Efeitos de dexmedetomidina em conjunto com o pré‐condicionamento isquêmico remoto em lesão de isquemia‐reperfusão renal em ratos

Background and objectivesThe aim of this study was to evaluate the effects of remote ischemic preconditioning by brief ischemia of unilateral hind limb when combined with dexmedetomidine on renal ischemia–reperfusion injury by histopathology and active caspase‐3 immunoreactivity in rats.Methods28 Wistar albino male rats were divided into 4 groups. Group I (Sham, n = 7): Laparotomy and renal pedicle dissection were performed at 65th minute of anesthesia and the rats were observed under anesthesia for 130 min. Group II (ischemia–reperfusion, n = 7): At 65th minute of anesthesia bilateral renal pedicles were clamped. After 60 min ischemia 24 h of reperfusion was performed. Group III (ischemia–reperfusion + dexmedetomidine, n = 7): At the fifth minute of reperfusion (100 μg/kg intra‐peritoneal) dexmedetomidine was administered with ischemia–reperfusion group. Reperfusion lasted 24 h. Group IV (ischemia–reperfusion + remote ischemic preconditioning + dexmedetomidine, n = 7): After laparotomy, three cycles of ischemic preconditioning (10 min ischemia and 10 min reperfusion) were applied to the left hind limb and after 5 min with group III.ResultsHistopathological injury scores and active caspase‐3 immunoreactivity were significantly lower in the Sham group compared to the other groups. Histopathological injury scores in groups III and IV were significantly lower than group II (p = 0.03 and p = 0.05). Active caspase‐3 immunoreactivity was significantly lower in the group IV than group II (p = 0.01) and there was no significant difference between group II and group III (p = 0.06).ConclusionsPharmacologic conditioning with dexmedetomidine and remote ischemic preconditioning when combined with dexmedetomidine significantly decreases renal ischemia–reperfusion injury histomorphologically. Combined use of two methods prevents apoptosis via active caspase‐3.     

Características da marcha de mulheres com fibromialgia: um padrão prematuro de envelhecimento

BackgroundFibromyalgia is a condition which involves chronic pain. Middle‐aged individuals with fibromyalgia seem to exhibit changes in gait pattern, which may prematurely expose them to a gait pattern which resembles that found in the elderly population.ObjectiveTo determine the 3 D spatial (linear and angular) gait parameters of middle‐aged women with fibromyalgia and compare to elderly women without this condition.Methods25 women (10 in the fibromyalgia group and 15 in the elderly group) volunteered to participate in the study. Kinematics was performed using an optoelectronic system, and linear and angular kinematic variables were determined.ResultsThere was no difference in walking speed, stride length, cadence, hip, knee and ankle joints range of motion between groups, except the pelvic rotation, in which the fibromyalgia group showed greater rotation (P < 0.05) compared to the elderly group. Also, there was a negative correlation with pelvic rotation and gluteus pain (r = –0.69; P < 0.05), and between pelvic obliquity and greater trochanter pain (r = –0.69; P < 0.05) in the fibromyalgia group.ConclusionMiddle‐aged women with fibromyalgia showed gait pattern resemblances to elderly, women, which is characterized by reduced lower limb ROM, stride length and walking speed.     

Tireoidite de Hashimoto pode estar associada a um subgrupo de pacientes de esclerose sistêmica com hipertensão pulmonar

IntroductionRecent studies show an association between autoimmune thyroiditis and systemic sclerosis (SSc) and suggest that this condition may interfere with the ES phenotype. However these studies evaluate the autoimmune thyroiditis as a whole and none of them specifically addresses Hashimoto's thyroiditis (HT) in SSc.ObjectiveTo investigate the presence of HT in SSc patients and its possible association with disease manifestations.MethodsClinical manifestations of hypothyroidism, TSH and anti‐thyroid auto antibodies (anti‐TPO. anti TBG and TRAb) were studied in 56 patients with SSc. SSc patients with HT were compared with SSc patients without thyroiditis.ResultsHT was observed in 19.64% of patients with SSc. No association was observed between HT and the different forms of disease or profile of autoantibodies. Likewise, there was no difference between the mean modified Rodnan score and presence of Raynaud's phenomenon, scars, digital necrosis, myositis, arthritis, sicca symptoms, esophageal dysmotility and scleroderma renal crisis when the groups were compared. On the other hand, patients with HT had higher frequency of pulmonary hypertension in relation to patients without HT (66.6% vs 22.5%, p = 0.016).ConclusionsIn the studied sample patients with ES and HT had higher prevalence of pulmonary hypertension. Long‐term follow‐up studies with a larger number of TH and SSc patients are needed to confirm these data.     

Efeitos do pré‐tratamento com propofol sobre a apoptose de células miocárdicas e expressão de SERCA2 em ratos com isquemia/reperfusão hepática

Introduction

Hepatic ischemia‐reperfusion injury is a common pathophysiological process in liver surgery. Whether Propofol can reduce myocardial ischemia‐reperfusion injury induced by hepatic ischemia‐reperfusion injury in rats, together with related mechanisms, still needs further studies.

Lesão do nervo mandibular bilateral após ventilação com máscara: um relato de caso

Background and objectives

Nerve injury following mask ventilation is a rare but serious anesthetic complication. The majority of reported cases are associated with excessive pressure applied to the face mask, long duration of mask ventilation, excessive digital pressure behind the mandible to relieve airway obstruction and pressure exerted by the plastic oropharyngeal airway.

Influência da velocidade da marcha sobre a pressão plantar em sujeitos com osteoartrite unilateral de joelho

ObjectiveChanging gait speed is a common strategy to manipulate exercise intensity during physical exercise, but may elicit higher impact forces and consequent joint loading. Here we analyzed the effects of increasing walking velocity on plantar pressure and asymmetries in elderly with knee osteoarthritis (OA). Our hypothesis was that the contralateral limb could receive higher loading compared to the OA limb in the different walking speeds tested.MethodsTwelve elderly with unilateral knee OA walked at different self‐selected speeds along a 10 m pass way stepping on an instrumented mat for measurement of plantar pressure at preferred, slow and fast gait speeds. Five steps were recorded for each speed. Plantar pressure data were compared between the speeds and legs.Resultsspeeds were significantly different between them (p < 0.05). Mean and peak plantar pressure increased when speed changed from slow to fast (p < 0.05). Velocity of the center of pressure increased and the single stance time decreased when walk speed was increased (p < 0.05). Any asymmetries were observed.ConclusionIncreasing gait speed from slow to fast in subjects with unilateral knee OA significantly affected variables of plantar pressure, but asymmetries between committed and contralateral leg were not detected.     

Reposição de volume orientada pela variação da pressão de pulso durante transplante renal: estudo randomizado controlado

PurposeKidney transplantation is the gold‐standard treatment for end stage renal disease. Although different hemodynamic variables, like central venous pressure and mean arterial pressure, have been used to guide volume replacement during surgery, the best strategy still ought to be determined. Respiratory arterial Pulse Pressure Variation (PPV) is recognized to be a good predictor of fluid responsiveness for perioperative hemodynamic optimization in operating room settings. The aim of this study was to investigate whether a PPV‐guided fluid management strategy is better than a liberal fluid strategy during kidney transplantation surgeries. Identification of differences in urine output in the first postoperative hour was the main objective of this study.MethodsWe conducted a prospective, single blind, randomized controlled trial. We enrolled 40 patients who underwent kidney transplantation from deceased donors. Patients randomized in the PPV Group received fluids whenever PPV was higher than 12%, patients in the Free Fluid Group received fluids following our institutional standard care protocol for kidney transplantations (10 mL.kg^‐1.h^‐1).ResultsUrinary output was similar at every time‐point between the two groups, urea was statistically different from the third postoperative day with a peak at the fourth postoperative day and creatinine showed a similar trend, being statistically different from the second postoperative day. Urea, creatinine and urine output were not different at the hospital discharge.ConclusionPPV‐guided fluid therapy during kidney transplantation significantly improves urea and creatinine levels in the first week after kidney transplantation surgery.     

Avaliação do comprometimento respiratório em pacientes com lúpus eritematoso sistêmico com o teste de caminhada de seis minutos

ObjectiveEvaluate SLE stable patients, without overt respiratory compromise, by means of 6 MWT.Casuistic and methodsForty‐five stable SLE patients were enrolled. The ATS/ERS protocol for 6 MWT, was used and two parameters with cut‐off points were chosen.ResultsForty‐two patients were women. The mean age was 39 ± 11.4 years; mean duration of disease, 121 ± 93.1 months; mean value of MRC, 2 ± 0; mean FVC, 85.9 ± 34.2%; meanFEV1, 67.5 ± 21.6%; mean MIP, 82 ± 58.4%; mean MEP, 78 ± 37.3%; mean heart rate at rest, 75 ± 12.8 bpm; mean respiratory rate at rest, 19 ± 5.3 bpm; mean 6 MWD, 478 ± 82 m; mean SpO2 at rest was 98 ± 0.8%; mean fall in SpO2, 4 ± 6 points. When the study population was divided according to the 400‐m walk distance cut‐off value, the heart rate immediately before the test was significant lower in those participants who walked less than 400 m (p = 0.0043), just like the value of Borg scale (p = 0.0036); according to the presence of saturation≥ 4, heart rate at the end of the test was significantly higher in those participants who were showing desaturation (p = 0.0170); MEP (p = 0.0282) and 6 MWD (p = 0.0291) were significantly lower, and MIP showed a tendency towards being smaller (p = 0.0504). FVC < normal inferior limit was significantly associated with the group with desaturation (p = 0.0274).ConclusionCompared to 6 MWD, desaturation was better suited to find the patients with the most compromised indexes in respiratory function tests.     

Herpetofauna of an Atlantic rainforest area (Morro São João) in Rio de Janeiro State, Brazil

We studied the herpetofaunal community from the Atlantic forest of Morro S?o Jo?o, in Rio de Janeiro State, Brazil, and present data on species composition, richness, relative abundance and densities. We combined three sampling methods: plot sampling, visual encounter surveys and pit-fall traps. We recorded sixteen species of amphibians and nine of reptiles. The estimated densities (based on results of plot sampling) were 4.5 ind/100 m2 for amphibians and 0.8 ind/100 m2 for lizards, and the overall density (amphibians and lizards) was 5.3 ind/100 m2. For amphibians, Eleutherodactylus and Scinax were the most speciose genera with three species each, and Eleutherodactylus binotatus was the most abundant species (mean density of 3.0 frogs/100 m2). The reptile community of Morro S?o Jo?o was dominated by species of the families Gekkonidae and Gymnophtalmidae (Lacertilia) and Colubridae (Serpentes). The gymnophtalmid lizard Leposoma scincoides was the most abundant reptile species (mean density of 0.3 ind/100 m2). We compare densities obtained in our study data with those of other studied rainforest sites in various tropical regions of the world.     

Composição corporal por absorciometria radiológica de dupla energia de mulheres com fibromialgia

ObjectivesTo assess body composition in women with fibromyalgia (FM) comparing to the reference value for healthy women.Patients and MethodsCross‐sectional observational analytical study, with 52 women selected with Fibromyalgia, according American College of Rheumatology (ACR, 1990) criteria. The patients were selected in Hospital de Clínicas da Universidade Federal do Paraná (HC‐UFPR) and divided into two groups, 28 patients with a BMI (Body Mass Index) equal or higher (≥) than 25 kg/m2 and 24 patients with BMI less or equal (≤) 24.99 kg/m2, subjected to physical examination for the count of tender points (TP) and completing the fibromyalgia impact questionnaire (FIQ). The assessment of body composition was performed by the Dual‐Energy X‐Ray Absorptiometry (DXA). The values of the fat mass percentage (MG %) found in the two groups were compared to the average percentage of MG by age and sex, described by Heward (2004).ResultsThe mean age of the study groups was 47.8 ± 8.6 years, the FIQ score was 70.5 ± 18.6 and TP 16.2 ± 2.0. The mean BMI was 26.4 ± 4.1 kg/m2, and the amount of MG was 25.2 ± 7.8 kg and 39.5 ± 6.8%, and lean mass (LM) was 37 2 ± 3.7 kg and 60.4 ± 7.3%. In the group with BMI ≤ 25 kg/m2, the MG % was 33.8% (21.5 ‐42.4) and in the group with BMI ≥ 25 kg/m2 of the MG was 44.4% (37.6 ‐56.2).ConclusionBoth groups women with FM eutrophic as the overweight and obese group, presented higher reference MG% levels comparing with the standard levels for healthy women.     

Correção endovascular de lesão de artéria subclávia secundária à cateterismo de veia jugular interna: relato de caso

Background and objectivesUltrasound‐guided internal jugular vein catheterization is a common and generally safe procedure in the operating room. However, inadvertent puncture of a noncompressible artery such as the subclavian artery, though rare, may be associated with life‐threatening sequelae, including hemomediastinum, hemothorax, and pseudoaneurysm.Case reportWe describe a case of the successful endovascular repair of right subclavian artery injury in a 75‐year‐old woman. Subclavian artery was injured secondary to ultrasound‐guided right internal jugular vein catheterization under general anesthesia for orthopedic surgery.ConclusionUnder general anesthesia several factors such as hypotension can mask the signs of subclavian artery injury. This case report indicates that clinicians should be aware of the complications of central venous catheterization and take prompt action.     

Perfil de especialistas e de serviços em reumatologia pediátrica no estado de São Paulo

IntroductionPaediatric rheumatology (PR) is an emerging specialty, practised by a limited number of specialists. Currently, there is neither a record of the profile of rheumatology patients being treated in Brazil nor data on the training of qualified rheumatology professionals in the country.ObjectiveTo investigate the profile of PR specialists and services, as well as the characteristics of paediatric patients with rheumatic diseases, for estimating the current state of rheumatology in the state of São Paulo.Patients and methodsIn 2010, the scientific department of PR of the Paediatric Society of São Paulo administered a questionnaire that was answered by 24/31 accredited specialists in PR practising in state of São Paulo and by 8/21 institutions that provide PR care.ResultsMost (91%) of the surveyed professionals practise in public institutions. Private clinics (28.6%) and public institutions (37.5%) reported not having access to nailfold capillaroscopy, and 50% of the private clinics reported not having access to acupuncture. The average duration of professional practise in PR was 9.4 years, and 67% of the physicians had attended postgraduate programmes. Seven (87.5%) public institutions perform teaching activities, in which new paediatric rheumatologists are trained, and five (62.5%) offer postgraduate programmes. Two-thirds of the surveyed specialists use immunosuppressants and biological agents classified as “restricted use” by the Health Secretariat. The disease most frequently reported was juvenile idiopathic arthritis (29.1–34.5%), followed by juvenile systemic lupus erythematosus (JSLE) (11.6–12.3%) and rheumatic fever (9.1-15.9%). The incidence of vasculitis (including Henoch-Schönlein purpura, Wegener's granulomatosis, and Takayasu's arteritis) and autoinflammatory syndromes was higher in public institutions compared to other institutions (P = 0.03, P = 0.04, P = 0.002, and P < 0.0001, respectively). Patients with JSLE had the highest mortality rate (68% of deaths), mainly due to infection.ConclusionThe field of PR in the state of São Paulo has a significant number of specialists with postgraduate degrees who mostly practise at teaching institutions with infrastructures appropriate for the care of high-complexity patients.     

Bloqueio lobar seletivo com um bloqueador Coopdech combinado com um tubo endotraqueal de duplo lúmen para ressecção de metástases pulmonares com laser

In recent years, laser resection of lung metastases has been established as the standard procedure worldwide. To avoid airway fire, it is necessary to collapse the surgical lung. The selective lobar bronchial blockade is a technique that allows one‐lung ventilation while the operated lobe is collapsed in patients with previous pulmonary resection requiring subsequent resection or with limited pulmonary reserve. We report a clinical case about our experience of a selective lobar bronchial blockade technique with a bronchial blocker (Coopdech endobronchial blocker) that was employed successfully with a double‐lumen endotracheal tube in a patient with previous contralateral pulmonary resection who was scheduled for atypical resections of pulmonary metastases by laser. We selectively blocked the right intermediate bronchus for management of hypoxemia during one‐lung ventilation. This technique provided adequate ventilation and oxygenation during surgery, avoiding the need of two‐lung ventilation during lung metastases resection by laser.

Relação entre consumo de tabaco e concentração de monóxido de carbono na expiração com complicações respiratórias perioperatórias

Background

The purpose of the current study was to determine the effects of preoperative cigarette smoking and the carbon monoxide level in the exhaled breath on perioperative respiratory complications in patients undergoing elective laparoscopic cholecystectomies.

Intubação traqueal difícil com fibra óptica em bebê de um mês de idade com síndrome de Treacher Collins

Neonates and small infants with craniofacial malformation may be very difficult or impossible to mask ventilate or intubate. We would like to report the fiberoptic intubation of a small infant with Treacher Collins Syndrome using the technique described by Ellis et al.

Algoritmo de tratamento guiado pelo fator XIII reduz a transfusão sanguínea na cirurgia de queimados

Background and objectives

Major burn surgery causes large hemorrhage and coagulation dysfunction. Treatment algorithms guided by ROTEM^® and factor VIIa reduce the need for blood products, but there is no evidence regarding factor XIII. Factor XIII deficiency changes clot stability and decreases wound healing. This study evaluates the efficacy and safety of factor XIII correction and its repercussion on transfusion requirements in burn surgery.

Impacto da hipotensão e hipoperfusão global sobre o delírio pós‐operatório: um estudo piloto com idosos submetidos à cirurgia aberta do cólon

Background

Post‐operative delirium is a serious complication in patients undergoing major abdominal surgery. It remains unclear whether peri‐operative hemodynamic and perfusion variables affect the risk for postoperative delirium. The objective of this pilot study was to evaluate the association between perfusion and hemodynamics peri‐operative with the appearance of post‐operative delirium.

Anafilaxia por corante azul patente V: relato de caso e revisão da literatura

BackgroundAnaphylaxis is a constant perioperative concern due to the exposure to several agents capable of inducing hypersensitivity reactions. Patent blue V (PBV), also known as Sulfan Blue, a synthetic dye used in sentinel node research in breast surgery, is responsible for 0.6% of reported anaphylactic conditions. We present a case of a 49‐year‐old female patient who underwent left breast tumorectomy with sentinel lymph node staging using PBV and experienced an anaphylactic reaction.MethodsWe conducted a literature search through PubMed for case reports, case series, reviews, and systematic reviews since 2005 with the keywords “anaphylaxis” and “patent blue”. We then included articles found in these publications’ reference sections.ResultsWe found 12 relevant publications regarding this topic. The main findings are summarized, with information regarding the clinical presentation, management, and investigation protocol. Hypotension is the most common clinical manifestation. The presentation is usually delayed when compared with anaphylaxis from other agents, and cutaneous manifestations are occasionally absent. Patients may have had previous exposure to the dye, used also as a food, clothes and drug colorant.ConclusionThe diagnosis of anaphylaxis in patients under sedation or general anesthesia may be difficult due to particularities of the perioperative context. According to the published literature, the presentation of the reaction is similar in most cases and a heightened clinical sense is key to address the situation appropriately. Finding the agent responsible for the allergic reaction is of paramount importance to prevent future episodes.     

Avaliação de entesopatia em pacientes com fibromialgia por meio do novo índice ultrassonográfico de entesite

ObjectiveThe aim of the present study is to determine the frequency of enthesopathy in fibromyalgia (FM) by using a newly developed ultrasonography (US) method, the Madrid Sonography Enthesitis Index (MASEI).MethodsThis study was conducted on 38 consecutive patients with FM and 48 healthy sex- and age-matched controls. Six entheseal sites (olecranon tuberosity, superior and inferior poles of patella, tibial tuberosity, superior and inferior poles of calcaneus) on both lower limbs were evaluated. All US findings were identified according to MASEI. Scores of patients and controls were compared by Student's t-test and Mann-Whitney U-test. Validity was analysed by receiver operating characteristic curve. Values of P < 0.05 were considered significant.ResultsTotal enthesitis score was 7.39 ± 4.99 (mean ± SD) among FM patients and 3.7 ± 3.22 among healthy controls (P < 0.001). The receiver operating characteristic curve established an ultrasound score of > 3.5 in the FM group as the best cut-off point to differentiate between cases and controls. No statistically significant correlation was found between the MASEI score and the FM disease duration, and the location of the tender points.ConclusionsMisdiagnoses of FM are harmful to patients and the community, and the presence of enthesopathy among FM patients increases. Its detection with the MASEI score may help to discriminate FM patients presenting with ill-defined symptoms and signs, in order to prevent mistreatment.