Intrapleural analgesia after endoscopic thoracic sympathectomy

OBJETIVO: Comparar a analgesia tradicionalmente utilizada para simpatectomia videotoracoscópica à injeção intrapleural de ropivacaína em duas doses diferentes. MÉTODOS: Vinte e quatro pacientes foram distribuídos em três grupos semelhantes, e todos eles receberam dipirona endovenosa. O grupo A recebeu tramadol endovenoso e injeção intrapleural de solução salina. O grupo B recebeu injeção intrapleural de ropivacaína a 0,33%, e Grupo C ropivacaína a 0,5%. Os aspectos analisados foram: capacidade inspiratória, freqüência respiratória e dor. A dor foi avaliada no período pós-operatório por meio da escala visual analógica e durante o período de uma semana. RESULTADOS: Nos grupos A e B, a redução da capacidade inspiratória foi observada no período pós-operatório. Nas primeiras 12 horas de pós-operatório, apenas 12,5% dos pacientes nos grupos B e C apresentaram dor intensa em comparação a 25% no Grupo A. Na semana seguinte, apenas um paciente do grupo A apresentou dor leve, enquanto o restante relatou dor intensa. No Grupo B, metade dos pacientes apresentou dor intensa, e no Grupo C, apenas um apresentou intensa dor. CONCLUSÃO: A analgesia intrapleural com ropivacaína resultou em menos dor no pós-operatório tardio com os melhores resultados analgésicos nas doses mais altas, proporcionando um melhor padrão ventilatório.

Esophagectomy and substitution of the thoracic esophagus in dogs

OBJETIVO: Avaliar, em cadáveres de cães, uma técnica para remoção do esôfago torácico sem toracotomia e dois métodos de substituição do esôfago torácico. MÉTODOS: Foram utilizados 27 cadáveres de cães. Estes foram aleatoriamente divididos em três grupos de nove animais, em que se estudou: G1 - esofagectomia torácica total pelo método de invaginação retrógrada; G2 - esofagectomia torácica total com substituição esofágica pelo estômago inteiro; G3 - esofagectomia torácica total com substituição esofágica por um gastrotubo confeccionado de acordo com a técnica de Büchler de gastroplastia por rotação do fundo. Após a ressecção esofágica no grupo 1, a integridade da rota intratorácica foi avaliada por endoscopia e solução de azul de metileno a 1%. RESULTADOS: A ruptura da pleura visceral ocorreu em todos os animais, especialmente no terço caudal. Entretanto, a rota transtorácica mediastinal permitiu a elevação de ambos os substitutos esofágicos (G2 e G3) para a realização da anastomose com a extremidade caudal do esôfago cervical. CONCLUSÕES: A substituição por estômago inteiro apresentou menor tensão na anastomose, maior facilidade e rapidez comparada à técnica de gastroplastia por rotação do fundo. Os resultados em cadáveres suportam a realização de estudos clínicos para validação da técnica.

Efeitos de concentrações crescentes de lidocaína hiperbárica, administradas no espaço subaracnóideo, sobre a medula espinhal e as meninges: estudo experimental em cães

JUSTIFICATIVA E OBJETIVOS: Ainda não está bem estabelecida a concentração de lidocaína que é potencialmente capaz de determinar lesão no tecido nervoso. O objetivo desta pesquisa foi estudar os efeitos sobre a medula espinhal e as meninges, de concentrações crescentes de lidocaína administrada por via subaracnóidea, em injeção única através de agulha de Quincke. MÉTODO: Após a aprovação da Comissão de Ética em Experimentação Animal, 40 cães adultos foram anestesiados com fentanil e etomidato e submetidos a punção subaracnóidea com agulha de Quincke 22G 21/2 para introdução de 1 mL, em 10 segundos, de solução glicosada a 7,5% - Grupo 1; lidocaína a 5% em solução glicosada a 7,5% - Grupo 2; lidocaína a 7,5% em solução glicosada a 7,5% - Grupo 3; lidocaína a 10% em solução glicosada a 7,5% - Grupo 4. Após a recuperação da anestesia venosa, foram observados, no período em que os animais estavam em vigência do bloqueio subaracnóideo, a presença de bloqueio motor, o tônus do esfíncter anal (normal ou relaxado) e o nível de bloqueio sensitivo nos diferentes dermátomos das regiões cervical, torácica, lombar e sacral. Os animais permaneceram em cativeiro por 72 horas. Foram avaliados o tônus do esfíncter anal, a motricidade das patas posteriores, a sensibilidade dolorosa nas patas anteriores e posteriores e nos dermátomos sacrais, lombares e torácicos. Após serem sacrificados por eletrocussão sob anestesia, foram retiradas porções lombar e sacral da medula espinhal e das meninges para exame histológico por microscopia óptica. RESULTADOS: Nenhum animal dos Grupos 1 e 2 apresentou lesões clínicas ou histológicas. Três animais do Grupo 3 apresentaram alterações motoras nas patas posteriores e relaxamento do esfíncter anal. Nestes, foram observados focos de necrose na região posterior (dois cães) e necrose em faixa em toda a superfície medular (um cão). em um outro animal deste grupo, no qual foram notados focos de necrose, em área inferior a 5% do campo histológico não foram encontradas alterações clínicas. Sete animais do Grupo 4 apresentaram alterações clínicas (paralisia ou diminuição de força muscular nas patas posteriores, relaxamento do esfíncter anal) e histológicas (necrose na faixa da superfície medular ou focos de necrose de tecido nervoso). CONCLUSÕES: Neste estudo, a lidocaína em concentrações superiores a 7,5%, em injeção única, administrada no espaço subaracnóideo por meio de agulha de Quincke, determinou alterações histológicas sobre a medula espinhal, mas não sobre as meninges.

Surgical risk tests related to cardiopulmonary postoperative complications: comparison between upper abdominal and thoracic surgery

PURPOSE: To investigate if tests used in the preoperative period of upper abdominal or thoracic surgeries are able to differentiate the patients that presented cardiopulmonary postoperative complications. METHODS: Seventy eight patients, 30 submitted to upper abdominal surgery and 48 to thoracic surgery were evaluated. Spirometry, respirometry, manovacuometry, six-minute walk test and stair-climbing test were performed. Complications from immediate postoperative to discharge from hospital were registered. RESULTS: The postoperative complications rate was 17% in upper abdominal surgery and 10% in thoracic surgery. In the univariate regression, the only variable that kept the correlation with postoperative complications in the upper abdominal surgery was maximal expiratory pressure. In thoracic surgery, the maximal voluntary ventilation, six-minute walk test and time in stair-climbing test presented correlation with postoperative complications. After multiple regression only stair-climbing test continued as an important risk predictor in thoracic surgery. CONCLUSION: The respiratory pressure could differentiate patients with complications in upper abdominal surgery, whereas in thoracic surgery, only spirometric values and exercise tests could differentiate them.

Trimetazidine and N-acetylcysteine in attenuating hind-limb ischemia and reperfusion injuries: experimental study in rats

Aim. Lower-limb traumatic injury associated with ischemia and followed by reperfusion (I/R) is a common severe situation in muscle lesions due to trauma and hypoxia followed by local and systemic injuries induced by oxygen-derived free radical release during reperfusion. The aim of this study was to evaluate the attenuating effects of trimetazidine (TMZ) and N-acetylcysteine (NAC) in such situation.Methods. The muscles at the root of the right hind limb of Wistar rats were cross-sectioned, preserving femoral vessels and nerves and clamping the femoral artery for four hours. The clamp was then released and the femoral artery has been reperfused for 2 hours. Rats were randomly divided in groups of ten as follows: Group 1: sham I/R, treated with saline; Group 2: I/R, treated with saline; Group 3: sham I/R, treated with TMZ (7.5 mg/kg/dose); Group 4: sham I/R, treated with NAC (375 mg/kg/dose); Group 5: I/R treated with TMZ (7.5 mg/kg/dose); Group 6: I/R treated with NAC (375 mg/kg/dose). All rats received two intravenous bolus injections of the drugs, one before ischemia and one before reperfusion. Oxidative stress in plasma (MDA, total, oxidized and reduced glutathione), creatinephosphokinase (CPK), optical and electron microscopy and pelvic extremity circumference and volume were studied.Results. No statistical differences were found between the groups for MDA or total and reduced glutathione. Oxidized glutathione increased significantly in groups 5 and 2. Limb circumference as well as limb volume increased in all groups over time, mainly in groups 5, 2 and 1. CPK increased in all groups, being highest in groups 5, 6 and 2. Histological lesions were present in all but sham groups, being less severe in group 6. Soleus muscle analyses at electron microscopy exhibit some degree of alteration in all groups.Conclusion. This experimental model simulated severe limb trauma associated with ischemia and reperfusion, and, as such, it was aggressive, causing severe injury and local inflammatory reaction. The model did not show antioxidant action from NAC, and possible antioxidant action from TMZ was insufficient to attenuate tissue injuries. [Int Angiol 2009;28:412-7]

Effects of pentoxifylline and n-acetylcysteine on injuries caused by ischemia and reperfusion splanchnic organs in rats

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

A total laparoscopic technique for endovascular thoracic stent graft deployment

Background: Limitations of endovascular thoracic aneurym treatment include small, tortuous, or severely calcified iliac Back, arteries. We present our experience with a total laparoscopic access to deploy thoracic endografts.Methods. A total laparoscopic left retrocolic approach was used in all cases. A Dacron conduit was laparoscopically sutured to either the iliac artery or to the aorta directly. The endograft was inserted through this conduit. After graft deployment, the Dacron prosthesis was tunneled to the groin and anastomosed with the femoral artery.Results. The laparoscopic procedure could successfully be performed in 11 patients. In six cases, the aorta was used as all access and in five patients, the iliac arteries were preferred. In one of these cases, the right iliac artery, was used for deployment of the endograft. After successful aorto- or ileo-femoral bypass grafting, all patients had an improvement of their ankle brachial index postoperatively. The mean operative time was almost four hours, including laparoscopy, laparoscopic anastomosis, endograft deployment, and femoral artery anastomosis or profundaplasty.Conclusion: Totally laparoscopic assisted graft implantation in aorta or iliac arteries provides a safe and effective access for the endovascular delivery system. However, further evaluation and long follow-up are necessary to ensure the potential advantages of this technique. It is a less invasive option to overcome access-related problems with thoracic endograft deployment, giving the patient the advantage of a totally minimal invasive procedure. (J Vasc Surg 2010;51:504-8.)

Relationship of upper-limb and thoracic muscle strength to 6-min walk distance in COPD patients

Study objectives: This study was developed to investigate the influence of thoracic and upperlimb muscle function on 6-min walk distance (6MWD) in patients with COPD.Design: A prospective, cross-sectional study.Setting: the pulmonary rehabilitation center of a university hospital.Patients: Thirty-eight patients with mild to very severe COPD were evaluated.Measurements and results: Pulmonary function and baseline dyspnea index (BDI) were assessed, handgrip strength, maximal inspiratory pressure (Pimax), and 6MWD were measured, and the one-repetition maximum (1RM) was determined for each of four exercises (bench press, lat pull down, leg extension, and leg press) performed on gymnasium equipment. Quality of life was assessed using the St. George Respiratory Questionnaire (SGRQ). We found statistically significant positive correlations between 6MWD and body weight (r = 0.32; p < 0.05), BDI (r = 0.50; p < 0.01), FEV, (r = 0.33; p < 0.05), PImax (r = 0.53; p < 0.01), and all values of 1RM. A statistically significant negative correlation was observed between 6MWD and dyspnea at the end of the 6-min walk test (r = -0.29; p < 0.05), as well as between 6MWD and the SGRQ activity domain (r = -0.45; p < 0.01) and impact domain (r = -0.34; p < 0.05) and total score (r = -0.40; p < 0.01). Multiple regression analysis selected body weight, BDI, Pimax, and lat pull down IRM as predictive factors for 6MWD (R-2 = 0.589).Conclusions: the results of this study showed the importance of the skeletal musculature of the thorax and upper limbs in submaximal exercise tolerance and could open new perspectives for training programs designed to improve functional activity in COPD patients.

Injuries caused by scorpionfishes and (Scorpaena plumieri Bloch, 1789 Scorpaena brasiliensis Cuvier 1829) in the Southwestern Atlantic Ocean (Brazilian coast): epidemiologic, clinic and therapeutic aspects of 23 stings in humans

Fishes of the family Scorpaenidae are responsible for severe injuries and occasionally deaths in humans around the world. The more venomous fishes on the Brazilian coast and in the Southwestern Atlantic region are classified in the genus Scorpaena (family Scorpaenidae). However, there are few studies on the venomous apparatus, the effects of the venom, or clinical aspects of human envenoming provoked by Atlantic scorpionfishes.In this communication, the authors present 23 accidents caused by scorpionfishes of the genus Scorpaena among fishermen, and report the species that provoked the injuries, the circumstances of contacts, the clinical aspects observed and the therapeutic measures utilized for control of the symptoms of the victims. The intense pain and the systemic findings observed in the patients were very frequent and we think that the injuries provoked by scorpionfishes should be considered the most important manifestations caused by venomous fishes of the East Atlantic Ocean. (C) 2003 Elsevier B.V. Ltd. All rights reserved.

Hand injuries in a human caused by a South American porcupine (ourico-cacheiro)

Human injuries caused by South American porcupines (in Portuguese, ourico-cacheiro) are rare. This study reports severe hand injuries provoked by the body spines of the animal in a human and discusses the circumstances involved in the accident, with emphasis on environmental factors.

Injuries and envenoming by aquatic animals in fishermen of Coxim and Corumbá municipalities, state of Mato Grosso do Sul, Brazil: identification of the causative agents, clinical aspects and first aid measures

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Association between distressing non-work-related events and occupational injuries

The following is a report on a case-control study whose objective was to investigate the association between distressing non-work-related events and occupational injures. Ninety three injured workers (cases) were matched with 372 non-injured controls in a large metallurgical factory in southeastern Brazil. Exposure to distressing non-work-related events was measured through a questionnaire focusing on situations pertaining to personal problems unrelated to work activities. The data were analyzed by adjusting a conditional logistic regression model, where occurrence of the work injury was the dependent dichotomous variable and answers from the questionnaire were independent continuous variables. The analysis showed an association between some distressing non-work-related events and occupational injuries. These findings imply expanding the horizon of preventive measures used in targeting. work injuries which have traditionally been focused on the control of strictly workplace risks.

Dentists' level of knowledge of the treatment plans for periodontal ligament injuries after dentoalveolar trauma

This study investigated the level of knowledge held by dentists about the possible treatment plan procedures for periodontal ligament injuries after dentoalveolar trauma. A 5-item self-applied questionnaire was prepared with questions referring to the professional profile of the interviewees and to the treatment plan they would propose for periodontal ligament injuries secondary to dentoalveolar trauma. The questionnaires were filled out by 693 dentists attending the 23rd Annual Meeting of the Brazilian Society for Dental Research, and the data obtained were subjected to descriptive analysis. Either the chi-square test or Fisher's exact test was applied to assess associations among variables, at a 5% level of significance. The results revealed that dentists experienced difficulty in establishing a treatment plan for subluxation, and for extrusive, lateral and intrusive luxations. In general, holding a dental specialty degree had no influence on the knowledge about treatment plan procedures for the most severe injuries. It could be concluded that the dentists participating in this study, whether specialists or not, did not have sufficient knowledge to treat most of the periodontal ligament injuries resulting from dentoalveolar trauma adequately.

Occurrence of tooth injuries in patients treated in hospital environment in the region of Aracatuba, Brazil during a 6-year period

Dental trauma has been considered as a public health problem that affects mainly children and youngsters and due to its impact on the patient's quality of life. This study presents the results of a 6-year survey of the occurrence and characteristics of dental trauma in patients admitted to the Service of Surgery and Oral and Maxillofacial Traumatology of the School of Dentistry of Aracatuba (UNESP, Brazil) after emergency care in hospital facilities in the region of Aracatuba, SP, Brazil. For such purpose, the clinical files of patients treated at the Service between 1999 and 2005 were reviewed. Information regarding gender, age, number of traumatized teeth, etiology and diagnosis of the trauma was collected from the files of patients with tooth injuries and recorded in case report forms specifically designed for this purpose. The results showed that from a total of 4112 patients admitted to the Service within the surveyed period, 266 (6.5%) had tooth injuries (172 males - 64.7%; 94 females - 35.3%). The total number of traumatized teeth was 496. Most patients belonged to the 16-20 year-old age group (20.3%) and the most frequent causes of tooth injuries were bicycle accidents (28.6%), motorcycle accidents (19.2%) and falls (18.8%). Injuries to the periodontal tissues were the most frequent type of tooth injuries (408 teeth; 82.26%), occurring in 118 primary and 290 permanent teeth. Among the injuries to the periodontal tissues, avulsion was the most common (32.86%) (29.41% for primary and 34.0% for permanent teeth), followed by extrusive luxation (19.15%) (25.21% for primary and 17.24% for permanent teeth). In conclusion, in the surveyed population, cases of tooth injuries were more frequent in males aged 16-20 years old due to cyclist accidents with predominance of injuries to the periodontal tissues, in particular, avulsions.

Luxation injuries in primary teeth: a retrospective study in children assisted at an emergency service

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)