Reports on vascular catheter-associated thromboembolic events in a burn unit - a gap in the literature?

Indwelling intravascular catheters are important tools in the care of critically ill patients; however, they have an inherent risk of infection or thromboembolic events. Reports on catheter associated thromboembolic events in burn units are rare, despite being well recognized that burn patients bear an increased baseline risk for thromboembolic events. We describe two catheter-associated thromboembolic complications in burn patients in a burn unit and the morbidity associated with these events. Patients with endovascular catheters in burn units may be at increased risk for severe thromboembolic events associated with intravascular catheters, but specific guidelines for prevention and management of these patients are still missing.

The Silent Threat-Alkali Foot Burn: A Case Report.

Despite current workplace protection measures, chemical burn accidents are not uncommon. Among these, alkali burn is the most challenging due to its silent behaviour and aggressive mechanism. Characterized by its initial painless onset, allowing a prolonged exposure, it tends to result in deeper and more destructive burns, creating major reconstructive and therapeutic challenges. This case concerns a 53-year-old male who sustained a full thickness burn of his left instep foot after prolonged contact with an alkali substance. The wound was submitted to several surgical debridement procedures, with preservation of the major tendinous and vascular-nervous structures. The skin defect was then repaired with skin graft. Early recognition and prompt management with copious and prolonged wound irrigation is paramount. As in this type of burn it is difficult to initially assess its true depth, even after initial surgical debridement, a more cautious approach is recommended. Chronic pain is associated with chemical burns and it should be treated early in the process with the use of multimodal analgesia in order to prevent future complications. No matter the absence of major complaints in the 4 week-postoperative evaluation, the possible long-term consequences are still unknown. Despite the prolonged exposure time and the initial presentation with a deep burn, after several surgical debridement procedures, preservation of major tendon and neurovascular structures was assured, which allowed a plain approach for reconstruction of the wound with a skin graft. The case illustrates different challenges associated with evaluation and treatment of patients with deep alkali burns. Also, usage auditing and awareness of regular users appear to be essential.

Les brûlures chimiques au travail restent relativement fréquentes malgré les mesures de protection. Les atteintes par agent alcalin sont particulièrement problématiques car elles sont insidieuses bien que très destructrices. Le temps de contact est prolongé et les destructions sont majeures, posant de difficiles problèmes de reconstruction, en raison de leur caractère initialement indolore. Nous présentons le cas d'un homme de 53 ans victime d'une brûlure du cou de pied gauche après contact prolongé avec un agent alcalin. Les excisions successives ont permis de préserver les éléments nobles et de greffer secondairement la zone touchée. Il est indispensable de diagnostiquer précisément l'atteinte et de laver la région atteinte à grande eau. La profondeur réelle est difficile à apprécier initialement si bien que les excisions doivent être prudentes. Les douleurs chroniques ne sont pas rares dans ces cas et peuvent être prévenues par la qualité de l'analgésie initiale, multimodale. A un mois, le patient ne se plaint de rien, ce qui ne préjuge pas de complications plus tardives. Malgré un temps de contact prolongé et un aspect initial profond, les éléments nobles on pu être préservés, permettant une couverture par simple greffe. Ce cas illustre les difficultés dans le diagnostic et le traitement des brûlures profondes par base. Il est essentiel d'éduquer et surveiller les usagers réguliers de ces produits.

Clinical Outcomes Among Elderly People With Burns.

Burns in the elderly are a public health concern. This study aimed to analyze etiology, clinical characteristics, and independent risk factors for outcomes of burns in elderly patients. This retrospective study included elderly patients (65 years and over) admitted to a major burn unit between 2006 and 2016. Demographic data, clinical characteristics and outcomes were analyzed. One hundred and thirty patients were included. Most were female (56.2%) and the highest incidence was among those aged 75-84 years. The median burn area was 10.5%. The incidence in winter (50%) was higher (p<0.001) and flame burns predominated (p<0.001). The mortality rate was 32.3%. Independent risk factors for death were older age, larger extent burns, need for escharotomy, and cardiac disease as comorbidity. Amongst the survivors, the median length of stay was 36 days. Development of pressure sores, need for skin grafts, larger extent burns, presence of full-thickness burns, and cardiac disease were shown to be significantly associated with increased length of stay amongst survivors. Preventive measures should target women aged between 75-84 years. Flame burns occurred more frequently in winter. Prognosis is related to age, extent of burns, need for escharotomy at admission, and cardiac disease.

Les brûlures du sujet âgé représentent un problème de santé publique. Cette étude rétrospective se penche sur les étiologies, les caractéristiques et l'évolution de cette pathologie. Elle concerne les 130 personnes de 65 ans et au-delà hospitalisés dans un CTB entre 2006 et 2016. Leur majorité (56,2%) étaient des femmes et la décennie 75-84 ans était la plus représentée. La surface touchée médiane était de 10,5%, les brûlures par flamme prédominaient (p<0,001) et il existait un pic hivernal (50% des brûlures, p<0,001). Les facteurs indépendants de mauvais pronostic étaient l'accroissement de l'âge et celui de la surface brûlée, la nécessité d'incision de décharge et les comorbidités cardiaques. La DMS médiane des survivants était de 36 jours. La survenue d'escarre, la présence de brûlure profonde (et corrélativement la nécessité de greffes), l'augmentation de la surface brûlée et l'existence d'une cardiopathie allongeaient la durée de séjour des survivants. La cible préférentielle des mesures préventive apparaît donc être la population féminine entre 75 et 84 ans. Les brûlures surviennent plus souvent en hiver et sont plus graves quand l'âge et la surface augmente, quand une incision de décharge est nécessaire et chez les "cardiaques".

Prognostic values of physical and hematological parameters of dogs naturally infected with parvovirus PVC-2: retrospective study of 103 cases / [Valores prognósticos de parâmetros físicos e hematológicos de cães naturalmente infectados pelo parvovírus PVC-2: estudo retrospectivo de 103 casos]

Canine parvovirosis is a high mortality disease with acute clinical picture. However, there are few available resources to help stablish prognosis accurately. This study aimed to determine the prognostic threshold values for vital and hematological parameters of dogs naturally infected by the Carnivore protoparvovirus 1 (CPV). A retrospective study of 103 canine parvovirosis cases was carried out. Twenty seven percent of these (28/103) died, 96% (27/28) of which within the first four days of hospitalization. Deceased animals had significantly higher median values for heart (HR) and respiratory (f) rates, as well as significantly lower systolic blood pressure (SBP) than survivors. Severely leukopenic animals (<1,000 cells/µL), had a significantly higher mortality rate (68%, n=13) compared to that of other patients (P<0.0007). Animals with at least two of the following findings: severe hypotension (SBP< 90mmHg), tachycardia (HR > 150 bpm) and leukopenia, represented 34% (34/101) of the cases and had a survival rate of 29% (10/34), while animals with at most one of these parameters represented 66% (67/101) and had a survival rate of 94% (63/67). The presence of two or three abnormal parameters was significantly related to the higher death risk among dogs with parvovirosis (P<0.0001).(AU)

A parvovirose canina é uma doença de alta mortalidade e de quadro clínico agudo. No entanto, existem poucos recursos para se estabelecer prognóstico de maneira precisa. Este estudo objetivou analisar os valores prognósticos de parâmetros físicos e hematológicos de cães naturalmente infectados pelo Carnivore protoparvovirus 1 (CPV). Um estudo retrospectivo de 103 casos de parvovirose canina foi realizado. Desses, 27% dos animais (28/103) foram a óbito, sendo 96% (27/28) com ocorrência nos primeiros quatro dias de internamento. Os cães que foram a óbito apresentaram medianas das frequências cardíaca (FC) e respiratória (f) significativamente maiores e pressão arterial sistólica (PAS) consideravelmente menor que a dos sobreviventes. Entre os animais mais intensamente leucopênicos (<1.000 células/(L), a taxa de mortalidade (68%, n=13) foi expressivamente maior que a dos demais pacientes (P<0,0007). Os animais com hipotensão grave (PAS<90mmHg), taquicardia (FC>150bpm) e leucopenia intensa (leucometria<1.000 células/µL), ou duas dessas alterações clínicas, representaram 34% (34/101) dos casos e tiveram taxa de sobrevida de 29% (10/34), enquanto os animais com, no máximo, um desses parâmetros alterados representaram 66% (67/101) dos animais, com taxa de sobrevida de 94% (63/67). A presença de dois ou três parâmetros alterados esteve significativamente relacionada ao maior risco de óbito de cães com parvovirose (P<0,0001).(AU)

ACCIDENTAL FINDING OF SYNCHRONOUS BILATERAL DUCTAL CARCINOMA IN SITU IN A YOUNG MAN REFERRED TO MASTECTOMY DUE TO GYNECOMASTIA - AND WHAT IF LIPOSUCTION HAVE BEEN USED? CASE REPORT.

Breast male cancer is a rare condition. We report a case of a synchronous bilateral ductal carcinoma in situ (DCIS) which developed in a 26-year-old man with long-standing gynecomastia. He underwent bilateral subcutaneous mastectomy. Histology revealed bilateral pure DCIS. There was no identifiable causative factor for the development of bilateral DCIS, and there was no family history of the disease. No other treatment was required, and after 18 months there were no signs of local recurrence. This case highlights the importance of staying vigilant regarding the presence of malignancy in normally benign conditions. Liposuction has become a very useful technique for gynecomastia correction, however, there is a risk of dissemination of an unknown malignant tumor. In atypical cases, en bloc surgical excision should be performed.

The outcome of fungal infections in a burn intensive care unit: a study of 172 patients.

Burned patients are an especially fragile population in which infections are a leading cause of death and morbidity. Fungal infections have become increasingly prevalent in Intensive Care Units (ICUs) and burn ICUs. Management of fungal colonization and infection still constitutes a challenge for clinicians. The aim of this retrospective cross-sectional study was to characterize the population of burn patients with fungal infections admitted to our Burn ICU between January 2013 and December 2015. Patients were characterized according to age, gender, date of admission and exit, type of burn, type of exit, total body surface area (TBSA) and presence of inhalation injury. Positive fungal cultures, causative pathogen and site of sampling were also registered. Statistical analysis centred around the presence of fungal infection/colonization was performed using IBM SPSS Statistics. A total of 172 patients were included, 38 (22.1%) had a positive fungal culture and of these 8 (21.1%) died. Patients with fungal infection/colonization stayed more days than those without infection. However, this tendency did not reach statistical significance when patients that died in the ICU were excluded. No relationships were found when comparing positive fungal cultures with TBSA, burn aetiology, inhalation injury or mortality. Fungal infections are a major cause of morbidity and mortality despite TBSA, burn type or presence of inhalation injury. Efforts should be made to improve management of fungal infections, especially in burn patients and other critically ill groups.

Les brûlés sont des patients particulièrement sensible aux infections, responsables majeures de morbidité et de mortalité. La prévalence des IF croît en réanimation, générale comme brûlologique, et la prise en charge des colonisations et infections reste un défi pour le clinicien. Le but de cette étude transversale était de préciser les caractéristiques des patients brûlés, hospitalisés dans notre CTB entre janvier 2013 et décembre 2015, ayant développé une IF. Nous avons relevé l'âge, le sexe, les dates d'entrée et de sortie, la modalité de sortie, le type de brûlure, la SCB et la présence de lésion d'inhalation. Les cultures fongiques positives, leur site et la levure isolée ont aussi été répertoriées, les études statistiques ayant utilisé SSPS Statistics (IBM). Parmi les 172 patients étudiés, 38 patients (22,1%) ont développé une IF et 8 (21,1%) en sont morts. Les patients souffrant d'une IF sont restés plus longtemps dans le service, cette constatation n'étant pas significative si les patients décédés ne sont pas comptabilisés. Nous n'avons pas trouvé de corrélation entre IF et SCB, cause de la brûlure, inhalation ni mortalité. Des efforts sont nécessaires pour améliorer la prise en charge des IF, en CTB comme en réanimation générale.

COMPLEX FACIAL RECONSTRUCTION BASED ON 3D MODELS: PRELAMINATION CASES AND LITERATURE REVIEW.

3D models allowed a huge advance of reconstructive surgery. A literature review was performed in order to ascertain the current applicability of 3D modeling combined with free flaps, the most commonly used free flaps, and whether the use of 3D models alongside prelaminated free flaps has already been described. Also, two patients with significant facial disfiguration scheduled for surgeries that included 3D modeling and prelamination techniques were selected. 3D modeling is mostly used for the correction of mandibular defects with fibular free flaps. No literature reports the combined use of 3D models and prelamination, but we have demonstrated its applicability: two costume-made prelaminated free flaps were obtained and the patients achieved an important aesthetic and morphological improvement. When no local grafts or flaps are available, and a three-dimensional facial reconstruction is intended, prelamination is a complex option to be considered. This complexity can be reduced by the use of 3D models, being a personalized flap obtained in a decreased operating time. Prelamination used alongside 3D modeling can be a powerful tool in the correction of complex facial deformities.

TISSUE ENGINEERING IN PLASTIC SURGERY - WHAT HAS BEEN DONE.

The field of tissue engineering applies principles of engineering and life sciences for the development of functional biologic substitutes. The increasing need of tissue for challenging reconstructive surgeries places plastic surgeons involvement as vital in the research and development of engineered constructs and subsequent use. This narrative review aims to summarize tissue engineering principles, to update on its current uses and breakthroughs, to approach its current limitations and possible future directions for this exciting new field of medicine. This revision addressed tissue engineering utilisation in skin lesions, craniocervical defects, musculoskeletal defects, peripheral nerves lesions, vascular tissue defects and adipose tissue uses. Research in tissue engineering is increasing exponentially, however, and although there are already several engineered constructs available, its widespread clinical application is still a hope. More long-term studies that answer outstanding issues are needed in order for that to become reality.

Evaluation of Histological, Immunohistochemical, Clinical and Genetic Prognostic Factors Associated with the Response of Canine Mast Cell Tumours to Glucocorticotherapy.

Mast cell tumours (MCTs) are one of the most frequent neoplasms in dogs. Glucocorticoids (GCs) are widely used in the management of this disease, although no guidelines for their use have been established. The aim of this study was to evaluate the correlation of MCT prognostic factors with measurable response to GCs. This retrospective study included 60 dogs treated with prednisone or prednisolone prior to surgical biopsy of MCT. Incisional or excisional biopsy was performed 7-14 days after initiation of GC therapy. Histopathology, immunohistochemical labelling for Ki67 and KITr, and polymerase chain reaction for the c-KIT gene were performed. Partial response occurred in 63.3% of cases (38/60), while 36.7% (22/60) did not respond. A response to GCs was correlated with lower stage of the disease, low histological grade, lower pattern of KITr expression and Ki67 score. Response to GCs was positively correlated with well-established favourable prognostic factors.

Tubulopapillary rectal adenocarcinoma in dog: clinical, surgical, pathological and immunophenotypical aspects: case report / Adenocarcinoma retal tubulopapilar em cão: descrição clínica, cirúrgica, anátomo-patológica e imunofenotípica: relato de caso

Intestinal carcinomas are rare in dogs. The prognosis and survival time are dependent of the histological type, the invasion of the intestinal wall by the malignant cells and the ability of primary neoplasm to produce metastasis. This study reports a case of a Yorkshire dog that developed a rectal tubulopapillary adenocarcinoma progressing to a peritoneal carcinomatosis and multiple metastasis in large intestines, bladder, kidney, iliac lymph node, liver and lungs, six months after transanal surgical resection of the primary rectal neoplasm. Clinical, surgical, pathological and immunophenotypic findings are described. COX-2 imunohistochemical score was higher in hepatic metastasis (score 9) than in the primary tumour (score 6), and the growth fraction (Ki-67) observed was of 49.2% in the rectal neoplasm.(AU)

Carcinomas intestinais são raros em cães. O prognóstico e a sobrevida são dependentes do tipo histológico, do grau de invasão nas camadas intestinais e da capacidade da neoformação primária em desenvolver metástases. Relata-se um caso de um cão, da raça Yorkshire, que desenvolveu adenocarcinoma tubulopapilar retal com evolução para carcinomatose peritoneal e múltiplos focos metastáticos no intestino grosso, na bexiga, no rim linfonodo ilíaco, no fígado e nos pulmões seis meses após ressecção cirúrgica da neoplasia primária. Aspectos clínicos, cirúrgicos, anatomopatológicos e imunofenotípicos são descritos. O escore de COX-2 na imuno-histoquímica foi maior na metástase hepática (escore 9) do que na massa primária (escore 6), e a fração de crescimento (Ki-67) na neoplasia retal foi de 49,2%.(AU)

Outcome of adjuvant chemotherapy with lomustine, vinblastine and chlorambucil on management of canine mast cell tumour of high to intermediate risk / Resultado da quimioterapia adjuvante com lomustina, vimblastina e clorambucil no manejo do mastocitoma canino de risco alto a intermediário

In spite of the many available protocols, the use of chemotherapy for the management of canine mast cell tumours (MCT) remains empirical, and there is lack of criteria for the choice of protocol and definition of patients who may benefit from treatment. The objective of this study was to evaluate the outcome of dogs with MCT after adjuvant chemotherapy according to the risk of recurrence or metastasis proposed on the literature. This prospective study included 89 followed up dogs with prognosis assesment including clinical, histological, immunohistochemical and genetic features of canine MCT. Patients were grouped according to risk of recurrence and metastasis and recommended treatment with lomustine followed by chlorambucil if considered at high-risk, or vinblastine followed by chlorambucil if a patient was at intermediate risk. Outcome was defined by disease-free interval (DFI) and overall survival (OS) estimated by Kaplan-Meier curve. Adjuvant lomustine was useful for control of canine MCT of high-risk of recurrence or metastasis, but only when sequentially associated to chlorambucil with a DFI of 686 days and not reached OS. There was no difference in outcome in the intermediate-risk group despite choosen treatment. Patients at intermediate-to-low risk may not require adjuvant treatments, even in the absence of free surgical margins.(AU)

Apesar dos inúmeros protocolos disponíveis, o uso da quimioterapia permanece empírico para o mastocitoma canino e faltam critérios para escolha do protocolo e da definição dos pacientes que poderiam se beneficiar do tratamento. O objetivo deste estudo foi avaliar o resultado de cães com mastocitoma após a quimioterapia adjuvante, de acordo com o risco de recorrência ou metástase proposto na literatura. Este estudo prospectivo incluiu 89 cães com acompanhamento clínico e avaliação prognóstica, incluindo características clínicas, histológicas, imuno-histoquímicas e genéticas dos mastocitomas. Os pacientes foram agrupados segundo o risco de recorrência ou metástase, sendo recomendado tratamento com lomustina seguida de clorambucila, se considerados sob alto risco, ou vimblastina seguida de clorambucila, se estivessem sob risco intermediário. O resultado final foi definido pelo intervalo livre de doença (ILD) e pela sobrevida global (SG), estimados pela curva de Kaplan-Meier. Na adjuvância, a lomustina foi útil no controle do mastocitoma canino de alto risco, mas apenas quando associada ao clorambucila, com um ILD de 686 dias, sem atingir a mediana para SG. Não houve diferença no grupo de risco intermediário, independentemente do tratamento escolhido. Pacientes de risco intermediário podem não necessitar de tratamentos adjuvantes, mesmo na ausência de margens cirúrgicas livres.(AU)

Evaluation of adjuvant chemotherapy in feline injection site-associated sarcoma / Avaliação da quimioterapia no tratamento do sarcoma de aplicação felino

Feline Injection Site-Associated Sarcoma (FISS) is a neoplasm that implies in reduction of quality of life and overall survival in feline patients. A retrospective study of 13 cases of FISS was conducted to evaluate the efficacy of surgical treatment associated to chemotherapy with doxorubicin or carboplatin. Local recurrence occurred in all patients. Patients treated with surgery and chemotherapy presented a longer overall survival and disease-free interval when compared to those that solely received surgical treatment, although no statistical significance was observed (p= 0.3360 and 0.7506, respectively). Surgery remains as the main option for FISS treatment. Further prospective studies with larger samples are warranted to investigate the benefit of chemotherapy for this neoplasm.(AU)

O Sarcoma de Aplicação Felino (SAF) é uma neoplasia associada a redução na qualidade de vida e sobrevida global. O objetivo deste estudo foi avaliar a eficácia da quimioterapia associada à cirurgia no manejo do SAF. Estudo retrospectivo de 13 pacientes com SAF submetidos à cirurgia isolada ou associada a quimioterapia com carboplatina ou doxorrubicina. Recorrência local ocorreu em todos os pacientes. Pacientes tratados com cirurgia e quimioterapia apresentaram maior sobrevida global e intervalo livre de doença quando comparados àqueles que receberam apenas tratamento cirúrgico, mas não foi observada diferença estatística (p=0,3360 e 0,7506, respectivamente). A cirurgia continua sendo a principal opção para o tratamento do SAF. Estudos prospectivos são necessários para investigação do real benefício da quimioterapia para esta neoplasia.(AU)

Assessment of electrochemotherapy effects on the development of Ehrlich solid tumor in swiss mice using a novel electroporator device / Avaliação dos efeitos da eletroquimioterapia sobre o desenvolvimento do tumor sólido de Ehrlich em camundongos Swiss utilizando um novo eletroporador

Electrochemotherapy is a local anticancer treatment in which non-permeant chemotherapeutic drugs are associated with electric pulses of well-established parameters. The electric pulses cause pores to open on the plasma membrane and facilitate drug transport, enhancing cytotoxicity and reducing side effects. Assessment of electrochemotherapy effects on Ehrlich solid tumor development in this work aims to evaluate in vivo usage of the electroporator device developed by the Department of Electrical Engineering of Engineering School of UFMG. Therefore, 40 Swiss mice were inoculated with Ehrlich tumor cells, and developed the tumor in solid form. After 21 days, mice were subjected to specific treatment protocols (control, bleomycin, electric pulses and electrochemotherapy); 17 days later they were euthanized and the tumors collected for histopathology analysis. Electrochemotherapy induced discrete weight loss and an inflammatory response in the tumor, which was not seen on the other treatment groups. Bleomycin alone induced necrosis. Both groups showed lower cellular proliferation rates. From this study, it was concluded that the animals tolerated electrochemotherapy treatment under anesthesia and the electroporator device developed by the Engineering School of UFMG was adequate when used in an electrochemotherapy protocol.(AU)

Eletroquimioterapia é uma modalidade de tratamento local contra o câncer em que a administração de quimioterápicos não penetrantes à membrana plasmática é associada à aplicação de pulsos elétricos com parâmetros bem estabelecidos, que abrem poros na membrana plasmática e facilitam a entrada desses fármacos nas células, aumentando sua citotoxicidade e reduzindo efeitos colaterais. A avaliação dos efeitos da eletroquimioterapia sobre o desenvolvimento do tumor sólido de Ehrlich em camundongos Swiss neste trabalho teve como objetivo testar o uso in vivo do aparelho eletroporador desenvolvido pelo Departamento de Engenharia Elétrica da Escola de Engenharia da UFMG. Para tanto, foram utilizados 40 camundongos fêmeas da linhagem Swiss, nos quais foram inoculadas células de tumor de Ehrlich, para o desenvolvimento do tumor na forma sólida. Após 21 dias, os camundongos foram submetidos ao protocolo de tratamento específico (controle, bleomicina, pulsos elétricos e eletroquimioterapia); 17 dias depois foram eutanasiados e seus tumores coletados para análise histopatológica e imuno-histoquímica. A eletroquimioterapia induziu perda de peso discreta e uma resposta inflamatória no tumor que não foi observada nos outros grupos. O grupo bleomicina apresentou maior porcentagem de necrose. Ambos os grupos apresentaram menor índice de proliferação celular. Com este estudo, pode-se concluir que o tratamento sob anestesia foi bem tolerado pelos animais e que o aparelho eletroporador desenvolvido pela Escola de Engenharia da UFMG é adequado para utilização em um protocolo de eletroquimioterapia.(AU)

Implementation of flu vaccination in community pharmacies: Understanding the barriers and enablers.

Improving influenza vaccination coverage has been, and still remains a challenge internationally. There are now many examples where countries have pursued a pharmacist-led influenza vaccination service in order to enhance vaccination coverage of at-risk populations. England, Portugal and the United States are successful examples where their experience implementing this service can now be explored retrospectively and learnt from. This review aims to provide evidence to help overcome barriers to commissioning and implementation of such services in countries new to the experience. Implementation is influenced by differing regulatory frameworks underpinning the provision of pharmacist-led influenza vaccination, methods of remuneration, training, and operating procedures. Practical aspects such as the facilities required, how patient records are maintained and how patients and other healthcare professionals are engaged also have an impact. These examples illustrate how community pharmacists can be trained to deliver influenza vaccinations safely, and coupled with their accessibility and convenience, can provide a complementary service to that already provided by family doctors and nurses to deliver influenza vaccinations for the benefit of patients.

Expression of Fibroblast Activating Protein and Correlation with Histological Grade, Mitotic Index and Ki67 Expression in Canine Mast Cell Tumours.

Fibroblast activating protein (FAP) is a membrane serine protease expressed by activated fibroblasts, particularly tumour associated fibroblasts (TAFs). FAP expression has not been reported in canine mast cell tumours (MCTs). The objective of this study was to evaluate the expression of FAP in TAFs and its correlation with histological grade, mitotic index and Ki67 expression in canine MCTs. FAP expression was evaluated by immunohistochemistry (IHC) in 30 canine MCTs. Twenty-eight (90%) of the MCTs expressed FAP in the stroma, 16 cases showed low to intermediate FAP score and 14 cases had a high FAP score. FAP was correlated positively with both Patnaik (P = 0.007) and Kiupel (P = 0.008) grading systems, mitotic index (P = 0.0008) and Ki67 expression (P = 0.009). High stromal FAP expression could be a potential negative prognostic factor in canine MCTs.

Aportes sobre el correlato neuroanatómico de la personalidad / Contributions on neuroanatomical correlate of personality

Concept of personality is refers to stable and relevant attributes of a person, that explain consistent behavior patterns. Many researchers have different brain areas involved in controlling personality. Several highlighted the role of the orbitofrontal cortex in the ability to reverse the association between stimulus and reinforcement, others associated it later with the prediction ofsensory events subsequent results. The medial frontal cortex has been involved with functions as the control of actions, monitoring results as punishments and rewards, personal perception of stimuli and social cognition. Others include the lateral prefrontal cortex in complex issues of valuation. Finally, the anterior temporal region is considered to be related with facial recognition and social knowledge. In this paper we review evidence available in today’s literature about the neuroanatomical substrate ofpersonality, and its application to the study of two disorders: psychopathy and borderline personality disorder. Understanding this substrate could mean a contribution for treatment.

La personalidad corresponde a aquellos atributos estables y relevantes de una persona, que explican patrones consistentes de comportamiento. Muchos investigadores han implicado distintas áreas cerebrales en el control de la personalidad. Varios destacaron el papel de la corteza orbitofrontal en la capacidad de revertir la asociación estímulo refuerzo y posteriormente en la predicción de resultados posteriores a eventos sensoriales. Se ha involucrado a la corteza medial frontal en funciones como el control de las acciones, el monitoreo de resultados como castigos y recompensas, la percepción personal de estímulos y la cognición social. Otros incluyen a la corteza prefrontal lateral en aspectos complejos de la valoración. Por último, se considera a la región temporal anterior en el reconocimiento facial y también en el conocimiento social. En la presente revisión se expone parte de la evidencia disponible en la actualidad en la literatura, acerca del sustrato neuroanatómico de la personalidad y su aplicación al estudio de dos patologías: la psicopatía y el trastorno limítrofe. La comprensión de este sustrato puede significar un aporte para el tratamiento.

Ciclooxygenase inhibitor and metronomic chemotherapy association for the treatment of metastatic anal sac carcinoma in dog: case report / Inibidor de ciclo-oxigenase associado à quimioterapia metronômica no tratamento de carcinoma de saco anal metastático canino: relato de caso

Metronomic chemotherapy consists of an anticancer modality treatment. It is applicable in patients at an advanced stage, with the objective of increasing overall survival. The aim of this study was to report an anal sac apocrine carcinoma case in a dog with lymph node metastasis treated with metronomic chemotherapy sequential to surgery and conventional chemotherapy using gemcitabine and carboplatin. Metronomic chemotherapy was associated with cyclooxygenase-2 (COX-2) inhibitors, due to strong tumor COX-2 immunohistochemistry expression. Metronomic chemotherapy was initiated with cyclophosphamide, but it was replaced by lomustine, also in metronomic dosage, due to adverse effects. Treatment showed effectiveness, since the patient's overall survival exceeded 1095 days (36 months), considerably higher than the mean overall survival expected for this pathology.(AU)

Quimioterapia metronômica consiste em uma modalidade de tratamento anticancerígeno, aplicável a pacientes em estadiamento avançado, com o objetivo de aumentar a sobrevida global. O objetivo deste trabalho foi relatar um caso de carcinoma apócrino do saco anal, em uma cadela, com metástase em linfonodo tratado com quimioterapia metronômica sequencial à cirurgia e quimioterapia convencional utilizando-se gencitabina e carboplatina. O tratamento metronômico foi associado ao uso de inibidores de ciclo-oxigenase-2 (COX-2), baseando-se na constatação de sua expressão tumoral. A terapia metronômica iniciou-se com ciclofosfamida, mas houve necessidade de substituição pela lomustina, também em dose metronômica, devido à ocorrência de efeitos adversos. O tratamento mostrou ser eficaz, pois a sobrevida do paciente ultrapassa 1095 dias (36 meses) desde a cirurgia, sendo consideravelmente maior que a média relatada para essa patologia.(AU)

From lime to silica and alumina: systematic modeling of cement clinkers using a general force-field.

Thirteen different cement-clinker crystalline phases present in the lime-silica-alumina system have been systematically modeled using a simple and general force field. This constitutes a new type of approach towards the study of lime-silica-alumina systems, where the simpler and more transferable Lennard-Jones potential was used instead of the more traditional Buckingham potential. The results were validated using experimental density and structural data. The elastic properties were also considered. Six amorphous phases (corresponding to calcium/silicon ratios corresponding to belite, rankinite, wollastonite and alumina-doped amorphous wollastonite with 5%, 10% and 15% alumina content) were also studied using molecular dynamics simulations. The obtained MD trajectories were used to characterize the different crystalline and amorphous phases in terms of the corresponding radial distribution functions, aggregate analyses and connectivity among silica groups. These studies allowed a direct comparison between the crystalline and amorphous phases and revealed how the structure of the silica network was modified in the amorphous materials or by the inclusion of other structural units such as alumina. The knowledge at an atomistic level of such modifications is paramount for the formulation of new cement-clinker phases.

Metastatic well differentiated squamous cell carcinoma in the prepuce of a dog: a report of clinicopathological, immunophenotypic and therapeutic approach / Carcinoma de células escamosas bem diferenciado metastático no prepúcio de cão: relato da abordagem clinicopatológica, imunofenotípica e terapêutica

This report describes a case of a well differentiated squamous cell carcinoma (SCC) of the foreskin of a dog, with metastasis in the regional lymph node. A six-year-old male intact Pit Bull dog presented a preputial ulcerated lesion with an evolution time of one year and enlarged left inguinal lymph node. Surgical resection of the preputial lesion and inguinal lymph nodes was made. The diagnosis of a well differentiated SCC was made following histopathological analysis and immunohistochemistry technique was used to confirm lymph node metastasis and to determine the histological features of the tumor. Here we demonstrated that immunohistochemistry can be an important complementary diagnostic tool to assess the prognostic features of SCC and to determine the treatment of choice. Also, the combination of COX-2 selective inhibitors in adjuvant therapy is presented as an effective alternative treatment for metastatic SCC in dogs...

Este relato descreve um caso de carcinoma de células escamosas (CCE) bem diferenciado no prepúcio de um cão, que apresentou metástase para o linfonodo regional. Um cão macho inteiro, de seis anos de idade, da raça Pit Bull, apresentou lesão ulcerada na região prepucial, com evolução de um ano, e linfonodo inguinal esquerdo aumentado, e foi submetido à exérese cirúrgica. O diagnóstico de CCE bem diferenciado foi obtido após avaliação histopatológica, e a técnica de imuno-histoquímica foi realizada para confirmação de metástase em linfonodo e para determinação das características imunofenotípicas do tumor. No estádio avançado da doença (T3N2M0) e com positividade para COX-2, foi proposta a utilização de quimioterapia adjuvante com carboplatina combinada com inibidor seletivo de COX-2. Neste estudo, demonstrou-se que a técnica de imuno-histoquímica pode ser uma importante ferramenta diagnóstica para determinar o prognóstico e o tratamento de escolha do CCE. Adicionalmente, a associação de carboplatina com inibidores seletivos de COX-2 é apresentada como uma efetiva alternativa de tratamento de CCE metastáticos caninos...

Electrical burns in sports fishing: a case report.

Electrical burns are among the most devastating types of burns, with wide-ranging injuries. They can sometimes occur in the context of fishing, usually involving high voltages. The authors present the case of a 59-year-old-man who suffered a sports accident during a fishing competition, with the formation of an electrical arc due to proximity of the fishing rod and high voltage cables. He presented burns affecting 3% of TBSA, third degree deep burns on trunk and left hand; no signs of cardiac injury. He was admitted to our Burn Unit for monitoring, care dressing and surgical treatment; complete wound healing was achieved after 24 days. Due to its relatively small share among burns, published data on electrical injuries and fishing remain scarce, and differ in patient collectives due to infrastructural or environmental differences. The authors are not aware of published specific reports on electrical burns in sports fishing practice, like the case here presented. The authors want to alert for potential medical, social and economic consequences of this type of sports accidents that could be entirely avoidable with some preventive measures.