Individual effect-site concentrations of propofol at return of consciousness are related to the concentrations at loss of consciousness and age in neurosurgical patients

Study ObjectiveTo investigate whether a patient's propofol effect-site concentration at return to consciousness (ROC) was related to the propofol effect-site concentration at loss of consciousness (LOC) and to patients' individual demographic parameters.DesignProspective study.SettingOperating room.Patients31 ASA physical status I and II neurosurgical patients with Glasgow Coma Score > 15, and scheduled to receive total intravenous anesthesia with effect-site target controlled infusion (TCI) of propofol and remifentanil.InterventionsA constant propofol infusion was administered until LOC. At LOC, remifentanil started with a plasma concentration target of 2.5 ng mL^?1.Main ResultsPropofol concentration at LOC was 4.9 ± 1 μg mL^?1. At ROC, propofol and remifentanil concentrations were 1.16 ± 0.3 μg mL^?1 and 3.41 ± 1.5 ng mL^?1. Significant correlation was observed between propofol concentrationa at ROC and LOC, between propofol concentration at ROC and patient age (48.7 ± 15 yrs), and between propofol concentrations at ROC and LOC, divided by patient's age.ConclusionsThe correlation between propofol concentrations at ROC and LOC was improved by inclusion of patient age data.     

Aesthetic Quality of the Nipple–Areola Complex in Breast Reconstruction with a New Local Graft Technique

Background  

Reconstruction of the nipple–areola complex (NAC) is the last stage of breast reconstruction and represents the search for symmetry in regard to the contralateral breast. The objective of this study was to present an areola reconstruction technique with local skin graft to improve the texture and aspect of the reconstructed areola, searching for a natural look.     

Botulinum Toxin Injection in Long-Standing Facial Paralysis Patients: Improvement of Facial Symmetry Observed up to 6 Months

Background  Despite modern reanimation surgical techniques, facial paralysis presents with functional and aesthetic deficits. We evaluated facial symmetry after treating with botulinum toxin the healthy side of the face of 25 patients with long-standing facial paralysis who had previously been treated by surgical methods, with 6 months follow-up. Methods  Evaluation consisted of a clinical score, the two subscales of the Facial Disability Index, and surface electromyography. The mean botulinum toxin dose was 38 ± 5 U (range = 15–69 U). Results  The clinical score showed significant reduction of asymmetry of 48.4% at 1 month and 16.8% after 6 months. The initial result was a consequence of reduced motion on the treated side combined with better motion on the paralyzed side. At 6 months, the treated side returned to basal scores. The residual effect seen in symmetry was due to an increase (18%) of motion in the paralyzed side. There was a significant decrease in the action potential of muscles on the nonparalyzed side 1 month post injection but completely reverted after 6 months. The Physical Function Index increased, but not significantly. The Social/Well-Being Function Index showed a significant increase at 6 months compared to pretreatment. Conclusion  The proposed treatment improved facial symmetry for up to 6 months. Even after the end of the clinical effect of the drug, the paralyzed side’s clinical score was 18% higher than pretreatment, with an increased quality of life.     

Magnetic Resonance Images and Linear Measurements in the Surgical Treatment of Breast Asymmetry

Background  Objective evaluation of breast asymmetry surgical treatment should consider not only breast shape but also breast volume. Methods  For this study, 22 patients with primary breast asymmetry were evaluated by magnetic resonance imaging (MRI) as well as linear measurements preoperatively and 6 months postoperatively. The mean difference between the pre- and postoperative linear measurements was graduated from excellent to poor. Breast volume was estimated by MRI from axial reconstruction for three-dimensional application using the Cavalieri formula and specific software. Results  A strong correlation (r = 0.817) was found between the pre- and postoperative breast volumes, as increased or decreased by the surgical procedure. Patients with less postoperative volume differences tended to have the best ratings with linear measurements. When the same surgical procedure was performed bilaterally or when only one breast was treated by surgery, greater volume symmetry was observed. Conclusions  Linear measurements and MRI are objective methods for evaluating postoperative symmetry, and when used in association, can help plastic surgeons to achieve favorable results in mammary asymmetry treatment.     

Experimental animal model and RNA interference: a promising association for bladder cancer research

Animal models are at the centre of laboratory bladder cancer (BC) research and at the same time, the bridge to the clinic. A new and very promising therapeutical approach is to silence abnormally up-regulated genes in cancer, through small interfering RNA (siRNA) molecules. Therapeutic use and success of siRNAs will largely depend on their efficient and safe in vivo delivery and on avoiding accidental off-target effects. Intravesical siRNA is a strategy which may be the best deliver option to surperficial BC like intravesical immunotherapy. Its direct action might allow a continuous intracellular exposure to effective siRNA concentrations. While the procedure of transurethral siRNA administration is promising for BC research allowing detection of new targets in BC therapy, the optimal intravesical carrier and the best target(s) to siRNA are to be determined.     

Pentoxifylline modifies three-dimensional collagen lattice model contraction and expression of collagen types I and III by human fibroblasts derived from post-burn hypertrophic scars and from normal skin

Fibroblasts are thought to be partially responsible for the persisting contractile forces that result in burn contractures. Using a monolayer cell culture and fibroblast populated collagen lattice (FPCL) three-dimensional model we subjected hypertrophic scar and non-cicatricial fibroblasts to the antifibrogenic agent pentoxifylline (PTF – 1 mg/mL) in order to reduce proliferation, collagen types I and III synthesis and model contraction. Fibroblasts were isolated from post-burn hypertrophic scars (HSHF) and non-scarred skin (NHF). Cells were grown in monolayers or incorporated into FPCL's and exposed to PTF. In monolayer, cell number proliferation was reduced (46.35% in HSHF group and 37.73% in NHF group, p < 0.0001). PTF selectively inhibited collagen III synthesis in the HSHF group while inhibition was more evident to type I collagen synthesis in the NHF group. PTF also reduced contraction in both (HSHF and NHF) FPCL.     

Kinetic characterization of l-[H]glutamate uptake inhibition and increase oxidative damage induced by glutaric acid in striatal synaptosomes of rats

Glutaric acidemia type I (GA-I) is an inherited metabolic disease characterized by accumulation of glutaric acid (GA) and striatal degeneration. Although growing evidence suggests that excitotoxicity and oxidative stress play central role in the neuropathogenesis of this disease, mechanism underlying striatal damage in this disorder is not well established. Thus, we decided to investigate the in vitro effects of GA 10 nM (a low concentration that can be present initial development this disorder) on l-[³H]glutamate uptake and reactive oxygen species (ROS) generation in synaptosomes from striatum of rats. GA reduced l-[³H]glutamate uptake in synaptosomes from 1 up to 30 min after its addition. Furthermore, we also provided some evidence that GA competes with the glutamate transporter inhibitor l-trans-pyrrolidine-2,4-dicarboxylate (PDC), suggesting a possible interaction of GA with glutamate transporters on synaptosomes. Moreover, GA produced a significant decrease in the V_MAX of l-[³H]glutamate uptake, but did not affect the K_D value. Although the GA did not show oxidant activity per se, it increased the ROS generation in striatal synaptosomes. To evaluate the involvement of reactive species generation in the GA-induced l-[³H]glutamate uptake inhibition, trolox (0.3, 0.6 and 6 μM) was added on the incubation medium. Statistical analysis showed that trolox did not decrease inhibition of GA-induced l-[³H]glutamate uptake, but decreased GA-induced reactive species formation in striatal synaptosomes (1, 3, 5, 10, 15 and 30 min), suggesting that ROS generation appears to occur secondarily to glutamatergic overstimulation in this model of organic acidemia. Since GA induced DCFH oxidation increase, we evaluate the involvement of glutamate receptor antagonists in oxidative stress, showing that CNQX, but not MK-801, decreased the DCFH oxidation increase in striatal synaptosomes. Furthermore, the results presented in this report suggest that excitotoxicity elicited by low concentration of GA, could be in part by maintaining this excitatory neurotransmitter in the synaptic cleft by non-competitive inhibition of glutamate uptake. Thus the present data may explain, at least partly, initial striatal damage at birth, as evidenced by acute bilateral destruction of caudate and putamen observed in children with GA-I.     

Metastatic uterine leiomyosarcoma to the submandibular gland

Metastasis of uterine leiomyosarcoma to the salivary glands is exceedingly rare. In this report, we present the clinicopathologic features of one such case. The patient was diagnosed with uterine leiomyosarcoma at age 58 years and was treated by hysterectomy only. The tumor was confined to the uterine body. The patient remained free of disease for 4 years and then developed a left submandibular mass. Imaging studies also showed lung involvement but no tumor in the abdomen or pelvis. The submandibular mass was resected; it had histologic and immunohistochemical features similar to those seen in the previous uterine leiomyosarcoma. After 7 months of follow-up, the patient is alive with disease, with progression of disease in the lungs despite receiving chemotherapy.