Anestesia para colecistectomía videolaparoscópica en paciente portador de enfermedad de Steinert. Relato de caso y revisiõn de la literatura

BACKGROUND AND OBJECTIVES: Myotonic dystrophies are autosomal dominant neuromuscular diseases. Among them, myotonic dystrophy type 1 (MD1), or Steinert disease, is the most common in adults, and besides muscular involvement it also has important systemic manifestations. Myotonic dystrophy type 1 poses a challenge to the anesthesiologist. Those patients are more sensitive to anesthetics and prone to cardiac and pulmonary complications. Besides, the possibility of developing malignant hyperthermia and myotonic episodes is also present. CASE REPORT: This is a 39-year old patient with DM1 who underwent general anesthesia for videolaparoscopic cholecystectomy. Total intravenous anesthesia with propofol, remifentanil, and rocuronium was the technique chosen. Intercurrences were not observed in the 90-minute surgical procedure, but after extubation, the patient developed respiratory failure and myotonia, which made tracheal intubation impossible. A laryngeal mask was used, allowing adequate oxygenation, and mechanical ventilation was maintained until full recovery of the respiratory function. The patient did not develop further complications. CONCLUSIONS: Myotonic dystrophy type 1 presents several particularities to the anesthesiologist. Detailed knowledge of its systemic involvement along with the differentiated action of anesthetic drugs in those patients will provide safer anesthetic-surgical procedure.

Involvement of organic systems in golden retriever X-linked muscular dystrophy

Duchenne muscular dystrophy is a lethal genetic disease characterized by progressive muscle degeneration that usually had been used the Golden Retriever as a model for studying the disease (GRMD - Golden Retriever Muscular Dystrophy). A total of 16 male dystrophic Golden Retrievers dogs between 5 to 51 months of age were examined in the present study. The animals were classified as dystrophic according to two simultaneous complementary criteria: genotypic analysis and serum creatine kinase levels. The macroscopic abnormalities of the different organs and tissues and histopathological features were described using hematoxylin-eosin. The lesions in the skeletal muscles associated with the digestive problems resulted in cachexia with different intensities in all the dystrophic dogs. Cardiac muscle involvement was found in 87,5% of the GRMD dogs resulting, however, in cardiac failure in only 18,8% of the animals. The musculature of the diaphragm was hypertrophic in all affected animals resulting in progressive respiratory muscle weakness and at later stages in respiratory failure (81,25%). The liver abnormalities found in dystrophic dogs were originated mainly from heart disease and developed progressively. Hyperemia of mucosa and granular material indicated changes in the functioning and emptying of bladder. The germinative lineage cells presented moderate to severe degeneration probably due to degeneration of the scrotum and cremaster muscle which prevented the proper thermo-regulation of the testicle. Our results highlight the fact that there is significant impairment of the cardiac, respiratory and skeletal muscle systems in GRMD dogs since the age of five months. In addition, significant alterations of the gastrointestinal tract, urinary and reproductive systems are indicating the presence of degenerative lesions in the smooth musculature.

Indicadores bioquímicos séricos e do líquido peritoneal de equinos submetidos à obstrução intestinal

Twenty-four horses were distributed into four different groups, instrumented control (GI), duodenum obstruction (GII), ileum obstruction (GIII) and large colon obstruction (GIV). Serum and peritoneal fluid analysis of aspartate aminotransferase, creatine kinase, lactate dehydrogenase, alkaline phosphatase, inorganic phosphorus and lactate were measured. Samples were collected one hour before the surgical procedure (T0); 3 hours after the obstruction (T3ob), 1, 3, 12, 24, 120 and 168 hours after the beginning of reperfusion/deobstruction. Duodenal (GII) and ileum (GIII) obstructions changed serum and peritoneal fluid biochemical analysis. However, only lactate, lactate dehydrogenase, creatine kinase and inorganic phosphorus concentrations were abnormal in peritoneal fluid three hours after the obstruction. The biochemical analysis of peritoneal fluid allowed a faster diagnostic of intestinal alterations than the serum analysis; hence it should be prioritized when pre-operatory colic assessment is carried out.

Biocompatible microemulsion modifies the pharmacokinetic profile and cardiotoxicity of doxorubicin

Doxorubicin (DOX) is an anthracycline antibiotic with a broad antitumor spectrum. However, the clinical use of DOX is limited because of its cardiotoxicity, a dose-dependent effect. Colloidal drug delivery systems, such as microemulsions (MEs), allow the incorporation of drugs, modifying the pharmacokinetic (PK) profile and toxic effects. In this study, we evaluated the PK profile and cardiotoxicity of a new DOX ME (DOX-ME). The PK profile of DOX-ME was determined and compared with that of the conventional DOX after single-dose administration (6mg/kg, intravenous) in male Wistar rats (n = 12 per group). The cardiotoxicity of DOX formulations was evaluated by serum creatine kinase MB (CKMB) activity in both animal groups before and after drug administration. The plasma DOX measurements were performed by high-performance liquid chromatography with fluorescence detection, and the CKMB levels were assayed using the CKMB Labtest® kit. The ME system showed a significant increase in plasma DOX concentrations and lower distribution volume when compared with conventional DOX. Serum CKMB activity increased after conventional DOX administration but was unchanged in the DOX-ME group. These results demonstrate modifications in drug access to susceptible sites using DOX-ME. DOX-ME displayed features that make it a promising system for future therapeutic application. © 2012 Wiley Periodicals, Inc.

Waist circumference, but not body mass index, is a predictor of ventricular remodeling after anterior myocardial infarction

Objective: The impact of obesity on ventricular remodeling after myocardial infarction (MI) is still poorly understood. Therefore, the aim of this study was to evaluate the role of waist circumference (WC) and body mass index as predictors of cardiac remodeling in patients after an anterior MI. Methods: Eighty-three consecutive patients with anterior MI were prospectively evaluated. Clinical characteristics and echocardiographic data were analyzed at admission and at a 6-mo follow-up. Ventricular remodeling was defined as a 10% increase in left ventricular end-systolic or end-diastolic diameter at the 6-mo follow-up. Results: In our study, 83 consecutive patients were evaluated (72% men). Ventricular remodeling was present in 31% of the patients (77% men). Patients with remodeling had higher creatine phosphokinase and creatine phosphokinase-MB peak values, a higher resting heart rate, a larger left atrial diameter, and a larger interventricular septum diastolic thickness. In addition, patients with remodeling had lower peak velocity of early ventricular filling deceleration time and ejection fraction. Patients with remodeling presented higher WC values (with remodeling, 99.2 ± 10.4 cm; without remodeling, 93.9 ± 10.8 cm, P = 0.04), but there were no differences in the body mass index values. In the logistic regression analysis, WC, adjusted by age, gender, ejection fraction, and creatine phosphokinase levels, was an independent predictor of left ventricular remodeling (odds ratio 1.067, 95% confidence interval 1.001-1.129, P = 0.02). Conclusion: Waist circumference, but not body mass index, is a predictor of ventricular remodeling after an anterior MI. Therefore, the WC of these patients should be measured in clinical practice. © 2013 Elsevier Inc.

Monitoring chronic physical stress using biomarkers, performance protocols and mathematical functions to identify physiological adaptations in rats

This study was undertaken to characterize the effects of monotonous training at lactate minimum (LM) intensity on aerobic and anaerobic performances; glycogen concentrationsin the soleus muscle, the gastrocnemius muscle and the liver; and creatine kinase (CK), free fatty acids and glucose concentrations in rats. The rats were separated into trained (n =10), baseline (n = 10) and sedentary (n=10) groups. The trained group was submitted to the following: 60 min/day, 6 day/week and intensity equivalent to LM during the 12-week training period. The training volume was reduced after four weeks according to a sigmoid function. The total CK (U/L) increased in the trained group after 12 weeks (742.0±158.5) in comparison with the baseline (319.6±40.2) and the sedentary (261.6+42.2) groups. Free fatty acids and glycogen stores (liver, soleus muscle and gastrocnemius muscle) increased after 12 weeks of monotonous training but aerobic and anaerobic performances were unchanged in relation to the sedentary group. The monotonous training at LM increased the level of energy substrates, unchanged aerobic performance, reduced anaerobic capacity and increased the serum CK concentration; however, the rats did not achieve the predicted training volume.

Exercise-induced muscle damage and running economy in humans

Running economy (RE), defined as the energy demand for a given velocity of submaximal running, has been identified as a critical factor of overall distance running performance. Plyometric and resistance trainings, performed during a relatively short period of time (15-30 days), have been successfully used to improve RE in trained athletes. However, these exercise types, particularly when they are unaccustomed activities for the individuals, may cause delayed onset muscle soreness, swelling, and reduced muscle strength. Some studies have demonstrated that exercise-induced muscle damage has a negative impact on endurance running performance. Specifically, the muscular damage induced by an acute bout of downhill running has been shown to reduce RE during subsequent moderate and high-intensity exercise (>65% VOax). However, strength exercise (i.e., jumps, isoinertial and isokinetic eccentric exercises) seems to impair RE only for subsequent high-intensity exercise (90% VOax). Finally, a single session of resistance exercise or downhill running (i.e., repeated bout effect) attenuates changes in indirect markers of muscle damage and blunts changes in RE. © 2013 Cláudio de Oliveira Assumpção et al.

Biochemical profile of the Pêga donkey (Equus asinus) breed: influence of age and sex

Inappropriate reference limits increase the risks of unnecessary investigations and diagnostic failures. Species, breed, environment, handling, and physiologic stage can influence serum biochemical variables. This study aimed to establish serum biochemical reference intervals of Pêga donkeys and the influence of age and sex on these variables. Samples were taken from 110 donkeys (79 females and 31 males; 8 under 1 year, 33 between 1 and 3 years, and 69 over 3 years old). There were no differences for creatine kinase (CK), albumin, urea, and magnesium among age groups. Animals under 1 year old had the lowest aspartate aminotransferase (AST), creatinine, triglycerides, total calcium, and chloride means; lower indirect bilirubin, gamma-glutamyl transferase (GGT), alanine aminotransferase (ALT), and sodium levels than over 3-year-old group and the highest phosphorus, glucose, cholesterol, ionized calcium, and alkaline phosphatase (AP) values. Total protein increased with age. The group from 1 to 3 years had higher potassium than up to 1-year-old group. Animals over 3 years old had the highest means of direct and total bilirubin. ALT, CK, GGT, direct and total bilirubin, urea, triglycerides, sodium, potassium, and chloride levels did not differ between genders. Females had higher AST, total protein, total calcium, and indirect bilirubin levels. Males showed greater AP, albumin, phosphorus, glucose, creatinine, cholesterol, magnesium, and ionized calcium values. Discrepancies among present results and previous studies show influencing factors on biochemical profile of donkeys and reinforce the importance of establishment of specific reference intervals. This study is useful in clinical routine and as basis to other scientific researches with Pêga donkeys. © 2013 Springer-Verlag London.

Acute Phase Responses of Different Positions of High-Goal (Elite) Polo Ponies

The aim of this study was to investigate the acute phase response (APR) in 15 horses by quantifying physiological venous blood variables and serum acute phase proteins (APP) at 5 minutes and 6 and 12 hours after a training match of high-goal polo. The horses were divided into three experimental groups based on their team positions, including defense (n = 6), midfield (n = 5), and attack (n = 4). Serum proteinograms were obtained by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Data were evaluated using analysis of variance for repeated measures. The match represented a high-intensity stimulus for all positions. Defenders appeared to use the anaerobic pathway more than the other positions, as shown by their lower pH and greater lactatemia. Alterations in muscle membrane permeability were observed in all horses, as seen by the increase in serum creatine kinase activity without a correlation with APR. Significant elevations in total serum protein, albumin, ceruloplasmin, haptoglobin, alpha-1 antitrypsin, and 23-kDa protein were seen only during the course of the physical exertion of the match, although there were no differences in these values among positions of the team. After 6 hours of the match, the concentration of transferrin declined, whereas that of alpha-1 acid glycoprotein remained unaltered at all assessed times. These results demonstrated that the defenders required the most use of the anaerobic pathway during the match, and that equestrian polo exercise triggers an acute phase response of relatively short duration; this APR is characterized as noninflammatory, as APR appears to be a physiological alteration related to the stress inherent in physical exercise. © 2013 Elsevier Inc. All rights reserved.

Caracterização do tratamento medicamentoso com estatinas em unidade básica de saúde

Study Model: Retrospective study. Study Objective: To characterize statin treatment management due to lipid alterations and side effects throughout statin treatment in basic healthcare unit. Methods: Medical reports of women from a basic healthcare unit were analyzed, obtaining: disease presence, regular medication prescription, statin type and dosage, biochemical exams results, musculoskeletal complaints, and statin use cessation, going back the information until the medical consultation of first prescription. Results: Prescribed statins were Simvastatin and Atorvastatin at low doses (10-20 mg). Dose (48,4%) and/or type (25,4%) alterations occurred for lipid profile adequacy. Lipid levels were reduced without creatine kinase elevation. Treatment withdrawn (30,6%) was mainly due to their own decision (74%), which was strongly associated with records of musculoskeletal complaints (Odds Ratio: 6,40[1,53-26,78]). Conclusion: Statin treatment was effective in reducing serum lipid levels and self-reported pain was underestimated, characterizing the major limiting factor for treatment adherence.

Physiological adaptations during endurance training below anaerobic threshold in rats

To assess the effects of continuous exercise training at intensities corresponding to 80 and 90 % of the lactate minimum test (LM), we evaluated antioxidant activity, hormone concentration, biochemical analyses and aerobic and anaerobic performance, as well as glycogen stores, during 12 weeks of swimming training in rats. One-hundred rats were separated into three groups: control (CG, n = 40), exercise at 80 (EG80, n = 30) and 90 % (EG90, n = 30) of LM. The training lasted 12 weeks, with sessions of 60 min/day, 6 days/week. The intensity was based at 80 and 90 % of the LM. The volume did not differ between training groups (Ẋ of EG80 = 52 ± 4 min; Ẋ of EG90 = 56 ± 2 min). The glycogen concentration (mg/100 mg) in the gastrocnemius increased after the training in EG80 (0.788 ± 0.118) and EG90 (0.795 ± 0.157) in comparison to the control (0.390 ± 0.132). The glycogen stores in the soleus enhanced after the training in EG90 (0.677 ± 0.230) in comparison to the control (0.343 ± 0.142). The aerobic performance increased by 43 and 34 % for EG80 and EG90, respectively, in relation to baseline. The antioxidant enzymes remain unchanged during the training. Creatine kinase (U/L) increased after 8 weeks in both groups (EG80 = 427.2 ± 97.4; EG90 = 641.1 ± 90.2) in relation to the control (246.9 ± 66.8), and corticosterone (ng/mL) increased after 12 weeks in EG90 (539 ± 54) in comparison to the control (362 ± 44). The continuous exercise at 80 and 90 % of the LM has a marked aerobic impact on endurance performance without significantly biomarkers changes compared to control. © 2013 Springer-Verlag Berlin Heidelberg.

Hypothyroidism and acute kidney injury: An unusual association

Association between severe hypothyroidism and acute kidney injury (AKI) is rare. A 40-year-old woman presented with 15 days history of generalised muscle pain, weakness, weight gain and oedema. Medical history: hypertension and hypothyroidism. Physical examination: dry skin, peripheral/periorbital oedema, slow thought and speaking, thyroid increased. Laboratory examinations: high levels of creatine kinase , creatinine, uric acid and lactate dehydrogenase. Free T4 was very low (<0.3 ng/dL) and thyroid-stimulating hormone was high (21.7 mIU/mL). Urinalysis showed haem pigment without haematuria. We performed the diagnosis of AKI secondary to hypothyroidism-induced rhabdomyolysis. Intravenous fluids were started, urinary alkalisation and increased l-thyroxine dose replacement. On the day after admission, forced diuresis with furosemide was introduced leading to a progressive improvement of symptoms. Although hypothyroidism and AKI is unusual, it should be suspected in patients presenting decrease of renal function and high creatine kinase in the absence of other causes of rhabdomyolysis.

Stress susceptibility in pigs supplemented with ractopamine

Ractopamine is a β-adrenergic agonist used as an energy repartitioning agent in the diets of finishing pigs. Most ractopamine studies are limited to evaluations of growth performance and meat quality, and there is little information on the effects of this additive on the behavior and welfare of pigs. Therefore, the objective of this study was to evaluate various indicators of stress caused by feeding diets containing ractopamine. One hundred seventy barrows and 170 gilts weighing 107.3 kg were allocated to 30 pens with 10 to 12 barrows or gilts per pen. Pigs were offered 1 of the 3 dietary treatments (0, 5, or 10 mg ractopamine/kg) for 28 d with 5 barrow pens and 5 gilt pens per treatment. Pigs were evaluated for behavior 3 d per week 1 wk before the initiation of the experiment and throughout the experiment. Each pig was classified into 1 of the 13 activities (drinking water, lying alone, lying in clusters, standing, nosing pig, sitting, feeding, biting pig, walking, exploring, running away, playing, and mounting pen mates) and also grouped into 1 of the 3 categories (calm, moving, and feeding themselves) based on those activities. At the end of the experiment, 3 pigs from each pen were slaughtered, and blood samples were collected during exsanguination to determine physiological indicators of stress (cortisol, lactate, and creatine-kinase enzymes). The incidence of skin and carcass lesions was determined at shoulder, loin, and ham. Ractopamine had no effect (P > 0.05) on pig behavior, total number of skin and carcass lesions, or blood concentrations of cortisol or lactate. However, there was an increase (P < 0.05) of creatine kinase concentrations in pigs receiving ractopaminesupplemented feed. This finding is consistent with the concept that ractopamine may cause muscular disorders, and this warrants further investigation. © 2013 American Society of Animal Science. All rights reserved.

Efeitos do treinamento resistido concêntrico versus excêntrico sobre respostas funcionais, clínicas e bioquímicas

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Influência do treinamento físico de alta intensidade sobre o metabolismo de ratos espontaneamente hipertensos (SHR)

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)