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1.
Ann Transl Med ; 9(7): 592, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33987290

RESUMO

The risk of unintended inhalation of fugitive aerosols is becoming a topic of increasing interest in the healthcare arena. These fugitive aerosols may be bioaerosols, generated by the patient themselves through cough or sneeze, or they may be therapeutic medical aerosols, generated by therapeutic medical aerosol generators with the intent of delivery to a specific patient's respiratory tract. This review focus' on therapeutic aerosols in the intensive care unit (ICU) only, those typically generated by nebulisers. In the intensive care environment, patients are generally in receipt of ventilatory support, and the literature suggests that these different support interventions influence fugitive therapeutic medical aerosol emissions in a variety of ways. Predominant ventilatory support interventions include, but are not limited to, invasive mechanical ventilation (MV), non-invasive mechanical ventilation (NIV), high flow nasal therapy (HFNT), and supplemental oxygen delivery in spontaneously breathing patients. Further, factors such as nebuliser type, patient interface, patient breathing pattern, nebuliser position in the patient breathing circuit and medication formulation characteristics also have been shown to exert influence on aerosol concentrations and distance from the source. Here we present the state of the art knowledge in this, as yet, poorly described field of research, and identify the key risks, and subsequently, opportunities to mitigate the risks of unintended exposure of both patients and bystanders during and for periods following the administration of therapeutic aerosols.

2.
Pharmaceutics ; 13(2)2021 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-33540764

RESUMO

COVID-19 may lead to serious respiratory complications which may necessitate ventilatory support. There is concern surrounding potential release of patient-derived bioaerosol during nebuliser drug refill, which could impact the health of caregivers. Consequently, mesh nebulisers have been recommended by various clinical practice guidelines. Currently, there is a lack of empirical data describing the potential for release of patient-derived bioaerosol during drug refill. This study examined the release of simulated patient-derived bioaerosol, and the effect on positive end expiratory pressure during nebuliser refill during mechanical ventilation of a simulated patient. During jet nebuliser refill, the positive end expiratory pressure decreased from 4.5 to 0 cm H2O. No loss in pressure was noted during vibrating mesh nebuliser refill. A median particle number concentration of 710 particles cm-3 above ambient was detected when refilling the jet nebuliser in comparison to no increase above ambient detected when using the vibrating mesh nebuliser. The jet nebuliser with the endotracheal tube clamped resulted in 60 particles cm-3 above ambient levels. This study confirms that choice of nebuliser impacts both the potential for patient-derived bioaerosol release and the ability to maintain ventilator circuit pressures and validates the recommended use of mesh nebulisers during mechanical ventilation.

3.
Pharmaceutics ; 11(6)2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31159408

RESUMO

BACKGROUND: Nebulised medical aerosols are designed to deliver drugs to the lungs to aid in the treatment of respiratory diseases. However, an unintended consequence is the potential for fugitive emissions during patient treatment, which may pose a risk factor in both clinical and homecare settings. METHODS: The current study examined the potential for fugitive emissions, using albuterol sulphate as a tracer aerosol during high-flow therapy. A nasal cannula was connected to a head model or alternatively, a interface was connected to a tracheostomy tube in combination with a simulated adult and paediatric breathing profile. Two aerodynamic particle sizers (APS) recorded time-series aerosol concentrations and size distributions at two different distances relative to the simulated patient. RESULTS: The results showed that the quantity and characteristics of the fugitive emissions were influenced by the interface type, patient type and supplemental gas-flow rate. There was a trend in the adult scenarios; as the flow rate increased, the fugitive emissions and the mass median aerodynamic diameter (MMAD) of the aerosol both decreased. The fugitive emissions were comparable when using the adult breathing profiles for the nasal cannula and tracheostomy interfaces; however, there was a noticeable distinction between the two interfaces when compared for the paediatric breathing profiles. The highest recorded aerosol concentration was 0.370 ± 0.046 mg m-3 from the tracheostomy interface during simulated paediatric breathing with a gas-flow rate of 20 L/min. The averaged MMAD across all combinations ranged from 1.248 to 1.793 µm by the APS at a distance of 0.8 m away from the patient interface. CONCLUSIONS: Overall, the results highlight the potential for secondary inhalation of fugitive emissions released during simulated aerosol treatment with concurrent high-flow therapy. The findings will help in developing policy and best practice for risk mitigation from fugitive emissions.

4.
Aesthet Surg J ; 39(Suppl_2): S67-S72, 2019 03 14.
Artigo em Inglês | MEDLINE | ID: mdl-30869751

RESUMO

Surgeons must select the optimal suture materials for tissue approximation to maximize wound healing and scar aesthetics. Thus, knowledge regarding their characteristics is crucial to minimize ischaemia, excess wound tension, and tissue injury. This article describes the selection of various suture materials available today and their intended design. Modern suture material should have predictable tensile strength, good handling, secure knot-tying properties, and could be enhanced with an antibacterial agent to resist infection. Tensile strength is limited by suture size. The smallest suture size that will accomplish the purpose should be chosen to minimize tissue trauma and foreign material within tissues. Monofilament suture has lower resistance when passed through tissues, whereas multifilament sutures possesses higher tensile strength and flexibility but greater tissue friction and pose risks of suture sinus and infection. Natural absorbable sutures derived from mammalian collagen undergo enzymatic degradation whereas synthetic polymers undergo hydrolysis. Collagen or polymer structures in the suture can be modified to control absorption time. In contrast, nonabsorbable sutures typically cause an inflammatory reaction that eventually encapsulates by fibrous tissue formation. Excess reaction leads to chronic inflammation, suboptimal scarring, or suture extrusion. More recently, barbed sutures have transformed the way surgeons approximate wounds by eliminating knots, distributing wound tension, and increasing efficiency of closure. Similarly, modern skin adhesives function both as wound closure devices as well as an occlusive dressing. They eliminate the need for skin sutures, thus improving scar aesthetics while sealing the wound from the external environment.


Assuntos
Deiscência da Ferida Operatória/prevenção & controle , Ferida Cirúrgica/complicações , Técnicas de Sutura , Suturas , Humanos , Deiscência da Ferida Operatória/etiologia , Procedimentos Cirúrgicos sem Sutura , Resistência à Tração , Adesivos Teciduais , Cicatrização
5.
Aesthet Surg J ; 39(Suppl_2): S73-S77, 2019 03 14.
Artigo em Inglês | MEDLINE | ID: mdl-30869752

RESUMO

A variety of modern surgical needles are available to today's surgeon. However, a surgeon's preference of surgical needles, is usually influenced by experience, ease of use, and the postoperative result, such as scar quality. This article describes the selection of needle designs available, and their intended clinical applications. Key factors in the basic design of the surgical needle include, the quality of its alloy, surface coating, and needle geometry. The needle alloy provides strength and ductility. Silicon coating maintains the sharpness and consistency of penetration of the needle. Sharpness is also determined by the angle of the point and taper ratio of the needle. Needle sizes range from extremely fine microsurgical needles to very thick needles for sternal closure. Needlepoint type is selected based on the particular tissue type where they are used. A conventional cutting needle is used for tough tissue, such as skin, whereas a reverse cutting needle is selected to reduce the risk of tissue cutout. Round-body needles are used in tissues that are easy to penetrate and in crucial procedures such as tendon repair, where suture cutout would be disastrous. A blunt-point, round-body needle dilates rather than cuts, and is preferred in abdominal fascial closure, to prevent inadvertent visceral injury and bleeding. The taper-cut needle punctures and then dilates and is used for vascular anastomosis. Although the needle and suture choice are entirely the surgeon's, this article hopefully may serve as a reference for those who are deciding on these issues critically.


Assuntos
Agulhas , Deiscência da Ferida Operatória/prevenção & controle , Ferida Cirúrgica/complicações , Técnicas de Sutura/instrumentação , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/instrumentação , Fístula Anastomótica/etiologia , Fístula Anastomótica/prevenção & controle , Humanos , Deiscência da Ferida Operatória/etiologia , Cicatrização
6.
Pharmaceutics ; 11(2)2019 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-30759879

RESUMO

BACKGROUND: Secondary inhalation of medical aerosols is a significant occupational hazard in both clinical and homecare settings. Exposure to fugitive emissions generated during aerosol therapy increases the risk of the unnecessary inhalation of medication, as well as toxic side effects. METHODS: This study examines fugitively-emitted aerosol emissions when nebulising albuterol sulphate, as a tracer aerosol, using two commercially available nebulisers in combination with an open or valved facemask or using a mouthpiece with and without a filter on the exhalation port. Each combination was connected to a breathing simulator during simulated adult breathing. The inhaled dose and residual mass were quantified using UV spectrophotometry. Time-varying fugitively-emitted aerosol concentrations and size distributions during nebulisation were recorded using aerodynamic particle sizers at two distances relative to the simulated patient. Different aerosol concentrations and size distributions were observed depending on the interface. RESULTS: Within each nebuliser, the facemask combination had the highest time-averaged fugitively-emitted aerosol concentration, and values up to 0.072 ± 0.001 mg m-3 were recorded. The placement of a filter on the exhalation port of the mouthpiece yielded the lowest recorded concentrations. The mass median aerodynamic diameter of the fugitively-emitted aerosol was recorded as 0.890 ± 0.044 µm, lower the initially generated medical aerosol in the range of 2⁻5 µm. CONCLUSIONS: The results highlight the potential secondary inhalation of exhaled aerosols from commercially available nebuliser facemask/mouthpiece combinations. The results will aid in developing approaches to inform policy and best practices for risk mitigation from fugitive emissions.

8.
Burns ; 42(2): 356-65, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26739087

RESUMO

INTRODUCTION: Fat transfer is increasingly used as part of our reconstructive armamentarium to address the challenges encountered in secondary burn reconstruction. The aim of this study was to review our experience with autologous fat transfer in relation to hand function, scarring and cosmesis, in patients undergoing secondary reconstruction after burns. METHOD: Retrospective analysis of burn patients (2010-2013) who underwent autologous fat transfer to improve scarring, contour deformity and/or scar contracture was performed. Hand function was assessed using grip strength measurement, Total Active Movement (TAM), the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire and Michigan Hand Outcome Questionnaire (MHQ). Patients' satisfaction was assessed using the Patient Observer Scar Assessment Scale (POSAS). RESULTS: Thirteen patients were included in this analysis. The average time from burns and from fat transfer were 2.3 years (10 months-3.9 years) and 9.1 months (3 months-1.3 years), respectively. There was a statistically significant improvement in TAM measurement. The total score, activity of daily living score and satisfaction score of the MHQ also statistically increased following fat transfer. The changes in function score, work score and pain score of the MHQ were not significant. Grip strength measurement and DASH score did not show improvement. For scar assessment, total score and overall score of POSAS improved significantly. Similarly, scores for scar colour, scar thickness, scar stiffness and scar regularity increased significantly. DISCUSSION: Autologous fat transfer directly replaces volume loss in the subcutaneous layer, physically releases tethered skin from underlying tissues and exerts downstream regenerative effects. Skin quality improvements combined with replacement of the subcutaneous adipose volume in the hand reduces overall scar tightness and tissue tethering and has the potential to enhance hand therapy. In our series, modest improvement in range of movement, scar quality and hand outcome scores were demonstrated following a single session of fat transfer.


Assuntos
Gordura Abdominal/transplante , Queimaduras/cirurgia , Cicatriz/cirurgia , Contratura/cirurgia , Traumatismos da Mão/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recuperação de Função Fisiológica , Adulto , Queimaduras/complicações , Cicatriz/etiologia , Contratura/etiologia , Estética , Feminino , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Amplitude de Movimento Articular , Estudos Retrospectivos , Inquéritos e Questionários , Adulto Jovem
10.
Eur J Dermatol ; 25(2): 162-8, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25787744

RESUMO

BACKGROUND: Distinguishing Spitz naevi from malignant melanoma can pose diagnostic dilemmas and atypical subtypes present particular challenges to both clinicians and pathologists. OBJECTIVES: We aimed to review our institutional experience of Spitz naevi, to characterise demographics and analyse the clinical and histological features associated with difficult/equivocal diagnosis of such lesions. Additionally we evaluated discordant cases following expert opinion at a second institution. MATERIALS & METHODS: Data was retrospectively analysed on all cases of Spitz naevi treated over an 18-year period (1991-2009). Equivocal cases, (where a diagnosis of classical Spitz naevi could not be confidently made) were identified. The original/provisional diagnosis and second histopathological opinions were compared. RESULTS: 148 cases were identified 112 lesions were classical Spitz naevi. 36 lesions (24.3%) posed diagnostic difficulty (equivocal cases). These equivocal cases tended to occur in the lower limbs, have brown pigmentation, be smaller in size (<6mm) and occur in older (>24 years) patients. Clinical sub-types and gender were not associated with equivocal cases. Of the 36 equivocal cases, the second opinion in 23 cases (63.9%) concurred with the original diagnosis. Of the remaining 13 cases (discordant cases), 10 cases that were originally deemed malignant were reported as benign after the second opinion. Two benign lesions were reclassified as malignant. CONCLUSION: A firm histological diagnosis of Spitz naevi cannot be made with certainty in nearly a quarter of cases. Thus, additional external analysis for a second opinion should be sought for these equivocal cases.


Assuntos
Neoplasias de Cabeça e Pescoço/patologia , Melanoma/patologia , Nevo de Células Epitelioides e Fusiformes/patologia , Neoplasias Cutâneas/patologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Pigmentação , Estudos Retrospectivos , Carga Tumoral , Adulto Jovem
11.
Ann Agric Environ Med ; 22(1): 17-22, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25780821

RESUMO

INTRODUCTION AND OBJECTIVE: House dust mites produce allergens which can cause or aggravate diseases such as asthma, eczema and rhinitis. The objectives of this study are to quantify typical house dust mite and Der p 1 allergen levels in child car seats, and to determine external variables that may influence mite populations in cars. MATERIALS AND METHODS: Dust samples were collected from the child car seats and driver seats of 106 cars using a portable vacuum sampling pump over a two minute sampling period. Mites were counted and identified and results were expressed as mites per gram (mites/g) of dust, while Der p 1 content of samples were measured by enzyme-linked immunosorbent assay (ELISA). Questionnaires were completed by participants to identify environmental and behavioural effects on mite populations. Results were analysed using General Linear Model (GLM) procedures. RESULTS: Twelve species of mites, of which nine are known to produce harmful allergens, were recorded from 212 dust samples. Over 80% of drivers' seats and over 77% of child car seats harboured dust mites with a significant correlation (p = 0.001) between the mites/g of dust and Der p 1 content recovered from each seat. A mean of 53 mites/g of dust per seat was recovered, with a mean Der p 1 level of 1.1µg/g. Over 12% of driver seats and 15% of child car seats contained house dust mite levels sufficient to be risk factors for sensitisation and allergic reactions. CONCLUSIONS: Child car seats and driver seats are habitats to a range of mite species which can be present in sufficient concentrations to cause or aggravate allergen related illnesses in individuals who are genetically predisposed.


Assuntos
Alérgenos/análise , Antígenos de Dermatophagoides/análise , Proteínas de Artrópodes/análise , Sistemas de Proteção para Crianças/parasitologia , Cisteína Endopeptidases/análise , Pyroglyphidae/fisiologia , Ácaros e Carrapatos/fisiologia , Animais , Ensaio de Imunoadsorção Enzimática , Irlanda , Densidade Demográfica , Fatores de Risco , Inquéritos e Questionários
12.
Ann Allergy Asthma Immunol ; 114(4): 335-40, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25680836

RESUMO

BACKGROUND: Clothing is largely presumed as being the mechanism by which house dust mites are distributed among locations in homes, yet little research to date has investigated the capacity with which various clothing fabric types serve as vectors for their accumulation and dispersal. Although previous research has indicated that car seats provide a habitat for mite populations, dynamics involved in the transfer of mites to clothing via car seat material is still unknown. OBJECTIVE: To investigate the dynamics involved in the transfer of house dust mites from car seat material to modern clothing fabrics. METHODS: A total of 480 samples of car seat material were seeded with mites and subjected to contact with plain woven cotton, denim, and fleece. Contact forces equivalent to the mass of a typical adult and child were administered for different durations of contact. RESULTS: Mean transfer efficiencies of mites from car seat material to receiving clothing fabrics ranged from 7.2% to 19.1%. Fabric type, mite condition (live or dead), and the force applied all revealed a significant effect (P < .001 for each variable) on the transfer efficiency of house dust mites from seeded material to receiving fabrics, whereas duration of contact revealed no effect (P = .20). In particular, mean numbers of mites transferred to fleece (compared with denim and plain woven cotton) were greater for each treatment. CONCLUSION: These findings indicate that clothing type can have important implications for the colonization of other biotopes by house dust mites, with potential for affecting an individuals' personal exposure to dust mite allergens.


Assuntos
Antígenos de Dermatophagoides/imunologia , Vestuário/efeitos adversos , Fibra de Algodão/estatística & dados numéricos , Hipersensibilidade/imunologia , Pyroglyphidae/imunologia , Animais , Exposição Ambiental/efeitos adversos , Humanos , Modelos Biológicos
13.
Hand Surg ; 19(2): 245-8, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24875512

RESUMO

Giant cell tumour of the tendon sheath is rare in children. We present an unusual case of a recurring multifocal giant cell tumour of the tendon sheath in the hand and wrist of an 11-year-old boy. We are not aware of any similar report in the literature.


Assuntos
Dedos , Tumores de Células Gigantes/cirurgia , Neoplasias Musculares/cirurgia , Recidiva Local de Neoplasia/cirurgia , Criança , Humanos , Masculino , Tendões/cirurgia
14.
J Craniomaxillofac Surg ; 42(7): 1062-70, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24581635

RESUMO

OBJECTIVE: To explore how improvement in facial appearance is related to patients' perception and satisfaction following cleft rhinoplasty. DESIGN: A cross-sectional survey. PARTICIPANTS: 35 cleft rhinoplasty patients treated between 2005 and 2010. 45 observers comprised of healthcare professionals. MAIN OUTCOME MEASURES: Evaluation of patient satisfaction including Rhinoplasty Outcome Evaluation (ROE) questionnaire, Preoperative and Postoperative Semi-quantitative Ordinal Scale Rating (PPSOSR) and a specifically designed semi-structured questionnaire. Evaluation by panel of observers using Asher-McDade Aesthetic Index (AMAI) Rating and PPSOSR. RESULTS: Patient satisfaction was high, based on the ROE questionnaire (score 76.1). 91% of patients rated their appearance as improved, 3% remained 'uncertain' and 6% felt 'different but not improved.' Teenage females (score 94.1) showed statistically higher satisfaction, when compared to older females (score 75.5), or their male counterparts (score 69.8). The preoperative appearance ratings were not statistically different between patients and panel members but postoperatively, patients' rating of their appearance was statistically higher. All components of the AMAI were scored between 'good' to 'fair' (score 9.3). Seventy percent of the panel rated the postoperative appearance as improved. Interestingly, 10% rated the postoperative appearance as 'unchanged', while 3% reported a 'worsened' appearance. There was no correlation between panel assessment of aesthetic outcome and patient satisfaction. CONCLUSIONS: Cleft rhinoplasty contributes to subjective patient satisfaction as a result of their perceived improvement in appearance and function, even though this was not correlated to objective aesthetic rating by panel members.


Assuntos
Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Estética , Satisfação do Paciente , Rinoplastia/psicologia , Adolescente , Adulto , Fatores Etários , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cartilagens Nasais/cirurgia , Nariz/anatomia & histologia , Nariz/fisiologia , Deformidades Adquiridas Nasais/cirurgia , Osteotomia/métodos , Respiração , Rinoplastia/métodos , Fatores Sexuais , Resultado do Tratamento , Adulto Jovem
15.
Int J Environ Res Public Health ; 6(4): 1456-71, 2009 04.
Artigo em Inglês | MEDLINE | ID: mdl-19440528

RESUMO

Implementing the World Health Organisation (WHO) Framework Convention on Tobacco Control (FCTC) relies heavily on enforcement. Little is known of the way different enforcement agencies operate, prioritise or network. A questionnaire was sent to representatives of the International Federation of Environmental Health (IFEH) in 36 countries. Tobacco control was given low priority. Almost two thirds did not have any tobacco control policy. A third reported their organisation had worked with other agencies on tobacco control. Obstacles to addressing tobacco control included a lack of resources (61%) and absence of a coherent strategy (39%).


Assuntos
Saúde Ambiental/organização & administração , Prioridades em Saúde , Prevenção do Hábito de Fumar , Tabaco , Benchmarking , Saúde Ambiental/legislação & jurisprudência , Humanos , Aplicação da Lei , Fumar/legislação & jurisprudência , Organização Mundial da Saúde
16.
Ann Surg ; 249(3): 355-63, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19247018

RESUMO

BACKGROUND: Esophagectomy represents an exemplar of controlled major trauma, with marked metabolic, immunologic, and physiologic changes as well as an associated high incidence of complications. Eicosapentaenoic acid (EPA) enriched enteral nutrition (EN) modulates immune function and limits catabolism in patients with advanced cancer, but its impact in the peri-operative period is unclear. OBJECTIVES: To examine the effects of perioperative EPA enriched EN on the metabolic, nutritional, and immuno-inflammatory response to esophagectomy, and on postoperative complications. METHODS: In a double-blind design, patients were randomized to a standard EN formula or a formula enriched with 2.2 g EPA/d for 5 days preoperatively (orally) and 21 days postoperatively (jejunostomy). Segmental bioelectrical impedance analysis was performed preoperatively and on POD 21. Postoperative complications were monitored, as well as the acute phase response, coagulation markers, and serum cytokines. RESULTS: Fifty-three patients (28 EPA, 25 standard) completed the study, and both groups were well matched. Serum and peripheral blood mononuclear cell (PBMC) membrane EPA levels were significantly increased in the EPA group. There was no difference in the incidence of major complications. The EPA group maintained all aspects of body composition postoperatively, whereas patients in the standard EN group lost significant amounts of fat-free mass (1.9 kg, P = 0.030) compared with the EPA group [leg (0.3 kg, P = 0.05), arm (0.17 kg, P = 0.01), and trunk (1.44 kg, P = 0.03)]. The EPA group had a significantly (P < 0.05) attenuated stress response for TNFalpha, IL-10, and IL-8 compared with the standard group. CONCLUSIONS: EPA supplemented early EN is associated with preservation of lean body mass post esophagectomy compared with a standard EN. These properties may merit longer-term study to address its impact on recovery of function and quality of life in models of complex surgery or multimodal cancer treatment regimens.


Assuntos
Composição Corporal/efeitos dos fármacos , Ácido Eicosapentaenoico/administração & dosagem , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Perda de Peso/efeitos dos fármacos , Idoso , Índice de Massa Corporal , Suplementos Nutricionais , Método Duplo-Cego , Impedância Elétrica , Nutrição Enteral , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estado Nutricional
17.
Ann Surg ; 247(6): 909-15, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18520215

RESUMO

BACKGROUND: Obesity is a risk factor for esophageal adenocarcinoma, with a pathway through inflammation and metaplasia secondary to reflux the dominant hypothesis. The proinflammatory impact of adipocytokines associated with the metabolic syndrome of central adiposity may also be relevant. The objective of this study was to explore this profile in Barrett esophagus. METHODS: Patients with specialized intestinal metaplasia were invited to attend the metabolic syndrome screening where they underwent anthropometry, segmental bioelectrical impedance analysis, and blood pressure measurement, and had blood taken for quantification of fasting lipids, insulin, glucose, C-reactive protein, and adipocytokines. RESULTS: One hundred two patients were studied. Forty-six percent of Barrett patients had metabolic syndrome and 78% were centrally obese. Patients with metabolic syndrome were significantly more obese by body mass index, had a 9.4 cm greater waistline, were more hypertensive, and were insulin resistant with 25% having fasting hyperinsulinemia compared with Barrett patients without metabolic syndrome. Metabolic syndrome was associated with elevated C-reactive protein, leptin, and a trend toward decreased adiponectin levels. Sixty percent of patients with long-segment Barrett had metabolic syndrome, and 92% were centrally obese compared with 23.8% and 62%, respectively (P = 0.007 and 0.005) in short-segment Barrett. Long-segment Barrett was associated with hyperinsulinemia and significantly increased levels of interleukin-6 compared with short-segment Barrett. CONCLUSIONS: The prevalence of metabolic syndrome in Barrett far exceeds population norms, and the syndrome was significantly associated with the length of specialized intestinal metaplasia. The data do suggest that the metabolic syndrome may be relevant to the continuum of metaplasia within the Barrett cohort.


Assuntos
Adiposidade , Esôfago de Barrett/complicações , Síndrome Metabólica/complicações , Síndrome Metabólica/epidemiologia , Adiponectina/sangue , Análise de Variância , Antropometria , Glicemia/análise , Determinação da Pressão Arterial , Proteína C-Reativa/análise , Distribuição de Qui-Quadrado , Citocinas/sangue , Impedância Elétrica , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Insulina/sangue , Leptina/sangue , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Fenótipo , Prevalência , Resistina/sangue
18.
J Environ Radioact ; 85(2-3): 196-204, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16249045

RESUMO

The residence time of particulate contamination on the human body is a factor that has an important impact on the accuracy of exposure assessment in the aftermath of an accidental release of radionuclides to the atmosphere. Measurements of particle clearance from human skin were made using an illumination system to excite fluorescence in labelled silica particles and a CCD camera and image processing system to detect this fluorescence. The illumination system consists of high-intensity light emitting diodes (LEDS) of suitable wavelengths arranged on a portable stand. The physically small size of the LEDs allows them to be positioned close to the fluorescing surface, thus maximising the fluorescent signal that can be obtained. The limit of detection was found to be 50 microg of tracer particle per cm2. Experiments were carried out to determine the clearance rates of 10 microm and 3 microm particles from the skin. Results show that, in the absence of any mechanical rubbing of the skin, the clearance of particles from the skin followed an approximately exponential decay with a half-time of 1.5-7.8 h. Skin hairiness and degree of human movement were found, in addition to particle size, to have an important influence on particle fall-off rate.


Assuntos
Poluentes Atmosféricos/análise , Monitoramento Ambiental/métodos , Pele , Aerossóis , Feminino , Fluoresceína-5-Isotiocianato , Fluorescência , Cabelo , Humanos , Locomoção , Masculino , Movimento , Tamanho da Partícula , Doses de Radiação , Dióxido de Silício/análise
19.
J Laryngol Otol ; 118(7): 532-6, 2004 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-15318960

RESUMO

Primary salivary adenocarcinoma of the head and neck is rare. In cases where cervical metastases are evident or suspected, neck dissection is likely to play a role in management. However, there is little data in the literature regarding the findings and outcome of neck dissection in these patients. The present study comprised a review of 12 patients with high-grade salivary adenocarcinoma (salivary ductal carcinoma or adenocarcinoma, not otherwise specified (NOS). Eight underwent neck dissection (four modified radical, four selective). Histological examination showed evidence of cervical metastases in five. The prevalence of occult metastases in the N(0) neck was 40 per cent. Computed tomography (CT) and magnetic resonance imaging (MRI) were not useful in detecting occult neck disease. Five patients had no evidence of disease at the most recent follow up. Neck dissection is indicated in patients with high-grade salivary adenocarcinoma, and may provide information for planning adjuvant treatment.


Assuntos
Adenocarcinoma/secundário , Adenocarcinoma/cirurgia , Esvaziamento Cervical , Neoplasias das Glândulas Salivares/patologia , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Ductal/patologia , Carcinoma Ductal/secundário , Carcinoma Ductal/cirurgia , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade
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