A comparison of intra and postoperative analgesic effects of sacrococcygeal and lumbosacral epidural levobupivacaine in cats undergoing ovariohysterectomy.

The aim of this study was to compare the intra and postoperative analgesic effects of sacrococcygeal epidural levobupivacaine with those of lumbosacral levobupivacaine in feline ovariohysterectomy. Thirty-six cats were premedicated with intramuscular acepromazine (0.05 mg/kg) and meperidine (6 mg/kg). Anesthesia was induced with intravenous propofol and maintained with isoflurane in oxygen. The cats were randomly assigned one of the three treatments receiving 0.33% levobupivacaine (0.3 mL/kg) into the sacrococcygeal (S-C group, n=12) or lumbosacral (L-S group, n=12) epidural space, or the same volume of 0.9% saline solution into one of the epidural approaches (Control group, n=12). Intraoperatively, cardiorespiratory variables, end-tidal isoflurane concentration (FE´ISO), and fentanyl requirements were recorded. Postoperative pain was assessed by the UNESP (Universidade Estadual Paulista)-Botucatu multidimensional composite pain scale and the Glasgow feline composite measure pain scale up to 8 hr post-extubation. Morphine was administered as rescue analgesia. Overall FE´ISO and fentanyl requirements were lower in the L-S and S-C compared to the Control (P=0.002-0.048, respectively). There was no significant difference in the cardiorespiratory variables during anesthesia, postoperative pain and rescue analgesia among groups. The time to standing after anesthesia was prolonged in the L-S and S-C groups than in the Control (P<0.001). Lumbosacral and sacrococcygeal epidural levobupivacaine resulted in similar decreases in isoflurane requirements and intraoperative fentanyl supplementation in the cats, with no postoperative benefits.

Effects of Lidocaine Injection at Acupuncture Points on Perioperative Analgesia in Cats Undergoing Ovariohysterectomy.

Background: Pharmacopuncture is an acupuncture-related technique that has been used to amplify the therapeutic effects of different medications. Objectives: To investigate the analgesic efficacy of a lidocaine injection at acupoints in cats undergoing ovariohysterectomy. Methods: Thirty cats were randomly distributed into two groups (n = 15, per group). The experimental group received a bilateral administration of lidocaine at the following acupoints: Stomach 36 (ST-36) and Spleen 6 (SP-6) (Lido group). The control group did not receive lidocaine (Control group). All cats were sedated with dexmedetomidine and anesthesia was induced with propofol and maintained with isoflurane. Intraoperatively, fentanyl was given to control cardiovascular responses to surgical stimulation. Postoperative pain was assessed at various time points, up to 24 hours after extubation, using the UNESP-Botucatu multidimensional composite pain scale (MCPS) and Glasgow feline composite measure pain scale (CMPS-Feline). Sedation scores were measured at the same time points. Morphine/meloxicam was administered as rescue analgesia. Data were analyzed using t-tests, Fisher´s exact test, the Mann-Whitney test, and the Friedman test (p < 0.05). Results: Intraoperatively, more cats in the Control group required analgesic supplementation than those in the Lido group, but the difference was not significant (p = 0.65). Postoperative pain, sedation scores, and analgesic requirements did not differ between groups. Rescue analgesia was given to 67% (10/15) of the cats in each group. Conclusion: The administration of lidocaine at ST-36 and SP-6 acupuncture points did not provide significant perioperative analgesic benefits in healthy cats undergoing ovariohysterectomy.

"CUIDARAS " : A Nominal and Personalized Health Care Model. Effectiveness of a Massive Screening for Colorectal Cancer Detection at Community level.

Health systems provides care only to those people who spontaneous demand for attention; excluding those who dont perceive illness or are not aware enough to consult. Alternative healthcare models based on the nominal-personalized care like "University Center for Integrated Care of Referred Health Care" (CUIDARAS) may have better results. In order to demonstrate benefits of this model, it was performed an experience based in colorectal cancer (CRC) detection and care that focused the entire population of the town. METHODS: It is an intervention study for early detection of CRC. A survey and a physical examination were performed in each adult from "CH" town. Two visits were made. Blood in stool test (BIST) was self-collected, analyzed and results delivered with appointment for a programmed video-colonoscopy (VCC) when test was positive. RESULTS: people enrolled (n546) had 59.9+/-6.4 yrs. Adherence was 93.8% of the target population; 99.2% performed BIST; while 95.3% a positive BIST had access to VCC and treatment. Overall cost of the experience (stool test, VCC, biopsy, local treatment) was 7685 USD, while costs associated to an advanced CRC classic treatment was USD 9577/patient (USD 26098 if treatment included bevacizumab). CONCLUSION: The present study based on preventive actions like blood in stool test, applied as a screening to all inhabitants in town, had 93.8% of adherence and high level of CRC early detection. A health model based on personalized care (CUIDARAS), achieved more effective results in terms health care and disease prevention, with a favorable benefit/cost ratio compared with classical health care provide by current system. Key words: Model of care; colorectal cancer; CUIDARAS; personalized care.

Histología del bíceps en pacientes con tendinopatía crónica tratados con tenodesis subpectoral / Histology of the biceps in patients with chronic tendinitis treated with subpectoral tenodesis

Introducción: El objetivo de este estudio fue evaluar los cambios morfológicos en la zona intrarticular y extrarticular de la porción larga del bíceps de pacientes sometidos a una tenodesis subpectoral.materiales y métodos: Se incluyeron 9 pacientes con diag-nóstico de tendinopatía del bíceps, a quienes se les realizó una tenodesis subpectoral de la porción larga del bíceps. La porción eliminada del tendón del bíceps se colocó en formalina al 10% y se dividió en 2 segmentos. Quedaron definidas la zona proximal, desde la inserción supraglenoidea hasta el borde proximal del pectoral mayor y la zona distal correspondiente a la inserción del pectoral mayor. Los segmentos se tiñeron con hematoxilina y eosina, y se evaluaron histológicamente utilizando el puntaje de Bo-nar.Resultados: Macroscópicamente todos los tendones estaban engrosados en la región proximal. En la evaluación histológica, entre las variables más relevantes evaluadas por el puntaje de Bonar, el puntaje de morfología celular en la zona proximal fue significativamente más alto que en la zona distal (p <0,0001).Conclusiones: Nuestros hallazgos mostraron niveles más altos de patología dentro del bíceps proximal, lo que respalda la eliminación de dicho segmento cuando se realiza un procedimiento para la tendinopatía crónica del bíceps, lo cual se puede lograr con una tenodesis subpectoral. Nivel de Evidencia: IV

Introduction: The objective of the present study was to evaluate the morphological changes in the intra- and extra-articular area of the long head of the biceps in patients who had undergone subpectoral tenodesis. methods: We included 9 patients with a diagnosis of biceps tendinitis, who underwent subpectoral tenodesis of the long head of the biceps. The removed portion of the biceps tendon was placed in 10% formalin and divided into 2 segments. The proximal area extended from the supraglenoid insertion to the proximal edge of the pectoralis major and the distal area corresponded to the insertion of the pectoralis major. The segments were histologically evaluated using the Bonar score. Results: Macroscopically, all the tendons were found to be thickened in the proximal region. In the histological evaluation, among the most relevant variables evaluated by the Bonar score, the cell morphology score in the proximal area was significantly higher than in the distal area (p <0.0001). Conclusion: Our findings showed higher levels of pathology within the proximal biceps, supporting the elimination of this segment for chronic biceps tendinopathy, which can be accomplished through subpectoral tenodesis. Level of Evidence: IV

Characterization of the LH peak after short and long fixed-time artificial insemination protocols in sheep raised in the tropics.

The aim of this study was to evaluate the peak in luteinizing hormone (LH) and the pregnancy rate of sheep (Texel × Santa Inês) in the tropics using short- (6 days) and long-term (12 days) progesterone protocols followed by artificial insemination (AI) both in and out of the breeding season. Experiment 1 was conducted within (IN) the breeding season (autumn, n = 36), and experiment 2 was conducted outside (OUT) of the breeding season (spring, n = 43). In each experiment, the sheep were divided into two groups (6 or 12 days) according to the duration of treatment with a single-use progesterone release vaginal device (CIDR® , Pfizer, São Paulo, SP, Brazil), and blood samples were collected from 10 animals per group every 4 hr to measure the LH and progesterone concentrations. In the spring, the characteristics of the LH peak did not differ between groups; but in the autumn, there were differences between groups at the beginning (G-6 IN: 36.44 ± 5.46 hr; G-12 IN: 26.57 ± 4.99 hr) and end of the LH peak (G-6 IN: 46.22 ± 7.51 hr; G-12 IN: 34.86 ± 8.86 hr). The results showed alterations in the LH peak during the breeding season only in the sheep undergoing the short-term protocol.

Carcinoma adenoide quístico de glándula sublingual: combinación de cirugía y radioterapia / Cystic adenoid carcinoma of sublingual gland: surgery and radiotherapy combination

El carcinoma adenoide quístico (CAQ) o cilindroma es una rara entidad clasificada por la OMS dentro de los carcinomas de glándulas salivales. Representa sólo el 1 por ciento de todos los tumores malignos de la región bucal y maxilofacial, aunque al hacer referencia a las glándulas salivales, constituye el 5 por ciento de los carcinomas de parótida, submaxilar y sublingual, y aproximadamente el 50 por ciento de las menores. La ubicación más frecuente es en las glándulas palatinas y sus características principales son: crecimiento lento pero persistente, altas tasas de recidiva local y metástasis a distancia, originando la muerte dentro de los 5 a 10 primeros años en aproximadamente el 50-70 por ciento de los casos. Se presenta un caso de localización en glándula sublingual, el cual fue tratado quirúgicamente con posterior radioterapia, obteniendo buenos resultados

Carcinoma adenoide quístico de glándula sublingual: combinación de cirugía y radioterapia / Cystic adenoid carcinoma of sublingual gland: surgery and radiotherapy combination

El carcinoma adenoide quístico (CAQ) o cilindroma es una rara entidad clasificada por la OMS dentro de los carcinomas de glándulas salivales. Representa sólo el 1 por ciento de todos los tumores malignos de la región bucal y maxilofacial, aunque al hacer referencia a las glándulas salivales, constituye el 5 por ciento de los carcinomas de parótida, submaxilar y sublingual, y aproximadamente el 50 por ciento de las menores. La ubicación más frecuente es en las glándulas palatinas y sus características principales son: crecimiento lento pero persistente, altas tasas de recidiva local y metástasis a distancia, originando la muerte dentro de los 5 a 10 primeros años en aproximadamente el 50-70 por ciento de los casos. Se presenta un caso de localización en glándula sublingual, el cual fue tratado quirúgicamente con posterior radioterapia, obteniendo buenos resultados (AU)

Síndrome de Fournier em pediatria: relato de caso / Fournier's syndrome in pediatrics: report of case

Os autores relatam um caso de "Síndrome de Fournier" em uma criança do sexo feminino de um ano de idade, discutem a etiologia, fatores predisponentes e a necessidade de um diagnóstico precoce e tratamento clínico e cirúrgico imediatos. Chamaram a atençäo para a necessidade do conhecimento desta patologia por parte de Cirurgiöes Pediátricos e Pediatras, evitando assim o retardo do diagnóstico e tratamento desta síndrome