Radiotherapy skin marking with lancets versus electric marking pen - Comfort, satisfaction, effectiveness and cosmesis results from the randomized, double-blind COMFORTATTOO trial.

INTRODUCTION: Set-up skin markings are performed, in several centers, for radiotherapy (RT) treatments. This study aimed to compare two permanent methods: lancets and an electric marking pen, the Comfort Marker 2.0® (CM). METHODS: This was a prospective, unicentric, randomized study. Patients aged 18 years or older referred to our department to receive RT were recruited. Patients were randomly assigned, in a 1:1 ratio, to receive set-up markings using lancets or CM. The markings arrangement followed our departmental protocols. The coprimary endpoints were patients' comfort and effectiveness. Secondary endpoints included radiation therapists (RTTs) satisfaction and cosmesis. RESULTS: Between October 2021 and January 2022, 100 patients were enrolled (50 received lancets and 50 CM) and assessed for the comfort and satisfaction outcomes. CM was significantly less painful than the lancets, with 44% and 16% of the patients, respectively, considering the tattooing process painless (RR = 2.75; 95% IC: 1.36 - 5.58). On the RTT-reported satisfaction, CM had significantly easier processes than lancets (98.0% vs. 78.0%, respectively; RR = 1.26; 95% CI: 1.08 - 1.46). For effectiveness and cosmesis assessment, 98 patients were analyzed (48 received lancets and 50 CM). Patients receiving CM had a significantly higher proportion of markings graded as good and excellent compared to those receiving lancets (98.0% and 50.0%, respectively, had ≥75% of the tattoos assessed as good/excellent, RR = 1.96; 95% CI: 1.47 - 2.61). On the cosmetic evaluation, patients receiving CM had significantly better cosmetic markings, with a median score of 4.4 (vs. 3.5 for lancets, p <0.001). CONCLUSION: The trial results demonstrated that tattooing with the CM is significantly less painful, more effective, easier to apply, and cosmetically superior to tattooing with lancets. IMPLICATIONS FOR PRACTICE: Tattooing with CM allows for better results regarding pain, quality, ease and cosmesis.

Surgical treatment of schistosomal portal hypertension.

Schistosomiasis mansoni is a widespread parasitic disease in the Brazilian territory that affects over 8 million individuals. Hepatosplenic schistosomiasis is a serious clinical presentation of this disease, associated with splenomegaly, liver fibrosis, and portal hypertension, and is responsible for approximately 7% of schistosomotic patients. The surgical treatment of portal hypertension in schistosomotic patients has distinct features when compared with cirrhotic patients, mostly because hepatic function is preserved in schistosomotic liver disease. Therefore, when attempting to reduce the portal pressure, the surgeon must be aware that the surgery might interfere with hepatic perfusion, and consequently with hepatic function. The aim of this study was to report the results achieved with splenectomy, division of the left gastric vein, devascularization of great gastric curvature, and postoperative endoscopic variceal sclerosis, as a surgical option to esophageal varices in hepatosplenic schistosomiasis. A total of 111 patients were studied, and the following is a list of inclusion criteria: age >16 years, history of gastrointestinal (GI) bleeding, presence of esophageal varices on preoperative endoscopy, hematocrit >22% and prothrombin enzymatic activity >50%, negative viral hepatitis on serologic tests (anti-HBV and anti-HCV), and definition, after liver biopsy, of exclusive schistosomotic liver disease. The following list includes exclusion criteria used: presence of liver disease other than schistosomotic, history of alcohol abuse, and preoperative thrombosis of the portal vein. The rebleeding rate was 14.4% during a mean 30-month follow-up period; portal vein thrombosis was 13.2%, and there was a global mortality of 5.4%. Gastric varices were present in 46.9% of the patients; for those patients, a gastrotomy and running suture of the varices achieved an eradication rate of the varices of 75.6%. The degree of periportal fibrosis was also analyzed. Periportal fibrosis staging revealed that patients with class II or III liver fibrosis had a significant increased risk of recurrent GI bleeding when compared with patients with class I liver fibrosis. Despite the elevation on alanine aminotransferase (ALT) and aspartate aminotransferase (AST), most other liver function tests showed no alteration or were corrected after surgery. We conclude that splenectomy, division of the left gastric vein, devascularization of great gastric curvature, and postoperative endoscopic variceal sclerosis showed good results globally and should be considered as therapeutic options in the treatment of hepatosplenic schistosomiasis.

Isquemia normotérmica y reperfusión de hígado en perros: evaluación de las concentraciones séricas en enzimas hepatocelulares / Normothermic ischemia and reperfusion in dogs

La lesion corriente de isquemia y reperfusion hepáticas normotermicas ha sido investigada a traves de varios modelos experimentales en perros. La intensidad de necrosis hepatocitica ha sido admitida como proporcional al tiempo de isquemia y a la cantidad de higado desvascularizado. En el presente trabajo, un modelo de isquemia y reperfusion hepáticas en perros fue evaluado a traves de enzimas indicativas de necrosis hepatocelular. Veinte perros mestizos con peso corporal de 15.25 ñ 1.25 kilos, bajo anestesia general, fueron agrupados de la siguiente manera: 1- Grupo test (n=10), los animales fueron sometidos a desvascularizacion hepática del 70 por ciento durante noventa minutos, con descompresion venosa esplénica a traves de los lobulos lateral derecho y caudado, seguido de revascularizacion del higado. 2- Grupo control (n=10), los perros fueron sometidos a operacion simulada. Se determinaron las concentraciones sericas de aspartato aminotransferasa, alanino aminotransferasa, deshidrogenasa lactica, 5 minutos antes de la isquemia (T0), 5 minutos antes de la revascularizacion (T1), 1 hora (T2) y 5 horas (T3) despues de la revascularizacion hepática, en la sangre de la vena cava inferior, a nivel de la auricula derecha. Con una seguridad del 95 por ciento, los resultados demostraron que: a) En el periodo de isquemia no se detectó alteracion alguna significativa en las Concentraciones de aspartato aminotransferasa, alanino aminotransferasa, deshidrogenasa lactica. b) Despues de la reperfusion hepática, hubo aumento significativo y persistente de los niveles de estas enzimas. Los resultados son indicativos de que el tiempo de isquemia y el volumen de higado desvascularizado fueron capaces de producir la necrosis hepática buscada.

Avaliação do tempo de sobrevida pós-operatória em lesão de isquemia normotérmica e reperfusão hepática induzidas em cães / Evaluation of postoperative survival time in normothermic hepatic ischaemia and reperfusion lesion induced in dogs

Prolongamento do tempo de sobrevida em animais de experimentação tem sido requerido para melhor investigação da fisiopatologia e da modulação farmacológica em lesões decorrentes de isquemia e reperfusão hepática. Vinte cães mestiços, pesando 15,25+-1,21Kg, foram distribuídos em dois grupos de investigação: 1. Grupo Teste (n=10) - Os animais foram submetidos a isquemia normotérmica de aproximadamente, 70por cento do fígado, durante 90 minutos, com descompressão venosa esplâncnica translobar, sequida de reperfusão hepática; 2.Grupo controle (n=10)- os cães foram submetidos a operação simulada. O tempo de sobrevida foi analisado estatisticamente através do teste do chi quadrado . Com confiança de 95 por cento, os resultados revelaram que: o índice de sobrevida de 72 horas (30Por cento) verificado no grupo teste foi significativamente inferior aos constatado nos animais do Grupo Controle (100por cento), em igual período. Bem como, observou-se que a causa mais frequente de óbto nos animais do Grupo Teste foi insuficiência hepática diagnosticada clínicamente e com dados da necróspsia, associada a diátese hemorrágica ou peritonite (60por cento) e ocorrida emtre 2 a 96 horas de pós-operatório. No grupo controle, o sangramento digestiavo e deiscência de parede abdominal, ambos associados a peritonite clínica, constituíram causas de óbitos observadas em dois animais, entre o 4§ e o 6§ dia de pós-operatório

Complete acute occlusion of the portal vein in dogs: I. a study based on hemodynamic and hematologic data aimed at its application in liver transplantation

Como etapa inicial de um plano de pesquisa sobre avaliacao de medidas descompressivas portosistemicas, comumente utilizadas em transplante hepatico experimental, foram estudados 20 caes mesticos, adultos, de ambos os sexos e com peso corporal de 15,2ñ1,7kg. Em dez caes praticou-se oclusao total e aguda da veia porta por um periodo de 2 horas (grupo oclusao portal). Em dez outros desses animais procedeu-se a operacao simulada (grupo controle). Foram investigados de modo sistematico dados hemodinamicos de pressao arterial (PA), pressao venosa central (PVC) e pressao portal (PP), assim como dados hematologicos de concentracao de hemoglobina (cHb) nos animais dos grupos estudados...

[Localized xanthoma in lymphedema]. / Xantoma localizado em linfedema.

We report a case of xanthoma and lymphoedema in a patient who has aortic insufficiency. The association of lymphoedema and vascular malformations has been reported and seems to be occasional. The lymphoedema is primary and of early onset. Localized xanthomas follow the ingestion of lipoproteins by local histiocytes. We observed partial regression of xanthomas with alleviation of lymphoedema. There seems to be the ten reports of such association.