RESUMO
The effect of intra-operative intravenous methadone on quality of postoperative recovery was compared with morphine after laparoscopic gastroplasty. We included 137 adult patients with a body mass index > 35 kg.m-2 who underwent bariatric surgery. Patients were allocated at random to receive either intra-operative methadone (n = 69) or morphine (n = 68). All patients received the same postoperative care and analgesia. The primary outcome of postoperative quality of recovery was assessed using the Quality of Recovery-40 questionnaire total score 24 h after surgery. Secondary outcomes were assessed in the post-anaesthesia care unit the night of the day of surgery (T1), in the morning after surgery (T2); and at night on the day following surgery (T3). The median (IQR [range]) total Quality of Recovery-40 questionnaire score of 194 (190-197 [165-200]) was higher (p < 0.0001) in the methadone group compared with the score of 181 (174-185.5 [121-200]) in the morphine group. In the post-anaesthesia care unit, the pain burden; incidence of nausea and vomiting; rescue morphine dose; and time to discharge, were significantly lower in the methadone group. On the ward, the methadone group had a lower: incidence of rescue morphine requests at T1 (5.8 vs. 54.4%, p < 0.0001) and T2 (0 vs. 20.1%, p < 0.0001); and incidence of nausea (21.7 vs. 41.2%, p = 0.014), compared with the morphine group. We conclude that intra-operative intravenous methadone improved quality of recovery in patients who underwent laparoscopic gastroplasty, compared with intra-operative morphine. Methadone also reduced postoperative pain, postoperative opioid consumption and the incidence of opioid-related adverse events.
Assuntos
Analgésicos Opioides/uso terapêutico , Gastroplastia/métodos , Laparoscopia/métodos , Metadona/uso terapêutico , Morfina/uso terapêutico , Adulto , Analgesia Controlada pelo Paciente , Analgésicos Opioides/efeitos adversos , Período de Recuperação da Anestesia , Método Duplo-Cego , Feminino , Humanos , Período Intraoperatório , Masculino , Metadona/efeitos adversos , Pessoa de Meia-Idade , Morfina/efeitos adversos , Manejo da Dor , Medição da Dor/efeitos dos fármacos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Náusea e Vômito Pós-Operatórios/epidemiologia , Resultado do TratamentoRESUMO
Morinda citrifolia L., commonly known as noni, has been used for the treatment of various diseases for over two centuries. It was introduced and widely disseminated in Brazil because of its high market value and ease of adaptation to the soil and climatic conditions of the country. The aim of this study was to estimate the genetic variability of noni accessions from the collection of Embrapa Agroindústria Tropical in Brazil. We evaluated 36 plants of the 13 accessions of noni from the germplasm collection of M. citrifolia. Several methods of DNA extraction were tested. After definition of the method, the DNA of each sample was subjected to polymerase chain reactions using 20 random amplified polymorphic DNA primers. The band patterns on agarose gel were converted into a binary data matrix, which was used to estimate the genetic distances between the plants and to perform the cluster analyses. Of the total number of markers used in this study, 125 (81.1%) were polymorphic. The genetic distances between the genotypes ranged from 0.04 to 0.49. Regardless of the high number of polymorphic bands, the genetic variability of the noni plants evaluated was low since most of the genotypes belonged to the same cluster as shown by the dendrogram and Tocher's cluster analysis. The low genetic diversity among the studied noni individuals indicates that additional variability should be introduced in the germplasm collection of noni by gathering new individuals and/or by hybridizing contrasting individuals.
Assuntos
Marcadores Genéticos/genética , Variação Genética , Morinda/genética , Plantas Medicinais/genética , Técnica de Amplificação ao Acaso de DNA Polimórfico/métodos , Brasil , Análise por Conglomerados , Primers do DNA/genética , DNA de Plantas/análise , DNA de Plantas/genética , Genótipo , Morinda/classificação , Filogenia , Plantas Medicinais/classificação , Especificidade da EspécieRESUMO
O noni é uma cultura de origem asiática que vem despertando interesse de agricultores brasileiros em virtude de suas propriedades fitoterápicas na medicina popular e de seu elevado valor comercial; contudo, são escassas as informações quanto ao manejo da cultura em geral e inexistentes estudos a respeito da irrigação da cultura no Brasil. Objetivou-se com este estudo definir, entre dois sistemas de irrigação e cinco laminas d´água, qual a melhor condição para o desenvolvimento vegetativo da cultura. O experimento foi realizado no período de maio de 2009 a março de 2010, em Trairi-CE. Utilizou-se o delineamento experimental de blocos casualizados e dois sistemas de irrigação localizada (gotejamento e microaspersão) dispostos em faixas verticais. Dentro de cada faixa foram distribuídos os blocos com as parcelas dos cincos níveis de irrigação correspondentes à aplicação de frações da evapotranspiração de referência FAO (ETo) de 40%, 60%, 80% 100% e 120%. Para o sistema de irrigação por microaspersão as lâminas correspondentes foram: 109,3 mm, 135,8 mm, 187,9 mm, 227,8 mm e 297,7 mm e para sistema de irrigação por gotejamento: 83,4 mm, 1237 mm, 166,5 mm, 204,7 mm e 254,4 mm, respectivamente. Foram utilizadas cinco repetições. O desenvolvimento vegetativo de plantas de noni foi influenciado tanto pelos sistemas de irrigação, quanto pelas lâminas d´água aplicadas. A lâmina de irrigação equivalente a 227,8 mm, correspondente a 100% da ETo, na irrigação por microaspersão, proporcionou maiores ganhos de diâmetro do coleto, altura da planta, e diâmetro de copa.
Noni is a crop of Asian origin that has piqued the interest of Brazilian farmers because of its properties in herbal folk medicine and its high commercial value. However, there is little information about the crop management in general, and particularly on the irrigation of the crop in Brazil. The objective of this study was to define what localized irrigation system (drip or micro sprinklers) and water depth that provide the best vegetative growth of noni plants. The experiment was conducted from May 2009 to March 2010 in the city of Trairi, Brazil. We used a split block experimental design, with two irrigation systems (drip and micro sprinklers) arranged in vertical lines. Within each line, five irrigation levels, corresponding to the application of fractions of the reference evapotranspiration (ETo) 40% 60% 80% 100% and 120%, were distributed in five blocks. For the micro sprinkler irrigation system, the corresponding slides were: 109.3 mm, 135.8 mm, 187.9 mm, 227.8 mm and 297.7 mm, respectively, and for the drip irrigation system, they were: 83.4 mm, 123.7 mm, 166.5 mm, 204.7 mm and 254.4 mm, respectively. The noni vegetative growth was influenced both by the irrigation systems and the depths of irrigation applied. The application of irrigation depths equivalent to 227.8 mm, which corresponds to 100% of ETo with the use of micro sprinklers, provided the largest gains in stem diameter, plant height and canopy diameter.
Assuntos
Morinda/crescimento & desenvolvimento , Irrigação Agrícola/métodos , Desenvolvimento VegetalRESUMO
The morphological characteristics of the oviduct of 12 sexually mature rheas (Rhea americana) were studied. Only the left oviduct is developed as a long tube with a length of 122 +/- 23.1 cm, and is subdivided into infundibulum (15.2 +/- 4.0 cm), magnum (63.3 +/- 9.4 cm), isthmus (5.6 +/- 3.1 cm), uterus (16.0 +/- 4.2 cm) and vagina (11.5 +/- 1.4 cm). The mucous membrane of the oviduct, as a whole, possesses luminal folds covered by ciliated columnar epithelium with secretory cells. The infundibulum part presents a cranial opening with thin and long fimbriae with few tubular glands in caudal tubular portion. In the magnum, the largest portion of the oviduct, the folds are thicker and are filled with tubular glands. The isthmus is short and presents less bulky folds and a few tubular glands. A bag-shaped uterus in the cranial area shows thin folds, and in the caudal region (shell gland) more ramified folds with few tubular glands. The vagina has long luminal folds and a thick muscular tunic; no glands with sperm-storage characteristics have been observed. In conclusion, the oviduct in sexually mature rhea has morphological similarities with the other species of birds already described; however it presents its own characteristics to produce a big egg.
Assuntos
Microscopia Eletrônica de Varredura/veterinária , Oviductos/anatomia & histologia , Oviductos/ultraestrutura , Reiformes/anatomia & histologia , Animais , Feminino , Microscopia Eletrônica de Varredura/métodos , Reprodução/fisiologiaRESUMO
OBJECTIVE: To report the role played by transesophageal echocardiography during implantation of self-expanding aortic endoprostheses (stent) at a hemodynamics laboratory. METHODS: Thirteen patients underwent stent implantation in the descending thoracic aorta with the aid of transesophageal echocardiography during the entire procedure. Indications for stenting were as follows: 8 aortic dissections, 2 true aneurysms, 2 penetrating atherosclerotic ulcers, and 1 traumatic pseudoaneurysm. RESULTS: No complications resulting from the use of transesophageal echocardiography were observed. In 12 patients, the initial result was considered appropriate, with total or partial resolution of the major lesion confirmed by a posterior examination. In 1 patient, the procedure was suspended after transesophageal echocardiography and angiography showed that the proximal aortic diameter was inappropriate. Transesophageal echocardiography contributed to clarifying relevant points, such as aortic diameter, anatomic detail of the intimal lesion, and location and size of the communicating orifice. In addition, it facilitated placing the stent in the target lesion, reduced the time of exposure to radiation and the use of contrast medium, and provided rapid identification of intercurrent events, possibly reducing the total duration of the procedure. CONCLUSION: The use of transesophageal echocardiography during placement of aortic stents seems appropriate. The actual advantages of the procedure will be defined in a comparative prospective study.
Assuntos
Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Ecocardiografia Transesofagiana/métodos , Implante de Prótese de Valva Cardíaca/métodos , Stents , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The purpose of this study was to study the monoclonal antibody MIB-1 in the normal breast epithelium adjacent to a fibroadenoma in women in the luteal phase of the menstrual cycle who were treated with tamoxifen at doses of 10 and 20 mg for 22 days. The proliferative activity of the mammary epithelium adjacent to the fibroadenoma was studied by immunohistochemistry on the basis of the monoclonal antibody MIB-1 (Immunotech, catalog No. 0505, lot 001). The study was randomized and double blind and was conducted on 44 women with fibroadenomas divided into three groups: A (n=16, placebo), B (n=15, tamoxifen, 10 mg), and C (n=13, tamoxifen, 20 mg). Tamoxifen was administered for 22 days starting on the 2nd day of the menstrual cycle, and a biopsy was taken on the 23rd day. Serum estradiol, progesterone, sex hormone binding globulin, follicle-stimulating hormone, luteinizing hormone, and prolactin were measured before treatment (21st and 24th day of the previous menstrual cycle) and on the day of the biopsy. The mean percentage of stained nuclei per 1,000 cells was 9.2 in group A, 4.5 in group B, and 3.2 in group C. The Fisher's test revealed that tamoxifen significantly reduced MIB-1 at doses of 10 and 20 mg compared with the placebo group (p < 0.0001), with no significant differences between doses in terms of proliferative activity (p=0.21). Groups B and C presented a significant increase in progesterone (p=0.038), estradiol (p < 0.001), and sex hormone binding globulin (p=0.001) levels. Elevation of serum follicle-stimulating hormone concentration (p=0.0045) and a fall in prolactin levels (p=0.0055) were observed. We conclude that tamoxifen significantly reduced the proliferative activity of the mammary epithelium at the doses of 10 and 20 mg/day.
Assuntos
Anticorpos Monoclonais , Antineoplásicos Hormonais/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Mama/patologia , Fibroadenoma/tratamento farmacológico , Proteínas Nucleares/imunologia , Tamoxifeno/uso terapêutico , Adolescente , Adulto , Antígenos Nucleares , Antineoplásicos Hormonais/administração & dosagem , Antineoplásicos Hormonais/farmacologia , Mama/efeitos dos fármacos , Mama/imunologia , Neoplasias da Mama/patologia , Divisão Celular , Método Duplo-Cego , Epitélio/efeitos dos fármacos , Epitélio/imunologia , Epitélio/patologia , Feminino , Fibroadenoma/patologia , Humanos , Imuno-Histoquímica , Antígeno Ki-67/imunologia , Fase Luteal , Pré-Menopausa , Tamoxifeno/administração & dosagem , Tamoxifeno/farmacologiaRESUMO
Los intentos de medir la función exócrina testicular en modelos animales de experimentación resultaron en una diversificación de métodos de muy difícil comparación y reproducibilidad.La presente investigación tiene como objetivo verificar el valor de la técnica de muicroaspiración del esperma en la cola del epido de la rata,evaluando sus parámetros seminales.Fueron utilizadas 35 ratas albinas,de la variedad de Wistar de 150 días de edad.Se desarrolló una técnica para la microaspiración del esperma en la cola del epidimo.La motilidad y concentración de los espermatozoides de ambos testículos de cada animal fueron analizados con el test T de Student para las muestras dependientes(p<0.05)según la concentración y motilidad espermática.La técnica de microaspiración de la cola del epídimo permite un adecuado acceso,confiable y de fácil ejecución
Assuntos
Animais , Camundongos , Inalação , Sêmen , EspermatozoidesRESUMO
Los intentos de medir la función exócrina testicular en modelos animales de experimentación resultaron en una diversificación de métodos de muy difícil comparación y reproducibilidad.La presente investigación tiene como objetivo verificar el valor de la técnica de muicroaspiración del esperma en la cola del epido de la rata,evaluando sus parámetros seminales.Fueron utilizadas 35 ratas albinas,de la variedad de Wistar de 150 días de edad.Se desarrolló una técnica para la microaspiración del esperma en la cola del epidimo.La motilidad y concentración de los espermatozoides de ambos testículos de cada animal fueron analizados con el test T de Student para las muestras dependientes(p<0.05)según la concentración y motilidad espermática.La técnica de microaspiración de la cola del epídimo permite un adecuado acceso,confiable y de fácil ejecución
Assuntos
Animais , Camundongos , Espermatozoides , Sêmen , InalaçãoRESUMO
The effect of lipids administration by gavage (0.4% body weight) given daily during four weeks on the hypersensitivity reaction in trachea, upper and lower bronchi, liver, kidney, mesentery, and pancreas was investigated in male rats. The plasma exudation was assessed by using Evans blue (EB) dye extravasation method. There was a significant difference in the permeability of the organs in nonimmunized rats. The immunization increased the vascular permeability and the response with the organs varied greatly. The effect of lipids on anaphylactic reaction was compared to those of untreated rats (control group). The EB extravasation was significantly increased in the trachea obtained from rats treated with cocoa butter and soybean oil. In the upper bronchi of rats treated with soybean oil, the EB extravasation was increased. However, in the lower bronchi, none of the treatments with lipids changed the extravasation of EB. The same was observed in the liver and kidney. The animals treated with lipids by gavage did not present differences in EB extravasation in the mesentery. However, in the pancreas and duodenum, the treatment with fish and soybean oils and cocoa butter markedly lowered EB extravasation.
Assuntos
Anafilaxia/induzido quimicamente , Permeabilidade Capilar/efeitos dos fármacos , Gorduras na Dieta , Hipersensibilidade a Drogas , Administração Oral , Animais , Gorduras na Dieta/efeitos adversos , Azul Evans , Imunização , Masculino , Ovalbumina/imunologia , RatosRESUMO
AIM: To evaluate the use of local transdermic anesthetics in fine needle aspiration biopsy (FNAB) in breast lesions. METHODS: Prospective randomized study of 119 patients having breast lesions, all being indicated for FNAB. The patients were divided into three groups: 40 patients entered in the active group (lidocaine + prilocaine); 40 patients underwent the placebo group (aqueous extract of Triticum vulgaris); and a control group of 39 women in whom FNAB was performed without the administration of any substance. Both the anesthetic and placebo were administered an hour before FNAB. Pain was quantified through a visual analogic scale of pain. The type of pain was also classified in terms of occurrence: only during the puncture, only during the movements and both. RESULTS: The visual linear analogic scale of pain showed an average of 3.3 in the active group, 3.5 in the placebo and 4.0 in the control group (NS). Analysis of the type of pain which was referred by the patient showed that 15% of the patients in the active group, 12.5% of those in the placebo group and 5.1% in the control group did not refer to any sensation of pain. Pain, when felt, was similar in all three groups (p < 0.4). CONCLUSIONS: Both the quantification and the type of pain referred to were similar in all three groups. However, there was a tendency of the patient to refer to less pain when the active substance or the placebo were used, when results were compared to the control group.
Assuntos
Anestésicos Locais/administração & dosagem , Biópsia por Agulha/efeitos adversos , Neoplasias da Mama/patologia , Lidocaína/administração & dosagem , Dor/etiologia , Prilocaína/administração & dosagem , Administração Cutânea , Adolescente , Adulto , Idoso , Distribuição de Qui-Quadrado , Método Duplo-Cego , Feminino , Humanos , Pessoa de Meia-Idade , Dor/prevenção & controle , Medição da Dor , Estudos ProspectivosRESUMO
PURPOSE: To evaluate the role of hemodynamic parameters in the diagnosis of acute rejection who underwent orthotopic cardiac transplantation. METHODS: A protocol was carried out in 19 patients who underwent heart transplantation and in whom Swan-Ganz hemodynamics was performed immediately prior to routine endomyocardial biopsy in the first few months postoperatively. The results of 28 biopsies were divided in group I--severe rejection who needed pulse-therapy (n = 10) and group II--No or mild/moderate rejection who did not need any pulse (n = 18). Hemodynamic parameters were compared between both groups. RESULTS: There were significant differences among hemodynamic parameters in groups I and II. Group I had higher mean right atrial pressures (13.0 x 7.3 mmHg), mean pulmonary pressure (26.3 x 20.4 mmHg), mean wedge pressure (14.4 x 10.9 mmHg) and lower cardiac index (2.57 x 3.10 l/min/m2). CONCLUSION: In a routine situation, hemodynamic measurements, as obtained with Swan-Ganz catheter, simultaneously with endomyocardial biopsies, show significant alterations in transplanted patients who develop acute rejection. This information, obtained earlier than the biopsy results, could shorten the time to initiate pulse-therapy in patients with severe rejection.
Assuntos
Cateterismo de Swan-Ganz , Endocárdio/patologia , Rejeição de Enxerto/diagnóstico , Transplante de Coração , Miocárdio/patologia , Adulto , Biópsia , Feminino , Rejeição de Enxerto/patologia , Rejeição de Enxerto/fisiopatologia , Insuficiência Cardíaca/cirurgia , Transplante de Coração/patologia , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Fatores de Tempo , Função Ventricular DireitaRESUMO
É apresentado um caso clínico de rectorragia devida a uma duplicaçäo gástrica cística numa criança. Para além da presença de heterotopia pancreática localizada ao cisto, existia também uma duplicaçäo pancreática; esta associaçäo de anomalias näo foi anteriormente descrita. As rectorragias foram causadas por erosäo da parede do cólon transverso, subseqüente à perfuraçäo do cisto. Uma aderência embrionária endo-ectodêrmica originou, provavelmente, a duplicaçäo gástrica com heterotopia pancreática, assim como a duplicaçäo pancreática por um mecanismo semelhante à formaçäo de um divertículo de traçäo
Assuntos
Humanos , Feminino , Lactente , Estômago/anormalidades , Estômago/cirurgia , Estômago/patologiaRESUMO
This is a case of a 5-month-old girl with massive rectal bleeding caused by a gastric duplication. Cyst heterotopic pancreas and pancreatic duplication, an association not previously reported were present. The peculiar clinical presentation was due to cyst perforation that had subsequently eroded the transverse colon. Coexistent gastric containing heterotopic pancreas and pancreatic duplications were probably produced as traction diverticular by an embryonic entoectodermal adhesions.
Assuntos
Estômago/anormalidades , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Lactente , Pâncreas/anormalidades , Reto , Estômago/patologia , Estômago/cirurgiaRESUMO
We have determined the genotoxic and mutagenic activities associated with inhalable particulate matter (IPM) collected in Rio de Janeiro, Brazil, Camden, NJ, and Caldecott Tunnel, CA, and used these results to compare three different bioassays. Samples collected every 12 hr (Rio) or every 24 hr (Camden) were extracted sequentially with cyclohexane (CX), dichloromethane (DCM), and acetone (ACE), for a rough fractionation by polarity, and composites of the extracts were tested for mutagenicity using the Salmonella frame shift (TA98) and base substitution (TA100) tester strains, as well as for genotoxicity using the Rossman Microscreen bioassay based on the induction of lambda-prophage in a lysogenic Escherichia coli strain. All samples were tested without and with S9 metabolic activation. Maximum mutagenic and genotoxic activities were in the nonpolar (CX) and polar (ACE) fractions, respectively, indicating that these two assays detect different classes of compounds with different efficiencies. Oxidative aging of the Rio aerosol is indicated by a shift in activities in both tests from the less polar fractions in the day to the polar (ACE) fraction at night. The Rio TA98 mutagenic (18 rev/m3) and genotoxic (1.4 x 10(5) PFU/m3) activities were higher than those for Camden, an Eastern U.S. city, by factors of 1.4 and 2.8, respectively.