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Background: The use of Indwelling Pleural Catheter (IPC) in the care of patients with Malignant Pleural Effusion (MPE) is well established, however studies involving public health systems of low and middle-income countries are still lacking. This study aimed to determine the effect of IPC on the respiratory symptoms and Quality of Life (QoL) of patients with MPE in the setting of a Brazilian public health system., Methods: From August 2015 to November 2019, patients with MPE underwent IPC placement and were prospectively followed. QoL and respiratory symptoms were assessed by the EORTC questionnaires (QLQ-30; LC13) and Visual Analogue Scale (VAS), respectively, at pre-treatment, 30 , and 60 days after IPC placement., Results: 56 patients were enrolled with 57 catheters inserted. The mean age was 63 (23‒88) years, of which 17 (30%) were men and 39 (70%) were women. Breast 24 (42%) and lung 21 (37%) were the main primary neoplasms. Cellulitis was the most common complication and all patients recovered with appropriate antimicrobial therapy. QoL did not change significantly over time, however, the VAS showed a significant improvement in dyspnea (+1.2: -0.5; p = 0.001)., Conclusion: IPC relieves respiratory symptoms without compromising the QoL, with a low complication rate. It represents a suitable option for patients with MPE and short LE in an emerging country., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2022 HCFMUSP. Published by Elsevier España, S.L.U. All rights reserved.)

Objectives: The scant data about non-cystic fibrosis bronchiectasis, including tuberculosis sequelae and impairment of lung function, can bias the preoperative physiological assessment. Our goal was to evaluate the changes in lung function and exercise capacity following pulmonary resection in these patients; we also looked for outcome predictors., Methods: We performed a non-randomized prospective study evaluating lung function changes in patients with non-cystic fibrosis bronchiectasis treated with pulmonary resection. Patients performed lung function tests and cardiopulmonary exercise tests preoperatively and 3 and 9 months after the operation. Demographic data, comorbidities, surgical data and complications were collected., Results: Forty-four patients were evaluated for lung function. After resection, the patients had slightly lower values for spirometry: forced expiratory volume in 1 s preoperatively: 2.21 l ± 0.8; at 3 months: 1.9 l ± 0.8 and at 9 months: 2.0 l ± 0.8, but the relationship between the forced expiratory volume in 1 s and the forced vital capacity remained. The gas diffusion measured by diffusing capacity for carbon monoxide did not change: preoperative value: 23.2 ml/min/mmHg ± 7.4; at 3 months: 21.5 ml/min/mmHg ± 5.6; and at 9 months: 21.7 ml/min/mmHg ± 8.2. The performance of general exercise did not change; peak oxygen consumption preoperatively was 20.9 ml/kg/min ± 7.4; at 3 months: 19.3 ml/kg/min ± 6.4; and at 9 months: 20.2 ml/kg/min ± 8.0. Forty-six patients were included for analysis of complications. We had 13 complications with 2 deaths. To test the capacity of the predicted postoperative (PPO) values to forecast complications, we performed several multivariate and univariate analyses; none of them was a significant predictor of complications. When we analysed other variables, only bronchoalveolar lavage with positive culture was significant for postoperative complications (P = 0.0023). Patients who had a pneumonectomy had a longer stay in the intensive care unit (P = 0.0348)., Conclusions: The calculated PPO forced expiratory volume in 1 s had an excellent correlation with the measurements at 3 and 9 months; but the calculated PPO capacity for carbon monoxide and the PPO peak oxygen consumption slightly underestimated the 3- and 9-month values. However, none of them was a predictor for complications. Better tools to predict postoperative complications for patients with bronchiectasis who are candidates for lung resection are needed., Clinical Trial Registration Number: Clinicaltrials.gov: NCT01268475., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Purpose: Experimental study aimed at evaluating whether pleural neoplastic disease is associated with the degree of pleural fibrosis over time caused by talc pleurodesis. The study describes changes in levels of inflammatory mediators and determines whether the course of time involved in progression of neoplastic pleural disease is the factor that influences safety of talc pleurodesis usage in mice., Materials and Methods: Animals were randomized into two groups: Cancer group (CG) that received intrapleural injection of Lewis cells or Saline group (SG) that received saline injection. After, the animals were subdivided into Early (pleurodesis 3 days after pleural injection) and Late (pleurodesis 7 days after pleural injection) groups. Half of the animals in each group were euthanized 24 hours after pleurodesis (to obtain the inflammatory data); the remaining animals were killed after 8 days (to obtain the scores of pleural fibrosis)., Results: CGs had lower fibrosis scores than SGs comparing early phases to late phases. Inflammation scores were lower in CGs, particularly in Late group. In SGs the inflammation was intense in 100% of the animals. In Late CG group pleural adhesions had the lowest scores; we found intense fibrosis only in SGs. VEGF and LDH levels had increased in animals with cancer, particularly in Late group. Systemic distribution of talc occurred only in Late CG., Conclusions: The time for pleural neoplasia to evolve is inversely proportional to the degree of pleural fibrosis. Earlier pleurodesis yielded the best results related to fibrosis, with less systemic inflammation and is safer in mice., Competing Interests: CONFLICTS OF INTEREST None.

Objective: To evaluate the structure, process and results of the Capillary Blood Glucose Self-monitoring Program in a Brazilian city., Method: Epidemiological, cross-sectional study. The methodological framework of Donabedian was used to construct indicators of structure, process and outcome. A random sample (n = 288) of users enrolled and 96 health professionals who worked in the program was studied. Two questionnaires were used that were constructed for this study, one for professionals and one for users, both containing data for the evaluation of structure, process and outcome. Anthropometric measures and laboratory results were collected by consulting the patients' health records. The analysis involved descriptive statistics., Results: Most of the professionals were not qualified to work in the program and were not knowledgeable about the set of criteria for patient registration. None of the patients received complete and correct orientations about the program and the percentage with skills to perform conducts autonomously was 10%. As regards the result indicators, 86.4% of the patients and 81.3% of the professionals evaluated the program positively., Conclusion: The evaluation indicators designed revealed that one of the main objectives of the program, self-care skills, has not been achieved.

Our aim was to study the protective effect of quercitin on liver cirrhosis induced by carbon tetrachloride (CCl(4)) in rats and its relationship with liver morphology. Thirty male Wistar rats weighing 200-250 g were randomly divided into three groups: control, CCl(4), and CCl(4)+ quercetin. Rats in the experimental groups were given CCl(4) (0.5 ml/kg i.p.), diluted 1:6 in vegetable oil (5 mmol/kg body wt), at 10:00 p.m. every 4 days for 17 weeks. Quercetin (500 microl/kg i.p.; 150 micromol/kg body wt) or vehicle was administered at 6:00 p.m. for the last 3 weeks of the study. Control group rats were given only olive oil for the same period. At the end of the 17 weeks, all rats were sacrificed. Blood samples were taken for determination of serum indicators (ALT, AST, total bilirubin, conjugated bilirubin, factor V) and the livers were dissected out and divided into two parts: one was homogenized and the supernatant was used for measurement of superoxide dismutase (SOD), catalase, and glutathione peroxidase (GPx) activities, as well as lipid peroxidation. The other part was used for the histopathological study. CCl(4) caused a marked rise in serum levels of ALT, AST, total bilirubin, and conjugated bilirubin, as well as a decrease in factor V (P<0.05). Lipid peroxidation levels were significantly increased, whereas GSH, SOD, catalase, GPx, and GST levels were decreased in the liver of CCl(4)-treated rats. Quercetin (50 mg/kg/day) successfully attenuated these effects of CCl(4). We conclude that quercetin has beneficial effects on liver fibrosis in rats by enhancing antioxidant enzyme activity and decreasing the pro-oxidant effect.

A hundred and ninety five percutaneous transluminal angioplasty (PTA) of a renal transplant artery were attempted before january 1st, 1990 in 151 patients. Analysis of the series was essentially based on follow-up after PTA. PTA was initially successful in 85% of the patients. Restenoses occurred in 30% of the patient. They were usually amenable to repeat PTA. Restenosis rate after repeat PTA was of 26%. The five year secondary patency rate of the renal artery was over 85%. After a successful PTA, the blood pressure, the number of antihypertensive drug per patient and serum creatinine returned to a level close to their basal value within few days and remained stable long. After an immediate failure of PTA, secondary patency rate of the renal transplant artery was over 80% at one year. Blood pressure returned to a level close to its basal value. But, that improvement was slower (1 to 6 months) and antihypertensive drug regimen and serum creatinine remained stable. We conclude that PTA is an effective treatment at long term of hypertension and of decline in renal function due to stenoses of renal transplant arteries. However PTA carried some risks and should be attempted only stenoses of renal transplants arteries cause, severe hypertension resisting to medical therapy or decline in renal function.

During the last 35 months, mechanical recanalisation was obtained in 25 (19 men, 6 women, aged 39 to 92 years, average 59 years) out of 30 patients admitted for percutaneous andovascular management, associating angioplasty and endovascular stents, of iliac artery occlusion of over 5 months duration. Forty-three balloon-expandable stents (27 Palmaz, 16 Strecker) were implanted in 29 iliac arteries (15 external, 14 common iliac arteries) with occlusions 2 to 7 cms long (average: 4.6 cm) either after balloon angioplasty (22 cases) or without angioplasty (7 cases) because of a suspected fresh thrombus suggested by easy recanalisation by the guide wire and with the aim of avoiding fragmentation and embolisation of the thrombotic material. In this type of case, a Strecker stent was preferred, a choice also justified by an "obligatory" contro-lateral approach (5 cases). With the exception of these cases, the treatment of first intention was to insert one or more Palmaz stents by a homo-lateral approach. Two haematomas with no complications and 1 reocclusion at the 24th hour, revascularised by urokinase with a good 6 months result, were observed. After the insertion of one Palmaz stent in one patient, a non-occlusive thrombus, probably due to embolism, was observed straddling the homolateral superficial and profunda femoral arteries, but it was of no clinical consequence. After thromboaspiration and angioplasty by a contro-lateral approach, the arterial lumen was recanalized with a sustained result at 18 months. Clinical Doppler and angiographic (digitised intravenous angioplasty) controls were obtained every 6 months in 22 patients.(ABSTRACT TRUNCATED AT 250 WORDS)