Sérgio Bernardo Tenório

Extrato de Passiflora edulis na cicatrização de feridas cutâneas abertas em ratos: estudo morfológico e histológico

INTRODUCTION: In Brazilian countryside, cataplasm made from Passiflora edulis leaves has been used by the population as a healing agent for infections and skin inflammations in an empiric basis. PURPOSE: the aim of this work was to evaluate the healing process of open wounds in rats, in which Passiflora edulis hydro-alcoholic extract was applied. METHODS: Sixty male, adult Wistar rats were divided into two groups: Passiflora group and Control group. Rats of the first group were treated with Passiflora edulis extract, and those of the second group received distilled water. The daily application of the extract or distilled water was carried out on a 2 cm diameter standardized circular wound on the dorsal region of each animal. Wound assessment was performed macroscopically and microscopically on the 7th, 14th, and 21st postoperative days. Microscopic analysis included hematoxylin-eosine and Masson Trichromium stains, evaluating inflammatory response, fibroplasia and collagen deposition. The wound retraction was evaluated by digital planimetry. RESULTS: No significant difference in the rate of wound healing was detected comparing both groups. However, a significant increase in the number of fibroblastic cells was seen on the 7th PO day, and significantly greater collagen deposition was observed on the 14th day PO day in rats from the Passiflora group (p=0,012). CONCLUSIONS: The application of the Passiflora edulis extract does not accelerate the healing process of open wounds in rats, but is associated with increased number of fibroblastic cells on 7th P.O. day and greater collagen deposition on the 14th PO day.

Graft-mediated functional recovery on a skilled forelimb use paradigm in a rodent model of Parkinson's disease is dependent on reward contingency

The Staircase test measures lateralised deficits in skilled paw reaching in rodents, and there is a long-standing discrepancy in the literature on whether the paradigm is sensitive to graft-mediated functional recovery in the rodent model of Parkinsons disease. The aim of the current study was to evaluate the critical influence of test conditions like pellet density on dopamine-dependent graft-mediated functional recovery. Rats were pre-trained on the Staircase test with a configuration of 8 pellets in each of the 6 wells bilaterally prior to receiving unilateral 6-OHDA lesions of the medial forebrain bundle. Later, the lesioned animals received E14 VM grafts into the striatum, and were tested on the Staircase test under one of two test configurations: bilaterally, either with 10 (HIGH) or with 2 (LOW) pellets per well. Subsequent sessions included unilateral forced-choice testing under the same pellet configuration, and second bilateral and forced-choice sessions with the pellet density configurations switched around between the groups (Cross-over). Animals were also tested on the Corridor and the Cylinder test, and subjected to drug-induced rotation. Graft-mediated functional recovery was observed in the pellets taken criteria only under the HIGH pellet configuration during the bilateral and the forced choice condition. When tested under the LOW configuration, the graft provided no measurable benefit. The presence of VM grafts reduced lateralised motor deficits in the Cylinder test, the adjacent version of the Corridor test, and drug-induced rotation. Our results confirm that VM transplants can partially restore skilled forelimb sensorimotor deficits under specific testing configuration.

Cochlear implant surgery with local anesthesia and sedation: comparison with general anesthesia.

Objectives The purpose of this study is to evaluate the possibility of performing cochlear implant surgery under local anesthesia and sedation and to evaluate the response of patients under sedation at the time of neural telemetry, comparing the differences with general anesthesia. Patients Twenty adult patients with bilateral sensorineural profound hearing loss submitted to cochlear implant surgery under general anesthesia and 20 patients under local anesthesia and intravenous sedation in the period from February 2011 to February 2012. The study was approved by the ethical committee of the institution. Intervention In both groups, we compared the costs of anesthesia, surgical time, time in recovery room, length of hospital stay, postoperative symptoms (pain, nausea, vomiting, and dizziness) and the degree of patient satisfaction. Besides, the reactions of the patients in the moment of the neural telemetry were also analyzed. Main Outcome Measures The endpoint of this study is to establish the possibility of doing cochlear implant surgery with local anesthesia and sedation, discussing the differences and advantages over general anesthesia. Results By t-test variables, time in recovery room, time in hospital stay, and cost of inpatient anesthesia differ between groups, being always lower in the group of local anesthesia with sedation. The same result can be obtained using the Wilcoxon test. The symptoms of nausea, vomiting, and dizziness did not differ in the 2 groups. Conclusion We conclude that the realization of the cochlear implant surgery under local anesthesia, and sedation is perfectly feasible with some advantages over general anesthesia. There were no problems during the neural telemetry performed by the time of the surgery in patients with local anesthesia with sedation.

Subthalamic nucleus lesion improves cell survival and functional recovery following dopaminergic cell transplantation in parkinsonian rats

Subthalamic nucleus (STN) modulation is currently the gold standard in the treatment of Parkinsons disease (PD) cases refractory to medication. Cell transplantation is a tissue‐restorative approach and is a promising strategy in the treatment of PD. One of the obstacles to overcome in cell therapy is the poor dopaminergic cell survival. Our experiment investigates the impact of a partial subthalamotomy prior to ventral mesencephalic (VM) embryonic cell transplantation on dopaminergic cell survival and functional outcome. Unilateral dopamine depletion was carried out in rats, via medial forebrain bundle (MFB) injection of 6‐hydroxydopamine, and half of the animals went on to receive unilateral excitotoxic lesions of the STN/Zone Incerta (ZI) causing partial lesion of these structures on the same side as the MFB lesion. All MFB‐lesioned animals, with or without the STN/ZI lesion, received striatal ipsilateral embryonic VM cell grafts. The data suggest that the STN/ZI lesion could boost the dopamine cell survival in the grafts by 2.6‐fold compared with the control grafted‐only group. Moreover, performance on the drug‐induced rotation and the spontaneous behavior tests were ameliorated on the STN/ZI‐lesioned group to a significantly greater extent than the grafted‐only group. These data suggest that the STN/ZI partial lesion optimized the striatal environment, promoting an improvement in cell survival. Further studies are needed to see whether the synergy between STN modulation via deep brain stimulation and cell therapy might have clinical applications in the management of PD.

Control of pain trough epidural block and incidence of cardiac dysrhythmias in postoperative period of thoracic and major abdominal surgical procedures: a comparative study

BACKGROUND AND OBJECTIVES Upper abdomen and thorax surgeries cause intense pain. Some of postoperative pain main complications are cardiocirculatory complications. The objective of this study was to test the hypothesis that postoperative analgesia with employment of local anesthetics plus spinal opioids may reduce the incidence of cardiovascular complications in postoperative period of patients in these conditions, comparing with classical methods of postoperative analgesia, opioids and NSAIDs, administered upon patients demand. METHOD Eighty adult patients, ASA I and II, without ECG alterations, were allocated into two groups of 40: Group A, patients under general anesthesia with propofol, cisatracurium and isoflurane, associated with epidural anesthesia with catheter and control of postoperative analgesia with bupivacaine and epidural morphine; and Group B, patients under general anesthesia with the same drugs and doses of A, plus postoperative analgesia carried out with NSAIDs and intravenous morphine at the end of surgery and in regular intervals. In both groups Holter was applied for 24 hours. Pain evaluation was carried out through visual analog scale. RESULTS In pain evaluation, an evident predominance of 0 score (p<0.001) was observed in Group A and there was also reduction of blood pressure levels in postoperative period in a more accentuated way. Ventricular and supraventricular dysrhythmias were five times more frequent in Group B (p=0.00001), in which a tendency to a higher frequency of ventricular extrasystoles in age>50 years (22.2% versus 0.0%. p=0.26) was also detected. No significative difference of heart rate among groups (p>0.05) was observed. CONCLUSIONS The best quality of analgesia in postoperative period, carried out in Group A, reduced the incidence of cardiovascular complications.

Randomized study of postcesarean analgesia with intrathecal morphine alone or combined with clonidine

STUDY OBJECTIVE To investigate the efficacy of the combination of intrathecal morphine with clonidine in comparison with 2 doses of intrathecal morphine alone for postcesarean analgesia. DESIGN Prospective, double-blinded, randomized clinical trial. SETTING Maternity ward of Hospital Santa Cruz, Curitiba, Paraná, Brazil (operating room and ward). PATIENTS The study included 195 American Society of Anesthesiologist I to III singleton parturients undergoing elective cesarean section. INTERVENTIONS The patients were randomized into 3 groups (M50, M100, and M/C). Patients were anesthetized intrathecally with 12 mg of 0.5% hyperbaric bupivacaine and 50 μg or 100 μg morphine (groups M50 and M100, respectively) or 50 μg morphine and 75 μg clonidine (group M/C). MEASUREMENTS The patients were subsequently assessed for pain levels and side effects at 9 to 11 hours and 22 to 24 hours after the injection. MAIN RESULTS There was no difference in the quality of pain relief among the groups. In all 3 groups, pain was more intense during the first assessment. Pruritus and nausea were more frequent in group M100, and dizziness was more frequent in group M/C; however, these results were statistically insignificant. The group receiving clonidine showed a significantly lower incidence of shivering compared with the other groups. CONCLUSIONS At these doses, there was no benefit of associating clonidine with morphine to improve postcesarean analgesia. Considering that higher doses of morphine were associated with more side effects, 50 μg of intrathecal morphine alone seems to be a better option for analgesia. The use of clonidine to reduce postoperative shivering must be balanced against the potential risks of hypotension, bradycardia, dizziness, and sedation.

Comparative study between doses of intrathecal morphine for analgesia after caesarean

BACKGROUND AND OBJECTIVES Analgesia after caesarean section is important because postpartum women with pain have difficulty in mobility, which undermines breastfeeding. Intrathecal morphine provides adequate and prolonged analgesia after cesarean. The aim of this study was to compare the quality of analgesia provided by two doses of intrathecal morphine and its side effects in patients undergoing cesarean section. METHOD The study included 123 pregnant women with gestational age over 38 weeks and scheduled for cesarean section. The women were randomly allocated into two groups to receive either 50 or 100 μg of intrathecal morphine (Group 50/Group 100). All patients were intrathecally anesthetized with 12 mg of 0.5% hyperbaric bupivacaine. Patients were assessed between the 9(th) and 11(th) hour and the 22(nd) and 24(th) hour after blockade for quality of analgesia, analgesic consumption, side effects, and main cause of discomfort in the first 24 hours after surgery. RESULTS There was similarity between groups regarding anthropometric data and obstetric history. There was no statistical difference in pain intensity between groups. In both groups, pain was more intense in the first 12 hours after anesthesia (p < 0.001). Tramadol hydrochloride consumption and time to first dose were similar in both groups. Pruritus was the most common side effect, with statistically higher incidence in Group 100 (p = 0.026). CONCLUSIONS Intrathecal morphine 50 μg provides the same quality of analgesia as 100 μg, with a lower incidence of side effects.

Controle da dor por bloqueio peridural e incidência de disritmias cardíacas no pós-operatório de procedimentos cirúrgicos torácicos e abdominais altos: estudo comparativo

JUSTIFICATIVA E OBJETIVOS: Operacoes no abdome superior e torax provocam intensa dor. Entre as principais complicacoes da dor pos-operatoria estao as complicacoes cardiocirculatorias. O objetivo deste trabalho foi testar a hipotese de que a analgesia pos-operatoria com o emprego de anestesicos locais mais opioides espinhais pode reduzir a incidencia de complicacoes cardiovasculares no pos-operatorio de pacientes nessas condicoes, comparando-se a metodos classicos de analgesia pos-operatoria, opioides e AINES, administrados segundo demanda do paciente. METODO: Oitenta pacientes adultos ASA I e II, sem alteracoes ECG, alocados em dois grupos de 40: Grupo A, sob anestesia geral com propofol, cisatracurio e isoflurano, associado a anestesia peridural, com cateter e controle da analgesia pos-operatoria com bupivacaina e morfina peridural; e Grupo B, sob anestesia geral com as mesmas drogas e doses que o Grupo A, mais analgesia pos-operatoria realizada com AINES e morfina endovenosa no final da operacao e em intervalos regulares. Em ambos foi aplicado Holter por 24 horas. A avaliacao da dor foi realizada pela escala analogica visual. RESULTADOS: Na avaliacao da dor observou-se no Grupo A evidente predominio do escore 0 (p 50 anos (22,2% versus 0,0%. p = 0,26). Nao se observou diferenca significativa da frequencia cardiaca entre os grupos (p > 0,05). CONCLUSOES: A melhor qualidade da analgesia no pos-operatorio, realizada nos pacientes do Grupo A, reduziu a incidencia de complicacoes cardiovasculares

Assessing the use of 50% enantiomeric excess bupivacaine-loaded microspheres after sciatic nerve block in rats

BACKGROUND AND OBJECTIVES To achieve better therapeutic benefits of local anesthetics in the control of postoperative pain through controlled-release carrier. The objective of this study was to compare the characteristics of sensory and motor blockade between microspheres without local anesthetic: racemic bupivacaine-loaded microspheres; 50% enantiomeric excess bupivacaine-loaded microspheres; and free 50% enantiomeric excess bupivacaine. METHODS Wistar rats were distributed into four groups: A (Microsphere); B (S50-R50 bupivacaine-loaded microsphere); C (50% enantiomeric excess bupivacaine-loaded microsphere); and D (50% enantiomeric excess bupivacaine). Inhalation anesthesia was performed before the sciatic nerve block (2% halothane and 100% O(2)). Sensorial blockade was measured by the time required for each rat to withdraw its paw from a hot plate at 56°C (positive>4 sec). Motor blockade was measured by the time between drug injection until recovery of a motor score of 2 on the established criterion. RESULTS The sensory response was significantly more frequent in groups B, C, and D than in group A (p<0.001). There were no statistically significant differences in the response to the sensory test in groups B, C, and D (p>0.05). The response to the motor test was also significantly more frequent in groups B, C, and D than in group A (p=0.02). A tendency to greater positivity in the motor test was more frequently found in groups B and D than in group C (p=0.10). CONCLUSIONS Controlled-release of 50% enantiomeric excess bupivacaine-loaded microspheres showed similar results regarding analgesia and less motor blockade when compared to other anesthetic formulations.

Comparison of turbinoplasty surgery efficacy in patients with and without allergic rhinitis

INTRODUCTION Turbinoplasty is a procedure that aims to reduce the size of the inferior turbinate through exuberant bone removal with high mucosal preservation. The procedure is recommended for patients with or without allergic rhinitis and those showing irreversible hypertrophy of inferior turbinates. OBJECTIVE To evaluate the efficacy of inferior turbinoplasty for obstructive and non-obstructive symptoms in patients with or without allergic rhinitis. METHODS Prospective study with 57 patients who underwent inferior turbinoplasty. They were evaluated for nasal obstruction, snoring, facial pressure, smell alterations, sneezing, nasal itching and runny nose symptoms, surgery time, and intraoperative bleeding. The last evaluation took place three months after surgery. RESULTS Thirty-nine patients with allergic rhinitis and 18 without were assessed. Ninety days after surgery, 94.7% of patients showed degrees IV and V of breathing improvement; 89.5% showed moderate or complete improvement in snoring; all patients showed smell improvement (only one showed moderate improvement; all the others had full improvement); 95.5% experienced complete facial pressure improvement; and 89.7% showed moderate to complete improvement in nasal itching and runny nose symptoms, as well as in sneezing. CONCLUSION The efficacy of inferior turbinoplasty was confirmed not only for obstructive symptoms, but also for non-obstructive symptoms in patients with and without allergic rhinitis.