RESUMO
The dynorphin peptides are the endogenous ligands for the kappa opioid receptor (KOR) and regulate food intake. Administration of dynorphin-A1-13 (DYN) in the paraventricular hypothalamic nucleus (PVN) increases palatable food intake, and this effect is blocked by co-administration of the orexin-A neuropeptide, which is co-released with DYN in PVN from neurons located in the lateral hypothalamus. While PVN administration of DYN increases palatable food intake, whether it increases food-seeking behaviors has yet to be examined. We tested the effects of DYN and norBNI (a KOR antagonist) on the seeking and consumption of sucrose using a progressive ratio (PR) and demand curve (DC) tasks. In PVN, DYN did not alter the sucrose breaking point (BP) in the PR task nor the elasticity or intensity of demand for sucrose in the DC task. Still, DYN reduced the delay in obtaining sucrose and increased licks during sucrose intake in the PR task, irrespective of the co-administration of orexin-A. In PVN, norBNI increased the delay in obtaining sucrose and reduced licks during sucrose intake in the PR task while increasing elasticity without altering intensity of demand in the DC task. However, subcutaneous norBNI reduced the BP for sucrose and increased the delay in obtaining sucrose in the PR task while reducing the elasticity of demand. Together, these data show different effects of systemic and PVN blockade of KOR on food-seeking, consummatory behaviors, and incentive motivation for sucrose and suggest that KOR activity in PVN is necessary but not sufficient to drive seeking behaviors for palatable food.
Assuntos
Dinorfinas , Motivação , Núcleo Hipotalâmico Paraventricular , Receptores Opioides kappa , Receptores Opioides kappa/metabolismo , Dinorfinas/farmacologia , Dinorfinas/metabolismo , Núcleo Hipotalâmico Paraventricular/metabolismo , Núcleo Hipotalâmico Paraventricular/efeitos dos fármacos , Animais , Masculino , Motivação/efeitos dos fármacos , Orexinas , Ratos , Ratos Sprague-Dawley , Naltrexona/farmacologia , Naltrexona/análogos & derivados , Ingestão de Alimentos/efeitos dos fármacos , Ingestão de Alimentos/fisiologia , Ingestão de Alimentos/psicologia , Sacarose , Comportamento Alimentar/efeitos dos fármacos , Comportamento Alimentar/psicologia , Antagonistas de Entorpecentes/farmacologiaRESUMO
The opioid receptors (OR) regulate food intake. Still, despite extensive pre-clinical research, the overall effects and individual contribution of the mu (MOR), kappa (KOR), and delta (DOR) OR subtypes to feeding behaviors and food intake remain unclear. To address this, we conducted a pre-registered systematic search and meta-analysis of rodent dose-response studies to evaluate the impact of central and peripheral administration of non-selective and selective OR ligands on intake, motivation, and choice of food. All studies had a high bias risk. Still, the meta-analysis confirmed the overall orexigenic and anorexigenic effects of OR agonists and antagonists, respectively. Our results support a larger orexigenic role for central MOR agonists among OR subtypes and that peripheral OR antagonists reduce motivation for and intake of preferred foods. In binary food choice studies, peripheral OR agonists selectively increase the intake of fat-preferred foods; in contrast, they did not increase the intake of sweet carbohydrate-preferred foods. Overall, these data support that OR regulation of intake, motivation, and choice is influenced by food macronutrient composition.
Assuntos
Motivação , Receptores Opioides , Analgésicos Opioides/farmacologia , Ingestão de Alimentos , Comportamento Alimentar , Ligantes , Receptores Opioides muRESUMO
Rickettsial diseases have seen a re-emergence in the Americas in the last few decades, with concerning morbidity, mortality and economic implications that result from loss of productivity, income, curbs in liberal trade agreements, and reduction in agricultural practices. The aim of this study is to determine the socioecological determinants and seroprevalence for Rickettsia typhi and Rickettsia rickettsii among residents of Teabo, a rural community of Yucatán, Mexico. Sociodemographic data and serum samples were obtained from 180 consenting participants. Antibody titers for R. typhi and R. rickettsii were determined by indirect immunofluorescence assay (IFA). Participants also submitted tick samples collected from their residential area. We conducted logistic regression models to evaluate the association between exposure variables and seroprevalence. Rhipicephalus sanguineus s.l. (37%; n = 65), and Amblyomma cajennense Fabricius (17%; n = 29) were the predominant tick species in peri-domestic areas. Out of the 180 participants, there was significantly higher seroprevalence of R. typhi (n = 77; 46%) compared to R. rickettsii [n = 27, 15%, (p < 0.05)]. Pearson's chi-square test of independence revealed significant differences in R. rickettsii seroprevalence by gender (X2 [n = 175, df = 4, (p < 0.001)] = 180.26), level of education, (X2 [n = 180, df = 4, (p < 0.001)] = 44.0), and by tick species found in residential area, (X2 [n = 180, df = 4, (p = 0.050)] = 9.48). After adjusting for other variables in a logistic regression model, for each unit increase in the number of dogs present in the residential area, there was a 27% increase in the odds of human seroprevalence for R. typhi IgG (AOR = 1.27, 95% CI: 1.01-1.63). Compared to study participants living in residential areas with a 'low' height of vegetation, those living in residential areas with a 'medium' height of vegetation had 2.5 times greater odds of human seroprevalence for R. typhi IgG (AOR = 2.51, 95% CI: 1.19-5.40). Potentially modifiable existing factors in the peri-domestic area may constitute a high-risk source of seroprevalence for rickettsial antibodies among residents of the rural community of Teabo, Yucatán, Mexico.
Assuntos
Doenças do Cão , Rhipicephalus sanguineus , Rickettsia , Animais , Doenças do Cão/microbiologia , Cães , Humanos , Imunoglobulina G , México/epidemiologia , Rhipicephalus sanguineus/microbiologia , População Rural , Estudos SoroepidemiológicosRESUMO
Congenital Disorders of Glycosylation (CDG) are scarcely reported from Latin America. We here report on a Mexican mestizo with a multi-systemic syndrome including neurological involvement and a type I transferrin (Tf) isoelectric focusing (IEF) pattern. Clinical exome sequencing (CES) showed known compound missense variants in PMM2 c.422Gâ¯>â¯A (p.R141H) and c.395â¯Tâ¯>â¯C (p.I132T), coding for the phosphomanomutase 2 (PMM2). PMM2 catalyzes the conversion of mannose-6-P to mannose-1-P required for the synthesis of GDP-Man and Dol-P-Man, donor substrates for glycosylation reactions. This is the third reported Mexican CDG patient and the first with PMM2-CDG. PMM2 has been recently identified as one of the top 10 genes carrying pathogenic variants in a Mexican population cohort.
RESUMO
The goal of this article is to provide recommendations about the management of muscle-invasive (MIBC) and metastatic bladder cancer. New molecular subtypes of MIBC are associated with specific clinical-pathological characteristics. Radical cystectomy and lymph node dissection are the gold standard for treatment and neoadjuvant chemotherapy with a cisplatin-based combination should be recommended in fit patients. The role of adjuvant chemotherapy in MIBC remains controversial; its use must be considered in patients with high-risk who are able to tolerate a cisplatin-based regimen, and have not received neoadjuvant chemotherapy. Bladder-preserving approaches are reasonable alternatives to cystectomy in selected patients for whom cystectomy is not contemplated either for clinical or personal reasons. Cisplatin-based combination chemotherapy is the standard first-line protocol for metastatic disease. In the case of unfit patients, carboplatin-gemcitabine should be considered the preferred first-line chemotherapy treatment option, while pembrolizumab and atezolizumab can be contemplated for individuals with high PD-L1 expression. In cases of progression after platinum-based therapy, PD-1/PD-L1 inhibitors are standard alternatives. Vinflunine is another option when anti-PD-1/PD-L1 therapy is not possible. There are no data from randomized clinical trials regarding moving on to immuno-oncology agents.
Assuntos
Neoplasias Musculares/terapia , Guias de Prática Clínica como Assunto/normas , Neoplasias da Bexiga Urinária/terapia , Ensaios Clínicos como Assunto , Terapia Combinada , Gerenciamento Clínico , Humanos , Neoplasias Musculares/secundário , Invasividade Neoplásica , Prognóstico , Sociedades Médicas , Neoplasias da Bexiga Urinária/patologiaRESUMO
Cancer cases are growing in an exponential way, likewise the prices of new cancer drugs. Continuing in this way, in the near future, it will be impossible to provide optimum care for all cancer patients. Therefore, it is important to establish mechanisms that enable the National Health Systems to provide the best options of treatment, either through the elaboration of decision-binding frameworks or through other initiatives that guarantee the best quality care for all oncology patients to overcome, in the best possible way, this difficult illness. Here, we review current proposals that have been established by different cancer organizations worldwide, their similarities, their differences and whether they are helpful in a real clinical setting. Facing present reality and despite these organizations' huge efforts, these proposals are not being implemented at all and it does not seem feasible that they will in the short run. In the same way, we support and argue why oncologists should have a crucial and a preponderant role to establish the best way of guaranteeing an equal access to the latest oncology care.
Assuntos
Antineoplásicos/economia , Oncologia/economia , Neoplasias/tratamento farmacológico , Neoplasias/economia , Humanos , Oncologia/métodosRESUMO
OBJECTIVES: Under the auspices of the Foundation for Excellence and Quality in Oncology (ECO), the Translational Research in Oncology Medical Services Study (INTRO) was conducted with the aim of describing the current state of, and future expectations for translational cancer research in Spanish medical centres. The first step in the investigation was intended to analyse the current condition of the national Medical Oncology Services network by examining different aspects of the oncology research field. METHODS: A descriptive and observational multicentre study was performed at a statewide level; information was collected by surveying a cross-section of all those responsible for Medical Oncology Services in Spain. RESULTS: The survey was completed by key informants, who were selected independently by each service, between September 2010 and April 2011. We were able to gather comprehensive data from a total of 27 Spanish hospitals. These data enabled us to describe the allocation of human and material resources devoted to clinical and translational research across the Medical Oncology Services and to describe the organisational and functional components of these services and units. These data included information pertaining to the activities developed, their funding sources, and their functional dependence on other internal or external bodies. Finally, we explored the degree of dissemination and use of some specific techniques used for the genetic diagnosis of cancer, which have recently been introduced in Medical Oncology within the Spanish healthcare system. CONCLUSIONS: A wide range of variability exists between different oncology services in Spanish hospitals. Time should be spent reflecting on the need and opportunities for improvement in the development of translational research within the field of oncology.
Assuntos
Oncologia , Neoplasias , Pesquisa Translacional Biomédica , Coleta de Dados , Humanos , EspanhaRESUMO
To carry out the intracellular phase of its life cycle, Trypanosoma cruzi must infect a host cell. Although a few molecules have been reported to participate in this process, one known protein is LYT1, which promotes lysis under acidic conditions and is involved in parasite infection and development. Alternative transcripts from a single LYT1 gene generate two proteins with differential functions and compartmentalization. Single-gene products targeted to more than one location can interact with disparate proteins that might affect their function and targeting properties. The aim of this work was to study the LYT1 interaction map using coimmunoprecipitation assays with transgenic parasites expressing LYT1 products fused to GFP. We detected several proteins of sizes from 8 to 150 kDa that bind to LYT1 with different binding strengths. By MS-MS analysis, we identified proteins involved in parasite infectivity (trans-sialidase), development (kDSPs and histones H2A and H2B), and motility and protein traffic (dynein and α - and ß -tubulin), as well as protein-protein interactions (TPR-protein and kDSPs) and several hypothetical proteins. Our approach led us to identify the LYT1 interaction profile, thereby providing insights into the molecular mechanisms that contribute to parasite stage development and pathogenesis of T. cruzi infection.
Assuntos
Doença de Chagas/parasitologia , Interações Hospedeiro-Parasita , Proteínas de Protozoários/genética , Trypanosoma cruzi/genética , Doença de Chagas/genética , Citoplasma/metabolismo , Humanos , Ligação Proteica , Mapas de Interação de Proteínas , Proteínas de Protozoários/metabolismo , Espectrometria de Massas em Tandem , Trypanosoma cruzi/metabolismo , Trypanosoma cruzi/patogenicidadeRESUMO
Introducción: El futuro de la salud bucal de un niño, aún antes de que nazca, puede estar determinado por la madre, y los cuidados que le provean en los primeros meses de vida garantizan una dentadura saludable en la infancia y la adolescencia. Objetivo: Describir el nivel de conocimiento de las madres sobre higiene bucal en niños de 0 a 3 años que asisten al Hospital Materno Infantil San Pablo en el año 2010. Material y método: Se realizó un estudio descriptivo observacional de corte transversal. La población consta de 102 madres de bebés de 0 a 3 años que acudieron al Hospital Materno Infantil de San Pablo. Resultados: La mayoria de las madres encuestadas (87-85%) denotaron niveles no aceptables en cuanto al conocimiento sobre salud bucal en los bebés. El nivel de conocimiento bueno (1-1%) es muy bajo. Se observa que las madres mayores de 25 años presentan mejores niveles de conocimiento, al igual que las que trabajan fuera de casa, en ellas la frecuencia de nivel no aceptable es menor. Conclusión: El conocimiento de las madres sobre los cuidados buco dentales de sus niños es bajo, por lo que se hace necesario impartir educación acerca de los mismos, tanto a las madres como a los profesionales de salud. Palabras clave: Nivel de conocimiento - Salud bucodental Niños de 0 a 3 años
Introduction: The future of oral health of a child can be determined by their mothers, even before his birth, and the care that it's provide them at the first months of their life would ensure healthy teeth in childhood and adolescence. Objective: Describe the level of knowledge of mothers on oral hygiene in children aged between 0 to 3 years attending the St. Paul's Maternal and Child Hospital in 2010. Material and Methods: It was conducted a descriptive cross-sectional observational study. The population consists of 102 mothers of infants of 0 to 3 years who attended the St. Paul's Maternal and Child Hospital. Results: The majority of mothers surveyed (87-85%) shown unacceptable levels in knowledge about oral health in infants. Good knowledge level (1-1%) is very low. It is observed that mothers over 25 years old have higher levels of knowledge, as well as those who work outside the home, to whom, the frequency of unacceptable level is low. Conclusion: the knowledge of mothers on dental oral care of they children is low, so it is necessary to provide education about it, to both mothers and health professionals. Keywords: Level of knowledge - Oral Health - Children from 0 to 3 years
Assuntos
Higiene Bucal , Conhecimentos, Atitudes e Prática em Saúde , Pré-EscolarRESUMO
Objetivos: Determinar el crecimiento intrahospitalario y las prácticas alimentarias de los RNMBP en la Unidad de Neonatología de la Cátedra y Servicio de Pediatría del Hospital de Clínicas sede San Lorenzo. Metodología: Estudio observacional analítico retrospectivo. Fueron incluidos los RN nacidos en el hopistal, asistidos en la Unidad de Cuidados Intensivos Neonatales (UCIN) con peso al nacer (PN) entre 500 y 1500 grs, de enero 2007 a diciembre 2009 seguidos desde su nacimiento hasta el alta; registrándose la evolución del peso y las prácticas alimentarias. Fueron considerados como grupo control los RNMBP de la red NEOCOSUR nacidos en el mismo periodo. Resultados: Nacieron 140 RNMBP, fueron incluidos 93 RN, la sobrevida al alta fue de 66,4%. El promedio de PN: 1187 ± 201 grs, a los 7días de vida 1091 ± 200 grs; con promedio de pérdida de 95,4 ± 5,6 grs que corresponde a 8% con relación PN; siendo la pérdida por día de 13,6 grs. A los 28 días de vida el promedio de peso fue de 1470 ± 271 grs; con variación de peso entre la semana de vida y los 28 días de 293 ± 79,4 grs, con ganancia de peso de 26,5%, correspondiendo a una ganancia estimada/día de 10,5 grs. Al alta el promedio de peso fue de 2140 ± 356 grs, con una variación de peso con relación al nacimiento de 930 ± 97 gramos, ganancia de peso de 85,3%, correspondiente a 14,5 grs de aumento/día. Recibieron NPT 69 RNMBP, los aminoácidos (AA) se iniciaron a los 2,7 ± 3,6 días y los lípidos a los 3,9 ± 3,4 días. En el NEOCOSUR, iniciaron AA a los 1,6 ± 1,8 días y lípidos a los 2 ± 1,8 días. Del total recibieron NPT 2346 RNMBP (89%). La alimentación enteral fue iniciada en la UCIN a los 4,1 ± 3,6 días y en el NEOCOSUR a los 3,2 ± 3 días. Se alcanzó el volumen de 100 ml/kg/día a los 14 ± 8 días en la UCIN, y en el NEOCOSUR a los 13,1 ± 8,4 días de vida...
Introduction: Assessing the growth and nutritional status of newborns (NB) is very important because of how strongly both factors are associated with overall health and development. Growth is associated with nutritional practices; with differences in calorie and protein intake varying according to when enteral and parenteral feeding of the VLBWI are begun. Objectives: To determine in-hospital weight gain and feeding practices for VLBWI in the Neonatal Unit of the Pediatrics Department of the Centro Materno-Infantil (CMI), of the School of Medical Sciences, National University of Asunción (UNA). Methodology: A retrospective, observational, and analytical study. Patients included were NB treated in the CMI Neonatal Intensive Care Unit (NICU) with birth weights between 500 and 1500 grams between 1 January 2007 and 31 December 2009. Their development, weight, and food intake were recorded in follow up from birth until discharge to home. VLBW newborns in the NEOCOSUR database for the same period of time served as the control group. Results: Of the 140 VLBW newborns in that time period, 93 met inclusion criteria, and their rate of survival to discharge was 66.4%. Average birth weight was 1187 ± 201 grams, while on day 7 weight was 1091 ± 200 grams: an average loss of 95.4 ± 5.6 grams, corresponding to 8% of birth weight, and a daily rate of loss of 13.6 grams per day. At 28 days of age, average weight was 1470 ± 271 grams, with weight gain from day 7 to day 28 days of 293 ± 79.4 grams, a gain of 26.5%, corresponding to an estimated gain of 10.5 grams per day. At discharge, the average weight was 2140 ± 356 grams: a variation of weight relative to birthweight of 930 ± 97 grams (85.3%), corresponding to a gain of 14.5 grams per day. Among the 69 (74%) of VLBW newborn who received total parenteral nutrition (TPN), total days of hospitalization averaged 16 ± 9.4, while amino acid supplementation was begun at 2.7 ± 3.6 days and lipids at 3.9 ± 3.4 days...
Assuntos
Recém-Nascido , Recém-Nascido de muito Baixo Peso , Estado Nutricional , Nutrição ParenteralRESUMO
Objetivos: Determinar la morbi-mortalidad de los Recién nacidos de muy bajo peso al nacer en la Unidad de Neonatología del Centro Materno Infantil del Hospital de Clínicas. Metodología: Estudio de tipo prospectivo descriptivo de cohorte de todos los recién nacidos que nacieron en el Centro Materno Infantil con peso entre 500 y 1500 gramos, entre el 1º de enero del 2004 al 31 de diciembre del 2007, con seguimiento desde su nacimiento hasta su alta o muerte hospitalaria. Resultados: Nacieron, 128 Recién Nacidos de Muy Bajo Peso, de un total de 9486 nacidos vivos, con una incidencia de 1,35%. La media de peso fue 1143 +/-247 gramos y la edad gestacional media fue de 29,6 +/- 2,8 semanas. Sexo femenino 54% y cesárea como vía del nacimiento 57%. Intervenciones prenatales tales como control prenatal y uso de corticoides se registró en 86% y 50,8%, la patología materna predominante fue la rotura prematura de membranas 37,5%. Dentro de las intervenciones en Sala de partos la reanimación con bolsa y máscara fue la más utilizada 36,7%. De las intervenciones en UCIN fueron analizados 119 Recién nacidos, excluyendo los óbitos en sala de partos. La patología neonatal más frecuente fue el síndrome de distrés respiratorio 59,6%, sepsis tardía 31%. Aquellos RN con distrés respiratorio recibieron surfactante pulmonar 57,7%. La ventilación mecánica fue utilizada en el 48,7%. Estudios de seguimiento como la ecografía transfontanelar y el fondo de ojo se realizaron en el 75,6% y en el 42% de los RN. La mortalidad global fue de 32,8% (42/128), si se excluyen las ocurridas en sala de partos la mortalidad registrada fue de 27,7% (33/119). El rango de peso en el que se observó mayor mortalidad fue entre 501- 750 gramos 88,9%. y a la edad gestacional de 30 semanas. La media de estancia hospitalaria fue de 44,3 +/- 30,12 días; la principal causa de muerte fue sepsis en un 30%.
Assuntos
Recém-Nascido , Mortalidade Infantil , Recém-Nascido de Baixo Peso , MorbidadeAssuntos
Anaplasma/isolamento & purificação , Ehrlichia/isolamento & purificação , Carrapatos/microbiologia , Animais , Técnicas Bacteriológicas/métodos , Análise por Conglomerados , DNA Bacteriano/química , DNA Bacteriano/genética , DNA Bacteriano/isolamento & purificação , DNA Ribossômico/química , DNA Ribossômico/genética , Cães/parasitologia , Cavalos/parasitologia , Panamá , Perissodáctilos/parasitologia , Filogenia , Reação em Cadeia da Polimerase/métodos , Prevalência , RNA Ribossômico 16S/genética , Análise de Sequência de DNARESUMO
Introducción: La calidad de atención de los servicios de salud se sustenta en el reconocimiento de las características de la población asitida, pudiéndose así definir y categorizar los problemas en los direfentes puestos de atención. Es fundamental tener información precisa y portuna para toma de decisiones. Objetivo: Conocer las características de la población neonatal en tres centros de referencia nacional e identificar los factores de riesgos asociados a morbimortalidad de los recién nacidos (RN). Facilitar la orientación de estrategias tendientes a mejorar la salud perinatal en estos servicios. Material y Metodos: Diseño observacional y analíticos de los registros neonatales del Sistema Informático Perinatal del 44767 historias clínicas en RN vivos del Centro Materno Infantil, Cruz Roja Paraguaya y Hospital Nacional durante cinco años (1 enero 1997 a 31 diciembre 2001). Datos tomados del Centro de Procesamiento y Computo de la Dirección General de Programas de Salud del Ministerio de Salud Pública y Bienestar Social. Resultados: El 69,5 porcientos de las madres tenían CPN insuficiente. Los RN el 10,9 porcientos tenían peso menor de 2500 gramos, 14,9 porcientos eran menor de 37 semanas, 8,4 porcientos tenía apgar al minuto menor o igual a 6, y 0,94 porcientos tuvieron apgar a los 5 minutos igual o menor 3. Fallecieron 18,6 por 1000 RN de estos casos 54,9 porcientos en la primera semana de vida, 13,97 porcientos en las primeras 24hs de vida, 90,9 porcientos de las madres tenían CPN insuficiente de estos 77,9 porcientos CPN nulo, 78,3 porciento tenían peso menor de 2500 gramos, el 77,45 porcientos eran menor de 37 semanas. El 75,3 porcientos tenían Apgar menor o igual y el 39 porcientos Apgar a los 5 minutos menor o igual a 3. Patología más frecuentes asociada a mortalidad neonatal fue dificultad respiratoria, 78,6 porcientos de los fallecidos, de los cuales Enfermedad Membrana Hialina (EMH) correspondió al 50 porcientos. Infecciones 30 porcientos de los fallecidos y hubo 12,6 porcientos con malformaciones congénitas. Conclusión: La morbimortalidad neonatal en estos centros hospitalarios de referencia se hallan asociados a 1) Bajo Peso 2) Prematurez 3)Depresión neonatal y asfixia 4) EMH, con 78 porcientos de las madres sin CPN
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Mortalidade Infantil , Indicadores de Morbimortalidade , ParaguaiRESUMO
Objetivo: Comparar los valores de CK total, CK mb y ácidos láctico en recién nacidos con asfixia perinatal, con los obtenidos en recién nacidos sanos. Metodología: Estudio observacional, propectivo, comparativo. La población de estudio fue dividida en 2 grupos. En el Grupo I: se incluyeron 104 RN de término con diagnóstico de asfixia perinatal. Periodo: mayo 2002-agosto 2004; y en el Grupo II: 96 RN. Periodo: junio 2002-narzo 2003. A los RN incluidos se les realizó determinaciones de CK total, Ck mb y ácido láctico al nacimiento. Resultados: De los RN del Grupo I, 31(30 porcientos) presentaron asfixia severa, 31(30 porcientos) asfixia moderada y 42 (40 porcientos) asfixia leve. En el Grupo I el valor medio de la CK total fue de 1037,67 (rango: 5488-80), CK mb 164,67 (rango: 1760-5) y ácido láctico 2.43 (rango:5,5-0,6), siendo que en los RN con asfixia severa el valor medio de CK total fue de 975,01, de CK mb 256,08 y el de ácido láctico 2,76; en los RN con asfixia moderada CK total 1256,86, de CK mb 144,34 y de ácido láctico 2,67; y en los RN con asfixia leve fue de CK total 956,54, Ck mb 114,02 y ácido láctico 2, 43. En el Grupo II el valor medio de CK total fue 420,13 (rango: 1672-84), de CK mb 191,21 (rango: 1456-10 y de ácido láctico 1,51 (rango: 3,22-0,35). Conclusión: Se constató niveles significante elevados de CK total y ácido láctico en los RN con asfixia cuando fueron comparados con los RN normales, sin embargo no se constató diferencia de estas enzimas en los direfentes grupos de RN asfixiados. Los valores de CK mb estaban más elevados en aquellos con asfixia severa pero no resulta significante al compararlo con los del grupo de asfixia moderada y leve y con el grupo II (p=0.3); por lo que los valores de estas enzimas no pueden ser considerados para determinar la severidad de la asfixia. Debido a la gran variabilidad observada debería de considerarse otros parámetros para ser asociados directamente con la severidad de la misma.
Assuntos
Paraguai , Asfixia Neonatal , Índice de Gravidade de Doença , Recém-NascidoRESUMO
Facial deformities due to loss of mandibular segments in children lead to severe functional and psychological disturbances. Such deformities should be corrected taking into account both contour and function. In addition, they should be planned for long-term growth and performed in the fewest possible surgical stages. This article presents the experience in seven cases of mandibular reconstruction in children after surgical ablation for benign conditions. We performed a scapular flap in one case and fibular flaps in six. The mean age of the patients was 9.1 years. Follow-up ranged from 1.5 to 5 years. All flaps survived. No osseous remodeling was needed in any case. All patients showed symmetrical facial and mandibular growth, as well as adequate masticatory function. Excision of the tumor and reconstruction should be carried out in the same surgical procedure whenever possible. The fibula was used in most cases because of its easy dissection, the ample amount of bone it provides, and the potential to redirect it. The author favors mandibular reconstruction in children with a free flap, as this approach offers adequate form and function in the long term.
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Transplante Ósseo , Doenças Mandibulares/cirurgia , Neoplasias Mandibulares/cirurgia , Procedimentos de Cirurgia Plástica , Adolescente , Criança , Feminino , Fíbula/transplante , Humanos , Masculino , Escápula/transplante , Retalhos CirúrgicosAssuntos
Músculos Abdominais/anormalidades , Músculo Esquelético/transplante , Retalhos Cirúrgicos , Músculos Abdominais/cirurgia , Anastomose Cirúrgica/métodos , Seguimentos , Sobrevivência de Enxerto , Humanos , Lactente , Masculino , Reto do Abdome/cirurgia , Transplante de Pele/métodos , Retalhos Cirúrgicos/irrigação sanguínea , Retalhos Cirúrgicos/inervação , Deiscência da Ferida Operatória/cirurgiaRESUMO
We report a whole-organ-section pathologic study of 66 cases of epidermoid carcinoma of the penis. Specimens were divided into three compartments: glans (G), coronal sulcus (COS), and foreskin (F) with 24, 4, and 12 histologic sections each. Four types of carcinomas were found: (a) superficially spreading (42%), a biphasic infiltrating and extensive carcinoma in situ usually involving more than one compartment and radially growing along the surface of G, BPS, F, or even urethra; (b) vertical growth (32%), unifocal high-grade, deeply invasive neoplasms with minimal or no carcinoma in situ component; (c) verrucous (18%), low-grade papillary or endophytic; and (d) multicentric (8%), two or more independent primary tumors separated by non-neoplastic mucosa. Inguinal lymph node metastasis were found in 82, 42, and 33% of pathologic types vertical growth, superficially spreading, and multicentric carcinomas, respectively; verrucous tumors did not show metastasis. The morphologic diversity of penile cancer may be related to different causative factors. Metastatic involvement suggests a distinctive biological behavior of the tumor. The widespread extension of superficially spreading and multicentric carcinomas to anatomical compartments indicate penile mucosa as one "field" prone to malignant transformation. These findings may be important for the selection of appropriate therapy and emphasize the need for a close follow-up of patients undergoing less than a complete removal of the three compartments.
Assuntos
Carcinoma de Células Escamosas/patologia , Neoplasias Penianas/patologia , Carcinoma de Células Escamosas/epidemiologia , Humanos , Metástase Linfática/patologia , Masculino , Neoplasias Penianas/epidemiologia , Estudos ProspectivosRESUMO
We have investigated the effect of blocking alpha-MSH on the release of LH in rats at pro-oestrus. Continuous infusion of Pro-Leu-Gly-NH2 (PLG; 0.2 microgram/h), from the afternoon of dioestrus-2 until the day of oestrus, inhibited LH at pro-oestrus and the next ovulation on the day of oestrus. Plasma alpha-MSH levels decreased significantly in rats treated with PLG. This inhibitory effect on LH release was not observed in rats treated with a continuous infusion of a diluted antiserum against alpha-MSH (0.5 microliter/h, diluted 1/10) from the afternoon of dioestrus-2 until the day of oestrus. On the contrary, the administration of undiluted antiserum against alpha-MSH (0.5 microliter/h) blocked LH release and ovulation. The release of alpha-MSH into the blood was also significantly blocked by this treatment. When serum levels of progesterone were measured at 12.00 and 14.00 h in rats in which alpha-MSH release was blocked by PLG or concentrated antiserum, a significant decrease was observed when compared with the levels of progesterone in control rats. These results show that the blockade of alpha-MSH inhibits LH release and the next ovulation in rats treated with PLG or with concentrated antiserum against alpha-MSH, through a blockade of progesterone of adrenal origin.