Navegando por Palavras-chave "Doença de Hirschsprung"

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    Abnormalities of digestive tract innervation in rat fetus treated with ethylenethiourea
    (Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2012-03-01) Lemos, Sidney Pereira Pinto [UNIFESP]; Martins, Jose Luiz [UNIFESP]; Lemos, Patrícia Veruska Ribeiro Barbosa; Silva, Silvio Romero Gonçalves e [UNIFESP]; Santos, Fernando Leandro dos; Silva Júnior, Valdemiro Amaro da; UNIVASF; Universidade Federal de São Paulo (UNIFESP); Federal Rural University Department of Veterinary Medicine; Federal Rural University Department of Animal Morphology and Physiology
    PURPOSE: The pathophysiology of abnormalities associated with myenteric plexus lesions remains imperfectly understood. Such abnormalities have been correlated with subocclusive intestinal conditions in children with Hirschsprung's disease, cases of chronic constipation and, postoperatively, in cases of anorectal anomalies. This study evaluated abnormalities of the myenteric plexus in fetus from female rats that received ethylenethiourea. METHODS: Female rats were exposed to ethylenethiourea on the 11th day of pregnancy (experimental group) or to 0.9% physiological solution (control group). Abnormalities were only found in the experimental group. The digestive tract muscle layer was analyzed morphometrically and changes to the frequencies of nerve plexus cells and interstitial cells of Cajal were evaluated, using hematoxylin-eosin, S-100 protein, neuron-specific enolase and C-Kit, respectively. RESULTS: Muscle and skeletal abnormalities were observed in 100%, anorectal anomalies in 86%, absent tail in 71%, short tail in 29%, duodenal atresia in 5%, esophageal atresia in 5% and persistent omphalomesenteric duct in 5%. Histopathological analysis showed a thinner muscle layer associated with lower frequencies of ganglion cells and interstitial cells of Cajal, in all gastrointestinal tract. CONCLUSION: Severe nerve plexus abnormalities associated with muscle layer atrophy were observed throughout the gastrointestinal tract in newborn rats exposed to ethylenethiourea.
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    Anorretomiectomia no tratamento do megarreto aglanglionar na criança
    (Universidade Federal de São Paulo (UNIFESP), 1990) Pinus, Jaques [UNIFESP]; Pinus, José [UNIFESP]
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    Avaliação clínica, manométrica e profilométrica dos pacientes portadores de megacolo congênito submetidos à cirurgia de abaixamento de colo pelas técnicas de Duhamel modificado ou Retossigmoidectomia Transanal
    (Universidade Federal de São Paulo (UNIFESP), 2007-09-26) Martins, Elaine Cristina Soares [UNIFESP]; Martins, José Luiz [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective: Several techniques are being proposed for a definite treatment using surgery for the Hirschsprung’s disease or congenital megacolon (CM). This study aims to evaluate the differences in the surgery results obtained with manometric anorectal procedure and profilometric analysis, as well as verify its correlation with clinical parameters of patients’ fecal standard results who were submitted to one of these two techniques for the CM chirurgic treatment: 1.colectomy of the aganglion segment and modified Duhamel procedure (MD) to perform a pull through of the ganglionic colon; and 2. colectomy of the anglion segment and modified transanal rectosigmoidectomy (MTR). Methods: The present study submitted, for the period of April 2001 to March 2006, 42 patients to clinical evaluations and anorectal manometry for a post-operative control for a CM correction procedure, of which 36 were male (74%) and 6 female (26%). All patients were submitted to the exam without sedation, using the perfusion technique, in the post-operative period, seeking to evaluate the resting pressure (RP), the pressure response of the sphincter to cough (C), the pressure response to voluntary contraction (VC), the pressure response to sustained voluntary contraction (SVC), the pressure response to perianal stimulation (PAS), the analysis of the rectal sphincter reflex (RSR) and to analyze the standard and potentiation pressure curves. With the pressures acquired from the pressure curve elaboration in the perfusion channels, a tridimensional image of the anorectal canal was taken, allowing us to study the distribution of the pressure in the anorectal walls. Furthermore, aiming to compare the manometric, profilometric and clinical variables between the two exploited techniques, a Student-t test was applied for the cases in which the variables were continuous. A Chi-squared test was also proposed and, whenever necessary, the Fisher’s exact test; in order to verify the differences in the distribution of a categorized characteristic, as well as to compare the variables between the techniques regarding the fecal continence standard (continent and partially continent), and the significant level criteria adopted was 5%. Results: The ARM demonstrated RP average of 53,44 mmHg for the MD group and 60,67 mmHg for the MTR. Regarding the VC pressure, an average of 94,50 mmHg was attained for the MD group and of 95,47 mmHg for the MTR. There is not a significant difference, statistically, between the MD and MTR groups. It is important to highlight that the average amount of the voluntary contraction pressure was almost double the resting pressure, which is expected, in general, when incontinence research is concerned. It was also noticed, that there was no significant difference, statistically, among the manometric variables, independently of the technique employed, whether in the general group, in the continent group, or, even in the partially continent group. The nonexistence of a significant difference, statistically, for the pressure amount of the internal, external sphincter and ascending colon reinforce the idea that the pull through procedure with the oversewing of the rectum technique, similar to the one proposed by Swenson, do not expose the complex of the sphincter muscles to risks.The absence of RSR was observed in almost all of the analyzed cases, which to the forms CPS and CPP did not show significant difference, statistically, independently of the technique employed. There is also no significant difference, statistically, for the CPS and CPP forms to the continent and partially continent groups, whether in the general group, in the DM group or in the MTR group. Conclusion: With this present study, it was perceived that both operative procedures for pull through procedure of the ganglionic colon, in which case were, the MD technique and MTR technique, are equivalent from the manometric and profilometric standpoint.
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    Avaliação morfogenética quantitativa dos plexos submucoso e mioentérico do íleo de eqüinos com aganglionose
    (Universidade Federal de São Paulo (UNIFESP), 2010-08-25) Muniz, Eliane [UNIFESP]; Ribeiro, Antonio Augusto Coppi Maciel [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Intestinal aganglionosis is the congenital and hereditary absence of the ganglionic neurons that form the submucosal and myenteric plexuses, a condition that consequently leads to peristaltic disorders. In humans this illness is called “Hirschsprung’s Disease” (HD) and in horses, ileocolic aganglionosis (ICA). Economic losses related to the seriousness of ICA, as well as the absence of three-dimensional quantitative studies on the morpho-functionality of the plexuses creates the need for studies that can contribute to an understanding of it. In this work, the aim was to carry out a morpho-quantitative assessment (stereological) of the submucosal and myenteric nerve plexuses of the ileums of clinically healthy foals and those suffering from ileocolic aganglionosis. The estimated stereological parameters were: volume of the ileum (Víleo), the volume density of the myenteric ganglia (VvGmio) and of the ganglia of the submucosal plexus (VvGsub), the total volume of the myenteric ganglia (VTOTGmio), the total volume of the submucosal ganglia (VTOTGsub), the volume density of the muscle tunic of the ileum (VvMUS), the submucosal tunic of the ileum (VvSUB), the mucosal tunic of the ileum (VvMUC) and the total volume of these tunics: (VTOTMUS), (VTOTSUB) and (VTOTMUC), respectively. The ileums from five healthy male foals, of indeterminate breed (control group, “CG”) and five male “paint horse” foals suffering from ICA (experimental group “EG”) were used. After the foals had been euthanized their ileums were removed and sampled using the fractionator principle. The samples were fixed (formaldehyde 4%), embedded (araldite) and sectioned (ultramicrotome). Within 18 hours of the EG foals being born they had signs of recurrent abdominal discomfort, a decrease in or absence of intestinal motility, hyporexia, tachypnea, tachycardia and tenesmus. Genetically, the EG foals were homozygotes in the PCR mutant gene analysis by SLOB. There was a reduction of 154% in the total volume of the ileum in animals suffering from ICA. In addition to this change we also identified a reduction in the total volume of the muscle, submucosal and mucosal tunics by around 207%, 285% and 280% respectively. The volume density of the myenteric ganglion of the ICA group was also drastically reduced by some 16 times. The total volume occupied by these ganglia in the ileum of the horses was also reduced by 42 times. ICA caused the following alterations in the structure of the ileum of the horses: (i) atrophy of the mucosal, submucosal and muscle tunics; (ii) atrophy of the neurons of the myenteric and submucosal plexuses; (iii) hypoplasia of the neurons of the myenteric and submucosal plexuses (iv) atrophy of the total volume of the ileum.
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    Clinical, manometric and profilometric evaluation after surgery for Hirschsprung's disease: comparison between the modified Duhamel and the transanal rectosigmoidectomy techniques
    (Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2009-10-01) Martins, Elaine Cristina Soares [UNIFESP]; Peterlini, Fábio Luis [UNIFESP]; Fagundes, Djalma José [UNIFESP]; Martins, Jose Luiz [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    PURPOSE: To evaluate fecal continence, anorectal manometry (AM) and profilometry (P), in patients operated for congenital megacolon, using either the modified Duhamel technique (MDT) or the modified transanal rectosigmoidectomy (MTR) technique. METHODS: 42 patients were evaluated clinically and via AM and P, for postoperative control. The resting, coughing, voluntary contraction, maintained voluntary contraction and perianal stimulation pressures were investigated. The rectosphincteric reflex was tested and the simple and enhanced pressure curves were evaluated. The three-dimensional profilometric outline was produced. Student's t, chi-squared and Fisher's exact tests were used for statistical analysis (p<0.05). RESULTS: AM showed mean resting pressures of 53.44 mmHg for MDT and 60.67 mmHg for MTR, and mean voluntary contraction pressures of 94.50 mmHg for MDT and 95.47 mmHg for MTR. There was no statistical difference between the groups. The shapes of the simple and enhanced pressure curves did not present any statistical difference, independent of the surgical technique used. CONCLUSION: The two surgical techniques were equivalent. MDT caused greater incidence of postoperative constipation that MTR did. AM and P were shown to be excellent tests for postoperative follow-up among these patients.
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    Comparison between perfusion and balloon techniques for performing anorectal manometry in children with intestinal constipation
    (Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2008-10-01) Marques, Geraldo Magela Nogueira [UNIFESP]; Martins, Jose Luiz [UNIFESP]; Nobre, Vânia Dolores Rodrigues Perdigão [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
    INTRODUCTION: Two anorectal manometry techniques have commonly been utilized: the perfusion technique and the balloon technique. PURPOSE: To compare both techniques in children with intestinal constipation who had not undergone surgical treatment for its correction. METHODS: Thirty-nine children aged between four and fourteen years underwent anorectal manometry using both techniques at random. Resting pressure, pressure response to voluntary contraction, coughing and perianal stimulation, maximum pressure on the anal canal pressure curve, and presence of rectosphincteric reflex were registered and submitted to statistics. Vectorgraphy of the sphincter muscle complex was obtained by perfusion technique. RESULTS: The statistical comparison between the techniques revealed statistically significant differences in resting pressure (p=0.041), pressure response to voluntary contraction (p=0.026) and maximum pressure within the pressure curve (p=0.010). The rectosphincteric reflex was demonstrated in 21 patients by both techniques. CONCLUSIONS: The perfusion technique presented greater sensitivity in the following parameters: resting pressure, pressure response to voluntary contraction and maximum pressure within the pressure curve. The methods studied are equivalent regarding the measurement of pressure responses to coughing and perianal stimulation and the investigation of rectosphincteric reflex.
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    Estudo comparativo do efeito do cloreto de benzalcôneo, em diferentes solventes, aplicados sobre o cólon de ratos
    (Universidade Federal de São Paulo (UNIFESP), 2003) Gerardi Filho, Vicente Antonio [UNIFESP]; Martins, José Luiz [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objetivo: Estudar o efeito do cloreto de benzalconeo a 0,1 por cento diluido em diferentes solventes, aplicado na superficie serosa do colon sigmoide de ratos. Metodo: Utilizou-se 225 ratos machos, Wistar, com 90 dias de vida, subdivididos em 5 grupos de 45: grupo I -aplicacao de cloreto de benzalconeo a 0,1 por cento diluido em alcool 70 por cento na superficie serosa do colon sigmoide, por 30 minutos, por meio de esponja com extensao de 1,Ocm; grupo II - aplicacao de alcool a 70 por cento, grupo III aplicacao de cloreto de benzalconeo em soro fisiologico, grupo IV - aplicacao de soro fisiologico e grupo V -permanencia de esponja embebedora das substancias por 30 minutos. Cada grupo foi subdividido em 3 grupos de 15 ratos com eutanasia aos 7, 15 e 30 dias para retirada do colon no local do experimento. Cortes dessas regioes foram submetidos a estudo histologico pela tecnica de hematoxilina e eosina e estudo imunohistoquimico pela tecnica da avidina-biotinaperoxidase para a pesquisa de proteina S-100. Resultados: a circunferencia do colon foi maior nos primeiros 7 dias, para os grupos I e li. A distensao abdominal nos primeiros 7 e 15 dias foi mais acentuada nos grupos I e li. Aderencias intestinais foram observadas nos grupos I, II e III em todos os periodos de tempo. Os grupos I, II e III apresentaram aos 7 dias tecido inflamatorio agudo que gradativamente passa a tecido do tipo linfocitario aos 15 e 30 dias, e o tecido de granulacao foi exuberante em todos os ratos dos grupos I e II, principalmente. Ocorreu diminuicao importante dos feixes neurais mioentericos e submucosos nos grupos I, II e III, porem, a intensidade da destruicao celular e menor no grupo III. As camadas circular e longitudinal aumentam de largura no grupo III, embora em menor tamanho que os grupos IV e V, enquanto no grupo I e II o alcool e responsavel por grande destruicao, que impossibilita as medidas. 0 numero de celulas neurais dos plexos mioentericos diminuem em numero nos ratos do grupo III, em relacao aos do grupo IV e V, e estao muito diminuidos nos grupos I e II pela grande destruicao tecidual. Conclusao: o cloreto de benzalconeo diluido em alcool a 70 por cento e mais lesivo ao tecido enterico que o cloreto de benzalconeo diluido em soro fisiologico