RESUMEN
BACKGROUND: The Ponseti method has been shown to be the most effective treatment for congenital clubfoot. The current challenge is to establish sustainable national clubfoot treatment programs that utilize the Ponseti method and integrate it within a nation's governmental health system. The Brazilian Ponseti Program (Programa Ponseti Brasil) has increased awareness of the utility of the Ponseti method and has trained >500 Brazilian orthopaedic surgeons in it. METHODS: A group of 18 of those surgeons had been able to reproduce the Ponseti clubfoot treatment, and compiled their initial results through structured spreadsheet. RESULTS: The study compiled 1040 patients for a total of 1621 feet. The average follow-up time was 2.3 years with an average correction time of approximately 3 months. Patients required an average of 6.40 casts to achieve correction. CONCLUSIONS: This study demonstrates that good initial correction rates are reproducible after training; from 1040 patients only 1.4% required a posteromedial release. LEVEL OF EVIDENCE: Level IV.
Asunto(s)
Moldes Quirúrgicos , Pie Equinovaro/terapia , Manipulación Ortopédica/métodos , Tenotomía , Tendón Calcáneo/cirugía , Preescolar , Países en Desarrollo , Femenino , Accesibilidad a los Servicios de Salud/normas , Humanos , Lactante , Masculino , Evaluación de Programas y Proyectos de Salud , Tenotomía/métodos , Resultado del TratamientoRESUMEN
Toxicity assessment is an important tool in drug discovery and development. PT-31 (3-(2-chloro-6-fluorobenzyl)-imidazolidine-2,4-dione) is an imidazolidine- 2,4-dione analogue of clonidine that displays a dose-dependent analgesic profile and synergism with morphine. This study investigated genotoxic and mutagenic effects of PT-31 in Swiss mice. For this, ten mice (M1:F1) per group were treated with PT-31 intraperitoneally (i.p.) at 0.5, 1.0 and 5.0 mg/kg. The dimethyl sulfoxide (0.5%) and 50 mg/kg cyclophosphamide (i.p.) were taken as negative (NC) and positive controls, respectively. The bone marrow cells were collected after 24 h, while peripheral blood after 30 min, 12 h and 24 h of the treatment for the comet assay. Micronucleus (MN) test was performed only on bone marrow cells collected after 24 h of i.p. treated animals. A hundred cells were considered for the comet assay and quantification of the index of damage and frequency of damage. Lack of genotoxicity with 0.5 mg/kg of PT-31 and DNA repair ability with 0.5 and 1.0 mg/kg doses at 12 h and 24 h in comparison to NC group was observed (P<0.05). There was an increase in MN formation by PT-31 1.0 and 5.0 mg/kg treated female and male mice, respectively. PT-31 induced genotoxic and mutagenic effects only in higher doses.
Asunto(s)
Células de la Médula Ósea/efectos de los fármacos , Daño del ADN/efectos de los fármacos , Animales , Ensayo Cometa , Ciclofosfamida/farmacología , Dimetilsulfóxido/farmacología , Relación Dosis-Respuesta a Droga , Femenino , Imidazolidinas/farmacología , Masculino , Ratones , Pruebas de Micronúcleos , MutágenosRESUMEN
BACKGROUND: Schistosomiasis is a major endemic disease that affects hundreds of millions worldwide. Since the treatment and control of this parasitic disease rely on a single drug, praziquantel, it is imperative that new effective drugs are developed. Here, we report that phytol, a diterpene alcohol from chlorophyll widely used as a food additive and in medicinal fields, possesses promising antischistosomal properties in vitro and in a mouse model of schistosomiasis mansoni. METHODS AND FINDINGS: In vitro, phytol reduced the motor activity of worms, caused their death and confocal laser scanning microscopy analysis showed extensive tegumental alterations in a concentration-dependent manner (50 to 100 µg/mL). Additionally, phytol at sublethal doses (25 µg/mL) reduced the number of Schistosoma mansoni eggs. In vivo, a single dose of phytol (40 mg/kg) administered orally to mice infected with adult S. mansoni resulted in total and female worm burden reductions of 51.2% and 70.3%, respectively. Moreover, phytol reduced the number of eggs in faeces (76.6%) and the frequency of immature eggs (oogram pattern) was significantly reduced. The oogram also showed increases in the proportion of dead eggs. Confocal microcopy studies revealed tegumental damage in adult S. mansoni recovered from mice, especially in female worms. CONCLUSIONS: The significant reduction in parasite burden by this chlorophyll molecule validates phytol as a promising drug and offers the potential of a new direction for chemotherapy of human schistosomiasis. Phytol is a common food additive and nonmutagenic, with satisfactory safety. Thus, phytol has potential as a safe and cost-effective addition to antischistosomal therapy.
Asunto(s)
Antihelmínticos/farmacología , Antihelmínticos/uso terapéutico , Fitol/farmacología , Fitol/uso terapéutico , Schistosoma mansoni/efectos de los fármacos , Esquistosomiasis mansoni/tratamiento farmacológico , Administración Oral , Animales , Modelos Animales de Enfermedad , Femenino , Locomoción/efectos de los fármacos , Ratones , Ratones Endogámicos BALB C , Carga de Parásitos , Pruebas de Sensibilidad Parasitaria , Análisis de SupervivenciaRESUMEN
AIM: Some stable prostaglandin analogues such as alprostadil have been used to attenuate the deleterious effects of ischemia and reperfusion injury. The aim of this paper was to test if alprostadil can decrease the ischemia- reperfusion injury in rat skeletal muscle using muscular enzymes as markers, such as aspartate aminotransferase (AST), creatine kinase (CPK), lactate dehydrogenase (LDH); degeneration products of cell membrane-malondialdehyde (MDA) and muscle glycogen storage. METHODS: Thirty male Wistar rats were used in a model of hind limb ischemia achieved by infrarenal aortic cross-clamping. The animals were randomized into three equal groups (N=10) submitted to 5 hours of ischemia followed by one hour of reperfusion. The first group (control) received continuous intravenous infusion of saline solution and the second group (preischemia, GPI) received continuous intravenous infusion of alprostadil throughout the experiment starting 20 minutes before the aortic cross-clamping. The third group, prereperfusion (GPR), received alprostadil only during the reperfusion period, with intravenous infusion being started 10 min before the clamp release. RESULTS: There was no difference in CPK, LDH, AST or tissue glycogen values between groups. However, a significant elevation in MDA was observed in the GPI and GPR groups compared to the control group, with no difference between the GPI and GPR. CONCLUSIONS: Under conditions of partial skeletal muscle ischemia, alprostadil did not reduce the release of muscular enzymes, the consumption of tissue glycogen or the effects of ischemia and reperfusion on the cell membrane, characterized by lipid peroxidation.
Asunto(s)
Alprostadil/uso terapéutico , Músculo Esquelético/anomalías , Daño por Reperfusión/tratamiento farmacológico , Animales , Masculino , Ratas , Ratas WistarRESUMEN
The consequence of an acute mesenteric venous thrombosis following porta-azygos disconnection for the treatment of bleeding esophageal varices due to mansonian schistosomiasis has not been well defined in the literature. The clinical manifestations reported were fever, spasmodic abdominal pain associated with food intake. We treated three patients with thrombosis of the portal-mesenteric trunk following porta-azygos disconnection and adopted a conservative clinical approach in two patients while one had to have a surgical small bowel ressection.
Asunto(s)
Várices Esofágicas y Gástricas/cirugía , Hemorragia Gastrointestinal/cirugía , Oclusión Vascular Mesentérica/etiología , Complicaciones Posoperatorias , Trombosis/etiología , Adulto , Vena Ácigos/cirugía , Várices Esofágicas y Gástricas/etiología , Hemorragia Gastrointestinal/etiología , Humanos , Masculino , Vena Porta/cirugía , Esquistosomiasis mansoni/complicaciones , EsplenectomíaRESUMEN
It is possible to obtain two good-quality hepatic transplants from a single cadaveric liver by separation of the right and left lobes of the liver. We attempted to define a relationship based only on donor body weight for predicting donor total liver weight as well as donor right (segments V-VIII) and left (segments II-IV) hepatic lobe weight. Segment I (caudate lobe) is resected and thus lost in this procedure. The study was performed on 60 human cadaveric livers. We correlated cadaveric body weight (mean +/- SD), 72.43 +/- 9.54 kg, with total liver weight, 1.54 +/- 0.36 kg, and right and left lobe weight, 0.88 +/- 0.23 kg and 0.65 +/- 0.17 kg, respectively, with total liver weight. A formula was obtained by linear regression which provided the following relationships: total liver weight (g) = [245.57 + 17.92 x (body weight, kg)]; right lobe weight (g) = [67.58 + 0.52 x (total liver weight, g)]; left lobe weight (g) = [-63.38 + 0.47 x (total liver weight, g)]. The selection of the recipient on the liver transplant waiting list can be made on the basis of these relationships.
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Peso Corporal , Trasplante de Hígado/métodos , Hígado/anatomía & histología , Adulto , Anciano , Humanos , Persona de Mediana Edad , Tamaño de los Órganos , Selección de Paciente , Valor Predictivo de las Pruebas , Análisis de Regresión , Donantes de TejidosRESUMEN
It is possible to obtain two good-quality hepatic transplants from a single cadaveric liver by separation of the right and left lobes of the liver. We attempted to define a relationship based only on donor body weight for predicting donor total liver weight as well as donor right (segments V-VIII) and left (segments II-IV) hepatic lobe weight. Segment I (caudate lobe) is resected and thus lost in this procedure. The study was performed on 60 human cadaveric livers. We correlated cadaveric body weight (mean + or - SD), 72.43 + or - 9.54 kg, with total liver weigh, 1.54 + or - 0.36 kg, and right and left lobe weight, 0.88 + or - 0.23 kg and 0.65 + or - 0.17 kg, respectively, with total liver weight. A formula was obtained by linear regression which provided the following relationships: total liver weight (g) = [245.57 + 17.92 x (body weight, kg)]; right lobe weight (g) = [67.58 + 0.52 x(total liver weight, g)]. The selection of the recipient on the liver transplant waiting list can be made on the basis of these relationships
Asunto(s)
Humanos , Adulto , Persona de Mediana Edad , Peso Corporal , Tamaño de los Órganos , Trasplante de Hígado/métodos , Selección de Paciente , Análisis de RegresiónRESUMEN
Sixty fresh adult livers were obtained from cadavers together with celiac trunk, head of the pancreas and superior mesenteric artery. The right portal vein, left portal vein and their respective branches were dissected as well as the hepatic veins. There was only one right hepatic vein in 59 cases. The median hepatic vein was present in 53 (88.3%) cases and the left hepatic vein only in 46(76.3%). In 59(98.3%) cases, there were right and left portal vein but in one (1.6%) case no portal bifurcation has been found. The median portal vein has been found only in 9(15.2%) cases.