RESUMO
Because insects are ectotherms, their physiology, behaviour and fitness are influenced by the ambient temperature. Any changes in environmental temperatures may impact the fitness and life history traits of insects and, thus, affect population dynamics. Here, we experimentally tested the impact of heat shock on the fitness and life history traits of adults of the aphid parasitoid Aphidius avenae and on the later repercussions for their progeny. Our results show that short exposure (1 h) to an elevated temperature (36 degrees C), which is frequently experienced by parasitoids during the summer, resulted in high mortality rates in a parasitoid population and strongly affected the fitness of survivors by drastically reducing reproductive output and triggering a sex-dependent effect on lifespan. Heat stress resulted in greater longevity in surviving females and in shorter longevity in surviving males in comparison with untreated individuals. Viability and the developmental rates of progeny were also affected in a sex-dependent manner. These results underline the ecological importance of the thermal stress response of parasitoid species, not only for survival, but also for maintaining reproductive activities.
Assuntos
Resposta ao Choque Térmico , Temperatura Alta , Vespas/fisiologia , Animais , Afídeos/parasitologia , Feminino , Longevidade , Masculino , Reprodução , Fatores Sexuais , Razão de Masculinidade , Comportamento Sexual Animal , Vespas/crescimento & desenvolvimentoRESUMO
The ontogeny of the cuticular hydrocarbons of three dipterans of importance to forensic entomology, Calliphora vomitoria (Linné), Calliphora vicina (Robineau-Desvoidy) and Protophormia terraenovae (Robineau-Desvoidy) (Diptera: Calliphoridae), was explored using gas chromatography analysis. The stages examined ranged from eggs to 8-day-old adults. Cuticular hydrocarbon profiles revealed that odd linear alkanes dominate in all three species. Short-chain carbon compounds in larvae and post-feeding larvae were seen to evolve to long-chain carbon compounds in pupae and adults. Discriminant analysis of cuticular hydrocarbon profiles showed a clear differentiation among the different stages (larvae, post-feeding larvae, pupae and adults) and within stages, according to the age of individuals. This study concluded that the postmortem interval can be determined from the composition of cuticular waxes in Calliphoridae in forensic situations.
Assuntos
Dípteros/crescimento & desenvolvimento , Hidrocarbonetos/metabolismo , Tegumento Comum/fisiologia , Animais , Dípteros/metabolismo , Feminino , Larva/crescimento & desenvolvimento , Larva/metabolismo , Masculino , Metamorfose Biológica , Óvulo/crescimento & desenvolvimento , Óvulo/metabolismo , Pupa/crescimento & desenvolvimento , Pupa/metabolismo , Especificidade da EspécieRESUMO
BACKGROUND: Two algorithms based on sequential measurements of liver and spleen stiffness using two-dimensional shearwave elastography (2D-SWE) have been recently proposed to estimate clinically significant portal hypertension (hepatic venous pressure gradient [HVPG] ≥10 mm Hg) in patients with cirrhosis, with excellent diagnostic accuracy. AIM: To validate externally these algorithms in a large cohort of patients with cirrhosis. METHODS: One hundred and ninety-one patients with stable cirrhosis (Child-Pugh class A 39%, B 29% and C 31%) who underwent liver and spleen stiffness measurements using 2D-SWE at the time of HVPG measurement were included. Diagnostic accuracy of the 2 algorithms was assessed by calculating sensitivity, specificity, positive and negative predictive values. RESULTS: The first algorithm, using liver stiffness <16.0 kilopascals (kPa) and then spleen stiffness <26.6 kPa, was used to rule-out HVPG ≥10 mm Hg. In our population, its sensitivity and negative predictive value were 95% and 63% respectively. The second algorithm, using liver stiffness >38.0 kPa, or liver stiffness ≤38.0 kPa but spleen stiffness >27.9 kPa, was used to rule-in HVPG ≥10 mm Hg. In our population, its specificity and positive predictive value were 52% and 83% respectively. Restricting the analyses to the 74 patients without any history of decompensation of cirrhosis or to the 65 patients with highly reliable liver stiffness measurement did not improve the results. CONCLUSION: In our population, diagnostic accuracies of non-invasive algorithms based on sequential measurements of liver and spleen stiffness using 2D-SWE were acceptable, but not good enough to replace HVPG measurement or to base clinical decisions.
Assuntos
Algoritmos , Técnicas de Imagem por Elasticidade , Hipertensão Portal/diagnóstico , Cirrose Hepática/diagnóstico , Fígado/diagnóstico por imagem , Baço/diagnóstico por imagem , Idoso , Técnicas de Imagem por Elasticidade/métodos , Feminino , Dureza/fisiologia , Humanos , Hipertensão Portal/complicações , Fígado/patologia , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Pressão na Veia Porta , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Baço/patologiaRESUMO
BACKGROUND: Beta-blockers may have to be interrupted in patients with cirrhosis. The concept of a rebound after interruption of beta-blockers is based on an animal study and on isolated case reports of variceal bleeding. AIM: To determine if a rebound occurs in patients with cirrhosis following abrupt interruption of beta-blockers. METHODS: We prospectively included all consecutive patients with cirrhosis undergoing right heart and hepatic vein catheterisation. Four groups were defined: 'no beta-blockers' including patients not receiving beta-blockers; '≤1 day', '2-3 days' and '≥4 days' classified according to the time patients had interrupted beta-blockers before catheterisation. Results were expressed as median (interquartile range). RESULTS: A total of 150 patients were included. Among the 25 patients in the groups '2-3 days' and '≥4 days', median duration of beta-blockers interruption was 4 (3-6) days. No gastrointestinal bleeding occurred during that period, nor during the following month. Hepatic venous pressure gradient was not different among patients in usually treated with beta-blockers. After adjustment, beta-blockers interruption was not associated with hepatic venous pressure gradient. Cardiac index was higher in the '≥4 days' group [4.6 L/min/m(2) (3.5-5.1)] than in the '≤1 day' group [3.4 (2.6-4.0); P = 0.001] or in the '2-3 days' group [3.1 (2.7-3.7); P = 0.007], but not different from the 'no beta-blockers' group. CONCLUSIONS: Abrupt interruption of beta-blockers is associated neither with an apparent increase in the risk of variceal bleeding nor with a haemodynamic rebound. Thus, interruption of beta-blockers in patients with cirrhosis may not require particular dosing or surveillance.
Assuntos
Antagonistas Adrenérgicos beta/efeitos adversos , Hemodinâmica/efeitos dos fármacos , Cirrose Hepática/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Veias Hepáticas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Pressão na Veia Porta/efeitos dos fármacosRESUMO
The authors report three new cases of olfactory esthesioneuromas. They emphasise, both the surgical and radiotherapeutic methods used, and staging according to Kadish. Very localized forms may be treated either by surgery or radiotherapy. Less localized forms require association of surgery and radiotherapy, with a craniofacial combined approach when extension goes beyong the lamina cribosa.
Assuntos
Tumores Neuroectodérmicos Primitivos Periféricos/terapia , Neoplasias Nasais/terapia , Adolescente , Adulto , Feminino , Humanos , Masculino , Métodos , Pessoa de Meia-Idade , Metástase Neoplásica , Recidiva Local de Neoplasia , Tumores Neuroectodérmicos Primitivos Periféricos/patologia , Tumores Neuroectodérmicos Primitivos Periféricos/radioterapia , Tumores Neuroectodérmicos Primitivos Periféricos/cirurgia , Neoplasias Nasais/patologia , Neoplasias Nasais/radioterapia , Neoplasias Nasais/cirurgia , PrognósticoRESUMO
Permanent endocavitary cardiac pacing is a widely used therapeutic method. The implantation of pacing catheters is usually performed by the supracardiac veins, the epicardial approach being the classical alternative. The ilio-femoral approach is a third possibility. The authors report three cases in which this approach was used. The implantations were performed under general anaesthesia with an abdominal pacemaker. In two cases, atrial and ventricular catheters were implanted. After an average of 19 months' follow-up, no short or long-term complications were observed: displacement or fracture of the pacing catheter, infection, venous thrombosis, threshold elevation. These results show that this is a safe and feasible alternative to implantation by the traditional or epicardial techniques when these approaches cannot be used.
Assuntos
Veia Femoral/cirurgia , Veia Ilíaca/cirurgia , Marca-Passo Artificial , Adulto , Idoso , Procedimentos Cirúrgicos Cardiovasculares/métodos , Humanos , Masculino , Complicações Pós-OperatóriasRESUMO
Despite recent large scale trials, the management of atrial fibrillation remains very variable. The authors report the results of a prospective study of the management of atrial fibrillation in their department. One hundred consecutive patients admitted for atrial fibrillation were included in the study. The epidemiological and clinical data and the results of the therapeutic strategy were recorded prospectively. Three embolic complications occurred before hospital admission. The hospital stay was marked by spontaneous reduction of atrial fibrillation in 14 cases in the 6 hours following admission. The therapeutic strategy was the following: 40 arrhythmias were respected (well tolerated, > 1 year or with a left atrium 60 mm). Oral amiodarone (30 mg/Kg and 15 mg/Kg the next day) was given to 22 patients. Only 9 patients (41%) were converted (average delay of 12 hours). Four patients received intravenous amiodarone, reducing two arrhythmias. Twenty patients were treated by external electrical cardioversion of first intent and 14 after failure of pharmacological reduction. All of these procedures, early (after 48 hours anticoagulation and transoesophageal echocardiography), or late (after 1 month of anticoagulation), restored sinus rhythm without complications, especially embolic. This register showed a relatively low efficacy of oral amiodarone in the reduction of atrial fibrillation and underlines the efficacy and safety of external electrical cardioversion, even when performed early.
Assuntos
Antiarrítmicos/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Administração Oral , Idoso , Amiodarona , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/patologia , Cardioversão Elétrica , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do TratamentoRESUMO
The authors report the case of a 50 year old man with pseudowanthoma elastica with a history of myocardial infarction and severe aortic regurgitation. Angiography showed multiple coronary artery aneurysms and aneurysmal dilatation of the aortic annulus. The outcome after triple coronary bypass surgery with aortic valve replacement in a valved Bentall conduit was favourable. Pseudoxanthoma elastica is a rare condition in which the prognosis depends on the degree of vascular involvement. In this context, coronary artery aneurysms and aneurysmal dilatation of the aorta are rare complications.
Assuntos
Insuficiência da Valva Aórtica/complicações , Aneurisma Coronário/complicações , Pseudoxantoma Elástico/complicações , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/cirurgia , Aneurisma Coronário/diagnóstico , Aneurisma Coronário/cirurgia , Angiografia Coronária , Ponte de Artéria Coronária , Próteses Valvulares Cardíacas , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Persistent left superior vena cava is an anomaly of the systemic venous return occurring in 0.5% of the general population. We report the case of a patient with an incidental diagnosis made during a dyspnea while he had chronic pulmonary disease. The diagnosis was suspected by the presence of a markedly dilated coronary sinus and confirmed by a simple contrast injection into the left antecubital vein. Transesophageal echocardiography and magnetic resonance imaging confirmed the existence of 2 superior vena cava with the left superior vena cava draining into the coronary sinus. This congenital anomaly is of minimal hemodynamic significance when isolated. The diagnosis can be useful for placement of central catheters from left superior approach.
Assuntos
Anomalias dos Vasos Coronários/diagnóstico , Ecocardiografia , Veia Cava Superior/anormalidades , Idoso , Idoso de 80 Anos ou mais , Humanos , Angiografia por Ressonância Magnética , MasculinoRESUMO
PURPOSE OF THE STUDY: The authors reviewed 70 cases of rheumatoid forefoot treated by Lelièvre, lateral metatarsal resection alignment, associated to first metatarsophalangeal joint arthrodesis. MATERIAL: Rheumatoid arthritis evolution was 20 years an average. It involved cortico-dependent polyarthritis in 48 per cent cases. Metatarsalgia were always present. METHODS: Mean follow up was 44 months (minimum 24 months) Results were analyzed according to Gainor. RESULTS: Foot pain disappeared in thirty two cases. Shoe wearing was normal 50 times. Arthrodesis fused 55 times. Lateral toes metatarsophalangeal joint space was satisfactory 28 times. Metatarsal divergence improved, 80 per cent of patients were satisfied in a subjective estimation and 85 per cent using Gainor's criteria. DISCUSSION: First-Metatarsophalangeal joint arthrodesis ensures permanent stability of the first ray and therefore an harmonious support distribution. The dorsal surgical approach allows an early weight bearing in cortico or immuno dependent patients. CONCLUSION: This technique keeps a low morbidity and ensures stable mid term results.
Assuntos
Artrite Reumatoide/cirurgia , Articulação Metatarsofalângica/cirurgia , Procedimentos Ortopédicos/métodos , Adulto , Idoso , Artrodese , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do TratamentoRESUMO
The first one is a neurofibroma associated with a Charcot-Marie Tooth's disease involving all the tympanic segment of the facial nerve: extirpation and graft. Improvement of facial motricity to 42%. The second one is a small Schwannoma lateral to tympanic segment: extirpation without paralysis. The third is a large Schawannoma of the tympanic mastoïd segments involving the facial nerve to its division in the parotid gland, and with a limited extension in the cerebello-pontine angle. Extirpation and graft. Discussion and recent bibliography.
Assuntos
Neoplasias dos Nervos Cranianos/patologia , Nervo Facial , Neurilemoma/patologia , Neurofibroma/patologia , Adulto , Neoplasias dos Nervos Cranianos/cirurgia , Nervo Facial/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurilemoma/cirurgia , Neurofibroma/cirurgia , Neurônios/transplante , Transplante AutólogoRESUMO
On the basis of a series of 577 tympanoplasties performed between January 1968 and December 1978 for 424 cholsteatomas and 153 epidermisations involving 464 adults and 113 children aged less than 15 years, the authors describe techniques, results and indications. An open technique was used in only 28 cases. Since 1973, the authors have preferred the closed technique in two stages (227 cases) to a, closed technique in 1 stage (113 cases). The open technique with obliteration was used in 68 cases in one stage and in 141 cases in 2 stages. This latter group included 17% of patients referred from elsewhere and already operated upon. Rates of tympanic closure varied between 93% for open techniques and 97% for closed techniques and open techniques with obliteration. The presence of silastic caused a fall in this closure rate of a little more than 2% both in the closed technique (94,8%) as well as in the open technique with obliteration (94,4%). An appreciably difference between the adult and child was seen only with the open technique with obliteration in two stages: 96% in the adult, 83% in the child. Residual cholesteatoma pearls extirpated during the 2nd stage were found in 28% of cases in the adult and in 36% of cases in the child in closed techniques and in 21% of cases in the adult and 33% of cases in the child in open techniques with obliteration. Retraction pockets were fairly common after the closed technique in one stage (6 out of 35 at 5 years). They were nevertheless also seen after closed techniques in two stages (5 out of 81 at one year and 3 out of 29 at 3 years). The best functional results were obtained with closed techniques in 2 stages. The air-bone gap was 10 dB or less in 44% of cases and 20 dB or less in 63% of cases when the stapes was intact. It was 10 dB or less in 31% of cases and 20 dB or less in 45% of cases when the stapes was destroyed. There was no appreciable difference between adults and children for a given technique. The closed technique in two stages is preferable, in particular when the mastoid is pneumatised and/or if the cholesteatoma is large or papillary, which is customary in the child. The open technique with obliteration is preferable if the wall of the mastoid antrum is destroyed if the mastoid is severely retracted and if the eustachian tube functions poorly. It is also the method indicated in the presence of a large retraction pocket.
Assuntos
Colesteatoma/cirurgia , Orelha Média/cirurgia , Adolescente , Adulto , Criança , Otopatias/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Four cases of uncommon tumours of the petrous bone treated by surgery alone or combined with radiotherapy are reported. There was one case embryonic sarcoma in a 3-year-old female child and one case each of chondroid chordoma, isolated plasmocytoma and malignant fibroid chondrosarcoma or histiocytoma with giant cells. The signal symptoms (pseudo-petrositis, isolated paralysis of a vocal cord, sudden deafness) may be misleading. The most helpful diagnostic methods are frontal tomography and CT scanning.
Assuntos
Osso Petroso/patologia , Neoplasias Cranianas/patologia , Pré-Escolar , Condroma/patologia , Condrossarcoma/patologia , Cordoma/patologia , Feminino , Humanos , Masculino , Mesenquimoma/patologia , Pessoa de Meia-Idade , Plasmocitoma/patologia , PrognósticoRESUMO
The authors describe a group of 9 resection anastomoses with end-to-end sutures of the cervical portion of the trachea after resuscitation. The operative results are analyzed first: in 8 cases the trachea recovered almost normal function in a very short time; one failure occurred : this was with a patient with considerable neuro-psychic sequelae following serious cranial traumatism. These results are then compared with 7 laryngo-tracheal plasties carried out according to the principles of Rethi's operation; it emerges from this study that circumferential resection followed by end-to-end anastomosis is still the ideal form of treatment for tracheal stenoses in view of the quality and consistency of the results. Operative technique is then described and, in giving their operative indication, the authors stress the need for medical and endoscopic treatment during the asphyxial crisis; this treatment is then suggested for removing the tube in open tracheal stenoses and in order to allow resection anastomosis with the trachea closed several weeks later.
Assuntos
Ressuscitação/efeitos adversos , Estenose Traqueal/cirurgia , Adulto , Idoso , Transtornos de Deglutição/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estenose Traqueal/etiologiaRESUMO
Facial paralysis caused by cranial traumatism often needs surgical treatment / 28 operations were carried out on a group of 47 paralysed patients. Direct lesion of the facial nerve was in fact common / 10 compressions or contusions, 4 sections. Associated kophosis was frequent (15 cases). Conductive deafness was not uncommon (11 cases). Transverse fractures (5 cases) and complicated fractures (4 cases), true to their reputation for seriousness, all needed surgery and span the four nerve sections observed. Surgery is often delayed due to extensive cranio-cerebral lesions requiring prolonged neuro-surgical nursing care / 16 patients were operated on between the 4th and 8th weeks, 9 patients after the 8th week. The operation was usually carried out through the mastoid. Posteiror lympanotomy enabled the bend and the second portion to be reached and later enabled the ossicular chain to be reconstructed. In two cases involving kophosis, the three portions of the nerve were tackled through the labyrinth. The choice depends on the audiometric, radiological and operative findings. Surgical indications depend on clinical, elecromyographic, audiometric and radiological results. A check was carried out by means of muscular tests in 23 out of 28 cases: --20 decompressions / 15 recuperations of more than 50 p. 100 of which 7 were above 75 p. 100; --3 grafts or sutures / 3 recuperations of 30 p. 100.
Assuntos
Paralisia Facial/cirurgia , Adolescente , Adulto , Paralisia Facial/diagnóstico , Paralisia Facial/diagnóstico por imagem , Paralisia Facial/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Crânio/lesõesRESUMO
On the basis of 25 cases of laryngotracheal stenosis of mescellaneous etiology, the authors report their experience of Rethi's operation carried out in 14 cases, 8 patients having received medical and instrumental treatment, 1 undergoing surgery for resection and anastomosis according to Pearson's technique and 3 receiving symptomatic treatment by tracheotomy because of inoperable stenosis. The frequency of postop-operative complications of Rethi's operation was analysed (essentially infectious, but also as a result of obstruction of the calibration prosthesis which represents a definite vial risk). Functional results were also assessed, being relatively satisfactory from a respiratory functional standpoint, but less good from a phonetic standpoint. The authors then define their present therapeutic attidude which leans, in the case of pure sub-glottal and sub-glotto-tracheal stenosis, towards a direct approach with resection anatomosis according to Pearson's technique rather than calibration procedures which remain the treatment ofa choice for glotto-sub-glottal stenosis.
Assuntos
Laringoestenose/cirurgia , Estenose Traqueal/cirurgia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Laringoestenose/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Testes de Função Respiratória , Estenose Traqueal/etiologia , Prega Vocal/fisiopatologiaRESUMO
From january 1976 to december 1986, 78 patients were treated surgically for squamous cell carcinoma of the lateral buccopharyngeal junction without chemotherapy at first. 36 patients were treated by primary surgery with post-operative radiotherapy and 31 patients were treated by recovery surgery. Post-operative course was uncomplicated in 41% of cases (39% in primary surgery, 43% in recovery surgery); in 14% of cases serious local complications were observed (11% in primary surgery, 17% in recovery surgery). Carcinological failures appeared in 46% of cases in primary surgery and in 70% of cases in recovery surgery. Three years and five years actuarial survival rate were 45% and 39% respectively in recovery surgery. Prognostic factors are studied: resection quality, histological metastasis in lymph nodes. The authors emphasize on the best control of the big tumors in primary surgery and on the best results with small ulcerated infiltrant carcinoma.