Single needle versus double needle celiac trunk neurolysis in abdominal malignancy pain management: a randomized controlled trial / Neurólise do tronco celíaco com o uso de agulha única versus agulha dupla no manejo da dor abdominal maligna: estudo randômico controlado

Abstract Background: Computerized tomography-guided celiac plexus neurolysis has become almost a safe technique to alleviate abdominal malignancy pain. We compared the single needle technique with changing patients' position and the double needle technique using posterior anterocrural approach. Methods: In Double Needles Celiac Neurolysis Group (n = 17), we used two needles posterior anterocrural technique injecting 12.5 mL phenol 10% on each side in prone position. In Single Needle Celiac Neurolysis Group (n = 17), we used single needle posterior anterocrural approach. 25 mL of phenol 10% was injected from left side while patients were in left lateral position then turned to right side. The monitoring parameters were failure block rate and duration of patient positioning, technique time, Visual Analog Scale, complications (hypotension, diarrhea, vomiting, hemorrhage, neurological damage and infection) and rescue analgesia. Results: The failure block rate and duration of patient positioning significantly increased in double needles celiac neurolysis vs. single needle celiac neurolysis (30.8% vs. 0%; 13.8 ± 1.2 vs. 8.9 ± 1; p = 0.046, p ≤ 0.001 respectively). Also, the technique time increased significantly in double needles celiac neurolysis than single needle celiac neurolysis (24.5 ± 5.1 vs. 15.4 ± 1.8; p ≤ 0.001). No significant differences existed as regards Visual Analog Scale: double needles celiac neurolysis = 2 (0-5), 2 (0-4), 3 (0-6), 3 (2-6) and single needle celiac neurolysis = 3 (0-5), 2 (0-5), 2 (0-4), 4 (2-6) after 1 day, 1 week, 1 and 3 months respectively. However, Visual Analog Scale in each group reduced significantly compared with basal values (p ≤ 0.001). There were no statistically significant differences as regards rescue analgesia and complications (p > 0.05). Conclusion: Single needle celiac neurolysis with changing patients' position has less failure block rate, less procedure time, shorter duration of patient positioning than double needles celiac neurolysis in abdominal malignancy.

Resumo Introdução: A neurólise do plexo celíaco guiada por tomografia computadorizada tornou-se uma técnica quase segura para aliviar a dor abdominal maligna. Comparamos a técnica de agulha única mudando o posicionamento do paciente e a técnica de agulha dupla usando a abordagem anterocrural posterior. Métodos: No grupo designado para neurólise celíaca com agulha dupla (n = 17), a técnica de abordagem anterocrural posterior foi utilizada com duas agulhas para injetar 12,5 mL de fenol a 10% de cada lado em decúbito ventral. No grupo designado para neurólise celíaca com agulha única (n = 17), a abordagem anterocrural posterior foi utilizada com uma única agulha para injetar 25 mL de fenol a 10% do lado esquerdo com o paciente em decúbito lateral esquerdo e posteriormente virado para o lado direito. Os parâmetros de monitorização foram a taxa de falha dos bloqueios e a duração do posicionamento dos pacientes, o tempo da técnica, os escores da escala visual analógica, as complicações (hipotensão, diarreia, vômitos, hemorragia, dano neurológico e infecção) e a analgesia de resgate. Resultados: A taxa de falha dos bloqueios e a duração do posicionamento dos pacientes aumentaram significativamente na neurólise celíaca com o uso de agulha dupla vs. agulha única (30,8% vs. 0%,13,8 ± 1,2 vs. 8,9 ± 1; p = 0,046, p ≤ 0,001, respectivamente). Além disso, o tempo da técnica foi significativamente maior na neurólise celíaca com agulha dupla que na neurólise celíaca com agulha única (24,5 ± 5,1 vs. 15,4 ± 1,8; p ≤ 0,001). Não houve diferença significativa em relação aos escores da escala visual analógica: neurólise celíaca com agulha dupla = 2 (0-5), 2 (0-4), 3 (0-6), 3 (2-6) e neurolise celíaca com agulha única = 3 (0-5), 2 (0-5), 2 (0-4), 4 (2-6) após um dia,uma semana, um e três meses, respectivamente. No entanto, os escores da escala visual analógica para cada grupo foram significativamente menores comparados aos valores basais (p ≤ 0,001). Não houve diferença estatisticamente significativa quanto à analgesia de resgate e complicações (p > 0,05). Conclusão: A neurólise celíaca com o uso de agulha única e a alteração do posicionamento do paciente apresenta uma taxa menor de falha do bloqueio, menos tempo de procedimento e menor duração do posicionamento do paciente que o uso de duas agulhas para neurólise celíaca em malignidade abdominal.

Histopathological aspects of cutaneous photoaging and phenol peeling

The skin is regarded as the largest organ in our system and has the general purposes of physical, mechanical and immunological protection, sealing against the elements and thermoregulation and tactile perception of environmental stimuli. Skin aging is a complex biological event that affects all skin layers. The dermis, however, is particularly affected due to its histophysiologies' characteristics. With the expansion of life expectancy, the dermatological questions among the older population has had an increasingly bigger importance, propelling the development and perfecting of rejuvenation techniques. The phenol peeling is a deep, chemical one, which offers intense clinical results. The application on small areas of the body, for example, around the eyes, is safe and does not lead to cardiovascular complications. This review aims to update the knowledge of skin histology, the alterations related to photoaging and phenol peeling.

Renal functional & haemodynamic changes following acute unilateral renal denervation in Sprague Dawley rats.

Background & objectives: Regulation of renal function and haemodynamics are under a direct control from the renal sympathetic nerves and renal denervation produces overt diuresis and natriuresis in several mammalian species. However, the inter-related series of changes in renal function and haemodynamics following acute renal denervation (ARD) is not fully understood. Thus, we aimed to investigate and relate the changes in renal function and haemodynamics following acute unilateral renal denervation in anaesthetized Sprague Dawley (SD) rats. Methods: Male SD rats were fasted overnight, anaesthetized with sodium pentobarbitone (60 mg/kg ip), denervated by application of phenol to the left renal artery and maintained on an intravenous (iv) infusion of isotonic saline for 2 h. Throughout this period, six urine and plasma samples were taken at 20-min intervals to study kidney function parameters. In a different set of experiments, renal nerve stimulation (RNS) was carried out to characterize the changes in renal vasoconstrictor responses following ARD. Results: Denervated animals showed significantly (P<0.05 vs. control innervated rats) higher urine flow rate (UFR), absolute sodium excretion (UNaV), fractional sodium excretion (FENa) and glomerular filtration rate (GFR). The renal vasoconstrictor responses to RNS were significantly (P<0.05) lower in denervated rats as compared to the innervated counterparts. However, no appreciable differences were seen in the mean arterial pressure (MAP), plasma sodium (PNa), basal renal blood flow (RBF) and basal renal vascular resistance (RVR) in both innervated and denervated SD rats. Interpretation & conclusions: Natriuresis, diuresis, enhanced GFR and impaired vasoconstriction in response to RNS are typical and instant responses to ARD in SD rats. Renal sympathetic nerves serve more important role in salt and water conservation than in dynamic autoregulation of RBF under normal sympathetic tone; yet, their effects on renal haemodynamics become more evident in the presence of augmented renal sympathetic nerve activity (RSNA).

Effects of intraperitoneal injection of phenol, glycerin and acetic acid on neoplastic ascitis in guinea pigs / Efeitos da injeção intraperitoneal de fenol, glicerina e ácido acético na ascite neoplásica em cobaias

PURPOSE: To investigate the histolytic action of a solution composed by phenol, glycerin and acetic acid on neoplastic ascitis in guinea pigs. METHODS: Thirty-two guinea pigs were used. The animals were randomly distributed in experimental and control groups, and the effects of the peritoneal injection of the testing solution were studied. Saline solution was used for the control groups. Biochemical and anatomopathological (heart, lungs, kidneys, spleen and peritoneal serous membrane) were evaluated at 24 hours and 4 weeks of development. RESULTS: It was observed that solution E, when infused into the peritoneal cavity, caused no clinical, histological or laboratory alterations in these animals when compared to those in the control group. CONCLUSION: Given our results, it would be interesting to study the effects of the proposed solution on cases with experimental neoplastic ascites with a later view to treating it in humans.

OBJETIVO: Investigar a ação hìstolítica de uma solução composta de fenol, glicerina e ácido acético na ascite neoplásica em cobaias. MÉTODOS: Foram utilizadas 32 cobaias, distribuídas por sorteio, em grupos experimentais e controles e estudados os efeitos da injeção peritonial da solução teste. Nos grupos controles empregou-se solução fisiológica. Foram estudadas alterações bioquímicas, anatomopatológicas (coração, pulmões, rins, baço e serosa peritonial), com 24 horas e 4 semanas de evolução. RESULTADOS: Verificou-se que a solução E quando instilada na cavidade peritonial não provocou nenhuma alteração clinica, histologica ou laboratorial nestes animais, quando comparados com o grupo controle. CONCLUSÃO: Frente aos resultados obtidos, consideramos interessante estudar os efeitos da solução proposta em casos de ascite neoplásica experimental em animais, com posterior estudo em seres humanos.

Sclerotherapy of idiopathic hydroceles and epididymal cysts: a historical comparison trial of 5% phenol versus tetracycline

Operating time for idiopathic hydroceles and epididymal cysts is scarce as these conditions compete with an increasing caseload of more consequential surgical disease. Therapy is often relegated to repeated aspiration. Sclerotherapy appears to be effective in a majority of published trials, but comparative effectiveness, efficacy and safety of most agents, including phenol versus tetracycline, has not been established A deliberate strategy of re-treatment until cure is not universally practised, with surgery still being offered after single-treatment failures. Two trials, the first consisting of 53 scrotal cysts treated with 5% phenol-in-water and the second, 42 cysts treated with tetracycline, are compared for effectiveness, efficacy and safety of sclerotherapy per se and of re-treatment. Intention-to-treat analysis yields similar cure rates (no re-accumulation three months after last injection) for phenol and tetracycline (83% and 81% respectively, p = 0.8). Per-protocol analysis also yields similar cure rates (100% and 97% respectively, p = 0.26) and mean number of injections to cure (1.34 and 1.12 respectively, p = 0.069), with range 1-4 and 1-3 respectively. Severe pain following tetracycline injection required administration of pre-injection cord block. Other complications occurred equally (25% and 25.7% respectively, p = 0.94) and were trivial except for one case of chronic haematocele treated by orchiectomy in the tetracycline group. Phenol (5%) and tetracycline are equally efficacious sclerosants for idiopathic scrotal cysts, achieving almost 100% cure with re-treatment and matching the efficacy of surgery. Concern about post-treatment fertility applies equally to surgery and demands informed consent for both modalities.

El tiempo de operación para los hidroceles y los quistes epididimales es escaso, ya que estas condiciones triviales compiten con una creciente carga de casos de enfermedades quirúrgicas de mayores consecuencias. La terapia es a menudo relegada a una aspiración repetida. La escleroterapiaparece ser efectiva en la mayoría de los ensayos publicados, pero no se han establecido la seguridad, eficacia y efectividad comparativa de la mayor parte de los agentes, incluyendo el fenol, frente a la tetraciclina. No se practica universalmente una estrategia deliberada de re-tratamiento hasta la cura, ofreciéndose todavía la cirugía, luego de fracasos con tratamientos individuales. Dos ensayos, el primero consistente en 53 quistes escrotales tratados con fenol acuoso al 5%, y el segundo, en 42 quistes tratados con tetraciclina, se comparan en cuanto a efectividad, eficacia y seguridad para laescleroterapia per se y para el re-tratamiento. El análisis de intención de tratamiento produce tasas de curación similares (no hay re-acumulación 3 meses después de la última inyección) para el fenol y la tetraciclina (83% y 81% respectivamente, p = 0.8). El análisis por protocolo también produce tasas de curación similares (100% y 97% respectivamente, p = 0.26) y el número medio de inyecciones paracurar (1.34 y 1.12 respectivamente, p = 0.069), con rangos de 1–4 y 1–3 respectivamente. El dolor severo tras la inyección de tetraciclina requirió hacer un bloqueo espinal de pre-inyec-ción. Asimismo ocurrieron otras complicaciones (25% y 25.7% respectivamente, p = 0.94) y fueron triviales, con excepción de un caso de hematoceles crónicos tratado mediante orquiectomía en el grupo de tetraciclina. El fenol (5%) y la tetraciclina poseen igual eficacia como esclerosantes de los quistes escrotales idiopáticos, ya que logran una curación de casi 100% con el re-tratamiento, e igualan la eficacia de la cirugía...

Rejuvenescimento facial: peeling de fenol atenuado / Face anti-ageing: profound phenolmethod

O objetivo do presente estudo é descrever a técnica de peeling de fenol pré-oxidado, os principais cuidados pré e pós-operatórios e a avaliação dos resultados obtidos em quatro pacientes submetidos ao método, breve comparação com o método de fenol profundo tradicional de Backer e Gordon.Apresenta-se, ainda.Ao final, conclui-se que o método de peeling de fenol pré-oxidado, sem a necessidade de máscaras oclusivas, é seguro, reprodutível e demonstra um alto grau de aceitação no grupo submetido ao tratamento.

The objective of the present work is to describe the techniques of phenol peeling, the main pre-peeling and post-peeling care and the evaluation from this method of the results obtained by four patients. Comparison with Backer and Gordon traditional profound phenol method. Finally, the conclusion is that the profound phenol peeling method which doesn't use occlusive mascara is secure, reproducible and shows a real acceptance in the group submitted to the treatment.

Pharmacologic interventions for reducing spasticity in cerebral palsy.

Motor function abnormalities are a key feature of cerebral palsy. Spasticity is one of the main motor abnormalities seen in children with cerebral palsy. Spasticity is a velocity dependent increased resistance to movement. While in some children, spasticity may adversely impact the motor abilities, in others, it may help maintain posture and ability to ambulate. Thus, treatment to reduce spasticity requires careful consideration of various factors. Non-pharmacologic interventions used to reduce spasticity include physiotherapy, occupational therapy, use of adaptive equipment, various orthopedic surgical procedures and neurosurgical procedures. Pharmacologic interventions used for reducing spasticity in children with cerebral palsy reviewed in this article include oral administration of baclofen, diazepam, dantrolene and tizanidine, intrathecal baclofen, and local injections of botulinum toxin, phenol, and alcohol.

Pesquisa de puntos gatillo abdominales en pacientes que consultan por algia pelviana / Search of abdominal trigger block points in patients with chronic pelvic pain

En seis pacientes que consultan por dolor pelviano crónico se efectuó el diagnóstico de dolor mioponeurótico. Se procedió a infiltrar los puntos gatillo con lidocaína al 2 por ciento para establecer el diagnóstico y posteriormente con fenol al 10 por ciento para obtener una remisión más duradera del dolor. Tres pacientes obtuvieron excelente respuesta con desaparición del dolor, dos pacientes, aunque mejoraron, hubo persistencia de dolor y en una paciente no hubo respuesta. Se revisa brevemente la fisiología del dolor. El ginecólogo debe tener presente la posibilidad de que la paciente con dolor pelviano crónico sea portadora de puntos gatillo, los que son fácilmente diagnosticados y en algunos casos, definitivamente tratados