Efeito analgésico de antagonistas do receptor da histamina H2 em modelo de dor provocada por formalina em ratos / Analgesic effect of hystamine H2 receptor antagonists in formalin-induced pain model in rats

JUSTIFICATIVA E OBJETIVOS: Antagonistas de receptor de histamina apresentam efeitos sobre a dor. Antagonistas de receptor H1 apresentam efeito analgésico local, o papel de antagonistas de receptor H2 sobre a dor no sistema nervoso periférico ainda não está claro. Esse estudo teve como objetivo avaliar os efeitos de diferentes antagonistas H2 sobre a dor induzida pela administração de formalina na pata de ratos.MÉTODO: Foram estudados ratos machos divididos em grupos que receberam formalina na pata e diferentes antagonistas de receptor H2 - ranitidina, cimetidina e loxtidina, injetados na pata em diferentes concentrações (0,05 µmol, 0,25 µmol ou 1 µmol). Foi avaliado o número de elevações da pata pelo período de 45 minutos.RESULTADOS: A loxtidina inibiu o número de elevações da pata nas duas fases do teste a partir das três concentrações utilizadas, a ranitidina diminuiu o número de elevações da pata a partir da concentração de 0,25 µmol na fase II, a cimetidina não inibiu esse comportamento doloroso.CONCLUSÃO: De acordo com os resultados deste estudo,alguns antagonistas do receptor H2 apresentaram efeito analgésico local fármaco específico e não classe farmacológica específica.

BACKGROUND AND OBJECTIVES: Histamine receptor antagonists affect pain perception. H1 receptor antagonists present local analgesic effect, but the role of H2 receptor antagonists on pain in the peripheral nervous system is not clear yet. This study aimed at evaluating the effects of different H2 receptor antagonists on pain induced by formalin paw injection in rats.METHOD: Male rats were studied and divided into groups that received formalin and different H2 receptor antagonists - ranitidine, cimetidine and loxtidine, injected in the paw at different concentrations (0.05 mol, 0.25 mol or 1 mol). The number of flinches was evaluated during 45 minutes.RESULTS: Loxtidine inhibited the number of flinches in both phases of the test with the three different concentrations. Ranitidine decreased the number of flinches in phase II as from 0.25 mol. Cimetidine did not affectpain behavior.CONCLUSION: According to the results of this study,some H2 receptor antagonists presented local analgesic effects, which seem to be drug-related and not pharmacological class-specific.

Cirurgia endovascular em ginecologia / Endovascular surgery in gynecology

Endovascular surgery has presented a high evolution since 1960 with Charles Dotter, who changed the concept of catheter utilization as a mean to diagnose and introduce therapeutic in interventionist vascular environment. The first reports of bleeding control of gastrointestinal and transluminal angioplasty input the development of new techniques for endovascular access, and new materials use, such as microcatheters and embolic agents, become this procedure effective and viable for treatment of several pathologies. The embolization of several organs of human body is a procedure carried out for more than 30 years all over the world showing safety, efficacy and of simple execution. In obstetrics and gynecology, particularly, the first reports refer to pelvic hemorrhage control of varied etiology, including pelvic trauma, bladder and gynecology neoplasia, anteriovenous fistulas and puerperal hemorrhages. The embolization of uterine myoma appears in the 1990?s as an alternative for treat of uterine leiomyoma, and a number of studies try to clarify the risks and benefits of this procedure. It is a multidisciplinary technique, with diagnostic and indication performed by gynecologist and the procedure done by interventional vascular radiologist. This review is a critical analysis of interventionist vascular radiologic methods and its main therapeutic indications in gynecology.

A cirurgia endovascular apresentou grande evolução a partir de 1960, com Charles Dotter, ao modificar o conceito de utilização de cateteres como meio diagnóstico e introduzir a terapêutica no ambiente vascular intervencionista. Os primeiros relatos de contenção de sangramento do trato gastrintestinal e angioplastia transluminal impulsionaram o desenvolvimento de novas técnicas de acesso endovascular, e a utilização de novos materiais como os microcateteres e agentes embolizantes tornaram o procedimento efetivo e viável no tratamento de diversas doenças. A embolização de diversos órgãos do corpo humano é procedimento realizado há mais de 30 anos em todo o mundo, mostrando ser seguro, eficaz e de simples execução. Particularmente em ginecologia e obstetrícia, os primeiros relatos referem-se à contenção de hemorragias pélvicas de etiologia variada, incluindo trauma pélvico, neoplasias de bexiga e ginecológicas, fístulas arteriovenosas e hemorragias puerperais. A embolização do mioma uterino surgiu em 1990 como alternativa ao tratamento cirúrgico do leiomioma uterino, sendo que vários estudos buscam esclarecer riscos e benefícios desse procedimento. Trata-se de uma técnica multidisciplinar, cujo diagnóstico e indicação são feitos pelo ginecologista e o procedimento pelo radiologista vascular intervencionista. Esta revisão é uma análise crítica de métodos radiológicos vasculares intervencionistas e suas principais indicações terapêuticas em ginecologia.

Endovascular surgery in gynecology.

Endovascular surgery has presented a high evolution since 1960 with Charles Dotter, who changed the concept of catheter utilization as a mean to diagnose and introduce therapeutic in interventionist vascular environment. The first reports of bleeding control of gastrointestinal and transluminal angioplasty input the development of new techniques for endovascular access, and new materials use, such as microcatheters and embolic agents, become this procedure effective and viable for treatment of several pathologies. The embolization of several organs of human body is a procedure carried out for more than 30 years all over the world showing safety, efficacy and of simple execution. In obstetrics and gynecology, particularly, the first reports refer to pelvic hemorrhage control of varied etiology, including pelvic trauma, bladder and gynecology neoplasia, anteriovenous fistulas and puerperal hemorrhages. The embolization of uterine myoma appears in the 1990's as an alternative for treat of uterine leiomyoma, and a number of studies try to clarify the risks and benefits of this procedure. It is a multidisciplinary technique, with diagnostic and indication performed by gynecologist and the procedure done by interventional vascular radiologist. This review is a critical analysis of interventionist vascular radiologic methods and its main therapeutic indications in gynecology.

Responsiveness to different volume therapies following hemodilution and hemorrhagic shock: a comparative experimental study in rats.

UNLABELLED: Guidelines for volume replacement for acutely hemorrhaged and hemodiluted trauma patients have not been well established. PURPOSE: To evaluate the effects of acute hemodilution on mean arterial pressure (MAP), and responsiveness of acutely hemodiluted and subsequently hemorrhaged rats to different volume therapies. METHODS: 180 rats were hemodiluted to simulate hemorrhaged trauma patients with persistent bleeding after high volume replacement with isotonic solutions. Thirty hemodiluted [Anemia (ANE) group] animals received no further treatment. The remaining 150 animals were subjected to hypovolemic shock and randomized into five groups, according to the treatment option employed: Control (CTL) animals did not receive subsequent treatment after hemorrhagic hypovolemia, SAL4 animals received isotonic saline 4 mL/kg, SAL32 animals received isotonic saline 32 mL/kg, HS animals received hypertonic saline 4 mL/kg and BLD animals received re-infusion of drawn blood. RESULTS: Highest mean arterial pressure (MAP) was achieved by BLD, followed by SAL32 and HS. MAP after treatment of BLD, HS, SAL32 and ANE were higher than CTL (p=0.036). At 85 and 95 minutes of experiment, SAL4, SAL32 and HS presented the lowest hematocrit levels (p<0.01). At day 3, ANE, CTL and HS had the highest hematocrit. SAL4 and CTL groups presented the highest mortality rates. CONCLUSION: Hypertonic saline is an effective and safe initial therapy for hemodiluted rats undergoing hemorrhagic shock, with an overall outcome comparable to blood replacement or high volume isotonic saline administration.

Responsiveness to different volume therapies following hemodilution and hemorrhagic shock: a comparative experimental study in rats

Guidelines for volume replacement for acutely hemorrhaged and hemodiluted trauma patients have not been well established. Purpose: To evaluate the effects of acute hemodilution on mean arterial pressure (MAP), and responsiveness of acutely hemodiluted and subsequently hemorrhaged rats to different volume therapies. Methods: 180 rats were hemodiluted to simulate hemorrhaged trauma patients with persistent bleeding after high volume replacement with isotonic solutions. Thirty hemodiluted [Anemia (ANE) group] animals received no further treatment. The remaining 150 animals were subjected to hypovolemic shock and randomized into five groups, according to the treatment option employed: Control (CTL) animals did not receive subsequent treatment after hemorrhagic hypovolemia, SAL4 animals received isotonic saline 4 mL/kg, SAL32 animals received isotonic saline 32 mL/kg, HS animals received hypertonic saline 4 mL/kg and BLD animals received re-infusion of drawn blood. Results: Highest mean arterial pressure (MAP) was achieved by BLD, followed by SAL32 and HS. MAP after treatment of BLD, HS, SAL32 and ANE were higher than CTL (p=0.036). At 85 and 95 minutes of experiment, SAL4, SAL32 and HS presented the lowest hematocrit levels (p<0.01). At day 3, ANE, CTL and HS had the highest hematocrit. SAL4 and CTL groups presented the highest mortality rates. Conclusion: Hypertonic saline is an effective and safe initial therapy for hemodiluted rats undergoing hemorrhagic shock, with an overall outcome comparable to blood replacement or high volume isotonic saline administration.

A conduta para reposição volêmica em pacientes traumatizados, hemodiluídos não está bem estabelecida. Objetivo: Avaliar o efeito da hemodiluição sobre a pressão arterial média (PAM), bem como a resposta de ratos agudamente hemodiluídos e submetidos a choque hemorrágico, à reanimação com diferentes soluções. Métodos: 180 ratos foram hemodiluídos, simulando pacientes traumatizados com sangramento persistente após reposição com soluções isotônicas. Trinta ratos hemodiluídos (grupo ANE) foram observados, sem tratamento. Os demais 150 foram submetidos a choque hipovolêmico e randomizados em 5 grupos segundo a opção terapêutica: CTL (controle), sem tratamento subseqüente após hipovolemia hemorrágica; SAL4 que recebeu 4 mL/kg de salina isotônica; SAL32 que recebeu 32 mL/kg de salina isotônica ; SH que recebeu 4mL/kg de salina hipertônica; e BLD que recebeu reinfusão do sangue removido. Resultados: A pressão arterial média (PAM) mais alta ocorreu no grupo BLD, seguida pelo SAL32, e SH. A PAM após tratamento nos grupos BLD, SH, SAL32 e ANE foram maiores que no CTL (-=0.036). Aos 85 e 95 minutos do experimento, SAL4, SAL32, e SH apresentaram os menores hematócritos (p<0.01). No 3° dia, ANE, CTL e SH apresentaram os maiores hematócritos. SAL4 e CTL apresentaram as maiores taxas de mortalidade. Em conclusão, nossos resultados indicam que a SH é uma terapia inicial efetiva e segura em ratos hemodiluídos, submetidos a hemorrágico choque, com prognóstico comparável à reposição com sangue ou administração de grande volume de solução isotônica.

Umbilical mass as the sole presenting symptom of pancreatic cancer: a case report.

Umbilical nodes are rare. The metastatic involvement of the region was first described in 1846. Sister Mary Joseph was the first observer to establish the correlation between carcinomas and umbilical nodes. The umbilical node may be the sole presenting sign of cancer and is usually associated with advanced disease and poor prognosis. A 64-year-old woman, previously healthy, presented vague abdominal discomfort and a hard umbilical nodule for 1 week, which was first diagnosed as an incarcerated umbilical hernia. She underwent a new clinical assessment and biopsy. After immunohistochemical analysis and computerized tomography, she was diagnosed with pancreatic cancer. The clinical staging showed advanced disease with distant metastasis. She received palliative chemotherapy. After 8 months, she was alive in poor clinical condition. Clinical suspicion should lead to a careful additional evaluation whenever an umbilical nodule presents with malignant signs.

Gastric carcinoma in a 13-year-old girl.

Gastric cancer is uncommon before the fifth decade of life. The appearance of adenocarcinoma in young adults has motivated molecular studies that aimed to identify inherited mutations. Moreover, carcinoma of the stomach in the young adult is sufficiently rare to generate considerable interest in each occurrence of it, especially when it occurs in the gastroesophageal junction. We report a case of gastric carcinoma in a 13-year-old girl, who was referred to our service with weakness, malaise, weight loss, and slight dysphagia. An upper endoscopy with biopsy revealed a gastric Borrmann III tumor, with invasion of the distal esophagus; histopathological analysis revealed a moderately differentiated adenocarcinoma. During staging, she was diagnosed with several metastases, including the lymph nodes, liver, spleen, and ovary. She was referred for radiochemotherapy and died within 4 months. We should consider and investigate the possibility of malignancy even in young patients with persistent symptoms or anemia, in order to diagnose this malignancy at earlier stages.

Nonsmall cell lung cancer: evaluation of 737 consecutive patients in a single institution.

OBJECTIVE: To analyze surgical and pathological parameters and outcome and prognostic factors of patients with nonsmall cell lung cancer (NSCLC) who were admitted to a single institution, as well as to correlate these findings to the current staging system. METHOD: Seven hundred and thirty seven patients were diagnosed with NSCLC and admitted to Hospital do Cancer A. C. Camargo from 1990 to 2000. All patients were included in a continuous prospective database, and their data was analyzed. Following staging, a multidisciplinary team decision on adequate management was established. Variables included in this analysis were age, gender, histology, Karnofsky index, weight loss, clinical stage, surgical stage, chemotherapy, radiotherapy, and survival rates. RESULTS: 75.5% of patients were males. The distribution of histologic type was squamous cell carcinoma 51.8%, adenocarcinoma 43.1%, and undifferentiated large cell carcinoma 5.1%. Most patients (73%) presented significant weight loss and a Karnofsky index of 80%. Clinical staging was IA 3.8%, IB 9.2%, IIA 1.4%, IIB 8.1%, IIIA 20.9%, IIIB 22.4%, IV 30.9%. Complete tumor resection was performed in 24.6% of all patients. Surgical stage distribution was IA 25.3%, IB 1.4%, IIB 17.1%, IIIA 16.1%, IIIB 20.3%, IV 11.5%. Chemotherapy and radiotherapy were considered therapeutic options in 43% and 72%, respectively. The overall 5-year survival rate of nonsmall cell lung cancer patients in our study was 28%. Median survival was 18.9 months. CONCLUSIONS: Patients with NSCLC who were admitted to our institution presented with histopathologic and clinical characteristics that were similar to previously published series in cancer hospitals. The best prognosis was associated with complete tumor resection with lymph node dissection, which is only achievable in earlier clinical stages.

Umbilical mass as the sole presenting symptom of pancreatic cancer: a case report

Nódulos umbilicais são raros. Desde 1846, o comprometimento metastático da região vem sendo descrito. A Irmã Mary Joseph foi a primeira a relacionar o aparecimento de nódulos umbilicais com carcinomas. Esses nódulos podem ser a única manifestação de câncer, normalmente associada a estadios avançados e pior prognóstico. Uma senhora de 64 anos, previamente hígida, apresentava desconforto abdominal inespecífico e aparecimento de nódulo umbilical endurecido há uma semana. O diagnóstico inicial foi hérnia umbilical encarcerada. Após reavaliação, o nódulo foi biopsiado, cujo exame anátomo-patológico demonstrou carcinoma com sítio primário desconhecido. A análise imuno-histoquímica e tomografia, o diagnóstico foi carcinoma de pâncreas. O estadiamento demonstrou doença avançada, com metastáses à distância. A paciente foi submetida a quimioterapia paliativa. Após 8 meses, encontrava-se em mau estado geral. A suspeita clínica deve originar avaliação clínica cuidadosa, auxiliada por exames subsidiários, sempre que um nódulo umbilical apresentar sinais de malignidade.

Nonsmall cell lung cancer: evaluation of 737 consecutive patients in a single institution

OBJETIVO: Analisar o resultado e fatores prognósticos de patients com CPNPC admitidos em uma única instituição e correlacionar os dados com o sistema atual de estadiamento. MÉTODO: Setecentos e trinta e sete pacientes com diagnóstico de CPNPC foram admitidos ao Hospital do Cancer A. C. Camargo entre 1990 e 2000. Todos os pacientes foram incluídos em um banco de dados contínuo prospectivo e seus dados foram analisados. Após o estadiamento, uma equipe multidisciplinar estabeleceu decisões sobre o manejo adequado para o caso. Variáveis analisadas incluíram idade, sexo, tipo histológico, índice de Karnofsky, perda de peso, estadio clínico, estadio cirúrgico, quimioterapia, radioterapia e taxa de sobrevida. RESULTADOS: 75,5% dos pacientes eram do sexo masculino. A distribuição dos tipos histológicos foi carcinoma espino celular 51,8%, adenocarcinoma 43,% e carcinoma indiferenciado de grandes células 5,1%. A maior parte apresentou perda de peso significativa e um Karnofsky Index de 80%. O estadiamento clínico foi IA 3,8%, IB 9,2%, IIA 1,4%, IIB 8,1%, IIIA 20,9%, IIIB 22,4%, IV 30,9%. A ressecção total do tumor foi possível em 24,6% dos casos. A distribuição do estadiamento cirúrgico foi IA 25,3%, IB 1,4%, IIA 1,4%, IIB 17,1%, IIIA 16,1%, IIIB 20,3%, IV 11,5%. Quimioterapia e radioterapia também foram consideradas opções terapêuticas. A sobrevida global de 5 anos em nosso estudo foi de 28%, sendo a sobrevida mediana de18,9 meses. CONCLUSÕES: CPNPC é uma doença que requer atenção especial, devido aos altos índices de morbi-mortalidade. Melhor prognóstico está associado à ressecção completa do tumor, com dissecção de linfonodos. Todavia, isso só é possível em estadios clínicos mais precoces.

Efeito do tratamento hormonal com estradiol e acetato de noretisterona de forma continua sobe o volume uterino e a espessura endometrial em mulheres menopausadas / Hormonal treatment effect with continuous estradiol and noretisterone acetate over the uterine volume and endometrial thickness in menopausal women

Analisar o efeito do tratamento com a associacao de 2 mg de estradiol e 1 mg de acetato de noretisterona por via oral de forma continua em mulheres menopausadas sobre...