Inspecção do sistema nervoso central em pequenos ruminantes

O Scrapie é uma doença neurodegenerativa fatal que afecta ovinos e caprinos e é a forma mais comum das Encefalopatias Espongiformes Transmissíveis (EET's), que incluem a doença de Creutzfeldt – Jakob (CJD), em humanos, e a Encefalopatia Espongiforme Bovina (BSE). O Plano de Vigilância Activa do Scrapie, em aplicação na União Europeia desde 2002, permitiu determinar uma prevalência de Scrapie superior ao esperado. De forma a efectuar uma avaliação preliminar da incidência desta patologia em Portugal, foram recolhidos os troncos cerebrais e cerebelos de 4822 pequenos ruminantes abatidos num matadouro no centro de Portugal e, posteriormente, enviados para pesquisa laboratorial de EETs. Após análise laboratorial, detectaram-se 8 casos de Scrapie atípico em ovinos. A percentagem de casos positivos (0,17%) detectados em pequenos ruminantes com mais de 18 meses, durante o período de realização deste estudo, foi baixa e, segundo os resultados laboratoriais, enquadram-se no perfil de Scrapie atípico.Centro de Estudos em Educação, Tecnologias e Saúde

Avaliação perioperatória da viabilidade intestinal

The assessment of a intestinal segment’s viability and its degree of ischemia only by clinical criteria is often hard for the surgeon. Sometimes it’s necessary to use auxiliary methods to assess the degree of intestinal injury, which sometimes is imperceptible by clinical evaluation. This review presents the principal methods to undergo this evaluation, describing their technique and necessary equipament, as long as their results. The analized methods were divided in experimental: eletromiography, non-contact tissue laser Doppler and thermal imaging; and clinical: clinical criteria, Dopplerultrasonography, laser Doppler, intravascular dyes, surface oximetry, pulse oxymetry, thermography, pH measurement, tonometry and infrared photopletysmography. The results of second-look laparotomies in patients with mesenteric vascular insufficiency who were operated are described too. After reviewing all the literature, we found that Doppler ultrasound and fluorescein injection are, due to its costs and easymenagement, the most used and accepted methods to assess the perioperative intestinal viability. We had also observed that post-operative laparoscopy has a high value on the monitorization of the intestinal viability in patients that undergo surgical treatment for mesenteric vascular insufficiency, especially if the introperative assessment of their intestinal viability wasn’t do precise.A determinação da viabilidade de segmentos intestinais e do grau de isquemia a partir de critérios clínicos pode ser de extrema dificuldade para o cirurgião. Faz-se necessário lançar mão de métodos auxiliares para se atestar o grau de comprometimento da alça intestinal, muitas vezes inaparenteà avaliação clínica. O presente trabalho apresenta uma revisão de literatura dos principais métodos existentes para se fazer essa avaliação, descrevendo a técnica e equipamentos necessários para cada um, bem como os resultados da aplicação dos mesmos. Os principais métodos auxiliares encontrados na literatura se dividem em experimentais: eletromiografia, laser Doppler sem contato e Imagem térmica; e clínicos: avaliação exclusiva por critérios clínicos, Doppler ultrassom, laser Doppler, injeção intravascular de corantes, oximetria superficial, oximetria de pulso, termometria, pHmetria, tonometria e fotopletismografia infravermelha. São também reinterados os resultados da indicação e realização das relaparotomias no manejo de pacientes com insuficiência vascular mesentérica. Após a revisão de literatura, pudemos concluir que o Doppler ultrassom e a injeção intravenosa de fluoresceína representam os métodos auxiliares para a avaliação perioperatória da viabilidade intestinal mais utilizados devidoprincipalmente ao seu baixo custo e relativa facilidade de uso. Optamos por destacar o papel da laparoscopia pós-operatória no segmento de pacientes submetidos ao tratamento cirúrgico de insuficiência vascular mesentérica, em especial naqueles em que a avaliação da viabilidade intestinal foi duvidosa

Incidence of postoperative residual neuromuscular blockade: a multicenter, observational study in Portugal (INSPIRE 2)

Background: Although the use of neuromuscular blocking agents (NMBAs) optimizes surgical conditions and facilitates tracheal intubation, it can lead to residual neuromuscular blockade (RNMB), with postoperative complications. This study aimed to assess RNMB incidence and management in Portugal. Methods: Prospective observational study of patients admitted for elective surgery requiring general anesthesia with nondepolarizing NMBAs between July 2018 and July 2019 at 10 Portuguese hospitals. The primary endpoint was the proportion of patients arriving at postanesthesia care unit (PACU) with a TOF ratio ,0.9. Results: A total of 366 patients were included, with a median age of 59 years, and 89.1% classified as ASA II or III. Rocuronium was the most used NMBA (99.5%). A total of 96.2% of patients received a reversal agent, 96.6% of which sugammadex and 3.4% neostigmine. Twenty patients displayed a TOF ratio ,0.9 at PACU arrival, representing an RNMB incidence of 5.5% (95% CI, 3.1%–7.8%). Only two patients displayed a TOF ratio ,0.7. RNMB incidence was 16.7% with neostigmine and 5.3% with sugammadex (P 5 .114). In patients with intraoperative neuromuscular blockade (NMB) monitoring, RNMB incidence was 5% (95% CI, 2%–8%), which varied significantly according to the type of monitoring (P 5 .018). Incidence of adverse events was 3.3% (2 severe and 10 moderate). Conclusions: The reported overall incidence of 5.5% is numerically lower than results from similar observational studies. An appropriate pharmacological neuromuscular reversal strategy, guided by quantitative neuromuscular monitoring, has the potential to achieve even better results, converting RNMB from an unusual to a very rare or even inexistent event.info:eu-repo/semantics/publishedVersio

Trashepatic left gastric vein embolization in the treatment of recurrent hemorrhaging in patients with schistosomiasis previously submitted to non-derivative surgery

CONTEXT: Non-derivative surgical techniques are the treatment of choice for the control of upper digestive tract hemorrhages after schistosomotic portal hypertension. However, recurrent hemorrhaging due to gastroesophagic varices is frequent. OBJECTIVE: To evaluate the outcome of treatment based on embolization of the left gastric vein to control the reoccurrence of hemorrhages caused by gastroesophagic varices in patients with schistosomiasis previously submitted to non-derivative surgery. METHODS: Rates of reoccurrence of hemorrhages and the qualitative and quantitative reduction of gastroesophagic varices in patients undergoing transhepatic embolization of the left gastric vein between December 1999 and January 2009 were studied based on medical charts and follow-up reports. RESULTS: Seven patients with a mean age of 39.3 years underwent percutaneous transhepatic embolization of the left gastric vein. The mean time between azigoportal disconnections employed in combination with splenectomy and the percutaneous approach was 8.4 ± 7.3 years, and the number of episodes of digestive hemorrhaging ranged from 1 to 7 years. No episodes of reoccurrence of hemorrhaging were found during a follow-up period which ranged from 6 months to 7 years. Endoscopic postembolization studies revealed reductions in gastroesophagic varices in all patients compared to preembolization endoscopy. CONCLUSIONS: Percutaneous transhepatic embolization of the left gastric vein in patients with schistosomiasis previously submitted to surgery resulted in a decrease in gastroesophagic varices and was shown to be effective in controlling hemorrhage reoccurrence

Trashepatic left gastric vein embolization in the treatment of recurrent hemorrhaging in patients with schistosomiasis previously submitted to non-derivative surgery Embolização transhepática da veia gástrica esquerda no tratamento da recidiva hemorrágica em esquistossomóticos submetidos previamente a cirurgia não derivativa

CONTEXT: Non-derivative surgical techniques are the treatment of choice for the control of upper digestive tract hemorrhages after schistosomotic portal hypertension. However, recurrent hemorrhaging due to gastroesophagic varices is frequent. OBJECTIVE: To evaluate the outcome of treatment based on embolization of the left gastric vein to control the reoccurrence of hemorrhages caused by gastroesophagic varices in patients with schistosomiasis previously submitted to non-derivative surgery. METHODS: Rates of reoccurrence of hemorrhages and the qualitative and quantitative reduction of gastroesophagic varices in patients undergoing transhepatic embolization of the left gastric vein between December 1999 and January 2009 were studied based on medical charts and follow-up reports. RESULTS: Seven patients with a mean age of 39.3 years underwent percutaneous transhepatic embolization of the left gastric vein. The mean time between azigoportal disconnections employed in combination with splenectomy and the percutaneous approach was 8.4 ± 7.3 years, and the number of episodes of digestive hemorrhaging ranged from 1 to 7 years. No episodes of reoccurrence of hemorrhaging were found during a follow-up period which ranged from 6 months to 7 years. Endoscopic postembolization studies revealed reductions in gastroesophagic varices in all patients compared to preembolization endoscopy. CONCLUSIONS: Percutaneous transhepatic embolization of the left gastric vein in patients with schistosomiasis previously submitted to surgery resulted in a decrease in gastroesophagic varices and was shown to be effective in controlling hemorrhage reoccurrence.INTRODUÇÃO: A cirurgia por técnicas não derivativas é o tratamento de escolha para o controle da hemorragia digestiva alta secundária à hipertensão portal esquistossomótica. Contudo, a recidiva hemorrágica em decorrência das varizes gastroesofágicas é um evento frequente. O programa de erradicação endoscópica das varizes gastroesofágicas tem o objetivo de prevenir e/ou tratar a recidiva hemorrágica, porém nem todos os doentes respondem ao tratamento. OBJETIVO: Avaliar o sucesso do tratamento de embolização da veia gástrica esquerda no controle da recidiva hemorrágica por varizes gastroesofágicas nos doentes esquistossomóticos submetidos previamente a cirurgia não derivativa. MÉTODOS: Foram estudadas, por meio de dados colhidos nos prontuários médicos e dos protocolos de seguimento ambulatorial, a incidência da recidiva hemorrágica e a diminuição quantitativa e qualitativa das varizes gastroesofágicas em detrimento das varizes gastroesofágicas dos doentes encaminhados para embolização transhepática da veia gástrica esquerda no período de dezembro de 1999 até janeiro de 2009. RESULTADOS: Sete doentes com média etária de 39,3 anos foram encaminhados para embolização percutânea transhepática da veia gástrica esquerda. O tempo médio decorrido entre a DAPE e a abordagem percutânea foi de 8,4 ± 7,3 anos e o número de episódios de hemorragia digestiva variou de um a sete neste período. Nenhum episódio de ressangramento foi verificado na população do estudo durante o período de acompanhamento, que variou de 6 meses a 7 anos. Após estudo endoscópico pós-embolização, todos os doentes apresentaram diminuição das varizes gastroesofágicas em comparação à endoscopia pré-embolização. CONCLUSÃO: A embolização percutânea transepática da veia gástrica esquerda nos doentes esquistossomóticos, previamente operados, determinou a redução das varizes gastroesofágicas e foi eficiente no controle do ressangramento para a população estudada

Subclavian and axillary arterial aneurysms: two case reports

Aneurysms of the subclavian-axillary segment are rare, but when diagnosed they must be treated. This article describes two cases of aneurysms of the upper extremities, one in a subclavian artery and the other in an axillary artery. The first case was a 71-year-old male with a pulsating supraclavicular bulge on the right and muscle weakness in the ipsilateral extremity. Duplex scanning and arteriography confirmed the diagnosis of aneurysm of the right subclavian artery and the patient underwent aneurysmectomy and end-to-end anastomosis. The second case was a 24-year-old female patient, with no history of comorbidities, who presented with a pulsating mass in the right axillary region and paresthesia of the ipsilateral extremity. Duplex scanning and arteriography confirmed an aneurysm in the right axillary artery, which was successfully treated with aneurysmectomy and end-to-end anastomosis. Pathology findings showed that the first case was an atherosclerotic aneurysm and the second was a congenital aneurysm

Stent thrombosis in aortic aneurysm: evaluation by multidetector CT

OBJETIVO: Avaliar as características demográficas e de imagens da trombose endoluminal em uma série de pacientes submetidos a tratamento endovascular do aneurisma de aorta abdominal (TEAAA). MÉTODOS: Avaliamos as características de imagem que permitiram o diagnóstico da trombose endoluminal em uma série de 30 pacientes submetidos ao TEAAA, com seguimento de 5 a 29 meses, através de exames de tomografia computadorizada multidetectores (TCMD) de 64 canais. RESULTADOS: Foram diagnosticados dez casos de trombose luminal (33,3%), sendo que em três pacientes a trombose foi total de um ramo ilíaco. CONCLUSÃO: A TCMD permitiu o diagnóstico de diferentes tipos de trombose endoluminal em pacientes submetidos ao TEAAA. O uso desta modalidade diagnóstica minimamente invasiva deverá ser encorajado na prática clínica.OBJECTIVE: Evaluate the imaging findings of thrombosis in a series of patients submitted to endovascular repair of aortic abdominal aneurysm. METHODS: MDCT images of 30 patients submitted to endovascular repair of aortic abdominal aneurysm were obtained by a 64 slice scanner, 5 to 29 months after the endovascular treatment. RESULTS: Thrombosis was diagnosed in 10 patients (33.3%), and in three patients thrombosis was total in an iliac branch. CONCLUSION: MDCT allowed diagnosis of different types of endoluminal thrombosis in patients submitted to endovascular repair of aortic abdominal aneurysm. Utilization of this minimally invasive diagnostic technique should be encouraged in clinical practice

Scientia Agricola Milk quality parameters associated with the occurrence of veterinary drug residues

ABSTRACT: Veterinary drug residues in bulk tank milk are important to all sectors of the dairy chain because they are one of the major factors which determine the safety of the final product. This study attempted to identify milk quality parameters that are associated with the occurrence of veterinary drug residues using multivariate principal component analysis (PCA). A total of 132 raw milk samples were collected from 45 dairy farms in the state of Minas Gerais -Brazil and analyzed for 42 analytes, including pyrethroids, macrocyclic lactones and antibacterials, using liquid chromatography coupled with mass spectrometry in tandem mode and gas chromatography with electron capture detection. Out of the 132 milk samples, 40 samples tested positive for at least one analyte (above the detection limit). The milk parameters associated with the antimicrobial residues by confirmatory tests were lactose and nonfat concentrations, as revealed by PCA. This analysis showed that fat and total solid concentrations, as well as the somatic cell and total bacteria counts were associated with macrocyclic lactone residues in bulk tank milk. A PCA assessing pyrethroid residues in bulk tank milk revealed that the lactose and nonfat solid concentrations and titratable acidity were inversely associated with these residues. Thus, the data analysis indicated that the veterinary drug residues were associated with certain milk quality parameters that can be used to target farms at higher risk of veterinary drug residue contamination for testing programs in combination with incentives, education and training programs to improve mammary health, milk hygiene and safety