Extrahepatic anterograde covered self-expandable metallic stent placement across malignant biliary obstruction passed by endoscopic ultrasound guidance access: a challenging technique.

The authors report the case of a female patient submitted to endoscopic cholangiography intending to drain the biliary tree due to jaundice. The patient had gastrointestinal deviation due to an advanced gastric cancer that evolved with a distal extrahepatic mass. Abdominal CT scan demonstrated a distal mass, extrahepatic biliary dilation and a normal intra-hepatic tree. In this condition and after a multidisciplinary discussion, an endoscopic ultrasound guided extrahepatic access with the deployment of a partially covered self-expandable metallic stent was performed. The patient normalized her bilirubin levels after a successful procedure.

A leucine-rich diet and exercise affect the biomechanical characteristics of the digital flexor tendon in rats after nutritional recovery.

An increase in the capacity of athletic performance depends on adequate nutrition, which ensures optimal function of the musculoskeletal system, including tendon stability. However, little is known about the status of tendons and extracellular matrix modifications during malnutrition and nutritional recovery when leucine is used in response to exercise conditioning. The purpose of this study was to evaluate the collagen content and biomechanical aspects of the deep digital flexor tendon (DDFT) in malnourished rats submitted to nutritional recovery (control diet or leucine-rich diet) and aerobic physical activity. After 60 days of undernourishment (6% protein diet), the malnourished rats were subsequently nutritionally recovered with a control diet or leucine-rich diet and trained or not (swimming, without overload) for 5 weeks. The biomechanical analysis and quantification of hydroxyproline were assessed in the DDFT in all experimental groups. The leucine-rich diet increased hydroxyproline content in the tension region, independently of the training. In the compression region, hydroxyproline content was higher in the malnourished and leucine-trained groups. Biomechanical analysis showed a lower load in the malnourished and all-trained groups. The lowest stress was observed with control-trained animals. The nutritional-recovered groups showed higher strain values corresponding to control group, while the lowest values were observed in malnourished and trained groups. The results suggest that a leucine-rich diet stimulates collagen synthesis of the DDFT, especially when in combination with physical exercise, and seems to determine the increase of resistance and the biomechanical characteristics of tendons.

Predictive complication factors for CT-guided fine needle aspiration biopsy of pulmonary lesions.

OBJECTIVE: Distinct aspects can influence the complication rates of computed tomography-guided percutaneous fine needle aspiration biopsy of lung lesions. The purpose of the current study is to determine the influence of radiological techniques and clinical characteristics in predicting complications from this procedure. SUBJECTS AND METHODS: A retrospective study was developed involving 340 patients who were submitted to a consecutive series of 362 computed tomography-guided fine needle aspiration biopsies of lung lesions between July 1996 and June 2004, using 22-gauge needles (CHIBA). Variables such as the radiological characteristics of the lesions, secondary pulmonary radiological findings, co-morbidities, and aspects concerning the procedure were studied. RESULTS: The diameters of the lung lesions varied from 9 to 140 mm, with a mean of 51.5 ± 24.3 mm and median of 40mm. The depth of the lesions varied from 10 mm to 130 mm, with a mean of 44 ± 20.9mm, and median median of 52 mm. Complications occurred in 52 (14.4%) cases, pneumothorax being the most frequent, with 40 (11.1%) cases, followed by hemoptisis with 7 (1.9%) cases, and hematoma with 4 (1.1%) cases. Lesions that did not contact the pleura, with normal pulmonary tissue interposition between lesion and pleura, had higher complication rates, with 22 (22%) cases, than lesions that contact the pleura, with 6 (9%) cases, with a statistically significant difference (p = 0.03). CONCLUSIONS: CT-guided percutaneous fine needle aspiration biopsy of lung lesions had a lower rate of complications in our study and presented more rates of complications on lesions that lack pleural contact.

Comparative study of the effects of gallium-aluminum-arsenide laser photobiomodulation and healing oil on skin wounds in wistar rats: a histomorphometric study.

OBJECTIVE: The present study compared the effects of gallium-aluminum-arsenide diode laser and healing oil on fibroblasts, blood vessels, and collagen maturation of skin wounds in Wistar rats. MATERIALS AND METHODS: Twenty-four male rats weighing 325 ± 27 g were used. Five wounds, 12 mm in diameter, were made on the animals' backs. The rats were randomly divided into four groups with six animals in each group. CONTROL GROUP: saline solution; L30 group: 30 J/cm(2) laser; L60 group: 60 J/cm(2) laser; Oil group: healing oil. Histomorphometric analysis was performed on the scar tissue removed from the different wounds every 4 d for 20 d. RESULTS: On day 4, there were significantly more fibroblasts in the wounds treated with the laser and the healing oil compared to the controls. On day 8, there were significantly more fibroblasts in the oil group compared to the L30 and L60 groups. On the same day, the quantity of vessels was significantly greater in the L60 group compared to the other groups. On day 16, there was a significant increase in the number of blood vessels in the wounds treated with the 60 J/cm(2) laser compared to the other groups. Analysis of the collagen maturation index throughout the experiment showed significantly higher values in the L60 group compared to the other groups at all time points. CONCLUSION: The healing oil exerted a greater effect on fibroblast proliferation, whereas the 60 J/cm(2) laser was more effective in stimulating angiogenesis and scar-tissue maturation.

The effect of age and spontaneous exercise on the biomechanical and biochemical properties of chicken superficial digital flexor tendon.

The aim of this study was to evaluate if spontaneous (nonforced active) exercise and age (maturation process) alter the biomechanical and biochemical properties of superficial digital flexor tendon. Chickens aged 1, 5, and 8 months were divided into two groups: caged and penned. The caged group was reared in an area of 0.5 m(2) (3 animals/cage), while the penned group was reared in an area of 60 m(2) (3 animals/area). For biochemical analysis, the tendon was divided into tensile and compressive regions for quantification of hydroxyproline and glycosaminoglycan content. Biomechanical properties were analyzed from tensile tests of intact tendons. The biomechanical measurements were taken at maximum load and maximum stress. In both the caged and penned groups, maximum load and energy absorption increased with maturation; however, the elastic modulus, maximum stress, and maximum strain did not increase with maturation. Exercise resulted in a higher load, stress, and elastic modulus in the fifth month. Collagen content increased with age in the penned group and with exercise in the fifth and eighth months. Exercise results in a higher expression of glycosaminoglycans in young tendons compared to mature tendons. Thus, low-intensity mechanical stimuli promote the synthesis and possible rearrangement of molecules in immature tendons, whereas inactivity leads to deleterious effects on the material properties (maximum stress and elastic modulus) during growth and maturation.

Predictive complication factors for ct-guided fine needle aspiration biopsy of pulmonary lesions

OBJECTIVE: Distinct aspects can influence the complication rates of computed tomography-guided percutaneous fine needle aspiration biopsy of lung lesions. The purpose of the current study is to determine the influence of radiological techniques and clinical characteristics in predicting complications from this procedure. SUBJECTS AND METHODS: A retrospective study was developed involving 340 patients who were submitted to a consecutive series of 362 computed tomography-guided fine needle aspiration biopsies of lung lesions between July 1996 and June 2004, using 22-gauge needles (CHIBA). Variables such as the radiological characteristics of the lesions, secondary pulmonary radiological findings, co-morbidities, and aspects concerning the procedure were studied. RESULTS: The diameters of the lung lesions varied from 9 to 140 mm, with a mean of 51.5 ± 24.3 mm and median of 40mm. The depth of the lesions varied from 10 mm to 130 mm, with a mean of 44 ± 20.9mm, and median median of 52 mm. Complications occurred in 52 (14.4 percent) cases, pneumothorax being the most frequent, with 40 (11.1 percent) cases, followed by hemoptisis with 7 (1.9 percent) cases, and hematoma with 4 (1.1 percent) cases. Lesions that did not contact the pleura, with normal pulmonary tissue interposition between lesion and pleura, had higher complication rates, with 22 (22 percent) cases, than lesions that contact the pleura, with 6 (9 percent) cases, with a statistically significant difference (p = 0.03). CONCLUSIONS: CT-guided percutaneous fine needle aspiration biopsy of lung lesions had a lower rate of complications in our study and presented more rates of complications on lesions that lack pleural contact.

Hemorragia digestiva alta varicosa: avaliação e terapêutica / Bleeding from esophagogastric varices: evaluation and therapy

A história natural da cirrose após um episódio de hemorragia das varizes foi definida a partir de ensaios clínicos em que indivíduos "controles" não receberam nenhum tratamento específico para evitar ressangramento. Os dados cumulativos indicam que mais de 70 por cento dos pacientes apresentarão recorrência hemorrágica dentro de primeiro ano do episódio inicial. O risco de ressangramento é maior imediatamente após a cessação do sangramento ativo e depois declina, chegando, após seis semanas, próximo aos valores basais. Cerca de 70 por cento de todos os pacientes não tratados morrem no primeiro ano após o primeiro episódio hemorrágico. As causas de morte incluem hemorragia variceal recorrente, insuficiência hepática, encefalopatia hepática, ascite progressiva e infecções. O tratamento ideal seria universalmente eficaz, seguro, disponível, fácil de administrar e barato. Por não existir este tipo ideal de tratamento, a escolha de determinada modalidade em relação à outra envolve considerações de sua relativa eficácia e segurança, disponibilidade e custos. As principais opções são escleroterapia endoscópica, ligadura endoscópica, terapia farmacológica com betabloqueadores e nitratos orais, inserção de TIPS (transjugular intrahepatic portosystemic shunt) e cirurgia

Comparison of two prognostic scores for patients with parotid carcinoma.

BACKGROUND: Salivary glands present a wide diversity in histopathologic types and biologic behaviors, thus complicating the search for prognostic factors. METHODS: We compared 2 prognostic scores that were previously published for patients with parotid carcinoma in a retrospective series of 175 patients treated in a single institution. RESULTS: Cox multivariate analysis indicated clinical skin invasion, facial nerve function, and perineural growth as the most significant recurrent disease-related prognostic factors. According to the Vander Poorten score, 148 patients were divided into 4 groups, with the 5-year disease-free survival of 76%, 81%, 69%, and 35%, respectively. In the Carrillo's score, the patients were divided into 3 groups: low-risk, intermediate-risk, and high-risk, with the 5-year disease-free survival of 84%, 73%, and 34%, respectively. CONCLUSION: Carrillo's score showed more distinct survival curves, and determination of groups with a more favorable prognosis was difficult for both scores. Therefore, both scores were not totally reproducible for our group of patients.

Biomechanical and biochemical properties of chicken calcaneal tendon under effect of age and nonforced active exercise.

This study investigated if nonforced active exercise alters the biomechanical and biochemical properties of calcaneal tendon during maturation. Chickens at 1, 5, and 8 months old were divided into two groups: caged and penned. Intact tendons were used for biomechanical analysis, but they were divided into tensile and compressive regions for quantification of hydroxyproline and glycosaminoglycans. The exercise increased tendon strength after the fifth month, energy absorption in the eighth month, and ultimate tensile stress in the first month. Age increased tendon strength and energy storage and reduced stiffness but did not alter stress. There was an increase in collagen content in the fifth month. Glycosaminoglycans showed a progressive decline in the tensile region. Thus, some biomechanical and biochemical changes depend on the maturation process itself and also are influenced by spontaneous exercise, showing that mechanical stimulation of low intensity may help to improve the quality of the tendon.

Biochemical and biomechanical analysis of tendons of caged and penned chickens.

Chickens were divided into two groups, one caged and the other penned. Superficial digital flexor tendons from penned chickens showed greater tensile strength, withstanding a greater strain before rupture than tendons from caged chickens. The tensile region of tendons from penned chickens showed more swelling in acetic acid and a higher hydroxyproline concentration compared with caged chickens, indicating the presence of large collagen amounts in the former. The tensile region of penned chickens presented higher glycosaminoglycan concentrations than the same region of caged chickens. For both groups, the predominant glycosaminoglycan in the compression regions was chondroitin sulfate, whereas dermatan sulfate was found in the tensile regions. N-terminal analysis identified the small proteoglycans fibromodulin and decorin. SDS-PAGE indicated that decorin was present in all regions and fibromodulin was mainly observed in the tensile region. These results indicate that an external condition, in this case the area available for locomotion, might influence the synthesis of extracellular matrix components and the mechanical properties of the tendon.