RESUMO
The present study evaluated the hematological, antiparasitic and growth responses in tambaqui (Colossoma macropomum) fed with diets supplemented with the microalgae Arthrospira platensis and Chlorella vulgaris (0%; 10% A. platensis; 10% C. vulgaris; and 5% A. platensis+5% C. vulgaris). Tambaqui (n=60, 62.57 ± 8.76 g) were fed for 20 days with experimental diets. Blood samples collection was done to determine hematological parameters, and gills were removed to identify and count monogenetic parasites. Supplementation with A. platensis 10% reduced red blood cells count, in consequence mean corpuscular volume and mean hemoglobin concentration increased. Total leukocyte, monocyte, eosinophil, and basophil counts reduced with the use of A. platensis. Higher monocytes, eosinophil, and basophil numbers in tambaqui fed with diet supplemented with 10% C. vulgaris were observed and may have been due to the presence of immunostimulants in this microalga composition. Reduction on total cholesterol in tambaqui that received both microalgae (A. platensis 5%+C. vulgaris 5%) may indicate that combined supplementation presented greater benefits to the health for C. macropomum than separately. Both microalgae were efficient against monogenetic parasites of tambaqui. Thus, the dietary use of the microalgae A. platensis and C. vulgaris provided immunostimulant and antiparasitic efficacy in C. macropomum.
Assuntos
Chlorella vulgaris , Spirulina , Chlorella vulgaris/química , Animais , Suplementos Nutricionais , Caraciformes , Microalgas/químicaRESUMO
PURPOSE: A residual bulge in the lateral abdominal wall is a reason for patient dissatisfaction after flank hernia repair (FHR). We hypothesized that combining a laparoscopically-placed intraperitoneal mesh (IPOM) with onlay hernia repair performed through a small open incision would increase repair durability and decrease such residual bulges. We aim to report our medium-term outcomes with this technique. METHODS: Patients who have undergone FHR using the technique described above from March 2013 through June 2017 were identified in a prospectively maintained database. Outcomes of interest included surgical site infections (SSI), surgical site occurrences (SSO), surgical site occurrences requiring procedural intervention (SSOPI) and hernia recurrence. RESULTS: Sixteen patients were identified (62% females; mean age 59 ± 8 years, mean body mass index 29.5 kg/m2). Mean hernia width was. 6.4 ± 3 cm and 31% were recurrent hernias previously repaired through an onlay approach. Mean operative time was 159 ± 40 min, fascial closure was achieved in all cases, and there were no intraoperative complications. Median length of stay was 3 days (IQR 3-4), and there were no unplanned readmissions or reoperations. At a median 37-month follow-up (IQR 21-55), wound morbidity rate was 12.5% (2 seromas). There were no SSI/SSOPI and one hernia recurrence (6%) was detected at 12 months postoperatively. CONCLUSION: Combining laparoscopic IPOM with open onlay hernia repair resulted in low recurrence and acceptable wound morbidity rates, with no residual bulges noted at medium-term follow-up. Further studies with larger number of patients and other surgeon's experiences are necessary to determine the role of such technique in the surgical armamentarium for flank hernia repair.
Assuntos
Parede Abdominal/cirurgia , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Hérnia Incisional/cirurgia , Laparoscopia/métodos , Cirurgiões , Telas Cirúrgicas , Músculos Abdominais/cirurgia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Recidiva , ReoperaçãoRESUMO
UNLABELLED: Pancreas transplant (Ptx) is the gold standard for the treatment of type I diabetes, mainly when associated with renal failure. The number of Ptx is increasing worldwide, but in developing countries, such as Brazil, the number of centers is small and transplant surgeons need to practice the technique. METHODS: For this model, 21 pancreas harvestings were performed in patient corpses after death from extra-abdominal causes, without pancreatic disease and peritoneal or systemic infection. The vessels of the grafts were prepared on the backtable according to the usual practice in humans. The pancreas was implanted in the inferior vena cava and aorta of mixed breed dogs, with 10 exocrine-bladder drainage and 11 duodenum-ileal anastomosis. RESULTS: There were anastomotic strictures of the portal vein in dogs 1 and 2. There was no arterial stricture or large bleeding. None of the animals died until the revascularization of the graft. Dogs 2, 5, and 8 died during the exocrine anastomosis. The arterial flow was initially high, but at the end of the procedure there were thromboses of small arteries. CONCLUSION: The experimental surgical technique model is feasible, repeating the stages of clinical pancreatic transplantation and allowing the training of surgeons.
Assuntos
Diabetes Mellitus Tipo 1/cirurgia , Transplante de Pâncreas/educação , Coleta de Tecidos e Órgãos/educação , Animais , Cadáver , Cães , Humanos , Modelos Animais , Transplante de Pâncreas/métodos , Coleta de Tecidos e Órgãos/métodosRESUMO
Fluid resuscitation administered before hemorrhage control for trauma victims sustaining blunt abdominal injury is controversial. Prehospital fluid resuscitation is limited by difficulty in delivering large volumes of fluid in the field and time delays associated with gaining vascular access. Venous access is often a clinical dilemma in severely hypovolemic children. Intraosseous infusion is considered a useful technique for the administration of fluids in emergency situations when peripheral intravascular access is not possible. This study investigated the effectiveness of intraosseous versus intravenous infusion of hypertonic saline solution in an uncontrolled hemorrhagic shock swine model. We also tested the effect of the different sites of infusion on the intra-abdominal bleeding. Relevant hemodynamic parameters were monitored and blood samples were collected. After liver injury, 20 anesthetized immature pigs were randomized to three groups: intraosseous access, intravenous access and control. After 20 min of uncontrolled hemorrhage, the hypertonic saline solution begins in the intraosseous access and intravenous access groups of animals. Thirty minutes later, the animals were killed and intra-abdominal blood loss was measured. All the pigs presented lower pressures and lower cardiac output after 20 min of hemorrhagic shock. The intravenous and intraosseous access groups did not show a better hemodynamic performance after 10 min of fluid resuscitation. At the end of the experiment, all animals were hemodynamically similar without an improved answer to a fluid resuscitation. There were no significant differences between groups regarding intra-abdominal blood loss. It was concluded that the hypertonic saline solution in this experimental model did not promote hemodynamic improvement and there were no differences between the two sites of fluid resuscitation regarding intra-abdominal blood loss.
Assuntos
Fígado/irrigação sanguínea , Fígado/lesões , Ressuscitação/métodos , Solução Salina Hipertônica/administração & dosagem , Choque Hemorrágico/etiologia , Choque Hemorrágico/terapia , Animais , Pressão Sanguínea/efeitos dos fármacos , Débito Cardíaco/efeitos dos fármacos , Hemodinâmica/efeitos dos fármacos , Infusões Intraósseas , Infusões Intravenosas , Masculino , Artéria Pulmonar/fisiopatologia , Pressão Propulsora Pulmonar/efeitos dos fármacos , Distribuição Aleatória , Solução Salina Hipertônica/farmacologia , Choque Hemorrágico/fisiopatologia , Suínos , Fatores de Tempo , Resistência Vascular/efeitos dos fármacos , Ferimentos e Lesões/complicaçõesRESUMO
The blood-brain barrier (BBB) controls the biochemical environment of the brain with variable permeability when comparing adults to children. Based on the knowledge that there is a greater vulnerability in the BBB of young subjects submitted to biochemical variations in the blood and in the brain, an experimental model was designed to study small volume resuscitation. Young Wistar rats were submitted to hemorrhage and resuscitated with 7.5% NaCl solution before undergoing a qualitative evaluation of their BBB. Thirty male rats were anesthetized and divided into four groups: Group 1 - submitted to hemorrhagic shock restored with hypertonic saline solution (HSS); Group 2 - submitted to hemorrhagic shock without volume restoration; Group 3 - receiving only HSS, and Group 4 - control. The data analyzed were: mean arterial blood pressure, base excess, sodium, chloride, urea, blood osmolarity and blood glucose levels. After infusing a 2% Evans blue solution, qualitative analysis of the BBB was carried out. Group 1 presented final mean blood pressure levels equivalent to groups 3 and 4. Group 2 had a significant difference in the final base excess when compared to the other groups. In groups 1 and 3, mean sodium and chloride, as well as serum osmolarity, were more elevated than groups 2 and 4. Macroscopic examination of the brain did not reveal any changes in color, which could be attributed to the opening of the BBB. It was concluded that the 7.5% NaCl solution in this experimental model did not promote qualitative changes in the BBB.
Assuntos
Barreira Hematoencefálica/efeitos dos fármacos , Substitutos do Plasma/farmacologia , Solução Salina Hipertônica/farmacologia , Choque Hemorrágico/fisiopatologia , Animais , Permeabilidade Capilar/efeitos dos fármacos , Masculino , Ratos , Ratos WistarRESUMO
The authors studied the effect of a positioning orifice introduced in the anterior palatine region of occlusal splints for patients with craniomandibular disorders of swallowing and speech patterns. The patients were evaluated in four distinct situations. It was concluded that the splint orifice significantly favored swallowing and speech while the splint was being used, and is more comfortable for the patient.
Assuntos
Placas Oclusais , Desenho de Aparelho Ortodôntico , Adaptação Fisiológica/fisiologia , Transtornos Craniomandibulares/fisiopatologia , Transtornos Craniomandibulares/terapia , Deglutição/fisiologia , Feminino , Humanos , Masculino , Mandíbula/fisiopatologia , Fala/fisiologia , Língua/fisiopatologiaRESUMO
The submammary incision has been postulated as an alternative in median sternotomy approach since 1960. We used this incision in 32 females patients from 1 to 24 years. The diagnoses were atrial septal defects (ASD) 23 patients, ventricular septal defect (VSD) 2 patients, double outlet right ventricle 1 patient, supravalvular aortic stenosis 1 patient, ASD with VSD 3 patients and partial anomalous pulmonary venous connection 1 patient. Nine patients had a complication: cheloid scar 1 patient, seroma 2 patients, wound dehiscence 3 patients, and diminution of sensitivity 3 patients. We conclude, that this type of surgical approach is an excellent alternative for women with good aesthetic and psychological results. Their complications are easy to correct.
Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Esterno/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Toracotomia/métodosRESUMO
Onze pacientes portadores de deficiência de hormônio de crescimento (DHC) foram tratados por três anos com hormônio de crescimento recombinante autêntico (HCr), em doses de 0,35 a 0,5U/Kg/semana. A velocidade de crescimento pré-tratamento de 2,91 ñ 1,58cm/a elevou-se a 11,07 ñ 2,52cm/a no primeiro ano, 8,62 ñ 2,81cm/a no segundo e 7,63 ñ 1,84 no terceiro ano de terapêutica. Embora tenha ocorrido importante ganho na idade estatural (deltaIE = 4,9 ñ 1 anos), houve também aceleraçäo significante da idade óssea (deltaIO = 4,3 ñ 1,4 anos), com relaçäo deltaIE/deltaIO de 1,1 ñ 0,2. Como o ganho em altura foi acompanhado de proporcional avanço de IO, a possibilidade de obter altura final normal näo seria alcançada a näo ser que a terapêutica com HCr seja instituída mais precocemente, antes do déficit estatural ser demasiadamente severo, como foi na maioria dos pacientes
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Hormônio do Crescimento/uso terapêutico , Transtornos do Crescimento/tratamento farmacológico , Fatores de Tempo , Estatura , Fator de Crescimento Insulin-Like I/análise , Hormônio do Crescimento/administração & dosagem , Hormônio do Crescimento/deficiência , Transtornos do Crescimento/etiologia , Determinação da Idade pelo EsqueletoRESUMO
Eleven growth hormone deficient (GHD) subjects were treated regularly for 3 years with an authentic recombinant growth hormone preparation (0.35 to 0.5U/kg/week). Growth velocity (GV) increased from a mean o 2.91 +/- 1.58cm/year during the 1st year to 8.62 +/- 2.81cm/y in the 2nd and 7.63 +/- 1.84cm/y in the 3th year of follow up. During that period height age (delta HA) increased by 4.9 +/- 1 years while bone age advanced 4.3 +/- 1.4 year (delta BA) resulting in a delta HA/delta BA of 1.1 +/- 0.2. Since the height increment was associated with BA advancement the final height within normal range could not be attained. Thus, GHr therapy should be instituted before the height deficit would became intense as it happened in the majority of our patients. Early diagnosis and therapy of GHD is important, when growth retardation is less severe, in order to allow a better final height.
Assuntos
Transtornos do Crescimento/tratamento farmacológico , Hormônio do Crescimento/uso terapêutico , Adolescente , Determinação da Idade pelo Esqueleto , Estatura/efeitos dos fármacos , Criança , Pré-Escolar , Esquema de Medicação , Feminino , Transtornos do Crescimento/etiologia , Hormônio do Crescimento/deficiência , Humanos , Fator de Crescimento Insulin-Like I/análise , MasculinoRESUMO
The challenge of quality improvement (QI) is to take its principles and tools and apply them to active problems in the clinical laboratory. The authors describe a 2-year QI project in which the staff of the laboratory and the neonatal care unit (NCU) significantly improved the care of babies who undergo heelsticks to provide blood samples for laboratory testing. Examples of quality tools used during the project are provided. The success of the QI project is due to the consistent and ongoing efforts of both staffs to care passionately about their customers--the babies of the NCU.