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1.
Cochrane Database Syst Rev ; 9: CD006946, 2020 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-32944940

RESUMO

BACKGROUND: Engorgement is the overfilling of breasts with milk, often occurring in the early days postpartum. It results in swollen, hard, painful breasts and may lead to premature cessation of breastfeeding, decreased milk production, cracked nipples and mastitis. Various treatments have been studied but little consistent evidence has been found on effective interventions. OBJECTIVES: To determine the effectiveness and safety of different treatments for engorgement in breastfeeding women. SEARCH METHODS: On 2 October 2019, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP), and reference lists of retrieved studies. SELECTION CRITERIA: All types of randomised controlled trials and all forms of treatment for breast engorgement were eligible. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for eligibility, extracted data, conducted 'Risk of bias' assessment and assessed the certainty of evidence using GRADE. MAIN RESULTS: For this udpate, we included 21 studies (2170 women randomised) conducted in a variety of settings. Six studies used individual breasts as the unit of analysis. Trials examined a range of interventions: cabbage leaves, various herbal compresses (ginger, cactus and aloe, hollyhock), massage (manual, electromechanical, Oketani), acupuncture, ultrasound, acupressure, scraping therapy, cold packs, and medical treatments (serrapeptase, protease, oxytocin). Due to heterogeneity, meta-analysis was not possible and data were reported from single trials. Certainty of evidence was downgraded for limitations in study design, imprecision and for inconsistency of effects. We report here findings from key comparisons. Cabbage leaf treatments compared to control For breast pain, cold cabbage leaves may be more effective than routine care (mean difference (MD) -1.03 points on 0-10 visual analogue scale (VAS), 95% confidence intervals (CI) -1.53 to -0.53; 152 women; very low-certainty evidence) or cold gel packs (-0.63 VAS points, 95% CI -1.09 to -0.17; 152 women; very low-certainty evidence), although the evidence is very uncertain. We are uncertain about cold cabbage leaves compared to room temperature cabbage leaves, room temperature cabbage leaves compared to hot water bag, and cabbage leaf extract cream compared to placebo cream because the CIs were wide and included no effect. For breast hardness, cold cabbage leaves may be more effective than routine care (MD -0.58 VAS points, 95% CI -0.82 to -0.34; 152 women; low-certainty evidence). We are uncertain about cold cabbage leaves compared to cold gel packs because the CIs were wide and included no effect. For breast engorgement, room temperature cabbage leaves may be more effective than a hot water bag (MD -1.16 points on 1-6 scale, 95% CI -1.36 to -0.96; 63 women; very low-certainty evidence). We are uncertain about cabbage leaf extract cream compared to placebo cream because the CIs were wide and included no effect. More women were satisfied with cold cabbage leaves than with routine care (risk ratio (RR) 1.42, 95% CI 1.22 to 1.64; 152 women; low certainty), or with cold gel packs (RR 1.23, 95% CI 1.10 to 1.38; 152 women; low-certainty evidence). We are uncertain if women breastfeed longer following treatment with cold cabbage leaves than routine care because CIs were wide and included no effect. Breast swelling and adverse events were not reported. Compress treatments compared to control For breast pain, herbal compress may be more effective than hot compress (MD -1.80 VAS points, 95% CI -2.07 to -1.53; 500 women; low-certainty evidence). Massage therapy plus cactus and aloe compress may be more effective than massage therapy alone (MD -1.27 VAS points, 95% CI -1.75 to -0.79; 100 women; low-certainty evidence). In a comparison of cactus and aloe compress to massage therapy, the CIs were wide and included no effect. For breast hardness, cactus and aloe cold compress may be more effective than massage (RR 0.66, 95% CI 0.51 to 0.87; 102 women; low-certainty evidence). Massage plus cactus and aloe cold compress may reduce the risk of breast hardness compared to massage alone (RR 0.38, 95% CI 0.25 to 0.58; 100 women; low-certainty evidence). We are uncertain about the effects of compress treatments on breast engorgement and cessation of breastfeeding because the certainty of evidence was very low. Among women receiving herbal compress treatment, 2/250 experienced skin irritation compared to 0/250 in the hot compress group (moderate-certainty evidence). Breast swelling and women's opinion of treatment were not reported. Medical treatments compared to placebo Protease may reduce breast pain (RR 0.17, 95% CI 0.04, 0.74; low-certainty evidence; 59 women) and breast swelling (RR 0.34, 95% CI 0.15 to 0.79; 59 women; low-certainty evidence), whereas serrapeptase may reduce the risk of engorgement compared to placebo (RR 0.36, 95% CI 0.14 to 0.88; 59 women; low-certainty evidence). We are uncertain if serrapeptase reduces breast pain or swelling, or if oxytocin reduces breast engorgement compared to placebo, because the CIs were wide and included no effect. No women experienced adverse events in any of the groups receiving serrapeptase, protease or placebo (low-certainty evidence). Breast induration/hardness, women's opinion of treatment and breastfeeding cessation were not reported. Cold gel packs compared to control For breast pain, we are uncertain about the effectiveness of cold gel packs compared to control treatments because the certainty of evidence was very low. For breast hardness, cold gel packs may be more effective than routine care (MD -0.34 points on 1-6 scale, 95% CI -0.60 to -0.08; 151 women; low-certainty evidence). It is uncertain if women breastfeed longer following cold gel pack treatment compared to routine care because the CIs were wide and included no effect. There may be little difference in women's satisfaction with cold gel packs compared to routine care (RR 1.17, 95% CI 0.97 to 1.40; 151 women; low-certainty evidence). Breast swelling, engorgement and adverse events were not reported. AUTHORS' CONCLUSIONS: Although some interventions may be promising for the treatment of breast engorgement, such as cabbage leaves, cold gel packs, herbal compresses, and massage, the certainty of evidence is low and we cannot draw robust conclusions about their true effects. Future trials should aim to include larger sample sizes, using women - not individual breasts - as units of analysis.


Assuntos
Doenças Mamárias/terapia , Transtornos da Lactação/terapia , Terapia por Acupuntura , Brassica , Doenças Mamárias/etiologia , Crioterapia/métodos , Feminino , Humanos , Massagem , Mastodinia/terapia , Ocitocina/uso terapêutico , Peptídeo Hidrolases/uso terapêutico , Fitoterapia/métodos , Folhas de Planta , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Terapia por Ultrassom/métodos
2.
Rev Med Suisse ; 16(701): 1412-1417, 2020 Aug 05.
Artigo em Francês | MEDLINE | ID: mdl-32833356

RESUMO

Whole body cryotherapy is mainly performed either by immersion in cold water or in a cryotherapy chamber. Practiced since Antiquity and considered as a «â€…natural ¼ method, cryotherapy is attracting more and more followers. Beneficial health effects have been described in the literature. However, interpretation of its effects is difficult due to low quality of current studies. Cryotherapy could however be useful in addition to conventional therapies in various pathologies and situations, provided that the risks, contraindications and rules of good practice are known.


Assuntos
Crioterapia/efeitos adversos , Crioterapia/métodos , Água , Crioterapia/instrumentação , Humanos
3.
J Korean Med Sci ; 35(22): e210, 2020 Jun 08.
Artigo em Inglês | MEDLINE | ID: covidwho-574614

RESUMO

We report a rapidly deteriorating coronavirus disease 2019 (COVID-19) patient, a-58-year-old woman, with severe acute respiratory distress syndrome and shock with hyperpyrexia up to 41.8°C, probably due to the cytokine storm syndrome. Considering extracorporeal membrane oxygenation (ECMO) as the last resort, we applied therapeutic temperature modulation for management of hyperpyrexia. The patient demonstrated rapid improvement in oxygenation and shock after achieving normothermia, and fully recovered from COVID-19 three weeks later. Therapeutic temperature modulation may have successfully offloaded the failing cardiorespiratory system from metabolic cost and hyperinflammation induced by hyperpyrexia. The therapeutic temperature modulation can safely be applied in a specific group of patients with cytokine storm syndrome and hyperpyrexia, which may reduce the number of patients requiring ECMO in the global medical resource shortage.


Assuntos
Infecções por Coronavirus/patologia , Infecções por Coronavirus/terapia , Crioterapia/métodos , Febre/terapia , Pneumonia Viral/patologia , Pneumonia Viral/terapia , Betacoronavirus , Estado Terminal/terapia , Síndrome da Liberação de Citocina/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Pandemias , Choque/terapia
4.
J Korean Med Sci ; 35(22): e210, 2020 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-32508069

RESUMO

We report a rapidly deteriorating coronavirus disease 2019 (COVID-19) patient, a-58-year-old woman, with severe acute respiratory distress syndrome and shock with hyperpyrexia up to 41.8°C, probably due to the cytokine storm syndrome. Considering extracorporeal membrane oxygenation (ECMO) as the last resort, we applied therapeutic temperature modulation for management of hyperpyrexia. The patient demonstrated rapid improvement in oxygenation and shock after achieving normothermia, and fully recovered from COVID-19 three weeks later. Therapeutic temperature modulation may have successfully offloaded the failing cardiorespiratory system from metabolic cost and hyperinflammation induced by hyperpyrexia. The therapeutic temperature modulation can safely be applied in a specific group of patients with cytokine storm syndrome and hyperpyrexia, which may reduce the number of patients requiring ECMO in the global medical resource shortage.


Assuntos
Infecções por Coronavirus/patologia , Infecções por Coronavirus/terapia , Crioterapia/métodos , Febre/terapia , Pneumonia Viral/patologia , Pneumonia Viral/terapia , Betacoronavirus , Estado Terminal/terapia , Síndrome da Liberação de Citocina/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Pandemias , Choque/terapia
5.
Complement Ther Med ; 51: 102453, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32507419

RESUMO

OBJECTIVES: There is a growing body of evidence supporting the role of whole-body cryostimulation (WBC) and sauna - bathing as treatments for relaxation, mental well-being and several health problems. Despite their polar opposite temperatures, both of these treatments come with a dose of similar health benefits. This study is designed to compare effects of WBC and sauna application on the athletes' response to exercise. DESIGN: The blood samples were collected from 10 professional cross-country skiers at four stages: before exercise, after exercise, at 1-h recovery and after 24 h of rest in sessions before and after 10 thermal treatments. Differential scanning calorimetry (DSC) was used to examine the process of serum denaturation. The parameters of endothermic transition were compared at various stages of each exercise session. RESULTS: Post-exercise changes in DSC profiles of athlete's blood serum are similar in character but clearly stronger in the session held after sauna treatments and slightly weaker after WBC than those in the session not preceded by treatments. These changes can be, at least in part, explained by the exercise induced increase in the concentration of oxidized albumin. A return of serum denaturation transition to pre-exercise shape has been observed within a few hours of rest. It suggests relatively quick restoration of a fraction of non-oxidized albumin molecules during the recovery period. CONCLUSIONS: An exercise performed by athletes after a series of sauna treatments leads to temporary greater modification of the blood serum proteome than the similar exercise during the session preceded by WBC treatments.


Assuntos
Atletas , Proteínas Sanguíneas/química , Crioterapia/métodos , Exercício Físico/fisiologia , Banho a Vapor/métodos , Adulto , Varredura Diferencial de Calorimetria , Humanos , Desnaturação Proteica , Proteoma/química , Soro/química , Esqui
6.
Complement Ther Med ; 50: 102409, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32444058

RESUMO

BACKGROUND AND PURPOSE: Restless legs syndrome (RLS) is a common sensory-motor disorder among the pregnant women. The aim of this study is to compare the impacts of two methods of immersion of legs in cold and warm water on the RLS symptoms among the pregnant women. METHODS: This randomized clinical trial was conducted on 80 pregnant women with RLS who referred to Taleghani educational-therapy center. After obtaining their informed consent, they were selected by accessible method and randomly allocated into group 1 (warm water) and group 2 (cold water). Group 1 were asked to put their legs in cold water for 10 min every night for 2 weeks. The group 2 put their legs in warm water under the same condition. The severity of RLS was measured before and after the study. Data analysis was conducted using descriptive as well as the analytical statistics such as Chi-square, independent T test, pair T test, Mann-Whitney U, Wilcoxon and covariance. RESULTS: After intervention, mean RLS of the cold water group was11.02 ± 4.93; while this mean was 13.50 ± 4.74 in the warm water group. The difference between the two groups was significant (p = 0.017). Results also revealed that the severity of RLS symptoms at the end of the treatment was different from the beginning of the research in both groups (p = 0.001). The intervention with both warm and cold water declined the RLS symptoms among pregnant women. CONCLUSION: The warm and cold water can be used for this purpose depending on the women's preference. However, this article recommends the cold water for more reducing of symptoms.


Assuntos
Crioterapia/métodos , Hipertermia Induzida/métodos , Complicações na Gravidez/terapia , Síndrome das Pernas Inquietas/terapia , Adulto , Terapia Combinada , Feminino , Humanos , Gravidez , Inquéritos e Questionários
7.
Medicine (Baltimore) ; 99(15): e19744, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282734

RESUMO

RATIONALE: Tattooing is a procedure where ink is inserted typically in the intraepidermal space of the skin. Multiple incidences of viral infections following tattooing which lead to warts have been reported in recent years. The aim of this report was to show a relatively rare adverse effect after tattooing - verruca plana. PATIENT CONCERNS: A 27-year-old female presented to our department with complains of multiple verrucous papules over her 2-year-old tattoo without itch. DIAGNOSES: Pathological investigation confirmed the diagnosis as verruca plana. INTERVENTIONS: The patient was treated with 3 cycles of liquid nitrogen cryotherapy and 5% imiquimod cream for 5 months. OUTCOMES: A significant improvement in her lesions was observed after the combined treatment. LESSONS: Clinically, verruca plana post-tattooing is relatively less reported. We need to combine clinical manifestations with pathological results to arrive at a definitive diagnosis. Besides, there are a large numbers of post-tattoo complications and various routes of virus inoculation. Therefore, it is important for medical professionals to caution people before considering to have a tattoo.


Assuntos
Tatuagem/efeitos adversos , Viroses/complicações , Verrugas/patologia , Verrugas/terapia , Adjuvantes Imunológicos/administração & dosagem , Adjuvantes Imunológicos/uso terapêutico , Administração Tópica , Adulto , Terapia Combinada , Crioterapia/métodos , Feminino , Humanos , Imiquimode/administração & dosagem , Imiquimode/uso terapêutico , Resultado do Tratamento , Viroses/patologia , Verrugas/etiologia
8.
Medicine (Baltimore) ; 99(14): e19711, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32243409

RESUMO

Anatomic course of medial branches in the thoracic spine is significantly different. Cooled RFA (CRFA) is a newer technique that can create a larger spherical lesion with a potential to compensate for the anatomic variability of the medial branches in the thoracic spine. Our retrospective study aimed to investigate the efficacy and the adverse effects of the CRFA in the treatment of thoracic facet-related pain.For this retrospective study, we evaluated 40 CRFA performed on 23 patients. The patients with diagnosis of thoracic facet joint-related pain underwent CRFA. Pain scores in numeric rating scale (NRS) were recorded at pretreatment and posttreatment at different time-points. The primary outcome measure was to report descriptive NRS score and average % improvement from baseline at each time point. A significant pain relief was determined by a decrease of ≥ 50% of mean NRS. Secondary outcome measure was the time to repeat treatment with subsequent CRFA. Adverse events were also recorded.Improvement of average pain level was 20.72% in the 1st follow-up (FU) (4-8 weeks), 53% in the 2nd FU (2-6 months), and 37.58% in the 3rd FU (6-12 months). Subgroup analysis was done based on age cutoff (age in years ≤ 50 versus >50), and pretreatment NRS (≤7 versus >7). Patients with age ≤50 and NRS score >7 experienced the best pain relief in the 2nd FU period (2-6 months). The patients with age > 50 and NRS pain level ≤7 showed steadily increased benefit both in the 2nd FU (2-6 months) and 3rd FU (6-12 months).This is the first clinical study to evaluate the efficacy and adverse effects of CRFA in the thoracic spine for facet joint-related pain. Our results suggest that CRFA procedure is an effective treatment modality for thoracic facet-related pain. Our subgroup analysis demonstrated that the pain relief and duration varies with the age and the pretreatment pain levels.


Assuntos
Artralgia/cirurgia , Dor Crônica/cirurgia , Crioterapia/métodos , Denervação/métodos , Articulação Zigapofisária/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Retrospectivos , Vértebras Torácicas/inervação , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Articulação Zigapofisária/inervação
9.
Am Fam Physician ; 101(7): 399-406, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32227823

RESUMO

Cryosurgery is the application of freezing temperatures to achieve the destruction of tissue. Cutaneous cryosurgery has become a commonly performed outpatient procedure because of the combination of its safety, effectiveness, low cost, ease of use, lack of need for injectable anesthetic, and good cosmetic results. Cryosurgery may be performed in the outpatient setting using dipstick, spray, or cryoprobe techniques to treat a variety of benign, premalignant, and malignant skin lesions with high cure rates. Benign lesions such as common and plantar warts, anogenital condylomas, molluscum contagiosum, and seborrheic keratoses can be treated with cryotherapy. Basal and squamous cell carcinomas with low-risk features may be treated with cryosurgery. Contraindications to cryosurgery include neoplasms with indefinite margins or when pathology is desired, basal cell or squamous cell carcinomas with high-risk features, and prior adverse local reaction or hypersensitivity to cryosurgery. Potential adverse effects include bleeding, blistering, edema, paresthesia, and pain and less commonly include tendon rupture, scarring, alopecia, atrophy, and hypopigmentation.


Assuntos
Criocirurgia/métodos , Medicina de Família e Comunidade/métodos , Dermatopatias/cirurgia , Criocirurgia/efeitos adversos , Crioterapia/métodos , Humanos , Ceratose Seborreica/cirurgia , Molusco Contagioso/cirurgia , Verrugas/cirurgia
10.
Rev Saude Publica ; 54: 27, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32187314

RESUMO

OBJECTIVES: To determine the efficacy and safety of the use of cryotherapy, cold knife or thermocoagulation compared to Loop Electrosurgical Excision Procedure (LEEP) for the treatment of cervical intraepithelial neoplasia. METHODS: Systematic review with meta-analysis of randomized controlled trials in women with cervical intraepithelial neoplasia undergoing treatment with cryotherapy, cold knife, or thermo-coagulation compared with LEEP, to estimate its efficacy and safety. The search was conducted on MEDLINE/PUBMED, Cochrane Central Register of Controlled Trials (CENTRAL) and Scopus, until September 2018. RESULTS: The total of 72 studies were identified, of which only 8 studies met the inclusion criteria. The treatment of CIN with cold knife decreases the risk of residual disease compared with LEEP (RR, 0.54, 95%CI, 0.30-0.96, p = 0.04). The management of premalignant lesions with cryotherapy, compared with LEEP, increases the risk of disease recurrence by 86% (RR, 1.86, 95%CI, 1.16-2.97, p = 0.01), increases the risk of infections (RR, 1.17, 95%CI, 1.08-1.28, p < 0.001) and reduces the risk of minor bleeding by 51% (RR, 0.49, 95%CI) %, 0.40-0.59, p ≤ 0.001). CONCLUSIONS: The treatment of premalignant lesions of cervical cancer with cold knife reduces the risk of residual disease. Nevertheless, cryotherapy reduces the risk of minor bleeding in the 24 hours after treatment and increases the risk of recurrence of disease and infections.


Assuntos
Neoplasia Intraepitelial Cervical/cirurgia , Conização/métodos , Crioterapia/métodos , Eletrocoagulação/métodos , Neoplasias do Colo do Útero/cirurgia , Neoplasia Intraepitelial Cervical/patologia , Feminino , Humanos , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Complicações Pós-Operatórias , Risco , Fatores de Risco , Neoplasias do Colo do Útero/patologia
11.
J Laryngol Otol ; 134(3): 197-204, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32114992

RESUMO

BACKGROUND: Cold dissection is the most commonly used tonsillectomy technique, with low post-operative haemorrhage rates. Coblation is an alternative technique that may cause less pain, but could have higher post-operative haemorrhage rates. OBJECTIVE: This study evaluated the peri-operative outcomes in paediatric tonsillectomy patients by comparing coblation and cold dissection techniques. METHODS: A systematic review was conducted of all comparative studies of paediatric coblation and cold dissection tonsillectomy, up to December 2018. Any studies with adults were excluded. Outcomes such as pain, operative time, and intra-operative, primary and secondary haemorrhages were recorded. RESULTS: Seven studies contributed to the summative outcome. Coblation tonsillectomy appeared to result in less pain, less intra-operative blood loss (p < 0.01) and a shorter operative time (p < 0.01). There was no significant difference between the two groups for post-operative haemorrhage (p > 0.05). CONCLUSION: The coblation tonsillectomy technique may offer better peri-operative outcomes when compared to cold dissection, and should therefore be offered in paediatric cases, before cold dissection tonsillectomy.


Assuntos
Crioterapia/métodos , Dissecação/métodos , Eletrocoagulação/métodos , Tonsilectomia/métodos , Adolescente , Perda Sanguínea Cirúrgica , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Duração da Cirurgia , Dor Pós-Operatória/etiologia
12.
J Athl Train ; 55(4): 329-335, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32160058

RESUMO

CONTEXT: Among sports-recovery methods, cold-water immersion (CWI), contrast-water therapy (CWT), and whole-body cryotherapy (WBC) have been applied widely to enhance recovery after strenuous exercise. However, the different timing effects in exercise-induced muscle damage (EIMD) after these recovery protocols remain unknown. OBJECTIVE: To compare the effects of CWI, CWT, and WBC on the timing-sequence recovery of EIMD through different indicator responses. DESIGN: Crossover study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: Twelve male middle- and long-distance runners from the Beijing Sport University (age = 21.00 ± 0.95 years). INTERVENTION(S): Participants were treated with different recovery methods (control [CON], CWI, CWT, WBC) immediately postexercise and at 24, 48, and 72 hours postexercise. MAIN OUTCOME MEASURE(S): We measured perceived sensation using a visual analog scale (VAS), plasma creatine kinase (CK) activity, plasma C-reactive protein (CRP) activity, and vertical-jump height (VJH) pre-exercise, immediately postexercise, and at 1, 24, 48, 72, and 96 hours postexercise. RESULTS: For the VAS score and CK activity, WBC exhibited better timing-sequence recovery effects than CON and CWI (P < .05), but the CWT demonstrated better effects than CON (P < .05). The CRP activity was lower after WBC than after the other interventions (P < .05). The VJH was lower after WBC than after CON and CWI (P < .05). CONCLUSIONS: The WBC positively affected VAS, CK, CRP, and VJH associated with EIMD. The CWT and CWI also showed positive effects. However, for the activity and timing-sequence effect, CWT had weaker effects than WBC.


Assuntos
Traumatismos em Atletas , Crioterapia/métodos , Hidroterapia/métodos , Mialgia , Corrida , Traumatismos em Atletas/complicações , Traumatismos em Atletas/fisiopatologia , Estudos Cross-Over , Humanos , Imersão , Masculino , Músculo Esquelético/lesões , Músculo Esquelético/fisiopatologia , Mialgia/diagnóstico , Mialgia/etiologia , Mialgia/terapia , Medição da Dor , Resultado do Tratamento , Adulto Jovem
13.
Support Care Cancer ; 28(10): 5005-5011, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32036471

RESUMO

PURPOSE: This randomized phase II study was conducted to investigate the efficacy of cryotherapy in preventing peripheral neuropathy and dermatological adverse events in breast cancer patients treated with weekly paclitaxel. METHODS: Patients treated with 12 weekly doses of paclitaxel for breast cancer were randomized (1:1) into a cryotherapy or control group. The primary endpoint was the percentage of patients with a marked decrease in the Functional Assessment of Cancer Therapy-Neurotoxicity (FACT-NTX) score. The secondary endpoints were Patient Neurotoxicity Questionnaire (PNQ), Common Terminology Criteria for Adverse Event (CTCAE) for peripheral neuropathy, and FACT-Taxane score. RESULTS: Forty-four patients were randomly assigned to the cryotherapy (n = 22) or control groups (n = 22). The percentage of patients with a marked decrease in FACT-NTX scores was significantly lower in the cryotherapy group than in the control group (41 vs. 73%, p = 0.03). The incidence of CTCAE grade ≥ 2 sensory (p = 0.001) and motor peripheral neuropathy (p = 0.01), and PNQ grade D or higher for sensory peripheral neuropathy (p = 0.02), and decrease in the FACT-Taxane score (p = 0.02) were also significantly lower in the cryotherapy group than in the control group. There were no serious side effects associated with cryotherapy. CONCLUSION: Cryotherapy is an effective approach for prevention of peripheral neuropathy and dermatological adverse events in breast cancer patients treated with weekly paclitaxel.


Assuntos
Neoplasias da Mama/tratamento farmacológico , Crioterapia/métodos , Síndromes Neurotóxicas/etiologia , Síndromes Neurotóxicas/prevenção & controle , Paclitaxel/efeitos adversos , Paclitaxel/uso terapêutico , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Doenças do Sistema Nervoso Periférico/prevenção & controle , Idoso , Feminino , Humanos , Inquéritos e Questionários
14.
Skin Therapy Lett ; 25(1): 1-4, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32023021

RESUMO

HP40 (Eskata™) is a stabilized, topical solution of 40% hydrogen peroxide (H2O2) packaged in an applicator pen that is US FDA-approved to treat seborrheic keratoses (SKs). By harnessing the oxidative capabilities of H2O2 , 1-2 treatments with HP40 produced a higher rate of clearance of four SKs per patient compared to vehicle in two phase 3 trials. The clearance rate was higher for the face than the trunk and extremities. Similarly, the risks of pigmentary changes and scarring from HP40 were lower for the face than other locations. Further, based on an ex vivo study, HP40 may be less cytotoxic to melanocytes than cryotherapy, but clinical trials comparing these therapies are needed. Limitations of HP40 are its low efficacy and requirement of multiple treatments, which can result in elevated costs. The application can also be time-consuming, though extenders or even staff members can apply it. Therefore, HP40 may be better reserved for the treatment of facial SKs.


Assuntos
Fármacos Dermatológicos/administração & dosagem , Peróxido de Hidrogênio/administração & dosagem , Ceratose Seborreica/tratamento farmacológico , Administração Cutânea , Crioterapia/métodos , Fármacos Dermatológicos/efeitos adversos , Humanos , Peróxido de Hidrogênio/efeitos adversos , Ceratose Seborreica/patologia , Resultado do Tratamento
15.
Sci Rep ; 10(1): 2105, 2020 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-32034162

RESUMO

Biological reconstruction of allografts and recycled autografts have been widely implemented in high-grade osteogenic sarcoma. For treating tumor-bearing autografts, extracorporeal irradiation (ECIR) and liquid nitrogen (LN) freezing techniques are being used worldwide as a gold standard treatment procedure. Both the methods aim to eradicate the tumor cells from the local recurrence and restore the limb function. Therefore, it is essential and crucial to find, and compare the alterations at molecular and physiological levels of the treated and untreated OGS recycled autografts to obtain valuable clinical information for better clinical practice. Thus, we aimed to investigate the significantly expressed altered proteins from ECIR-and cryotherapy/freezing- treated OGS (n = 12) were compared to untreated OGS (n = 12) samples using LC-ESI-MS/MS analysis, and the selected proteins from this protein panel were verified using immunoblot analysis. From our comparative proteomic analysis identified a total of 131 differentially expressed proteins (DEPs) from OGS. Among these, 91 proteins were up-regulated (2.5 to 3.5-folds), and 40 proteins were down-regulated (0.2 to 0.5 folds) (p < 0.01 and 0.05). The functional enrichment analysis revealed that the identified DEPs have belonged to more than 10 different protein categories include cytoskeletal, extracellular matrix, immune, enzyme modulators, and cell signaling molecules. Among these, we have confirmed two potential candidates' expressions levels such as Fibronectin and Protein S100 A4 using western blot analysis. Our proteomic study revealed that LN-freezing and ECIR treatments are effectively eradicating tumor cells, and reducing the higher expressions of DEPs at molecular levels which may help in restoring the limb functions of OGS autografts effectively. To the best of our knowledge, this is the first proteomic study that compared proteomic profiles among freezing, ECIR treated with untreated OGS in recycled autografts. Moreover, the verified proteins could be used as prognostic or diagnostic markers that reveal valuable scientific information which may open various therapeutic avenues in clinical practice to improve patient outcomes.


Assuntos
Neoplasias Ósseas/diagnóstico , Crioterapia , Osteossarcoma/diagnóstico , Proteoma/análise , Adulto , Idoso , Biomarcadores Tumorais/análise , Western Blotting , Neoplasias Ósseas/química , Neoplasias Ósseas/terapia , Terapia Combinada , Crioterapia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Proteínas de Neoplasias/análise , Osteossarcoma/química , Osteossarcoma/terapia , Adulto Jovem
16.
Otolaryngol Head Neck Surg ; 162(3): 326-328, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31986977

RESUMO

To describe proof of concept and pilot data for a cryotherapy application in the subglottis in a rabbit airway model. Four New Zealand white rabbits (3 experimental, 1 control) underwent general anesthesia and laryngoscopy and bronchoscopy. Experimental animals had cryotherapy applied with a direct contact 1.9-mm cryoprobe. Animals were euthanized at days 0, 2, and 6 posttreatment. Histologic changes were assessed in the treated subglottic tissues. This preliminary work has demonstrated that, with early cryogenic injury in the subglottis, there is mild mucosal epithelial injury associated with submucosal edema, acute inflammatory infiltrate, and degeneration of venule endothelial cells. Mucosal epithelial repair and resolution of the inflammatory response appear to be relatively rapid. We hope that this may provide a foundation to further explore cryotherapy as a primary or adjuvant treatment option for pediatric subglottis stenosis.


Assuntos
Crioterapia/métodos , Glote , Animais , Broncoscopia , Modelos Animais de Doenças , Laringoestenose/terapia , Projetos Piloto , Estudo de Prova de Conceito , Coelhos , Cicatrização/fisiologia
17.
BMJ Case Rep ; 13(1)2020 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-31915188

RESUMO

Recurrence of lobular capillary haemangioma of conjunctiva after surgical excision is rare but sometimes it may be difficult to manage multiple recurrences. A 31-year-old female patient presented with recurrent polypoid conjunctival lobular capillary haemangioma. Excisional biopsy was performed, followed by eye drop mitomycin C 0.04% four times a day for 1 week postoperatively. She reported again after 3 months with recurrence of vascular elongated nodular lesion. Excision of the mass with application of mitomycin C 0.02% intraoperatively for 1 min and cryotherapy using double thaw technique of the peripheral conjunctival margin was done. The histopathological examination confirmed the recurrence of lobular capillary haemangioma. On review, 1 year after treatment there was no evidence of recurrence. A combined use of cryotherapy and intraoperative mitomycin C as adjunctive therapy after surgical excision can successfully prevent further recurrence without any adverse effect.


Assuntos
Neoplasias da Túnica Conjuntiva/terapia , Crioterapia/métodos , Granuloma Piogênico/terapia , Mitomicina/uso terapêutico , Recidiva Local de Neoplasia/terapia , Adulto , Antibióticos Antineoplásicos/uso terapêutico , Terapia Combinada , Diagnóstico Diferencial , Feminino , Humanos , Soluções Oftálmicas
18.
Phys Ther Sport ; 42: 61-67, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31927349

RESUMO

OBJECTIVE: To assess multifidus muscle thickness, cross-sectional area (CSA) and disability in patients with chronic non-insertional Achilles tendinopathy (AT) who developed an eccentric exercise (EE) vibration program compared to an EE program with cryotherapy. DESIGN: Single-blinded randomized clinical trial. SETTING: Outpatient clinic. PARTICIPANTS: A total sample of 61 patients diagnosed with chronic non-insertional AT was recruited and randomly divided into two groups. A group (n = 30) developed the EE program plus vibration and B group (n = 31) received the EE program plus cryotherapy for 12 weeks. Multifidus thickness and CSA were measured at rest and during maximal isometric contraction by ultrasound imaging. The Victorian Institute for Sport Assessment (VISA-A) was used to asses functionality. RESULTS: Multifidus CSA was statistically significant increased (P < 0.05) for the EE vibration program group with respect to EE plus cryotherapy during maximal isometric contraction and at rest at 12-weeks after intervention in individuals with chronic non-insertional AT. Despite both interventions showed differences for the multifidus thickness and AT disability variables over time, there were not between-groups differences. CONCLUSIONS: Authors encourage the use of vibration with respect to cryotherapy added to EE programs in order to enhance multifidus CSA in addition to lower limb functionality in individuals who suffer from chronic non-insertional AT.


Assuntos
Tendão do Calcâneo/diagnóstico por imagem , Crioterapia/métodos , Terapia por Exercício/métodos , Exercício Físico/fisiologia , Contração Isométrica/fisiologia , Músculos Paraespinais/fisiopatologia , Tendinopatia/terapia , Adulto , Feminino , Humanos , Masculino , Método Simples-Cego , Tendinopatia/diagnóstico , Tendinopatia/fisiopatologia , Resultado do Tratamento , Ultrassonografia , Vibração
19.
Anesthesiology ; 133(1): 185-194, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31977524

RESUMO

BACKGROUND: Postoperative pain caused by trauma to nerves and tissue around the surgical site is a major problem. Perioperative steps to reduce postoperative pain include local anesthetics and opioids, the latter of which are addictive and have contributed to the opioid epidemic. Cryoneurolysis is a nonopioid and long-lasting treatment for reducing postoperative pain. However, current methods of cryoneurolysis are invasive, technically demanding, and are not tissue-selective. This project aims to determine whether ice slurry can be used as a novel, injectable, drug-free, and tissue-selective method of cryoneurolysis and resulting analgesia. METHODS: The authors developed an injectable and selective method of cryoneurolysis using biocompatible ice slurry, using rat sciatic nerve to investigate the effect of slurry injection on the structure and function of the nerve. Sixty-two naïve, male Sprague-Dawley rats were used in this study. Advanced Coherent anti-Stokes Raman Scattering microscopy, light, and fluorescent microscopy imaging were used at baseline and at various time points after treatment for evaluation and quantification of myelin sheath and axon structural integrity. Validated motor and sensory testing were used for evaluating the sciatic nerve function in response to ice slurry treatment. RESULTS: Ice slurry injection can selectively target the rat sciatic nerve. Being injectable, it can infiltrate around the nerve. The authors demonstrate that a single injection is safe and selective for reversibly disrupting the myelin sheaths and axon density, with complete structural recovery by day 112. This leads to decreased nocifensive function for up to 60 days, with complete recovery by day 112. There was up to median [interquartile range]: 68% [60 to 94%] reduction in mechanical pain response after treatment. CONCLUSIONS: Ice slurry injection selectively targets the rat sciatic nerve, causing no damage to surrounding tissue. Injection of ice slurry around the rat sciatic nerve induced decreased nociceptive response from the baseline through neural selective cryoneurolysis.


Assuntos
Crioterapia/métodos , Gelo , Bloqueio Nervoso/métodos , Nervo Isquiático , Analgesia , Animais , Axônios/efeitos dos fármacos , Axônios/ultraestrutura , Injeções , Masculino , Bainha de Mielina/efeitos dos fármacos , Bainha de Mielina/ultraestrutura , Nociceptividade , Medição da Dor , Ratos , Ratos Sprague-Dawley , Nervo Isquiático/efeitos dos fármacos , Nervo Isquiático/ultraestrutura , Caminhada
20.
Support Care Cancer ; 28(10): 4869-4879, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31993753

RESUMO

PURPOSE: To evaluate the feasibility of oral cryotherapy (OC) in children and to investigate if OC reduces the incidence of severe oral mucositis (OM), oral pain, and opioid use in children undergoing hematopoietic stem cell transplantation (HSCT). METHODS: Fifty-three children, 4-17 years old, scheduled for HSCT in Sweden were included and randomized to OC or control using a computer-generated list. OC instructions were to cool the mouth with ice for as long as possible during chemotherapy infusions with an intended time of ≥ 30 min. Feasibility criteria in the OC group were as follows: (1) compliance ≥ 70%; (2) considerable discomfort during OC < 20%; (3) no serious adverse events; and (4) ice administered to all children. Grade of OM and oral pain was recorded daily using the WHO-Oral Toxicity Scale (WHO-OTS), Children's International Oral Mucositis Evaluation Scale, and Numerical Rating Scale. Use of opioids was collected from the medical records. RESULTS: Forty-nine children (mean age 10.5 years) were included in analysis (OC = 26, control = 23). The feasibility criteria were not met. Compliance was poor, especially for the younger children, and only 15 children (58%) used OC as instructed. Severe OM (WHO-OTS ≥ 3) was recorded in 26 children (OC = 15, control = 11). OC did not reduce the incidence of severe OM, oral pain, or opioid use. CONCLUSION: The feasibility criteria were not met, and the RCT could not show that OC reduces the incidence of severe OM, oral pain, or opioid use in pediatric patients treated with a variety of conditioning regimens for HSCT. TRIAL REGISTRATION: ClinicalTrials.gov id: NCT01789658.


Assuntos
Crioterapia/métodos , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Estomatite/prevenção & controle , Adolescente , Criança , Pré-Escolar , Estudos de Viabilidade , Feminino , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Incidência , Masculino , Dor/etiologia , Dor/prevenção & controle , Estomatite/etiologia , Condicionamento Pré-Transplante/efeitos adversos , Condicionamento Pré-Transplante/métodos
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