Same-day discharge protocol for laparoscopic treatment of adnexal disease: management and acceptance.

OBJECTIVE: Develop a 'same-day discharge' setting for laparoscopic treatment of adnexal disease. SETTING: Preventive Gynecology, European Institute of Oncology, Milan, Italy. POPULATION: Two hundred patients undergoing laparoscopic procedures. MATERIAL AND METHODS: Data were retrospectively collected through clinical, surgical and laboratory reports. After discharge patients were contacted by phone and e-mail. MAIN OUTCOME MEASURES: The rate of discharge, adverse events and readmission was measured. The need for adjunctive care provided by our on-call service or by a primary care physician and the acceptability of the same-day discharge protocol were also investigated. RESULTS: One hundred and sixty-five patients out of 200 were discharged on the same day. Of the 35 patients hospitalized, the most frequent causes for overnight admission were: uncontrolled pain, surgical length or complexity of the procedure in nine patients, nausea/vomit in four patients. One hundred and one out of 200 patients answered the mailed questionnaire. None of the discharged patients were readmitted. Eighty-five percent of the answering patients evaluated the length of their hospital stay as adequate or moderately adequate. Ninety-two percent of the patients would recommend the day surgery to other patients. CONCLUSIONS: our experience demonstrates that the same-day discharge protocol for laparoscopic treatment of adnexal disease is safe and acceptable.

Development of Nanoemulsions to Enhance the Antileishmanial Activity of Copaifera paupera Oleoresins.

Based on the ethnopharmacological evidences about the antileishmanial activity of Copaifera spp. oleoresins, the effects of crude extracts and fractions of oleoresin of two specimens from Copaifera paupera were evaluated on Leishmania amazonensis and Leishmania infantum strains. The oleoresin rich in α-copaene (38.8%) exhibited the best activity against L. amazonensis (IC50 = 62.5 µg/mL) and against L. infantum (IC50 = 65.9 µg/mL). The sesquiterpene α-copaene isolated was tested alone and exhibited high antileishmanial activity in vitro with IC50 values for L. amazonensis and L. infantum of 17.2 and 11.4 µg/mL, respectively. In order to increase antileishmanial activity, nanoemulsions containing copaiba oleoresin and α-copaene were developed and assayed against L. amazonensis and L. infantum promastigotes. The nanoemulsion containing α-copaene (NANOCOPAEN) showed the best activity against both species, with IC50 of 2.5 and 2.2 µg/mL, respectively. This is the first report about the antileishmanial activity of α-copaene.

Wound healing properties of Copaifera paupera in diabetic mice.

Copaifera oleoresin is one of the most used natural products in popular medicine all over the world. Among other effects (i.e., anti-inflammatory, antinociceptive, microbicidal) one of the most well-known is its wound healing capacity. However, the mechanism by which the oleoresin presents its effect is still not clear. In this study, our aim was to evaluate the wound healing capacity of oleoresin obtained from Copaifera paupera, its mechanism of action and identify its major components. For these purposes, diabetic Swiss Webster mice were topically treated with oleoresin (100, 150 or 200 mg/kg) for 14 consecutive days after an excision was performed in the back of the mice. Cytokines, wound retraction and histological evaluation were conducted at 3, 7 and 10 days (for cytokines); 0, 3, 7, 10 and 14 days (for wound retraction); and 7 and 14 days (for histological evaluation). Our data indicate that oleoresin significantly reduced production of MCP-1 and TNF-α at days 7 and 10 post-excision and increased IL-10 production at both days. All treatments demonstrated an effect similar or higher to that in collagenase-treated mice. Histological evaluations demonstrated that higher dose treatment resulted in better resolution and closure of the wound and higher levels of collagen deposition and indexes of re-epithelialization even when compared with the collagenase-treated group. The treatment with oleoresin from Copaifera paupera demonstrated that it is even better than an ointment routinely used for improvement of wound healing, suggesting this oleoresin as an option for use in diabetic patients.

OECI accreditation of the European Institute of Oncology of Milan: strengths and weaknesses.

The European Institute of Oncology began the process to reach the accreditation promoted by the Organisation of European Cancer Institutes (OECI) in 2012. This accreditation integrates the quality and safety path started in 2001 with accreditation by the Joint Commission International. Despite the presence of diversified accreditations and certifications and the clear need of time, effort, and commitment, the models are complementary. Each model is not to be considered as an end but as a tool for improvement: e.g., mixing accreditation standards led to an improvement in the quality and safety of processes. The present article details the OECI accreditation experience of the European Institute of Oncology, in particular the following strengths of OECI standards: collaboration among several involved parties (patient, volunteer, patient's general practitioner) in the clinical and quality/safety processes; a larger involvement of support personnel (psycho-oncologists, dieticians, physical therapists); and the development of clinical/translational research and innovation in prevention, diagnosis, and treatment to guarantee the best available practice in diagnosis and treatment. The OECI accreditation is specific to oncology and therefore its standards are tailored to a cancer center, both in terms of language used in the standards manual and in terms of patient needs. The OECI accreditation system puts an auditor team with a standards manual in charge of verifying quality and confirms the definition of IEO as a Comprehensive Cancer Center.

Mitos e verdades sobre pata-de-vaca - Bauhinia forficata Link - uma revisão / Myths and truths about pata-de-vaca - Bauhinia forficata Link - a review

Uma revisão acerca dos acontecimentos sobre Bauhinia forficata Link é apresentada dando-se ênfase sobre informações derivadas de suas características botânicas, químicas e farmacológicas. Constam das tradições oral e escrita do Brasil vários exemplos de vegetais usados como medicinais entre os quais vários empregados como hipoglicemiantes e como diuréticos. Entre esses últimos destaca-se Bauhinia forficata Link. Inúmeros trabalhos científicos põem em evidência suas propriedades hipoglicemiantes, diuréticas, bem como sua possível atividade antiinflamatória e analgésica. Em sua composição foi evidenciada presença de beta-sitosterol e quempferirina, além de glicósidos do sitosterol. Estigmasterol de campesterol também estão presentes, além de abordagem fitoquímica indicar a presença de óleo essencial, alcalóides, taninos e mucilagens.