Low-to-moderate alcohol consumption is associated with increased fibrosis in individuals with metabolic dysfunction-associated steatotic liver disease.

BACKGROUND & AIMS: Both metabolic dysfunction and alcohol consumption cause steatotic liver disease (SLD). New nomenclature and distinction of metabolic dysfunction-associated SLD (MASLD) and MetALD categories is based on arbitrary thresholds of alcohol intake. We assessed the impact of different levels of alcohol consumption on SLD severity and its interaction with metabolic comorbidities. METHODS: Population-based study with transient elastography (FibroScan®) data from participants in Spain (derivation) and U.S. (validation) cohorts. Controlled attenuation parameter (CAP≥275 dB/m) identified SLD. At least one cardiometabolic risk factor was required to define MASLD. Among MASLD patients, low alcohol consumption was defined as an average of 5-9 drinks/week, moderate consumption as 10-13 drinks/week for females and 10-20 drinks/week for males, and increased alcohol intake (MetALD) as 14-35 drinks/week for females and 21-42 drinks/week for males. Significant fibrosis was defined as LSM≥8 kPa and at-risk MASH as FAST score≥0.35. RESULTS: The derivation cohort included 2,227 subjects with MASLD (9% reported low, 14% moderate alcohol consumption), and 76 cases with MetALD. Overall prevalence of significant fibrosis and at-risk MASH were 7.6% and 14.8%, respectively. In the multivariable analysis, alcohol consumption was independently associated with significant fibrosis and at-risk MASH. A dose-dependent increase in the prevalence of significant fibrosis and at-risk MASH was observed between the number of drinks/week and the number of cardiometabolic factors. The validation cohort included 1,732 participants with MASLD, of whom 17% had significant fibrosis and 13% at-risk MASH. This cohort validated the association between moderate intake and MASLD at risk of progression (OR=1.69 [95%CI 1.06-2.71]). CONCLUSIONS: Moderate alcohol intake is commonly seen in MASLD and increases the risk of advanced disease, in a similar magnitude to MetALD spectrum. IMPACT AND IMPLICATIONS: Metabolic risk factors such as overweight, diabetes or dyslipidemia, and alcohol consumption can cause liver disease. These factors frequently co-exist, but their joint effects on liver fibrosis remain uncertain. This study analyzes subjects form the general population with metabolic dysfunction-associated steatotic liver disease (MASLD) enrolled in Spain and U.S. We show that moderate alcohol consumption has a supra-additive effect with metabolic risk factors, exponentially increasing the risk of liver fibrosis. These results suggest that patients with unhealthy metabolic status and MASLD have no safe limits of daily alcohol intake.

Paired Primary and Recurrent Rhabdoid Meningiomas: Cytogenetic Alterations, BAP1 Gene Expression Profile and Patient Outcome.

Rhabdoid meningiomas (RM) are a rare meningioma subtype with a heterogeneous clinical course which is more frequently associated with recurrence, even among tumors undergoing-complete surgical removal. Here, we retrospectively analyzed the clinical-histopathological and cytogenetic features of 29 tumors, from patients with recurrent (seven primary and 14 recurrent tumors) vs. non-recurrent RM (n = 8). Recurrent RM showed one (29%), two (29%) or three (42%) recurrences. BAP1 loss of expression was found in one third of all RM at diagnosis and increased to 100% in subsequent tumor recurrences. Despite both recurrent and non-recurrent RM shared chromosome 22 losses, non-recurrent tumors more frequently displayed extensive losses of chromosome 19p (62%) and/or 19q (50%), together with gains of chromosomes 20 and 21 (38%, respectively), whereas recurrent RM (at diagnosis) displayed more complex genotypic profiles with extensive losses of chromosomes 1p, 14q, 18p, 18q (67% each) and 21p (50%), together with focal gains at chromosome 17q22 (67%). Compared to paired primary tumors, recurrent RM samples revealed additional losses at chromosomes 16q and 19p (50% each), together with gains at chromosomes 1q and 17q in most recurrent tumors (67%, each). All deceased recurrent RM patients corresponded to women with chromosome 17q gains, although no statistical significant differences were found vs. the other RM patients.

Triangle Tip-Jet Knife used as "probe mode" can reduce the risk of mucosal damage during incision and tunneling phase of peroral endoscopic myotomy (POEM) procedures.

Peroral endoscopic myotomy (POEM) is a minimally invasive endoscopic technique for the treatment of achalasia and its use has been widely spread in recent years. The Triangle Tip-Jet (TTJ) (Olympus Triangle TipKnife-J, KD645L) has become very popular in this field and currently one of the most used knives for POEM procedures. It has the capability of knife dissection along with submucosal injection and its triangle tip shape is especially useful for pulling tissue during the myotomy phase. However, its length may be too long in situations such as tight esophagogastric junction (EGJ), narrow submucosa due to fibrosis, trimming after mucosal incision and/or less experienced endoscopists3 in which preserving the integrity of the mucosa is vitally important. Distal attachment conical caps like ST Hood (DH28GR,29CR; Fujifilm, Tokyo, Japan) are commonly used for POEM, resting the distal end of the TTJ on the cap, with only the triangular tip protruding. By using straight caps, you can get a wider view and greater maneuverability, however is more difficult to calculate the distance between the triangle tip and the distal attachment end due to its straight shape. The T-shape of the distal TTJ tip was designed for its use in an open position. In this way, while using straight caps and/or less experiences endoscopists during challenging procedures (tight EGJ, submucosal fibrosis) can make them feel unsafe during incision and/or tunneling phase. Herein, we suggest the use of the TTJ knife in "probe mode"4 to reduce the distal knife length from 4.5 mm to 0.3 mm, thus allowing a greater control of the knife tip. In addition, the TTJ probe mode can be safely used with both contact and non-contact currents, which are becoming increasingly popular in recent years.

Triangle Tip-Jet Knife used as “probe mode” can reduce the risk of mucosal damage during incision and tunneling phase of peroral endoscopic myotomy (POEM) procedures

Peroral endoscopic myotomy (POEM) is a minimally invasive endoscopic technique for the treatment of achalasia and its use has been widely spread in recent years. The Triangle Tip-Jet (TTJ) (Olympus Triangle TipKnife-J, KD645L) has become very popular in this field and currently one of the most used knives for POEM procedures. It has the capability of knife dissection along with submucosal injection and its triangle tip shape is especially useful for pulling tissue during the myotomy phase. However, its length may be too long in situations such as tight esophagogastric junction (EGJ), narrow submucosa due to fibrosis, trimming after mucosal incision and/or less experienced endoscopists3 in which preserving the integrity of the mucosa is vitally important. Distal attachment conical caps like ST Hood (DH28GR,29CR; Fujifilm, Tokyo, Japan) are commonly used for POEM, resting the distal end of the TTJ on the cap, with only the triangular tip protruding. By using straight caps, you can get a wider view and greater maneuverability, however is more difficult to calculate the distance between the triangle tip and the distal attachment end due to its straight shape. The T-shape of the distal TTJ tip was designed for its use in an open position. In this way, while using straight caps and/or less experiences endoscopists during challenging procedures (tight EGJ, submucosal fibrosis) can make them feel unsafe during incision and/or tunneling phase. Herein, we suggest the use of the TTJ knife in “probe mode”4 to reduce the distal knife length from 4.5 mm to 0.3 mm, thus allowing a greater control of the knife tip. In addition, the TTJ probe mode can be safely used with both contact and non-contact currents, which are becoming increasingly popular in recent years. (AU)

NAFLD and type 2 diabetes: A practical guide for the joint management / Esteatosis hepática metabólica y diabetes mellitus tipo 2: Una guía práctica para el manejo conjunto

Non-alcoholic fatty liver disease (NAFLD) is becoming a major cause of liver disease-related morbidity, as well as mortality. Importantly, NAFLD is considered a mediator of systemic diseases including cardiovascular disease. Its prevalence is expected to increase, mainly due to its close association with obesity and type 2 diabetes mellitus (T2D). In addition, T2D and NAFLD share common pathophysiological mechanisms, and one can lead to or worsen the other. Therefore, a close collaboration between primary care physician, endocrinologists and hepatologists is essential to optimize the management of patients with NAFLD and T2D. Here, we summarize relevant aspects about NAFLD and T2D that all clinician managing these patients should know as well as current therapeutic options for the treatment of T2D associated with NAFLD. (AU)

La esteatosis hepática metabólica (EHmet) se está convirtiendo en una de las causas más importantes de morbimortalidad relacionada con las enfermedades hepáticas. Es importante destacar que la EHmet se considera un mediador de enfermedades sistémicas, incluidas las enfermedades cardiovasculares. Se espera que su prevalencia aumente, principalmente debido a su estrecha relación con la obesidad y la diabetes mellitus tipo 2 (DM2). Además, la DM2 y la EHmet comparten mecanismos fisiopatológicos comunes y una puede provocar o empeorar la otra. Por lo tanto, una estrecha colaboración entre el médico de atención primaria, endocrinólogos y hepatólogos es fundamental para optimizar el manejo de los pacientes con EHmet y DM2. En esta guía resumimos aspectos relevantes sobre EHmet y DM2 que todo médico que maneja a estos pacientes debe conocer, así como las opciones terapéuticas actuales para el tratamiento de DM2 asociada a EHmet. (AU)

Fatty Liver Disease, Metabolism and Alcohol Interplay: A Comprehensive Review.

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide, and its incidence has been increasing in recent years because of the high prevalence of obesity and metabolic syndrome in the Western population. Alcohol-related liver disease (ArLD) is the most common cause of cirrhosis and constitutes the leading cause of cirrhosis-related deaths worldwide. Both NAFLD and ArLD constitute well-known causes of liver damage, with some similarities in their pathophysiology. For this reason, they can lead to the progression of liver disease, being responsible for a high proportion of liver-related events and liver-related deaths. Whether ArLD impacts the prognosis and progression of liver damage in patients with NAFLD is still a matter of debate. Nowadays, the synergistic deleterious effect of obesity and diabetes is clearly established in patients with ArLD and heavy alcohol consumption. However, it is still unknown whether low to moderate amounts of alcohol are good or bad for liver health. The measurement and identification of the possible synergistic deleterious effect of alcohol consumption in the assessment of patients with NAFLD is crucial for clinicians, since early intervention, advising abstinence and controlling cardiovascular risk factors would improve the prognosis of patients with both comorbidities. This article seeks to perform a comprehensive review of the pathophysiology of both disorders and measure the impact of alcohol consumption in patients with NAFLD.

Faecal Microbiota Transplantation, Paving the Way to Treat Non-Alcoholic Fatty Liver Disease.

Non-alcoholic fatty liver disease (NAFLD) is currently the most prevalent cause of chronic liver disease (CLD). Currently, the only therapeutic recommendation available is a lifestyle change. However, adherence to this approach is often difficult to guarantee. Alteration of the microbiota and an increase in intestinal permeability seem to be key in the development and progression of NAFLD. Therefore, the manipulation of microbiota seems to provide a promising therapeutic strategy. One way to do so is through faecal microbiota transplantation (FMT). Here, we summarize the key aspects of FMT, detail its current indications and highlight the most recent advances in NAFLD.

Increased risk of MAFLD and Liver Fibrosis in Inflammatory Bowel Disease Independent of Classic Metabolic Risk Factors.

BACKGROUND & AIMS: There is conflicting evidence regarding the prevalence of and risk factors for metabolic-associated fatty liver disease (MAFLD) in patients with inflammatory bowel disease (IBD). We aimed to determine MAFLD prevalence and risk factors in IBD patients. METHODS: Cross-sectional, case-control study included all consecutive IBD patients treated at 2 different university hospitals. Controls were subjects randomly selected from the general population and matched by age, sex, type 2 diabetes status, and body mass index in a 1:2 ratio. MAFLD was confirmed by controlled attenuation parameter. Liver biopsies were collected when MAFLD with significant liver fibrosis was suspected. In addition, age- and fibrosis stage-paired non-IBD patients with biopsy-proven MAFLD served as a secondary control group. RESULTS: Eight hundred thirty-one IBD patients and 1718 controls were included. The prevalence of MAFLD and advanced liver fibrosis (transient elastography ≥9.7 kPa) was 42.00% and 9.50%, respectively, in IBD patients and 32.77% and 2.31%, respectively, in the general population (P < .001). A diagnosis of IBD was an independent predictor of MAFLD (adjusted odds ratio, 1.99; P < .001) and an independent risk factor for advanced liver fibrosis (adjusted odds ratio, 5.55; P < .001). Liver biopsies were obtained from 40 IBD patients; MAFLD was confirmed in all cases, and fibrosis of any degree was confirmed in 25 of 40 cases (62.5%). Body mass index and type 2 diabetes prevalence were significantly lower in IBD-MAFLD patients than in severity-paired patients with biopsy-proven MAFLD. CONCLUSIONS: MAFLD and liver fibrosis are particularly prevalent in IBD patients, regardless of the influence of classic metabolic risk factors.

NAFLD and type 2 diabetes: A practical guide for the joint management.

Non-alcoholic fatty liver disease (NAFLD) is becoming a major cause of liver disease-related morbidity, as well as mortality. Importantly, NAFLD is considered a mediator of systemic diseases including cardiovascular disease. Its prevalence is expected to increase, mainly due to its close association with obesity and type 2 diabetes mellitus (T2D). In addition, T2D and NAFLD share common pathophysiological mechanisms, and one can lead to or worsen the other. Therefore, a close collaboration between primary care physician, endocrinologists and hepatologists is essential to optimize the management of patients with NAFLD and T2D. Here, we summarize relevant aspects about NAFLD and T2D that all clinician managing these patients should know as well as current therapeutic options for the treatment of T2D associated with NAFLD.

Prevalence of antinuclear antibodies in inflammatory bowel disease and seroconversion after biological therapy.

BACKGROUND: Estimates of detectable antinuclear antibodies (ANA) prevalence vary widely, from 6% in healthy populations to 50-80% in patients with autoimmune disease. However, there is a lack of evidence about the overall prevalence in inflammatory bowel disease (IBD) and ANA seroconversion after the beginning of biological therapy. OBJECTIVES: The aim of the study was to investigate the overall prevalence of ANA in IBD patients, their relationship with different treatments, clinical outcomes and the seroconversion rate of ANA in patients treated with biological therapy. METHODS: Ambispective observational study including all consecutive IBD patients was carried out. Information about the presence of ANA, disease phenotype, duration, activity, complications, and past and current treatments were transversally collected. Retrospectively, in patients with detectable ANA, data regarding previous ANA detection and the diagnosis of lupus-like syndrome (LLS) was gathered. RESULTS: A total of 879 IBD patients were included. We observed a detectable ANA prevalence of 13.6%. The presence of ANA was frequently associated with biological therapy (36/118) and decreased when immunomodulators were combined to this therapy (7/32). Of 78 patients with ANA prior to the beginning of biological therapy, a seroconversion rate of 28.8% was observed after a mean of 3.14 years. Only 1 patient suffered LLS. CONCLUSION: Our study showed a prevalence of detectable ANA higher than the expected in healthy population. The presence of ANA was lower when immunomodulator therapy is associated. The ANA seroconversion rate is relevant after the initiation of biological treatment nevertheless, the risk of LLS appeared to be marginal.

Efficacy and safety of endoscopic sleeve gastroplasty versus laparoscopic sleeve gastrectomy in obese subjects with Non-Alcoholic SteatoHepatitis (NASH): study protocol for a randomized controlled trial (TESLA-NASH study).

BACKGROUND: Non-alcoholic steatohepatitis (NASH) is frequently associated with obesity, and its standard treatment is weight loss with diet and exercise; a dy% weight reduction has been associated with improvement in liver histological and analytical abnormalities. However, less than 25% of subjects achieve this goal. Laparoscopic sleeve gastrectomy (LSG) represents the most common procedure of bariatric surgery, providing effective weight loss and improvement in comorbidities such as NASH, but it is associated with several postoperative complications. Endoscopic bariatric techniques are currently on the rise as a new tool in the fight against obesity, offering patients an alternative to more invasive surgery. However, their efficacy and safety compared with LSG is unclear. METHODS: The TESLA-NASH study is a randomized, controlled, open-label, unicentric clinical trial with a medical device. The aim of this study is to evaluate and compare the efficacy and safety of endoscopic sleeve gastroplasty (ESG) versus laparoscopic sleeve gastrectomy (LSG) in liver histology improvement of patients with obesity +/- metabolic syndrome and NASH. A total of 30 patients will be randomized 1:1 to the experimental or control group. DISCUSSION: LSG is an effective treatment for weight reduction and for the remission of hepatic alterations. However, LSG is associated with acute and chronic postoperative complications. Bariatric endoscopic techniques promise less invasive and more cost-effective approaches to the treatment of obesity and metabolic comorbidities. ESG represents one of the most promising novel endoscopic interventions and it is mainly proposed for patients with mild-to-moderate obesity, but there are still no guidelines that specify its applicability criteria. This clinical trial will help us apply different tactics to the treatment of obesity and NASH. TRIAL REGISTRATION: ClinicalTrials.gov NCT04060368. Registered on Nov 15, 2019.

Quality of life, health, and government perception during COVID-19 times: Data from Colombia.

This analysis presents data collected through an online survey about the quality of life, health, subjective wellbeing, and government perception in four cities in Colombia during the COVID-19 crisis. Four universities and a local newspaper promoted the survey to assess how the pandemic affected the population's quality of life in a broad range of social and economic aspects. Respondents were adults (+18 years old) living in the largest Colombia cities: Bogotá, Medellín, Cali, and Barranquilla, totaling 1637 complete observations. Researchers used snowballing sampling strategy, social networks, a web page, and an advertisement in the partner newspaper for data collection. This data set helps to conduct social research and policy reports about the consequences of the pandemic. The data enclosed in this paper includes socioeconomic variables, income reduction, employment, household composition, teleworking, indebtedness, physical and mental health, physical activity behavior, subjective wellbeing, affective and communal relationships, institutional trust, and perception of government performance during COVID-19. We aim at contributing to a better understating of the consequences of the pandemic in Colombia and general in the Global South through the collection and dissemination of data for academic and policy purposes.

National digestive disease specialists survey on cardiovascular risk management in non-alcoholic fatty liver disease in spanish hospitals.

BACKGROUND & AIMS: Cardiovascular disease (CVD) is the main cause of mortality among non-alcoholic fatty liver disease (NAFLD) patients. The aim was to explore the level of knowledge and clinical management of cardiovascular risk (CVR) in NAFLD patients by Digestive Disease specialists. METHODS: An anonymous web-based survey was designed with 44 close-ended questions, divided into five sections, that were based on current guidelines on CVD prevention. Between November 2019 and January 2020, Digestive Disease specialists from Spanish hospitals were invited to participate in this survey via email and Twitter. Student's t, chi-square and Fishers' exact tests, and logistic regression were used for data analysis. RESULTS: 208 clinicians completed the survey. Most respondents (83.2%) believe that NAFLD is an independent risk factor for CVD, especially in the presence of NASH and fibrosis. Personal history of CVDs and cardiovascular risk-related comorbidities are collected by more than 75% of respondents. However, less than 17% perform an elementary physical examination to address the CVR, except weight which is evaluated by 69.8%. Over 54% of respondents do not perform or request any supplementary tests for CVR assessment, and only 10.2% use specific calculators. Furthermore, 54.3% spend less than 5 minutes giving lifestyle advice, and more than 52% do not start drug treatment after a recent diagnosis of any cardiovascular comorbidity. Only 25.6% have a multidisciplinary Unit for metabolic comorbidities in their hospitals, although 89% of the respondents would support the implementation of this Unit. CONCLUSIONS: Cardiovascular risk management in daily clinical practice by Digestive Disease specialists in Spain remains suboptimal.

The heartbeat of the city.

Human activity is organised around daily and weekly cycles, which should, in turn, dominate all types of social interactions, such as transactions, communications, gatherings and so on. Yet, despite their strategic importance for policing and security, cyclical weekly patterns in crime and road incidents have been unexplored at the city and neighbourhood level. Here we construct a novel method to capture the weekly trace, or "heartbeat" of events and use geotagged data capturing the time and location of more than 200,000 violent crimes and nearly one million crashes in Mexico City. On aggregate, our findings show that the heartbeats of crime and crashes follow a similar pattern. We observe valleys during the night and peaks in the evening, where the intensity during a peak is 7.5 times the intensity of valleys in terms of crime and 12.3 times in terms of road accidents. Although distinct types of events, crimes and crashes reach their respective intensity peak on Friday night and valley on Tuesday morning, the result of a hyper-synchronised society. Next, heartbeats are computed for city neighbourhood 'tiles', a division of space within the city based on the distance to Metro and other public transport stations. We find that heartbeats are spatially heterogeneous with some diffusion, so that nearby tiles have similar heartbeats. Tiles are then clustered based on the shape of their heartbeat, e.g., tiles within groups suffer peaks and valleys of crime or crashes at similar times during the week. The clusters found are similar to those based on economic activities. This enables us to anticipate temporal traces of crime and crashes based on local amenities.

Mutational profiling can identify laryngeal dysplasia at risk of progression to invasive carcinoma.

Early diagnosis of laryngeal squamous cell carcinoma (LSCC) at the stage of dysplasia could greatly improve the outcome of affected patients. For the first time we compared the mutational landscape of non-progressing dysplasia (NPD; n = 42) with progressing dysplasia (PD; n = 24), along with patient-matched LSCC biopsies; a total of 90 samples. Using targeted next-generation sequencing identified non-synonymous mutations in six genes (PIK3CA, FGFR3, TP53, JAK3, MET, FBXW7), and mutations were validated by Sanger sequencing and/or qPCR. Analysis was extended in silico to 530 head and neck (HNSCC) cases using TCGA data. Mutations in PIK3CA and FGFR3 were detected in PD and LSCC cases, as well as other HNSCC cases, but absent in NPD cases. In contrast, mutations in JAK3, MET and FBXW7 were found in NPD cases but not PD, LSCC or other HNSCC cases. TP53 was the most frequently mutated gene in both PD and NPD cases. With the exception of R248W, mutations were mutually exclusive. Moreover, five of seven PD mutations were located in motif H2 of p53, whereas none of the NPD mutations were. In summary, we propose that the mutational profile of laryngeal dysplasia has utility for the early detection of patients at risk of progression.

Meth Mouth-A Growing Epidemic in Dentistry?

In the past two decades, the synthetic style and fashion drug "crystal meth" ("crystal", "meth"), chemically representing the crystalline form of the methamphetamine hydrochloride, has become more and more popular in the United States, in Eastern Europe, and just recently in Central and Western Europe. "Meth" is cheap, easy to synthesize and to market, and has an extremely high potential for abuse and dependence. As a strong sympathomimetic, "meth" has the potency to switch off hunger, fatigue and, pain while simultaneously increasing physical and mental performance. The most relevant side effects are heart and circulatory complaints, severe psychotic attacks, personality changes, and progressive neurodegeneration. Another effect is "meth mouth", defined as serious tooth and oral health damage after long-standing "meth" abuse; this condition may become increasingly relevant in dentistry and oral- and maxillofacial surgery. There might be an association between general methamphetamine abuse and the development of osteonecrosis, similar to the medication-related osteonecrosis of the jaws (MRONJ). Several case reports concerning "meth" patients after tooth extractions or oral surgery have presented clinical pictures similar to MRONJ. This overview summarizes the most relevant aspect concerning "crystal meth" abuse and "meth mouth".

A comparison of the analgesic efficacy of vedaprofeno, carprofen or ketofen after ovariohysterectomy in bitches / Comparação da eficácia analgésica do vedaprofeno, do carprofeno ou do cetoprofeno após ovariohisterectomia em cadelas

In this study the authors aimed to compare the efficiency of carprofen, ketoprofen and vedaprofen for alleviating postoperative pain in bitches submitted to ovariohysterectomy (OH). Pre- and postoperative assessment of pain was made using serum levels of cortisol and glucose, the visual analogue scale (VAS) and the University of Melbourne pain scale (UMPS) in twenty-one bitches undergoing OH. Dogs were randomly assigned to one of three groups: vedaprofen at 0.5mg kg-1, carprofen at 2.2mg kg-1 or ketoprofen at 2.2mg kg-1. All analgesics were given orally 2 hour before surgery. Assessments were made before surgery and at 1, 2, 3, 4, 5, 6, 7, 8, 12 and 24 hours post-extubation. No dog of this study required additional doses of analgesics. There were no significant differences on serum cortisol and glucose concentrations among groups or from basal values, excepted one hour after extubation. No significant differences on pain scores were observed. It was concluded that vedaprofen provided as good a level of postoperative analgesia as carprofen and ketoprofen.

O objetivo deste estudo foi comparar a eficiência do carprofeno, do cetoprofeno e do vedaprofeno no alívio da dor pós-operatória em cadelas submetidas à ovariohisterectomia (OH) eletiva. Para tal, foram realizadas avaliações pré e pós-operatórias de cortisol e glicose séricos e foram usadas a escala análoga visual (VAS) e a escala da Universidade de Melbourne (University of Melbourne Pain Scale - UMPS). Vinte e uma cadelas foram distribuídas aleatoriamente em três grupos de sete animais cada: vedaprofeno 0,5mg kg-1, carprofeno 2,2mg kg-1 ou cetoprofeno 2,2mg kg-1. Todos os analgésicos foram administrados pela via oral, duas horas antes da cirurgia. As avaliações foram realizadas antes da cirurgia e uma, duas, três, quatro, cinco, seis, sete, oito, 12 e 24 horas após a extubação. Nenhum dos cães precisou de analgesia de resgate. Com exceção dos valores observados uma hora após a extubação, não houve diferenças significativas nas concentrações séricas de cortisol e glicose entre grupos ou quando foram comparadas aos valores basais. Tampouco houve diferenças significativas nos escores de dor entre as escalas usadas, nos tempos de avaliação para cada grupo, nem entre os grupos. Concluiu-se que o vedaprofeno fornece analgesia pós-operatória de qualidade similar à obtida com carprofeno e com cetoprofeno.

Avaliação hemodinâmica e metabólica da cetamina e cetamina S(+) após a reposição volêmica com hidroxietilamido 130/0,4 e solução salina hipertônica 7,5 por cento / Hemodynamic and metabolic evaluation of ketamine and S(+) ketamine after volemic expansion with hydroxyethyl starch 130/0.4 and hypertonic saline solution

O objetivo deste estudo foi avaliar os efeitos hemodinâmicos e metabólicos, após a administração de solução salina hipertônica (NaCL) 7,5 por cento ou em associação ao hidroxietilamido (HES), em cães com hipovolemia induzida e tratados com cetamina. Após a indução da hipovolemia, administrou-se NaCl 7,5 por cento (4,0ml kg-1) no grupo hipertônica levógira (GHL) e grupo hipertônica racêmica (GHR) ou HES 130/0,4 na mesma proporção de sangue retirado, associado a NaCl 7,5 por cento (4ml kg-1) no grupo hipertônica colóide levógira (GHCL) e no grupo hipertônica colóide racêmica (GHCR). Após 30 minutos, administrou-se, por via IV, cetamina levógira (CL) (5mg kg-1) no GHL e GHCL ou cetamina racêmica (CR) (10mg kg-1) no GHR e GHCR. Empregou-se a análise de variância de uma única via com repetições múltiplas (ANOVA) e o teste de Student Newman Keuls (P ≤ 0,05). A frequência cardíaca e a pressão arterial sistólica foram menores após a hipovolemia e após a CR. As pressões arteriais média e diastólica foram menores após a hipovolemia e cetamina. A pressão venosa central foi maior após a administração do colóide. Os índices cardíaco e sistólico foram menores após a hipovolemia em todos os grupos e, após a fase de expansão no GHL e GHR. A pressão média da artéria pulmonar foi menor após a hipovolemia em todos os grupos. A pressão de oclusão da artéria pulmonar foi maior após o colóide. O índice do trabalho ventricular esquerdo foi menor após a hipovolemia no GHCL e GHCR. O índice da resistência periférica total foi maior após a hipovolemia e menor após a CL. Observou-se acidose metabólica após a hipovolemia e após a cetamina. Ocorreu acidose respiratória após a cetamina no GHL e GHR. Conclui-se que a administração de NaCl 7,5 por cento associado ao HES 130/0,4 promove o restabelecimento imediato dos parâmetros hemodinâmicos e metabólicos no paciente hipovolêmico; a administração isolada de NaCl 7,5 por cento não é capaz...

The objective of this study was to evaluate the hemodynamics and hemogasometrics effects, after the administration of hypertonic solution (NaCl 7.5 percent) or in association with hidroxyethyl starch 130/0.4 (HES), in dogs with induced experimental hypovolemia and treated with racemic ketamine (RK) or S(+) ketamine (SK). After the hypovolemia induction, administration of NaCl 7.5 percent (4 ml kg-1) was performed in two groups called hypertonic S(+) group (HSG) and hypertonic racemic group (HRG), or NaCl 7.5 percent (4 ml kg-1) in association with HES, in the same ratio of removed blood, in two groups called hypertonic colloid S(+) group (HCSG) and hypertonic colloid racemic group (HCRG). After 30 minutes, it was administered by intravenous injection, SK (5tymg kg-1) in HSG and HCSG groups, or RK (10 mg kg-1) in HRG and HCRG groups. To evaluate the significance of the results, it was used One-way Analysis of variance (ANOVA) for repeated measures and Student Newman Keuls method (P ≤ 0.05). The heart rate and the systolic arterial pressure were reduced after hypovolemia and administration of the RK. Mean and diastolic arterial pressure were reduced after hypovolemia and either SK or RK administration. The central venous pressure was increased after administration of the colloid. The cardiac output, index cardiac, and index systolic were reduced after hypovolemia in all groups and, after phase of expansion in HSG and HRG. The pulmonary arterial occlusion pressure was increased after colloid administration. The left ventricular work index was reduced after hypovolemia in HCSG and HCRG. The systemic vascular resistance index was increased after hypovolemia and decreased after administration of the SK. The CO2 concentration to the end of the expiration increased after administration of ketamine in HCSG and HCRG. Metabolic acidosis was observed after hypovolemia and after administration of ketamine in all...

Blastoma pleuropulmonar: un tumor pediátrico infrecuente. A propósito de un caso y revisión de la literatura / Pleuropulmonary blastoma: an unusual pediatric tumor. Case report and review of literature

El blastoma pleuropulmonar (BPP) es un tumor disontogénicopediátrico muy raro y agresivo reconocido comoentidad clínico-patológica desde 1988 y del que se han descritoalrededor de 100 casos en la literatura mundial. Se clasificacomo tipo I, II y III en base a su naturaleza quística osólida. Presentamos un caso de una niña de 3 años con unatumoración que ocupa gran parte del hemitórax izquierdocon colapso del pulmón izquierdo y derrame pleural.Macroscópicamente es una masa sólida con áreas quísticasde 400 g y 15 cm de diámetro. Microscópicamente se tratade una tumoración mesenquimal de diferenciación divergentecon zonas blastematosas y mesenquimales que incluyediferenciación rabdomioblástica, fibroblástica, liposarcomatosay condroblástica-condroide. Su inmunofenotipomuestra positividad para desmina en extensas áreas deltumor, actina estriada en célula aisladas y S-100 en losfocos condroides. Marcadores neuroendocrinos negativos.Queratina positiva únicamente en las células epiteliales ymesoteliales de revestimiento atrapadas en el crecimientotumoral

Pleuropulmonary blastoma is an aggressive and extremelyrare pediatric dysontogenic tumor. It was firstly describedin 1988 and since then only about 100 cases havebeen reported. Based on of cystic or solid predominant features,type I, type II and type III were established. In thispaper a 3 yrs old female case is reported. The tumor massoccupied the main part of left hemithorax, collapsing lungand causing pleural effusion. Surgical specimen was a solidwith cystic areas, 400 g and 15 cm in main diameter mass.Microscopically it was a mesenchymal tumor showing blastematousareas and divergent differentiation with rhabdomyoblastic,fibroblastic, liposarcomatous and chondroblastic/chondroid components. Immunohistochemistry showedpositivity for desmin in wide areas, striated muscle actin inisolated cells and S-100 in chondroid foci. Neuroendocrinemarkers were negative. Cytokeratins were positive only inepithelial and mesothelial cells remaining within the tumor (AU)

[Behavior of intraocular pressure according to cardiorespiratory and hemodynamic effects induced by desflurane in dogs subjected to experimental hypovolemia]. / Comportamento da pressão intra-ocular segundo os efeitos cardiorrespiratórios e hemodinâmicos induzidos pela anestesia com desflurano, em cães submetidos à hipovolemia experimental.

PURPOSE: To observe the behavior of intraocular pressure according to the cardiopulmonary and hemodynamic effects induced by desflurane in dogs subjected to experimental hypovolemia. METHODS: Eighteen healthy male and female mongrel dogs, weighing between 10 and 15 kg were used. Hypovolemia was induced by withdrawal of 40 ml blood/kg body weight. Then anesthesia was induced with desflurane by mask until tracheal intubation was permitted. Intraocular pressure was measured with applanation tonometry. Heart rate, cardiac output, mean arterial pressure, central venous pressure, end-tidal concentration of CO2 and respiratory rate were recorded. Parameters were registered after animal instrumentation and before any procedure in the awake dogs (T0), fifteen minutes after experimental hemorrhage induction (T45), and after thirty minutes of desflurane anesthesia (T75). RESULTS: Intraocular pressure presented direct correlation only with pressure and end-tidal concentration of CO2. CONCLUSIONS: It was not possible to establish a correlation between alterations of mean arterial pressure and central venous pressure and intraocular pressure and there was a direct relationship between values of intraocular pressure and values of exhaled CO2.