RESUMO
Lower urinary tract dysfunctions (LUTDs) are commonly reported in multiple sclerosis (MS) patients and are mainly related to neurogenic overactive bladder (OAB). The aim of this observational study was to assess the effect of a tetrahydrocannabinol-cannabidiol (THC/CBD) oromucosal spray on resistant OAB by means of clinical and instrumental tools. Twenty-one MS patients were screened, and 15 cases have been evaluated. They underwent a specific clinical assessment (overactive bladder symptom score, OABSS) and a urodynamic assessment evaluating the maximal cystometric capacity (CCmax), bladder compliance (Qmax), maximum detrusor pressure (Pdet max), detrusor pressure at the first desire (Pdet first), bladder volume at the first desire (BVFD), leakage volume (LV), and post-void residual volume (PVR), before and after 4 weeks of THC/CBD administration. A complete neurological evaluation, including the assessment of their spasticity using the Modified Ashworth Scale (MAS) and the spasticity 0-10 numerical rating scale (NRS), was performed at the same times. Mobility was evaluated through the 25-ft walking-time test (T25-WT). The THC/CBD treatment successfully reduced the OAB symptoms (p = 0.001). Regarding the urodynamic findings after the end of treatment, PVR was significantly reduced (p = 0.016). Regarding the urodynamic findings after the end of treatment, PVR was significantly reduced (p = 0.016), while BVFD and CCmax were increased although the difference was not statistically significant. THC/CBD oromucosal spray has shown to be effective in improving overactive bladder symptoms in MS patients demonstrating a favorable impact on detrusor overactivity.
Assuntos
Canabidiol/uso terapêutico , Dronabinol/uso terapêutico , Esclerose Múltipla/tratamento farmacológico , Bexiga Urinária Hiperativa/tratamento farmacológico , Administração através da Mucosa , Administração Oral , Canabidiol/administração & dosagem , Dronabinol/administração & dosagem , Combinação de Medicamentos , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Projetos Piloto , Estudos Prospectivos , Resultado do Tratamento , Bexiga Urinária Hiperativa/complicaçõesRESUMO
INTRODUCTION: Medulloblastomas are malignant, invasive and highly cellular tumours from the cerebellum, rarely seen in adults. We describe the experience in the treatment of this entity in our institution. MATERIALS AND METHODS: A retrospective study was made including 11 adult patients with medulloblastomas confined to the craniospinal axis treated between 1984-2010. Clinical, radiological and therapeutic data were assessed during the evolution of this entity. RESULTS: Mean age of patients was 30.2 years (9 women/2 men). Over 80% of the patients presented intracranial hypertension, while 54.5% presented cerebellum syndrome. Gross total surgical resection was achieved in 8 patients (72.7%) and subtotal resection in the other 3 (27.3%). All patients received craniospinal radiotherapy. After primary surgical resection, 6 patients received chemotherapy with cisplatin (CDDP) and etoposide (VP-16). During the follow up period and after a median time of 35.2 months, 4 patients (36.4%) presented with relapse, mainly in the posterior cranial fossa, managed in the majority of cases with surgical resection plus additional chemotherapy. Mean survival time was 100.3 months with a 5- and 8- year overall survival rate of 84 and 56% respectively. CONCLUSIONS: In the treatment of this malignancy, gross surgical resection has a crucial role, followed as soon as possible by oncological therapy, specially radiotherapy if needed.
Assuntos
Meduloblastoma/cirurgia , Adolescente , Adulto , Terapia Combinada , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Meduloblastoma/tratamento farmacológico , Meduloblastoma/patologia , Meduloblastoma/radioterapia , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
Introducción. Los meduloblastomas son tumores malignos, invasivos, altamente celulares, del cerebelo, infrecuentes en el adulto. En el presente trabajo describiremos la experiencia en el manejo de esta patología en nuestro centro.Material y métodos. Se trata de un trabajo retrospectivo que incluyó 11 pacientes adultos con diagnóstico de meduloblastoma del eje craneoespinal atendidos entre 1984-2010. Se evaluaron datos clínicos, radiológicos y terapéuticos durante la evolución de la enfermedad.Resultados. La edad media de los pacientes fue 30,2 años (9 mujeres y 2 varones). Más del 80% de los pacientes manifestaron clínica de hipertensión intracraneal, mientras el 54,5% presentaron síndrome cerebeloso. El grado de resección quirúrgica fue total en 8 pacientes (72,7%) y subtotal en 3 (27,3%). Todos los pacientes recibieron tratamiento radioterápico adyuvante. Posterior a la exéresis tumoral inicial, 6 pacientes recibieron quimioterapia adyuvante con cisplatino (CDDP) y etopósido (VP-16). Durante el seguimiento, después de un tiempo medio de 35,2 meses, se observaron recidivas en el 36,4% de los pacientes (n= 4), con mayor frecuencia en la fosa posterior, empleando en todos ellos tratamiento con cirugía y quimioterapia. El tiempo medio de supervivencia fue 100,3 meses, con un índice de supervivencia estimado a los 5 y 8 años de seguimiento del 84 y 56 % respectivamente.Conclusiones. La máxima resección quirúrgica forma parte crucial del tratamiento, seguida de adyuvancia oncológica tan pronto sea posible, con radioterapia seguida o no de quimioterapia (AU)
Introduction. Medulloblastomas are malignant, invasive and highly cellular tumours from the cerebellum, rarely seen in adults. We describe the experience in the treatment of this entity in our institution.Materials and methods. A retrospective study was made including 11 adult patients with medulloblastomas confined to the craniospinal axis treated between 1984-2010. Clinical, radiological and therapeutic data were assessed during the evolution of this entity.Results. Mean age of patients was 30,2 years (9 women/2 men). Over 80% of the patients presented intracranial hypertension, while 54,5% presented cerebellum syndrome. Gross total surgical resection was achieved in 8 patients (72,7%) and subtotal resection in the other 3 (27,3%). All patients received craniospinal radiotherapy. After primary surgical resection, 6 patients received chemotherapy with cisplatin (CDDP) and etoposide (VP-16). During the follow up period and after a median time of 35,2 months, 4 patients (36,4%) presented with relapse, mainly in the posterior cranial fossa, managed in the majority of cases with surgical resection plus additional chemotherapy. Mean survival time was 100,3 months with a 5- and 8- year overall survival rate of 84 and 56% respectively. Conclusions. In the treatment of this malignancy, gross surgical resection has a crucial role, followed as soon as possible by oncological therapy, specially radiotherapy and chemotherapy if needed (AU)
Assuntos
Humanos , Masculino , Feminino , Meduloblastoma/cirurgia , Neoplasias Cerebelares/cirurgia , Estudos Retrospectivos , Radioterapia Adjuvante , Antineoplásicos/uso terapêutico , Recidiva Local de Neoplasia/epidemiologiaRESUMO
El Consenso Venezolano de Enfermedad por Reflujo Gastroesófágico (ERGE) se realizó con el objeto de proveer guías para mejorar la identificación, el diagnóstico y el tratamiento de este trastorno en el país. Los coordinadores establecieron las líneas de consenso, basado en una revisión sistemática de la literatura médica de los últimos 15 años a partir de 1995. Participaron 55 miembros con el aval de sus respectivas cátedras y sociedades locales de gastroenterología. Éstos revisaron y presentaron los temas con sus niveles de evidencia y grados de recomendación para discutirlos y votarlos en una reunión plenaria. Tras un informe final de los miembros, los coordinadores prepararon las declaraciones finales. El consenso concluyó que la enfermedad por reflujo gastroesofágico tiene una prevalencia estimada del 11,54% en Venezuela, a predominio del sexo femenino (Grado B). El diagnóstico es fundamentalmente clínico, basado en la presencia de síntomas típicos y/o atípicos, e incluso síntomas de alarma que sugieren alguna complicación (Grado B). La endoscopia es importante en la investigación de la presencia de esofagitis de reflujo y laringitis de reflujo (Grado B). Las otras pruebas diagnósticas como lo son la pHmetría esofágica de 24 horas con o sin impedancia intraluminal multicanal son importantes en los pacientes que no tienen esofagitis, tienen síntomas atípicos o cuando hay falla en la respuesta al tratamiento médico (Grado B). La radiología, manometría esofágica y el ultrasonido endoscópico no están indicados en el diagnóstico de la ERGE (Grado B). El objetivo del tratamiento es reducir la exposición ácida en el esófago y con esto: aliviar los síntomas, cicatrizar las lesiones en la mucosa esofágica, prevenir la recurrencia y las complicaciones. Los inhibidores de bomba de protones deberían ser la primera opción en el tratamiento en el síndrome de ERGE y en la esofagitis por reflujo tanto en la fase aguda como durante el mantenimiento...
The Venezuelan Gastroesophageal Reflux Disease (GERD) Consensus was carried out in order to provide guidelines to improve the identification, diagnosis and treatment of this illness in Venezuela. The coordinators established the consensuslines, based on a systematic revision of the medical literature of the last 15 years starting from 1995. 55 physicians participated with the support of their respective medical schools and local societies. They revised and presented the topics with their respective evidence levels and recommendation grades to discuss and vote them in a plenary meeting. After a final report of the members, the coordinators prepared the definitive declarations. The consensus concluded that GERD prevalence in Venezuela is 11,54%, higher in women than men (Grade B). The diagnosis is mainly clinical, based on the presence of typical and/or atypical symptoms and alarm symptoms that may suggest the presence of complications (Grade B). Endoscopy is important when reflux esophagitis and laryngitis are present (Grade B). Other diagnostic tests as ambulatory 24 hours pH monitoring with or without multichannel intraluminal impedance are important in patients without esophagitis, with atypical symptoms or when there is flaw in the answer to the medical treatment (Grade B). Radiology, esophageal manometry and endoscopic ultrasonography are not indicated in the diagnosis of GERD (Grade B). The objective of the treatment is to reduce the presence of acid in the esophagus and consequently: alleviate the symptoms and heal lesions in the esophagus mucosa to prevent recurrence and complications. Proton pump inhibitors should be the first option drug in the treatment of GERD syndrome andin esophagitis during the acute and the maintenance phase using standard or half dose (Grade A). So far, pokinetics are drugs with a limited use in GERD patients; they stimulate the esophagus/gastric motility...
Assuntos
Humanos , Inibidores da Bomba de Prótons , Refluxo Gastroesofágico/cirurgia , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/terapia , Educação Médica , Faculdades de MedicinaRESUMO
La enfermedad por reflujo gastroesofágico (ERGE) es una enfermedad crónica recurrente, que constituye uno de los trastornos gastrointestinales que afecta con mayor frecuencia a población mundial. Objetivo: Determinar la prevalencia de enfermedad por reflujo gastroesofágico en la población adulta venezolana. Pacientes y Métodos: Se realiza un estudio descriptivo, de corte transversal, multicéntrico durante los meses de abril y mayo de 2008. Se entrevistaron a individuos en edades comprendidas entre 15 - 65 años de diferentes estados del país (Aragua, Anzoátegui, Barinas, Carabobo, Delta Amacuro, Distrito Capital, Mérida, Miranda, Sucre, Zulia) escogidos a través del azar simple, realizándose un muestreo por conglomerados, de donde, en cada estado se seleccionó un Municipio y de éste, lugares como iglesias, centro comerciales, cines y paradas de autobuses. Se tomó en consideración la población de cada municipio según el Censo Nacional 2001. Resultados: Un total de 1318 individuos fueron encuestados en los estados incluidos, 814 mujeres (61,76%) y 504 Hombres (38,24%). En cuanto a la distribución por categoría de edad, el grupo de 25-35 años constituyó el de mayor predominio. Se obtuvo una Prevalencia Nacional de 11,54%, donde los síntomas cardinales pirosis y regurgitación ácida representaron 16,62% y 12,75% respectivamente. Conclusión: La prevalencia nacional de enfermedad por reflujo gastroesofágico en la población venezolana es del 11,54%.
The gastroesophageal reflux disease (GERD) is a chronic recurrent illness that represents one of the most common gastrointestinal disorders that affects worldwide population. Aim: To determine the prevalence of gastroesophageal reflux disease in the Venezuelan adult population. Patients and Methods: A Descriptive, cross section, multicentric study was made. A survey was done to people in ages between 15 - 65 years of different states of the country (Aragua, Anzoátegui, Barinas, Carabobo, Delta Amacuro, Distrito Capital, Mérida, Miranda, Sucre, Zulia) chosen randomly. Cluster sampling was performed, where in each State was selected a municipality and, of which one places like churches, malls, cinemas and bus stops. To calculate de amount of people The National Census 2001 was taken in account in each municipality. Results: A total of 1318 individuals were surveyed in the mentioned States including, 814 women (61.76%) and 504 men (38.24%). The predominant distribution by age was the group of 25-35 years old. A National Prevalence of 11.54% was obtained, where the cardinal symptoms were heartburn and acid regurgitation represented 16.62% and 12.75% respectively. Conclusion: The national prevalence of gastroesophageal reflux disease in the Venezuelan adult population is 11.54%.
RESUMO
Recombinant purine nucleoside phosphorylase (PNPase) from Escherichia coli was prepared in high yield in order to facilitate its use in coupled assays to measure the kinetics of phosphate-liberating enzymes. The E. coli enzyme was overexpressed in E. coli by inserting the genomic fragment containing the deoD gene downstream of the isopropyl beta-d-thiogalactoside-inducible promotor of pSE380 expression vector. The recombinant protein was purified to approximately 90% homogeneity and with a yield of approximately 9000 units of activity/L of culture, using an efficient one-column procedure. A continuous spectrophotometric assay coupling P(i) release to the phosphorolysis of the nucleoside analogue 7-methylinosine (m(7)Ino) was recently described. Here, we report the steady-state kinetic parameters of the recombinant E. coli PNPase catalyzed reaction with m(7)Ino and P(i) as substrates and compare these parameters with those of a bacterial PNPase commercially available for use in coupled assays. Under the assay conditions described, the recombinant E. coli protein is active at higher pH values and is stable up to a temperature of approximately 55 degrees C and following multiple freeze-thaw cycles. It is activated by high ionic strength but loses some activity following dialysis or concentration under pressure. Finally, a new procedure for the synthesis of m(7)Ino from inosine is described which is safe and cost effective, making the use of this methylated nucleoside in PNPase-coupled P(i) assays more attractive.
Assuntos
Escherichia coli/enzimologia , Escherichia coli/genética , Inosina/análogos & derivados , Purina-Núcleosídeo Fosforilase/genética , Purina-Núcleosídeo Fosforilase/isolamento & purificação , Proteínas Recombinantes/biossíntese , Proteínas Recombinantes/isolamento & purificação , Actinomycetales/enzimologia , Dicroísmo Circular , Clonagem Molecular , Estabilidade Enzimática , Vetores Genéticos/síntese química , Concentração de Íons de Hidrogênio , Inosina/síntese química , Inosina/metabolismo , Cinética , Peso Molecular , Concentração Osmolar , Fosfatos/metabolismo , Estrutura Secundária de Proteína , Purina-Núcleosídeo Fosforilase/biossíntese , Purina-Núcleosídeo Fosforilase/química , Proteínas Recombinantes/química , Especificidade por SubstratoRESUMO
This case study discusses the advantage of using both lateral and protrusive mandibular excursive movements to improve the accuracy of the joint vibration analysis rather than relying only on opening and closing movements of the mandible for analysis.
Assuntos
Transtornos da Articulação Temporomandibular/diagnóstico , Articulação Temporomandibular/fisiopatologia , Auscultação , Eletrodiagnóstico , Humanos , Mandíbula/fisiopatologia , Movimento , Som , Transtornos da Articulação Temporomandibular/fisiopatologia , VibraçãoRESUMO
The use of minimally invasive surgery continues to evolve in all fields of surgery with new developments in techniques and instrumentation. One instrument that has evolved and become useful in the field of plastic surgery is the balloon dissector. The purpose of this paper is to examine the role of the balloon dissector in minimally invasive aesthetic and reconstructive plastic surgery. We define the concept of the fascial cleft-the loose areolar space between fascial linings. In addition, the balloon dissector and its use is described. The optical cavity created by the balloon dissector device is discussed, along with the two techniques used to maintain the optical cavity, and manual retraction and carbon dioxide insufflation. The application of the balloon dissector in various regions of the body is discussed along with its use in free tissue transfers. Three patients are presented to illustrate the application of the balloon dissector.
Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos de Cirurgia Plástica/instrumentação , Adulto , Braço/cirurgia , Cateterismo/instrumentação , Criança , Pré-Escolar , Dissecação/instrumentação , Feminino , Humanos , Traumatismos da Perna/cirurgia , Mamoplastia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Reimplante , Retalhos CirúrgicosRESUMO
BACKGROUND: Sternal nonunion, defined as sternal pain with clicking, instability, or both for more than 6 months in the absence of infection, is an uncommon complication of median sternotomy. Nonunion is frequently complicated by the presence of multiple transverse fractures, which make simple rewiring inadequate. METHODS: Six patients with debilitating pain secondary to sternal nonunion were treated with the technique of sternal plating between 1989 and 1995. RESULTS: Sternal plating corrected sternal instability and provided excellent pain relief in all 6 patients. All patients reported an improved quality of life and were able to resume recreational activities. Two patients have had plate removal for late bursa formation. Sternal healing was complete in both instances. CONCLUSIONS: Sternal plating, which is based on the tension-band principle, is an effective treatment of sternal nonunion. The technique is applicable to both simple and complex nonunions. The stainless steel plates resist bending stresses, and the cortical bone resists compressive forces. The technique requires minimal dissection of the posterior sternal border, is not circumferential, and provides secure sternal approximation.
Assuntos
Placas Ósseas , Esterno/cirurgia , Toracotomia/efeitos adversos , Idoso , Parafusos Ósseos , Desenho de Equipamento , Fraturas Ósseas/cirurgia , Humanos , Anastomose de Artéria Torácica Interna-Coronária , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/cirurgia , Maleabilidade , Qualidade de Vida , Recreação , Aço Inoxidável , Estresse Mecânico , Doenças Torácicas/cirurgia , CicatrizaçãoRESUMO
The Test of Gross Motor Development was administered to 300 children, ages 5 to 7 yr., attending public schools in Puerto Rico. Statistical comparisons indicated that the test-manual norms for US children were applicable to Puerto Rican children except for 7-yr.-old girls. A 2 x 3 x 2 factor analysis of intercorrelations of Puerto Rican scores indicated no significant difference between rural and urban children, expected age group differences, and sex differences favoring boys.
Assuntos
Desenvolvimento Infantil , Comparação Transcultural , Hispânico ou Latino/psicologia , Destreza Motora , Desempenho Psicomotor , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Porto Rico/etnologiaRESUMO
El autor define el concepto de "familia suicidogenica", que son aquellas en las cuales la conducta consciente o inconsciente de sus integrantes contribuyen en forma importante a determinar, predisponer o desencadenar el acto suicida. Conducta grupal dirigida a facilitar la autodestruccion de uno o varios miembros de la familia. Se describen varios modelos de dichas familias y se hace hincapie en la actitud perseguidora y rechazante en especial sobre el miembro mas vulnerable emocionalmente
Assuntos
Humanos , Família , Suicídio , Tentativa de SuicídioRESUMO
El autor destaca la alta incidencia del suicidio entre las personas de 15 a 19 anos. En el grupo de adolescentes, esta es la segunda causa de muerte en Venezuela.En cuanto a los metodos mas frecuentes en los varones adolescentes predomino el ahorcamiento y el arma de fuego, y en las adolescentes el envenenamiento y la precipitacion de lugares elevados. Se mencionan algunas de las causas que contribuyen a la conducta suicida: la crisis de identidad, la depresion, otros trastornos mentales como la esquizofrenia, los conflictos amorosos y familiares, la ausencia de padres, la crisis de valores, los conflictos sexuales. Por ultimo se da una orientacion en relacion al manejo terapeutico de estos jovenes suicidas
