Laparoscopic Liver Resection: A South American Experience with 2887 Cases.

BACKGROUND: Laparoscopic liver resections (LLR) have been increasingly performed in recent years. Most of the available evidence, however, comes from specialized centers in Asia, Europe and USA. Data from South America are limited and based on single-center experiences. To date, no multicenter studies evaluated the results of LLR in South America. The aim of this study was to evaluate the experience and results with LLR in South American centers. METHODS: From February to November 2019, a survey about LLR was conducted in 61 hepatobiliary centers in South America, composed by 20 questions concerning demographic characteristics, surgical data, and perioperative results. RESULTS: Fifty-one (83.6%) centers from seven different countries answered the survey. A total of 2887 LLR were performed, as follows: Argentina (928), Brazil (1326), Chile (322), Colombia (210), Paraguay (9), Peru (75), and Uruguay (8). The first program began in 1997; however, the majority (60.7%) started after 2010. The percentage of LLR over open resections was 28.4% (4.4-84%). Of the total, 76.5% were minor hepatectomies and 23.5% major, including 266 right hepatectomies and 343 left hepatectomies. The conversion rate was 9.7%, overall morbidity 13%, and mortality 0.7%. CONCLUSIONS: This is the largest study assessing the dissemination and results of LLR in South America. It showed an increasing number of centers performing LLR with the promising perioperative results, aligned with other worldwide excellence centers.

The association between the HLA-G 14-bp insertion/deletion polymorphism and type 1 diabetes.

Type 1 diabetes (T1D) is a multifactorial disease that has a strong genetic component. The HLA-G is a nonclassical HLA class I locus that is associated with immunomodulatory functions, including downregulation of innate and adaptive immune responses and induction of immune tolerance. However, there is currently limited information about the involvement of HLA-G in T1D susceptibility. This case-control study aims to investigate the T1D susceptibility association of alleles and genotypes of a widely investigated 14-bp insertion/deletion polymorphism in the HLA-G and to provide further evidence of the frequency distribution of class II HLA-DR-DQ-risk genotypes in T1D children and adolescents in the Brazilian population. The deletion allele and the homozygous deletion genotype are associated with susceptibility to T1D and the insertion allele and the heterozygous deletion/insertion genotype are associated with protection from T1D. We also confirm that genetic susceptibility to T1D is associated with the DRB1*03:01-DQA1*05:01-DQB1*02:01 and DRB1*04-DQA1*03:01-DQB1*03:02 haplotypes in Brazilian northeast region. The DR3-DQ2/DR4-DQ8 genotype conferred the highest detected risk for T1D. Our results identify a novel association of the 14-bp deletion allele and the homozygous deletion genotype with T1D development and provide additional evidence of the importance of HLA class II heterozygous DR3-DQ2/DR4-DQ8 genotype in T1D susceptibility.

Genetic and non-genetic factors that increase the risk of non-syndromic cleft lip and/or palate development.

OBJECTIVES: We investigated the relationship between non-syndromic cleft lip/palate (NSCLP) and polymorphisms in methylenetetrahydrofolate reductase (MTHFR), methionine synthase (MTR), methionine synthase reductase (MTRR), and RFC1, as well as the corresponding interactions with environmental factors. SUBJECTS AND METHODS: One hundred and forty NSCLP patients and their mothers, as well as 175 control individuals and their mothers, were recruited. Information regarding smoking and alcohol consumption was recorded. Blood samples were obtained in order to measure serum folate and cobalamin, as well as, plasma total homocysteine concentrations and to extract DNA. Polymorphisms in MTHFR(677C>T and 1298A>C), MTR(2756A>G), MTR(66A>G), and RFC1(80A>G) were analyzed by PCR-restriction fragment length polymorphism. RESULTS: Among the patients, 59.5% had cleft lip and palate, 22.0% had cleft palate, and 18.5% had cleft lip only. Maternal alcohol consumption and reduced folic acid concentrations in both children and mothers (P < 0.001 and P = 0.003, respectively) were risk factors for NSCLP. Patients and their mothers carrying the MTHFR 667T allele showed lower serum folate than CC (P = 0.011 and P = 0.030, respectively). Mothers who carried the MTHFR 1298C allele exhibited increased risk of having a child with NSCLP, after adjusting for alcohol consumption (OR: 1.75, 95% CI: 1.03-2.99, P = 0.038). CONCLUSIONS: Reduced folic acid levels, alcohol consumption, and the MTHFR 677T and 1298C alleles may have contributed to NSCLP development in this sample population from Rio Grande do Norte.

Integrity of prokaryotic mRNA isolated from complex samples for in vivo bacterial transcriptome analysis.

Even though several in vitro studies have focused on bacterial biology, the extent of such knowledge is not complete when considering an actual infection. As culture-independent microbiology methods such as high-throughput sequencing became available, important aspects of host-bacterium interactions will be elucidated. Based on microbiological relevance, we considered Bacteroides fragilis in a murine experimental infection as a model system to evaluate the in vivo bacterial transcriptome in host exudates. A disproportionate number of reads belonging to the host genome were retrieved in the first round of pyrosequencing, even after depletion of ribosomal RNA; the average number of reads related to the eukaryotic genome was 71.924-67.7%, whereas prokaryotic reads represented 34.338-32.3% in host exudates. Thus, different treatments were used to improve the prokaryotic RNA yield: i) centrifugation; ii) ultrasonic treatment; and iii) ultrasonic treatment followed by centrifugation. The latter treatment was found to be the most efficient in generating bacterial yields, as it resulted in a higher number of Bacteroides cells. However, the RNA extracted after this treatment was not of sufficient quality to be used in cDNA synthesis. Our results suggest that the methodology routinely used for RNA extraction in transcriptional analysis is not appropriate for in vivo studies in complex samples. Furthermore, the most efficient treatment for generating good bacterial cell yields was not suitable to retrieve high-quality RNA. Therefore, as an alternative methodological approach to enable in vivo studies on host-bacterium interactions, we advise increasing the sequencing depth despite the high costs.

MSX1 gene polymorphisms in non-syndromic cleft lip and/or palate.

OBJECTIVE: The aim of this study was to investigate the contribution of 6 polymorphic variants of the MSX1 gene in non-syndromic cleft lip and/or palate (NSCL/P). METHODS: Three hundred and fifty-eight individuals (158 NSCL/P cases and 200 controls) were genotyped by TaqMan allelic discrimination using predesigned SNP assays. Statistical analyses were conducted using the software spss 15.0 and the r statistical suite. Haplotype block structure and haplotype frequencies were determined using the Haploview. A P-value of 0.05 and confidence interval of 95% were used for all of statistical tests. RESULTS: The patients with non-syndromic cleft lip and/or palate were characterized by similar distribution of MSX1 genotypes and allele in comparison to subjects without oral clefts (P > 0.05). Two haplotype blocks were constructed with polymorphisms of MSX1 gene and haplotypes formed showed a similar frequency in patients with and without oral clefts. CONCLUSIONS: The present study provides no evidence that MSX1 polymorphisms (rs3775261, rs1042484, rs12532, rs6446693, rs4464513 and rs1907998) play a major role in NSCL/P.

Splenic autotransplantation reverses interferon-gamma and nitric oxide production and resistance to Listeria monocytogenes in splenectomized mice.

Splenectomized mice control Listeria monocytogenes infection better than non-splenectomized mice. Here, BALB/c mice subjected to splenectomy and autogenous grafting of spleen were evaluated after 3 and 7 days of intravenous L. monocytogenes infection. The group of splenectomized animals (SP) presented a lower number of bacteria in the liver in comparison with both the sham-operated control group (CT) and the group that received splenic autotransplantation (AT) in the retroperitoneal site. The AT group presented bacterial counts in the liver similar to the CT group. SP animals showed larger production of interferon-gamma (IFN-γ) and nitric oxide (NO) in the liver in comparison with CT and AT, this being associated with greater accumulation of mononuclear cells. IFN-γ production by spleen cells after stimulation with heat-killed Listeria was similar between the AT and CT groups, suggesting that the implanted fragments behaved like the original organ. The autogenous grafting of spleen fragments reverses the resistance to L. monocytogenes infection found in splenectomized mice, associated with a reduced IFN-γ and NO production in the liver. The present study shows that splenic autotransplantation restores the function of the spleen in splenectomized mice, even though in this case it does favor the susceptibility to L. monocytogenes infection.

Microsatellite loci: determining the genetic variability of Plasmodium vivax.

OBJECTIVE: To describe the genetic diversity of Plasmodium vivax isolates from different areas in the Brazilian Amazon using 11 polymorphic microsatellites and to evaluate the correlation between microsatellite variation and repeat array length. METHODS: Microsatellites with variable repeat units and array lengths were selected using in silico search of the P. vivax genome. We designed primers and amplified the selected loci in DNA obtained from patients with P. vivax acute infections. RESULTS: Positive correlation between repeat array length and microsatellite variation was detected independently of the size of repeat unit (di, tri, or tetranucleotide). We used these markers to describe the genetic variability of P. vivax isolates from four geographic regions of the Brazilian Amazon. Substantial variability was observed among P. vivax isolates within populations, concurrent with high levels of multiple-clone infections and high linkage disequilibrium. Overall, structured populations were observed with moderate to high genetic differentiation. CONCLUSION: The markers studied are useful tools for assessing population structure of P. vivax, as demonstrated for Brazilian populations and for searching for evidence of recent selection events associated with different phenotypes, such as drug resistance.

Irrigation of eucalyptus plantation using treated bleached kraft pulp mill effluent.

The use of treated pulp mill effluent on eucalyptus plantation appears to be an attractive option for plant nutrition and water supply. It also constitutes a supplementary treatment process and a final disposal option for the mill effluent. This study aimed at the investigation and evaluation of the effects of bleached kraft pulp mill treated effluent on three typical Brazilian soils used for eucalyptus plantation. The effluent was characterized and five different application rates, defined according to the load of sodium, were tested in controlled environment experiments (greenhouse). After effluent application over a six month period an increase in the salinity of the studied soils was observed, although no soil dispersion was detected. The low content of some nutrients in the treated effluent indicated the need for fertilizer complementation. In general, the best biomass productivity and plant growth results were obtained in fine textured soil at a loading rate of 6.49 t Na ha(-1). The good response of the soil-plant system under different effluent application rates showed the feasibility for the eucalyptus irrigation if adequate management practices and monitoring are carried out.

Staphylococcus aureus infection after splenectomy and splenic autotransplantation in BALB/c mice.

Splenectomy results in an increased risk of sepsis. The autogenous transplant of the spleen is an option for preserving splenic functions after total splenectomy. In this study, the capacity of animals undergoing autogenous spleen transplantation to respond to Staphylococcus aureus infection was investigated. BALB/c mice were divided into three groups: splenectomy followed by autotransplantation in the retroperitonium (AT), splenectomized only (SP) and operated non-splenectomized sham control (CT). Thirty days after surgery the mice were infected intravenously with S. aureus. Splenectomized mice had a higher number of colony-forming units (CFU) of S. aureus in liver and lungs in comparison with either AT or with CT mice (P < 0.05). Higher CFU numbers in lung of SP mice correlated with elevated production of interleukin-10 associated with a lower production of interferon-gamma and tumour necrosis factor-alpha. However, systemically, the level of tumour necrosis factor-alpha was higher in the SP group than in CT or AT. Lower titres of specific anti-S. aureus immunoglobulin (Ig)M and IgG1 were observed 6 days after infection in SP mice in comparison either with the AT or CT groups. Thus, splenectomy is detrimental to the immune response of BALB/c mice against infection by S. aureus which can be re-established by autogenous implantation of the spleen.

Incidence and growth of Listeria monocytogenes in persimmon (Diospyros kaki) fruit.

The incidence of Listeria monocytogenes on persimmon (Diospyros kaki) surface of 'Fuyu' and 'Rama Forte' was evaluated during a 5-month-period (from March to July) of two seasons periods (years 2005 and 2006). The fruits were collected in wholesale and street markets and retail in Sao Paulo and Campinas City, Brazil. A total of 582 fruits were analyzed using the Bax System which is based on the Polymerase Chain Reaction. The ability of this pathogen to grow on the peel and pulp of the two persimmon varieties was also verified at different incubation periods at the temperatures of 10, 20 and 30 degrees C. The growth parameters were obtained by modeling the experimental data using the Gompertz function. The incidence survey showed the absence of L. monocytogenes. The growth curves showed that L. monocytogenes can grow on the peel as well as in the pulp of the two persimmon varieties studied incubated at 10, 20 and 30 degrees C and that low temperatures can reduce the generation rate but does not inhibit its growth.

Transverse leukonychia: a case report.

A case of transverse leukonychia following chemotherapy for Hodgkin's disease in a 17-year-old white male is reported. The patient presented with multiple white bands across the fingernails, which appeared three weeks after the end of chemotherapy. The changes were almost homogeneously spread across the breadth of the fingernail plates, showing smooth borders with a rounded distal edge. Because of Hodgkin's disease in Costwold stage IE, he received sequential chemotherapy with cyclophosphamide, adriamycin, procarbazine, prednisolone, vincristine and bleomycine, and mediastinal mass irradiation. The authors emphasize that white transverse nail banding - Leukonychia striata or Muehrcke lines - constitute an aesthetical unpleasant side-effect of medication, but may represent an easily observed sign indicative of previous use of cytotoxic therapy for malignancy.

Assessment of the acid phosphatase CP01850 from Corynebacterium pseudotuberculosis in DNA and subunit vaccine formulations against caseous lymphadenitis / Avaliação da fosfatase ácida recombinante CP01850 de Corynebacterium pseudotuberculosis em formulações vacinais de subunidade e de DNA contra a linfadenite caseosa

The target cp1002_RS01850 from Corynebacterium pseudotuberculosis was used to construct a DNA and recombinant subunit vaccine against caseous lymphadenitis. Recombinant protein rCP01850 was expressed in Escherichia coli using pAE vector, and DNA vaccine was engineered with pTARGET vector. BALB/c mice were divided in five groups containing eight animals each, inoculated with: pTARGET/cp01850 as DNA vaccine (G1); rCP01850 plus Al (OH)3 as recombinant subunit vaccine (G2); pTARGET/cp01850 and a boost with rCP01850 plus Al (OH)3 (G3); pTARGET (G4); or Al (OH)3 (G5). Mice were inoculated and blood samples were collected on days 0, 21, and 42 for the analysis of total IgG, IgG1 and IgG2a by ELISA. In each group, five animals were challenged with Mic-6 C. pseudotuberculosis strain, and three were used for cytokine quantification by qPCR. Although no group has been protected by vaccines against lethal challenge, G2 showed an increase in the survival rate after challenge. Significantly higher levels of IL-4, IL-12, IFN-γ, total IgG, IgG1 and IgG2a were also detected for G2, evidencing a mixed Th1/Th2 immunological profile. In conclusion, despite no protection level provided by different vaccinal strategies using cp1002_RS01850 from C. pseudotuberculosis, G2 developed a Th1/Th2 immune response with an increase in survival rate.(AU)

O alvo cp1002_RS01850 de Corynebacterium pseudotuberculosis foi utilizado para construir uma vacina recombinante de subunidade e de DNA contra a linfadenite caseosa. A proteína recombinante rCP01850 foi expressa em Escherichia coli usando o vetor pAE, e a vacina de DNA foi construída com o vetor pTARGET. Camundongos BALB/c foram divididos em grupos de oito animais, inoculados com: pTARGET/cp01850 como vacina de DNA (G1); rCP01850 e Al (OH)3 como vacina recombinante de subunidade (G2); pTARGET/cp01850 e um boost com rCP01850 e Al (OH)3 (G3); pTARGET (G4); ou Al (OH)3 (G5). Os animais foram inoculados e amostras de sangue foram coletadas nos dias 0, 21, e 42 do experimento para a análise de IgG total, IgG1 e IgG2a por ELISA. De cada grupo, cinco animais foram desafiados com a cepa Mic-6 de C. pseudotuberculosis, e três foram usados para a quantificação de citocinas por qPCR. Apesar de nenhum grupo ter sido protegido pelas vacinas testadas contra o desafio letal, G2 apresentou taxa de sobrevida e níveis de IL-4, IL-12, IFN-γ, IgG total, IgG1 e IgG2a significativamente mais altos, evidenciando um perfil imunológico misto Th1/Th2. Conclui-se que apesar das diferentes estratégias vacinais utilizando cp1002_RS01850 de C. pseudotuberculosis não terem sido capazes de gerar proteção, G2 desenvolveu uma resposta Th1/Th2 e elevou a taxa de sobrevida.(AU)

Desordens hematológicas em onças-pardas (Puma concolor; Linnaeus, 1771) infectadas por Citauxzoon felis / [Hematological disorders in Brown jaguars (Puma concolor; Linnaeus 1771) infected by Citauxzoon felis]

Este estudo objetivou descrever o aspecto hematológico de seis onças-pardas (Puma concolor) infectadas pelo Cytauxzoon felis. Os seis casos de infecção foram identificados durante o manejo sanitário de 11 animais de um centro de reabilitação de animais silvestres. Estruturas compatíveis com piroplasmídeos foram observadas durante a avaliação do esfregaço sanguíneo e confirmadas como Cytauxzoon felis pela técnica de PCR. A análise estatística demonstrou diferença significativa (P<0,05) no número absoluto dos linfócitos entre os grupos dos animais infectados e não infectados. Assim, expressivas alterações hematológicas e bioquímicas entre os grupos investigados alertam para a dificuldade de identificação de onças-pardas infectadas por C. felis, apoiada apenas em exames de rotina, bem como para o risco, sobretudo, da reintrodução desses animais na natureza.(AU)

This Cytauxzoon felis by the PCR technique. Statistical analysis showed a significant difference is study aimed to describe the hematological appearance of six puma (puma concolor) infected with cytauxzoon felis. The six cases of infection were identified during the sanitary management of 11 animals from a wild animal rehabilitation center. Piroplasmid compatible structures were observed during the blood smear evaluation and confirmed as (P<0.05) in the absolute number of lymphocytes between the groups of infected and uninfected animals. Thus expressive hematological and biochemical alterations between the groups investigated alert to the difficulty of identifying infected brown jaguars by C. felis, supported only by routine examinations, and the risk especially when aiming at the reintroduction of these animals in the wild.(AU)

A temporal extension to the parsimonious covering theory.

In this paper, parsimonious covering theory is extended in such a way that temporal knowledge can be accommodated. In addition to causally associating possible manifestations with disorders, temporal relationships about duration and the time elapsed before a manifestation comes into existence can be represented by a graph. Precise definitions of the solution of a temporal diagnostic problem as well as algorithms to compute the solutions are provided. The medical suitability of the extended parsimonious cover theory is studied in the domain of food-borne disease.

[A comparative study of the incidence of sudden death from Chagas' disease in Uberaba in the years 1980 and 1990]. / Estudo comparativo da freqüência da morte súbita inesperada por doença de Chagas, em Uberaba, nos anos de 1980 e 1990.

A comparison was made between the years 1980 and 1990 for the frequency and causes of sudden death occurring in the urban and rural areas of the city of Uberaba in individuals older than 15 years. It aims mainly to analyse the current frequency of sudden death in that region and to evaluate the impact, it any, of prophylaxis and therapy on sudden death due to Chagas' disease. For the 1226 deaths cases studied from our 1980, 54 (4.4%) were sudden ones; out of these, 13 (24.1%) were supposedly due to Chagas' disease. For the 1740 death cases studied form our 1990 series, 44 (2.5%) were sudden ones; out of these, only 3 (6.8%) were considered to be due to Chagas' disease. The results indicate a significant decrease in the frequency both for sudden death in general and for sudden death due to Chagas' disease when the year 1990 is compared with 1980. Probable explanations for the findings are discussed.

[Autologous transplantation of the spleen--comparative and experimental study in the abdomen]. / Enxerto autólogo de baço--estudo comparativo e experimental no abdome.

Autologous spleen grafts were implanted in various abdominal sites in 32 guinea pigs (Cavea porcellus) divided in 2 groups according to the use of slided or maccerated spleens. Each guinea pig was grafted in 5 different sites: subcutaneous tissue, rectus abdominalis muscle, properitoneum, greater omentum and mesenterial root. Grafts weighted initially 50 mg and were examined after 16 weeks according to the following variables: phagocytic ability (as measured by recovery of Tc99m-labelled, heat-modified erithrocytes), weight and histological appearance. Statistical analysis showed better graft results of sliced as compared to maccerated specimens in respect to weight and histological appearance (p less than or equal to 0.01). No significant difference was found regarding phagocytic ability. Intra-abdominal sites, especially the greater omentum, were found to yield significantly better graft results than sites at the abdominal wall (p less than or equal to 0.01). No graft-associated pathological changes were observed during the study period.

[Epidemiological pattern of lymphatic filariasis in children living in endemic areas]. / Perfil epidemiológico da filariose linfática em crianças residentes em áreas endêmicas.

OBJECTIVE: Lymphatic filariasis still represents a major public health problem in the city of Recife. In spite of the fact that previous surveys had already shown high frequency of microfilaraemia in pediatric population, the prevalence of filarial disease and the microfilaraemic pattern of this group were unknown. This paper describes the clinical-epidemiological pattern of filariasis in children and adolescents living in two highly endemic areas of Recife. METHODS: The parasitological survey was done through a census carried out between December 1990 and July 1991. Thick drop technique (45 micro l) was performed on a total of 1,464 children and adolescents between the ages of 5 and 14, of whom 967 were submitted to clinical examination. Positive cases had their blood recollected (60 micro l) to measure the microfilaraemic density. RESULTS: The microfilaraemia prevalence was 6.4 %. In the age groups of 5 to 9 and 10 to 14 a microfilaraemia prevalence of respectively 4.6% and 8.3% was observed. The microfilaraemic density varied from 3 to 864 microfilariae per 60 microl of blood, there having been no statistically significant difference between the sexes and age groups (p<0.05). 6 cases (0.6 %) of acute filarial disease and 11 of chronic filarial disease (1.1%) were identified, hydrocele being the principal manifestation found. Lymphadenopathy was found in 22% of the children, statistical association with microfilaraemia being observed (p<0.001). CONCLUSIONS: The results of the parasitological survey show the strong presence of children in the contingent of microfilaraemic individuals, indicating an early and intense exposure to filariasis in the population studied.

[Catheter ablation of atrial flutter. Electrophysiological characterization of posterior and septal isthmus block]. / Ablação por cateter do flutter atrial. Caracterização eletrofisiológica da interrupção da condução pelos istmos posterior e septal.

PURPOSE: Evaluate the different types of conduction blocks obtained between inferior vena cava-tricuspid annulus (posterior isthmus) and between tricuspid annulus-coronary sinus ostium (septal isthmus) after radiofrequency (RF) catheter ablation of atrial flutter (AFL). METHODS: In 16 procedures, 14 patients (pts), 9 male, with type I AFL underwent RF ablation. Atrial activation around tricuspid annulus was performed with a 10-bipole "Halo" catheter (H1-2; H19-20). In sinus rhythm, isthmus conduction was evaluated during proximal coronary sinus (PCS) and low lateral right atrium (H1-2) pacing, before and after linear ablation. According to the wave front of impulse propagation we assessed absence of block (bidirectional conduction); incomplete block (bidirectional conduction with delay in one front of impulse propagation) and complete block (absence of conduction). The PCS/H1-2 interval was measured before and after ablation. RESULTS: Complete isthmus block was achieved in 7 (44%) and incomplete block in 4 (25%) procedures. Conduction block was not achieved in 5 procedures. At a mean follow-up of 12 months, there were no recurrences in the pts with complete block, whereas AFL recurred in the 6 pts with incomplete or no conduction block (p < 0.001). Pts with complete block had delta PCS/H1-2 interval (74.0 +/- 26.0 ms) greater than incomplete (30.5 +/- 7.5 ms) or absent block (p < 0.05). CONCLUSION: The verification of complete isthmus conduction block with atrial multipolar mapping is an effective strategy to assess electrophysiological success and absence of late recurrence in common atrial flutter ablation.

[Daily experiences of a health care team. Case report]. / O cotidiano de uma equipe de saúde--relato de caso.

The authors present daily experience report of a health staff, based in some aspects of microsociology in which the human being manifests all of its "theatrical behavior". Daily life is revealed in a closer look by the health field professionals. Daily life is the "stage" where the plot of life takes place in all of its complexity, the joy, the dreams, the conflicts and the suffering of each day, of each human being. This report analysis some aspects of the "underground centralization of actions", which determines human existence. It has been observed that the power category represented by the "game" had outstanding relevance in the work social relations of the staff. The "theatrical behavior" was the other element found in the analysis made.

[Funeral rites in memory of the elderly]. / Ritos de morte na lembrança de velhos.

This a phenomenologial study rites in the memory of elderly people, originated from the discomfort lived by the authors in their professional life dealing with death and dying. Verbal information from elderly people was collected with the objective of recovery and decoding mortuary rites. Nine themes originated from these informations: feelings and meanings in relation to death, the time of death, the annunciation death, the body's preparations, the watcher, the funeral procession, the grave, the return to home, the remembered death. The results gave the authors opportunity to understand better the attitudes of health professionals in caring for patients and their families in this existential experience of to-be-for-death. The death rationalized by scientific knowledge and nonpersonal technological care hides new rites, transmuted by new representations which the society built.