Estudo das alterações eletrocorticográficas na insuficiência hepática aguda experimental.

The aim of this study was to test the application and value of electrocorticography (ECG) in the early diagnosis and characterization of electrocorticograms changes on experimental fulminant hepatic failure (FHF). Our material was composed of two groups of guinea pigs: a) ethanolamine group--42 animals with FHF induced by intrabiliary injection of 2.5 ml of monoethanolamine oleate; b) control group--10 animals submitted to intrabiliary injection of 2.5 ml of saline. Electrocorticograms recordings were taken in both groups with the electrodes implanted on the parieto-occipital regions of the skull. The hepatic failure was characterized by clinical manifestations, serum biochemical tests and histopathological findings. In the early hepatic coma the electrocorticograms could not be unequivocally distinguished from normal pattern, and alpha rhythm was recognizable in most animals. With further deterioration of the clinical condition the tracing showed progressive slowness of the normal rhythm, increased voltage and triphasic waves followed by suppression of electrical activity preceding the animal death. The electrocorticography was not suitable for the early diagnosis of hepatic coma, since the ECG alterations became evident only in overt coma. However the method could be useful for the characterization of cerebral disorders and the study of the pathogenesis of fulminant hepatic failure.

Insuficiência renal aguda. Estudo do quadro clínico e prognóstico.

Acute renal failure (ARF) is a frequent complication in hospitalized patients, and is strongly related to increase of mortality. PURPOSE: To analyze the clinical outcome and the prognostic factors in hospital acquired AFR. METHOD: A prospective study was performed. Data from 200 patients with established ARF admitted during the period of January, 1987 and July, 1990 were collected. RESULTS: The incidence of ARF was 4.9/1000 admissions. Renal ischemia (50%) and nephrotoxic drugs (21%) were the main etiologic factors. The histologic study done in 43 patients showed: acute tubular necrosis (53%), tubular hydrophic degeneration (16%), glomerulopathies (16%) and other lesions (15%). Dialysis therapy was performed in 101 patients and the main indications were: uremia (67%), hypervolemia (22%) and hyperkalemia (9%). The mortality rate was 46.5% and the most important causes of death were: sepsis (38%), respiratory failure (19%) and multiple organs failure (11%). Treatment withdraw was the cause of death in 2 patients. Higher mortality was observed in oliguric patients (62.9%) than non-oliguric (34.5%) (p < 0.05) and in ischemic renal failure (56.7%) when compared to nephrotoxic renal failure (14.7%) (p < 0.05). This difference was maintained when the comparison was done only between dialyzed patients. CONCLUSION: As primary cause of death was not associated to the acute renal failure, we conclude that acute renal failure is an important marker of the gravity of the underlying disease and not the cause of death.

Comparacao da recuperacao de anestesia venosa com propofol e anestesia inalatoria com sevoflurano para laparoscopia ginecologica

Backgrounds and Objectives: Both continuous venous anesthesia with propofol and inhalational anesthesia with sevoflurane propitiate fast arousal with few side effects. The aim of this study was to compare the arousal and post anesthestic recovery times in patients submitted to these two agents. Methods: Forty three patient aged 18 to 50 years, physical status I or II, submitted to gynecological laparoscopy were distributed in two groups: G1 - propofol in continuous infusion of 115 μg.kg -1.min -1 and G2 sevoflurane. All the patients were pre-medicated with 7.5 mg midazolam, sufentanil 0.5 μg.kg -1, propofol 2 mg.kg -1, atracurium 0.5 mg.kg -1, N 2O in 50% of oxygen in a no-rebreathing system. The depth of the anesthesia and arousal time were assessed by the Bispectral index (BIS). The time between end of anesthesia and eye opening, time for command response and time for orientation were also evaluated. Results: The times recorded in minutes were: G1 - eye opening 8.2 ± 2.9, command response 8.6 ± 3.1, orientation 9.8 ± 3.4, recovery 31.6 ± 3.8; G2 - eye opening 4.5 ± 3, command response 4.9 ± 3.4, orientation 6.2 ± 3.4, recovery 66 ± 8. Except the recovery time, all the values were larger in G1. Conclusions: Both intravenous propofol or inhalational sevoflurane were considered excellent anesthetic techniques as to recovery time and recovery room discharge. Sevoflurane provided an earlier arousal with a longer recovery room stay as compared to propofol.

Análise das vantagens de duas técnicas anestésicas - Venosa e inalatória - Para colecistectomia por videolaparoscopia

Background and Objectives - It is essential to reduce health care costs without impairing the quality of care. Propofol is associated to faster recovery and it is known that post-anesthesia care unit (PACU) costs are high. The aim of this study was to evaluate the advantages of two anesthesia regimens - propofol continuous infusion or isoflurane - taking into account the cost of both techniques on PACU stay. Methods - Forty seven patients, physical status ASA I, II and III, undergoing laparoscopic cholecystectomy were divided into 2 groups according to the anesthetic agent: G1, conventional propofol continuous infusion (100-150 μg.kg-1.min-1) and G2, isoflurane. All patients were induced with sufentanil (1 μg.kg-1) and propofol (2 mg.kg-1) and were kept in a re-inhalation circuit (2 L.min-1 of fresh gas flow) with 50% N2O in O2, sufentanil (0.01 μg.kg-1.min-1) and atracurium (0.5 mg.kg-1), or pancuronium (0.1 mg.kg-1) for asthma patients. All patients received atropine and neostigmine at the end of the surgery. Prophylactic ondansetron, dipyrone and tenoxican were administered and, when necessary, tramadol and N-butylscopolamine. Costs of anesthetic drugs (COST), total PACU stay (t-PACU), and PACU stay after extubation (t-EXT) were computed for both groups. Results - Costs were significantly lower in the isoflurane group but t-PACU was 26 minutes longer and t-EXT G1

Abordagem diagnóstica dos pacientes com suspeita de trombose venosa profunda dos membros inferiores

Deep venous thrombosis is a relatively common disease, which can present pulmonary embolism as a complication in its acute phase, and later the post-thrombotic syndrome. Thus, diagnosis should be made as soon as possible, in order to prevent or minimize such complications. Several studies have shown that the symptoms and the clinical signs are inaccurate for the deep venous thrombosis diagnosis and that complementary exams are necessary. As an attempt to simplify the patients' assessment, Well et al., in 1997, developed a clinical prediction index that combines symptoms, signs and risk factors for deep venous thrombosis and managed to make a simpler approach through an association of this index with the complementary exams. Phlebography has been considered the gold standard of complementary exams. However, since it is an invasive exam and thus subject to complications, other diagnostic methods were introduced aiming at making the diagnostic approach simpler and less invasive. Doppler ultrasound, duplex scan, impedance plethysmography, computed tomography, and blood tests such as the D-dimer are some of the available methods for assessing the patient with suspicion of deep venous thrombosis. Among them, duplex scan has shown excellent accuracy and it is currently widely accepted as the first choice test for approaching the patient with deep venous thrombosis. Several authors have suggested an association of diagnostic methods to simplify and make the assessment of such patients more cost-effective, leading to the introduction of a wide range of diagnostic strategies. The different diagnostic methods used for assessing deep venous thrombosis are discussed, as well as a review of the literature on the accuracy, advantages and disadvantages of these methods. Copyright © 2005 by Sociedade Brasileira de Angiologia e Cirurgia Vascular.

Mortalidade e prognóstico específico em pacientes com insuficiência renal aguda

A variety of systems of risk factor stratification have been studied to predict the outcome in acute renal failure (ARF). OBJECTIVES. Assess and compare mortality and the Acute Tubular Necrosis Individual Severity Score (ATN-ISS) in patients with AFR treated in a university hospital. METHODS. A prospective analysis was made of 103 patients with a diagnosis of intrinsic ARF admitted to the Hospital das Clinicas da Faculdade de Medicina de Botucatu, UNESP. Patients were followed up until recovery of renal function or death. The Score ATN-ISS was recorded during the first hours of the assessment by a nephrologist. Results were reported as median or mean ± SD, with statistical significance of p<0.05. RESULTS. Fifty-one percent of patients were male with a mean age of 58 ± 36 years. Forty-four percent died in the hospital. Mortality was higher in patients from the surgical wards (52.7%) and in patients who were treated with dialysis (63.8%). The score ATN-ISS showed a good confidence level, with high discriminatory power (area under the curve of 0.95) and good accuracy. CONCLUSIONS. Mortality in this study was comparable to that found in literature. The ATN-ISS was shown to be a prognostic index with a high confidence level that could be routinely applied by nephrologists to patients with AFR.

Mecanismo de centralização: Da insuficiência placentária à adaptação circulatória fetal

The application and development of obstetric Dopplervelocimetry provide a basis for the investigation of placental insuf ciency and demonstrate the dynamic behavior of fetal circulation during hypoxia. In clinical practice, assessing hemodynamics in three vascular regions involved in pregnancy, namely the uterine, umbilical and middle cerebral arteries, has become routine. Roughly, the cerebral artery expresses the balance between uterine artery oxygen supply and umbilical artery oxygen uptake. Currently, when such balance is unfavorable, the fetal cardiac reserve is investigated by assessing the venous duct. However, determining and interpreting vascular resistance indexes is not an easy task. The starting point is to know the physiopathology of placental insuf ciency and fetal circulatory adaptation through which Doppler con rmed its role in the assessment of fetal well-being.

Vascularização arterial e venosa do linfonodo poplíteo em cães

Poplíteo lympho nodes in the dogs is placed, to the right and the left in popliteo an appointed space fossa, in distal part of the muscles femoral biceps, laterally and semi-tendinous, medially, projecting in the height of the face volume of the joint to femoro tibial e femoro patellar (joint of the knee). In this study twenty and five dogs, males and females adult, originating the Araçatuba municipal kennel had been used whose captures had been effected by the animal sanitary defense of this city. The arterial vessels destined to this structure always derive, of both the sides, the femoral artery distal volume and vary of 10 the 1, more frequently of 2 (7 times, 28%) to the right and of 6 the 2, equally more frequently of 2 (8 times, 32%). So soon as one has still to right 5 and 6 branches (3 times, 12%), 1, 7 and 10 (1 time, 4%). Relatively to the veins derived from this lympho nodes, always converges to the lateral safena vein, these vessels oscillates between 9 and 2, more frequently of 3 (6 times, 24%), to the right and of 12 the 2, more frequently of 3 (10 times, 40%) to the left. Thus, others deriving branches of popliteo lympho nodes right and that if they insert in the above-mentioned vein are in number of 2 and 5 (5 times, 20%), 4 and 6 (2 times, 8%) and 8 and 9 (1 time, 4%). In spite of, to the left side it is examined in number de 2 branches (6 times, 24%), 4 (4 times, 16%), 6 (3 times, 12%) and finishing 9 and 12 branches (1 time, 4%). The size of popliteo lympho node in seropositive dogs for Visceral Leishmaniasis can meets enters 7,8 × 3,8 × 6,1 a 50,0 × 20,7 × 28,5, in mm, being average 26,18 × 10,5 × 15,97 mm for right and 26,98 × 11,14 × 15,25 mm for left (concerning the measures dorsoventral, latero-lateral and cranial-caudal, respectively).

Espectros Clínicos da Trombose Venosa Cerebral

Introduction. Cerebral Venous Thrombosis has a highly variable clinical presentation. Four major syndromes had been described in patients with cerebral venous thrombosis: isolated intracranial hypertension, focal neurological deficits, focal or generalized seizures and disturbances of consciousness and cognitive dysfunction. Method. We describe five consecutive patients admitted to our service with a diagnosis of cerebral venous thrombosis, highlighting the different possibilities of clinical presentation and prognosis. Discussion. The diagnosis of cerebral venous thrombosis should be considered in patients with acute, subacute or chronic headache, with or without signs of intracranial hypertension or focal deficits, even in the absence of cerebrovascular risk factors. Treatment should be started as soon as the diagnosis is confirmed and consists of reversal of the underlying cause when known, control of seizures and intracranial hypertension, and antithrombotic therapy.

Dosagem de NGAL no perioperatório de cirurgia bariátrica videolaparoscópica: comparação de Anestesia Venosa Total (TIVA) versus Sevoflurano

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

Avaliação bioquímica, morfológica e funcional do músculo estriado esquelético de ratos na insuficiência cardíaca

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Insuficiência aórtica subcrônica e vias centrais relacionadas à regulação da ingestão de sódio

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Análise dos receptores de acetilcolina (nAChRs) na musculatura esquelética de ratos com insuficiência cardíaca submetidos ao treinamento aeróbico

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Influência do exercício físico na expressão da miostatina e folistatina no músculo sóleo de ratos com insuficiência cardíaca crônica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Expressão dos fatores de regulação miogênica, composição das miosinas e trofismos no músculo esquelético periférico de ratos com insuficiência cardíaca crônica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)