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      Estudo da função hepática de ratos espontaneamente hipertensos submetidos a diferentes pressões de pneumoperitônio com CO2 Translated title: Study of the hepatic function in spontaneously hipertensive rats submitted to different pressures of the CO2 pneumoperitoneum

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          Abstract

          OBJETIVOS: Avaliar a função hepática de ratos hipertensos submetidos a baixa ou alta pressão de pneumoperitônio. MÉTODOS: Foram utilizados 60 ratos, distribuídos em dois grupos (n= 30), de acordo com a pressão de pneumoperitônio de 4 e 10mmHg, sendo 15 animais da linhagem EPM-1 Wistar e 15 animais da linhagem SHR. Logo após a pesagem, os animais foram submetidos à anestesia com cetamina e xilazina intramuscular e, em seguida, submetidos a pneumoperitônio, durante 1 hora e desinsuflação por mais 1 hora. Foram coletadas amostras sangüíneas logo após a realização do cateterismo da artéria femoral esquerda, após uma hora de insuflação, assim como, depois de uma hora de desinsuflação. Estas amostras foram encaminhadas para a avaliação das enzimas hepáticas (AST, ALT, DHL) e bilirrubinas (total, direta e indireta). O nível de significância estatístico foi estabelecido em 5%. RESULTADOS: Com pneumoperitônio de 4mmHg a AST e ALT apresentaram níveis iniciais menores do que após insuflação e desinsuflação enquanto a DHL, a BT e a BD não se alteraram; em ambas as linhagens. Na pressão de 10mmHg a AST e a DHL não se alteraram nos ratos normotensos e aumentaram nos hipertensos, a BD não se alterou, a ALT e a BT aumentaram para ambas as linhagens. CONCLUSÃO: A função hepática mostrou-se alterada e a medida do tempo após a desinsuflação foi curta para evidenciar uma eventual reversão dessas alterações, tanto nos animais hipertensos, como em animais hígidos.

          Translated abstract

          PURPOSE: In order to determine the behavior of the hepatic function in spontaneously hipertensive Rats Which underiwent low pressure and high pressure pneumoperitoneum. METHODS: 60 rats were studied two groups of 30 rats, each formed by 15 Wistar EPM-1 and 15 SHR, were subjmitted to 4mmHg and 10mmHg pressure respectively, for 1 hour plus peritoneal pressure normalization time of 1 hour. Immediately after being weighed the rats were given an anesthetic (cetamine and xylazine) intramuscular. Blood samples for hepatic function evaluation were taken immediately after the insertion of a catheter in the left femural artery as well as after 1 hour insufflation and after the one-hour pressure normalization. The significance coeficient was 5 %. RESULTS: Animals submitted to 4mmHg pressure had inicial AST and ALT levels lower than after insuflation and after pressure normalization. DHL, BT and BD levels did not change for both strains. Animals submitte to 10mmHg pressure AST and DHL levels modification for normotensive rats but increased for hypertensive ones; BD did not change; ALT and BT changed for Wistar and SHR. CONCLUSION: Our study shows that pneumoperitoneum has changed the hepatic function of the animals and suggests that one-hour peritoneal pressure normalization seems to be too short to allow hepatic function normalization in both hyper and normotensive animals.

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          Most cited references35

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          Hepatic and portal vein blood flow during carbon dioxide pneumoperitoneum for laparoscopic hepatectomy.

          S Takagi (1998)
          Laparoscopy under carbon dioxide (CO2) pneumoperitoneum has many advantages. However, the risks of CO2 pneumoperitoneum during laparoscopic hepatectomy (LH) have not been defined. The hemodynamics of the hepatic vein were examined during CO2 pneumoperitoneum both pre- and posthepatectomy in eight pigs. Portal blood flow was measured with Doppler ultrasound during laparoscopic cholecystectomy in 10 human patients. Experimentally, elevated intraabdominal pressure (IAP) with CO2 insufflation produced significant increases in CO2 partial pressure and echogenicity of the hepatic vein in the posthepatectomy group. Clinically, elevated IAP caused significant narrowing of the portal vein and significant decreases in portal blood velocity. The mean portal flow was significantly decreased with elevation of IAP >10 mmHg. LH with CO2 pneumoperitoneum may lead to embolism caused by CO2 bubbling through the hepatic vein. Elevated IAP may cause a decrease in hepatic blood flow and induce severe liver damage, especially in patients with poor liver function. Gasless laparoscopy using abdominal wall lifting should be employed in LH to avoid the risks of CO2 embolism and liver damage.
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            Estrutura das revoluções científicas

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              Are elevated liver enzymes and bilirubin levels significant after laparoscopic cholecystectomy in the absence of bile duct injury?

              Increased aspartate aminotransferase (AST), alanine aminotransferase (ALT), and bilirubin levels were noted incidentally after a laparoscopic cholecystectomy. The percentage in which such elevation occurs and its clinical significance in the absence of bile duct injury were investigated. Bile duct injury is the most feared complication of laparoscopic cholecystectomy. Some laboratory tests may be indicative of this complication, such as increases in liver enzyme (AST, ALT, and alkaline phosphatase [ALP]) and bilirubin. These parameters have not been investigated in patients who had laparoscopic cholecystectomy and in whom no damage to the bile duct was noted. Sixty-seven patients with normal results of preoperative liver function test were entered into the study. Blood was collected 24 hours after laparoscopic cholecystectomy, and AST, ALT, ALP, and bilirubin levels were measured. A mean 1.8-fold increase in AST occurred in 73% of patients; 82% showed a 2.2-fold increase in ALT. A statistically nonsignificant increase was noted in 53% of patients (ALP remained within normal limits), and in 14% of patients bilirubin levels were increased (they were primarily of the unconjugated type). In many patients a significant increase in AST and ALT levels occurred after laparoscopic cholecystectomy, but they returned to normal values within 72 hours. The cause of this is unclear, and these elevations appear to have no clinical significance.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                acb
                Acta Cirurgica Brasileira
                Acta Cir. Bras.
                Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia (São Paulo )
                1678-2674
                January 2003
                : 18
                : 1
                : 01-12
                Affiliations
                [1 ] Universidade Federal de São Paulo Brazil
                [2 ] Universidade Federal de São Paulo Brazil
                [3 ] Universidade Federal de São Paulo Brazil
                Article
                S0102-86502003000100010
                10.1590/S0102-86502003000100010
                7445a69c-d439-493b-8159-5b99e6c13056

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0102-8650&lng=en
                Categories
                SURGERY

                Surgery
                Pneumoperitoneum, artificial,Rats, inbred SHR,Liver,Pneumoperitônio artificial,Ratos endogâmicos SHR,Fígado

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