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1.
Rom J Ophthalmol ; 63(3): 273-276, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687631

RESUMO

Purpose. To report a case of benign fibrous histiocytoma of the conjunctiva involving the cornea, an uncommon ocular surface tumor. Methods. A 57-year-old patient came in our service complaining of a progressively enlarging conjunctival mass temporally to the limbus and invading the adjacent cornea of the left eye. Results. The approach consisted in surgical excision followed by cryotherapy on the edges and on the base of the excision site and amniotic membrane patch reconstruction of the ocular surface defect. Pathologic examination and immunohistochemistry were performed in order to establish the diagnosis. No recurrences appeared in 8 months of follow up. Conclusions. Fibrous histiocytoma might be easily misdiagnosed as it is exceedingly rare. Complete resection with careful inspection of edges is advised. Cryotherapy at the base and borders of the resection site is recommended as both benign and malignant tumors can show recurrence. Amniotic membrane should always be regarded as an efficient option in reconstruction of broad surface defects after tumor resection. Abbreviations: FH = fibrous histiocytoma, CIN = corneal intraepithelial neoplasia, SSCA = squamous cell carcinoma, AM = amniotic membrane, MMC = topical mitomycin-C, 5-FU = 5-fluorouracil, BCVA = best corrected visual acuity.


Assuntos
Túnica Conjuntiva/patologia , Doenças da Túnica Conjuntiva/diagnóstico , Crioterapia/métodos , Histiocitoma Fibroso Benigno/diagnóstico , Procedimentos Cirúrgicos Oftalmológicos/métodos , Doenças da Túnica Conjuntiva/terapia , Diagnóstico Diferencial , Histiocitoma Fibroso Benigno/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Lâmpada de Fenda
3.
Arch Esp Urol ; 72(8): 750-758, 2019 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-31579033

RESUMO

OBJECTIVE: Renal cryotherapy (RC) is an alternative therapeutic option to partial nephrectomy in elderly patients and/or patients with comorbidities. The technique can be guided by ultrasound, CT and MRI. Although CT is the most used technique, there are no comparative studies. The objective of this study was to review the current status of ultrasound as a guide for the planning and execution of RC. METHODS: A systematic review of the literature was carried out in the Pubmed/Medline database following the PRISMA guidelines. We used 42 articles that met the inclusion criteria for the synthesis of the evidence. RESULTS: Ultrasound allows dynamic and real-time monitoring of the entire procedure to guide the biopsy, placement of the cryoprobes, cryoball formation, and early identification of complications. The success rate and recurrences found in the percutaneous renal cryotherapy (PRC) were 97.04% and 1.81%, respectively, with 9.35% complications. The ultrasound during laparoscopic renal cryotherapy (LRC) has been shown to reduce the time spent in localizing the renal mass and also decreases the need for large dissections. On the other hand, contrast-enhanced ultrasound during follow-up shows a concordance with the CT or MRI of 72-96% and no complications have been described associated with its execution. CONCLUSION: Renal cryotherapy guided by ultrasound is a feasible technique, its main advantage is based on real-time monitoring during the procedure. The PRC presents an acceptable rate of complications and excellent oncological results. The LRC allows a rapid localization of the renal mass and reduces extensive dissections. During follow-up, the use of contrast ultrasound is a safe alternative that has been shown to have a good degree of agreement with respect to CT and MRI.


Assuntos
Crioterapia , Neoplasias Renais , Ultrassonografia de Intervenção , Idoso , Criocirurgia , Crioterapia/métodos , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/terapia , Recidiva Local de Neoplasia , Nefrectomia
4.
Oxid Med Cell Longev ; 2019: 7524878, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31485298

RESUMO

Objective: The aim of the study was to estimate the impact of whole-body cryotherapy (WBC) and subsequent kinesiotherapy on oxidative stress and lipid profile when performed in a closed cryochamber on healthy subjects. Material and Methods: The effect of ten WBC procedures lasting 3 minutes a day followed by a 60-minute session kinesiotherapy on oxidative stress and lipid profile in healthy subjects (WBC group, n = 16) was investigated. The WBC group was compared to the kinesiotherapy only (KT; n = 16) group. The routine parameters of oxidative stress (antioxidant enzymatic and nonenzymatic antioxidant status, lipid peroxidation products, total oxidative status (TOS), and oxidative stress index (OSI)) and lipid profile were estimated one day before the beginning and one day after the completion of the research program. Results: After treatment, in the WBC group, a significant decrease of oxidative stress markers (TOS and OSI) and a significant increase of total antioxidant capacity were observed. The activity of plasma SOD-Mn and erythrocyte total SOD increased significantly in the WBC group. In the KT group, the erythrocyte activity of total SOD, CAT, and GR decreased significantly after the treatment. The levels of T-Chol and LDL-Chol decreased significantly after treatment in both groups, but the observed decrease of these lipid parameters in the WBC group was higher in comparison to the KT group. The level of TG decreased significantly after treatment in the WBC group only. Conclusion: WBC performed in a closed cryochamber followed by kinesiotherapy improves lipid profile and decreases oxidative stress in healthy subjects.


Assuntos
Crioterapia/efeitos adversos , Cinesiologia Aplicada/métodos , Lipídeos/fisiologia , Estresse Oxidativo/fisiologia , Crioterapia/métodos , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade
7.
J Cardiothorac Surg ; 14(1): 155, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31455391

RESUMO

BACKGROUND: This study aimed to study the clinical efficacy of argon plasma coagulation plus cryotherapy for central airway stenosis caused by lung cancer. METHODS: The clinical data of 177 patients with central airway stenosis caused by lung cancer received surgery from June, 2017 to July 2018 were retrospectively analyzed. According to different treatments, 43 patients received cryotherapy were included in the control group, while 134 patients received argon plasma coagulation plus cryotherapy were in the observation group. After propensity score matching, patients in the two groups were in a 1:1 ratio. The Karnofsky score, partial pressure of oxygen (PaO2), arterial oxygen saturation (SaO2), partial pressure of arterial carbon dioxide (PaCO2) and adverse reactions in patients were analyzed one week before and after treatment. Besides, the survival rates of the two groups were compared. RESULTS: After propensity score matching, the baseline data were not significantly different between the two groups. The post-treatment Karnofsky scores in the two groups were significantly higher than those of before treatment, and the post-treatment score of the observation group was higher than that of the control group (all P < 0.05). The post-treatment PaO2 and SaO2 in the observation group were both higher than those of the control group; while the PaCO2 in the observation group was significantly lower than that of the control group (all P < 0.05). In the observation group, the levels of PaO2 and SaO2 were significantly higher, and the level of PaCO2 was significantly lower after treatment than those of before treatment (all P < 0.05). The rates of completely effective and mild effective in the observation group were significantly higher than those in the control group (both P < 0.05). The incidences of bleeding, arrhythmia and fever in the observation group were significantly lower than those in the control group (all P < 0.05). The survival rate was significantly higher in the observation group (72.09%) than in the control group (51.16%). CONCLUSIONS: Argon plasma coagulation combined with cryotherapy can significantly alleviate the central airway stenosis caused by lung cancer, reduce the incidence of adverse reactions, and improve prognosis in patients.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Coagulação com Plasma de Argônio/métodos , Crioterapia/métodos , Neoplasias Pulmonares/complicações , Adulto , Idoso , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/etiologia , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
8.
Cient. dent. (Ed. impr.) ; 16(2): 111-116, mayo-ago. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-183721

RESUMO

Introducción: La extracción de los terceros molares es una práctica habitual en la consulta odontológica. Es muy común la aparición postoperatoria de respuestas fisiológicas como el dolor, inflamación, hematomas y trismo, y cuyo tratamiento de elección sigue siendo la farmacología. La hiloterapia es un tratamiento alternativo complementario que forma parte de la medicina física terapéutica. Se trata de una unidad conectada a una máscara preformada de contorno facial que, mediante la reducción de la termperatura tisular de manera constante, persigue conseguir la disminución del flujo sanguíneo, la inflamación, el dolor y el edema. Caso clínico: Se presenta el caso clínico de una mujer de 22 años de edad, sin antecedentes médicos de interés, que acudió al Hospital Virgen de la Paloma por presentar dolor en el tercer molar inferior izquierdo. Una vez realizada la exploración clínica y radiológica de la paciente, se propuso como plan de tratamiento la extracción de los cuatro cordales, bajo anestesia general. Inmediatamente después de la cirugía se colocó a la paciente la máscara facial de Hilotherm(R), programada a una temperatura constante de 15ºC. Se revisó a las 24h y a los 8 días tras la intervención. Conclusiones: La terapia con la máscara facial Hilotherm(R) ha demostrado ser de utilidad en la disminución del dolor y la inflamación postoperatorios derivados de la extracción quirúrgica de los terceros molares, probablemente debido a la posibilidad de un control constante de la temperatura y a la mayor colaboración del paciente. No hay evidencia científica suficiente que respalde su posible participación en la reducción de hematomas. Asimismo, este sistema sugiere un aumento significativo de la calidad de vida de los pacientes, así como una buena aceptación por parte de éstos otorgando más comodidad y satisfacción


Introduction: The extraction of third molars is common practice in the dental practice. The postoperative appearance of physiological responses such as pain, inflammation, bruising and trismus is very common, for which the treatment of choice is still pharmacology. The hilotherapy is a complementary alternative treatment that is part of the therapeutic physical medicine which consists on a unit connected to a preformed face contour mask that, by constantly reducing tissue temperature, aims to achieve decreased blood flow, inflammation, pain and edema. Clinical case: A clinical case of a 22-year-old woman is presented, with no interesting medical record, who went to the Virgen de la Paloma Hospital with pain in the left lower third molar. Once the clinical and radiological examination of the patient had been carried out, a treatment plan for the extraction of the four wisdom teeth, under general anesthesia, was proposed. Immediately after the surgery, the patient was placed the facial mask of Hilotherm(R) on, programmed at a constant temperature of 15ºC. It was reviewed twice, 24h and 8 days after the intervention. Conclusions: Hilotherm(R) facial mask therapy has been shown to be useful in the reduction of postoperative pain and inflammation derived from the surgical extraction of third molars, probably due to the possibility of constant temperature control and greater patient collaboration. There is not enough scientific evidence to support its possible participation in the reduction of bruising. Likewise, this system suggests a significant increase in the quality of life of patients, as well as a good acceptance from patients, providing them with more comfort and satisfaction


Assuntos
Humanos , Feminino , Adulto , Dente Serotino/cirurgia , Edema/prevenção & controle , Dor Pós-Operatória/prevenção & controle , Crioterapia/métodos , Máscaras , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Bucais , Equimose/prevenção & controle , Hematoma/prevenção & controle , Cuidados Pós-Operatórios
9.
Int J Gynaecol Obstet ; 147(1): 4-18, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31273785

RESUMO

BACKGROUND: Thermal coagulation is gaining popularity for treating cervical intraepithelial neoplasia (CIN) in screening programs in low- and middle-income countries (LMICs) due to unavailability of cryotherapy. OBJECTIVES: Assess the effectiveness of thermal coagulation for treatment of CIN lesions compared with cryotherapy, with a focus on LMICs. SEARCH STRATEGY: Papers were identified from previous reviews and electronic literature search in February 2018 with publication date after 2010. SELECTION CRITERIA: Publications with original data evaluating cryotherapy or thermal coagulation with proportion of cure as outcome, assessed by colposcopy, biopsy, cytology, and/or visual inspection with acetic acid (VIA), and minimum 6 months follow-up. DATA COLLECTION AND ANALYSIS: Pooled proportions of cure are presented stratified per treatment modality, type of lesion, and region. MAIN RESULTS: Pooled cure proportions for cryotherapy and thermal coagulation, respectively, were 93.8% (95% CI, 88.5-97.7) and 91.4% (95% CI, 84.9-96.4) for CIN 1; 82.6% (95% CI, 77.4-87.3) and 91.6% (95% CI, 88.2-94.5) for CIN 2-3; and 92.8% (95% CI, 85.6-97.7) and 90.1% (95% CI, 87.0-92.8) for VIA-positive lesions. For thermal coagulation of CIN 2-3 lesions in LMICs 82.4% (95% CI, 75.4-88.6). CONCLUSIONS: Both cryotherapy and thermal coagulation are effective treatment modalities for CIN lesions in LMICs.


Assuntos
Neoplasia Intraepitelial Cervical/terapia , Crioterapia/métodos , Eletrocoagulação/métodos , Programas de Rastreamento/métodos , Lesões Pré-Cancerosas/terapia , Neoplasias do Colo do Útero/terapia , Feminino , Humanos , Pobreza , Gravidez , Resultado do Tratamento
10.
Cochrane Database Syst Rev ; 7: CD009058, 2019 07 10.
Artigo em Inglês | MEDLINE | ID: mdl-31291464

RESUMO

BACKGROUND: The liver is affected by two of the most common groups of malignant tumours: primary liver tumours and liver metastases from colorectal carcinoma. Liver metastases are significantly more common than primary liver cancer and long-term survival rates reported for patients after radical surgical treatment is approximately 50%. However, R0 resection (resection for cure) is not feasible in the majority of patients. Cryotherapy is performed with the use of an image-guided cryoprobe which delivers liquid nitrogen or argon gas to the tumour tissue. The subsequent process of freezing is associated with formation of ice crystals, which directly damage exposed tissue, including cancer cells. OBJECTIVES: To assess the beneficial and harmful effects of cryotherapy compared with no intervention, other ablation methods, or systemic treatments in people with liver metastases. SEARCH METHODS: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ovid, Embase Ovid, and six other databases up to June 2018. SELECTION CRITERIA: Randomised clinical trials assessing beneficial and harmful effects of cryotherapy and its comparators for liver metastases, irrespective of the location of the primary tumour. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We extracted information on participant characteristics, interventions, study outcomes, and data on the outcomes important for our review, as well as information on the design and methodology of the trials. Two review authors independently assessed risk of bias in each study. One review author performed data extraction and a second review author checked entries. MAIN RESULTS: We found no randomised clinical trials comparing cryotherapy versus no intervention or versus systemic treatments; however, we identified one randomised clinical trial comparing cryotherapy with conventional surgery. The trial was conducted in Ukraine. The trial included 123 participants with solitary, or multiple unilobar or bilobar liver metastases; 63 participants received cryotherapy and 60 received conventional surgery. There were 36 women and 87 men. The primary sites for the metastases were colon and rectum (66.6%), stomach (7.3%), breast (6.5%), skin (4.9%), ovaries (4.1%), uterus (3.3%), kidney (3.3%), intestines (1.6%), pancreas (1.6%), and unknown (0.8%). The trial was not reported sufficiently enough to assess the risk of bias of the randomisation process, allocation concealment, or presence of blinding. It was also not possible to assess incomplete outcome data and selective outcome reporting bias. The certainty of evidence was low because of risk of bias and imprecision.The participants were followed for up to 10 years (minimum five months). The trial reported that the mortality at 10 years was 81% (51/63) in the cryotherapy group and 92% (55/60) in the conventional surgery group. The calculated by us relative risk (RR) with 95% Confidence Interval (CI) was: RR 0.88, 95% CI 0.77 to 1.02. We judged the evidence as low-certainty evidence. Regarding adverse events and complications, separately and in total, our calculation showed no evidence of a difference in recurrence of the malignancy in the liver: 86% (54/63) of the participants in the cryotherapy group and 95% (57/60) of the participants in the conventional surgery group developed a new malignancy (RR 0.90, 95% CI 0.80 to 1.01; low-certainty evidence). The frequency of reported complications was similar between the cryotherapy group and the conventional surgery group, except for postoperative pain. Both insignificant and pronounced pain were reported to be more common in the cryotherapy group while intense pain was reported to be more common in the conventional surgery group. However, the authors did not report whether there was any evidence of a difference. There were no intervention-related mortality or bile leakages.We identified no evidence for health-related quality of life, cancer mortality, or time to progression of liver metastases. The study reported tumour response in terms of the carcinoembryonic antigen level in 69% of participants, and reported results in the form of a graph for 30% of participants. The carcinoembryonic antigen level was lower in the cryotherapy group, and decreased to normal values faster in comparison with the control group (P < 0.05). FUNDING: the trial did not provide information on funding. AUTHORS' CONCLUSIONS: The evidence for the effectiveness of cryotherapy versus conventional surgery in people with liver metastases is of low certainty. We are uncertain about our estimate and cannot determine whether cryotherapy compared with conventional surgery is beneficial or harmful. We found no evidence for the benefits or harms of cryotherapy compared with no intervention, or versus systemic treatments.


Assuntos
Crioterapia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/terapia , Neoplasias Colorretais/patologia , Crioterapia/métodos , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
Facial Plast Surg Clin North Am ; 27(3): 273-290, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31280843

RESUMO

The Renuvion/J-Plasma helium based plasma device from Apyx Medical has technological features that result in a unique and effective method of action for the contraction of subdermal soft tissue. The device achieves soft tissue contraction by instantly heating tissue to temperatures greater than 85°C for between 0.040 and 0.080 seconds. The tissue surrounding the treatment site remains at much cooler temperatures resulting in rapid cooling of the tissue through conductive heat transfer. Compared to bulk tissue heating devices, this method of action results in effective soft tissue contraction with a lower risk of injury to surrounding tissue.


Assuntos
Contorno Corporal/métodos , Crioterapia/métodos , Regeneração da Pele por Plasma/métodos , Rejuvenescimento/fisiologia , Envelhecimento da Pele , Estética , Face , Humanos , Pescoço
12.
J Laparoendosc Adv Surg Tech A ; 29(10): 1244-1251, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31259649

RESUMO

Introduction: Cryoanalgesia has been applied to minimally invasive repair of pectus excavatum (MIRPE). After implementation of cryoanalgesia at our institution, we had several cases of delayed postoperative pneumothorax. The purpose of this study was to critically evaluate the complications and efficacy of cryoanalgesia in MIRPE. Materials and Methods: We performed a single institution retrospective review of pediatric patients undergoing MIRPE from June 2017 to July 2018. Multimodal (MM) analgesia was used in all patients. In addition, most patients received either cryoanalgesia or elastomeric pain pumps (EPPs) as adjuncts to postoperative analgesia. Primary outcome was clinically significant late pneumothorax. Secondary outcomes included length of stay, pain scores, opiate use, and bar displacement requiring reoperation. Results: A total of 101 patients undergoing MIRPE were included: 45 had cryoanalgesia + MM, 45 EPP + MM, and 11 MM alone. Postoperative tube thoracostomy was placed in 5 patients with cryoanalgesia (4 pneumothorax; 1 effusion), 1 patient with EPP (1 pneumothorax), and none in MM alone (P = .25). Pain scores at discharge were similar in all groups. Cryoanalgesia patients received less overall inpatient opioids than other groups (P < .05). No patient required reoperation for bar displacement. Conclusion: Cryoanalgesia is an effective therapy for pain control in MIRPE. Because thermal injury can occur on the lung and chest wall with cryoanalgesia, we implemented techniques to limit and prevent this injury. Cryoanalgesia offers a safe alternative for postoperative analgesia with significant reduction in inpatient opioid requirement. Larger prospective studies are required to assess the long-term impact and complications of cryoanalgesia.


Assuntos
Crioterapia/métodos , Tórax em Funil/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Procedimentos Ortopédicos , Dor Pós-Operatória/terapia , Adolescente , Analgésicos Opioides/uso terapêutico , Criança , Terapia Combinada , Crioterapia/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Dor Pós-Operatória/diagnóstico , Pneumotórax/epidemiologia , Pneumotórax/etiologia , Pneumotórax/prevenção & controle , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Resultado do Tratamento
13.
Pain Res Manag ; 2019: 8514808, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31191790

RESUMO

Objective: In this study, we compared the effects of intermittent pneumatic compression along with conventional treatment with cold-pack treatment along with conventional treatment on clinical outcomes in patients with knee osteoarthritis. Methods: Eighty-nine patients with knee osteoarthritis participated in this study. One group received ultrasound, transcutaneous electrical nerve stimulation, electrical stimulation, exercise, and cold packs. The second group received ultrasound, transcutaneous electrical nerve stimulation, electrical stimulation, exercise, and intermittent pneumatic compression. Range of motion, muscle strength, knee swelling, pain intensity, and functional status were measured at baseline and 4th week. Results: We found significant improvements in range of motion, muscle strength, pain intensity, and functional status after the treatment in both groups (p < 0.05). When comparing the effects of these two treatment programs, it was observed that the intermittent pneumatic compression treatment group had a better outcome in terms of knee swelling (p=0.028). Conclusions: According to the results, we could report that intermittent pneumatic compression therapy in addition to conventional treatment has significant positive effects on clinical outcomes in patients with knee osteoarthritis. We could also report that intermittent pneumatic compression therapy along with conventional treatment is superior to cold-pack therapy along with conventional treatment in terms of knee swelling in patients with knee osteoarthritis. This trial is registered with NCT03806322.


Assuntos
Terapia Combinada/métodos , Edema/etiologia , Edema/terapia , Dispositivos de Compressão Pneumática Intermitente , Osteoartrite do Joelho/complicações , Idoso , Crioterapia/métodos , Terapia por Exercício/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/terapia , Método Simples-Cego , Estimulação Elétrica Nervosa Transcutânea/métodos , Resultado do Tratamento , Terapia por Ultrassom/métodos
14.
J Sci Med Sport ; 22(8): 912-917, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31151878

RESUMO

OBJECTIVES: The study examined if three feasible strategies involving additional in-play cooling periods attenuate the core (rectal) temperature rise during simulated football matches. DESIGN: Four counterbalanced experimental trials in an environmental chamber set to 35 °C ambient temperature, 55% relative humidity, and 30 °C WBGT. METHODS: Twelve healthy well-trained football players completed a regular simulated match (REG), regular simulated match with additional 3-min cooling periods at the 30-min mark of each half inclusive of chilled water consumption (COOLwater), regular simulated match with additional 3-min cooling periods at the 30-min mark of each half inclusive of chilled water consumption and the application of an ice towel around the neck (COOLtowel), regular simulated match with an extended (+5 min; total of 20-min) half-time break (HTextended). RESULTS: The difference in rectal temperature change was significantly lower in the COOLwater (-0.25 °C), COOLtowel (-0.28 °C), and HTextended (-0.21 °C) trials in comparison to the REG (all p < 0.05). Exercising heart rate and session rating of perceived exertion was lower in the COOLwater (-13 bpm; -1.4 au), COOLtowel (-10 bpm; -1.3 au), and HTextended (-8 bpm; -0.9 au) trials in comparison to the REG trial (all p < 0.05). The cooling interventions did not significantly change skin temperature or thermal sensation in comparison to the REG (all p > 0.05). CONCLUSIONS: All three cooling interventions attenuated core body thermal strain during simulated matches. The laboratory-based study supports the use of brief in-play cooling periods as a means to attenuate the rise in core temperature during matches in hot and humid conditions.


Assuntos
Regulação da Temperatura Corporal/fisiologia , Crioterapia/métodos , Futebol Americano/fisiologia , Transtornos de Estresse por Calor/prevenção & controle , Temperatura Alta/efeitos adversos , Esforço Físico/fisiologia , Humanos , Masculino , Descanso/fisiologia , Água , Adulto Jovem
15.
PLoS Negl Trop Dis ; 13(6): e0007423, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31188834

RESUMO

BACKGROUND: The control of cutaneous leishmaniasis (CL) is facilitated by knowledge of factors associated with the treatment failures in endemic countries. The aim of this evaluation was to identify the potential risk determinants which might affect the significance of demographic and clinical characteristics for the patients with anthroponotic CL (ACL) and the outcome of meglumine antimoniate (MA) (Glucantime) treatment. METHODOLOGY/PRINCIPAL FINDINGS: This current was executed as a cohort spanning over a period of 5 years which centered in southeastern part of Iran. Altogether, 2,422 participants were evaluated and 1,391 eligible volunteer patients with ACL caused by Leishmania tropica were included. Overall, 1,116 (80.2%) patients received MA intraleisionally (IL), once a week for 12 weeks along with biweekly cryotherapy, while 275 (19.8%) patients received MA alone (20 mg/kg/day for 3 weeks) (intramuscular, IM). The treatment failure rate in ACL patients was 11% using IL combined with cryotherapy plus IM alone, whilst 9% and 18.5% by IL along with cryotherapy or IM alone, respectively. Multivariate logistic regression model predicted 5 major associated-risk determinants including male (odds ratio (OR) = 1.54, confidence interval (CI) = 1.079-2.22, p = 0.018), lesion on face (OR = 1.574, CI = 1.075-2.303, p = 0.02), multiple lesions (OR = 1.446, CI = 1.008-2.075, p = 0.045), poor treatment adherence (OR = 2.041, CI = 1.204-3.46, p = 0.008) and disease duration > 4 months (OR = 2.739, CI = 1.906-3.936, p≤0.001). CONCLUSIONS/SIGNIFICANCE: The present study is the original and largest cohort of ACL patients who treated with MA. A comprehensive intervention and coordinated action by the health authorities and policy-makers are crucial to make sure that patients strictly follow medical instructions. Early detection and effective therapy < 4 months following the onset of the lesion is critical for successful treatment of the patients. Since a significant number of patients are still refractory to MA, reducing man-vector exposure and development of new effective alternative drugs are essential measures against ACL due to L. tropica.


Assuntos
Antiprotozoários/uso terapêutico , Leishmania tropica/isolamento & purificação , Leishmaniose Cutânea/tratamento farmacológico , Leishmaniose Cutânea/epidemiologia , Antimoniato de Meglumina/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos de Coortes , Crioterapia/métodos , Feminino , Humanos , Lactente , Recém-Nascido , Irã (Geográfico)/epidemiologia , Leishmaniose Cutânea/microbiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Falha de Tratamento , Adulto Jovem
16.
Altern Ther Health Med ; 25(4): 40-45, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31202210

RESUMO

Context: Manual therapy and kinesiotherapy are used for knee osteoarthritis (OA). Yet, a clear evidence of the effects of manual therapy versus kinesiotherapy on knee OA is limited. The addition of cryotherapy to manual therapy or to kinesiotherapy may enhance the health benefits in patients with knee OA. Objective: The study intended to evaluate the efficacy of manual therapy combined with cryotherapy versus kinesiotherapy combined with cryotherapy for patients with knee OA. Design: The research team designed a randomized, controlled trial. Setting: The study occurred in the Physiotherapy Outpatient Department of the Regional Hospital (Sandomierz, Poland). Participants: The participants were 128 females and males with knee OA, aged 40 to 80 y, who were patients in the department at the hospital. Intervention: The participants were randomly assigned to an intervention group that received manual therapy combined with cryotherapy, the MT-C group (n = 64), or to a control group, which received kinesiotherapy combined with cryotherapy, the KIN-C group (n = 64). The participants in both groups received 10 treatments, 2 per wk for 5 wk. Outcome Measures: The primary outcome was measured using a visual analog scale pain ratings. The secondary outcome measured the quality of life using the Western Ontario and McMaster Universities questionnaire, knee extension, and flexion range of motion using the goniometer, and functional capacity using the 6-min walk test. Results: After the treatments, the intervention group had significantly lower scores than the control group for pain, as well as significantly higher scores for quality of life, range of motion of the affected knee, and functional capacity. Conclusion: The patients achieved better health benefits from manual therapy when it was combined with cryotherapy.


Assuntos
Crioterapia/métodos , Articulação do Joelho/fisiopatologia , Manipulações Musculoesqueléticas/métodos , Osteoartrite do Joelho/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Cinesiologia Aplicada/métodos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Qualidade de Vida , Resultado do Tratamento
17.
Arch Orthop Trauma Surg ; 139(10): 1399-1405, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31203381

RESUMO

INTRODUCTION: The use of evaporative coolants in the management of acute musculoskeletal injury has received increasing attention recently. However, its efficacy compared with conventional cryotherapy in treating injured human subjects remains unclear. The purpose of this study is to compare the efficacy of evaporative coolants with that of ice packs in preoperative management of edema and pain in patients with an ankle fracture. MATERIAL AND METHODS: Sixty-three patients in need of surgical treatment for ankle fracture were randomly assigned to either an evaporative coolant group or an ice pack group. Both treatments were applied for 5 days after injury and outcomes were measured daily. The primary outcome was a reduction in edema as measured by the figure-of-eight-20 method and the secondary outcome was measured by visual analog scale (VAS) for pain. RESULTS: Two-way analysis of variance with repeated measures showed no significant group effect and no significant group-by-time interaction in terms of reduction of edema and VAS score for pain between two groups. No adverse effects were reported in either group. CONCLUSION: Evaporative coolants exhibited comparable efficacy to ice packs in preoperative cryotherapy of ankle fractures without adverse effects. While evaporative coolants are more expensive than ice packs, they can present a viable option for cryotherapy. LEVEL OF EVIDENCE: Level I, prospective randomized study.


Assuntos
Fraturas do Tornozelo/terapia , Crioterapia/métodos , Edema/terapia , Dor Musculoesquelética/terapia , Manejo da Dor/métodos , Cuidados Pré-Operatórios/métodos , Adolescente , Adulto , Idoso , Análise de Variância , Fraturas do Tornozelo/complicações , Bandagens , Feminino , Humanos , Gelo , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
18.
Cardiovasc Intervent Radiol ; 42(8): 1128-1134, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31073824

RESUMO

PURPOSE: We investigated the usefulness of the modified RENAL nephrometry (mRN) scoring system for predicting post-cryotherapy renal function in patients with T1a renal mass. PATIENTS AND METHODS: A total of 75 patients with a T1a renal mass were enrolled. The mRN score was determined based on the tumor size, the tumor's exophytic/endophytic properties, the tumor's nearness to the collecting system, and the anterior/posterior location of the kidney. The change in the estimated glomerular filtration rate (ΔeGFR) was calculated as follows: ΔeGFR = 100 × ([pretreatment eGFR - eGFR at 6 months after cryotherapy]/pretreatment eGFR). Based on the ΔeGFR results, we classified the patients into two groups: a preserved renal function group (ΔeGFR < 10%) and an impaired renal function group (ΔeGFR ≥ 10%). We then analyzed the relationships between the mRN score and ΔeGFR and between the mRN score and the chronic kidney disease (CKD) stage. RESULTS: The mean ΔeGFR for all patients was 5.5%. The mRN scores of the preserved renal function group (5.8 ± 0.3) were significantly lower than those of the impaired group (7.4 ± 0.3) (p < 0.001). When the mRN score cutoff value was set at 7 points, the mRN had 67.7% sensitivity, 72.7% specificity, 61.8% positive predictive value (PPV), 76.1% negative predictive value (NPV), and 70.7% accuracy for predicting impaired renal function. For predicting a deterioration of CKD stage, the mRN had 92.9% sensitivity, 67.2% specificity, 39.4% PPV, 97.6% NPV, and 72% accuracy. CONCLUSION: Our newly proposed modified RENAL nephrometry score was suggested to be useful for predicting renal function after renal cryotherapy.


Assuntos
Crioterapia/métodos , Neoplasias Renais/fisiopatologia , Neoplasias Renais/terapia , Insuficiência Renal/diagnóstico por imagem , Insuficiência Renal/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Taxa de Filtração Glomerular , Humanos , Rim/diagnóstico por imagem , Rim/fisiopatologia , Neoplasias Renais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
19.
Semin Ophthalmol ; 34(3): 182-187, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31135259

RESUMO

Purpose: To describe the clinical features, treatment, and outcomes of conjunctival melanoma in Asian Indians. Methods: Retrospective study of 42 patients. Results: The mean age at presentation of conjunctival melanoma was 43 years (median, 45 years; range, 9-78 years). There were 20 (48%) males and 22 (52%) females. Nineteen patients (45%) had a known history of a preexisting pigmented conjunctival lesion. Bulbar conjunctiva (n = 28; 67%) was the most common tumor epicenter, and medial ocular surface quadrant (n = 15; 36%) was more commonly involved. The mean tumor basal diameter was 12 mm (median, 10 mm; range, 4-30 mm), and the mean tumor thickness was 4 mm (median, 2 mm; range, 1-30 mm). Majority of the patients had a pigmented tumor (n = 33; 79%). The tumors arose de novo (n = 17, 41%) or were associated with conjunctival nevus (n = 9; 21%) or primary acquired melanosis (n = 16, 38%). Wide excisional biopsy, adjunctive cryotherapy, and amniotic membrane grafting were performed in 27 (71%) patients, 11 (29%) underwent orbital exenteration, and 4 were lost to follow-up prior to definitive treatment. Over a mean follow-up period of 24 months (median, 9 months; range, <1 to 136 months), four (11%) patients had tumor recurrence, seven (18%) had locoregional lymph node metastasis, and four (11%) developed systemic metastasis and died due to metastatic disease. Conclusion: Conjunctival melanoma predominantly occurs in middle-aged Asian Indians and is associated with a high rate of systemic metastasis and death.


Assuntos
Neoplasias da Túnica Conjuntiva , Melanoma , Adolescente , Adulto , Distribuição por Idade , Idoso , Âmnio/transplante , Grupo com Ancestrais do Continente Asiático , Criança , Neoplasias da Túnica Conjuntiva/epidemiologia , Neoplasias da Túnica Conjuntiva/patologia , Neoplasias da Túnica Conjuntiva/cirurgia , Neoplasias da Túnica Conjuntiva/terapia , Crioterapia/métodos , Feminino , Humanos , Incidência , Índia/epidemiologia , Masculino , Melanoma/epidemiologia , Melanoma/patologia , Melanoma/cirurgia , Pessoa de Meia-Idade , Metástase Neoplásica/patologia , Recidiva Local de Neoplasia/epidemiologia , Estudos Retrospectivos , Distribuição por Sexo , Adulto Jovem
20.
Ear Nose Throat J ; 98(6): 351-355, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31072196

RESUMO

Botulinum toxin is the most commonly performed facial cosmetic procedure and pain at the injection site is a frequent patient concern. While various topical interventions have been described for analgesia, there have not been any studies comparing different techniques. We compared the use of a vibratory stimulus, ice pack application, and no intervention on injection site pain for cosmetic botulinum toxin injection. A prospective-, randomized-, individual-controlled study was conducted using a visual analog scale to assess pain. Patients received bilateral glabellar injections, with randomization into unilateral vibration, unilateral ice application, or vibration and ice on either side. We analyzed 88 injections on 22 patients. Mean visual analog scores were 26.5 (standard deviation [SD]: 23.1) among injections with vibration, 24.4 (SD: 22.9) with ice, and 29.4 (SD: 27.1) without analgesia. There was no significant difference in pain scale scores with the use of vibration, ice, or no topical anesthesia (P = .737). Further, pain scale scores did not differ significantly between medial and lateral injections nor did patients have a reduction in pain on either side of the forehead regardless of which method was used. While there may be a role for topical interventions to improve injection site analgesia, we maintain that consistently proper technique plays a greater role in improving patient tolerance. Future studies will continue to investigate the role of topical anesthesia in cosmetic facial injections and address patient-specific factors contributing to discomfort.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Crioterapia/métodos , Fármacos Neuromusculares/administração & dosagem , Dor Processual/prevenção & controle , Vibração/uso terapêutico , Adulto , Músculos Faciais , Feminino , Testa , Humanos , Gelo , Injeções Intramusculares , Pessoa de Meia-Idade
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