RESUMEN
PURPOSE: To investigate the efficacy of cordycepin, an adenosine analogue, on prevention of esophageal damage and stricture formation due to esophageal caustic burns in rat model comparing with prednisolone. METHODS: Caustic esophageal burn was introduced by 37.5% of NaOH to distal esophagus. Thirty-two Wistar albino rats were divided in four groups: sham rats undergone laparotomy, treated with 0.9% NaCl; control rats injured with NaOH without cordycepin treatment; cordycepin group injured with NaOH, treated with 20 mg/kg cordycepin; prednisolone group injured with NaOH, treated with 1 mg/kg prednisolone for 28 days. Efficacy was assessed by histopathological and immunohistochemical analysis of esophageal tissues. RESULTS: Cordycepin treatment significantly decreased inflammation, granulation tissue and fibrous tissue formation and prevented formation of esophageal strictures shown by histopathological damage score and stenosis indexes compared to control group (p < 0.01). These effects are relatively more substantial than prednisolone, probably based on attenuation of elevation of proinflammatory cytokines hypoxia-inducible factor 1-alpha (HIF-1?), tumor necrosis factor alpha (TNF-?), proliferative and fibrotic factor fibroblast growth factor 2 (FGF2) and angiogenic factor vascular endothelial growth factor A (VEGFA) (p < 0.05). CONCLUSIONS: The findings suggest that cordycepin has a complex multifactorial healing process in alkali-burned tissue, more successful than prednisolone in preventing the formation of esophageal strictures and may be used as a therapeutic agent in the acute phase of esophageal alkali-burn.
Asunto(s)
Quemaduras Químicas , Cáusticos , Estenosis Esofágica , Álcalis/uso terapéutico , Animales , Antiinflamatorios/uso terapéutico , Quemaduras Químicas/tratamiento farmacológico , Cáusticos/uso terapéutico , Cáusticos/toxicidad , Desoxiadenosinas , Estenosis Esofágica/inducido químicamente , Estenosis Esofágica/tratamiento farmacológico , Estenosis Esofágica/prevención & control , Ratas , Ratas Wistar , Factor A de Crecimiento Endotelial Vascular/uso terapéuticoRESUMEN
ABSTRACT Purpose To investigate the efficacy of cordycepin, an adenosine analogue, on prevention of esophageal damage and stricture formation due to esophageal caustic burns in rat model comparing with prednisolone. Methods Caustic esophageal burn was introduced by 37.5% of NaOH to distal esophagus. Thirty-two Wistar albino rats were divided in four groups: sham rats undergone laparotomy, treated with 0.9% NaCl; control rats injured with NaOH without cordycepin treatment; cordycepin group injured with NaOH, treated with 20 mg/kg cordycepin; prednisolone group injured with NaOH, treated with 1 mg/kg prednisolone for 28 days. Efficacy was assessed by histopathological and immunohistochemical analysis of esophageal tissues. Results Cordycepin treatment significantly decreased inflammation, granulation tissue and fibrous tissue formation and prevented formation of esophageal strictures shown by histopathological damage score and stenosis indexes compared to control group (p < 0.01). These effects are relatively more substantial than prednisolone, probably based on attenuation of elevation of proinflammatory cytokines hypoxia-inducible factor 1-alpha (HIF-1?), tumor necrosis factor alpha (TNF-?), proliferative and fibrotic factor fibroblast growth factor 2 (FGF2) and angiogenic factor vascular endothelial growth factor A (VEGFA) (p < 0.05). Conclusions The findings suggest that cordycepin has a complex multifactorial healing process in alkali-burned tissue, more successful than prednisolone in preventing the formation of esophageal strictures and may be used as a therapeutic agent in the acute phase of esophageal alkali-burn.
Asunto(s)
Animales , Ratas , Quemaduras Químicas/tratamiento farmacológico , Cáusticos/toxicidad , Cáusticos/uso terapéutico , Estenosis Esofágica/inducido químicamente , Estenosis Esofágica/prevención & control , Estenosis Esofágica/tratamiento farmacológico , Desoxiadenosinas , Ratas Wistar , Factor A de Crecimiento Endotelial Vascular/uso terapéutico , Álcalis/uso terapéutico , Antiinflamatorios/uso terapéuticoRESUMEN
BACKGROUND: Many therapies involving varying degrees of complexity have been used to treat acne scars, but none is considered the gold standard treatment. OBJECTIVE: A comparative evaluation of 88% phenol and 90% trichloroacetic acid (TCA) applied using the chemical reconstruction of skin scars (CROSS) technique. MATERIALS AND METHODS: A nonrandomized, single-blinded self-controlled clinical trial was conducted among patients with ice pick-type and boxcar-type atrophic acne scars. Using 88% phenol on the left hemiface and 90% TCA on the right hemiface was adopted as the standard practice of the CROSS technique. The dermatological quality of life index (DLQI) questionnaire, acne scar grading scale Échelle d´Evaluation Clinique des Cicatrices d'Acne (ECCA), and evaluation of improvement were performed pretreatment and post-treatment. RESULTS: Regarding ECCA, significant differences were found in pretreatment and post-treatment (p < .001). Regarding tolerance to pain, it was found that the discomfort felt with 90% TCA was significantly less than that felt with 88% phenol (p = .020). Regarding the quality of life measured with the DLQI, the results showed that the mean score in post-treatment assessment was significantly lower than that in the pretreatment assessment (p < .05). Hypochromia and enlargement scar were only seen after the use of 90% TCA. CONCLUSION: This study confirmed the efficacy of both TCA and phenol for treating such scars, with less severe complications from the use of phenol.
Asunto(s)
Acné Vulgar/complicaciones , Cáusticos/uso terapéutico , Cicatriz/tratamiento farmacológico , Hidroxibenzoatos/uso terapéutico , Ácido Tricloroacético/uso terapéutico , Adolescente , Adulto , Atrofia , Cáusticos/efectos adversos , Cicatriz/etiología , Cicatriz/patología , Cicatriz Hipertrófica/inducido químicamente , Femenino , Humanos , Hidroxibenzoatos/efectos adversos , Hipopigmentación/inducido químicamente , Masculino , Persona de Mediana Edad , Neoplasias Primarias Secundarias , Dolor/inducido químicamente , Calidad de Vida , Índice de Severidad de la Enfermedad , Método Simple Ciego , Ácido Tricloroacético/efectos adversos , Adulto JovenAsunto(s)
Antagonistas Adrenérgicos beta/administración & dosificación , Cáusticos/administración & dosificación , Granuloma Piogénico/tratamiento farmacológico , Timolol/administración & dosificación , Ácido Tricloroacético/administración & dosificación , Administración Tópica , Antagonistas Adrenérgicos beta/uso terapéutico , Cáusticos/uso terapéutico , Preescolar , Humanos , Masculino , Timolol/uso terapéutico , Ácido Tricloroacético/uso terapéuticoRESUMEN
OBJECTIVES: To assess the efficacy of topical 80% trichloroacetic acid (TCA) to treat internal anal high-grade squamous intraepithelial lesions (HSILs) in HIV-positive individuals. METHODS: All patients who attended the University of Pittsburgh Anal Dysplasia Clinic for treatment of biopsy-proven internal anal HSIL with topical TCA between July 1, 2009, and June 30, 2012, and who had 1 or more follow-up visits to assess treatment efficacy were included in the analysis. Recurrence of HSIL was assessed in July 1, 2013. RESULTS: A total of 98 HSILs from 72 patients were treated, and 77 (78.6%) resolved to normal epithelium or low-grade SIL during follow-up. Forty-eight (49.0%) and 27 (27.6%) of lesions resolved with 1 and 2 TCA treatments, respectively, whereas 1 lesion (1%) each resolved with 3 and 4 TCA treatments. Twenty-one (21.4%) lesions in 20 patients remained without resolution after TCA treatments. These patients were offered an alternative treatment. During follow-up, 8 (15.1%) of 53 patients had a lesion that recurred at the index site (11/53 [20.8%], inclusive of adjacent lesions) and 17 patients had new lesions diagnosed. CONCLUSIONS: Topical TCA is an efficacious treatment of internal anal HSIL in an anal dysplasia clinic setting with high-resolution anoscopy capacity. Advantages of TCA for this recurrent disease process include the following: low cost, no requirement for special equipment beyond that for high-resolution anoscopy, and painless application procedure. A larger prospective comparative study would better define efficacy and patient acceptability between treatment methods.
Asunto(s)
Canal Anal/patología , Neoplasias del Ano/prevención & control , Carcinoma de Células Escamosas/prevención & control , Cáusticos/uso terapéutico , Seropositividad para VIH/patología , Lesiones Intraepiteliales Escamosas de Cuello Uterino/tratamiento farmacológico , Ácido Tricloroacético/uso terapéutico , Administración Tópica , Adulto , Anciano , Canal Anal/inmunología , Neoplasias del Ano/patología , Carcinoma de Células Escamosas/patología , Cáusticos/administración & dosificación , Femenino , Estudios de Seguimiento , Seropositividad para VIH/inmunología , Humanos , Masculino , Tamizaje Masivo , Salud del Hombre , Persona de Mediana Edad , Recurrencia Local de Neoplasia/prevención & control , Proctoscopía , Estudios Retrospectivos , Lesiones Intraepiteliales Escamosas de Cuello Uterino/inmunología , Lesiones Intraepiteliales Escamosas de Cuello Uterino/patología , Lesiones Intraepiteliales Escamosas de Cuello Uterino/prevención & control , Resultado del Tratamiento , Ácido Tricloroacético/administración & dosificaciónRESUMEN
Cistos conjuntivais em cavidades anoftálmicas podem ter implicações funcionais e estéticas negativas para os pacientes. Dentre as opções terapêuticas disponíveis, o uso do ácido tricloroacético é relativamente recente. Os casos relatados apresentaram boa evolução após 30 dias do tratamento, sendo bem tolerado pelos pacientes e possibilitando maior preservação de tecido conjuntival...
Conjunctival cysts in anophthalmic socket may have functional and aesthetic implications for the patients.Among the available treatment options, the use of trichloroacetic acid is relatively recent. Our reported cases showed a good outcome after 30 days of treatment, that was well tolerated by patients, with greater conjunctival tissue preservation...
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Ácido Tricloroacético/administración & dosificación , Ácido Tricloroacético/uso terapéutico , Cáusticos/administración & dosificación , Cáusticos/uso terapéutico , Quistes/tratamiento farmacológico , Enfermedades de la Conjuntiva/tratamiento farmacológico , Evisceración del Ojo , Ojo Artificial , Inyecciones IntralesionesRESUMEN
Objetivo: Demostrar la eficacia de la instilación intrauterina de ácido tricloroacético como método de ablación endometrial para el tratamiento de la hemorragia uterina. Métodos: Se realizó un estudio prospectivo, analítico, comparativo, en 60 pacientes que acudieron a la consulta del Servicio de Ginecología del Hospital Universitario de Caracas entre mayo 2008 y agosto 2009, en quienes se empleó ácido tricloroacético al 95 %, como método de ablación endometrial. Se seleccionaron dos grupos al azar, uno sujeto a la colocación previa de analógos de GnRh y otro control, sin este. Resultados: A los 3 meses del tratamiento, el grupo que recibió acetato de leuprolide presentó eumenorrea en 62,5 % e hipomenorrea en 37,5 %. Ninguna de las pacientes de este grupo presentó hipermenorrea, ni amenorrea. El grupo que no recibió análogos presentó eumenorrea en 50 % de los casos, hipomenorrea en 32,1 % e hipermenorrea en 17,9 %. La tasa de éxito y satisfacción de la paciente, fue de 100 % para el grupo con análogos y de 82,1 % para el control. Estos cambios resultaron estadísticamente significativos (P < 0,05). Conclusión: La instilación intrauterina de ácido tricloroacético es eficaz en el tratamiento de la hemorragia uterina, obteniendo mejores resultados al preparar el endometrio con acetato de leuprolide.
Objective: To demonstrate the efficiency of intrauterine instillation of trichloroacetic acid as a method of endometrial ablation for the treatment of uterine hemorrhage. Methods: This was a prospective, analytical and comparative study performed in 60 patients who came to consultation at the Servicio de Ginecologia del Hospital Universitario de Caracas between May, 2008 and August, 2009, in whom 95 % trichloroacetic acid was used as method of endometrial ablation. Two groups were selected at random, one subject to the previous administration of gonadotropin-releasing hormone analogue and another control, without this one. Results: To 3 months of treatment, the group that received leuprolide acetate presented eumenorrhea rates of 62.5 % and hypomenorrhea of 37.5 %. None of the patients of this group presented menorrhagia, not amenorrhea. The group that did not receive analogous presented eumenorrhea in 50 % of the cases, hypomenorrhea in 32.1 % and menorrhagia in 17.9 %. The rate of success and satisfaction of the patient was 100 % for the group with analogous and 82.1 % for the control group. These results turned out to be statistically significant (P <0.05). Conclusion: Intrauterine instillation of trichloroacetic acid is effective in the treatment of uterine hemorrhage, obtaining better results when leuprolide acetate is used previous the procedure.
Asunto(s)
Humanos , Femenino , Hemorragia Uterina/terapia , Hormona Liberadora de Gonadotropina , Transfusión de Sangre Intrauterina , Técnicas de Ablación Endometrial , Ácido Tricloroacético/uso terapéutico , Cáusticos/uso terapéutico , Estudios Prospectivos , Instilación de Medicamentos , Perimenopausia/sangre , Procesos Estocásticos , Trastornos de la MenstruaciónRESUMEN
BACKGROUND: Acne is an inflammatory disease of the pilosebaceous follicles. Oral isotretinoin is the treatment of choice for severe acne. Exaggerated cicatrization related to oral isotretinoin was reported in the 1980s and 1990s. Currently, dermabrasion for acne scar revision is only recommended 6 to 12 months after the completion of oral isotretinoin treatment. OBJECTIVE: To evaluate the evolution of healing from manual chemabrasion of depressed scars resulting from acne conducted within 1 to 3 months after oral isotretinoin treatment. METHODS AND MATERIALS: This was an interventional, prospective study involving 10 patients with depressed facial scars. A medium-depth chemical peel was applied to the entire face. Manual sandpaper dermabrasion was performed to areas of scarring until the appearance of bloody dew. A 6-month reepithelization follow-up was conducted. RESULTS: All of the patients presented with normal cicatrization, and neither hypertrophic scars nor keloids were observed. Depressed acne scar revision was satisfactory. CONCLUSION: Our observations may contribute to the discussion of the negative influence of oral isotretinoin on wound healing. Other studies are necessary to reevaluate the current recommendation of a 6- to 12-month waiting period after oral isotretinoin treatment before performing dermabrasion or fractional ablative laser for acne scar revision.
Asunto(s)
Quimioexfoliación , Cicatriz/terapia , Dermabrasión , Cicatrización de Heridas , Acné Vulgar/complicaciones , Acné Vulgar/tratamiento farmacológico , Adolescente , Adulto , Cáusticos/uso terapéutico , Cicatriz/etiología , Cicatriz/fisiopatología , Fármacos Dermatológicos/efectos adversos , Femenino , Humanos , Isotretinoína/efectos adversos , Masculino , Factores de Tiempo , Resultado del Tratamiento , Ácido Tricloroacético/uso terapéutico , Adulto JovenRESUMEN
BACKGROUND: Earlobe cleft is a common problem caused by the wearing of jewelry or decorative objects. Incomplete earlobe clefts are usually bilateral and are often converted to complete clefts as part of the surgical repair procedure. OBJECTIVE: We present a nonsurgical procedure for incomplete earlobe cleft repair using trichloroacetic acid 90%. METHODS AND MATERIALS: We assessed 32 patients with a total of 53 earlobes to be noninvasively repaired. RESULTS: Complete treatment varied from 2 to 50 days, an average of 15 days between the first and last application of trichloroacetic acid 90%. No recurrences were observed during 1 year of follow-up. All of the clefts were totally repaired, and all of the patients were satisfied with the aesthetic results. CONCLUSIONS: Considering the surgical limitations, the noninvasive procedure described here may be considered to be a good option for incomplete earlobe cleft repair because of its good functional and cosmetic results, low cost, minimum risk, and easy application.
Asunto(s)
Cáusticos/uso terapéutico , Oído Externo/lesiones , Laceraciones/terapia , Ácido Tricloroacético/uso terapéutico , Adolescente , Adulto , Anciano , Cáusticos/administración & dosificación , Niño , Femenino , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
La aplicación de esteroides intralesionales ha mostrado ser efectiva en las estenosis esofágicas refractarias de diferentes etiologías. El presente estudio pretende evaluar la eficacia de la aplicación intralesional del acetónido de triamcinolona y comparar los resultados de la dilatación endoscópica en un grupo que recibe el esteroide con un grupo control, en las estenosis esofágicas causadas por cáusticos o posquirúrgicas. De 56 pacientes con estenosis esofágica, 35 por cáusticos y 21 posquirúrgicas, 17 pacientes con ingesta de corrosivos y 11 postoperatorios se sometieron a la dilatación y aplicación de triamcinolona intralesional. Se calculó el intervalo y frecuencia de las dilataciones antes y después de la aplicación del esteroide y se cálculo un índice de dilatación periódica con base en el número de dilataciones sobre el número de meses antes y después de la aplicación de los esteroide. El promedio de edad de los 28 pacientes (13 hombres y 15 mujeres) con esteroides intralesionales fue de 36 años (rango de 15 a 70) y para el grupo control de 29 años (rango de 15 a 68). No se encontraron diferencias entre el grupo tratado y el grupo control en lo referente al origen de la estenosis, longitud, ubicación y distribución por sexo. En diez pacientes se aplicó una sola dosis del esteroide, mientras 13 requirieron 2 dosis y en 5 hasta 3 dosis. La totalidad de los pacientes ya habían sido dilatados cuando se les aplicó los esteroides. Se cálculo el índice de dilatación antes y después de la aplicación de los esteroides encontrándose que este índice mejoraba significativamente (p<0,01) para el grupo que recibía los esteroides y tenía una estenosis posquirúrgicas. La aplicación intralesional de esteroides no aumenta los efectos de la dilatación endoscópica en los pacientes con estenosis esofágica por cáusticos, teniendo un efecto significativamente favorable en las estenosis posquirúrgicas. La aplicación de esteroides no aumenta los efectos de la dilatación endo...
Asunto(s)
Masculino , Humanos , Femenino , Cáusticos/uso terapéutico , Estenosis Esofágica/terapia , Esteroides/administración & dosificación , Dilatación Gástrica , Gastroenterología , VenezuelaRESUMEN
BACKGROUND: Solar lentigines are benign keratinocytic proliferations resulting from prolonged and cumulative sun exposure. The newer photoselective lasers have become the mainstay of treatment. However, cryosurgery and trichloroacetic acid (TCA) solution are cost-effective alternatives in the treatment of solar lentigines. METHODS: Twenty-five patients with multiple solar lentigines over the dorsa of their hands were included. Each hand was treated randomly with either 30% TCA solution or liquid nitrogen spray. The efficacy of treatment was evaluated at 8 weeks. RESULTS: Cryosurgery was more likely to produce significant lightening of the lentigines than 30% TCA solution (P < 0.05) but was more painful and took longer to heal. CONCLUSION: Cryosurgery was found to be superior to TCA 30% solution in the treatment of solar lentigines. This study demonstrates that old-fashioned treatments for solar lentigines are still excellent and cost-effective therapeutic choices.
Asunto(s)
Cáusticos/uso terapéutico , Criocirugía , Dermatosis de la Mano/terapia , Lentigo/terapia , Ácido Tricloroacético/uso terapéutico , Rayos Ultravioleta/efectos adversos , Criocirugía/efectos adversos , Femenino , Dermatosis de la Mano/etiología , Humanos , Lentigo/etiología , Dolor/etiología , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del Tratamiento , Cicatrización de HeridasRESUMEN
Se trata de un estudio de tipo descriptivo retrospectivo, con la finalidad de determinar la incidencia y las principales características epidemiológicas y clínicas de la Intoxicación por cáusticos en el Hospital tipo II "Padre Justo Arias" de la Ciudad de Rubio, Estado Táchira, para el período 1996 a 2000. Se revisaron 24 historias clínicas con el diagnóstico de "Intoxicación por Cáusticos" (ácidos y álcalis). Las variables estudiadas fueron: edad sexo, distribución por años, características clínicas, estancia hospitalaria, hallazgos endoscópicos y principales sustancias ingeridas. En los resultados se evidenció: el grupo etareo más afectado fueron los preescolares de 2 a 6 años; el 54 por ciento de los casos fueron del sexo masculino, la mayor incidencia se presentó durante los años 1996 a 1998; el 62,5 por ciento de los pacientes ameritó más de tres días de hospitalización; los principales síntomas fueron: odinofagia/disfagia, lesiones orales, sialorrea y taquicardia. Las sustancias principales implicadas fueron el hidróxido de sodio (38 por ciento) y el hipoclorito de sodio (28 por ciento). Al 60 por ciento de los pacientes se les realizó endoscopia digestiva superior, de los cuáles el 75 por ciento presentó lesiones de primer grado y el 25 por ciento restante lesiones de segundo grado, no se reportaron lesiones de tercer grado. Se concluye la necesidad de incrementar las medidas preventivas adecuadas tanto en los hogares como a nivel industrial para evitar este tipo de accidentes capaces de producir complicaciones severas e incluso la muerte
Asunto(s)
Humanos , Masculino , Adolescente , Femenino , Niño , Cáusticos/administración & dosificación , Cáusticos/química , Cáusticos/uso terapéutico , Endoscopía , Intoxicación , Toxicología , VenezuelaAsunto(s)
Herpes Zóster/complicaciones , Molusco Contagioso/complicaciones , Adulto , Cáusticos/uso terapéutico , Cicatriz/complicaciones , Cicatriz/patología , Femenino , Infecciones por VIH/complicaciones , Herpes Zóster/patología , Humanos , Molusco Contagioso/tratamiento farmacológico , Molusco Contagioso/patología , Ácido Tricloroacético/uso terapéuticoRESUMEN
Atendemos 67 doentes HIV+, portadores de condilomas acuminados perianais, entre agosto de 1996 e junho de 1998. Eram 61 homens e seis mulheres com média etária de 32 anos. Em 61 porcento dos pacientes, os condilomas acometiam tanto a margem como o canal acima da linha pectínea em 10 porcento das vezes. Encontramos lesöes condilomatosas macroscópicas associadas na cavidade oral em 6 porcento dos casos, no pênis de 19 porcento dos homens e na vulva e vagina de 67 porcento das mulheres. O tratamento consistiu de aplicaçöes semanais de podofilina a 25 porcento, em vaselina sólida, nas lesöes da margem anal e de ácido tricloroacético a 95 porcento (ATA) nos condilomas localizados acima da linha pectínea. Avaliamos os doentes após a quarta aplicaçäo. As verrugas regrediram totalmente em 46 porcento e diminuíram em 33 porcento dos doentes. Em 7,5 porcento das vezes as lesöes da margem anal desapareceram, persistindo as do canal anal e, em 4,5 porcento dos casos, ocorreu o contrário. O tratemento foi inútil em outros 9 porcento. Operamos os condilomas remanescentes (54 porcento). As aplicaçöes de podofilina foram eficazes em 51 porcento dos casos e de ATA em 47 porcento...