Uso de dexmedetomidina em anestesiologia

JUSTIFICATIVA E OBJETIVOS: A dexmedetomidina é um novo agonista alfa2-adrenérgico que apresenta relação de seletividade entre os receptores alfa2:alfa1 de 1600:1, com importante ação sedativa e analgésica, bom controle hemodinâmico frente ao estresse e que pode produzir, por si só, anestesia. Este agente tem sido empregado para promover analgesia e sedação no período pós-operatório e nas unidades de tratamento intensivo. Devido à suas propriedades, recentemente, a dexmedetomidina passou a ser utilizada também na sala de operações, como fármaco coadjuvante em anestesia. Assim, este artigo faz uma revisão da literatura com relação ao uso da dexmedetomidina na prática anestésica. CONTEÚDO: São apresentados os principais trabalhos com o emprego da dexmedetomidina em Anestesiologia, seja como medicação pré-anestésica, ou durante o ato anestésico-cirúrgico. O mecanismo de ação dos fármacos alfa2-agonistas e as propriedades farmacocinéticas e farmacodinâmicas da dexmedetomidina também são revistos neste artigo. CONCLUSÕES: O uso da dexmedetomidina como medicação pré-anestésica, durante anestesia, ou no período pós-operatório, promove boa estabilidade hemodinâmica. Há redução do consumo de anestésicos durante a anestesia. Os pacientes sedados com a dexmedetomidina podem ser despertados, quando solicitados, e tornarem-se cooperativos. Mesmo doses elevadas do fármaco não provocam depressão respiratória. Bradicardia é um efeito adverso observado com freqüência, problema amenizado pela administração lenta da droga. Assim, a dexmedetomidina torna-se importante recurso adicional para a prática clínica da Anestesiologia, com possibilidade de uso em diversos tipos de pacientes e procedimentos cirúrgicos.

Avaliação da mutagenicidade e antimutagenicidade de um biopolímero extraído do microorganismo Agrobacterium radiobacter em camundongos Swiss

A presente pesquisa avaliou a ação mutagênica e antimutagênica de um biopolímero de glucose extraído da Agrobacterium radiobacter (Biopolímero de Agrobacterium radiobacter). O experimento foi realizado com camundongos Swiss machos divididos em oito grupos. O tratamento com o biopolímero foi realizado por gavage em dose única concomitante a uma dose de solução tampão fosfato nos grupos de avaliação da mutagenicidade, ou ao agente indutor de danos no DNA, ciclofosfamida, na concentração de 50 mg/kg (peso corpóreo - p.c.), nos grupos de avaliação da antimutagenicidade. Utilizou-se o teste de micronúcleo em sangue periférico e a coleta de sangue foi realizada 24 e 48 h após a aplicação das substâncias-teste. A análise estatística demonstrou que o biopolímero não possui atividade mutagênica e que é efetivo em prevenir danos no DNA. As porcentagens de redução de danos nos grupos de antimutagenicidade foram de 83,9%, 89,1% e 103,1% em 24 h e 101,24%, 98,14% e 120,64% em 48 h para as doses de 75, 150 e 300mg/kg (p.c.), respectivamente. A alta porcentagem de redução de danos associada à ausência de efeitos mutagênicos indica, além da atividade quimioprotetora, a possibilidade do biopolímero ser um alimento funcional candidato à utilização como co-adjuvante na quimioterapia para prevenir efeitos colaterais.

Eletroacupuntura na anestesia com propofol em cães

Resultados satisfatórios têm sido relatados com o emprego da eletroacupuntura (EA), como adjuvante da anestesia geral no homem e em animais. O objetivo do trabalho é avaliar a dose de indução anestésica do propofol em função do emprego da eletroacupuntura em cães. Foram utilizados 20 cães, distribuídos em dois grupos de igual número, GEA: foi realizada EA nos acupontos estômago 36 (E36), vesícula biliar 34 (VB 34) e baço-pâncreas 6 (BP 6), bilateralmente, durante 45 minutos antes da indução anestésica e GC: não foi realizada EA antes da indução anestésica. Os animais foram tranqüilizados com acepromazina intravenosa (0,05mg.kg-1) 60 minutos antes da indução anestésica, realizada com propofol na taxa de 0,2ml.kg.min-1. A análise estatística foi realizada por test t não pareado(P<0,05). Os valores foram apresentados em média±SD. Não houve diferença significativa na dose do propofol entre os grupos (5±2mg kg-1 no GC e 5,2±1,6mg kg-1 no GEA), sugerindo que a eletroacupuntura não potencializou o efeito depressor do propofol sobre o sistema nervoso central.

Evaluation of different immunization protocols with P. brasiliensis antigens in Guinea pigs

O objetivo deste trabalho foi desenvolver protocolo eficiente e reprodutível de imunização em cobaias com antígenos de P. brasiliensis, visando a obtenção de modelo experimental para futuros estudos de mecanismos de proteção imunológica. Testaram-se três diferentes antígenos (particulado, solúvel e composto) e seis protocolos nos quais foram avaliadas as influências dos seguintes fatores: presença ou ausência de adjuvante completo de Freund, número de doses imunizantes e intervalo de tempo entre a última dose imunizante e o desafio. A eficiência do protocolo de imunização foi estudada pela avaliação da resposta imune celular e humoral anti-P. brasiliensis, utilizando teste cutâneo e teste de inibição da migração do macrófago, e imunodifusão, respectivamente. Observou-se que: 1. Três doses imunizantes de antígeno induziram melhor resposta do que duas doses; 2. Maior resposta imune foi conseguida com a utilização de adjuvante completo de Freund; 3. Animais desafiados depois de longo tempo (6 semanas) da última dose imunizante mostraram melhor resposta imune anti-P. brasiliensis; 4. Os antígenos solúvel e composto foram igualmente eficientes induzindo maior resposta imune humoral e celular anti-P. brasiliensis enquanto que o antígeno particulado provocou menor reatividade

Immunisation of dogs and guinea pigs against Rhipicephalus sanguineus ticks using gut extract

Tick-bite naive guinea pigs were inoculated three times with Rhipicephalus sanguineus gut or salivary gland extracts and saponin as adjuvant. Dogs were inoculated three times with gut extract only as this fraction induced a more efficient resistance in guinea pigs (lower tick recovery and lower engorged female weights). Freund's adjuvant and saponin were used as adjuvants for the immunisation of dogs. Freund's adjuvant was used to enhance cellular immunity. The highest level of resistance in dogs was induced by the immunisation with gut extract and Freund's adjuvant. Many female ticks from dogs immunised this way engorged fully but died prior to oviposition. Resistant guinea pigs and dogs seemed to trigger different immune mechanisms against R. sanguineus ticks as damage to parasites also differed. A major role for cellular immunity in the resistance of dogs against R. sanguineus ticks is suggested. Resistance mechanisms against R. sanguineus ticks is discussed.

Interferon Alpha-2B and liver resection to treat multifocal hepatic epithelioid hemangioendothelioma: A relevant approach to avoid liver transplantation

Background. Hepatic epithelioid hemangioendothelioma is a rare malignant tumor of vascular origin with frequent multifocal appearance. Liver resection may cause tumor spread. Liver transplantation has been indicated for unresectable nodules. We hypothesized that adjuvant interferon treatment is effective to prevent metastasis after liver resection. We report a case of multifocal hepatic epithelioid hemangioendothelioma successfully treated with interferon pulse therapy and bilobar hepatic resection.Methodology. CT scan and magnetic resonance imaging diagnosed three nodules in the liver (segments IV, VI and VII). Histopathology and specific immunostaining of a percutaneous nodule biopsy confirmed the diagnosis of hepatic epithelioid hemangioendothelioma. The treatment protocol included daily interferon alpha 2b 9 weeks before and 1 week after resection of liver segments IV, VI and VII.Results. The postoperative outcome was complicated by a self-limited biliary fistula. The patient remains tumor free at 3 years after liver resection and currently enjoys excellent health.Conclusion. Interferon pulse therapy and hepatic resection was a good option to treat multifocal bilobar hepatic epithelioid hemangioendothelioma; it may prevent metastasis dissemination.

Haemagglutination induced by Bordetella pertussis filamentous haemagglutinin adhesin (FHA) is inhibited by antibodies produced against FHA(430-873) fragment expressed in Lactobacillus casei

Filamentous haemagglutinin adhesin (FHA) is an important virulence factor from Bordetella pertussis related to the adhesion and spread of the bacteria through the respiratory tract. Three distinct domains have been characterized in mature FHA, and among them, the FHA(442-863) fragment was suggested to be responsible for the heparin-binding activity. In this study, we cloned the gene encoding the HEP fragment (FHA(430-873)) in a Lactobacillus casei-inducible expression vector based on the lactose operon. The recombinant bacteria, transformed with the resulting construct (L. casei-HEP), were able to express the heterologous protein depending on the sugar added to the culture. Subcutaneous inoculation of L. casei-HEP in Balb/C mice, using the cholera toxin B subunit as adjuvant, induced systemic anti-HEP antibodies that were able to inhibit in vitro erythrocyte haemagglutination induced by FHA. This is the first example of a B. pertussis antigen produced in lactic acid bacteria and opens new perspectives for alternative vaccine strategies against whooping cough.

Glutathione transferase pi (GSTpi) expression in breast cancer: An immunohistochemical and molecular study

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

Plant derived alkaloid (-)-cassine induces anti-inflammatory and anti-hyperalgesics effects in both acute and chronic inflammatory and neuropathic pain models

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Effect of low-level laser therapy on pain levels in patients with temporomandibular disorders: a systematic review

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

AVALIACAO DA REACAO DE MITSUDA EM PACIENTES VIRCHOVIANOS INATIVOS ANTES E APOS IMUNOTERAPIA

In this study the immunopotentiator levamisole as well as a mixture of BCG/Mycobacterium leprae were investigated in inactive lepromatous leprosy patients by using the Mitsuda reaction as a parameter. Twenty lepromatous patients ten years ago classified as histologically negative for Mitsuda's test were divided into three groups: five patients that were only retested with Mitsuda antigen; eight patients that received oral levamisol and seven patients that received a mixture of alive BCG plus autoclaved M. leprae. The results indicated that: 1) the levamisole did not alter the reactivity to lepromin in any of the patients studied; 2) neither the changes in the reactivity to lepromin by using the mixture (3 cases) nor those that occurred spontaneously (3 cases) were clear. They properly reflected the natural variation of patients with some degree of resistance to Mycobacterium leprae.

Severe forms of neurocysticercosis: Treatment with albeimdazole

Study of 22 patients with the severe form of neurocysticercosis treated with albendazole (ABZ) administered in 6 different schedules ranging from 15 to 30 mg/kg/day for 21 to 60 days. Dextrochloropheniramine and ketoprofen were the adjuvant drugs Multiple symptoms were observed in 90 9% of patients. Intracranial hypertension was manifested in 90.9%. Hydrocephaly occurred in 86.4%. Evolution was satisfactory in 10 patients, 8 died and 4 had sequelae. Tomographic studies showed the appearance of an isolated IVth ventricle in 9 patients, after ventriculoperitoneal shunt, before ABZ treatment in 3 of them, during in 5 and after treatment in one. Median clinical follow-up duration was 10 months for the patients who died and 3-4 years for survivors. In 3 patients there was an increase in cyst size during the administration of the 15 mg/kg/day ABZ dose, which was not observed in any patient when the 30 mg/kg/day dose was used.

Subcutaneous and testicular metastasis from prostatic adenocarcinoma with neuroendocrine differentiation

The pathological finding of testicular metastasis in cases of disseminated prostatic adenocarcinoma is rare, but was more frequently reported in the past, when bilateral castration was performed more often. The existence of skin and subcutaneous metastasis adds a worse prognosis, because generally it is sign of advanced disease with an average survival time of less than one year. The synchronous occurrence of such metastasis has not been described previously, neither their association to neuroendocrine differentiation. The presence of such differentiation of prostatic adenocarcinoma represents a very unfavorable prognostic factor, as suggested in recent literature. Herein, we discuss the case of a 53 year old man, who presented with macroscopic hematuria and frequency associated to several painless subcutaneous nodules in left axilla and shoulder, as well as in the lower abdominal wall. The right testis was painful, endured and on rectal examination, the prostate was diffusely enlarged. Serum PSA was elevated, reaching 1760 ng/ml and prostatic biopsy disclosed a Gleason 10 prostatic adenocarcinoma with neuroendocrine differentiation. The same pathological pattern was detected in the right testis and in all subcutaneous nodules, documented by positive staining of chromogranin, a marker of neuroendocrine cells. He was submitted to a prostate tunnelization and maximal androgen blockade plus adjuvant chemotherapy, nevertheless, he died 5 months latter.

P-077. Myxoma of bone. Review of 17 cases

Myxoma of bone (fibromyxoma) is a slowly growing, locally invasive tumor that almost always occurs in the facial bones. The tumor has a potential to recur, but does not metastasize. The lesion is usually painless but causes slowly progressive swelling, sometimes resulting in severe facial deformity. Aim: Review of myxoma of bone experience in two institutions. Methods: Retrospective chart review of all patients with diagnose of myxoma/fibromyxoma of bone identified in the tumor registry of two referral cancer centers: Hospital Erasto Gaerntner (HEG), Curitiba, PR Brazil and University of Sao Paulo (UNESP), Aracaatuba Campus, Sao Paulo, SP Brazil. We reviewed the age, sex, ace, presenting symptoms, topography of lesion and treatment. Results: From January 1972 to July 2000 we found 17 patients from both institutions that met the diagnostic criteria; 15 from HEG and two from UNESP. The median age was 32 years (range 10-55 years). Eleven patients were male, 14 were white and three were black. Only three patients presented with local pain, the remaining were free of symptoms, presenting only with local tumor. The tumor affected the maxilla in 11 patients (six on the right), the mandible in five and the zygomatic bone in one. All patients were treated by excisional surgery and one patient received adjuvant radiation therapy. Nine patients needed reconstruction after the tumor excision. Five of them were reconstructed with local soft tissue flaps; two received iliac crest autologous bone graft; and two had a microvascularized autologous fibula graft. Conclusion: The myxoma of bone in our experience is a rare tumor and occurs more frequently in the maxilly bone in young males. These findings are consistent with the literature data.