RESUMO
BACKGROUND AND OBJECTIVE: The latency times of midfemoral sciatic nerve blocks vary greatly. This study investigated the correlation between the type of motor response to nerve stimulation on the one hand and latency and block efficacy on the other. PATIENTS AND METHODS: We enrolled 215 consecutive patients (184 women) undergoing orthopedic foot surgery. A tourniquet was applied above the malleolus. The puncture location was found by palpating to locate the groove between the vastus lateralis and biceps femoris muscles, at the mid-point of the line between the posterior edge of the greater trochanter muscle and the insertion of the biceps femoris muscle in the popliteal fossa. A solution of equal proportions (1:1) of 1.5% mepivacaine (with bicarbonate 1:10) and 0.75% levobupivacaine was injected at a dose of 0.45 mL x kg(-1) (maximum 40 mL) using a 10-cm needle. Nerve stimulation was applied at 100-300 ms, 02-0.4 mA, and 2 Hz. Latency was classified as response in less than 15 minutes, in 15 to 30 minutes, or later than 30 minutes. RESULTS: The evoked motor response was inversion in 30 patients, flexion or extension in 38, plantar flexion in 101, dorsiflexion in 37, and eversion in 9. Shorter latencies (15 minutes) were observed in all patients with inversion or flexion/extension and in 84 (83%) of the 101 patients with plantar flexion. Mid-range latencies were observed in 13% of those with a plantar flexion response and in 29.7% of those with dorsiflexion. All 9 patients with eversion and 17 (45.9%) of the 37 patients with dorsiflexion had the longest latencies. The surgical block was complete for all patients. CONCLUSIONS: This approach provides an effective block with minimum latency in patients who have a flexion or extension motor response in the foot and/or fingers, inversion, or plantar flexion, which assumes that the injection has reached the common trunk of the sciatic or tibial nerve. However, a longer latency is associated with a peroneal motor response, particularly eversion.
Assuntos
Nervo Femoral/fisiologia , Pé/cirurgia , Bloqueio Nervoso/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/farmacologia , Bupivacaína/análogos & derivados , Bupivacaína/farmacologia , Feminino , Nervo Femoral/anatomia & histologia , Nervo Femoral/efeitos dos fármacos , Pé/anatomia & histologia , Pé/inervação , Humanos , Levobupivacaína , Masculino , Mepivacaína/farmacologia , Pessoa de Meia-Idade , Movimento , Procedimentos Ortopédicos , Estudos Prospectivos , Tempo de Reação/efeitos dos fármacos , Tempo de Reação/fisiologia , Adulto JovemRESUMO
INTRODUCTION: Massive small bowel resection (MSBR) with a remnant jejunum shorter than 60 cm produces severe water, electrolytes, vitamins and protein-caloric depletion. While waiting for a viable intestinal transplantation, most of MSBR patients depend on total parenteral nutrition (TPN). CLINICAL CASE: 32 years old male, with MSBR due to sectioning trauma of the superior mesenteric artery root. First surgical intervention: jejunostomy with small bowel, right colon, and spleen resection. Six months later: jejunocolic anastomosis with 12-cm long jejunum remnant and prophylactic cholecystectomy. NUTRITIONAL INTERVENTION: 1st phase. Hemodynamic stabilization and enteral stimulation (6 months): TPN + enteral nutrition with elemental formula + oral glucohydroelectrolitic solution (OGHS) + 15 g/d of oral glutamine + omeprazol. Clinical course indicators: biochemistry, I/L balance. 2a phase. Digestive adaptation with colonic integration (8 months): replacement of TPN by part-time peripheral PN. Progressive cooked diet complemented with pancreatic poly-enzyme preparation, omeprazol, OGHS, glutamine, elemental formula. Clinical course indicators: biochemistry, diuresis, weight and feces. 3a phase. Auto-sufficiency without parenteral dependence: fragmented free oral diet supplemented with pancreatic poly-enzyme preparation, mineralized beverages, enteral formula supplement, Ca and Mg oral supplements, oral multivitamin and mineral preparation, monthly IM vitamin B12. Current situation actual (52 months): slight ponderal gain, diuresis > liter/day, 2-3 normal feces, no clinical signs of any deficiency and normal blood levels of micronutrients. CONCLUSION: It may be possible to withdraw from PN in MSBR considering, as in this case, favorable age and etiology and early implementation of an appropriate protocol of remnant adaptation.
Assuntos
Traumatismos Abdominais/cirurgia , Colo/cirurgia , Jejuno/cirurgia , Artéria Mesentérica Superior/lesões , Apoio Nutricional/métodos , Síndrome do Intestino Curto/terapia , Traumatismos Abdominais/reabilitação , Adulto , Anastomose Cirúrgica , Colecistectomia , Terapia Combinada , Diurese , Nutrição Enteral , Hidratação , Alimentos Formulados , Humanos , Jejunostomia , Masculino , Nutrição Parenteral , Síndrome do Intestino Curto/sangue , Síndrome do Intestino Curto/etiologia , Síndrome do Intestino Curto/reabilitação , EsplenectomiaRESUMO
The peritoneal cells of mice injected with aclacinomycin (ACM), an oncostatic drug of the anthracyclin family, were found to secrete more interleukin (IL-1), after two successive 24-h periods of in vitro LPS stimulation than those of control mice. This measured IL-1 production is one of the signs of enhanced macrophage activity. The cells of ACM-injected mice also contained more intracellular IL-1 than those of controls. In contrast, macrophages from ACM-injected mice only increased their IL-1 production after the first 24-h incubation with PMA, and not after the second 24-h incubation. The response to ACM was dose- and time-dependent. We have also compared the IL-1 production by macrophages from mice injected with other anthracyclins, at doses equimolar to that of 4 mg/kg ACM and we have observed that adriamycin, 4'-epiadriamycin and aclacinomycin had similar activity, while THP-adriamycin an daunorubicine were slightly more active. Exploitation of this increased IL-1 production by macrophages could be beneficial in the design of tumor treatment protocols.
Assuntos
Aclarubicina/farmacologia , Interleucina-1/metabolismo , Macrófagos/efeitos dos fármacos , Animais , Antibióticos Antineoplásicos/farmacologia , Cinética , Macrófagos/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Cavidade Peritoneal/citologia , Ratos , Ratos EndogâmicosRESUMO
Two patients with metastatic neoplastic disease received 2-3 X 10(6) IU alpha recombinant interferon (IFN) 3 times/wk, every other week, for 3-6 mth. The natural killer (NK) activity of their peripheral blood leukocytes, was followed during the course of the treatment. A significant decrease was observed in the NK activity, which returned to normal values at the end of IFN administration. The treatment did not modify the evolution of metastasis.
Assuntos
Interferon Tipo I/farmacologia , Células Matadoras Naturais/imunologia , Adenocarcinoma/terapia , Citotoxicidade Imunológica/efeitos dos fármacos , Feminino , Humanos , Imunidade Inata/efeitos dos fármacos , Interferon Tipo I/uso terapêutico , Neoplasias Renais/terapia , Masculino , Melanoma/terapia , Pessoa de Meia-Idade , Proteínas Recombinantes/farmacologia , Proteínas Recombinantes/uso terapêuticoRESUMO
OBJECTIVES: Dyspepsia and irritable bowel syndrome (IBS) share aetiopathogenic factors, and may therefore be part of a single disorder. This study was intended to determine their prevalence in the general population, and the degree of overlap between these two digestive disorders. DESIGN: Descriptive study. METHODS: A sample of 264 subjects chosen randomly from the population census of a city in Spain, and considered representative of the general population in this city, was surveyed by questionnaire. RESULTS: The prevalence of dyspepsia was 23.9%, and that of IBS was 13.6%. Of the subjects with dyspepsia, 31.6% had IBS, and of the subjects with IBS, 55.6% reported symptoms of dyspepsia. The prevalence of IBS was higher among subjects with dyspepsia (31.7%) than among those who reported no symptoms of dyspepsia (7.9%; P < 0.05). Moreover, the prevalence of IBS was similar in three subgroups identified according to the type of dyspepsia described (ulcer-like, reflux-like or dysmotility-like). When we compared subjects with both dyspepsia and IBS and those with dyspepsia alone, we found no significant differences in clinical characteristics except for abdominal pain and fear of cancer, which were more frequent in the former. Of the entire sample, 27.7% of the subjects sought medical attention for IBS and 17% missed work because of IBS. CONCLUSION: Our findings suggest that functional dyspepsia and IBS are two manifestations of a single, more extensive digestive system disorder.
Assuntos
Doenças Funcionais do Colo/epidemiologia , Dispepsia/epidemiologia , Comorbidade , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Espanha/epidemiologiaRESUMO
AIM: The prevalence of dyspepsia in the community is poorly known, because most studies have used samples that were not representative of the general population. This study was intended to determine the prevalence of dyspepsia in a random sample of the general population, and its epidemiologic and sociodemographic characteristics. METHODS: In this descriptive study we used a questionnaire administered during a personal interview to survey a random sample of 264 subjects in a Mediterranean population. RESULTS: The prevalence of dyspepsia was 24%; we found no relation between prevalence and demographic characteristics, smoking and drinking, or type of dyspepsia. Forty subjects with dyspepsia were examined and the specific diagnosis was found in 18 (45%) of them. The subgroup with reflux-like dyspepsia was the largest (60%), although there was considerable overlap between subgroups with reflux-like, ulcer-like and dysmotility-like dyspepsia. Anti-Helicobacter pylori antibodies (IgG) were found in 52% of the subjects, but bacterial infection was not related with dyspepsia. CONCLUSIONS: Up to one-fourth of the general population in the city where the subjects reside may have dyspepsia. This disorder was associated with irritable bowel syndrome in half of the cases, but was not associated with H. pylori infection.
Assuntos
Dispepsia/epidemiologia , Dispepsia/microbiologia , Infecções por Helicobacter/complicações , Infecções por Helicobacter/epidemiologia , Helicobacter pylori , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , EspanhaRESUMO
Ten cases of xanthogranulomatous cholecystitis are presented, 5 women and 5 men, from a total of 439 cholecystectomies (2.2%). In 50% of cases the clinical course was consistent with acute cholecystitis; in 30%, gallbladder cancer was suspected preoperatively; and in 70% of cases cancer was suspected during surgery but intraoperative biopsies showed no malignancy. Definitive pathological findings included early carcinoma of the gallbladder in two patients, and a cholecystocolic fistula in one patient. A perforated gallbladder was found in one patient. The incidence of postoperative septic complications was 18.1%, a figure that doubles that of elective biliary surgery in our hospital.
Assuntos
Colecistite/complicações , Granuloma/complicações , Xantomatose/complicações , Idoso , Idoso de 80 Anos ou mais , Colecistite/diagnóstico , Colecistite/cirurgia , Feminino , Doenças da Vesícula Biliar/complicações , Doenças da Vesícula Biliar/diagnóstico , Doenças da Vesícula Biliar/cirurgia , Granuloma/diagnóstico , Granuloma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Xantomatose/diagnóstico , Xantomatose/cirurgiaRESUMO
Zinc acexamate (ZAM) is an antiulcer agent with antisecretory and gastroprotective properties. The aim of this study was to evaluate endoscopically and morphometrically the efficacy of ZAM in the prophylaxis of gastroduodenal lesions induced by pyroxicam. Thirty nine patients from 30 to 70 years of age diagnosed with osteoarthritis without lesions in the upper digestive tract on basal endoscopy were studied. A randomized, double blind study was designed in which the patients received 20 mg/day of pyroxicam together with 300 mg/day of ZAM or placebo for 4 weeks. Clinical controls were undertaken on days 0, 14, 28 and endoscopic and histologic controls performed on days 0 and 28. The two groups were homogeneous regarding basal parameters. Endoscopic grading of the gastroduodenal lesions at the end of the study was lower in the group treated with ZAM (p < 0.001). Ulcers were found in only 2 patients (one antral and one duodenal) both of whom were in the placebo group (10.5%). Histologic scoring following treatment demonstrated higher values in the placebo group (p < 0.001) and scarce alterations with respect to base values in the group treated with ZAM. Morphometric quantification showed lower cell densities in both groups at the body level (p < 0.001). However, these did not vary in the antrum in the group treated with ZAM but increased in the placebo group (p < 0.001) as an expression of proliferative cell response to mucosal damage. At a single nightly dosis of 300 mg ZAM is effective in the prophylaxis of gastric and duodenal lesions induced by pyroxicam.
Assuntos
Aminocaproatos , Anti-Inflamatórios não Esteroides/efeitos adversos , Antiulcerosos/uso terapêutico , Mucosa Gástrica/efeitos dos fármacos , Osteoartrite/tratamento farmacológico , Piroxicam/efeitos adversos , Adulto , Idoso , Ácido Aminocaproico/uso terapêutico , Método Duplo-Cego , Feminino , Mucosa Gástrica/patologia , Gastroenteropatias/induzido quimicamente , Gastroenteropatias/patologia , Gastroenteropatias/prevenção & controle , Gastroscopia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Eosinophilic gastroenteritis is an infrequent entity characterized by tissular eosinophilia that can affect different layers of the intestinal wall. This entity can affect any area of the digestive apparatus from the esophagus to the rectum. Clinical manifestations depend on the affected layers and range from barely perceptible symptoms to intestinal obstruction or ascites. We present the case of an 18-year-old woman who showed abdominal ascites as a rare form of presentation with difficult differential diagnosis with peritoneal carcinomatosis.
Assuntos
Ascite/etiologia , Enterite/complicações , Eosinofilia/complicações , Dor Abdominal/diagnóstico por imagem , Dor Abdominal/etiologia , Dor Abdominal/terapia , Adolescente , Ascite/diagnóstico por imagem , Ascite/terapia , Enterite/diagnóstico por imagem , Enterite/terapia , Eosinofilia/terapia , Feminino , Glucocorticoides/uso terapêutico , Humanos , Radiografia , Resultado do TratamentoRESUMO
An analytical method of histologic imaging of the gastric mucosa by computerized densitometry based on the extraction of components of an image on the basis of its luminous density is described. A group of 10 healthy controls, a group of 10 subjects with gastric ulcer and 10 with duodenal ulcer were included in the study. The method was particularly useful in the identification of atrophic and hypertrophic processes. A decrease was found in the density of parietal and chief cells in atrophic gastritis of the gastric body. In atrophic gastritis of the gastric antrum a decrease was observed in global cell density of the antrum. Patients with gastric ulcer did not present variations versus the control group. In those with duodenal ulcers an increase was observed in the density of surface cell of the gastric body with no variation in the density of parietal and principal cells. This finding challenges the classical concept on the increase in parietal cell mass accompanying duodenal ulcers.
Assuntos
Densitometria/métodos , Diagnóstico por Computador/métodos , Mucosa Gástrica/patologia , Adolescente , Adulto , Idoso , Biópsia , Densitometria/instrumentação , Densitometria/estatística & dados numéricos , Diagnóstico por Computador/instrumentação , Diagnóstico por Computador/estatística & dados numéricos , Úlcera Duodenal/patologia , Dispepsia/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera Gástrica/patologia , Televisão/instrumentaçãoRESUMO
Anesthesiology has progressed spectacularly over the last two decades, largely parallel to developments in basic and clinically applied sciences such as immunology. The anesthesiologist's involvement now extends to all matters involved in perioperative care. Surgery, anesthetic procedures themselves, and other associated techniques such as blood transfusion all alter the patient's immune response and all fall within the range of procedures monitored by the anesthesiologist. The repercussions on the patient are important, given that alterations suppose increased risk of postoperative infection and increased recurrence of neoplastic disease. The present article reviews available knowledge on how and to what extent the patient's immune status is affected in the perioperative period. Generally, surgery and anesthesia induce immune system depression. It is possible to demonstrate a decrease in the number and activity of circulating immune cells and alterations of various types in interleukins and in protein synthesis during acute phase response. Research in this field is complex given that the individual effect of each factor involved is difficult to measure and experimental or clinical designs usually yield only biased views. Replacement of lost red blood cells is another factor leading to immunological changes. New anesthetic techniques, the optimization of methods already in use, and the development of modern, less immunodepressant drugs and of alternatives to homologous blood transfusion are all solutions that have been proposed. This is an exciting field of study in which today, perhaps more than ever, the anesthesiologist has a critical role to play.
Assuntos
Anestesia , Transfusão de Sangue , Sistema Imunitário/fisiologia , Procedimentos Cirúrgicos Operatórios , HumanosAssuntos
Doenças Funcionais do Colo/epidemiologia , Adulto , Feminino , Humanos , Masculino , Prevalência , Espanha/epidemiologiaAssuntos
Ácido Gástrico/metabolismo , Encéfalo/fisiologia , Fator de Crescimento Epidérmico/fisiologia , Suco Gástrico/metabolismo , Mucosa Gástrica/metabolismo , Gastrinas/metabolismo , ATPase Trocadora de Hidrogênio-Potássio/metabolismo , Homeostase , Humanos , Prostaglandinas/fisiologia , Somatostatina/fisiologia , Estômago/fisiologia , Nervo Vago/fisiologiaAssuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Mucosa Gástrica/efeitos dos fármacos , Fatores Etários , Idoso , Apoptose , Aspirina/efeitos adversos , Divisão Celular , Mucosa Gástrica/citologia , Mucosa Gástrica/patologia , Gastrite Atrófica/patologia , Humanos , Indometacina/efeitos adversos , Fatores de RiscoAssuntos
Amoxicilina/efeitos adversos , Antibacterianos/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Ácidos Clavulânicos/efeitos adversos , Quimioterapia Combinada/efeitos adversos , Penicilinas/efeitos adversos , Inibidores de beta-Lactamases , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Amoxicilina/administração & dosagem , Antibacterianos/administração & dosagem , Biópsia , Doença Hepática Induzida por Substâncias e Drogas/diagnóstico , Doença Hepática Induzida por Substâncias e Drogas/patologia , Criança , Pré-Escolar , Ácido Clavulânico , Ácidos Clavulânicos/administração & dosagem , Ensaios Enzimáticos Clínicos , Quimioterapia Combinada/administração & dosagem , Feminino , Humanos , Fígado/patologia , Masculino , Pessoa de Meia-Idade , Penicilinas/administração & dosagem , Fatores de Tempo , beta-Lactamases/administração & dosagemRESUMO
Aclacinomycin (ACM) is an oncostatic substance on the family of the Anthracyclines, with a proven activity in human and rodents. Splenic cells from C57BL/6 ACM injected mice by intraperitoneal or intravenous route four days before their sacrifice showed a significant increase in the proliferative and cytotoxic response respectively measured by incorporation of 3H-TdR and by the liberation of 51Cr when stimulated in vitro with irradiated mouse DBA/2 splenic cells. This response is doses dependent, and one can clearly observe different effects on the proliferative and cytotoxic responses at high doses. The cultures supernatants of splenic cells from mice treated with ACM during allogeneic stimulation showed a greater activity to induce the proliferation of a line of T cytotoxic cells dependent on Interleukin-2. Finally, the cytotoxic activity of splenic cells induced by the allogeneic stimulation in vitro, of mice treated with ACM, was found in a subpopulation of cells non adherent to plastic, mainly made up of lymphocytes.
Assuntos
Aclarubicina/análogos & derivados , Linfócitos T/efeitos dos fármacos , Aclarubicina/farmacologia , Animais , Divisão Celular/efeitos dos fármacos , Células Cultivadas , Citotoxicidade Imunológica/efeitos dos fármacos , Relação Dose-Resposta a Droga , Antígenos H-2/imunologia , Interleucina-2/análise , Isoantígenos/imunologia , Ativação Linfocitária/efeitos dos fármacos , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Endogâmicos DBA , Baço/citologia , Linfócitos T/imunologiaRESUMO
OBJECTIVE: To determine the relationship between Helicobacter pylori infection and parietal cell mass and functional status in 10 patients with duodenal ulcer and 22 patients with functional dyspepsia. METHODS: We measured pentagastrin-stimulated acid secretion, determined the activity status of parietal cells on the basis of ultrastructural morphological features, and measured parietal cell mass and canalicular area with computerized densitometric morphometry. The number of antral G cells per square millimeter of mucosa was estimated inmunohistochemically, and basal serum gastrinemia was determined. RESULTS: In patients with duodenal ulcer, acid secretion, the percentage of activated parietal cells, and canalicular area were increased, but there was no difference between patients and dyspeptic controls in parietal cell mass. Helicobacter pylori infection did not modify these parameters, although it was associated with basal hypergastrinemia. CONCLUSION: In patients with duodenal ulcer, parietal cells display functional hyperactivity, which causes hypersecretion of acid; this effect is apparently unrelated to Helicobacter pylori infection.