Brazilian consensus on gastroesophageal reflux disease: Proposals for assessment, classification, and management

The Brazilian Consensus on Gastroesophageal Reflux Disease considers gastroesophageal reflux disease to be a chronic disorder related to the retrograde flow of gastroduodenal contents into the esophagus and/or adjacent organs, resulting in a variable spectrum of symptoms, with or without tissue damage. Considering the limitations of classifications currently in use, a new classification is proposed that combines three criteria - clinical, endoscopic, and pH-metric - providing a comprehensive and more complete characterization of the disease. The diagnosis begins with the presence of heartburn, acid regurgitation, and alarm manifestations (dysphagia, odynophagia, weight loss, GI bleeding, nausea and/or vomiting, and family history of cancer). Also, atypical esophageal, pulmonary, otorhinolaryngological, and oral symptoms may occur. Endoscopy is the first approach, particularly in patients over 40 yr of age and in those with alarm symptoms. Other exams are considered in particular cases, such as contrast radiological examination, scyntigraphy, manometry, and prolonged pH measurement. The clinical treatment encompasses behavioral modifications in lifestyle and pharmacological measures. Proton pump inhibitors in manufacturers' recommended doses are indicated, with doubling of the dose in more severe cases of esophagitis. The minimum time of administration is 6 wk. Patients who do not respond to medical treatment, including those with atypical manifestations, should be considered for surgical treatment. Of the complications of gastroesophageal reflux disease, Barrett's esophagus presents a potential development of adenocarcinoma; biopsies should be performed, independent of Barrett's esophagus extent or location. In this regard the designation short Barrett's is not important in terms of management and prognosis. © 2002 by Am. Coll. of Gastroenterology.

Chemical control of different digitaria insularis populations and management of a glyphosate-resistant population

This study aimed to control different populations of Digitaria insularis by glyphosate herbicide, isolated and mixed, besides the combination of methods (chemical and mechanical) to manage resistant adult plants. Three experiments were conducted, one in pots which were maintained under non-controlled conditions and two under field conditions. In the experiment in pots, twelve populations of D. insularis were sprayed with isolated glyphosate (1.44 and 2.16 kg a.e. ha(-1)) and mixed (1.44 and 2.16 kg a.e. ha(-1)) with quizalofop-p tefuryl (0.12 kg i.a. ha(-1)). The treatment of 1.44 kg a.e. ha(-1) of glyphosate plus 0.12 kg a.i. ha(-1) of quizalofop was sufficient for adequate control (>95%) of all populations. Population 11 (area of grain production in Itumbiara, GO) was considered sensitive to glyphosate. Others populations were moderately sensitive or tolerant to the herbicide. In the field, the plants of D. insularis of one of the experiments were mowed and, in the other, there were not. Eight treatments with herbicides [isolated glyphosate (1.44 and 2.16 kg a.e. ha(-1)) and mixed (1.44 and 2.16 kg a.e. ha(-1)) with quizalofop-p-tefuryl at 0.12 kg a.i. ha(-1)), clethodim at 0.108 kg a.i. ha(-1)) or nicosulfuron at 0.06 kg a.i. ha(-1))] were assessed, in combination with or without sequential application of the standard treatment, sprayed 15 days after the first application. The combination of the mechanic control with the application of glyphosate (2.16 and 1.44 kg a.e. ha(-1)) plus quizalofop-p-tefuryl (0.12 kg a.i. ha(-1)) or clethodim (0.108 kg a.i. ha(-1)), associated to the sequential application, was the most effective strategy for the management of adult plants of resistant D. insularis.

Dental implant fractures: aetiology, treatment and case report

Purpose: This study aimed to investigate the etiology, clinical manifestations, and treatment options of dental implants fractures through a literature review and to relate a clinical report. Methods: A literature review was performed using the Medline database and this paper describes a case demonstrating the management of implant fracture. Twenty two articles were selected in the present literature review. Results: Nowadays the use of dental implants to rehabilitate completely and partially edentulous patients became the best treatment option; however, this treatment is suitable to failure. The fracture of implant body is a possible complication. The fracture of implant body is a late complication and is related to the failure in implant design or material, non-passive fitting of the prosthetic crown and overloading. Clinically, prosthesis instability and spontaneous bleeding are observed. Three options of treatment have been indicated: complete removal of implant fragment, maintenance of implant fragment, and surface preparation of the fragment with insertion of a new abutment. Conclusion: The literature indicates the complete removal of the fragment as the best treatment option.

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.

Effects of plant densities and management of purple nutsedge on sugarcane yield and effect of growth stages and main way of herbicides contact and absorption on the control of tubers

Field experiments carried out with Cyperus rotundus L. at low (58-246), medium (318773), and high (675-1198 shoots/m(2)) densities showed sugarcane yield reductions of 13.5, 29.3, and 45.2%, respectively in relation to the control. In the second field experiment, the integration of a mechanic method with two sequences of plowing and disking operations in the dry season, and complementary applications of trifloxysulfuron-sodium + ametrine and sulfentrazone (rainy season) was studied. Average of the chain connected to original shoot showed 92, 95, and 65% of reduction with trifloxysulfuron-sodium + ametrine and surfactant, at the application stages early, preflowering, and full flowering, respectively.

Influence of Heat Treatment and Oxygen Doping on the Mechanical Properties and Biocompatibility of Titanium-Niobium Binary Alloys

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Effect of monomer treatment and polymerisation methods on the bond strength of resin teeth to denture base material

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

The black lion tamarin Leontopithecus chrysopygus - its conservation and management

The black lion tamarin Leontopithecus chrysopygus originally occurred throughout a large part of the Atlantic forest in the west of the state of São Paulo, Brazil. Today, however, it is restricted to a few isolated forest fragments as a result of deforestation caused by cattle ranching, and urban and agricultural expansion, especially in this century. One of its last strongholds is a small gallery forest at Lencois Paulista in the west-central part of the state. The authors report on a long-term study of this small and isolated population, aimed particularly at providing a basis for the intensive management and conservation of the species and its habitat.

Oral microbial colonization in patients with systemic lupus erythematous: correlation with treatment and disease activity

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Dental fluorosis: Exposure, prevention and management

Dental fluorosis is a developmental disturbance of dental enamel, caused by successive exposures to high concentrations of fluoride during tooth development, leading to enamel with lower mineral content and increased porosity. The severity of dental fluorosis depends on when and for how long the overexposure to fluoride occurs, the individual response, weight, degree of physical activity, nutritional factors and bone growth. The risk period for esthetic changes in permanent teeth is between 20 and 30 months of age. The recommended level for daily fluoride intake is 0.05 - 0.07 mg F/Kg/day, which is considered of great help in preventing dental caries, acting in remineralization. A daily intake above this safe level leads to an increased risk of dental fluorosis. Currently recommended procedures for diagnosis of fluorosis should discriminate between symmetrical and asymmetrical and/or discrete patterns of opaque defects. Fluorosis can be prevented by having an adequate knowledge of the fluoride sources, knowing how to manage this issue and therefore, avoid overexposure.

Influence of Y-TZP ceramic treatment and different resin cements on bond strength to dentin

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Design and management optimization of trickle irrigation systems using non-linear programming

A non-linear model is presented which optimizes the lay-out, as well as the design and management of trickle irrigation systems, to achieve maximum net benefit. The model consists of an objective function that maximizes profit at the farm level, subject to appropriate geometric and hydraulic constraints. It can be applied to rectangular shaped fields, with uniform or zero slope. The software used is the Gams-Minos package. The basic inputs are the crop-water-production function, the cost function and cost of system components, and design variables. The main outputs are the annual net benefit and pipe diameters and lengths. To illustrate the capability of the model, a sensitivity analysis of the annual net benefit for a citrus field is evaluated with respect to irrigated area, ground slope, micro-sprinkler discharge and shape of the field. The sensitivity analysis suggests that the greatest benefit is obtained with the smallest microsprinkler discharge, the greatest area, a square field and zero ground slope. The costs of the investment and energy are the components of the objective function that had the greatest effect in the 120 situations evaluated. (C) 1996 Academic Press Limited