ABSTRACT
Introdução: A dor, sintoma comum em pacientes oncológicos, é mal controlada com a terapia convencional em cerca de 10% a 25% dos casos, levando a uma piora significativa da qualidade de vida. Para esses pacientes, a terapia intervencionista, como bloqueios nervosos, procedimentos neurolíticos ou cordotomia e aquelas que necessitam de tratamento contínuo, como a terapia de infusão, levam a bons resultados no controle da dor. Método: Esse artigo é uma revisão bibliográfica realizada entre os anos de 2010 até 2018 sobre métodos intervencionistas para o tratamento da dor em pacientes oncológicos. Resultados: Bloqueios de nervos periféricos são uma forma de tratar a dor relacionada ao câncer, uma única injeção ou série de injeções de anestésico local com ou sem adjuvantes, com a expectativa de alívio da dor de 2 a 6 semanas. Quase todas as regiões das extremidades superior e inferior e a maioria das áreas da cabeça, pescoço e tronco podem ser anestesiados por bloqueios de nervos periféricos. Neurólise com agentes químicos ou físicos é uma outra opção, utilizada para bloquear nervos espinhais ou cranianos e os plexos autonômicos, oferece alívio da dor por alguns meses. A neurólise química é realizada com álcool de alta concentração ou fenol, já a física é através da thermal radiofrequency lesioning (RFL) ou a crioanalgesia. Conclusão: O uso de medicamentos neuroaxiais, proporcionam redução da dose de analgésicos opioides se comparada a dose via oral necessária para obter analgesia semelhante. Isso reduz os efeitos secundários desagradáveis. Os candidatos à terapia neuroaxial contínua são aqueles com requisitos crescentes de opiáceos, dor de difícil controle ou intolerância ao plano analgésico escolhido.
Introduction: Cancer pain management by conventional therapy is ineffective in about 10-25% of cases, leading to a significant decrease in quality of life. interventional therapy, applying either one-time session of nerve blocks, neurolytic procedures, or cordotomy, or long-term treatments as infusion therapy is able to improve cancer pain management. Methodology: This article is a bibliographic review carried out between 2010 and 2018 on interventional methods for the treatment of pain in cancer patients. Results: Peripheral nerve blocks are a way to treat oncology pain. A single injection or a series of injections of local anesthetic with or without adjuvants, with an expectation of pain relief of 2 to 6 weeks. Almost all regions of the upper and lower extremities and most areas of the head, neck and trunk may be anesthetized by peripheral nerve blocks. Neurolysis with chemical or physical agents is another option used to block spinal or cranial nerves and autonomic plexuses offers pain relief for a few months. Chemical neurolysis is performed with high concentrated alcohol or phenol, yet the physical is usually through thermal radiofrequency lesioning (RFL) or cryoanalgesia. Conclusion: The use of neuroaxial drugs, provide a dose reduction of opioid analgesics use compared to the oral dose required to obtain similar analgesia. This reduces unpleasant side effects. The candidates for continuous neuroaxial therapy are those with increasing requirements for opioids, pain of difficult control or intolerance to the chosen analgesic plan.
Subject(s)
Cancer Pain , Anesthetics , PainABSTRACT
Introdução: A neutropenia febril (NF) é uma das mais graves complicações em pacientes com câncer submetidos a quimioterapia. Estes casos exigem pronta avaliação diagnóstica e instituição de terapêutica adequada. A conduta frente a tal emergência ainda é muito discutida apesar dos avanços no tratamento. O objetivo do estudo foi revisar na literatura as medidas mais eficazes de manejo sindrômico da NF. Métodos: Este artigo é uma revisão bibliográfica realizada entre abril e maio de 2018 sobre neutropenia febril. Foi realizada pesquisa de artigos científicos de revisão, guidelines e artigos originais, dos últimos 15 anos. Resultados: O reconhecimento imediato do paciente com NF e seu adequado tratamento com início imediato de terapia empírica, conforme o risco do paciente, são definidores de qualidade do manejo desta síndrome. Conclusão: A avaliação inicial de todos os pacientes com NF deve ser ágil para que terapia empírica seja imediatamente iniciada.
Introduction: Febrile neutropenia (NF) is one of the most serious complications in cancer patients undergoing chemotherapy. These cases require prompt diagnostic evaluation and management. The objective of the study was to review the most effective aspects of NF syndromic management in the literature. Methods: This article is a bibliographical review performed between April and May of 2018 on febrile neutropenia. Research was done on review articles, seminars and original articles of the last 15 years. Results: The immediate recognition of the patient with NF and its appropriate treatment with immediate onset of empirical therapy, according to the risk of the patient, are critical and impact clinical outcomes. Conclusion: The initial assessment of all NF patients should be agile for empirical therapy to be initiated immediately.
Subject(s)
Febrile Neutropenia , Febrile Neutropenia/diagnosis , Febrile Neutropenia/therapy , NeoplasmsABSTRACT
Astrocytes are multitasking players in brain complexity, possessing several receptors and mechanisms to detect, participate and modulate neuronal communication. The functionality of astrocytes has been mainly unraveled through the study of primary astrocyte cultures, and recently our research group characterized a model of astrocyte cultures derived from adult Wistar rats. We, herein, aim to characterize other basal functions of these cells to explore the potential of this model for studying the adult brain. To characterize the astrocytic phenotype, we determined the presence of GFAP, GLAST and GLT 1 proteins in cells by immunofluorescence. Next, we determined the concentrations of thirteen amino acids, ATP, ADP, adenosine and calcium in astrocyte cultures, as well as the activities of Na(+)/K(+)-ATPase and acetylcholine esterase. Furthermore, we assessed the presence of the GABA transporter 1 (GAT 1) and cannabinoid receptor 1 (CB 1) in the astrocytes. Cells demonstrated the presence of glutamine, consistent with their role in the glutamate-glutamine cycle, as well as glutamate and D-serine, amino acids classically known to act as gliotransmitters. ATP was produced and released by the cells and ADP was consumed. Calcium levels were in agreement with those reported in the literature, as were the enzymatic activities measured. The presence of GAT 1 was detected, but the presence of CB 1 was not, suggesting a decreased neuroprotective capacity in adult astrocytes under in vitro conditions. Taken together, our results show cellular functionality regarding the astrocytic role in gliotransmission and neurotransmitter management since they are able to produce and release gliotransmitters and to modulate the cholinergic and GABAergic systems.
Subject(s)
Acetylcholinesterase/analysis , Amino Acids/analysis , Astrocytes/chemistry , Cerebral Cortex/chemistry , Sodium-Potassium-Exchanging ATPase/analysis , Acetylcholinesterase/metabolism , Age Factors , Amino Acids/metabolism , Animals , Astrocytes/metabolism , Cells, Cultured , Cerebral Cortex/metabolism , Chromatography, High Pressure Liquid/methods , GABA Plasma Membrane Transport Proteins/analysis , GABA Plasma Membrane Transport Proteins/metabolism , Male , Rats , Rats, Wistar , Sodium-Potassium-Exchanging ATPase/metabolismABSTRACT
Hyperammonemia induces significant changes in the central nervous system (CNS) in direct association with astroglial functions, such as oxidative damage, glutamatergic excitotoxicity, and impaired glutamine synthetase (GS) activity and pro-inflammatory cytokine release. Classically, lipoic acid (LA) and N-acetylcysteine (NAC) exhibit antioxidant and anti-inflammatory activities by increasing glutathione (GSH) biosynthesis and decreasing pro-inflammatory mediator levels in glial cells. Thus, we evaluated the protective effects of LA and NAC against ammonia cytotoxicity in C6 astroglial cells. Ammonia decreased GSH levels and increased cytokine release and NFκB transcriptional activation. LA and NAC prevented these effects by the modulation of ERK and HO1 pathways. Taken together, these observations show that LA and NAC prevent the ammonia-induced inflammatory response.
