Estudo das alterações ultra-estruturais em pleura de ratos pós pleurodese por talco

OBJETIVO: O talco é considerado um agente efetivo de pleurodese freqüentemente utilizado no tratamento de derrame pleural maligno. Entretanto, questiona-se sua segurança em relação à carcinogênese. O objetivo deste trabalho é descrever as alterações ultra-estruturais encontradas nas pleuras de ratos submetidos à pleurodese com talco buscando esclarecer sua segurança em relação à carcinogênese. MÉTODO: Neste estudo randomizado foram utilizados seis ratos machos do tipo Wistar, pesando 250 g. Através de uma toracotomia mínima no quinto espaço intercostal esquerdo foi colocado lavado de talco em concentrações de 0,5mg (n=2) e 0,1 mg (n=2) de talco por grama de peso. Dois ratos foram apenas anestesiados e foi instilado solução fisiológica (NaCl 0,9%) intrapleural para configurar o grupo controle. Os ratos foram mortos após 45 dias. As alterações morfológicas e morfométricas ultra-estruturais foram analisadas através de microscopia eletrônica de transmissão. RESULTADOS: A análise ultra-estrutural das pleuras submetidas à talcagem demonstrou desorganização celular do tecido conjuntivo, evidenciando alterações nucleares, mitocondriais e espessamento da camada submesotelial. O grupo controle manteve a arquitetura celular preservada. CONCLUSÕES: Este estudo revelou alterações da estrutura celular da pleura exposta ao talco quando comparado ao grupo controle

Analysis of socio-political and health practices influencing sex ratio at birth in Viet Nam

Viet Nam has experienced rapid social change over the last decade, with a remarkable decline in fertility to just below replacement level. The combination of fertility decline, son preference, antenatal sex determination using ultrasound and sex selective abortion are key factors driving increased sex ratios at birth in favour of boys in some Asian countries. Whether or not this is taking place in Viet Nam as well is the subject of heightened debate. In this paper, we analyse the nature and determinants of sex ratio at birth in Viet Nam, including a small family size norm, recent reinforcement by the Government of the “one-to-two child” family policy, traditional son preference, easy access to antenatal ultrasound screening and legal abortion, and an increase in the proportion of one-child families. In order to prevent an increased sex ratio at birth in Viet Nam, we argue for the relaxation of the one-to-two child family policy and a return to the policy of “small family size” as determined by families, in tandem with a comprehensive approach to promoting the value of women and girls in society, countering traditional gender roles, and raising public awareness of the negative social consequences of a high sex ratio at birth

Management and Treatment of Fistulas after Surgical Treatment of Ulcerative Colitis

Ileal-pouch fistulas after total proctocolectomy and pouch-anal anastomosis are a rare and overwhelming complication for patients and a challenging problem for surgeons. In patients with ileal pouch-anal anastomosis (IPAA), fistulous tracts can originate at any level of the pouch and anal canal, and they can extend into any adjacent hollow organs or to the skin. Even though several studies have assessed pouch-vaginal fistula formation, little has been published regarding overall perianal fistula formation after restorative proctocolectomy. Pouch-anal or pouch-vaginal fistulas may occur at any time following restorative proctocolectomy, with an incidence of 2.6–14%, depending on the length of the follow-up. A fistula after ileoanal pouch construction may occur in the form of a leak in the early period, but it is more frequently seen as a late complication some months after the procedure. In the majority of cases, the ileoanal anastomosis is the origin of early fistulas presenting with pelvic and perianal sepsis, and most likely associated with the technical aspects of the operation. Several operative techniques have been described to control perianal sepsis and, ultimately, heal the fistulous tract; however, due to the individual complexity of the fistulas, optimal management continues to be controversial. In patients with pouch-anal and pouch-vaginal fistulas, pouch failure, defined as a definitive ileostomy with or without pouch excision, remains high and is reported in 21–30% of patients with fistulas; however, the factors contributing to pouch excision remain poorly defined