RESUMO
BACKGROUND: Chemotherapy-associated liver injury (CALI) is a matter of concern for hepatobiliary surgeons as it can entail postoperative liver failure after an extensive hepatectomy. Recent studies have taken special interest in liver function parameters which can correlate with CALI to decrease this adverse event. Therefore, the current study investigates the usefulness of splenic volume as a biomarker of CALI through a portal hypertension mechanism, in patients with colorectal liver metastases (CRLM). STUDY DESIGN: We carried out a study in patients with CRLM operated on between 2009 and 2014 in our center. All samples of healthy liver were graded for non-alcoholic fatty liver disease (NAFLD) and sinusoidal obstructive syndrome. Computarized tomography scans for spleen volumetry were analyzed for each patient at CRLM diagnosis, after neoadjuvant chemotherapy, 1 and 6 months after resection. RESULTS: A group of 65 consecutive patients with CRLM of large bowel adenocarcinoma submitted to liver resection were included. Patients receiving neoadjuvant chemotherapy had a greater spleen volume increase than those who did not receive treatment (p = 0.053), finding a statistically significant spleen growth in patients with NAFLD (p = 0.036). There was no correlation between spleen enlargement and postoperative complications or average stay. However, survival was decreased in patients with spleen growth and CALI. CONCLUSIONS: Patients who receive neoadjuvant chemotherapy for liver metastasis surgery have a greater splenic volume increase, which correlates with NAFLD and a lower survival.
Assuntos
Adenocarcinoma/terapia , Antineoplásicos/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/patologia , Neoplasias Colorretais/patologia , Hepatectomia , Hepatopatia Veno-Oclusiva/patologia , Neoplasias Hepáticas/terapia , Hepatopatia Gordurosa não Alcoólica/patologia , Baço/diagnóstico por imagem , Adenocarcinoma/secundário , Antineoplásicos/uso terapêutico , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Fígado Gorduroso/induzido quimicamente , Fígado Gorduroso/patologia , Hepatopatia Veno-Oclusiva/induzido quimicamente , Humanos , Neoplasias Hepáticas/secundário , Metastasectomia , Terapia Neoadjuvante , Hepatopatia Gordurosa não Alcoólica/induzido quimicamente , Tamanho do Órgão , Oxaliplatina/efeitos adversos , Oxaliplatina/uso terapêutico , Complicações Pós-Operatórias , Baço/patologia , Taxa de Sobrevida , Tomografia Computadorizada por Raios XRESUMO
AIM: To assess the penetration of sodium hypochlorite (NaOCl) gel or NaOCl solutions with surfactants, and the effect of passive ultrasonic irrigation (PUI) on penetration into dentinal tubules. METHODOLOGY: Bovine incisor root canals were instrumented, the roots sectioned and the dentine blocks obtained were stained with crystal violet. Dentine blocks (n = 10 per group) were exposed to 3% NaOCl gel or 3% NaOCl solution for 10 and 20 min. Other dentine blocks (n = 10 per group) were exposed to Chlor-Extra (6% NaOCl + surfactant), 6% NaOCl, 2.5% NaOCl with 0.2% cetrimide and 2.5% NaOCl for 10 and 20 min. The penetration depth of irrigants into dentinal tubules was measured in micrometres by viewing the bleached crystal violet under a stereomicroscope. Additionally, bovine incisor root canals, instrumented and stained with crystal violet, were distributed into two groups (n = 10) and irrigated with 2.5% NaOCl with PUI or conventional syringe irrigation (CSI). The penetration depth of irrigants into dentinal tubules was assessed 3 and 7 mm from the apex. Statistical analysis was performed by ANOVA and Tukey tests (α = 0.05). RESULTS: There was significantly greater penetration of 3% NaOCl solution into dentinal tubules compared with the gel form (P < 0.05). There was no difference (P > 0.05) between 6% NaOCl and Chlor-Extra, and between 2.5% NaOCl and 2.5% NaOCl + cetrimide. PUI significantly increased the penetration depth of NaOCl into dentinal tubules when compared with CSI (P < 0.05). CONCLUSIONS: In extracted bovine incisors, NaOCl gel penetrated less into dentinal tubules than NaOCl solution. The addition of surfactants did not increase the penetration depth. The use of PUI significantly increased NaOCl penetration into dentinal tubules.
Assuntos
Dentina/efeitos dos fármacos , Irrigantes do Canal Radicular/farmacocinética , Hipoclorito de Sódio/farmacocinética , Raiz Dentária/efeitos dos fármacos , Animais , Bovinos , Géis , Técnicas In Vitro , Soluções , Tensoativos/farmacologia , Irrigação Terapêutica/métodos , Ultrassom/métodosRESUMO
INTRODUCTION: The maintenance of cerebral perfusion during shoulder surgery performed in the beach chair position is controversial. The aim of this report is to present the first case in Mexico of a total shoulder arthroplasty performed with interscalene block and monitoring of the cerebral oxygen saturation. This monitoring was described in 1977, but only until the last decade has it reached relevance from the clinical point of view. CLINICAL CASE: We present an 84-year-old patient scheduled for total shoulder arthroplasty in beach chair position under regional anesthesia (ultrasound-guided interscalene block) in which the regional oxygen saturation (CrSO2) was monitored. DISCUSSION: Monitoring of cerebral oximetry is a suitable tool that allows us to have a continuous assessment throughout the transanesthetic, so we can make decisions more expeditiously. On this basis, we believe that this type of monitoring should be fundamental in patients placed in a beach chair position, as well as predominantly use regional anesthesia. In cases where it cannot be used, this monitor is absolutely essential.
INTRODUCCIÓN: Desde hace algún tiempo es tema de controversia el mantenimiento de la perfusión cerebral durante la cirugía de hombro realizada en posición de silla de playa. El objetivo de este reporte es presentar el primer caso en México de una artroplastía total de hombro realizada con bloqueo interescalénico y monitoreo de la saturación cerebral de oxígeno. Este monitoreo se describió en 1977, pero sólo hasta la última década ha alcanzado relevancia desde el punto de vista clínico. CASO CLÍNICO: Paciente de 84 años programado para artroplastía total de hombro en posición de silla de playa bajo anestesia regional tipo bloqueo interescalénico guiado por ultrasonido, en la cual se monitoreó la saturación regional de oxígeno (CrSO2). DISCUSIÓN: El monitoreo de la oximetría cerebral es una herramienta adecuada que nos permite tener una valoración continua durante todo el transanestésico, con lo que podemos tomar decisiones de forma más expedita. Con base en esto consideramos que este tipo de monitoreo debe ser básico en pacientes colocados en posición de silla de playa, así como el uso preponderante de anestesia regional; en los casos donde ésta no se pueda utilizar, este monitor es primordial.
Assuntos
Artroplastia do Ombro , Idoso de 80 Anos ou mais , Humanos , México , Posicionamento do Paciente , Estudos Prospectivos , Ombro/cirurgiaRESUMO
AIM: To evaluate the effectiveness of isopropyl alcohol, saline or distilled water to prevent the precipitate formed between sodium hypochlorite (NaOCl) and chlorhexidine (CHX) and its effect on the bond strength of an epoxy-based sealer in radicular dentine. METHODOLOGY: The root canals of 50 extracted human canines (n = 10) were instrumented. In G1, root canals were irrigated with 17% EDTA and 2.5% NaOCl; G2, as G1, except that 2% CHX was used as the final irrigant. In the other groups, intermediate flushes with isopropyl alcohol (G3), saline (G4) or distilled water (G5) were used between NaOCl and CHX. The specimens were submitted to SEM analysis to evaluate the presence of debris and smear layer, in the apical and cervical segments. In sequence, fifty extracted human canines were distributed into five groups (n = 10), similar to the SEM study. After root filling, the roots were sectioned transversally to obtain dentine slices, in the cervical, middle and apical thirds. The root filling was submitted to a push-out bond strength test using an electromechanical testing machine. Statistical analysis was performed using Kruskal-Wallis and Dunn's tests (α = 5%). RESULTS: All groups had similar amounts of residue precipitated on the canal walls (P > 0.05). The push-out bond strength values were similar for all groups, independently of the root third evaluated (P > 0.05). CONCLUSIONS: Isopropyl alcohol, saline and distilled water failed to prevent the precipitation of residues on canal walls following the use of NaOCl and CHX. The residues did not interfere with the push-out bond strength of the root filling.
Assuntos
Precipitação Química , Clorexidina/química , Resinas Epóxi/química , Irrigantes do Canal Radicular/química , Hipoclorito de Sódio/química , 2-Propanol/química , Dente Canino , Cavidade Pulpar , Análise do Estresse Dentário , Dentina/química , Humanos , Técnicas In Vitro , Microscopia Eletrônica de Varredura , Preparo de Canal Radicular , Camada de Esfregaço , Cloreto de Sódio/química , Água/químicaRESUMO
Novel biodegradable segmented polyurethanes (SPUs) were synthesized with polycaprolactone diol, 4,4'-methylen bis (cyclohexyl isocyanate) (HMDI), and either L-glutathione or its constituent amino acids (L-glutamic acid, L-cysteine and glycine) as chain extenders. Fourier transform infrared spectroscopy analysis revealed the feasibility of obtaining polyurethanes through the presence of NH (Amide II), C-N, C-O, and C=O bands and the absence of NCO band. Differential scanning calorimetry and X-ray diffraction revealed that a semicrystalline polymer (T m = 42-52 °C; 2θ = 21.3° and 23°) was obtained in all cases, while dynamic mechanical analysis (DMA) revealed an amorphous phase (T g = -30 to -36 (o)C). These properties, in addition to their high molecular weight, led to high moduli and higher extensibilities when glycine and glutamic acid were used as chain extenders. Clotting times (Lee-White test) and activated partial thromboplastin time determined on these polyurethanes were longer than with glass. In addition, all synthesized SPU exhibited platelet activation indexes below the collagen type I positive control. Human umbilical vein endothelial cells viability was higher in SPUs containing either glycine or cysteine. The obtained results indicate that SPUs that use cysteine as chain extender are promising candidates for cardiovascular applications.
Assuntos
Aminoácidos/química , Glutationa/química , Células Endoteliais da Veia Umbilical Humana/citologia , Células Endoteliais da Veia Umbilical Humana/efeitos dos fármacos , Ativação Plaquetária/efeitos dos fármacos , Poliuretanos/química , Poliuretanos/farmacologia , Materiais Biocompatíveis/química , Materiais Biocompatíveis/farmacologia , Sobrevivência Celular/efeitos dos fármacos , Humanos , Teste de Materiais , Fenômenos Mecânicos , TemperaturaRESUMO
Two isolates of Haemophilus paragallinarum were obtained from a layer chicken in Mexico. The isolates were confirmed as H. paragallinarum by polymerase chain reaction and conventional biochemical identification. The isolates were nicotinamide adenine dinucleotide (NAD) independent-growing on blood agar without the need of a nurse colony as well as on a complex medium that lacked both NAD and chicken serum. Both isolates were pathogenic, causing the typical clinical signs of infectious coryza in susceptible chickens. One isolate was Page serovar B/Kume serovar B-1 and the other isolate was Page serovar C/Kume serovar C-2. The isolates were associated with a field outbreak that involved an egg drop of 20% over a 3-wk period and a doubling of weekly mortality (from 0.1% to 0.2%). This is the first report of NAD-independent H. paragallinarum outside South Africa and is the first time that NAD-independent H. paragallinarum of serovar B has been reported.
Assuntos
Galinhas/microbiologia , Infecções por Haemophilus/microbiologia , Haemophilus paragallinarum/isolamento & purificação , NAD/metabolismo , Doenças das Aves Domésticas/microbiologia , Animais , Técnicas de Tipagem Bacteriana/veterinária , Haemophilus paragallinarum/metabolismo , México , Reação em Cadeia da Polimerase/veterinária , Sorotipagem/veterináriaRESUMO
UNLABELLED: The purpose of this paper was to assess the accuracy of computed tomography (CT) and magnetic resonance (MR) in the preoperative identification of corticotropin-secreting pituitary adenomas and to evaluate the concordance with the postoperative outcome. A total of 44 images of patients with Cushing's disease were retrospectively taken into consideration; 23 CT and 29 MR were evaluated. Patients were subdivided into remission or persistence, following the postoperative outcome and biochemical tests. In 13 out of 23 CT performed, an adenoma was found, the remaining 10 being negative. TC sensitivity was 56.5%. Twenty five MR were positive and 4 were negative. The overall sensitivity of MR in detecting ACTH-secreting adenoma was greater (86.0%, P: 0.0373, after Yates correction). After operation, 31 patients (70.5%, Cl 0.70 +/- 0.13) were considered to be in remission (27 total remission and 4 partial remission); 23 had had preoperative visualization of the pituitary tumor and 8 negative neuroradiological evaluation. Thirteen patients had persistence of disease as shown by sustained hypercotisolism in biochemical tests. In 11 of these patients, an adenoma had been preoperatively identified whereas in the remaining 2 no evidence of tumor lesion had been detected. An histologically proven tumor was found in 33 patients but findings were negative in the remaining 11 cases. Lack of histological evidence of an ACTH-secreting adenoma was more frequent in patients with persistent hypercortisolism (P < 0.0078). IN CONCLUSION: 1) MR seems to be more sensitive than CT for detecting ACTH-secreting adenomas (P: 0.037, after Yates correction); 2) no relationship was disclosed between the absence of imaging signs of adenoma and the postsurgical outcome; 3) the remission rate was significantly higher in patients with positive than in those with negative histological findings.
Assuntos
Adenoma/diagnóstico , Síndrome de Cushing/diagnóstico , Neoplasias das Glândulas Endócrinas/diagnóstico , Hipófise , Adenoma/cirurgia , Adolescente , Adulto , Idoso , Neoplasias das Glândulas Endócrinas/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Hipófise/cirurgia , Período Pós-Operatório , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios XRESUMO
We report a 49-year-old woman with Marfan syndrome who underwent total thyroidectomy for follicular carcinoma. The patient was given 100 mCi of radioactive iodine (131I) followed by levothyroxine (LT4) 0.2 mg/day after surgery. The subsequent five total body scans were negative and thyroglobulin (TG) measurements ranged between undetectable levels to 12 ng/mL. Nine years after thyroidectomy the patient developed bilateral exophthalmos with markedly positive thyroid-stimulating immunoglobulins (TSI), indicating the presence of Graves' disease. TG levels increased and concurrently pulmonary metastases that did not concentrate radioiodine at tracer doses, were diagnosed. Due to these metastatic lesions, the patient received a therapeutic dose of 150 mCi of 131I 1 month after LT4 withdrawal, and a total body scan was made 10 days later. Slight uptake of 131I was found in the right side of the neck, whereas predominant uptake occurred in the right lung base. We suggest that the elevated TSI played a role in the growth of metastases.
Assuntos
Adenocarcinoma Folicular/patologia , Doença de Graves/etiologia , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia/efeitos adversos , Adenocarcinoma Folicular/cirurgia , Feminino , Doença de Graves/imunologia , Humanos , Imunoglobulinas Estimuladoras da Glândula Tireoide/metabolismo , Neoplasias Pulmonares/secundário , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Neoplasias da Glândula Tireoide/cirurgia , Fatores de TempoRESUMO
Hyperparathyroidism is a relatively frequent condition mostly due to a solitary parathyroid adenoma. Although it has been claimed that surgical exploration is the best way to visualize the abnormal parathyroid gland, several imaging techniques have been proposed to localize it in order to simplify and shorten the surgical procedure. Echography, thalium-technetium scintigraphy, computerized tomography and nuclear magnetic resonance have shown a mean sensitivity of 75% which can be increased to about 90% by combining 2 or more of these procedures. In this study, we evaluated the utility of Tc-99m-sestamibi scintigraphy in 13 patients with hyperparathyroidism (11 primary, 2 secondary). High resolution neck echography was carried out in all of the cases. Cervical scans were obtained 10-15 min and 3 hours after giving an i.v. injection of 25 mCi Tc-99m-sestamibi in all the patients; suppression studies with combined 131-I were also done. Positive scans were obtained in 11 out of the 13 patients. Abnormal parathyroid glands were found and surgically excised in all the cases (10 adenomas, 1 carcinoma, 2 hyperplasias). Echographic localization had a sensitivity of only 33.3%. On the contrary, Tc-99m-sestamibi showed a sensitivity of 56% for the whole group, increasing to 82% in the 11 patients with primary hyperparathyroidism whereas the positive predictive value was of 91% and 90%, respectively. We conclude that Tc-99m-sestamibi is a very useful tool in localizing abnormal parathyroid glands and should be the first choice before reoperation after surgical failure or before the first parathyroid surgery whenever it is desired to shorten the surgical and anesthetic duration.