Mandibular Myxoid Liposarcoma: a Case Study.

Liposarcomas are described as soft tissue sarcomas derived from adipose tissue. The finding of this tumor in the mandibular region is exceedingly rare. As of now, it has been described mainly in case reports and small series. A multidisciplinary approach is required to offer optimal treatment and may involve surgery, radiation and systemic therapies. Surgical repair of these defects represents a major challenge in oral and maxillofacial reconstructive surgery. We present the case of a 54-year-old man referred to our center with a progressively increasing mass in the anterior portion of the mandible. Biopsy revealed a well-differentiated myxoid liposarcoma. Resection of the tumor was performed with an additional primary reconstruction.

Post-intubation double tracheal stenosis.

Post-intubation tracheal stenosis is a condition that can occur as a consequence of tracheostomy or prolonged intubation. The development of two levels of airway narrowing is rare. We present the case of a 43-year-old male with a history of prolonged mechanical ventilation, who presented to our center with progressive respiratory impairment. Computed tomography with three-dimensional reconstruction demonstrated complex tracheal anatomy with double-level stenosis. The patient underwent successful endoscopic procedure. Supplementary Information: The online version contains supplementary material available at 10.1007/s12055-022-01426-y.

Massive hemoptysis as a complication of pulmonary actinomycosis: a case report.

Massive hemoptysis is a rare life-threatening complication of pulmonary actinomycosis that should be treated promptly due to the risk of asphyxiation and hemodynamic instability. We present the case of a 57-year-old female who was presented to our center with massive hemoptysis. Thoracic computed tomography scan revealed a cavitated lesion with perilesional ground-glass opacity. Right lower lobectomy was then performed using uniportal video-assisted thoracic surgery, excising a 13 × 12 × 8 cm cavitated lung fragment. The pathology service reported the presence of microscopical evidence of filamentous gram positive bacterial colonies, showing compatible features of pulmonary actinomycosis. The patient was discharged with oral penicillin with an uneventful post-operative course.

La hemoptisis masiva es una complicación poco frecuente de la actinomicosis pulmonar que pone en peligro la vida del paciente y que debe ser tratada con prontitud debido al riesgo de asfixia e inestabilidad hemodinámica. Presentamos una mujer de 57 años que acudió a nuestro centro con hemoptisis masiva. La tomografía reveló una cavitación con opacidad perilesional en vidrio deslustrado. Realizamos lobectomía mediante cirugía uniportal, extirpando un fragmento de lesión. Patología informó de la presencia de colonias bacterianas filamentosas grampositivas, mostrando características compatibles con actinomicosis pulmonar. El paciente fue dado de alta con penicilina oral, con un curso postoperatorio sin incidentes.

Coccidioidomycosis mimicking testicular cancer: A case report.

We present the case of a 48 year-old man with a history of pulmonary tuberculosis who was brought to our centre with a progressively increasing left testicular mass. Radiological findings were not conclusive on whether the mass was neoplastic or infectious in nature. Therefore, an orchiectomy was performed. Pathology examination revealed coccidioidomycosis of the left testicle, highlighting an exceedingly rare presentation of disseminated genitourinary coccidioidomycosis.

Surgical activation protocol COVID-19 (SAP COVID).

BACKGROUND: The coronavirus disease 2019 (COVID-19) outbreak have major implications in conventional surgical practice. As the number of patients with this diagnosis is rising, the infection risk for the surgical staff will be higher. Few publications have addressed the surgical management of patients diagnosed with COVID-19. OBJECTIVE: To assess recommendations for care of patients and surgical team during the COVID-19 pandemic. METHOD: MEDLINE, Embase and the Cochrane Database of Systematic Reviews (April 2020) were searched the key words "COVID-19", "PROTOCOL" and "SURGERY". Relevant recommendations, guidelines and cases series were checked for the most accurate information for apply to our center. RESULTS: We found 379 papers that included the key words. A total of 25 papers were included in the manuscript based in the pertinence of the recommendations. Three major topics were selected: perioperative, intraoperative and postoperative. CONCLUSION: As an attempt to regulate the surgical team approach, we present recommendations to preserve patients and surgical staff safety with high quality standards of care through reproducible strategies applicable in most hospital centers.

ANTECEDENTES: La pandemia de COVID-19 ha tenido un gran impacto en la práctica quirúrgica convencional. Conforme el número de pacientes diagnosticados con esta enfermedad vaya en aumento, el riesgo de contagio para el equipo quirúrgico será mayor. Pocas publicaciones han abordado el manejo del paciente diagnosticado con COVID-19 dentro del quirófano. OBJETIVO: Evaluar las recomendaciones para el cuidado de pacientes y del equipo quirúrgico durante la pandemia de COVID-19. MÉTODO: La búsqueda bibliográfica principal utilizó las bases de datos MEDLINE, Embase y Cochrane, utilizando las palabras clave "COVID-19", "PROTOCOL" y "SURGERY". Se verificaron recomendaciones, guías y series de casos relevantes para obtener la información más precisa y aplicable. RESULTADOS: Se hizo la revisión de 379 artículos que contenían las palabras clave. Se incluyeron 25 artículos basándose en la pertinencia de las recomendaciones. Los tres temas principales seleccionados fueron las fases preoperatoria, transoperatoria y posoperatoria. CONCLUSIÓN: En un esfuerzo por tratar de normar el manejo quirúrgico, presentamos recomendaciones para preservar la seguridad del paciente y del equipo quirúrgico con estándares de alta calidad, mediante estrategias reproducibles en la mayoría de los centros hospitalarios.

The effect of anesthetic preconditioning with sevoflurane on intracellular signal-transduction pathways and apoptosis, in a lung autotransplant experimental model / O efeito do pré-condicionamento anestésico com sevoflurano sobre as vias de transdução de sinal intracelular e a apoptose, em modelo experimental de autotransplante pulmonar

Abstract Background: Anesthetic pre-conditioning attenuates inflammatory response during ischemia-reperfusion lung injury. The molecular mechanisms to explain it are not fully understood. The aim of our investigation was to analyze the molecular mechanism that explain the anti-inflammatory effects of anesthetic pre-conditioning with sevoflurane focusing on its effects on MAPKs (mitogen-activated protein kinases), NF-κB (nuclear factor kappa beta) pathways, and apoptosis in an experimental lung autotransplant model. Methods: Twenty large white pigs undergoing pneumonectomy plus lung autotransplant were divided into two 10-member groups on the basis of the anesthetic received (propofol or sevoflurane). Anesthetic pre-conditioning group received sevoflurane 3% after anesthesia induction and it stopped when one-lung ventilation get started. Control group did not receive sevoflurane in any moment during the whole study period. Intracellular signal-transduction pathways (MAPK family), transcription factor (NF-κB), and apoptosis (caspases 3 and 9) were analyzed during experiment. Results: Pigs that received anesthetic pre-conditioning with sevoflurane have shown significant lower values of MAPK-p38, MAPK-P-p38, JNK (c-Jun N-terminal kinases), NF-κB p50 intranuclear, and caspases (p < 0.05) than pigs anesthetized with intravenous propofol. Conclusions: Lung protection of anesthetic pre-conditioning with sevoflurane during experimental lung autotransplant is, at least, partially associated with MAPKs and NF κB pathways attenuation, and antiapoptotic effects.

Resumo Justificativa: O pré-condicionamento anestésico atenua a resposta inflamatória durante a lesão de isquemia-reperfusão do pulmão. Os mecanismos moleculares para explicá-lo não são totalmente compreendidos. O objetivo de nossa investigação foi analisar o mecanismo molecular que explica os efeitos anti-inflamatórios do pré-condicionamento anestésico com sevoflurano, enfocar seus efeitos sobre as proteínas quinases ativadas por mitógenos (MAPKs), o fator nuclear kappa beta (NF-κB) e a apoptose em modelo experimental de autotransplante pulmonar. Métodos: Vinte porcos Large White submetidos à pneumonectomia e autoimplante de pulmão foram divididos em dois grupos de 10 membros com base no anestésico recebido (propofol ou sevoflurano). O grupo de pré-condicionamento anestésico recebeu sevoflurano a 3% após a indução da anestesia, que foi descontinuado quando a ventilação monopulmonar foi iniciada. O grupo controle não recebeu sevoflurano em qualquer momento durante todo o período do estudo. As vias de transdução de sinal intracelular (família MAPK), o fator de transcrição (NF-κB) e a apoptose (caspases 3 e 9) foram analisados durante o experimento. Resultados: Os suínos que receberam pré-condicionamento anestésico com sevoflurano apresentaram valores mais baixos de MAPK-p38, MAPK-P-p38, c-Jun N-terminal quinases (JNK), NF-κB p50 intranuclear e caspases (p < 0,05) do que os suínos anestesiados com propofol intravenoso. Conclusões: A proteção pulmonar do pré-condicionamento anestésico com sevoflurano durante o autotransplante pulmonar experimental está, pelo menos, parcialmente associada à atenuação das vias de MAPKs e NF κB e aos efeitos antiapoptóticos.

[The effect of anesthetic preconditioning with sevoflurane on intracellular signal-transduction pathways and apoptosis, in a lung autotransplant experimental model]. / O efeito do pré­condicionamento anestésico com sevoflurano sobre as vias de transdução de sinal intracelular e a apoptose, em modelo experimental de autotransplante pulmonar.

BACKGROUND: Anesthetic pre-conditioning attenuates inflammatory response during ischemia-reperfusion lung injury. The molecular mechanisms to explain it are not fully understood. The aim of our investigation was to analyze the molecular mechanism that explain the anti-inflammatory effects of anesthetic pre-conditioning with sevoflurane focusing on its effects on MAPKs (mitogen-activated protein kinases), NF-κB (nuclear factor kappa beta) pathways, and apoptosis in an experimental lung autotransplant model. METHODS: Twenty large white pigs undergoing pneumonectomy plus lung autotransplant were divided into two 10-member groups on the basis of the anesthetic received (propofol or sevoflurane). Anesthetic pre-conditioning group received sevoflurane 3% after anesthesia induction and it stopped when one-lung ventilation get started. Control group did not receive sevoflurane in any moment during the whole study period. Intracellular signal-transduction pathways (MAPK family), transcription factor (NF-κB), and apoptosis (caspases 3 and 9) were analyzed during experiment. RESULTS: Pigs that received anesthetic pre-conditioning with sevoflurane have shown significant lower values of MAPK-p38, MAPK-P-p38, JNK (c-Jun N-terminal kinases), NF-κB p50 intranuclear, and caspases (p<0.05) than pigs anesthetized with intravenous propofol. CONCLUSIONS: Lung protection of anesthetic pre-conditioning with sevoflurane during experimental lung autotransplant is, at least, partially associated with MAPKs and NF κB pathways attenuation, and antiapoptotic effects.

Effect of carbon nanohorns in the radical polymerization of methacrylate monolithic capillary columns and their application as extractant phases.

A successful copolymerization of the single-walled carbon nanohorns (SWNHs) with methacrylate monomers was achieved via thermal initiated free-radical polymerization because of the high reactivity of the SWNHs in comparison with other carbon nanostructures. The hybrid solids were deeply characterized in terms of morphology, by scanning electron microscopy (SEM). The effect of the incorporation of the bare or oxidized (o-SWNHs) carbon nanoparticles at different percentages (0-0.5 wt%) in polymerization mixtures to obtain hybrid monolithic capillary columns has been evaluated. In addition, their impact both in the polymerization step and in the extraction capacity was deeply studied. Final hybrid monoliths were applied for the extraction of polycyclic aromatic hydrocarbons and nonsteroidal anti-inflammatory drugs in water and biological samples, respectively. The precision was calculated both intra- and inter-capillaries obtaining satisfactory RSD values of less than 19.1%, which indicated the high robust reproducibility of the extraction procedure and the synthesis method. The accuracy of the method was also evaluated through a recovery study giving good recovery values, which varied between 78% and 112% for PAHs in waters, and 90-114% for NSAIDs in human urine samples.

Intravenous lidocaine decreases tumor necrosis factor alpha expression both locally and systemically in pigs undergoing lung resection surgery.

BACKGROUND: Lung resection surgery is associated with an inflammatory reaction. The use of 1-lung ventilation (OLV) seems to increase the likelihood of this reaction. Different prophylactic and therapeutic measures have been investigated to prevent lung injury secondary to OLV. Lidocaine, a commonly used local anesthetic drug, has antiinflammatory activity. Our main goal in this study was to investigate the effect of IV lidocaine on tumor necrosis factor α (TNF-α) lung expression during lung resection surgery with OLV. METHODS: Eighteen pigs underwent left caudal lobectomy. The animals were divided into 3 groups: control, lidocaine, and sham. All animals received general anesthesia. In addition, animals in the lidocaine group received a continuous IV infusion of lidocaine during surgery (1.5 mg/kg/h). Animals in the sham group only underwent thoracotomy. Samples of bronchoalveolar lavage (BAL) fluid and plasma were collected before initiation of OLV, at the end of OLV, at the end of surgery, and 24 hours after surgery. Lung biopsy specimens were collected from the left caudal lobe (baseline) before surgery and from the mediastinal lobe and the left cranial lobe 24 hours after surgery. Samples were flash-frozen and stored to measure levels of the following inflammatory markers: interleukin (IL) 1ß, IL-2, IL-10, TNF-α, nuclear factor κB, monocyte chemoattractant protein-1, inducible nitric oxide synthase, and endothelial nitric oxide synthase. Markers of apoptosis (caspase 3, caspase 9, Bad, Bax, and Bcl-2) were also measured. In addition, levels of metalloproteinases and nitric oxide metabolites were determined in BAL fluid and in plasma samples. A nonparametric test was used to examine statistical significance. RESULTS: OLV caused lung damage with increased TNF-α expression in BAL, plasma, and lung samples. Other inflammatory (IL-1ß, nuclear factor κB, monocyte chemoattractant protein-1) and apoptosis (caspase 3, caspase 9, and BAX) markers were also increased. With the use of IV lidocaine there was a significant decrease in the levels of TNF-α in the same samples compared with the control group. Lidocaine administration also reduced the inflammatory and apoptotic changes observed in the control group. Hemodynamic values, blood gas values, and airway pressure were similar in all groups. CONCLUSIONS: Our results suggest that lidocaine can prevent OLV-induced lung injury through reduced expression of proinflammatory cytokines and lung apoptosis. Administration of lidocaine may help to prevent lung injury during lung surgery with OLV.