Microlithiasis of the gallbladder: role of endoscopic ultrasonography in patients with idiopathic acute pancreatitis

OBJECTIVES: Causes may be found in most cases of acute pancreatitis, however no etiology is found by clinical, biological and imaging investigations in 30% of these cases. Our objective was to evaluate results from endoscopic ultrasonography (EUS) for diagnosis of gallbladder microlithiasis in patients with unexplained (idiopathic) acute pancreatitis. METHODS: Thirty-six consecutive non-alcoholic patients with diagnoses of acute pancreatitis were studied over a five-year period. None of them showed signs of gallstones on transabdominal ultrasound or tomography. We performed EUS within one week of diagnosing acute pancreatitis. Diagnosis of gallbladder microlithiasis on EUS was based upon findings of hyperechoic signals of 0.5-3.0 mm, with or without acoustic shadowing. All patients (36 cases) underwent cholecystectomy, in accordance with indication from the attending physician or based upon EUS diagnosis. RESULTS: Twenty-seven patients (75%) had microlithiasis confirmed by histology and nine did not (25%). EUS findings were positive in twenty-five. Two patients had acute cholecystitis diagnosed at EUS that was confirmed by surgical and histological findings. In two patients, EUS showed cholesterolosis and pathological analysis disclosed stones not detected by EUS. EUS diagnosed microlithiasis in four cases not confirmed by surgical treatment. In our study, sensitivity, specificity and positive and negative predictive values to identify gallbladder microlithiasis (with 95% confidence interval) were 92.6% (74.2-98.7%), 55.6% (22.7-84.7%), 86.2% (67.4-95.5%) and 71.4% (30.3-94.9%), respectively. Overall EUS accuracy was 83.2%. CONCLUSIONS: EUS is a very reliable procedure to diagnose gallbladder microlithiasis and should be used for the management of patients with unexplained acute pancreatitis. This procedure should be part of advanced endoscopic evaluation.

Relationship between the southern annular mode and southern hemisphere atmospheric systems

Seasonal relationship between the Southern Annular Mode (SAM) and the spatial distribution of the cyclone systems over Southern Hemisphere is investigated for the period 1980 to 1999. In addition, seasonal frontogenesis and rainfall distribution over South America and South Atlantic Ocean during different SAM phases were also analyzed. It is observed that during negative SAM phases the cyclone trajectories move northward when compared to the positive one, and in the South America and South Atlantic sector there is intense frontogenetic activity and positive anomaly precipitation over the Southeast of the South America. In general, SAM positive phase shows opposite signals.

Karyological study of Amphisbaena ridleyi (Squamata, Amphisbaenidae), an endemic species of the Archipelago of Fernando de Noronha, Pernambuco, Brazil

The karyotype of Amphisbaena ridleyi, an endemic species of the archipelago of Fernando de Noronha, in State of Pernambuco, Brazil, is described after conventional staining, Ag-NOR impregnation and fluorescence in situ hybridization (FISH) with a telomeric probe. The diploid number is 46, with nine pairs of macrochromosomes (three metacentrics, four subtelocentrics and two acrocentrics) and 14 pairs of microchromosomes. The Ag-NOR is located in the telomeric region of the long arm of metacentric chromosome 2 and FISH revealed signals only in the telomeric region of all chromosomes. Further cytogenetic data on other amphisbaenians as well as a robust phylogenetic hypothesis of this clade is needed in order to understand the evolutionary changes on amphisbaenian karyotypes.

Hemodynamic, morphometric and autonomic patterns in hypertensive rats - renin-angiotensin system modulation

BACKGROUND: Spontaneously hypertensive rats develop left ventricular hypertrophy, increased blood pressure and blood pressure variability, which are important determinants of heart damage, like the activation of renin-angiotensin system. AIMS: To investigate the effects of the time-course of hypertension over 1) hemodynamic and autonomic patterns (blood pressure; blood pressure variability; heart rate); 2) left ventricular hypertrophy; and 3) local and systemic Renin-angiotensin system of the spontaneously hypertensive rats. METHODS: Male spontaneously hypertensive rats were randomized into two groups: young (n=13) and adult (n=12). Hemodynamic signals (blood pressure, heart rate), blood pressure variability (BPV) and spectral analysis of the autonomic components of blood pressure were analyzed. LEFT ventricular hypertrophy was measured by the ratio of LV mass to body weight (mg/g), by myocyte diameter (μm) and by relative fibrosis area (RFA, %). ACE and ACE2 activities were measured by fluorometry (UF/min), and plasma renin activity (PRA) was assessed by a radioimmunoassay (ng/mL/h). Cardiac gene expressions of Agt, Ace and Ace2 were quantified by RT-PCR (AU). RESULTS: The time-course of hypertension in spontaneously hypertensive rats increased BPV and reduced the alpha index in adult spontaneously hypertensive rats. Adult rats showed increases in left ventricular hypertrophy and in RFA. Compared to young spontaneously hypertensive rats, adult spontaneously hypertensive rats had lower cardiac ACE and ACE2 activities, and high levels of PRA. No change was observed in gene expression of Renin-angiotensin system components. CONCLUSIONS: The observed autonomic dysfunction and modulation of Renin-angiotensin system activity are contributing factors to end-organ damage in hypertension and could be interacting. Our findings suggest that the management of hypertensive disease must start before blood pressure reaches the highest stable levels and the consequent established end-organ damage is reached.

Engagement of multifocal neural circuits during recall of autobiographical happy events

Happy emotional states have not been extensively explored in functional magnetic resonance imaging studies using autobiographic recall paradigms. We investigated the brain circuitry engaged during induction of happiness by standardized script-driven autobiographical recall in 11 healthy subjects (6 males), aged 32.4 ± 7.2 years, without physical or psychiatric disorders, selected according to their ability to vividly recall personal experiences. Blood oxygen level-dependent (BOLD) changes were recorded during auditory presentation of personal scripts of happiness, neutral content and negative emotional content (irritability). The same uniform structure was used for the cueing narratives of both emotionally salient and neutral conditions, in order to decrease the variability of findings. In the happiness relative to the neutral condition, there was an increased BOLD signal in the left dorsal prefrontal cortex and anterior insula, thalamus bilaterally, left hypothalamus, left anterior cingulate gyrus, and midportions of the left middle temporal gyrus (P < 0.05, corrected for multiple comparisons). Relative to the irritability condition, the happiness condition showed increased activity in the left insula, thalamus and hypothalamus, and in anterior and midportions of the inferior and middle temporal gyri bilaterally (P < 0.05, corrected), varying in size between 13 and 64 voxels. Findings of happiness-related increased activity in prefrontal and subcortical regions extend the results of previous functional imaging studies of autobiographical recall. The BOLD signal changes identified reflect general aspects of emotional processing, emotional control, and the processing of sensory and bodily signals associated with internally generated feelings of happiness. These results reinforce the notion that happiness induction engages a wide network of brain regions.

Hormônio do crescimento e exercício físico: considerações atuais

Embora o hormônio do crescimento (GH) seja um dos hormônios mais estudados, vários de seus aspectos fisiológicos ainda não estão integralmente esclarecidos, incluindo sua relação com o exercício físico. Estudos mais recentes têm aumentado o conhecimento a respeito dos mecanismos de ação do GH, podendo ser divididos em: 1) ações diretas, mediadas pela rede de sinalizações intracelulares, desencadeadas pela ligação do GH ao seu receptor na membrana plasmática; e 2) ações indiretas, mediadas principalmente pela regulação da síntese dos fatores de crescimento semelhantes à insulina (IGF). Tem sido demonstrado que o exercício físico é um potente estimulador da liberação do GH. A magnitude deste aumento sofre influência de diversos fatores, em especial, da intensidade e do volume do exercício, além do estado de treinamento. Atletas, normalmente, apresentam menor liberação de GH induzida pelo exercício que indivíduos sedentários ou pouco treinados. Evidências experimentais demonstram que o GH: 1) favorece a mobilização de ácidos graxos livres do tecido adiposo para geração de energia; 2) aumenta a capacidade de oxidação de gordura e 3) aumenta o gasto energético.

Supressão das anomalias de fase e batimentos laterais em espectros de RMN 13c obtidos com a sequência de precessão livre no estado estacionário

The Steady-State Free Precession (SSFP) sequence has been widely used in low-field and low-resolution imaging NMR experiments to increase the signal-to-noise ratio (s/n) of the signals. Here, we analyzed the Scrambled Steady State - SSS and Unscrambled Steady State - USS sequences to suppress phase anomalies and sidebands of the 13C NMR spectrum acquired in the SSFP regime. The results showed that the application of the USS sequence allowed a uniform distribution of the time interval between pulses (Tp), in the established time range, allowing a greater suppression of phase anomalies and sidebands, when compared with the SSS sequence.

Estudo de filtros RC para baixas e altas freqüências por meio de um circuito para superposição de sinais

Apresentamos nesse trabalho, um experimento realizado nos Laboratórios didáticos do Instituto de Física da USP, relacionado ao estudo do funcionamento de filtros RC para baixas e altas freqüências. Para tal, foi especialmente projetado um circuito que efetua a superposição de um sinal gerado internamente, a uma onda senoidal externa. Várias situações experimentais podem ser geradas, por meio da variação da freqüência, tanto do sinal interno quanto da onda senoidal externa. Um estudo das componentes de freqüência de Fourier é também realizado para se estabelecer os parâmetros de funcionamento dos filtros. O funcionamento dos circuitos como integradores e diferenciadores também é explorado. Os estudantes são, portanto, levados a compreender a eficácia desses filtros mais simples, dependendo das freqüências dos sinais de entrada e correspondentes componentes de Fourier, e das freqüências de corte estabelecidas.

As vivências: questões de tradução, sentidos e fontes epistemológicas no legado de Vigotski

O objetivo deste artigo é abordar a questão das vivências na perspectiva de L.S. Vigotski, tratando de suas fontes epistemológicas, de suas raízes na língua russa e de seus sentidos específicos, priorizando "A Tragédia do Hamlet, Príncipe da Dinamarca" (1916) e os textos pedológicos dos anos 1930, com destaque para "A questão do meio na pedologia". Destacam-se as transformações das ideias do autor sobre vivências e sua contribuição metodológica à  análise da relação indivíduo-meio no desenvolvimento humano, articulada aos conceitos de consciência e sistema.

O conceito de vivência em Freud e Husserl

Este artigo visa explicitar as concepções freudiana e husserliana de “vivência” (Erlebnis). Por “vivência” entende-se genericamente um tipo fundamental de experiência do mundo. Esse tema, ainda que não diretamente explorado por Freud, tornou-se necessário em sua teoria desde a descoberta da etiologia da histeria no início dos anos 1890 à luz do método catártico: a da vivência traumática. Por outro lado, Husserl, a partir do problema filosófico de garantir a possibilidade do conhecimento universal e necessário, se viu obrigado a combater o naturalismo das ideias, em 1900, e o naturalismo da consciência, em 1913, em ambos os casos partindo de uma análise das vivências (intencionais). Mostrarei que a abordagem freudiana (natural-científica) visa explicar metapsicologicamente a vivência, ao passo que a abordagem husserliana pretende descrever a estrutura da vivência (intencional). Por fim, apontarei para algumas das grandes diferenças entre ambas as abordagens desse tema.

Evaluation of a simple hyphenated system for flow injection solid-phase pre-concentration and capillary electrophoresis

In this work, the development and evaluation of a hyphenated flow injection-capillary electrophoresis system with on-line pre-concentration is described. Preliminary tests were performed to investigate the influence of flow rates over the analytical signals. Results revealed losses in terms of sensitivity of the FIA-CE system when compared to the conventional CE system. To overcome signal decrease and to make the system more efficient, a lower flow rate was set and an anionic resin column was added to the flow manifold in order to pre-concentrate the analyte. The pre-concentration FIA-CE system presented a sensitivity improvement of about 660% and there was only a small increase of 8% in total peak dispersion. These results have confirmed the great potential of the proposed system for many analytical tasks especially for low concentration samples.

Production of DNA microarray and expression analysis of genes from Xylella fastidiosa in different culture media

DNA Microarray was developed to monitor the expression of many genes from Xylella fastidiosa, allowing the side by-side comparison of two situations in a single experiment. The experiments were performed using X. fastidiosa cells grown in two culture media: BCYE and XDM2. The primers were synthesized, spotted onto glass slides and the array was hybridized against fluorescently labeled cDNAs. The emitted signals were quantified, normalized and the data were statistically analyzed to verify the differentially expressed genes. According to the data, 104 genes were differentially expressed in XDM2 and 30 genes in BCYE media. The present study showed that DNA microarray technique efficiently differentiate the expressed genes under different conditions.

Heartworm (Dirofilaria immitis) disease in a Brazilian oncilla (Leopardus tigrinus)

Heartworm disease is caused by the intravascular nematode Dirofilaria immitis, a pathogen of public health importance usually associated to domestic dogs and cats, and to a lesser extend to other mammal species. The oncilla (Leopardus tigrinus) is a threatened neotropic felid species that naturally occurs in Brazil. Here, we report the encounter of adult and larval stages of heartworms in a female specimen of L. tigrinus, probable of free-ranging origin, from Ubatuba, São Paulo, Brazil, which died showing clinical signals compatible with heartworm disease. This was the first reported case of D. immitis infection and associated disease in L. tigrinus, also suggesting that the oncilla acted as a definitive host for this parasite. The present findings confirmed D. immitis as a pathogenic agent for this felid species, thus supporting the recommendation for the inclusion of diagnostic testing for this pathogen in routine health screening procedures for captive and free-ranging oncillas in Brazil, especially in those localities where climate conditions support the occurrence of the parasite. Potential reservoirs as oncillas are established beyond the reach of veterinary care, thus representing a continuing risk for domestic animals and humans acquiring heartworm infection. We encourage further serologic and molecular studies aiming to establish D. immitis prevalences in L. tigrinus and other wild carnivores in the region of Ubatuba, as well as ecological and veterinary studies to access the role of this pathogen for the survival of this threatened felid species.

A fuzzy reed-frost model for epidemic spreading

In this paper, we present a fuzzy approach to the Reed-Frost model for epidemic spreading taking into account uncertainties in the diagnostic of the infection. The heterogeneities in the infected group is based on the clinical signals of the individuals (symptoms, laboratorial exams, medical findings, etc.), which are incorporated into the dynamic of the epidemic. The infectivity level is time-varying and the classification of the individuals is performed through fuzzy relations. Simulations considering a real problem with data of the viral epidemic in a children daycare are performed and the results are compared with a stochastic Reed-Frost generalization

Cuidado à saúde de crianças Kaiowá e Guarani: notas de observação de campo

Inicia-se uma discussão sobre as práticas de saúde e cuidado utilizadas pelos Kaiowá e Guarani da Terra Indígena de Caarapó no enfrentamento das doenças diarréicas na infância. Utilizou-se de uma contribuição etnográfica, através do uso da técnica da observação participante e de entrevistas aberta com moradores da comunidade. Em se tratando de uma sociedade que vivencia permanentes transformações de ordem social advindas das relações interétnicas e da sucessiva presença dos serviços de saúde, observa-se que o significado de diarréia infantil, assim como as decisões relativas à prevenção e ao seu tratamento, refletem comportamentos diferenciados e complexos. A diarréia, também conhecida como chiri, é definida através de sinais que, de certa forma, são semelhantes aos biomédicos. No entanto, nem sempre as explicações de causalidade e as formas de tratamento seguem, unicamente, a abordagem biomédica. A variedade de causas da doença diarréica entre as crianças indígenas implica na escolha do processo terapêutico, que pode ser desde a procura por um especialista tradicional, realização de chás e infusões e, ainda, procura pelos serviços de saúde. Tais explicações e formas de tratamento pressupõem a existência de um processo de negociação entre pessoas de uma mesma cultura e de culturas distintas. Neste sentido, os serviços de saúde ao tratar a criança com diarréia, devem considerar não apenas a perspectiva biomédica, mas também dialogar com a percepção e as práticas indígenas na identificação da causalidade, na definição do diagnóstico e do tratamento, sobretudo, pela coexistência destas práticas no contexto local