The challenging approach to a combined neurotrophic and exposure corneal ulcer / Abordagem desafiante de uma úlcera de córnea neurotrófica e por exposição

ABSTRACT This study aims to describe a challenging clinical case of a patient with a neurotrophic and exposure corneal ulcer. A 75-year-old male patient, with history of right eye (RE) limbic stem-cell insuficiency due to complications of recurrent herpetic keratitis, underwent successful limbic stem-cell transplantation in 2008. In 2010, an uneventful penetrating keratoplasty was performed. After a cataract phacoemulsification surgery with intraocular lens implantation done in 2011, best corrected visual acuity was 20/20, and remained stable until 2015. In July 2015, the patient developed right facial nerve palsy and two months later, presented with an extensive central corneal ulcer, with a significant thinning of central stroma, without infection signs, but with an imminent risk of perforation. Treatment with topical ofloxacin and intensive ocular lubrification was started in association with permanent ocular oclusion. Due to lack of any clinical improvement, treatment with RGTA [Poli (carboximetilglucose) sulfate, dextrano T40] (Cacicol®, Thea) was started. After two weeks of treatment, a complete reepithelization and partial stromal filling was observed. Continued monitoring and treatment with artificial tears was maintained, with no recurrence observed. There is an unmet need for a medical therapy that could help corneal neurotrophic ulcers to heal. The presented clinical case shows that the approach of targeting extracellular matrix can be effective in the reepithelialization of neurotrophic and exposure corneal ulcer that do not respond to conventional treatments.

RESUMO Este trabalho relata um caso clínico desafiante de doente com uma úlcera de córnea neurotrófica e de exposição. Doente do sexo masculino, de 75 anos, com antecedentes de queratites herpéticas de repetição no olho direito (OD), complicadas com o desenvolvimento de uma insuficiência límbica, foi submetido com sucesso a transplante de células límbicas em 2008. Em 2010 foi submetido a queratoplastia penetrante e em 2011, após realização de cirurgia de catarata, apresentava uma melhor acuidade visual corrigida (MAVC) de 20/20. A MAVC manteve-se estável até Julho de 2015, altura em que desenvolveu paresia facial periférica à direita. Dois meses depois, o doente desenvolveu uma úlcera de córnea central extensa, com adelgaçamento significativo do estroma central, sem sinais de infeção, mas com risco iminente de perfuração. Foi iniciado tratamento tópico com ofloxacina, lubrificação intensiva e oclusão ocular contínua. Por ausência de melhoria clínica, foi iniciado tratamento tópico com um RGTA [Poli (carboximetilglucose) sulfato, dextrano T40] (Cacicol®, Thea). Após duas semanas de tratamento, observou-se uma reepitelização completa e regeneração parcial do estroma. Foi mantida monitorização regular e tratamento com lágrimas artificiais, sem recidiva do quadro clínico. Há uma grande necessidade de tratamentos médicos que possam ajudar na regeneração de úlceras de córnea neurotróficas e de exposição. O caso clínico apresentado sugere que os fármacos que têm por alvo a matrix extracelular poderão ser eficazes na reepitelização de úlceras de córnea neurotróficas e de exposição que não respondem ao tratamento convencional.

The learning curve of sting method for endoscopic injection treatment of vesicoureteral reflux

ABSTRACT Objective: To identify how many endoscopic injection (EI) procedures, STING method, must be performed before reaching an ideal success rate when simulation training has not been received. Materials and Methods: The EI procedures performed by two pediatric urology fellows were investigated. The study excluded patients without primary VUR and those with previous EI or ureteroneocystostomy, lower urinary tract dysfunction, and/or duplicate ureters. The EIs used dextranomer hyaluronate and the STING method, as described by O'Donnell and Puri. Groups number was determined by multiple statistical trials. Statistically significance differences were achieved with one combination that had 35 EI procedures each and with 3 different combination of patients, having 12, 24, and 36 patients, respectively. Therefore, groups were established 12 patients. The first fellow performed 54 EIs, and the second performed 51. Therefore, each of the first fellow's three groups contained 18 EI procedures, and each of the second fellow's 17. Results: The study included 72 patients and 105 ureter units. When the data from both fellows were combined, each of the three groups contained 35 procedures. For the first fellow, the success rates in the first, second, and third groups were 38.3%, 66.6%, and 83.3% (p = 0.02), respectively, and for the second fellow, the success rates were 41.2%, 64.7%, and 82.3% (p = 0.045), respectively. The increased success rates for both fellows were very similar. Conclusions: An acceptable rate of success for EI may be reached after about 20 procedures and a high success rate after about 35-40 procedures.

Changing bulking agent may require change in injection volume for endoscopic treatment of vesicoureteral reflux

ABSTRACT Introduction: Various bulking agents were utilized for endoscopic correction of VUR. A study reviewing multi-institutional data showed that the amount of injection material has increased over time with the purpose of improving success rates, which also resulted in costs. We noticed an opposite trend in our center since we started using a new bulking agent. The aim of this study was to evaluate evolution of our practice with different bulking agents. Patients and Methods: Records of VUR patients who underwent subureteric injection with polyacrylate polyalcohol copolymer (PPC) and dextronomere hyaluronic acide (DxHA) between 2005 and 2014 were reviewed. Variation of different parameters throughout the study period was evaluated along with the success rate. Success was defined as complete resolution of reflux. Results: A total of 260 patients with 384 refluxing units were included. The success rate was higher in PPC group compared to DxHA group. There was no statistically significant difference between years regarding distribution of VUR grade, body weight, patient height, and age in PPC group. Despite significant reduction in injection volume, success rate did not decrease through the years with PPC. Conclusion: Different bulking agents may require different injection volumes to achieve the same success rate in endoscopic treatment of vesicoureteral reflux. Habits gained with previous experience using other materials should be revised while using a new agent.

Does the Modified STING Method Increase the Success Rate in the Management of Moderate or High-Grade Reflux?

PURPOSE: To evaluate the efficacy of subureteral injection types in patients with middle- to high-grade vesicoureteral reflux (VUR). MATERIALS AND METHODS: Between June 1999 and September 2010, subureteral dextranomer was applied at our clinic to 149 patients (214 refluxing ureters) with grades II, III, and IV VUR. Group 1 consisted of 54 patients (80 ureters), and group 2 consisted of 95 patients (134 ureters). The standard subureteric transurethral injection (STING) procedure was applied to group 1, and the modified STING procedure was applied to group 2. A second and if needed a third injection was applied to unsuccessfully treated patients. The mean follow-up period was 2 years. Patients were evaluated by cystography and ultrasonography in the third month of follow-up. RESULTS: VUR was resolved completely after a single injection in 54/80 ureters (67.5%) in group 1 and in 94/134 ureters (70.1%) in group 2. Overall successes after a second or a third injection were 61/80 (76.2%) and 111/134 (82.8%), respectively. There was a statistically significant difference between the groups only for grade IV reflux following multiple injections (p<0.05). CONCLUSIONS: Endoscopic treatment of VUR is a recommended treatment because it is minimally invasive, efficient, and repeatable. Our study confirmed that a modified STING procedure can be an alternative treatment to the standard technique.

Does the Modified STING Method Increase the Success Rate in the Management of Moderate or High-Grade Reflux?

PURPOSE: To evaluate the efficacy of subureteral injection types in patients with middle- to high-grade vesicoureteral reflux (VUR). MATERIALS AND METHODS: Between June 1999 and September 2010, subureteral dextranomer was applied at our clinic to 149 patients (214 refluxing ureters) with grades II, III, and IV VUR. Group 1 consisted of 54 patients (80 ureters), and group 2 consisted of 95 patients (134 ureters). The standard subureteric transurethral injection (STING) procedure was applied to group 1, and the modified STING procedure was applied to group 2. A second and if needed a third injection was applied to unsuccessfully treated patients. The mean follow-up period was 2 years. Patients were evaluated by cystography and ultrasonography in the third month of follow-up. RESULTS: VUR was resolved completely after a single injection in 54/80 ureters (67.5%) in group 1 and in 94/134 ureters (70.1%) in group 2. Overall successes after a second or a third injection were 61/80 (76.2%) and 111/134 (82.8%), respectively. There was a statistically significant difference between the groups only for grade IV reflux following multiple injections (p<0.05). CONCLUSIONS: Endoscopic treatment of VUR is a recommended treatment because it is minimally invasive, efficient, and repeatable. Our study confirmed that a modified STING procedure can be an alternative treatment to the standard technique.

Injeção intraoperatória de dextran-500-99m_tecnécio para identificação do linfonodo sentinela em câncer de mama / Intraoperative injection of technetium-99m-dextran 500 for the identification of sentinel lymph node in breast cancer

OBJETIVO: avaliar a eficácia da injeção intraoperatória para identificação do LS em câncer de mama com o uso do Dextran 500-99m-tecnécio (Tc) e analisar o tempo para marcação do linfonodo sentinela (LS) axilar. MÉTODOS: estudo prospectivo realizado entre abril de 2008 e junho de 2009 que incluiu 74 biópsias de LS em pacientes com câncer de mama em estádios T1N0 e T2N0. Após a indução anestésica, injetou-se de 0,5 a 1,5 mCi (18 a 55 MBq) de Dextran 500-99m-Tc filtrado 0,22 µm num volume de 5 mL de acordo com a técnica de injeção subareolar para a biópsia do LS. Após a marcação com o radiofármaco injetou-se 2 mL de azul patente. O tempo entre a injeção e a marcação na região axilar, a contagem com o probe do LS in vivo, ex vivo, background e o número de LS identificados foram documentados. Os dados foram analisados por meio da estatística descritiva pelo programa SPSS, versão 18. RESULTADOS: identificamos o LS em 100 por cento dos casos. A taxa de identificação com o probe foi de 98 por cento (73/74 casos). Um caso (1,35 por cento) estava marcado apenas com o azul. A dose média do radiofármaco aplicada foi 0,97 mCi±0,22. O tempo para marcação na região axilar, após a injeção subareolar, foi de 10,7 minutos (±5,7 min. ). Foram identificados, em média, 1,66 linfonodos marcados com o radioisotopo. CONCLUSÃO: o procedimento para identificação do LS com injeção intraoperatória do radiofármaco é oncologicamente seguro, apresentando conforto ao paciente e agilidade à equipe cirúrgica.

PURPOSE: to determine the efficacy of intraoperative injection of Dextran-500-99m-technetium (Tc) for the identification of the sentinel lymph node (SLN) in breast cancer and analyze time to label the SLN in the axillary region. METHODS: a prospective study between April 2008 and June 2009, which included 74 sentinel lymph node biopsies (SLNB) in patients with breast cancer in stages T1N0 and T2N0. After induction of anesthesia, 0.5 to 1.5 mCi of Dextran-500-99m-Tc filtered 0.22 µm in a volume of 5 mL was injected intraoperative using the subareolar technique for SLNB. After labeling with the radioisotope, 2 mL of patent blue was injected. The time elapsed between injection and the axillary hot spot, the in vivo and ex vivo counts of the hottest nodes, the background count, and the number of SLN identified were documented. Data were analyzed using descriptive statistics with SPSS program, version 18. RESULTS: we identified the SLN in 100 percent of cases. The rate of SLN identification with the probe was 98 percent (73/74 cases). In one case (1.35 percent) the SLN was labeled only with the blue dye. The mean dose of radioisotope injected was 0.97±0.22 mCi. The average time to label the SLN was 10.7 minutes (±5.7 min). We identified on average of 1.66 SLN labeled with the radioisotope. CONCLUSION: the procedure for SLN identification with an intraoperative injection of the radioisotope is oncologically safe and comfortable for the patient, providing agility to the surgical team.

Operating room use of hypertonic solutions: a clinical review

Hyperosmotic-hyperoncotic solutions have been widely used during prehospital care of trauma patients and have shown positive hemodynamic effects. Recently, there has been a growing interest in intra-operative use of hypertonic solutions. We reviewed 30 clinical studies on the use of hypertonic saline solutions during surgeries, with the majority being cardiac surgeries. Reduced positive fluid balance, increased cardiac index, and decreased systemic vascular resistance were the main beneficial effects of using hypertonic solutions in this population. Well-designed clinical trials are highly needed, particularly in aortic aneurysm repair surgeries, where hypertonic solutions have shown many beneficial effects. Examining the immunomodulatory effects of hypertonic solutions should also be a priority in future studies.

Small volume hypertonic resuscitation of circulatory shock

O uso de soluções hipertônicas para reanimação de pacientes em choque é um conceito relativamente novo. Baseou-se originalmente na idéia de que uma expansão volêmica significativa podia ser obtida às custas de um volume relativamente diminuto de infusão, aproveitando a propriedade física de osmose. Logo ficou claro que a capacidade fisiológica de produzir vasodilatação, compartilhada por todas as soluções hipertônicas, seria valiosa para reperfundir territórios tornados isquêmicos pelo choque, embora os malefícios da seqüência isquemia - reperfusão devessem ser considerados. Pesquisa subseqüente revelou propriedades antes insuspeitadas da reanimação hipertônica. Verificou-se que este procedimento revertia instantaneamente o edema endotelial e de hemácias, com importantes conseqüências em termos de circulação capilar. Mais recentemente, um conjunto de efeitos da hipertonicidade sobre o sistema imune vem sendo estudado, mas as possíveis implicações destas descobertas em relação ao cenário clínico ainda suscitam discussão. As soluções hipertônicas estão em uso em algumas partes do mundo, apesar de objeções levantadas contra tal uso, em virtude de dados experimentais derivados de experimentos de hemorragia não controlada. Tais objeções não parecem se justificar em face dos resultados obtidos numa série de ensaios clínicos e no uso corrente destas soluções. Esta revisão procura cobrir um pouco da história, remota e recente, deste campo do conhecimento.

Reposiçäo volêmica no choque hemorrágico: a soluçäo empregada faz diferença em relaçäo aos efeitos hemodinâmicos e renais? / Hemorrhagic shock volume replacement: does the solution make a difference in hemodynamic and renal effects?

Justificativa e objetivos - O emprego de pequenos volumes de soluçäo hipertônica (SH) isoladamente ou em associaçäo à soluçäo de dextran 70 a 6 por cento (SHD), abre novas perpectivas no manuseio da reposiçäo volêmica durante o choque hipovolêmico, em relaçäo ao emprego de soluçöes cristalóides. A pesquisa experimental tem como objetivo verificar se o tipo de soluçäo empregada na reposiçäo do choque hemorrágico apresenta alguma diferença em relaçäo aos efeitos hemodinâmicos e renais. Método - Foram utilizados 24 cäes anestesiadoscom pentobarbital sódico. Após retirada de 40 por cento do volume sanguíneo, os cäes foram distribuídos de forma aleatória em grupos de 8 animais, de acordo com a soluçäo empregada para a reposiçäo volêmica: G1 - SH a 7,5 por cento em volume de 4ml.kg-1; G2 - soluçäo de Ringer com lactato (RL) na proporçäo 2:1 em relaçäo ao volume de sangue retirado; e G3 - SHD em volume de 4ml.kg-1. Foram estudados os seguintes atributos: frequência cardíaca (FC), pressäo arterial média (PAM), pressäo venosa central (PVC), fluxo sanguíneo aortico (FAo), resistência vascular aórtica (RvAo), fluxo plasmático renal (FPR), ritmo de filtraçäo glomerular (RFG), fluxo sanguíneo renal, débito urinário (DU), resistência vascular renal, excreçäo urinária de sódio (EFNa), depuraçäo osmolar (Dosm) e depuraçäo de água livre (DH2O). Os atributos PAM, PVC, FAo foram estudados nos momentos: M1 (controle); M2 - após a retirada dos 40 por cento da volemia; M3, M4 e M5 - imediatamente e após 15 e 60 min da reposiçäo volêmica, respectivamente. Os demais atributos estudados nos momentos: M1 (controle); M2 e M3-15 e 60 min da reposiçäo volêmica, respectivamente. Resultados - A reposiçäo com RL (G2) aumentou o FAo e a PVC em M3 e M4, em níveis superiores aos determinados pela reposiçäo com pequenos volumes (G1 e G3). Näo houve diferença significante da PAM entre os grupos, que se elevou após a reposiçäo, mas näo retornou aos níveis do controle. O DU aumentou significativamente em G2 (RL), com aumento da DH2O nesse grupo em G3 (SHD). Conclusöes - A reposiçäo com RL determina excessiva expansäo volêmica, enquanto a reposiçäo com SH e SDH determina boa expansäo volêmica, sem diferença significante entre elas. Todas as soluçöes mantêm a hemodinâmica e funçäo renais, com o RL provocando aumento do débito urinário

Comparación entre la anestesia local y el bloqueo peridural en plastia inguinal / Comparison between local anesthesia and peridural block used in inguinoplasty

En este estudio se recomienda la anestesia local como procedimiento de elección en la reparación de la hernia inguinal unilateral y no complicada. Se presenta un estudio prospectivo, comparativo y aleatorio en 165 pacientes con hernia inguinal, dividiéndolos en dos grupos: grupo I, 80 pacientes operados con anestesia local; grupo II, 85 pacientes operados bajo bloqueo peridural. Se excluyeron los pacientes con hernia recidivante o complicada. El tiempo anestésico-quirúrgico empleado fue menor en el grupo I, con promedio de 71.5 minutos en comparación al II, que empleó 121.3 minutos en promedio. Las complicaciones fueron menores en el grupo I y la estancia hospitalaria fue significativamente menor en comparación al grupo II. Se considera que la anestesia local en la plastia inguinal unilateral y no complicada debe ser el procedimiento de elección por su buena tolerancia y efectividad, únicamente se requiere experiencia en su uso por parte del cirujano

Cardiovascular responses to phenylephrine during acute experimental anaemia in anaesthetized cats.

Experiments were performed on anaesthetized artificially ventilated cats to study the effects of phenylephrine (PE) on cardiovascular responsiveness, before and after induction of experimental anaemia. Acute anaemia was induced by replacement of blood by dextran in three steps of 20% each of total estimated blood volume. The effect of PE (20 micrograms/kg) was investigated at four stages: control and after 1st, 2nd and 3rd exchanges of blood. Induction of anaemia produced a significant increase in heart rate (HR) and cardiac output (CO) and a decrease in right atrial pressure (RAP). No significant change in mean arterial pressure (MAP), LV dP/dt max and blood gas tension was observed. Administration of bolus dose of PE produced a rapid rise in MAP, LVdP/dt max, and a decrease in HR without a change in the RAP. The pattern of response to PE was similar after induction of acute anaemia, however the magnitude of the response was significantly reduced. The attenuation in the response to PE was related to the fall in the haematocrit (HCT) level. This shows that induction of experimental anaemia, produced an increase in CO due to an increase in HR and SV and the effect of PE on cardiovascular responsiveness was significantly attenuated. The reduced sensitivity to PE during acute anaemia could be due to many factors such as inadequate O2 supply, effect of local vasodilating agents or some other cardiotonic agents which are known to contribute to vascular responsiveness.

Paracentesis masiva con reposición de dextran 70 vs albúmina en pacientes cirróticos con ascitis a tensión / Dextran 70 vs albumin after total paracentesis in cirrhotic

Algunos estudios han demostrado que la paracentesis con extracción de grandes volúmenes de ascitis conduce a insuficiencia renal e hiponatremia, y que la infusión intravenosa de expansores del plasma previenen estas complicaciones. Realizamos un estudio en el que comparamos la efectividad del dextran 70 con la albúmina, en la prevención de estos efectos adversos y su diferencia de costos. Se formaron 2 grupos al azar, de 8 pacientes cada uno, cirrótico, con ascitis a tensión. Se les practicó paracentesis con extracción de más de 5 litros, el grupo albúmina y el grupo B dextran 70, ambos a dosis de 6 gramos por litro de líquido extraído. Se realizó pruebas de función hepática, química sanguínea que incluyó renina y aldosterona, 24 horas antes y 48 horas después de la paracentesis. Los datos clínicos y bioquímicos finales fueron similares en los 2 grupos, sin diferencias estadísticas significativas cuando se compararon con los valores iniciales (p < 0.05). Aunque la cantidad infundida del expansor plasmático fue similar en los 2 grupos, el costo promedio en el grupo A fue de N$ 891.33, y en el N de N$ 69.80. Se presentó hiponatremia en el 12.5 por ciento de cada grupo y azoemia en el 12.5 por ciento del grupo A, ambas asintomáticas. Estos datos indican que el dextran 70 evita las complicaciones de la paracentesis de gran volumen, como lo hace la albúmina, pero su costo es mucho menor

Paracentese associada a dextran-70 no tratamento da ascite de hepatopatas crônicos / Paracentesis associated to dextra-70 in the treatment of ascites in patients with chronic liver disease: a randomized therapeutic study

O tratamento da ascite de grande volume em hepatopatas foi avaliado através do presente estudo, onde comparamos diuréticos com paracentese e infusäo de Dextran-70. Eficácia terapêutica, complicaçöes e permanência hospitalar foram as variáveis estudadas. De 38 pacientes, 20 foram randomizados e avaliados através de critérios clínicos, laboratoriais e/ou histológicos: 10 pacientes no grupo paracentese com Dextran-70 e 10 no grupo diurético. Os grupos foram semelhantes quanto a idade, diagnóstico, classificaçäao de Child-Pugh; entretanto o sexo masculino predominou sobre o feminino no grupo paracentese com Dextran-70. Em cada paracentese retirou-se em média 9,41 litros de líquido ascítico (4,5 a 14 L). O período médio de hospitalizaçäao no grupo paracentese com Dextran-70 foi de 10,5 dias (8-14), significativamente menor quando comparado ao grupo diurético: 24,4 dias (14-48). No grupo diurético observou-se em um paciente complicaçöes como hiperpotassemia, elevaçäo de uréia e creatinina e no grupo paracentese com Dextran-70, um paciente apresentou temperatura acima de 38§C durante o tratamento. Os resultados sugerem que a paracentese associada ao Dextran-70 pode representar uma alternativa terapêutica para hepatopatas com ascite na nossa populaçäo. Este tratamento foi eficaz, näo apresentou efeitos colaterais importantes, diminuiu a permanência hospitalar e, conseqüentemente, deve diminuir o custo e o risco de complicaçöoes de pacientes com hospitalizaçäo prolongada

Efeitos hemodinâmicos imediatos da infusäo rápida de soluçäo hipertônica de cloreto de sódio-dextran-70 para tratamento de choque hemorrágico em cäes / Early Hemodynamic Effects of the Rapid Infusion of NaCl/Dextran Hypertonic Solution as Treatment for Hemorrhagic Shock in Dogs

PURPOSE--To study the early hemodynamic effects of the rapid infusion of 7.5g/dl NaCl/ 6g/dl dextran-70 solution in dogs submitted to hemorrhagic shock. METHODS--Mongrel dogs were anesthetized with pentobarbital and a electromagnetic flowmeter probe was placed around the ascending aorta or the portal vein. By external bleeding the arterial pressure was lowered to 40mmHg and held for 30min. The animals received a 4ml/kg infusion of the hypertonic solution in 90s. Arterial blood pressure and flow were registered continuously during 3min and the derived hemodynamic variables were calculated at regular time intervals. RESULTS--The total plasma protein concentration decreased and the cardiac output showed a continuous elevation during the infusion. The arterial blood pressure showed two oscillations and then decreased during a short period of time. This moment was coincident with the initial increase of the portal flow and preceded the elevation of the systemic vascular resistance and the arterial pressure. CONCLUSION--The rapid infusion of hypertonic NaCl/dextran solution to dogs in hemorrhagic shock determines immediate and intense hemodynamic effects. During the infusion period there is volemic expansion and the cardiac output increases rapidly. The arterial pressure shows oscillations and decreases as a consequence of visceral arterial dilation before starting its final elevation that occurs as the vascular resistance increases

Purpose - To study the early hemodynamic effects of the rapid infusion of 7.5g/dl NaCl/ 6g/dl dextran-70 solution in dogs submitted to hemorrhagic shock. Methods - Mongrel dogs wore anesthetized with pentobarbital and a electromagnetic flowmeter probe was placed around the ascending aorta or the portal vein. By external bleading the arterial pressure was lowered to 40mmHg and held for 30min. The animals received a 4ml/kg infusion of the hypertonic solution in 90s. Arterial blood pressure and flow were registered continuously during 3min and the derived hemodynamic variables were calculated at regular time intervals. Results - The total plasma protein concentration decreased and the cardiac output showed a continuous elevation during the infusion. The arterial blood pressure showed two oscillations and then decreased during a short period of time. This moment was coincident with the initial increase of the portal flow and preceded the elevation of the systemic vascular resistance and the arterial pressure. Conclusion - The rapid infusion of hypertonic NaCl/dextran solution to dogs in hemorrhagic shock determines immediate and intense hemodynamic effects. During the infusion period there is volemic expansion and the cardiac output increases rapidly. The arterial pressure shows oscillations and decreases as a consequence of visceral arterial dilation before starting its final elevation that occurs as the vascular resistance increases

Trasplante total heterotópico de intestino delgado en la rata: consideraciones técnicas para la obtención, preservación y trasplante del órgano / Total heterotype transplantation of the small intestine in rat:technical considerations about the obtention

Se comunica la técnica, modificaciones, y resultados, en el desarrollo experimental del transplante total heterotópico de intestino delgado en la rata. En el desarrollo del protocolo, se evaluaron todos los aspectos técnicos y de preservación, desde la descripción original de Monchik y Russell en 1917, sobre el trasplante total de intestino delgado en ratas, así como las modificaciones posteriores postuladas por diversos autores, y las de nuestro propio grupo. Se revisan los resultados obtenidos mediante el uso de modificaciones en la técnica de obtención y preservación del intestino delgado para el trasplante total heterotópico en la rata. Un total de 80 ratas sprague-dawley, fueron divididas en tres grupos (trasplante inmediato, con lavado del lecho vascular con solución salina, y trasplante a las 24 horas, con solución de lavado y preservación tipo UW y ADAAV) las supervivencia para cada uno de los grupos fue de 80, 50 y 70 por ciento respectivamente. Se discuten las ventajas de esta técnica, y su futuro uso para aspectos de investigación aplicables a la clínica del transplante de órganos

Prolongation of bupivacaine effect in epidural block by dextraven-150.

A double blind study was conducted on 84 subjects (needing surgery) of both sexes who were randomly divided into two groups. In group I 30 ml of 0.33 per cent bupivacaine (20 ml 0.5% bupivacaine + 10 ml of N saline) was injected epidurally and in group II 20 ml of 0.5 per cent bupivacaine + 10 ml of dextraven - 150 (6% solution in 5% dextrose). The subject were observed for the onset of block, degree of motor blockade, period of analgesia and complications during and after surgery. Dextran - 150 mixture significantly prolonged the duration of action of bupivacaine (13.5 +/- 6.25 h) when given epidurally, without affecting the onset, muscular paralysis, quality of block and the incidence of complications.

Tratamento do choque hemorrágico com dextran 40 e ringer-lactato

O choque hemorrágico deve ser tratado precocemente com reposiçäo volêmica. Estudou-se o resultado imediato da administraçäo de Dextran-40 em soluçäo de Ringer-Lactato em cäes anestesiados e submetidos a choque hemorrágico. Foram observados o comportamento dos parâmetros cardio-respiratório, equilibrio ácido-básico, hematócrito, glicose, sódio e potássio. Durante o período de estudo houve a recuperaçäo dos animais, tendo sido entäo proposta uma reposiçäo semelhante, em condiçöes de emergência, para tratamento do choque hemorrágico em seres humanos