Avaliação dos resultados entre a colecistectomia laparoscópica eletiva ou de urgência

Introdução: Colecistectomia laparoscópica é tratamento padrão-ouro para colecistolitíase. É classificada em eletiva ou de urgência e existe uma quantidade pequena de publicações que comparam esses dois momentos de atendimento. Objetivo: Analisar os resultados de colecistectomias laparoscópicas eletivas ou de urgência quanto ao tempo entre internação e cirurgia, tempo de hospitalização, complicações, uso de antimicrobianos e de drenos, mortalidade e custo. Métodos: Análise retrospectiva de 368 pacientes submetidos à colescistectomia laparoscópica. Dados foram coletados do prontuário e da conta hospitalar dos pacientes. Resultados: Dos 368 pacientes, 277 (75,3%) foram submetidos à colecistectomia laparoscópica eletiva e 91 (24,7%) à de urgência. Dos submetidos à eletiva, 194 (70,04%), eram mulheres. A idade média foi de 45,66±14,87 anos. A permanência hospitalar média foi de 26,60±16,85 horas. Utilizaram terapia antimicrobiana 2 (0,72%) pacientes e dreno 16 (5,78%) pacientes. Houve complicações em 6 (2,17%) casos. O custo médio foi 3.157,76±1.882,22 reais. Nas de urgência, 61 (67,03%) eram mulheres. A idade média foi 51,36±19,08 anos. A permanência hospitalar média foi de 108,27±96,11 horas. Usaram antimicrobiano 33 (36,26%) pacientes e dreno 21 (23,08%) pacientes. Complicações ocorreram em 13 (14,29%) pacientes. Dois (2,20%) pacientes foram a óbito. O custo médio foi de 9.357,00±7.224,14 reais. Analisando as variáveis, o custo médio das colecistectomias de urgência foi o triplo do das eletivas. Conclusão: Colecistectomias laparoscópicas de caráter urgente apresentam um custo consideravelmente mais elevado devido ao maior tempo entre internação e cirurgia, maior tempo de hospitalização, maior índice de complicações, mais uso de drenos e maior necessidade de terapia antimicrobiana, quando comparadas a procedimentos eletivos.Background: Laparoscopic cholecystectomy is gold standard treatment for cholecystolithiasis. It is classified as elective or urgent and there is a small amount of publications comparing these two moments of attendance. Aim: To analyze the results of elective and urgent laparoscopic cholecystectomy regarding the time between hospitalization and surgery, the length of hospitalization, complications, use of antimicrobials and drains, mortality, and cost. Methods: Retrospective analysis of 368 patients who underwent laparoscopic cholecystectomy. Data were collected from the medical records and from the hospital account of the patients. Results: Of 368 patients, 277 (75.3%) underwent elective cholecystectomy and 91 (24.7%) under emergency cholecystectomy. Of those submitted to the elective, 194 (70.04%) were women. The average age was 45,66±14,87 years. The average hospital stay was 26.60±16,85 hours. Two (0.72%) patients used antimicrobial therapy and 16 (5.78%) patients used drain. There were complications in 6 (2.17%) cases. The average cost was 3,157.76±1.882.22 reais. In emergency cholecystectomies, 61(67.03%) patients were women. The average age was 51.36±19,08 years. The average hospital stay was 108.27±96,11 hours. Antimicrobials were used by 33 (36.26%) patients and drain by 21(23.08%) patients. Complications occurred in 13 (14.29%) patients. Two (2.20%) patients died. The average cost was 9,357.00±7.224.14 reais. Analyzing the variables, the average cost of emergency cholecystectomies was three times the cost of electives. Conclusion: Urgent laparoscopic cholecystectomies have a considerably higher cost due to longer time between hospitalizations and surgeries, longer hospitalization time, higher complication rate, more use of drains and greater need for antimicrobial therapy when compared to elective procedures

Study of human adult parotid duct in the area of penetration through buccinator muscle and their functional relationship as a sphincter

The adult human parotid duct is roughly 6-8 cm long. From the parotid gland, parotid duct traverses through masseter muscle, penetrates through buccinator muscle, and opens into the oral cavity. This unique form of the parotid duct is likely correlated with the function of the duct, directly affected by the movement of the buccinator muscle during mastication and swallowing. Histological structure of the duct is known to be different in each region, and details of smooth muscle present in the parotid duct are mostly unclear. In this study, we conducted SEM and histological observations of the area where the parotid duct penetrates the buccinator muscle, and an observation of smooth muscle to investigate its existence using α-smooth muscle antibody. We confirmed the presence of an abundance of skeletal muscle bundles likely originating from the buccinator muscle under the epithelium of the parotid duct wall in the region where it penetrates the buccinator muscle. We also observed that some of the muscle fibers were completely attached to the epithelium. We observed a lack of smooth muscle in this region of the duct wall. From these results, we suggest that the area of the duct penetrating buccinator muscle plays a role in regulating the salivary passage through the contraction of the surrounding buccinator muscle fibers

Distribution and roles of substance P in human parotid duct

Sialadenitis occurs with greatest frequency in the parotid glands because infection and inflammation arise easily from the oral cavity. Since patients often experience severe swelling and pain during inflammation, the distribution of sensory nerves in these ducts may have clinical significance. We used antibodies to the known neuropeptide substance P and to tyrosine hydroxylase - a marker of adrenergic fibres - to observe their distribution and gain insight on their functional role in adult human parotid duct. After excising the parotid duct along with the gland, specimens were divided into three regions: the tract adjacent to the parotid gland, the route along the anterior surface of the masseter, and the area where the duct penetrates the buccinator muscle and opens into the oral cavity. Specimens were prepared and examined under a fluorescence microscope following immunostaining. Substance P positivity was observed in all three regions of the duct, whereas tyrosine hydroxylase was distributed mainly in the vascular walls and surrounding areas. The distribution of substance P candidates this molecule to assist in tissue defense in conjunction with the blood and lymph vessels of this area. Tyrosine hydroxylase in the blood vessel wall likely contributes to regulation of blood flow in concert with substance P positive nerves surrounding the blood vessels

Morphological study of the parotid duct in human fetuses with special emphasis on the relationship between the buccinator muscle and the parotid duct

Parotid glands secrete about 25% of all saliva produced in the salivary glands. In the presence of a stimulus, the amount of saliva secreted from the parotid gland increases to 50% (1). In human adults, the parotid duct, approximately 6-8 cm long, traverses the masseter muscle and penetrates through the buccinator muscle into the oral cavity. Although various studies have been conducted on the parotid gland, there are only few suggesting the functional roles of the parotid duct, especially of the area penetrating the buccinator muscle. In the present study, we observed parotid ducts of human fetuses to morphologically analyze the function of the buccinator muscles in the flux of parotid saliva. Thirty fetal specimens ranging from five to ten months of age were dissected for anatomical and histological examinations. The area of the parotid duct penetrating the buccinator muscle was fully formed in six-month-old fetuses. Furthermore, this study confirms the existence of thin buccinator muscle fibers underneath the epithelium of the parotid duct’s distal portion. Results suggest that the buccinator muscle may play a major role in preventing the reflux of salivary secretions by assisting the contraction of the parotid duct

Nexin-Dynein regulatory complex component DRC7 but not FBXL13 is required for sperm flagellum formation and male fertility in mice

Nexin-Dynein regulatory complex component DRC7 but not FBXL13 is required for sperm flagellum formation and male fertility in mice. Morohoshi A, Miyata H, Shimada K, Nozawa K, Matsumura T, et al. PLOS Genetics. 2020. 16(1) doi:10.1371/journal.pgen.100858

Study of human Wharton’s duct structure and its relationship with salivary flow

Of all major salivary glands, the human submandibular gland secretes the largest amount of saliva. Along with the sublingual duct, the main duct (Wharton’s duct) is known to open into the sublingual caruncula; however, reports regarding this common opening structure are scarce and details unclear. The structure of Wharton’s duct opening is quite different from that of parotid duct (Stensen’s duct) opening in its overall size and diameter despite what is commonly noted in text books. About 85% of sialolith occurrences in humans is in the submandibular gland and duct, which causes local pain during swallowing in most cases. The details of Wharton’s duct’s inner structure is relatively unknown, and further investigation is necessary to understand its special characteristics and clinical applications. In this study, we observed the inner structure of the ducts’ common opening area by scanning electron microscopy and confirmed a large number of blood vessels present in the connective tissue layer just under the epithelium. In addition, we confirmed the presence of smooth muscle in the same area using smooth muscle actin antibody. These structural findings suggest that Wharton’s duct itself is likely responsible for the regulation of salivary flow

Delayed Methotrexate Elimination after Administration of a Medium Dose of Methotrexate in a Patient with Genetic Variants Associated with Methotrexate Clearance

Polymorphisms in methotrexate transporter pathways have been associated with methotrexate toxicities and clearance. Recent genome-wide association studies have revealed that the SLCO1B1 T521C variant is associated with methotrexate elimination. We present a case of a pediatric patient with acute lymphoblastic leukemia who suffered from persistently high plasma methotrexate concentrations and acute kidney injuries after the admin-istration of a medium dose of methotrexate. Subsequent genetic analysis showed that he was a carrier of dys-functional genetic variants associated with methotrexate clearance. This case highlights that polymorphisms of methotrexate transporter pathways can adversely affect methotrexate elimination in a clinically significant manner

Coordinated regulation of hepatic and adipose tissue transcriptomes by the oral administration of an amino acid mixture simulating the larval saliva of Vespa species

Genes mapped on Fig. 3. (XLSX 13 kb

RSPH6A is required for sperm flagellum formation and male fertility in mice

The flagellum is an evolutionarily conserved appendage used for sensing and locomotion. Its backbone is the axoneme and a component of the axoneme is the radial spoke (RS), a protein complex implicated in flagellar motility regulation. Numerous diseases occur if the axoneme is improperly formed, such as primary ciliary dyskinesia (PCD) and infertility. Radial spoke head 6 homolog A (RSPH6A) is an ortholog of Chlamydomonas RSP6 in the RS head and is evolutionarily conserved. While some RS head proteins have been linkedtoPCD, littleisknown about RSPH6A. Here, weshow that mouse RSPH6A is testis-enriched and localized in the flagellum. Rsph6a knockout (KO) male mice are infertile as a result of their short immotile spermatozoa. Observation of the KO testis indicates that the axoneme can elongate but is disrupted before accessory structures are formed. Manchette removal is also impaired in the KO testis. Further, RSPH9, another radial spoke protein, disappeared in the Rsph6a KO flagella. These data indicate that RSPH6A is essential for sperm flagellar assembly and male fertility in mice. This article has an associated First Person interview with the first author of the paper

Case report: A case of acute exacerbation of interstitial pneumonia associated with TAFRO syndrome

Cytokine storm caused by the overproduction of inflammatory interleukin (IL)-6 plays a central role in the development of acute inflammation. The extremely rare disease, TAFRO syndrome, progresses quickly. Renal dysfunction, fever, reticulin fibrosis, anasarca, thrombocytopenia, and organomegaly with pathological findings such as idiopathic multicentric Castleman disease are all characteristics of TAFRO syndrome. Interstitial pneumonia (IP), which is not characteristic of this disease, is probably a complication of the inflammatory process. An 88-year-old man presented with a 3-day history of fever, dry cough, and progressive dyspnea. After he was first treated with antibiotics, he was transferred to our hospital because he showed no improvement. Data showed hemoglobin Hb 90.00 (SI) (9.0 g/dL); leukocyte count WBC 23 × 109/L (SI) [23,000/μL (neutrophils 87.5%, lymphocytes 2.5%, blast cells 0%)]; hemoglobin 90 g/L (9.0 g/dL); platelet count 101.00 × 109/L (10 100/μL); lactate dehydrogenase 4.78 μkat/L (286 U/L); serum albumin 25.00 g/L (2.5 g/dL); blood urea nitrogen 18.17 μmol/L (50.9 mg/dL); creatinine 285.53 μmol/L (3.23 mg/dL); C-reactive protein 161.50 mg/L (16.15 mg/dL); IL-61830 pg/mL; and surfactant protein D level 26.6 ng/mL. Findings from computed tomography indicated increased ground-glass opacities without traction bronchiectasis consistent with acute IP. The diagnosis was leukocytosis and progressive kidney injury. After bone marrow aspiration caused by persistent pancytopenia, mild reticulin fibrosis was identified. Because of the high IL-6 concentration, which revealed small atrophic follicles with regressed germinal centers surrounded by several lymphocytes, right inguinal lymph node biopsy was performed. Two minor and three major criteria led to diagnosis of TAFRO syndrome. Administrations of antibiotic therapy and methylprednisolone pulse therapy were ineffective. After rapid progress of respiratory failure, the patient died on day 30 of hospitalization. Autopsy of lung tissues showed diffuse alveolar damage with hyaline membranes. Based on these findings, we diagnosed acute exacerbation of IP associated with TAFRO syndrome due to IL-6 overproduction-associated cytokine storm