Arm vein as an alternative autogenous conduit for infragenicular bypass in the treatment of critical limb ischaemia: a 15 year experience.

OBJECTIVES: The value of alternative autogenous venous conduits for treating critical limb ischaemia (CLI) with infragenicular bypass surgery is well established. In this study, the results of using arm veins as alternative conduits for treating CLI over a 15-year period have been evaluated. METHODS: This was a retrospective study. Between 1991 and 2005. 120 infragenicular bypasses using arm vein conduits (AVCs) were performed in 120 patients. CLI was the main indication (87.5%) for the procedures. The indications for using arm veins were inadequacy or absence of the ipsilateral greater saphenous vein (GSV). Survival, limb salvage, and patency rates were calculated using the Kaplan-Meier method. RESULTS: There was a predominance of male gender (65%), and the group mean age was 68.1 ± 8.3 years. The mean follow-up period was 29.6 ± 26.3 months. The operative mortality (30 days) rate was 7.5%. The main alternative conduit was non-spliced cephalic vein (37.5%). Composite grafts included GSV + AVC (45.2%), AVC + AVC (43.3%) and small saphenous vein + AVC (11.5%). The 5-year primary and secondary patency (SP) rates were 45.2 ± 5.6% and 56.5 ± 5.0%, respectively. The 5-year SP rate was greatest when using non-spliced cephalic vein (65.8 ± 7.6%), but there was no difference in cumulative patency between spliced and non-spliced veins (49.5 ± 8.0% vs. 61.2 ± 6.4%; p = 0.501). The 5-year limb salvage and survival rates were 70.6 ± 5.9% and 59.6 ± 5.8%, respectively. CONCLUSIONS: The favourable long term results of secondary patency and limb salvage rates encourage the use of arm veins as alternative conduits for infragenicular bypass surgery.

Inframalleolar bypass grafts for limb salvage.

OBJECTIVE: To report our experience of long-term results of inframalleolar bypass. DESIGN: Retrospective analysis. MATERIALS AND METHODS: We analysed 122 inframalleolar bypasses performed between January 1991 and June 2005 in 116 patients. Most patients were treated for critical ischaemia (97%). The indication for the use of podalic arteries was a lack of tibial arteries with run-off to the foot. The dorsalis pedis was predominantly used for distal anastomoses (62.3%) and the greater saphenous vein (84.4%) as the conduit. The follow-up periods ranged from 1 to 60 months. The endpoints analysed were graft patency, limb salvage, preservation of deambulation and survival rate. RESULTS: The cumulative patency was 58.2% at 3 years and 53.4% at 5 years. The best results were achieved with the devalvulated greater saphenous veins. Limb salvage was 70.0% at 3 years and 50.4% at 5 years, with preserved deambulation rates of 57.3% and 47.1%, respectively. There were 36 major and 45 minor amputations. At 3 years, the survival rate was 50.2% and the surgical mortality 13%. Female sex was associated with worse results for cumulative patency and limb salvage (P<0.01). CONCLUSIONS: In the long term, inframalleolar bypass is a satisfactory option for limb salvage.

Giardia duodenalis: kinetics of cyst elimination and the systemic humoral and intestinal secretory immune responses in gerbils (Meriones unguiculatus) experimentally infected.

This study aimed to determine the pre-patent period and to evaluate the kinetics of cyst elimination and the systemic humoral (IgA, IgG(1), IgG(2a), IgM, IgE) and intestinal secretory (IgA) immune responses in gerbils (Meriones unguiculatus) experimentally innoculated with different doses of Giardia duodenalis trophozoites. Forty-eight animals aged 6-8 weeks were used, equally distributed among six groups, five groups innoculated with different doses of trophozoites (10(1), 10(2), 10(3), 10(4), 10(5)) and one control (non-infected) group. Coproparasitological examinations were carried out daily up to 91 days after inoculation (d.a.i.) to determine the pre-patent period and the kinetics of cyst elimination. Blood and stool samples were weekly collected for antibody assays. The pre-patent period was observed from the 9 d.a.i. onwards, with intermittent elimination of variable quantities of cysts up to 27 d.a.i.. All infected gerbils, irrespective of the dose received, were able to mount systemic humoral immune responses as evidenced by specific IgM titers from 7 to 28 d.a.i., corresponding to the peak of cyst elimination, followed by high and persistent IgG1 titers. Intestinal secretory responses were also seen with two peaks of fecal IgA titers, corresponding to IgM and IgG1 response peaks, respectively. In conclusion, systemic and intestinal humoral immune responses were related to the control of giardiasis in this experimental model.

An alternative method for DNA extraction and PCR identification of Entamoeba histolytica and E. dispar in fecal samples.

Since it is known that Entamoeba dispar is non-pathogenic and morphologically similar to E. histolytica, there are many targets used in PCR for differentiating these species. However, obtaining high quality DNA from fecal samples is fundamental for PCR. Most methods are laborious or use kits that make diagnosis expensive. In the present work, a new simple, fast and cheap technique of DNA extraction from fecal samples was combined with a PCR for an episomal target in order to identify E. histolytica and E. dispar in feces.

Inflammatory bowel diseases: time of diagnosis, environmental factors, clinical course, and management - a follow-up study in a private inflammatory bowel disease center (2003-2017).

BACKGROUND: The governmental program of Brazilian Unified National Health System has already published studies on the incidence of inflammatory bowel diseases (IBD), but up until now, there have been no epidemiological studies in private centers in Brazil. However, these diseases tend to affect people from a higher socioeconomic class, mainly in the capital of MS state that has the third highest GDP in Brazil. OBJECTIVES: The aim was to analyze an observational, descriptive study of an IBD database in a private center including: the side, behavior of the disease and medical management, the association of extra-intestinal manifestations, and the main clinical symptoms which led to the investigation and diagnosis of IBD. PATIENTS AND METHODS: A cohort study was developed in which data of all patients with IBD were analyzed with SPSS software in a constructed electronic database. RESULTS: Of 329 patients, 212 (64.4%) had Crohn's disease (CD) and 117 (35.6%) had ulcerative colitis (UC). Average age at diagnosis of CD was 36.19 (±14.33) and of UC was 41.61 (±15.37). An amount of 50.05% of the patients with CD and 72.7% (P<0.001) with UC were female. We have observed that concerning the first symptoms, diahrrea and blood feces corresponded to 70% in UC while in CD 50% of the patients presented diahrrea with blood feces, loss of weight corresponded to 50% and only diahrrea 25%. (P<0.001). Anti-TNFs corresponded to 56.2% being more frequent in CD 0.001%. CD patients used biologic therapy and antibiotics more frequently than those with UC. In conclusion, IBD is also frequent in private health care centers in Brazil; women are most affected. Symptoms such as diarrhea and bleeding, as well as diarrhea and weight loss, must be taken as warning signs to investigate for inflammatory disease. The use of biologic therapies is frequent in referral centers when patients have severe disease.

Infection of dogs by experimental inoculation with human isolates of Giardia duodenalis: clinical and laboratory manifestations.

The susceptibility of dogs to experimental inoculation with trophozoites and cysts of human isolates of Giardia duodenalis and the clinical and laboratory profiles of infection of these animals were studied. Two groups (A and B), each comprising three dogs, were inoculated with G. duodenalis trophozoites and cysts, respectively. A third group of two dogs was not inoculated and remained as control. After inoculation feces were collected daily to determine the pre-patent period, by flotation in 33% zinc sulfate solution. Blood samples (5mL) were collected from animals at 15-day intervals during the 165 days of the experimental period and were used to carry out the hemogram and biochemical evaluation of the levels of total protein, albumin, alanine aminotransferase, gamma glutamyltransferase, urea and creatinine. A prepatent period was observed at 5-6 days post-inoculation (p.i.) in the inoculated dogs, with cysts eliminated for approximately 3 months. No alterations were seen in the clinical parameters evaluated. Anemia was observed at 15 p.i. in the inoculated dogs. The mean eosinophil count of inoculated groups was higher than that of the control (p< or =0.05) but none of the biochemical parameters analyzed presented significant differences. The results of this study show that G. duodenalis from human isolates is able to infect dogs with minimal systemic manifestations without producing clinical signs of giardiasis.

Prevalence of Giardia duodenalis and Cryptosporidium spp. in dogs from different living conditions in Uberlândia, Brazil.

Infection rates with Giardia duodenalis and Cryptosporidium spp. were compared among dogs living under different conditions. Stool samples (n = 433) collected from dogs of different ages, gender, living conditions and origin were analyzed using three techniques, i.e., centrifugal flotation in zinc sulfate solution, centrifugal flotation in sucrose solution, and methylene blue gram safranin staining. Eighty-nine of the samples were from stay dogs living in shelters run by animal protection societies, 199 were from kennels and 122 from households. A total of 119 (29.0%) had G. duodenalis cysts and six (1.4%) were positive for Cryptosporidium spp. oocysts. Dogs from kennels were most frequently affected by G. duodenalis (49.7%) while those from shelters showed a higher prevalence of Cryptosporidium spp. (2.2%). A significant difference (p < or = 0.05) was observed between immature dogs and adults only with respect to Giardia infection. There was no significant difference between the gender with regard to the presence of either protozoan.

Biochemical serum profiles in dogs experimentally infected with Angiostrongylus vasorum (Baillet, 1866).

The biochemical profiles of crossbred dogs experimentally infected with the parasite Angiostrongylus vasorum were studied. Two groups of five dogs were experimentally inoculated with 50 and 100 third stage infective larvae (L3) of A. vasorum per kilogram of body weight. A third group of five uninfected animals were used as control. Serum from these animals were used for biochemical tests to measure total and fractioned proteins, urea, creatinine and to determine the activities of aspartate (AST), alanine (ALT) aminotransferase, gamma-glutamyl transferase (GGT), alkaline phosphatase (PAL) and creatine kinase isoenzyme MB (CK-MB). The alpha-1, alpha-2 and beta-globulins fractions showed alterations during acute phase of the infection. No modifications were observed in the biochemical profiles of ALT, AST, GGT, PAL, urea and creatinine. CK-MB was shown to be a good early indicator of cardiac injury in dogs experimentally infected with A. vasorum.

Vesical endometriosis.

A case is presented of vesical endometriosis treated surgically in a thirty-one-year-old woman who presented with hypogastric pain and a pelvic mass. Echography showed an intravesical tumor, and cystoscopy led to a presumptive diagnosis of bladder endometriosis. The clinical features, diagnosis, and management are discussed, based on a review of the literature.

Tetrodotoxin-sensitive sodium channels in a continuously cultured cell line derived from the adult rat cerebellum.

A method to establish continuously cultured cell lines from adult cerebellar cortex is reported. Clones (prepared by this procedure) were isolated from cerebellar established cultures at the 25th passage and after 15 months in vitro. One clone (UCHCC1) was maintained in culture and studied while the others were frozen. The cerebellar cell line UCHCC1 retained a neuronal-like morphology; the addition of dimethylsulfoxide (DMSO) to the culture medium elicited a reproducible morphological 'differentiation' event, characterized mainly by process extension. In 'differentiated' cells, veratridine significantly increased the uptake of 22Na. Such enhanced uptake was blocked by tetrodotoxin (TTX) with a half-maximal inhibitory concentration of 0.9 nM. Binding of an [3H]ethylenediamine derivative of TTX ([3H]en-TTX) to the microsomal fraction prepared from same DMSO-treated cells, showed a single class of receptors with a maximal binding (Bmax) of 173 fmol/mg protein and a Kd of 1.1 nM. Thyroid UCHT1 cells and 'undifferentiated' (cultured without DMSO) cerebellar cells, did not show significant effects of veratridine on 22Na-uptake, or [3H]en-TTX binding. The 'differentiated' nerve-like properties, induced by appropriate environmental manipulation, demonstrate the usefulness of cerebellar UCHCC1 cells as a model system for the developing central neuron. On the other hand, the novel transforming procedure opens new possibilities for obtaining permanent cell lines from other regions of the adult CNS.

Rupture of femoral artery in a dog infected with Angiostrongylus vasorum.

A crossbred bitch, infected with Angiostrongylus vasorum, died on the 46th day post infection. Post mortem findings showed that the rupture of the femoral artery was the cause of death. A. vasorum was present in the femoral artery.

Western blot analysis of the humoral response of dogs experimentally infected with Angiostrongylus vasorum (Baillet, 1866).

Seven cross-bred dogs were inoculated with Angiostrongylus vasorum and serum samples were analyzed using the enzyme-linked immunosorbent assay (ELISA) and Western blot (WB). ELISA detected specific antibodies anti-A. vasorum, from 14 to 28 days after inoculation (DAI) and persisted throughout the experiment. Using WB, the main antigens detected had molecular weight of approximately 115, 102, 86, 76, 69, 56, 41, 32, 28, 20-22 and 10kDa.

Prevalence of anti-Neospora caninum antibodies in dogs from urban, periurban and rural areas of the city of Uberlândia, Minas Gerais--Brazil.

In Brazil there are few reports on the prevalence of anti-Neospora caninum antibodies in dogs from urban, periurban and rural areas. Serum samples from 450 dogs, 300 from urban, 58 from periurban and 92 from rural areas, were tested for the detection of anti-N. caninum IgG antibodies using IFAT: indirect fluorescent antibody test (IFAT, > or =50). Antibodies were observed in 63 (14%) of the 450 serum samples analyzed, with 32 (10.7%) in dogs coming from the urban area, 11 (18.9%) from the periurban area and 20 (21.7%) from the rural area. Statistical differences were seen between the occurrences in animals from the urban area and those of the rural area (P = 0.01). The antibody titers found were: 1:50 in 20 dogs, 1:100-1:800 in 41 dogs, and 1:3200 in two dogs. In the female dogs, a smaller prevalence of dogs with antibodies was observed in those from the urban area (7.5%) in comparison with those of the rural (21.0%) (P = 0.05) and periurban (23.3%) (P = 0.01) areas. There were growing levels of antibody prevalence with the increase in age of the dogs in all three areas studied. Although this increase was not significant, it indicates a tendency towards more infections with age, suggesting post-natal exposure to N. caninum. However, a significant difference (P = 0.05) was observed in the occurrence of anti-N. caninum antibodies in dogs with ages = 2 years in urban (13.1% urban) versus rural environments (27.1% rural). Among the other age brackets studied the difference was not significant. The results confirm the presence of N. caninum in the region and reveal the important role of dogs in the parasite's epidemiology.

[Multiple primary neoplasms in colorectal cancer patients] . / Neoplasias primárias múltiplas em pacientes com câncer colorretal.

INTRODUCTION: Multiple primary neoplasms are defined as a second malignance having histology and site different from the first. The increase of the life expectation in cancer patients leads to an increase in multiple primary neoplasms incidence. This study analyzes the characteristics of patients with colorectal cancer and another primary neoplasms. PATIENTS AND METHODS: In the period from 1993 to 1998, 145 patients with colorectal cancer were accompanied in the Oncology Division of Gastroenterology of Federal University of São Paulo, São Paulo, SP, Brazil. Five patients (3.4%) had multiple primary neoplasms. The possibility of metastasis were excluded and the second cancer was confirmed by hystological examination. RESULTS: The medium age was of 60.6 years old, four were female and one male. Three had rectum cancer and two colon cancer, one in the right colon and one in the left colon. The other site of cancer was breast, uterus, uterus and vagina, skin and lip. One patient died and the others were in attendance, two for more than three years. Two patients received pelvic radiotherapy before the rectal cancer. In one patient the tumor colorectal cancer appeared before the other cancer, and in four it appeared later on to the diagnosis of the other primary neoplasia. DISCUSSION: The prevalence of multiple primary neoplasms was of 3.4%, being major in female. Uterus' cancer was the more frequent association. Radiotherapy was performed in 40% of patients. We believe that attendance of cancer patients is very important to precocious diagnosis and treatment of multiple primary neoplasms.

[Colonoscopy or sigmoidoscopy: risk of isolated right colon lesions]. / Colonoscopia ou sigmoidoscopia: risco de lesões isoladas no cólon direito.

BACKGROUND: Colorectal cancer is an important cause of death in western countries. Screening methods are based on flexible sigmoidoscopy, a cheap, effective, and less painful procedure, but some important lesions on the right colon can be missed. AIM: Evaluate how many important lesions would be missed if colonoscopy indicated only for patients with distal lesions identified during flexible sigmoidoscopy. MATERIAL AND METHODS: All consecutive colonoscopy performed in the Endoscopy Unit of the Gastroenterology Division of Federal University of São Paulo, SP, Brazil, with polyps and cancer suspicious lesions were reviewed. Patients with a second procedure, inflammatory bowel disease or colonic surgery were excluded. RESULTS: We reviewed 101 patients with 38 possible cancer lesions and 70 polyps. The mean age was 62 years (SD 13.7 years) and 45 were male. Forty five lesions were in the right colon, namely 23 adenomas, 10 adenocarcinomas, 1 lymphoma and 11 benign lesion. Among such lesions, 28 were isolated in the right colon (16 adenomas and 7 adenocarcinomas). CONCLUSION: In our study 23 patients (22.77%) had adenomas or adenocarcinomas isolated in the right colon, that would be missed if flexible sigmoidoscopy was used alone.

[Evaluation of rapid urease test stored in refrigerator]. / Avaliação do teste rápido da urease conservado em geladeira.

UNLABELLED: The rapid urease test is an accurate and cheap method, which results are readily available, and broadly used for routine Helicobacter pylori infection diagnosis. AIM: The evaluation of rapid urease test stored in refrigerator at 4 degrees C (SRUT) compared to regular rapid urease test. PATIENTS AND METHOD: Endoscopic biopsies were obtained from gastric antrum in 104 consecutive patients. Diagnosis of Helicobacter pylori infection was accomplished by rapid urease test, histology and rapid urease test stored (kept in refrigerator by a period ranging from 1 to 8 days). RESULTS: Infection was considered present if both rapid urease test and histology were positive. Helicobacter pylori was present in 45/104 patients (42%). Rapid urease test stored had specificity comparable to rapid urease test (93%), with sensitivity of 88%. CONCLUSION: We concluded that rapid urease test can be stored in refrigerator for up to 1 week, without loss of clinical applicability, and that can make the test even easier to use for routine Helicobacter pylori tests in a busy endoscopy unit.

The head-eye-body turning behavior induced by electrical or cholinergic stimulation of the pulvinar-lateralis posterior nucleus complex is not dependent on the catecholaminergic system.

Two experimental designs were developed in cats in order to analyze the role of the catecholaminergic system in the turning response evoked by cholinergic or electrical stimulation of the pulvinar-lateralis posterior nucleus complex (P-LP). Twenty one adult cats were employed. In one series of experiments, nine cats had a cannula implanted in one P-LP, and through it, apomorphine alone or mixed with carbachol were microinjected. The behavior was observed and the EEG was recorded. In the second experimental design, a cannula and bipolar electrodes were implanted unilaterally in the P-LP of nine cats, and a series of electrical stimulations were performed before and after 6-OHDA administration into the P-LP, and apomorphine was injected parenterally in order to induce turning behavior. Finally three cats received 16 micrograms of 6 OHDA into the P-LP, through a Hamilton syringe and no electrodes or cannula were implanted, to study the histological damage. No evidence of involvement of the catecholaminergic system was found in either of these two experimental series. These results contrast with what has been found in the nigrostriatal dopaminergic system, where an imbalance in dopamine concentration induces turning behavior. High doses (16 micrograms) of 6-OHDA induced minimal damage in the P-LP.

Morpho-functional effects of kainic acid injection into the cat's pulvinar-lateralis posterior nucleus complex.

The histological, electroencephalographic, behavioral changes as well as the changes in the intensity threshold of stimulation necessary to induce contralateral turning were studied in 16 cats, in which kainic acid (KA) was injected locally into the pulvinar-lateralis posterior nucleus complex (P-LP). In 13 cats a stainless-steel tube with two attached electrodes was implanted in P-LP, and electrodes were also implanted in the ipsilateral dorsal hippocampus, the superior colliculus and the caudate nucleus. KA was injected through the tube using a 10 microliters Hamilton syringe. In other 3 cats, KA was injected stereotaxically through the needle of the Hamilton syringe and two electrodes were implanted in these areas after withdrawal of the syringe. The intensity thresholds of stimulation required to induce turning behavior were controlled before and after KA administration in the 13 cats with an implanted tube and only after KA injections in the three cats without a tube; in these instances the current threshold of the contralateral P-LP served as control. The histological results showed a moderate KA damage of the P-LP, with destruction of neuronal soma and gliosis and additional involvement, in all the experiments, of the dorsal hippocampus; however, passage fibers were spared by the lesions. A dose-dependent epileptic effect of KA was seen, which was slight with the 3 micrograms dose and intense with 6 micrograms. The EEG recording showed a prominent and almost simultaneous epileptic involvement of the hippocampus and the P-LP after KA, with less involvement of the other implanted structures. Turning behavior induced by electrical stimulation of the P-LP was suppressed when the electrode tip was located inside the lesioned area. When the electrode tip was placed inside a slight or moderate damaged tissue, a significative increase in current threshold was found, and finally when the tip of the electrode was outside the lesioned area no change in threshold was observed. These findings do not contradict our previous hypothesis of an intrinsic cholinergic mechanism involved in the turning response evoked by P-LP electrical stimulation, although it cannot be excluded that fibers coming presumably from the superior colliculus or pretectum may contribute to the response.

[Traumatic ventricular septal defect. A case report]. / Communicção interventricular traumática. Relato de caso.

A 34 years old woman, without previous cardiac symptoms, suffered a closed thoracic trauma in a car accident. Three days after presented dyspnea and orthopnea. Physical examination revealed a systolic murmur consistent with ventricular septal defect (VSD). Doppler echocardiography and angiography confirmed the presence of a muscular VSD with severe left-to-right shunt. Surgical intervention was indicated and VSD closure was performed with a patch, through a right atrium approach. Third degree atrioventricular block developed after surgery and a definitive pacemaker was implanted. The patient is asymptomatic and without murmurs in postoperative follow-up.

Prevalence and molecular characterization of Hepatozoon canis in dogs from urban and rural areas in Southeast Brazil.

The objective of this survey was to investigate the prevalence of Hepatozoon infection in dogs in the rural and urban areas of Uberlândia, Brazil by PCR and molecular characterization. DNA was obtained from blood samples collected from 346 local dogs from both genders and various ages. Seventeen PCR products from positive blood samples of urban dogs and 13 from the rural dogs were sequenced. Partial sequences of the 18S rRNA gene indicated that all 30 dogs were infected with Hepatozoon canis similar in sequence to H. canis from southern Europe. Four local dog sequences were submitted to GenBank (accessions JN835188; KF692038; KF692039; KF692040). This study indicates that H. canis is the cause of canine hepatozoonosis in Uberlândia and that infection is similarly widespread in rural and urban dogs.