Ultrasound-guided anhydrous ethanol and microwave ablation for functional parathyroid cyst: a case report / 南方医科大学学报

We report a case of functional parathyroid cyst treated by ultrasound-guided anhydrous ethanol sclerotherapy and microwave ablation. The 63-year-old female patient was diagnosed to have functional parathyroid cyst with hypercalcemia, high PTH and cystic space-occupying lesions in the neck by ultrasound, radionuclide scanning and PTH measurement of the cystic fluid. The patient refused to receive cyst resection, and anhydrous ethanol sclerotherapy with microwave ablation was performed under ultrasound guidance. The procedure was completed smoothly without any complications either during or after the operation. Follow-up examination of the patient at 18 months after the operation showed a significant reduction of the mass and normal blood calcium and iPTH levels, demonstrating a clinical cure of the patient. Ablative treatment of functional parathyroid cyst has not been documented so far. This approach provides a minimally invasive treatment modality for such cases where surgical resection is not an option, but its efficacy and safety need to be evaluated in more cases with longer follow-up time.

Therapeutic effects of alcohol septal ablation in mildly symptomatic patients with hypertrophic obstructive cardiomyopathy / 中华心血管病杂志

Objective: To observe the therapeutic effects of alcohol septal ablation (ASA) in mildly symptomatic patients (NYHA class Ⅱ) with hypertrophic obstructive cardiomyopathy(HOCM). Methods: This retrospective study included 150 mildly symptomatic patients with HOCM hospitalized in Beijing Anzhen Hospital affiliated to Capital Medical University from March 2001 to December 2017, consisting of medical therapy group (n=102) and ASA group (n=48). Baseline clinical data were collected, patients were followed up to a mean of 6.0 (3.5, 8.1) years. Overall and HCM-related mortality events (including chronic heart failure, atrial fibrillation related stroke, sudden cardiac death) were observed in the two groups. Moreover, the improvement of NYHA function classification and left ventricular outflow tract gradient (LVOTG) were also evaluated. Survival analysis was performed by Kaplan-Meier method. Results: Age of this cohort was (52.9±14.5)years, 92 cases(61.3%) were male. In the follow-up, LVOTG was reduced from (85.8±35.4)mmHg (1 mmHg=0.133 kPa) to (27.7±19.8)mmHg (P<0.001) in the ASA group, and from (66.3±35.0)mmHg to (56.5±27.7)mmHg in medical therapy group(P<0.01). At the last clinical follow-up, there were 32 patients (66.7%) whose LVOTG were<30 mmHg, septal thickness decreased from (20.3±3.8)mm to (16.1±3.4)mm (P<0.001), NYHA classification was also remarkably improved (P<0.001). New-onset atrial fibrillation tended to be lower in the ASA group compared to medical therapy group (9.3%(4/43) vs. 20.8%(20/96),P=0.096). Eleven patients (10.8%) in the medical therapy group and 2 patients (4.2%) in the ASA group died during the follow-up. One patient received pacemaker during the peri-procedural period, 1 patient was implanted with two-chamber pacemaker due to Ⅲ° atrioventricular block at 10 years after operation in the ASA group. Survival free of all-cause mortality of ASA group at 5 and 10 years was 97.9% and 97.9%, respectively, which was comparable to the medical therapy group (P=0.231). Survival free of HCM-related mortality was similar between the two groups (P=0.397). Conclusions: Compared with medical therapy in mildly symptomatic patients with HOCM, long-term survival rate is similar after ASA. Meanwhile, ASA can remarkably reduce LVOTG and improve the clinical status of the patients. Therefore, ASA may be used as an alternative therapy for mildly symptomatic HOCM patients.

Bioseguridad en el laboratorio dental / Biosafety in the dental laboratory

Una enfermedad infecciosa es aquella producida por un agente infeccioso (bacterias, hongos, virus, etc.) que ingresa y se desarrolla en el organismo de un hospedero. Posteriormente, puede trasmitirse de un individuo a otro directamente por contacto entre ambos, o bien, indirectamente, por medio de un vec-tor biológico (de naturaleza animal o vegetal), o de un fómite (objeto inanimado). Las vías por las que un agente infeccioso puede ingresar a un hospedero son: inhalación (respiración de aerosoles), ingestión (salpicaduras de gotas), penetración de mucosas (na-sal, ocular y bucal) o lesiones en la piel o mucosas. Las fuentes de infección pueden ser los pacientes, el personal del consultorio o laboratorio, las superficies e instrumental contaminados y las prótesis o com-ponentes de éstas. Para evitar la propagación de los agentes microbianos se debe interrumpir el proceso de transmisión de los mismos. Todo profesional debe fortalecer y readecuar normas y protocolos de biose-guridad en la tarea diaria, para minimizar el riesgo de transmisión directa y cruzada entre el profesional, su equipo auxiliar, el laboratorista y los pacientes (AU)

An infectious disease is one caused by an infectious agent (bacteria, fungi, virus, etc.) that enters and develops in a host. Then it can be transmitted from one individual to another directly by contact between the two or, indirectly through a biological vector (an animal or plant nature), or a fomite (an inanimate object). The routes by which an infectious agent can enter a host are: inhalation (breathing of aerosols), ingestion (splash of droplets), penetration of mucous membranes (nasal, ocular and oral) and skin or mucous lesions. Sources of infection can be patients, office or laboratory personnel, contaminated surfaces and instruments and the prosthesis or component thereof. To prevent the spread of microbial agents, the process of their transmission must be interrupted. Every professional must strengthen and readjust biosafety standards and protocols in daily work to minimize the risk of direct and cross-transmission between the professional, his auxiliary team, the laboratory technician and the patients (AU)

Inhibición de las actividades proteolítica y fosfolipasa A2 del veneno de Bothrops asper por el extracto etanólico de Neurolaena lobata (L) Cass / Inhibition of proteolytic and phospholipase A2 activities of Bothrops asper venom by the ethanolic extract of Neurolaena lobata (L) Cass

Neurolaena lobata es utilizada tradicionalmente en Centroamérica para tratar la mordedura de serpiente, pero su efectividad para contrarrestar el envenenamiento producido por Bothrops asper ha sido poco estudiada. Se evaluó la capacidad del extracto etanólico de sus hojas para inhibir las actividades proteolítica, fosfolipasa A2 (PLA2; evaluada como hemólisis indirecta) y coagulante del veneno in vitro. El material vegetal fue colectado en Izabal, Guatemala, secado, se hicieron extracciones con etanol y se evaluó la presencia de actividades proteolítica, PLA2 y coagulante in-trínsecas en ensayos de concentración-actividad. Los efectos inhibitorios de la actividad proteolítica y PLA2 del veneno se evaluaron después de pre-incubar concentraciones variables del extracto con concentraciones fijas de veneno. La inhibición de la actividad coagulante del veneno no fue evaluada porque el extracto presentó actividad anticoagulante intrínseca dependiente de la concentración. El extracto inhibió completamente las actividades proteolítica (CE50 = 15.7 µg/µl) y PLA2 (CE50 = 32.5 µg/µl) del veneno. El análisis fitoquímico utilizando ensayos macro y semimicrométricos de cromatografía en capa fina, demostró la presencia de flavonoides, cumarinas, saponinas, taninos, sesquiterpenlactonas y aceites esenciales en el extracto. Su efecto sobre las proteínas del veneno se evaluó por electroforesis SDS-PAGE, mostrando cambios en el patrón electroforético atribuidos a la formación de complejos moleculares con los metabo-litos del extracto. Los resultados indican que el extracto podría inhibir los efectos tóxicos del veneno inducidos por las metaloproteinasas dependientes de zinc (SVMPs) y PLA2s, pero podría afectar las alteraciones en la coagulación, coadyuvando en la desfibrinogenación inducida por el veneno.

Neurolaena lobata has been used by traditional healers in Central America to treat snakebite, but its ability to neutralize Bothrops asper envenomations needs to be proved. This study evaluated the inhibitory potential of the ethanolic extract of the leaves of N. lobata against proteolytic, phospholipase A2 (PLA2) and coagulant activities of the venom in vitro. Leaves were collected in Izabal, Guatemala, dried, extracted with ethanol and concentration-response assays were conducted to detect intrinsic proteolytic, PLA2 (evaluated as indirect hemolysis) and coagulant activities. Assays for anti-proteolytic and anti-PLA2 activities were performed after pre-incubation of several amounts of extract with a fixed concentration of venom. Inhibition assay for the coagulant effect of the venom was not tested because pre-incubation of thrombin with the extract prolonged the clotting time of plasma in a concentration-dependent manner. Proteolytic (EC50 = 15.7 µg/µl) and PLA2 (EC50 = 32.5 µg/µl) activities of the venom resulted completely inhibited by the extract. Phytochemical profiles, determined by micrometric assays and semi microanalysis by thin layer chro-matography, showed the presence of flavonoids, coumarins, saponins, tannins, sesquiterpene lactones and essential oils in the extract. SDS-PAGE was used to assess the action of the extract on the venom proteins. Results showed changes in the electrophoretic profile, probably due to the formation of insoluble complexes with plant specialized metabolites. These findings demonstrated that the extract could be able to inhibit toxic effects triggered by zinc-dependent snake venom metalloproteinases (SVMPs) y PLA2s but might aggravate the alterations induced by the venom in coagulation.

Perinevic dermatosis neglecta: clinical and dermoscopic description

Abstract: Perinevic dermatosis neglecta is an underestimated skin condition usually affecting children and adolescents, characterized by the appearance of dirt-like brownish pigmentation around a preexisting nevus and often a matter of concern for parents. We describe the clinical and dermoscopic findings in a case of perinaevic dermatosis neglecta and discuss the possible etiology of this phenomenon.

Actividad antiurolítica del extracto etanólico de propóleo ayacuchano en ratas / Antiurolithic Activity of the Ethanolic Extract of Ayacuchano Propolis in Rats

RESUMEN Objetivos Determinar la actividad antiurolítica del extracto etanólico de propóleo ayacuchano en un modelo preventivo de urolitiasis inducido en ratas. Materiales y métodos Se estudiaron 45 ratas albinas macho Sprague-Dawley. El efecto antiurolítico se analizó en cinco grupos de seis animales: blanco, control (1 mL de etilenglicol al 5% y 1 mL cloruro de amonio al 5%) y tres grupos tratados con el extracto etanólico de propóleo a dosis diaria de 250, 350 y 500 mg/Kg. Las sustancias fueron administradas mediante canulación orogástrica durante 16 días. El efecto diurético se evaluó en 15 ratas distribuidas en cinco grupos: blanco, control (furosemida 20 mg/Kg) y tres grupos tratados con extracto etanólico de propóleo a dosis de 250, 350 y 500 mg/Kg. Se midió el pH urinario, densidad urinaria y sedimentación del oxalato de calcio; la presencia de cálculos renales se evaluó mediante cortes histopatológicos por tinción con hematoxilina-eosina bajo luz polarizada. Resultados El extracto etanólico de propóleo ayacuchano produjo cambios significativos en los valores de ácido úrico, lactato deshidrogenasa sérico, pH, densidad urinaria al comparar los tres grupos dosis; en el análisis histológico observado a luz polarizada se observó menor presencia de cristales de oxalato de calcio en células tubulares del riñón en el grupo tratado a dosis de 250 mg/Kg; el efecto diurético en el grupo tratado con dosis de 250 mg/kg fue mayor en comparación con la furosemida. Conclusiones El extracto etanólico de propóleo ayacuchano presenta actividad antiurolítica en el modelo preventivo de urolitiasis en ratas albinas.

ABSTRACT Objectives To determine the antiurolytic activity of the ethanolic extract of Ayacuchan propolis in a preventive model of urolithiasis in rats. Materials and methods A total of 45 male Sprague-Dawley albino rats were studied. The antiurolithic effect was analyzed in five groups of six animals each: blank, control (treated with 1 mL of 5% ethylene glycol and 1 mL of 5% ammonium chloride), and three experimental groups (treated with the ethanol extract of propolis at a daily dose of 250, 350, and 500 mg/kg, respectively). The drugs were administered by orogastric cannulation for 16 days. The diuretic effect was evaluated in 15 rats distributed in five groups: blank, control (treated with furosemide at 20 mg/kg), and three experimental groups (treated with the ethanol extract of propolis at daily doses of 250, 350, and 500 mg/kg, respectively). Urinary pH, urinary density, and sedimentation of calcium oxalate were measured. The presence of kidney stones was evaluated by examination of hematoxylin-eosin-stained histopathological sections under polarized light. Results The ethanolic extract of Ayacuchan propolis caused significant changes in the levels of uric acid, serum lactate dehydrogenase, pH, and urinary density in the three dose groups. The results of histological analysis indicated a lower presence of calcium oxalate crystals in kidney tubular cells in the group treated with 250 mg/kg. The diuretic effect in the group treated with 250 mg/kg was higher than that in the control group. Conclusions The ethanolic extract of Ayacuchan propolis demonstrated antiurolytic activity in a preventive rat model of urolithiasis.

Reclassification and treatment of odontogenic keratocysts: A cohort study

Abstract: The odontogenic keratocyst (OKC) is a recurrent cyst that has been recently reclassified from an odontogenic tumor to an odontogenic cyst. The aim of the present study was to investigate its treatment and address issues related to its association with nevoid basal cell carcinoma syndrome (NBCCS). Lesions from the cohort of patients included in the present study consisted of 40 OKCs, of which 27 lesions were treated by enucleation (GE) and 13 underwent decompression (GD). Complementary treatment occurred in 38 (95%) lesions, of which 10 underwent isolated peripheral ostectomy (GO) and 28 underwent peripheral ostectomy combined with Carnoy's solution (GC). Thirteen lesions were associated with NBCCS (GS), while the others (n=27) were non-syndromic lesions (GnS). The recurrence-free periods (RFP) in the sample groups were compared using the Kaplan-Meier function and log-rank test at a significance level of 5% (p < 0.05) and were used to calculate the cumulative risk of recurrence (CRR) in each postoperative year. During the follow-up period, which had a mean of 43.5 months (range: 12-102 months), six (15%) recurrences were diagnosed. There was no significant difference among the RFP for the compared groups (p > 0.05) or increased CRR for the decompression (15.4%) over five years. Application of Carnoy's solution did not increase the efficacy of the peripheral ostectomy, but was related to a CRR of 0% for the syndromic lesions over five years. Therefore, 1) decompression did not increase the recurrence risk; 2) peripheral ostectomy demonstrated a similar efficacy as the combination with Carnoy's solution; 3) the association of NBCCS did not seem to significantly influence OKC recurrence; and 4) syndromic lesions seem to behave in the same manner as non-syndromic lesions when submitted to complementary treatments.

Long-term Results after CT-Guided Percutaneous Ethanol Ablation for the Treatment of Hyperfunctioning Adrenal Disorders

OBJECTIVES: To evaluate the safety and long-term efficacy of computed tomography-guided percutaneous ethanol ablation for benign primary and secondary hyperfunctioning adrenal disorders. METHOD: We retrospectively evaluated the long-term results of nine patients treated with computed tomography-guided percutaneous ethanol ablation: eight subjects who presented with primary adrenal disorders, such as pheochromocytoma, primary macronodular adrenal hyperplasia and aldosterone-producing adenoma, and one subject with Cushing disease refractory to conventional treatment. Eleven sessions were performed for the nine patients. The patient data were reviewed for the clinical outcome and procedure-related complications over ten years. RESULTS: Patients with aldosterone-producing adenoma had clinical improvement: symptoms recurred in one case 96 months after ethanol ablation, and the other patient was still in remission 110 months later. All patients with pheochromocytoma had clinical improvement but were eventually submitted to surgery for complete remission. No significant clinical improvement was seen in patients with hypercortisolism due to primary macronodular adrenal hyperplasia or Cushing disease. Major complications were seen in five of the eleven procedures and included cardiovascular instability and myocardial infarction. Minor complications attributed to sedation were seen in two patients. CONCLUSION: Computed tomography-guided ethanol ablation does not appear to be suitable for the long-term treatment of hyperfunctioning adrenal disorders and is not without risks.

Fungal contamination and disinfection of dental chairs, Teresina, Piauí, Brazil / Contaminação de fungos e desinfecção em cadeiras odontologicas, Teresina, Piauí, Brasil

The aim of this study was to analyze fungal contamination on dental chairs at the clinic of a Higher Education Institution in TeresinaPI, Brazil, and to evaluate the effectiveness of different disinfectants: 70% alcohol and 1% sodium hypochlorite. We selected the five sites with most contact between patient and chair: headrest, backrest, armrests, seat and foot rest. Samples were collected from these sites on 14 chairs and inoculated in agar Sabouraud culture medium containing chloramphenicol. Pathogenic fungi were isolated from all sampling sites on the chairs. Highest frequencies were found on footrest, followed in decreasing order by seat, backrest, armrests and headrest. Fourteen species of filamentous fungi were identified, belonging to the genera Alternaria, Aspergillus, Cladosporium, Curvularia, Drechslera, Fusarium, Penicillium and Paecillomyces. After sampling, seven chairs were disinfected with 70% alcohol and seven with 1% sodium hypochlorite, and samples were taken again using the same procedure. No fungal growth was detected following disinfection with sodium hypochlorite, which was clearly more effective than alcohol, after which there was still fungal growth. This study highlights the need for the biosafety protocol to include cleaning and disinfection of dental chairs with 1% sodium hypochlorite after each attendance in order to prevent crossinfection.

O objetivo deste estudo foi analisar contaminação fúngica em cadeiras odontológicas na clínica de uma Instituição de Educação Superior em TeresinaPI, Brasil, e avaliar a efetividade de diferentes desinfetantes: álcool 70% e hipoclorito de sódio 1%. Nós selecionamos os cinco locais com maior contato entre o paciente e a cadeira: encosto da cabeça, das costas, dos braços, assento e encosto dos pés. As amostras foram coletadas destes locais das 14 cadeiras e inoculadas em meio de cultura agarSabouraud contendo cloranfenicol. Fungos patogênicos foram isolados de todos os locais de amostragem das cadeiras. As frequências mais altas foram encontradas no encosto dos pés, seguido em ordem decrescente pelo assento, encosto das costas, dos braços e encosto da cabeça. Quatorze espécies de fungos filamentoso foram identificados, pertencente aos gêneros Alternaria, Aspergillus, Cladosporium, Curvularia, Drechslera, Fusarium, Penicillium e Paecillomyces. Após a coleta, sete cadeiras foram desinfe tadas com álcool 70% e sete com hipoclorito de sódio 1%, e as amostras foram colhidas novamente usando o mesmo procedimento. Não foi detectado crescimento fúngico após desinfecção com hipoclorito de sódio, que foi claramente mais efetivo que o álcool, do qual ainda houve crescimento fúngico.Este estudo destaca a necessidade da inclusão no protocolo de biossegurança a limpeza e desinfecção das cadeiras odontológicas com o hipoclorito 1% após cada atendimento, a fim de prevenir infecções cruzadas.

Sterilizing elastomeric chains without losing mechanical properties. Is it possible?

OBJECTIVE: To investigate the effects of different sterilization/disinfection methods on the mechanical properties of orthodontic elastomeric chains. METHODS: Segments of elastomeric chains with 5 links each were sent for sterilization by cobalt 60 (Co60) (20 KGy) gamma ray technology. After the procedure, the elastomeric chains were contaminated with clinical samples of Streptococcus mutans. Subsequently, the elastomeric chains were submitted to sterilization/disinfection tests carried out by means of different methods, forming six study groups, as follows: Group 1 (control - without contamination), Group 2 (70°GL alcohol), Group 3 (autoclave), Group 4 (ultraviolet), Group 5 (peracetic acid) and Group 6 (glutaraldehyde). After sterilization/disinfection, the effectiveness of these methods, by Colony forming units per mL (CFU/mL), and the mechanical properties of the material were assessed. Student's t-test was used to assess the number of CFUs while ANOVA and Tukey's test were used to assess elastic strength. RESULTS: Ultraviolet treatment was not completely effective for sterilization. No loss of mechanical properties occurred with the use of the different sterilization methods (p > 0.05). CONCLUSION: Biological control of elastomeric chains does not affect their mechanical properties. .

OBJETIVO: verificar os efeitos de diferentes métodos de esterilização/desinfecção nas propriedades mecânicas de elásticos ortodônticos em cadeia. MÉTODOS: segmentos de elástico em cadeia com 5 elos cada foram enviados para esterilização em radiação gama com cobalto 60 (20 KGy). Após esterilização, esses foram contaminados com amostras clínicas de Streptococcus mutans. Passado esse período, foram submetidos aos testes de esterilização/desinfecção por diferentes métodos, formando seis grupos de estudo, assim denominados: Grupo 1 (controle - sem ter sido contaminado), Grupo 2 (álcool 70°GL), Grupo 3 (autoclave), Grupo 4 (ultravioleta), Grupo 5 (ácido peracético) e Grupo 6 (glutaraldeído). Após esterilização/desinfecção, avaliou-se a efetividade desses métodos, por meio de contagem de unidades formadoras de colônias por mL (UFC/mL), e as propriedades mecânicas desses materiais. Utilizou-se o teste t de Student para avaliar o número de UFC, além do ANOVA e, posteriormente, do teste de Tukey para avaliação da força. RESULTADOS: verificou-se que o ultravioleta não obteve eficácia total quanto à esterilização. E não ocorreu perda das propriedades mecânicas dos elásticos, com os diferentes métodos de esterilização utilizados (p > 0,05). CONCLUSÃO: o controle biológico de elásticos em cadeia não interfere nas suas propriedades mecânicas. .

Radiofrequency versus Ethanol Ablation for Treating Predominantly Cystic Thyroid Nodules: A Randomized Clinical Trial

OBJECTIVE: To compare single-session radiofrequency ablation (RFA) and ethanol ablation (EA) for treating predominantly cystic thyroid nodules (PCTNs). MATERIALS AND METHODS: This single-blind, randomized trial was approved by the Institutional Review Board of two centers and informed consent was obtained from all patients before enrollment. Fifty patients with a single PCTN (cystic portion less than 90% and greater than 50%) were randomly assigned to be treated by either RFA (25 patients) or EA (25 patients) at two hospitals. The primary outcome was the tumor volume reduction ratio (%) at the six-month follow-up and the superiority margin was set at 13% (RFA minus EA). Analysis was performed primarily in an intention-to-treat manner. The secondary outcomes were the therapeutic success rate, improvement of symptomatic and cosmetic problems, and the number of major complications. RESULTS: The mean volume reduction was 87.5 ± 11.5% for RFA (n = 22) and 82.4 ± 28.6% for EA (n = 24) (p = 0.710; mean difference [95% confidence interval], 5.1% [-8.0 to 18.2]), indicating no significant difference. Regarding the secondary outcomes, therapeutic success (p = 0.490), mean symptom (p = 0.205) and cosmetic scores (p = 0.710) showed no difference. There were no major complications in either group (p > 0.99). CONCLUSION: The therapeutic efficacy of RFA is not superior to that of EA; therefore, EA might be preferable as the first-line treatment for PCTNs.

Ethanol sclerotherapy of head and neck venous malformations / Escleroterapia com etanol em malformações venosas da cabeça e pescoço

Objective This retrospective study evaluated the results of sclerotherapy with low doses of ethanol for treatment of head and neck venous malformations. Methods We treated 51 patients, 37 females. Median age was 23 years. Patients were treated with percutaneous intralesional injection of alcohol every two weeks and followed up prospectively for a median period of 18 months. Most lesions affected the face and cosmetic disfigurement was the most frequent complaint. Results We performed a median of 7 sessions of sclerotherapy. Complete resolution or improvement was observed in 48 patients presented. Five cases of small skin ulceration, two cases of hyperpigmentation and two of paresthesia were documented; all of them were treated conservatively. Conclusion Percutaneous sclerotherapy with low doses of ethanol is a safe and effective treatment modality for venous malformations affecting the head and neck. .

Objetivo Estudo retrospectivo que analisou os resultados da escleroterapia, com doses baixas de etanol, realizada sob anestesia local para tratamento de malformações venosas na cabeça e pescoço. Métodos Foram tratados 51 pacientes, sendo 37 do gênero feminino. A mediana de idade foi de 23 anos. Os pacientes foram tratados com injeções alcoólicas nas lesões, por via percutânea, em sessões quinzenais, e acompanhados prospectivamente por um período mediano de 18 meses. A maioria das lesões acometia a face e a queixa principal mais frequente foi deformidade estética. Resultados Foram realizadas, em média, sete sessões de escleroterapia. Resolução completa ou melhora foi observada em 48 pacientes. Cinco pacientes apresentaram pequena úlcera cutânea, dois hiperpigmentação e dois parestesia, sendo todos tratados conservadoramente. Conclusão A escleroterapia percutânea com doses baixas de etanol é um método seguro e eficaz para tratar malformações venosas na cabeça e pescoço. .

Metástases hepáticas: abordagem atual / Liver metastases: current approach

O tratamento cirúrgico das metástases hepáticas cada vez mais é evidenciado como o mais importante nos pacientes com câncer. Mesmo sabendo-se que 25% a 50% dos pacientes que morrem por neoplasias malignas apresentam metástases hepáticas, muito benefício tem sido relatado com os avanços da cirurgia hepática e da terapia anticancerosa regional. Com isso, cada vez mais os cirurgiões acreditam na necessidade de reavaliação e de manejo dos pacientes com metástases no fígado.

Surgical treatment of liver metastasis is increasingly highlighted as the most important in patients with cancer. Even knowing that 25% to 50% of patients who die from malignant neoplasms have liver metastasis, much benefit has been reported with advances in liver surgery and regional anticancer therapy. With this, more and more surgeons believe in the re-evaluation and management of patients with liver metastasis.

The Effect of Obturator Nerve Block on Hip Lateralization in Low Functioning Children with Spastic Cerebral Palsy

PURPOSE: Hip adductor spasticity has a great impact on developing hip displacement in children with cerebral palsy (CP). Obturator nerve (ON) block is less invasive intervention rather than soft tissue surgery for reduction of hip adductor spasticity. The aim of this study is to investigate the effect of ON block on hip lateralization in low functioning children with spastic CP. MATERIALS AND METHODS: The study was performed by retrospective investigation of the clinical and radiographic follow-up data of low functioning children [gross motor function classification system (GMFCS) level III to V] with spastic cerebral palsy whose hip was subluxated. Migration percentage (MP) was measured on hip radiographs and its annual change was calculated. In intervention group, ON block was done with 50% ethyl alcohol under the guidance of electrical stimulation. RESULTS: The data of 49 legs of 25 children for intervention group and the data of 41 legs of 23 children for nonintervention group were collected. In intervention group, the MP were significantly reduced at 1st follow-up and the MPs at 2nd and last follow-up did not show significant differences from initial MP. Whereas in nonintervention group, the MPs at 1st, 2nd and last follow-up were all significantly increased compared to initial MPs. CONCLUSION: ON block with ethyl alcohol is useful as an early effective procedure against progressive hip displacement in these children with spastic CP.

Percepção dos pacientes em uso de enxaguatórios bucais: óleos essenciais e cloreto de cetilperidíneo / Perception of patients with use mouthwashes: essential oils and cetylpyridinium chloride

Objetivo: Avaliar a percepção dos pacientes quanto às sensações após o uso de enxagua­tórios à base de óleos essenciais e àlcool e à base de cloreto de cetilperidíneo. Métodos: Foram constituídos 2 grupos (n= 15) que realizaram 2 bochechos diários durante 3 semanas: G 1 - enxaguatório a base de óleos essenciais e álcool, em bochechos de 30 segundos; G2 - enxaguatório à base de cloreto de cetilperidínio, em bochechos de 60 segundos. Ao final de 3 semanas, os participantes responderam a um questionário sobre desconforto, alteração de paladar, sensibi­lidade dentária e ressecamento da mucosa oral. Resultados: O desconforto foi de 93,3% para G1 e de 26,6% em G2, sendo o ardor o mais relatado (86,6% em G1 e 26,6% em G2). Não foi relatada sensibilidade ou alteração dentária nos grupos avaliados. O ressecamento da mucosa ocorreu em 66,6% no G 1 e 33,3% no G2. A alteração de paladar ocorreu somente em 13,3% do G1 com diminuição da sensibilidade e gosto metálico. Conclusão: A utilização contínua de enxaguatórios com óleos essenciais e álcool causou maior desconforto quando comparado ao cloreto de cetilperidínio.

Objective: Evaluate the perceptions of patients about the effects of the use of mouthwash based on essential oils and alcohol -based and cetylpyridinium chloride. Methods: 2 groups ( n = 15) who underwent 2 mouthwash daily for 3 weeks were formed: G1 - a mouthwash based on essential oils and alcohol in mouthwash for 30 seconds; G2 - the base of mouthwash cetil­ peridínio chloride in mouthwashes 60 seconds. At the end of 3 weeks, participants answered a questionnaire on discomfort , change in taste, tooth sensitivity and dryness of the oral mucosa. Results: The discomfort was 93.3 % for G1 and 26.6% in G2, with the ardor as reported (86.6% in G1 and 26.6 % in G2) . It was reported tooth sensitivity or change in study groups. The dryness of the mucosa occurred in 66.6 % in G1 and 33.3% in G2. The taste change occurred in only 13.3% of G 1 with decreased sensitivity and metallic taste . Conclusion: The continuous use of mouthwashes with essential oils and alcohol caused greater discomfort when compared to cetilperidínio chloride.

Alcohol extract of Schinu sterebinthifolius raddi (anacardiaceae) as a local antimicrobial agent in severe autogenously fecal peritonitis in rats

PURPOSE: To develop an alcoholic extract of the inner bark of the Schinus terebinthifolius raddi and to test its impact on autogenously fecal peritonitis in Wistar rats. METHODS: The inner bark of the Schinus terebinthifolius raddi was kept for seven days in 70% ethanol alcohol. The total elimination of the solvent was performed in a rotary evaporator under reduced pressure at 55-60°C. Four milliliter of this extract was injected, after 24 h, into the abdominal cavity of six out of eight survival rats that underwent autogenously fecal peritonitis with five milliliter of 10% filtered fecal suspension. They were clinically followed up for 45 days when they were euthanized. The necropsy findings (inventory) of the abdominal and thorax cavities were inspected and the main findings were recorded and photographed. The investigation was approved by the Ethics Committee. RESULTS: Two out of six survival rats that were critically ill after 24 h died within the 12 h after the extract injection into the abdominal cavity. Four rats that were also critically ill recovered and gradually became healthy, eating well, regaining weight and moving normally in the cage. At 45 days post severe peritonitis the necropsy findings revealed few signs of residual infection on the abdominal and thorax cavities. There were no bowel adhesions. CONCLUSION: The impact of alcoholic extract of the inner bark of the Schinus terebinthifolius raddi was considered very positive and promising as natural local antiseptic against very severe peritonitis in Wistar rats. .

RE: Metastasis of Gallbladder Adenocarcinoma to Bauhin's Valve: An Extremely Rare Cause of Intestinal Obstruction

No abstract available.

Sclerotherapy of hydroceles and spermatoceles with alcohol: results and effects on the semen analysis

PURPOSE: To evaluate the success rates of sclerotherapy of the tunica vaginalis with alcohol for the treatment of hydroceles and/or spermatoceles, as well as, evaluation of pain, formation of hematomas, infection and its effects in spermatogenesis . MATERIALS AND METHODS: A total of 69 patients, with offsprings and diagnosis of hydrocele and/or spermatocele, were treated during the period from April 2003 to June 2007. Semen analysis was obtained from patients who were able to provide us with samples. The sclerotherapy with alcohol at 99.5 percent was undertaken as outpatient procedure. RESULTS: The average volume drained pre-sclerotherapy was 279.82 mL (27 to 1145). The median follow-up was 43 months (9 to 80). A total of 114 procedures were performed on 84 units, with an average of 1.35 procedures / unit and an overall success rate of 97.62 percent. Of the 69 patients, 7 (10.14 percent) reported minor pain immediately after the procedure, 3 (4.35 percent) moderate pain and 2 (2.89 percent) intense pain. Post-Sclerotherapy spermograms revealed reduction of the parameters regarding: concentration, motility and morphology up to 6 months post procedure , with return to normal parameters 12th months after procedure. CONCLUSIONS: Sclerotherapy of hydroceles and spermatoceles with 99.5 percent alcohol is an efficient procedure that can be perormed without difficulties, cost-effectiveness, with few side effects and which may be performed in patients who wish fertility.