[Effects of partial colonic resection in rats]

In order to study the effects of partial colectomy, 30 rats Wistar were divided into three groups: GI and GII had the cecun and the ileo cecal valve resected and proximal colectomy was performed in GI and distal in GII. GIII had distal colectomy without cecum resection. The length of the remain colon was of 5 cm in all groups. Colostomy was performed in GI, GII and GIII. Parameters evaluated: body weight, fecal composition concerning to water, lipids and proteins on preoperative time and on the 10th, 20th, 30th, 40th, 50th and 60th days of postoperative time. All statistical tests were conducted at a 5% two-sided risk level. The evaluation was made by analysis of variance techniques.

CONCLUSIONS

Concerning to body weight, there is no significant difference on the late postoperative time in any group or when comparing the three groups on this same period. On late postoperative time, GI and GII had a large amount of fecal water, lipids and proteins when compared to the preoperative time and to GIII. On the 60th day there's no significant difference on the quantity of fecal water when comparing the three groups and the same occurs on the 50th day when considering the quantity of fecal proteins.

Clinical and radiological postoperative evaluation of posterior sagittal anorectoplasty in patients with upper and intermediate anorectal malformations

The PSARP is today the most-used surgical technique for correction of high and intermediary anorectal malformations. There is much controversy in the literature about the post-operative evaluation of these cases. We studied 27 cases of anorectal malformations from clinical and radiological aspects, in order to analyse: 1. Fecal continence 2. Relationship between post-operative fecal continence and the associated sacral anomalies 3. Relationship between the radiological evaluation by defecogram and fecal continence From the analysis of the cases, we concluded: 1. Fecal continence was achieved in 48.14% of the cases; partial continence in 25.92%; and fecal incontinence in 25.92% of the cases. 2. The presence of fecal incontinence was directly related to the associated sacral anomalies.

[Hepatic mesenchimal hamartoma in neonates]

OBJECTIVES

To approach the diagnosis and management of two different features of hepatic mesenchymal hamartoma (HMH) in the neonate.

METHODS

Report of two cases of HMH in newborns and review of the literature (MEDLINE and LILACS).

RESULTS

Two cases of newborns with huge abdominal masses are presented, one of them complicated by rupture and hemorrhage during ultrasound manipulation, leading to hypovolemic shock. Urgent operation showed a ruptured giant hepatic cyst containing hemorrhagic yellowish fluid. The cyst was removed by edge resection at the level of hepatic segment 6 and the postoperative period was uneventful. The pathological analysis of the cyst including immunohistochemical tests revealed HMH. In case 2, with prenatal diagnosis of hepatic tumor, the mass progressively enlarged after birth, and a left hepatectomy was performed. The macroscopic appearance suggested hemangioma but the histopathological aspect indicated mesenchymal hamartoma with endothelial predominance. Nowadays both children are healthy and asymptomatic.

CONCLUSIONS

The management of HMH is surgical treatment, because it does not disappear spontaneously. Some cases evolve to giant forms even in the neonatal period leading to fatal complications. Preoperative differential diagnosis from hemangioma is quite difficult for cystic types, and immunohistochemical analysis is important for pathological confirmation.

Use of biofeedback (BFB) in the treatment of fecal incontinence after surgical correction of anorectal malformations by posterior sagittal anorectoplasty (PSARP)

OBJECTIVE

To evaluate biofeedback (BFB) responses to rehabilitation techniques and physical exercises in incontinent or partially continent anorectal malformations patients after posterior sagital anorectoplasty (PSARP).

DESIGN

Prospective study.

SETTING

Pediatric Surgery-Department of Surgery-UNIFESP-EPM.

PATIENTS

The authors report on 14 patients with anorectal malformations (4 with partial fecal incontinence after primary PSARP; 6 with fecal incontinence after primary PSARP; 3 with partial fecal incontinence after secondary PSARP; and 1 with fecal incontinence after secondary PSARP). All patients were rehabilitated via a BFB program of exercises in order to improve the function of the anal sphincteric muscular complex for a period of 1-3 years.

MAIN OUTCOME MEASURE

Clinical and manometric control.

RESULTS

After BFB, of 4 partially continent patients after primary PSARP, 3 became continent; of 6 incontinent patients after primary PSARP, 4 became continent; of 3 partially continent patients after secondary PSARP, 1 became continent, 1 showed no improvement and 1 became incontinent (infection + abscess + fibrosis + important anorectal stenosis). The incontinent patient after secondary PSARP showed no improvement.

CONCLUSION

The authors concluded that BFB, used at the appropriate time with patient collaboration, is an important complement to the anatomical reconstruction of anorectal malformations in order to achieve good development and contractile functioning of the sphincteric muscular complex.

Clinical and manometric postoperative evaluation of posterior sagital anorectoplasty (PSARP) in patients with upper and intermediate anorectal malformations

PSARP is currently the most widely-used surgical technique for surgical correction of high and intermediary anorectal malformations, but there is much controversy in the literature about the postoperative evaluation of these cases. We studied 27 cases of anorectal malformations operated with PSARP from clinical and manometric aspects in order to analyze: 1) fecal continence; 2) the relationship between fecal continence and the associated sacral anomalies and; 3) the relationship between the postoperative manometric evaluation and fecal continence. From the analysis of 27 cases of high and intermediary anorectal malformations, we concluded that: 1) fecal continence was achieved in 48.14 percent of the cases; partial fecal continence in 25.92 percent; and fecal incontinence in 25.92 percent of the cases; 2) the presence of fecal incontinence was directly related to the association of sacral anomalies and; 3) anorectal manometry is a useful test to evaluate the patients operated by PSARP, due to the existence of a relationship between the manometric results and the degree of fecal continence.

Electronic States of KxC60: Insulating, Metallic, and Superconducting Character

The recent report of electrical conductivity in the alkali metal fullerides and the discovery of superconductivity at 18 K for KxC(60) has raised fundamental questions about the electronic states on either side of the Fermi level, their occupancy with K intercalation, and the mechanism of superconductivity. Direct photoemission evidence is presented of filling of bands derived from the lowest unoccupied molecular orbital as a function of K incorporation for the metallic and insulating phases. This filling is not rigid band-like, and it reflects disorder in the K sites. Theoretical analysis indicates that KxC(60) is a strong coupling superconductor, and we suggest that the enhanced electron-phonon interaction is related to the unique hybridization of the C sp-derived states.