Complicacoes respiratorias em criancas submetidas a anestesia geral

Background and Objectives - The decision to perform anesthetic and surgical procedures in children with upper airway infeccious disease, due to the possibility of intraoperative respiratory morbidity, has been a dilemma for anesthesiologists. This study aimed at evaluating the incidence of respiratory complications in children submitted to general anesthesia and correlate them to preoperative signs and symptoms related to the respiratory tract, thus determining anesthetic-surgical morbidity. Methods - Participated in this study 284 children, physical status ASA I or II, submitted to general anesthesia. During preoperative evaluation, respiratory signs and symptoms were recorded, as well as types of diseases and corresponding diagnoses. Respiratory complications during anesthesia and in the recovery room were also recorded and analyzed taking into account age, elective or urgent procedure, airway management and presence or absence of signs, symptoms or history of respiratory tract diseases. Results - We found 38% of patients with preoperative respiratory disease history. The most common respiratory disease was upper airway infection. Intraoperative respiratory complications were present in 26.4% of patients. Children under 12 months of age and those with preoperative respiratory disease history had more intraoperative and PACU complications. Conclusions - We concluded that children, specially younger, with respiratory system involvement, like upper airway infections, are at a higher risk of intra and postoperative respiratory complications, thus with an increased incidence of anesthetic-surgical morbidity.

Blefarospasmo essencial e espasmo hemifacial: Características dos pacientes, tratamento com toxina botulínica A e revisão da literatura

Purpose: To evaluate the characteristics of the essential blepharospasm and hemifacial spasm patients and the feasible treatment with botulinum toxin. A. Methods: Thirty-four essential blepharospasm or hemifacial spasm patients were evaluated according to gender, ocular complaint, time of disease, treatment outcome and complications. Results: Age median was 63 years and the mean was 61 years, with no difference regarding sex; 66.66% of the patients had hemifacial spasm and 33.33%, essential blepharospasm. Many patients complained of dry eye associated with involuntary spasm. Botulinum toxin A showed a positive outcome in 91.30% of the treated patients and complications observed after treatment were eyelid ptosis (8.33%) and buccal angle deviation (8.33%). Conclusion: Essential blepharospasm and hemifacial spasm occurred in the elderly, of both sexes. Treatment with botulinum toxin A was useful, with very low complication rates.

Edema agudo pulmonar associado à obstrução das vias aéreas. Relato de caso

BAKGROUND AND OBJECTIVES: Negative pressure pulmonary edema has been defined as non-cardiogenic edema, with transudation of fluid to the interstitial space of the lungs due to an increase in negative intrathoracic pressure secondary to obstruction of the upper airways. This is the case of a healthy patient who underwent general anesthesia and developed acute pulmonary edema after extubation. CASE REPORT: A 23-year old female patient, physical status ASA II, underwent gynecologic videolaparoscopy under general anesthesia. The procedure lasted 3 hours without intercurrence. After extubation the patient developed laryngeal spasm and reduction in oxygen saturation. The patient improved after placement of an oral cannula and administration of oxygen under positive pressure with a face mask. Once the patient was stable she was transferred to the recovery room where, shortly after her arrival, she developed acute pulmonary edema with elimination of bloody serous secretion. Treatment consisted of elevation of the head, administration of oxygen via a face mask, furosemide and fluid restriction. Chest X-ray was compatible with acute pulmonary edema and normal cardiac area. Electrocardiogram (ECG), echocardiogram and cardiac enzymes were normal. The condition of the patient improved and she was discharged from the hospital the following day, asymptomatic. CONCLUSIONS: Acute pulmonary edema associated with obstruction of the upper airways can aggravate surgical procedures with low morbidity, affecting mainly young patients. Early treatment should be instituted because it has a fast evolution and, in most cases, resolves without lasting damages. © Sociedade Brasileira de Anestesiologia, 2008.

Infantile epileptic encephalopathy with hypsarrhythmia (infantile spasms/west syndrome) and immunity

West syndrome is a severe epilepsy, occurring in infancy, that comprises epileptic seizures known as spasms, in clusters, and a unique EEG pattern, hypsarrhythmia, with psychomotor regression. Maturation of the brain is a crucial component. The onset is within the first year of life, before 12 months of age. Patients are classified as cryptogenic (10 to 20%), when there are no known or diagnosed previous cerebral insults, and symptomatic (80 to 90%), when associated with pre-existing cerebral damages. The time interval from a brain insult to infantile spasms onset ranged from 6 weeks to 11 months. West syndrome has a time-limited natural evolutive course, usually disappearing by 3 or 4 years of age. In 62% of patients, there are transitions to another age-related epileptic encephalopathies, the Lennox-Gastaut Syndrome and severe epilepsy with multiple independent foci. Spontaneous remission and remission after viral infections may occur. Therapy with ACTH and corticosteroids are the most effective. Reports about intravenous immunoglobulins action deserve attention. There is also immune dysfunction, characterized mainly by anergy, impaired cell-mediated immunity, presence of immature thymocytes in peripheral blood, functional impairment of T lymphocytes induced by plasma inhibitory factors, and altered levels of immunoglobulins. Changes in B lymphocytes frequencies and increased levels of activated B cells have been reported. Sensitized lymphocytes to brain extract were also described. Infectious diseases are frequent and may, sometimes, cause fatal outcomes. Increase of pro-inflamatory cytokines in serum and cerebrospinal fluid of epileptic patients were reported. Association with specific HLA antigens was described by several authors (HLA-DR7, HLA-A7, HLA-DRw52, and HLA-DR5). Auto-antibodies to brain antigens, of several natures (N-methyl-d-aspartate glutamate receptor, gangliosides, brain tissue extract, synaptic membrane, and others), were described in epileptic patients and in epileptic syndromes. Experimental epilepsy studies with anti-brain antibodies demonstrated that epileptiform discharges can be obtained, producing hyperexcitability leading to epilepsy. We speculate that in genetically prone individuals, previous cerebral lesions may sensitize immune system and trigger an autoimmune disease. Antibody to brain antigens may be responsible for impairment of T cell function, due to plasma inhibitory effect and also cause epilepsy in immature brains. © 2008 Bentham Science Publishers Ltd.

Human eosinophil adhesion and degranulation stimulated with eotaxin and RANTES in vitro: Lack of interaction with nitric oxide

Background: Airway eosinophilia is considered a central event in the pathogenesis of asthma. The toxic components of eosinophils are thought to be important in inducing bronchial mucosal injury and dysfunction. Previous studies have suggested an interaction between nitric oxide (NO) and chemokines in modulating eosinophil functions, but this is still conflicting. In the present study, we have carried out functional assays (adhesion and degranulation) and flow cytometry analysis of adhesion molecules (VLA-4 and Mac-1 expression) to evaluate the interactions between NO and CC-chemokines (eotaxin and RANTES) in human eosinophils. Methods: Eosinophils were purified using a percoll gradient followed byimmunomagnetic cell separator. Cell adhesion and degranulation were evaluated by measuring eosinophil peroxidase (EPO) activity, whereas expression of Mac-1 and VLA-4 was detected using flow cytometry. Results: At 4 h incubation, both eotaxin (100 ng/ml) and RANTES (1000 ng/ml) increased by 133% and 131% eosinophil adhesion, respectively. L-NAME alone (but not D-NAME) also increased the eosinophil adhesion, but the co-incubation of L-NAME with eotaxin or RANTES did not further affect the increased adhesion seen with chemokines alone. In addition, L-NAME alone (but not D-NAME) caused a significant cell degranulation, but it did not affect the CC-chemokine-induced cell degranulation. Incubation of eosinophils with eotaxin or RANTES, in absence or presence of L-NAME, did not affect the expression of VLA-4 and Mac-1 on eosinophil surface. Eotaxin and RANTES (100 ng/ml each) also failed to elevate the cyclic GMP levels above baseline in human eosinophils. Conclusion: Eotaxin and RANTES increase the eosinophil adhesion to fibronectin-coated plates and promote cell degranulation by NO-independent mechanisms. The failure of CC-chemokines to affect VLA-4 and Mac-1 expression suggests that changes in integrin function (avidity or affinity) are rather involved in the enhanced adhesion. © 2008 Lintomen et al; licensee BioMed Central Ltd.

Acute coronary syndrome associated with continuous 5-fluorouracil infusion in a patient with metastatic colorectal cancer-a case report with a discussion on this clinical dilemma

Introduction: 5-Fluorouracil (5-FU) is considered to be the backbone of colorectal cancer (CRC) systemic therapy since the great majority of recommended regimens include its administration. A clinical picture consisting of chest pain, sometimes cardiac enzyme elevation, electrocardiogram abnormalities consistent with myocardial ischemia, and normal coronary angiogram associated with 5-FU administration have been infrequently reported. The clinical dilemma is: Which chemotherapy regimen should we use in CRC patients with a previous acute coronary syndrome (ACS) associated with 5-FU? Case Report: We describe the case of a 55-year-old otherwise healthy woman with metastatic colon adenocarcinoma who presented an ACS probably secondary to arterial vasospasm while receiving continuous intravenous 5-FU infusion (mFOLFOX6 regimen). After the ACS, the patient was treated with raltitrexate plus oxaliplatin (TOMOX) and subsequently with irinotecan plus cetuximab with no other cardiac event. Conclusion: The risk of cardiotoxicity associated with 5-FU is low but real. The probable mechanism is arterial vasospasm, as suggested by our case report. Both the use of the TOMOX regimen and irinotecan plus cetuximab seems to be safe regimens to be considered in this clinical scenario. © 2009 Humana Press Inc.

Atuação fisioterapêutica na lesão medular em unidade de terapia intensiva: Atualização de literatura

Objective. Collate and update knowledge in relation to physical therapy in spinal cord injury (SCI) in the intensive care unit (ICU). Method. We performed a literature update in the databases Lilacs, PubMed and Scielo, crossing the descriptors spinal cord injury, cinesiotherapy, physiotherapy, mobilization, rehabilitation, intensive care unit, respiratory therapy and electrotherapy in the period of 2005 to 2010. Results. We found 21 studies, however, only five articles met the inclusion criteria. Kinesiotherapy is essential since the phase of spinal shock, since it favors the maintenance of joint range of motion and flexibility, and to prevent circulatory complications caused/ resulted from prolonged immobilization in bed. Respiratory therapy promotes bronchial hygiene, correction of abnormal respiratory patterns and respiratory diseases. The electrotherapy is a feature still little used by physiotherapists in the intensive care units. Conclusions. The physical therapy in SCI in ICU is focused on motor rehabilitation through kinesiotherapy and intervention through the respiratory bronchial hygiene and training of respiratory muscles. New treatment modalities such as electrotherapy, there have been in intensive environment, there is a need for more studies to confirm benefits and risks of this feature in the spinal cord.

́Toma que o filme é teú: Sai de Baixo entre o teleteatro e a sitcom

A program recorded in a theater, with the audience, incorporating all of the improvisations and later televised. That was Sai de Baixo, TV Globos program broadcasted between 1996 and 2002. However, a specific episode limit this article. Toma 0que o filmeéteu, 1998, was made alive. Was it a spasm of the old teleplay Or was it just a common sitcom episode To answer these questions, the paper used a case study, bibliographical and documentary research and concluded that this episode was not a brief return of teleplay, having in mind that the fact of being alive is not a requirement to be teleplay, but there are other criteria.

Case report: Disseminated Mycobacterium tuberculosis infection in a dog

An uncommon disseminated Mycobacterium tuberculosis infection is described in a 12-year-old female dog presenting with fever, dyspnea, cough, weight loss, lymphadenopathy, melena, epistaxis, and emesis. The dog had a history of close contact with its owner, who died of pulmonary tuberculosis. Radiographic examination revealed diffuse radio-opaque images in both lung lobes, diffuse visible masses in abdominal organs, and hilar and mesenteric lymphadenopathy. Bronchial washing samples and feces were negative for acid-fast organisms. Polymerase chain reaction (PCR)-based species identification of bronchial washing samples, feces, and urine revealed M. tuberculosis using PCR-restriction enzyme pattern analysis-PRA. Because of public health concerns, which were worsened by the physical condition of the dog, euthanasia of the animal was recommended. Rough and tough colonies suggestive of M. tuberculosis were observed after microbiological culture of lung, liver, spleen, heart, and lymph node fragments in Löwenstein-Jensen and Stonebrink media. The PRA analysis enabled diagnosis of M. tuberculosis strains isolated from organs. Copyright © 2013 by The American Society of Tropical Medicine and Hygiene.

Interleucina-9 estimula a expressão de CCL17/TARC em células epiteliais de pulmão murino

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

Incidência de linfoadenopatia compatível com tuberculose em bovinos abatidos em frigorífico de exportação no período de 2007 a 2011

Pós-graduação em Medicina Veterinária - FMVZ

Equipamento de hipotermia para ser utilizado em tratamento muscular com lesões na fase aguda

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Efeitos da higienização brônquica nas variáveis cardiorrespiratórias de pacientes em ventilação mecânica

INTRODUCTION: During mechanical ventilation (MV), the airways may accumulate secretions. Patients are submitted to Respiratory Therapy (RT) and tracheal aspiration when in MV, alone or associated, to eliminate these secretions. OBJECTIVE: The objective was to compare the effects of different protocols of bronchial hygiene in blood pressure, heart rate, oxygen saturation and respiratory rate of patients undergoing MV. MATERIALS AND METHODS: We conducted a prospective, randomized, controlled crossover, with intentional non-probabilistic sample in the Medical School Hospital of Marília. We included patients in invasive MV who were submitted to three different bronchial hygiene protocols: PP - physiotherapy protocol (manual chest compression and manual hyperinflation); AP - aspiration protocol; and PP + AP. Respiratory rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), oxygen saturation and heart rate were evaluated in three moments: before (M1), immediately after (M2) and 30 minutes after (M3) for each protocol. The differences among protocols and times were assessed using ANOVA and post hoc Student Newman-Keus (p < 0.05). RESULTS: We studied eighteen 71.2 ± 13.9 year-old patients with 15.1 ± 17.7 days of MV. There were no differences among protocols. There was a significant decreasing in SBP (p = 0.0261) and DBP (p = 0.0119) from M2 to M3 in the aspiration protocol. CONCLUSION: There was a decrease of blood pressure on MV patients after 30 minutes of aspiration and no change in the other variables, and there was no difference among protocols.

Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery

BackgroundThis is an update of a Cochrane Review first published in The Cochrane Library 2008, Issue 3.Upper abdominal surgical procedures are associated with a high risk of postoperative pulmonary complications. The risk and severity of postoperative pulmonary complications can be reduced by the judicious use of therapeutic manoeuvres that increase lung volume. Our objective was to assess the effect of incentive spirometry compared to no therapy or physiotherapy, including coughing and deep breathing, on all-cause postoperative pulmonary complications andmortality in adult patients admitted to hospital for upper abdominal surgery.ObjectivesOur primary objective was to assess the effect of incentive spirometry (IS), compared to no such therapy or other therapy, on postoperative pulmonary complications and mortality in adults undergoing upper abdominal surgery.Our secondary objectives were to evaluate the effects of IS, compared to no therapy or other therapy, on other postoperative complications, adverse events, and spirometric parameters.Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 8), MEDLINE, EMBASE, and LILACS (from inception to August 2013). There were no language restrictions. The date of the most recent search was 12 August 2013. The original search was performed in June 2006.Selection criteriaWe included randomized controlled trials (RCTs) of IS in adult patients admitted for any type of upper abdominal surgery, including patients undergoing laparoscopic procedures.Data collection and analysisTwo authors independently assessed trial quality and extracted data.Main resultsWe included 12 studies with a total of 1834 participants in this updated review. The methodological quality of the included studies was difficult to assess as it was poorly reported, so the predominant classification of bias was 'unclear'; the studies did not report on compliance with the prescribed therapy. We were able to include data from only 1160 patients in the meta-analysis. Four trials (152 patients) compared the effects of IS with no respiratory treatment. We found no statistically significant difference between the participants receiving IS and those who had no respiratory treatment for clinical complications (relative risk (RR) 0.59, 95% confidence interval (CI) 0.30 to 1.18). Two trials (194 patients) IS compared incentive spirometry with deep breathing exercises (DBE). We found no statistically significant differences between the participants receiving IS and those receiving DBE in the meta-analysis for respiratory failure (RR 0.67, 95% CI 0.04 to 10.50). Two trials (946 patients) compared IS with other chest physiotherapy. We found no statistically significant differences between the participants receiving IS compared to those receiving physiotherapy in the risk of developing a pulmonary condition or the type of complication. There was no evidence that IS is effective in the prevention of pulmonary complications.Authors' conclusionsThere is low quality evidence regarding the lack of effectiveness of incentive spirometry for prevention of postoperative pulmonary complications in patients after upper abdominal surgery. This review underlines the urgent need to conduct well-designed trials in this field. There is a case for large RCTs with high methodological rigour in order to define any benefit from the use of incentive spirometry regarding mortality.

Avaliação Postural em Sujeitos com Disfunção Temporomandibular Submetidos a Tratamento de Terapia Manual

Individuals with temporomandibular disorders (TMD) often have signs and symptoms such as intra-articular pain, muscle spasm, neck pain radiating from others who interfere with this balance. Over time can lead to postural changes and correction of the cervical spine, anterior head and shoulder asymmetry. The aim was to verify the effects of manual therapy on posture in subjects with TMD. Materials and methods: 30 volunteers (mean: 21.43± SD:1.43) of both sexes who had TMD classified according to axis I of the Research Diagnostic Criteria participated in this study. These were photographed in the anterior frontal and sagittal planes for analysis of the following angles (acromion clavicular joint, sternoclavicular joint, orbicular external, corners of the mouthand and protruding head). After, the volunteers were divided into groups ATM (manual therapy in the treatment of temporomandibular joint), Cervical (manual therapy in the treatment of cervical joint) and Control. The Kolmogokov-Smirnov test, followed by ANOVA, considering a significance level of 5% was used. Results: Groups ATM, Cervical and Control were considered homogeneous with respect to the values of the angles measured. These also showed no significant difference between the 1st, 5th and 10th sessions, so the manual therapy techniques applied to the TMJ and Cervical groups were not sufficient to change postural alignment. Conclusion: The postural alignment, the TMD patients evaluated in this study did not change after attending the sessions proposals with manual therapy techniques in the cervical and TMJ.