Preoperative anxiety management: acupuncture vs. pharmacological treatment - A prospective study.

OBJECTIVE: Acupuncture, both auricular and somatic, is a widely adopted and well-tolerated treatment for preoperative anxiety. The aim of our study was to compare the effectiveness of acupuncture with pharmacological treatment in reducing preoperative anxiety in patients undergoing cholecystectomy or TEP. MATERIALS AND METHODS: We randomized 120 patients in a control group PT (where patients underwent pharmacological treatment with Midazolam) and in an acupuncture group (here patients received somatic acupuncture SA and auricular acupuncture AA). Anxiety reduction was measured by intraoperative consumption of Propofol and Fentanyl and preoperatively by the Italian Version of the State-Trait Anxiety Inventory questionnaire (STAI). RESULTS: Propofol consumption in the somatic (SA) and auricular (AA) acupuncture groups was found to be lower compared to patients that did not receive any treatment. SA and AA patients required less Propofol than the PT group (p=0.0019 and p=0.0016 respectively) and patients that underwent SA treatment used less Fentanyl than the PT group (p=0.002). No difference was measured when comparing SA to AA (p=0.15) and AA to PT (p=0.16). CONCLUSIONS: Acupuncture is a safe and well-tolerated procedure that reduces preoperative anxiety. Both somatic and auricular acupuncture are more effective than pharmacological treatment in the intraoperative period. AA is easier to implement than SA.

Transnasal sphenopalatine ganglion blockade for acute facial pain: a prospective randomized case-control study.

OBJECTIVE: Long-term physical inactivity can cause the atrophy of skeletal muscle. The aim of this study is to explore the underlying mechanisms of physical inactivity-induced atrophy of skeletal muscle. MATERIALS AND METHODS: 14 Sprague- Dawley (SD) male rats were divided into 2 groups including normal control (NC) and hindlimb suspension (HS) groups. After two weeks of HS stimulation, the ratio between skeletal muscle weight and body weight, and cross-sectional area (CSA) of skeletal muscle fibers, were measured. Western blot was applied to evaluate the expression of proteins associated with atrophy and autophagy. The transmission electron microscope was used to observe the ultra-microstructure and the mitochondrial quality of skeletal muscle. RESULTS: The rats subjected to 2-week HS treatment presented an evident atrophy of the skeletal muscle with a significantly reduced ratio between skeletal muscle weight and body weight, and smaller cross-sectional area (CSA) of skeletal muscle fibers when compared with control rats. Meanwhile, HS stimulation resulted in the damage of mitochondria, the increased expression of MuRF1 and Atrogin-1/MAFbx, and enhanced apoptosis, as well as dysfunctional autophagy in skeletal muscle. CONCLUSIONS: HS-induced skeletal muscle atrophy involves the activation of AMPK/FoxO3 signal pathway, evidenced as AMPK phosphorylation, FoxO3 activation, and Atrogin-1 and MuRF1 up-regulation. FoxO3-mediated autophagy plays an important regulatory role in HS-induced skeletal muscle atrophy.

Regulation of extracellular matrix compounds involved in angiogenic processes in short- and long-track elite runners.

Exercise induces alterations of the extracellular matrix (ECM), e.g. by an increased release of endostatin or by regulation of matrix metalloproteases (MMP)-2/-9, and cathepsin L. To investigate the influence of training status on exercise-induced ECM-processing of angiogenic molecules, alterations of endostatin-, MMP-2, and MMP-9 plasma concentrations during incremental running step tests in male elite short-track (n=6) and male elite long-track runners (n=7) were studied. Three blood samples (pre-exercise, 0, and 1 h post-exercise) were taken from each subject at each running test. In both groups, the basal endostatin plasma concentration was significantly decreased at the second running test, i.e. after the training season. Exercise-related acute alterations of the parameters were also observed only during the second test. In the long-track group, there was a significant increase in endostatin at 0 h and of MMP-2 at 1 h post-exercise. In the short-track group, only MMP-9 was significantly increased at 0 h post-exercise. Cathepsin L was increased at 0 h post-exercise. In conclusion, regular exercise performance decreases the basal endostatin plasma concentration, facilitates ECM-processing of angiogenic molecules by regular performance, and seems to be dependent on the kind of training.

Short-term therapy for recurrent abortion using intravenous immunoglobulins: results of a double-blind placebo-controlled Italian study.

It is still unclear whether i.v. immunoglobulins (Ig) can facilitate the reproductive prognosis of women who have suffered recurrent pregnancy loss. We report the results of a multicentre placebo-controlled study on the effect of Ig administration on pregnancy outcome in 46 women who had suffered at least three recurrent miscarriages. All were screened to exclude chromosomal or Müllerian abnormalities, the presence of antinuclear antibodies, lupus anticoagulant (LA) or elevated titres of anticardiolipin antibodies which may have revealed an underlying autoimmune problem. To avoid a selection bias towards ongoing pregnancies, i.v. Ig or placebo were administered between weeks 5 and 7 of gestation for 2 consecutive days as soon as each woman knew she was pregnant and before embryonic heart activity could be detected. A further infusion was administered at week 8 when ultrasonography confirmed an ongoing embryonic development. In all, 68% of the women who received Ig went to term versus 79% of those who received a placebo (not significant), with no significant differences in the pregnancy course or the perinatal outcome. These results suggest either that women with recurrent miscarriages who have no recognized cause of pregnancy loss have a good reproductive prognosis without any treatment or that the emotional care associated with the administration of a placebo can indirectly facilitate the progression of pregnancy.

Hyperopia correction by noncontact holmium:YAG laser thermal keratoplasty. Clinical study with two-year follow-up.

BACKGROUND: Thermal keratoplasty to correct hyperopia has been attempted with nonlaser and laser devices. Problems have included long-term regression and irregular induced astigmatism. The present clinical study was performed to investigate the safety, efficacy, and stability of a noncontact mode of holmium: YAG laser energy delivery and a modified laser thermal keratoplasty treatment procedure for correction of low hyperopia. METHODS: Seventeen patients underwent noncontact holmium: YAG laser thermal keratoplasty in their nondominant eyes for correction of hyperopia of up to 3.00 diopters. Treatment parameters included simultaneous delivery of eight holmium: YAG laser spots in a symmetrical octagonal array with a centerline diameter of 6mm, 10 pulses of laser light at 5-Hz pulse repetition frequency, and pulse energies of 159 to 199mJ. Follow-up was 2 years in 15 of 17 patients. RESULTS: In the 15 eyes examined at 2 years after surgery, mean uncorrected distance Snellen visual acuity improved from 20/125-1 to 20/50-2. The mean change in spherical equivalent of subjective manifest refraction was -0.79 diopter. Eleven of these 15 eyes (73%) had a mean refractive correction of -1.1 diopters (range, -0.38 to -2.63 diopters); regression between 14 days and 2 years was 0.2 diopter. Four eyes (27%) had no persistent refractive correction (within +/- 0.25 diopter). Mean induced refractive astigmatism was 0.18 diopter. None of the eyes lost two or more lines of spectacle-corrected distance vision. The amount of refractive correction at 2 years after surgery was correlated to the treatment pulse energy and the volume of the opacified corneal tissue observed immediately after treatment. CONCLUSIONS: This technique of noncontact laser thermal keratoplasty produced safe, effective, and persistent corrections of low hyperopia in the majority of treated eyes.

[Benign lesions of the thyroid. Clinical methodology++ and therapeutic management in our personal experience]. / Le affezioni benigne della tiroide. Metodologia clinica e tattica terapeutica nella nostra esperienza personale.

Thyroid benign nodules are common (90-95%). A personal series of 544 cases forms the basis for a discussion of modern diagnostic techniques, their value and limitations. At the present time, subtotal or near total thyroidectomy is preferred, also in benign thyroid disease. The perfect anatomical knowledge of the neck is of paramount importance to minimize the risk of complications, such as a superior or inferior laryngeal nerve injury and hypoparathyroidism. Temporary suclinic, clinic, definitive hypoparathyroidism was never observed. Relapse was observed in 20 hypothyreosic patients with hormonal therapy.

Orientaçäo atual em abscessos subfrênicos: contribuiçäo clínica / Up-to-date orientation in subphrenic abscesses: clinical contribution

Os traumatismos e as agressöes cirúrgicas abdominais representam, pelo menos na experiência dos autores, as causas que levam mais freqüentemente à formaçäo de abscessos na cavidade peritoneal. Näo obstante os progressos da antibioticoterapia e das técnicas de assepsia, a sua freqüência torna-se alvo de interesse. A presença de febre e leucocitose no pós-operatório ou em paciente politraumatizado devem sempre fazer suspeitar do aparecimento de tal complicaçäo. Um tratamento precose e adequado torna-se fundamental para eliminar o estado tóxico que a coleçäo purulenta produz e permitir a sobrevida do paciente

Operative laparoscopy for uterine pathology.

In the first years of its use, operative laparoscopy for uterine pathology was employed in the surgical treatment of myomas and in the correction of uterine retroversion (hysteropexy). More recently the technique has been employed for the laparoscopically assisted hysterectomy or for subtotal laparoscopical hysterectomy using the Semm Kit. Also radical hysterectomy has been performed in advanced centers by laparoscopy. In this paper, the Authors discuss the indications, the counterindications, the risks and complications of the operative laparoscopy in the different forms of ovarian pathology.

Transcanalicular THC:YAG dacryocystorhinostomy.

Chromium-sensitized and thulium- and holmium-doped YAG lasers (THC:YAG laser) were used to create a nasal bony ostium in the area of the lacrimal sac fossa in four fresh frozen bisected human cadaver heads. The lasers-long pulsed (300 milliseconds), compact, self-contained, and solid state--operate in the near infrared (2.1 microns). The opening was created by passing the 320-micrometer laser fiber across the canalicular system. Pulse energies of 250 to 900 mJ were used with a repetition rate of 5 to 15 pulses per second. Energy levels ranging from 1.25 to 9 W produced a full-thickness bony ostium approximately 3 to 4 mm in diameter. Silicone tubing was then threaded through the superior and inferior canaliculus system in the standard fashion. This technique may simplify conventional dacryocystorhinostomy as well as endonasal laser dacryocystorhinostomy procedures.

Subconjunctival THC:YAG laser thermal sclerostomy.

A THC:YAG laser (thulium, holmium, chromium-doped YAG crystal) was used to create thermal sclerostomies in 21 glaucomatous eyes of 19 patients. The laser is a long-pulsed (300 microsec), compact, self-contained, solid state laser operating in the near infrared (2.1 mu). A 1-mm conjunctival stab incision was made 12 mm away from the sclerostomy site to allow entry of a specially designed 22-gauge (712 mu) optic probe that delivers energy at a right angle to the long axis of the fiber. Probe insertion produced minimal disturbance of the conjunctiva. Pulse energies of 80 mJ to 120 mJ were used with a repetition rate of 5 pulses/second. Total energy levels to produce full-thickness sclerostomies ranged from 1.4 to 4.8 J. Subconjunctival 5-fluorouracil injections were administered in 15 eyes. At 3 months the mean intraocular pressure of successful cases (16) was 14 mmHg (range, 9 to 22 mmHg). Of successful cases, the mean intraocular pressure at 6 months was 13 mmHg (range, 2 to 22 mmHg). Five cases failed within the initial 3 months, and 3 additional cases failed by 6 months. The authors conclude that this full-thickness sclerostomy technique may simplify filtering surgery without anterior chamber instrumentation and with minimal conjunctival trauma.

Lysosomal cobalamin accumulation in fibroblasts from a patient with an inborn error of cobalamin metabolism (cblF complementation group): visualization by electron microscope radioautography.

Cobalamin (Cbl, vitamin B12) bound to transcobalamin II (TCII) enters cultured fibroblasts by receptor-mediated endocytosis. Following degradation of the TCII, Cbl is subsequently found in either the cytoplasm bound to methionine synthase or in the mitochondria bound to methylmalonyl CoA mutase. In fibroblasts from patients belonging to the cblF complementation group, Cbl is found free in the cell and is not transferred to the above two target enzymes. Quantitative EM radioautography was utilized to visualize intracellular Cbl in fibroblasts from cblF patients and from normal subjects. In cblF cells, 60% of all silver grains were assigned to lysosomes, with only 12.6% over cytoplasm and 1.2% over mitochondria. In contrast, in control cells, only 4.7% were assigned to lysosomes, with 47% to cytoplasm and 23.4% to mitochondria. Subcellular fractionation showed that in cblF cells, the majority of label was associated with clearly recognizable lysosomes. These studies conclusively demonstrate that secondary lysosomes accumulate Cbl in cblF disease.

A new contact neodymium:YAG laser for cyclophotocoagulation.

A newly developed compact (40 kg), self-contained contact Neodymium:YAG laser produces high-peak, high-energy (800 mJ/pulse), short (1.0 millisecond) pulses with 1 to 3 pulses/exposure. Energy is delivered via a 320-microns cleaved quartz fiber optic probe. Cyclophotocoagulation was performed in five eyes of three medium-sized Dutch-pigmented rabbits. The eyes received exposures of 1 to 3 pulses/exposure. Energy delivered ranged from 100 to 800 mJ/pulse. Histopathology revealed ciliary body disruption and hemorrhage with no damage to overlying sclera. When used for transscleral cyclodiathermy in the rabbit, the laser created significant ciliary body disruption with minimal scleral injury.

Subconjunctival THC: YAG laser limbal sclerostomy Ab externo in the rabbit.

A chromium-sensitized, and thulium and holmium-doped YAG laser (THC:YAG laser) was used to create bilateral limbal sclerostomies in six Dutch pigmented rabbits. The laser is a long-pulsed (300 microseconds) [corrected], compact, self-contained, solid-state laser operating in the near infrared (2.1 microns). A 1-mm conjunctival stab incision was made 12 mm away from the sclerostomy site to allow entry of a specially designed 26-gauge (480 microns) optic probe that delivers energy at right angles to the long axis of the fiber. Probe insertion minimally disturbed the conjunctiva. Pulse energies of 60 to 150 mJ were used with a repetition rate of 5 pulses/s. Energy levels ranging from 1.35 to 6.6 J produced full-thickness sclerostomies. Histopathology showed a sharply defined perforating limbal wound at all energy levels. The overlying conjunctiva was intact, with swelling of the adjacent cornea. A peripheral iridectomy was intentionally created with the laser through the peripheral limbus, resulting in a sharply defined perforating tract through the iris/ciliary body. This technique may simplify filtering sclerostomy surgery, without anterior chamber instrumentation and with minimal conjunctival trauma.

Terapia cirurgica da litiase residual e recidiva da via biliar principal / Surgical therapy of residual lithiasis of the common bile duct

Os autores apresentam sua casuistica operatoria relativa a litiase biliar. Consiste de 3.017 intervencoes, das quais 2.395 por litiase de vesicula e 622 por litiase da vesicula e ou da via biliar principal (V.B.P.). Considerando-se somente as intervencoes por litiase da via biliar principal(V.B.P.), em 539 casos se tratava de uma primeira intervencao e nos 83 restantes, os pacientes ja tinham sido submetidos a uma ou mais intervencoes sobre a via biliar. Faz-se uma revisao analitica do problema da litiase residual e da recidiva. Depois de ter considerado as possibilidades de terapia alternativa aquela exclusivamente cirurgica , os autores ressaltam a necessidade de cuidadosa exploracao da via biliar na fase intra-operatoria e propoem um protocolo terapeutico por eles adotado no tratamento de litiase residual recidivada

Tratamento do derrame quiloso / Treatment of chylothorax

Os autores baseando-se na observaçäo de dois casos de quilotórax, sendo um espontâneo e um pós-traumático, tecem algumas consideraçöes com relaçäo a medida terapêutica a ser adotada. A terapêutica médica conservadora e cirúrgica têm, de fato, indicaçöes precisas e modalidades para serem efetuadas que, se bem conduzidas, levam a cura do paciente