Preoperative biliary drainage in patients performing pancreaticoduodenectomy : guidelines and real-life practice.

BACKGROUND AND AIM: Preoperative biliary drainage (PBD) in patients with pancreatic cancer remains debatable. The aim of this study was to analyse the indications for PBD in patients performing pancreaticoduodenectomy (PD) and to evaluate the impact of this procedure on postoperative outcome. METHODS: Observational retrospective cohort study of patients undergoing PD for pancreatic cancer. Clinical data and postoperative outcome, namely complications and 90-day mortality, were prospectively collected and compared between patients performing PBD or direct surgery (DS). RESULTS: Eighty-two patients were included: 40 underwent PBD and 42 performed DS. Major complications (27.5% vs 33.3%, P=0.156) and 90-day mortality (10% vs 16.7%, P=0.376) were similar between the two groups. There was a trend for higher mean total bilirubin in patients with PBD (P=0.073). The indication for PBD was suspicion of cholangitis/choledocholithiasis or need to perform neoadjuvant chemotherapy in 24 (60%) patients. In the remaining, elevated bilirubin was probably the only reason to perform PBD. Length of hospital stay was longer in PBD group (P=0.003). On multiple logistic regression, 90-day mortality was not related with preoperative bilirubin levels, biliary drainage or its indication, but solely with age (OR 1.15, 95%CI 1.05-1.31, P=0.008). CONCLUSIONS: PBD is often performed in patients undergoing PD without a formal indication, mainly due to high bilirubin levels. No increased morbidity/mortality was observed but length of hospital stay was prolonged in patients performing PBD.

Topical monomethylsilanetriol can deliver silicon to the viable skin.

OBJECTIVE: Organic silicon has been linked to positive effects on the skin rejuvenation, mainly by the oral route. Thus, the main objective of the present study was to assess whether monomethylsilanetriol (MMST, a source of organic silicon) can deliver silicon to the epidermis and dermis, when applied topically in a cream. Once the hypothesis was confirmed, the present study also evaluated whether the product was toxic to keratinocytes; additionally, its possible antioxidant activity was assessed. METHODS: The ex vivo skin permeation profile was determined using human skin in Franz-cells equipment; cytotoxicity was assessed using HaCaT keratinocytes. Antioxidant capacity was determined as scavenging activity, measured according to the 1,1-diphenyl-2-picrylhydrazil free radical method. RESULTS: The permeation percentage was almost 60% of the applied MMST, with a large quantity of drug found in the viable epidermis and dermis. The cell viability assay showed no significant difference in the percentage of viable keratinocytes among the treated groups at the doses used. In terms of antioxidant activity, the IC50 value obtained was 2400 µg mL-1 . Low antioxidant activity, negligible toxicity for keratinocytes and a significant percentage of permeation were observed. CONCLUSION: We provide evidence that MMST applied topically can deliver silicon to the skin in biorelevant levels for cosmetic purposes.

OBJECTIF: Le silicium organique a été associé à des effets positifs sur le rajeunissement de la peau, principalement par voie orale. Ainsi, l'objectif principal de la présente étude était d'évaluer si le monométhylsilanetriol (MMST, une source de silicium organique) pouvait livrer du silicium à l'épiderme et au derme, lorsqu'il était appliqué localement dans une crème. Une fois l'hypothèse confirmée, la présente étude a également évalué si le produit était toxique pour les kératinocytes; de plus, son éventuelle activité antioxydante a été évaluée. MÉTHODES: Le profil de permeation cutanée ex vivo a été déterminé en utilisant de la peau humaine dans un équipement à cellules Franz; la cytotoxicité a été évaluée à l'aide de kératinocytes HaCaT. La capacité d'antioxydant a été déterminée en tant qu'activité de piégeage, mesurée selon la méthode des radicaux libres au 1,1-diphényl-2-picrylhydrazil. RÉSULTATS: Le pourcentage de perméation était proche de 60% du MMST appliqué, une grande quantité de médicament se trouvant dans l'épiderme et le derme viables. Le test de viabilité cellulaire n'a montré aucune différence significative dans le pourcentage de kératinocytes viables parmi les groupes traités aux doses utilisées. En termes d'activité antioxydante, la valeur de la CI50 obtenue était de 2400 µg mL−1 . Une faible activité antioxydante, une toxicité négligeable pour les kératinocytes et un pourcentage important de perméation ont été observés. CONCLUSION: Nous apportons la preuve que le MMST appliqué localement peut délivrer du silicium sur la peau à des niveaux biologiquement pertinents à des fins esthétiques.

Morphological study of the eye bulb of the hammerhead shark, Sphyrna lewini (Elasmobranch: Carcharhinidae) / Estudio morfológico del bulbo ocular del tiburón martillo, Sphyrna lewini (Elasmobranch: Carcharhinidae)

The hammerhead sharks shows a head laterally expanded with eyes and nostrils on the edges, which gives the species a hammer appearance. Another strand of studies indicates that the hypothesis of head shape alterations for better adaptions in the sensorial system with the development of structures associated to binocular sight and others sensorial organs. Given the variety of characteristics, the study aim was to describe the anatomical constitution of the hammerhead shark eye bulb. The bulb and its annexes exenteration was performed, and further dissection; the morphological description of the muscle insertions and eye bulb components were based on direct observation and were further photographed and catalogued. The eye bulb fragments and its annexes were histological technical. Between the sclera and the choroid it was possible to observe, by the electronical scanning microscopy, the thin layer called supra-choroid, in this region, spaces often filled by lymphatic vessels allied to a matrix formed by loose conjunctive tissue are found. In the choroid, a layer which is rich in blood vessels, loose conjunctive tissue and collagen fibers, was observed, besides pigmentary cells full of melanin in its interior, which result in its layer's dark color. Ciliary body is a choroid's dilatation; it has the aspect of a thick ring in finger-like shape, pigmented, covering the sclera surface and containing pigmentary cells. The crystalline capsule, which shows an acellular covering that, is hyaline and homogeneous. In the electronical scanning microscopy, it was observed that the capsule is extremely thick especially in the anterior face. The capsule is very elastic, constituted mainly by thin lamellae of collagenous fibers, as illustrated by the electronically scanning microscopy. Anatomic variations related mainly to the position of the eye bulb in the skull, fibrous tunica and lens call the attention and must be related to its habitat.

El tiburón martillo tiene la cabeza lateralmente expandida con los ojos y la nariz en sus márgenes. Estudios indican que alteraciones de la forma de la cabeza de estos animales son adaptaciones que mejoran el desarrollo del sistema sensorial y estructuras asociadas a la visión binocular y otros órganos sensoriales. Dada la variedad de características, el objetivo del estudio fue describir la constitución anatómica del bulbo ocular. Se disecó el bulbo ocular junto a sus anexos. La descripción morfológica de las inserciones musculares y componentes del bulbo ocular se basaron en la observación directa, siendo éstas fotografiadas y catalogadas. Entre la esclera y la coroides se observó através de microscopía electrónica de barrido, una delgada capa supra-coroides, y vasos linfáticos junto a la matriz formada por tejidos conectivos. La coroides, era abundante en vasos sanguíneos y fibras de tejido conectivo. Se observaron escasas células pigmentarias llenas de melanina, lo que se asemeja a un anillo en forma de dedo, de manera que cubren la superficie de la esclera y células que contienen pigmentos. En la cápsula del lente, fue posible observar un recubrimiento celular, hialino y homogéneo. En la microscopía electrónica de barrido, se observó una cápsula muy gruesa, principalmente en la región frontal. La cápsula elástica,estaba constituida por láminas delgadas, principalmente, por fibras de colágeno. Se concluyó que el bulbo ocular de estos animales posee variaciones anatómicas relacionadas, principalmente, con la posición del bulbo ocular en el cráneo, túnica fibrosa y lente, lo que puede estar directamente relacionado con su hábitat.

Morphological study of the eye bulb of the hammerhead shark, sphyrna lewini (Elasmobranch: Carcharhinidae) / Estudio morfológico del bulbo ocular del tiburón martillo, sphyrna lewini (Elasmobranch: Carcharhinidae)

The hammerhead sharks shows a head laterally expanded with eyes and nostrils on the edges, which gives the species a hammer appearance. Another strand of studies indicates that the hypothesis of head shape alterations for better adaptions in the sensorial system with the development of structures associated to binocular sight and others sensorial organs. Given the variety of characteristics, the study aim was to describe the anatomical constitution of the hammerhead shark eye bulb. The bulb and its annexes exenteration was performed, and further dissection; the morphological description of the muscle insertions and eye bulb components were based on direct observation and were further photographed and catalogued. The eye bulb fragments and its annexes were histological technical. Between the sclera and the choroid it was possible to observe, by the electronical scanning microscopy, the thin layer called supra-choroid, in this region, spaces often filled by lymphatic vessels allied to a matrix formed by loose conjunctive tissue are found. In the choroid, a layer which is rich in blood vessels, loose conjunctive tissue and collagen fibers, was observed, besides pigmentary cells full of melanin in its interior, which result in its layer's dark color. Ciliary body is a choroid's dilatation; it has the aspect of a thick ring in finger-like shape, pigmented, covering the sclera surface and containing pigmentary cells. The crystalline capsule, which shows an acellular covering that, is hyaline and homogeneous. In the electronical scanning microscopy, it was observed that the capsule is extremely thick especially in the anterior face. The capsule is very elastic, constituted mainly by thin lamellae of collagenous fibers, as illustrated by the electronically scanning microscopy. Anatomic variations related mainly to the position of the eye bulb in the skull, fibrous tunica and lens call the attention and must be related to its habitat.

El tiburón martillo tiene la cabeza lateralmente expandida con los ojos y la nariz en sus márgenes. Estudios indican que alteraciones de la forma de la cabeza de estos animales son adaptaciones que mejoran el desarrollo del sistema sensorial y estructuras asociadas a la visión binocular y otros órganos sensoriales. Dada la variedad de características, el objetivo del estudio fue describir la constitución anatómica del bulbo ocular. Se disecó el bulbo ocular junto a sus anexos. La descripción morfológica de las inserciones musculares y componentes del bulbo ocular se basaron en la observación directa, siendo éstas fotografiadas y catalogadas. Entre la esclera y la coroides se observó através de microscopía electrónica de barrido, una delgada capa supra-coroides, y vasos linfáticos junto a la matriz formada por tejidos conectivos. La coroides, era abundante en vasos sanguíneos y fibras de tejido conectivo. Se observaron escasas células pigmentarias llenas de melanina, lo que se asemeja a un anillo en forma de dedo, de manera que cubren la superficie de la esclera y células que contienen pigmentos. En la cápsula del lente, fue posible observar un recubrimiento celular, hialino y homogéneo. En la microscopía electrónica de barrido, se observó una cápsula muy gruesa, principalmente en la región frontal. La cápsula elástica,estaba constituida por láminas delgadas, principalmente, por fibras de colágeno. Se concluyó que el bulbo ocular de estos animales posee variaciones anatómicas relacionadas, principalmente, con la posición del bulbo ocular en el cráneo, túnica fibrosa y lente, lo que puede estar directamente relacionado con su hábitat.

Compatibility of cholecalciferol, haloperidol, imipramine hydrochloride, levodopa/carbidopa, lorazepam, minocycline hydrochloride, tacrolimus monohydrate, terbinafine, tramadol hydrochloride and valsartan in SyrSpend SF PH4 oral suspensions.

A challenge with compounding oral liquid formulations is the limited availability of data to support the physical, chemical and microbiological stability of the formulation. This poses a patient safety concern and a risk for medication errors. The objective of this study was to evaluate the compatibility of the following active pharmaceutical ingredients (APIs) in 10 oral suspensions, using SyrSpend SF PH4 (liquid) as the suspending vehicle: cholecalciferol 50,000 IU/mL, haloperidol 0.5 mg/mL, imipramine hydrochloride 5.0 mg/mL, levodopa/carbidopa 5.0/1.25 mg/mL, lorazepam 1.0 mg/mL, minocycline hydrochloride 10.0 mg/mL, tacrolimus monohydrate 1.0 mg/mL, terbinafine 25.0 mg/mL, tramadol hydrochloride 10.0 mg/mL and valsartan 4.0 mg/mL. The suspensions were stored both refrigerated (2 - 8 degrees C) and at controlled room temperature (20 - 25 degrees C). This is the first stability study for these APIs in SyrSpend SF PH4 (liquid). Further, the stability of haloperidol,ilmipramine hydrochloride, minocycline, and valsartan in oral suspension has not been previously reported in the literature. Compatibility was assessed by measuring percent recovery at varying time points throughout a 90 days period. Quantification of the APIs was performed by high performance liquid chromatography (HPLC-UV). Given the percentage of recovery of the APIs within the suspensions, the beyond-use date of the final preparations was found to be at least 90 days for most suspensions both refrigerated and at room temperature. Exceptions were: Minocycline hydrochloride at both storage temperatures (60 days), levodopa/carbidopa at room temperature (30 days), and lorazepam at room temperature (60 days). This suggests that compounded suspensions of APIs from different pharmacological classes in SyrSpend SF PH4 (liquid) are stable.

Non-steroidal anti-inflammatory use in the XV Pan-American Games (2007).

BACKGROUND: non-steroidal anti-inflammatory drugs (NSAIDs) are frequently used in sports medicine to reduce time of incapacity. OBJECTIVE: to describe the frequency of NSAIDs use by athletes in the XV Pan-American Games. METHODS: all athletes who were tested by the anti-doping control filled a form. The voluntarily declared medications were recorded and categorised according to sport modality, sex, region and control situation according to the World Anti-Doping Agency. RESULTS: among the 1261 athletes tested (231 out-competition (OC) and 1030 in-competition (IC); 733 men and 528 women), 63% reported use of drugs, NSAIDs being the most frequently (64% of users) used medications. The use of medications was not significantly different between sexes or among different regions of the world. The number of users of only one type of NSAID was higher than those who used more than one type of NSAIDs or a combination with analgesics (335 vs 168 cases). IC reports presented higher use of NSAIDs than OC. CONCLUSION: athletes tested by the anti-doping control of the XV Pan-American Games reported a high frequency of NSAIDs use. The frequent utilisation in competition suggests that these medications might be used as ergogenic aid.

Development of a standardized procedure for cleaning glass apparatus in analytical laboratories / Desenvolvimento de procedimento padronizado para a lavagem de vidraria em laboratórios analíticos

Adequate cleaning of analytical glassware is an essential procedure that determines the reliability of assays and tests carried out in laboratories, keeping the glassware free of interference from residues left by previous tests. In the present paper, standard cleaning procedures are proposed for laboratory glassware, which were tested on cyanocobalamin as a marker contaminant. A spectrophotometric method was used for quantitative determination of both residual marker and cleaning product. Beakers, volumetric flasks and volumetric pipettes were successfully cleaned with a 2% detergent solution, with several rinses in water. Vials were cleaned adequately in an ultrasonic bath. These procedures utilize non-toxic and cheap reagents, factors of paramount importance for their application in routine laboratory analysis.

A lavagem da vidraria analítica é um procedimento essencial e determinante na confiabilidade dos resultados de testes e ensaios, a despeito da interferência dos resíduos de análises anteriores. Neste trabalho, foram propostos procedimentos de limpeza de vidrarias utilizando cianocobalamina como um marcador da eficiência de limpeza. Foi utilizado método espectrofotométrico para determinação dos resíduos do marcador e também do agente de limpeza. Béqueres, balões volumétricos e pipetas volumétricas foram comprovadamente limpos com detergente a 2% e múltiplos enxágues. Vials e seringas foram apropriadamente limpos utilizando-se banho ultrassônico. Esses procedimentos de limpeza fazem uso de reagentes baratos e não tóxicos, parâmetros de suma importância para sua aplicação em rotina laboratorial de análises físico-químicas.