HEADINGS -Rats. Experimental surgery. Physiology.RESUMO -Racional -Milhões de ratos são empregados anualmente em pesquisas e no ensino. A exata relação entre a idade dos ratos, comparada com a idade dos humanos ainda é assunto de discussão e controvérsias. Objetivo -É revisar a literatura, analisando a idade dos ratos em comparação com a idade dos homens. Métodos -Foram revisadas as publicações existentes sobre o assunto contidas nas bases Medline/Pubmed, Scielo, Biblioteca Cochrane e Lilacs cruzando os descritores ratos, cirurgia experimental e fisiologia. Resultados -Ratos desenvolvem rapidamente durante a infância e se tornam sexualmente maduros com cerca de seis semanas de idade, mas atingem a maturidade social cinco a seis meses mais tarde. Na idade adulta, a cada mês do animal é aproximadamente equivalente a 2,5 anos humanos. Vários autores realizaram trabalhos experimentais em ratos e afirmaram existir Correspondence de 30 dias de vida do homem para cada dia de vida do rato. Conclusão -As diferenças na anatomia, fisiologia, desenvolvimento e fenômenos biológicos devem ser levados em consideração quando são analisados os resultados de qualquer pesquisa em ratos em que a idade é um fator crucial. Cuidado especial é necessário ser tomado quando os estudos efetuados pretendem produzir correlação com a vida humana. Para isso, atenção especial é necessária para verificar a fase em dias do animal e sua correlação com os anos em humanos. ABCDDV/836ABSTRACT -Background -Millions of mice are used annually in research and teaching. The exact relationship between age of the animals compared with the age of humans is still subject to discussion and controversy. Objective -Literature review analyzing the age of rats in comparison with men age. Methods -Were reviewed the existing publications on the subject contained in Medline / Pubmed, Scielo, The Cochrane Database of Systematic Reviews and Lilacs crossing the headings rats, experimental surgery and physiology. Results -Rats rapidly develop during childhood and become sexually mature at about six weeks old, but reach social maturity five to six months later. In adulthood, every month of the animal is approximately equivalent to 2.5 human years. Several authors performed experimental studies in rats and estimated 30 days of human life for every day life of the animal. Conclusion -The differences in anatomy, physiology, development and biological phenomena must be taken into consideration when analyzing the results of any research in rats when age is a crucial factor. Special care is necessary to be taken when the intention is to produce correlation with human life. For this, special attention is needed to verify the phase in days of the animal and its correlation with age in years of humans

Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index <20), moderate lockdowns (20–60), and full lockdowns (>60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov , NCT04384926 . Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include...

Pilocarpine is a cholinergic agonist that increases salivary flow and has been used to treat xerostomia. Oral intake is the most frequent route of administration. Adverse effects are dose-dependent and include sudoresis, facial blushing and increased urinary frequency. The objective of the present study was to evaluate the effects of topical pilocarpine solutions as mouthwashes on salivary flow and their adverse effects on healthy subjects. Forty volunteers received 10 ml 0.5, 1 and 2% pilocarpine solutions or 0.9% saline in a randomized, double-blind, placebo-controlled manner. Salivation was measured before and 45, 60 and 75 min after mouth rinsing for 1 min with 10 ml of saline or pilocarpine solutions. Vital signs were measured and ocular, gastrointestinal and cardiovascular symptoms, anxiety and flushing were estimated using visual analog scales. There was a dosedependent increase in salivation. Salivation measured after 1 and 2% pilocarpine (1.4 ± 0.36 and 2.22 ± 0.42 g, respectively) was significantly (P<0.001) higher than before (0.70 ± 0.15 and 0.64 ± 0.1 g), with a plateau between 45 and 75 min. Cardiovascular, visual, gastrointestinal and behavioral symptoms and signs were not changed by topical pilocarpine. Mouth rinsing with pilocarpine solutions at concentrations of 1 to 2% induced a significant objective and subjective dose-dependent increase in salivary flow, similar to the results reported by others studying the effect of oral 5 mg pilocarpine. The present study revealed the efficacy of pilocarpine mouthwash solutions in increasing salivary flow in healthy volunteers, with no adverse effects. Additional studies on patients with xerostomia are needed.

Chagas' disease (CD) is highly prevalent in South America. Brazilian surgeons and gastroenterologists gained valuable experience in the treatment of CD esophagopathy (chagasic achalasia) due to the high number of cases treated. The authors reviewed the lessons learned with the treatment of achalasia by different centers experienced in the treatment of Chagas' disease. Preoperative evaluation, endoscopic treatment (forceful dilatation and botulinum toxin injection), Heller's myotomy, esophagectomy, conservative techniques other than myotomy, and reoperations are discussed in the light of personal experiences and review of International and Brazilian literature. Aspects not frequently adopted by North American and European surgeons are emphasized. The review shows that nonadvanced achalasia is frequently treated by Heller's myotomy. Endoscopic treatment is reserved to limited cases. Treatment for end-stage achalasia is not unanimous. Esophagectomy was a popular treatment in advanced disease; however, the morbidity/mortality associated to the procedure made some authors seek different alternatives, such as Heller's myotomy and cardioplasties. Minimally invasive approach to esophageal resection may change this concept, although few centers perform the procedure routinely.

Inflammatory myofibroblastic tumor (IMT) of the stomach is extremely rare and its prognosis is unpredictable. We present a 37-year-old woman with a gastric IMT. She presented epigastric pain since 2 months, anemia and weight loss associated. Physical examination showed cutaneous pallor and mild abdominal tenderness in the epigastrium. Abdominal ultrasonography showed a tumor near the pancreas and the CT scan revealed that the lesion was arising from the stomach. Upper endoscopy showed a submucosal lesion of approximately 7.5 cm located in the posterior wall of the gastric body such as a gastrointestinal stromal tumor (GIST). The patient underwent a subtotal gastrectomy and Billroth I reconstruction. The histopathological and immunohistochemical analysis revealed an IMT that originated from the gastric wall.

InTRODUÇÃODivertículo faringoesofágico, descrito inicialmente por Ludlow (1769) 19 , ou divertículo de pulsão, por Zenker (1877) 26 , é herniação adquirida na mucosa faríngea através de um defeito muscular entre as fibras oblíquas do músculo constritor inferior da faringe e as transversas do músculo cricofaríngeo. Nesta localização, há área triangular bem delimitada, denominada de triângulo de Killian, na qual as fibras musculares estão rarefeitas, deixando exposta a mucosa da hipofaringe. A mucosa herniando através desta área vai formar o divertículo de Zenker (DZ) de variados tamanhos 8 .A ocorrência do DZ é muito variável, sendo mais freqüentemente encontrado no norte da Europa. Não é raro na América do Norte e Austrália, mas muito incomum no Japão e Indonésia. Não há relatos sobre sua freqüência na América do Sul e Brasil, contudo é considerado como de ocorrência pouco freqüente. A sua ocorrência entre ABCDDV/568Andreollo NA, Lopes LR, Brandalise NA, Camargo MA, Coelho-Neto JS. Tratamento cirúrgico do divertículo de Zenker: diverticulopexia versus diverticulectomia. ABCD Arq Bras Cir Dig 2007;20(4):245-9. RESUMO -Racional -Divertículo faringoesofágico, conhecido como de Zenker, é herniação adquirida na mucosa faríngea através de um defeito muscular entre as fibras oblíquas do músculo constritor inferior da faringe e as transversas do músculo cricofaríngeo. Objetivo -estudo retrospectivo, não randomizado, compararando os resultados da diverticulopexia e diverticulectomia, ambas associadas à miotomia do músculo cricofaríngeo, no tratamento do divertículo de Zenker. os doentes com disfagia é de 1 a 3%, mais comum na faixa etária entre 60 e 90 anos, e predominante no sexo masculino (2:1) 5 .Muitas teorias foram lançadas ao longo dos anos sobre a sua etiopatogenia, porém, nenhuma delas tem sido totalmente aceita, apesar de estudos detalhados com manometria e cinerradiografia. A maioria dos autores concorda que a seu aparecimento é secundário à obstrução funcional e aumento da pressão intraluminal ao nível do músculo cricofaríngeo, ou seja decorrente de incoordenação entre as contrações da faringe e o relaxamento do esfíncter esofágico superior. Caracteriza-se por ter evolução progressiva ao longo dos anos 4,5,24 .Os sintomas mais freqüentes incluem disfagia referida na região cervical, regurgitação, halitose, tosse à ingestão alimentar e aspiração pulmonar. Ocasionalmente os pacientes poderão apresentar emagrecimento importante, chegando à desnutrição grave e com pneumonias de repetição. O diagnóstico é estabelecido mediante história clínica minuciosa, radiografias contrastadas da faringe e esôfago, endoscopia digestiva alta, e eventualmente utilizando a manometria e a cinerradiografia 2,20 . Entre as complicações é citada a sua perfuração, considerada muito

A tripanossomíase americana descrita por Carlos Chagas em 1909 constitui, ainda hoje, um problema sócio-econômico nacional e regional que aflige, principalmente, os países do cone sul da América, prevalentemente. O nível endêmico decorreu, principalmente, devido à domiciliação dos vetores motivada por más condições de habitação, esgotamento de fontes alimentares ABSTRACTMegaesophagus is one of the manifestations of Chagas disease and surgical treatment is the approach that presents the best results. In this retrospective study, the epidemiological profile of patients operated in the Clinical Hospital of University of Campinas between 1989 and 2005 was evaluated with regard to: place of birth, place of residence, probable place of infection, age, degree of megaesophagus, etiology, duration and evolution of dysphagia, other diseases in association and the type of surgery chosen. The method used was to analyze the 390 medical files of these patients, at the hospital's medical archive service. The results made it possible to establish the endemic regions, place of birth and place of residence of the patients with Chagas disease attended at our clinic, and to characterize the group. After detailed analysis, it was found that the mean age was 47 years and the mean duration of dysphagia was 9.47 years. It was observed that: a) in 84.4% of the patients, dysphagia took hold progressively; b) 306 (78.5%) patients presented Chagas disease etiology; c) grade 2 was prevalent in 48%; d) 89.8% of the patients underwent cardiomyotomy; and e) there were frequent associations with gastritis, esophagitis, megacolon, arterial hypertension and cardiopathy. Key-words:Megaesophagus. Chagas disease. Cardiomyotomy. Idiopathic achalasia of the esophagus. Esophagus.originais (ação antrópica destrutiva) e características dos vetores (fototropismo e hematofagia) 13 .O Banco Mundial (World Development Report, 1993) estudou o peso relativo da doença de Chagas, comparado ao de outras enfermidades transmissíveis endêmicas na América Latina e Caribe, e avaliou os pacientes chagásicos quanto aos anos de

Background:Breast cancer is the most common malignant neoplasm in the female population. However, stomach is a rare site for metastasis, and can show up many years after initial diagnosis and treatment of the primary tumor. Aim:Analyze a case series of this tumor and propose measures that can diagnose it with more precocity. Methods:Were analyzed 12 patients with secondary gastric tumors. Immunohistochemistry has demonstrated that primary tumor was breast cancer. We retrieved information of age, histological type, interval between diagnosis of the primary breast cancer and its metastases, immunohistochemistry results, treatment and survival. Results:The mean age was 71.3 years (ranging 40-86). Ten cases had already been underwent mastectomy in the moment of the diagnosis of gastric metastasis. Two patients had diagnosis of both primary and secondary tumors concomitantly. At average, diagnosis of gastric metastasis was seven years after diagnosis of primary breast cancer (ranging 0-13). Besides, nine cases had also metastases in other organs, being bones the most affected ones. Immunohistochemistry of the metastases has shown positivity for CK7 antibody in 83.34%, estrogen receptor in 91.67%, progesterone receptor in 66.67% and AE1AE3 antibody in 75%, considering all 12 cases. Moreover, CK20 was absent significantly (66.67%). The positivity of BRST2 marker did not present statistical significance (41.67%). Eight cases were treated with chemotherapy associated or not with hormonal blockade. Surgical treatment of gastric metastasis was performed in four cases: three of them with total gastrectomy and one with distal gastrectomy. Follow-up has shown a mean survival of 14.58 months after diagnosis of metastasis, with only two patients still alive. Conclusion:Patients with a history of breast cancer presenting endoscopic diagnosis of gastric cancer it is necessary to consider the possibility of gastric metastasis of breast cancer. The confirmation is by immunohistochemistry and gastrectomy should be oriented in the absence of other secondary involvement and control of the primary lesion.