Hypnosis and superficial cervical anesthesia for total thyroidectomy in a high-risk patient - A case report.

INTRODUCTION: Total thyroidectomy can be challenging in high-risk patients. Local cervical anesthesia with sedation is an alternative to general anesthesia. CASE PRESENTATION: A 33-year old male patient with cyanotic congenital heart disease due to unrepaired tricuspid atresia type Ic and associated pulmonary arterial hypertension presented with tachycardic atrial fibrillation and amiodarone-induced thyrotoxicosis resulting in recurrent hemodynamic instability. Because of difficulties controlling the thyrotoxic state, the indication for total thyroidectomy was established. Total thyroidectomy was subsequently performed using local anesthesia combined using a hypnosis-analgesia technique instead of intravenous sedation. The intervention and the post-operative course were uneventful. DISCUSSION: A well-established therapist-patient relationship is crucial for a successful induction of hypnosis. Patient motivation and expectations are equally important for a successful implementation of this approach. CONCLUSION: We conclude that hypnosis combined with local anesthesia provides an effective alternative in selected patients with very high anesthesiological risk.

Prevention of vascular damage with Lisosan G wheat extract: the in vitro basis for a clinical investigation.

Vascular damage and impairment play a crucial role in the pathogenesis of nonalcoholic fatty liver disease (NAFLD). Nutraceutical supplements might have a role in reducing vascular damage, provided that their efficacy is proven by controlled studies and is supported by a mechanistic rationale. Therefore, the use of nutraceutical supplements can have some effects also in the prevention of NFLD. Epidemiological evidence correlates the intake of whole grain and whole-grain products with a reduced occurrence of vascular disease. Lisosan G is a powder obtained from Triticum Sativum (wheat), which is registered with the Italian Ministry of Health as a nutritional supplement. In vivo, Lisosan G has been shown to protect against cisplatin induced toxicity, and the use of this compound in the prevention of cirrhosis and steatosis has been recently been proposed thanks to its marked anti-oxidant activity. We discuss here the rationale for further investigation on this compound in the prevention of NAFLD.

Diuretic activity and acute oral toxicity of Palicourea coriacea (Cham.) K Schum.

AIM OF THE STUDY: Palicourea coriacea (Cham.) K Schum, is an endemic plant used in the Midwestern Region of Brazil, popularly known as "douradinha do campo" and "congonha do campo". This plant has been used in traditional medicine for several ailments, especially to treat kidney diseases. Since no formal studies on the biological activities and medicinal properties of the ethanolic extract of Palicourea coriacea (PCEE) have been carried out previously, the present study represents the first research into the efficacy of this plant as a diuretic agent employing laboratory rats as test animals. MATERIALS AND METHODS: For diuretic activity evaluation we assayed three doses of PCEE (20, 40 and 80mg/kg) and measurement of the urinary volume and electrolytes (Na(+), K(+)) concentration were taken. The acute oral toxicity of PCEE was investigated according to OECD Guideline 423. RESULTS: The oral administration of a single dose of PCEE significantly increased the urinary volume in 24h. Additionally, the treatment with PCEE increased, in a dose-dependent manner, the excretion of both, Na(+) and K(+). No sign of toxicity was observed in the animals. CONCLUSIONS: The present study confirmed the ethnopharmacological use of Palicourea coriacea as a diuretic agent in the experimental condition tested here. Additionally, this work supports the importance of the preservation of local knowledge as well as the conservation of Brazilian biodiversity.