Ressecção de cisto e abscesso renais por laparoscopia em um cão / Resection of renal cyst and abscess by laparoscopy in a dog

Cistos renais podem formar-se em qualquer parte do néfron e dos ductos coletores. Alguns são hereditários, originando-se durante a organogênese, e outros se desenvolvem no tecido renal normal, depois que os rins estão completamente formados. No presente relato, descreve-se a ressecção de cisto e abscesso renais, por cirurgia laparoscópica em um cão. Para o acesso, foram utilizados três portais, dois de 10mm de diâmetro e um de 5mm, dispostos na parede abdominal lateral direita e, num segundo momento, na parede abdominal lateral esquerda. Conclui-se, portanto, que a técnica laparoscópica com três portais permite a realização de ressecção de cisto e abscesso renais em cães, sem a ocorrência de recidivas em curto prazo.

Renal cysts can be formed anywhere in the nephron and collecting duct system. Some are hereditary, originated during organogenesis, and others could have origin in the normal kidney tissue, after the kidney's development. This report describes the resection of renal cysts and abscesses by laparoscopic surgery in a dog. In order to access the cavity, three portals were used; two with 10mm and another with 5mm diameter, in the right lateral abdominal wall, and in another moment, in the left lateral abdominal wall. It is concluded that the laparoscopic technique with three portals allows the resection of renal cysts and abscesses in dogs, without the occurrence of relapses in the short postoperative time.

Sleep habits and complaints of adults in the city of São Paulo, Brazil, in 1987 and 1995.

This study compares the prevalence of complaints of insomnia, excessive diurnal sleepiness, parasomnias, and sleep habits of the adult population in the city of São Paulo, Brazil, estimated in surveys carried out in 1987 and 1995. Representative samples of 1000 adult residents per survey were interviewed using a validated structured sleep questionnaire, the "UNIFESP Sleep Questionnaire". Difficulty maintaining sleep, difficulty initiating sleep and early morning awakening, occurring at least three times a week, were reported in 1987 and 1995, by 15.8/27.6, 13.9/19.1, and 10.6/14.2% of the interviewees, respectively, significantly increasing throughout time. These sleep problems were more often found among women. Frequencies of excessive diurnal sleepiness and sleep attacks were unchanged comparing 1987 with 1995 (4.5 vs 3.8 and 3.1 vs 3.0%, respectively). Parasomnia complaints remained unchanged, with the exception of leg cramps, which doubled in prevalence from 1987 to 1995 (2.6 to 5.8%). Snoring was the most common parasomnia (21.5% in 1995), reported more often by men than by women, and somnambulism was the least common (approximately 1%). Besides sleeping slightly less, interviewees went to bed and woke up later in 1995. Approximately 12% of the subjects in both surveys had consulted a physician due to sleep problems and 3.0% reported habitual use of sleep-promoting substances in 1995. Overall, there was a significant increase in insomnia complaints from 1987 to 1995 in the general population of the city of São Paulo. This major change over a little under a decade should be considered as an important public health issue.

Behavioral and physiological methods for early quantitative assessment of spinal cord injury and prognosis in rats.

Methods for reliable evaluation of spinal cord (SC) injury in rats at short periods (2 and 24 h) after lesion were tested to characterize the mechanisms implicated in primary SC damage. We measured the physiological changes occurring after several procedures for producing SC injury, with particular emphasis on sensorimotor functions. Segmental and suprasegmental reflexes were tested in 39 male Wistar rats weighing 250-300 g divided into three control groups that were subjected to a) anesthesia, b) dissection of soft prevertebral tissue, and c) laminectomy of the vertebral segments between T10 and L1. In the lesion group the SC was completely transected, hemisected or subjected to vertebral compression. All animals were evaluated 2 and 24 h after the experimental procedure by the hind limb motility index, Bohlman motor score, open-field, hot-plate, tail flick, and paw compression tests. The locomotion scale proved to be less sensitive than the sensorimotor tests. A reduction in exploratory movements was detected in the animals 24 h after the procedures. The hot-plate was the most sensitive test for detecting sensorimotor deficiencies following light, moderate or severe SC injury. The most sensitive and simplest test of reflex function was the hot-plate. The hemisection model promoted reproducible moderate SC injury which allowed us to quantify the resulting behavior and analyze the evolution of the lesion and its consequences during the first 24 h after injury. We conclude that hemisection permitted the quantitation of behavioral responses for evaluation of the development of deficits after lesions. Hind limb evaluation scores and spontaneous exploration events provided a sensitive index of immediate injury effects after SC lesion at 2 and 24 h. Taken together, locomotion scales, open-field, and hot-plate tests represent reproducible, quantitatively sensitive methods for detecting functional deficiencies within short periods of time, indicating their potential for the study of cellular mechanisms of primary injury and repair after traumatic SC injury.

Behavioral and physiological methods for early quantitative assessment of spinal cord injury and prognosis in rats

Methods for reliable evaluation of spinal cord (SC) injury in rats at short periods (2 and 24 h) after lesion were tested to characterize the mechanisms implicated in primary SC damage. We measured the physiological changes occurring after several procedures for producing SC injury, with particular emphasis on sensorimotor functions. Segmental and suprasegmental reflexes were tested in 39 male Wistar rats weighing 250-300 g divided into three control groups that were subjected to a) anesthesia, b) dissection of soft prevertebral tissue, and c) laminectomy of the vertebral segments between T10 and L1. In the lesion group the SC was completely transected, hemisected or subjected to vertebral compression. All animals were evaluated 2 and 24 h after the experimental procedure by the hind limb motility index, Bohlman motor score, open-field, hot-plate, tail flick, and paw compression tests. The locomotion scale proved to be less sensitive than the sensorimotor tests. A reduction in exploratory movements was detected in the animals 24 h after the procedures. The hot-plate was the most sensitive test for detecting sensorimotor deficiencies following light, moderate or severe SC injury. The most sensitive and simplest test of reflex function was the hot-plate. The hemisection model promoted reproducible moderate SC injury which allowed us to quantify the resulting behavior and analyze the evolution of the lesion and its consequences during the first 24 h after injury. We conclude that hemisection permitted the quantitation of behavioral responses for evaluation of the development of deficits after lesions. Hind limb evaluation scores and spontaneous exploration events provided a sensitive index of immediate injury effects after SC lesion at 2 and 24 h. Taken together, locomotion scales, open-field, and hot-plate tests represent reproducible, quantitatively sensitive methods for detecting functional deficiencies within short periods of time, indicating their potential...

Safety of celecoxib in patients with adverse skin reactions to acetaminophen (paracetamol) and other non-steroidal anti-inflammatory drugs.

BACKGROUND: Acetaminophen (paracetamol-P) is a widely used analgesic-antipyretic drug with no anti inflammatory effects and its rate of adverse hypersensitivity reactions is very low. On the contrary non-steroidal anti-inflammatory drugs (NSAIDs) are commonly involved in side effects. Celecoxib (CE) is a novel drug, with high selectivity and affinity for COX-2 enzyme. OBJECTIVE: We evaluated the tolerability of CE in a group of patients with documented history of adverse cutaneous reactions to P and to classic NSAIDs. METHODS: We studied 29 patients with hypersensitivity to P and classic NSAIDs. The diagnosis of P-induced skin reactions was based on in vivo challenge. The placebo was blindly administered at the beginning of each challenge. After three days, a cumulative dosage of 200 mg of CE in refracted doses was given. After 2-3 days, a single dose of 200 mg was administered. All patients were observed for 6 hours after each challenge, and they were controlled again after 24 hours to exclude delayed reactions. The challenge was considered positive if one or more of the following appeared: erythema, rash or urticaria-angioedema. RESULTS: No reaction was observed with placebo and twenty eight patients (96.5 %) tolerated CE. Only one patient developed a moderate angioedema of the lips. CONCLUSION: Only one hypersensitivity reaction to CE was documented among 29 P-intolerant patients. Thus, we conclude that CE is a reasonably safe alternative which can be used in subjects who do not tolerate P.

[Vesicouterine fistula and bladder endometriosis. A case report]. / Fistola vescicouterina ed endometriosi vesicale.

Vesicouterine fistula is rare, accounting nearly 4% of all urogenital fistulas. Cesarean delivery through uterine lower segment is the main predisposing event but in the last years other possible predisposing factors have been pointed out. Clinically, it can occur in different forms and the diagnosis is often delayed although it is not difficult. In this study personal experience in a case of postcesarean vesicouterine fistula arisen on a focus of bladder endometriosis is reported and an eventual hypothetical pathogenetic correlation between bladder endometriosis and vesicouterine fistula is discussed.

The histamine releasers crotamine, protamine and compound 48/80 activate specific proteases and phospholipases A2.

Crotamine, a basic, myonecrotic, histamine-releasing neurotoxin, was isolated from Crotalus durissus terrificus venom. Carboxypeptidase A was shown to be activated by crotamine when acting upon N-carbobenzoxyglycil-L-phenylalanine. However the activity of carboxypeptidase B upon the substrate hippuryl-L-arginine was not enhanced by this toxin. Teh basic histamine releasers protamine and compound 48/80 also activated carboxypeptidase A. These three agents activated both alpha-chymotrypsin when acting upon acetyl-L-tyrosine ethyl ester and also five snake venom phospholipase-like myotoxins acting upon egg yolk phosphatidylcholine. These findings suggest that the action of these agents during histamine release may involve the participation of specific intermediary hydrolases which, upon activation, would enhance their cytolytic effects on the sequence of events which lead to granule extrusion and histamine release from mast cells.

Combination therapy with subcutaneous interleukin-2 and interferon-alpha in advanced renal cancer patients with poor prognostic factors.

Sixteen patients with metastatic renal cell carcinoma were treated with a combination of low-dose subcutaneous interleukin-2 (IL-2) and recombinant interferon (IFN)-alpha. One treatment course included 6 weeks of treatment followed by a 2-week rest. Patients received therapy as outpatients. All patients were assessable for toxicity and response assessment. Nine patients experienced severe toxicities resulting in dosage modification. The major treatment-limiting side effects were gastrointestinal, cutaneous, fever and flu-like symptoms. One patient (6%) had partial remission and six patients (37.5%) had disease stabilization. Overall median survival was 8 months. In our study IL-2 and IFN-alpha showed a low activity and a quite high toxicity. It seems that the prognostic factors per se rather than treatment options might impact the treatment results in advanced renal cancer patients.

Flomoxef, a new oxacephem antibiotic, does not cause hemostatic defects.

Antibiotics of the beta-lactam class may cause coagulation defects and bleeding. It has been suggested that N-methyltetrazolethiol (NMTT), a common side chain group at the 3'-position of the cephem or 1-oxacephem frame, could be responsible for the hypoprothrombinemic effect of the antibiotics and that it could inhibit the liver vitamin K-epoxide reductase activity. Flomoxef (6315-S) is a new oxacephem antibiotic which differs from latamoxef because it has [1-(2-hydroxethyl)-1H-tetrazol-5-yl] thiomethyl (HTT) as a side chain at the 3'-position of cephem group instead of NMTT and an extensive modification of 7 beta-acylamino side chain. The present study was carried out to study its effects on vitamin K-dependent blood coagulation parameters in human volunteers. Ten adult patients (6 men and 4 women), suffering from chronic bronchitis, entered into the study. Each patient received ten 1 g i.m. injections of flomoxef at 12-hourly intervals. Apparently, the treatment with this oxacephem antibiotic had no significant effect. PT, PTT and fibrinogen remained in the normal range in all patients and factors II+VII+X, protein C, protein S and AT III were not depleted. The trend was similar both in men and women. Based on the results of the present study, we conclude that flomoxef is an antibiotic that does not exhibit an effect on blood coagulation, even in males.(ABSTRACT TRUNCATED AT 250 WORDS)

Refining an aftercare program for New York state's outpatient insanity acquittees.

Non-secure state operated psychiatric centers and community based providers of mental health services have witnessed an increase in their caseloads of defendants adjudicated not responsible for criminal activity as a result of mental disease or defect (NGRIs). NGRIs receiving services in these traditionally non-forensic settings are subject to continued court supervision by virtue of Court Orders of Conditions that are designed to assure that NGRIs receive services in a manner that is consistent with the public safety. Several characteristics of the current service delivery system often impede the ability to fulfill statutory mandates and the effective delivery of services to NGRIs. The authors provide an overview of the statutory provisions governing the care of NGRIs, discuss obstacles to the implementation of integrated services to NGRIs and propose a model for the development of an effective community based monitoring and treatment program.

[Role of Actinobacillus actinomycetemcomitans in human infection]. / Rol del actinobacillus actinomycetemcomitans en infecciones humanas.

Actinobacillus actinomycetemcomitans (AA), is a cocobacillus thin and small, non motile, uncapsulate and capnophilic. AA, is: one of the species encountered in the mouth's comensal flora being able to be isolated in gingival crevices culture and oral mucosa in a 20% of the healthy population. An important number of pathogenic factors make it well equipped, to protect itself from host's defense mechanisms, and to destroy the periodontal tissue. Between the most important we find lipopolisacarides and leucotoxines which promote tisular invasion and destructive qualities of this microorganism. Since 1912, there are numerous reports of infectious process associated to it, between which we find: endocarditis in native and prothesic valve, soft tissues abscess, pneumonia, brain's abscess, urethritis, vertebral osteomielitis, thyroid's abscess, pericarditis and periodontal juvenile illness, being this one in which its isolation is more frequent. In vitro, AA is very susceptible to tetracicline. This antibiotic reaches high concentrations in gingival crevices, has significant affinity to the alveolar bone and contributes to protect the collagen. These special feature make them the election drug in periodontal disease produced by this microorganism.

Receptors mediating contraction of isolated human vas deferens.

A large body of evidences has suggested the role of adrenergic, opioidergic and other peptidergic receptors in the mediation of animal vas deferens motility. Different animal species showed different neurochemical patterns, so it is to be expected that human vas deferens has its own specific response to several substances, in relation to its peculiar function. In this study we report on the effects of monoaminergic (norepinephrine, dopamine, serotonin, isoproterenol, cholinomimetic drugs) and opioidergic (morphine, buprenorphin, beta-endorphin, met-enkephalin and dynorphin) agonists on isolated human vas deferens motility. Norepinephrine and dopamine provoked complex patterns of motility while opioids did not affect the field electroinduced contractions. The implications of this finding are discussed in relation to human vas deferens function.

[Liquid embolization of the renal artery with absolute ethanol]. / L'embolisation liquide de l'artère rénale avec l'éthanol absolu.

Absolute ethanol is a new agent for use in embolization which has demonstrated excellent efficacy, is simple to manage, and above all is innocuous in case of reflux into the aorta. A part from provoking irreversible occlusion of the complete renal artery circle, embolization with ethanol provokes direct cellular toxic necrosis comparable with a true mummification. This is of fundamental importance during palliative embolization for renal cancer or in all cases of medical nephrectomy for non-neoplastic disease. Results of the use of liquid embolization of the renal artery with absolute ethanol are presented, the technique, described, and mechanisms of action analyzed based on histologic findings.

[Percutaneous dilatation of renal artery stenoses. Apropos of 7 cases]. / Les dilatations percutanées des sténoses de l'artère rénale. A propos de sept observations.

The authors report the results of percutaneous dilatation of renal artery stenoses, performed on 8 occasions in 7 patients. One patient had bilateral stenoses which were operated at two separate occasions. The authors had no complications and they confirm the stability of the results with a follow-up of up to 2 years. In the 4 cases with an isolated unilateral renal artery stenosis, dilatation of the artery led to normalization of the blood pressure within hours of the operation. When there was another cause for hypertension apart from the renal artery stenosis, the dilatation did not cause the blood pressure to return to normal, although the anatomical result was confirmed on arteriography. The authors then review the literature and compare the complications of surgery for renal artery stenoses with those occurring during or after percutaneous dilatation of the renal artery lumen. Because of the quality of the results, the complication rate and the good results obtained with percutaneous dilatation in the literature, the authors conclude that percutaneous dilatation of the renal artery lumen is the treatment of choice for these stenoses. The indication for this operation can be extended, as its aim is not only reduction of hypertension, but also to improve renal function and to avoid the risk of thrombosis on a very narrow stenosis. In this way, the indications for this operation extend to include a population which, up until now, has been excluded from surgery, such as elderly patients, patients with coronary disease, or with renal failure.

Fluoroscopically guided skinny-needle aspirative biopsy in normal and suspected lymph nodes in urologic cancer.

The authors present their experience with transperitoneal thin-needle biopsy of the retroperitoneal lymph nodes. This method is a means of improving lymphographic diagnosis in suspected lymph node metastases, the small contrast defects serving as a sign. The high rate of false-negative results makes its use unadvisable in patients with negative lymphography where the sample cannot be aimed at but is multiple and randomized.

[Histological follow-up after implantation of grains of I-125 for prostatic cancer]. / Contrôles histologiques après implant de grains d'I125 pour cancer de la prostate. Rapport préliminaire.

The authors report a preliminary study of 12 cases of carcinoma of the prostate confined to the prostate (T1, T2, T3, NO, MO) treated by pelvic lymphadenectomy and the implantation of grains of I 125 in the prostatic tissue. Irradiation continued for six months, providing most dose of 100 Gy in the prostate. Interstitial irradiation caused not only the destruction of tumour cells but also "radiation prostate" lesions with vascular obliteration which itself caused sufficient impairment of the vitality of the prostatic tissue for any residual tumour to disappear with a frequency which increased with the time elapsing between the follow up prostatic biopsy and the implantation of radioactive iodine. Experience remains limited but the initial figures given here suggest the validity of continuing along these lines.

[Endo-urological techniques. New applications in two cases]. / De nouvelles indications à l'application des techniques endo-urologiques. Présentation de deux cas.

Two new indications for the application of endo-urological techniques are reported. One case involved recanalization of stenosis at the ureterovesical junction, while in the other case a double J ureteral endoprosthesis was extracted by the transnephropyelostomy percutaneous route.

[Percutaneous fine needle lymphnode biopsy in prostatic cancer patients with negative lymphography (author's transl)]. / Biopsie ganglionnaire per-cutanée transpéritonéale à l'aiguille fine. Etude chez des patients porteurs de cancer de la prostate à lymphographie négative.

The authors refer their experience in fine needle transperitoneal lymphnodes biopsy in 19 prostatic cancer patients with negative or border-line lymphography. This technique improved the diagnosis and may be applied in staging of malignant diseases of the pelvis.