O perfil sociodemográfico de pacientes em pós-operatório imediato de prostatectomia

Identificar o perfil sociodemográfico de pacientes submetidos à prostatectomia. Método: estudo quantitativo, transversal e descritivo, realizado na clínica cirúrgica de um Hospital Universitário na cidade de Natal/RN/Brasil, com 50 indivíduos em pós-operatório imediato de prostatectomia. A coleta de dados deu-se com um roteiro de anamnese e exame físico. Para a análise estatística dos dados foi utilizado o Programa Statistical Package for the Social Sciences, versão 16.0. O projeto de pesquisa foi aprovado pelo Comitê de Ética da Universidade Federal do Rio Grande do Norte, protocolo nº 130/10 CEP/UFRN. Resultados: os homens entrevistados tinham idade média de 67,78 anos, 80% tinham companheiros, com número de filhos variando de zero a quatro (56%). Conclusão: o conhecimento do perfil sociodemográfico dos pacientes prostatectomizados proporciona um direcionamento das ações de enfermagem frente à realidade de vida dessa clientela, uma vez que os pacientes estudados apresentaram perfil similar ao observado em outras cidades brasileiras

Perfil socioeconômico de pessoas com úlcera venosa: aspectos relevantes para a enfermagem

Traçar o perfil socioeconômico dos pacientes com úlcera venosa. Método: estudo quantitativo, transversal e descritivo, realizado com 50 pessoas no ambulatório de clínica cirúrgica do Hospital Universitário Onofre Lopes/HUOL, localizado no município de Natal/RN/Nordeste do Brasil, utilizando-se um roteiro de entrevista. Os dados coletados foram tabulados e armazenados numa planilha do software Excel e analisadas pela estatística descritiva. O estudo foi aprovado pelo Comitê de Ética em Pesquisa, CAAE 0038.0.294.000-11. Resultados: idade média de 59,72 anos, 66% pertenciam ao sexo feminino, 60% possuíam companheiro, a média de estudos foi de 4,98 (±3,36) anos e a renda familiar 2,3 salários mínimos. Encontrou-se, portanto, o perfil de pessoas com úlcera venosa semelhante ao evidenciado na literatura. Conclusão: é imprescindível conhecer as características dessa clientela para desenvolver estratégias visando à melhoria de suas condições de saúde

Potencial terapêutico de um heparinóide isolado do invertebrado marinho Litopenaeus vannamei

The occurrence of bioactive compounds in marine organisms comes awaking the interest of the pharmaceutical industry. Heparin, a sulfated polysaccharide which presence was already identified in several marine invertebrates, is very attractive due its remarkable functional versatility. Besides to intervene in blood coagulation, this molecule has a great anti-inflammatory potential. However, its strong anticoagulant activity difficult the clinical exploitation of its anti-inflammatory properties. Thus, the aims of this work were to evaluate the effect of a heparin-like compound (heparinoid), isolated from the cephalotorax of the Litopenaeus vannamei shrimp, on the inflammatory response, hemostasia and synthesis of antithrombotic heparan sulfate by endothelial cells, besides studying some aspects concerning its structure. The purified heparinoid was structurally characterized following an analytical boarding, involving electrophoresis and chromatography. The structural analysis have shown that this compound possess a high content of glucuronic acid residues and disulfated disaccharide units. In contrast to mammalian heparin, the heparinoid was incapable to stimulate the synthesis of heparan sulfate by endothelial cells in the tested concentrations, beyond to show reduced anticoagulant activity and hemorrhagic effect. In a model of acute inflammation, the compound isolated from the shrimp reduced more than 50% of the cellular infiltration. Besides reduce the activity of MMP-9 and proMMP-2 of the peritoneal lavage of inflamed animals, the heparinoid also reduced the activity of MMP-9 secreted by activated human leukocytes. These results demonstrate the potential of heparinoid from L. vannamei to intervene in the inflammatory response. For possessing reduced anticoagulant activity and hemorrhagic effect, this compound can serve as a structural model to direct the development of more specific therapeutical agents to the treatment of inflammatory diseases

Avaliação do potencial antiinflamatório, anticoagulante e hemorrágico de heparinóides presentes em "Artemia franciscana"

Heparan sulfate (HS) and Heparin (Hep) glycosaminoglycans (GAGs) are heterogeneous and highly charged polysaccharides. HS is structurally related to Hep but is much less substituted with sulfo groups than heparin and has a more varied structure (or sequence). Because of structural similiarities between these two polymers, they have been described together as heparinoids . Both chains bind a variety of proteins and mediate various physiologically important processes including, blood coagulation, cell adhesion and growth factor regulation. Heparinoids with structural characteristics similar to these described from HS and/or Hep from mammalian tissues have been isolated from different species of invertebrates, although only a few heparinoids from unusual sources have been characterized. The present study describes the presence of unusual heparinoids population from Artemia franciscana, isolated after proteolysis and fractionation by ion exchange resin and named, F-3.0M. The study model in vivo were hemostasis (rat tail scarification) and inflamatoty activity. The tests in vitro were used for coagulations assays (PT and APTT). The analyse of the heparinoids eluted with 3,0M NaCl showed electrophoretic migration in different buffer systems a single band with a behaviour intermediate between those of mammalian HEP and HS. The main products obtained from Artemia heparinoids after enzymatic degradation with heparitinases I and II from F. heparinum were N-sulphated disaccharides (∆U-GlcNS,6S/ ∆U,2S-GlcNS and ∆U-GlcNS) and N-acetylated disaccharides (∆U, GlcNAc). This heparinoid had a lower hemorrhagic effect (400μg/ml) when compared to unfractiionated heparins(25μg/ml).The results also suggest a negligible APTT activity of this heparinoid (62.2s). No action was observed on PT indicating that F-3.0M haven t action on the extrinsic pathway. The results showed that the fraction F- 3.0M have inhibitory effect on migration of leukocytes, 64.5% in the concentration of 10 μg/ml (P<0.001). The search for new heparin and/or heparan sulphates analogs devoid of anticoagulant activity is an atractive alternative and may open up a wide variety of new therapeutic applications

Aspectos estruturais, farmacológicos e biológicos de fucanas da alga marrom sargassum vulgare

The present study examines the chemical composition and their effects on free radicals, inflammation, angiogenesis, coagulation, VEGF effects and cellular proliferation of a polysaccharides from alga Sargassum vulgare. The sulfated polysaccharide was extracted from brown seaweed by proteolysis with enzymes maxataze. The presence of proteins and sugars were observed in crude polysaccharides. Fractionation of this crude extract was made with growing concentration of acetone (0.3-1.5 v) and produced four groups of polysaccharides. Anionic polysaccharides from brown seaweed Sargassum vulgare, SV1and PSV1 were fractionated (SV1) and purified (PSV1), and displayed with high total sugars and sulfate content and very low level of protein. This fucan SV1 contains low levels of protein and high carbohydrate and sulfate content. This polysaccharides prolonged activated partial thromboplastin time (aPTT) at 50 μg (>240 s). SV1 was found to have no effect on prothrombin time (PT), corresponding to the extrinsic pathway of coagulation. SV1 exhibits high antithrombotic action in vivo, with a concentration ten times higher than heparin. Polysaccharides from S. vulgare promoted direct inhibition enzymatic activity of thrombin and stimulated enzymatic activity of FXa. SV1 showed optimal inhibitory activity of thrombin (50.2±0.28%) at a concentration of 25 μg/mL. Its antioxidant action on scavenging radicals by DPPH was (22%), indicating the polymer has no cytotoxic action (hemolytic) on ABO and Rh blood types in different erythrocyte groups and displays strong anti-inflammatory action on all concentrations tested in the carrageenan-induced paw edema model, demonstrated by reduced edema and cellular infiltration. Angiogenesis is a dynamic process of proliferation and differentiation. It requires endothelial proliferation, migration, and tube formation. In this context, endothelial cells are a preferred target for several studies and therapies. The antiangiogenic efficacy of polysaccharides was examined in vivo in the chick chorioallantoic membrane (CAM) model by using fertilized eggs. Decreases in the density of the capillaries were assessed and scored. The results showed that SV1 and PSV1 have an inhibitory effect on angiogenesis. These results were also confirmed by inhibition tubulogenesis in rabbit aorta endothelial cell (RAEC) in matrigel. These compounds were assessed in Apoptosis assay (Annexin V - FITC / PI) and cell viability by MTT assay of RAEC. These polysaccharides do not affect the viability and do not have apoptotic or necrotic action. RAEC cell when incubated with SV1 and PSV1showed inhibition of VEGF secretion, observed when compounds were incubated at 25, 50 and 100 μg/μL. The VEGF secretion with the RAEC cell line for 24 h, was more effective for PSV1 at 50 μg/μL(71.4%) than SV1 100 μg/μL (75.9%). SV1 and PSV1 had an antiproliferative action (47%) against tumor cell line HeLa. Our results indicate that these sulfated polysaccharides have antiangiogenic and antitumoral actions

Polissacarídeos sulfatados de interesse farmacológico no camarão litopenaeus schimitti

Sulfated Polysaccharides with unique chemical structures and important biological activities has been found in a diversity of sea invertebrates. For that, to exist a huger interest on the biotechnology field in the research theses sulfated compounds isolated from sea organisms. Despite the privileged brazilian position for these compounds attainment, there are still a few scientific informations about the isolated substances and their biological activities. A head the displayed, the present work has for objectives, to evaluate the pharmacological properties of the glycosaminoglycans isolated from the sea shrimp Litopenaeus schimitti on homeostasis, blood coagulation, leukocytes migration and platelet/leukocyte adhesion. For this, yhe glycosaminoglycans were extracted from crustacean tissues by proteolysis, fractionation with acetone and later submitted to pharmacological assays. The crustacean tissues showed compounds heparin-like, with anticoagulant activity of 45 IU/mg and 90 IU/mg, respectively. These molecules showed low residual hemorrhagic effects in the tested concentration (100 µg/mL), when compared to unfractionated commercial heparin (UFH). Another dermatan sulfate-like compound, predominately constituted for disulfated disaccharides, was isolated from crustacean abdomen. This compound showed an efficient effect on leukocytes migration inhibition, in the concentration of 15 µg/mL, reducing the cellular infiltration in 65% when compared to the controlled animals. In this same concentration, the DS reduced in 60% the protein concentration of the peritoneal exudates. In the concentration, this compound of 0.5 mg/mL, it was capable to reduce in 40% platelet/leukocytes adhesion. Our data demonstrate that these sulfated polysaccharides isolated from the shrimp L. schimitti will can be used as bioactive compounds, appearing as active principles for pharmacological development, anticoagulants and inflammatory response regulators

Avaliação do potencial de formigas (Hymenoptera: formicidae) como vetores mecânicos de bactérias do gêneroSstaphylococcus no ambiente hospitalar.

In a hospital environment, these bacteria can be spread by insects such as ants, which are characterized by high adaptability to the urban environment. Staphylococcus is a leading cause of hospital infection. In Europe, Latin America, USA and Canada, the group of coagulase negative staphylococci (CoNS) is the second leading cause of these infections, according to SENTRY (antimicrobial surveillance program- EUA). In this study, we investigated the potential of ants (Hymenoptera: Formicidae) as vehicle mechanics of Staphylococcus bacteria in a public hospital, in Natal-RN. The ants were collected, day and night, from June 2007 to may 2008, in the following sectors: hospitals, laundry, kitchen, blood bank. The ants were identified according to the identification key of Bolton, 1997. For the analysis of staphylococci, the ants were incubated in broth Tryptic Soy Broth (TSB) for 24 hours at 35 º C and then incubated on Mannitol Salt Agar. The typical colonies of staphylococci incubated for 24 hours at 35 ° C in Tryptic Soy Agar for the characterization tests (Gram stain, catalase, susceptibility to bacitracin and free coagulase). The identification of CoNS was performed through biochemical tests: susceptibility to novobiocin, growth under anaerobic conditions, presence of urease, the ornithine decarboxylation and acid production from the sugars mannose, maltose, trehalose, mannitol and xylose. The antimicrobial susceptibility examined by disk-diffusion technique. The technique of Polymerase Chain Reaction was used to confirm the presence of mecA gene and the ability to produce biofilm was verified by testing in vitro using polystyrene inert surface, in samples of resistant staphylococci. Among 440 ants, 85 (19.1%) were carrying coagulase-negative staphylococci (CoNS) of the species Staphylococcus saprophyticus (17), Staphylococcus epidermidis (15), Staphylococcus xylosus (13), Staphylococcus hominis hominis (10), Staphylococcus lugdunensis (10), Staphylococcus warneri (6), Staphylococcus cohnii urealyticum (5), Staphylococcus haemolyticus (3), Staphylococcus simulans (3), Staphylococcus cohnii cohnii (2), and Staphylococcus capitis (1). No Staphylococcus aureus was found. Among the isolates, 30.58% showed resistance to erythromycin. Two samples of CoNS (2.35%), obtained from the ant Tapinoma melanocephalum collected in the post-surgical female ward, S. Hominis hominis and S. lugdunensis harbored the mecA gene and were resistant to multiple antibiotics, and the specie S. hominis hominis even showed to be a biofilm producer. This study proves that ants act as carriers of multidrug-resistant coagulase-negative Staphylococci and biofilm producers and points to the risk of the spreading of pathogenic microorganisms by this insect in the hospital environment

Avaliação do desenvolvimento neuropsicomotor em crianças na rede básica de saúde utilizando o teste de Denver II: identificação de fatores de risco materno

Alterations in the neuropsychomotor development of children are not rare and can manifest themselves with varying intensity at different stages of their development. In this context, maternal risk factors may contribute to the appearance of these alterations. A number of studies have reported that neuropsychomotor development diagnosis is not an easy task, especially in the basic public health network. Diagnosis requires effective, low-cost, and easy - to-apply procedures. The Denver Developmental Screening Test, first published in 1967, is currently used in several countries. It has been revised and renamed as the Denver II Test and meets the aforementioned criteria. Accordingly, the aim of this study was to apply the Denver II Test in order to verify the prevalence of suspected neuropsychomotor development delay in children between the ages of 0 and 12 months and correlate it with the following maternal risk factors: family income, schooling, age at pregnancy, drug use during pregnancy, gestational age, gestational problems, type of delivery and the desire to have children. For data collection, performed during the first 6 months of 2004, a clinical assessment was made of 398 children selected by pediatricians and the nursing team of each public health unit. Later, the parents or guardians were asked to complete a structured questionnaire to determine possible risk indicators of neuropsychomotor development delay. Finally the Denver II Developmental Screening Test (DDST) was applied. The data were analyzed together, using Statistical Package for Social Science (SPSS) software, version 6.1. The confidence interval was set at 95%. The Denver II Test yielded normal and questionable results. This suggests compromised neuropsychomotor development in the children examined and deserves further investigation. The correlation of the results with preestablished maternal risk variables (family income, mother s schooling, age at pregnancy, drug use during the pregnancy and gestational age) was strongly significant. The other maternal risk variables (gestational problems, type of delivery and desire to have children) were not significant. Using an adjusted logistic regression model, we obtained the estimate of the greater likelihood of a child having suspected neuropsychomotor development delay: a mother with _75 4 years of schooling, chronological age less than 20 years and a drug user during pregnancy. This study produced two manuscripts, one published in Acta Cirúrgica Brasileira , in which an analysis was performed of children with suspected neuropsychomotor development delay in the city of Natal, Brazil. The other paper (to be published) analyzed the magnitude of the independent variable maternal schooling associated to neuropsychomotor development delay, every 3 months during the first twelve months of life of the children selected.. The results of the present study reinforce the multifactorial characteristic of development and the cumulative effect of maternal risk factors, and show the need for a regional policy that promotes low-cost programs for the community, involving children at risk of neuropsychomotor development delay. Moreover, they suggest the need for better qualified health professionals in terms of monitoring child development. This was an inter- and multidisciplinary study with the integrated participation of doctors, nurses, nursing assistants and professionals from other areas, such as statisticians and information technology professionals, who met all the requirements of the Postgraduate Program in Health Sciences of the Federal University of Rio Grande do Norte

Redução da morbi-mortalidade na síndrome de hellp completa com o uso de altas doses de dexametasona

Objective: To determine the clinical maternal and neonatal outcomes in HELLP syndrome patients treated with dexamethasone who either developed renal injury or renal insufficiency and to identify predictive values of urea and creatinine for the identification of subjects with HELLP syndrome at risk of developing renal insufficiency. Methods: Non-radomized intervention study of dexamethasone use in HELLP syndrome. A total of 62 patients were enrolled at Maternidade Escola Januário Cicco (MEJC). Patients received a total of 30 mg of dexamethasone IV, in three doses of 10 mg every 12 hours. A clinical and laboratory follow up were performed at 24, 48 and 72 hours. Patients were followed up to 6 months after delivery. Patients were grouped in accordance to renal function, i.e, normal and some type of renal lesion. Renal lesion was considered when creatinine was equal or greater than 1.3 mg/dl and diuresis less than 100 ml in 4 hours period and renal insufficiency was defined when dialysis was needed. Results: A total of 1230 patients with preeclampsia were admitted at MEJC. Of those 62 (5%) developed HELLP syndrome. There was no statistical difference in the groups with renal involvement or normal renal function with respect to the demographics, type of anesthesia used and delivery, and weight of the newborn. An improvement in the AST, ALT, LDH, haptoglobine, antithrombine, fibrinogenen and platelets was observed within 72 hours after dexamethosone use. There was a significant increase in the diuresis within the interval of 6 hours before the delivery and 24 hours after it. Of the 62 patients, 46 (74. 2%) had normal renal function and 16 (25.8%) evolved with renal lesion, with 5 (8.1%) needing dialysis. These 5 patients who received dialysis recovered the xi renal function. The delay in administering dexamethasone increased in 4.6% the risk of development of renal insufficiency. Patients with renal insufficiency had received significantly more blood products than subjects without renal lesion (p=0.03). Diuresis, leukocytes, uric acid, urea, creatinine were significantly different between the groups with normal renal function, renal lesion and renal insufficiency. The levels of creatinine 1.2mg/dl and uric acid 51mg/dl, at admission are predictive of subjects who will evolve with renal lesion (p<0.001). Maternal mortality was 3.2%. None of the subjects with renal insufficiency evolved with chronic renal disease. Conclusions: Dexamethasone in patients with HELLP syndrome seems to reduce significantly the hepatic microthrombosis and normalize hemostasis as seen by improvement of liver function. Renal injury can be considered, in HELLP syndrome, when creatinine levels are greater than 1.3 mg/dl and diuresis less than 100 ml/h in interval of 4 hours. The level of creatinine greater than 1.2 mg/dl and urea greater than 51mg/dl are predictive of subjects with HELLP syndrome who will develop renal injury. Patients who receive more red cell packs develop renal insufficiency. Finally, the delay in administering dexamethasone increases the risk of developing renal insufficiency

Biodistribuição do pertecnetato de sódio após desvio gástrico em Y de Roux (técnica de capella)

O desvio gástrico em Y de Roux é a técnica cirúrgica mais utilizada no tratamento da obesidade mórbida. Esta operação reduz o volume do estômago e o comprimento do intestino delgado, gerando alterações estruturais e metabólicas que podem influenciar no resultado de exames cintilográficos de pacientes operados. Com o objetivo de avaliar a biodistribuição pós-operatória do pertecnetato de sódio (Na99mTc) em órgãos de ratos Wistar submetidos à técnica do bypass (desvio) gástrico em Y de Roux (BGYR), foram utilizados 12 ratos distribuídos aleatoriamente em grupo tratado (n=6), submetido à cirurgia do BGYR e o grupo controle (C; n=6). No 15º dia de pós-operatório foi administrado 0,1 mL via plexo orbital de Na99mTc aos animais dos dois grupos, com atividade radioativa média de 0,66MBq. Após 30 minutos, os ratos foram mortos e retirados fragmentos de tireóide, coração, pulmão, fígado, estômago, rim e fêmur. As amostras foram lavadas com solução salina 0,9%, pesadas e submetidas ao Contador Gama 1470, WizardTM Perkin-Elmer-Finlândia para determinação do percentual de atividade radioativa total por grama (%ATI/g) de cada órgão. Empregou-se o teste t de Student para análise estatística, considerando-se significantes as diferenças das médias quando p<0,05. Redução significante na média de %ATI/g foi observada no fígado, estômago e fêmur dos animais submetidos à cirurgia de BGYR comparada ao grupo controle (p<0,05). Nos demais órgãos não houve diferença estatisticamente significativa entre os grupos. Em conclusão, a cirurgia BGYR em ratos modificou a biodistribuição do Na99mTc em alguns órgãos, podendo ter implicações clínicas na interpretação de exames cintilográficos. Este estudo xi teve um caráter multidisciplinar com a participação de pesquisadores das áreas de Cirurgia Experimental, Farmácia, Radiobiologia, Medicina Nuclear e Estatística

Fatores litogênicos em pacientes com litíase urinária de Fortaleza, Ceará

Lithiasis is considered a public health issue due to its high prevalence and rates of recurrence. Objective: To identify risk factors for lithiasis in kidney stone patients from Fortaleza, Brazil. In the first stage of the study, the medical records of 197 patients with urinary lithiasis covering the period 1996 2006 were analyzed with regard to clinical and metabolic data. In the second stage, 340 kidney stones were submitted to morphological examination under 10x magnification. According to the external morphology and the cut surface, the stones were classified as pure or mixed, and major and minor components were identified. In addition, the stone fragments of 25 patients treated with lithotripsy were submitted to morphological analysis. In the third stage, a subsample of 50 stones was used in a double-blind comparison of morphological and chemical findings. Results were expressed as concordant, partly concordant (discordant for minor components) or discordant (discordant for major components). The average age of first symptoms was 35.8±13.3 years, with no significant difference between the genders. The male/female ratio was 1:1.7. Recurrence was reported in 53.3% of cases. The main metabolic changes observed were hypernatriuria (80.7%), hypercalciuria (48.7%), low urine volume (43.7%), hyperoxaluria (30.5%) and hyperuricosuria (17.3%). Pure stones represented 34.7% of the total sample of 340 stones. The most common route of elimination was spontaneous for pure stones (49.1%) and surgical for mixed stones (50.5%). Pure stones consisted most frequently of calcium oxalate (OxCa) (59.3%) and uric acid (UA) (23.7%), the former prevalent in women, the latter prevalent in men. The most frequently observed component in mixed stones was OxCa (67.1%), followed by carbapatite (11.2%) and struvite (7.9%). The main components were OxCa and UA for men, and carbapatite and struvite for women. Nearly half (48%) the 25 analyzed fragments were pure, consisting of calcium oxalate dihydrate (COD) (56%), calcium oxalate monohydrate (COM) (48%), phosphate (32%) and UA (20%). Four patients (16%) had infectious stones. In the chemical analysis of the subsample of 50 stones, the most 64 frequently observed major components were calcium (70%), oxalate (66%), ammonium (56%), urate (28%) and carbonate (24%). In the morphological analysis, the main components were calcium and magnesium phosphate (32%), COM (24%), UA (20%), COD (18%) and cystine (6%). Morphological and chemical findings were totally concordant for 38% of the stones, partly concordant in 52% and discordant in 10%. Conclusion: The risk factors for lithiasis in kidney stone patients from Fortaleza (Brazil) were hyperoxaluria, hypercalciuria with or without hypernatriuria, hyperuricosuria and low urine volume

Desenvolvimento de sistemas magnéticos com potencialidades terapêuticas para vetorização de fármacos

Magnetic targeting is being investigated as a means of local delivery of drugs, combining precision, minimal surgical intervention, and satisfactory concentration of the drug in the target region. In view of these advantages, it is a promising strategy for improving the pharmacological response. Magnetic particles are attracted by a magnetic field gradient, and drugs bound to them can be driven to their site of action by means of the selective application of magnetic field on the desired area. Helicobacter pylori is the commonest chronic bacterial infection. The treatment of choice has commonly been based upon a triple therapy combining two antibiotics and an anti-secretory agent. Furthermore, an extended-release profile is of utmost importance for these formulations. The aim of this work was to develop a magnetic system containing the antibiotic amoxicillin for oral magnetic drug targeting. First, magnetic particles were produced by coprecipitation of iron salts in alkaline medium. The second step was coating the particles and amoxicillin with Eudragit® S-100 by spray-drying technique. The system obtained demonstrated through the characterization studies carried out a possible oral drug delivery system, consisting in magnetite microparticles and amoxicillin, coated with a polymer acid resistant. This system can be used to deliver drugs to the stomach for treatment of infections in this organ. Another important finding in this work is that it opens new prospects to coat magnetic microparticles by the technique of spray-drying.

Abordagem inicial de lesões mamárias por biopsia helicóide: estudo experimental

OBJECTIVE: Evaluating the kit-Bh performance in carrying out of breast biopsies. METHODS: They were randomly selected a sample of 30 patients with breast cancer undergoing mastectomy, based on the results of a pilot study from February 2008 to April 2010. They were excluded women with had not palpable, stone-hard consistency tumors, previous surgical manipulation or that contains liquid. Using the helicoid biopsy Kit (kit Bh) and an equipment Core biopsy with cannula and needle and 14 gauge respectively, it was collected a fragment of sound equipment in the area and in tumors in each specimen, totaling 120 fragments for histological study. For data analysis, it was defined a 95% confidence level and used the SPSS-13 version, the Kappa index and the parametric Student t test. RESULTS: Mean age of patients was 51.6 years (± 11.1 years). The infiltrating ductal carcinoma showed a higher incidence, 26 cases (86.7%). The Core biopsy had a sensitivity of 93.3%, specificity of 100% and accuracy 96.7%, while the helicoid biopsy had a sensitivity of 96.7%, specificity of 100% and accuracy 98.3%. By comparing the histology of tumors and the fragments of biopsies, there was high degree of agreement in diagnoses (kappa of 0.93 with p <0.05) CONCLUSION: Both devices provided the histological diagnosis of lesions with high accuracy. Results of this study showed that the helicoid biopsy is a reliable alternative in 22 the preoperative diagnosis of breast lesions. Further studies in vivo better will define the role of Kit Bh in the diagnosis of these lesions

Tratamento de fístulas enterocutâneas através de sistema a vácuo com alta pressão e dieta oral normal

Enterocutaneous fistulas are associated with prolonged hospital stay, high morbidity/mortality, and increase in hospital costs. This study aims to describe the use of a vacuum system and normal oral diet in dealing with this problem. Methods: Seventy-four consecutive patients with recent and defined external postoperative fistulas were analyzed. Abdominal imaging was used to exclude abscess and distal obstruction. The fistula tract was sealed with Foley catheter, connected to a negative pressure flask, changed daily for 5, 10 or 15 days, as necessary. Normal oral diet was permitted. Results: No patient died. Serum albumin and transferrin showed significantly higher levels at the end of treatment than at the beginning. The moderate and low-output fistulas had the best results (97% closed). Forty-eight (65%) fistulas closed after five days, 16(22%) after 10 days and 4(5%) after 15 days. Treatment failed in 6(8%) patients, who subsequently underwent surgery. Only one patient with low-output did not close her fistula. The cost of the treatment was US$ 41.75/day and it was considered cost effective. Conclusions: The vacuum system demonstrated good results in the treatment of fistulas. It included simplicity, low cost, short hospital stay, absence of skin breakdown, normal eating, good nutrition and activity patterns

A influência do sorriso gengival no vedamentos labial

Ideally the smile should expose minimal gingival, therefore patients with gummy smile and passive eruption altered or excessive marginal gingivae, usually excessive gingival display because incomplete anatomical crown exposure is present. If the maxillary incisor show at rest is optimal, active upper incisor intrusion should not be iniciated. To achieve a smile with minimal gingival exposure, the anatomic crown should be fully exposed by surgical crown lengthening. Precise determination of the location of cementoenamel junction prior to surgery, precise placement of incisions and correct establish of biological width are necessary in order to achive this goal. One protocol is decribed and clinical results from 15 brazilian subjects, after three years post surgery are showed