Selective internal carotid artery cross-clamping increases the specificity of cerebral oximetry for indication of shunting during carotid endarterectomy.

BACKGROUND: An indication for selective shunting during carotid endarterectomy (CEA) is based on monitoring during a procedure. Cerebral oximetry (CO) using near-infrared spectroscopy (NIRS) may be a simple technique, but its relevance during CEA, especially with respect to cutoff values indicating shunt implantation, still needs to be elucidated. METHODS: One hundred twenty five patients underwent CEA under local anesthesia (LA) and were monitored clinically throughout the whole procedure. The patients were also monitored using bilateral NIRS probes during surgery. The NIRS values were recorded and evaluated before and after selective cross-clamping, firstly by the external carotid artery (ECA), followed by the internal carotid artery (ICA). The decrease in the ipsilateral CO values, with respect to the indication of shunting, was only analyzed after selective cross-clamping of the ICA. The decision to use an intraluminal shunt was solely based on the neurological status evaluation after ICA cross-clamping. RESULTS: One hundred five patients (85%) were stable throughout the CEA, while 20 patients (15%) clinically deteriorated during surgery. The mean drop in the CO after selective ICA clamping in clinically stable patients was 6%, while in patients with clinical deterioration, the NIRS decreased by 14.5% (p < 0.05). When the cutoff value for selective shunting was set as a 10% decrease of the ipsilateral CO after selective ICA clamping, the sensitivity of the technique was 100% and the specificity 83.0%. CONCLUSIONS: Our study showed that a 10% decrease in the ipsilateral brain tissue oximetry after selective cross-clamping the ICA provides a reliable cutoff value for selective shunting during CEA. Despite the availability of a variety of monitoring tools, the NIRS may be an easy, reliable option, especially in the scenario of acute CEA in general anesthesia.

[Treatment for volume upgrading of the low-grade supratentorial glioma after the subtotal neurosurgical resection]. / Lécba nízkostupnového gliomu supratentoriální oblasti mozku po neurochirurgické subtotální resekci s projevy objemového up-gradingu.

BACKGROUND: Low-grade gliomas WHO II (LGG) are mostly detected in patients with neurological symptomatology between 20 and 45 years of age very often as secondary epilepsy. We present two cases in which low-grade gliomas attacked neurological zones. Neurosurgical resection was subtotal because of the risk of the damage in neurocognitive functions in both these patients. After the operation, both patients were followed at neurosurgery department in regular intervals using different imaging methods (MRI, MRS and PET). After resections, the MRI detected the enlargement of the volumes of the tumor residua in both patients. PATIENTS AND METHODS: Owing to the risk of up-grading to high-grades glial tumors (overexpression of EGFR and VEGF), both patients were indicated for curative treatment by external beam radiotherapy combined with chemotherapy (Temodal®) and adjuvant chemotherapy. RESULTS: After the end of this treatment, the MRI proved considerable partial regressions in both patients. Moreover, three months later, the MRI did not prove any residual disease. CONCLUSION: Radiotherapy combined with the administration of Temodal should prolong the OS and TTP in patients with a high risk of up-grading of low-grade gliomas of the brain. Both the patients are in a follow-up program, also because of the risk of duplicite brain tumor.

Proposta de Sistema de Informação para Atenção Farmacêutica baseado no Método Dáder / Proposal of an Information System for Pharmaceutical Care based on Dader Method

A característica principal do Acompanhamento Farmacoterapêutico, um dos macrocomponentes da Atenção Farmacêutica, é a documentação sistemática de informações para solução dos Problemas Relacionados aos Medicamentos (PRM). Essa documentação é feita, com frequência, de forma não automatizada e com o preenchimento de fichas manuais catalogadas em arquivos, o que dificulta a sua organização e torna o processo de recuperação dos dados exaustivo e complicado, limitando a sua aplicação no cotidiano. Uma maneira de minimizar estes problemas é utilizar um sistema de informação para dinamizar esse processo, facilitar o acesso aos dados da terapia e melhorar a comunicação entre o médico e a equipe de saúde responsável pelo paciente. Este artigo apresenta, portanto, o desenvolvimento de um sistema para Atenção Farmacêutica baseado no método Dáder, denominado Farmatools. Esse sistema tem como objetivo informatizar o método Dáder, facilitando o acompanhamento farmacoterapêutico, otimizando o tempo de visita e melhorando a recuperação de informação e a comunicação entre os profissionais de saúde. O Farmatools visa melhorar o acesso à informação, diminuindo a inacessibilidade e a perda das informações.

These registrations are often not automated, but done by filling manual forms, that are cataloged. Over time, with the increase in attendances, there is an increase in the number of forms (amount of paper), making the recovery data process extensive and complicated, thereby, its application in daily life. One way to minimize these problems is to use an information system to improve the process and facilitate the data access recorded during the visits, improving communication with the doctor and the health care team responsible for the patient. This paper presents Farmatools, anelectronic system for pharmaceutical care based on Dader Method. The system aims to automate the Dader method, facilitating the pharmaceutical monitoring, reducing visit time, improving the information retrieval, as well as the communication between health professionals. Furthermore, Farmatools avoid the pharmaceutical paper records of patients accumulation, the inaccessibility of them and the loss of information.

Quantification of androgen receptor mRNA in tissues by competitive co-amplification of a template in reverse transcription-polymerase chain reaction.

We describe a polymerase chain reaction (PCR)-based method for the quantification of androgen receptor (AR) mRNA in tissues. The amount of PCR products depends on the exponential amplification of the initial cDNA copy number; therefore minor differences in the efficiency of amplification may dramatically influence the final product yield. To overcome these tube-to-tube differences in reaction efficiency, an internal control AR cRNA was reverse transcribed along with the target mRNA using the same primers. This standard was obtained by deleting a 38 bp fragment from an amplified bovine AR sequence, which was then subcloned and transcribed into cRNA. Known dilutions of the competitor cRNA were spiked into a series of RT-PCR reaction tubes containing equal amounts of the target mRNA. Following RT-PCR, the co-amplified specimens obtained were separated by gel electrophoresis and quantified by densitometric analysis of ethidium bromide stain. We applied this method to quantify the AR-mRNA in skeletal muscle of castrated as well as from intact male cattle. The applicability of the quantification system for AR-mRNA described herein was demonstrated for other species, e.g. man.

Expression of estrogen and androgen receptor in the bovine gastrointestinal tract.

Reproductive and maturational nutritive needs are examples for situations in which alterations in circulating concentrations of sex steroids are associated with changes in gastrointestinal function. In order to investigate whether there is a causal relationship between sex steroids and gastrointestinal function, we aimed to investigate the responsiveness for androgens and for estrogens of the bovine gastrointestinal tract. Using Northern blot analysis, estrogen receptor (ER) mRNA was detected in rumen tissue. Comparing the ER expression in rumen from females of different reproductive stages, we found that no differences related to cycle stage, pregnancy or parturition could be detected. In contrast, the ER expression rates in the uterus of the respective animals showed the same dependency of reproductive stage as demonstrated earlier for the ER protein, indicating that there might be a tissue specific regulation of ER. By in-situ hybridization of rumen tissue sections the expression of ER was localized in the epithelium of the papillae. In the muscular layer no positive signals for ER mRNA were observed. Above rumen, the presence of ER and androgen receptor (AR) mRNA was determined in various intestinal tissues using reverse transcription (RT) and polymerase chain reaction (PCR). Primers were selected from the bovine androgen and estrogen receptor sequence to amplify parts of the sequence coding for the hormone binding part of the respective receptor. The PCR amplifies were subsequently electrophoresed on 1% agarose gels and visualized by ethidium bromide staining. ER mRNA expression was demonstrated in reticulum, omasum, abomasum, duodenum, jejunum, ileum, caecum and colon. AR mRNA expression was not determined in the forestomaches, but was present in all intestinal segments investigated.(ABSTRACT TRUNCATED AT 250 WORDS)

Tissue distribution and residues of clenbuterol, salbutamol, and terbutaline in tissues of treated broiler chickens.

To examine the tissue distribution and residues after withdrawal of various beta-agonists (i.e., clenbuterol, salbutamol, and terbutaline) 160 1-d-old broiler chickens were assigned to four groups. During treatment (16 to 35 d), the birds were fed a control diet or a diet containing 1 ppm of clenbuterol, 10 ppm of salbutamol, or 10 ppm of terbutaline. After d 35 all groups received the control diet. Five birds of each group were then slaughtered and tissues were collected on d 0, 1, 2, 3, 7, 14, and 43 following withdrawal of beta-agonists from the feed. Extraction of beta-agonists from the tissues was carried out by a new method using hetero-bifunctional solid phase extraction. The amount of beta-agonists in the extracts was measured by an enzyme immunoassay (EIA). The highest concentrations of beta-agonists were found in feathers: 224 ng of clenbuterol/g, 1,140 ng of salbutamol/g, and 1,159 ng of terbutaline/g. Clenbuterol accumulated above plasma levels in all tissues that were investigated (liver, kidney, stomach, muscle, fat, feather, eye). Salbutamol was most concentrated in feather, eye, liver, and kidney; terbutaline accumulated only in feather, liver, and kidney. Overall, clenbuterol showed the highest accumulation in the tissues analyzed. A withdrawal period of greater than 2 wk was required for residues in edible tissues to decline below detectable levels.