RESUMO
Neurodevelopment has been studied extensively, especially in respect to abuse, anoxia, nutritional status and prematurity/low birth weight. However, less attention has been paid to innate and environmental factors, as well as to inflammatory conditions that may adversely affect neurodevelopment and learning in children. These include heavy metals, herbicides and polyvinyl chlorides (PVCs), mycotoxins, viral infections and Lyme disease-associated pathogens, as well as number of conditions such as chronic inflammatory response syndrome (CIRS) and Mast cell activation syndrome (MCAS). Early recognition of factors/conditions that could interfere with neurodevelopment is critical. Corrective actions, including the use of some unique natural flavonoids, could have lasting beneficial results.
Assuntos
Sistema Nervoso Central/fisiopatologia , Desenvolvimento Infantil , Sistema Nervoso Central/efeitos dos fármacos , Criança , Flavonoides/uso terapêutico , Herbicidas/efeitos adversos , Humanos , Inflamação/complicações , Aprendizagem , Doença de Lyme/complicações , Mastocitose/complicações , Metais Pesados/efeitos adversos , Micotoxinas/efeitos adversos , Cloreto de Polivinila/efeitos adversos , Viroses/complicaçõesRESUMO
Gastric carcinogenesis involves a slow but continuous, stepwise evolution from superficial gastritis to glandular atrophy, metaplasia, dysplasia, and finally, to adenocarcinoma. In 1994, the International Agency for Research on Cancer defined Helicobacter pylori (H. pylori) as a group I carcinogen. Evidence supporting a causal association has been demonstrated by epidemiological data as well as by experimental animal models. The process of carcinogenesis, which may well extend over decades, provides an excellent opportunity for prevention or early detection of the events preceding development of the neoplasm. This is especially true because, at present, H. pylori can be readily treated. Despite this, the prognosis for gastric cancer is poor and, in most industrialised countries, the survival is only 10% after 5 years from diagnosis. The sole exception is Japan where this malignancy is often identified at an early stage when cure by radical surgery is more probable.
Assuntos
Infecções por Helicobacter/complicações , Helicobacter pylori , Lesões Pré-Cancerosas/microbiologia , Neoplasias Gástricas/microbiologia , Adenocarcinoma/microbiologia , Infecções por Helicobacter/epidemiologia , Helicobacter pylori/genética , Humanos , Lesões Pré-Cancerosas/epidemiologia , Neoplasias Gástricas/epidemiologiaRESUMO
BACKGROUND: Staple-line disruption may occur after vertical banded gastroplasty (VBG). METHODS: Since May 1996, the authors have performed the gastric restrictive procedure divided VBG, as described by MacLean, as a first-choice operation and not only as correction for staple-line breakdown. Divided VBG was done in 111 patients, 32 as correction after staple-line disruption and 79 as a first choice, 29 of them by hand-assisted laparoscopy with the dexterity pneumosleeve. RESULTS: Weight loss and nutritional status have been very satisfactory. Operating time for the standardized operation has been no longer than 60 minutes. CONCLUSION: Divided VBG, especially if done by hand-assisted laparoscopy using the dexterity pneumosleeve, is a valid restrictive procedure.
Assuntos
Gastroplastia/métodos , Laparoscopia/métodos , Obesidade Mórbida/cirurgia , Adulto , Feminino , Gastroplastia/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Prognóstico , Reoperação , Resultado do Tratamento , Redução de PesoRESUMO
BACKGROUND: Sevoflurane is a good halogen agent for bariatric surgery anesthesia because of its physical and chemical characteristics and its repartition coefficient (blood/gas = 0.65). METHOD: From November 1997 to April 1998, 98 bariatric surgery procedures with sevoflurane anesthesia were done: 17 lipectomies, 71 vertical gastroplasties, and 10 biliopancreatic diversions in 71 women and 27 men, average age 30.3+/-8.3 years, with body mass index 43.9+/-5.7. The average operating time was 50+/-15 minutes for vertical gastroplasty, 160+/-20 minutes for biliopancreatic diversion, and 80+/-12 minutes for lipectomy. The technique of anesthesia was as follows: preanesthesia with atropine sulfate 0.01 mg/kg (dosage refers to ideal weight), ranitidine 50 mg, fentanyl 0.1 mg, ketorolac 60 mg; induction with propofol 0.5-1 mg/kg, succinylcholine 1 mg/kg; orotracheal intubation; maintenance with O2-N2O 50%, sevoflurane 1% to 1.5%, actracurium 0.5 mg/kg (dosage refers to ideal weight); awakening and decurarization with atropine sulfate 1 mg and prostigmine 2 mg. RESULTS: This method permitted correct control of the anesthesia, a quick awakening with a low incidence of nausea and vomiting, a prompt regain of physical and psychological functioning, an early discharge from the hospital, and a larger turnover of patients with lower costs. CONCLUSION: Sevoflurane balanced anesthesia seems to be the best anesthesiologic method for bariatric surgery.
Assuntos
Anestesia Geral/métodos , Anestésicos Inalatórios , Éteres Metílicos , Obesidade Mórbida/cirurgia , Adulto , Desvio Biliopancreático/métodos , Feminino , Gastroplastia/métodos , Humanos , Lipectomia/métodos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Sevoflurano , Resultado do TratamentoRESUMO
BACKGROUND: Thymic humoral factor-gamma 2 is a thymus-derived synthetic octapeptide, shown to be effective in chronic hepatitis B virus infection; as the latter is needed to support hepatitis D virus, thymic humoral factor-gamma 2 may have a therapeutic role in hepatitis D. AIM: To evaluate tolerability and efficacy of thymic humoral factor-gamma 2 in chronic hepatitis D. METHODS: Intramuscular thymic humoral factor-gamma 2, 40 microg, was given for 15 consecutive days and twice weekly for 22 additional weeks to adult patients with chronic hepatitis D virus hepatitis. RESULTS: A total of 11 patients (male/female 9/2, mean age 45.9 years] completed the treatment period, 10 the 6-month follow-up. At baseline, hepatitis D virus-RNA was positive in 8/11 (73%) patients. During treatment, hepatitis D virus-RNA became undetectable in 3/8 (37%), decreased in 1/8 (13%), remained unchanged in 4/8 (50%) and persisted undetectable in 3 patients, negative at baseline. During follow-up hepatitis D-viraemia relapsed in all patients but 2, one already negative at baseline. No changes in hepatitis B virus markers occurred. Mean serum alanine aminotransferase levels did not change significantly None of the patients reached normal serum alanine aminotransferase levels. CONCLUSION: At the doses given, thymic humoral factor-gamma 2 has been of limited efficacy A possible role of thymic humoral factor-gamma 2 in the treatment of chronic hepatitis D requires further dose-finding studies and/or combination with other antivirals.
Assuntos
Hepatite D Crônica/tratamento farmacológico , Oligopeptídeos/uso terapêutico , Adjuvantes Imunológicos/uso terapêutico , Adolescente , Adulto , Alanina Transaminase/sangue , Feminino , Hepatite D/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , RNA Viral/análise , Resultado do TratamentoRESUMO
From February 1996 to December 1998, 95 patients affected with colorectal liver metastases underwent the positioning of an intraarterial hepatic catheter by a transcutaneous subclavian access, under local anesthesia. All patients were evaluated for catheter implantation complications. Moreover, 61 patients of 95 treated at our center were retrospectively evaluated for results of chemotherapy performed with two different schedules of hepatic artery infusion (HAI) combined with systemic chemotherapy (SC). Eleven patients (group A) were treated with combined SC (5-fluorouracil continuous infusion) and HAI (floxuridine). A subsequent 50 patients underwent HAI (floxuridine, 4 cycles) followed, if a response or stable disease were observed, by combined SC and HAI (group B). Three cases of aneurysm of subclavian artery occurred, which were treated by the positioning of a radiologic arterial stent and the reimplantation of the catheter by a femoral access. Thrombosis of the hepatic artery was registered in four cases. We observed 10.5% occurrence of dislocation of the catheter, which was always moved again in the hepatic artery. In group A, with 45% clinical objective response rate and 10% stable disease rate, median survival time and median time to extrahepatic progression were 9 and 6 months, respectively. In group B, we observed 44% clinical objective responses and 26% stable disease after HAI. Patients without disease progression and therefore submitted to sequential SC and HAI had a median survival time of 21 months and a median time to extrahepatic progression of 16 months. The development of the mini-invasive technique of implantation of an arterial port can avoid laparotomy for HAI. Percutaneous implantation of an arterial port has a low rate of technical complications. HAI followed by combined systemic and regional chemotherapy has good results in terms of survival and time to extrahepatic progression.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Cateteres de Demora , Artéria Hepática , Infusões Intra-Arteriais/métodos , Neoplasias Hepáticas/tratamento farmacológico , Artéria Subclávia , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cateteres de Demora/efeitos adversos , Neoplasias Colorretais/patologia , Feminino , Humanos , Infusões Intra-Arteriais/efeitos adversos , Infusões Intravenosas , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de SobrevidaRESUMO
The authors investigated systolic time intervals in 28 cases of acute myocardial infarction (AMI). Polygraph recordings were made on the first day of illness and repeated at two, three, five, and seven hospital days. The patients were divided into two groups: one with a contributory history of ischemic and/or hypertensive heart disease (Group PH for "positive history") and one without such history (Group NH for "negative history"). The influence of numerous variables on systolic times were explored in both groups, and the emerging data were processed by multiple stepwise regression analysis. The results show that the left ventricular ejection time (LVET) is invariably shortened in AMI, whereas the pre-ejection indices (PEP and ICT) afford definite differentiation of patients of Group PH (with lengthened PEP and ICT values) from those of Group NH (shortened PEP and ICT). The authors emphasize the importance of obtaining polygraph recordings very early in the course of AMI and of taking into account the patient's history in view of a correct assessment of pre-ejection times.
Assuntos
Contração Miocárdica , Infarto do Miocárdio/fisiopatologia , Sístole , Idoso , Feminino , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Análise de RegressãoRESUMO
Hepatocellular carcinoma (HCC) is the fourth cause of death for cancer, the first in northern Africa and is the eighth tumor for incidence in the world. Risk factors are: liver cirrhosis, HBV, HCV and natural toxins (i.e. aflatoxin). A screening program is feasible and based on serum alpha-fetoprotein dosage and periodic liver ultrasonography. Instrumental diagnosis is based on ultrasonography associated with angiography or spiral TC associated with systemic portography. The best therapy of HCC is based on a multimodal approach: surgery when feasible, associated with or in alternative to intratumoral ethanol injection (PEI), transcatheter arterial chemoembolization (TACE), chemotherapy and radiotherapy. These different therapeutical approaches are related to the liver extent of the disease and liver functioning. Poor results obtained with chemotherapy led to research different therapeutical approaches as hormonal substances, immune modulators or genetic modulators. Most patients present with advanced disease, and their survival rate decreases with the increase of liver cirrhosis concomitant with HCC. Better results should be obtained with the use of different therapeutical approaches as angiogenetic inhibitors, today only for experimental use at present.
Assuntos
Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/terapia , Antineoplásicos/administração & dosagem , Antineoplásicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Hepatocelular/tratamento farmacológico , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/radioterapia , Carcinoma Hepatocelular/cirurgia , Ablação por Cateter , Quimioembolização Terapêutica , Terapia Combinada , Etanol/administração & dosagem , Feminino , Hepatectomia , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/cirurgia , Transplante de Fígado , Masculino , Dosagem Radioterapêutica , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Fatores de TempoRESUMO
The plasma an intra-erythrocyte acid-base balance in man was studied, along with blood pyruvate and lactate levels, in acute metabolic alkalosis induced by i.v. infusion of bicarbonate. It was found that the red cell offers a satisfactory expression of the phenomena that occur in the intracellular space. The bicarbonate ion has difficulty in crossing the red cell membrane, while the production of lactate is seen as a fundamental compensation mechanism for rapid buffering of the extra base.
Assuntos
Alcalose/sangue , Bicarbonatos/farmacologia , Eritrócitos/metabolismo , Lactatos/sangue , Equilíbrio Ácido-Base , Adulto , Idoso , Bicarbonatos/administração & dosagem , Soluções Tampão , Permeabilidade da Membrana Celular/efeitos dos fármacos , Espaço Extracelular/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Changes in arterial blood and erythrocyte acid-base and electrolyte balance in the course of acute alkalinisation caused by bicarbonate loading showed that extracellular alkalosis has no significant effect on the concentration of intraerythrocyte bicarbonate concentration, though a marked increase in pH and electrolyte balance within the red cell is apparent. Erythrocyte alkalinisation may thus be seen as essentially due to the escape of H+ ions, while the entry of Na+ ions is the main device by which the law of electroneutrality is respected. The literature suggests that lactic acid offers a source of H+ ions for destruction of bicarbonate, whereas the diffusion of the ion lactate within the cell is compensated by the release of Cl-. In addition, the data now reported indicate that the red cell is a sufficiently valid model for the study of phenomena occurring within the intracellular compartment when a state of extracellular alkalinisation in created.
Assuntos
Alcalose/sangue , Idoso , Bicarbonatos/sangue , Eritrócitos/metabolismo , Feminino , Hematócrito , Humanos , Concentração de Íons de Hidrogênio , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Pressão Parcial , Equilíbrio HidroeletrolíticoRESUMO
Plasma and red cell acid-base balance were studied in 13 patients with metabolic alkalosis and 14 healthy subjects following the infusion of bicarbonate. Differences between the plasma and red cell patterns suggested that application of the results of plasma determinations to the body as a whole could be the cause of serious inaccuracies. Since the changes noted occurred in different combinations according to whether alkalinisation was acute or not, it is felt that cell response to a fall in (H+) varies in relation to the time available for compensation.
Assuntos
Alcalose/fisiopatologia , Eritrócitos/fisiologia , Plasma/fisiologia , Equilíbrio Ácido-Base/efeitos dos fármacos , Adulto , Idoso , Alcalose/sangue , Bicarbonatos/farmacologia , Dióxido de Carbono/sangue , Feminino , Humanos , Concentração de Íons de Hidrogênio , Masculino , Pessoa de Meia-Idade , Pressão ParcialRESUMO
BACKGROUND: This report deals with the techniques of peripheral anaesthesia used by the Authors for surgical treatment of lesions of the upper extremity. METHODS: Plexus brachial block anaesthesia using a supraclavicular approach was performed for arm, forearm and hand surgery, axillary block anaesthesia for forearm and hand surgery, while block anaesthesia was employed for wrist and hand injuries. Local anaesthetics as Bupivacaine 0.5% and Mepivacaine 2% without Epinephrine were used. RESULTS: In 95% of the cases the results were satisfactory, in 5% (not cooperating and young patients, long operations, incomplete block anaesthesia) it was necessary to perform a general anaesthesia. CONCLUSIONS: Surgeons and patients well accepted these techniques of anaesthesia because of: less bleeding during the operation, easy surgical performance, high percentage of success in reimplantations, absence of side effects due to narcosis, better recovery of psycho-physical conditions and long lasting postoperative analgesia.
Assuntos
Braço/cirurgia , Bloqueio Nervoso/métodos , HumanosRESUMO
Posthypoxic myoclonus is a rare and devastating complication of near-fatal cardiopulmonary arrest. Despite treatment with available anti-myoclonic agents, some patients may recover cognitively but remain completely disabled by severe myoclonus. We report a 16-year-old patient with severe treatment-refractory posthypoxic myoclonus, which improved markedly with administration of the drug sodium oxybate.
Assuntos
Parada Cardíaca/complicações , Hipóxia Encefálica/complicações , Mioclonia/tratamento farmacológico , Oxibato de Sódio/uso terapêutico , Adolescente , Eletroencefalografia , Humanos , Masculino , Mioclonia/etiologia , Mioclonia/fisiopatologia , SíndromeRESUMO
Plasma and red cell acid-base equilibrium was studied in 14 healthy subjects following the induction of acidosis by means of i.v. acetazolamide. It was found that changes in red cell values were significantly less marked than those in plasma.
Assuntos
Acetazolamida/efeitos adversos , Equilíbrio Ácido-Base/efeitos dos fármacos , Acidose/induzido quimicamente , Eritrócitos/fisiologia , Acidose/sangue , Acidose/fisiopatologia , Doença Aguda , Adulto , Idoso , Feminino , Humanos , Concentração de Íons de Hidrogênio , Masculino , Pessoa de Meia-IdadeRESUMO
The present study was designed to investigate systolic time intervals (STI) in 100 normal subjects undergoing continuous-maximal supine cycle ergometry and to search for possible linear correlations between STI (dependent variables) and heart rate, diastolic blood pressure, systolic blood pressure, age, sex, weight, and height (independent variables), by stepwise regression analysis. The only significant correlation discovered in the study was between the contractility index (isometric contraction time-ICT) and the total work produced by each participant. Exercise tolerance was limited primarily by shortening of the ICT interval, all subjects discontinuing the test when ICT reached 13.7 +/- 7 ms.
Assuntos
Teste de Esforço , Frequência Cardíaca , Contração Miocárdica , Esforço Físico , Sístole , Adulto , Eletrocardiografia , Feminino , Humanos , Masculino , Monitorização Fisiológica , Fonocardiografia , Análise de RegressãoRESUMO
Echocardiography was used to explore the influence of independent variables (age, body surface area and heart rate) on the mean circumferential shortening velocity (MVCF) in 183 healthy subjects. Multiple stepwise regression analysis shows that heart rate is the only variable of the three just mentioned that influences MVCF. A regression equation is evolved and proposed as an index of MVCF correction for varying heart rates.
Assuntos
Ecocardiografia , Frequência Cardíaca , Contração Miocárdica , Adolescente , Adulto , Fatores Etários , Idoso , Superfície Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Função VentricularRESUMO
A typical case of CVT is reported in which a certain diagnosis was reached only through NMR. Etiopathogenesis, clinical pictures and therapy are shortly discussed. Anticoagulant therapy at both short and long term is a preventive measure recommended for patients with thrombophilia.
Assuntos
Embolia e Trombose Intracraniana/diagnóstico , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-IdadeRESUMO
We have explored the systolic time intervals of 52 patients with angina pectoris at the time of their hospitalization in our wards. Our results are in close agreement with published data, essentially indicating prolongation of the preejection time and shortening of the ejection time. These alterations of systolic times can be interpreted pathophysiologically as as expressing reduced myocardial contractility. The long PEP-short LVET polygraph picture, occurring in the course of chronic ischemic heart disease, reveals the deficit of myocardial contractility at a stage of the disease at which clinical evidence of left ventricular failure is usually not yet detectable.
Assuntos
Angina Pectoris/fisiopatologia , Contração Miocárdica , Sístole , Adolescente , Adulto , Idoso , Eletrocardiografia , Feminino , Frequência Cardíaca , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/fisiopatologia , Fonocardiografia , Volume Sistólico , Fatores de TempoRESUMO
Platelet count and platelet function (circulating platelet aggregates, retention by glass beads and aggregation) were studied under basal conditions and after a cycloergometric exercise test in 10 subjects with stable angina pectoris and 10 normal subjects. There were no baseline differences between patients and controls in any of the tests of platelet function, nor did the values change after the exercise test. There was, however, a significant increase in the number of circulating platelets after the test in angina patients. Possible reasons for this phenomenon are discussed, with emphasis on the role of catecholamine hypersecretion induced by the physical exercise.