OBJETIVO: Determinar os efeitos do comprimento da alça jejunal em Y de Roux sobre o esvaziamento gástrico e o refluxo enterogástrico. MÉTODOS: Setenta e cinco ratos machos foram submetidos à antrectomia com reconstrução em Y de Roux e divididos em dois grupos de 35 animais. Grupo A, alça curta (7,5cm) e Grupo B (15cm), alça de comprimento padrão. Os grupos A e B foram subdivididos em cinco subgrupos cada para o estudo do refluxo enterogástrico aos 30 e 60 minutos e para o estudo do esvaziamento gástrico aos 5, 10 e 15 minutos. 99m Tc-Fitato and 99m Tc-DISIDA foram utilizados para os estudos do esvaziamento gástrico e do refluxo enterogástrico, respectivamente. RESULTADOS: No estudo do esvaziamento gástrico, a concentração do radiotraçador foi menor no grupo A do que no Grupo B aos cinco minutos. Foi encontrado o refluxo enterogástrico, nos grupos A e B, sem diferenças entre eles. CONCLUSÃO: A alça em Y de Roux de comprimento padrão foi ineficaz em proteger o estômago do refluxo enterogástrico, e pode tornar-se uma barreira funcional ao esvaziamento gástrico.

PURPOSE: To assess the effects of Roux-en-Y jejunal limb length on gastric emptying and enterogastric reflux. METHODS: Seventy male Wistar rats were submitted to antrectomy with Roux-en-Y reconstruction and then were divided into two groups of 35 animals. Group A, short limb (7.5 cm) and Group B, standard limb (15 cm). Group A and B were subdivided into five subgroups each in order to study enterogastric reflux at 30 and 60 minutes and to evaluate gastric emptying at 5, 10 and 15 minutes. In order to measure gastric emptying and enterogastric reflux, radiotracers 99m Tc-Phytate and 99m Tc-DISIDA were respectively used. RESULTS: For gastric emptying, the radiotracer concentration was lower in Group A than in Group B after five minutes. The enterogastric reflux was present, but there were no significant differences between enterogastric reflux indexes concerning both A and B Groups. CONCLUSION: A standard Roux limb, besides being unable to protect the stomach from the enterogastric reflux, may become a functional barrier for gastric emptying.

A Assistência domiciliar (home care), definida como um conjunto de procedimentos hospitalares possíveis de serem realizadas na casa do paciente, abrange ações de saúde desenvolvidas por equipe interprofissional. Este estudo visa a transmitir a experiência do serviço de assistência domiciliar do Hospital São Francisco (HSF), de Ribeirão Preto, apresentando os resultados de 12 meses de atividades (período de setembro de 2001 a agosto de 2002). Durante o período analisado, o serviço prestou atendimento, em sua maioria, a mulheres (57%), com idade predominantemente entre 70-80 anos (30%), com diagnóstico prevalente de doença neurológica (27%) e neoplasias (17%). O setor possui, como coordenadoras, enfermeiras, também responsáveis pela captação do cliente. O trabalho é realizado por uma equipe interprofissional que realiza desde procedimentos, como coleta de exames laboratoriais, curativos, cuidados com sondas e ostomias, até internação domiciliar.

Home care is defined as a group of hospital procedures that can be developed at home, encompassing health actions developed by a multiprofessional team. This study aims at disseminating the experience of a home care service offered by São Francisco Hospital, located in the city of Ribeirão Preto, presenting the results of a 12-month period (from September 2001 to August 2002). During the analyzed period, the service provided care mainly to women (57%), with age between 70 and 80 years (30%), with diagnosis of neurological diseases (27%) and tumors (17%). The sector is coordinated by nurses, who are also responsible for bringing in clients. The work is performed by an interprofessional team that performs procedures of collecting material for lab examinations, dressing, deliver care with catheters and ostomies, as well as home hospitalization.

La atención domiciliaria, definida como un conjunto de procedimientos hospitalarios que pueden ser realizados en la casa del paciente, engloba acciones de salud desarrolladas por un equipo interprofesional. Este estudio visa trasmitir la experiencia del servicio de atención domiciliaria del Hospital São Francisco (HSF) de Ribeirão Preto, Brasil, presentando los resultados de 12 meses de actividades (período de septiembre de 2001 a agosto de 2002). Durante el período analizado, el servicio prestó atención a, en su mayoría, mujeres, (57%), con edad predominantemente entre 70-80 años (30%) y con diagnóstico predominante de enfermedad neurológica (27%) y neoplasias (17%). El sector cuenta con coordinadoras enfermeras, también responsables por la captación del cliente. El trabajo es realizado por un equipo interprofesional que realiza desde procedimientos como recolección de exámenes de laboratorio, curativos, cuidados con sondas y ostomías, hasta la internación domiciliaria.

Home care is defined as a group of hospital procedures that can be developed at home, encompassing health actions developed by a multiprofessional team. This study aims at disseminating the experience of a home care service offered by São Francisco Hospital, located in the city of Ribeirão Preto, presenting the results of a 12-month period (from September 2001 to August 2002). During the analyzed period, the service provided care mainly to women (57%), with age between 70 and 80 years (30%), with diagnosis of neurological diseases (27%) and tumors (17%). The sector is coordinated by nurses, who are also responsible for bringing in clients. The work is performed by an interprofessional team that performs procedures of collecting material for lab examinations, dressing, deliver care with catheters and ostomies, as well as home hospitalization.

La atención domiciliaria, definida como un conjunto de procedimientos hospitalarios que pueden ser realizados en la casa del paciente, engloba acciones de salud desarrolladas por un equipo interprofesional. Este estudio visa trasmitir la experiencia del servicio de atención domiciliaria del Hospital São Francisco (HSF) de Ribeirão Preto, Brasil, presentando los resultados de 12 meses de actividades (período de septiembre de 2001 a agosto de 2002). Durante el período analizado, el servicio prestó atención a, en su mayoría, mujeres, (57%), con edad predominantemente entre 70-80 años (30%) y con diagnóstico predominante de enfermedad neurológica (27%) y neoplasias (17%). El sector cuenta con coordinadoras enfermeras, también responsables por la captación del cliente. El trabajo es realizado por un equipo interprofesional que realiza desde procedimientos como recolección de exámenes de laboratorio, curativos, cuidados con sondas y ostomías, hasta la internación domiciliaria.

A Assistência domiciliar (home care), definida como um conjunto de procedimentos hospitalares possíveis de serem realizadas na casa do paciente, abrange ações de saúde desenvolvidas por equipe interprofissional. Este estudo visa a transmitir a experiência do serviço de assistência domiciliar do Hospital São Francisco (HSF), de Ribeirão Preto, apresentando os resultados de 12 meses de atividades (período de setembro de 2001 a agosto de 2002). Durante o período analisado, o serviço prestou atendimento, em sua maioria, a mulheres (57%), com idade predominantemente entre 70-80 anos (30%), com diagnóstico prevalente de doença neurológica (27%) e neoplasias (17%). O setor possui, como coordenadoras, enfermeiras, também responsáveis pela captação do cliente. O trabalho é realizado por uma equipe interprofissional que realiza desde procedimentos, como coleta de exames laboratoriais, curativos, cuidados com sondas e ostomias, até internação domiciliar.

We report a case of a 49 years-old man who underwent a barium meal examination for an epigastric pain. A perforated gastric ulcer with barium extravasation into peritoneal cavity was seen on X-rays. During an emergency laparotomy, a perforated pyloric ulcer was noted, along with barium contamination in the peritoneal cavity. The ulcer was closed with an omental patch and an extensive peritoneal lavage with saline was performed. During the postoperative period, the patient developed signs of peritonitis and underwent a new laparotomy was at the 9th day showing a subfrenic abscess with a large barium contamination. The patient presented septic shock and multiple organ failure. dying on the 21th day.

Nas últimas décadas, diversas alternativas têm sido propostas para o tratamento do trauma esplênico. O presente estudo procurou comparar o tratamento não-operatório e a cirurgia conservadora na lesão esplênica. Foram analisados, retrospectivamente, os prontuários de 136 portadores de trauma esplênico atendidos na Unidade de Emergência do Hospital das Clínicas da FMRPUSP (1986-1995). Foram utilizados o lnjury Severity Score (1SS) e o Organ lnjury Scaling (OIS) para a definição da gravidade dos casos. Os pacientes foram divididos em dois grupos: grupo A (n=32): conservador não operatório e grupo B (n=104): cirurgia conservadora. As médias de idade, em anos, foram semelhantes (A: 20,31 + 12,43 e B: 25,02 + 14,98; p>0,05). Houve predominância do sexo masculino em ambos os grupos. Os dois grupos diferiram quanto à etiologia (p<0,01). A avaliação das médias do ISS não mostrou diferença significativa (A: 14,21 ± 8,67 e B: 19,44 ± 11,33; p>0,05). Ocorreram complicações em 9,37% e 24,03% dos grupos A e B, respectivamente, mas a diferença não foi significativa (p>0,05). A média de permanência hospitalar foi de 6,68 ± 5,65 e 9,24 ± 9,09 dias, grupos A e B, sem diferença significativa (p>0,05). Concluímos, portanto: o tratamento não-operatório e a cirurgia conservadora do trauma esplênico são condutas equivalentes, sendo opções terapêuticas válidas nas lesões esplênicas de menor gravidade.

Management of the injured spleen has changed radically over the past decade. The objective of this study was to analyze the nonoperative treatment and the conservative surgery in the splenic trauma. A retrospective study was performed in 136 patients sustaining splenic trauma from Hospital das Clínicas da FMRPUSP (1986-1995). The Injury Severity Score (ISS) and the Organ Injury Scaling (OIS) were determined to evaluate the severity of the cases. Two groups were defined: group A (n=32): nonoperative management and group B (n=104): conservative surgery. The mean age between groups were similar (Group A: 20,31 ± 12,43 years and Group B: 25,02 ± 14,98 years; p>0.05). There was male predominance in both groups. The analysis of the etiology showed difference between the groups (p<0,01). There was no statistical difference in the mean ISS in both groups (A: 14,21 ± 8,67 and B: 19,44 ± 11,33; p>0.05). There was a 9,37% and 24,03% incidence of complications in groups A and B, but it was not statistically significant (p>0,05). The mean length of stay were 6,68 + 5,65 and 9,24 + 9,09 for groups A and B, respectively, with no statistical significance (p>0,05). Conclusion: either conservative surgery or nonoperative treatment are good options in the management of traumatic injuries of the spleen, and both are valid therapeutic choices when dealing with minor splenic injuries.

Colonic obstruction is a very rare complication of gallstone disease. We describe two cases of colonic obstruction by gallstone in old age women, in which the final diagnosis was made on surgery. In one it was found a cholecystocolic fistula and a stone impacted in the sigmoid colon which was milked until the cecum, where it was removed through a cecolithotomy. In the other there was a cholecystoduodenal fistula, the stone was impacted in the sigmoid colon and in association there was a colonic necrosis, treated by colectomy, ileostomy and mucous fistula, During colonic mobilization a colecystoduodenal fistula was exposed, making necessary to perform a cholecystectomy and fistula repair. Both patients died in sepsis.

Apresentamos uma revisão sobre trauma renal, com ênfase na avaliação radiológica, particularmente com o uso da tomografia computadorizada, que tem se tornado o exame de eleição, ao invés da urografia excretora e arteriografia. O sucesso no tratamento conservador dos pacientes com trauma renal depende de um acurado estadiamento da extensão da lesão, classificado de acordo com a Organ Injury Scaling do Colégio Americano de Cirurgiões. O tratamento conservador não-operatório é seguro e consiste de observação contínua, repouso no leito, hidratação endovenosa adequada e antibioti- coterapia profilática, evitando-se uma exploração cirúrgica desnecessária e possível perda renal. As indicações para exploração cirúrgica imediata são abdome agudo, rápida queda do hematócrito ou lesões associadas determinadas na avaliação radiológica. Quando indicada, a exploração renal após controle vascular prévio é segura, permitindo cuidadosa inspeção do rim e sua reconstrução com sucesso, reduzindo a probabilidade de nefrectomia.

We present a revision of the renal trauma with emphasis in the radiographic evaluation, particularly CT scan that it has largely replaced the excretory urogram and arteriogram in the diagnostic worh-up and management of the patient with renal trauma. The successful management of renal injuries depends upon the accurate assessment of their extent in agreement with Organ Injury Scaling classification. The conservative therapy managed by careful continuous observation, bed rest, appropriate fluid ressuscitation and prophylactic antibiotic coverage after radiographic staging for severely injured kidneys can yield favorable results and save patients from unnecessary exploration and possible renal loss. The indications for immediate exploratory laparotomy were acute abdomen, rapidly dropping hematocrit or associated injuries as determinated from radiologic evaluation. When indicated, renal exploration after trauma is safe and in a high percentage of cases reconstruction will be successful. Isolation of the renal vasculature before exploration of the renal trauma is believed to reduce blood loss, allow for more careful and confident renal inspection and reconstruction, and reduce the probability of nephrectomy.

The papillary cystic and solid tumor of the pancreas is rare. It occurs predominantly in young women and most present a benign behavior. The most common clinical sign is a large palpable abdominal mass. The pathogenesis of this tumor has attracted a number of investigations but remains unclear. We present a 18 year old white woman with abdominal mass detected after cesarian. Clinical examination showed minimal tenderness. There was no history of weight loss or jaundice. Haematological parameters were normal, except anaemia. The computed tomography was performed and surprisingly showed a 10 cm mass in the region of the tail of the pancreas. An extended distal pancreatectomy was performed with splenic preservation. The patient had an uneventful recovery and two months later remains asymptomatic.

Para avaliar os efeitos da gastrectomia segmentar do corpo associada à vagotomia gástrica proximal (GS + VGP), sobre a vascularização arterial da curvatura menor do estômago, foram utilizados 24 cães distribuídos em dois grupos de 12 animais, com as seguintes denominações: Grupo I, animais submetidos à laparotomia e manipulação gástrica; Grupo II, animais submetidos à GS + VGP. Em cada grupo, metade dos animais foi sacrificada no terceiro, metade no oitavo dia pós- operatório. No dia do sacrifício, procedeu-se à injeção de mistura de bário-gelatina, na vascularização arterial do estômago. A seguir, o estômago foi removido do animal, fixado em solução de formol, aberto pela curvatura maior e radiografado com técnica padronizada. A intensidade da vascularização da curvatura menor do estômago foi determinada por microdensitometria e morfometria. Pela microdensitometria, foram determinados os valores de densidade óptica, convertidos em equivalentes de milímetros de alumínio, da imagem radiográfica da curvatura menor do estômago. Com base nesses resultados, verificou-se que os valores médios de densidade óptica do grupo II foram significativamente maiores do que o grupo I (p<0,001). Pelo estudo morfométrico de fragmento histológico da curvatura menor, observou-se que os valores médios de volume relativo das arteríolas, em relação ao volume total da camada submucosa, foram significativamente maiores no grupo II em comparação ao grupo I (p<0,001). Os valores médios dos diâmetros das arteríolas da camada submucosa foram significativamente mais elevados no grupo II que no grupo I (p<0,001). O número de arteríolas por mm2 da camada submucosa não diferiu significativamente entre os dois grupos (p>0,05). Embora a execução da GS + VGP implique desvascularização da curvatura menor do estômago, observou-se aumento da intensidade da vascularização arterial desta curvatura nos animais do grupo II, conseqüente à dilatação das arteríolas da camada submucosa.

In order to evaluate the possible effects determined by combined body segmental gastrectomy and proximal gastric vagotomy on the arterial vascularization of the lesser curvature of the stomach, twenty-four dogs. weighing 10 to 20 kg, were divided into two groups of 12 animals each: Group 1, animals were submitted to laparotomy and gastric manipulation for 30 minutes; Group II, animals were submitted to segmental gastrectomy with proximal gastric vagotomy. In each group, six animals were sacrificed on the third postoperative day and six on the eighth postoperative day. Neither death nor other postoperative complications occurred. On the sacrifice day barium-gelatin contrast was injected into the arterial vascularization of the stomach, which was then removed from the animal, opened along the greater curvature, fixed in formalin and submitted to radiographs. The intensity of the vascularization of the lesser curvature of the stomach was determined by microdensitometric and molphometric study. By means of microdensitometry. values of the optical densities were determined of the radiograph image of the lesser curvature of the stomach. Considering the microspectrophotometry principies. the values of the optical densities converted in aluminum equivalent were directly proportional to the intensity of vascularization of the gastric lesser curvature. The analysis of the obtained microdensitometry data revealed mean values of optical densities significantly more intense in group 11, when compared to group 1 (p<0.001). On the basis of the morphometric study of the histologic fragment of the lesser curvature, it was observed that: a) the mean arteriole volumes, relative to total submucosa volumes, were significantly greater in group 11 than in group 1 (p<0.001); b) the mean values of the arterioles diameter of the submucosal of group 11 were significantly larger than in the group 1 (p<0.001); c) there was no change in the number of arterioles per mm2 of the submucosal between the two groups (p>0.05). Therefore. it was found an increased intensity of the arterial vascularization of the lesser. The increased vascularization was consequence of arteriole dilatation of the submucosal layer.

Afferent loop obstruction after gastrectomy and Billroth II reconstruction is an uncommon problem. Complete acute obstruction requires emergent laparotomy. We describe a patient who developed acute abdominal pain, hyperamylasemia, and palpable abdominal mass, five years after Billroth II gastrectomy. At laparotomy the patient was found to have a complete stricture of the afferent limb with evidence of strangulation and necrosis. There was no evidence of pancreatitis or pancreatic pseudocyst. The patient underwent pancreaticoduodenectomy plus degastrectomy and died 18 hours after the procedure in the ICU. The mass was initially inte1preted as pancreatic pseudocyst. Ultrasonography may provide enough evidence to differentiate a pancreatic pseudocyst. from an obstructed afferent loop, by the presence of a peripancreatic cystic mass or debris within the mass or the absence of the keyboard sign, suggesting effacement of the valvulae conniventes of the small bowel. Howewer, CT scan of the abdomen has been suggested to be highly characteristic, if not pathognomonic, for an obstructed afferent loop and should be considered first in patients with pancreatitis after Billroth II gastrectomy. A history of previous gastrectomy, recurrent or severe abdominal pain, hyperamylasemia with characteristic tomography, and endoscopic findings will establish the diagnosis and necessitate surgical evaluation and intervention.