RESUMO
Health risks due to NO2 exposure commonly exceed acceptable levels in modern societies. Among the measures to reduce such risks, photocatalytic materials present a promising technology. However, while the pollutant remediation of such materials has been extensively validated in laboratory studies, the performance under real world environmental exposure conditions is still subject to controversy. Indeed, a comparison of available in-situ monitoring studies manifests non-conclusive and highly scattered results regarding the photocatalytic effectiveness observed. The reasons for this behaviour must be carefully explored in order to prevent non-efficient photocatalytic applications from being put into practice on a larger scale. This paper presents a comprehensive large-scale study for assessing the photocatalytic NO2 remediation by active pavements in a street of Madrid (Spain), comprising different in-situ monitoring techniques. The discussion is enriched by relating the obtained results to those of other large-scale studies. The discrepancies between these results may be traced back to different circumstances, among them the distance between the active pavement and the pollutant concentration sampling inlet, as well as to significant site-specific and time-dependent variations of pollutant concentrations and climatic parameters. Under due consideration of these influences, for materials with relatively high initial effectiveness, it was concluded that in most such applications, the average NO2 removal effectiveness, if evaluated at a typical inlet height of Air Quality Stations (3 m), will not exceed a value of 4% (averaged over a sufficiently large number of measurement points in the area of application and a sustained amount of time, i.e. several months). When considering more realistic human exposure conditions (lower heights and daytime), it might be justified to assume somewhat higher average effectiveness.
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ABSTRACT Dynorphin A is an endogenous opioid peptide that is part of the KNDy system in the hypothalamus of mammals. This peptide acts as an inhibitor of the GnRH pulse generation, thus regulating the onset of puberty and reproductive cycles. The PDYN gene encodes the propeptide Prodynorphin, the precursor of Dynorphin A. Despite its physiological relevance, PDYN has not emerged as a candidate gene associated with puberty in genomic association studies conducted in cattle. The present work aimed to search for signatures of selection on the PDYN gene among cattle breeds. To this, the whole genome sequences from 57 samples of ten cattle breeds were used. The samples were grouped based on breed selection history and their productive differences, particularly in terms of sexual precocity. The population structure was analyzed using Principal Component Analyses. To evidence recent selection processes, neutrality tests, such as Tajima's D and Fu & Li's F* and D* were performed in defined functional regions of PDYN. The putative promoter of PDYN showed a population structure that is in agreement with the criteria considered to make the groups. In that region, neutrality tests were consistently negative and resulted in statistically significant for the dairy breeds. Also, these breeds exhibited less variability in the haplotype analyses than the others. The results presented here suggest that regulatory regions of PDYN could be under positive selection, particularly in dairy breeds.
RESUMEN Dinorfina A es un péptido opioide endógeno que forma parte del sistema KNDy en el hipotálamo de mamíferos. Este péptido actúa como inhibidor de la generación de los pulsos de GnRH, regulando así el inicio de la pubertad y los ciclos reproductivos. El gen PDYN codifica el propéptido Prodinorfina, precursor de Dinorfina A. A pesar de su relevancia fisiológica, PDYN no ha surgido como gen candidato asociado a pubertad en estudios de asociación genómicos en bovinos. El presente trabajo tuvo como objetivo buscar huellas de selección en el gen PDYN entre diferentes razas bovinas. Para alcanzarlo se utilizaron secuencias genómicas de 57 muestras de diez razas bovinas. Las muestras fueron agrupadas considerando la historia de selección y las diferencias productivas entre razas, particularmente en términos de precocidad sexual. La estructura poblacional fue analizada usando análisis de componentes principales. Para evidenciar procesos de selección recientes se realizaron pruebas de neutralidad, tales como D de Tajima y F* y D* de Fu & Li, en diferentes regiones funcionales de PDYN. El promotor putativo de PDYN mostró una estructura poblacional que es consistente con los criterios usados para agrupar las razas. En esa región, las pruebas de neutralidad fueron consistentemente negativas y estadísticamente significativas en las razas lecheras. Además, estas razas también exhibieron menor variabilidad en los análisis de haplotipos que las demás razas. Los resultados presentados aquí sugieren que regiones regulatorias de PDYN estarían bajo selección positiva, particularmente en razas bovinas lecheras.
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Photocatalytic technology implemented in construction materials is a promising solution to contribute to alleviate air quality issues found in big cities. Photocatalysis has been proved able to mineralise most harmful contaminants. However, important problems associated with monitoring the efficiency of these solutions under real conditions still remain, including the lack of affordable analytical tools to measure NOx concentrations with enough accuracy. In this work, two pilot scale demonstration platforms were built at two different locations to assess the photocatalytic NOX removal efficiency of ten selected materials exposed outdoors for AQmesh low-cost sensor PODs were used to measure ground-level to measure NO and NO2 concentrations during nearly one year. The pollutant removal efficiency of the materials was then calculated based on a comparison with simultaneously concentration measurements carried-out on reference, non-active materials. It was found that the NO2 removal efficiency presented large variations across the seasons, with maxima during the warmer months, while NO efficiencies were comparatively steadier. Statistical analysis delivered evidence that the efficiencies significantly depend on different meteorological variables (irradiance and relative humidity) besides NO, NO2 ambient concentrations. Lower efficiencies were observed for higher concentration levels and vice versa. The influence of water vapour could be related to two different effects: a short-term contribution by the instantaneous air humidity and a long-term component associated with the hygroscopic state of the material. The contribution of wind to the pollutant removal efficiencies was principally related to the humidity of air masses moving above the location and to the advection of pollutants from specific emission sources.
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The 70 kilodalton heat shock proteins (Hsp70) are highly conserved molecular chaperones which have a crucial role in the stress response of the cell. In mammals, the Hsp70 proteins are encoded by a cluster of three genes: HSPA1A, HSPA1B and HSPA1L. In bovines, this cluster is located on chromosome 23 downstream of the major histocompatibility complex (BoLA). We detected inconsistencies in the location of markers on the Hsp70 genes reported in the literature that pointed to a potential deletion in the bovine reference genome UMD 3.1.1. An in silico analysis of the bovine genomic region of the Hsp70 cluster, using available information from public databases, confirmed the existence of a deletion of 11.1-kb spanning the HSPA1B gene and the intergenic region between HSPA1B and HSPA1A. Although we originally considered this an assembly error, it is most likely a particular condition of L1 Dominette 01449, the cow sequenced in the Bovine Genome Project. Moreover, we suggest a new classification of bovine Hsp70 sequences reported in NCBI and a reassignment of the location of SNPs from dbSNP that map to the deletion on BTA23. We also compared the location of selected transcription factor binding sites on the promoters of HSPA1A and HSPA1B. The results generated in the present work could be helpful to refine the reference genome of an important livestock species and also to understand the role and the regulation of the bovine Hsp70 genes.
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Bovinos/genética , Proteínas de Choque Térmico HSP70/genética , Deleção de Sequência , Animais , Sítios de Ligação , DNA Intergênico , Genoma , Família Multigênica , Polimorfismo de Nucleotídeo Único , Regiões Promotoras Genéticas , Análise de Sequência de DNARESUMO
In this paper a procedure for selecting the enhancing solutions in electrokinetic remediation experiments is proposed. For this purpose, dredged marine sediment was contaminated with fuel, and a total of 22 different experimental conditions were tested, analysing the influence of different enhancing solutions by using three commercial non-ionic surfactants, one bio-surfactant, one chelating agent, and one weak acid. Characterisation, microelectrophoretic and electrokinetic remediation trials were carried out. The results are explained on the basis of the interactions between the fuel, the enhancing electrolytes and the matrix. For one specific system, the electrophoretic zeta potential, (ζ), of the contaminated matrix in the solution was found to be related to the electroosmotic averaged ζ in the experiment and not to the efficiency in the extraction. This later was correlated to a parameter accounting for both contributions, the contaminant and the enhancing solution, calculated on the basis of differences in the electrophoretic ζ in different conditions which has allowed to propose a methodology for selection of enhancing solutions.
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Quelantes/química , Técnicas Eletroquímicas/métodos , Sedimentos Geológicos/química , Petróleo/análise , Tensoativos/química , Poluentes Químicos da Água/química , Recuperação e Remediação AmbientalRESUMO
INTRODUCTION: The aim of this study was to identify the commonest referrals to a paediatric orthopaedic outpatient clinic and, therefore, to be able to improve the paediatric residency program in managing musculoskeletal problems. MATERIAL AND METHODS: Demographic data, referrals and final diagnosis were collected prospectively on all patients that were evaluated in a paediatric orthopaedic outpatient clinic. RESULTS: The majority of referrals were to evaluate musculoskeletal pain (37%), foot deformity (20%), spine deformity (15%), walking pattern (11%), alignment of the lower limbs (4%), and development of the hip (4%). A normal physical examination or a normal variation was observed in 42% of patients. A mild condition was observed in 17% of patients that should have only been referred to a paediatric orthopaedic clinic after failing to resolve pain with anti-inflammatories or physiotherapy. A mild deformity that only needed treatment if it became symptomatic was seen in 8% of patients. CONCLUSIONS: The majority of referrals were due to a normal variation or mild conditions that only required symptomatic treatment. Paediatric residency programs do not reflect the prevalence of musculoskeletal conditions in clinical practice.
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Doenças Musculoesqueléticas , Encaminhamento e Consulta , Adolescente , Instituições de Assistência Ambulatorial , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/terapia , Ortopedia , Pediatria , Estudos ProspectivosRESUMO
This paper explores the potential of a hazardous waste of difficult management, electric arc furnace dust (EAFD), as photocatalytic material. Starting from a real waste coming from a Spanish steel factory, chemical, mineralogical, and optical characterizations have been carried out. Direct trials on EAFD and mortar containing this waste have been performed to evaluate its potential as photocatalyst itself and within a cementitious material. The analysis of photocatalytic properties has been done by two different methods: degradation of NO x and degradation of rhodamine (RhB). As a result, it can be said that EAFD exhibited photocatalytic activity for both configurations with UV and visible light, having the mortar enhanced photocatalytic activity for NO x with respect to the EAFD itself. Additionally, in direct trials on the EAFD, it has been able to degrade RhB even in the dark, which has been attributed to transfer of electrons between the adsorbed RhB and the conduction band of some oxides in the dust.
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Poeira/análise , Eletricidade , Resíduos Perigosos/análise , Luz , Catálise/efeitos da radiação , Nitratos/química , Óxido Nítrico/química , Nitritos/química , Óxidos/química , Rodaminas/química , Soluções , Espectrofotometria UltravioletaRESUMO
Nowadays, a large proportion of photocatalytic oxidation (PCO) devices are being implemented in heating, ventilation and air-conditioning systems. However, no systematic studies have been carried out regarding the influence of inlet air preconditioning. To analyse the impact of the inlet air-conditions into photocatalytic efficiency, a simulated air-conditioning duct with flowing gas through inside was designed. Isobutylene was chosen as the target VOCs. The concentration in the gas phase was monitored using a photoionization detector. The influence of flow rate, relative humidity and temperature on the VOC removal efficiency was analysed. Experimental results were presented in terms of gas-removal efficiency (η) and clean air delivery rate (CADR) and analysed on a kinetic basis. From them, the weight of each parameter in the global process has been determined, from bigger to smaller contribution, flow>>temperature>relative humidity. Also, the relevance of the inlet air conditions has been illustrated in a model room in order to determinate the time necessary to obtain a threshold value accomplishing with enough air quality and the energy consumption of the device. Additionally, the photocatalytic decontamination has been assimilated to the "air exchange rate", a parameter commonly used in indoor air quality studies. The results show that preconditioning of air can improve the efficiency of photocatalytic devices and bring important energy savings.
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Ar Condicionado , Movimentos do Ar , Poluentes Atmosféricos/análise , Poluição do Ar em Ambientes Fechados/análise , Processos Fotoquímicos , Compostos Orgânicos Voláteis/química , Catálise , Descontaminação , Umidade , Cinética , Modelos Químicos , Oxirredução , TemperaturaRESUMO
Airborne pollen is a worldwide problem because is a very important allergenic agent; it can be altered only by certain microorganisms and by some oxidizers, such as reactive oxygen species (ROS). On the other hand, heterogeneous photocatalysis (HPC) arose as a promising technology for reducing the level of contaminants in the air, based on their degradation by the production of ROS. In this paper, study of the feasibility of HPC to diminish the counts of pollen is undertaken. The research has been carried out at different levels, from solutions to mortar specimens with the evidence that HPC is able to reduce the amount of pollen grains. This is a major breakthrough that opens the door to a whole field of research, already full of gaps, whose implications could be quite controversial.
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Poluição do Ar/prevenção & controle , Pólen/efeitos da radiação , Raios Ultravioleta , Catálise/efeitos da radiação , Cedrus/química , Cor , Eletroforese , Pólen/ultraestrutura , Soluções , Espectrometria de Fluorescência , Eletricidade Estática , Sobrevivência de Tecidos , Difração de Raios XRESUMO
BACKGROUND: We evaluated whether the incidence of recurrent venous thromboembolic events (VTEs) during and after therapy differs for patients treated with full or reduced doses of low-molecular-weight heparin (LMWH) used long term compared with vitamin K antagonists (VKAs). METHODS: We identified randomized studies of long-term treatment with LMWH or VKA by searching MEDLINE, EMBASE, BIOSIS, and PASCAL. Seventeen studies were included, with 4,002 patients. RESULTS: In the assessment at 12 months of 1,957 patients without cancer, the recurrence rates of VTE in the LMWH/VKA groups were 8.3%/7.6% in the studies using full doses and 12.3%/12.1% in those using prophylactic doses. However, combined analysis after treatment to 1 year showed a nonsignificant (NS) trend to lower recurrent symptomatic VTE in favor of VKA (RR = 1.46, 95% CI 0.96-2.23). In 1,292 patients with cancer the recurrence rates of VTE in the LMWH/VKA groups were 6.5%/17.9% (p = 0.005) in the studies using full doses, 7.1%/13.4% (p = 0.002) in the studies using intermediate doses, and 14.3%/19.1% (p = NS) in the studies using prophylactic doses. Furthermore, the recurrences of VTE after discontinuation of treatment in the LMWH/VKA groups were 1.6%/9.5% (RR = 0.25, 95% CI 0.06-1.1) in 252 patients with full doses and 12%/7.4% (RR = 1.49, 95% CI 0.3-7.48) in 52 patients with prophylactic doses. In this population with cancer, the full-treatment LMWH regimen did not produce more major bleeding events than intermediate or prophylactic doses (5.1% vs. 6.3% or 8.1%, respectively). CONCLUSION: Full-dose LMWH for 3-6 months is as safe as intermediate and prophylactic doses for the long-term treatment of deep vein thrombosis. In patients with cancer it appears that there is an excess of VTE recurrence after treatment with prophylactic doses that does not occur with full therapeutic doses.
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Anticoagulantes/administração & dosagem , Fibrinolíticos/administração & dosagem , Heparina de Baixo Peso Molecular/administração & dosagem , Tromboembolia Venosa/tratamento farmacológico , Vitamina K/antagonistas & inibidores , Anticoagulantes/efeitos adversos , Relação Dose-Resposta a Droga , Esquema de Medicação , Medicina Baseada em Evidências , Fibrinolíticos/efeitos adversos , Hemorragia/induzido quimicamente , Heparina de Baixo Peso Molecular/efeitos adversos , Humanos , Neoplasias/sangue , Neoplasias/complicações , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Medição de Risco , Fatores de Tempo , Resultado do Tratamento , Tromboembolia Venosa/sangue , Tromboembolia Venosa/etiologiaRESUMO
The setting and development of strength of Portland cement concrete depends upon the reaction of water with various phases in the Portland cement. Nuclear resonance reaction analysis (NRRA) involving the (1)H((15)N,alpha,gamma)(12)C reaction has been applied to measure the hydrogen depth profile in the few 100 nm thick surface layer that controls the early stage of the reaction. Specific topics that have been investigated include the reactivity of individual cementitious phases and the effects of accelerators and retarders.
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Espectroscopia de Ressonância Magnética/métodos , Manufaturas/análise , Água/análise , Água/química , Íons , Manufaturas/efeitos da radiação , Teste de Materiais/métodosRESUMO
AIM: Arteriography is the gold-standard in decision making in patients with critical lower-limb ischemia. Such method is not bereft of side effects and only gives morphologic information about lesions. Duplex allows to evaluate hemodynamically the arteriosclerotic lesions of ischemic lower limbs non-invasivelly and with the same reliability, in some studies, as angiography. Aim of this study was to determine the value and safety of arterial ultrasonic mapping in decision making for treatment of critical lower-limb ischemia. METHODS: This was a prospective and comparative study in patients with critical lower-limb ischemia recruited from March 2005 to June 2006. Ultrasonic arterial mapping was performed in 130 patients. Arteriography was performed only in those patients with elevated risk of major amputation or if ultrasound was not feasible (44 patients). Patients were randomized into two groups according to decision making criteria: 1) group A based on mapping alone; 2) group B based on arteriography. There was no statistical difference between risk factors in the two groups (P>0.05). Cumulative patency was recorded and compared at one and three months (Log Rank) as well as degree of concordance of decision making using mapping and arteriography in the group with both tests (B); and degree of concordance of the two tests with decision making based on intraoperative findings. RESULTS: The degree of concordance between mapping and arteriography was 84.1% (P<0.0001), and the degree of concordance between mapping and arteriography with respect to final decision according to intraoperative findings was 93.1% and 97.7%, respectively (P<0.0001). There were no statistically significative differences in patency rates at one and three months between the two groups (P>0.05). CONCLUSIONS: Ultrasonic arterial mapping is sufficient and comparable to arteriography for purposes of decision making in patients with critical lower-limb ischemia.
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Isquemia/diagnóstico por imagem , Isquemia/cirurgia , Extremidade Inferior/irrigação sanguínea , Ultrassonografia Doppler Dupla , Procedimentos Cirúrgicos Vasculares , Idoso , Artérias/diagnóstico por imagem , Artérias/cirurgia , Distribuição de Qui-Quadrado , Estado Terminal , Feminino , Humanos , Isquemia/fisiopatologia , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Radiografia , Espanha , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
AIM: To determine the clinical usefulness of Doppler ultrasonography in the diagnosis of the Nutcracker phenomenon, as an alternative to computed tomographic scans (CT). METHODS: This study consisted of 52 patients that presented with intermittent hematuria of unknown origin between January 2006 to April 2008. Doppler ultrasonography was used to assess the left renal vein (LRV) by measuring the anteroposterior (AP) diameter and peak systolic velocity (PSV) in supine and standing positions, at the hilar and interaortomesenteric portions of the LRV. These data were compared with CT scans. The sensitivity and specificity of duplex sonography was determined using the AP diameter and PSV ratios to assess the cut-off levels. Kappa (k) statistic was also evaluated. RESULTS: mean AP diameters of the LRV measured by Doppler sonography were 8.38 mm at the hilar and 3.17 mm under the SMA, compared to 9.3 mm (hilar) and 3.2 mm (SMA) in the supine and standing position respectively. The PSV in the supine position was 25.77 cm/s and 115.48 cm/s, respectively, compared to 25.54 cm/s and 125.96 cm/s in the standing position. The cut-off levels were 3.85 (sensitivity: 61.5%, specificity: 80.8%, k:0.42) for the supine and 4.12 (sensitivity:61.5%, specificity: 65.4%, k: 0.27) for the standing AP diameter, 2.99 (sensitivity: 92.3%, specificity: 73.1%, k: 0.65) for the supine and 3.73 (sensitivity: 96.4%, specificity: 79.2%, k: 0.76) for the standing PSV. CONCLUSIONS: Our data show that the standing PSV ratio is the best parameter for to detecting entrapment of the LRV.
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Posicionamento do Paciente , Doenças Vasculares Periféricas/diagnóstico por imagem , Veias Renais/diagnóstico por imagem , Ultrassonografia Doppler Dupla , Adolescente , Adulto , Velocidade do Fluxo Sanguíneo , Constrição Patológica , Feminino , Hematúria/etiologia , Humanos , Masculino , Doenças Vasculares Periféricas/complicações , Doenças Vasculares Periféricas/fisiopatologia , Valor Preditivo dos Testes , Circulação Renal , Veias Renais/fisiopatologia , Sensibilidade e Especificidade , Espanha , Decúbito Dorsal , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
AIM: The purpose of the study was to determine if early mobilisation in patients with acute lower limb deep vein thrombosis (DVT) increases the incidence of symptomatic pulmonary embolism (PE) and to evaluate the predisposing factors for PE such as location of the thrombus and duration of symptoms. METHODS: The current study was a prospective randomised clinical trial. Between January 2005 and December 2007, 219 patients with acute lower limb DVT were enrolled in the study (118 males and 101 females); the mean age was 64.2 years. INCLUSION CRITERIA: <15 days of initial symptoms, life expectancy >1 year, no life-threatening clinical conditions, and signed informed consent. The patients were randomised into two groups. Group A, 105 patients (47.9%) were hospitalized and received 5 days of bed rest; Group B, 114 patients (52.1%) received care at home with early walking and compression stockings. The primary end point was the presence of symptomatic PE during the first 10 days of treatment. The relationships between the duration of symptoms, location of the thrombus, and symptomatic PE were also analysed. RESULTS: Five cases of symptomatic PE were detected (2.3%), three in Group B and two in Group A. There was no significant difference in the occurrence of new PE between the two groups (P=0.54). Likewise, no difference was detected based on the duration of symptoms (P=0.62) and the location of the thrombus (P=0.43). CONCLUSIONS: In acute DVT , early walking, thrombus location, and duration of the symptoms did not influence the incidence of symptomatic PE.
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Repouso em Cama , Deambulação Precoce , Serviços de Assistência Domiciliar , Extremidade Inferior/irrigação sanguínea , Embolia Pulmonar/etiologia , Trombose Venosa/terapia , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Distribuição de Qui-Quadrado , Deambulação Precoce/efeitos adversos , Feminino , Hospitalização , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/epidemiologia , Restrição Física , Medição de Risco , Fatores de Risco , Espanha/epidemiologia , Meias de Compressão , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/epidemiologia , Caminhada , Adulto JovemRESUMO
AIM: Non-cardiac arterial disease (NCAD) is a frequent cause of hospital admission. The aim of this study was to investigate differences in patient profiles and clinical records as a function of the size of the Vascular Surgery Unit (VSU). METHODS: Retrospective observational study. Stratified cluster sampling and selection of patients hospitalized for NCAD. ANALYSIS: 1) description of patient profiles, quality of clinical records, and VSU [availability of diagnostic (DR) and therapeutic (TR) resources, and of written protocols (WP)]; 2) association between these variables and size of VSU. RESULTS: The sample consisted of 14 hospitals, 6 with a VSU of 15 or fewer beds (VSU < or = 15B) and 8 with >15 beds (VSU >15B). The mean number of DRs, TRs and WPs was 9, 2.8 and 2 in VSUs < or = 15B, and 11.5, 6.5 and 3.3 in VSUs >15B. The proportion of patients older than 70, female, with ischemic disease, or with coexisting diabetes was significantly higher in VSUs < or = 15B (67%, 31%, 95% and 57%, respectively) than in VSUs >15B (58%, 22%, 69% and 48%). Comorbid conditions and treatment during admission and at discharge were documented significantly less frequently in the clinical records in VSUs < or = 15B. Risk factors were under-reported in the clinical records of both types of VSU. CONCLUSION: Patient profiles and the quality of clinical records vary by size of VSU. Under-reporting of risk factors may hinder the implementation of prevention and treatment measures.
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Unidades Hospitalares/estatística & dados numéricos , Prontuários Médicos/normas , Doenças Vasculares Periféricas/epidemiologia , Qualidade da Assistência à Saúde , Idoso , Comorbidade , Técnicas de Diagnóstico Cardiovascular/estatística & dados numéricos , Feminino , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologiaRESUMO
OBJECTIVE: The clinical usefulness of the determination of polymorphonuclear elastase in serum, in patients with acute pancreatitis as a predictive value of severity. MATERIAL AND METHODS: A prospective study was made of 60 patients who at admission in the hospital showed high rates not only of lipase but also of polymorphonuclear elastase. High rates of this enzyme have been statistically related with the severity of pancreatitis. This severity is expressed by multifactorial Glasgow prognostic factors and by Ranson's CT degree. The predictive value in the evolution of the disease has been related to the need for surgery and related to the number of hospitalization days in non-operated patients. All these factors have been analysed taking into account such variables as age, sex, and biliary origin of the acute pancreatitis. RESULTS: Our study shows no statistically significant correlation between high polymorphonuclear (pmn) elastase serum levels in patients with acute pancreatitis (AP) and their evolution (as evaluated by means of clinical signs and CT images). In other words, determination of high pmn elastase serum levels has no predictive value to indicate the degree of severity in AP. Finally, we have found no clinical use in the lipase/ amylase ratio, neither as a predictive value in the evolution of our AP patients nor as a diagnostic tool to aid in the distinction among AP of biliary origin and AP due to other causes. CONCLUSION: The severity of acute pancreatitis must be evaluated according to clinical parameters and CAT scan imaging.
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Elastase de Leucócito/sangue , Lipase/sangue , Neutrófilos/enzimologia , Elastase Pancreática/sangue , Pancreatite/enzimologia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite/sangue , Valor Preditivo dos Testes , Estudos ProspectivosRESUMO
OBJECTIVES: To determine the utility of renal duplex sonography in the detection of vascular complications in renal grafts. PATIENTS AND METHODS: 45 patients with a median post-transplant follow-up of 39.3 +/- 28.8 months were evaluated. The renal artery maximum systolic velocity (SVmax) and the renal artery/iliac artery Svmax ratio (RIR) were utilized to detect stenosis. RESULTS: The SVmax was > 200 cm/sec in 6 cases, indicating renal artery stenosis (RAS). Angiographic evaluation of 5 patients revealed 3 had RAS > 60% and 2 had RAS < 60%. The 3 patients with RAS > 60% had RIR > 2. Increased vascular resistance in renal parenchyma was detected in 8 patients (1 acute rejection, 1 acute tubular necrosis, 6 histopathologically confirmed chronic rejection). Seventeen patients had one or more biopsies done during the follow-up. Six patients had a Doppler pattern compatible with arteriovenous fistula; two were confirmed by arteriography and one of these was embolized. CONCLUSIONS: Duplex sonography is no substitute for the other methods utilized in the early detection of vascular complications in the renal graft, but it can identify those patients requiring angiographic assessment and can therefore reduce the number of biopsies for posttransplant evaluation.
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Transplante de Rim/efeitos adversos , Obstrução da Artéria Renal/diagnóstico por imagem , Ultrassonografia Doppler em Cores , Adulto , Idoso , Algoritmos , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/etiologia , Feminino , Humanos , Necrose Tubular Aguda/diagnóstico por imagem , Necrose Tubular Aguda/etiologia , Masculino , Pessoa de Meia-Idade , Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/etiologia , Veias Renais/diagnóstico por imagemRESUMO
We report a case of tumor embolism of the lower right extremity after right pneumonectomy. This is an infrequent complication and in most cases occurs during the intraoperative or immediate postoperative period. Our patient underwent surgery for primary pulmonary neoplasia (squamous cell carcinoma) and 4 hours later showed clinical signs of acute arterial occlusion in the lower right extremity. An emergency embolectomy was performed and a thrombus with tumor characteristics was extracted from the right common femoral artery. The pathologic features of this thrombus were identical to those of the pulmonary tumor.
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Carcinoma de Células Escamosas/cirurgia , Neoplasias Pulmonares/cirurgia , Células Neoplásicas Circulantes/patologia , Pneumonectomia/efeitos adversos , Idoso , Carcinoma de Células Escamosas/patologia , Embolectomia , Humanos , Perna (Membro)/irrigação sanguínea , Neoplasias Pulmonares/patologia , Masculino , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/cirurgiaRESUMO
The patient was a 50-year-old alcoholic man with a left palatine tonsillar ulcer. Histopathological and bacteriological studies established the diagnosis of tonsillar tuberculosis with asymptomatic advanced pulmonary tuberculosis and multiple cerebral supra- and infratentorial tuberculomas previously unnoticed.