Bloqueio de plexo braquial em um bugio-ruivo (Alouatta guariba): relato de caso / Brachial plexus block in a red howler monkey (Alouatta guariba): case report

Os bloqueios regionais vêm sendo explorados e difundidos no dia a dia da medicina veterinária. O presente trabalho relata a execução do bloqueio de plexo braquial em um bugio-ruivo (Alouatta guariba) submetido à amputação de três dígitos. Foi utilizada ropivacaína para o bloqueio, com o paciente sob anestesia geral, com auxílio de neuroestimulador periférico. Quatro horas após a cirurgia e cinco horas após o bloqueio, o paciente não apresentava desconforto ou evitava a manipulação do membro operado e não foram observadas complicações. O bloqueio do plexo braquial é mais comumente utilizado quando se pretende promover analgesia e relaxamento muscular do membro torácico em procedimentos cirúrgicos distais à articulação escápulo-umeral. Há carência em estudos anatômicos sobre diversos primatas, incluindo o bugio-ruivo (Alouatta guariba). Apesar da crescente expansão da clínica de animais silvestres, ainda há lacunas no que diz respeito à execução de técnicas anestésicas em diversas espécies.(AU)

The regional blocks are being exploited and disseminated on a daily basis of veterinary medicine. This study describes the implementation of the brachial plexus block in a red howler-monkey (Alouatta guariba) that underwent amputation of three digits. Ropivacaine was employed for blocking, with the patient under general anesthesia, with the aid of a peripheral nerve stimulator. Four hours after surgery, and five hours after the blockade, the patient had no discomfort nor avoided manipulation of the operated limb and no complications were observed. The brachial plexus block is most commonly used when you want to promote analgesia and muscle relaxation of the forelimb in distal surgical procedures to the scapular-humeral joint. There is a lack of anatomical studies on various primates, including the red howler-monkey (Alouatta guariba). Despite the growing expansion of clinic of wild animals, there are still shortcomings with regards to the implementation of anesthetic techniques in many species.(AU)

Ethical issues in end of life treatments for patients with dementia.

Dementia is a terminal disease, associated with great suffering and difficult decisions in the severe stage. The decision-making process is characterized by uncertainty because of lack of scientific evidence in treatments and by the need to reconcile conflicting points of view. In intercurrent diseases, aggressive interventions are used without consideration of its futility; in comparison with cancer, several consequences of physicians' attitude not to consider dementia as a terminal disease have been reported, especially concerning pain relief. Lack of evidence of artificial nutrition and hydration effectiveness makes advance care planning relevant.

Ethical questions in the treatment of subjects with dementia. Part I. Respecting autonomy: awareness, competence and behavioural disorders.

The document deals with some ethical issues raised by the treatment of demented people. In particular the conceptual and empirical aspects of the assessment of awareness and competence of these patients are analysed, as well as the dilemmas related to the treatment of behavioral disorders.

Efficacy and tolerability of recombinant human erythropoietin treatment in pre-dialysis patients: results of a multicenter study.

Chronic renal failure is characterized by a normochromic normocytic anemia, the severity of which generally increases during progression toward uremia. The purpose of the study was to evaluate the efficacy and safety of recombinant human erythropoietin (rHu-EPO) given subcutaneously (s.c.), the dose required to reach and maintain Hb levels within 10 and 11 g% and its effects, if any, on the progression of chronic renal failure. Eighty-four pre-dialysis patients (46 F, 38M, age 61.7+/-13.9 years) with Hb levels between 6 and 9 g% and serum creatinine ranging from 3 to 9 mg/dl were treated with s.c. rHu-EPO (2000 U/twice weekly). After 6 weeks, if Hb increase was below 1 g%, 1000 U of s.c. rHu-EPO were added at each administration (3000 U twice weekly). Once the Hb target was reached (10-11 g%), the rHu-EPO weekly dose was halved and administration reduced to once weekly. The patients showed a significant rise in mean Hb values (p<0.001) after 3 months. Mean Hb values were as follows: 8.00+/-0.77 g% (pretreatment), 9.35+/-1.0 (3rd month), 10.06+/-1.04 (6th month), 10.25+/-0.62 g% (12th month). The mean rHu-EPO doses were 4000 U/w (start of the study), 3592+/-1685 U/w (6th month), 2840-/+1178 U/w (12th month). Renal function was evaluated by plotting the reciprocal of serum creatinine values vs time with a two period comparison: period A (retrospective-8 mo); period B (prospective-12 mo). The residual renal function was not impaired by rHu-EPO therapy. Meanwhile, no relevant modifications were observed in mean blood pressure values. Low doses of s.c. rHu-EPO were well tolerated, safe and effective; this therapeutic approach should therefore be considered for the improvement of anemia in pre-dialysis patients. A slow and gradual correction of anemia induces an improved sense of well being and a more active of life style.

Use of recombinant human erythropoietin (rh-EPO) in the treatment of anemia in hemodialysis patients: a multicenter Italian experience.

BACKGROUND AND METHODS: After the phase I-II clinical trials in 1986, several studies on the use of rHuEPO in the treatment of anemia of renal failure have been carried out and the drug has been introduced into clinical practice. In the present article we analyze the results of recombinant human erythropoietin (rh-EPO) therapy administered intravenously (i.v.) to 759 patients in several italian dialysis centers. RESULTS AND CONCLUSIONS: Data analysis confirms the erythropoietic efficacy of the drug (mean Hct increase from 22.1 +/- 2.8 to 31.5 +/- 3.0%) as well as the generalized Italian position toward a cautious correction of anemia (the increase is achieved in 6 months). Such a therapeutic approach is consistent with the chronic anemia of the dialysis patient. Low doses are widely used (40-100 IU/kg x three times a week). Analysis of adverse events seems to point out that some correlate directly with the drug and are therefore difficult to eliminate (flu-like syndrome). On the other hand, certain adverse events seem to correlate with the modalities of drug use (dosage, time required for the Hct increase). The possible advantages of subcutaneous administration are also described.

Subjective and metabolic effects of clodronate in patients with advanced breast cancer and symptomatic bone metastases.

Twenty postmenopausal women (aged between 46 and 67 years old) with skeletal metastases from breast carcinoma were treated with clodronate 450 mg i.v. daily for 5 days and thereafter with 100 mg i.m. daily for 10 days. All patients received standard hormonal therapy (tamoxifen). Symptomatic pain (evaluated according to a linear analog scale), performance status (according to Karnofsky), serum alkaline phosphatase, serum creatinine and osteocalcin were measured before and after treatment on days 5, 15, 30 and 45. Scanning by radiology were performed pre- and post-therapy. Bone pain was significantly reduced in 15 out of 20 patients. After clodronate treatment the base line value of circulating osteocalcin (3.2 +/- 1.6 ng/ml) showed a significant increase on days 30 and 45 (p less than 0.001). Radiological assessment of bone lesions showed stable disease in 18 patients and progression in two patients. No adverse side effects were observed. These data show that clodronate provided pain relief in 75% of treated patients and the increase in circulating osteocalcin levels can be considered a marker of the stabilization of skeletal metastatic lesions.

Influence of glutathione administration on the disposition of free and total platinum in patients after administration of cisplatin.

The kinetics of platinum (Pt) was studied in 12 patients suffering from non-small-cell lung cancer or pleural mesothelioma. Each subject received an infusion of cisplatin (CDDP, 80 mg/m2), and six patients were pretreated with glutathione (GSH, 2.5 g given i.v.) at 15 min prior to the cisplatin infusion. After a 3- to 4-week interval, all patients were given a second course of treatment on the same schedule. A biexponential model was fitted to plasma concentrations of total and ultrafilterable Pt. The excretion of Pt in urine was evaluated during the first 48 h after the CDDP infusion. Following the administration of CDDP alone or with GSH pretreatment, the pharmacokinetic parameters of Pt did not significantly differ between the treatments. Also, the unbound fraction determined at each sampling time did not vary significantly between the treatments. However, it is noteworthy that the mean values obtained for the terminal half-life, the volume of distribution, the renal clearance, the percentage of the dose excreted in the urine, and the mean residence time of total Pt were higher in patients who had been pretreated with GSH, suggesting that GSH might increase both the rate of Pt elimination and the extent of Pt distribution and, as a consequence of the latter, might prolong the residence time of Pt in the body. In addition, the unbound fraction of Pt from the 4th to the 48th was higher following the first dose of CDDP+GSH than after treatment with CDDP alone. Because of the rather high variability in the values of the parameters obtained, further work is planned using a larger number of patients.

[Cisplatin nephrotoxicity: effects on fractional excretion of sodium and enzymuria]. / Nefrotossicità del cisplatino. Effetto sull'escrezione frazionale del sodio e sulla enzimuria.

The effects (in five therapeutic cycles) of Cisplatin on urinary enzyme excretion (specific markers of tubular damage), fractional excretion of sodium, fractional reabsorption of phosphate, serum Creatinine and creatinine Clearance were assessed in 17 female patients with ovarian carcinoma. An immediate reduction of sodium fractional excretion was observed: this appears a more sensible Cisplatin-nephrotoxicity marker than serum Creatinine and creatinine Clearance. No significant variations were noted in fractional reabsorption of phosphate or urinary Lysozyme and Beta-2-microglobulin but there was a significant increase of other urinary enzymes, confirming the potential nephrotoxicity of DDP treatment.

An investigation on lipoperoxidation mechanisms in boar spermatozoa.

Aerobic incubation of washed boar spermatozoa in a heavy metal free medium at 37 degrees C results in a peroxidative breakdown of membrane phospholipids as revealed by malondialdehyde production. In the presence of iron ions, alone and with ascorbate, the amount of malondialdehyde produced increases noticeably. Alkoxy and lipoperoxy radicals are likely involved in these peroxidative processes, while OH. radical does not seem to be essential in the pathway of malondialdehyde formation.

Synchronous adenoacanthoma of the ovary and endometrial adenocarcinoma. Report of two cases.

Two cases of synchronous endometrioid adenocarcinoma of the endometrium and ovary are here presented. The clinical aspects and the pathologic findings support an autochthonous origin of these neoplasias. The existence of the extended Müllerian system can explain such a possibility. The recognition of this possible association is really important because it implies a different therapeutic approach.

Second look laparotomy in the management of malignant epithelial ovarian neoplasias.

In the present study we examined 15 patients with malignant epithelial ovarian neoplasms who underwent primary surgery and chemotherapy at the Institute of Obstetric and Gynecologic Clinic of the University of Pisa between 1983 and 1985. At the time of diagnosis and monthly during chemotherapy plasma levels of CEA, CA 19-9, CA 125 and TPA were detected. At the end of pharmacological treatment a second-look laparotomy was performed in each patient to assess the status of cancer. At this time the clinical response was complete in 13 patients and partial in 2. These results were confirmed at second-look laparotomy in 11 of 13 cases of complete clinical remission and in 1 of the 2 cases of partial clinical remission. Two patients in complete clinical remission showed persistent disease. The other one in partial clinical remission was surgically found to have unmodified tumor. Tumoral markers, and especially CA 125, have a good correlation with the clinical course of the disease. However these tumor associated antigens cannot replace second-look laparotomy for assessing the response to cytostatic drugs. In fact patients with normal serum levels of these markers at the end of chemotherapy, were surgically found to have both complete pathological remission and persistent disease. Therefore we have come to the conclusion that the second-look laparotomy and the evaluation of tumor markers have to be performed together in the management of malignant ovarian neoplasms.

Wertheim's radical hysterectomy with pelvic lymphadenectomy in the treatment of cervical carcinoma at the Obstetric and Gynecological Clinic of the University of Pisa.

The Authors report their experience in 49 operations of radical hysterectomy with pelvic lymphadenectomy in the treatment of stage I b and stage II cervical cancer. They describe particularly the precocious and late urinary complications and the arrangements made for their prevention. We had no uretero-vaginal fistula in 21 of the 49 patients, on whom a kind of roof and floor around the terminal tract of the ureters was created by placing some surgical stitches between the posterior wall of the bladder and the anterior lateral wall of the rectum.

Polychemotherapy with carmustine, cyclophosphamide plus adriamycin in the treatment of advanced ovarian cancer.

The Authors describe their experience with a combination therapy with carmustine (BCNU), cyclophosphamide (CTX) plus adriamycin (ADM) in the treatment of advanced ovarian cancer. The complete remission was obtained in 33.3% of subjects, the partial remission in 37.5%. Almost all patients suffered nausea, vomiting and alopecia. Myelosuppression was acceptable. No heart damage was observed. This pharmacological association can be considered an effective medical treatment in the management of ovarian carcinomas in advanced stages.

Struma ovarii. Observations on three cases.

The true struma ovarii is a rare teratomatous neoplasia, composed with typical thyroid tissue. Generally it is asymptomatic or only determines a mild hypogastric weighting feeling. In a few subjects this neoplasm is secreting and rise to hyperthyroidism. The Authors describe the clinical and anatomopathological characteristics of 3 cases of true struma ovarii come to their observation. No malignant histologic features in any of them was seen. In the relatively short period of post surgical observations no women showed relapses or metastases. This confirms that true struma ovarii is usually a benign tumor.