Tranquilização de asininos com acepromazina associada ou não ao diazepam / Tranquilization of donkeys using acepromazine or acepromazine: diazepam

Avaliaram-se os efeitos da acepromazina isolada ou associada ao diazepam em asininos. Cinco asininos foram submetidos a dois protocolos anestésicos: os do grupo acepromazina (AC) receberam acepromazina, 0,1mg/kg/IV, e os do grupo acepromazina-diazepam (ACD), acepromazina na mesma dose e via do AC, associada ao diazepam, 0,1mg/kg/IV. Foram mensuradas as frequências cardíaca (FC) e respiratória (FR) e a temperatura retal (TR) e analisadas variáveis eletrocardiográficas, tranquilização, período de latência, início do prolapso peniano e grau de ataxia. A tranquilização iniciou-se aos 10,4±0,9 minutos nos asininos do AC e aos 4,8±1,1 nos do ACD. Ocorreu prolapso peniano aos 4,2±1,3min no AC e aos 2,7±0,4 no ACD. A FC elevou-se aos 15 e 30min no AC. Não ocorreu variação significativa nas variáveis eletrocardiográficas e na temperatura retal. A FR diminuiu no AC a partir de 60min e no ACD a partir de 30min. A distância focinho-solo reduziu-se significativamente em ambos os grupos e nos momentos a partir de 15min. Concluiu-se que a acepromazina promove tranquilização discreta, e a adição do diazepam potencializa a tranquilização, diminui o período de latência e aumenta a ataxia.

The effects of acepromazine isolated or associated with diazepam were evaluated in five donkeys were underwent in two anesthetic protocols, in the acepromazine group (AC), animals received acepromazine (0.1mg/kg/IV) and in acepromazine-diazepam group (ACD), acepromazine at the same dose and route of AC, associated with diazepam (0.1 mg/kg/IV). Heart frequency (HR), respiratory frequency (RF) and rectal temperature (RT) were measured and electrocardiographic variables analyzed, in addition to tanquilization, latency, beginning of the penile prolapse and degree of ataxia. The tanquilization began at 10.4±0.9 minutes (min) in the AC donkeys and 4.8±1.1 in ACD. Penile prolapse occurred at 4.2±1.3 minutes in AC and 2.7±0.4 in ACD. The HR increased to 15 and 30min. Electrocardiographic parameters and rectal temperature not varied significantly. RF decreased from AC in 60min and 30min from ACD. The muzzle-to-ground distance reduced significantly in both groups and at times from 15min. It was concluded that the acepromazine promotes discreet tanquilization and the adition of diazepam potentiates the tranquilization, decreases the latency period and increases ataxia caused by acepromazine.

Efficacy of shoulder exercises on locoregional complications in women undergoing radiotherapy for breast cancer: clinical trial / Eficácia dos exercícios para ombro nas complicações loco-regionais em mulheres submetidas a radioterapia para câncer de mama: ensaio clínico

Objective: To investigate the effect of shoulder exercises during radiotherapy in relation to prevention of locoregional physical complications: limitation of range of motion (ROM) and functional capacity, arm circumference and scar tissue adhesion. Methods: Sixty-six women without shoulder ROM impairment following breast cancer surgery that included complete axillary dissection were allocated to one of two groups: 32 in the physical therapy group (PG) (52.7±10.2 years), who underwent an exercise program; and 34 in the control group (CG) (48±10.1years). Shoulder ROM, upper-limb circumference and functional capacity and scar tissue adhesion were evaluated at the beginning and end of radiotherapy and six months after completing radiotherapy. Results: The PG showed improvements in flexion and abduction ROM between the first and third evaluations (flexion from 164.77°±8.9° to 167.98°±9.5° and abduction from 168.56°±10.0° to 175.62°±10.2°),which was not observed in the CG (flexion from 167.06±06° to 165.16°±9.2° and abduction from 169.71° 10.1° to 169.53°±12.8°). There was a statistically significant increase in ROM in the PG in relation to the CG (flexion, p=0.02; and abduction, p=0.004). The circumference and functional capacity were similar between the groups and the frequency of scar tissue adhesion in the CG was twice that observed in the PG (48% versus 24%, p=0.04). Conclusions: These results suggest that shoulder exercises favor maintenance of flexion and abduction ROM of the shoulder and minimize the incidence of scar tissue adhesion in women undergoing radiotherapy for breast cancer treatment.

Objetivo: Verificar o efeito da realização de exercícios para o ombro durante a radioterapia na prevenção de complicações físicas locoregionais: limitação da amplitude de movimento (ADM) e da capacidade funcional, circunferência do braço e aderência cicatricial. Métodos: Sessenta e seis mulheres sem comprometimento de ADM de ombro no pós-operatório de cirurgia para câncer de mama com dissecção axilar completa foram alocadas em dois grupos, sendo 32 no grupo de fisioterapia (GF) (52,7±10,2 anos), o qual foi submetido a um programa de exercícios, e 34 no grupo controle (GC) (48±10,1 anos). A ADM do ombro, a circunferência e capacidade funcionaldos membros superiores e a aderência cicatricial foram avaliados no início e no final da radioterapia e seis meses após seu término. Resultados: O GF apresentou melhora da ADM de flexão e abdução entre a primeira e terceira avaliação (Flexão: de 164,77°±8,9° para 167,98°±9,5° e Abdução: 168,56°±10° para 175,62°±10,2°), o que não se observou no GC (Flexão: 167,06°±6° para 165,16°±9,2° e Abdução: 169,71°±10,1° para 169,53°±12,8°), demonstrando uma melhora significativa do GF em relação do GC (Flexão: p=0,02 e Abdução: p=0,004). A circunferência e a capacidade funcional foram similares entre os grupos e a frequência de aderência cicatricial no GC foi o dobro daquela observada no GF (48% e 24%, p=0,04). Conclusões: Esses resultados sugerem que exercícios para o ombro favorecem a manutenção da ADM de flexão e abdução de ombro e minimizam a incidência de aderência cicatricial em mulheres submetidas à radioterapia para tratamento por câncer de mama.

NK/T-cell lymphoma in AIDS.

A 42-year-old man diagnosed to be HIV positive and on highly active antiretroviral treatment (HAART), presented with double vision and gradual drooping of the left eyelid. He had left 3rd cranial nerve palsy and partial right lower-motor-neuron facial palsy. CT of the PNS revealed soft tissue filling the right maxillary sinus antruin. Further workup showed the mass to be an NK/T cell lymphoma.

Prevalence and risk factors for bronchial asthma in Indian adults: a multicentre study.

BACKGROUND: There is limited information on field epidemiology of bronchial asthma in Indian adults. OBJECTIVES: To estimate prevalence of bronchial asthma in different regions of India and to define risk factors influencing disease prevalence. METHODS: A field study was conducted at Chandigarh, Delhi, Kanpur and Bangalore through a two stage stratified (urban/ rural) sampling and uniform methodology using a previously validated questionnaire. Asthma was diagnosed if the respondent answered affirmatively both to (a) whistling sound from chest, or chest tightness, or breathlessness in morning, and (b) having suffered from asthma, or having an attack of asthma in the past 12 months, or using bronchodilators. Besides demographic data, information on smoking habits, domestic cooking fuel used, atopic symptoms, and family history suggestive of asthma was also collected. Univariate and multivariate logistic regression modelling was performed to calculate odds ratio of various potential risk factors. RESULTS: Data from 73605 respondents (37682 men, 35923 women) were analysed. One or more respiratory symptoms were present in 4.3-10.5% subjects. Asthma was diagnosed in 2.28%, 1.69%, 2.05 and 3.47% respondents respectively at Chandigarh, Delhi, Kanpur and Bangalore, with overall prevalence of 2.38%. Female sex, advancing age, usual residence in urban area, lower socio-economic status, history suggestive of atopy, history of asthma in a first degree relative, and all forms of tobacco smoking were associated with significantly higher odds of having asthma. CONCLUSION: Prevalence estimates of asthma in adults in this study, although lower than several previously reported figures, point to a high overall national burden of disease.

A multicentric study on epidemiology of chronic obstructive pulmonary disease and its relationship with tobacco smoking and environmental tobacco smoke exposure.

INTRODUCTION: Population prevalence of chronic obstructive pulmonary disease (COPD) and its relationship with tobacco smoking, environmental tobacco smoke (ETS) exposure and other variables were studied in adult subjects of 35 years and above at four different centres in India. Question-items for the diagnosis of COPD were included in the questionnaire used for the field study on asthma epidemiology. METHODS: Field surveys were conducted in both the urban and the rural populations at Bangalore, Chandigarh, Delhi and Kanpur with the help of a structured and validated questionnaire for diagnosis of asthma and COPD. Separate sets of questions were used for the diagnoses of the two diseases. A two-stage stratified sample design was employed where a village or an urban locality formed the first stage unit and a household formed the second stage unit. A uniform methodology was used at all the four centres and the analyses were done at the central coordinating centre--Chandigarh. Chronic obstructive pulmonary disease, defined by chronic bronchitis (CB) criteria, was diagnosed from the presence of cough and expectoration on most of the days for at least three months in a year for two consecutive years or more. RESULTS: Chronic obstructive pulmonary disease was diagnosed in 4.1% of 35295 subjects, with a male to female ratio of 1.56:1 and a smoker to nonsmoker ratio of 2.65: 1. Prevalence among bidi and cigarette smokers was 8.2% and 5.9%, respectively. Odds ratio (OR) for COPD was higher for men, elderly individuals, lower socio-economic status and urban (or mixed) residence. Environmental tobacco smoke exposure among nonsmokers had an OR of 1.4(95% CI 1.21-1.61). Combined exposure to both ETS and solid fuel combustion had higher OR than for ETS exposure alone. CONCLUSIONS: Population prevalence of COPD is very high in India with some centre to centre differences. Smoking of both bidis and cigarettes, and ETS exposure among nonsmokers, were two important risk factors at all centres. It is important to employ uniform methodology for assessment of national burden and disease-surveillance programme.

Household environmental tobacco smoke exposure, respiratory symptoms and asthma in non-smoker adults: a multicentric population study from India.

BACKGROUND: Exposure to environmental tobacco smoke (ETS) is a risk factor for childhood asthma. Its association with asthma in adults is less clear. METHODS: In a multicentric population study on asthma prevalence in adults, specific enquiries were made into childhood and adulthood exposure to household ETS, and its relationship with asthma diagnosis were analysed. RESULTS: From a total of 73605 respondents, 62109 were studied after excluding current or past smokers. Overall observed prevalence of asthma was 2.0% (men 1.5%,women 2.5%, p < 0.001). Of all asthma patients, history of ETS exposure was available in 48.6 percent. Prevalence of asthma in the ETS exposed subjects was higher compared to non-exposed individuals (2.2% vs 1.9%, p < 0.05). Multiple logistic regression analysis showed a higher risk of having asthma in persons who were exposed to ETS compared to those not exposed (odds ratio [OR] 1.22, 95% CI 1.08-1.38) after adjusting for age, gender, usual residence, exposure to biomass fuels and atopy. Stratification of ETS exposure revealed that exposure during childhood and both during childhood and adulthood were significantly associated with asthma prevalence. Exposure only in adulthood was not a significant risk factor (OR 1.13, 95% CI 0.95-1.33). Persons reporting combined environmental tobacco smoke exposure from parents during childhood and spouse during adulthood had highest risk of having asthma (OR 1.69, 95% CI 1.38-2.07). Environmental tobacco smoke exposure was also significantly associated with prevalence of respiratory symptoms such as wheezing, cough and breathlessness. CONCLUSIONS: Environmental tobacco smoke exposure during childhood is an important risk factor for asthma and respiratory symptoms in non-smoking adults.

Tobacco smoking in India: prevalence, quit-rates and respiratory morbidity.

BACKGROUND: Population prevalence of tobacco smoking especially with reference to detailed habits such as the amount smoked, the smoking forms, quit-rates and relationship with demographic variables were studied at four different centres in India along with the study on epidemiology of asthma and chronic obstructive pulmonary disease. METHODS: The study population included adults of over 15 years of age selected with two-stage stratified random sample design. A specifically designed questionnaire was used for the study. RESULTS: There were 11496 (15.6%) ever smokers in the study sample of 73605 subjects. Among 37682 males, 10756 (28.5%) were ever smokers and among 35923 females, 740 (2.1%) were ever smokers. Bidi was the commonest form of smoking, more so in the rural areas. The mean number of cigarettes/bidis smoked per day was 14 (+/- 11.5) and the mean age of starting smoking was 20.5 (+/- 20.0) years. Increasing age, low socio-economic status and rural residence were important factors associated with smoking. Vigorous anti-tobacco measures under the tobacco control programmes yielded only a quit-rate of 10 percent. Nearly 14% of ever smokers had some respiratory symptoms. CONCLUSIONS: A substantial proportion of population in India has current or past smoking habit with higher prevalence among males than females. The quit-rates have been low in spite of the various anti-tobacco measures. There is a significant respiratory morbidity associated with smoking.

A clinical trial of the efficacy and safety of montelukast as monotherapy in patients with chronic stable bronchial asthma.

This study is aimed to evaluate the efficacy and safety of montelukast, as monotherapy, in the treatment of chronic stable bronchial asthma in adults. This was a multicentre, open label, non-comparative, prospective, 4-week study. Eligible patients discontinued all anti-inflammatory medication (steroids, chromoglycate sodium) 2 weeks prior to starting therapy with montelukast (10 mg daily). The primary efficacy criteria were improvements in forced expiratory volume in one second (FEV1), peak exploratory flow rate (PEFR) after 4 weeks of therapy. Secondary efficacy criteria were improvement in the patients' symptoms (assessed on an ordinal scale), decrease in discomfort levels (scored on a scale of 0-100), change in peripheral eosinophil counts, decrease in total daily dose of inhaled beta2 agonist (salbutamol). A total of 148 patients, mean age (+/- SD) 40.21 +/- 13.70 years, were enrolled into the study. At the end of the study there were significant improvements in FEV1 and PEFR (29% and 28% increase respectively from baseline values, p<0.000001). The mean total daily dose of inhaled salbutamol decreased significantly from prestudy values of 461 +/- 332 microg/day to 161 +/- 207 microg/day (p<0.000001). The mean eosinophil counts fell from 5.80 +/- 4.90% (+/- SD) to 4.84 +/- 4.42% (+/- SD) (p=0.02). Symptom scores improved significantly as did subjective assessment of discomfort. A total of 29 (19.6%) adverse events were reported, all of which were of mild to moderate intensity. Monotherapy with montelukast significantly improved parameters of asthma control. It was well tolerated with no reports of serious or severe adverse events.

Turpentine-induced chemical pneumonitis with broncho-pleural fistula.

Turpentine is a volatile hydrocarbon used in polishes, solvents, paints and textile industry. When hydrocarbons are aspirated into the lung, they cause chemical pneumonitis, acute respiratory distress syndrome (ARDS), and rarely pneumatoceles and pneumothorax. We report a 20-year old boy with turpentine-induced chemical pneumonitis that evolved into a bronchopleural fistula. He was treated with oxygen, steroids and intercostal tube drainage. This is the first reported case of turpentine-associated bronchopleural fistula.

Respiratory complications in postoperative patients.

OBJECTIVES: This study was conducted to see the extent of respiratory morbidity in the general surgical unit of a teritiary care teaching hospital and to look for probable factors that were responsible for them. METHODS: A prospective study was conducted over a six month period, of patients who underwent both elective and emergency surgeries. Patients were assessed pre-operatively, on the fifth post operative day and at the time of discharge for respiratory complications. RESULTS: Five hundred eighty four consecutive patients who underwent surgeries were studied. Eighty one of them (13.9%) had respiratory complications. Pneumonia was the most common complication (68%). The others included pleural effusion, empyema, pneumothorax and exacerbations of asthma and chronic obstructive pulmonary disease (COPD). One patient developed ARDS (Adult respiratory distress syndrome) and died. Patients who underwent upper abdominal surgery (both elective and emergency), those who had a stay in the surgical ICU for more than 24 hours and those who were on the ventilator for more than 24 hours had a higher incidence of respiratory complications (p < 0.001). CONCLUSION: Respiratory complications increase the morbidity in post operative patients. Pre-operative respiratory illnesses, upper abdominal surgery, ICU stay and mechanical ventilation in the post-operative period predispose patients to respiratory complications. Pre-operative respiratory assessment and treatment of any underlying respiratory disorder is necessary and may decrease the morbidity in surgical patients.

Bronchial responsiveness of non-smoking women exposed to environmental tobacco smoke or biomass fuel combustion.

We studied bronchial responsiveness (BR) in three groups of housewives with or without history of exposure to tobacco smoke or combustion of biomass fuels. Methacholine bronchoprovocation test was used to study BR. The group I subjects (60), who served as controls, were nonsmokers and had no chronic exposure to passive smoking or environmental tobacco smoke (ETS) or biomass fuels. Three of these women showed a 20 per cent FEV1 fall with a cumulative methacholine dose of 72.5 mg or less. Of 60 women in group II (ETS-exposure) and 52 in group III (biomass exposure), 26 (43.3%) and 10 (19.2%) respectively showed bronchial hyper-responsiveness (BHR). The odds ratios for BHR in groups II and III were 14.53 and 4.52 respectively. The number of hyper-responders was significantly more and the mean PD20 less in the exposed than the non-exposed groups. The occurrence of BHR in the ETS exposed group was more (P < 0.05) than the biomass combustion group. There were more hyper-responders (both groups II and III) amongst those who had an exposure index (EI) of 50 or more compared to those with EI of less than 50. We conclude that chronic cumulative exposure to both ETS and biomass combustion produces significant BHR. Further, BHR developed more often on ETS exposure, and when the exposure was present for a longer period.

Repercussao neonatal do aspecto do liquido amniotico e das caracteristicas dos batimentos cardiacos fetais durante o trabalho de parto / Neonatal repercussion of the aspect of the amniotic fluid and the fetal heart rate characteristics during labor

Foram analisados 2741 partos ocorridos na Maternidade do Departamento de Tocoginecologia da UNICAMP, para estudo da repercussao neonatal do aspecto do liquido amniotico e das caracteristicas dos batimentos cardiacos fetais durante o trabalho de parto. O aspecto do liquido amniotico foi distribuido em cinco grupos: claro, ligeiramente tingido de meconio, tingido de meconio, com meconio espesso e com meconio antigo. A presenca de batimentos cardiacos fetais normais e anormais foi considerada em cada grupo, e as condicoes neonatais avaliadas pelos indices de Apgar no primeiro e quinto minuto. Concluiu-se que os resultados neonatais sao semelhantes nos casos com liquido amniotico claro, ligeiramente tingido e tingido de meconio, enquanto partos que evoluem com meconio espesso e antigo aumentam significativamente a incidencia de recem-nascidos deprimidos....

Diagnostico ultra-sonografico de corioangioma complicado por hidropisia fetal e polidramnio transitorios. / Ultrasonographic diagnosis of chorioangioma complicated by fetal hydrops and transitory hydramnios

Os autores apresentam um caso de coriangioma complicado por hidropisia fetal e polidramnio transitorios destacando a importancia do diagnostico ultra-sonografic

Culdoscopia: metodo endoscopico em ginecologia. / Culdoscopy: endoscopic method in ginecology

E apresentada a experiencia dos autores relativa a 500 culdoscopias. A anestesia preferente foi a peridural, utilizada em 82% dos casos. O exame foi realizado com as pacientes na classica posicao genupeitoral, a qual permite exposicao da pelve vista em angulo de 90 gruas e dispensa a insuflacao de qualquer gas. Em nenhum caso se procedeu a sutura do orificio deixado pela perfuracao do trocater. As principais indicacoes foram esterilidade e dor pelvica, aguda ou cronica, de causa a esclarecer. Os resultados mostraram variada patologia. Em 26,4% dos casos, os achados foram normais. Em 3,8% das oportunidades, o exame foi incompleto ou inconclusivo.Houve seis complicacoes: perfuracoes extraperitoneais do reto, as quais nao deixaram sequelas. Conclui-se que a culdoscopia, apesar de pouco conhecida, nao deixa de ser meio pratico e recomendavel, para fins diagnosticos, em qualquer servico

Ligadura das arterias hipograstricas no tratamento de hemorragias graves em tocoginecologia. / Hypogastric arteries ligation in the treatment of severe hemorrhages in tocogynecology

Os autores apresentam seus resultados com a ligadura das arterias hipogastricas em 19 pacientes para controle de hemorragias internas e externas de causa ginecologica ou obstetrica. Fazem analise dos resultados, discutem as indicacoes e comentam as complicacoes. Tecem consideracoes anatomicas fisiologicas e cirurgicas