Vascular ligations for control of postpartum hemorrhage / Ligaduras vasculares para el control de la hemorragia posparto

Objective: To present a case series of 26 patients with postpartum hemorrhages treated with vascular ligations and analyze its efficiency for hemorrhagic control.Material and methods: This case series included patients with postpartum hemorrhages hospitalized in a high risk pregnancy unit in Sofia Feldman Hospital, Brazil, between January 2014 and May 2017, who were treated with vascular ligation techniques. The data were collected from patient medical records.Results: The success rate in hemorrhagic control was 96.2% and hemorrhagic control of the single case in which vascular ligation failed was obtained with total hysterectomy. Hypovolemic shock occurred in 19.2% of the patients and blood transfusion was required in 26.9%. No patient required intensive care unit treatment. Hypertensive syndrome was the most prevalent comorbidity (46.2%). The main etiology was uterine atony (65.4%). Uterine and/or pelvic adhesions and uterine lacerations associated with fetal extraction occurred in 19.3% and 15.4% of cases, respectively. Conclusion: Vascular ligations are efficient strategies for hemorrhagic control during cesarean sections and should be an integral part of the set of techniques that allow uterus preservation in the treatment of postpartum hemorrhage.(AU)

Objetivo: Presentar una serie de casos de 26 pacientes con hemorragias posparto tratadas con ligaduras vasculares y analizar su eficacia para el control hemorrágico. Material y métodos: Esta serie de casos incluyó a pacientes con hemorragias posparto hospitalizadas en la Unidad de Embarazo de Alto Riesgo del Hospital Sofia Feldman, Brasil, entre enero de 2014 y mayo de 2017, que fueron tratadas con técnicas de ligaduras vasculares. Los datos se obtuvieron de los registros médicos de las pacientes. Resultados: La tasa de éxito en el control hemorrágico fue del 96,2% y el control hemorrágico del caso único en el que falló la ligadura vascular, se obtuvo con histerectomía total. El choque hipovolémico ocurrió en el 19,2% de los pacientes y se requirió transfusión de sangre en el 26,9%. Ningún paciente requirió tratamiento en la Unidad de Cuidados Intensivos. El síndrome hipertensivo fue la comorbilidad con mayor prevalencia (46,2%). La principal etiología fue la atonía uterina (65,4%). Las adherencias uterinas y/o pélvicas y las laceraciones uterinas asociadas con la extracción fetal ocurrieron en el 19,3% y el 15,4% de los casos, respectivamente. Conclusión: Las ligaduras vasculares son estrategias eficaces para el control hemorrágico durante la cesárea y deben integrar el conjunto de técnicas que permiten la preservación del útero en el tratamiento de la hemorragia posparto.(AU)

Pathogenicity of Aphelenchoides Pseudogoodeyi on the Ornamental Plants Asplenium Nidus and Lilium Speciosum in Brazil.

Aphelenchoides pseudogoodeyi has recently been reported in association with seeds of forage grasses and rice in Brazil and senescent strawberry plants, in the United States. This nematode is likely a mycophagous species; however, so far, its pathogenicity potential to plants is unclear. This study aimed to verify the pathogenicity of A. pseudogoodeyi to two species of ornamental plants. The experiments were conducted by inoculating A. pseudogoodeyi onto Bird's-Nest Fern (Asplenium nidus) and Oriental Lily (Lilium speciosum) leaves, using two inoculation methods (with and without injury). After 40 days of inoculation (DAI) in Bird's-Nest Fern and 5, 10, 20 and 40 DAI in Oriental Lily, the pathogenicity and the host efficiency were evaluated by symptoms observation and by severity, final nematode population and reproductive factor (RF), respectively. Additionally, a histopathological study was performed by inoculating A. pseudogoodeyi onto Bird's-Nest Fern for observing anatomical alterations. A. pseudogoodeyi was able to cause local necrotic lesions on both Bird's-Nest Fern and Oriental Lily leaves. However, the presence of injury was essential to enable A. pseudogoodeyi to penetrate and cause those symptoms in both plant species. Also, the total population of A. pseudogoodeyi decreased drastically over time and RF was <1, which characterized these species as poor-host or resistant plants. A. pseudogoodeyi penetrated into the foliar tissue and induced a total destruction of the mesophyll and collapse of the cells, with the formation of large intercellular spaces. It is concluded that A. pseudogoodeyi is an opportunistic pathogen as injury was required to induce symptoms in Bird's-Nest Fern and Oriental Lily.

Serum evaluation of leptin, IL-6, IGF-1 and estrogen in obese bitches with early stages of mammary carcinoma / Avaliação sérica de leptina, IL-6, IGF-1 e estrógeno em cadelas com excesso de peso e portadoras de carcinomas mamários em estágio inicial

The aim of this study was to relate the serum concentration IL-6, IGF-1, leptin and estrogen in non-castrated bitches with or without overweight and early stage mammary carcinomas. Forty-three bitches were divided into four groups, two groups without mammary carcinomas with and without overweight, and two groups with mammary carcinomas with and without overweight. Overweight bitches, with or without mammary carcinomas, were statistically different from bitches by ideal weight, in relation to ECC, IMCC and body fat percentages (P< 0.0001). There was a positive correlation between ECC and IMCC (P< 0.0001), ECC and % GC (P< 0.0001), and IMCC and % GC (P< 0.0001). A positive correlation was found between serum leptin and IL-6 (P= 0.0451) and leptin and IGF-1 (P= 0.05). A positive correlation (P= 0.0053) between ECC and leptin was found in the analysis of body evaluation methods and serum concentrations, and a negative correlation between ECC and IL-6 (P= 0.0435). Among the fat percentage and the leptin concentration, there was a positive correlation (P= 0.0016), as found between the IMCC and leptin (P= 0, 0209). In this study, no association was observed between excessive weight and the presence of early stage mammary carcinomas.(AU)

Este estudo teve por objetivo relacionar a concentração sérica de IL-6, IGF-1, leptina e estrógeno, em cadelas não castradas com ou sem excesso de peso, e carcinomas mamários em estágio inicial. Quarenta e três cadelas foram divididas em quatro grupos, sendo dois de cadelas sem carcinomas mamários, com e sem excesso de peso, e dois de cadelas com carcinomas mamários, com e sem excesso de peso. Cadelas com excesso de peso, com ou sem carcinomas mamários, foram estatisticamente diferentes de cadelas em peso ideal, em relação às avaliações corporais de ECC, IMCC e percentual de gordura corpórea (P<0,0001). Foi observada uma correlação positiva entre ECC e IMCC (P<0,0001), ECC e %GC (P<0,0001), e IMCC e %GC (P<0,0001). As análises de estrógeno, leptina, IL-6 e IGF-1 não apresentaram diferenças estatísticas entre os grupos. Demonstrou-se correlação positiva entre as concentrações séricas de leptina e IL-6 (P=0,0451) e leptina e IGF-1 (P=0,05). Encontrou-se correlação positiva entre ECC e leptina (P=0,0053) e negativa entre ECC e IL-6 (P=0,0435). Entre o percentual de gordura e leptina encontrou-se correlação positiva (P=0,0016), assim como entre IMCC e leptina (P=0,0209). Neste estudo, não se observou associação entre excesso de peso e a presença de carcinomas mamários em estadio inicial.(AU)

Perioperative outcomes and adverse events of robotic colorectal resections for inflammatory bowel disease: a systematic literature review.

The purpose of this study was to assess outcome measures and cost-effectiveness of robotic colorectal resections in adult patients with inflammatory bowel disease. The Cochrane Library, PubMed/Medline and Embase databases were reviewed, using the text "robotic(s)" AND ("inflammatory bowel disease" OR "Crohn's" OR "Ulcerative Colitis"). Two investigators screened abstracts for eligibility. All English language full-text articles were reviewed for specified outcomes. Data were presented in a summarised and aggregate form, since the lack of higher-level evidence studies precluded meta-analysis. Primary outcomes included mortality and postoperative complications. Secondary outcomes included readmission rate, length of stay, conversion rate, procedure time, estimated blood loss and functional outcome. The tertiary outcome was cost-effectiveness. Eight studies (3 case-matched observational studies, 4 case series and 1 case report) met the inclusion criteria. There was no reported mortality. Overall, complications occurred in 81 patients (54%) including 30 (20%) Clavien-Dindo III-IV complications. Mean length of stay was 8.6 days. Eleven cases (7.3%) were converted to open. The mean robotic operating time was 99 min out of a mean total operating time of 298.6 min. Thirty-two patients (24.7%) were readmitted. Functional outcomes were comparable among robotic, laparoscopic and open approaches. Case-matched observational studies comparing robotic to laparoscopic surgery revealed a significantly longer procedure time; however, conversion, complication, length of stay and readmission rates were similar. The case-matched observational study comparing robotic to open surgery also revealed a longer procedure time and a higher readmission rate; postoperative complication rates and length of stay were similar. No studies compared cost-effectiveness between robotic and traditional approaches. Although robotic resections for inflammatory bowel disease are technically feasible, outcomes must be interpreted with caution due to low-quality studies.

A systematic review to assess the management of patients with cerebral metastases secondary to colorectal cancer.

BACKGROUND: Colorectal cancer (CRC) rarely metastasizes to the brain. The incidence of cerebral metastases (CM) is estimated between 1 and 3%. Given the improved survival from advanced CRC as a result of surgical and oncological advances, it is anticipated that the incidence of patients with CM from CRC will rise over the next few years. The aim of this article was to systematically review the treatment options and outcome of patients with CM from CRC. METHODS: PubMed and Medline databases were examined using the search words or MESH headings "colorectal" "cancer/carcinoma/adenocarcinoma", "cerebral"/"brain" and "metastases/metastasis". RESULTS: CM from CRC are diagnosed on average 28.3 months after the primary tumour. The median survival time following diagnosis is 5.3 months. Surgery (with or without associated radiotherapy), stereotactic radiosurgery, whole brain radiotherapy and best supportive care result in median survival of 10.3, 6.4, 4.4 and 1.8 months, respectively. On average, the 1-year overall survival rate for patients with CM from CRC regardless of the treatment modality is estimated to be around 24%. CONCLUSIONS: The prognosis of patients with CM from CRC is dismal. Surgery may increase survival, but the additional benefit of perioperative radiotherapy cannot be ascertained due to paucity of data. Further studies are required to identify the role of the different oncological and surgical therapies and identify those patients likely to benefit most. Identification of patients who are at higher risk of developing brain metastases may be another important area for future research.

Analysis of EGFR and HER-2 expressions in ductal carcinomas in situ in canine mammary glands / Análise da expressão de EGFR e HER-2 em carcinomas ductais in situ da glândula mamária canina

Biomolecular evidence has shown that ductal carcinoma in situ (DCIS) may develop into invasive carcinoma of the canine mammary gland, and mutations in proto-oncogenes HER2 and EGFR; two members of the family of epidermal growth factor receptors, may be involved in this process. The purpose of this study was the characterization of the immunohistochemical expression of the EGFR and HER2 proteins in the process of neoplastic transformation, supposedly present in ductal carcinomas in situ in canine mammary glands. Fifteen cases of DCIS were evaluated, with a higher expression of HER2 and EGFR being observed in low-grade carcinomas when compared with high-grade neoplasms, and with a high positive statistical correlation in the latter. Results suggest that aggressive tumors tend to lose the expression of EGFR and HER2 simultaneously. The loss of the expression of these markers may be related to the process of neoplastic progression in canine mammary tumors...

Evidências biomoleculares sugerem que o carcinoma ductal in situ (CDIS) pode progredir para carcinoma invasor na mama canina e que mutações nos proto-oncogenes HER-2 e EGFR, dois membros da família de receptores para fatores de crescimento epidérmicos, podem estar envolvidas neste processo. A partir disso, este trabalho teve por objetivo caracterizar a expressão imuno-histoquímica das proteínas EGFR e HER-2 no processo de transformação neoplásica supostamente presente em carcinomas ductais in situ da glândula mamária canina. Foram avaliados 15 casos de CDIS, sendo observada maior expressão de HER-2 e EGFR em carcinomas de baixo grau em comparação às neoplasias de alto grau, com correlação estatística positiva alta nestes últimos. Os resultados sugerem que tumores mais agressivos tendem a perder, simultaneamente, a expressão de EGFR e HER-2. A perda na expressão desses marcadores pode estar envolvida no processo de progressão neoplásica em tumores mamários caninos...

Evaluation of the effectiveness of a phonoaudiology program for the rehabilitation of dysphagia in the elderly.

The object of this study was to evaluate the effectiveness of a phonoaudiology rehabilitation program directed towards the degenerative changes of the neurophysiological mechanisms responsible for the upper digestive system compromised by the age between 80 and 90 years, in a regime of internment in a long permanence institution in the city of Rio de Janeiro, which express, bodily, their difficulty in swallowing food of liquid or pasty consistency. To achieve such an object, the current study was developed in an experimental format or design, comprised of a sample group of 23 elderly subjects, of both genders, undergoing evaluation by the phonoaudiology protocol for evaluating the risk of dysphagia (abbreviated from the Portuguese name: Protocolo de Avaliação do Risco para Disfagia=PARD), pre- and post-intervention procedure. The developed program used the indirect therapy approach based on the adaptive myotherapeutic and myofunctional stimulation, contemplating two isometric and isokinetic orofacial active myotherapeutic exercises, two passive myotherapeutic manipulations for the supra-hyoidal musculature, as well as adaptive cephalic postural maneuvres, associated to the intra-oral olfactive and gustative sensory stimulation. The evolution of the individuals was analyzed before and after the therapy by estimating the capacity of swallowing food in the liquid fluid (LF) consistency, by the paired Student t-test, giving a p=0.01, making the difference of 2.31 between the 2 evaluations statistically significant. The changes produced by the PARD program in the capacity of individuals in swallowing food of a pasty consistency were also significant when analyzing the variance of the results on the 2 instances by using the F-test (pre- and post-intervention difference=4.47, p=0.039).

Paediatric anaphylaxis: a 5 year retrospective review.

OBJECTIVE: To describe the demographic characteristics, clinical features, causative agents, settings and administered therapy in children presenting with anaphylaxis. METHODS: This was a retrospective case note study of children presenting with anaphylaxis over a 5-year period to the Emergency Department (ED) at the Royal Children's Hospital, Melbourne. RESULTS: One-hundred and twenty-three cases of anaphylaxis in 117 patients were included. There was one death. The median age of presentation was 2.4 years. Home was the most common setting (48%) and food (85%) the most common trigger. Peanut (18%) and cashew nut (13%) were the most common cause of anaphylaxis. The median time from exposure to anaphylaxis for all identifiable agents was 10 min. The median time from onset to therapy was 40 min. Respiratory features were the principal presenting symptoms (97%). Seventeen per cent of subjects had experienced anaphylaxis previously. CONCLUSIONS: This is the largest study of childhood anaphylaxis reported. Major findings are that most children presenting to the ED with anaphylaxis are first-time anaphylactic reactions and the time to administration of therapy is often significantly delayed. Most reactions occurred in the home. Peanut and cashew nut were the most common causes of anaphylaxis in this study population, suggesting that triggers for anaphylaxis in children have not changed significantly over the last decade.