RESUMO
INTRODUCTION AND AIMS: Cardiovascular disease is a growing public health problem. Forty percent of the general population will suffer from the disease by 2030, consequently requiring antithrombotic therapy. Cardiogastroenterology is a new area of knowledge that evaluates the gastrointestinal effects and complications of antithrombotic therapy. Our aim was to evaluate, through a validated questionnaire, the knowledge held by a group of specialists and residents in the areas of gastroenterology and internal medicine, about pharmacology and drug prescription, as well as gastrointestinal risks and complications, in relation to antithrombotic therapy. PATIENTS AND METHODS: A validated questionnaire composed of 30 items was applied to a group of specialists and residents in the areas of gastroenterology and internal medicine. The questions were on indications, pharmacology, evaluation of risks for gastrointestinal bleeding and thromboembolic events, and use of antithrombotic therapy during endoscopic procedures. Sufficient knowledge was defined as 18 or more (≥ 60%) correct answers. RESULTS: The questionnaire was answered by 194 physicians: 82 (42%) internal medicine residents and gastroenterology residents and 112 (58%) specialists. Only 40 (20.6%) of the participants had sufficient knowledge of cardiogastroenterology. Residents had a higher number of correct answers than specialists (53 vs. 36%, P<.0001). The gastroenterology residents had more correct answers than the internal medicine residents, gastroenterologists, and internists (70 vs. 53, 40, and 46%, respectively, P<.001). Only residents had sufficient knowledge regarding pharmacology and the use of antithrombotic therapy in endoscopy (P<.0001). All groups had insufficient knowledge in evaluating the risk for gastrointestinal bleeding and thrombosis. CONCLUSIONS: Knowledge of cardiogastroenterology was insufficient in the group of residents and specialists surveyed. There is a need for medical education programs on the appropriate use of antithrombotic therapy.
Assuntos
Cardiologia , Competência Clínica/estatística & dados numéricos , Gastroenterologia , Medicina Interna , Especialização , Adulto , Cardiologia/educação , Estudos Transversais , Feminino , Gastroenterologia/educação , Humanos , Medicina Interna/educação , Internato e Residência , Masculino , MéxicoRESUMO
A tautomeric pair of new isoprenylated benzophenones, aristophenone A (1a) and B (1b), have been isolated from Garcinia aristata fruits. Their structures has been determined using high-field 2D NMR techniques.
Assuntos
Benzofenonas/isolamento & purificação , Plantas Medicinais/química , Benzofenonas/química , Cromatografia Líquida de Alta Pressão , Cuba , Frutas/química , Espectroscopia de Ressonância Magnética , Estrutura Molecular , EstereoisomerismoRESUMO
INTRODUCTION: The combination of stereotaxic techniques, advances in neuroimaging and the creation of continually improving software has permitted stereotaxic biopsy of cerebral lesions at the most varied sites. Improvement in the method of permanent interstitial radiation (brachytherapy) improves the precision with which the radioactive sources may be inserted, releasing a maximum dose of radiation to the tumour with minimum radiation to the surrounding tissue. PATIENTS AND METHODS: We treated 237 patients (aged 1 to 78 years) with intracranial lesions, all included in the protocol of our centre. Stereotaxic systems of Leksell, Riechert-Mundinger, Micromar and Estereoflex were used. The procedure was in three stages: acquisition of the image, surgical planning and surgical operation. The imaging guide was the computerized axial tomography (CAT). RESULTS: Stereotaxic biopsy guided by CAT images was done in 153 patients. These were divided into three groups, taking the biopsy findings as the reference: group A (primary tumors, 128), group B (metastatic tumors, 15) and group C (non-malignant lesions, 10). Ninety six permanent implants of 192Ir were inserted, with a low dose of 4-7 cGy/h and a total dose of 80-120 Gy. CONCLUSIONS: Stereotaxic biopsy is a very effective procedure with a significantly low range of complications. The permanent implant with a low dose rate, well situated and using a source of 192Ir is a safe, simple, effective method for the treatment of primary and recurrent glial tumours, and non-glial tumours which fulfil criteria for this type of brachytherapy.
Assuntos
Braquiterapia , Neoplasias Encefálicas/radioterapia , Radioisótopos de Irídio/uso terapêutico , Técnicas Estereotáxicas , Adolescente , Adulto , Biópsia/métodos , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de TempoRESUMO
Introducción. Las técnicas microquirúrgicas para la resección de lesiones intracraneales se limitan donde las referencias anatómicas no existen o no pueden utilizarse como guía para la disección de lesiones localizadas profundamente o en áreas elocuentes más superficiales. La guía estereotáxica guiada por imágenes ofrece una definición volumétrica y geométrica precisa de las lesiones intracraneales. Su aplicación en la resección de los tumores intracraneales presenta algunas particularidades por la propia condición biológica de los mismos, así como por su variada localización. Objetivos. La orientación espacial durante la microcirugía constituye un elemento indispensable. Demostramos esta aplicación de la cirugía estereotáxica en el Centro Internacional de Restauración Neurológica (CIREN) en La Habana, Cuba, desde mayo de 1994 a febrero de 1998, al describir la realización de 65 intervenciones microquirúrgicas en condiciones estereotáxicas a 62 pacientes portadores de tumores cerebrales intracraneales. Pacientes y métodos. El procedimiento se dividió en tres etapas: adquisición de la imagen, tomografía axial computadorizada y planificación quirúrgica, con sistema de planeamiento STASSIS y procedimientos microquirúrgicos, que incluyó los sistemas estereotáxicos: Leksell, Micromar y Estereoflex. Resultados. Del total, 27 de estos pacientes presentaron tumores gliales, 33 no gliales y sólo 2 lesiones no neoplásicas de localización y tamaño variados. Se realizaron 30 resecciones totales, la morbilidad quirúrgica fue mínima y no hubo mortalidad quirúrgica. Conclusión. Las principales ventajas del método son: localización exacta de la craneotomía, fácil orientación espacial y facilidad para distinguir los límites entre el tumor y el tejido sano. Se demostró la aplicabilidad del Estereoflex a la microcirugía cerebral(AU)
Assuntos
Microcirurgia , Técnicas Estereotáxicas , NeurocirurgiaRESUMO
Introducción. La combinación de técnicas estereotáxicas, los avances en las neuroimágenes y la creación de programas informáticos cada vez más óptimos ha permitido la realización de biopsias estereotáxicas a lesiones cerebrales en las más variadas localizaciones. El perfeccionamiento del método de radiación intersticial permanente (braquiterapia) mejora la exactitud en la colocación de las fuentes radiactivas, liberando una dosis de radiciación máxima al tumor con mínima irradiación del tejido normal que lo rodea. Pacientes y métodos. Fueron tratados 237 pacientes (de 1 a 78 años) con lesiones intracraneales, todos ellos incluidos en el protocolo de nuestra institución; se utilizaron los sitemas estereotáxicos de Leksell, Riechert-Mundinger, Micromar y Estereoflex. El procedimiento constó de tres etapas: adquisición de la imagen, planificación quirúrgica e intervención quirúrgica. La guía por imagen fue la tomografía axial computarizada (TAC). Resultados. Se realizó biopsia estereotáxica guiada por imágenes de TAC a 153 pacientes, los cuales se dividieron en tres grupos tomando como referencia el hallazgo de la biopsia: grupo A (tumores primarios, 128); grupo B (tumores metastásicos, 15), y grupo C (lesiones no malignas, 10). Se realizaron 96 implantes permanentes de 192Ir con una tasa de dosis baja de 4-7 cGy/h con dosis total de 80 a 120 Gy. Conclusiones. La biopsia estereotáxica es un procedimiento muy eficaz con un margen de complicaciones significativamente bajo. El implante permanente de tasa de dosis baja, bien localizado y utilizando una fuente de 192Ir es un método simple, seguro y eficaz en el tratamiento de tumores gliales primarios y recurrentes, así como en otros no gliales que reunan los criterios para dicha modalidad de braquiterapia(AU)
Assuntos
Braquiterapia , Glioma , Irídio , Radioisótopos de Irídio , Biópsia , Técnicas EstereotáxicasRESUMO
Depression of liver microsomal glucose-6-phosphatase (G6Pase) activity is a relevant feature of CCl4 poisoning. In vitro studies from several laboratories led to the hypothesis that a CCl4 promoted lipid peroxidation (LP) process is responsible for that effect. In vivo studies from our laboratory with potent antioxidants in dosage regimes inhibiting LP, however, were in contrast with that hypothesis. In this work we studied the potential preventive effects of Pyrazole (Pyr), alpha-tocopherol (alpha T), and 3-amino-1,2,4-triazole (AT) against CCl4-induced depression of G6Pase activity. Pyr decreases the intensity of the covalent binding (CB) of CCl4 reactive metabolites to cellular components but does not inhibit LP in vitro or in vivo. alpha T inhibits LP in vitro and in vivo and AT inhibits both CB and LP. Our present studies give evidence that AT but neither Pyr nor alpha T are able to prevent the CCl4-induced depression of G6Pase activity. Results are compatible with the hypothesis that the cooperation of both factors is critical to explain the observed effects, and suggest that under in vitro experimental conditions used by others the relevance of LP might be artifactually promoted.
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Intoxicação por Tetracloreto de Carbono/metabolismo , Glucose-6-Fosfatase/metabolismo , Peroxidação de Lipídeos , Fígado/metabolismo , Microssomos Hepáticos/metabolismo , Pirazóis/farmacologia , Vitamina E/metabolismo , Amitrol (Herbicida)/farmacologia , Animais , Tetracloreto de Carbono/toxicidade , Sinergismo Farmacológico , Inibidores Enzimáticos/farmacologia , Peroxidação de Lipídeos/efeitos dos fármacos , Fígado/efeitos dos fármacos , Masculino , Microssomos Hepáticos/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley , Vitamina E/farmacologiaRESUMO
We have previously reported that treatments stimulating phospholipid (PL) synthesis or preventing PL degradation were late preventive agents against CCl4-induced liver necrosis. Later studies by others postulated that stimulation of phospholipase A2 (PLA2) plays a role in PL degradative processes responsible for CCl4 damage. Quinacrine (QUIN) is a well known inhibitor of PLA2. In this work we report that QUIN (150 mg/kg i.p.) partially prevents CCl4-induced liver necrosis at 24 h when given 30 min before or 6 or 10 h after CCl4 (2.5 ml/kg p.o.) QUIN administration does not modify at 1 or 3 h after poisoning CCl4 levels reaching the liver, covalent binding of CCl4 reactive metabolites to proteins or lipids, CCl4-induced lipid peroxidation process, CCl4-induced decreases in body temperature, or glutathione levels in liver. QUIN concentrations in liver at times from 1 to 24 h are well over those required to inhibit PLA2 activity. Results are compatible with the hypothesis that CCl4 activation of PLA2 at late stages of poisoning plays a role in CCl4-induced liver necrosis.