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1.
Artigo em Inglês | MEDLINE | ID: mdl-38739098

RESUMO

KEY POINTS: Virtual reality (VR) and Fitbit devices are well tolerated by patients after skull base surgery. Postoperative recovery protocols may benefit from incorporation of these devices. However, challenges including patient compliance may impact optimal device utilization.

2.
Laryngoscope ; 134(3): 1197-1202, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37578212

RESUMO

OBJECTIVE: To evaluate the effect of different virtual reality (VR) experiences on perioperative anxiety and pain among patients undergoing head and neck surgery. METHODS: Prospective, randomized, comparative trial among patients undergoing outpatient head and neck surgery from December 2021 to April 2022 at a single academic institution. Group 1 utilized a preoperative VR gaming experience and a postoperative VR mindfulness experience, while Group 2 utilized the same interventions in the reverse order. Anxiety and pain were measured using visual analog scales (VAS). Primary outcomes were changes in post-intervention anxiety and pain. Secondary outcomes included vital sign changes and subjective patient experiences using a 5-point Likert scale. RESULTS: There were 32 patients randomized for inclusion, with 16 patients per group. The majority of patients were female (65.6%) and mean (standard deviation) age was 47.3 (16.7) years. After outlier exclusion, there were no differences in post-intervention preoperative anxiety reduction (Group 1 vs. Group 2, median [IQR]: -12.0 [15] vs. -10.5 [13], p = 0.62). There were minor differences in vital sign changes (p < 0.05). Among the 10 patients in Group 1 and 12 patients in Group 2 who completed postoperative VR use, there were no differences in post-intervention pain reduction (-8.5 [22.3] vs. -7.5 [19.3], p = 0.95) or vital sign changes (p > 0.05). There were no differences in questionnaire responses, with high satisfaction in both groups (p > 0.05). No adverse events encountered. CONCLUSIONS: Use of different VR experiences among patients undergoing outpatient head and neck surgery appears associated with similar reductions in perioperative anxiety and pain. LEVEL OF EVIDENCE: 2 Laryngoscope, 134:1197-1202, 2024.


Assuntos
Dor , Realidade Virtual , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Prospectivos , Ansiedade/etiologia , Ansiedade/prevenção & controle , Transtornos de Ansiedade
3.
Laryngoscope ; 131(8): 1810-1815, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33009850

RESUMO

OBJECTIVES: Laryngeal amyloidosis (LA) is a rare disease characterized by extracellular protein deposition within the larynx. Treatment is difficult due to the frequently submucosal and multifocal nature of disease. The mainstay of treatment is surgical resection; however, recurrence rates are high. Recently, use of radiotherapy (RT), either alone or postoperatively, for LA has been adapted from the management of extramedullary plasmacytoma and has been shown to provide local disease control. Here, we describe the experience with adjuvant RT for LA at our center. STUDY DESIGN: Retrospective case series. METHODS: Retrospective study of patients with amyloidosis of the larynx, with or without other disease sites, seen at a tertiary academic center between 2011 and 2019. Outcomes included disease characteristics, recurrence rates, treatment modalities, and pre- and posttreatment voice handicap index (VHI)-10. RESULTS: Ten patients met eligibility criteria. Mean follow-up time for all patients was 62.0 ± 41.0 months; mean follow-up time after last treatment was 51 ± 55 months. All but one patient underwent surgical resection of disease. Seven patients underwent subsequent RT. Of these seven, six underwent RT at our institution; five received a dose of 45 Gray (Gy); and one received a dose of 20 Gy. All seven completed RT without toxicity-related interruption. Patients undergoing RT underwent 2.1 ± 1.3 surgical procedures prior to RT; no patients required surgery after RT. Mean pretreatment VHI-10 was 22.9 ± 8.1; mean posttreatment VHI-10 was 12.9 ± 13.3. CONCLUSION: RT after surgery for LA can provide good local control without unacceptable toxicity and may decrease the need for further surgery. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:1810-1815, 2021.


Assuntos
Amiloidose/radioterapia , Doenças da Laringe/radioterapia , Laringoscopia , Radioterapia Adjuvante/métodos , Adulto , Idoso , Amiloidose/cirurgia , Feminino , Seguimentos , Humanos , Doenças da Laringe/cirurgia , Laringe/efeitos da radiação , Laringe/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
4.
J Voice ; 33(1): 40-44, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29326026

RESUMO

BACKGROUND: Presbylaryngis is a common cause of dysphonia in elderly patients. Type I thyroplasty serves to improve glottic closure and vocal quality by correcting bowing. Although unilateral and injection-based procedures are well-characterized in the treatment of broadly defined glottic insufficiency, there are insufficient outcomes data for bilateral medialization thyroplasty in the treatment of presbylaryngis. The aim of this study was to review the change in measures of vocal quality before and after bilateral medialization thyroplasty for presbylaryngis. STUDY DESIGN: This is a retrospective case series. METHODS: The records of 21 patients with presbylaryngis undergoing bilateral medialization thyroplasty between 2007 and 2014 were reviewed. Implant materials included silastic (n = 17) and hydroxyapatite (n = 4). Preoperative and postoperative comparison of vocal function was conducted using Voice Handicap Index, maximum phonation time, auditory-perceptual severity ratings, and blinded paired-comparison of Consensus Auditory-Perceptual Evaluation of Voice and Visual-perceptual stroboscopic ratings. Paired sample t tests were used to assess all outcome measures. RESULTS: Significant improvements were found in Voice Handicap Index scores (P < 0.007), maximum phonation time (P < 0.03), Consensus Auditory-Perceptual Evaluation of Voice (P < 0.04), and clinician rating of vocal quality (P < 0.0001). Blinded raters noted a significant improvement in audio (P < 0.05) and videostroboscopic (P < 0.003) samples after surgery. There were no operative complications observed, and median hospital stay was one night. CONCLUSIONS: Patients with presbylaryngis demonstrated significant improvement in both objective and subjective measures of vocal quality following bilateral medialization thyroplasty. These data suggest that medialization thyroplasty is a safe option that warrants consideration in the treatment of presbylaryngis.


Assuntos
Disfonia/cirurgia , Laringoplastia/estatística & dados numéricos , Idoso , Disfonia/etiologia , Feminino , Humanos , Laringoplastia/métodos , Masculino , Estudos Retrospectivos
5.
Ecol Evol ; 8(23): 11808-11818, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30598778

RESUMO

Understanding the relationship between environmental factors and vital rates is an important step in predicting a species' response to environmental change. Species associated with sea ice are of particular concern because sea ice is projected to decrease rapidly in polar environments with continued levels of greenhouse gas emissions. The relationship between sea ice and the vital rates of the Spectacled Eider, a threatened species that breeds in Alaska and Russia and winters in the Bering Sea, appears to be complex. While severe ice can impede foraging for benthic prey, ice also suppresses wave action and provides a platform on which eiders roost, thereby reducing thermoregulation costs. We analyzed a 23-year mark-recapture dataset for Spectacled Eiders nesting on Kigigak Island in western Alaska, and tested survival models containing different ice and weather-related covariates. We found that much of the variation in eider survival could be explained by the number of days per year with >95% sea ice concentration at the Bering Sea core wintering area. Furthermore, the data supported a quadratic relationship with sea ice rather than a linear one, indicating that intermediate sea ice concentrations were optimal for survival. We then used matrix population models to project population trajectories using General Circulation Model (GCM) outputs of daily sea ice cover. GCMs projected reduced sea ice at the wintering area by year 2100 under a moderated emissions scenario (RCP 4.5) and nearly ice-free conditions under an unabated emissions scenario (RCP 8.5). Under RCP 4.5, stochastic models projected an increase in population size until 2069 coincident with moderate ice conditions, followed by a decline in population size as ice conditions shifted from intermediate to mostly ice-free. Under RCP 8.5, eider abundance increased until 2040 and then decreased to near extirpation toward the end of the century as the Bering Sea became ice-free. Considerable uncertainty around parameter estimates for survival in years with minimal sea ice contributed to variation in stochastic projections of future population size, and this uncertainty could be reduced with additional survival data from low-ice winters.

6.
Cell Rep ; 19(1): 203-217, 2017 04 04.
Artigo em Inglês | MEDLINE | ID: mdl-28380359

RESUMO

Here, we describe a multiplexed immunohistochemical platform with computational image processing workflows, including image cytometry, enabling simultaneous evaluation of 12 biomarkers in one formalin-fixed paraffin-embedded tissue section. To validate this platform, we used tissue microarrays containing 38 archival head and neck squamous cell carcinomas and revealed differential immune profiles based on lymphoid and myeloid cell densities, correlating with human papilloma virus status and prognosis. Based on these results, we investigated 24 pancreatic ductal adenocarcinomas from patients who received neoadjuvant GVAX vaccination and revealed that response to therapy correlated with degree of mono-myelocytic cell density and percentages of CD8+ T cells expressing T cell exhaustion markers. These data highlight the utility of in situ immune monitoring for patient stratification and provide digital image processing pipelines to the community for examining immune complexity in precious tissue sections, where phenotype and tissue architecture are preserved to improve biomarker discovery and assessment.


Assuntos
Biomarcadores Tumorais/análise , Carcinoma de Células Escamosas/imunologia , Neoplasias de Cabeça e Pescoço/imunologia , Citometria por Imagem/métodos , Processamento de Imagem Assistida por Computador , Monitorização Imunológica/métodos , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/metabolismo , Estudos de Coortes , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Prognóstico , Estatísticas não Paramétricas , Análise Serial de Tecidos
7.
Mar Pollut Bull ; 117(1-2): 178-183, 2017 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-28162252

RESUMO

We compared total mercury (Hg) concentrations in whole blood of harlequin ducks (Histrionicus histrionicus) sampled within and among two geographically distinct locations and across three years in southwest Alaska. Blue mussels were collected to assess correlation between Hg concentrations in locally available forage and birds. Mercury concentrations in harlequin duck blood were significantly higher at Unalaska Island (0.31±0.19 mean±SD, µg/g blood) than Kodiak Island (0.04±0.02 mean±SD, µg/g blood). We found no evidence for annual variation in blood Hg concentration between years at Unalaska Island. However, blood Hg concentration did vary among specific sampling locations (i.e., bays) at Unalaska Island. Findings from this study demonstrate harlequin ducks are exposed to environmental sources of Hg, and whole blood Hg concentrations are associated with their local food source.


Assuntos
Patos/sangue , Monitoramento Ambiental , Mercúrio/sangue , Mytilus edulis/química , Poluentes Químicos da Água/sangue , Alaska , Animais , Poluentes da Água/sangue
8.
J Wildl Dis ; 53(2): 417-419, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28094610

RESUMO

We determined reference intervals for nine serum biochemistries in samples from 329 molting, after-hatch-year, Pacific Black Brant ( Branta bernicla nigricans) in Alaska, US. Cholesterol and nonesterified fatty acids differed by sex, but no other differences were noted.


Assuntos
Gansos , Muda , Alaska , Animais , Anseriformes , Ecossistema
9.
Mar Pollut Bull ; 111(1-2): 453-455, 2016 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-27381988

RESUMO

Blood samples collected from 81 female Pacific black brant (Branta bernicla nigricans) molting near Teshekpuk Lake, Alaska, were analyzed for selenium concentration. The concentration of selenium in blood of after second year (hatched two or more years ago) females (0.84µg/g wet weight) was significantly greater than the concentration in second year (hatched the previous year) females (0.61µg/g wet weight). The concentrations of selenium we found in blood of black brant were 1.5 to 2 times greater than baseline values typical of freshwater birds, but considerably lower than reported in other marine waterfowl sampled in Alaska. This finding may be attributable in part to the nearly exclusive herbivorous diet of black brant. No relationship was noted between blood selenium concentration and molting habitat salinity. We are unaware of any previous reports of blood selenium concentrations in black brant.


Assuntos
Anseriformes/sangue , Selênio/sangue , Fatores Etários , Alaska , Animais , Regiões Árticas , Ecossistema , Poluentes Ambientais/sangue , Comportamento Alimentar , Feminino , Muda , Salinidade
10.
Virol J ; 12: 151, 2015 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-26411256

RESUMO

It is unknown how the current Asian origin highly pathogenic avian influenza H5 viruses arrived, but these viruses are now poised to become endemic in North America. Wild birds harbor these viruses and have dispersed them at regional scales. What is unclear is how the viruses may be moving from the wild bird reservoir into poultry holdings. Active surveillance of live wild birds is likely the best way to determine the true distribution of these viruses. We also suggest that sampling be focused on regions with the greatest risk for poultry losses and attempt to define the mechanisms of transfer to enhance biosecurity. Responding to the recent outbreaks of highly pathogenic avian influenza in North America requires an efficient plan with clear objectives and potential management outcomes.


Assuntos
Monitoramento Epidemiológico , Glicoproteínas de Hemaglutininação de Vírus da Influenza/análise , Vírus da Influenza A/isolamento & purificação , Influenza Aviária/epidemiologia , Influenza Aviária/virologia , Animais , Aves , América do Norte/epidemiologia , Sorogrupo
12.
Anesth Analg ; 121(1): 127-139, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26086513

RESUMO

BACKGROUND: Difficult airway cases can quickly become emergencies, increasing the risk of life-threatening complications or death. Emergency airway management outside the operating room is particularly challenging. METHODS: We developed a quality improvement program-the Difficult Airway Response Team (DART)-to improve emergency airway management outside the operating room. DART was implemented by a team of anesthesiologists, otolaryngologists, trauma surgeons, emergency medicine physicians, and risk managers in 2005 at The Johns Hopkins Hospital in Baltimore, Maryland. The DART program had 3 core components: operations, safety, and education. The operations component focused on developing a multidisciplinary difficult airway response team, standardizing the emergency response process, and deploying difficult airway equipment carts throughout the hospital. The safety component focused on real-time monitoring of DART activations and learning from past DART events to continuously improve system-level performance. This objective entailed monitoring the paging system, reporting difficult airway events and DART activations to a Web-based registry, and using in situ simulations to identify and mitigate defects in the emergency airway management process. The educational component included development of a multispecialty difficult airway curriculum encompassing case-based lectures, simulation, and team building/communication to ensure consistency of care. Educational materials were also developed for non-DART staff and patients to inform them about the needs of patients with difficult airways and ensure continuity of care with other providers after discharge. RESULTS: Between July 2008 and June 2013, DART managed 360 adult difficult airway events comprising 8% of all code activations. Predisposing patient factors included body mass index >40, history of head and neck tumor, prior difficult intubation, cervical spine injury, airway edema, airway bleeding, and previous or current tracheostomy. Twenty-three patients (6%) required emergent surgical airways. Sixty-two patients (17%) were stabilized and transported to the operating room for definitive airway management. There were no airway management-related deaths, sentinel events, or malpractice claims in adult patients managed by DART. Five in situ simulations conducted in the first program year improved DART's teamwork, communication, and response times and increased the functionality of the difficult airway carts. Over the 5-year period, we conducted 18 airway courses, through which >200 providers were trained. CONCLUSIONS: DART is a comprehensive program for improving difficult airway management. Future studies will examine the comparative effectiveness of the DART program and evaluate how DART has impacted patient outcomes, operational efficiency, and costs of care.


Assuntos
Serviço Hospitalar de Emergência/normas , Intubação Intratraqueal/normas , Avaliação de Processos e Resultados em Cuidados de Saúde/normas , Equipe de Assistência ao Paciente/normas , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Adulto , Idoso , Baltimore , Comportamento Cooperativo , Análise Custo-Benefício , Emergências , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/organização & administração , Feminino , Custos Hospitalares , Humanos , Capacitação em Serviço , Comunicação Interdisciplinar , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/economia , Intubação Intratraqueal/mortalidade , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde/economia , Avaliação de Processos e Resultados em Cuidados de Saúde/organização & administração , Equipe de Assistência ao Paciente/economia , Equipe de Assistência ao Paciente/organização & administração , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade/economia , Indicadores de Qualidade em Assistência à Saúde/economia , Medição de Risco , Fatores de Risco , Fatores de Tempo
13.
Anesthesiol Clin ; 33(2): xv-xvi, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25999013
14.
JAMA Otolaryngol Head Neck Surg ; 139(11): 1143-50, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24076972

RESUMO

IMPORTANCE: Venous thromboembolism (VTE) is associated with significant morbidity and mortality in surgery patients, but little data exist on the incidence of VTE in head and neck cancer surgical patients. OBJECTIVE: To determine the incidence of VTE in postoperative patients with head and neck cancer. DESIGN, SETTING, AND PARTICIPANTS: A prospective study of 100 consecutive patients hospitalized at a tertiary care academic surgical center who underwent surgery to treat head and neck cancer. Routine chemoprophylaxis was not used. On postoperative day (POD) 2 or 3, participants received clinical examination and duplex ultrasonographic evaluation (US). Participants with negative findings on clinical examination and US were followed up clinically; participants with evidence of deep venous thrombosis (DVT) or pulmonary embolism (PE) were given therapeutic anticoagulation. Participants with superficial VTE underwent repeated US on POD 4, 5, or 6. Participants were monitored for 30 days after surgery. MAIN OUTCOME AND MEASURE: Total number of new cases of VTE (superficial and deep) identified within 30 days of surgery and confirmed on diagnostic imaging. RESULTS: Of the 111 participants enrolled, 11 withdrew before completing the study; thus, 100 participants were included. The overall incidence of VTE was 13%. Eight participants were identified with clinically significant VTE: 7 DVT and 1 PE. An additional 5 participants had asymptomatic lower extremity superficial VTE detected on US alone. Fourteen percent of patients received some form of postoperative anticoagulation therapy; the rate of bleeding complications in these patients (30.1%) was higher than that in patients without anticoagulation therapy (5.6%) (P = .01). CONCLUSIONS AND RELEVANCE: Hospitalized patients with head and neck cancer not routinely receiving anticoagulation therapy after surgery have an increased risk of VTE. Bleeding complications are elevated in patients receiving postoperative anticoagulation.


Assuntos
Neoplasias de Cabeça e Pescoço/cirurgia , Esvaziamento Cervical/efeitos adversos , Medição de Risco/métodos , Tromboembolia Venosa/epidemiologia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Prospectivos , Fatores de Risco , Ultrassonografia Doppler Dupla , Estados Unidos/epidemiologia , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/etiologia
15.
J Wildl Dis ; 49(3): 600-10, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23778609

RESUMO

The Yukon-Kuskokwim Delta (Y-K Delta) in western Alaska is an immense and important breeding ground for waterfowl. Migratory birds from the Pacific Americas, Central Pacific, and East Asian-Australasian flyways converge in this region, providing opportunities for intermixing of North American- and Eurasian-origin hosts and infectious agents, such as avian influenza virus (AIV). We characterized the genomes of 90 low pathogenic (LP) AIV isolates from 11 species of waterfowl sampled on the Y-K Delta between 2006 and 2009 as part of an interagency surveillance program for the detection of the H5N1 highly pathogenic (HP) strain of AIV. We found evidence for subtype and genetic differences between viruses from swans and geese, dabbling ducks, and sea ducks. At least one gene segment in 39% of all isolates was Eurasian in origin. Target species (those ranked as having a relatively high potential to introduce HP H5N1 AIV to North America) were no more likely than nontarget species to carry viruses with genes of Eurasian origin. These findings provide evidence that the frequency at which viral gene segments of Eurasian origin are detected does not result from a strong species effect, but rather we suspect it is linked to the geographic location of the Y-K Delta in western Alaska where flyways from different continents overlap. This study provides support for retaining the Y-K Delta as a high priority region for the surveillance of Asian avian pathogens such as HP H5N1 AIV.


Assuntos
Virus da Influenza A Subtipo H5N1/genética , Influenza Aviária/virologia , Vigilância de Evento Sentinela/veterinária , Alaska/epidemiologia , Migração Animal , Animais , Aves , Surtos de Doenças/prevenção & controle , Surtos de Doenças/veterinária , Feminino , Influenza Aviária/epidemiologia , Masculino
16.
PLoS One ; 8(3): e58308, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23472177

RESUMO

We examined seroprevalence (presence of detectable antibodies in serum) for avian influenza viruses (AIV) among 4,485 birds, from 11 species of wild waterfowl in Alaska (1998-2010), sampled during breeding/molting periods. Seroprevalence varied among species (highest in eiders (Somateria and Polysticta species), and emperor geese (Chen canagica)), ages (adults higher than juveniles), across geographic locations (highest in the Arctic and Alaska Peninsula) and among years in tundra swans (Cygnus columbianus). All seroprevalence rates in excess of 60% were found in marine-dependent species. Seroprevalence was much higher than AIV infection based on rRT-PCR or virus isolation alone. Because pre-existing AIV antibodies can infer some protection against highly pathogenic AIV (HPAI H5N1), our results imply that some wild waterfowl in Alaska could be protected from lethal HPAIV infections. Seroprevalence should be considered in deciphering patterns of exposure, differential infection, and rates of AIV transmission. Our results suggest surveillance programs include species and populations with high AIV seroprevalences, in addition to those with high infection rates. Serologic testing, including examination of serotype-specific antibodies throughout the annual cycle, would help to better assess spatial and temporal patterns of AIV transmission and overall disease dynamics.


Assuntos
Anticorpos Antivirais/sangue , Patos/virologia , Gansos/virologia , Influenza Aviária/epidemiologia , Alaska , Animais , Feminino , Geografia , Virus da Influenza A Subtipo H5N1 , Masculino , Razão de Chances , Análise de Regressão , Estudos Soroepidemiológicos , Fatores de Tempo
17.
JAMA Otolaryngol Head Neck Surg ; 139(2): 161-7, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23429947

RESUMO

OBJECTIVES: To prospectively determine the incidence of venous thromboembolism (VTE) following major head and neck surgery. At the midpoint of enrollment, an interim analysis was performed to determine if it was ethical to continue this study as an observational study without routine anticoagulation. DESIGN: Prospective, observational cohort study. SETTING: Academic surgical center. PATIENTS: The interim analysis comprised 47 subjects. MAIN OUTCOME MEASURE: The total number of new cases of VTE (superficial and deep) identified within 30 days of surgery and confirmed on diagnostic imaging. These cases were further categorized as clinically relevant and nonclinically relevant. Clinically relevant VTEs were those requiring more than 6 weeks of anticoagulation or were associated with any negative impact on clinical course. On postoperative day 2 or 3, subjects were clinically examined and received duplex ultrasonography. Subjects with negative findings from examination and ultrasonography were followed up clinically; subjects with evidence of deep venous thrombus or pulmonary embolism were given therapeutic anticoagulation. Subjects with superficial VTE received repeated ultrasonography on postoperative days 4 to 6. Subjects were monitored for 30 days after surgery. RESULTS: Three subjects (6%) were identified as having clinically significant VTE: 2 cases of deep venous thrombus and 1 case of pulmonary embolism. Two additional subjects had lower extremity superficial VTE without clinical findings, which were detected by ultrasonography alone. No statistically significant differences were seen between patients with VTE and those without VTE. CONCLUSIONS: This interim analysis of the first prospective study of the incidence of VTE in patients with head and neck cancer showed a VTE rate slightly higher than previously estimated in retrospective studies. There have been no unexpected serious adverse events and no rationale for early termination of the study.


Assuntos
Neoplasias de Cabeça e Pescoço/cirurgia , Complicações Pós-Operatórias , Embolia Pulmonar/etiologia , Trombose Venosa/etiologia , Fatores Etários , Idoso , Anticoagulantes/uso terapêutico , Carcinoma de Células Escamosas/cirurgia , Feminino , Humanos , Incidência , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/tratamento farmacológico , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler Dupla , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/tratamento farmacológico
18.
Environ Toxicol Chem ; 31(12): 2828-31, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22933448

RESUMO

We evaluated chronic exposure of harlequin ducks (Histrionicus histrionicus) to hydrocarbons associated with the 2004 M/V Selendang Ayu oil spill at Unalaska Island, Alaska. We measured levels of hepatic 7-ethoxyresorufin-O-deethylase activity (EROD) in liver biopsy samples as an indicator of hydrocarbon exposure in three oiled bays and one reference bay in 2005, 2006, and 2008. Median EROD activity in ducks from oiled bays was significantly higher than in the reference bay in seven of nine pairwise comparisons. These results indicated that harlequin ducks were exposed to lingering hydrocarbons more than three years after the spill.


Assuntos
Patos/metabolismo , Hidrocarbonetos/metabolismo , Poluição por Petróleo , Poluentes Químicos da Água/metabolismo , Alaska , Animais , Citocromo P-450 CYP1A1/metabolismo , Monitoramento Ambiental , Feminino , Hidrocarbonetos/análise , Fígado/metabolismo , Masculino , Poluentes Químicos da Água/análise
20.
Environ Toxicol Chem ; 30(6): 1479-81, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21462234

RESUMO

The relationships of selenium (Se) concentrations in whole blood with plasma activities of total glutathione peroxidase, Se-dependent glutathione peroxidase, and glutathione reductase were studied in long-tailed ducks (Clangula hyemalis) and common eiders (Somateria mollissima) sampled along the Beaufort Sea coast of Alaska, USA. Blood Se concentrations were >8 µg/g wet weight in both species. Linear regression revealed that the activities of total and Se-dependent glutathione peroxidase were significantly related to Se concentrations only in long-tailed ducks, raising the possibility that these birds were experiencing early oxidative stress.


Assuntos
Patos/sangue , Glutationa/sangue , Selênio/sangue , Oligoelementos/sangue , Alaska , Animais , Feminino , Glutationa Peroxidase/sangue , Glutationa Redutase/sangue , Peróxidos Lipídicos/sangue , Masculino , Estresse Oxidativo , Selênio/toxicidade , Substâncias Reativas com Ácido Tiobarbitúrico/metabolismo , Oligoelementos/toxicidade
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