Analysis of electrocautery generated smoke by chromatographic-mass spectrometry.

OBJECTIVE: to analyze the chemical components of the smoke from electrocautery from coagulating muscle and liver tissues of pigs. METHODS: we collected smoke produced by electrocautery applied to porcine tissue in previously evacuated bottles, with qualitative and quantitative analysis of the compounds present through the hyphenated technique gas chromatography / mass spectrometry. RESULTS: there was a majority of decanal aldehyde in the fumes from the subcutaneous, muscle and liver tissues. Fumes of subcutaneous and muscular tissues also showed the presence of hexanal and phenol. In the fumes of subcutaneous and liver tissues we also found toluene and limonene and, finally, nonanal smoke was present in the muscle and liver tissues. CONCLUSION: there is increasing evidence showing that smoke from electrocautery used in subcutaneous, muscle and liver tissue is harmful to human health. Thus, there is need to reduce exposure to it or wear masks with filters capable of retaining these particles. OBJETIVO: analisar quimicamente os componentes da fumaça do eletrocautério, provenientes da coagulação de tecidos, muscular e hepático de suino. MÉTODOS: coleta de fumaça produzida por eletrocauterização de tecido porcino em frascos previamente evacuados com análise qualitativa e quantitativa dos compostos presentes, através de técnica hifenada, cromatografia a gás/espectrometria de massas. RESULTADOS: houve presença majoritária do aldeído decanal nas fumaças provenientes dos tecidos subcutâneo, muscular e hepático. Fumaças dos tecidos subcutâneo e muscular mostraram também a presença de hexanal e fenol. Nas fumaças dos tecidos subcutâneo e hepático foram encontrados ainda tolueno e limoneno e, por fim, nonanal estava presente nas fumaças dos tecidos muscular e hepático. CONCLUSÃO: há número crescente de evidências mostrando que fumaça proveniente de eletrocauterização de tecidos subcutâneo, muscular e hepático é nociva à saúde de seres humanos. Portanto, há necessidade de reduzir a exposição a ela ou usar máscara com filtro capaz de reter essas partículas.

Analysis of electrocautery generated smoke by chromatographic-mass spectrometry / Análise, mediante cromatografia/espectrometria de massas, da fumaça gerada por eletrocautério

ABSTRACT Objective: to analyze the chemical components of the smoke from electrocautery from coagulating muscle and liver tissues of pigs. Methods: we collected smoke produced by electrocautery applied to porcine tissue in previously evacuated bottles, with qualitative and quantitative analysis of the compounds present through the hyphenated technique gas chromatography / mass spectrometry. Results: there was a majority of decanal aldehyde in the fumes from the subcutaneous, muscle and liver tissues. Fumes of subcutaneous and muscular tissues also showed the presence of hexanal and phenol. In the fumes of subcutaneous and liver tissues we also found toluene and limonene and, finally, nonanal smoke was present in the muscle and liver tissues. Conclusion: there is increasing evidence showing that smoke from electrocautery used in subcutaneous, muscle and liver tissue is harmful to human health. Thus, there is need to reduce exposure to it or wear masks with filters capable of retaining these particles.

RESUMO Objetivo: analisar quimicamente os componentes da fumaça do eletrocautério, provenientes da coagulação de tecidos, muscular e hepático de suino. Métodos: coleta de fumaça produzida por eletrocauterização de tecido porcino em frascos previamente evacuados com análise qualitativa e quantitativa dos compostos presentes, através de técnica hifenada, cromatografia a gás/espectrometria de massas. Resultados: houve presença majoritária do aldeído decanal nas fumaças provenientes dos tecidos subcutâneo, muscular e hepático. Fumaças dos tecidos subcutâneo e muscular mostraram também a presença de hexanal e fenol. Nas fumaças dos tecidos subcutâneo e hepático foram encontrados ainda tolueno e limoneno e, por fim, nonanal estava presente nas fumaças dos tecidos muscular e hepático. Conclusão: há número crescente de evidências mostrando que fumaça proveniente de eletrocauterização de tecidos subcutâneo, muscular e hepático é nociva à saúde de seres humanos. Portanto, há necessidade de reduzir a exposição a ela ou usar máscara com filtro capaz de reter essas partículas.

Baseline characteristics and risk factors for ulcer, amputation and severe neuropathy in diabetic foot at risk: the BRAZUPA study.

BACKGROUND: Studies on diabetic foot and its complications involving a significant and representative sample of patients in South American countries are scarce. The main objective of this study was to acquire clinical and epidemiological data on a large cohort of diabetic patients from 19 centers from Brazil and focus on factors that could be associated with the risk of ulcer and amputation. METHODS: This study presents cross sectional, baseline results of the BRAZUPA Study. A total of 1455 patients were included. Parameters recorded included age, gender, ethnicity, diabetes and comorbidity-related records, previous ulcer or amputation, clinical symptomatic score, foot classification and microvascular complications. RESULTS: Patients with ulcer had longer disease duration (17.2 ± 9.9 vs. 13.2 ± 9.4 years; p < 0.001), and poorer glycemic control (HbA1c 9.23 ± 2.03 vs. 8.35 ± 1.99; p < 0.001). Independent risk factors for ulcer were male gender (OR 1.71; 95 % CI 1.2-3.7), smoking (OR 1.78; 95 % CI 1.09-2.89), neuroischemic foot (OR 20.34; 95 % CI 9.31-44.38), region of origin (higher risk for those from developed regions, OR 2.39; 95 % CI 1.47-3.87), presence of retinopathy (OR 1.68; 95 % CI 1.08-2.62) and absence of vibratory sensation (OR 7.95; 95 % CI 4.65-13.59). Risk factors for amputation were male gender (OR 2.12; 95 % CI 1.2-3.73), type 2 diabetes (OR 3.33; 95 % CI 1.01-11.1), foot at risk classification (higher risk for ischemic foot, OR 19.63; 95 % CI 3.43-112.5), hypertension (lower risk, OR 0.3; 95 % CI 0.14-0.63), region of origin (South/Southeast, OR 2.2; 95 % CI 1.1-4.42), previous history of ulcer (OR 9.66; 95 % CI 4.67-19.98) and altered vibratory sensation (OR 3.46; 95 % CI 1.64-7.33). There was no association between either outcome and ethnicity. CONCLUSIONS: Ulcer and amputation rates were high. Age at presentation was low and patients with ulcer presented a higher prevalence of neuropathy compared to ischemic foot at risk. Ischemic disease was more associated with amputations. Ethnical differences were not of great importance in a miscegenated population.

Pixel-Level Tissue Classification for Ultrasound Images.

BACKGROUND: Pixel-level tissue classification for ultrasound images, commonly applied to carotid images, is usually based on defining thresholds for the isolated pixel values. Ranges of pixel values are defined for the classification of each tissue. The classification of pixels is then used to determine the carotid plaque composition and, consequently, to determine the risk of diseases (e.g., strokes) and whether or not a surgery is necessary. The use of threshold-based methods dates from the early 2000s but it is still widely used for virtual histology. METHODOLOGY/PRINCIPAL FINDINGS: We propose the use of descriptors that take into account information about a neighborhood of a pixel when classifying it. We evaluated experimentally different descriptors (statistical moments, texture-based, gradient-based, local binary patterns, etc.) on a dataset of five types of tissues: blood, lipids, muscle, fibrous, and calcium. The pipeline of the proposed classification method is based on image normalization, multiscale feature extraction, including the proposal of a new descriptor, and machine learning classification. We have also analyzed the correlation between the proposed pixel classification method in the ultrasound images and the real histology with the aid of medical specialists. CONCLUSIONS/SIGNIFICANCE: The classification accuracy obtained by the proposed method with the novel descriptor in the ultrasound tissue images (around 73%) is significantly above the accuracy of the state-of-the-art threshold-based methods (around 54%). The results are validated by statistical tests. The correlation between the virtual and real histology confirms the quality of the proposed approach showing it is a robust ally for the virtual histology in ultrasound images.

Superior mesenteric artery syndrome: an uncommon complication of abdominal aortic aneurysm repair.

The superior mesenteric artery syndrome (SMAS) is an uncommon finding, especially when occurring after open abdominal aortic aneurysm (AAA) repair. Very few cases have been previously reported in the literature. The underlying anatomic mechanism as well as a better way to manage this complication remains controversial. We report a case of well-documented duodenum obstruction occurring after an elective, uneventful open AAA repair in an 83-year-old white male. The patient was initially discharged from hospital on the fifth postoperative (PO) day but was readmitted on the seventh PO day with suspicion of intestinal obstruction caused either by adhesions or extrinsic pressure by a retroperitoneal hematoma. A laparotomy carried out on the 10th PO day was unremarkable and the patient continued vomiting until a left lateral decubitus positioning was assumed. The patient was discharged home on the 19th PO day and has remained well since.