The effect of pelvic floor muscle training alone or in combination with electrostimulation in the treatment of sexual dysfunction in women with multiple sclerosis.

BACKGROUND: Sexual dysfunction (SD) affects up to 80% of multiple sclerosis (MS) patients and pelvic floor muscles (PFMs) play an important role in the sexual function of these patients. OBJECTIVES: The objective of this paper is to evaluate the impact of a rehabilitation program to treat lower urinary tract symptoms on SD of women with MS. METHODS: Thirty MS women were randomly allocated to one of three groups: pelvic floor muscle training (PFMT) with electromyographic (EMG) biofeedback and sham neuromuscular electrostimulation (NMES) (Group I), PFMT with EMG biofeedback and intravaginal NMES (Group II), and PFMT with EMG biofeedback and transcutaneous tibial nerve stimulation (TTNS) (Group III). Assessments, before and after the treatment, included: PFM function, PFM tone, flexibility of the vaginal opening and ability to relax the PFMs, and the Female Sexual Function Index (FSFI) questionnaire. RESULTS: After treatment, all groups showed improvements in all domains of the PERFECT scheme. PFM tone and flexibility of the vaginal opening was lower after the intervention only for Group II. All groups improved in arousal, lubrication, satisfaction and total score domains of the FSFI questionnaire. CONCLUSION: This study indicates that PFMT alone or in combination with intravaginal NMES or TTNS contributes to the improvement of SD.

[Practical aspects for minimizing errors in the cross-cultural adaptation and validation of quality of life questionnaires]. / Cómo minimizar errores al realizar la adaptación transcultural y la validación de los cuestionarios sobre calidad de vida: aspectos prácticos.

BACKGROUND: The development and validation of questionnaires for evaluating quality of life (QoL) has become an important area of research. However, there is a proliferation of non-validated measuring instruments in the health setting that do not contribute to advances in scientific knowledge. AIMS: To present, through the analysis of available validated questionnaires, a checklist of the practical aspects of how to carry out the cross-cultural adaptation of QoL questionnaires (generic, or disease-specific) so that no step is overlooked in the evaluation process, and thus help prevent the elaboration of insufficient or incomplete validations. METHODS: We have consulted basic textbooks and Pubmed databases using the following keywords quality of life, questionnaires, and gastroenterology, confined to «validation studies¼ in English, Spanish, and Portuguese, and with no time limit, for the purpose of analyzing the translation and validation of the questionnaires available through the Mapi Institute and PROQOLID websites. RESULTS: A checklist is presented to aid in the planning and carrying out of the cross-cultural adaptation of QoL questionnaires, in conjunction with a glossary of key terms in the area of knowledge. The acronym DSTAC was used, which refers to each of the 5 stages involved in the recommended procedure. In addition, we provide a table of the QoL instruments that have been validated into Spanish. CONCLUSIONS: This article provides information on how to adapt QoL questionnaires from a cross-cultural perspective, as well as to minimize common errors.

Leachability of automotive shredder residues burned in a fluidized bed system.

This paper presents the results of the study of a combustible fraction of automotive shredder residues (CASRs) and the corresponding ashes generated by combustion on a fluidized bed pilot with the aim to understand the influence of thermal treatment regarding properties for final disposal, such as landfilling. The chemical composition was evaluated and the leachability behaviour of ashes and CASR was investigated using the three more commonly used tests: the European Standard EN 12457, the US TCLP-EPA 1311 and the Dutch availability test EA NEN 7371. Different results were obtained depending on the specific conditions of the methods employed. It was found that both the CASR and the ashes contained large amounts of toxic metals and other undesirable elements, such as Cl and S. For the CASR, in addition to the leachability of organic matter above the limit set for hazardous materials, the release of heavy metals, either under alkaline and acidic conditions was significant, revealing the serious risks associated to the landfilling practices still being undertaken worldwide. Release of organic matter from ashes was insignificant, but solubility of sulphates increased and chlorides exceed the hazardous limits in the case of fly ashes. Toxic metals were found to leach from the ashes only under acidic conditions, except Pb and Cu which also leached from finer ashes at alkaline pH. Cr also leached from ashes at alkaline pH values. Both the Dutch availability and TCLP revealed much higher leaching intensities than the European Standard due to the acidity of leachants. However, it was found that ashes may be more resistant to acidification because they exhibit much higher acid neutralization capacity (ANC) than the untreated CASR. The study undertaken shows that thermal valorisation of the combustible fraction of ASR may avoid the risks associated with their landfilling; however, care has to be taken with the ashes because they also behave as hazardous residues. Although, the mass reduction provided by thermal treatment may make landfilling less expensive, a more profitable reutilization of the ashes should be developed.

Evaluation of the vaccination status in pediatric renal transplant recipients.

To assess the immunization status of pediatric renal transplant patients followed at a single center in Brazil, vaccination charts of all patients aged between one and 18 yr were analyzed both pre- and post-transplantation. Appropriate immunization was defined according to the National Immunization Program (routine vaccines) - for all Brazilian children - and the Special Immunobiological Agents Program that also includes special vaccines for immunodeficient or other high-risk children. A total of 46 patients was evaluated (mean age 13.7 yr; range 4-17 yr). Vaccination charts were found to be up to date in only two patients (4.3%) pretransplant and in two (4.3%) post-transplant. Although 36 patients (62.2%) in the pretransplant phase and 24 (52.1%) in the post-transplant phase had been vaccinated according to the National Immunization Program, they had not received the special vaccines indicated for their immunocompromised condition. Therefore, despite being followed at a referral center, almost all patients presented an incomplete immunization status pre- and post-transplant. This probably reflects missed opportunities and medical/parental apprehension related to vaccination of patients with chronic renal insufficiency, dialysis or kidney transplantation. Efforts should be made to ensure adequate vaccination in children with kidney diseases, especially before kidney transplantation.

Chemical and ecotoxicological characterization of ashes obtained from sewage sludge combustion in a fluidised-bed reactor.

In 1999, the DEECA/INETI and the UBiA/FCT/UNL started a researching project on the partition of heavy metals during the combustion of stabilised sewage sludge (Biogran), in a fluidised-bed reactor, and on the quality of the bottom ashes and fly ashes produced. This project was entitled Bimetal and was funded by the Portuguese Foundation for Science and Technology. In this paper only the results on the combustion of Biogran are reported. The combustion process was performed in two different trials, in which different amounts of sewage sludge and time of combustion were applied. Several ash samples were collected from the bed (bottom ashes) and from two cyclones (first cyclone and second cyclone ashes). Sewage sludge, bed material (sand) and ash samples were submitted to the leaching process defined in the European leaching standard EN 12457-2. The eluates were characterized for a set of inorganic chemical species. The ecotoxicological levels of the eluates were determined for two biological indicators (Vibrio fischeri and Daphnia magna). The results were compared with the limit values of the CEMWE French Regulation. The samples were also ranked according to an index based on the chemical characterization of the eluates. It was observed an increase of the concentration of metals along the combustion system. The ashes trapped in the second cyclone, for both combustion trials, showed the highest concentration of metals in the eluates. Chemically, the ashes of the second cyclone were the most different ones. In the ecotoxicological point of view, the ecotoxicity levels of the eluates of the ashes, for both combustion cycles, did not follow the same pattern as observed for the chemical characterization. The ashes of the first cyclone showed the highest ecotoxicity levels for V. fischeri and D. magna. This difference on chemical and ecotoxicological results proves the need for performing both chemical and ecotoxicological characterizations of the sub-products of such type of thermal processes.

Immunogenicity of a 23-valent pneumococcal polysaccharide vaccine in Brazilian elderly.

Serum antibodies specific for the capsular polysaccharides of Streptococcus pneumoniae provide protection against invasive pneumococcal infection. In Brazil, this vaccine has been used for people over 65 years with clinical risk to develop pneumococcal infection since 1999. We evaluated the immune response of 102 elderly subjects (75.5% females and 24.5% males) with a mean age of 71 years, and 19 young healthy adults (63.2% females and 36.8% males) with a mean age of 27 years. The elderly study group consisted of outpatients who received follow-up care in the Geriatric Department of General Hospital, Faculty of Medicine, University of São Paulo. None had acute illness at the time of vaccination. Both groups were immunized with one intra-deltoid injection with 0.5 ml of a 23-valent pneumococcal polysaccharide vaccine. The total IgG specific antibody concentrations to capsular polysaccharides 1, 3, 5, 6B, 8, and 14 were determined against pre- and 1-month post-vaccination sera. All samples were analyzed according to the second-generation pneumococcal polysaccharide ELISA protocol. We observed that the pneumococcal polysaccharide vaccine evoked consistent antibody increase for serotypes 1, 5, 6B, 8, and 14 (geometric mean concentration increase of 2.46 in the elderly and 2.84 in the young adults). Otherwise, we observed no increase in antibody concentration for serotype 3 in both groups.

Disruption of prion protein-HOP engagement impairs glioblastoma growth and cognitive decline and improves overall survival.

Glioblastomas (GBMs) are resistant to current therapy protocols and identification of molecules that target these tumors is crucial. Interaction of secreted heat-shock protein 70 (Hsp70)-Hsp90-organizing protein (HOP) with cellular prion protein (PrP(C)) triggers a large number of trophic effects in the nervous system. We found that both PrP(C) and HOP are highly expressed in human GBM samples relative to non-tumoral tissue or astrocytoma grades I-III. High levels of PrP(C) and HOP were associated with greater GBM proliferation and lower patient survival. HOP-PrP(C) binding increased GBM proliferation in vitro via phosphatidylinositide 3-kinase and extracellular-signal-regulated kinase pathways, and a HOP peptide mimicking the PrP(C) binding site (HOP230-245) abrogates this effect. PrP(C) knockdown impaired tumor growth and increased survival of mice with tumors. In mice, intratumor delivery of HOP230-245 peptide impaired proliferation and promoted apoptosis of GBM cells. In addition, treatment with HOP230-245 peptide inhibited tumor growth, maintained cognitive performance and improved survival. Thus, together, the present results indicate that interfering with PrP(C)-HOP engagement is a promising approach for GBM therapy.

Reactivation of Chagas' disease in a human immunodeficiency virus-infected patient leading to severe heart disease with a late positive direct microscopic examination of the blood.

We report a human immunodeficiency virus (HIV)-infected man with chronic Chagas' disease who developed a congestive heart failure that could not be clinically controlled. Endomyocardial biopsy revealed severe myocarditis and the xenodiagnosis result was positive, but Trypanosoma cruzi by direct microscopic examination of the blood was found only four months after the symptoms had started. Treatment with benznidazole was effective in reducing parasitemia, stabilizing the clinical status, and controlling tissue damage related to the parasite. Although the finding of T. cruzi trypomastigotes by direct microscopic examination of the blood has been considered the mark of Chagas' reactivation in immunocompromised patients with chronic disease, in this case it was a late finding.

Envenoming by Bothrops jararaca in Brazil: association between venom antigenaemia and severity at admission to hospital.

The association between the clinical severity of Bothrops jararaca envenoming at admission and serum venom and plasma fibrinogen concentrations before antivenom administration is reported in 137 patients admitted to Hospital Vital Brazil, Instituto Butantan, São Paulo, Brazil, between 1989 and 1990. Other variables such as age, gender, site of the bite, use of tourniquet and the time interval between the bite and start of antivenom therapy, spontaneous systemic bleeding, and the 20 minute whole blood clotting test (20WBCT) at admission showed no association with either severity or serum venom antigen concentration (SVAC). Mean SVAC in patients with mild envenoming was significantly lower than in the group with moderate envenoming (P = 0.0007). Patients with plasma fibrinogen concentrations > 1.5 g/L had a lower mean SVAC than patients with plasma fibrinogen concentrations < or = 1.5 g/L (P = 0.02). Those admitted with a tourniquet in place had significantly higher plasma fibrinogen concentrations than those without a tourniquet (P = 0.002). A multiple logistic regression model showed independent risk factors for severity: bites at sites other than legs or forearms, SVACs > or = 400 ng/mL, and the use of a tourniquet. Rapid quantification of SVAC before antivenom therapy might improve initial evaluation of severity in B. jararaca bites.

Antimutagenicity of a suberin extract from Quercus suber cork.

The possible protective effect of a suberin extract from Quercus suber cork on acridine orange (AO)-, ofloxacin- and UV radiation-induced mutagenicity (bleaching activity) in Euglena gracilis was examined. To our knowledge, the present results are the first attempt to analyse suberin in relation to mutagenicity of some chemicals. Suberin exhibits a significant dose-dependent protective effect against AO-induced mutagenicity and the concentration of 500 micrograms/ml completely eliminates the Euglena-bleaching activity of AO. The mutagenicity of ofloxacin is also significantly reduced in the presence of suberin (125, 250 and 500 micrograms/ml). However, the moderate protective effect of suberin on UV radiation-induced mutagenicity was observed only at concentrations 500 and 1000 micrograms/ml. Our data shows that suberin extract from Q. suber cork possess antimutagenic properties and can be included in the group of natural antimutagens acting in a desmutagenic manner.

Composition of suberin extracted upon gradual alkaline methanolysis of Quercus suber L. cork.

The monomeric composition of suberin extracts obtained by gradual alkaline methanolysis of Quercus suber cork was determined by gas chromatography-mass spectrometry (GC-MS). Results show that 1-alkanols and alkanoic and alpha,omega-alkanedioic acids are preferentially removed upon mild alkaline conditions, whereas mid-chain-modified omega-hydroxyalkanoic acids are preferentially removed under stronger alkaline conditions. Saturated omega-hydroxyalkanoic acids are found to be abundant in all suberin extracts. These results are consistent with two distinct suberin fractions with different locations in cork cell walls and/or esterification degrees. It is proposed that these fractions correlate with the two main suberin peaks in the solid state (13)C NMR spectra of cork and suberin extracts. Quantitative GC-MS analysis showed that suberin monomers comprise approximately 30% (w/w) of the suberin extracts, the remaining comprising nonvolatile structures with high M(n) values, as measured by vapor pressure osmometry. The presence of a large fraction of high molecular weight aliphatic structures in suberin extracts is supported by the corresponding NMR spectra.

Effectiveness of influenza vaccination in elderly outpatients in São Paulo city, Brazil.

To investigate the effectiveness of the influenza vaccine in a population of elderly outpatients, we compared the occurrence and frequency of influenza like illness (ILI), respiratory illness and hospitalization in vaccinated and non-vaccinated subjects. All the outcomes were clinically defined. The two groups were similar with respect to demographics, health situation and habits. The influenza vaccine contributed to the protection of the elderly investigated, since the vaccinated subjects referred a significantly lower number of ILI than the non-vaccinated. There is a need for more studies about the effectiveness of the influenza vaccine in our country in elderly and other groups of our population.

Measles vaccination: influence of age on its efficacy.

The authors compare the serologic efficacy and the clinical protection afforded by three different measles vaccination schemes in adequately nourished children in São Paulo city, Brazil. Two hundred forty two children were divided into three groups. Group A, comprising 117 children who had received the vaccine before 12 months of age and a second dose at 12 months of age or more. Group B, comprising 46 children who had received only one dose, before 12 months of age. Group C, comprising 79 children who had received only one dose, at 12 months of age or more. The geometric mean titer of antibodies in Group A was 790.1; in Group B, 251.1; and in Group C, 550.3. There was no statistically significant difference between Groups A and C. The exposure to the measles virus was probably similar in all groups, and the children in Group A and C had similar chances of acquiring the disease after vaccination whereas in Group B the chances were higher when compared to the other two groups. The results obtained in this study favor the use, in developing countries, of a vaccination program against measles that includes an early first dose at eight months of age and revaccination after 12 months of age.

Comparison of indirect immunofluorescence test for measles antibodies with haemagglutination inhibition and plaque neutralization tests.

Indirect Immunofluorescence (IFA), Plaque Reduction Neutralization (PRN) and Haemagglutination Inhibition (HI) tests for measles antibodies were carried out in 197 sera obtained from umbilical cord and vaccinated children. The IFA was also applied to blood samples collected with filter paper. IFA results demonstrated that the test is relatively simple to perform, with good reproducibility for different antigen lots. Good correlation was obtained between IFA, PRN and HI antibody titers. Better correlation was demonstrated with IFA and PRN than with HI and PRN tests. Sensitivity of IFA in detecting antibody was less effective than PRN, however more effective than HI using rhesus monkey red blood cells. PRN antibody titers over 100 were detected by IFA but not by HI (9.7% with negative results). IFA may be of considerable practical use and able to substitute HI in seroepidemiological surveys and to evaluate vaccine efficacy. It also can be simplified by employing filter paper collected samples.

[Acute Chagas' disease: transmission routes, clinical aspects and response to specific therapy in diagnosed cases in an urban center]. / Doença de Chagas aguda: vias de transmissão, aspectos clínicos e resposta à terapêutica específica em casos diagnosticados em um centro urbano.

The authors report clinical features and therapeutic response of 24 outpatients with acute Chagas' disease, and 3 in the initial chronic phase, referred to the Clinic for Infectious and Parasitic Diseases of the FMUSP "Clínicas" Hospital between 1974 and 1987. The following transmission routes were involved: triatominae in 7 cases, blood transfusion in 9, kidney transplantation and/or blood transfusion in 4, accidental in 1, oral route in 3, probably breast feeding in 1, congenital or breast feeding in 1, and congenital or blood transfusion in 1. Six patients infected by triatominac acquired the disease between 1974 and 1980 and one in 1987. The blood transfusion infected patients acquired the disease in Greater São Paulo, seven of whom after 1983. The acute phase Chagas' disease was oligosymptomatic in 4 patients: three of such patients being immunocompromised by drugs or other diseases. Another two adult immunocompromised patients developed myocarditis and congestive heart failure. Clinical features were severe in 5 from 6 children under two years, irrespective of the transmission route. Evaluation of the acute phase patients treated with benznidazol (4-10 mg/kg/day) showed: therapeutic failure in 4/16 (25.0%); possible cure in 9/16 (53.2%) and inconclusive results in 3/16 (18.8%). The antibody and complement-mediated lysis reaction was in keeping with the xenodiagnosis in 18/22 cases, having shown negative results after treatment earlier than classical serological reactions. One aplastic anaemia patient receiving corticosteroid presented lymphoproliferative disease 6 years after being treated with benznidazol for acute Chagas' disease.

[Inactivated vaccine against hepatitis A: review of the literature and considerations on its use]. / Vacina inativada contra a hepatite A: revisão da literatura e considerações sobre seu uso.

A new, safe, highly immunogenic and probably long term effective inactivated hepatitis A virus vaccine has been licensed for clinical use. Clinical trials in developed countries have demonstrated its efficacy in preventing hepatitis A in high risk groups, such as travelers to regions where HAV infection is endemic and day care children and staff, its efficacy in postexposure conditions and in community outbreaks. The authors review the basic and changing features of the disease and its epidemiology in specific geographical regions trying to elucidate its use in the control of the disease in developing countries, especially in Brazil. Taking in consideration its efficacy, safety and immunogenicity, the inactivated hepatitis A vaccine may be of extreme value in terms of individual protection. Because this vaccine is so new, there are no formal recommendations for its use in developing countries, and appropriate public health use of hepatitis A vaccine requires up-to-date epidemiological information.

[An attempt to detect Trypanosoma cruzi in the peripheral blood of patients with Chagas' disease, in chronic phase, using quantitative buffy coat (QBC)]. / Tentativa de evidenciar o Trypanosoma cruzi no sangue periférico de pacientes com doença de Chagas, em fase crônica, por meio do Quantitative Buffy coat (QBC).

Taking for granted the sensitivity of the Quantitative Buffy Coat (QBC) system, as documented in a murine experimental model, we assayed to detect Trypanosoma cruzi in the peripheral blood of 100 patients with Chagas disease in its chronic phase. By means of the method, no positivity occurred, evently as a consequence of small parasitemias, undetectable by this technique as assessed by the cases in consideration.

[Hepatic puncture biopsy in the outpatient clinic]. / Biopsia hepática por puncão em ambulatório.

The authors present the results of a prospective study on percutaneous needle biopsy of the liver conducted at the Hepatology Outpatients' Ward of the Gastroenterology Unit of the University Hospital -" Universidade Federal de Juiz de Fora", MG, Brazil. In 16 months 61 biopsies were made in patients with chronic liver disease according to the technique described by menghini. The inclusion criteria were established by The Patient Care Committee of The American Gastroenterological Association. Abdominal ultrasound was done before and after the procedure. The patients stayed six hours under control (blood pressure and pulse rate) in the hospital. After 24 hours other clinical, laboratorial and ultrasonic control were performed. The main complication was local pain or in the right shoulder (32 patients--52.5%). Abdominal ultrasound after 24 hours revealed only one hematoma of the abdominal wall (1.8%). This study shows that the outpatient needle liver biopsy is a safe procedure with low complication rate when performed in a judicious way, by specialized personnel and under strict clinical control.

[Intestinal parasitosis and hepatic cirrhosis]. / Parasitoses intestinais e cirrose hepática.

The authors describe their experience, in a prospective survey, with the prevalence rates of intestinal parasites in patients with hepatic cirrhosis admitted to the Gastroenterology Unit of University Hospital of Federal University in Juiz de Fora, Brazil, whose fresh stools were examined by Hoffman-Pons-Janner, Baermann-Moraes and Willis methods. They compare the results of stool exams with two control groups and look for a relation with cirrhosis' etiology. A higher prevalence of some parasites was observed in cirrhosis than in people with other digestive diseases (group I). mainly for the Strongyloides stercoralis, found in 40.2%, chiefly in alcoholic cirrhosis. Oddly no one of the group I admitted in the same period had strongyloidiasis. Another group including all the people who had stool samples examined in the same period at the hospital had 1.91% of that helmintic infection (group II). A comparison is also made with the prevalence in schoolchildren between the ages of 7 and 14 studies eight years before (13.16%). Other parasites were also observed in different incidence between those with cirrhosis and the other groups and the results are presented. They conclude that hepatic cirrhosis must be included in the list of conditions which increases the risk of Strongyloides stercoralis infection.

PIP: In a prospective study conducted between July 1995 and June 1996 the prevalence of intestinal parasites is described in 35 (32 male, 3 female) patients with hepatic cirrhosis, aged 13-77 years, who had been admitted to the gastroenterology unit of the Federal University in Juiz de Fora, Brazil. The causes of cirrhosis were: alcohol (19 cases), hepatitis B virus (HBV) (3 cases), hepatitis C virus (HCV) (5 cases), HBV and HCV (2 cases), cryptogenetics (3 cases), Wilson's disease (1 case), biliary cirrhosis (1 case), and Gaucher's disease (1 case). Another 45 patients who were hospitalized during this period served as controls (Group I). Group II was comprised of 1411 persons who underwent parasitological tests during December 1995 and May 1996. Comparison was also made with 7371 tests performed in children aged 7-14 years who had been studied in 1988. Stools were examined by the Hoffman-Pons-Janner, Baermann-Moraes, and Willis methods. The results of stool exams were compared with those of the two control groups. A higher prevalence of some parasites was observed in cirrhosis patients than in patients with other digestive diseases (Group I). Of the 35 cirrhosis patients, 19 presented with positive parasite tests. Strongyloides stercoralis was found in 40.2%, chiefly in alcoholic cirrhosis patients, which was significant when compared to the other two control groups, but not significant when compared to the patients with nonalcoholic cirrhosis (4 cases of strongyloidiasis out of 16 patients). None of the 45 patients in Group I had strongyloidiasis. Group II (including all the people who had stool samples examined during the same period in the hospital) had a 1.91% rate of helminthic infection. A rate of 13.16% was found in the children's group.

[Epidemiology, clinical features and clinical course of Crohn's disease: a study of 60 cases]. / Epidemiologia, aspectos clínicos e evolutivos da doença de Crohn: um estudo de 60 casos.

The authors present their experience with the follow-up of 60 cases of Crohn's disease, from 1970 until 1998, in the city of Juiz de Fora, Minas Gerais state, a county of the Southeast region of Brazil, and analyse the epidemiology of disease to improve the understanding of its behaviour in the country. The incidence rates increased greatly in the last 28 years. In the group studied 53.3% were men, 90% white, 71.7% non-smokers, 93.3% non-alcoholics, and all, but two, lived in urban area; 58.3% had their symptoms started at the age between 11 and 30 years and 30% were in the second decade of life. Relatives with Crohn's disease were seen in 6.7%, and the most common symptoms observed at the beginning of disease were: abdominal pain (78.3%), diarrhea (68.3%), weight loss (26.7%) and small bowel obstruction or localized peritonitis (15%). The ileum was involved in 90% and five cases (8.3%) with lesions restricted to the colon were observed. Two patients died because they were non-responders despite any therapy schedule and had sepsis after surgery. The effect of several substances used in the treatment is described, being prednisone the most effective in controlling the active disease. Other drugs as aminosalicilates, metronidazol and immunomodulators are also considered to avoid the side-effects of long-term use of steroides. Comments are made about the clinical evolution, surgeries and response to many treatments adopted. The authors conclude that Crohn's disease is increasing its incidence rate in Brazil and probably in South America formerly considered as a region of low frequency.