Rouquidão após intubação traqueal

JUSTIFICATIVA E OBJETIVOS: Descrever as principais causas de rouquidão após intubação traqueal. CONTEÚDO: A rouquidão após intubação traqueal é um dos sintomas mais freqüentes no pós-operatório, podendo apresentar durações variáveis, dependendo dos fatores causais e da gravidade do comprometimento das estruturas da laringe. Foi realizada uma breve revisão das estruturas anatômicas da laringe, em que foram descritas as principais lesões traumáticas desse órgão, decorrentes da intubação traqueal e salientou-se a importância dos seus cuidados, bem como do diagnóstico e tratamento precoces. CONCLUSÕES: As lesões traumáticas das estruturas da laringe durante a intubação são causas freqüentes de rouquidão, sendo importante o diagnóstico precoce e a adoção de medidas preventivas.

Complicações das vias aéreas relacionadas à intubação endotraqueal

Descrevemos as principais complicações das vias aéreas relacionadas à intubação endotraqueal, por meio de revisão da literatura e apresentação dos resultados de pesquisas clínicas e experimentais realizadas pelo nosso grupo de estudo. Procuramos alertar os profissionais de saúde quanto à alta incidência de complicações secundárias à intubação, as quais podem ser reduzidas com a adoção de medidas profiláticas simples e de cunho prático, estabelecidas após a compreensão da fisiopatologia das lesões.

Intubação traqueal e o paciente com o estômago cheio

A aspiração pulmonar do conteúdo gástrico, apesar de pouco frequente, exige cuidados especiais para sua prevenção. A depressão da consciência durante a anestesia predispõe os pacientes a esta grave complicação pela diminuição na função do esfíncter esofágico e dos reflexos protetores das vias aéreas. Guias de jejum pré-operatório elaborados recentemente sugerem períodos menores de jejum, principalmente para líquidos, permitindo mais conforto aos pacientes e menor risco de hipoglicemia e desidratação, sem aumentar a incidência de aspiração pulmonar perioperatória. O uso rotineiro de agentes que diminuem a acidez e volume gástrico parece estar indicado apenas para pacientes de risco. A intubação traqueal após indução anestésica por meio da técnica de sequência rápida está indicada naqueles pacientes, com risco de aspiração gástrica, em que não há suspeita de intubação traqueal difícil. A indicação correta da técnica, sua aplicação criteriosa e a utilização racional das drogas disponíveis podem promover condições excelentes de intubação, com curto período de latência, rápido retorno da consciência e da respiração espontânea, caso haja falha na intubação traqueal.O presente artigo tem como objetivo discutir os métodos atualmente utilizados para controlar o volume e o pH do conteúdo gástrico, proteger as vias aéreas durante as manobras de intubação e reduzir o refluxo gastroesofágico.

Effect of age on the gastrointestinal-associated mucosal immune response of humans

Age-related changes in gastrointestinal-associated mucosal immune response have not been well studied. Thus, we investigated the effect of age on this response and compared these responses to those of peripheral immune cells. Saliva, blood, and intestinal biopsies were collected from young and old healthy subjects to determine immunoglobulin (Ig) levels and to isolate peripheral blood mononuclear cells, intraepithelial lymphocytes (IELs), and lamina propria lymphocytes (LPLs). Although subject age did not influence the level of total IgA found in saliva, IgA levels in serum increased (p < .05) with age. Older subjects' peripheral blood mononuclear cell proliferation and IL-2 production were significantly lower than those of young subjects. LPLs from older subjects produced significantly less IL-2 in response to all stimuli than did that from the young. IEL's ability to proliferate and produce IL-2 was not affected by subject age. Thus, LPL but not IEL demonstrated an age-related decline in immune function similar to that seen in peripheral lymphocytes.

Heterotopic gastrointestinal cyst partially lined with dermoid cyst epithelium

We report a rare heterotopic gastrointestinal cyst located in the right submandibular/submental area with histopathologic features that included portions resembling a dermoid cyst. Some theories of pathogenesis are discussed, and an origin of this lesion in entrapped undifferentiated endodermal cells is suggested.

Immunolocalization of estrogen and progesterone receptors in neuroendocrine tumors of lung, skin, gastrointestinal and female genital tracts

Expression of estrogen (ER) and progesterone (PR) receptors has traditionally been associated with hormone-responsive organs, such as breast, ovary, and endometrium, and carcinomas arising therefrom. More recently, examples of ''unexpected'' ER or PR expression have been reported, particularly in tumors of endocrine tissues, such as thyroid and pancreatic islet cells. We tested the hypothesis that neuroendocrine tumors of various primary and metastatic sites might also express ER or PR or both by performing a retrospective immunohistochemical study in a series of 59 formalin- or mechacarn-fixed neuroendocrine carcinomas of various sites, including lung, skin, gastrointestinal and female genital tracts, and including carcinoid and atypical carcinoid tumors, small cell carcinomas, and Merkel cell carcinomas. We employed the anti-ER monoclonal antibody 1D5 and the anti-PR monoclonal antibody PgR1A6 using standard immunohistochemical techniques after microwave-based heat-induced epitope retrieval. Two of 28 carcinoid tumors demonstrated ER positivity; six of 30 cases were positive for progesterone receptor only. In addition, PR expression was found in one of two cases of atypical carcinoid, in five of 25 cases of small cell carcinoma, and in one of two cases of Merkel cell carcinoma. None of the atypical carcinoids, small cell carcinomas, or Merkel cell carcinomas were ER positive. In most cases, the fraction of tumor cell nuclei that were positive was <50%. These studies add the spectrum of neuroendocrine tumors that can express these hormone receptors. Similar to the pattern previously described in the subsets of meningiomas and islet cell tumors, PR but not ER is detectable in most cases. These results underscore the caution that should be exercised in determining tissue origin of metastatic carcinomas based only on detection of hormone receptors by immunohistochemistry.

Posthatching water and feed deprivation affect the gastrointestinal tract and intestinal mucosa development of broiler chicks

We studied the effect of feed and water deprivation on gastrointestinal tract and intestinal mucosa development of chicks at 24, 48, and 72 h posthatching. The treatments were water and feed ad libitum, water ad libitum and no feed, no water but feed ad libitum, and no water and no feed. The relative weight of the yolk sac was not influenced by the treatments. However, at 48 and 72 h posthatching, the relative weight of the liver increased, and the gizzard + proventriculus weight decreased in birds receiving feed ad libitum. An increase in jejunum and ileum relative weights and lengths was observed when the birds were supplied with feed and water. The lack of water produced the same effect as the lack of feed, both causing a higher number of villi per area with reduction in villus size, when compared with feed and water ad libitum treatments. The results of this study revealed that feed and water are able to affect intestinal villus development after hatching, indicating that both feed and water must be supplied to the chicks immediately after hatching.

CD34 EXPRESSION IN STROMAL TUMORS OF THE GASTROINTESTINAL-TRACT

Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors that may exhibit varied morphologic appearances (spindle, epithelioid) and biologic potentials. Given the continuing controversy regarding the type of cell differentiation present in these tumors (muscle versus nerve sheath versus null), we evaluated a set of GISTs, most of which had been previously examined for the presence of smooth muscle differentiation, for expression of CD34, a 115 kDa cell-surface progenitor cell marker also recently identified in a subset of mesenchymal tumors. Using antibody My 10 in deparaffinized, formalin-fixed tissue after pretreatment with microwave energy, we found that 46 of 57, or 81%, of GISTs were CD34+; this fraction of CD34+ tumors exceeded the fraction of these same GISTs found to show muscle actin (72%) expression. In addition, a consistently higher fraction of the tumor cell population was CD34+ than was muscle actin positive. These findings suggest that CD34 is a very sensitive marker for the identification of GISTs. CD34 is normally expressed by endothelial as well as perivascular cells, perhaps related to, but distinct from, vascular smooth muscle cells. While the nature of these latter cells is uncertain, the expression of CD34 in such a large fraction of GISTs may provide evidence of a unique differentiation pathway in these tumors.

Neuropathy of Gastrointestinal Chagas' Disease: Immune Response to Myelin Antigens

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Identification of quantitative trait loci affecting resistance to gastrointestinal parasites in a double backcross population of Red Maasai and Dorper sheep

A genome-wide scan for quantitative trait loci (QTL) affecting gastrointestinal nematode resistance in sheep was completed using a double backcross population derived from Red Maasai and Dorper ewes bred to F1 rams. This design provided an opportunity to map potentially unique genetic variation associated with a parasite-tolerant breed like Red Maasai, a breed developed to survive East African grazing conditions. Parasite indicator phenotypes (blood packed cell volume PCV and faecal egg count FEC) were collected on a weekly basis from 1064 lambs during a single 3-month post-weaning grazing challenge on infected pastures. The averages of last measurements for FEC (AVFEC) and PCV (AVPCV), along with decline in PCV from challenge start to end (PCVD), were used to select lambs (N = 371) for genotyping that represented the tails (10% threshold) of the phenotypic distributions. Marker genotypes for 172 microsatellite loci covering 25 of 26 autosomes (1560.7 cm) were scored and corrected by Genoprob prior to qxpak analysis that included BoxCox transformed AVFEC and arcsine transformed PCV statistics. Significant QTL for AVFEC and AVPCV were detected on four chromosomes, and this included a novel AVFEC QTL on chromosome 6 that would have remained undetected without BoxCox transformation methods. The most significant P-values for AVFEC, AVPCV and PCVD overlapped the same marker interval on chromosome 22, suggesting the potential for a single causative mutation, which remains unknown. In all cases, the favourable QTL allele was always contributed from Red Maasai, providing support for the idea that future marker-assisted selection for genetic improvement of production in East Africa will rely on markers in linkage disequilibrium with these QTL.

Assessment of Gastrointestinal Motility in Renal Transplant Recipients by Alternate Current Biosusceptometry

Background. Gastrointestinal (GI) complications are common after renal transplantation, mainly owing to immunosuppressive therapy. Assessment of GI transit time can facilitate rational management of these disorders.Objective. We evaluate the GI transit parameters in renal transplant recipients taking tacrolimus, azathioprine, and prednisone with the use of the alternate current biosusceptometry (ACB) technique and compared them with healthy volunteers.Methods. Ten renal transplant recipients and 10 healthy volunteers were enrolled in this study. After an overnight fast, patients and volunteers ingested a standard meal containing magnetic markers. The biomagnetic monitoring was performed at 10-minute intervals for at least 8 hours to obtain gastric emptying as well as the colonic arrival time-intensity curves. Mean gastric emptying time (MGET), mean colon arrival time (MCAT), and mean small intestinal transit time (MSITT) were quantified and compared between control and patient groups with results expressed as mean +/- SD.Results. The MGET measured by the ACB technique was 48 +/- 31 minutes and 197 +/- 50 minutes for patients and healthy subjects, respectively. MSITT and MCAT values calculated for patients versus volunteers were 171 +/- 71 minutes versus 197 +/- 71 minutes and 219 +/- 83 minutes versus 373 +/- 52 minutes, respectively. Renal transplant recipients showed significantly faster; gastric emptying and colon arrival times (P < .001) compared with normal volunteers; however, small intestinal transit time was not significantly different (P = .44).Conclusions. In stable renal transplant recipients, the GI transit parameters were significantly faster than in normal healthy volunteers. ACB sensors are versatile technologies that can be used for clinical research, because they offer an excellent opportunity to evaluate GI transit in a noninvasive manner without the use of ionizing radiation.