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BACKGROUND: Biliary atresia (BA) is the most common indication for pediatric liver trans plantation, although portoenterostomy is usually performed first. However, due to the high failure rate of portoenterostomy, liver transplantation has been advocated as the primary procedure for patients with BA. It is still unclear if a previous portoenterostomy has a negative impact on liver transplantation outcomes. AIM: To investigate the effect of prior portoenterostomy in infants un dergoing liver transplantation for BA. METHODS: This was a retrospective cohort study of 42 pediatric patients with BA who underwent primary liver transplantation from 2013 to 2023 at a single tertiary center in Brazil. Patients with BA were divided into two groups: Those under going primary liver transplantation without portoenterostomy and those undergoing liver transplantation with prior portoenterostomy. Continuous variables were compared using the Student's t-test or the Kruskal-Wallis test, and categorical variables were compared using the χ2 or Fisher's exact test, as appropriate. Multivariable Cox regression analysis was performed to determine risk factors for portal vein thrombosis. Patient and graft survival analyses were conducted with the Kaplan-Meier product-limit estimator, and patient subgroups were compared using the two-sided log-rank test. RESULTS: Forty-two patients were included in the study (25 [60%] girls), 23 undergoing liver transplantation without prior portoenterostomy, and 19 undergoing liver transplantation with prior portoenterostomy. Patients with prior portoenterostomy were older (12 vs 8 months; P = 0.02) at the time of liver transplantation and had lower Pediatric End-Stage Liver Disease scores (13.2 vs 21.4; P = 0.01). The majority of the patients (35/42, 83%) underwent living-donor liver transplantation. The group of patients without prior portoenterostomy appeared to have a higher incidence of portal vein thrombosis (39 vs 11%), but this result did not reach statistical significance. Prior portoenterostomy was not a protective factor against portal vein thrombosis in the multivariable analysis after adjusting for age at liver transplantation, graft-to-recipient weight ratio, and use of vascular grafts. Finally, the groups did not significantly differ in terms of post-transplant survival. CONCLUSION: In our study, prior portoenterostomy did not significantly affect the outcomes of liver transplantation.
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The shortage of deceased donor organs has prompted the development of alternative liver grafts for transplantation. Living-donor liver transplantation (LDLT) has emerged as a viable option, expanding the donor pool and enabling timely transplantation with favorable graft function and improved long-term outcomes. An accurate evaluation of the donor liver's volumetry (LV) and anatomical study is crucial to ensure adequate future liver remnant, graft volume and precise liver resection. Thus, ensuring donor safety and an appropriate graft-to-recipient weight ratio. Manual LV (MLV) using computed tomography has traditionally been considered the gold standard for assessing liver volume. However, the method has been limited by cost, subjectivity, and variability. Automated LV techniques employing advanced segmentation algorithms offer improved reproducibility, reduced variability, and enhanced efficiency compared to manual measurements. However, the accuracy of automated LV requires further investigation. The study provides a comprehensive review of traditional and emerging LV methods, including semi-automated image processing, automated LV techniques, and machine learning-based approaches. Additionally, the study discusses the respective strengths and weaknesses of each of the aforementioned techniques. The use of artificial intelligence (AI) technologies, including machine learning and deep learning, is expected to become a routine part of surgical planning in the near future. The implementation of AI is expected to enable faster and more accurate image study interpretations, improve workflow efficiency, and enhance the safety, speed, and cost-effectiveness of the procedures. Accurate preoperative assessment of the liver plays a crucial role in ensuring safe donor selection and improved outcomes in LDLT. MLV has inherent limitations that have led to the adoption of semi-automated and automated software solutions. Moreover, AI has tremendous potential for LV and segmentation; however, its widespread use is hindered by cost and availability. Therefore, the integration of multiple specialties is necessary to embrace technology and explore its possibilities, ranging from patient counseling to intraoperative decision-making through automation and AI.
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The aim of this study was to analyze the effect of essential oils on the control of soft rot of kale. Clove essential oil at 0.25%, lemongrass and palmarosa essential oils at 0.5%, melaleuca and orange essential oils at 0.75%, bergamot, rosemary, sage and ginger essential oils at 1% were evaluated for the in vitro inhibition of Pectobacterium carotovorum subsp. brasiliensis (Pcb) and control of soft rot of kale, sprayed 72 hours before or seven hours after inoculation. Clove, citronella, bergamot, rosemary, palmarosa, sage, melaleuca, and lemongrass oils completely inhibited the growth of Pcb. Lemongrass oil (0.5%) caused 0% of disease incidence (INC), providing 100% of disease control in both periods of inoculation. Clove oil (0.25%) showed a lower INC (25%) when applied after inoculation, providing a control percentage of 71.42%. The lemongrass and clove essential oils were analyzed by GC/FID (Gas Chromatography Flame Ionization Detector) and by GC/MS (Gas Chromatography /Mass Spectrometer). The major components were eugenol (91,9%) for clove oil and citral, isometric mixture of neral (34,1%) and geranial (42,9%) for lemongrass oil. The Minimum inhibitory concentration (MIC) of lemongrass, clove oils and their major components (citral and eugenol, respectively) was determined by using a broth macrodilution technique, as well as they were evaluated at different concentrations on the control of soft rot of kale, sprayed according descriptions above. The MIC was 0.03125% for citral, and 0.0625 and 0.125% for lemongrass and clove oils, respectively. Eugenol didn't show MIC. Lemongrass oil at 0.125% (post-inoculation) and citral at 0.125% (pre and post-inoculation) provided the highest percentages of disease control (33.33, 50, and 100%, respectively). Clove oil at 0.125% (post-inoculation) showed better effectiveness than eugenol (0.25%), providing a percentage of disease control of 16.67%. Lemongrass and clove essential oils were the most effective in control of soft rot of kale, suggesting that these oils have a potential to be used as antibacterial agents.
O objetivo do estudo foi avaliar o efeito de óleos essenciais no controle da podridão mole em couve. Os óleos essenciais de cravo a 0,25%, capim-limão e palmarosa a 0,5%, citronela, melaleuca e laranja a 0,75%, bergamota, alecrim, sálvia e gengibre a 1% foram avaliados na inibição in vitro de Pectobacterium carotovorum subsp. brasiliensis (Pcb) e controle da podridão mole em couve, pulverizados 72 horas antes ou sete horas após a inoculação. Os óleos essenciais de cravo, citronela, bergamota, alecrim, palmarosa, sálvia, melaleuca e capim-limão inibiram completamente o crescimento de Pcb. O óleo de capimlimão (0,5%) promoveu 0% de incidência (INC) da doença (percentual de controle de 100%), em ambos os períodos de inoculação. O óleo de cravo (0,25%) proporcionou menor INC (25%) quando aplicado após inoculação (percentual de controle de 71,42%). Os óleos essenciais de capim-limão e cravo foram analisados por GC/FID (cromatografia gasosa/detector por ionização de chama) e por GC/MS (cromatografia gasosa/ espectometria de massas). Os componentes majoritários foram eugenol (91,9%) no óleo de cravo e citral (neral34,1% e geranial- 42,9%) no óleo de capim-limão. A concentração inibitória mínima (CIM) dos óleos essenciais de capim-limão e cravo e de seus componentes majoritários (citral e eugenol, respectivamente) foi determinada por meio da técnica de macrodiluição em caldo, bem como foram avaliados, em diferentes concentrações, no controle da podridão mole em couve, pulverizados conforme descrito acima. A concentração inibitória mínima (CIM) foi de 0,03125% para o citral, e de 0,0625 e 0,125% para os óleos de capim-limão e cravo, respectivamente. O eugenol não apresentou CIM. O óleo de capim-limão a 0,125% (pós-inoculação) e o citral (0,125%), em ambos os períodos de inoculação, proporcionaram os maiores percentuais de controle (33,33; 50 e 100%, respectivamente). O óleo de cravo a 0,125% (pós-inoculação) mostrou maior eficiência que o eugenol (0,25%), promovendo um percentual de controle de 16,67%. Os óleos essenciais de capim-limão e cravo destacaram-se na eficiência de controle da podridão mole em couve, sugerindo que esses óleos têm potencial para serem utilizados como agentes antibacterianos.
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Brassica/microbiologia , Óleos Voláteis/análise , Pectobacterium carotovorum/patogenicidade , Plantas/microbiologiaRESUMO
Abstract Many people use medicinal plants to relieve disorders related to the central nervous system, such as depression, epilepsy, anxiety and pain, even though the effectiveness of most of them has not yet been proven through scientific studies. Plants of the Lippia genus, Verbenaceae, are widely used in ethnobotany as a food, for seasoning and in antiseptic remedies. They are also marketed and used for the treatment of different types of pain, including stomach ache, abdominal pain and headache, as well as being used as sedatives, anxiolytics and anticonvulsants. Despite their widespread use, there are no reviews on the central nervous system profile of plants of this genus. Therefore, the databases Medline-PubMed, Embase, Scopus and Web of Science were searched using the terms Lippia and biologic activity. Thirty-five papers were found. Eleven species of Lippia showed central nervous system activity, with leaves and the aerial parts of plants being the most commonly used, especially in aqueous and ethanol extracts or volatile oil. The species are composed mainly of terpenoids and phenylpropanoids, including polyketides, flavonoids and in less quantity some alkaloids. Although several species of Lippia present analgesic activity, most studies have not explored the mechanisms responsible for this effect, however, there is some evidence that volatile oils and constituents of the extracts may be responsible for the relief of some CNS disorders, but the effects on pain modulation seem to be the most exploited so far.
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ABSTRACT Background: Primary intrahepatic lithiasis is defined when the stones are formed in the liver and associated with local dilatation and biliary stricture. Liver resection is the ideal procedure. Aim: To evaluate the results of liver resection in the treatment of non-oriental intrahepatic lithiasis. Methods: Fifty-one patients with symptomatic benign non-oriental hepatolithiasis underwent surgical resection in six institutions in Brazil. Demography data, clinical symptoms, classification, diagnosis, management and postoperative course were analyzed. Results: Of the 51 patients, 28 were male (54.9%), with a mean age of 49.3 years. History of cholangitis was observed in 15 (29.4%). The types of intrahepatic lithiasis were type I in 39 (76.5%) and type IIb in 12 (23.5%), with additional type Ea in six (11.8%). Liver function test were normal in 42 patients (82.4%). Segmental atrophy was observed in 12 (23.5%). Treatments included left lateral sectionectomy in 24 (47.1%), left hepatectomy in 14 (27.5%) and right hepatectomy in eight (15.7%), with associated hepaticojejunostomy in four (7.8%). Laparoscopic liver resection was performed in eight (15.7%). Postoperative complications were observed in 20 (39.2%) with no mortality. Conclusion: Liver resection in patients with hepatolithiasis is the ideal procedure as it removes stones, stricture, atrophic parenchyma, and minimizes the risk of cholangiocarcinoma.
RESUMO Racional: Litíase intra-hepática primária é definida quando os cálculos são formados dentro do fígado, podendo estar associada à dilatação local e estenosa da via biliar. A ressecção hepática é considerada o procedimento ideal. Objetivo: Avaliar os resultados da ressecção hepática no tratamento da litíase intra-hepática não oriental. Métodos: Cinquenta e um pacientes com hepatolitíase benigna não oriental sintomática foram submetidos à ressecção hepática em seis instituições no Brazil. Os dados demográficos, sintomas clínicos, classificação, diagnóstico, tratamento e evolução pós-operatória foram analisados. Resultados: Dos 51 pacientes havia 28 homens (54,9%), e a idade média era de 49,3 anos. História de colangite foi observada em 15 pacientes (29,4%). Os tipos de litíase observados foram tipo I em 39 (76,5%) e tipo IIb em 12 (23,5%), com o tipo adicional Ea em seis pacientes (11,8%). Os testes de função hepática estavam normais em 42 (82,4%) e atrofia segmentar foi observada em 12 (23,5%). O tratamento incluiu setorectomia lateral esquerda em 24 (47,1%), hepatectomia esquerda em 14 (27,5%) e hepatectomia direita em oito pacientes (15,7%). A hepaticojejunostomia esteve associada ao procedimento inicial em quatro (7,8%). Hepatectomia por videolaparoscopia foi realizada em oito (15,7%). Complicações pós-operatórias foram observadas em 20 pacientes (39,2%) e não houve mortalidade. Conclusão: Ressecção hepática na hepatolitíase é o procedimento ideal, pois remove os cálculos, a estenose, o parênquima atrofiado e minimiza os riscos para colangiocarcinoma.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Litíase/cirurgia , Hepatectomia/métodos , Hepatopatias/cirurgia , Resultado do TratamentoRESUMO
ABSTRACT This paper reports the first study of the variation of the chemical composition and abundance of the essential oil of Croton heliotropiifolius, in four seasons, and the evaluation of its antibacterial activity. Essential oil obtained from leaves of C. heliotropiifolius were analyzed by GC/MS and evaluated against eight bacteria strains by broth microdilution method. The chemical constituents identified were the same in all samples, but with different proportions. The total percentages identified were 96.58% in summer, 92.08% in autumn, 98.44% in winter and 90.78% in spring. The majors constituents are β-caryophyllene, bicyclogermacrene, germacrene-D, limonene and 1,8-cineole. β-Caryophyllene was the major compound in all samples. The results of the antibacterial evaluations showed weak to moderate activity against the analyzed strains. In all analyzes was observed that essential oil sample collected in summer stands out from the others, displaying stronger activity against Gram-positive as Gram-negative bacteria.
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ABSTRACT: The semiarid region of Brazil holds a great richness of medicinal and aromatic plants with considerable potential for pharmaceutical, food, cosmetic and biopesticide industries. Martianthus leucocephalus (Mart. Ex Benth.) J. F. B. Pastore is endemic to this region, and its essential oils contain a principle compound, isobornyl formate, which demonstrates antimicrobial activity against Bacilus cereus, Staphylococcus aureus and Candida albicans. In spite of its significant pharmacological potential, little is known about its growth. In light of the influence of seasonality on plant growth, development, and secondary metabolism, the present study evaluated the growth and essential oil content of M. leucocephalus grown and harvested during different months of the year in the edaphoclimatic conditions of Feira de Santana, Bahia State, Brazil. The experimental design was entirely randomized, with twelve harvesting periods and five replicates. The study acquired monthly data of mean temperatures, relative humidity, rainfall, irradiance, and photoperiod from the National Institute of Meteorology (INMET) and quantified the fresh and dry weights of leaves, flowers and branches, as well as leaf area, and essential oil content. The data were submitted to Spearman correlation analysis and the means were compared using the Scott-Knott test. Total leaf masses and oil contents were higher during periods with longer photoperiods and higher solar irradiance. Rainfall and relative humidity reduced plant growth and essential oil content. Higher total mean dry masses were recorded from September to January (except October), while oil content was higher in March.
RESUMO: O semiárido brasileiro apresenta grande riqueza de espécies medicinais e aromáticas, com intenso uso na indústria farmacêutica, alimentícia, de cosméticos e de biopesticidas. A espécie Martianthus leucocephalus (Mart. ex Benth.) J. F. B. Pastore é endêmica dessa região. Seu óleo essencial apresenta como composto majoritário o formiato de isobornila, com atividade antimicrobiana frente à Bacilus cereus, Staphylococcus aureus e Candida albicans. Devido à grande influência da sazonalidade sobre o crescimento e produção vegetal, sobretudo quando envolve o metabolismo secundário de plantas, o objetivo deste trabalho foi avaliar o crescimento e a produção de óleo essencial de M. leucocephalus cultivada e colhida em diferentes meses do ano, nas condições edafoclimáticas de Feira de Santana, BA. O experimento foi conduzido em delineamento inteiramente casualizado (DIC), com doze tratamentos, constituídos dos diferentes meses de colheita, com cinco repetições. Mensalmente, foram obtidos os valores médios de temperatura, umidade relativa do ar, precipitação pluviométrica, irradiância e fotoperíodo, através do Instituto Nacional de Meteorologia (INMET), quantificando-se também a massa fresca e seca das folhas, flores e caule, a área foliar e o teor de óleo essencial das plantas. Os dados foram submetidos à análise de correlação de Spearman e as médias foram comparadas pelo teste de Scott-Knott. A massa seca total e o teor de óleo aumentaram em função da irradiância e reduziram em função da precipitação pluviométrica e umidade relativa do ar. As maiores médias de massa seca total foram encontradas durante os meses de setembro a janeiro, exceto outubro, e de teor de óleo no mês de março.
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ABSTRACT: Martianthus leucocephalus is found in the semi-arid Northeast of Brazil and has high pharmacological potential due to the production of volatile compounds. This study aimed to evaluate the Cd (15, 30, 45 and 60µmol L-1), Cu (30, 60, 90 and 120µmol L-1) and Zn (150, 300, 450 and 600µmol L-1) levels on the growth of this species and its volatile compounds production. Apical cuttings were placed in plastic trays containing 6.0L nutrient solution, and after rooting, they were submitted to Cd, Cu and Zn treatments for 15 days. All the metals evaluated reduced the succulence and growth of all parts of M. leucocephalus . This effect was accompanied by the increase of Cd, Cu and Zn concentrations in all plant tissues. Volatile compounds content produced by M. leucocephalus was increased only by Zn (86%).
RESUMO: Martianthus leucocephalus é encontrada no semiárido nordestino e possui potencial farmacológico atribuído à produção de compostos voláteis. Este trabalho objetivou avaliar o efeito de doses de Cd (15, 30, 45 and 60µmol L-1), Cu (30, 60, 90 and 120µmol L-1) e Zn (150, 300, 450 and 600µmol L-1) no crescimento dessa espécie e na produção de compostos voláteis. Estacas apicais foram transferidas para bandejas plásticas contendo 6,0L de solução nutritiva e, após o enraizamento, foram submetidas aos tratamentos de Cd, Cu e Zn, durante 15 dias. Todos os metais avaliados reduziram a suculência e o crescimento de todas as partes de M. leucocephalus . Este efeito foi acompanhado pelo incremento das concentrações de Cd, Cu e Zn em todos os tecidos das plantas. Também foi observado que o teor de compostos voláteis, produzido por M. leucocephalus, foi aumentado apenas pelo Zn (86%).
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Neste breve artigo de revisão serão expostos os principais diagnósticos diferenciais do paciente que se apresenta ictérico no primeiro atendimento na emergência, abordando a apresentação clínica e aspectos relacionados aos exames subsidiários utilizados no diagnóstico dessas patologias, com ênfase na obstrução biliar extra-hepática.
These brief review article will expose the major differential diagnosis of patients who present with jaundice in the first emergency care, approaching the clinical presentation and aspects related to subsidiary tests used in the diagnosis of these diseases, with emphasis on extrahepatic biliary obstruction.
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Colestase/diagnóstico , Icterícia/diagnóstico , Diagnóstico Diferencial , Serviços Médicos de EmergênciaRESUMO
A atividade antimicrobiana de méis produzidos por Melipona asilvai, Melipona quadrifasciata anthidioides, Friseomelita doederleinei, Tetragonisca angustula e Plebeia sp. foi investigada. O teste de difusão em poço demonstrou que todos os méis tem ação antibacteriana frente a Staphylococcus aureus, mas somente as amostras produzidas por M. quadrifasciata anthidioides e F. doederleinei inibiram o crescimento de Escherichia coli. No ensaio de determinação da concentração inibitória mínima, os méis de M. asilvai, M. quadrifasciata anthidioides, F. doederleinei e T. angustula foram mais ativos que os de Plebeia sp. frente a S. aureus e E. coli. Os micro-organismos Pseudomonas aeruginosa e Candida albicans foram resistentes a todos os méis em ambos ensaios. Os méis foram mais efetivos contra as bactérias do que frente a uma solução de açúcar, sugerindo que o mecanismo de inibição do crescimento bacteriano não está somente relacionado ao efeito osmótico. Os resultados obtidos podem explicar o uso medicinal desses méis em doenças bacterianas.
The antimicrobial activity of honey produced by Melipona asilvai, Melipona quadrifasciata anthidioides, Friseomelita doederleinei, Tetragonisca angustula and Plebeia sp. were investigated. The agar well diffusion assay demonstrated that all honeys had antibacterial activity against Staphylococcus aureus, but only the samples from M. quadrifasciata anthidioides and F. doederleinei inhibited the growth of Escherichia coli. In the Minimum Inhibitory Concentration determination assay, M. asilvai, M. quadrifasciata anthidioides, F. doederleinei and T. angustula honeys were more active than that from Plebeia sp. for S. aureus and E. coli. The microorganisms Pseudomonas aeruginosa and Candida albicans were resistant to the all native stingless bee honeys in both assays. Honeys were more effective against bacteria than a sugar solution, suggesting that the mechanism for bacterial growth inhibition is not only related to the osmotic effect. The results of antimicrobial activity may explain the popular medicinal use of these honeys in bacterial diseases.
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This work aimed to evaluate the antimicrobial activity of aqueous and methanol extracts of leaves, inflorescences, nut-shell, liquid and solid endosperm nuts of Syagrus coronata against pathogenic bacteria and yeast. Screening was initially performed using the agar dilution method. The extracts regarded as bioactive underwent liquid-liquid partition for determination of their minimum inhibitory concentration and minimum bactericide concentration (MIC and MBC) and those of their respective fractions against the microorganisms inhibited in preliminary tests. Antimicrobial activity was observed only in inflorescences. The corresponding aqueous extract was effective against B. cereus and the three strains of S. aureus, and the corresponding MIC and MCB values were lower than those of dichloromethane, ethyl acetate and butanol fractions of the same extract. The methanol extract was effective against B. cereus, and the corresponding MIC and MBC values were higher than those of ethyl acetate and butanol fractions of the same extract.
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Na doença periodontal, a resposta imune ao desafio microbiano resulta em ativação de osteoclastos e reabsorção do osso alveolar, culminando com a perda do dente. Deste modo, a busca por compostos com atividade antimicrobiana torna-se relevante no controle da formação do biofilme dental. Com o crescente aumento da resistência bacteriana aos antimicrobianos, o descobrimento de novas drogas seria uma ferramenta útil e neste cenário as plantas medicinais são alternativas promissoras. No presente estudo a atividade antimicrobiana de óleos essenciais extraídos de folhas e flores de Ocimum americanum e Ocimum basilicum foi avaliada frente aos periodontopatógenos Aggregatibacter actinomycetemcomitans (ATCC 43717), Fusobacterium nucleatum (ATCC 25586), Porphyromonas gingivalis (ATCC 33277) e frente ao micro-organismo Bacteroides fragilis (ATCC 25285). O método de macrodiluição em tubos foi utilizado para determinação da concentração inibitória mínima (CIM) e concentração bactericida mínima (CBM). Foram registrados menores valores de CIM (0,00625 mg.mL-1 a 0,0125 mg.mL-1) frente a bactéria P. gingivalis, sendo os maiores valores ( <3,2 mg.mL-1) registrados para A. actinomycetemcomitans. Estas concentrações foram consideradas bactericidas quando a CBM foi avaliada. A composição química dos óleos mostrou a presença de linalol e metil cinamato, compostos com reconhecida atividade antimicrobiana, o que poderia explicar os resultados encontrados. Este trabalho mostrou que as plantas medicinais do gênero Ocimum estudadas foram capazes de inibir o crescimento microbiano, especialmente de P. gingivalis, apresentando, portanto, potencial biotecnológico para uso na área de odontologia
In Periodontal disease, the immune response to microbial challenge results in osteoclast activation and alveolar bone resorption, leading to tooth loss, so the search for chemical compounds with antimicrobial activity is relevant to control biofilm formation. With the increasing of bacterial resistance to antibiotics, the discovery of new drugs would be a useful tool, and in this scenario the medicinal plants are promising alternatives. In this study, the antimicrobial activity of essential oils extracted from leaves and flowers of Ocimum americanum and Ocimum basilicum was evaluated against the periodontopathogens Aggregatibacter actinomycetemcomitans (ATCC 43717), Fusobacterium nucleatum (ATCC 25586), Porphyromonas gingivalis (ATCC 33277) and against the bacteria Bacteroides fragilis (ATCC 25285). The macrodilution method was used to determine the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). There were recorded lower values of MIC (0.00625 mg.mL-1 to 0.0125 mg.mL-1) against P. gingivalis, and the highest values (<3,2 mg.mL-1) were recorded for A. actinomycetemcomitans. These concentrations were considered bactericidal when MBC was assessed. The chemical composition of the oils showed the presence of linalool and methyl cinnamate, compounds with proven antimicrobial activity, which could explain the results. This project showed that medicinal plants studied were able to inhibit microbial growth, especially against P. gingivalis, presenting therefore biotechnological potential for use in dentistry
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Anti-Infecciosos , Doenças Periodontais , Placa Dentária , Plantas MedicinaisRESUMO
Os adenocarcinomas constituem quase a totalidade de todas as malignidades encontradas no intestino grosso, sendo a maioria originada a partir de pólipos adenomatosos. Por isso é muito importante a realização de exames de rastreamento com intuito de um diagnóstico precoce, proporcionando um tratamento curativo.
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Adenocarcinoma , Neoplasias Colorretais , Intestino Grosso , PrognósticoRESUMO
OBJETIVO: Estimar o custo anual do manejo da doenca arterial coronária (DAC) em valores do SUS e convênios. MÉTODOS: Estudo de coorte, incluindo pacientes ambulatoriais com DAC comprovada. Considerou-se para estimar custos diretos: consultas, exames, procedimentos, internacões e medicamentos. Valores de consultas e exames foram obtidos da tabela SUS e da Lista de Procedimentos Médicos (LPM). Valores de eventos cardiovasculares foram obtidos de internacões em hospital público e privado com estas classificacões diagnósticas em 2002. O preco dos fármacos utilizado foi o de menor custo no mercado. RESULTADOS: Os 147 pacientes (65n12 anos, 63 por cento homens, 69 por cento hipertensos, 35 por cento diabéticos e 59 por cento com IAM prévio) tiveram acompanhamento médio de 24n8 meses. O custo anual médio estimado por paciente foi de R$ 2.733,00, pelo SUS, e R$ 6.788,00, para convênios. O gasto com medicamentos ($ 1.154,00) representou 80 por cento e 55 por cento dos custos ambulatoriais, e 41 por cento e 17 por cento dos gastos totais, pelo SUS e para convênios, respectivamente. A ocorrência de evento cardiovascular teve grande impacto (R$ 4.626,00 vs. R$ 1.312,00, pelo SUS, e R$ 13.453,00 vs. R$ 1.789,00, para convênios, p<0,01). CONCLUSAO: O custo médio anual do manejo da DAC foi elevado, sendo o tratamento farmacológico o principal determinante dos custos públicos. Essas estimativas podem subsidiar análises econômicas nesta área, sendo úteis para nortear políticas de saúde pública.
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Humanos , Masculino , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Isquemia Miocárdica/economia , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Brasil , Estudos de Coortes , Sistemas Pré-Pagos de Saúde/economia , Sistemas Pré-Pagos de Saúde/normas , Hospitalização/economia , Isquemia Miocárdica/terapia , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/normasRESUMO
Os autores fazem uma revisão sobre o adenocarcinoma da vesícula biliar abordando aspectos diagnósticos, manifestações clínicas e tratamento.