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Background: Laparoscopic distal pancreatectomy (LDP) is the preferred approach for resection of tumors in the distal pancreas because of its many advantages over the open approach., Aim: To analyse and compare short and long-term outcomes from LDP performed through two different techniques: with splenectomy vs. spleen preservation and splenic vessel preservation., Method: Fifty-eight patients were operated and subsequently divided between two groups: Group 1, LDP with splenectomy (LDPS); and Group 2, LDP with spleen preservation and preservation of splenic vessels (LDPSPPSV)., Results: The epidemiological characteristics were statistically similar between the two groups (age, gender, BMI and lesion size). Both the mean of operative time (p=0.04) and the mean of intra-operative blood loss (p=0,03) were higher in Group 1. The mean of resected lymph nodes was also higher in Group 1 (p<0.000). There were no statistic differences between the groups in relation to open conversion, morbidity or early postoperative mortality. The mean hospital stay was similar between groups. Pancreatic fistula (grade B and C) was similar between the groups. The mean of overall follow-up was 37.6 months (5-96). Late complications were similar between the groups., Conclusion: Both techniques were superimposable; however, LDPS presented, respectively, higher intra-operative bleeding, longer duration of the operation and higher number of lymph nodes resected. No differences were observed in the studied period in relation to the appearance of infections or neoplasm related to splenectomy during follow-up. Maintenance of the spleen avoided periodic immunizations in patients in LDPSPSV. It is indicated in small pancreatic lesions with indolent course.

Background: Based on the International ALPPS registry, we have recently proposed two easily applicable risk models (pre-stage1 and 2) for predicting 90-day mortality in ALPPS but a validation of both models has not been performed yet., Methods: The validation cohort (VC) was composed of subsequent cases of the ALPPS registry and cases of centers outside the ALPPS registry., Results: The VC was composed of a total of 258 patients including 70 patients outside the ALPPS registry with 32 cases of early mortalities (12%). Development cohort (DC) and VC were comparable in terms of patient and surgery characteristics. The VC validated both models with an acceptable prediction for the pre-stage 1 (c-statistic 0.64, P = 0.009 vs. 0.77, P < 0.001) and a good prediction for the pre-stage 2 model (c-statistic 0.77, P < 0.001 vs. 0.85, P < 0.001) as compared to the DC. Overall model performance measured by Brier score was comparable between VC and DC for the pre-stage 1 (0.089 vs. 0.081) and pre-stage 2 model (0.079 vs. 0087)., Conclusion: The ALPPS risk score is a fully validated model to estimate the individual risk of patients undergoing ALPPS and to assist clinical decision making to avoid procedure-related early mortality after ALPPS., (Copyright © 2018 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)

Aim: This study compares the reliability of brain CT interpretations performed using a diagnostic workstation and a mobile tablet computer in a telestroke context., Methods: A factorial design with 1,452 interpretations was used. Reliability was evaluated using the Fleiss' kappa coefficient on the agreements of the interpretation results on the lesion classification, presence of imaging contraindications to the intravenous recombinant tissue-type plasminogen activator (t-PA) administration, and on the Alberta Stroke Program Early CT Score (ASPECTS)., Results: The intra-observer agreements were as follows: good agreement on the overall lesion classification (κ= 0.63, p <0.001), very good agreement on hemorrhagic lesions (κ= 0.89, p <0.001), and moderate agreements on both without acute lesion classification and acute ischemic lesion classification (κ= 0.59 and κ= 0.58 respectively, p <0.001). There was good intra-observer agreement on the dichotomized-ASPECTS (κ= 0.65, p <0.001)., Conclusions: The results of our study allow us to conclude that the reliability of the mobile solution for interpreting brain CT images of patients with acute stroke was assured, which would allow efficient and low-cost telestroke services.

BACKGROUND Solid pseudopapillary tumor of the pancreas (Frantz tumor) is a rare, low-grade malignant neoplasm. Laparoscopic pancreatoduodenectomy is a good approach for tumors located in the pancreatic head. We present two successful cases in young women. CASE REPORT A 19-year-old woman was admitted to Department of Digestive Surgery due to epigastric pain, nausea, and vomiting. Computed tomography scan of the abdomen was performed, and a 3.0×2.2 cm solid tumor localized in the head of the pancreas was observed. After the diagnosis of Frantz tumor of the pancreas, the patient underwent laparoscopic pancreatoduodenectomy. Histopathology confirmed solid and cystic pseudopapillary tumor. The postoperative course was uneventful, and after 8 months the patient remained disease-free. An 18-year-old woman was admitted at the emergency room with abdominal pain, vomiting, and diarrhea. Computed tomography scans revealed a mass of 4.1×3.3 cm in size in the head of the pancreas consistent with a solid pseudopapillary tumor. Laparoscopic pancreatoduodenectomy was performed by two expert surgeons who divided the work: one did resection and the other did reconstruction. The patient was discharged at postoperative day 6 without complications, and during five months of follow-up the patient has been well and without disease. CONCLUSIONS Laparoscopic pancreatoduodenectomy can be performed safely in patients with Frantz tumor by surgeons with expertise in laparoscopic surgery, technical skill, and adequate equipment., Competing Interests: Conflicts of Interest: None declared Conflict of interest statement The authors declare that they have no conflict of interest.

In the last module of this consensus, controversial topics were discussed. Management of the disease after progression during first line chemotherapy was the first discussion. Next, the benefits of liver resection in the presence of extra-hepatic disease were debated, as soon as, the best sequence of treatment. Conversion chemotherapy in the presence of unresectable liver disease was also discussed in this module. Lastly, the approach to the unresectable disease was also discussed, focusing in the best chemotherapy regimens and hole of chemo-embolization., Competing Interests: none

Background: Liver metastases of colorectal cancer are frequent and potentially fatal event in the evolution of patients., Aim: In the second module of this consensus, management of resectable liver metastases was discussed., Method: Concept of synchronous and metachronous metastases was determined, and both scenarius were discussed separately according its prognostic and therapeutic peculiarities., Results: Special attention was given to the missing metastases due to systemic preoperative treatment response, with emphasis in strategies to avoid its reccurrence and how to manage disappeared lesions., Conclusion: Were presented validated ressectional strategies, to be taken into account in clinical practice.

Background: Hepatopancreatoduodenectomy is one of the most complex abdominal operations mainly indicated in advanced biliary carcinoma., Aim: To present 10-year experience performing this operation in advanced malignant tumors., Methods: This is a retrospective descriptive study. From 2004 to 2014, 35 hepatopancreatoduodenectomies were performed in three different institutions. The most common indication was advanced biliary carcinoma in 24 patients (68.5%)., Results: Eighteen patients had gallbladder cancer, eight Klatskin tumors, five neuroendocrine tumors with liver metastasis, one colorectal metastasis invading the pancreatic head, one intraductal papillary mucinous neoplasm with liver metastasis, one gastric cancer recurrence with liver involvement and one ocular melanoma with pancreatic head and right liver lobe metastasis. All patients were submitted to pancreatoduodenectomy with a liver resection as follows: eight right trisectionectomies, five right lobectomies, four left lobectomies, 18 central lobectomies (IVb, V and VIII). The overall mortality was 34.2% (12/35) and the overall morbidity rate was 97.4%., Conclusion: Very high mortality is seen when major liver resection is performed with pancreatoduodenectomy, including right lobectomy and trisectionectomy. Liver failure in combination with a pancreatic leak is invariably lethal. Efforts to ensure a remnant liver over 40-50% of the total liver volume are the key to obtain patient survival.

Introduction: The only means of achieving long-term survival in hepatocellular carcinoma is complete tumor resection or liver transplantation. Patients with large hepatocellular carcinomas are currently not considered for liver transplantation. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is indicated in selected patients. We present the case of a patient with a huge hepatocellular carcinoma who underwent an ALPPS procedure., Presentation of Case: A 57-year-old man initially presented with a tumor measuring 19cm×10cm in the right lobe of the liver. The liver function was normal and there was no evidence of portal hypertension. The first part of the procedure was performed without mobilizing the liver. The middle hepatic vein was divided during parenchymal transection. The second procedure was performed after 15days. During that procedure the right hepatic artery, right bile duct, and the right hepatic vein were ligated and divided. Liver segments 4-8 with the tumor were removed. The patient developed moderate ascites but recovered after ten days. After 90days, the patient is doing well with no signs of recurrence., Discussion: Hepatocellular carcinoma is a complicated disease and ALPPS is not considered an optimal treatment option. However, patients with large tumors are not considered for liver transplantation or chemotherapy. Patients with Child-Pugh A liver disease without portal hypertension can benefit from surgical treatment for hepatocellular carcinoma; in some situations, surgery may be considerably better than other forms of treatment., Conclusion: ALPPS should be considered in selected patients with large hepatocellular carcinomas., (Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: to evaluate liver regeneration in rats after partial hepatectomy of 60% with and without action diet supplemented with fatty acids through the study of the regenerated liver weight, laboratory parameters of liver function and histological study., Methods: thirty-six Wistar rats, males, adults were used, weighing between 195 and 330 g assigned to control and groups. The supplementation group received the diet by gavage and were killed after 24h, 72h and seven days. Evaluation of regeneration occurred through analysis of weight gain liver, serum aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltranspeptidase, and mitosis of the liver stained with H&E., Results: the diet supplemented group showed no statistical difference (p>0.05) on the evolution of weights. Administration of fatty acids post-hepatectomy had significant reduction in gamma glutamyltransferase levels and may reflect liver regeneration. Referring to mitotic index, it did not differ between period of times among the groups., Conclusion: supplementation with fatty acids in rats undergoing 60% hepatic resection showed no significant interference related to liver regeneration.

Background: Liver metastases of colorectal cancer are frequent and potentially fatal event in the evolution of patients with these tumors., Aim: In this module, was contextualized the clinical situations and parameterized epidemiological data and results of the various treatment modalities established., Method: Was realized deep discussion on detecting and staging metastatic colorectal cancer, as well as employment of imaging methods in the evaluation of response to instituted systemic therapy., Results: The next step was based on the definition of which patients would have their metastases considered resectable and how to expand the amount of patients elegible for modalities with curative intent., Conclusion: Were presented clinical, pathological and molecular prognostic factors, validated to be taken into account in clinical practice.

Purpose: To evaluate wound healing in rats by using low-level laser therapy (LLLT) associated with hydrocolloid occlusive dressing., Methods: Forty male, adult, Wistar rats were used, distributed into four groups: LG (received 2 J/cm² of laser therapy); HG (treated with hydrocolloid); LHG (treated with 2 J/cm² of laser therapy and hydrocolloid); and the CG (treated with 1 mL of 0.9% saline). The wound was evaluated at pre-determined periods 3rd and 7th days, considering the macroscopic and histological parameters (inflammatory cells, capillary neoformation, fibroblasts, collagen formation and reepithelialization)., Results: The LG group at seven days showed increased collagen formation, the LHG group at 3 days showed mild collagen formation. The HG group and the CG at 7 days showed complete reepithelialization., Conclusion: Low-level laser therapy as well as the hydrocolloid dressing have favored the wound-healing process in rats.

Purpose: The purpose of the study is to compare the clearance of procalcitonin (PCT-c) in the first 24 and 48 hours of treatment of severe sepsis and septic shock with another early prognostic marker represented by the 48-hour Δ Sequential Organ Failure Assessment (SOFA)., Materials and Methods: Prospective, observational cohort study conducted in a general intensive care unit including patients with severe sepsis and septic shock. The PCT-c was determined at the diagnosis of sepsis and after 24 and 48 hours. The SOFA score was determined at the time of intensive care unit admission and after 48 hours., Results: One hundred thirty adult patients with severe sepsis and septic shock were studied over an 18-month period. The 24- and 48-hour PTC-c scores were significantly higher in survivors (P < .0001). In nonsurvivors, the initial SOFA was significantly higher, and the 48-hour Δ SOFA was significantly smaller (P = .01). The area under the receiver operating characteristic curve was 0.68 for Δ SOFA and 0.76 for 24- and 48-hour PCT-c., Conclusions: The 48-hour Δ SOFA score and the clearance of 24- and 48-hour PCT are useful markers of prognosis in patients with severe sepsis and septic shock. A decrease in PCT-c in the first 24 hours of treatment should prompt the reassessment of the appropriateness and adequacy of treatment., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: To compare between electrocautery and fibrin sealant hemostasis in rats after partial hepatectomy., Methods: we used 24 Wistar rats, which were submitted to 30% hepatic resection, divided into two groups of 12 animals each: Group Electrocautery and Group Tachosil(r). These animals were evaluated after three and 14 days. We assessed the presence of complications, laboratory tests and histological exam of the recovered liver., Results: the presence of abscess was more prevalent in the electrocautery group. The observed adhesions were more pronounced in the electrocautery group, both in frequency and in intensity, after three and 14 days. There were no deaths in either group. As for laboratory analysis, after three days the hematocrit was lower in the TachoSil(r) Group. The elevation of AST and ALT were more pronounced in the electrocautery group (p = 0.002 and p = 0.004) in three days. Histological analysis of specimens collected on the third day after surgery showed similar results in both groups for the presence of polymorphonuclear cells, whereas mononuclear was more evident in the TachoSil(r) group. We also observed that angiogenesis, although present in both groups, was more pronounced in the TachoSil(r) group (p = 0.030). However, on the 14th day angiogenesis was more pronounced in the electrocautery group, but without statistical significance., Conclusion: hemostasis achieved by the groups was similar; however, the use of electrocautery was associated with infections, adhesions at higher grades and elevated liver enzymes.

Objective: To assess liver regeneration in rats after 60% hepatectomy with and without supplementation of L-glutamine through liver weight changes, laboratory parameters and histological study., Methods: 36 male rats were divided into two groups: glutamine group and control group. Each group was subdivided into three subgroups, with death in 24h, 72h and seven days. The glutamine group received water and standard diet supplemented with L-glutamine, and the control recieved 0.9% saline. In all subgroups analysis of liver regeneration was made by the Kwon formula, study of liver function (AST, ALT, GGT, total bilirubin, indirect and indirect bilirubin and albumin) and analysis of cell mitosis by hematoxylin-eosin., Results: In both groups there was liver regeneration by weight gain. Gamma-GT increased significantly in the control group (p < 0.05); albumin increased in the glutamine group. The other indicators of liver function showed no significant differences. Histological analysis at 72h showed a higher number of mitoses in the glutamine group, with no differences in other subgroups., Conclusion: Diet supplementation with L glutamine is beneficial for liver regeneration.

Objective: To evaluate the preoperative condition and the surgical procedure of surgical patients in a general intensive care unit of a university hospital, relating them to morbidity and mortality., Methods: We studied the medical records of patients undergoing medium and large surgical procedures, admitted to the general intensive care unit. We analyzed: demographic data, clinical records personal history and laboratory tests, both preoperatively and on admission to the intensive care unit, imaging, operative reports, anesthetic reports and antibiotic prophylaxis. After admission, the variables studied were: length of stay, type of nutritional support, use of thromboprophylaxis, mechanical ventilation, description of complications and mortality., Results: We analyzed 130 medical records. Mortality was 23.8% (31 patients), Apache II greater than 40 was observed in 57 patients undergoing major surgery (64%), ASA classification e" II was observed in 16 patients who died (51.6%), the length of stay in the intensive care unit ranged from one to nine days and was observed in 70 patients undergoing major surgery (78.5%), the use of mechanical ventilation for up to five days was observed in 36 patients (27.7%), hypertension was observed in 47 patients (47.4%), the most frequent complication was sepsis., Conclusion: the correct stratification of surgical patient determines their early discharge and reduced exposure to random risk.

Background: Postoperative liver failure consequent to insufficiency of remnant liver is a feared complication in patients who underwent extensive liver resections. To induce rapid and significant hepatic hypertrophy, associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been recently developed for patients which tumor is previously considered unresectable., Aim: To present the Brazilian experience with ALPPS approach., Method: Were analyzed 39 patients who underwent hepatic resection using ALPPS in nine hospitals. The procedure was performed in two steps. The first operation was portal vein ligation and in situ splitting. In the second operation the right hepatic artery, right bile duct and the right hepatic vein were isolated and ligated. The extended right lobe was removed. There were 22 male (56.4%) and 17 female (43.6%). At the time of the first operation, the median age was 57.3 years (range: 20-83 years)., Results: The most common indication was liver metastasis in 32 patients (82.0%), followed by cholangiocarcinoma in three (7.7%). Two patients died (5.2%) during this period and did not undergo the second operation. The mean interval between the first and the second operation was 14.1 days (range: 5-30 days). The volume of the left lateral segment of the liver increased 83% (range 47-211.9%). Significant morbidity after ALPPS was seen in 23 patients (59.0%). The mortality rate was 12.8% (five patients)., Conclusion: The ALPPS approach can enable resection in patients with lesions previously considered unresectable. It induces rapid liver hypertrophy avoiding liver failure in most patients. However still has high morbidity and mortality.

Introduction: The surgical technique of sleeve gastrectomy has not been fully standardized and, therefore, there are issues to be solved. There is a tendency to increase its application due to proved efficiency in weight loss, low morbidity and good postoperative results. However, gastroesophageal reflux disease, which can result from it, is still not well understood., Aim: To present variant technique for sleeve gastrectomy that leaves the stomach totally with the appearance of a homogeneous tube, without manipulation in pyloric and lower esophageal sphincters., Tecnique: Vertical gastrectomy starts with vessel ligation of the greater curvature at the pylorus till esophagogastric angle. Stapling also starts from the pylorus in the same direction. For modeling was used Fouchet 32 F and all the staple line was done just to it. At the end, oversuture of the staple line and "sump" drainage were done., Results: The procedure was used in 55 patients with BMI between 35 and 41. Complications in this group were two fistulas at the esophagogastric angle, one twist of the gastric tube and one postoperative conversion to Roux-en-Y gastric bypass due to untreatable gastroesophageal reflux disease. Fistulas were treated by endoscopic procedure with dilation and septotomy. Mild dysphagia due to tube twisting responded satisfactorily to dilatation. The longest follow-up was two years. The loss of overweight was 67.7% at one year and 69.7% in two. Patients who were suffering from type 2 diabetes mellitus showed disease control in 84.6 % in the first year and 91.6 % in the second. Comorbidities were controlled in all cases., Conclusion: The variant technique proposed here for sleeve gastrectomy leaves the stomach homogeneously in a shape of a tube and in small caliber, providing small free gastric cavity and keeping natural functional activity of the sphincters. However, it may lead to unwanted gastroesophageal reflux, which needs to be better measured in future research.

Objective: To evaluate the tendency of the plasma concentration and clearance of procalcitonin (PCT-c) as biomarkers of prognosis of patients with severe sepsis and septic shock, compared to another early prognosis marker, the number of SIRS criteria at sepsis diagnosis., Methods: We conducted a prospective, observational, cohort study, with patients with severe sepsis and septic shock. The serum procalcitonin was determined at diagnosis of sepsis and after 24 and 48 hours. Demographic data, APACHE IV, SOFA score on arrival, number of SIRS criteria at diagnosis, site of infection and microbiological results were recorded., Results: Twenty-eight patients were included, 19 clinical and nine surgical. In 13 (46.4%) the source of sepsis was pulmonary, abdominal in seven (25.0%), urinary in five (17.9%) and soft tissue in three cases (10.7%). Fifteen patients had severe sepsis and 13 septic shock. Overall mortality was 17.9% (five patients), three with septic shock. Twenty-eight PCT determinations were performed at sepsis diagnosis, 27 after 24 hours and 26 after 48 hours. The initial concentration was not significantly different between survivors and non-survivors groups, but the differences between the two groups after 24 and 48 hours were statistically significant. There was no difference in the number of SIRS criteria. The 24-hour procalcitonin clearance proved to be significantly higher in the group of survivors (-3.0 versus -300.0, p = 0.028). Although the 48-hour procalcitonin clearance has shown to be higher in the group of survivors when compared to non-survivors, the difference did not reach statistical significance., Conclusion: Persistently high procalcitonin concentrations in plasma, as well as reduced 24-hours PCT clearence, were associated with a significant increase in mortality in patients with severe sepsis and septic shock.

Background: The venous thromboembolism is a common complication after surgical treatment in general and, in particular, on the therapeutic management on cancer. Surgery of the digestive tract has been reported to induce this complication. Patients with digestive cancer have substantial increased risk of initial or recurrent thromboembolism., Aim: To provide to surgeons working in digestive surgery and general surgery guidance on how to make safe thromboprophylaxis for patients requiring operations in the treatment of their gastrointestinal malignancies., Methods: The guideline was based on 15 relevant clinical issues and related to the risk factors, treatment and prognosis of the patient undergoing surgical treatment of cancer on digestive tract. They focused thromboembolic events associated with operations and thromboprophylaxis. The questions were structured using the PICO (Patient, Intervention or Indicator, Comparison and Outcome), allowing strategies to generate evidence on the main primary bases of scientific information (Medline / Pubmed, Embase, Lilacs / Scielo, Cochrane Library, PreMedline via OVID). Evidence manual search was also conducted (BDTD and IBICT). The evidence was recovered from the selected critical evaluation using discriminatory instruments (scores) according to the category of the question: risk, prognosis and therapy (JADAD Randomized Clinical Trials and New Castle Ottawa Scale for studies not randomized). After defining potential studies to support the recommendations, they were selected by the strength of evidence and grade of recommendation according to the classification of Oxford, including the available evidence of greater strength., Results: A total of 53,555 papers by title and / or abstract related to issue were found. Of this total were selected (1st selection) 478 studies that were evaluated as full-text. From them to support the recommendations were included in the consensus 132 papers. The 15 questions could be answered with evidence grade of articles with 31 A, 130 B, 1 C and 0 D., Conclusion: It was possible to prepare safe recommendations as guidance for thromboembolism prophylaxis in operations on the digestive tract malignancies, addressing the most frequent topics of everyday work of digestive and general surgeons.

Background: Postoperative liver failure consequent to insufficiency of remnant liver is a feared complication in patients who underwent extensive liver resections. The associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a new approach for patient which tumor is previously considered unresectable., Aim: To present ALPPS as an innovative surgical technique of two-staged hepatectomy for the treatment of patients with marginally resectable or initially nonresectable primary and metastatic liver tumors., Technique: The procedure is performed in two steps. The first consists on ligation of the right portal vein branch. Subsequently, total or nearly total parenchyma dissection along the falciform ligament is performed, including the middle hepatic vein. A plastic bag is used to cover the right extended lobe, and the abdomen is drained and closed. The second one is performed after a computer tomography, six to 12 days interval. After laparotomy, the plastic bag is removed. The right artery, right bile duct and the right hepatic vein are divided. The extended right lobe is removed. Drain is placed at the resection surface, and the abdomen is closed., Conclusion: The associating of liver partition and portal vein ligation can enable curative resection of liver metastasis in patients with lesions previously considered unresectable.

Objective: The authors present their experience with the laparoscopic management of non-parasitic liver cysts., Methods: During the period from May 2003 to August 2006, thirteen patients with non-parasitic liver cysts underwent laparoscopic fenestration. Eleven patients were female (84.6%) and two (15.4%) were male. The average age at diagnosis was 48.3 years (range 35-72). The majority of patients presented with pain, discomfort, dyspepsia, or early satiety at diagnosis. Computed tomography scans were performed in all cases. The cysts were solitary in eleven patients (84.6%) and polycystic liver disease in two patients (15.4%). The average size of the solitary cysts was 11.3 cm (range 9.5-17 cm), and the polycystic liver disease was 10.6 cm (range 9.2-12.1 cm). Operation was indicated due to symptoms in all patients. The technique performed was laparoscopic cyst fenestration., Results: Laparoscopic fenestration was completed in all patients. Mean operative time was 85 minutes (range 53-110). Intraoperative complications were not detected and there was no death. Postoperative complications were observed in two patients (15.4%). Bile leakage was present in one patient, and ascites in another patient. Both cases were treated conservatively. The average hospital stay was 3.5 days (range 2-9 days). Mean follow-up was 36 months. There was one asymptomatic recurrence (7.6%) in a patient with polycystic liver disease after two years of follow-up., Conclusion: Laparoscopic fenestration is the preferred method of treatment for non-parasitic liver cyst. This operation causes low morbidity and the recurrence is uncommon. Adequate selection of patients and the laparoscopic technique are important for the treatment.

Purpose: To describe the hemodynamic alterations during orthotopic liver transplantation in pigs., Methods: In the period from April 2004 to December 2005, forty-four female Landrace pigs, weighting between 32 and 38 Kg underwent orthotopic liver transplantation. The animals were divided into two groups, donor and recipient pairs, which received whole liver grafts. The surgical procedure was divided into four parts: harvested, back-table, hepatectomy of the recipient and implantation. We analyzed heart rate, blood gas, mean systemic arterial pressure (MAP-mmHg), central venous pressure, pH, Na-, K+, Cl-, Ca+ and urinary output., Results: The mean anhepatic time was 69 min, cold ischemia was 252.2 min and back-table was 56.6 min. Blood pressure and heart rate dropped significantly during anhepatic phase and after revascularization. Blood gas and electrolytes alterations were observed during anhepatic and reperfusion phases. Although alterations were noted during these phases, the hemodynamic status was recovered and stabilized in the end of the surgery., Conclusions: Simplified technique of liver transplant was achieved and description of hemodynamic alterations was possible in pigs.

Purpose: To evaluate macroscopically the growth degree of self-transplantation of endometriosis in rats., Methods: Forty female rats, after a 7-day period for adpating and evaluating of the estrous cycle regularity, underwent tail abdominal midline laparotomy with 3-cm cuts. The average third of the left uterine horn was removed, 4mm x 4mm patches in liquid environment were made, and self-transplanted in the rat mesenterium with a single stitch, and the endometrial surface of the endometriotic implant facing the lumen of the peritoneal cavity. The rats were programmed to die after three weeks. The abdominal cavity displaying was held and self-transplants were identified and classified., Results: The results achieved were: one case for degree 0 (2,5%), three cases for degree 1 (7,5%), eleven cases for degree II (27,5%) and twenty-five cases for degree III (62,5%)., Conclusion: The experimental endometriosis development, through the self-transplantation technique, showed to be most common in degrees 3 and 2 of development.

Introduction: The healing is a complex biological event that involves inflammation, chemotaxis, cells proliferation, differentiation and remodeling. In Brazilian popular medicine, the "Aroeira" is used to treat different situations The anastomotic healing is always a preoccupation among surgeons. The fail in intestinal anastomosis leads to fistulas and dehiscences., Purpose: To evaluate the effect of the hydroalcoholic extract of Schinus terebinthifolius Raddi (Brazilian pepper tree) in the healing of colonic anastomosis., Methods: Forty Wistar rats were randomly divided in two groups (Aroeira and control), each one with 20 animals, according to the treatment received after the anastomosis (Aroeira extract or saline solution 0,9%) and each group was divided in two subgroups (C3 and C7 and A3 and A7,) according to the euthanasia day (at 3rd and at 7th). The macroscopic, microscopic and bursting pressure measurements were performed. To evaluate the groups, the non-parametric test of Mann-Whitney was applied., Results: In the macroscopic aspects, there was no significant difference between the Aroeira and the control group, both at the 3rd and the 7th days. When compared the subgroups of microscopic analysis at the 3rd day, the difference between the Aroeira and the control group was significant in the variables congestion (p = 0.005), polymorphonuclears (p = 0.034), mononuclears (p = 0.023), fibroblastic proliferation (p = 0.023) and at the healing stage (p = 0.001). At the 7th day analysis, the difference between the Aroeira and the control group was significant in all the variables of microscopic analysis. No significant differences were found in the bursting pressure., Conclusion: It was observed a favorable effect of Aroeira, at microscopic level, in the healing process of colonic anastomosis.

Introduction: The Brazilian popular habit of using plants to treat several health conditions is ancient. Passion fruit (Passiflora edulis) is widely used to treat, usually in an empiric basis, a variety of medical conditions. Anti-inflammatory activity of Passiflora edulis extract, similar to non-steroidal anti-inflammatory drugs (NSAID's), has been described., Purpose: To evaluate the effect of Passiflora edulis hydroalcoholic extract on the healing of midline abdominal incisions in rats by morphological and tensiometric methods., Methods: Forty male Wistar rats were randomly allocated into two groups to either receive Passiflora edulis extract (study group, P) or saline (control group, C) intraperitoneally, in a single isovolumetric dose, after a standardized ventral midline laparotomy had been performed. The twenty rats of the control group as well as those twenty of the study group were divided into subgroups according to the time of sacrifice, either the 3rd PO day (P3, C3) or the 7th PO day (P7, C7). On day three and on day seven after surgery, the rats were sacrificed and the wound area was excised by a standardized protocol. The healing process of the specimens was evaluated macroscopically and histologically. The tensile strength was evaluated by a constant speed computerized tensiometer to determine the breaking strength and the deformation of the healing incision., Results: The macroscopic examination did not show significant differences between study and control groups. Histologically, the C3 vs. P3 comparison showed the following differences: for the variables acute inflammation (p=0.045 in favor of C3), collagenization and capillary neoformation: p=0.001 e 0.001, respectively in favor of P3. Similarly, the C7 vs. P7 comparison showed the following differences for the variables acute inflammation (p=0.002 in favor of C7), chronic inflammation and capillary neoformation: p= 0.006 e 0.001, respectively in favor of P7. Tensiometrically, maximal breaking strength (C(máx)) on day seven of the study group was higher when compared to control group, (6.91 +/- 1.36 vs. 5.05 +/- 1.63, p=0.013). Maximal deformation strength (D(máx)) on day seven of the study group was higher when compared to control group (36.49 +/- 4.61 vs. 26.19 +/-5.74, p=0.001)., Conclusion: Passiflora edulis extract enhances the healing of midline abdominal incisions in rats, especially the histological and tensiometric aspects.

Introduction: The babassu mesocarp (Orbignya phalerata) has been used in experimental research studies focused on its antiinflammatory action. In state of Maranhão--Brazil it is widely used not only as food, but also as popular medicine in wound healing process., Purpose: To evaluate the action of Orbignya phalerata extract in macroscopic, histologic and tensiometric aspects in the healing process of median laparotomy in rats., Methods: Forty male adult Wistar rats were submitted to an incision in the alba linea, sutured back in one plan with separated stitches of polypropylene 5-0. After regular procedure, the animals were divided into two groups of 20 rats each. To the group named control an intraperitoneal, dose of 1.0 ml of saline solution per kilogram of body weight was done. To the experimental group, the same thing was also done, but instead of saline solution it was injected water solution of babassu, in a dose of 50 mg/kg. The animals were observed in the following days. All of them were killed within a three and seven day post-operative period schedule, and then a histological and tensiometric analysis was carried out., Results: On macroscopic examination no relevant adherence, between the alba linea and the abdominal organs in the study groups, was found. Histological evaluation presented marginal significant effects (p=0.86) to acute inflammation and significant effects (p=0.003) to giant cell reaction in both control and experimental three days groups. Significant difference was observed to acute inflammation in both seven days control and experimental groups. In the intragroup analysis (control three and seven) some marginal significant effect was in relationship to acute and chronic inflammation. In the inter-experimental groups analysis, only the giant cell reactions (0.002) and colagenization had significant results. The tensiometric evaluation showed in the seven day experimental group more resistance then others., Conclusion: The macroscopic and histological evaluation didn't show any significant difference between the experimental and control groups, but the tensiometric evaluation at the 7th day experimental group had significant difference compared to the control group, signaling that the use of the extract of babassu intraperitoneally injected can improve the healing process.

Introduction: In Brazilian countryside, cataplasm made from Passiflora edulis leaves has been used by the population as a healing agent for infections and skin inflammations in an empiric basis., Purpose: the aim of this work was to evaluate the healing process of open wounds in rats, in which Passiflora edulis hydro-alcoholic extract was applied., Methods: Sixty male, adult Wistar rats were divided into two groups: Passiflora group and Control group. Rats of the first group were treated with Passiflora edulis extract, and those of the second group received distilled water. The daily application of the extract or distilled water was carried out on a 2 cm diameter standardized circular wound on the dorsal region of each animal. Wound assessment was performed macroscopically and microscopically on the 7th, 14th, and 21st postoperative days. Microscopic analysis included hematoxylin-eosine and Masson Trichromium stains, evaluating inflammatory response, fibroplasia and collagen deposition. The wound retraction was evaluated by digital planimetry., Results: No significant difference in the rate of wound healing was detected comparing both groups. However, a significant increase in the number of fibroblastic cells was seen on the 7th PO day, and significantly greater collagen deposition was observed on the 14th day PO day in rats from the Passiflora group (p=0,012)., Conclusions: The application of the Passiflora edulis extract does not accelerate the healing process of open wounds in rats, but is associated with increased number of fibroblastic cells on 7th P.O. day and greater collagen deposition on the 14th PO day.

Introduction: The large use of plants in the prevention and treatment of different diseases is a milenar practice. In Brazil due to it's rich flora there is a huge material for research and use in popular medicine. The babassu (Orbignya phalerata) is a native tree from North of the Brazil and has a high concentration at the State of Maranhão. The powder of it's mesocarp is known as amid, and has been used as meal and medication due to the known activity against antiinflammatory reaction, pain, pyrexia and immunomodulation., Purpose: To analyze the effect of mesocarp of Orbignya phalerata (babassu) in gastric wound healing in rats under morphologic and tensiometric aspects., Method: Forty Wistar rats, male, adults were submitted to a longitudinal incision of 1 cm in the gastric body and sutured with separated stitches of polypropylene 6.0. After this common procedure the animals were allocated in the aleatory way in two groups Orbignya (GO) and Control (GC) with 20 animals each one. In the GO was used intraperitoneal doses of 50 mg/kh of Orbignya phalerata extract and in the GC water 1 ml/kg. Each group was divided in two subgroups of ten rats according to the period of death, at 3rd and 7th post-operative days. After the death, the abdominal cavity was evaluated and the stomach withdrawn. For the comparative analysis between the groups the macroscopic and histological parameters of wound healing were utilized., Results: There were no abscess, fistulae and haematom in the animals of the study. Abdominal adhesions were observed in both groups of the animals at 3rd and 7th post-operative days. Dehiscence of the gastrography was identified in one 3rd day rat of subgroups GO. The resistance to air insufflation was higher in GO 3rd day (p=0.087). The analysis of histological parameters showed statistical difference related to wound coaptation in favor to subgroup GO 7th post-operative day., Conclusions: The extract of mesocarp of Orbignya phalerata in dose and path utilized positively interfered on the gastrography when compared with control group in animals at 7th post-operative day.

Introduction: Phytotherapy has been drawing interest from the scientific community regarding its potential wound healing properties. There are few studies available that present a correct scientific methodology and, therefore, phytotherapy remains an open field for further research., Purpose: To evaluate the effects of Jatropha gossypiifolia L. (bellyache bush) on the healing of colonic anastomosis in rats., Methods: Forty Wistar rats were subjected to a complete section of the colon, that was soon sutured with eight separate stitches using monofilament polypropylene 6-0. Randomly, the animals were divided into control group (CG), with 20 rats, which were injected with 0.9% sodium chloride solution intraperitoneally (1 mL/kg) and Jatropha group (JG), also with 20 rats, which were injected with Jatropha gossypiifolia L. alcoholic extract intraperitoneally (1 mL/kg). Each of the groups was subdivided into two subgroups of ten rats, according to the sacrifice date, third and seventh days (CG3/ CG7 and JG3/ JG7). After sacrifice, the segment of the colon containing 1cm proximal and distal to the site of anastomosis was removed and subjected to the pressure test with air insulation. This segment was then opened and a 1.0 x 0.5 cm part was removed and placed under 10% formaldehyde for histological analysis with hematoxylin-eosin and Masson's trichrome stainings., Results: The evaluation of the pressure rupture test demonstrated statistical significance regarding the sacrifice date. On the third day, the average pressure of the CG (25.4 mmHg) and the JG (76.4 mmHg) revealed p = 0.013, and on the seventh day, the average pressure of the CG (187,3 mmHg.) and the JG (135.1 mmHg.) revealed p = 0.014. When assessing the microscopic variables among the groups of the 3rd day, only the variables edema and polymorphonuclear cells did not show statistical differences. On the 7th day, all of the variables assessed demonstrated significant differences., Conclusions: Regarding mechanical resistance, there was a difference in resistance between the JG3 and the CG3, and a shift of resistance when comparing the JG7 and CG7, which suggests a weakening of the Jatropha effect at a later stage of healing. The histological evaluation revealed an improvement of the acute inflammatory process in the JG3 when compared to the CG3, which was even more intense during the chronic stage, when the two groups are compared on the seventh day. The histological study of the inflammatory process, in general, showed a favorable effect to the Jatropha group compared to the control group.

Purpose: To evaluate the effects of hydroalcoholic extract of Passiflora edulis leaves in the healing of urinary bladder in rats from histological aspects., Methods: Forty Wistar male rats were submitted to a longitudinal incision of the bladder followed by a stetching in only one level. After this common procedure, animals were divided at random two groups: Passiflora and Control. In the Passiflora group the only dosage used was administered by intraperitoneal injection of hydroalcoholic extract of Passiflora edulis leaves while in the Control group distilled water was injected. Each subgroup was then divided in two subgroups according to the death of these animals: Control, three and seven days, Passiflora, three and seven days. After the death of these animals, an inventory of the abdominal cavity was performed and the bladder was removed. A comparative analysis was done between the two groups with microscopic evaluation of the healing. There was less acute inflammation (p=0.008), greater collagenous formation (p=0.001) and greater capillary neo-formation (p=0.000) in the third day Passiflora subgroup when compared to the Control subgroup of the third day., Results: There was less acute inflammation (p=0.001), greater fibroblastic proliferation (p=0.011) and greater collagenous formation (p=0.001) in the Passiflora subgroup of seventh day when compared with the Control seventh day subgroup., Conclusion: The use of Passiflora edulis leaves extract resulted in less acute inflammation, greater fibroblastic proliferation, collagenous formation and capillary neo-formation on rats' bladder wound healing.