Myotonic dystrophy type 1 (Steinert disease): 29 years of experience at a tertiary pediatric hospital.

BACKGROUND: Myotonic dystrophy type 1 (DM1) is a multisystemic disorder caused by the expansion of a noncoding triplet repeat. METHODS: A cross-sectional study was performed to characterize pediatric patients with DM1 followed in a tertiary hospital over the last 29 years, comparing the congenital and the childhood/juvenile-onset forms. RESULTS: Thirty-seven patients (59.5 % male) were included, with a median age at the latest assessment of 16.8 years and a median follow-up of 7.7 years. Eleven patients were lost to follow-up, and two died. Twenty-five had congenital DM1 (CDM1), and this form had significantly higher triplet repeat length, history of polyhydramnios, lower median age at diagnosis, and first and last assessment. Common symptoms included distal skeletal muscle weakness (75.7 %) and facial involvement (94.6 %), along with dysphonia/dysarthria (73.0 %) and myotonia (73.0 %). Delayed independent ambulation frequency was significantly higher for CDM1 cases. Skeletal deformities affected 54.1 %, with talipes equinovarus and scoliosis occurring exclusively in CDM1 patients. Cognitive deficit was present in 75.7 % of cases. Polysomnograms revealed seven cases of obstructive sleep apnea and two of hypoventilation. Noninvasive ventilation was used in nine cases, and three had recurrent respiratory infections. The cardiovascular system was affected in 21.6 % of cases. Gastrointestinal issues included constipation (24.3 %), feeding difficulties (16.2 %), and cholelithiasis (5.4 %). Cataracts, epilepsy, and diabetes mellitus were reported in two cases each. CONCLUSION: Our study highlights the diverse spectrum of severity and multiorgan involvement of DM1 in pediatric patients. It underscores the importance of establishing a pediatric-specific standard of care to enhance health outcomes through comprehensive multidisciplinary management.

Protective effect of an ERAP1 haplotype in ankylosing spondylitis: investigating non-MHC genes in HLA-B27-positive individuals.

OBJECTIVE: The association of non-MHC genes with AS has been recently suggested. We aimed to investigate the association of the ERAP1, IL23R and TNFSF15 regions and the susceptibility to and protection from AS in HLA-B27-positive individuals. METHODS: A total of 200 unrelated AS patients and 559 healthy unrelated subjects, all HLA-B27 positive, were tested. Twenty single nucleotide polymorphisms (SNPs) were investigated in and near IL23R (nine SNPs), in ERAP1 (five SNPs) and in TNFSF15 (six SNPs). RESULTS: ERAP1 rs30187 [odds ratio (OR) = 1.5, P = 4.7 × 10(-3)] had the strongest association with AS susceptibility. A protective effect was found in three of the ERAP1 SNPs: rs17482078 (OR = 0.7, P = 2.8 × 10(-2)), rs10050860 (OR = 0.7, P = 2.3 × 10(-2)), rs2287987 (OR = 0.6, P = 1.3 × 10(-2)). The ERAP1 haplotype rs17482078/rs10050860/rs30187/rs2287987-CCTT showed an association with AS susceptibility (P = 6.8 × 10(-3)) and a protective effect was identified in rs17482078/rs10050860/rs30187/rs2287987-TTCC (P = 3.1 × 10(-2)). Significant association with AS susceptibility was found in one IL23R marker (rs1004819, P = 4.3 × 10(-2), OR = 1.3). No associations were observed in the TNFSF15 region. CONCLUSION: The identification of a new protection haplotype in ERAP1 and the lack of association of the TNFSF15 region can provide new insights into the understanding of the mechanisms underlying the susceptibility to and protection from AS.

Estimating the Glomerular Filtration Rate in Pediatric Patients With Neurogenic Bladder: A Comparison Between Creatinine- and Cystatin C-Equations.

Background and objective Patients with neurogenic bladder (NB) are at a higher risk of developing chronic kidney disease (CKD). Due to their lower muscle mass, the estimated glomerular filtration rate (eGFR) based on creatinine (Cr) may be overestimated and delay the diagnosis of renal failure. This study compared eGFR calculated with different equations based on Cr and/or cystatin C (CysC) in children with NB, and the differences between patients with lower muscle mass (underdeveloped lower limbs) and those with independent gait (less muscle depletion). Methods We calculated the eGFR in pediatric patients with NB and CKD stages 1 and 2 by using the following equations: Chronic Kidney Disease in Children equation for serum creatinine (CKiD-Cr), CKiD-CysC, CKiD combined-Cr/CysC, Zappitelli-CysC, and Zappitelli combined-Cr/CysC. Results We evaluated a total of 47 patients, 74.5% with CKD stage 1, with a median age of 14.1 years. Of these participants, 59.6% had lipo/myelomeningocele. The CKiD-Cr and CysC-based equations led to significantly lower calculated eGFR ​​(p<0.05), specifically CKiD-CysC (p<0.001), Zappitelli-CysC (p<0.001), CKiD-Cr/CysC (p<0.001), and Zappitelli combined-Cr/CysC (p<0.05). When CKiD-CysC was used, 68% of the patients moved to a more advanced CKD stage. In patients without independent gait, with lower muscle mass (55.3%), the median eGFR calculated using the CKiD-Cr and CKiD combined-Cr/CysC equations was significantly higher (p<0.05). However, there were no differences between the two groups when using the other CysC-based equations. Conclusion In patients with NB and poor muscle mass, the CKiD-Cr equation may overestimate renal function. CysC-based equations seem more reliable in these patients, especially in those with greater muscular atrophy.

Chromium (VI) ion adsorption features of chitosan film and its chitosan/zeolite conjugate 13X film.

This research evaluated the importance of the adsorption properties of chitosan a chitosan/zeolite conjugate film for the removal of Cr(VI) ions from solutions in the 5-260 mg/L concentration range, when the pH was adjusted to 4.0 and 6.0. The uptake capacities of the films formed by chitosan and by the chitosan/zeolite conjugate were calculated by mass balance. The equilibrium isotherms were fitted to the Langmuir, Freundlich and Redlich-Peterson models. The chitosan film seems to be a good sorbent for Cr(VI) at pH 4, but its physical instability suggests the need for a more resilient support. Due to this fact zeolite was added to the chitosan matrix in solution and a chitosan/zeolite (CS/Zeo) film was thus formed. The solubility of the film and the characterization of the different matrices by FTIR, TGA and X-Ray showed that a cross-linked structure was formed between the chitosan and zeolite and the solubility of the film increased. In this study, the low manufacturing cost of the CS/Zeo matrix, the good uptake of Cr(VI) at acidic pH (17.28 mg/g) and the non desorption of Cr(VI) from the film in water suggests this combination should be tested in industrial environment.

Multi-Loculated Catamenial Pneumothorax: A Rare Complication of Thoracic Endometriosis.

The presence of endometrial tissue outside the uterine cavity is known as endometriosis. Catamenial pneumothorax (CP) is a recurrent spontaneous pneumothorax that occurs in women of childbearing age. Thoracic endometriosis is a rare clinical entity, and CP is the most common presentation. Imaging diagnosis is based on computed tomography (CT) scans and magnetic resonance imaging (MRI), detecting blood products in endometrial deposits. We report a case of right CP in a 37-year-old woman with chest pain and dyspnea 48 hours after the onset of menstruation. The pneumothorax was drained, continuous hormonal therapy was started, and she underwent video-assisted thoracoscopic surgery (VATS), which revealed multiple diaphragmatic fenestrations and a solitary nodular thickening in the diaphragmatic pleura (endometrial deposit). After pleurodesis, multiple CP recurred, and later underwent a total hysterectomy. CP is the most common form of thoracic endometriosis and should be suspected in women of childbearing age.

Treatment of mycobacteriosis in a patient with compatible symptoms after a cesarean delivery.

This study aims to report the diagnostic course and treatment of a fast-growing mycobacteria infection after cesarean delivery. We report the case of a 37-year-old woman admitted to the Infectious Diseases' Clinic of the Hospital das Clinicas da Universidade Federal de Pernambuco, Pernambuco State, Brazil, four months after a cesarean section, presenting with healing difficulties and located pain outside the surgical site. The first diagnosis was a probable rejection of the sutures that were not absorbed, but based on the clinical signs, reported history, complementary laboratory tests and no response to treatment with the conventional antibiotic therapy (cephalosporins/quinolones) prescribed, the ultimate diagnosis was a mycobacteriosis caused by Micobacterium fortuitum. Since fast-growing mycobacteria do not easily penetrate host tissues, they is mainly related to post-trauma or post-surgical procedures. It is extremely important to call attention to these occurrences in the gynecological-obsthetric field. Treatment for mycobacteriosis is often complicated because of the side effects of antibiotics, especially the ototoxicity of amikacin.

Preoperative warming combined with intraoperative skin-surface warming does not avoid hypothermia caused by spinal anesthesia in patients with midazolam premedication.

CONTEXT AND OBJECTIVE: Inadvertent perioperative hypothermia is common during spinal anesthesia and after midazolam administration. The aim of this study was to evaluate the effects of intraoperative skin-surface warming with and without 45 minutes of preoperative warming in preventing intraoperative and postoperative hypothermia caused by spinal anesthesia in patients with midazolam premedication. DESIGN AND SETTING: Prospective and randomized study at Hospital das Clínicas, Universidade Estadual Paulista, Botucatu. METHODS: Thirty patients presenting American Society of Anesthesiologists (ASA) physical status I and II who were scheduled for elective lower abdominal surgery were utilized. The patients received midazolam premedication (7.5 mg by intramuscular injection) and standard spinal anesthesia. Ten patients (Gcontrol) received preoperative and intraoperative passive thermal insulation. Ten patients (Gpre+intra) underwent preoperative and intraoperative active warming. Ten patients (Gintra) were only warmed intraoperatively. RESULTS: After 45 min of preoperative warming, the patients in Gpre+intra had significantly higher core temperatures than did the patients in the unwarmed groups (Gcontrol and Gintra) before the anesthesia (p < 0.05) but not at the beginning of surgery (p > 0.05). The patients who were warmed intraoperatively had significantly higher core temperatures than did the patients in Gcontrol at the end of surgery (p < 0.05). All the patients were hypothermic at admission to the recovery room (T CORE < 36 degrees C). CONCLUSIONS: Forty-five minutes of preoperative warming combined with intraoperative skin-surface warming does not avoid but minimizes hypothermia caused by spinal anesthesia in patients with midazolam premedication.

Noradrenaline and dobutamine effects on the volume expansion with normal saline in rabbits subjected to hemorrhage.

PURPOSE:: To evaluate the effects of dobutamine (DB), noradrenaline (NA), and their combination (NADB), on volume retention in rabbits submitted to hemorrhage. METHODS:: Thirty six rabbits were randomly divided into 6 groups: SHAM, Control, Saline, DB, NA, DB+NA. All the animals, except for SHAM, were subjected to hemorrhage of 25% of the calculated blood volume. Control animals were replaced with their own blood. The other groups received NSS 3 times the volume withdrawn. The intravascular retention, hematocrit, diuresis, central venous pressure, mean arterial pressure, NGAL, dry-to-wet lung weight ratio (DTWR) and the lung and kidney histology were analyzed. RESULTS:: Replacement with NSS and NA, DB or NA+DB did not produce differences in the intravascular retention. After hemorrhage, the animals presented a significant decrease in the MAP and CVP, which were maintained until volume replacement. Regarding NGAL, dry-to-wet-lung-weight ratio, lung and kidney histology, there were no statistical differences between the groups. CONCLUSION:: The use of noradrenaline, dobutamine or their combination did not increase the intravascular retention of volume after normal saline infusion.

Preoperative combined with intraoperative skin-surface warming avoids hypothermia caused by general anesthesia and surgery.

STUDY OBJECTIVES: To evaluate the effects of intraoperative skin-surface warming with and without 1 hour of preoperative warming, in preventing intraoperative hypothermia, and postoperative hypothermia, and shivering, and in offering good conditions to early tracheal extubation. DESIGN: Prospective, randomized, blind study. SETTING: Teaching hospital. PATIENTS: 30 ASA physical status I and II female patients scheduled for elective abdominal surgery. INTERVENTIONS: Patients received standard general anesthesia. In 10 patients, no special precautions were taken to avoid hypothermia. Ten patients were submitted to preoperative and intraoperative active warming. Ten patients were only warmed intraoperatively. MEASUREMENTS AND MAIN RESULTS: Temperatures were recorded at 15-minute intervals. The patients who were warmed preoperatively and intraoperatively had core temperatures significantly more elevated than the other patients during the first two hours of anesthesia. All patients warmed intraoperatively were normothermic only at the end of the surgery. The majority of the patients warmed preoperatively and intraoperatively or intraoperatively only were extubated early, and none had shivering. In contrast, five unwarmed patients shivered. CONCLUSIONS: One hour of preoperative warning combined with intraoperative skin-surface warming, not simply intraoperative warming alone, avoided hypothermia caused by general anesthesia during the first two hours of surgery. Both methods prevented postoperative hypothermia and shivering and offered good conditions for early tracheal extubation.

Balanced anesthesia with sevoflurane does not alter redox status in patients undergoing surgical procedures.

Despite the effectiveness and safety of anesthetics, some unanswered questions remain concerning their toxicity and effects on cellular redox balance. To test for possible toxic effects of balanced anesthesia maintained with the volatile anesthetic sevoflurane, we evaluated oxidative stress during and after general anesthesia in 15 adult patients without comorbidities who underwent elective minor surgical procedures. Venous blood samples were collected at baseline, before anesthesia (t0); after anesthesia induction and immediately before surgery (t1); 2h after the beginning of anesthesia (t2); and on the day following surgery (t3). Antioxidant defense was determined by fluorometry. Oxidative stress markers included oxidative DNA damage, evaluated by the alkaline comet assay, and plasma malondialdehyde (MDA), assessed by high performance liquid chromatography (HPLC). No increase in oxidized DNA damage or antioxidant defense was observed. Plasma MDA increased only at t3 compared with t2. Balanced sevoflurane-maintained anesthesia appears neither to damage DNA nor to alter redox status.

Evaluation of acute toxicity of β-lapachone associated with chitosan as a cytoprotective agent / Avaliação da toxicidade aguda da β-lapachona associada à quitosana como agente citoprotetor

ABSTRACT INTRODUCTION: β-lapachone (β-LAP), a potent antitumor agent, has limited therapeutic use due to its low solubility and high toxicity. A possible strategy to overcome these drawbacks may be the use of adjuvants such as chitosan (CS), a cationic polysaccharide with biological properties of biocompatibility and biodegradability. OBJECTIVE: Evaluate the adjuvant action of CS as a cytoprotectant associated with β-LAP, through acute toxicity studies, evaluating histopathological changes in organs such as liver and kidneys. METHODS: The β-LAP-CS conjugate was prepared in a 1:1 ratio, administered orally, with a single dose of β-LAP of 80 mg/kg, in Swiss mice. Histomorphological and histomorphometric analyses of the kidneys and liver were performed. RESULTS: In the histomorphological studies of the tested groups, we observed that the hepatocytes of animals treated with the free drug presented morphological alterations, such as cytoplasmic vacuolization, cellular extravasation, atypical and pyknotic nuclei. In this same group, the kidneys presented granular aspects suggestive of glomerulonephritis. These changes were not found in the control group and in animals treated with CS-conjugated β-LAP. There was no statistical difference in the histomorphometric analyses of the distal tubules and the renal glomeruli between the three groups analyzed, even with evident histomorphological alterations. After histomorphometric studies, it was observed that the area of hepatocytes and their cell nuclei presented a statistically significant difference between the animals treated with free β-LAP and the β-LAP-CS. CONCLUSION: The decrease in β-LAP toxicity after conjugation may be related to the hepatoprotective property of CS.

RESUMO INTRODUÇÃO: A β-lapachona (β-LAP), um potente agente antitumoral, tem uso terapêutico limitado devido a sua baixa solubilidade e elevada toxicidade. Uma possível estratégia para contornar esses inconvenientes pode ser a utilização de adjuvantes como a quitosana (QS), um polissacarídeo catiônico com propriedades biológicas, como biocompatibilidade e biodegradabilidade. OBJETIVO: Avaliar a ação adjuvante da QS como citoprotetor associada à β-LAP por meio de estudos de toxicidade aguda, verificando as alterações histopatológicas em órgãos como fígado e rins. MÉTODOS: Um conjugado da β-LAP-QS foi preparado na proporção 1:1, administrado por via oral, com dose única da β-LAP de 80 mg/kg, em camundongos Swiss. Foram realizadas análises histomorfológicas e histomorfométricas dos rins e do fígado desses animais. RESULTADOS: Nos estudos histomorfológicos dos grupos testados, observamos que os hepatócitos dos animais tratados com a droga livre apresentaram alterações morfológicas, como vacuolização do citoplasma, extravasamento celular, núcleos atípicos e picnóticos. Nesse mesmo grupo, os rins apresentaram aspectos granulosos sugestivos de glomerulonefrite. Essas alterações não foram encontradas no grupo-controle e nos animais tratados com a β-LAP conjugada com QS. Não houve diferença estatística nas análises histomorfométricas dos túbulos distais e dos glomérulos renais entre os três grupos analisados, mesmo com alterações histomorfológicas evidentes. Após estudos histomorfométricos, foi observado que a área dos hepatócitos e seus núcleos celulares apresentaram diferença estatística significativa entre os animais tratados com a β-LAP livre e o conjugado β-LAP-QS. CONCLUSÃO: A diminuição da toxicidade da β-LAP, após ser conjugada, pode estar relacionada com a propriedade hepatoprotetora da QS.

Volkmann ischemic contracture in a newborn.

Congenital Volkmann ischemic contracture is a very rare condition in which a neonate presents skin, muscular and nerve lesions due to increased intracompartment pressure and subsequent ischemia, probably due to extrinsic intrauterine compression. In this age group, there are only about 50 reported cases and a specific cause is unknown. The authors describe the case of a newborn who presented with bullous and ulcerated skin lesions and nerve palsy of his forearm at birth, evolving to subcutaneous and muscular necrosis and contracture. Two surgeries were performed and the baby began a daily physiotherapy program that resulted in aesthetical improvement and recovery of his hand and forearm mobility. Early recognition of this rare entity and subsequent emergency fasciotomy are the best ways to improve prognosis.

The encapsulation of ß-lapachone in 2-hydroxypropyl-ß-cyclodextrin inclusion complex into liposomes: a physicochemical evaluation and molecular modeling approach.

The aim of this study was to encapsulate lapachone (ß-lap) or inclusion complex (ß-lap:HPß-CD) in liposomes and to evaluate their physicochemical characteristics. In addition, the investigation of the main aspects of the interaction between ß-lap and 2-hydroxypropyl-ß-cyclodextrin (HPß-CD), using both experimental and molecular modeling approaches was discussed. Furthermore, the in vitro drug release kinetics was evaluated. First, a phase solubility study of ß-lap in HPß-CD was performed and the ß-lap:HPß-CD was prepared by the freeze-drying technique. A 302-fold increase of solubility was achieved for ß-lap in HPß-CD solution with a constant of association K(1:1) of 961 M(-1) and a complexation efficiency of ß-lap of 0.1538. (1)H NMR, TG, DSC, IR, Raman and SEM indicated a change in the molecular environment of ß-lap in the inclusion complex. Molecular modeling confirms these results suggesting that ß-lap was included in the cavity of HPß-CD, with an intermolecular interaction energy of -23.67 kJ mol(-1). ß-lap:HPß-CD and ß-lap-loaded liposomes presented encapsulation efficiencies of 93% and 97%, respectively. The kinetic rate constants of 183.95±1.82 µg/h and 216.25±2.34 µg/h were calculated for ß-lap and ß-lap:HPß-CD-loaded liposomes, respectively. In conclusion, molecular modeling elucidates the formation of the inclusion complex, stabilized through hydrogen bonds, and the encapsulation of ß-lap and ß-lap:HPß-CD into liposomes could provide an alternative means leading eventually to its use in cancer research.

Noradrenaline and dobutamine effects on the volume expansion with normal saline in rabbits subjected to hemorrhage

ABSTRACT PURPOSE: To evaluate the effects of dobutamine (DB), noradrenaline (NA), and their combination (NADB), on volume retention in rabbits submitted to hemorrhage. METHODS: Thirty six rabbits were randomly divided into 6 groups: SHAM, Control, Saline, DB, NA, DB+NA. All the animals, except for SHAM, were subjected to hemorrhage of 25% of the calculated blood volume. Control animals were replaced with their own blood. The other groups received NSS 3 times the volume withdrawn. The intravascular retention, hematocrit, diuresis, central venous pressure, mean arterial pressure, NGAL, dry-to-wet lung weight ratio (DTWR) and the lung and kidney histology were analyzed. RESULTS: Replacement with NSS and NA, DB or NA+DB did not produce differences in the intravascular retention. After hemorrhage, the animals presented a significant decrease in the MAP and CVP, which were maintained until volume replacement. Regarding NGAL, dry-to-wet-lung-weight ratio, lung and kidney histology, there were no statistical differences between the groups. CONCLUSION: The use of noradrenaline, dobutamine or their combination did not increase the intravascular retention of volume after normal saline infusion.

Retrospective analysis of risk factors and predictors of intraoperative complications in neuraxial blocks at Faculdade de Medicina de Botucatu-UNESP.

BACKGROUND AND OBJECTIVES: Cardiovascular changes associated with neuraxial blocks are a cause of concern due to their frequency and because some of them can be considered physiological effects triggered by the sympathetic nervous system blockade. The objective of this study was to evaluate intraoperative cardiovascular complications and predictive factors associated with neuraxial blocks in patients ≥ 18 years of age undergoing non-obstetric procedures over an 18-year period in a tertiary university hospital--HCFMB-UNESP. METHODS: A retrospective analysis of the following complications was undertaken: hypertension, hypotension, sinus bradycardia, and sinus tachycardia. These complications were correlated with anesthetic technique, physical status (ASA), age, gender, and preoperative co-morbidities. The Tukey test for comparisons among proportions and logistic regression was used for statistical analysis. RESULTS: 32,554 patients underwent neuraxial blocks. Intraoperative complications mentioned included hypotension (n=4,109), sinus bradycardia (n=1,107), sinus tachycardia (n=601), and hypertension (n=466). Hypotension was seen more often in patients undergoing continuous subarachnoid anesthesia (29.4%, OR=2.39), ≥ 61 years of age, and female (OR=1.27). CONCLUSIONS: Intraoperative hypotension and bradycardia were the complications observed more often. Hypotension was related to anesthetic technique (CSA), increased age, and female. Tachycardia and hypertension may not have been directly related to neuraxial blocks.

Assessment of a DNA vaccine encoding an anchored-glycosylphosphatidylinositol tegumental antigen complexed to protamine sulphate on immunoprotection against murine schistosomiasis.

Protamine sulphate/DNA complexes have been shown to protect DNA from DNase digestion in a lipid system for gene transfer. A DNA-based vaccine complexed to protamine sulphate was used to induce an immune response against Schistosoma mansoni anchored-glycosylphosphatidylinositol tegumental antigen in BALB/c mice. The protection elicited ranged from 33 to 44%. The spectrum of the elicited immune response induced by the vaccine formulation without protamine was characterized by a high level of IgG (IgG1> IgG2a). Protamine sulphate added to the DNA vaccine formulation retained the green fluorescent protein encoding-plasmid longer in muscle and spleen. The experiments in vivo showed that under protamine sulphate effect, the scope of protection remained unchanged, but a modulation in antibody production (IgG1= IgG2a) was observed.

[The interaction between labor analgesia and its results: assessment using the newborn s weight and Apgar score.]. / Interação entre a analgesia de parto e o seu resultado: avaliação pelo peso e índice de Apgar do recém-nascido.

BACKGROUND AND OBJECTIVES: There are controversies regarding whether labor analgesia can interfere with labor and the vitality of the newborn. The objective of this study was the interaction between labor analgesia, using the continuous epidural and combined spinal-epidural techniques with a small dose of local anesthetic, and the type of delivery analyzing the newborn's weight and Apgar score. METHODS: The results of 168 labor analgesias (from January 2002 to January 2003) were analyzed. They were divided in 4 groups: G1 (n = 58), continuous epidural and evolution to vaginal delivery; G2 (n = 69), combined spinal-epidural and evolution to vaginal delivery; G3 (n = 25), continuous epidural and evolution to cesarean; G4 (n = 16), combined spinal-epidural and evolution to cesarean. G1 received 0.125% ropivacaine (12 to 15 mL), G2 received subarachnoid 0.5% bupivacaine (0.5 to 1 mL) and sufentanil (10 mg). Epidural ropivacaine 0.5% for the vaginal delivery (8 mL) and for cesarean (20 mL). The patient's age, weight, height, body mass index (BMI), gestational age, number of prior pregnancies, and complications (arterial hypotension, bradycardia, and hypoxia) and the newborn's weight and Apgar score (at 1, 5, and 10 minutes) were evaluated. RESULTS: The majority of pregnant women were primiparous and presented with a term pregnancy (one with gestational age of 28 weeks and none post-term pregnancy); weight, G2 < G4; and MBI, G2 pound G4. For the weight of the newborn, G1 < G3 and G2 < G4, and for the Apgar score at 1st minute, G1 > G3. CONCLUSIONS: If the analysis focuses the newborn's weight and Apgar score, the techniques of analgesia, continuous epidural and combined spinal-epidural with small doses of local anesthetic, do not interfere with the result of the delivery.

Análise retrospectiva de fatores de risco e preditores de complicações intraoperatórias dos bloqueios do neuroeixo realizados na Faculdade de Medicina de Botucatu-UNESP / Retrospective analysis of risk factors and predictors of intraoperative complications in neuraxial blocks at Faculdade de Medicina de Botucatu-UNESP

JUSTIFICATIVA E OBJETIVOS: As alterações cardiovasculares associadas aos bloqueios do neuroeixo apresentam interesse pela frequência com que ocorrem e porque algumas delas podem ser consideradas efeitos fisiológicos desencadeados pelo bloqueio do sistema nervoso simpático. O objetivo desta pesquisa foi avaliar as complicações cardiovasculares intraoperatórias e os fatores preditores associados aos bloqueios do neuroeixo em pacientes com idades > 18 anos submetidos a procedimentos não obstétricos, em um período de 18 anos, em hospital universitário de atendimento terciário-HCFMB-UNESP. MÉTODO: Foi realizada análise retrospectiva das seguintes complicações: hipertensão arterial, hipotensão arterial, bradicardia sinusal e taquicardia sinusal. Tais complicações foram correlacionadas com técnica anestésica, estado físico (ASA), idade, sexo e comorbidades pré-operatórias. Para a análise estatística, foram utilizadas o teste de Tukey para comparações entre proporções e regressão logística. RESULTADOS: Foram avaliados 32.554 pacientes submetidos a bloqueios do neuroeixo e houve 4.109 citações de hipotensão arterial, 1.107 de bradicardia sinusal, 601 de taquicardia sinusal e 466 de hipertensão arterial no período intraoperatório. Hipotensão foi mais frequente nos pacientes submetidos à anestesia subaracnoidea contínua (29,4 por cento, OR = 2,39), com idades > 61 anos e do sexo feminino (OR = 1,27). CONCLUSÕES: Hipotensão e bradicardia intraoperatórias foram complicações mais frequentes, sendo que a hipotensão arterial esteve relacionada à técnica anestésica (ASC), faixa etária elevada e sexo feminino. Taquicardia e hipertensão arterial podem não ter sido diretamente relacionadas aos bloqueios do neuroeixo.

BACKGROUND AND OBJECTIVES: Cardiovascular changes associated with neuraxial blocks are a cause of concern due to their frequency and because some of them can be considered physiological effects triggered by the sympathetic nervous system blockade. The objective of this study was to evaluate intraoperative cardiovascular complications and predictive factors associated with neuraxial blocks in patients > 18 years of age undergoing non-obstetric procedures over an 18-year period in a tertiary university hospital - HCFMB-UNESP. METHODS: A retrospective analysis of the following complications was undertaken: hypertension, hypotension, sinus bradycardia, and sinus tachycardia. These complications were correlated with anesthetic technique, physical status (ASA), age, gender, and preoperative co-morbidities. The Tukey test for comparisons among proportions and logistic regression was used for statistical analysis. RESULTS: 32,554 patients underwent neuraxial blocks. Intraoperative complications mentioned included hypotension (n = 4,109), sinus bradycardia (n = 1,107), sinus tachycardia (n = 601), and hypertension (n = 466). Hypotension was seen more often in patients undergoing continuous subarachnoid anesthesia (29.4 percent, OR = 2.39), > 61 years of age, and female (OR = 1.27). CONCLUSIONS: Intraoperative hypotension and bradycardia were the complications observed more often. Hypotension was related to anesthetic technique (CSA), increased age, and female. Tachycardia and hypertension may not have been directly related to neuraxial blocks.

JUSTIFICATIVA Y OBJETIVOS: Las alteraciones cardiovasculares asociadas a los bloqueos del neuro eje son de interés por la frecuencia con que ocurren y porque algunas de ellas pueden ser consideradas como efectos fisiológicos desencadenados por el bloqueo del sistema nervioso simpático. El objetivo de esta investigación, fue evaluar las complicaciones cardiovasculares intraoperatorias y los factores predictores asociados a los bloqueos del neuro eje, en pacientes con edades > 18 años, sometidos a procedimientos no obstétricos, en un período de 18 años, en un hospital universitario de atención terciario-HCFMB-UNESP. MÉTODO: Fue realizado un análisis retrospectivo de las siguientes complicaciones: hipertensión arterial, hipotensión arterial, bradicardia sinusal y taquicardia sinusal. Esas complicaciones se correlacionaron con la técnica anestésica, estado físico (ASA), edad, sexo y comorbilidades preoperatorias. Para el análisis estadístico, se usó el test de Tukey para las comparaciones entre las proporciones y la regresión logística. RESULTADOS: Fueron evaluados 32.554 pacientes sometidos a bloqueos del neuro eje y hubo 4.109 apariciones de hipotensión arterial, 1.107 de bradicardia sinusal, 601 de taquicardia sinusal y 466 de hipertensión arterial en el período intraoperatorio. La hipotensión fue más frecuente en los pacientes sometidos a la anestesia subaracnoidea continua (29,4 por ciento, OR = 2,39), con edades > 61 años y pertenecientes al sexo femenino (OR =1,27). CONCLUSIONES: La hipotensión y la bradicardia intraoperatorias fueron las complicaciones más frecuentes, siendo que la hipotensión arterial se relacionó con la técnica anestésica (ASC), franja etaria elevada y sexo femenino. La taquicardia y la hipertensión arterial pueden no haber sido directamente relacionadas con los bloqueos del neuro eje.

[Anesthetic management for neonatal conjoined twins separation: case report.]. / Anestesia para separação de gêmeos isquiópagos no período neonatal: relato de caso.

BACKGROUND AND OBJECTIVES: The separation of conjoined twins has always raised considerable interest because of surgical and anesthetic complexity, pathology rarity and few survival chances. The goal of this description was to contribute to existing literature by reporting the challenges faced by our team during an anesthetic-surgical procedure for ischiopagus twins separation. CASE REPORT: Term conjoined twins, born from Cesarean section, weighing together 5100 g, who were classified as ischiopagus tetrapus. Two anesthetic-surgical teams were present and the anesthetic procedure was programmed using two units of each device: anesthesia machine, cardioscope, capnograph, pulse oximetry, electric thermometer and esophageal stethoscope. Halothane and fentanyl were used for anesthesia induction, with the twins in the lateral position and 45 masculine head rotation to allow tracheal intubation. Ventilation was manually controlled using Rees-Baraka systems. Anesthesia was also maintained with halothane, fentanyl and oxygen. Double abdominal organs were found during surgery, except for the single colon. Bladders and ischia were joined. At surgery completion, twins had stable vital signs. They remained in Neonatal Intensive Care Unit for four weeks and were discharged in good general conditions. CONCLUSIONS: The importance of the teams 'meshing of gears', multidisciplinary retrospective studies, adequate and careful monitoring and good clinical observation is emphasized. All those factors contributed for twins good evolution.

[Effects of rphedrine on cardiovascular and renal function of dogs anesthetized with sodium pentobarbital.]. / Efeitos da efedrina sobre as funções cardiovascular e renal de cães sob anestesia com pentobarbital sódico.

BACKGROUND AND OBJECTIVES: Some studies have shown differentiated dose-dependent effects of ephedrine on cardiovascular and renal functions. This study aimed at verifying whether different ephedrine doses determine differentiated hemodynamic and renal effects. METHODS: Cardiovascular and renal hemodynamics and renal function were evaluated in 32 dogs anesthetized with sodium pentobarbital (SP) for surgical preparation, catheterization, extracellular fluid volume expansion and mechanical ventilation. Dogs were randomly distributed in four groups: G control (n = 8), in which dogs remained only under the effect of SP; G ephedrine 2 microg (n = 8); G ephedrine 10 microg (n = 8); and G ephedrine 100 microg (n = 8), in which dogs received 2, 10, and 100 microg.kg-1.min-1 ephedrine, respectively. Cardiovascular and renal parameters were studied at control (M1 and M2), during ephedrine infusion (M3 and M4) and after ephedrine infusion withdrawal (M5). RESULTS: There were no significant differences among groups. There has been a significant increase in heart rate, aortic blood flow, urinary output and fractional sodium excretion in G ephedrine 2 microg. There has been a significant increase in heart rate and filtration fraction in G ephedrine 10 microg while in G ephedrine 100 microg there has been a significant increase in heart rate, mean blood pressure, aortic blood flow, central venous pressure, renal vascular resistance and hematocrit, and a significant decrease in renal plasma and blood flow. CONCLUSIONS: Our study has shown that ephedrine has differentiated dose-dependent hemodynamic and renal effects.