ABSTRACT
BACKGROUND: Currently, the most common treatment for idiopathic normal pressure hydrocephalus (INPH) is a ventriculoperitoneal shunt (VPS), generally with programmable valve implantation. Endoscopic third ventriculostomy (ETV) is another treatment option, and it does not require prosthesis implantation. OBJECTIVE: To compare the functional neurological outcome in patients after 12 months of treatment with INPH by using 2 different techniques: ETV or VPS. METHODS: Randomized, parallel, open-label trial involving the study of 42 patients with INPH and a positive response to the tap test, from January 2009 to January 2012. ETV was performed with a rigid endoscope with a 30° lens (Minop, Aesculap), and VPS was performed with a fixed-pressure valve (PS Medical, Medtronic). The outcome was assessed 12 months after surgery. The neurological function outcomes were based on the results of 6 clinical scales: mini-mental, Berg balance, dynamic gait index, functional independence measure, timed up and go, and normal pressure hydrocephalus. RESULTS: There was a statistically significant difference between the 2 groups after 12 months of follow-ups, and the VPS group showed better improvement results (ETV = 50%, VPS = 76.9%). CONCLUSION: Compared with ETV, VPS is a superior method because it had better functional neurological outcomes 12 months after surgery.
Subject(s)
Endoscopy/methods , Hydrocephalus, Normal Pressure/pathology , Hydrocephalus, Normal Pressure/surgery , Third Ventricle/surgery , Ventriculoperitoneal Shunt/methods , Ventriculostomy/methods , Aged , Combined Modality Therapy/methods , Female , Humans , Male , Middle Aged , Pilot Projects , Treatment OutcomeABSTRACT
IRI is closely related to sepsis in ITx setting. Complete understanding of the mechanisms involved in IRI development may improve outcomes. Ortothopic ITx without immunosuppression was performed in order to characterize IRI-associated mucosal damage. Twenty pigs underwent ITx. Two groups were assigned to different CI times: G1: 90 min and, G2: 180 min. Euro-Collins was used as preservation solution. Jejunal fragments were collected at donor laparotomy, 30 min, and 3 days after reperfusion. IRI assessment involved: histopathologic analysis, quantification of MPO-positive cells through immunohistochemical studies, quantification of epithelial apoptotic cells using TUNEL staining, and quantification of IL-6, ET-1, Bak, and Bcl-XL genes expression by RT-PCR. Neutrophilic infiltration increased in a similar fashion in both groups, but lasted longer in G2. Apoptosis detected by TUNEL staining increased and anti-apoptotic gene Bcl-XL expression decreased significantly in G1, 3 days after surgery. Endothelin-1 and IL-6 genes expression increased 30 min after the procedure and returned to baseline 3 days after surgery. In conclusion, IL-6 and ET-1 are involved precociously in the development of intestinal IRI. Apoptosis was more frequently detected in G1 grafts by TUNEL-staining and by RT-PCR.
Subject(s)
Apoptosis , Endothelins/metabolism , Interleukin-6/metabolism , Intestines/transplantation , Reperfusion Injury/pathology , Animals , Endothelin-1/biosynthesis , Gene Expression Profiling , Gene Expression Regulation , Immunohistochemistry/methods , Ischemia/pathology , Neutrophils/pathology , Swine , bcl-2 Homologous Antagonist-Killer Protein/biosynthesis , bcl-X Protein/biosynthesisABSTRACT
BACKGROUND/PURPOSE: Central venous catheterization is among the most common procedures performed by pediatric surgeons. Significant morbidity and even mortality can ensue from the widespread approach to the deep veins of the neck and femoral region. The external jugular vein (EJV) is a low-morbidity alternative for percutaneous catheterization in children, but it has yielded a low success rate in previous reports . The authors show an improved success rate with this option. METHODS: We performed an analysis of 33 patients' charts in which central venous catheterization using Seldinger technique through the EJV was attempted in 2005. Age, diagnosis, maneuvers used for success, fluoroscopy usefulness, and types of inserted catheters were evaluated. RESULTS: The procedure was successful in 26 (78.8%) patients without complications. Diagnosis was neoplasia in almost half of the patients (42%). In half of the successful cases, body maneuvers were used, namely, twisting the head of the patient to the side of the vein and stretching the ipsilateral arm and shoulder. All but one procedure were completed under fluoroscopic guidance. In 6 (23%) patients, a long-term catheter was inserted. CONCLUSIONS: The EJV is an excellent option for central venous catheterization in children. The execution of simple maneuvers along with fluoroscopic assistance might allow for an improved success rate not only for short-term but also for long-term catheter insertion.
Subject(s)
Catheterization, Central Venous/methods , Jugular Veins , Adolescent , Child , Child, Preschool , Female , Fluoroscopy , Humans , Infant , Infant, Newborn , Male , Posture , Retrospective StudiesABSTRACT
BACKGROUND: A growing interest in the possible influences of pre- and postoperative anxiety and pain scores as outcomes of surgical treatment and benefits of anxiety or pain-reducing interventions has emerged. The aim of this study was to evaluate the influence of three different premedication regimens on postoperative pain and anxiety in children. METHODS: A prospective, randomized, open-label clinical trial enrolled 60 schoolchildren. They were randomized for premedication with oral midazolam 0.5 mgxkg(-1), oral clonidine 4 microgxkg(-1), or transmucosal dexmedetomidine (DEX) 1 mug.kg(-1), submitted to a pre- and postoperative evaluation of anxiety with the State-Trait Anxiety Inventory for Children and asked to report any pain in verbal and visual analog scales. We also evaluated secondary outcomes such as parents' anxiety, sedation, separation from parents, adverse effects and hemodynamic status. RESULTS: Dexmedetomidine and clonidine were related to lower scores of pain than midazolam. alpha(2)-agonists produced lower scores of peroperative mean arterial pressure and heart rate than midazolam. Both groups had similar levels of postoperative state-anxiety in children. There was no difference in preanesthesia levels of sedation and response to separation from parents between groups. CONCLUSIONS: These findings indicate that children receiving clonidine or DEX preoperatively have similar levels of anxiety and sedation postoperatively as those receiving midazolam. However, children given alpha(2)-agonists had less perioperative sympathetic stimulation and less postoperative pain than those given midazolam.
Subject(s)
Adrenergic alpha-Agonists , Anesthetics, Intravenous , Anxiety/prevention & control , Clonidine , Dexmedetomidine , Hypnotics and Sedatives , Midazolam , Pain, Postoperative/prevention & control , Postoperative Complications/prevention & control , Preanesthetic Medication , Adrenergic alpha-Agonists/adverse effects , Anesthetics, Intravenous/adverse effects , Anxiety/psychology , Blood Pressure/drug effects , Carbon Dioxide/blood , Child, Preschool , Clonidine/adverse effects , Dexmedetomidine/adverse effects , Double-Blind Method , Female , Heart Rate/drug effects , Humans , Hypnotics and Sedatives/adverse effects , Male , Midazolam/adverse effects , Oxygen/blood , Pain Measurement , Postoperative Complications/psychology , Prospective Studies , Psychiatric Status Rating ScalesABSTRACT
Justificativa e Objetivos - O cloridrato de bupivacaína utilizado clinicamente é uma mistura racêmica de dois enantiômeros: a S(-) bupivacaína e a R(+) bupivacaína (isômero dextrógiro) é mais cardiotóxica. Recentemente a indústria Farmacêutica desenvolveu a técnica de separaçäo (resoluçäo) dos enantiômeros, preparando a bupivacaína isomérica levógira, por apresentar menor efeito cardiotóxico potencial. Este novo anestésico local (levobupivacaína) está sendo submetido à fase pré-clínica para avaliaçäo de sua eficácia como anestésico local. Com o intiuto de investigar a atividade bloqueadora de nervo periférico, a levobupivacaína foi comparada com a bupivacaína racêmica em nervo ciático de rato. Método - Foram estudados dezoito ratos, divididos em dois grupos: Grupo I, (n=9), foi injetada levobupivacaína 0,5 por cento (0,2 ml) na regiäo periarticular da pata direita, no trajeto do nervo ciático; Grupo II, (n=9), foi injetado 0,2 ml da bupivacaína racêmica 0,5 por cento, utilizando-se a mesma técnica. Foram estudados: o tempo de instalaçäo do efeito (latência), duraçäo do bloqueio motor e bloqueio sensitivo. Para a avaliaçäo do bloqueio sensitivo. Para a avaliaçäo do bloqueio sensitivo foi produzido um estímulo pressórico (gramas/segundo) com o equipamento Analgesy-meter, e aplicado o teste de Randall-Selitto. Os animais foram observados por 24 horas para detecçäo de eventuais seqüelas. Resultados - O tempo de instalaçäo do efeito (latência) foi significativamente menor com a levobupi (Grupo I), enquanto que a duraçäo do bloqueio foi igual com os dois anestésicos locais (Grupo I e II). Quanto ao bloqueio sensitivo houve equivalência quanto ao bloqueio sensitivo houve equivalência quanto à analgesia, evidenciada pelo reflexo de retirada da pata (RRP), cujos valores em gramas/segundo foram semelhantes nos dois grupos, sem significância estatística. Näo foram detectados seqüelas motoras ou sinais comportamentais que sugerissem irritaçäo local em todos os animais estudados. Conclusöes - A levobupivacaína apresenta a mesma eficácia bloqueadora da mistura racêmica. A duraçäo do bloqueio motor e intensidade e duraçäo do bloqueio sensitivo confirmam que ambos os anestésicos têm o mesmo perfil farmacológico. O tempo de instalaçäo, contudo, foi marcadamente reduzido com a levobupivacaína, sendo uma vantagem a qual se soma sua menor cardiotoxicidade potencial...
