Use of botulin toxin in the treatment of diffuse esophageal spasm. A case report

The diffuse esophageal spasm distinguishes from others esophageal disturbs by the symptoms severity and bad results to conservative treatment. This situation requires formal indication to surgical treatment or dilation. In high risk patients this situation becomes a big problem, due to the lack of another therapeutic option. In a patient with this problem we use an endoscopic injection of botulin toxin in cardia with good results in three months follow-up. Despite this short period of observation we believe that the infiltration with botulin toxin in cardia constitutes a valid therapeutic option in treatment of diffuse esophageal spasm.

The glasgow prognostic score. An useful tool to predict survival in patients with advanced esophageal squamous cell carcinoma

To evaluate the usefulness of the Glasgow Prognostic Score (GPS) in patients with esophageal carcinoma (EC). A total of 50 patients with EC were analyzed for GPS, nutritional and clinicopathologic parameters. Patients with CRP ≤ 1.0mg/L and albumin ≥ 3.5mg/L were considered as GPS=0. Patients with only CRP increased or albumin decreased were classified as GPS=1 and patients with CRP > 1.0mg/L and albumin < 3.5mg/L were considered as GPS=2. GPS of 0, 1 and 2 were observed in seven, 23 and 20 patients, respectively. A significant inverse relationship was observed between GPS scores and the survival rate. The survival rate was greatest in patients with GPS= 0 and significantly higher than those from patients with GPS=1 and GPS=2. Minimum 12-month survival was observed in 71% patients with GPS=0 and in 30% patients with GPS=1. None of the patients with GPS=2 survived for 12 months. A significant relationship between CRP or albumin individually and the survival rate was observed. No significant relationship among nutritional, clinic pathological parameters and survival was found. Glasgow Prognostic Score is an useful tool to predict survival in patients with esophageal carcinoma.

Diagnosis and management of gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is probably one of the most prevalent diseases in the world that also compromises the quality of life of the affected significantly. Its incidence in Brazil is 12%, corresponding to 20 million individuals. OBJECTIVE: To update the GERD management and the new trends on diagnosis and treatment, reviewing the international and Brazilian experience on it. METHOD: The literature review was based on papers published on Medline/Pubmed, SciELO, Lilacs, Embase and Cochrane crossing the following headings: gastroesophageal reflux disease, diagnosis, clinical treatment, surgery, fundoplication. RESULTS: Various factors are involved on GERD physiopathology, the most important being the transient lower esophageal sphincter relaxation. Clinical manifestations are heartburn, regurgitation (typical symptoms), cough, chest pain, asthma, hoarseness and throat clearing (atypical symptoms), which may be followed or not by typical symptoms. GERD patients may present complications such as peptic stenosis, hemorrhage, and Barrett's esophagus, which is the most important predisposing factor to adenocarcinoma. The GERD diagnosis must be based on the anamnesis and the symptoms must be evaluated in terms of duration, intensity, frequency, triggering and relief factors, pattern of evolution and impact on the patient's quality of life. The diagnosis requires confirmation with different exams. The goal of the clinical treatment is to relieve the symptoms and surgical treatment is indicated for patients who require continued drug use, with intolerance to prolonged clinical treatment and with GERD complications. CONCLUSION: GERD is a major digestive health problem and affect 12% of Brazilian people. The anamnesis is fundamental for the diagnosis of GERD, with special analysis of the typical and atypical symptoms (duration, intensity, frequency, triggering and relief factors, evolution and impact on the life quality). High digestive endoscopy and esophageal pHmetry are the most sensitive diagnosctic methods. The clinical treatment is useful in controlling the symptoms; however, the great problem is keeping the patients asymptomatic over time. Surgical treatment is indicated for patients who required continued drug use, intolerant to the drugs and with complicated forms of GERD.

Estenose da fossa intercondilar após estabilização articular com retalho de fáscia lata em cães

Determinaram-se os índices de largura da fossa intercondilar (FI), após transecção do ligamento cruzado cranial em nove cães adultos submetidos à estabilização articular com retalho de fáscia lata. Os joelhos foram alocados em dois grupos, sendo o joelho direito (GI) submetido à incisuroplastia troclear (ITR) e posterior estabilização articular, e o joelho esquerdo submetido somente à substituição ligamentar (GC). Cada grupo foi dividido em três subgrupos correspondentes aos momentos de eutanásia aos 30, 90 e 180 dias de pós-operatório. Os índices de largura da FI foram determinados, macroscópica e radiograficamente, pela mensuração da abertura cranial da FI nos terços cranial, médio e caudal, e indexados em relação à largura epicondilar. Observou-se aumento significativo dos índices macroscópicos e radiográficos nas articulações do GI, sendo estes estatisticamente diferentes daqueles das articulações de GC. Não foi observada estenose intercondilar nos joelhos de GC após a estabilização articular. Conclui-se que a estabilização articular com retalho de fáscia lata preveniu a estenose da fossa intercondilar, e que a ITR promoveu o alargamento permanente dessa estrutura.

Predição do Consumo Voluntário do Capim-Tanzânia (Panicum maximum, J. cv. tanzânia), sob Pastejo, por Vacas em Lactação, a partir das Características de Degradação

O consumo de matéria seca (CMS) do capim tanzânia de 24 vacas lactantes mestiças (HPB x Gir) e Gir, sob pastejo, foi estimado no mês de janeiro de 1998, a partir da relação entre a digestibilidade da MS da forragem e a produção fecal obtida com auxílio do cromo mordente por meio de um modelo não-linear. Os resultados do consumo estimado foram comparados aos consumos preditos por diferentes equações baseadas nos dados de degradabilidade do capim, no rúmen. A pastagem foi manejada com taxa de lotação de dois animais/ha, em sistema de pastejo rotativo com três dias de ocupação do piquete e 39 dias de descanso. Foram utilizadas para predizer o CMS diferentes equações: CMS = -1,19 + 0,035 (a+ b) + 28,5c (1), CMS = -0,822 + 0,0748 (a+ b) + 40,7c (2), CMS = -8,286 + 0,266a + 0,102b +17,696c (3) e CMS = [%FDN na MS]* [consumo de FDN ] / [(1-a-b)/K P +b/(c+ k p)]/24] (4). As equações, em geral, subestimaram o consumo obtido no modelo não-linear (9,6 kg/vaca/dia). Os consumos médios de capim de 6,2 e 6,0 kg MS/vaca/dia obtidas, respectivamente, nas equações de (2) e (4) foram semelhantes entre si e inferiores ao das equações de (1) (12,7 kg/vaca/dia) e (3) (8,1 kg/vaca/dia). A predição do consumo de forrageiras tropicais, sob pastejo, utilizando-se as equações baseadas nas variáveis da degradação in situ, constitui um importante potencial para estas avaliações. Entretanto, mais estudos dessa natureza devem ser realizados para validar o uso destas equações na prática.

Performance of supplemented heifers on Marandu grass pastures in the wet-to-dry transition and dry seasons

The objective of the present study was to evaluate the characteristics of the sward canopy of Marandu grass during the rainy season, the wet-to-dry transition and the dry seasons, between March and September 2004, under intermittent grazing, and to correlate those characteristics with the performance of crossbred heifers receiving mineral supplements ad libitum or protein supplements. The experiment consisted of a randomized block design with three blocks (set of 13 paddocks), each containing five crossbred heifers per experimental unit, totaling 15 replicates. The heifers were given protein supplements daily in individual stalls and received an average 4 g/kg/day of the supplement during the rainy season and 5 g/kg/day during the dry season. Their weight gain was assessed monthly. The pasture structure was assessed through destructive sampling, and the bromatological composition of esophageal extrusa samples was also assessed. Analysis of variance was used to assess performance, and regression analysis was used to evaluate the sward canopy characteristics in relation to the months of the year. A cluster procedure was used to determine the similarity between the months of the year under assessment. Two different groups were formed for pasture evaluation: one group including the months of March to July and another group including the months of August and September. The first group exhibited a better canopy structure than the second group. This fact was corroborated by the animal performance, which was lower during the months of the second group. Low-intake protein supplementation was effective in increasing the performance of the grazing heifers. Pasture structure is critical for animal performance in a grazing environment, regardless of the type of supplementation.

Estimativa da ingestão voluntária a partir das características de degradação do capim-coastcross (Cynodon dactylon L. Pers.), sob pastejo, por vacas em lactação

O consumo de matéria seca (CMS) do capim-coastcross, sob pastejo, de vacas lactantes mestiças (HPB x Gir) e Gir, foi calculado a partir da relação entre a digestibilidade in vitro da MS (DIVMS) da forragem (extrusa colhida com animais esôfago- fistulados) e a produção fecal obtida com auxílio do cromo mordante por meio de um modelo não-linear. A pastagem foi manejada com uma taxa de lotação de 1,6 e 3,2 animais/ha, respectivamente para as épocas seca e chuvosa do ano, num sistema de pastejo rotativo com três dias de ocupação e 27 dias de descanso. Quatro diferentes equações baseadas em variáveis de degradação ruminal foram utilizadas para predizer o consumo de MS: CMS = -1,19 + 0,035 (a+ b) + 28,5c (1), CMS = -0,822 + 0,0748 (a+ b) + 40,7c (2), CMS = -8,286 + 0,266a + 0,102b +17,696c (3) e CMS = [%FDN na MS]* [consumo de FDN ] / [(1-a-b)/K P +b/(c+ k p)]/24] (4). Os dados observados utilizando as equações 1 e 2 (12,2 e 12,7 kg/vaca/dia respectivamente) foram similares entre si e superiores aos resultados obtidos na equação 4 (7,8 kg/vaca/dia). Já o resultado obtido pela equação 3 (5,5 kg/vaca/dia) foi menor do que aqueles determinados pelas outras equações, subestimando o CMS calculado a partir do cromo mordante (6,3 kg/vaca/dia). A predição do consumo de forrageiras tropicais sob pastejo, utilizando equações baseadas nas variáveis de degradação, constitui um importante potencial para estas avaliações. Entretanto, mais estudos devem ser realizados antes de se usarem estas equações na prática.

Review of Fluconazole Properties and Analytical Methods for Its Determination

Fluconazole, alpha-(2.4-diflurofenil)-alpha-(1H-triazol-1-methyl)-1H-1,2,4-triazol-1-ethanol, is an antifungal of the triazoles class. It shows activity against species of Candida sp. and it is indicated in cases of oropharyngeal candidiasis, esophageal, vaginal, and deep infection. Fluconazole is a selective inhibitor of ergosterol, a steroid exclusive of the cell membrane of fungal cells. Fluconazole is highly absorbed by the gastrointestinal tract and spreads easily by body fluids. The main adverse reactions related to the use of fluconazole are nausea, vomiting, headache, rash, abdominal pain, diarrhea, and alopecia in patients undergoing prolonged treatment with a dose of 400 mg/day. In the form of raw material, pharmaceutical formulations, or biological material, fluconazole can be determined by methods such as titration, spectrophotometry, and thin-layer, gas, and liquid chromatography. This article discusses the pharmacological and physicochemical properties of fluconazole and also the methods of analysis applied to the determination of the drug.