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1.
Microvasc Res ; 133: 104100, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33181169

RESUMO

INTRODUCTION: Microvascular function is impaired in patients with diabetes mellitus (DM) and is involved in numerous DM complications. Several microvascular-supporting interventions have been proposed of which the transcutaneous application of gaseous CO2 (hereinafter CO2 therapy) is one of the most promising. The aim of present study was to determine the effect of repeated CO2 therapies on the cutaneous microvascular function in DM patients with diabetic foot ulcers. METHODOLOGY: A total of 42 subjects with at least one chronic diabetic foot ulcer were enrolled in the study. They were divided into the experimental group (21 subjects aged 64.6 ±â€¯11.6 years) that underwent 4-week-long treatment with transcutaneous application of gaseous CO2 (hereinafter CO2 therapies), and the placebo group (21 subjects aged 65.0 ±â€¯10.7 years) that underwent 4-week-long placebo treatment with transcutaneous application of air. Before the first and after the last treatment in both groups, laser Doppler (LD) flux in foot cutaneous microcirculation, heart rate, and arterial blood pressure measurements were carried out during rest and local thermal hyperaemia (LTH) provocation test. RESULTS: In the experimental group the following statistically significant changes were observed after the completed treatment 1) increased mean relative powers of LD flux signals during rest in the frequency bands related to NO-independent endothelial (0.07 ±â€¯0.055 vs. 0.048 ±â€¯0.059, p = 0.0058), NO-mediated endothelial (0.154 ±â€¯0.101 vs. 0.113 ±â€¯0.108, p = 0.015), and neurogenic (0.17 ±â€¯0.107 vs. 0.136 ±â€¯0.098, p = 0.018) activity; 2) decreased resting LD flux (35 ±â€¯29 PU vs. 52 ±â€¯56 PU; p = 0.038); and 3) increased peak LD flux as a function of baseline during LTH (482 ±â€¯474%BL vs. 287 ±â€¯262%BL, p = 0.036); there were no statistically significant changes observed in the placebo group. No systemic effects were observed in none of the two groups by means of mean values of heart rate and arterial blood pressure. CONCLUSIONS: Repeated CO2 therapies improves the microvasular function in DM patients without any systemic side effects.


Assuntos
Dióxido de Carbono/administração & dosagem , Pé Diabético/tratamento farmacológico , Microcirculação/efeitos dos fármacos , Pele/irrigação sanguínea , Administração Cutânea , Idoso , Velocidade do Fluxo Sanguíneo , Dióxido de Carbono/efeitos adversos , Dióxido de Carbono/uso terapêutico , Pé Diabético/diagnóstico , Pé Diabético/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento
2.
J Vet Sci ; 21(2): e37, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32233140

RESUMO

Poultry red mites (PRMs), Dermanyssus gallinae, are one of the most harmful ectoparasites of laying hens. Because of their public health impact, safe, effective methods to eradicate PRMs are greatly needed. Carbon dioxide (CO2) was shown to eradicate phytophagous mites; however, there is no evidence that PRMs can be eradicated by CO2. Thus, the efficacy of CO2, applied by direct-spraying and dry ice-generated exposure, for eradicating PRMs was investigated. Both treatments eradicated > 85% of PRMs within 24 h and 100% of PRMs by 120 h of post-treatment. Therefore, these novel approaches may be useful for eradicating PRMs in clinical settings.


Assuntos
Dióxido de Carbono/uso terapêutico , Erradicação de Doenças/métodos , Infestações por Ácaros/veterinária , Ácaros , Doenças das Aves Domésticas/prevenção & controle , Animais , Galinhas , Infestações por Ácaros/parasitologia , Infestações por Ácaros/prevenção & controle , Doenças das Aves Domésticas/parasitologia
3.
Maturitas ; 135: 34-39, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32252962

RESUMO

OBJECTIVES: To evaluate the safety of and patient satisfaction with fractional CO2 laser for the treatment of vulvo-vaginal atrophy (VVA) in postmenopausal patients. STUDY DESIGN: Patients affected by VVA were considered for the study. All women were treated using a Lumenis AcuPulse DUO (Lumenis, Yokneam, Israel) in fractionated mode with a 28 mm probe, FemTouch™. Pain during different steps of the procedure (introduction, rotation and extraction of probe and laser impulse transmission) was evaluated on a 7-point Likert scale. The occurrence of side-effects was evaluated at the end of the procedure, and in the three-month follow-up (after the last treatment) complications were classified as 'early' (occurring within 30 days) or late (after 30 days). Participant satisfaction was measured on a 7-point Likert scale (1= strongly disagree, 7= strongly agree). The institutional review board approved the study protocol. RESULTS: Fifty-three women were enrolled in the study. No severe complications occurred after a median follow-up of six months. One patient (1.9 %) reported dizziness immediately after treatment, which completely resolved within 15 min. A minor bleeding occurred related to tip introduction and rotation. One patient (1.9 %) aborted the procedure because of discomfort on probe introduction but decided to repeat the procedure after two weeks. Two patients (3.7 %) reported symptoms of dysuria within 7 days of the procedure. The mean overall pain score at first treatment, evaluated on the 7-point Likert scale, was 3.57 ± 1.50. The mean pain scores related to probe introduction and rotation were 3.13 ± 1.37 and 2.32 ± 1.08, whereas pain scores for extraction and laser impulse transmission were 1.23 ± 0.27 and 1.13 ± 0.37 respectively. Mean overall pain score (1.27; CI 95 % 0.83-1.71, p < 0.001) and pain scores related to probe introduction (0.54; CI 95 % 0.18-0.90, p = 0.001) and probe rotation (0.46; CI 95 % 0.12-0.90, p = 0.003) all statistically significantly decreased between the first and third treatment (Fig. 1). Mean pain scores related to laser activation (0.01; CI 95 % -0.06 - 0.20, p = 0.07) and extraction (0.08; CI 95 % -0.04-0.19, p = 0.31) did not change over the course of treatment. Overall, patient satisfaction with the procedure was high: 89.7 % of patients would highly (value 5-7) recommend the procedure and 94.9 % would be ready to repeat the procedure to maintain results. Discomfort related to treatment was lower than expected for 41 % of patients (value 5-7) and as expected for 48.7 % (value 3-4). CONCLUSION: Fractional CO2 laser for treatment of VVA seems a safe therapeutic option. No severe complications occurred. A minority of patients reported mild complications, but these resolved without the need for treatment. Most discomfort was related to probe introduction and rotation. Overall, patients were highly satisfied, and they would repeat laser treatment.


Assuntos
Dióxido de Carbono/uso terapêutico , Lasers de Gás/uso terapêutico , Doenças Vaginais/cirurgia , Idoso , Atrofia/cirurgia , Feminino , Humanos , Israel , Pessoa de Meia-Idade , Satisfação do Paciente , Pós-Menopausa , Estudos Prospectivos , Resultado do Tratamento , Vagina/patologia , Vulva/patologia
4.
J Orthop Sci ; 25(2): 338-343, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31031109

RESUMO

BACKGROUND: Muscle atrophy causes difficulty in resuming daily activities after a fracture. Because transcutaneous carbon dioxide (CO2) application has previously upregulated oxygen pressure in the local tissue, thereby demonstrating its potential in preventing muscle atrophy, here we investigated effects of CO2 application on muscle atrophy after femoral shaft fracture. METHODS: Thirty fracture model rats were produced and randomly divided into a no treatment (control group) and treatment (CO2 group) groups. After treatment, the soleus muscle was dissected at post-fracture days 0, 14, and 21. Evaluations were performed by measuring muscle weight and performing histological examination and gene expression analysis. RESULTS: Muscle weight was significantly higher in the CO2 group than in the control group. Histological analysis revealed that the muscle fiber cross-sectional area was reduced in both groups. Nevertheless, the extent of atrophy was lesser in the CO2 group. Muscle fibers in the control group tended to change into fast muscle fibers. Vascular staining revealed that more capillary vessels surrounded the muscle fibers in the CO2 group than in the control group. Messenger RNA (mRNA) analysis revealed that the CO2 group had a significantly enhanced expression of genes that were related to muscle synthesis. CONCLUSION: Transcutaneous CO2 application may be a novel therapeutic strategy for preventing skeletal muscle atrophy after fracture.


Assuntos
Dióxido de Carbono/uso terapêutico , Fraturas do Fêmur , Músculo Esquelético/efeitos dos fármacos , Atrofia Muscular/prevenção & controle , Administração Cutânea , Animais , Modelos Animais de Doenças , Masculino , Ratos , Ratos Sprague-Dawley
5.
Orv Hetil ; 160(41): 1617-1622, 2019 Oct.
Artigo em Húngaro | MEDLINE | ID: mdl-31587579

RESUMO

Introduction: Genitourinary syndrome of menopause (GSM) affects up to 40-57% of postmenopausal women. Intravaginal microablative fractional CO2 laser is a new proposal for the management of GSM, although the evidence of safety and efficacy of the procedure appears to be insufficient. Aim: The aim of the study was to assess the efficacy of fractional CO2 laser for the treatment of GSM at the Department of Obstetrics and Gynecology of the University of Debrecen. Method: Postmenopausal women with symptoms of GSM underwent three sessions of microablative fractional rejuvenation CO2 laser therapy at 4-6 weeks intervals. Vaginal health index (VHI) scores were completed before each treatment and at 6 weeks follow-up as an objective measurement and visual analog scale was used to assess subjective complaints. Statistical analysis included Student's paired two-sampling t-test for the measure of statistical significance using the standard cutoff for significance p<0.05. Results: 51 women participated (mean age 57.0 ± 9.9 y). Average VHI score was 14.0 ± 4.9 before treatment, 15.0 ± 4.7 after the first session, 18.2 ± 4.6 after the second treatment and 19.5 ± 4.9 at follow-up. The improvement of VHI score was statistically significant between all sessions. Average VAS score was 15.6 ± 14.1 before treatment, 9.0 ± 10.8 after the first session, 5.9 ± 9.2 after the second treatment and 3.4 ± 7.5 at follow-up. The improvement of VAS score was statistically also significant between all sessions. Conclusions: Our study suggests that the fractional CO2 laser is an effective and safe treatment of symptoms associated with GSM. Orv Hetil. 2019; 160(41): 1617-1622.


Assuntos
Dióxido de Carbono/uso terapêutico , Dispareunia/cirurgia , Doenças Urogenitais Femininas/cirurgia , Terapia a Laser , Lasers de Gás/uso terapêutico , Menopausa , Disfunções Sexuais Fisiológicas/cirurgia , Doenças Vaginais/cirurgia , Idoso , Dispareunia/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Disfunções Sexuais Fisiológicas/etiologia , Síndrome , Resultado do Tratamento
6.
ACS Nano ; 13(10): 10887-10917, 2019 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-31538764

RESUMO

Gas-involving cancer theranostics have attracted considerable attention in recent years due to their high therapeutic efficacy and biosafety. We have reviewed the recent significant advances in the development of stimuli-responsive gas releasing molecules (GRMs) and gas nanogenerators for cancer bioimaging, targeted and controlled gas therapy, and gas-sensitized synergistic therapy. We have focused on gases with known anticancer effects, such as oxygen (O2), carbon monoxide (CO), nitric oxide (NO), hydrogen sulfide (H2S), hydrogen (H2), sulfur dioxide (SO2), carbon dioxide (CO2), and heavy gases that act via the gas-generating process. The GRMs and gas nanogenerators for each gas have been described in terms of the stimulation method, followed by their applications in ultrasound and multimodal imaging, and finally their primary and synergistic actions with other cancer therapeutic modalities. The current challenges and future possibilities of gas therapy and imaging vis-à-vis clinical translation have also been discussed.


Assuntos
Gases/uso terapêutico , Neoplasias/terapia , Nanomedicina Teranóstica , Dióxido de Carbono/uso terapêutico , Monóxido de Carbono/uso terapêutico , Humanos , Hidrogênio/uso terapêutico , Sulfeto de Hidrogênio/uso terapêutico , Neoplasias/diagnóstico por imagem , Neoplasias/patologia , Óxido Nítrico/uso terapêutico , Oxigênio/uso terapêutico
7.
Artigo em Russo | MEDLINE | ID: mdl-31513169

RESUMO

The problem of finding new ways for pharmacological prophylaxis and treatment of respiratory tract diseases is very relevant in public health. To eliminate hypoxia, many European and American clinics use carboxytherapy as an additional or alternative treatment. Carbon dioxide administration eliminates the sequels of oxygen starvation, by producing artificial tissue hypercapnia, which causes an increase in oxygen delivery and carbon dioxide removal from the tissues and then from the body. The main mechanism of action of carboxytherapy is associated with enhanced tissue oxygenation and is due to the Verigo-Bohr effect: the effect of CO2 concentration and pH on the binding of hemoglobin to oxygen and release of the latter from hemoglobin. By affecting the chemoreceptors of the respiratory center, carboxytherapy contributes to increased pulmonary ventilation and reduces bronchial smooth muscle tone and bronchial mucous secretion, as well as inflammation; all this improves breathing. By exerting a direct and reflex effect on the respiratory center, carboxytherapy induces hurried and deeper breathing, which increases pulmonary ventilation, speeds up perfusion and gas exchange in the lung, eliminates dyspnea and bronchospasm; therefore, it is widely used for lung diseases (asthma, pneumosclerosis, and silicosis). Carboxytherapy improves lung function in case of bronchopulmonary diseases, performance, and quality of life and it is used as an additional method in the pharmacotherapy of many diseases in pulmonology.


Assuntos
Dióxido de Carbono/uso terapêutico , Oxigênio/uso terapêutico , Doenças Respiratórias/tratamento farmacológico , Humanos , Doenças Respiratórias/fisiopatologia , Resultado do Tratamento
8.
Eur Arch Otorhinolaryngol ; 276(12): 3405-3412, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31520161

RESUMO

PURPOSE: An anterior glottic web consists of the formation of a bridge of scar tissue covered by epithelium between the anterior free edges of the true vocal cords and represents one of the most common complications of laryngeal endoscopic surgery for tumors involving the anterior commissure. Endoscopic surgery is the therapy of choice, but simple section of the web is burdened by a high recurrence rate. Topical application of mitomycin C, intracordal stents, and the use of mucosal microflaps have been proposed to improve outcomes. We report our experience with the use of single and double mucosal microflaps (sliding technique) during the management of iatrogenic anterior glottic web (IAGW). METHODS: From November 2010 to December 2018, 30 patients (29 males, 1 female, mean age 65 years, range 47-87 years) were observed for IAGW, and 11 of these patients (36.7%) required surgical treatment. The Voice Handicap Index (VHI) and the GRBAS were used for the perceptive evaluation of pre- and post-operative voice quality. RESULTS: A reduction of the web length was observed in all cases, and we did not observe any residual web at the mid-third of the glottis. The mean post-operative VHI score decreased from 45 to 24, and the mean post-operative GRBAS values were reduced from 2.8, 2.4, 2.3, 2.1, and 1.1 to 1.9, 1.4, 1.3, 1.1, and 0, respectively. CONCLUSIONS: The microflap technique represents an effective and reproducible one-step procedure that, in expert hands, allows to obtain good anatomical and functional results in a high percentage of cases.


Assuntos
Glote/cirurgia , Laringectomia/métodos , Laringoplastia/métodos , Terapia a Laser/métodos , Lasers de Gás/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Dióxido de Carbono/uso terapêutico , Avaliação da Deficiência , Disfonia , Endoscopia , Feminino , Glote/patologia , Humanos , Doença Iatrogênica , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Membrana Mucosa , Retalhos Cirúrgicos , Resultado do Tratamento , Prega Vocal/cirurgia , Qualidade da Voz
9.
Int. arch. otorhinolaryngol. (Impr.) ; 23(3): 354-359, July-Sept. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1040017

RESUMO

Abstract Introduction Schwannomas are benign, solitary, encapsulated tumors that may originate at any site of the peripheral nervous system, with the exception of the olfactory and optic nerves. Schwannomas of the base of tongue are very rare, and only sporadic cases are documented. The tongue base represents a challenge for surgeons. Carbon dioxide (CO2) laser might provide an effective surgical option for such lesions because of the easy access to the lesion, the bloodless surgical field and optimum epithelization of wounds. Objective We present an unusual case of pedunculated schwannoma of the tongue base treated via transoral CO2-assisted excision. We also provide a review of the available literature, in English language, on humans. Data synthesis The authors searched the PubMed database and Google up to July 2018. The following search terms were applied: tongue and lingual, combined with schwannoma and neurilemmoma. Titles and abstracts were screened, and, then, only supraglottic (hypopharyngeal) tongue base masses were considered. Fourteen articles were included in this review, reporting 17 cases. The age of the patients ranged from 9 to 39 years, affecting predominantly females. Dysphagia and lump sensations were the most common presenting symptoms, and the mean follow-up period range was 1.5 to 60 months (mean = 13 months). There was no evidence of recurrence in any of the cases. Conclusion We could conclude that tongue base schwannomas are rare. Transoral complete excision of the tumor is the treatment of choice. CO2 laser surgery is a minimally invasive treatment option that has been performed in few reports with no recurrence and with favorable outcomes.


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Neoplasias da Língua/cirurgia , Dióxido de Carbono/uso terapêutico , Terapia a Laser/métodos , Neurilemoma/cirurgia , Tomografia Computadorizada por Raios X , Diagnóstico Diferencial , Neurilemoma/diagnóstico , Neurilemoma/patologia
10.
PLoS One ; 14(7): e0207107, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31269078

RESUMO

Breast cancer rates are rising in low- and middle-income countries (LMICs), yet there is a lack of accessible and cost-effective treatment. As a result, the cancer burden and death rates are highest in LMICs. In an effort to meet this need, our work presents the design and feasibility of a low-cost cryoablation system using widely-available carbon dioxide as the only consumable. This system uses an 8-gauge outer-diameter needle and Joule-Thomson expansion to percutaneously necrose tissue with cryoablation. Bench top experiments characterized temperature dynamics in ultrasound gel demonstrated that isotherms greater than 2 cm were formed. Further, this system was applied to mammary tumors in an in vivo rat model and necrosis was verified by histopathology. Finally, freezing capacity under a large heat load was assessed with an in vivo porcine study, where volumes of necrosis greater than 1.5 cm in diameter confirmed by histopathology were induced in a highly perfused liver after two 7-minute freeze cycles. These results demonstrate the feasibility of a carbon-dioxide based cryoablation system for improving solid tumor treatment options in resource-constrained environments.


Assuntos
Dióxido de Carbono/uso terapêutico , Ablação por Cateter , Criocirurgia , Neoplasias Mamárias Experimentais/cirurgia , Animais , Ablação por Cateter/instrumentação , Ablação por Cateter/métodos , Criocirurgia/instrumentação , Criocirurgia/métodos , Feminino , Neoplasias Mamárias Experimentais/patologia , Ratos , Ratos Sprague-Dawley , Suínos
11.
Am J Case Rep ; 20: 988-992, 2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31287809

RESUMO

BACKGROUND Schwannoma, also called neuroma or neurolemmoma, is a tumor originating from the Schwann cells surrounding the nerves. It is an isolated benign tumor and its transformation into malignant cancer is very rare. Relatively uncommon, it is only the 5% of all the tumors of soft tissues. Its localization in the head and neck region accounts for up to 25-45% of schwannomas. In the outer ear, it commonly involves the external auditory canal, while auricle and tympanic membranes are very rare localizations of schwannomas. CASE REPORT We report a case of a 23-year-old male with a 3-year medical history of a growing neoplasm located in the left auricle concha, which was treated with a carbon dioxide laser (CO2 laser) under local anesthesia. CONCLUSIONS Using a CO2 laser allowed us to easily remove the tumor, reduce bleeding and surgical time, and avoid sutures and thus unsightly scars on the face. No complications and no relapse at 5 years of follow-up occurred.


Assuntos
Dióxido de Carbono/uso terapêutico , Pavilhão Auricular/cirurgia , Neoplasias da Orelha/cirurgia , Lasers de Gás/uso terapêutico , Neurilemoma/cirurgia , Pavilhão Auricular/patologia , Neoplasias da Orelha/patologia , Humanos , Masculino , Adulto Jovem
12.
Skin Res Technol ; 25(6): 805-809, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31115110

RESUMO

BACKGROUND: Ablative fractional laser surgery is a common technique for treating acne scars. However, an in vivo and noninvasive analysis of the histologic variations between acne skin and the resulting resurfaced skin is needed in order to evaluate the wound healing process of the scars induced by the ablative fractional laser surgery. MATERIALS AND METHODS: Nine patients with acne scars underwent a single treatment with a CO2 ablative fractional laser surgery. Collagen presence on the resurfaced skin was noninvasively assessed by means of Raman spectroscopy and principal component analysis. RESULTS: Principal component analysis shows that all the patients presented a collagen regeneration on the resurfaced skin after the laser treatment. CONCLUSION: Collagen plays a crucial role in the wound healing process. By assessing the collagen presence on the skin, it was possible to quantify the regenerative effects of the ablative fractional laser in a noninvasive way.


Assuntos
Acne Vulgar , Cicatriz , Colágeno , Terapia a Laser , Análise Espectral Raman/métodos , Acne Vulgar/diagnóstico por imagem , Acne Vulgar/terapia , Adolescente , Dióxido de Carbono/uso terapêutico , Bochecha/diagnóstico por imagem , Criança , Cicatriz/diagnóstico por imagem , Cicatriz/terapia , Colágeno/análise , Colágeno/química , Feminino , Humanos , Masculino , Regeneração da Pele por Plasma , Pele/diagnóstico por imagem , Adulto Jovem
13.
Med. intensiva (Madr., Ed. impr.) ; 43(4): 234-242, mayo 2019. graf
Artigo em Espanhol | IBECS | ID: ibc-183128

RESUMO

En los últimos años han surgido importantes descubrimientos sobre el papel del dióxido de carbono (CO2) a nivel celular y molecular, y sobre los efectos de la hipercapnia. Esta última puede tener efectos beneficiosos en pacientes con patología pulmonar aguda, como la reducción de la inflamación pulmonar y del daño oxidativo alveolar, la regulación de la inmunidad innata, la defensa del huésped y la inhibición de la expresión de citoquinas inflamatorias. Sin embargo, otros estudios sugieren que el CO2 puede tener efectos nocivos en el pulmón, como retraso en la reparación alveolar tras la injuria pulmonar, disminución de las tasas de reabsorción del fluido alveolar e inhibición de la proliferación de células alveolares. Por lo tanto, la hipercapnia tiene efectos tanto beneficiosos como nocivos y es importante determinar el efecto neto en condiciones específicas. El propósito de esta revisión es describir los efectos fisiológicos e inmunomoduladores de la hipercapnia, considerando sus potenciales consecuencias en el paciente con insuficiencia respiratoria aguda


Important recent insights have emerged regarding the cellular and molecular role of carbon dioxide (CO2) and the effects of hypercapnia. The latter may have beneficial effects in patients with acute lung injury, affording reductions in pulmonary inflammation, lessened oxidative alveolar damage, and the regulation of innate immunity and host defenses by inhibiting the expression of inflammatory cytokines. However, other studies suggest that CO2 can have deleterious effects upon the lung, reducing alveolar wound repair in lung injury, decreasing the rate of reabsorption of alveolar fluid, and inhibiting alveolar cell proliferation. Clearly, hypercapnia has both beneficial and harmful consequences, and it is important to determine the net effect under specific conditions. The purpose of this review is to describe the immunological and physiological effects of carbon dioxide, considering their potential consequences in patients with acute respiratory failure


Assuntos
Humanos , Dióxido de Carbono/uso terapêutico , Cuidados Críticos , Hipercapnia/tratamento farmacológico , Dióxido de Carbono/efeitos adversos , Insuficiência Respiratória/complicações , Insuficiência Respiratória/tratamento farmacológico , Respiração Artificial/efeitos adversos , Acidose Respiratória/tratamento farmacológico
14.
Medicine (Baltimore) ; 98(14): e15112, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30946379

RESUMO

BACKGROUND: Laparoscopic colorectal surgery may adversely affect respiration, circulation, and acid-base balance in elderly patients, owing to the relatively long duration of CO2 absorption. We conducted this retrospective study to determine the safety and efficacy of warmed, humidified CO2 pneumoperitoneum in elderly patients undergoing laparoscopic colorectal surgery. METHODS: We enrolled 245 patients between January 2016 and August 2018.The experimental group (warming and humidification group [WH]) received warmed (37°C), humidified (98%) insufflation of CO2, and the control group (cold, dry CO2/control group [CD]) received standard CO2 (19°C, 0%). All other aspects of patient care were standardized. Intraoperative hemodynamic data, arterial blood pH, and lactic acid levels were recorded. We also recorded intra-abdominal pressure, incidence of shivering 1 hour after surgery, satisfaction scores of patients and surgeons 24 hours after surgery, times to first flatus/defecation, first bowel movement, and tolerance of semiliquid food, discharge time, and incidence of vomiting, diarrhea, and surgical site infections. RESULTS: Compared with the WH group, heart rate and mean arterial pressure were significantly higher from T3 to T8 (P < .05), lactic acid levels were significantly higher from T4 to T9 (P < .05), and recovery time in the post-anesthesia care unit (PACU) was significantly longer in the CD group (P < .05). Patient and surgeon satisfaction scores were significantly higher in the WH group than the CD group (P < .05). In addition, the times to first flatus/defecation and bowel movement were significantly longer in the CD group (P < .05). No significant differences were noted between the groups in the time to tolerance of semiliquid food and time of discharge (P > .05). The incidence of vomiting, diarrhea, and shivering was significantly lower in the WH group (P < .05). The number of patients with a shivering grade of 0 was significantly higher in the WH group, whereas the number with a shivering grade of 3 was significantly higher in the CD group (P < .05). CONCLUSION: Warmed, humidified insufflation of CO2 in elderly patients undergoing laparoscopic colorectal surgery could stabilize hemodynamics, and reduce lactic acid levels, recovery time in the PACU, and the incidence of acute gastrointestinal injury-related symptoms.


Assuntos
Dióxido de Carbono/uso terapêutico , Cirurgia Colorretal/métodos , Insuflação/métodos , Complicações Intraoperatórias/prevenção & controle , Pneumoperitônio Artificial/métodos , Idoso , Dióxido de Carbono/efeitos adversos , Estudos de Casos e Controles , Feminino , Temperatura Alta/uso terapêutico , Humanos , Insuflação/efeitos adversos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Pneumoperitônio Artificial/efeitos adversos , Estudos Retrospectivos , Estatísticas não Paramétricas
15.
J Neuroinflammation ; 16(1): 36, 2019 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-30760300

RESUMO

BACKGROUND: This study investigated whether therapeutic hypercapnia (TH) ameliorated blood-brain barrier (BBB) damage and improved the neurologic outcome in a rat model of lateral fluid percussion injury (FPI), and explored the possible underlying mechanism. METHODS: Rats underwent lateral FPI and received inhalation of 30%O2-70%N2 or 30%O2-N2 plus CO2 to maintain arterial blood CO2 tension (PaCO2) between 80 and 100 mmHg for 3 h. To further explore the possible mechanisms for the protective effects of TH, a PKC inhibitor staurosporine or PKCαß inhibitor GÖ6976 was administered via intracerebral ventricular injection. RESULTS: TH significantly improved neurological function 24 h, 48 h, 7 d, and 14 d after FPI. The wet/dry ratio, computed tomography values, Evans blue content, and histological lesion volume were significantly reduced by TH. Moreover, numbers of survived neurons and the expression of tight junction proteins (ZO-1, occludin, and claudin-5) were significantly elevated after TH treatment at 48-h post-FPI. TH significantly increased the expression of protein kinase Cε (PKCε) at 48-h post-FPI, but did not significantly change the expression of PKCα and PKCßII. PKC inhibitor staurosporine (but not the selective PKCαß inhibitor-GÖ6976) inhibited the protective effect of TH. CONCLUSIONS: Therapeutic hypercapnia is a promising candidate that should be further evaluated for clinical treatment. It not only protects the traumatic penumbra from secondary injury and improves histological structure but also maintains the integrity of BBB and reduces neurologic deficits after trauma in a rat model of FPI.


Assuntos
Barreira Hematoencefálica/fisiopatologia , Lesões Encefálicas Traumáticas/patologia , Lesões Encefálicas Traumáticas/terapia , Dióxido de Carbono/uso terapêutico , Hipercapnia , Proteína Quinase C-épsilon/metabolismo , Animais , Pressão Sanguínea/efeitos dos fármacos , Edema Encefálico/etiologia , Edema Encefálico/terapia , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Carbazóis/uso terapêutico , Modelos Animais de Doenças , Frequência Cardíaca/efeitos dos fármacos , Masculino , Exame Neurológico , Oxigênio/metabolismo , Proteína Quinase C-épsilon/genética , Inibidores de Proteínas Quinases/uso terapêutico , Ratos , Ratos Sprague-Dawley , Estaurosporina/uso terapêutico , Fatores de Tempo , Tomógrafos Computadorizados
16.
Aesthetic Plast Surg ; 43(1): 213-220, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30132109

RESUMO

PURPOSE: A linear surgical scar, when located in the head and neck region, can be a significant cosmetic concern. Laser skin resurfacing with a fractional laser and a pulsed dye laser has been proven to be useful for treating such scars. As alternatives, we used a classic ablative CO2 laser in continuous mode with a 1-mm spot size and a 595-nm Nd:YAG laser. We investigated the effect of the combination of the continuous CO2 laser and 595-nm Nd:YAG laser and compared it to the effect of fractional CO2 laser monotherapy on linear scars. METHODS: This was a retrospective, case-controlled study designed to compare the efficacy between fractional CO2 laser therapy and combination therapy with a conventional CO2 laser in continuous mode and a 595-nm Nd:YAG laser. Treatment efficacy was evaluated by two different scar scales: the Stony Brook Scar Evaluation Scale (SBSES) and the modified Vancouver Scar Scale (mVSS). Laser treatments were performed every month until the 6th month after surgery. RESULTS: The SBSES and mVSS scores improved over time in both the monotherapy and the combination therapy (P < 0.001). No significant differences were found between the therapies for all the subcategories of the SBSES. However, among all the subcategories of the mVSS, pigmentation showed a better prognosis with combination therapy (P = 0.04). CONCLUSION: Monotherapy and combination therapy can provide similar positive effects on linear scar improvement after repeated treatment, whereas combination therapy exerts more favorable anti-pigmentation effects than monotherapy. The combination of a continuous ablative CO2 laser with a 595-nm Nd:YAG laser can be used as a favorable alternative to a fractional CO2 laser. The 1-mm spot size of the CO2 laser beam may mimic the fractional laser form and offer more effective results for linear incision scars. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .


Assuntos
Cicatriz/prevenção & controle , Terapia a Laser/métodos , Lasers de Gás/uso terapêutico , Lasers de Estado Sólido/uso terapêutico , Ferida Cirúrgica/cirurgia , Adulto , Dióxido de Carbono/uso terapêutico , Estudos de Casos e Controles , Cicatriz/cirurgia , Terapia Combinada , Estética , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ferida Cirúrgica/patologia , Resultado do Tratamento
17.
J Surg Res ; 234: 334-342, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30527494

RESUMO

BACKGROUND: Recently, atmospheric low-temperature plasma (LTP) has attracted attention as a novel medical tool that might be useful for achieving hemostasis. However, conventional plasma sources are too big for use with endoscopes, and the efficacy of LTP for achieving hemostasis in cases of gastrointestinal bleeding is difficult to investigate. In this study, to solve the problem, we developed a 3D-printed LTP jet that has a diameter of 2.8 mm and metal body for endoscopic use. The characteristics, hemostasis efficacy, and safety were investigated. MATERIALS AND METHODS: On investigating the basic characteristics of the developed plasma jet, the electron densities, gas temperatures, and reactive species were measured by emission spectroscopy and thermocouple. To evaluate the efficacy of such hemostatic treatment, porcine gastrointestinal bleeding was treated with the device. In addition, to investigate the safety of such treatment, the CO2 LTP-treated tissue was compared with tissue that was treated with clipping-based or argon plasma coagulation-based hemostasis for 5 d, and hematoxylin and eosin staining was used to evaluate tissue damage in the treated regions. RESULTS: The measurement of emission spectroscopy, power, and electron density of various gas plasmas suggested that a high-density (1014 cm-3) LTP of CO2 was generated by the LTP jet, and the gas temperature was 41.5°C at 3 mm from the outlet of the LTP jet. The CO2 LTP achieved hemostasis of oozing blood by 70 ± 20 s. In addition, the CO2 LTP resulted in earlier recovery than clipping-based or argon plasma coagulation-based hemostases, and the treated regions had no damage by the CO2 LTP treatment. CONCLUSIONS: These results indicated that the developed LTP plasma jet has the potential to be used for endoscopic hemostasis.


Assuntos
Dióxido de Carbono/uso terapêutico , Hemorragia Gastrointestinal/terapia , Hemostase Endoscópica/métodos , Hemostáticos/uso terapêutico , Gases em Plasma/uso terapêutico , Animais , Coagulação com Plasma de Argônio , Hemostase Endoscópica/instrumentação , Impressão Tridimensional , Suínos , Resultado do Tratamento
18.
Int Wound J ; 16(2): 316-324, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30467979

RESUMO

To examine the influence of carboxytherapy on wound healing under venous insufficiency, full-thickness excisional wounds were created on Wistar rats. We used three groups with 32 rats each: Group (I): daily cleaning with 0.9% saline solution; Group Sulfadiazine (II): 1% silver sulfadiazine; and Carboxytherapy (III): subcutaneous application of 0.3 mL of carbon dioxide. The predetermined periods of analysis were the 3rd, 7th, 14th, and 30th day. The slides were stained with haematoxylin and eosin and Picrosirius red and submitted for immunohistochemistry. Groups II and III presented a statistically significant decrease in relation to the presence of neutrophilic and lymphocytic infiltrates. The presence of collagen significant increased in groups II and III. However, group III presented better organisation. Only group I maintained the neovascularisation until the 30th day. The new epithelium statistically significantly increased in groups II and III. On immunohistochemistry, regarding fibronectin expression, only group III demonstrated a statistically significant increase since the beginning of the healing process. Thus, the use of carboxytherapy promotes the formation of a tissue better structured and that may be an important resource for the treatment of wounds under venous insufficiency, especially those of recurrent re-openings.


Assuntos
Dióxido de Carbono/uso terapêutico , Fibronectinas/efeitos dos fármacos , Inflamação/tratamento farmacológico , Sulfadiazina de Prata/uso terapêutico , Insuficiência Venosa/tratamento farmacológico , Cicatrização/efeitos dos fármacos , Animais , Masculino , Ratos , Ratos Wistar
19.
Med Intensiva ; 43(4): 234-242, 2019 05.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29486904

RESUMO

Important recent insights have emerged regarding the cellular and molecular role of carbon dioxide (CO2) and the effects of hypercapnia. The latter may have beneficial effects in patients with acute lung injury, affording reductions in pulmonary inflammation, lessened oxidative alveolar damage, and the regulation of innate immunity and host defenses by inhibiting the expression of inflammatory cytokines. However, other studies suggest that CO2 can have deleterious effects upon the lung, reducing alveolar wound repair in lung injury, decreasing the rate of reabsorption of alveolar fluid, and inhibiting alveolar cell proliferation. Clearly, hypercapnia has both beneficial and harmful consequences, and it is important to determine the net effect under specific conditions. The purpose of this review is to describe the immunological and physiological effects of carbon dioxide, considering their potential consequences in patients with acute respiratory failure.


Assuntos
Dióxido de Carbono/fisiologia , Dióxido de Carbono/uso terapêutico , Estado Terminal , Humanos , Hipercapnia , Alvéolos Pulmonares/citologia , Alvéolos Pulmonares/fisiologia , /terapia
20.
Surg Laparosc Endosc Percutan Tech ; 29(2): 90-94, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30395045

RESUMO

PURPOSE: Laparoscopic appendectomy has become more popular compared with the open appendectomy in children, but there are limited data on the effects of pneumoperitoneum and Trendelenburg position on cerebral oxygenation. This study was designed to evaluate the changes in cerebral saturation using near-infrared spectroscope during laparoscopic surgery in children. METHODS: The children underwent laparoscopic (LAP Group, n=22) or open appendectomy (OPEN Group, n=22). Right and left cerebral oxygenation (RScO2-LScO2), heart rate (HR), mean arterial pressure (MAP), end-tidal CO2pressure (PETCO2), and peripheral oxygen saturations (SpO2) were recorded between anesthesia induction (T0, baseline), after induction (T1), after intubation (T2), 5 minutes after intubation (T3), 5 minutes after pneumoperitoneum-15th minute at OPEN (T4), 5 minutes after Trendelenburg-20th minute at OPEN (T5), 30 minutes after pneumoperitoneum-45th minute at OPEN (T6), 5 minutes after supine position-skin suturing at OPEN (T7), 5 minutes postextubation (T8). RESULTS: Groups were similar with respect to their demographic data. In LAP group, a significant increase in HR was recorded at T5. No significant difference was observed in the MAP, PETCO2, SpO2, RScO2, and LScO2 values between the groups. There was a significant increase in the perioperative T1 to T8 values compared with the T0 values in LScO2 of the LAP group. CONCLUSIONS: Our results suggest that pneumoperitoneum and Trendelenburg position does not alter the hemodynamic values and can be safely performed in children without altering regional brain oxygenation levels.


Assuntos
Química Encefálica/fisiologia , Decúbito Inclinado com Rebaixamento da Cabeça/fisiologia , Laparoscopia , Oxigênio/sangue , Adolescente , Apendicectomia/métodos , Pressão Sanguínea/fisiologia , Dióxido de Carbono/uso terapêutico , Criança , Pré-Escolar , Feminino , Frequência Cardíaca/fisiologia , Humanos , Insuflação/métodos , Cuidados Intraoperatórios , Masculino , Monitorização Intraoperatória , Duração da Cirurgia , Pneumoperitônio Artificial
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