RESUMO
Nowadays, the scarcity of energy resources is promoting the search for alternative energy sources, boosting interest in the use of forest lignocellulosic residue in the energy sector. In this study, the focus is on the energy recovery from two lignocellulosic residues originated during the pruning of ornamental trees (Horse Chestnut, CI, and False Acacia, FA). Both conventional and flash pyrolysis techniques were applied. The experimental pyrolysis variables were obtained from the study of the thermal behaviour of the pruning residues in thermogravimetric analysis. It was carried out under 5 heating rates and kinetic parameters were estimated using Flynn-Wall-Ozawa method. Results denoted higher maximum mass loss rate values for the same release temperature regions under FA experiments. Also, FA samples had lower final residues for the processes. However, activation energy values were so close for both species. FA was also linked to the faster reactions according frequency factor outcomes. Conventional pyrolysis of pruning residues was carried out in a horizontal oven of original design at a heating rate of 25 °C/min, at 750 °C and 60 min of permanence at that temperature; flash pyrolysis was tested in that oven at 750 and 850 °C. In these pyrolysis processes, three fractions were obtained: bio-char, bio-oil and gas. The physicochemical attributes of the bio-chars suggested their potential utility as biofuels (28.4-29.8 MJ/kg), adsorbent precursors or soil additives. Conventional pyrolysis bio-oils had a dominant monoaromatic hydrocarbons nature, with phenols being the most abundant (≥60%), while flash bio-oils contain mainly polycyclic aromatic hydrocarbons. Conventional pyrolysis gases contained up to 60 vol% of CO2; flash pyrolysis gases had high combustible gas content (CO, CH4, H2) and a low CO2 content (<25 vol%). As a result, their calorific value (18.06 MJ/kg) exhibited a threefold increase compared to the gas produced through conventional pyrolysis (6.04 MJ/kg).
Assuntos
Biocombustíveis , Biomassa , Pirólise , Biocombustíveis/análise , Acacia/química , Corylus/química , Termogravimetria , ÁrvoresRESUMO
No disponible
Assuntos
Humanos , Masculino , Adulto , Molusco Contagioso/diagnóstico , Molusco Contagioso/terapia , Crioterapia/métodos , Ceratodermia Palmar e Plantar/complicações , Ceratodermia Palmar e Plantar/terapia , Diagnóstico DiferencialRESUMO
Antecedentes y objetivo: Diferentes estudios muestran la efectividad de la aplicación de electrolisis percutánea ecoguiada en el tratamiento de problemas de tendón. El objetivo del estudio fue mostrar los efectos de la aplicación de un protocolo de electrólisis percutánea ecoguiada y ejercicio terapéutico en un proceso de tendinopatía aquílea. Descripción del caso: Paciente de 33 años con dolor en porción media del tendón de Aquiles y evolución de más de 6 meses. Inicialmente presentó: dolor de 6 en la escala numérica de evaluación del dolor, puntuación de 4 en 3 actividades cotidianas en escala de discapacidad específica del paciente, 4,05 kg/cm2 en umbral de tolerancia de dolor a la presión, puntuación de 61 en el cuestionario Victorian Institute of Sport Assessment-Achilles y máxima contracción voluntaria isométrica de 162,7μV en gastrocnemio lateral y de 335μV en gastrocnemio medial medida con electromiografía de superficie. Intervención: Se realizó tratamiento consistente en 4 sesiones semanales consecutivas de electrólisis percutánea ecoguiada y un programa de ejercicio terapéutico. Resultados: Tras 14 semanas, la escala numérica de evaluación del dolor se valoró en 0, las actividades en escala de discapacidad específica del paciente en 10, aumento del umbral de tolerancia de dolor a la presión hasta 8,55 kg/cm2, en el cuestionario Victorian Institute of Sport Assessment-Achilles una puntuación de 100 y aumento de la máxima contracción voluntaria del gastrocnemio lateral hasta 400,6μV. Discusión: Un tratamiento basado en la combinación de electrólisis percutánea ecoguiada y ejercicio terapéutico puede resultar beneficioso en patologías de tendón de Aquiles
Background and objective: Different studies have shown the effectiveness of the ultrasound-guided percutaneous electrolysis application in the treatment of tendon problems. The aim of this study was to show the effects of the application of a protocol of ultrasound-guided percutaneous electrolysis and therapeutic exercise in the Achilles tendinopathy process. Clinical case description: A 33 year-old patient who complained of pain in the mid-portion of the Achilles tendon of more than 6 months onset. He initially presented with a pain of 6 in the Numerical Pain Rate Scale, a score of 4 in 3 daily activities in the Patient-Specific Functional Scale, 4.05 kg/cm2 in Pressure Pain Tolerance Threshold, a score of 61 in the Victorian Institute of Sport Assessment-Achilles questionnaire, and a Maximum Voluntary Isometric Contraction of 162.7μV in lateral gastrocnemius, and 335μV in medial gastrocnemius measured with surface electromyography. Intervention: Treatment consisted of 4consecutive weekly sessions of ultrasound-guided percutaneous electrolysis and a therapeutic exercise program. Results: After 14 weeks, the Numerical Pain Rate Scale was 0, a score of 10 in the activities of the Patient-Specific Functional Scale, an increase in the pressure pain tolerance threshold of up to 8.55 kg/cm2, score of 100 in the Victorian Institute of Sport Assessment-Achilles questionnaire, and an increase in the maximum voluntary contraction of the lateral gastrocnemius up to 400.6μV. Discussion: A treatment based on the combination of ultrasound-guided percutaneous electrolysis and therapeutic exercise may be beneficial in Achilles tendon diseases
Assuntos
Humanos , Masculino , Adulto , Tendão do Calcâneo/patologia , Eletrólise/métodos , Terapia por Exercício/métodos , Ultrassonografia de Intervenção , Traumatismos dos Tendões/terapia , Eletromiografia/métodos , Limiar da DorRESUMO
Determinou-se a digestibilidade intestinal (DI) da proteína de vários coprodutos do biodiesel nas formas de farelo e torta. Foram avaliados oito coprodutos: tortas e farelos de pinhão manso, nabo forrageiro, tremoço, algodão. Os coprodutos foram incubados no rúmen por 16 horas, e os resíduos não degradados no rúmen submetidos à digestão enzimática com solução de pepsina e pancreatina para a determinação da DI. Ainda, nos resíduos da incubação ruminal, foram determinadas: degradabilidade da matéria seca (DR), proteína degradável no rúmen (PDR) e proteína não degradável no rúmen (PNDR). A digestibilidade intestinal da proteína para os coprodutos do biodiesel variou de 2,4 a 48,6%. Todos os coprodutos avaliados caracterizaram-se como alimentos de alto teor proteico, sendo considerados de alta PDR, e apresentaram baixa digestibilidade intestinal da proteína. A DI da proteína dos coprodutos do biodiesel na forma de torta foi maior em comparação com a dos farelos. A torta e o farelo de algodão apresentaram os maiores coeficientes de DI.
The objective of this research was to determine intestinal protein digestibility (ID) of some biodiesel by-products in the form of cakes and the meals. Eight by-products were: cakes and meals of physic nut, turnip, lupine, cotton cake, cottonseed meal. The by-products were incubated in the rumen for 16 hours, were the undegradable rumen residues were submitted to enzymatic digestion with pepsin and pancreatin solution for the determination of ID. In the incubation residues the following was also determined: dry matter degradability (RD), rumen degradable protein (RDP) and rumen undegradable protein (RUP). The intestinal protein digestibility of biodiesel by-products ranged from 2.4 to 48.6%. All the by-products evaluated in this study were characterized as high protein sources and were considered high-RDP. The by-products presented low intestinal protein digestibility. The ID protein of biodiesel by-products was higher in the cakes than the meals. The by-products evaluated, the cottonseed cake and meal presented the highest ID coefficients.
Assuntos
Animais , Digestão , Ruminantes , Rúmen/metabolismo , Proteínas/análise , ProteínasRESUMO
Dois modelos compartimentais foram aplicados e comparados para avaliar o fluxo biológico de fósforo em ovinos que receberam dietas com níveis crescentes do mineral - 0, 2, 4 e 6g por dia. Foram utilizados 24 machos, da raça Santa Inês, com média de peso de 33,6kg. Foi utilizado fosfato bicálcico como fonte de fósforo e 32P como traçador. Avaliou-se o fluxo de fósforo entre os compartimentos: trato gastrintestinal, sangue, ossos e tecidos moles, além da ingestão, excreção e balanço do mineral. O incremento na ingestão de P aumentou a perda fecal do mineral. O fluxo de fósforo entre o trato gastrintestinal e o sangue e o fluxo contrário foram influenciados de forma quadrática pelo incremento na ingestão, diminuindo após a ingestão de 5,5g/dia, sem diferença entre os modelos avaliados. Os modelos estudados mostraram diferenças em relação ao fluxo entre sangue, ossos e tecidos moles, sem efeito dos tratamentos sobre o balanço geral do mineral, porém os níveis de ingestão praticados interferiram no fluxo biológico do fósforo. A disponibilidade biológica do fósforo ingerido diminuiu quando a ingestão superou a necessidade do animal, o que aumentou as excreções no ambiente. A quantificação do fluxo biológico de fósforo diferiu quando aplicados os modelos estudados em decorrência da sua estrutura.
Two compartimental models were applied and compared to evaluate the biological flow of P in lambs fed diets containing increasing levels of P (0, 2, 4 and 6g per day). Twenty four Santa Inês lambs with liveweight of 33.6kg were used. Dicalcium phosphate was used as P source and 32P as a tracer. P flow between compartments (gastrointestinal tract, blood, bones and soft tissues), ingestion, excretion and the mineral balance were evaluated. The increase in P intake increased fecal P loss. P flow from gastrointestinal tract to blood stream and opposite flow were affected quadratically by increased P intake, decreasing after the ingestion of 5.5g/day, without a difference among models. The models studied showed differences regarding the P flow between blood, bone and soft tissues, however, the P balance was not affected by the treatments. The increased P levels interfered with the biological P flow in sheep. The bioavailability of P diet decreases when intake exceeds the animal requirement, increasing losses to the environment. The quantification of biological P flow was different between models due to the structure of each one.
Assuntos
Animais , Dieta , Ovinos/classificação , Poluição Ambiental , Fósforo na Dieta/análise , Minerais na Dieta/análiseRESUMO
Introducción: La cirugía bariátrica ha demostrado ser un tratamiento eficaz para la pérdida de peso en pacientes con obesidad severa, recomendándose la aplicación de un protocolo de actuación multidisciplinar. Objetivos: Evaluar la utilidad de la implantación de un protocolo de actuación en cirugía de la obesidad basado en el Documento de consenso español de la SEEDO. Métodos: Estudio restrospectivo comparativo de resultados de pacientes intervenidos previamente (51 pacientes) y tras la implantación del protocolo (66 pacientes). Se recogieron datos de: antropometría , comorbilidades pre y postcirugía, complicaciones nutricionales y quirúrgicas postcirugía, test de Calidad de Vida validado, y hábitos alimentarios. Resultados: Los abandonos (17,6%) y el alcoholismo (5,8%) fueron mayores en pacientes preprotocolo frente postprotocolo (4,5% y 3% respectivamente) con diferencias estadísticamente significativas. La mortalidad fue del 2% en los preprotocolo y del 0% en los postprotocolo. Los hábitos alimentarios fueron mejores en los postprotocolo, presentando mayor porcentaje de trastornos de conducta alimentaria los preprotocolo (5,1%) aunque sin significación estadística. La mejoría de la calidad de vida fue superior en los postprotocolo en todos los items, pero solo con significación estadística en la actividad sexual (p 0,004). El 70,5% de los pacientes preprotocolo tenían más de una complicación nutricional frente al 32,8% de los postprotocolo (p < 0,05). No hubo diferencias en cuanto a porcentaje de sobrepeso perdido a los dos años (superior al 50% en el 81,3% de los casos preprotocolo y en el 74,8% de los postprotocolo) ni evolución de comorbilidades. Conclusiones: La cirugía bariátrica consigue excelentes resultados en: pérdida de peso, comorbilidades y calidad de vida, pero presenta complicaciones nutricionales, quirúrgicas y psiquiátricas que exigen un abordaje multidisciplinar y protocolizado. Nuestro protocolo mejora resultados de tasa de abandonos, trastornos de conducta alimentaria, hábitos alimentarios, complicaciones nutricionales y mejoría de calidad de vida (AU)
Introduction: Bariatric surgery has been shown to be an effective therapy for weight loss in patients with severe obesity, and the implementation of a multidisciplinar management protocol is recommended. Objectives: To assess the usefulness of the implementation of a management protocol in obesity surgery based on the Spanish Consensus Document of the SEEDO. Methods: Retrospective comparative study of the outcomes in patients previously operated (51 patients) and after the implementation of the protocol (66 patients). The following data were gathered: anthropometry, pre-and post-surgery comorbidities, post-surgical nutritional and surgical complications, validated Quality of Life questionnaire, and dietary habits. Results: Withdrawals (l7.6%) and alcoholism (5.8%) were higher in patients pre- versus post-implementation of the protocol (4.5% vs. 3%, respectively), the differences being statistically significant. The mortality rate was 2% in the pre-protocol group and 0% in the postprotocol group. The dietary habits were better in the post-protocol group, the pre-protocol group presenting a higher percentage of feeding-behavior disorders (5.1%) although not reaching a statistical significance. The improvement in quality of life was higher in the post-protocol group for all items, but only reaching statistical significance in sexual activity (p = 0.004). In the pre-protocol group, 70.5% of the patients had more than one nutritional complication vs. 32.8% in the post-protocol group (p < 0.05). There were no differences regarding the percentage of weight in excess lost at two years (> 50% in 81.3% in the pre-protocol group vs. 74.8% in the pos-protocol group) or the comorbidities. Conclusions: Bariatric surgery achieves excellent outcomes in weight loss, comorbidities, and quality of life, but presents nutritional, surgical, and psychiatric complications that require a protocol-based and multidisciplinary approach. Our protocol improves the outcomes regarding the withdrawal rates, feeding-behavior disorders, dietary habits, nutritional complications, and quality of life (AU)
Assuntos
Humanos , Cirurgia Bariátrica/reabilitação , Obesidade Mórbida/cirurgia , /métodos , Complicações Pós-Operatórias/epidemiologia , Protocolos Clínicos , Qualidade de Vida , Redução de PesoRESUMO
Objetivos: valorar la rentabilidad diagnóstica de la ecoendoscopiaen la estadificación locorregional del cáncer gástrico ennuestro medio y determinar el impacto de la técnica sobre el manejoterapéutico posterior.Material y métodos: estudio retrospectivo realizado en pacientesdiagnosticados histológicamente de adenocarcinoma gástricoque habían sido remitidos para la realización de ecoendoscopia.Se comparó el resultado de la técnica con el estudio final obtenidoen la pieza operatoria y/o laparoscopia-laparotomía exploradora.Se comparó la decisión terapéutica inicial basada en los resultadosde las técnicas diagnósticas convencionales, con el manejo terapéuticofinal basado en el resultado de la ecoendoscopia.Resultados: se incluyeron en el estudio 46 pacientes conadenocarcinoma gástrico (en 36 de los cuales se disponía de exploraciónde referencia). La precisión diagnóstica fue del 70%para el estadio T, y para T1, T2, T3 y T4 del 100, 38, 82 y100%, respectivamente. La sensibilidad y especificidad para diferenciarel estadio T1-2 del T3-4 fue del 94 y 85% respectivamente.No se identificaron factores relacionados con la obtención deun diagnóstico correcto en la estadificación T. La precisión diagnósticafue del 72% para el estadio N (N0: 58%; Nx 88%). En 7pacientes se identificó la presencia de líquido libre perigástrico, en5 de los cuales se confirmó posteriormente la existencia de carcinomatosisperitoneal. En 13 pacientes (28%) del resultado de laecoendoscopia se derivó una modificación en el manejo terapéuticoposterior.Conclusiones: la ecoendoscopia es una técnica útil en la estadificaciónlocorregional del adenocarcinoma gástrico, lo quepuede tener importantes implicaciones en el manejo terapéuticode estos pacientes(AU)
Objectives: to evaluate the diagnostic yield of endoscopic ultrasonographyin loco-regional staging of gastric cancer in ourmedium and to determine the impact of this technique on latertherapeutic management.Material and methods: this is a retrospective study carriedout on patients histologically diagnosed with gastric adenocarcinomawho had been referred for endoscopic ultrasonographic examination.The technique results were compared with those obtainedfrom surgical samples and/or from exploratory laparoscopylaparotomy.We compared the initial therapeutic decision basedon conventional diagnostic techniques with the final therapeuticmanagement based on the endoscopic ultrasonography results.Results: forty-six patients with gastric adenocarcinoma wereincluded in the study (a reference exploration was available in 36cases). Diagnostic precision was 70% in stage T, while in stagesT1, T2, T3 y T4 was 100, 38, 82, and 100%, respectively. Thesensitivity and specificity to differentiate T1-2 from T3-4 was 94and 85%, respectively. We could not identify factors associatedwith obtaining a correct diagnosis in staging T. Diagnostic precisionwas 72% for stage N (N0: 58%; Nx 88%). The presence offree perigastric fluid was identified in 7 cases; the presence of peritonealcarcinomatosis was later confirmed in 5 of these. The resultof endoscopic ultrasonography led to a modification in thesubsequent therapeutic management in 13 patients (28%).Conclusions: endoscopic ultrasonography is a useful techniquefor loco-regional staging of gastric adenocarcinoma, whichmay have important implications in the therapeutic managementof these patients(AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Endossonografia/métodos , Endossonografia , Estadiamento de Neoplasias/métodos , Estadiamento de Neoplasias , Neoplasias Gástricas/diagnóstico , Valor Preditivo dos Testes , Adenocarcinoma/diagnóstico , Endossonografia/instrumentação , Endossonografia/estatística & dados numéricos , Endossonografia/tendências , Estadiamento de Neoplasias/estatística & dados numéricos , Neoplasias Gástricas , Estudos Retrospectivos , Radiografia Torácica , Endossonografia/economia , Carcinoma/complicações , Carcinoma/diagnósticoRESUMO
Introducción: el receptor del factor de crecimiento epidérmico,EGFR(HER-1), es un receptor de tirosina quinasas cuya activaciónpermite un aumento de la proliferación celular, angiogénesis,proceso metastásico y disminución de la apoptosis celular. Nuestroobjetivo es conocer el valor pronóstico de la inmunotinción deEGFR en tumores estromales gastrointestinales (GIST).Pacientes y método: estudio retrospectivo que incluye todoslos GIST intervenidos quirúrgicamente entre 1995-2007 en elServicio de Cirugía General y del Aparato Digestivo del HospitalGeneral de Ciudad Real. Variables clínicas: edad, sexo, clínica,mortalidad, recidiva. Variables patológicas: a) macroscópicas: localización,diámetro; b) microscópicas: necrosis tumoral, índicemitótico, tipo celular; y c) inmunohistoquímicas: vimentina (V9,Dako A/s); actina del músculo liso (HHF-35, Biogenex); CD34(QBEND/10); S100 (Policlonal Dako A/S); CD117 (c-kit Rabbit,antihuman polyclonal antibody, 1:600); PDGFR-alfa (Rabbitpolyclonal antibody, 1:50, Sta. Cruz Biotechnology). Variablesmoleculares pronósticas: P-53, PAb240 (DakoCytomation), 1:75,Ki-67, clona MIB1 (Dako), 1:120 y EGFR pharmDx Dako Autostainer(Dako, Dinamarca). Criterios de malignidad: criteriosde Fletcher.Resultados: entre 1995 y 2007, 35 GIST, fueron intervenidosquirúrgicamente en nuestro Servicio. Edad media: 61,11 ±11,02, siendo mujeres en el 62,9% de los casos. Debutaron conhemorragia digestiva en un 40%. La mediana de seguimiento fuede 28 meses (3-133). La mortalidad fue de 54,3%, con recidivadel 40%. Variables morfológicas: la localización más frecuente fuegástrica, 51,4% (18). Existió necrosis tumoral en un 57,1%, 20.El patrón celular fue fusocelular en un 57,1%, y epitelioide en un14,3%. El diámetro máximo fue de 9,58 ± 6,29. El índice mitóticopor 50 campos de gran aumento fue de 13,44 ± 16,08. En un51,45%, 18, fueron neoplasias de alto riesgo. Valores inmunohistoquímicos:CD117+, 85,7%. PDGFRA+, 85,7%. CD34+,77,1%. EGFR+, 62,9%. S100+, 34,3%. Actina+, 20%. Vimentina+,100%. p53+, 40%. ki67+, 10,71 ± 10,82. La expresión deEGFR no se relacionó con la recidiva y/o mortalidad del enfermo p = 0,156, y p = 0,332, respectivamente. El índice mitótico serelacionó con la mortalidad del enfermo, p = 0,02, y recidiva neoplásica,p = 0,013.Conclusión: en nuestra muestra no existió relación entre lainmunotinción de EGFR y el pronóstico del tumor estromal gastrointestinal
Introduction: the epidermal growth factor receptor, EGFR(HER-1), is a tyrosine kinase receptor. EGFR activation plays animportant role in increased cell proliferation, angiogenesis, anddecreased apoptosis. Our objective was to study EGFR immunoexpressionin GIST, as well as its prognostic value.Patients and method: a retrospective study that included allpatients operated on with a histologic diagnosis of GIST at Departmentof Surgery, Hospital General, Ciudad Real, between1995 and 2007. Clinical features: age, sex, manifestations, mortality,recurrence. Pathological features: origin, size, tumoralnecrosis, mitotic index, cell type. Immunohistochemical features:vimentin, (V9, Dako A/s); smooth muscle actin (HHF-35,Biogenex); CD34 (QBEND/10); S100 (Policlonal Dako A/S),CD117, (c-kit Rabbit, antihuman polyclonal antibody, 1:600);PDGFR-alfa (Rabbit polyclonal antibody, 1:50, Sta. Cruz Biotechnology).Prognostic molecular features: P-53, PAb240 (DakoCytomation)1:75; Ki-67, clona MIB1 (Dako), 1:120 y (EGFR)pharmDx Dako Autostainer (Dako, Denmark). Malignancycritera: Fletcher's critera.Results: from 1995 to 2007, 35 GISTs were resected in ourDepartment. Mean age: 61.11 ± 11.02, with a female predominanceof 62.9%. Initial clinical manifestation included digestivehemorrhage in 40%. Median follow-up was 28 months (3-133).Mortality was 54.3%, and recurrence rate was 40%. The mostfrequent origin was the stomach, 51.4%, (18). There was tumornecrosis in 57.1% (20). There were spindle-like cells in 57.1%,and epithelioid cells in 14.3%. Mean size was 9.58 ± 6.29. Mitoticindex per 50 high-power fields was 13.44 ± 16.08; 51.45%(18) were high-risk tumors. Immunohistochemical expression:CD117+, 85.7%. PDGFRA+, 85.7%. CD34+, 77.1%. EGFR+,62.9%. S100+, 34.3%. Actin+, 20%. Vimentin+, 100%. p53+,40%. ki67+, 10.71 ± 10.82. There was no correlation betweenEGFR expression and recurrence and/or mortality, p = 0.156and p = 0.332, respectively. Mitosis index related to mortality, p= 0.02, and recurrence, p = 0.013. Conclusion: in our study there was no relation betweenEGFR immunohistochemical expression and the prognosis of GIST (AU)
Assuntos
Receptores de Fatores de Crescimento/análise , Neoplasias Gastrointestinais/química , Neoplasias Gastrointestinais/mortalidade , Imuno-Histoquímica , Prognóstico , Estudos Retrospectivos , Vimentina/análise , Actinas/análise , Recidiva Local de NeoplasiaRESUMO
No disponible
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Humanos , Masculino , Feminino , Síndrome de Stevens-Johnson/complicações , Síndrome de Stevens-Johnson/tratamento farmacológico , Febre/complicações , Febre/diagnóstico , Febre/etiologia , Amoxicilina/uso terapêutico , Cloxacilina/uso terapêutico , Gentamicinas/uso terapêuticoRESUMO
El síndrome de Stevens-Johnson es un proceso agudo poco frecuente con una morbimortalidad próxima al 20%. El síndrome de Stevens-Johnson es una dermatosis reactiva consistente en un eritema multiforme con presencia de vesículas y/o ampollas en mucosas (sobre todo oral). Su presentación más severa es la necrólisis epidérmica tóxica. La causa más frecuente es la hipersensibilidad a múltiples fármacos, seguido de infecciones, enfermedades del tejido conectivo y neoplasias. Es un síndrome, que aunque poco frecuente, debemos de pensar en él ya que la instauración rápida de un tratamiento adecuado así como la rápida retirada del fármaco desencadenante pueden reducir considerablemente la morbimortalidad (AU)
Stevens-Johnson syndrome is a rare acute process with a mortality rate of 20%. Stevens-Johnson syndrome is a reactive dermatosis consisting of an erythema multiforme with the presence of vesicles and or blisters in the mucosa (particularly oral). Its more severe presentation is toxic epidermal necrolysis. The most frequent cause is hypersensitivity to multiple drugs, followed by infections, connective tissue diseases, and neoplasms. Although it is a rare syndrome, we must consider it, as the rapid installation of an appropriate treatment, as well as the rapid withdrawal of the triggering drug, can considerably reduce the morbidity and mortality (AU)
Assuntos
Humanos , Masculino , Adulto , Síndrome de Stevens-Johnson/complicações , Síndrome de Stevens-Johnson/diagnóstico , Febre/complicações , Febre/etiologia , Exantema/complicações , Estomatite/complicações , Estomatite/diagnóstico , Indicadores de Morbimortalidade , Hipersensibilidade a Drogas/complicações , Hipersensibilidade a Drogas/diagnóstico , Tecido Conjuntivo/patologia , Doenças do Tecido Conjuntivo/complicações , Doenças do Tecido Conjuntivo/diagnósticoRESUMO
Objetivo: Existen estudios en animales con cáncer de mama y estudios retrospectivos en humanos que sugieren una reducción de riesgo de metástasis tras realizar una anestesia regional en la cirugía de mama. Hemos estudiado si la realización de bloqueo paravertebral torácico (BPVT) asociado a una anestesia general comparado con una anestesia general sin BPVT reduce la incidencia de metástasis a corto plazo en las pacientes sometidas a cirugía oncológica de mama. Métodos: Se recogieron retrospectivamente 138 pacientes sometidas a cirugía de mama (bien cirugía conservadora, o bien mastectomía, en ambos casos con o sin linfadenectomía) en el periodo entre enero de 2008 hasta junio de 2009. Se consideraron las siguientes variables: edad, peso, antecedentes personales, tipo de tumor, grado histológico, TNM, índice de Nottingham, si recibió o no terapia sistémica, tipo de cirugía, tipo de anestesia, metástasis a 6 meses y a 12 meses, y la supervivencia libre de enfermedad. Resultados: En 40 pacientes se practicó un BPVT más anestesia general, y en 98 anestesia general solamente. En cuanto al grado histológico, clasificación TNM, índice de Nottingham y terapia sistémica no presentaban diferencias entre los dos grupos. La aparición de metástasis a 6 meses fue de 2,5% en el grupo de anestesia con BPVT y de un 6,1% en el grupo de anestesia general (p = 0,673), y a 12 meses, un 2,5% en el grupo de anestesia general con BPVT, y un 9,2% en el de anestesia general (p = 0,281). El consumo intraoperatorio de fentanilo y remifentanilo y de analgesia postoperatoria fue mayor en el grupo con anestesia general. Conclusiones: En este estudio retrospectivo el porcentaje de metástasis fue menor tanto a 6 como a 12 meses en las pacientes en las que se realizó un bloqueo paravertebral con respecto a las que se realizó anestesia general exclusivamente, sin que la diferencia fuera estadísticamente significativa(AU)
Objectives: A reduction in risk of metastasis after performing regional anesthesia in breast surgery has been suggested in both animal studies and retrospectives human studies with breast cancer. We studied whether thoracic paravertebral block (TPVB) associated with general anesthesia compared with general anesthesia reduces the metastases incidence in short term in patients undergoing breast cancer surgery. Methods: 138 patients undergoing breast surgery (either conservative breast surgery or mastectomy, both of them with or without lymphadenectomy) were retrospectively examined between January 2008 and June 2009. The following variables were recorded: age, weight, medical history, type of tumor, histological grade, TNM, Nottingham Index, adjuvant therapy, type of surgery, type of anesthesia, metastasis at 6 and 12 months and disease-free survival. Results: In 40 patients a TPVB combined with general anesthesia were performed, and 98 patients had general anesthesia alone. There were no differences in histological grade, TNM classification, Nottingham index and adjuvant therapy between the two groups. Metastasis at 6 months was 2.5% in the group of anesthesia combined with TPVB and 6.1% in the General Anesthesia group (p = 0.673). At 12 months was 2.5% and 9.2%, respectively (p = 0.281). The intraoperative consumption of fentanyl and remifentanil and postoperative analgesia requirements were higher in the group with general anesthesia. Conclusions: In this retrospective study, the rate of metastasis was lower at both 6 and 12 months in patients who underwent the paravertebral block combined with general anesthesia compared to general anesthesia. However, differences between both groups were not found to be significant(AU)
Assuntos
Humanos , Animais , Feminino , Neoplasias da Mama/cirurgia , Metástase Neoplásica/tratamento farmacológico , Fatores de Risco , Anestesia por Condução/métodos , Anestesia por Condução , Anestesia Geral/métodos , Anestesia Geral , /métodos , Fentanila/uso terapêutico , Estudos Retrospectivos , Anestesia por Condução/instrumentação , Anestesia por Condução/tendências , /tendênciasRESUMO
No disponible
Assuntos
Masculino , Idoso , Humanos , Ampola Hepatopancreática/patologia , Tumor Carcinoide/patologia , Tumor Carcinoide/cirurgia , Imuno-Histoquímica , Pancreaticoduodenectomia , Prognóstico , Resultado do TratamentoRESUMO
Objetivos: La cirugía bariátrica ha demostrado su eficacia en pérdida de peso y reducción de comorbilidades en el obeso mórbido. Los objetivos de nuestro trabajo fueron: evaluar los resultados con las técnicas de Scopinaro y Bypass gástrico, mediante cirugía abierta y laparoscópica. Material y métodos: 78 pacientes con obesidad mórbida intervenidos desde el año 2000 al 2005. 50 pacientes fueron intervenidos por cirugía abierta y 28 por laparoscopia. Se realizó bypass gástrico en 54 pacientes, la técnica Scopinaro en 20 y gastroplastia vertical anillada en 3. El tiempo de seguimiento fue desde 6 y 60 meses. Se recogieron los resultados obtenidos con las diversas técnicas y vías quirúrgicas. Resultados: El porcentaje de pacientes con pérdida de exceso de peso inferior al 50% a los dos años fue del 5% y del 13%, y superior al 75% fue del 55% y del 40% en el bypass gástrico y el Scopiraro respectivamente. Todas las comorbilidades mejoraron significativamente. La estancia media fue inferior (p < 0,001) en el caso de laparoscopia. Las complicaciones no nutricionales fueron en su mayoría superiores en la cirugía abierta destacando las eventraciones (30%), infección de las herida (32%), y complicaciones respiratorias (16%). Las complicaciones nutricionales fueron superiores en la técnica Scopinaro destacando el déficit de vitamina D (50%), Zinc (25%), magnesio (10%) y albúmina (5%). Conclusiones: En nuestra experiencia, la realización del bypass gástrico por laparoscopia, consigue menor estancia media, menores complicaciones nutricionales y quirúrgicas, sin diferencias significativas con respecto al Scopinaro en cuanto a pérdida de peso y reducción de comorbilidades. Sin embargo, para poder defender esta técnica como de elección se requieren estudios de mayor tamaño, controlados y aleatorizados y a más largo plazo, teniendo siempre en cuenta la experiencia de nuestros cirujanos (AU)
Objetives: Bariatric surgery has demonstrated its efficacy in weight loss and in reducing the comorbidities in the morbid obesity patient. The objectives of this study were to analyze the effectiveness and complication of the Scopinaro and gastric bypass techniques as well as the results from open surgery verses laparoscopy. Design: Retrospective study from 1999-2005. Subject and methods: 78 patients with morbid obesity were operated. 50 patients underwent open surgery and 28 underwent laparoscopy. Gastric bypass was performed in 54 patients, Scopinaro was performed in 20 patients and Vertical Banded Gastroplasty (VBG) was performed in 3 patients. The follow up time was between 6 and 60 months. The results obtained with Scopinaro and gastric bypass were compared as well as the results from open surgery verses laparoscopy. Results: The percentage of patients with a percent of excess weight loss under 50% in two years was of 5% and 13%, and the excess weight loss over 75% was of 55% ad 40% in the gastric bypass and the Scopinaro technique respectively. All the comorbidities improved.The average stay was decreased in the case of laparoscopy.The non-nutritional complications were increased for most cases in open surgery with the emphasis in eventrations, infections of the wound and respiratory complications. The nutritional complications were superior with Scopinaro´s technique. Conclusions: Based on our study, we would recommend the performance of gastric bypass for laparoscopy due to the reduced average stay and less nutritional and surgical complications. The literature results vary and therefore we consider necessary further control and random studies to correctly establish these comparisons (AU)
Assuntos
Masculino , Feminino , Adulto , Humanos , Obesidade Mórbida/cirurgia , Estudos Retrospectivos , SeguimentosRESUMO
Introducción: La necrosis grasa subcutánea del recién nacido es una paniculitis transitoria aguda de presentación infrecuente en la infancia, con lesiones cutáneas características y de evolución generalmente benigna. De las diversas complicaciones asociadas, la hipercalcemia es la más frecuente y la más severa. Caso clínico: Neonato de sexo femenino nacida de gestación a término, que ingresa en una Unidad de Neonatología por síndrome de aspiración meconial. En las primeras horas de vida presenta acidosis mixta severa, hipoglucemia, trombopenia y recibe tratamiento con ventilación mecánica y antibioterapia. Presenta nódulos violáceos en la región glutea y la espalda a los 4 días de vida, con diagnóstico final de necrosis grasa subcutánea tras estudio histopatológico. Las lesiones cutáneas han evolucionado favorablemente. Durante los primeros meses de vida presentó hipercalcemia moderada que cursó clínicamente con episodios de irritabilidad, rechazo de tomas y estancamiento ponderal. Recibió tratamiento con hidratación intravenosa, exclusión de vitamina D y corticoides, con normalización de los niveles de calcio sérico a los12 meses de edad sin evidencia de calcificaciones tisulares. Conclusiones: Es imprescindible un seguimiento precoz y prolongado de los pacientes con necrosis grasa subcutánea, sobre todo para la detección temprana de alteraciones metabólicas potencialmente graves como la hipercalcemia (AU)
Introduction: Subcutaneous fat necrosis of the newborn is an uncommon panniculitis, with carachteristical skinlesions; prognosis is considered good. Several complications have been reported, being hypercalcaemia the most frequent and severe. Case: Female newborn had a history of meconium aspiration syndrome, acidosis, hypoglicemia and thrombocytopenia,thus she was treated with mechanical ventilation and antibiotics in a Neonatal Unit. Violaceus subcutaneous nodules in back and buttocks appeared at day 4. Diagnosis of subcutaneous fat necrosis was made by dermatologists based on clinical and histological findings obtained by skinbiopsy; cutaneous lesions disappeared after several months. The patient had moderate symptomatic hypercalcaemia, presenting irritability, feeding problems and failure to thrive, and she received treatment with intravenous fluids and short-term oral steroids therapy. Serum calcium was normal by 12 months-old with no evidence of tissue calcifications (AU)
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Humanos , Feminino , Recém-Nascido , Hipercalcemia/diagnóstico , Hipercalcemia/etiologia , Necrose Gordurosa/complicações , Necrose Gordurosa/diagnóstico , Paniculite/complicações , Paniculite/diagnóstico , Doença Aguda , Necrose Gordurosa/patologia , Hipercalcemia/terapia , Necrose Gordurosa/terapia , Paniculite/patologia , Paniculite/terapiaRESUMO
No disponible
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Feminino , Adulto , Humanos , Ductos Biliares Intra-Hepáticos/patologia , Cistadenoma/patologia , Progesterona , Neoplasias Hormônio-Dependentes/patologia , Antineoplásicos Hormonais/efeitos adversosRESUMO
Describimos un caso de linfoma secundario no Hodgkin con presentación metacrónica en vejiga y riñón izquierdo, en un paciente con diferentes afectaciones extragonadales. Tanto en la vejiga como en el riñón se trataba de un linfoma de bajo grado tipo B de células centrofoliculares. Se sugiere la diseminación hematógena y afinidad del clon linfomatoso por el aparato urinario. Se establecen algunas consideraciones diagnósticas, así como sobre el enfoque terapéutico en este tipo de patologías (AU)
We pass to describe a case of non Hodgkins secondary lymphoma with metachronic affectation in bladder and left kidney, in a patient with different extranodals locations. Both in bladder and kidney, it was a low grade lymphoma type B with centrofolicular cells. We suggest haematogenous dissemination and affinity of lymphomatous clone to the urinary tract. We establish some diagnostic considerations, such about the therapeutic management in this type of pathologies (AU)
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Masculino , Idoso , Humanos , Linfoma não Hodgkin/patologia , Neoplasias da Bexiga Urinária/patologia , Linfoma de Células B/patologia , Neoplasias Renais/secundárioRESUMO
Ovarian cysts are found in 32 per cent of necropsies performed to neonates. They can also be diagnosed during gestation by ultrasonography. The clinical evolution of these cysts is variable, but in most cases the prognosis is favorable. Some complications such as ovarian torsion, bleeding, rupture and peritonitis have been described. We report two newborn girls with ovarian cysts, diagnosed during gestation. One required an emergency operation due to vomiting and abdominal distension, interpreted as a possible torsion of the cyst. The second girl was operated at the fourth day of life, finding a left ovarian cyst with torsion of the pedicle. Both girls had a favorable postoperative evolution.
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Humanos , Feminino , Gravidez , Recém-Nascido , Ultrassonografia Pré-Natal , Cistos Ovarianos , Doenças Fetais , Cistos Ovarianos , Cistos Ovarianos/cirurgia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: In Chile, 14 to 16 per cent of births occur in teenage mothers. These mothers apparently have a higher frequency of premature labor, low birth weight and congenital malformations. AIM: To assess the frequency of prematurity, congenital malformations and weight at birth among the offspring of adolescent mothers. PATIENTS AND METHODS: The births occurred in a hospital between 1982 and 2001, were analyzed using the Latin American Collaborative Study for Congenital Malformations (ECLAMC) data base. Mothers were classified as teenagers when their age ranged between 10 and 19 years old and older when their age was over 20 years old. All women were subdivided as cases and controls. RESULTS: The sample was formed by 894 teenage and 806 older mothers. Seven percent of both teenage and older mothers had offspring with one or more malformations. The incidence of low birth weight newborns and of prematurity was also similar in both groups of mothers. CONCLUSIONS: In this sample, offspring of teenage mothers do not have a higher frequency of malformations, low birth weight or prematurity.
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Humanos , Feminino , Gravidez , Recém-Nascido , Criança , Adolescente , Adulto , Anormalidades Congênitas , Gravidez na Adolescência , Recém-Nascido de Baixo Peso , Trabalho de Parto Prematuro/epidemiologia , Chile/epidemiologia , Estudos de Casos e Controles , Idade Materna , PrevalênciaRESUMO
Clásicamente, la infección por Nocardia spp. se asocia a estados de depresión inmunológica, procesos neoplásicos y tratamientos prolongados con inmunosupresores y glucocorticoides. La afectación pulmonar es la más característica, siendo infrecuente la diseminación del proceso por extensión local a la pared costal y el tejido celular subcutáneo. Presentamos un caso de nocardiosis pulmonar por Nocardia asteroides en una paciente diabética sin otros factores de riesgo conocidos, que se manifestó por el desarrollo de un absceso en la pared torácica con destrucción del 5º arco costal y que respondió adecuadamente al tratamiento prolongado con cotrimoxazol tras el drenaje de la colección. Revisamos la literatura y destacamos el carácter invasivo de la infección, las nuevas formas de diagnóstico y las diferentes pautas de antibioterapia. Así mismo, destacamos la dificultad en el diagnóstico de esta infrecuente entidad, que motiva la falta de un adecuado diagnóstico y tratamiento en muchos pacientes. (AU)