RESUMO
INTRODUCTION: Myasthenia gravis (MG) is an antibody-mediated autoimmune disease characterised by fluctuating, fatigable muscle weakness, frequently involving bulbar and respiratory muscles. Considering the severity of respiratory involvement in MG, routine evaluation of respiratory function is essential. The aim of this study was to identify a useful clinical marker of respiratory involvement in patients with MG. METHODS: We performed an observational study of patients with MG. All cases were evaluated with the single-breath count test, peak expiratory flow (PEF), a modified Medical Research Council dyspnoea scale (mMRC), and a neck strength assessment. The results of these parameters were correlated with forced vital capacity (FVC), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP). RESULTS: The study included 45 patients with MG: 2 patients classified as grade I on the Myasthenia Gravis Foundation of America classification at the time of evaluation, 35 classified as grade II, 7 classified as grade III, and one classified as grade IV. Positive correlations were found between single-breath count test scores and FVC values (r = 0.57, P = .000), and between PEF and FVC values (r = 0.76, P = .000). Severity of dyspnoea according to the mMRC scale showed a negative correlation with FVC values (r = -0.31, P = .03). PEF also showed a significant correlation with MEP (r = 0.51, P = .002). CONCLUSIONS: PEF, the single-breath count test, and the mMRC scale are useful measures for evaluating respiratory function in patients with MG.
Assuntos
Miastenia Gravis , Humanos , Miastenia Gravis/diagnóstico , Testes de Função Respiratória , Respiração , Músculos Respiratórios , Dispneia/etiologiaRESUMO
The objective of this study was to evaluate the effect of the presence of calcium oxalate (CaOx) crystals on the micromechanical properties of sclerenchyma tissue from the pecan nutshell (Carya illinoinensis). The microstructure of the cross-section nutshell was examined using light microscopy (LM) and atomic force microscopy (AFM). Using an instrumented indentation system, indentation tests with maximum loads of 500 mN were made on the biological material where the variables studied were the number of crystals present in the evaluated area and the size of individual crystals. Microscopic analysis revealed that the pecan nutshell consists of sclerenchyma tissue with multiple CaOx crystals randomly distributed throughout the material, exhibiting prismatic shapes and various sizes. The results of the indentation tests showed that the examined areas where there were crystals (1, 2 or up to 3) presented values of hardness and elastic modulus significantly higher (P < 0.05) compared to the sclerenchyma (without crystals). Likewise, there were no significant differences (P > 0.05) between the values of the micromechanical properties of the areas evaluated as a function of the number of crystals. On the other hand, it was observed that the size of the crystals did not show a direct correlation with the mechanical properties evaluated as expected. In conclusion, the biomineralization phenomenon is a successful strategy designed by nature to improve the rigidity of the pecan nutshell, where the CaOx crystals strengthen the structure by increasing the micromechanical properties.
Assuntos
Carya , Oxalato de CálcioRESUMO
In the present work a comprehensive characterization of the hierarchical architecture of the walnut shell (Juglans regia L.) was carried out using scanning electron microscopy (SEM), atomic force microscopy (AFM) and confocal laser scanning microscopy (CLSM). Furthermore, micromechanical properties (hardness, HIT and elastic modulus, EIT) of plant tissues were evaluated at cell wall level by applying the instrumented indentation technique (IIT). The complex architecture of the material was described in terms of four hierarchical levels (HL): endocarp (H1), plant tissues (H2), plant cells (H3) and cell wall (H4). Our findings revealed that the walnut shell consists of a multilayer structure (sclerenchyma tissue, ST; interface tissue, IT; porous tissue, PT; and flattened parenchyma tissue, FPT), where differences in the microstructure and composition of plant tissues generate parallel gradients along the cross-section. The indentation tests showed a functional gradient with a sandwich-like configuration, i.e., a lightweight and soft layer (PT, HIT = 0.04 GPa) is located between two dense and hard layers (ST, HIT = 0.33 GPa; FPT, HIT = 0.28 GPa); where additionally there is an interface between ST and PT (IT, HIT = 0.16 GPa). This configuration is a successful strategy designed by nature to improve the protection of the kernel by increasing the strength of the shell. Therefore, the walnut shell can be considered as a functionally graded material (FGM), which can be used as bioinspiration for the design of new functional synthetic materials. In addition, we proposed some structure-property-function relationships in the whole walnut shell and in each of the plant tissues.
Assuntos
Juglans , Parede Celular , Juglans/químicaRESUMO
INTRODUCTION: Myasthenia gravis (MG) is an antibody-mediated autoimmune disease characterised by fluctuating, fatigable muscle weakness, frequently involving bulbar and respiratory muscles. Considering the severity of respiratory involvement in MG, routine evaluation of respiratory function is essential. The aim of this study was to identify a useful clinical marker of respiratory involvement in patients with MG. METHODS: We performed an observational study of patients with MG. All cases were evaluated with the single-breath counting test, peak expiratory flow (PEF), a modified Medical Research Council dyspnoea scale (mMRC), and a neck strength assessment. The results of these parameters were correlated with forced vital capacity (FVC), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP). RESULTS: The study included 45 patients with MG: 2 patients classified as grade I on the Myasthenia Gravis Foundation of America classification at the time of evaluation, 35 classified as grade II, 7 classified as grade III, and one classified as grade IV. Positive correlations were found between single-breath counting test scores and FVC values (r = 0.57, p = .000), and between PEF and FVC values (r = 0.76, p = .000). Severity of dyspnoea according to the mMRC scale showed a negative correlation with FVC values (r = -0.31, p = .03). PEF also showed a significant correlation with MEP (r = 0.51, p = .002). CONCLUSIONS: PEF, the single-breath counting test, and the mMRC scale are useful measures for evaluating respiratory function in patients with MG.
RESUMO
Thirty-eight patients with pseudomyxoma peritonei were treated at the M. D. Anderson Hospital, Houston, from 1954 to 1978. The various treatment regimens used have provided actuarial survival rates of 54% at five years and 18% at ten years. Local or regional disease was the cause of death in 68% of patients, and no patient died of metastatic disease. Initial definitive surgery should consist of effective tumor reduction, omentectomy, appendectomy, and, in the female subject, bilateral oophorectomy. Most patients have been treated adjunctively with either fluorouracil or melphalan (L-phenylalanine mustard) depending on the presumed site of origin, but results in a small number of patients treated with either whole abdominal or strip abdominal radiotherapy suggest that this modality may offer improved survival. Treatment with adjunctive radiotherapy alone has provided a five-year survival rate of 75%, compared with 44% for chemotherapy.
Assuntos
Neoplasias do Apêndice/cirurgia , Cistadenoma/cirurgia , Neoplasias Ovarianas/cirurgia , Adolescente , Adulto , Idoso , Antineoplásicos/uso terapêutico , Neoplasias do Apêndice/tratamento farmacológico , Cistadenoma/tratamento farmacológico , Cistadenoma/radioterapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/radioterapiaRESUMO
The authors report the results of normative studies of pattern-shift visual, brainstem auditory and somatosensory evoked potentials of upper and lower limbs carried out in a sample of 51 normal subjects of a Brazilian population. Normal values were thus established for the main components of each modality of evoked potentials, with special emphasis on those having more clinical utility. The results were compared to the data available in the literature.
Assuntos
Potenciais Evocados/fisiologia , Adolescente , Adulto , Brasil , Eletrofisiologia , Potenciais Evocados Auditivos/fisiologia , Potenciais Somatossensoriais Evocados/fisiologia , Potenciais Evocados Visuais/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores de ReferênciaRESUMO
Based on the fact that Brazilian ethnic groups are mixed and therefore different from caucasian, chinese or japanese populations the authors studied the HLA antigen distribution in 37 myasthenic patients. The control group consisted of 69 healthy individuals of the same population studied in the same laboratory. The antigens HLA B8 showed the highest relative risk for female, younger than 40 years old, with thymic hyperplasia. Also the HLA B8 and A1 showed high frequency for black myasthenic patients.
Assuntos
Antígenos HLA/genética , Miastenia Gravis/imunologia , Fatores Etários , Brasil/etnologia , Suscetibilidade a Doenças , Feminino , Antígenos HLA-A/genética , Antígenos HLA-B/genética , Antígenos HLA-C/genética , Humanos , Masculino , Miastenia Gravis/etnologia , Fatores de Risco , Fatores SexuaisRESUMO
It is reported our diagnosis and therapeutical experience with a patient that presented clinical, radiological and tomographical manifestations of paracoccidioidomycosis with involvement of lungs, brain and spinal cord. Besides being a rare case the authors call attention for the extreme difficulty in defining the final diagnosis, which was achieved only after laminectomy and surgical biopsy of the intra spinal cord tumor at the C5 level. The patient received two series of treatment with ketoconazole (400-600 mg/day). After both the patient presented tonic and clonic convulsive disorders. We speculated about a possible perigranulomatous inflammatory response related to the therapeutical intervention, not yet described in literature.
Assuntos
Doenças do Sistema Nervoso Central/diagnóstico , Paracoccidioidomicose/diagnóstico , Doenças do Sistema Nervoso Central/tratamento farmacológico , Humanos , Cetoconazol/uso terapêutico , Masculino , Pessoa de Meia-Idade , Paracoccidioidomicose/tratamento farmacológicoRESUMO
Patients with intractable heart failure (New York Heart Association [NYHA] class III and IV) who were receiving maximal conventional treatment were enrolled in an outpatient program that included inotropic infusions, intensive patient education, and close follow-up. The effects of this approach to therapy were evaluated on (1) the number of hospital admissions, (2) length of stay, and (3) number of emergency room visits during the ensuing year. These data were compared with similar data from the year before entry in the program for each patient. Thirty-six patients with stable NYHA class III and IV heart failure received milrinone or dobutamine to manage chronic heart failure in an outpatient setting. The cause of heart failure was ischemic heart disease in 12, idiopathic in 11, hypertension in 8, and pulmonary hypertension in 5. Four patients received dobutamine and 32 patients received milrinone. The mean period of observation was 294 days. For the period before entry in the program, patients had 21 emergency room visits, 75 admissions, and 528 days spent in the hospital. After enrollment, patients had 10 emergency room visits, 34 admissions, and 150 days spent in the hospital. In conclusion, this therapeutic regimen reduced the number of hospital admissions, days spent in the hospital, and emergency room visits. Our study supports the concept that the use of intermittent inotropic therapy in the outpatient setting plays an important role in managing this severely ill group of patients.
Assuntos
Assistência Ambulatorial , Cardiotônicos/administração & dosagem , Dobutamina/administração & dosagem , Insuficiência Cardíaca/tratamento farmacológico , Piridonas/administração & dosagem , Amrinona/administração & dosagem , Amrinona/uso terapêutico , Cardiotônicos/uso terapêutico , Análise Custo-Benefício , Dobutamina/uso terapêutico , Esquema de Medicação , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Seguimentos , Insuficiência Cardíaca/economia , Humanos , Infusões Intravenosas , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Milrinona , Admissão do Paciente/economia , Admissão do Paciente/estatística & dados numéricos , Educação de Pacientes como Assunto , Piridonas/uso terapêutico , Fatores de TempoRESUMO
A retrospective study of 910 patients surviving at least five years after cervical irradiation for Hodgkin's disease, non-Hodgkin's lymphoma, or primary head an neck neoplasms showed the incidence of stroke following cervical irradiation was 63 of 910 patients (6.3%) during a mean period of observation of nine years. This represents a trend toward an increased risk for this population observed over the same period of time (p = 0.39). A prospective study of 118 similar patients currently living five years after cervical radiotherapy was performed to determine the incidence of carotid artery disease occurring as a consequence of neck irradiation. Abnormal carotid phonangiograms (CPA) were found in 25% of the patients and abnormal oculoplethysmographs (OPG) were found in 17%. These studies represent significant carotid lesions that are not expected in such a population. It is concluded that the carotid stenoses demonstrated are most likely a consequence of prior irradiation. Patients that are five-year survivors of cervical irradiation should have noninvasive vascular laboratory studies performed as part of their routine follow-up examinations in order to detect these carotid lesions while they are occult.
Assuntos
Doenças das Artérias Carótidas/etiologia , Transtornos Cerebrovasculares/etiologia , Neoplasias de Cabeça e Pescoço/radioterapia , Radioterapia/efeitos adversos , Adolescente , Adulto , Idoso , Artérias Carótidas/efeitos da radiação , Criança , Pré-Escolar , Feminino , Doença de Hodgkin/radioterapia , Humanos , Linfoma/radioterapia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Dosagem Radioterapêutica , Estudos Retrospectivos , RiscoRESUMO
O presente relato de caso, descreve nossa experiência diagnóstica e terapêutica com um paciente que apresentou manifestaçöes clínicas, radiológicas e tomográficas de paracoccidioidomicose comprometendo os pulmöes, cérebro e, particularmente, a medula espinhal. Além da raridade do caso, chama-se a atençäo para a extrema dificuldade na elucidaçäo diagnóstica definitiva, obtida somente após laminectomia e biópisa cirúrgica de tumoraçäo iintramedular ao nvel de C5. O paciente recebeu duas séries de tratamento com ketoconazol (400 a 600 mg/dia). No início de ambas apresentou crise convulsiva tònico-clónica. Especula-se sobre uma possível resposta inflamatória perigranulomatosa intracerebral, relacionada à intervençäo terapêutica, ainda sem relato na literatura