Cir Cir
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Preoperative exams are a common practice for surgeons; however, their use is not based on a scientific or medical basis. In the best of scenarios, it is an institutional policy. ⋯ The use of PRT in young clinically healthy subjects is an expensive and inefficient practice.
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Cervical cancer (CC) is a public health problem among women worldwide, especially in emerging nations. To improve CC control, new adjuvant therapeutic strategies are required. Advances in immunology, genomics and proteomics have accelerated our understanding of the genetic and cellular basis of many cancer types. ⋯ It is hoped that in the future it may be possible to eradicate cervical cancer. The success of immunotherapy anti-HPV clinical trials in CC patients will be determined at a future time. The scientific basis for the development of papillomavirus prophylactic and therapeutic vaccines against persistent infection and preinvasive-invasive associated cervical lesions along with the present status of immunopreventive and immunotherapy clinical trials against cervical cancer are commented on in this paper.
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Hyperglycemia is frequent during critical illness and is perceived by the clinician as part of the systemic metabolic response to stress. Of all patients with "stress hyperglycemia" only one third are known to have diabetes mellitus. Previous studies reported that patients presenting hyperglycemia during acute illness have an increased risk for nosocomial infections. ⋯ A recent trial showed that intensive insulin treatment of critically ill patients in the intensive care unit with the goal of maintaining blood glucose levels between 80 and 110 mg/dl significantly reduced morbidity and mortality without significant risk of hypoglycemia. These benefits of insulin treatment are not yet well understood, but some pathophysiological evidence suggests that hyperglycemia contributes to perpetuate the systemic proinflammatory response, and insulin--a natural endogenous hormone that has a major role in the intermediary metabolism--participates actively in the systemic anti-inflammatory response. As a result of these findings, we recommend that hyperglycemia during critical illness should be treated with insulin, in order to achieve blood glucose levels in a normal range, regardless of whether or not these patients have diabetes mellitus.
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The current treatment of Shamblin's class III carotid body tumors includes a variety of reconstructive techniques for the internal carotid artery, ranging from angioplasty to the use of various grafts such as autologous saphenous vein or synthetic shunts. We present the case of a 56-year-old female patient with a carotid body tumor. The diagnosis and therapeutic approach is discussed, as well as the surgical technique and postoperative outcome. In those cases where the carotid body tumor involves the internal carotid artery to the point that its sacrifice is imminent and synthetic grafts are not available, reconstruction of the internal carotid artery with transposition of the external carotid artery is recommended.