Clinics
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Dysphagia is the important symptom in achalasia, and surgery is the most common treatment. The Heller-Pinotti technique is the method preferred by Brazilian surgeons. For many years, this technique was performed by laparotomy, and now the laparoscopic method has been introduced. The objective was to evaluate the immediate and long-term results of patients submitted to surgery by either laparotomy or laparoscopy. ⋯ There was no difference between the two groups with respect to relief from dysphagia, thereby confirming the safety and effectiveness of the Heller-Pinotti technique, which can be performed by laparotomy or laparoscopy, depending on the surgeon's experience.
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Sepsis is a major cause of mortality and morbidity in intensive care units. Organ dysfunction is triggered by inflammatory insults and tissue hypoperfusion. The brain plays a pivotal role in sepsis, acting as both a mediator of the immune response and a target for the pathologic process. ⋯ Although sepsis-associated encephalopathy was described decades ago, it has only recently been subjected to scientific scrutiny and is not yet completely understood. The pathophysiology of sepsis-associated encephalopathy involves direct cellular damage to the brain, mitochondrial and endothelial dysfunction and disturbances in neurotransmission. This review describes the most recent findings in the pathophysiology, diagnosis, and management of sepsis-associated encephalopathy and focuses on its many presentations.
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Randomized Controlled Trial
Dexmedetomidine for the prevention of shivering during spinal anesthesia.
The aim of this study was to evaluate the effect of dexmedetomidine on shivering during spinal anesthesia. ⋯ Dexmedetomidine infusion in the perioperative period significantly reduced shivering associated with spinal anesthesia during minor surgical procedures without any major adverse effect during the perioperative period. Therefore, we conclude that dexmedetomidine infusion is an effective drug for preventing shivering and providing sedation in patients during spinal anesthesia.
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Breast cancer is the most prevalent cancer in women. The most frequent therapeutic approaches for the treatment of this disease are chemotherapy, radiotherapy, hormone therapy, and surgery. Conventional pharmacological treatments cause many harmful side effects in patients. ⋯ The pharmacological effects of nutritional and medicinal mushrooms have been reported in several experimental clinical studies and have shown promising results in the adjuvant treatment of breast cancer. Adjuvant treatment with mushrooms is associated with improvements in the immunological and hematologic parameters of breast cancer, as well as in the quality of life of these patients. Randomized clinical studies are needed to elucidate the possible mechanisms of action and clinical benefits of these fungi with respect to survival time, disease progression, and metastasis in breast cancer.
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Randomized Controlled Trial Comparative Study
Influence of metal alloy and the profile of coronary stents in patients with multivessel coronary disease.
In Brazil, despite the recommendations of the Brazilian Society of Hemodynamics and Interventional Cardiology, the National Health System has not yet approved the use of drug-eluting stents. In percutaneous coronary interventions performed in the public and part of the private health care system, bare metal stents are used as the only option. Therefore, new information on bare metal stents is of great importance. The primary endpoint was to evaluate the influence of the alloy and the profile of coronary stents on late loss and restenosis rates 6 months after implantation in patients with multivessel coronary disease. ⋯ The use of two different alloys, stainless steel and cobalt-chrome stents, in the same patient and in the same vessel produced similar 6-month restenosis and late loss rates.