The importance of early diagnosis and treatment of incidental tension pneumothorax during robotic assisted laparoscopy for diaphragmatic endometriosis: a report of two cases.

We describe two cases of diaphragmatic endometriosis treated using the robotic assisted laparoscopic approach, in which an incidental tension pneumothorax occurred during the initial inspection and assessment of diaphragmatic lesions. We demonstrate the importance of early diagnosis of this complication and report successful resolution using the thoracic drainage technique. In case one, after the pneumoperitoneum was installed, during the cavity assessment and inspection, small endometriotic lesions were observed in the tendon portion of the diaphragmatic surface. We observed a sudden increase in maximum airway pressures and a reduction in tidal volume, associated with arterial hypotension and hemodynamic instability and bulging of the diaphragm, which led to the diagnosis of a tension pneumothorax. In case two, diaphragmatic endometriotic lesions were also observed after hepatic mobilisation and following visualisation of the endometriotic lesions, an abrupt decrease in the capnography values was observed, consistent with hypertensive pneumothorax. In both cases, even after deflation of the abdominal cavity, hemodynamic instability persisted. We treated both cases with thoracic drainage, which immediately normalised respiratory parameters and resulted in hemodynamic stabilisation, and the surgical procedures were continued. During laparoscopic procedures for the treatment of diaphragmatic endometriosis, the endometriotic lesions can behave as communication hole in the tendon portion of the diaphragmatic surface and the changes in ventilatory patterns and haemodynamic instability should alert the medical team to the development of an incidental tension pneumothorax. The early identification of this complication in both cases allowed rapid intervention for chest drainage and allowed the surgical procedure to continue.

Performance and Meat Quality of Broiler Chickens Reared on two Different Litter Materials and at two Stocking Densities.

1. This study evaluated the performance and meat quality of broiler chickens reared on two litter materials and at two stocking densities.2. The chicks were allotted in a completely randomised design in a 2 × 2 factorial arrangement with two litter materials (wood shavings or rice straw) and two stocking densities (24 or 30 kg/m2), with six replicates per treatment. Broiler performance, carcase yield, prime cuts, blood plasma proteins, the enzymes alanine aminotransferase and aspartate aminotransferase, edible viscera, immune organs, intestine weight and length, abdominal fat, breast meat colour, pH, weight loss by defrosting, weight loss by cooking and shear force were evaluated.3. The density of 24 kg/m2 positively influenced feed consumption and weight gain. The type of litter had a positive influence on feed conversion, with a lower value for birds raised on wood shavings.4. Breast production was improved in birds reared at a density of 24 kg/m2 when compared to birds reared at a density of 30 kg/m2. The rice straw bedding negatively affected abdominal fat (resulting in higher percentages) when compared to birds reared on wood shavings.5. The types of litter affected the enzyme aspartate aminotransferase in birds raised on wood shavings, although these values were not increased to the point of influence on the physiological functions of broilers.6. The colour of the breast meat, pH, temperature, weight loss after thawing or cooking, shear force, cholesterol, triglycerides, albumin, total proteins, glucose or alanine aminotransferase content were not influenced by the stocking densities or bedding.7. The use of wood shavings as poultry bedding at a stocking density of 24 kg/m2resulted in the best performance for broiler chickens at 42 days of age.

Comportamento ingestivo e respostas fisiológicas de cabritos alimentados com dietas contendo torta de girassol oriunda da produção de biodiesel / Ingestive behavior and physiological responses of goats fed with diets containing sunflower cake from biodiesel production

Avaliou-se o efeito de dieta com torta de girassol, oriunda da produção de biodiesel, sobre o comportamento ingestivo e a resposta fisiológica de 32 cabritos ½ sangue Boer, não castrados, com peso médio inicial de 15,3±3,2kg e idade média de 135 dias. Utilizou-se delineamento inteiramente ao acaso, com quatro tratamentos 0; 8; 16 e 24% de inclusão da torta de girassol e oito repetições. O tempo despendido com ruminação, ócio e mastigação total não foi influenciado pela dieta, e observou-se efeito linear crescente sobre o tempo de ingestão em min/período e em min/dia. A eficiência de ingestão e ruminação da matéria seca e da fibra em detergente neutro também não diferiu entre dietas. Quanto às respostas fisiológicas, as frequências respiratória e cardíaca e as temperaturas retal e superficial não sofreram influência da dieta. Concluiu-se que a torta de girassol pode ser incluída até 24% da matéria seca em dietas de cabritos ½ sangue Boer sem comprometer o comportamento ingestivo e os parâmetros fisiológicos desses animais. O fornecimento de dietas com até 24% de matéria seca de torta de girassol não interfere no estresse calórico de cabritos.

The effect of diets with sunflower cake originated from biodiesel production on the ingestive behavior and physiological responses of 32 crossbred Boer goats, noncastrated, with initial weight of 15.3±3.2 kg and mean age of 135 days was evaluated. A completely randomized design with four treatments (0, 8, 16 and 24% of sunflower cake inclusion) and eight replicates was used. The rumination and idling times and the total chewing time were not affected by diets, but the ingestion time (min/period and min/day) had an increasing linear effect. The rumination and ingestion efficiencies of dry matter and neutral detergent fiber also did not differ among diets. Regarding the physiological responses of animals, the heart and respiratory frequencies and the surface and rectal temperatures were not influenced by diets. Sunflower cake can be included up to 24% DM in diets of crossbred Boer goats without compromising the ingestive behavior and physiological parameter of these animals. Under the climatic conditions evaluated the supply of diets with up to 24% DM of sunflower cake does not mitigate or enhance the heat stress in kids.

Optimization of the tartrate-resistant acid phosphatase detection by histochemical method.

According to the new KDIGO (Kidney Disease Improving Global Outcomes) guidelines, the term of renal osteodystrophy, should be used exclusively in reference to the invasive diagnosis of bone abnormalities. Due to the low sensitivity and specificity of biochemical serum markers of bone remodelling,the performance of bone biopsies is highly stimulated in dialysis patients and after kidney transplantation. The tartrate-resistant acid phosphatase (TRACP) is an iso-enzyme of the group of acid phosphatases, which is highly expressed by activated osteoclasts and macrophages. TRACP in osteoclasts is in intracytoplasmic vesicles that transport the products of bone matrix degradation. Being present in activated osteoclasts, the identification of this enzyme by histochemistry in undecalcified bone biopsies is an excellent method to quantify the resorption of bone. Since it is an enzymatic histochemical method for a thermolabile enzyme, the temperature at which it is performed is particularly relevant. This study aimed to determine the optimal temperature for identification of TRACP in activated osteoclasts in undecalcified bone biopsies embedded in methylmethacrylate. We selected 10 cases of undecalcified bone biopsies from hemodialysis patients with the diagnosis of secondary hyperparathyroidism. Sections of 5 μm were stained to identify TRACP at different incubation temperatures (37º, 45º, 60º, 70º and 80ºC) for 30 minutes. Activated osteoclasts stained red and trabecular bone (mineralized bone) was contrasted with toluidine blue. This approach also increased the visibility of the trabecular bone resorption areas (Howship lacunae). Unlike what is suggested in the literature and in several international protocols, we found that the best results were obtained with temperatures between 60ºC and 70ºC. For technical reasons and according to the results of the present study, we recommended that, for an incubation time of 30 minutes, the reaction should be carried out at 60ºC. As active osteoclasts are usually scarce in a bone section, the standardization of the histochemistry method is of great relevance, to optimize the identification of these cells and increase the accuracy of the histomosphometric results. Our results, allowing an increase in osteoclasts contrast, also support the use of semi-automatic histomorphometric measurements.

Trailing end-point phenotype antibiotic-sensitive strains of Candida albicans produce different amounts of aspartyl peptidases.

Candida albicans is an opportunistic fungal pathogen that causes severe systemic infections in immunosuppressed individuals. C. albicans resistance to antifungal drugs is a severe problem in patients receiving prolonged therapy. Moreover, trailing yeast growth, which is defined as a resistant MIC after 48 h of incubation with triazole antifungal agents but a susceptible MIC after 24 h, has been noted in tests of antifungal susceptibility against some C. albicans isolates. In this context, we recently noticed this phenomenon in our routine susceptibility tests with fluconazole/itraconazole and C. albicans clinical isolates. In the present study, we investigated the production of cell-associated and secreted aspartyl peptidases (Saps) in six trailing clinical isolates of C. albicans, since this class of hydrolytic enzymes is a well-known virulence factor expressed by this fungal pathogen. Sap2, which is the best-studied member of the Sap family, was detected by flow cytometry on the cell surface of yeasts and as a 43-kDa polypeptide in the culture supernatant, as demonstrated by Western blotting assay using an anti-Sap1-3 polyclonal antibody. Released aspartyl peptidase activity was measured with BSA hydrolysis and inhibited by pepstatin A, showing distinct amounts of proteolytic activity ranging from 5.7 (strain 44B) to 133.2 (strain 11) arbitrary units. Taken together, our results showed that trailing clinical isolates of C. albicans produced different amounts of both cellular and secreted aspartyl-type peptidases, suggesting that this phenotypic feature did not generate a regular pattern regarding the expression of Sap.

Trailing end-point phenotype antibiotic-sensitive strains of Candida albicans produce different amounts of aspartyl peptidases

Candida albicans is an opportunistic fungal pathogen that causes severe systemic infections in immunosuppressed individuals. C. albicans resistance to antifungal drugs is a severe problem in patients receiving prolonged therapy. Moreover, trailing yeast growth, which is defined as a resistant MIC after 48 h of incubation with triazole antifungal agents but a susceptible MIC after 24 h, has been noted in tests of antifungal susceptibility against some C. albicans isolates. In this context, we recently noticed this phenomenon in our routine susceptibility tests with fluconazole/itraconazole and C. albicans clinical isolates. In the present study, we investigated the production of cell-associated and secreted aspartyl peptidases (Saps) in six trailing clinical isolates of C. albicans, since this class of hydrolytic enzymes is a well-known virulence factor expressed by this fungal pathogen. Sap2, which is the best-studied member of the Sap family, was detected by flow cytometry on the cell surface of yeasts and as a 43-kDa polypeptide in the culture supernatant, as demonstrated by Western blotting assay using an anti-Sap1-3 polyclonal antibody. Released aspartyl peptidase activity was measured with BSA hydrolysis and inhibited by pepstatin A, showing distinct amounts of proteolytic activity ranging from 5.7 (strain 44B) to 133.2 (strain 11) arbitrary units. Taken together, our results showed that trailing clinical isolates of C. albicans produced different amounts of both cellular and secreted aspartyl-type peptidases, suggesting that this phenotypic feature did not generate a regular pattern regarding the expression of Sap.

Effect of Erythrina velutina and Erythrina mulungu in rats submitted to animal models of anxiety and depression.

Erythrina velutina (EV) and Erythrina mulungu (EM), popularly used in Brazil as tranquilizing agents, were studied. The effects of acute and chronic oral treatment with a water:alcohol extract of EV (7:3, plant grounded stem bark; acute = 100, 200, 400 mg/kg; chronic = 50, 100, 200 mg/kg) were evaluated in rats (N = 11-12) submitted to the elevated T-maze (for avoidance and escape measurements) model of anxiety. This model was selected for its presumed capacity to elicit specific subtypes of anxiety disorders recognized in clinical practice: avoidance has been related to generalized anxiety and escape to panic. Additionally, animals were treated with the same doses of EV and EM (water:alcohol 7:3, inflorescence extract) and submitted to the forced swim test for the evaluation of antidepressant activity (N = 7-10). Both treatment regimens with EV impaired elevated T-maze avoidance latencies, without altering escape, in a way similar to the reference drug diazepam (avoidance 1, mean +/- SEM, acute study: 131.1 +/- 45.5 (control), 9.0 +/- 3.3 (diazepam), 12.7 +/- 2.9 (200 mg/kg), 28.8 +/- 15.3 (400 mg/kg); chronic study: 131.7 +/- 46.9 (control), 35.8 +/- 29.7 (diazepam), 24.4 +/- 10.4 (50 mg/kg), 29.7 +/- 11.5 (200 mg/kg)). Neither EV nor EM altered measurements performed in the forced swim test, in contrast to the reference drug imipramine that significantly decreased immobility time after chronic treatment. These results were not due to motor alterations since no significant effects were detected in an open field. These observations suggest that EV exerts anxiolytic-like effects on a specific subset of defensive behaviors which have been associated with generalized anxiety disorder.

Effect of Erythrina velutina and Erythrina mulungu in rats submitted to animal models of anxiety and depression

Erythrina velutina (EV) and Erythrina mulungu (EM), popularly used in Brazil as tranquilizing agents, were studied. The effects of acute and chronic oral treatment with a water:alcohol extract of EV (7:3, plant grounded stem bark; acute = 100, 200, 400 mg/kg; chronic = 50, 100, 200 mg/kg) were evaluated in rats (N = 11-12) submitted to the elevated T-maze (for avoidance and escape measurements) model of anxiety. This model was selected for its presumed capacity to elicit specific subtypes of anxiety disorders recognized in clinical practice: avoidance has been related to generalized anxiety and escape to panic. Additionally, animals were treated with the same doses of EV and EM (water:alcohol 7:3, inflorescence extract) and submitted to the forced swim test for the evaluation of antidepressant activity (N = 7-10). Both treatment regimens with EV impaired elevated T-maze avoidance latencies, without altering escape, in a way similar to the reference drug diazepam (avoidance 1, mean ± SEM, acute study: 131.1 ± 45.5 (control), 9.0 ± 3.3 (diazepam), 12.7 ± 2.9 (200 mg/kg), 28.8 ± 15.3 (400 mg/kg); chronic study: 131.7 ± 46.9 (control), 35.8 ± 29.7 (diazepam), 24.4 ± 10.4 (50 mg/kg), 29.7 ± 11.5 (200 mg/kg)). Neither EV nor EM altered measurements performed in the forced swim test, in contrast to the reference drug imipramine that significantly decreased immobility time after chronic treatment. These results were not due to motor alterations since no significant effects were detected in an open field. These observations suggest that EV exerts anxiolytic-like effects on a specific subset of defensive behaviors which have been associated with generalized anxiety disorder.

Opioids for the management of breakthrough (episodic) pain in cancer patients.

BACKGROUND: Breakthrough pain is a transient increase in pain intensity over background pain. It is a common and distinct component of cancer pain that can have a negative impact for both the patient and carers' quality of life. Breakthrough pain is usually related to background pain and is typically of rapid onset, severe in intensity, and generally self-limiting with an average duration of 30 minutes. At present the current approach to managing breakthrough pain is using supplemental analgesia (also known as rescue medication) at a dose proportional to the total around-the-clock (ATC) opioid dose. OBJECTIVES: This review explores and assesses the evidence for the use of opioids in the management of breakthrough pain in patients with cancer. SEARCH STRATEGY: MEDLINE (1966 to 2005), EMBASE (1980 to 2005), CancerLit (1993 to 2005), CINAHL (1982 to 2005) and Cochrane databases were searched. Handsearching of medical journals and reference from key textbooks was undertaken and drug companies contacted for unpublished data. There was no language restriction. Date of most recent search: January 2005. SELECTION CRITERIA: Randomized controlled trials of opioids used as rescue medication against active or placebo comparator in patients with cancer pain were included. Outcome measures sought were reduction in pain intensity measured by an appropriate scale, adverse effects, attrition, patient satisfaction and quality of life. There were no language restrictions. DATA COLLECTION AND ANALYSIS: Eligible studies were selected and examined independently by the two reviewers. Full text was retrieved if any uncertainty about eligibility remained. Non-English texts were screened. Quality assessment and data extraction were conducted using standardised data forms. Drug and placebo dose, titration, route and formulation were compared and detail of all outcome measures (if available) recorded. MAIN RESULTS: Four studies (393 participants) met the inclusion criteria, all were concerned with the use of oral transmucosal fentanyl citrate (OTFC) in the management of breakthrough pain. Two studies examined the titration of OTFC, one study compared OTFC to normal release morphine and one study compared OTFC to placebo.OTFC was shown to be an effective treatment for breakthrough pain. When compared to placebo and morphine, participants gave lower pain intensity scores and higher pain relief scores for OTFC at all time points. Global assessment scores also favoured OTFC. AUTHORS' CONCLUSIONS: There is evidence that OTFC is an effective treatment in the management of breakthrough pain. The randomised trial literature for the management of breakthrough pain is small and no trials were found for other opioids. Given the importance of this subject, more trials need to be undertaken.

Prenatal starvation and maternal blood pressure near delivery.

Maternities in cities exposed to the Dutch famine of 1944 to 1945 and in control cities were compared. Systolic blood pressure near the time of delivery was significantly reduced by exposure to famine late in the 2nd trimester and early in the 3rd trimester. Blood pressure correlated best with caloric rations in the 3rd month before delivery, and this relationship holds consistently below a ration level of 1900 cal. Above 1900 cal and up to 2200 cal (the upper limit of rations for the data analyzed) the relationship is inconsistent across cities. Edema, analyzed in one city, varied in a manner similar to blood pressure.