Fetal alcohol spectrum disorders among children in a Brazilian orphanage.

BACKGROUND: The objective was to investigate the frequency of fetal alcohol spectrum disorders (FASD) and ophthalmologic anomalies in orphanage children in Brazil. METHODS: A prospective study was performed on 94 children living in an orphanage in Brazil. The children were examined by a multidisciplinary team consisting of specialists in pediatrics, neurology, psychology, neuropsychiatry, and ophthalmology. RESULTS: The main reasons for living in the orphanage, in 61% of the children, were negligence, child abuse, and abandonment. Of all the children studied, 50% had mothers with known alcohol abuse and 47% had one or more diagnoses of neurodevelopmental/behavioral and/or cognitive deficits. General developmental delay was found in 18%, intellectual disability in 3%, cognitive impairment in 27%, attention-deficit/hyperactivity disorder in 14%, and autism in 3%. Altogether 17% had FASD, comprising three children with fetal alcohol syndrome (FAS), six with partial FAS, and seven with alcohol-related neurodevelopmental disorder. 16% had ophthalmological findings such as poor vision, strabismus, and dysmorphology of the optic nerves. Twenty-eight children (30%) were adopted from the orphanage; of these, six had FASD (two FAS, three partial FAS, one alcohol-related neurodevelopmental disorder), five had attention-deficit/hyperactivity disorder, and eight had developmental delay. CONCLUSION: Nearly half of the children living in the orphanage had neurodevelopmental disorders and a considerable number showed signs of damage from prenatal alcohol exposure. A broader look at the problem of FASD in Brazil and other South American countries is desirable to document the burden of disease and provide data for targeting prevention efforts.

Dillapiole as antileishmanial agent: discovery, cytotoxic activity and preliminary SAR studies of dillapiole analogues.

In this paper, the isolation of dillapiole (1) from Piper aduncum was reported as well as the semi-synthesis of two phenylpropanoid derivatives [di-hydrodillapiole (2), isodillapiole (3)], via reduction and isomerization reactions. Also, the compounds' molecular properties (structural, electronic, hydrophobic, and steric) were calculated and investigated to establish some preliminary structure-activity relationships (SAR). Compounds were evaluated for in vitro antileishmanial activity and cytotoxic effects on fibroblast cells. Compound 1 presented inhibitory activity against Leishmania amazonensis (IC(50) = 69.3 µM) and Leishmania brasiliensis (IC(50) = 59.4 µM) and induced cytotoxic effects on fibroblast cells mainly in high concentrations. Compounds 2 (IC(50) = 99.9 µM for L. amazonensis and IC(50) = 90.5 µM for L. braziliensis) and 3 (IC(50) = 122.9 µM for L. amazonensis and IC(50) = 109.8 µM for L. brasiliensis) were less active than dillapiole (1). Regarding the molecular properties, the conformational arrangement of the side chain, electronic features, and the hydrophilic/hydrophobic balance seem to be relevant for explaining the antileishmanial activity of dillapiole and its analogues.

The anti-inflammatory activity of dillapiole and some semisynthetic analogues.

CONTEXT: Piper aduncum L. (Piperaceae) produces an essential oil (dillapiole) with great exploitative potential and it has proven effects against traditional cultures of phytopathogens, such as fungi, bacteria and mollusks, as well as analgesic action with low levels of toxicity. OBJECTIVE: This study investigated the in vivo anti-inflammatory activity of dillapiole. Furthermore, in order to elucidate its structure-anti-inflammatory activity relationship (SAR), semisynthetic analogues were proposed by using the molecular simplification strategy. MATERIALS AND METHODS: Dillapiole and safrole were isolated and purified using column chromatography. The semisynthetic analogues were obtained by using simple organic reactions, such as catalytic reduction and isomerization. All the analogues were purified by column chromatography and characterized by (1)H and (13)C NMR. The anti-inflammatory activities of dillapiole and its analogues were studied in carrageenan-induced rat paw edema model. RESULTS: Dillapiole and di-hydrodillapiole significantly (p<0.05) inhibited rat paw edema. All the other substances tested, including safrole, were less powerful inhibitors with activities inferior to that of indomethacin. DISCUSSION AND CONCLUSION: These findings showed that dillapiole and di-hydrodillapiole have moderate anti-phlogistic properties, indicating that they can be used as prototypes for newer anti-inflammatory compounds. Structure-activity relationship studies revealed that the benzodioxole ring is important for biological activity as well as the alkyl groups in the side chain and the methoxy groups in the aromatic ring.

Differences between inflamed and non inflamed appendices diagnosed as acute appendicitis.

BACKGROUND: Despite the great advances in diagnostic methods, the incidence of the surgical removal of a morphologically normal appendix in patients with clinical and complementary signs of acute appendicitis continues to exceed 20%. This study aimed to compare the clinical, laboratory, and ultrasound findings of inflammatory and noninflammatory appendiceal disorders diagnosed as acute appendicitis. METHODS: The medical records of 208 patients with clinical, laboratory, and ultrasound findings indicative of acute appendicitis were studied. The patients were divided into two groups: group 1 comprising 94 patients whose appendicular histological results suggested a normal appendix and group 2 comprising 114 patients with histopathological tests confirming acute appendicitis. The variables analyzed were age at the time of surgery, sex, nausea and vomiting, inappetence, fever, pain migrating to the right iliac fossa, pain on palpation of the right iliac fossa, Blumberg's sign, blood counts, ultrasound findings, and Alvarado score. RESULTS: An inflamed appendix was associated with inappetence, pain on palpation of the right iliac fossa, appendiceal diameter >6 mm, and Alvarado score >6 (p < 0.001). In contrast, fever was more frequently found in noninflammatory appendiceal disorders (p < 0.001). CONCLUSION: Inappetence, pain on palpation of the right iliac fossa, appendiceal diameter > 6 mm, and Alvarado score > 6 indicate an inflammatory appendiceal disease, whereas fever is more often present in noninflammatory appendiceal diseases.

QSAR modeling of a set of pyrazinoate esters as antituberculosis prodrugs.

Tuberculosis is an infection caused mainly by Mycobacterium tuberculosis. A first-line antimycobacterial drug is pyrazinamide (PZA), which acts partially as a prodrug activated by a pyrazinamidase releasing the active agent, pyrazinoic acid (POA). As pyrazinoic acid presents some difficulty to cross the mycobacterial cell wall, and also the pyrazinamide-resistant strains do not express the pyrazinamidase, a set of pyrazinoic acid esters have been evaluated as antimycobacterial agents. In this work, a QSAR approach was applied to a set of forty-three pyrazinoates against M. tuberculosis ATCC 27294, using genetic algorithm function and partial least squares regression (WOLF 5.5 program). The independent variables selected were the Balaban index (J), calculated n-octanol/water partition coefficient (ClogP), van-der-Waals surface area, dipole moment, and stretching-energy contribution. The final QSAR model (N = 32, r(2) = 0.68, q(2) = 0.59, LOF = 0.25, and LSE = 0.19) was fully validated employing leave-N-out cross-validation and y-scrambling techniques. The test set (N = 11) presented an external prediction power of 73%. In conclusion, the QSAR model generated can be used as a valuable tool to optimize the activity of future pyrazinoic acid esters in the designing of new antituberculosis agents.

Isolated intestinal transit bipartition: a new strategy for staged surgery in superobesity. / Bipartição de trânsito intestinal isolada: uma nova estratégia para cirurgia em estágios em superobesos.

OBJECTIVE: biliopancreatic diversion with duodenal switch is a complex, malabsorptive procedure, associated with improved weight loss and metabolic control. Staged surgery with sleeve gastrectomy as the first stage is an option for reducing complications in superobese patients. However, some problems persist: large livers can hamper the surgical approach and complications such as leaks can be severe. Intestinal transit bipartition is a modified and simplified model of biliopancreatic diversion that complements sleeve gastrectomy. It is similar to the duodenal switch, but with less complexity and fewer nutritional consequences. This study assessed the feasibility and safety of isolated transit bipartition as the initial procedure in a two-step surgery to treat superobesity. METHODS: this prospective study included 41 superobese patients, with mean BMI 54.5±3.5kg/m2. We performed a laparoscopic isolated transit bipartition as the first procedure in a new staged approach. We analyzed weight loss and complications during one year of follow-up. RESULTS: we completed all the procedures by laparoscopy. After six months, the mean percent excess weight loss was 28%, remaining stable until the end of the study. There were no intraoperative difficulties. Half of the patients experienced early diarrhea, and three had marginal ulcers. There were no major surgical complications or deaths. CONCLUSION: isolated laparoscopic transit bipartition is a new option for a staged approach in superobesity, which can provide a safer second procedure after effective weight loss over six months. It may be useful particularly in the management of patients with severe obesity.

OBJETIVO: o duodenal switch é um procedimento disabsortivo complexo, associado aos melhores resultados de perda de peso e controle metabólico. A cirurgia em etapas, com gastrectomia vertical como primeiro passo, é uma opção para reduzir complicações em pacientes superobesos. No entanto, alguns problemas persistem, como fígados grandes, que dificultam a abordagem cirúrgica, e complicações, como fístulas graves. A bipartição do trânsito intestinal é um modelo modificado e simplificado de desvio biliopancreático que complementa a gastrectomia vertical. É semelhante ao duodenal switch com menores complexidade e consequências nutricionais. Este estudo avaliou a viabilidade e a segurança da bipartição de trânsito isolada como o procedimento inicial para tratar a superobesidade. MÉTODOS: foram incluídos 41 pacientes superobesos, com IMC médio de 54,5±3,5kg/m2. Uma bipartição de trânsito isolada laparoscópica foi realizada como o primeiro procedimento em uma nova abordagem em duas etapas. Perda de peso e complicações foram analisadas durante um ano de acompanhamento. RESULTADOS: todos os procedimentos foram completados por laparoscopia. Após seis meses, a perda média de excesso de peso percentual foi de 28%, permanecendo estável até o final do estudo. Não houve dificuldades intraoperatórias. Metade dos pacientes apresentou diarreia precoce e três tiveram úlceras marginais. Não houve complicações cirúrgicas maiores ou mortes. CONCLUSÃO: a bipartição de trânsito isolada laparoscópica é uma nova opção para uma abordagem em estágios na superobesidade, que pode permitir um segundo procedimento mais seguro após a perda de peso ao longo de seis meses. Pode ser útil, particularmente, para pacientes com obesidade grave.

Role of moxifloxacin-dexamethasone in cardiac histomorphometric findings among Wistar rats from infected mothers.

PURPOSE: To investigate cardiac changes in young rats, whose mothers underwent autogenic fecal peritonitis, during organogenesis phase and to evaluate the role of intravenous administration of moxifloxacin and dexamethasone in preventing infection-related cardiac changes. METHODS: A prospective histomorphometric study was performed on 29 hearts of Wistar four-month old rats. Animals were divided into three groups: Negative Control Group (NCG) included 9 subjects from healthy mothers; Positive Control Group (PCG) included 10 subjects from mothers with fecal peritonitis (intra-abdominal injection of 10% autogenic fecal suspension in the gestational period) and did not receive any treatment; and Intervention Group (IG), with 10 animals whose infected mothers received moxifloxacin and dexamethasone treatment 24 hours after induction of fecal peritonitis. RESULTS: Nuclear count was higher in the IG group as compared to PCG (p = 0.0016) and in NCG as compared to PCG (p = 0.0380). There was no significant difference in nuclear counts between NCG and IG. CONCLUSION: Induced autogenic fecal peritonitis in pregnant Wistar rats determined myocardial changes in young rats that could be avoided by the early administration of intravenous moxifloxacin and dexamethasone.

Fecal peritonitis in aging rat model. Therapeutic response to different antibiotic strategies.

PURPOSE: To evaluate the response of aging rats with sepsis to two different antibiotic regimens. METHODS: The study was conducted with 30 aging rats (18 month-old) with autologous feces peritonitis. The animals were divided into three groups: Group 0 received no therapeutic intervention (control), while Group 1 received a single dose of 40 mg/kg meropenem and Group 2 received a single dose of 20 mg/kg moxifloxacin. The intervention in both Groups was made 6 hours after induction of peritonitis. The animals were followed up to 15 days for evaluating morbidity and mortality. The weights at baseline were similar in all groups. RESULTS: At the end of follow-up, weight loss was significantly greater (p=0.0045) in Group 0 (non-intervention controls). Culture from a blood sample at the end of follow-up was positive in all the animals in Group 0, in two animals in Group 1 and in four animals in Group 2. Morbidity/mortality was significantly higher in Group 0 compared to both Groups 1 and 2 (p=0.003) but the scores were not significantly different between Groups 1 and 2 (p=0.6967). CONCLUSION: Both antibiotic regimens rendered promising results for the treatment of fecal peritonitis.

[Portal hypertension in mansonic schistosomiasis: repercussions of surgical treatment on the histomorphometric profile of the gastric mucosa]. / Hipertensão porta na esquistossomose mansônica: repercussões do tratamento cirúrgico no perfil histomorfométrico da mucosa gástrica.

The repercussions from surgical treatment for controlling portal hypertension and its effects on the gastric vasculature of young patients with mansonic schistosomiasis were investigated by digital image analysis. The study included five patients at the preoperative stage and 27 patients who had undergone surgical intervention at different times in the past: 0-2 years ago, n=4; 2-6 years ago, n=13, and more than 6 years ago, n=10. Endoscopic biopsies were taken from the mucosa of the gastric antrum and body endoscopic mucosa and the samples underwent routine histological tests after embedding in paraffin blocks. Histological thin sections were used for histomorphometric analysis of the following parameters: mean number of vessels per field, and mean diameter and thickness of the vessel walls. The results showed that, between the patients whose operation was not more than two years ago and those whose operation was more than six years ago, there was a significant decrease in the density and diameter of the vessels. These findings give support to the concept that the surgical treatment administered decreases specific histological alterations like hemorrhage and ectasia, over the long term.

["Vision through the hands": experience of a project]. / Experiência em projeto: "Enxergando através das mãos"

PURPOSE: The Project "Vision through the hands" was performed by the Altino Ventura Foundation, with the purpose of investigating the present child situation with multiple disabilities in the state of Pernambuco, Brazil. METHODS: Birth and social conditions, social problems, and difficulty in accessing the specialized services were evaluated, aiming to collect relevant data with the goal of posterior implantation of a specialized diagnosis and treatment center. Ophthalmologic care and proper treatment were offered. RESULTS: Three hundred and nine children from five reference institutions in disabilities were attended, on six non consecutive days. All cases underwent ophthalmologic examinations and parent interviews. During the waiting time between the ophthalmologic visits and parent interviews the patients performed activities with artists. A multidisciplinary team of 31 professionals was available. According to parent information 83.1% of the patients were considered included in the society and only 45.4% attended school (normal or special). The difficulty to get access to ophthalmologic service was reported by 51.1%. Two hundred and seventy children with multiple disabilities were identified, 154 (56.2%) of whom underwent an ophthalmologic examination for the first time, and 33.0% had low visual acuity (inferior to 20/60 Snellen). The most frequent diagnoses were: refraction error, strabismus, ambliopia, alterations of optic nerve (glaucoma and atrophy), and cataract. Eighty-four glasses were prescribed. CONCLUSION: This project was pioneer in the region, allowing to obtain the information about important problems regarding multiple disabilities, and making possible ophthalmologic care and specialized treatment to the children.

Evidence and experience: what is the balance in surgeons' training?

Surgeons' training requires professionalism, continuing medical education, and appropriate environment to ensure the desirable success. However, generally, this goal is pursued in an inefficient way, based upon intensive training skills founded in the age-old philosophy of "the way I have learned it". There is, usually, a lack of patient outcome evaluation, especially of long-term follow-up of surgical procedures, which in turns provide little evidence of senior surgeons for adequate training junior surgeons. On the other hand, questioning the established knowledge is not stimulated, or even not tolerated by the seniors. It seems like the "truth" is absolute and allows no change for the new knowledge, which would mean no additional progress. There is a need to significantly alter the implementation of new knowledge, if possible based on evidence, to ensure the best medical care for the surgical patient. Experimental surgery, and nowadays bench model surgery, may be useful in minimizing the predictable complications of patients under the surgeon training responsibility, while on learning curve. Surgery based on evidence should be one of the tools for improving patient surgical care, since this important branch of medical activity must rest on two pillars "art and science"; and surgeon in good training needs to be close to both.

Bacterial translocation in rats nonfunctioning diverted distal colon.

PURPOSE: To investigate whether the alterations of the diverted colon segment mucosa, evidenced in fecal colitis, would be able to alter Bacterial Translocation (BT). METHODS: Sixty-two Wistar male rats ranging from 220 to 320 grams of weight, were divided in two groups: A (Colostomy) and B (Control), with 31 animals each one. In group A, all animals underwent end colostomy, one stoma, in ascending colon; and in the 70th POD was injected in five rats, by rectal route diverted segment - 2 ml of a 0.9% saline solution in animals (A1 subgroup); in eight it was inoculated, by rectal route, 2 ml of a solution containing Escherichia coli ATCC 25922 (American Type Culture Collection), in a concentration of 10(8) Colony Forming Unit for milliliters (CFU/ml) - A2 Subgroup; in ten animals the same solution of E. coli was inoculated, in a concentration of 10(11) CFU/ml (A3 Subgroup); and in eight it was collected part of the mucus found in the diverted distal colonic segment for neutral sugars and total proteins dosage (A4 subgroup). The animals from the group B underwent the same procedures of group A, but with differences in the colostomy confection. In rats from subgroups A1, A2, A3, B1, B2, and B3 2 ml of blood were aspirated from the heart, and fragments from mesenteric lymphatic nodule, liver, spleen, lung and kidney taken for microbiological analysis, after their death. This analysis consisted of evidencing the presence of E. coli ATCC 25922 CFU. Mann-Whitney and ANOVA Tests were applied as analytic techniques for association of variables. RESULTS: The occurrence of BT was evidenced only in those animals in which inoculated concentration of E. coli ATCC 25922, reached levels of 10(11)CFU/ml, i.e. in Subgroups A3 and B3, although, being significantly greater (80%) in those animals without colostomy (subgroup B3) when compared to the ones with colostomy (20%) from the subgroup A3 (P <0.05). Lung, liver and mesenteric lymphatic nodules were the tissues with larger percentile of bacterial recovery, so much in subgroup A3, as in B3. Blood culture was considered positive in 60% of the animals from subgroup B3 and in 10% of those from subgroup A3 (p <0.05). There was greater concentration of neutral sugars, in subgroup A4 - mean 27.3mg/ml -, than in subgroup B4 - mean 8.4 mg/ml - (P <0.05). CONCLUSION: The modifications in the architecture of intestinal mucosa in colitis following fecal diversion can cause alterations in the intestinal barrier, but it does not necessarily lead to an increased frequency of BT.

Intima-Media Thickness in the Carotid and Femoral Arteries for Detection of Arteriosclerosis in Human Immunodeficiency Virus-Positive Individuals.

BACKGROUND: The prevalence of atherosclerosis is higher in HIV-positive people, who also experience it earlier than the general population. OBJECTIVES: To assess and compare the prevalence of atherosclerosis evaluated by the intima-media thickness of carotid and femoral arteries, and by the ankle-brachial pressure index (ABPI) in HIV patients treated or not treated with protease inhibitors (PIs) and controls. METHODS: Eighty HIV+ subjects (40 using PIs and 40 not using PIs) and 65 controls were included in the study. Atherosclerosis was diagnosed by (carotid and femoral) ITM measurement and ABPI. Classical risk factors for atherosclerosis and HIV were compared between the groups by statistical tests. A p ≤ 0.05 was considered significant. RESULTS: An IMT > P75 or the presence of plaque was higher in the HIV+ than in the control group (37.5% vs 19%, p = 0.04). Comparative analysis showed a significant difference (p=0.014) in carotid IMT between HIV+ with PIs (0.71 ± 0.28 mm), without PIs 0.63 ± 0.11 mm and, and controls (0.59 ± 0.11 mm). There was no significant difference in femoral IMT between the groups or in ABPI between HIV+ subjects and controls. However, a significant difference (p=0.015) was found between HIV+ patients not treated with PIs (1.17 [1.08 - 1.23]), and controls 1.08 [1.07 - 1.17]). CONCLUSION: In HIV patients, atherosclerosis is more prevalent and seems to occur earlier with particular characteristics compared with HIV-negative subjects.

[Phagocytes rate and cellular viability of the monocytes in patients with hepatosplenic schistosomiasis mansoni who underwent splenectomy and auto-implantation of spleen tissue]. / Fagocitose e viabilidade monocitária de pacientes com esquistossomose mansônica na forma hepatoesplênica submetidos à esplenectomia e ao auto-implante esplênico.

Mansonic schistosomiasis remains a medical-social issue in Northeastern Brazil. In children, surgical treatment includes splenectomy and spleen autoimplantation. This procedure reduces post-splenectomy sepsis. The aim of this study was to analyze the phagocyte rate and the cellular viability of monocytes in patients with hepatosplenic schistosomiasis, who underwent splenectomy and spleen autoimplantation from 1991 to 2001. Of the 22 individuals analyzed, 11 were patients who underwent splenectomy and spleen autoimplantation (Study group) and 11 were healthy individuals from the same region (Control group). Both groups presented similar mean age. No difference was found in the phagocyte rate between the control group (36.1%+/-4.9%) and study group (33.5%+/-5.7%). However, phagocyte viability after stimulation with lipopolysaccharide was higher (94%) in control group, when compared to the study group (65%), p<0.001. It is possible to hypothesize that monocytes from the study group patients presented a reduced response to the microorganism challenge, in the face of a harmful and long-lasting stimulus.

[Study of retinal nerve fiber layer in patients with schistosomiasis mansoni: analysis with GDX]. / Estudo da camada de fibras nervosas da retina em pacientes com esquistossomose mansônica: análise com GDx.

PURPOSE: To study the retinal nerve fiber layer in young patients suffering from hepatosplenic schistosomiasis mansoni. METHODS: Twenty-three patients with hepatosplenic schistosomiasis mansoni who were submitted, when children, to splenectomy, ligature of the left gastric vein and auto-implantation of spleen tissue in the major omentum underwent GDx Scanning Laser System evaluations. All patients presented with intraocular pressure below 21 mmHg. RESULTS: Only one patient suffering from hepatosplenic schistosomiasis mansoni showed abnormalities on the GDx examination. There were no abnormalities on GDx examination in the control group. CONCLUSION: There was no significant difference between the two groups of this study. Only one patient showed retinal nerve fiber layer reduction.

[Phacoemulsification of first and second eye: indication criteria and results]. / Facoemulsificação do primeiro e segundo olho: critérios de indicação e resultados.

PURPOSE: To compare indication criteria, intra- and postoperative complications, visual outcomes and time interval between the first and second eye surgery (phacoemulsification). METHODS: Prospective study was done in 96 eyes of patients who underwent bilateral consecutive phacoemulsification surgery, performed by a third-year ophthalmology resident. An established protocol was filled out before, during and after the surgery. The same surgical technique was used. Chi-squared, Mann-Whitney, Kruskal-Wallis, Dunn multiple comparison and Student's t tests were used for statistical analysis. Bicaudal tests were used in all situations. p<0.05 rejected the null hypothesis. RESULTS: The indication for the second eye surgery was done earlier and with best correct visual acuity when compared with the first eye (p=0.016). The mean phacoemulsification ultrasound time (US time) of the first eye was significantly higher (p=0.026). There were no statistically significant differences between the two groups in relation to type of cataract, previous intraocular diseases, final visual acuity and mean spherical equivalent. The incidence of intra- and postoperative complications was smaller in the second eye, but was not statistically significant (p=0.07). Time interval between the first and second eye surgery was significantly lower along the trimesters. CONCLUSION: The patients underwent the second eye phacoemulsification surgery earlier (with better visual acuity and shorter time interval), had a shorter phacoemulsification time and tendency to be followed by less intra- and postoperative complications.

Nitric oxide monocyte production levels in patients with the hepatosplenic form of schistosomiasis mansoni who underwent splenectomy, ligature of the left gastric vein and auto implantation of spleen tissue in the major omentum.

PURPOSE: To measure the levels of NO production by monocytes in patients with the hepatosplenic form of Schistosomiasis mansoni who underwent splenectomy, ligature of the left gastric vein and auto implantation of spleen tissue in the major omentum. METHODS: Four groups of volunteers were enrolled in the investigation: G1 - 12 patients with S. mansoni infection in its hepatosplenic form without any kind of treatment (SMH); G2 - 13 SMH patients who underwent medical treatment and portal hypertension decompression splenectomy and ligature of the left gastric vein (SMH/SLGV); G3 - 19 patients similar to the later group, but additionally received auto implantation of spleen morsels in the major omentum (SMH/SLGV/AI); and G4 - 15 individuals with no S. mansoni infection coming from the same geographical area and presenting similar socio-economical status (CG). Nitrite production by monocytes was determined by a standard Griess reaction adapted to microplates. The results were presented by mean +/- SD for each group. Significant differences in NO production by monocytes were determined by Tukey-Kramer multicomparisons test. Probability values of 0.05 were considered significant. RESULTS: Patients from G1 (SMH) showed lower level of NO production by monocytes (5.28 +/- 1.28 micromol/ml). Patients from G2 (SMH/SLGV) showed similar results (6.67 +/- 0.44 micromol/ml-q = 2.681 p > 0.05). Individuals of G4 (CG) showed higher level of NO production by monocytes (8.19 +/- 2.74 micromol/ml). Patients from G3 (SMH/SGLV/AI) showed similar NO production by PBMC as compared to individuals of G4 (CG) - (7.41 +/- 1.65 micromol/ml- q = 1.615 p > 0.05). The volunteers from G4 (CG) and G3 (SMH/SLGV/AI) showed significantly greater levels of NO production by monocytes as compared to those from G1 (SMH) - (q = 5.837 p < 0.01, and q = 4.285 p < 0.05). CONCLUSION: Collectively, the results point to a restoration of NO normal production by monocytes in SHM patients who underwent medical and surgical treatments, especially in those who had received auto implantation of spleen tissue in the major omentum after splenectomy and ligature of the left gastric vein. The data gives further support to the hypothesis that this additional procedure is important in the restoration of the immune response of these patients, since NO synthesis by the monocytes correlates with protective immunity against infection; thus, protecting them against overwhelming post splenectomy infection.

Avaliação dos dados pré e resultados pós operatórios de facotrabeculectomia em seguimento mínimo de cinco anos / Evaluation of preoperative data and post-operative results of phacotrabeculectomy in minimum five-year follow-up

RESUMO Objetivo: Avaliar os resultados da facotrabeculectomia em seguimento igual ou superior a 5 anos. Métodos: Estudo retrospectivo, de intervenção e analítico realizado no centro cirúrgico da clínica de olhos de Juazeiro do Norte com pacientes operados no período de 2006 a 2013. Foram envolvidos na investigação 34 olhos de 29 pacientes com catarata senil e glaucoma primário de ângulo aberto submetidos à facotrabeculectomia. Foi criado um escore de risco de dano glaucomatoso variando de 0 a 5 ao avaliar pressão intraocular, escavação do disco óptico, número de drogas hipotensoras utilizadas para o tratamento do glaucoma e a idade do paciente em anos. A amostra foi de conveniência e pareada. Foi utilizado o teste de Wilcoxon pareado para a verificação de diferenças entre médias. Foi aceito p< 0,05 para a rejeição da hipótese de nulidade. O estudo foi aprovado pelo comitê de ética da plataforma Brasil e segue a resolução 466 do Conselho Nacional de Saúde. Resultados: A média da acuidade visual foi significantemente maior após o seguimento de 5 anos (média pré-operatória 0,42 +/- 0,23 ver-sus média pós-operatória 0,62 +/- 0,29 - p=0,0031). A média dos escores de risco para dano glaucomatoso após 5 anos de seguimento foi significativamente menor quando comparado ao pré-operatório (media pré-operatória: 9,47 +/- 1,61 versus média pós-operatória 6,55 +/- 2,21) p < 0,0001, considerado extremamente significante. Conclusão: A facotrabeculectomia foi significantemente efetiva na melhora da acuidade visual e na redução do risco de dano glau-comatoso após seguimento pós-operatório igual ou superior a 5 anos.

ABSTRACT Objective: To evaluate the results of phacotrabeculectomy in a follow-up of five years or more. Methods: Retrospective, interventional and analytical study that was carried out in the surgical center of clínica de olhos do juazeiro with patients operated on from 2006 to 2013. 34 eyes of 29 patients with senile cataract and primary open-angle glaucoma, who underwent phacotrabeculectomy were involved in the investigation. A risk score for glaucomatous dam-age ranging from 0 to 5 when evaluating intraocular pressure, excavation of the optic disc, number of hypotensive drugs used to treat glaucoma and the patient's age in years. The sample was of convenience and paired. The paired Wilcoxon test was used to verify differences be-tween means. P <0.05 was accepted for the rejection of the null hypothesis. The study was approved by the ethics committee of the Brazil platform and follows the principles of resolu-tion 466 of the National Health Council. Results: The mean visual acuity was significantly higher after a five-year follow-up (preoperative average 0.42 +/- 0.23 versus postoperative average 0.62 +/- 0.29 - p = 0.0031). The average risk score for glaucomatous damage after five years of follow-up was significantly lower when compared to the preoperative (preoperative mean: 9.47 +/- 1.61 versus postoperative mean 6.55 +/- 2, 21) p <0.0001, considered extremely significant. Conclusion: Phacotrabeculectomy was significantly effective in improving visual acuity and reducing the risk of glaucomatous damage after a five-year postoperative follow-up.

[Evaluation of the effect of splenectomy with autologous spleen tissue implantation in some monocyte functions in children with hepatosplenic schistosomiasis mansoni]. / Avaliação do efeito da esplenectomia e auto-implante esplênico sobre algumas funções de monócitos em crianças com esquistossomose mansônica.

Adherence index, superoxide and TNF-alpha production in monocytes, with or without tuftsin treatment, were investigated in hepatosplenic schistosomiasis mansoni bearers with splenectomy with or without autologous implantation of spleen tissue. Three groups were evaluated: Healthy volunteers control group (CG) (n=12); Splenectomy with seft auto-transplant AG (n=18) and Splenectomy without auto-transplant WAG (n=9). Adherence index and TNF-alpha did not differ among the groups. Superoxide production was similar in CG and AG, in the 1st hour after cell stimulation. SP was larger in each hour time in CG and AG groups as compared WAS group. TT recovered normal pattern of SP in AG comparable with levels found in CG, with increase from the 1st to 2nd hour. However, TT did not alter SP in WAG, which remained reduced in all time points. Autologous implantation of spleen tissue seems to contribute for recovery and maintenance of the evaluated immunological reactions, which might be important in response to infections.

[Intraoperative mapping of motor areas during brain tumor surgery: electrical stimulation patterns]. / Mapeamento da área motora durante a cirurgia de tumor intracraniano: fatores que podem modificar a intensidade da estimulação.

UNLABELLED: Brain mapping with direct electrical stimulation is usefull when the tumor is located near or has infiltrated the central lobe. OBJECTIVE: To analyze the surgical findings with direct electrical stimulation of the cortex and white matter under general anesthesia during surgery for brain tumors related to the central lobe. METHOD: We studied 42 patients operated on from June 2000 to June 2003. We analyzed surgical findings and details of brain mapping. RESULTS: The mean value of the intensity of the stimulus was greater among those who presented motor deficit prior to surgery (p = 0.0425) and edema on MRI (p = 0.0468) or during anesthesia with continuous propofol (p = 0.001). CONCLUSION: The functional mapping of the central lobe may be influenced by severe motor deficit, edema on MRI and propofol's anesthesia.