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PURPOSE: We aimed to investigate controversial pediatric urolithiasis issues systematically, integrating expert consensus and comprehensive guidelines reviews. METHODS: Two semi-structured online focus group meetings were conducted to discuss the study's need and content, review current literature, and prepare the initial survey. Data were collected through surveys and focus group discussions. Existing guidelines were reviewed, and a second survey was conducted using the Delphi method to validate findings and facilitate consensus. The primary outcome measures investigated controversial issues, integrating expert consensus and guideline reviews. RESULTS: Experts from 15 countries participated, including 20 with 16+ years of experience, 2 with 11-15 years, and 4 with 6-10 years. The initial survey identified nine main themes, emphasizing the need for standardized diagnostic and treatment protocols and tailored treatments. Inter-rater reliability was high, with controversies in treatment approaches (score 4.6, 92% agreement), follow-up protocols (score 4.8, 100% agreement), and diagnostic criteria (score 4.6, 92% agreement). The second survey underscored the critical need for consensus on identification, diagnostic criteria (score 4.6, 92% agreement), and standardized follow-up protocols (score 4.8, 100% agreement). CONCLUSION: The importance of personalized treatment in pediatric urolithiasis is clear. Prioritizing low-radiation diagnostic tools, effectively managing residual stone fragments, and standardized follow-up protocols are crucial for improving patient outcomes. Integrating new technologies while ensuring safety and reliability is also essential. Harmonizing guidelines across regions can provide consistent and effective management. Future efforts should focus on collaborative research, specialized training, and the integration of new technologies in treatment protocols.
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Guias de Prática Clínica como Assunto , Urolitíase , Humanos , Criança , Urolitíase/terapia , Urolitíase/diagnóstico , Consenso , Técnica DelphiRESUMO
Context: Papillary thyroid carcinoma(PTC)s are the indolent progressive tumours. Survivin is a unique bifunctional protein with cell cycle regulation and apoptosis inhibition. The expression of this protein has been shown to be increased in thyroid tumours correlated with aggressive behavior from well differentiated to anaplastic. Objective: In this study, we aimed to investigate the relationship between immunohistochemically survivin expression and tumour-associated prognostic factors in papillary thyroid carcinomas. Design: In patients with thyroidectomy, we compared the clinicopathological findings and immunohistochemical positivity for survivin. Subjects and Methods: In 109 patients, sex, age, tumour size, histological tumour variant, tumour focality, tumour border pattern, tumour peripheral/intratumoural lymphocytic and stromal response, intraglandular spread, extrathyroideal spread, lymph node metastases, lymphocytic tiroiditis and relationships of these findings with survivin positivity were investigated. Results: When we indicated the tumour size and compared it with survivin expression, tumour size correlates with, survivin expression (p = 0.016). Survivin expression was correlated statistically significant with lymphovascular invasion, without stromal response and with intraglandular extension respectively (p<0.001, p = 0.043, p<0.001). No significant correlation was found between other clinicopathological parameters and survival. Conclusion: Few studies have investigated the relationship of survivin expression with prognosis in thyroid papillary carcinomas and showed that survivin was a poor prognostic marker. If its expression is detected in preoperative cytology smears, it may affects the surgical treatment strategy. When it is detected in the tissue, postoperative radioactive iodine treatment plan may be modified and the need for more aggressive follow-up may be considered.
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Modifying genes play an exclusive role in the genetic regulation of the risk of breast cancer development in women with a pathogenic variation of BRCA1 or BRCA2. Therefore, it has been suggested that TNFRSF11A, which is among those modifying genes present in breast cancer development, may have a significant role in patients with positive BRCA1 or BRCA2 variations. In our study, we investigated the probable effects of single nucleotide polymorphisms (SNPs) in the TNFRSF11A gene, such as rs4485469, rs9646629, rs34739845, rs17069904, rs 884205, rs4941129 on the risk of breast cancer in patients with BRCA1 or BRCA2 variations. A total of 23 breast cancer patients with pathogenic variations in the BRCA1 or BRCA2 genes, 28 patients with no pathogenic variations in the BRCA1 or BRCA2 genes, and 55 healthy women as a control group, were included in this study. The SNPs were determined with allelic discrimination analysis through the real-time polymerase chain reaction (qPCR) method. There was no statistically significant difference between the SNPs of the TNFRSF11A gene rs4485469, rs9646629, rs34739845, rs17069904, rs884205, rs4941129 and metastasis, estrogen receptor, progesterone receptor and CerB2 receptor positivity between patient and control group (p >0.05). However, the rs4485469 SNP was found to be borderline significant between the patient groups with and without BRCA1 or BRCA2 mutations (p = 0.059). In patients with BRCA1 or BRCA2 pathogenic variations living in the Trakya region of Turkey, we could not determine the relationship between TNFRSF11 SNPs with breast cancer risk.
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Calciphylaxis, also known as calcific uremic arteriolopathy (CUA), is usually observed in women and it is a serious complication of hyperparathyroidism secondary to chronic renal failure. CUA is characterized by ischemic tissue loss secondary to progressive vascular degeneration. Although it is rare, it may end up with sepsis and organ failure and can be fatal. Its pathogenesis is not fully understood, but it is thought that it occurs secondary to increased calcification activators such as oxidized LDL, TNF- α, calcitriol, fibronectin, collagen-I, and TGF-1α. The most effective treatment is managing underlying pathology and decreasing serum calcium and phosphorus levels. In this report, we aimed to present an end stage renal failure case with coexisting hyperparathyroidism, hyperthyroidism and calciphylaxis in whom cutaneous manifestations were healed 6 months after parathyroidectomy.
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BACKGROUND: Occult papillary thyroid carcinoma presented as isolated cervical lymphadenopathy without clinical and radiologic findings has been rarely reported. CASE REPORT: A 47 years old female patient admitted to otorhinolaryngology clinic with 4X3 cm sized cervical mass. Physical examination of the patient was noted as a nontender, firm, mobile lymph node at right lateral cervical region. There was no inflammatory or infection disease in the history of patients anamnesis and no abnormal value on laboratory tests. Ultrasound screening of the neck detected a lymph node with suspicious features for malignancy. Head and neck examination was normal and there is no evidence of a tumoral mass or nodule in the thyroid gland. Whole body scan of MRI showed no pathologic sign both in the neck and body. Excisional biopsy was performed and revealed a carcinoma with papillary morphology. Immunohistochemical staining features of the tumor confirmed a papillary carcinoma derived from the thyroid gland. Second look USG of the neck and thyroid was performed but it revealed no tumoral mass. The patient underwent total thyroidectomy with right functional and central lymph node dissection. Histological examination of the thyroid gland showed multicentric 2 mm sized, three foci of papillary carcinoma located in bilateral thyroid lobes and metastatic lymph nodes in the right side of the neck. CONCLUSION: A metastatic cervical lymph node can be evidence of a clinically undetected occult papillary thyroid carcinoma. Specific immunohistochemistry staining of specimen may lead to appropriate surgery and progression of carcinoma may be hindered by application of additional RAI therapy.
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Hyperthyroidism is not a rare entity in pregnancy and 85% of these cases attributed to Graves' disease (GD). There is no therapeutic modality for GD considered as totally safe in pregnancy. Fetal and neonatal risks of maternal hyperthyroid disease are related to the hyperthyroidism itself and/or to the medical treatment of the disease. There are no data supporting an association between congenital anomalies in the fetus and propylthiouracil (PTU). Hepatotoxicity, cytopenias--especially agranulocytosis and quite rarely, angioedema, may be seen as side effects of PTU. In this case report, we examine an instance of Graves' hyperthyroidism diagnosed during pregnancy. In this case, a serious side effect during anti-thyroid drug usage was encountered, eventually resulting in surgery in the second trimester. This intervention was assisted by the use of plasmapheresis to obtain rapid normalization of serum thyroid hormone levels.
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Angioedema/terapia , Antitireóideos/efeitos adversos , Doença de Graves/tratamento farmacológico , Plasmaferese , Complicações na Gravidez/tratamento farmacológico , Propiltiouracila/efeitos adversos , Angioedema/induzido quimicamente , Feminino , Doença de Graves/diagnóstico , Humanos , Gravidez , Complicações na Gravidez/induzido quimicamente , Complicações na Gravidez/diagnóstico , Cuidados Pré-Operatórios , Tireoidectomia , Adulto JovemRESUMO
INTRODUCTION AND OBJECTIVES: We aimed to present a clinical study that compares standard and miniaturized percutaneous nephrolithotomy (PNL) effects on kidney function with scintigraphic imaging in primary kidney stone patients. MATERIALS AND METHODS: One hundred four patients were included in this prospective study between May 2014 and February 2017. Eligible patients were divided into two groups miniaturized PNL (mPNL) and standard PNL (sPNL) with matched-pair analysis (1:1 scenario). Technetium-99m Dimercaptosuccinic Acid cortical scintigraphy imaging was performed before and after the operation. RESULTS: There were no differences between the two groups in terms of success rate (mPNL (63.5%) vs. sPNL (71.2%), p=0.403), serum creatinine, glomerular filtration rate, split renal functions pre- and postoperatively (p≥0.05). There was no relationship between the type of operation and new scar formation (p=0.780). The rates of serious complication (grades 3 and 4 according to modified Clavien-Dindo Classification) were higher in sPNL (p=0.034). Stone burden, duration of operation, hemoglobin drop, multiple access, blood transfusion, and angioembolization were higher in patients with scarred kidneys (p<0.001, p=0.008, p=0.004, p<0.001, p=0.003, p=0.001, respectively). In multivariate analysis, only multiple access was found statistically significant for predicting new scar formation (p<0.001, OR: 24.28). CONCLUSIONS: Miniaturized and standard PNL are reliable and successful operations for treating large kidney stones. No significant difference was found between the operation types regarding a decrease in renal function.
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Cálculos Renais , Nefrolitotomia Percutânea , Humanos , Nefrolitotomia Percutânea/métodos , Estudos Prospectivos , Cicatriz , Resultado do Tratamento , Rim/diagnóstico por imagem , Rim/cirurgia , Rim/fisiologia , Cálculos Renais/diagnóstico por imagem , Cálculos Renais/cirurgia , Cintilografia , Ácido Dimercaptossuccínico Tecnécio Tc 99mRESUMO
Nontraumatic rapid growing giant fat necrosis of the breast mimicking breast tumors is a rare clinical manifestation. The imaging features of the fat necrosis which range from benign to malign findings may be better explained with associated aetiology. The present paper reports a 54-year old woman with a rapid growing, fibrous, and hard giant mass originating in the subareolar region of the left breast. Mammography and magnetic resonance imaging demonstrated a heterogeneous, well circumscribed mass in 12 × 12 cm size in the left breast. The lesion was suspected as a malignant tumor and underwent core biopsy. The histopathology examination of the biopsy revealed mononuclear cells, foamy, vacuolated, and bubbly cells containing fat. Excision biopsy of the mass was performed and the final pathological diagnosis was confirmed as fat necrosis. The wide clinical and radiologic manifestations of fat necrosis are still difficult to diagnose even with the new diagnostic modalities and a great proportion of these lesions need a biopsy to diagnose.
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Doenças Mamárias/diagnóstico , Neoplasias da Mama/diagnóstico , Necrose Gordurosa/diagnóstico , Doenças Mamárias/patologia , Diagnóstico Diferencial , Necrose Gordurosa/patologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Mamografia , Pessoa de Meia-IdadeRESUMO
PURPOSE: The purpose of this study was to report the clinical course and outcome of patients suffering from advanced cholangiocarcinoma (CCA). METHODS: The medical records of 93 patients with unresectable or metastatic CCA were retrospectively analyzed. RESULTS: Out of 93 patients, 53 (64.9%) were initially managed with palliative biliary drainage (PBD). Cisplatinbased regimens were administered to 18 (19.3%) patients, and non-cisplatin regimens (mainly 5-fluorouracil [5-FU]- based) were administered to 23 (24.8%) patients. Of all 93 patients 53 (55.9%) did not receive chemotherapy. The median overall survival (OS) for all patients was 6.1 months and was significantly higher in patients treated with chemotherapy as compared to those without chemotherapy (p=0.002). However, no difference in OS was seen in patients treated with cisplatin- or 5-FU-based chemotherapy. We noticed that a high number of patients were not referred to a medical oncologist even for advice. CONCLUSION: The relief of bile duct obstruction is an important part of the initial patient management. One of the main observations of this study was that systemic chemotherapy significantly improved survival. Increased awareness of the medical oncologists' role in the management of CCA can increase the number of patients who can have access to chemotherapy.
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Neoplasias dos Ductos Biliares/tratamento farmacológico , Ductos Biliares Intra-Hepáticos , Colangiocarcinoma/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias dos Ductos Biliares/mortalidade , Colangiocarcinoma/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The aim of this study was to prepare a new microsphere (fucosphere) system based on polyion complexation of fucoidan with chitosan, and to evaluate its treatment efficiency on dermal burns. The physicochemical properties such as mean particle size and distribution, zeta potential and bioadhesive properties of the microspheres were investigated. The formulation which had the high surface charge, narrow size distribution and the highest bioadhesive property was selected and applied on seven male New Zealand white rabbits with dermal burns. Biopsy samples were taken on day 7, 14 and 21. Each burn site was evaluated macroscopically and histopathologically and the findings were compared with controls of fucoidan solution and chitosan microspheres. The microspheres between the size ranges of 367 and 1017 nm were obtained. The work of bioadhesion of microspheres, with the surface charges +6.1 to +26.3 mV, changed between 0.081 and 0.191 mJ cm(-2). Macroscopically and histopathological observations indicated that the fastest healing of the burns was obtained in group treated with fucosphere after 21 days of treatment (P<0.05). Rete peg formation values and nuclear organize regions (NORs) were higher with treated fucospheres than the other groups on day 14. In conclusion, in vitro and in vivo evaluation of fucospheres indicated that the new microsphere system shortened the treatment period of burns and provided fast and effective healing by improving regeneration and re-epithelization. Hence fucosphere may find application in the treatment of dermal burns.
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Queimaduras/terapia , Quitosana/química , Microesferas , Polissacarídeos/química , Cicatrização , Animais , Química Farmacêutica/métodos , Epitélio/efeitos dos fármacos , Masculino , Microscopia Eletrônica de Varredura , Região Organizadora do Nucléolo/metabolismo , Tamanho da Partícula , Coelhos , Regeneração , Tecnologia Farmacêutica/métodosRESUMO
The effect of applying ozonation and perozonation to antibiotic cefazolin-Na formulation effluents were investigated in this study. Twenty minutes of ozonation at a rate of 1,500 mg/L-h was observed to remove COD by 38%, whereas a COD removal efficiency of 40% was achieved via H2O2 enhanced ozonation (same conditions + 31.25 mM H2O2). Both of the pretreatment alternatives were monitored to elevate the BOD5/COD ratio from 0.01 to 0.08. The initially inert COD was reduced by 38% using ozonation and by 60% employing H2O2 enhanced ozonation. In terms of the lowest achievable effluent COD levels after bio-treatment, ozonation was observed to yield a residual COD of 205 mgL(-1), while a residual COD of 135 mgL(-1) was involved for perozonation. According to the results of acute toxicity on Phaedactylum tricornutum, ozonated and perozonated samples exhibited more toxicity than the untreated effluent after 4 days. The activated sludge inhibition test demonstrated that both of the pretreatment alternatives efficiently eliminated the inhibition of investigated formulation effluent.
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Antibacterianos/química , Cefazolina/química , Peróxido de Hidrogênio/química , Ozônio/química , Eliminação de Resíduos Líquidos/métodos , Purificação da Água/métodos , Diatomáceas/efeitos dos fármacos , Oxirredução , Oxigênio/análise , Testes de Toxicidade Aguda , Poluentes Químicos da Água/análise , Poluentes Químicos da Água/toxicidadeRESUMO
Introducción y objetivos Nos propusimos realizar un estudio clínico para comparar los efectos de la nefrolitotomía percutánea (NLP) convencional y miniaturizada sobre la función renal evaluada mediante imágenes de gammagrafía en pacientes con cálculos renales primarios. Materiales y métodos Se incluyeron 104 pacientes en este estudio prospectivo entre mayo de 2014 y febrero de 2017. Los pacientes elegibles se dividieron en dos grupos: NLP miniaturizada (NLPm) y NLP convencional (NLPc) mediante muestras emparejadas (escenario 1:1). Se realizó una gammagrafía cortical con ácido dimercaptosuccínico de tecnecio-99m antes y después de la intervención. Resultados No hubo diferencias entre los dos grupos en cuanto a las tasas de éxito (NLPm [63,5%] frente a NLPc [71,2%], p=0,403), creatinina sérica, tasa de filtración glomerular, funciones renales diferenciales evaluadas antes y después de la intervención (p≥0,05). No hubo relación entre el tipo de procedimiento y la formación de nuevo tejido cicatricial (p=0,780). Las tasas de complicaciones graves (grados 3 y 4 según la clasificación de Clavien-Dindo modificada) fueron más altas en la NLPc (p=0,034). La carga litiásica, el tiempo quirúrgico, el descenso de la hemoglobina, los accesos múltiples, la transfusión de sangre y la angioembolización fueron mayores en los pacientes con riñones cicatrizados (p<0,001, p=0,008, p=0,004, p<0,001, p=0,003, p=0,001, respectivamente). En el análisis multivariante, sólo el acceso múltiple resultó estadísticamente significativo para predecir la formación de tejido cicatricial nuevo (p<0,001, OR: 24,28). Conclusiones La NLP miniaturizada y la convencional son intervenciones fiables y efectivas para el tratamiento de cálculos renales de gran tamaño. No se encontraron diferencias significativas entre los dos procedimientos en cuanto a la disminución de la función renal (AU)
Introduction and Objectives We aimed to present a clinical study that compares standard and miniaturized percutaneous nephrolithotomy (PNL) effects on kidney function with scintigraphic imaging in primary kidney stone patients. Materials and Methods One hundred four patients were included in this prospective study between May 2014 and February 2017. Eligible patients were divided into two groups miniaturized PNL (mPNL) and standard PNL (sPNL) with matched-pair analysis (1:1 scenario). Technetium-99m Dimercaptosuccinic Acid cortical scintigraphy imaging was performed before and after the operation. Results There were no differences between the two groups in terms of success rate (mPNL(63.5%) vs. sPNL(71.2%), p=0.403), serum creatinine, glomerular filtration rate, split renal functions pre- and postoperatively (p≥0.05). There was no relationship between the type of operation and new scar formation (p=0.780). The rates of serious complication (grades 3 and 4 according to modified Clavien-Dindo Classification) were higher in sPNL (p=0.034). Stone burden, duration of operation, hemoglobin drop, multiple access, blood transfusion, and angioembolization were higher in patients with scarred kidneys (p<0.001, p=0.008, p=0.004, p<0.001, p=0.003, p=0.001, respectively). In multivariate analysis, only multiple access was found statistically significant for predicting new scar formation (p<0.001, OR:24.28). Conclusions Miniaturized and standard PNL are reliable and successful operations for treating large kidney stones. No significant difference was found between the operation types regarding a decrease in renal function (AU)
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/métodos , Cálculos Renais/cirurgia , Estudos Prospectivos , Cintilografia , Ácido Dimercaptossuccínico Tecnécio Tc 99m , Compostos RadiofarmacêuticosRESUMO
Hydatid disease of the bone represents about 1-2.5% of all human hydatid disease. Spine is the most affected part of the skeleton with 50% incidence of all bone hydatidosis. Extraspinal bone hydatidosis is much rare. Diagnosis is difficult in the bone hydatid disease. Bone tumors, tumor-like lesions, and specific and nonspecific infections should be considered in the differential diagnosis. Radiological, laboratory, and clinical findings combined with strong element of suspicion are the key for diagnosis. Bone biopsies should be avoided because of the danger of anaphylaxis, sensitization, and spread. This paper describes the management of a patient with primary hydatidosis of the femur, which had been complicated by an extraosseous involvement, cortical erosion, and a pathological fracture due to a former needle biopsy.
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The most effective form of treatment for chronic renal failure is kidney transplantation from a cadaver or a living donor. For a kidney transplant to be successful, tissue compatibility and a lack of donor-specific anti-human leukocyte antigen (HLA) antibodies in the circulation of the patient are vital, in addition to ABO blood group compatibility. The presence of anti-HLA antibodies is assayed before transplantation using various methods, but because organ rejections have been observed in previous studies, different techniques are required to detect anti-HLA antibodies. Today, flow cytometry crossmatching is one of the most important and effective techniques in testing for donor-specific anti-HLA antibodies (DSAs). If weakly positive serum is assayed after serial dilution, it can yield high positivity. Herein, we describe the differences between the results for diluted and undiluted weakly positive sera studied using the flow cytometry crossmatch (FCXM) technique. In a recent study, the sera of weakly FCXM-positive patients were diluted 1/50, and the FCXM test was repeated. The use of diluted serum eliminated the effect of the prozone so that the DSAs could be detected.
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Citometria de Fluxo , Antígenos HLA/imunologia , Teste de Histocompatibilidade/métodos , Histocompatibilidade , Isoanticorpos/sangue , Falência Renal Crônica/cirurgia , Transplante de Rim/imunologia , Feminino , Humanos , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Soro/imunologia , CônjugesRESUMO
Cutaneous manifestations can occur in the wide range of internal malignancy. They can occur by metastases or local spread, direct infiltration, or a site of primary malignancy itself. Sometimes these manifestations are related with an underlying malignancy but they do not contain malignant cells as paraneoplastic dermatological syndromes. Chronic lymphocytic leukemia (CLL) is the most common leukemia all over the world. Cutaneous lesions occur in up to 25% of patients. Most commonly seen cutaneous lesions in CLL are those of infectious or hemorrhagic origin. Skin cancer risk was also increased eightfold in CLL when compared with normal population, so cutaneous lesions in CLL can be the first manifestation of secondary skin malignancy. Herein, we report an interesting case of Kaposi's sarcoma which was diagnosed during the course of CLL.
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Determining the presence of anti-HLA antibodies before transplantation is an important factor to prevent loss of function among renal transplantations. In addition, recent studies have shown that not only the pretransplantation existence of anti-HLA antibody but also posttransplantation donor-specific antibodies (DSA) and non-donor-specific antibodies are significantly associated with allograft rejection or loss of graft function. This study presented DSA among patients after renal transplantation together with graft function and survival.
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Antígenos HLA/imunologia , Histocompatibilidade , Isoanticorpos/sangue , Transplante de Rim/imunologia , Doadores de Tecidos , Dessensibilização Imunológica/métodos , Seleção do Doador , Feminino , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto , Teste de Histocompatibilidade , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Plasmaferese , Resultado do Tratamento , TurquiaRESUMO
The aim of this study was to evaluate the effect of epidural levobupivacaine on recovery from vecuronium-induced neuromuscular block. Ninety patients undergoing lower abdominal surgery were randomised into two groups after an epidural test dose: the epidural group (n = 45) received a bolus of 15 ml of 0.5% levobupivacaine whereas the control group (n = 45) did not. Anaesthesia was induced and maintained with propofol, fentanyl, vecuronium and nitrous oxide. Neuromuscular block was induced with vecuronium 0.1 mg/kg and monitored with acceleromyographic train-of-four at the adductor pollicis. Patients in each group received neostigmine at 25% recovery of the first twitch of train-of-four during recovery from anaesthesia. The effect of epidural levobupivacaine on the speed of recovery of neuromuscular function was evaluated. The lag time, onset time and time from vecuronium administration until 25% T1 recovery did not differ between the groups. The times of the recovery index (the time from 25% to 75% recovery of T1) and of the DUR 25-train-of-four 90 (time from 25% T1 to train-of-four ratio of 0.9) in the epidural group were significantly longer than those for the control group (5.2 [2.1] vs 3.04 [1.02] minutes and 10.8 [3.3] vs 8.2 [2.3] minutes, P < 0.001). This study shows that epidural levobupivacaine significantly delays the train-of-four recovery from vecuronium-induced block. Although the interaction is small in the clinical setting, anaesthetists should take this interaction into consideration when combining general and epidural anaesthesia during surgery.
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Abdome/cirurgia , Período de Recuperação da Anestesia , Anestesia Epidural , Anestésicos Locais , Bloqueio Neuromuscular , Fármacos Neuromusculares não Despolarizantes , Brometo de Vecurônio , Adulto , Idoso , Anestesia Geral , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Bupivacaína/análogos & derivados , Monitores de Consciência , Feminino , Humanos , Levobupivacaína , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Transmissão Sináptica/efeitos dos fármacosRESUMO
INTRODUCTION: Colorectal cancer is the third leading cause of cancer-related deaths in the world. Mostly, death occurs with complications of distant metastases. DISCUSSION: Effective systemic chemotherapy regimen and resultant improved survival for patients are associated with an increased incidence of metastases at uncommon sites. Therefore, incidences of osseous metastases are rising at the last decade. Osseous metastases are mostly diffuse, along with visceral metastases. CONCLUSION: Most common osseous metastatic sites are lumbal, sacral vertebrae, and pelvis region, probably because of colonic anatomical proximity to the paravertebral venous plexus. Herein, we report an uncommon case of isolated solitary tibia metastasis in the colorectal cancer patient and management of disease course.
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Adenocarcinoma/patologia , Neoplasias Ósseas/secundário , Neoplasias do Colo/patologia , Tíbia/patologia , Adulto , Neoplasias Ósseas/diagnóstico , Feminino , Humanos , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: Fucoidan is a complex polysaccharide containing sugars and high amounts of sulphate derived from marine brown algaes. In this study, a new microsphere-delivery system based on cross-linking of fucoidan with chitosan, named Fucosphere, was evaluated as a drug carrier. Bovine serum albumin (BSA) was used as a model protein. The effect of fucoidan (1.5, 1.75, 2.0 and 2.5%), chitosan (0.25, 0.50 and 0.75%) and protein (0.25, 0.50 and 0.75%) concentrations, the origin of chitosan and the preparation methods of the particles on the microsphere characteristics were evaluated. METHODS: The microspheres were prepared by a simple method based on the cross-linking of the opposite charged biopolymers. The shape and surface morphologies of the particles were evaluated by scanning electron microscopy (SEM) and the size, charge and encapsulation capacity of the microspheres were determined. The released amount of BSA from the microspheres into phosphate buffered saline (PBS pH 7.4) was determined spectrophotometrically by the Bradford method. SDS-PAGE was performed to check the structural integrity of BSA after the preparation. RESULTS: Smooth and spherical microspheres between the size ranges of 0.61-1.28 microm were obtained. BSA was efficiently encapsulated into the microspheres (51.8-89.5%). All formulation parameters affected the encapsulation capacity of Fucosphere (p < 0.05). The highest encapsulation was obtained with microspheres containing 2.5% of fucoidan (89.5%). CONCLUSIONS: The extent of drug release from the microspheres was dependent on the concentrations of polymers and BSA, chitosan origin and type of preparation method. When the addition methods of protein compared, BSA encapsulated into Fucosphere released slower than the adsorbed protein (E) (p < 0.05). The electrophoretic mobility values of Fucospheres changed between +6.9 and +32.3 mV. In general, BSA release from Fucosphere showed a three-phasic release curve. In conclusion, this new fucoidan microsphere system may be a potential delivery of macromolecular drug such as peptide and protein.
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Quitosana/química , Microesferas , Polissacarídeos/química , Soroalbumina Bovina/administração & dosagem , Animais , Materiais Biocompatíveis/química , Bovinos , Quitosana/análise , Preparações de Ação Retardada/administração & dosagem , Portadores de Fármacos , Composição de Medicamentos/métodos , Eletroforese em Gel de Poliacrilamida , Microscopia Eletrônica de Varredura , Tamanho da Partícula , Polissacarídeos/análise , Propriedades de SuperfícieRESUMO
Alginate and chitosan treated alginate beads were prepared and compared as an oral controlled release system for macromolecular drugs. Dextran (M.W. 70,000) was used as a model substance. The beads were prepared by the ionotropic gelation method and the effect of various factors (alginate, chitosan, drug and calcium chloride concentrations, the volume of external and internal phases and drying methods) on bead properties were investigated. The addition of chitosan increased the drug loading capacity of the beads, and larger beads were obtained in the presence of chitosan. On the other hand, addition of chitosan in the gel structure reduced the drug release from beads. The erosion of the beads was suppressed by chitosan treatment. The drying method was important to the properties of the chitosan-alginate beads. It is proposed that chitosan treated alginate beads may be used as a potential controlled release system of such macromolecules.