RESUMO
OBJECTIVE: To determine if laparoscopic excision is more effective than open excision in the treatment of choledochal cysts. MATERIAL AND METHODS: A systematic review of randomized clinical trials in 3 databases measuring the efficacy of laparoscopic and open excision of choledochal cysts was performed. The authors considered international and national reports, whose results were analyzed in detail. RESULTS: Mean duration of laparoscopic excision was 51 min, open excision - 35.4 min. Length of hospital-stay after laparoscopic excision ranged between 5 and 74 days, after open excision - between 7 and 146 days. Bile leakage rate was 1-2% and 4%, respectively. Laparoscopic excision was followed by lower complication rate. Morbidity and mortality in laparoscopic excision was 20% and 0%, in open excision - 60% and 3.3%, respectively. CONCLUSION: Laparoscopic excision is more effective than open excision in the treatment of choledochal cysts.
Assuntos
Cisto do Colédoco , Laparoscopia , Complicações Pós-Operatórias , Humanos , Cisto do Colédoco/cirurgia , Laparoscopia/métodos , Laparoscopia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/epidemiologia , Tempo de Internação/estatística & dados numéricos , Resultado do Tratamento , Avaliação de Processos e Resultados em Cuidados de SaúdeRESUMO
INTRODUCTION: One of the major concerns with post-acute sequelae of COVID-19 (PASC) is the development of pulmonary fibrosis, for which no approved pharmacological treatment exists. Therefore, the primary aim of this open-label study was to evaluate the safety and the potential clinical efficacy of a prolonged-release pirfenidone formulation (PR-PFD) in patients having PASC-pulmonary fibrosis. METHODS: Patients with PASC-pulmonary fibrosis received PR-PFD 1800 mg/day (1200 mg in the morning after breakfast and 600 mg in the evening after dinner) for three months. Blood samples were taken to confirm the pharmacokinetics of PR-PFD, and adverse events (AEs) were evaluated monthly using a short questionnaire. Symptoms, dyspnea, and pulmonary function tests (spirometry, diffusing capacity for carbon monoxide, plethysmography, and 6-min walk test [6MWT]) were evaluated at baseline, and one and three months after having started the PR-PFD treatment. RESULTS: Seventy subjects with mild to moderate lung restriction were included. The most common AEs were diarrhea (23%), heartburn (23%), and headache (16%), for which no modifications in the drug study were needed. Two patients died within the first 30 days of enrolment, and three opted not to continue the study, events which were not associate with PR-PFD. Pulmonary function testing, 6MWT, dyspnea, symptoms, and CT scan significantly improved after three months of treatment with PR-PFD. CONCLUSION: In patients with PASC pulmonary fibrosis, three months' treatment with PR-PFD was safe and showed therapeutic efficacy. Still, it remains to be seen whether the pulmonary fibrotic process remains stable, becomes progressive or will improve.
Assuntos
COVID-19 , Fibrose Pulmonar Idiopática , Pneumonia , Humanos , COVID-19/complicações , Progressão da Doença , Dispneia/tratamento farmacológico , Dispneia/etiologia , Fibrose Pulmonar Idiopática/complicações , Fibrose Pulmonar Idiopática/tratamento farmacológico , Fibrose Pulmonar Idiopática/diagnóstico , Fenótipo , Pneumonia/tratamento farmacológico , Piridonas/efeitos adversosRESUMO
We developed allometric equations to predict whole-tree leaf area (A(l)), leaf biomass (M(l)) and leaf area to sapwood area ratio (A(l):A(s)) in five rain forest tree species of Costa Rica: Pentaclethra macroloba (Willd.) Kuntze (Fabaceae/Mim), Carapa guianensis Aubl. (Meliaceae), Vochysia ferru-gi-nea Mart. (Vochysiaceae), Virola koshnii Warb. (Myristicaceae) and Tetragastris panamensis (Engl.) Kuntze (Burseraceae). By destructive analyses (n = 11-14 trees per species), we observed strong nonlinear allometric relationships (r(2) > or = 0.9) for predicting A(l) or M(l) from stem diameters or A(s) measured at breast height. Linear relationships were less accurate. In general, A(l):A(s) at breast height increased linearly with tree height except for Penta-clethra, which showed a negative trend. All species, however, showed increased total A(l) with height. The observation that four of the five species increased in A(l):A(s) with height is consistent with hypotheses about trade--offs between morphological and anatomical adaptations that favor efficient water flow through variation in the amount of leaf area supported by sapwood and those imposed by the need to respond quickly to light gaps in the canopy.
Assuntos
Ecossistema , Folhas de Planta/fisiologia , Árvores/classificação , Árvores/fisiologia , Madeira/fisiologia , Costa Rica , Fotossíntese/fisiologia , Caules de Planta/fisiologia , Especificidade da EspécieRESUMO
In this study we evaluate the accuracy of four global and regional forest cover assessments (MODIS, IGBP, GLC2000, PROARCA) as tools for baseline estimation. We conduct this research at the national scale for Costa Rica and for two tropical dry forest study sites in Costa Rica (Santa Rosa) and Mexico (Chamela-Cuixmala). We found that at the national level, the total forest cover accuracy of the four land cover maps was inflated due to an overestimation of forest in areas with an evergreen canopy. However, the four maps greatly underestimated the extent of the deciduous forest (dry forest); an ecosystem that faces high deforestation pressure and poses complications to the mapping of its extent from remotely sensed data. For the tropical dry forest sites, all maps have low forest cover accuracies (mean for Santa Rosa: 27%; mean for Chamela-Cuixmala: 56%). This has implications for policy implementation.
Assuntos
Conservação dos Recursos Naturais/economia , Conservação dos Recursos Naturais/métodos , Monitoramento Ambiental/economia , Monitoramento Ambiental/métodos , Astronave , Costa Rica , México , Fatores de Tempo , Árvores , Clima TropicalRESUMO
A simple measure of the amount of foliage present in a forest is leaf area index (LAI; the amount of foliage per unit ground surface area), which can be determined by optical estimation (gap fraction method) with an instrument such as the Li-Cor LAI-2000 Plant Canopy Analyzer. However, optical instruments such as the LAI-2000 cannot directly differentiate between foliage and woody components of the canopy. Studies investigating LAI and its calibration (extracting foliar LAI from optical estimates) in tropical forests are rare. We calibrated optical estimates of LAI from the LAI-2000 with leaf litter data for a tropical dry forest. We also developed a robust method for determining LAI from leaf litter data in a tropical dry forest environment. We found that, depending on the successional stage of the canopy and the season, the LAI-2000 may underestimate LAI by 17% to over 40%. In the dry season, the instrument overestimated LAI by the contribution of the woody area index. Examination of the seasonal variation in LAI for three successional stages in a tropical dry forest indicated differences in timing of leaf fall according to successional stage and functional group (i.e., lianas and trees). We conclude that when calculating LAI from optical estimates, it is necessary to account for the differences between values obtained from optical and semi-direct techniques. In addition, to calculate LAI from litter collected in traps, specific leaf area must be calculated for each species rather than from a mean value for multiple species.