Brazilian national bariatric registry - pilot study.

INTRODUCTION: Brazil is a world leader in bariatric surgery. However, the actual number of surgeries performed in the country is still unknown. It is necessary to implement an instrument to monitor the quality of care provided. This study evaluated the implementation of a Bariatric Surgery Data Registry in Brazil. METHODOLOGY: the registry was developed with Dendrite Clinical Systems Ltd., with data collected prospectively on an internet-based software. Seven centers were selected based on surgical volume and data entry commitment. The project covered three years after system implementation. RESULTS: 1,363 procedures performed by 17 surgeons were included. Most patients were female (67.2%), with average age of 39 years old and average baseline BMI of 41.5kg/m2. Diabetes mellitus was present in 34.5%, and hypertension in 40.1%. Roux-en-Y gastric bypass was performed in 79.3%, 95.5% by laparoscopy. There was one in-hospital death of cardiovascular cause. The average hospital stay was 2.03 days. The surgery-related complication rate was 0.97% in the first month, with three reoperations. Short-term follow-up was recorded in 75.6% and one-year follow-up in 21.64%. Total body weight loss was 10% in 30 days, rising to 33.3% after one year, with no difference between surgical techniques. CONCLUSIONS: the population profile was in accordance with the global registry of the International Federation for the Surgery of Obesity and Metabolic Disorders. The main difficulty encountered was low postoperative data entry. The experience acquired in this project will help advance data collection and knowledge of the safety and effectiveness of bariatric surgery in Brazil.

Brazilian national bariatric registry - pilot study / Registro nacional de dados em cirurgia bariátrica - estudo piloto

ABSTRACT Introduction: Brazil is a world leader in bariatric surgery. However, the actual number of surgeries performed in the country is still unknown. It is necessary to implement an instrument to monitor the quality of care provided. This study evaluated the implementation of a Bariatric Surgery Data Registry in Brazil. Methodology: the registry was developed with Dendrite Clinical Systems Ltd., with data collected prospectively on an internet-based software. Seven centers were selected based on surgical volume and data entry commitment. The project covered three years after system implementation. Results: 1,363 procedures performed by 17 surgeons were included. Most patients were female (67.2%), with average age of 39 years old and average baseline BMI of 41.5kg/m2. Diabetes mellitus was present in 34.5%, and hypertension in 40.1%. Roux-en-Y gastric bypass was performed in 79.3%, 95.5% by laparoscopy. There was one in-hospital death of cardiovascular cause. The average hospital stay was 2.03 days. The surgery-related complication rate was 0.97% in the first month, with three reoperations. Short-term follow-up was recorded in 75.6% and one-year follow-up in 21.64%. Total body weight loss was 10% in 30 days, rising to 33.3% after one year, with no difference between surgical techniques. Conclusions: the population profile was in accordance with the global registry of the International Federation for the Surgery of Obesity and Metabolic Disorders. The main difficulty encountered was low postoperative data entry. The experience acquired in this project will help advance data collection and knowledge of the safety and effectiveness of bariatric surgery in Brazil.

RESUMO Introdução: o Brasil é líder mundial em cirurgia bariátrica. No entanto, o número de cirurgias realizadas no país ainda é desconhecido. É necessário um instrumento para monitorar a qualidade da assistência prestada. Este estudo avaliou a implantação de um Registro de Dados de Cirurgia Bariátrica no Brasil. Metodologia: O registro foi desenvolvido com a Dendrite Clinical Systems Ltd., com dados coletados prospectivamente em software na internet. Sete centros foram selecionados, baseado no volume cirúrgico e compromisso de inserção de dados. O projeto abrangeu três anos após implementação. Resultados: foram incluídos 1.363 procedimentos realizados por 17 cirurgiões. A maioria dos pacientes eram mulheres (67,2%), com idade média de 39 anos e IMC basal médio de 41,5kg/m2. Diabetes mellitus estava presente em 34,5% e hipertensão em 40,1%. Bypass gástrico em Y de Roux foi realizado em 79,3%, 95,5% por laparoscopia. Houve um óbito hospitalar de causa cardiovascular. A média de permanência hospitalar foi de 2,03 dias. A taxa de complicações relacionadas à cirurgia foi 0,97% no primeiro mês, com três reoperações. Seguimento de curto prazo foi registrado em 75,6% e de um ano em 21,64%. A perda de peso corporal total foi de 10% em 30 dias, aumentando para 33,3% após um ano, sem diferença entre técnicas cirúrgicas. Conclusões: o perfil populacional está de acordo com o registro global da IFSO. A principal dificuldade encontrada foi a baixa inserção de dados pós-operatórios. A experiência adquirida neste projeto ajudará no conhecimento da segurança e eficácia da cirurgia bariátrica no Brasil.

Association between Helicobacter pylori, Epstein-Barr virus, human papillomavirus and gastric adenocarcinomas.

AIM: To correlate Helicobacter pylori (H. pylori), Epstein-Barr virus (EBV) and human papillomavirus (HPV) with gastric cancer (GC) cases in Pará State, Brazil. METHODS: Tissue samples were obtained from 302 gastric adenocarcinomas. A rapid urease test was used to detect the presence of H. pylori, and the presence of the cagA gene in the HP-positive samples was confirmed by PCR. An RNA in situ hybridization test designed to complement Eber1 RNA was used to detect the presence of EBV in the samples, and the L1 region of HPV was detected using nested PCR. Positive HPV samples were genotyped and analyzed for E6 and E7 viral gene expression. Infections were also correlated with the clinical and pathological characteristics of the patients. RESULTS: The majority of the 302 samples analyzed were obtained from men (65%) aged 55 years or older (67%) and were classified as the intestinal subtype (55%). All three pathogens were found in the samples analyzed in the present study (H. pylori: 87%, EBV: 20%, HPV: 3%). Overall, 78% of the H. pylori-positive (H. pylori +) samples were cagA+ (H. pylori-cagA +), and there was an association between the cytotoxic product of this gene and EBV. Coinfections of H. pylori-cagA + and EBV were correlated with the most advanced tumor stages. Although only 20% of the tumors were positive for EBV, infection with this virus was associated with distant metastasis. Only the HPV 16 and 18 strains were found in the samples, although no expression of the E6 and E7 oncoproteins was detected. The fundus of the stomach was the region least affected by the pathogens. CONCLUSION: HPV was not involved in gastric tumorigenesis. Prophylactic and therapeutic measures against H. pylori and EBV may prevent the development of GC, especially the more aggressive forms.

Molecular biology as a tool for the treatment of cancer.

Cancer is a genetic disease characterized by uncontrolled cell growth and metastasis. Cancer can have a number of causes, such the activation of oncogenes, the inactivation of tumor-suppressing genes, mutagenesis provoked by external factors, and epigenetic modifications. The development of diagnostic tools and treatments using a molecular biological approach permits the use of sensitive, low-cost, noninvasive tests for cancer patients. Biomarkers can be used to provide rapid, personalized oncology, in particular the molecular diagnosis of chronic myeloid leukemia, and gastric, colon, and breast cancers. Molecular tests based on DNA methylation can also be used to direct treatments or evaluate the toxic effects of chemotherapy. The adequate diagnosis, prognosis, and prediction of the response of cancer patients to treatment are essential to ensure the most effective therapy, reduce the damaging effects of treatment, and direct the therapy to specific targets, and in this context, molecular biology has become increasingly important in oncology. In this brief review, we will demonstrate the fundamental importance of molecular biology for the treatment of three types of cancer-chronic myeloid leukemia, hereditary diffuse gastric cancer, and astrocytomas (sporadic tumors of the central nervous system). In each of these three models, distinct biological mechanisms are involved in the transformation of the cells, but in all cases, molecular biology is fundamental to the development of personalized analyses for each patient and each type of neoplasia, and to guarantee the success of the treatment.

Frequency of the Loss of Heterozygosity of the NF2 Gene in Sporadic Spinal Schwannomas.

BACKGROUND/AIM: Individuals with type 2 Neurofibromatosis are predisposed for the appearance of schwannomas. In the present study we analyzed the loss of heterozygosity and mutations in the NF2 gene in patients with sporadic Schwannoma without Neurofibromatosis type 2. MATERIALS AND METHODS: We analyzed 39 patients with sporadic spinal schwannoma. We quantified the number of alleles by FISH and sequenced the NF2 gene. RESULTS: We identified 16/39 patients with point mutations and/or LOHs in the tumor samples analyzed. The LOHs were found in 7/39 patients. Two homozygous mutations were detected in 4/39 tumors, and the presence of the mutation in heterozygosis was revealed in 3/39 patients. In two tumors, we detected the loss of one allele of the NF2 gene, with no mutation. CONCLUSION: The genetic alterations observed in the NF2 gene indicated that spinal schwannomas are associated with genetic alterations also found in other schwannomas and type 2 Neurofibromatosis, which reinforces the etiological role of this gene.

INFLAMMATORY DISORDERS ASSOCIATED WITH HELICOBACTER PYLORI IN THE ROUX-EN-Y BYPASS GASTRIC POUCH.

Background: The prevalence of Helicobacter pylori in obese candidates for bariatric surgery and its role in the emergence of inflammatory lesions after surgery has not been well established. Aim: To identify the incidence of inflammatory lesions in the stomach after bariatric surgery and to correlate it with H. pylori infection. Methods: This is a prospective study with 216 patients undergoing Roux-en-Y gastric bypass. These patients underwent histopathological endoscopy to detect H. pylori prior to surgery. Positive cases were treated with antibiotics and a proton inhibitor pump followed by endoscopic follow-up in the 6th and 12th month after surgery. Results: Most patients were female (68.1%), with grade III obesity (92.4%). Preoperative endoscopy revealed gastritis in 96.8%, with H. pylori infection in 40.7% (88/216). A biopsy was carried out in 151 patients, revealing H. pylori in 60/151, related to signs of inflammation in 90% (54/60). In the 6th and 12th month after surgery, the endoscopy and the histopathological exam showed a normal gastric pouch in 84% of patients and the incidence of H. pylori was 11% and 16%, respectively. The presence of inflammation was related to H. pylori infection (p<0,001). Conclusion: H. pylori has a similar prevalence in both obese patients scheduled to undergo bariatric surgery and the general population. There is a low incidence of it in the 6th and 12th months after surgery, probably owing to its eradication when detected prior to surgery. When inflammatory disease is present in the new gastric reservoir it is directly related to H. pylori infection.

Racional: Helicobacter pylori é responsável por várias doenças gastrointestinais. Com o aumento de cirurgia bariátrica no país, há poucos estudos sobre a prevalência desta bactéria em obesos com indicação cirúrgica e o seu papel no surgimento de lesões inflamatórias no pós-operatório. Objetivo: Identificar a incidência de lesões inflamatórias no estômago pós-cirurgia bariátrica e correlacionar com a infecção por H. pylori. Métodos: Estudo prospectivo com dois grupos de pacientes. Em ambos os grupos verificou-se a prevalência do H. pylori no pré-operatório através de histopatologia, mas em apenas um dos grupos, nos casos de H. pylori positivo realizou-se o tratamento com antibioticoterapia e inibidor de bomba de próton com realização de nova endoscopia no 6° e 12° mês pós-operatório. Resultados: Avaliou-se 216 pacientes, com as seguintes características: sexo feminino (68,1%), faixa etária entre 30-40 anos, com 31,9% e 31%, respectivamente. De acordo com o IMC, 17,6% apresentavam obesidade moderada, 82,4% obesidade severa/mórbida e 9,7% superobesidade. Nos pacientes submetidos à endoscopia, a positividade do H. pylori se manifestou em 40,7%, sendo responsável pela atividade inflamatória na mucosa gástrica (p<0,001). No pós-operatório, investigou-se a mucosa gástrica através de endoscopia e histopatologia no 6° e 12° mês, que demonstrou normalidade no neorreservatorio gástrico em 84% dos pacientes, e a incidência de H. pylori foi 11% aos seis meses e 16% aos 12 meses, sendo a presença de processo inflamatório relacionado com a infecção pela bactéria (p<0,001). Conclusão: H. pylori apresenta prevalência similar tanto em obesos que irão submeter-se à cirurgia bariátrica quanto à população em geral; há baixa incidência dele no 6° e 12° mês após a operação e isto deve-se provavelmente à sua erradicação quando detectado no pré-operatório; quando presente a doença inflamatória no neorreservatório gástrico possui relação direta com a infecção por H. pylori.

Water mutagenic potential assessment on a semiarid aquatic ecosystem under influence of heavy metals and natural radioactivity using micronuclei test.

The contamination of water bodies by heavy metals and ionizing radiation is a critical environmental issue, which can affect water quality and, thus, human health. This study aimed to evaluate the water quality of the Boqueirão de Parelhas Dam in the Brazilian semiarid region. A 1-year study (2013-2014) was performed through the assessment of physicochemical parameters, heavy metal content, and radioactivity along with the mutagenicity potential of water using micronuclei test in Orechromis niloticus (in vivo) and the cytokinesis-block micronucleus (CBMN) assay in human lymphocytes (in vitro). A deterioration of water organoleptics characteristics by the presence of high levels of sulfate and total solids was observed. High concentrations of aluminum, nickel, silver, and lead along with the alpha particle content were higher than the limits suggested by the World Health Organization and Brazilian legislation for drinking water. An increase in the frequency of micronuclei and nuclear abnormalities was observed in both experimental models. The results obtained confirmed the mutagenic potential present in water samples. This study highlights that geogenic agents affect water quality becoming a human health concern to be taken into account due to the relevance that this water reservoir has in the region.

INFLAMMATORY DISORDERS ASSOCIATED WITH HELICOBACTER PYLORI IN THE ROUX-EN-Y BYPASS GASTRIC POUCH / ALTERAÇÕES INFLAMATÓRIAS ASSOCIADAS AO HELICOBACTER PYLORI NA BOLSA GÁSTRICA DE BYPASS EM Y-DE-ROUX

ABSTRACT Background: The prevalence of Helicobacter pylori in obese candidates for bariatric surgery and its role in the emergence of inflammatory lesions after surgery has not been well established. Aim: To identify the incidence of inflammatory lesions in the stomach after bariatric surgery and to correlate it with H. pylori infection. Methods: This is a prospective study with 216 patients undergoing Roux-en-Y gastric bypass. These patients underwent histopathological endoscopy to detect H. pylori prior to surgery. Positive cases were treated with antibiotics and a proton inhibitor pump followed by endoscopic follow-up in the 6th and 12th month after surgery. Results: Most patients were female (68.1%), with grade III obesity (92.4%). Preoperative endoscopy revealed gastritis in 96.8%, with H. pylori infection in 40.7% (88/216). A biopsy was carried out in 151 patients, revealing H. pylori in 60/151, related to signs of inflammation in 90% (54/60). In the 6th and 12th month after surgery, the endoscopy and the histopathological exam showed a normal gastric pouch in 84% of patients and the incidence of H. pylori was 11% and 16%, respectively. The presence of inflammation was related to H. pylori infection (p<0,001). Conclusion: H. pylori has a similar prevalence in both obese patients scheduled to undergo bariatric surgery and the general population. There is a low incidence of it in the 6th and 12th months after surgery, probably owing to its eradication when detected prior to surgery. When inflammatory disease is present in the new gastric reservoir it is directly related to H. pylori infection.

RESUMO Racional: Helicobacter pylori é responsável por várias doenças gastrointestinais. Com o aumento de cirurgia bariátrica no país, há poucos estudos sobre a prevalência desta bactéria em obesos com indicação cirúrgica e o seu papel no surgimento de lesões inflamatórias no pós-operatório. Objetivo - Identificar a incidência de lesões inflamatórias no estômago pós-cirurgia bariátrica e correlacionar com a infecção por H. pylori. Métodos - Estudo prospectivo com dois grupos de pacientes. Em ambos os grupos verificou-se a prevalência do H. pylori no pré-operatório através de histopatologia, mas em apenas um dos grupos, nos casos de H. pylori positivo realizou-se o tratamento com antibioticoterapia e inibidor de bomba de próton com realização de nova endoscopia no 6° e 12° mês pós-operatório. Resultados: Avaliou-se 216 pacientes, com as seguintes características: sexo feminino (68,1%), faixa etária entre 30-40 anos, com 31,9% e 31%, respectivamente. De acordo com o IMC, 17,6% apresentavam obesidade moderada, 82,4% obesidade severa/mórbida e 9,7% superobesidade. Nos pacientes submetidos à endoscopia, a positividade do H. pylori se manifestou em 40,7%, sendo responsável pela atividade inflamatória na mucosa gástrica (p<0,001). No pós-operatório, investigou-se a mucosa gástrica através de endoscopia e histopatologia no 6° e 12° mês, que demonstrou normalidade no neorreservatorio gástrico em 84% dos pacientes, e a incidência de H. pylori foi 11% aos seis meses e 16% aos 12 meses, sendo a presença de processo inflamatório relacionado com a infecção pela bactéria (p<0,001). Conclusão - H. pylori apresenta prevalência similar tanto em obesos que irão submeter-se à cirurgia bariátrica quanto à população em geral; há baixa incidência dele no 6° e 12° mês após a operação e isto deve-se provavelmente à sua erradicação quando detectado no pré-operatório; quando presente a doença inflamatória no neorreservatório gástrico possui relação direta com a infecção por H. pylori.

Qualidade de vida de pacientes submetidos à cirurgia bariátrica, por meio da aplicação do questionário Baros / Quality of life of pacients submitted to bariatric surgery, by the application of baroquestionary

Objetivo: avaliar a qualidade de vida de pacientes submetidos à cirurgia bariátrica, no Hospital Ophir Loyola, emBelém do Pará. Método: estudo transversal, com 22 pacientes, submetidos à cirurgia bariátrica pela técnica do bypassgástrico, no período de outubro de 2002 a outubro de 2003. Para a realização da pesquisa, foi utilizado o questionárioBAROS que analisa três parâmetros: a perda do excesso de peso, a melhora da comorbidez e a melhora da qualidadede vida. Resultados: 82% sexo feminino; 100% com obesidade grau III no pré-operatório; 40,9% de obesidade grau Ino pós-operatório; 34% com osteoartrite, seguida de 18% de hipertensão no pré-operatório; 68,2% com todas as coafecçõesmaiores resolvidas e as outras melhoradas; 90,9% com auto-estima, 59,1% com disposição para atividadesfísicas; 81,8% com relacionamento social; 72,7% com disposição para o trabalho e 63,6% com interesse em sexo;todos estes aspectos muito melhorados e 59% obtiveram resultado excelente da cirurgia Conclusão: verificou-se entreos pacientes submetidos à cirurgia bariátrica: a prevalência do sexo feminino; a obesidade grau III no pré-operatório egrau I no pós-operatório; a osteoartrite, seguida de hipertensão como comorbidades mais freqüentes no pré-operatórioe todas as co-afecções maiores resolvidas e as outras melhoradas. Em relação à qualidade de vida, a auto-estima, adisposição para atividades físicas, o relacionamento social, a disposição para o trabalho e o interesse em sexo forammuito melhoradas, apontando que o resultado da cirurgia foi excelente

Objective: to evaluate the quality of life of pacients submitted to bariatric surgery, in Hospital Ophir Loyola, inBelém of Pará. Method: transversal study, with 22 patients, undergoing to the bariatric surgery by the technique ofthe gastric bypass, in the period of October of 2002 until October of 2003. For the accomplishment of the research,BAROS questionary was used to analyzes three parameters: the loss of the weight excess, the improvement of thecomorbidity and the improvement of the quality of life. Results: 82% were feminine sex; 100% with obesitydegree III in the preoperative; 40,9% of obesity degree I in the postoperative; 34% with osteoarthritis, followed by18% of hypertension in the preoperative; 68,2% with all comorbidities biggest resolved and the others improved;90,9% with self-esteem, 59,1% with disposition for physical activities, 81,8% with social relationship, 72,7% withdisposition for work and 63,6% with interest in sex, all these aspects very improved and; 59% had gotten excelentresults of the surgery. Conclusion: it was verified among the patients submitted to the bariatric surgery: theprevalence of the feminine sex; the obesity degree III in the preoperative and degree I in the postoperative; theosteoarthritis, followed by hypertension as more frequent comorbidities in the preoperative and; all the biggestcomorbidities resolved and the others improved. About the quality of life, the self-esteem, the disposition for thephysical activities, the social relationship, the disposition for the work and the interest in sex were very improved,pointing that the result of the surgery was excellent.

A cluster of polyneuropathy and Wernicke-Korsakoff syndrome in a bariatric unit.

BACKGROUND: Wernicke-Korsakoff syndrome and peripheral neuropathy are very uncommon in bariatric surgical practice. The literature indicates that these complications tend to strike patients receiving unbalanced diets or undergoing rapid weight-loss. METHODS: In a retrospective analysis of the initial experience of a bariatric team in the city of Belem, Pará, in northern Brazil, 5 cases were diagnosed in the first year, 4 of them following gastric bypass and the last one after therapy with an intragastric balloon. RESULTS: All episodes followed periods of severe vomiting, which certainly interfered with intake of food as well as of routine vitamin supplements, resulting in severe polyneuropathy and other neurologic manifestions, mostly damaging motility of lower limbs. Therapy consisted of pharmacologic doses of vitamin B1 along with restoration of adequate diet and multivitamin prescriptions. Physical therapy was employed to prevent atrophy and accelerate normalization of muscle strength. All patients responded to this program after variable intervals without significant sequelae. CONCLUSIONS: Thiamine-related neurologic derangements were a cause for much concern and prolonged morbidity in this series, but responded to vitamin B1 replenishment. A high degree of clinical suspicion in bariatric patients and urgent therapeutic intervention whenever postoperative vomiting persists for several days, especially during the first 2-3 months after operation, are the safest approach to these uncommon episodes. It is speculated whether peculiarities in the regional diet of this area in Brazil could have influenced the high incidence of the neurologic aberrations.

Complicaçäo pouco relatada em obesos mórbidos: polineuropatia relacionada à hipovitaminose B1 / A rarely reported complication in morbid obesity - vitamin B1 - related polyneuropathy

Deficiências agudas de vitamina B1 vinculam-se a quadros neurológicos e graves como síndrome de Wernicke-Korsakoff e neuropatias periféricas. A imensa maioria é observada na esfera de alcoólatras crônicos com dieta pobre e mal balanceada, porém há um pequeno contingente visto em pacientes com emagrecimento acelerado por tratamento anti-obesidade, greve de fome, hiperemese gravídica, e nutriçäo parenteral sem reposiçäo vitamínica. Neste estudo, é apresentada uma série de pacientes bariátricos que desenvolveral grave neuropatia em conexäo com vômitos e intolerância ao procedimento após a alta hospitalar. Todos os casos tivaram reposiçäo de tiamina observando-se respostas geralmente favoráveis. Discute-se a provável etiopatogenia desta complicaçäo.(au)

Avaliaçäo da eficácia da ceftriaxona e cefalotina na profilaxia da infecçäo em cirurgia digestiva / Evaluation of ceftriaxone and cephalothin: Efficacy in prophylaxis of infection in digestive surgery

Em um estudo prospectivo, randomizado, os autores procuram avaliar, comparativamente, a eficácia de duas Cefalosporinas, a Cefalotina e a Ceftriaxona, na profilaxia da infecçäo pós-operatória em 100 indivíduos que deveriam ser submetidos à cirurgia digestiva, exceto colo retal, nos quais haviam sido identificados fatores de risco. Segundo distribuiçäo aleatória, foram os pacientes randomizados em dois grupos, homogêneos segundo sexo e idades, denominados grupo da Cefalotina, constituído de 44 pessoas que tomaram a droga 1 hora antes da cirurgia, na dose de 1g, via endovenosa, repetida 4 e 8 horas após, e o grupo da Ceftriaxona, representado por 56 pacientes, tratados com dose única de 1 g endovenosa, aplicada também 1 hora antes do início da intervençäo. Como critério de avaliaçäo, terminada a cirurgia, todos os indivíduos foram atentamente observados durante a permanência no hospital e dez dias em seguida à alta, no sentido de detectar qualquer sinal de infecçäo, quer na ferida operatória, quer em áreas distantes. A ausência de sepse foi considerada resposta eficaz à antibioticoprofilaxia. Como objetivo do estudo, investigou-se ainda a tolerância dos enfermos às drogas usadas, registando-se reaçöes adversas imediatas e/ou tardias, aparecidas ou referidas. Quanto aos resultados, do total de 100 doentes que profilaticamente receberam antibióticos, 89 evoluíram sem infecçäo no pós operatório. Em relaçäo ao comportamento de cada droga, no grupo da Cefalotina a infecçäo ocorreu em 7 casos (15,2%), enquanto que no grupo da Ceftriaxona registraram-se 4 casos de infeccäo (9,3%). A infecçäo de ferida operatória foi a complicaçäo mais freqüente, diagnósticada em 7 pacientes (63,6%), sendo 5 do grupo da Cefalotina e 2 do grupo da Ceftriaxona, seguindo-se, em ordem de aparecimento, a infecçäo urinária em 2 casos e o abscesso subfrênico em 2 casos...

O misoprostol no tratamento da úlcera duodenal / Misoprostol in the treatment of duodenal ulcer

Realiza-se um estudo aberto, objetivando avaliar os efeitos terapêuticos do Misoprostol, um derivado metilado da PGE1, na cicatrizaçäo da úlcera duodenal. Assim, foram tratados 20 indivíduos, 19 do sexo masculino e um do feminino, portadores de úlcera duodenal ativa, diagnosticada pela endoscopia. Cada paciente recebeu o Misoprostol em comprimidos, na posologia de 400 mcg duas vezes ao dia, por um período de quatro semanas. Concluído o ensaio, foi registrado um índice de cicatrizaçäo de 100%, baseado na cicatrizaçäo total da(s) úlcera(s) comprovada pela endoscopia. Os controles clínicos efetuados nos 14ª e 28ª dias de tratamento demonstraram remissäo dos sintomas, notadamente da dor, em 80% e 100% dos casos respectivamente. As reaçöes adversas representadas basicamente por aumento do número de evacuaçöes ou diarréia em 13 pacientes (65%) em nenhum momento teve significado clínico e nem mesmo obrigou à interrupçäo da medicaçäo. Conclue-se que, com base nos resultados, que o Misoprostol, na dose de 400 mcg duas vezes ao dia, durante (quatro) semanas, é uma droga segura e plenamente eficaz para a cicatrizaçäo da úlcera duodenal

Abscesso amebiano do fígado: abordagem diagnóstica e terapêutica

O autor analisa 90 casos de abscesso amebiano do fígado, no Hospital dos Servidores do Estado do Pará, no período de 1961 a 1986. O sexo masculino foi mais freqüente na proporção de 4 : 1 sobre o feminino, a faixa etária de maior incidência foi entre 30 a 60 anos e todos os pacientes eram procedentes da Amazônia, 88 viviam no Pará. O diagnóstico por ocasião da internação foi realizado em 17% dos casos. Dor no quadrante superior D. acompanhada de febre ocorreu em 82% e hepatomegalia em 59%. A icterícia apresentou-se em 23% dos casos e é demonstrativa da gravidade dos pacientes. A leucometria foi normal em 45% dos casos e em 23% situou-se entre 11 - 15.000 e em 20% dos pacientes entre 16-20.000. As provas funcionais hepáticas foram pouco elevadas. A radiologia mostrou a hemicúpula D. elevada em 52% e caracterizou a hepatomegalia em 42%, outros achados são descritos. A tomografia foi usada em 6 pacientes sendo 100% eficaz. A ultra-sonografia, dentro do hospital, possibilitou o diagnóstico mais rápido e preciso, sendo realizada em 45 pacientes e em todos demonstrou com exatidão a lesão hepática. Somente nos últimos nove pacientes a sorologia foi realizada pelas técnicas de imunofluorescência indireta e gel difusão sendo positiva para confirmar o diagnóstico em 78%. O tratamento nos últimos anos evoluiu com o uso dos derivados nitroimidazólicos (metronidazol e tinidazol) e a drenagem per-cutânea. Realizamos o tratamento clínico isolado em 44 pacientes (49%) com eficácia em 33 casos (75%). A cirurgia foi efetuada em 42 casos (47%) com bons resultados em 32 pacientes (76%). A drenagem per-cutânea sob orientação da US foi feita em 15 casos (17%) com cura em todas elas. Óbito ocorreu em 11 pacientes (12%), sendo destes 10 em conseqüência da ruptura com peritonite

Ninety cases of amebic liver abscesses were studied at the Hospital dos Servidores do Estado, through the period of 1961 until 1986. Males were prevalent over females at a rate of 4 : 1 and the highest incidence was between the ages of 30 and 60 years. Ali cases were original from the Amazonia and 88 were living in the state of Pará. The diagnosis was determined at admission in 17% of all cases. Pain over the right upper quadrant with fever ocurred in 82% and hepatomegaly in 59%. Jaundice was present in 23% of all cases and was paralel to the severeness of the disease. The total white cell count was normal in 45%, where as 23% was between 11 - 15.000 and 20% was found between 16 - 20.000. The liver function tests were slightly altered. The X-Ray has demonstrated elevation of the right diaphagmatic leaf in 52% and suggested hepatomegaly in 42% besides other finding wich were repported.CAT scan, was 100% efective in the 6 patients that were studied. Ultrasonography in the Hospital proved to be the most fast and precise method, with correct demonstration of the liver abscess in all 45 patients who were submitted to this procedure. Serology using the indirect immunofluorescence and gel diffusion technics was able to confirm the diagnosis in 78% of the nine patients submitted this test The treatment, in the last years, has been evaluating with the use of imidazoles derivates (metronidazole and tinidazole) and the percutaneons drainage. Exclusive clinical treatment was performed in 44 patients (49%) with favorable results in 33 cases (75%). Surgery was carried out in 42 cases (47%) with good results in 32 patients (76%). Percutaneous drainage under ultrasonographic control was conducted in 15 cases (17%) achieving complete healing in all cases. Death occurred in 11 patients (12%). among them 10 patients died following rupture with peritonitis