Physical exercise reduces the deleterious effects of cardiovascular and inflammatory disorders. The purpose of the present study was to evaluate the beneficial effects of physical training on the inflammatory responses following lung ischaemia-reperfusion (IR) in rats.Male Wistar rats were divided into sham-operated animals and sedentary and trained animals submitted to lung IR. The run training programme consisted of 5 sessions?week , at 66% of maximal oxygen consumption for 8 weeks. The left pulmonary artery, bronchus and pulmonary vein were occluded for 90 min and reperfused for 2 h. Lung protein extravasation was measured as 125 I-human albumin accumulation, whereas lung neutrophil infiltration was measured as myeloperoxidase activity. Lung IR in sedentary rats resulted in marked increases in protein extravasation and neutrophil influx, and in significant elevations of serum tumour necrosis factor (TNF)-a and interleukin (IL)-1b levels. Physical preconditioning attenuated the increased IR-induced protein leakage without affecting neutrophil influx. It also reduced serum TNF-a (and IL-1b) levels, but had no effect on IL-10 levels. Plasma superoxide dismutase activity was significantly increased in trained IR rats.The present data show that physical preconditioning protects the rat lung from ischaemiareperfusion injury by attenuating the pulmonary vascular permeability that may be a consequence of reduced levels of tumour necrosis factor-a and interleukin-1b and elevated superoxide dismutase activity.

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a simpatectomia torácica por videotoracoscopia melhora a qualidade de vida de pacientes com hiperidrose primária, mesmo com o surgimento de sudorese reflexa. A ansiedade está diretamente relacionada com a intensidade da sudorese reflexa, sem comprometer o grau de satisfação do paciente.

O derrame pleural parapneumônico (DPP) ocorre durante o curso clínico de uma pneumonia ou abscesso pulmonar. Sua incidência é freqüentemente subestimada, podendo aparecer em cerca de 25% a 44% dos casos de pneumonias adquiridas na comunidade (PAC).(1-3) Na maioria das vezes o quadro clínico do DPP se sobrepõe ao da PAC, sendo ele descoberto devido à realização da radiografia de tórax para o diagnóstico inicial ou avaliação da falta de resposta ao tratamento para a PAC.A maioria desses derrames é resolvida com o mesmo tratamento antibiótico da PAC, e sua presença pode passar despercebida. ABSTRACTThe infectious effusion, one of the most frequent causes of pleural effusions in the clinical practice, is a sign of complication of the pneumonic disease. The early recognition of the parapneumonic effusion is crucial to determine the best treatment form and reduce the risk of morbidity and mortality. The evolution in the diagnostic methods and the contribution of several studies published in the literature allowed to establish evidence-based guidelines that are used to guide the treatment of the parapneumonic pleural effusion and empyema.Keywords: Pneumonia/complications; Pleural effusion/etiology; Drainage; Empyema, pleural; Radiography, thoracic RESUMOO derrame infeccioso, uma das causas mais freqüentes de derrame pleural obervados na pratica clinica, é um sinal de complicação do quadro pneumônico. O reconhecimento precoce do derrame parapneumônico é fundamental para determinar a melhor forma de tratamento, reduzindo o risco de morbidade e mortalidade. A evolução dos métodos diagnósticos e a experiência dos diversos estudos publicados na literatura permitiram estabelecer diretrizes baseadas em evidencias que orientam a conduta de abordagem terapêutica do derrame parapneumônico e empiema.Descritores: Pneumonia/complicações; Derrame pleural/etiologia; Drenagem; Empiema pleural; Radiografia torácica tações (denominados de DPP complicados) ou para empiema pleural. (4)(5)(6) EPIDEMIOLOGIANo Brasil, existem estudos localizados em que a incidência de DPP se encontra entre 20% e 30% dos casos de PAC internados.(3-7) Em 2005, calculase que o número de pacientes com PAC internados foi de aproximadamente 730.000, (8) o que permite estimar entre 140.000 e 210.000 casos de DPP.Na literatura mundial, estima-se que 10% dos DPP podem evoluir para DPP complicado ou empiema pleural, (2) com a mortalidade situando-se entre 6% e 10% dos casos. (4,6) No Brasil, não dis- Capítulo 5Capítulo 5

OBJECTIVE: To describe demographic characteristics, surgical results, postoperative complications, and overall survival rates in surgically treated patients with lung metastases. METHODS: This was a retrospective analysis of 119 patients who underwent a total of 154 lung metastasis resections between 1997 and 2011. RESULTS: Among the 119 patients, 68 (57.1%) were male and 108 (90.8%) were White. The median age was 52 years (range, 15-75 years). In this sample, 63 patients (52.9%) presented with comorbidities, the most common being systemic arterial hypertension (69.8%) and diabetes (19.0%). Primary colorectal tumors (47.9%) and musculoskeletal tumors (21.8%) were the main sites of origin of the metastases. Approximately 24% of the patients underwent more than one resection of the lesions, and 71% had adjuvant treatment prior to metastasectomy. The rate of lung metastasis recurrence was 19.3%, and the median disease-free interval was 23 months. The main surgical access used was thoracotomy (78%), and the most common approach was wedge resection with segmentectomy (51%). The rate of postoperative complications was 22%, and perioperative mortality was 1.9%. The overall survival rates at 12, 36, 60, and 120 months were 96%, 77%, 56%, and 39%, respectively. A Cox analysis confirmed that complications within the first 30 postoperative days were associated with poor prognosis (hazard ratio = 1.81; 95% CI: 1.09-3.06; p = 0.02). CONCLUSIONS: Surgical treatment of lung metastases is safe and effective, with good overall survival, especially in patients with fewer metastases.

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RESUMO: Objetivo:Conduziu-se este estudo prospectivo a fim de avaliar-se a influência do uso da braçadeira sobre o acúmulo de coágulos dentro dos drenos pleurais. Método: Os drenos pleurais foram pesados logo após sua retirada, lavados e secados e pesados novamente. A diferença entre a primeira e a segunda pesagem foi admitida como a quantidade de coágulos acumulada. Resultados: Houve maior acúmulo de coágulo nos drenos temporariamente obstruídos por braçadeira em relação àqueles não obstruídos. Conclusão: Notou-se, neste estudo, maior acúmulo de coágulo dentro de drenos pleurais obstruídos, mesmo que intermitentemente, o que pode levar ao mau funcionamento de todo o sistema de drenagem. A discussão sobre o correto uso dos drenos pleurais deve ser constante e fazer parte de programas de educação continuada para médicos e enfermagem, a fim de que este sistema, amplamente utilizado e altamente eficiente, seja otimizado (Rev. Col. Bras. Cir. 2008; 35(2): 079-082). AgradecimentosAgradecemos à colaboração dos laboratórios de patologia clínica do Hospital Estadual Sumaré e do Hospital das Clínicas da Unicamp por ceder seus equipamentos de precisão e seu espaço físico. Congratulamo-nos com a equipe de enfermagem do Hospital Estadual Sumaré pela predisposição à discussão e à educação continuada. ABSTRACT Background: A prospective study was done to evaluate the influence of clamp usage on clot formation inside thoracic drains.Methods: Each drain was weighed soon after removal; they were then washed, dried and weighed again. The difference between the first and second weights was taken as the amount of clot deposit formed. Results: We found more clots accumulated inside the drains that were temporarily obstructed by the clamp. Conclusion: In this study, there were more clots formation inside thoracic drains clamped, even if they were occluded intermittently. This can lead thoracic drains to function improperly. The discussion about the correct usage of thoracic drains must be a subject for educational programs for physicians and nurses, to aim for the safest use of this widely used and highly efficient system.