa depleção de GSH e formação de GSSG após a preservação em solução devido a um intenso estresse oxidativo nos enxertos ótimos e subótimos, porém estes níveis não se correlacionaram com a viabilidade dos enxertos.

PURPOSE: The oxidative stress is an important mechanism responsible for dysfunction after orthotopic liver transplantation (OLT). Glutathione (GSH) low levels after cold storage render the grafts vulnerable to reperfusion injury. Aim of this study was to evaluate GSH and oxidized glutathione (GSSG) liver concentrations, the hepatocellular injury and function in optimal and suboptimal grafts after human OLT. METHODS: Liver biopsies were taken in 33 patients before the implant and two hours after reperfusion, allowing determination of GSH, GSSG and oxidative stress ratio (GSH/GSSG). Serum transaminases, prothrombin activity (PT) and factor V were measured to evaluate injury and function respectively. Histopathological injury was analyzed by an index of five parameters. RESULTS: There was a decrease in GSH (p<0.01) after reperfusion (0.323 ± 0.062 ìmol/g to 0.095 ± 0.01 ìmol/g and 0.371 ± 0.052 ìmol/g to 0.183 ± 0.046 ìmol/g) in suboptimal and optimal groups, respectively. An increase of GSSG (p<0.05) occurred after reperfusion (0.172 ± 0.038 ìmol/g to 0.278 ± 0.077 ìmol/g and 0.229 ± 0.048 ìmol/g to 0.356 ± 0.105 ìmol/g) in suboptimal and optimal groups, respectively. A decrease (p<0.01) occurred in the GSH/GSSG ratio after reperfusion (2.23 ± 0.31 to 0.482 ± 0.042 and 2.47 ± 0.32 to 0.593 ± 0.068) in suboptimal and optimal groups, respectively. Histopathological injury scores were higher (p<0.05) in the suboptimal group than in optimal (6.46 ± 0.4 vs. 5.39 ± 1.1) and showed correlation with PT and factor V in the optimal group (p<0.05). Multivariate analysis pointed steatosis as an independent risk factor to histopathological injury (p<0.05). CONCLUSION: There was a significant GSH depletion and GSSG formation after cold storage and reperfusion due to a similar oxidative stress in optimal and suboptimal grafts, but these levels were not related to graft viability.

OBJETIVO: Comparar os efeitos após 6 horas do tratamento do choque hemorrágico (CH) com solução de NaCl 7,5% (Solução Salina Hipertônica - SSH) e Ringer Lactato (RL) sobre a função e integridade hepática em ratos. MÉTODOS: Ratos Wistar (n=16) machos foram submetidos a choque hemorrágico controlado (Pressão Arterial Média - PAM = 45 mmHg) durante 60 minutos e após ressuscitados com SSH (10% da perda volêmica, n=8) ou RL (4 vezes o volume sangüíneo retirado, n=8). Após 6 horas a função hepática foi determinada pela quantificação do fluxo biliar. A integridade hepática foi avaliada pelas bilirrubinas e pela alanino aminotransferase (ALT). RESULTADOS: Não foi constatada diferença de PAM entre os grupos durante os experimentos. O fluxo biliar apresentou recuperação significativa no grupo SSH em comparação ao grupo RL (p<0,05). O grupo SSH apresentou diminuição significativa nos níveis de ALT (p<0,001) e das bilirrubinas (p<0,001). CONCLUSÃO: Após 6 horas de tratamento do choque hemorrágico a SSH mostrou-se superior ao RL, recuperando a função e a integridade hepatocelular, provavelmente por melhora da perfusão nutricional hepática, e diretamente relacionada ao seu mecanismo de ação.

PEURPOSE: The comparison after 6h of hemorrhagic shock (HS) treatment with NaCl 7.5% (Hypertonic Saline Solution - SSH) or Ringer Lactate (RL) on liver function and integrity. METHODS: Male Wistar rats were submitted to HS (Mean Arterial Pressure - MAP= 45 mmHg) during 60 min and then treated with NaCl 7.5% (SSH, 10% of blood loss, n=8) or Ringer Lactate (RL, 400% of blood loss, n=8). After 6h rats were anesthetized, hepatic function was assessed by bile flow measurement and liver integrity evaluated by determination of alanine aminotransferase (ALT) and bilirubin activities. RESULTS: There was no difference in MAP between the groups during the whole experiments. Biliary flow showed a significant recovery after SSH treatment (p<0.05), and significant decrease of ALT (p<0.001) and bilirubin levels (p<0.001) in comparison to RL. CONCLUSION: Resuscitation of HS with NaCl 7.5% promoted better recovery of liver function and lesser hepatocellular damage after 6h of treatment compared to RL. The improvement is very likely related to increased microvascular perfusion provided by small volume resuscitation.