Mas receptor blockade impairs exercise-induced cardiac hypertrophy.

Exercise training leads to physiological cardiac hypertrophy and the protective axis of the renin-angiotensin system composed of angiotensin-converting enzyme 2, angiotensin-(1-7), and Mas receptor seems involved in this process. However, the role of the basal activity of the Mas receptor in exercise-induced physiological cardiac hypertrophy is still unclear. We evaluated the effects of the Mas receptor blockade on the left ventricular structure and function of rats submitted to running training. Rats were assigned to 4 groups: sedentary (S), sedentary + A-779 (Mas receptor antagonist, 120 µg/kg/day, i.p.; SA), trained (60-minute treadmill running sessions, five days a week, 8 weeks; T), and trained + A-779 (TA). Systolic blood pressure was higher in sedentary and trained rats treated with A-779 at the end of the experimental period. The A-779 treatment prevented the left ventricular hypertrophy evoked by physical exercise and increased collagen deposition in sedentary and trained rats. Cardiomyocytes from the SA group presented increased length and thickness of the sarcomeres, elongated mitochondria, glycogen deposits, and enlarged cisterns of the sarcoplasmic reticulum. TA group presented a reduced sarcomere thickness and cytoplasm with a degenerative aspect. These findings show that the basal activity of the Mas receptor is essential for the proper turnover of the extracellular matrix in the myocardium and the maintenance of the sarcomeric structure of cardiomyocytes.

A prospective validation and comparison of three multivariate models for prediction of difficult intubation in adult patients

Abstract Purpose Several bedside clinical tests have been proposed to predict difficult tracheal intubation. Unfortunately, when used alone, these tests show less than ideal prediction performance. Some multivariate tests have been proposed considering that the combination of some criteria could lead to better prediction performance. The goal of our research was to compare three previously described multivariate models in a group of adult patients undergoing general anesthesia. Methods This study included 220 patients scheduled for elective surgery under general anesthesia. A standardized airway evaluation which included modified Mallampati class (MM), thyromental distance (TMD), mouth opening distance (MOD), head and neck movement (HNM), and jaw protrusion capacity was performed before anesthesia. Multivariate models described by El-Ganzouri et al., Naguib et al., and Langeron et al. were calculated using the airway data. After anesthesia induction, an anesthesiologist performed the laryngoscopic classification and tracheal intubation. The sensitivity, specificity, and receiver operating characteristic (ROC) curves of the models were calculated. Results The overall incidence of difficult laryngoscopic view (DLV) was 12.7%. The area under curve (AUC) for the Langeron, Naguib, and El-Ganzouri models were 0.834, 0.805, and 0.752, respectively, (Langeron > El-Ganzouri, p= 0.004; Langeron = Naguib, p= 0.278; Naguib = El-Ganzouri, p= 0.101). The sensitivities were 85.7%, 67.9%, and 35.7% for the Langeron, Naguib, and El-Ganzouri models, respectively. Conclusion The Langeron model had higher overall prediction performance than that of the El-Ganzouri model. Additionally, the Langeron score had higher sensitivity than the Naguib and El-Ganzouri scores, and therefore yielded a lower incidence of false negatives.

A prospective validation and comparison of three multivariate models for prediction of difficult intubation in adult patients.

PURPOSE: Several bedside clinical tests have been proposed to predict difficult tracheal intubation. Unfortunately, when used alone, these tests show less than ideal prediction performance. Some multivariate tests have been proposed considering that the combination of some criteria could lead to better prediction performance. The goal of our research was to compare three previously described multivariate models in a group of adult patients undergoing general anesthesia. METHODS: This study included 220 patients scheduled for elective surgery under general anesthesia. A standardized airway evaluation which included modified Mallampati class (MM), thyromental distance (TMD), mouth opening distance (MOD), head and neck movement (HNM), and jaw protrusion capacity was performed before anesthesia. Multivariate models described by El-Ganzouri et al., Naguib et al., and Langeron et al. were calculated using the airway data. After anesthesia induction, an anesthesiologist performed the laryngoscopic classification and tracheal intubation. The sensitivity, specificity, and receiver operating characteristic (ROC) curves of the models were calculated. RESULTS: The overall incidence of difficult laryngoscopic view (DLV) was 12.7%. The area under curve (AUC) for the Langeron, Naguib, and El-Ganzouri models were 0.834, 0.805, and 0.752, respectively, (Langeron...>...El-Ganzouri, p...=...0.004; Langeron...=...Naguib, p...=...0.278; Naguib...=...El-Ganzouri, p...=...0.101). The sensitivities were 85.7%, 67.9%, and 35.7% for the Langeron, Naguib, and El-Ganzouri models, respectively. CONCLUSION: The Langeron model had higher overall prediction performance than that of the El-Ganzouri model. Additionally, the Langeron score had higher sensitivity than the Naguib and El-Ganzouri scores, and therefore yielded a lower incidence of false negatives.

Maternal postnatal early overfeeding induces sex-related cardiac dysfunction and alters sexually hormones levels in young offspring.

Postnatal early overfeeding (PO) is a risk factor for cardiometabolic disorders. However, remains unknown the cardiac effects in the second generation from postnatal overfed dams. Our aim was to investigate the effects of maternal PO on cardiac parameters in second generation (F2) offspring. For this, pregnant Wistar rats (F0) were divided into two groups: normal litter (NL, 9 pups) and small litter (SL, 3 pups). At P70, female offspring (F1) of both groups were mated with non-PO male rats. At P21 male and female F2 offspring (NLO and SLO) were weaned, and at P45 they were euthanized to evaluate the cardiac function and sample collection. Male and female SLO showed increased body weight, food intake and adiposity. Blood estradiol levels were increased in the male SLO and decreased in the female SLO. Blood testosterone levels increased in SLO females, but not change in SLO male rats. Although SLO offspring presented cardiac hypertrophy, only males had ex vivo functional impairments, such as reduction of the intraventricular systolic pressure and dP/dt. Male and female SLO had increased interstitial fibrosis; however, only the male SLO had increased perivascular fibrosis. In addition, only male rats from SLO group had decreased AKT and Type 2 Ang-2 receptor, increased catalase and type alpha estrogenic receptor protein levels. Maternal PO leads to obese phenotype and alters sex-steroid levels in both male and female offspring. Although both sexes showed cardiac hypertrophy, only male offspring showed cardiac dysfunction, which may be related with Ang2 and AKT signaling impairments.

Ru(II)/amino acid complexes inhibit the progression of breast cancer cells through multiple mechanism-induced apoptosis.

For some cancer subtypes, such as triple-negative breast cancer, there are no specific therapies, which leads to a poor prognosis associated with invasion and metastases. Ruthenium complexes have been developed to act in all steps of tumor growth and its progression. In this study, we investigated the effects of Ruthenium (II) complexes coupled to the amino acids methionine (RuMet) and tryptophan (RuTrp) on the induction of cell death, clonogenic survival ability, inhibition of angiogenesis, and migration of MDA-MB-231 cells (human triple-negative breast cancer). The study also demonstrated that the RuMet and RuTrp complexes induce cell cycle blockage and apoptosis of MDA-MB-231 cells, as evidenced by an increase in the number of Annexin V-positive cells, p53 phosphorylation, caspase 3 activation, and poly(ADP-ribose) polymerase cleavage. Moreover, morphological changes and loss of mitochondrial membrane potential were detected. The RuMet and RuTrp complexes induced DNA damage probably due to reactive oxygen species production related to mitochondrial membrane depolarization. Therefore, the RuMet and RuTrp complexes acted directly on breast tumor cells, leading to cell death and inhibiting their metastatic potential; this reveals the potential therapeutic action of these drugs.

Antiepileptic effects of long-term intracerebroventricular infusion of angiotensin-(1-7) in an animal model of temporal lobe epilepsy.

Temporal lobe epilepsy (TLE) is the most frequent type of epilepsy and is often refractory to pharmacological treatment. In this scenario, extensive research has identified components of the renin-angiotensin system (RAS) as potential therapeutic targets. Therefore, the aim of the present study was to evaluate the effects of long-term treatment with angiotensin-(1-7) [Ang-(1-7)] in male Wistar rats with TLE induced by pilocarpine (PILO). Rats with TLE were submitted to intracerebroventricular (icv) infusion of Ang-(1-7) (200 ng/kg/h) for 28 days, starting at the first spontaneous motor seizure (SMS). Body weight, food intake, and SMS were evaluated daily. Behavioral tests and hippocampal protein levels were also evaluated at the end of the treatment. Ang-(1-7) treatment reduced the frequency of SMS and attenuated low anxiety levels, increased locomotion/exploration, and reduced body weight gain that was induced by TLE. Moreover, Ang-(1-7) positively regulated the hippocampal levels of antioxidant protein catalase and antiapoptotic protein B-cell lymphoma 2 (Bcl-2), as well as mammalian target of rapamycin (mTOR) phosphorylation, which were reduced by TLE. The hippocampal up-regulation of angiotensin type 1 receptor induced by TLE was also attenuated by Ang-(1-7), while the Mas receptor (MasR) was down-regulated compared with epilepsy. These data show that Ang-(1-7) presents an antiepileptic effect, increasing neuroprotection markers and reducing SMS frequency, body weight, and behavior impairments found in TLE. Therefore, Ang-(1-7) is a promising coadjutant therapeutic option for the treatment of TLE.

Blood pressure-lowering effects of a Bowman-Birk inhibitor and its derived peptides in normotensive and hypertensive rats.

Bioactive plant peptides have received considerable interest as potential antihypertensive agents with potentially fewer side effects than antihypertensive drugs. Here, the blood pressure-lowering effects of the Bowman-Birk protease inhibitor, BTCI, and its derived peptides, PepChy and PepTry, were investigated using normotensive (Wistar-WR) and spontaneously hypertensive rats (SHR). BTCI inhibited the proteases trypsin and chymotrypsin, respectively, at 6 µM and 40 µM, a 10-fold greater inhibition than observed with PepTry (60 µM) and PepChy (400 µM). These molecules also inhibited angiotensin converting enzyme (ACE) with IC50 values of 54.6 ± 2.9; 24.7 ± 1.1; and 24.4 ± 1.1 µM, respectively, occluding its catalytic site, as indicated by molecular docking simulation, mainly for PepChy and PepTry. Gavage administration of BTCI and the peptides promoted a decrease of systolic and diastolic blood pressure and an increase of renal and aortic vascular conductance. These effects were more expressive in SHR than in WR. Additionally, BTCI, PepChy and PepTry promoted coronary vasodilation and negative inotropic effects in isolated perfused hearts. The nitric oxide synthase inhibitor blunted the BTCI and PepChy, with no cardiac effects on PepTry. The findings of this study indicate a therapeutic potential of BTCI and its related peptides in the treatment of hypertension.

Reconstrução de mandíbula com retalho livre da fíbula em um caso de ameloblastoma / Mandibule reconstruction with free fibula flap in an ameloblastoma case

Objetivo: Relatar um caso de ameloblastoma na mandíbula, do tipo histológico plexiforme, com remoção completa da lesão e reconstrução com enxerto livre da fíbula. Materiais e métodos: Paciente do sexo feminino, 19 anos de idade, ASA I, atendida na Clínica Odontológica da Faculdade de Estudos Administrativos (FEAD), em Belo Horizonte, queixando-se de inchaço e incômodo na mandíbula do lado direito. O diagnóstico foi dado por exames clínicos e radiográficos e confirmado pelo exame anatomopatológico, que indicou ameloblastoma do tipo histológico plexiforme. O tratamento foi a hemimandibulectomia por meio do acesso submandibular do lado direito e reconstrução da área removida com enxerto livre da fíbula da paciente. Resultados: Remoção total da lesão com margem de segurança, reconstrução mandibular com placa óssea removida da fíbula. No pós-operatório foi realizada a laserterapia para melhor cicatrização e encaminhamento para tratamento fonoaudiólogico para ajudar na fonética e recuperação da função muscular, devido à excisão do nervo alveolar inferior, que teve como consequência uma parestesia definitiva comprometendo a fonética e a função. A paciente encontra-se há 2 anos sem sinais de reaparecimento do tumor e ausência de alterações funcionais. Conclusão: O tratamento adequado para este tipo de lesão neoplásica é controverso e sua indicação deve ser individualizada. A ressecção marginal é o tratamento mais seguro por remover completamente a lesão, determinar a cura por longo prazo e favorecer menor taxa de recorrência. A reconstrução mandibular com fíbula é considerada padrão-ouro por apresentar benefícios trans e pós-operatórios, levando-se em consideração riscos, benefícios e impacto na qualidade de vida do paciente.

Objective: to present a case of mandible ameloblastoma, plexiform histologic type, with complete removal of the lesion and reconstruction with free fibula graft. Materials and Methods: A 19-year-old female patient, ASA I, attended at the Dental Clinic of FEAD, in Belo Horizonte, complaining of swelling and discomfort in the right side of the jaw. The diagnosis was given by clinical and radiographic exams and confirmed by anatomopathological examination, which indicated ameloblastoma of plexiform histologic type. The treatment was hemimandibulectomy through right submandibular access and reconstruction of the area removed with free graft of the patient's fibula. Results: Total removal of the lesion with safety margin, mandibular reconstruction with bone plate removed from the fibula. No postoperative was performed to laser therapy for better healing and referral for speech therapy, to aid in the recovery of muscle function due to excision of the inferior alveolar nerve, which resulted in a definite paraesthesia compromising a phonetics and a function. The patient has been found for 1 year and 7 months with no signs of tumor recurrence and no employee. Conclusion: The adequate treatment for this type of neoplastic lesion is controversial and its indication must be individualized. Marginal resection is the safest treatment by completely removing the lesion, determining the long-term cure, and preferring lower recurrence rates. The mandibular reconstruction with fibula is standard gold-gold for presenting trans and postoperative benefits, leading to risks, impacts and impact on the quality of life of the patient.

Antitumor effectiveness and mechanism of action of Ru(II)/amino acid/diphosphine complexes in the peritoneal carcinomatosis progression.

Peritoneal carcinomatosis is considered as a potentially lethal clinical condition, and the therapeutic options are limited. The antitumor effectiveness of the [Ru(l-Met)(bipy)(dppb)]PF6(1) and the [Ru(l-Trp)(bipy)(dppb)]PF6(2) complexes were evaluated in the peritoneal carcinomatosis model, Ehrlich ascites carcinoma-bearing Swiss mice. This is the first study that evaluated the effect of Ru(II)/amino acid complexes for antitumor activity in vivo. Complexes 1 and 2 (2 and 6 mg kg-1) showed tumor growth inhibition ranging from moderate to high. The mean survival time of animal groups treated with complexes 1 and 2 was higher than in the negative and vehicle control groups. The induction of Ehrlich ascites carcinoma in mice led to alterations in hematological and biochemical parameters, and not the treatment with complexes 1 and 2. The treatment of Ehrlich ascites carcinoma-bearing mice with complexes 1 and 2 increased the number of Annexin V positive cells and cleaved caspase-3 levels and induced changes in the cell morphology and in the cell cycle phases by induction of sub-G1 and G0/G1 cell cycle arrest. In addition, these complexes reduce angiogenesis induced by Ehrlich ascites carcinoma cells in chick embryo chorioallantoic membrane model. The treatment with the LAT1 inhibitor decreased the sensitivity of the Ehrlich ascites carcinoma cells to complexes 1 and 2 in vitro-which suggests that the LAT1 could be related to the mechanism of action of amino acid/ruthenium(II) complexes, consequently decreasing the glucose uptake. Therefore, these complexes could be used to reduce tumor growth and increase mean survival time with less toxicity than cisplatin. Besides, these complexes induce apoptosis by combination of different mechanism of action.

Use of the buccal fat pad as free graft for closure of oronasal fistula in a cleft palate patient.

Oronasal fistulas are frequent complications after cleft lip and palate surgery, with difficult treatment because of the presence of fibrotic and scarred tissue as well as the absence of local virgin tissue, representing a challenge in oral and maxillofacial surgery. The size of the fistula, its location, and the cause of the defect are important factors to determine the type of treatment and surgical technique. The use of pedicled buccal fat pad (BFP) for the repair of cleft palate has shown promising results, becoming a safe and effective method. On the other hand, the use of BFP as a free graft for oral defects has been rarely described in the literature. The current study is the first case report that shows the use of free graft of BFP in oronasal fistula after cleft lip and palate surgery and aimed to discuss the promising results of this surgical technique, suggesting it as a treatment option for anterior maxillary defects, when properly indicated.

An alternative technique using a gutta percha points and blue methylene to excision of congenital fistula of lower lip in patient with Van der Woude syndrome.

Van der Woude syndrome is a rare disorder of craniofacial development, characterized by the triad (congenital lip fistula, cleft lip and/or cleft palate). Discomfort caused by spontaneous or induced drainage of saliva/mucus when pressure is applied or during a meal as well as poor aesthetics match is one of the main complaints of patients with congenital lip fistula. This paper aims to describe an alternative technique for excision of the congenital fistula of lower lip in patient with Van der Woude syndrome, using gutta percha points and methylene blue for better identify the the fullest extent of the fistula. This approach aims to facilitate a dissection of fistula tissues providing better preservation of the tissues around the fistula, faster healing and better aesthetics lip of the patient.

Deslocamento acidental de implante para o interior do seio maxilar / Accidental implant displacement into maxillary sinus

Introdução: a reabilitação bucal usando implantes é difundida em todo o mundo e tem sido desenvolvida há mais de trinta anos. Como toda técnica, a Implantodontia é passível de complicações que, muitas vezes, originam-se da inexperiência profissional, de fatores técnicos relacionados à instalação dos implantes, da necessidade de procedimentos complementares e fatores relacionados ao paciente. Apesar do grande número de implantes instalados na atualidade, a migração para o interior do seio maxilar é uma complicação rara. Existem diversas técnicas para corrigi-la e cabe ao profissional escolher a que mais se adequa ao paciente. Objetivo: esse artigo tem como objetivo relatar um caso de deslocamento acidental de implante para o interior do seio maxilar. Conclusão: o planejamento adequado é a melhor forma de evitar-se tal complicação, sendo prudente, por parte do cirurgião-dentista, a busca constante pelo aprimoramento profissional para o completo domínio teórico-prático das formas de prevenção, assim como das condutas e tratamentos específicos.

Introduction: The oral rehabilitation practice using dental implants have developed over the past thirty years. Like any technique, implant dentistry is subject to complications that often arise from professional inexperience, technical factors related to implant placement, the need for additional procedures and patient-related factors. Despite the large number of implants placed today, migration of an implant into the maxillary sinus is a rare complication. There are several techniques to correct it and it is up to the professional to choose the one that best suits the patient. Objective: This paper aims to report a case of accidental displacement of an implant into the maxillary sinus. Conclusions: Proper planning is the best tool to avoid such complications. It would be wise on the part of the dentist to constantly seek to improve their professional skills and knowledge in order to attain complete mastery of the theoretical and practical forms of prevention, as well as specific conducts and treatments.

Angiotensin-(1-7) receptor Mas is an essential modulator of extracellular matrix protein expression in the heart.

In this study we investigated the effects of genetic deletion of the Angiotensin-(1-7) receptor Mas or the Angiotensin II receptor AT(2) on the expression of specific extracellular matrix (ECM) proteins in atria, right ventricles and atrioventricular (AV) valves of neonatal and adult mice. Quantification of collagen types I, III and VI and fibronectin was performed using immunofluorescence-labeling and confocal microscopy. Picrosirius red staining was used for the histological assessment of the overall collagen distribution pattern. ECM proteins, metalloproteinases (MMP), ERK1/2 and p38 levels were quantified by western blot analysis. Gelatin zymography was used to evaluate the activity of MMP-2 and MMP-9. We observed that the relative levels of collagen types I and III and fibronectin are significantly higher in both the right ventricle and AV valves of neonatal Mas(-/-) mouse hearts (e.g., collagen type I: 85.28±6.66 vs 43.50±4.41 arbitrary units in the right ventricles of Mas(+/+) mice). Conversely, the level of collagen type VI was lower in the right ventricle and AV valves of Mas(-/-) mice. Adult Mas(-/-) mouse hearts presented similar patterns as observed in neonates. No significant differences in ECM protein level were detected in atria. Likewise, no changes in ECM levels were observed in AT(2) knockout mouse hearts. Although deletion of Mas induced a significant reduction in the level of the active form of MMP-2 in neonate hearts and a reduction of both MMP-2 and MMP-9 in adult Mas(-/-) mice, no significant differences were observed in MMP enzymatic activities when compared to controls. The levels of the active, phosphorylated forms of ERK1/2 and p38 were higher in hearts of both neonatal and adult Mas(-/-) mice. These observations suggest that Mas is involved in the selective expression of specific ECM proteins within both the ventricular myocardium and AV valves. The changes in the ECM profile may alter the connective tissue framework and contribute to the decreased cardiac performance observed in Mas(-/-) mice.

Tumor odontogênico adenomatóide em mandíbula / Tumor odontógeno adenomatoide de la mandíbula / Adenomatoid odontogenic tumor in mandible

El tumor odontógeno adenomatoide es una lesión relativamente infrecuente que afecta principalmente a las mujeres durante la segunda década de vida, porque su sitio predilecto es la región anterior de la mandíbula, con una lesión por lo general asociada con la corona del diente. Se reporta un caso de tumor odontógeno adenomatoide en la región anterior de la mandíbula junto con sus resultados clínicos, radiológicos e histológicos así como su tratamiento quirúrgico(AU)

Adenomatoid odontogenic tumor is a relatively uncommon lesion, which affects mainly individuals of the female during the second decade due, showing as a site of predilection for the anterior region of the maxilla presenting lesion usually associated with the crown of a tooth incluso. Os authors report a case of an adenomatoid odontogenic tumor in the anterior region of mandible, together with their clinical, radiographic and histological and its surgical treatment(AU)

Tumor odontogênico adenomatóide é uma lesão relativamente incomum, que acomete preferencialmente indivíduos do sexo feminino durante a segunda década de vida. Exibe como sítio de predileção a região anterior da maxila, é geralmente associado à coroa de um dente incluso. Este trabalho tem o objetivo de apresentar um caso clínico de tumor odontogênico adenomatóide. Este se apresenta localizado em região anterior da mandíbula. Pretende-se ainda abordar suas características clínicas, radiográficas e histológicas, além do tratamento cirúrgico conservador de eleição(AU)

Correlação entre a fração inspirada de oxigênio, a pressão parcial de oxigênio materno e a pressão parcial de oxigênio fetal durante parto cesáreo em gestações normais / Correlación entre la fracción inspirada de oxígeno, la presión parcial de oxígeno materno y la presión parcial de oxígeno fetal durante el parto por cesárea en embarazos normales / Correlation between the inspired fraction of oxygen, maternal partial oxygen pressure, and fetal partial oxygen pressure during cesarean section of normal pregnancies

JUSTIFICATIVA E OBJETIVOS: Apesar das alterações na função pulmonar, a oxigenação materna se mantém nas anestesias regionais para obstetrícia. Mesmo assim, nessas situações, o fornecimento de oxigênio suplementar para a mãe é prática disseminada. A principal justificativa é a boa oxigenação fetal; entretanto, não há devida comprovação. Este estudo prospectivo e com distribuição randômica das pacientes teve o objetivo de testar a hipótese da existência ou não de correlação entre hiperóxia materna e elevação de parâmetros gasométricos fetais na cesariana eletiva. MÉTODO: Foram estudadas vinte pacientes grávidas, submetidas à raquianestesia, através de gasometrias arteriais, com diferentes frações inspiradas de oxigênio e correlacionadas com a gasometria fetal. RESULTADOS: O aumento da fração inspirada de oxigênio materno não se correlacionou com o aumento da pressão parcial de oxigênio fetal. CONCLUSÕES: A indução de hiperóxia materna através de oxigenoterapia suplementar não foi capaz de aumentar a pressão parcial de oxigênio no feto. Não houve modificação nos parâmetros gasométricos fetais, mesmo em caso de mudança desses parâmetros na parturiente, induzidos pela hiperóxia durante a cesariana sob raquianestesia.

BACKGROUND AND OBJECTIVES: Despite changes in pulmonary function, maternal oxygenation is maintained during obstetric regional blocks. But in those situations, the administration of supplementary oxygen to parturients is a common practice. Good fetal oxygenation is the main justification; however, this has not been proven. The objective of this randomized, prospective study was to test the hypothesis of whether maternal hyperoxia is correlated with an increase in fetal gasometric parameters in elective cesarean sections. METHODS: Arterial blood gases of 20 parturients undergoing spinal block with different inspired fractions of oxygen were evaluated and correlated with fetal arterial blood gases. RESULTS: An increase in maternal inspired fraction of oxygen did not show any correlation with an increase of fetal partial oxygen pressure. CONCLUSIONS: Induction of maternal hyperoxia by the administration of supplementary oxygen did not increase fetal partial oxygen pressure. Fetal gasometric parameters did not change even when maternal parameters changed, induced by hyperoxia, during cesarean section under spinal block.

JUSTIFICATIVA Y OBJETIVOS: A pesar de las alteraciones en la función pulmonar, la oxigenación materna se mantiene en las anestesias regionales para obstetricia. Pero incluso así, en esas situaciones, el suministro de oxígeno suplementario para la madre se practica en forma diseminada. La principal justificación es la buena oxigenación fetal, sin embargo, no existe la debida comprobación al respecto. Este estudio prospectivo y con distribución randómica de las pacientes, tuvo el objetivo de comprobar la hipótesis de la existencia o no de una correlación entre la hiperoxia materna y la elevación de los parámetros gasométricos fetales en la cesárea por elección.? MÉTODO: Se estudiaron veinte pacientes embarazadas, sometidas a la raquianestesia, a través de gasometrías arteriales, con diferentes fracciones inspiradas de oxígeno y correlacionadas con la gasometría fetal. RESULTADOS: El aumento de la fracción inspirada de oxígeno materno no se correlacionó con el aumento de la presión parcial de oxígeno fetal. CONCLUSIONES: La inducción de hiperoxia materna a través de la oxigenoterapia suplementaria, no fue capaz de aumentar la presión parcial de oxígeno en el feto. No hubo modificación en los parámetros gasométricos fetales, incluso en el caso del cambio de esos parámetros en la parturiente, inducidos por la hiperoxia durante la cesárea bajo raquianestesia.

Estudo da eficácia da associação entre dexametasona, piroxican, cianocobalamina e orfenadrina (Rheumafim®) em modelos experimentais de inflamação em ratos / Efficacy of an association involving dexamethasone, piroxicam, cyanocobalamin and orphenadrine (Rheumafim®) in diverse inflammation models in rats

O cirurgião-dentista é diariamente apresentado a novos medicamentos, principalmente aqueles que objetivam a redução dos principais sinais clínicos pós-operatórios: dor e edema. Embora existam várias apresentações envolvendo drogas analgésicas e antiinflamatórias, em alguns casos se faz necessária a associação entre medicamentos, buscando uma eficácia ou uma duração de efeito maior. Recentemente, uma nova associação foi incluida no mercado farmacêutico visando a classe odontológica. O Rheumafim® é uma associação entre um antiinflamatório esteróide (dexamatasona), um não esteróide (piroxicam), uma vitamina com propriedades neuro-moduladoras (cianocobalamina), e, por fim, um relaxante muscular (orfenadrina). Neste trabalho, foi avaliada, em um modelo experimental, a eficácia da associação farmacológica entre os compostos do Rheumafim®, comparada individualmente com os antiinflamatórios presentes na formulação. Nossos dados demonstraram que o efeito analgésico alcançado com o tratamento dos animais com Rheumafim® foi superior aqueles obtido com o piroxicam e a dexametasona separadamente, em doses equivalentes. Entretanto, o efeito inibitório sobre a migração de leucócitos, bem como o antiedematogênio, foi observado de maneira similar no grupo tratado com a dexametasona e com o Rheumafim®. Nossos dados nos permitem concluir que a associação entre os princípios ativos do Rheumafim® promove uma potencialização do efeito analgésico e antiinflamatório final.

Dentists arefrequently presented to new drugs, manly to those that aim to control postoperative symptoms: pain and edema. In despite of the different available drugs, in some cases is necessary to combine two or more different drgs in order to achieve better therapeutic results. Recently, a new association involving four drugs was releases in the odontology market. Rheumaphim® is a pharmacological association involving a sterioidal anti-inflammatory drug (dexamathasone), a nonsteroidal anti-inflammatory drugs, vitamin B12, and a myorelaxant. In this work, we set up to evaluated experimentally, using animal model of inflammation, the efficacy of this drug in compassion to the anti-inflammatory drugs presented in this drug alone. Our data suggest that the analgesic effect achieved with Rhuemaphim® was higher in comparison with both anti-inflammatory drugs alone. However, edema and leokocyte migration inhibition were completely dependent on dexamethasone activity. Our data allow us to suggest that the drug association found in Rheumaphim® can promote better results in compariosn to each anti-inflammatory alone, considering the final anti-inflammatory effect.

Estudo comparativo da eficácia analgésica pós-operatória de 20 mL de ropivacaína a 0,5, 0,75 ou 1 por cento no bloqueio de plexo braquial pela via posterior / Estudio comparativo de la eficacia analgésica postoperatoria de 20 mL de ropivacaina a 0,5, 0,75 ó 1 por ciento en el bloqueo de plexo braquial por la vía posterior / Comparative study for the postoperative analgesic efficacy of 20 mL at 0.5, 0.75, and 1 percent ropivacaine in posterior brachial plexus block

JUSTIFICATIVA E OBJETIVOS: As intervenções cirúrgicas por via artroscópica no ombro estão relacionadas com a dor pós-operatória de grande intensidade. Dentre as técnicas de analgesia, o bloqueio do plexo braquial é a que oferece os melhores resultados. O objetivo deste estudo foi determinar qual concentração de anestésico local no bloqueio de plexo braquial pela via posterior propicia analgesia pós-operatória mais prolongada para essas operações. MÉTODO: Noventa pacientes submetidos ao bloqueio do plexo braquial pela via posterior foram divididos aleatoriamente em três grupos de 30. Grupo 1: 20 mL de ropivacaína a 0,5 por cento; Grupo 2: 20 mL de ropivacaína a 0,75 por cento; Grupo 3: 20 mL de ropivacaína a 1 por cento. O bloqueio foi avaliado por meio da pesquisa de sensibilidade térmica utilizando-se algodão embebido em álcool e a dor pós-operatória foi avaliada seguindo-se uma escala numérica verbal (ENV) nas primeiras 48 horas. RESULTADOS: Nos três grupos a analgesia pós-operatória foi similar segundo os parâmetros avaliados; ENV de dor média, tempo até a primeira queixa de dor e consumo de opióides no pós-operatório. CONCLUSÕES: Este estudo mostrou que o bloqueio do plexo braquial pela via posterior é uma técnica que promove analgesia eficaz para intervenções cirúrgicas no ombro. Utilizando-se 20mL de ropivacaína, as três diferentes concentrações estudadas promovem analgesia similar.

BACKGROUND AND OBJECTIVES: Arthroscopic shoulder surgeries are associated with severe postoperative pain. Among the analgesic techniques available, brachial plexus block has the best results. The objective of this study was to determine which concentration of local analgesic used in the posterior brachial plexus block provides longer postoperative analgesia. METHODS: Ninety patients undergoing posterior brachial plexus block were randomly divided into three groups of 30 patients each. Group I: 20 mL of 0.5 percent ropivacaine; Group 2: 20 mL of 0.75 percent ropivacaine; and Group 3: 20 mL of 1 percent ropivacaine. The blockade was evaluated by assessing the thermal sensitivity using a cotton pad with alcohol and postoperative pain was evaluated according to a Verbal Numeric Scale (VNS) in the first 48 hours. RESULTS: Postoperative analgesia was similar in all three groups according to the parameters evaluated: mean VNS, time until the first complaint of pain, and postoperative opioid consumption. CONCLUSIONS: This study demonstrated that posterior brachial plexus block provides effective analgesia for shoulder surgeries. Twenty milliliters of ropivacaine in the different concentrations used in this study promoted similar analgesia.

JUSTIFICATIVA Y OBJETIVOS: Las intervenciones quirúrgicas por vía artroscópica en el hombro se relacionan con el dolor postoperatorio de gran intensidad. Entre las técnicas de analgesia, el bloqueo del plexo braquial es la que ofrece los mejores resultados. El objetivo de este estudio fue determinar cuál concentración de anestésico local en el bloqueo de plexo braquial por la vía posterior, propicia analgesia postoperatoria más prolongada para esas operaciones. MÉTODO: Noventa pacientes sometidos al bloqueo del plexo braquial por la vía posterior se dividieron aleatoriamente en tres grupos de 30. Grupo 1: 20 mL de ropivacaina a 0,5 por ciento; Grupo 2: 20 mL de ropivacaina a 0,75 por ciento; Grupo 3: 20 mL de ropivacaina a 1 por ciento. El bloqueo se evaluó a través de la investigación de sensibilidad térmica utilizando algodón con alcohol y el dolor postoperatorio se evaluó según una escala numérico verbal (ENV) en las primeras 48 horas. RESULTADOS: En los tres grupos la analgesia postoperatoria fue similar según los parámetros evaluados; ENV de dolor medio, tiempo hasta el primer quejido de dolor y consumo de opioides en el postoperatorio. CONCLUSIONES: Este estudio mostró que el bloqueo del plexo braquial por la vía posterior es una técnica que promueve una analgesia eficaz para intervenciones quirúrgicas en el hombro. Utilizando 20 mL de ropivacaina, las tres diferentes concentraciones estudiadas promueven analgesia similar.

Hematoma subdural após punção inadvertida da dura-máter: relato de caso / Subdural hematoma after inadvertent dura mater puncture: case report / Hematoma subdural después de la punción inadvertida de la duramadre: relato de caso

JUSTIFICATIVA E OBJETIVOS: A cefaléia pós-punção da dura-máter é complicação bastante conhecida das anestesias subaracnóidea e peridural, e o tratamento mais difundido é o tampão sangüíneo. O tampão sangüíneo alivia totalmente a cefaléia na grande maioria dos pacientes, e nos demais não há melhora ou, apenas, melhora parcial. Nesses casos, é prudente buscar diagnósticos diferenciais, como o hematoma subdural ou pneumoencéfalo. Os métodos de imagem são extremamente úteis nessas situações. O objetivo deste relato foi apresentar o caso de um paciente que desenvolveu hematoma subdural intracraniano após punção inadvertida da dura-máter em anestesia peridural. RELATO DO CASO: Paciente do sexo masculino, 47 anos, 147 kg, 1,90 m, estado físico ASA II, foi admitido para realização de dermolipectomia abdominal, após ter-se submetido à gastroplastia redutora. Durante anestesia peridural, houve perfuração acidental da dura-máter. O paciente evoluiu com sintomas de cefaléia pós-punção da dura-máter que foram tratados com tampão sangüíneo, com melhora parcial. Houve, posteriormente, piora da cefaléia, e a ressonância nuclear magnética de encéfalo mostrou hematoma subdural intracraniano, que foi tratado clinicamente. Houve melhora progressiva, com recuperação total após 30 dias. CONCLUSÕES: A ocorrência de hematoma subdural é complicação rara, mas grave da perfuração de dura-máter. O diagnóstico é difícil e deve ser sempre cogitado quando a cefaléia pós-punção da dura-máter não se resolve com o tampão sangüíneo ou piora com sua realização. No esclarecimento diagnóstico é fundamental o auxílio de um método de imagem.

BACKGROUND AND OBJECTIVES: Post-dural puncture headache is a well-known complication of epidural and subarachnoid blockades and the blood patch is the treatment used more often. In most patients, the blood patch relieves the headache completely, but for the remaining there is no improvement or only partial relief of the symptom. In those cases, it is prudent to look for other differential diagnosis, such as subdural hematoma or pneumoencephalus. In those situations, imaging exams are extremely useful. The objective of this report was to present the case of a patient who developed subdural hematoma after accidental puncture of the dura mater during epidural block. CASE REPORT: A 47-year old male patient, 147 kg, 1.90 m, physical status ASA II, was admitted for abdominal dermolipectomy after undergoing gastroplasty. The dura mater was accidentally punctured during the epidural block. The patient developed post-dural puncture headache treated with an epidural blood patch, with partial improvement of his symptoms. However, it was followed by worsening of the headache and an MRI showed the presence of an intracranial subdural hematoma, which was treated clinically. The patient evolved with progressive improvement of the symptom and full recovery after 30 days. CONCLUSIONS: Subdural hematoma is a rare, but severe, complication of dura mater puncture. It is difficult to diagnose, but it should always be remembered when post-dural puncture headache shows no resolution or even worsens after an epidural blood patch. An imaging exam is fundamental for the diagnosis of this rare complication.

JUSTIFICATIVA Y OBJETIVOS: La cefalea pos punción de la duramadre es una complicación bastante conocida de las anestesias subaracnoidea y epidural, siendo que el tratamiento más difundido es el tapón sanguíneo. El tapón sanguíneo alivia totalmente la cefalea en la gran mayoría de los pacientes, y en los demás no hay mejorías o apenas se ve una mejoría parcial. En esos casos, es prudente buscar diagnósticos diferenciales, como el hematoma subdural o neumoencéfalo. Los métodos de imagen son extremadamente útiles en esas situaciones. El objetivo de este relato fue el de presentar el caso de un paciente que debutó con hematoma subdural intracraneal después de la punción inadvertida de la duramadre en anestesia epidural. RELATO DEL CASO: Paciente del sexo masculino, 47 años, 147 kg, 1,90 m, estado físico ASA II, fue admitido para la realización de dermolipectomía abdominal, después de haberse sometido a la gastroplastía reductora. Durante la anestesia epidural, hubo perforación accidental de la duramadre. El paciente evolucionó con síntomas de cefalea pospunción de la duramadre que fueron tratados con tapón sanguíneo, obteniéndose una mejora parcial. Hubo posteriormente, un empeoramiento de la cefalea y la resonancia nuclear magnética de encéfalo mostró un hematoma subdural intracraneal, que se trató clínicamente. Hubo una mejoría progresiva, con recuperación total después de 30 días. CONCLUSIONES: La aparición de hematoma subdural es una complicación rara, pero grave de la perforación de la duramadre. El diagnóstico es difícil y debe ser siempre pensado, cuando la cefalea pospunción de la duramadre no se resuelva con el tapón sanguíneo o tampoco se resuelva su empeoramiento. En la aclaración del diagnóstico es fundamental la ayuda de un método de imagen.