Complex Regional Pain Syndrome Type I: Evidence for the CB1 and CB2 Receptors Immunocontent and Beneficial Effect of Local Administration of Cannabidiol in Mice.

Introduction: Complex regional pain syndrome type I (CRPS-I) is a debilitating neuropathic painful condition associated with allodynia, hyperalgesia, sudomotor and/or vasomotor dysfunctions, turning investigation of its pathophysiology and new therapeutic strategies into an essential topic. We aim to investigate the impact of ischemia/reperfusion injury on the immunocontent of CB1 and CB2 cannabinoid receptor isoforms in the paws of mice submitted to a chronic postischemia pain (CPIP) model and the effects of local administration of cannabidiol (CBD) on mechanical hyperalgesia. Methods: Female Swiss mice, 30-35 g, were submitted to the CPIP model on the right hind paw. Skin and muscle samples were removed at different periods for western blot analysis. Results: No changes in the immunocontent of CB1 and CB2 receptors in paw muscle tissues after ischemia-reperfusion were observed. CBD promoted an antihyperalgesic effect in both phases. AM281 reversed the effect of CBD, whereas ruthenium red abolished the late phase. Conclusion: Our results point to the possible beneficial effects of local administration of CBD in modulating CRPS-I in humans. As possible targets for CBD antihyperalgesia in this model, the contribution of cannabinoid receptor CB1, in addition to TRPM8 is suggested.

Tabagismo e uso de anticoncepcionais orais relacionados a fenômenos tromboembólicos: relato de caso e revisão de literatura / Smoking and the use of oral contraceptives related to thromboembolic events: a case report and literature review

Objetivo: Fazer revisão de literatura sobre tabagismo e uso de anticoncepcionais orais (ACO) relacionados a fenômenos tromboembólicos, com apresentação do caso clínico de trombose proximal de artéria mesentérica superior e extensa necrose de intestino delgado em paciente do sexo feminino com coagulopatia provável por associação de uso de anticoncepcional oral com tabagismo. Materiais e métodos: Revisão bibliográfica, com seleção de artigos científicos nacionais e internacionais por meio de busca no banco de dados do PubMed, Lilacs e SciELO. Resultados: A relação entre uso de contraceptivos orais combinados e risco aumentado de doenças tromboembólicas baseia­se na ação pró­coagulante dos ACO, torna­se fator de risco para a ocorrência de trombose arterial e venosa. Já o tabagismo, isoladamente, apresenta risco moderadamente aumentado de trombose venosa em comparação com não fumantes. Ademais, observou­se relação entre trombose de artéria mesentérica superior com uso de anticoncepcional oral associado ao tabagismo. Conclusões: Todos os estudos analisados confirmaram o uso de ACO e o tabagismo como fatores de risco para o desenvolvimento de doenças tromboembólicas. O estudo feito com base na história clínica da paciente sugere um caso de trombose arterial secundária a coagulopatia pela combinação de fumo com o uso de ACO combinado.(AU)

Purpose: Conduct a review of the literature on smoking and use of oral contraceptives related to thromboembolic events, with presentation of the case of proximal thrombosis of the superior mesenteric artery and extensive necrosis of the small intestine in a female patient with probable coagulopathy caused by the association of oral contraceptive with smoking. Materials and methods: This study consisted of a literature review, with selection of national and international scientific articles through research in PubMed, Lilacs and SciELO database. Results: The relationship between the use of combined oral contraceptives and increased risk of thromboembolic disease is based on the procoagulant action of OCs, which translates into a risk factor for the occurrence of arterial and venous thrombosis. Smoking alone has moderately increased risk of venous thrombosis compared with non­smokers. Besides that, there is a relation between the superior mesenteric artery thrombosis with the use of oral contraceptives associated with smoking. Conclusion: All analysed studies have confirmed the use of OCs and smoking as risk factors for the development of thromboembolic diseases. The study based on the clinical history of the patient suggests a case of secondary arterial thrombosis coagulopathy by combining smoking with the use of combined OCs.

Incidência de hérnias incisionais em pacientes submetidos a laparotomias medianas em um hospital de ensino no interior do estado do Rio Grande do Sul / Incidence of incisional hernias in patients submitted to midline laparotomy in a teaching hospital in the interior of Rio Grande do Sul

Introdução: Avaliar o comportamento da parede abdominal dos pacientes submetidos à laparotomia mediana em um programa de residência médica em cirurgia geral no interior do estado do Rio Grande do Sul. Métodos: Trata-se de um estudo longitudinal de cará- ter descritivo que avalia o comportamento da parede abdominal após laparotomia mediana, no período de 2011 a 2014, em pacientes com idade superior a 13 anos. Resultados: Dos 30 pacientes avaliados, 12 apresentaram hérnia incisional (40%); destes, 25% eram obesos e 25% diabéticos. Em 17% dos casos com hérnia incisional, houve infecção de ferida operatória. No grupo que apresentou hérnia, a maioria dos pacientes teve o fechamento de sua parede realizado por residentes do primeiro ano (R1). Em 42% dos casos com hérnia, foi utilizado poliglactina 910 para fechamento da parede abdominal. Os pacientes que foram diagnosticados com hérnia incisional permaneceram internados uma média de 4 dias a menos que os pacientes que não apresentaram hérnia. Todos os pacientes foram submetidos à laparotomia mediana e 29 deles foram submetidos à cirurgia de urgência, não sendo possível realizar uma comparação entre estas variáveis. Conclusão: De todos os parâmetros analisados, o tipo de fio de sutura utilizado para fechamento da parede, bem como por quem este fechamento foi realizado e o tempo que estes pacientes permaneceram internados foram os mais expressivos quanto ao desenvolvimento de hérnia incisional(AU)

Background: To evaluate the behavior of the abdominal wall in patients undergoing laparotomy in a medical residency program in general surgery in the interior of Rio Grande do Sul. Methods: This is a descriptive longitudinal study that evaluates the behavior of the abdominal wall after laparotomy, in the period from 2011 to 2014 in patients aged over 13 years. Results: Of the 30 patients evaluated, 12 had incisional hernia (40%), and of these, 25% were obese and 25% were diabetic. In 17% of the cases with incisional hernia, there was wound infection. In the group with hernia, most patients had the closing of their wall performed by a first year resident (R1). In 42% of the cases with hernia, polyglactin 910 was used for closure of the abdominal wall. The patients diagnosed with incisional hernia remained hospitalized an average of four days less than did those without hernia. All patients underwent midline incision and 29 of them underwent emergency surgery, but it was not possible to make a comparison between these variables. Conclusion: Of all the analyzed parameters, the type of suture used to lock the wall, who performed this closure and the length of time these patients remained hospitalized were the most significant ones regarding the development of incisional hernia(AU)

The hidden symbols of the female anatomy in Michelangelo Buonarroti's ceiling in the Sistine Chapel.

A number of published articles have suggested that each element of Renaissance art contains an inner meaning. Some of these elements include the choice of theme and protagonists, faces selected for the characters, colors used, species of flowers and trees chosen, animals depicted, positions of the elements, posture of the characters and their gestures, juxtapositions in the scenes, and even the very scenario or landscape. All of these elements are thought to have hidden meanings. In this context, this manuscript presents a new hypothesis suggesting that Michelangelo Buonarroti (1475-1564) may have concealed symbols associated with female anatomy in the ceiling of the Sistine Chapel (painted 1508-1512) in Rome. Thus, this paper is useful to better understand the history of anatomy and corroborates recent descriptions that have suggested the possible existence of anatomic figures concealed in many of Michelangelo's works. Clin. Anat. 29:911-916, 2016. © 2016 Wiley Periodicals, Inc.