Concomitant involvement of the small intestine and the distal esophagus in an infant with massive necrotizing enterocolitis

Necrotizing enterocolitis is a disease of the newborn that may involve the small intestine and/or the colon, and the stomach. To our knowledge, massive necrosis of the small intestine with concomitant involvement of the esophagus has never been reported. A case of a 6-month-old boy with necrotizing enterocolitis and pan-necrosis of the small intestine, cecum, and the lower third of the esophagus is presented. After 70 days of treatment, intestinal transit was established by an anastomosis between the first centimeter of jejunum and the ascending colon. Finally, esophageal transit was established by a total gastric transposition with cervical esophagogastric anastomosis. The patient was maintained under total parenteral nutrition, and after 19 months he developed fulminant hepatic failure due to parenteral nutrition; he then underwent combined liver and small bowel transplantation. After 2 months, the patient died due to undefined neurologic complications, probably related to infection or immunosuppressive therapy.

Retrospective evaluation of bone pain palliation after samarium-153-EDTMP therapy

PURPOSE: The aim of this study was to evaluate the degree of metastatic bone pain palliation and medullar toxicity associated with samarium-153-EDTMP treatment. METHODS: Seventy-three patients with metastatic bone pain having previously undergone therapy with samarium-153-EDTMP (1 mCi/kg) were retrospectively evaluated. Routine follow-up included pain evaluation and blood counts for 2 months after treatment. Pain was evaluated using a subjective scale (from 0 to 10) before and for 8 weeks after the treatment. Blood counts were obtained before treatment and once a week for 2 months during follow-up. Dosimetry, based upon the urinary excretion of the isotope, was estimated in 41 individuals, and the resulting radiation absorbed doses were correlated with hematological data. RESULTS: Reduction in pain scores of 75% to 100% was obtained in 36 patients (49%), with a decrease of 50% to 75%, 25% to 50%, and 0% to 25% in, respectively, 20 (27%), 10 (14%), and 7 (10%) patients. There was no significant relationship between the pain response and location of the primary tumor (breast or prostate cancer). Mild to moderate myelosuppression was noted in 75.3% of patients, usually with hematological recovery at 8 weeks. The mean bone marrow dose was 347 ± 65 cGy, and only a weak correlation was found between absorbed dose and myelosuppression (Pearson coefficient = .4). CONCLUSIONS: Samarium-153-EDTMP is a valuable method for metastatic bone pain palliation. A mild to moderate and transitory myelosuppression is the main toxicity observed after samarium therapy, showing a weak correlation with dosimetric measures.

Treinamento Físico Aeróbico como Tratamento não Farmacológico da Síncope Neurocardiogênica

Fundamento: Caracterizada por perda súbita e transitória da consciência e do tônus postural, com recuperação rápida e espontânea, a síncope é causada por uma redução aguda da pressão arterial sistêmica e, por conseguinte, do fluxo sanguíneo cerebral. Os resultados insatisfatórios com o uso de fármacos permitiu que o tratamento não farmacológico da síncope neurocardiogênica fosse contemplado como primeira opção terapêutica. Objetivos: Comparar, em pacientes com síncope neurocardiogênica, o impacto do Treinamento Físico Aeróbico (TFA) de moderada intensidade e de uma intervenção controle, na positividade do Teste de Inclinação Passiva (TIP) e no tempo de tolerância ortostática. Métodos: Foram estudados 21 pacientes com história de síncope neurocardiogênica recorrente e TIP positivo. Esses foram aleatorizados em: Grupo Treinado (GT), n = 11, e Grupo Controle (GC), n = 10. O GT foi submetido a 12 semanas de TFA supervisionado, em cicloergômetro, e o GC, a um procedimento controle que consistia na realização de 15 minutos de alongamentos e 15 minutos de caminhada leve. Resultados: O GT apresentou efeito positivo ao treinamento físico, com aumento significativo do consumo de oxigênio-pico. Já o GC não apresentou nenhuma mudança estatisticamente significante, antes e após a intervenção. Após o período de intervenção, 72,7% da amostra do GT apresentou resultado negativo ao TIP, não apresentando síncope na reavaliação. Conclusão: O programa de treinamento físico aeróbico supervisionado por 12 semanas foi capaz de reduzir o número de TIP positivos, assim como foi capaz de aumentar o tempo de tolerância na posição ortostática durante o teste após o período de intervenção.

Temporal variability of benthic macrofauna on Cassino beach, southernmost Brazil

The temporal variability of benthic macrofauna on Cassino beach, southernmost Brazil, was studied for a period of one year (June 2004 to May 2005) based on monthly sampling. Three sites were selected distant 50m from each other. At each site, 3 transects were established, 2m equidistant from one another. Each transect extended from the base of the primary dunes to the inner surf zone at approximately 1m in depth, with 7 or 8 sampling levels. Within transects, the distance between the levels was 20m until the upper swash zone, from which distance was 10m until the 1-meter isobath. The temporal variation in the abundance of benthic macrofauna observed in the present study can be attributed to (1) the positive effects of the recruitment peaks and migration of particular species to the swash zone and (2) negative effects of the migration of some species to deeper waters, as well (3) as mortality through natural causes (stranding and action of predators) and (4) human causes (harvesting and vehicle transit). We attribute the expressive abundance increase of benthic macrofauna to recruitment. The stranding, that is, the trapping of the organisms on the upper parts of the beach, is likely the main cause of abrupt drops in benthic macrofauna abundance.

Inhibition of gastric secretion by a water extract from Baccharis triptera, Mart

Baccharus triptera Mart, is a widespread Compositae used in Brazilian folk medicine to treat gastrointestinal disturbances, rheumatic disease, mild fever, diabetes and as an anti-helminthic. Water extract of small branches of the plant (WE) administered to mice and rats (0.1 to 2 g/Kg, p.o) did not alter spontaneous motor activity, sleeping time induced by barbiturates or the tailflick response in mice. The extract decreased by 40 por cento the number of writhings induced by 0.8 por cento scetic acid, i.p., but did not influence paw edema induced by carrageenan or dextran in rats WE (2g/Kg, p.o.) decreased the intestinal transit of charcoal in mice by 20//. Gastric secretion in pylorus ligated rats was reduced after treatment with WE (1 and 2 g/Kg. i.p. or intraduodenal and the gastric pH was raised. The extract (1 g/Kg, p.o.) prevented gastric ulcers induced in rats by immobilization at 4ºC, but not those induced by indomethacin (10 mg/Kg, s.c.). The results indicate that WE may relieve gastrointestinal disorders by reducing acid secretion and gastrointestinal hiperactivity. Neither analgesic nor anti-inflammatory activities were detectable.

The water extract of Coleus barbatus Benth decreases gastric secretion in rats

Coleus barbatus (Labiatae) Benth is popularly used in Brazil "for the healing of liver and stomach diseases". The water extract (WE 1 to 10 g/Kg, p.o.) of stem and leaves given to rats and mice did not induce signs of intoxication. Preveious treatment of mice with WE (1 g/kg, p.o.) shortened the sleeping time induced by pentobarbital (50 mg/Kg, i.p.) by 37 por cento, althoyugh the extract alone did not increase the spontaneous activity nor did it induce hyperexcitability. In mice WE (2 g/Kg, p.o.) increased the intestinal transit of charcoal by 30 por cento, while reduced gastric secretions ion rats treated with WE (2g/Kg intraduodenal) 3,9 ± 1.0 to 0.5 ± 0.2 ml/4h, respectively). The treatment also reduced the total acid secretion from 34.4 ± 11.0 to 2.7 ± 0.5 mEq/l and raisedgastric pH from 2.2 ± 0.3 to 6.5 ± 0.8. Treatment with WE (2g/Kg, p.o.) protected against gastric ulcers induced by stress (5.3 ± 1.6 and 1.5 ± 0.5 ulcers/cm²), but did nor protect against indonethacin induced ulcers. The results show that the water extract of C barbatus Benth produces mild stimulation of thecentral nervous system and increases intestinal movements. The extract also reduces gastric secretion indicating an antidyspeptic activity, and protects against gastric ulcers induced by stress.

Evaluation of occupational and patient dose in cerebral angiography procedures

Objective The present study was aimed at estimating the doses received by physicians and patients during cerebral angiography procedures in a public hospital of Recife, PE, Brazil. Materials and Methods The study sample included 158 adult patients, and during the procedures the following parameters were evaluated: exposure parameters (kV, mAs), number of acquired images, reference air kerma value (Ka,r) and air kerma-area product (PKA). Additionally, the physicians involved in the procedures were evaluated as for absorbed dose in the eyes, thyroid, chest, hands and feet. Results The results demonstrated that the doses to the patients' eyes region were relatively close to the threshold for cataract occurrence. As regards the physicians, the average effective dose was 2.6 µSv, and the highest effective dose recorded was 16 µSv. Conclusion Depending on the number of procedures, the doses received by the physicians may exceed the annual dose limit for the crystalline lenses (20 mSv) established by national and international standards. It is important to note that the high doses received by the physicians are due to the lack of radiation protection equipment and accessories, such as leaded curtains, screens and protective goggles.

Doses monitoring in radiology: calibration of air kerma-area product (PKA) meters

Objective The authors have sought to study the calibration of a clinical PKA meter (Diamentor E2) and a calibrator for clinical meters (PDC) in the Laboratory of Ionizing Radiation Metrology at Instituto de Energia e Ambiente - Universidade de São Paulo. Materials and Methods Different qualities of both incident and transmitted beams were utilized in conditions similar to a clinical setting, analyzing the influence from the reference dosimeter, from the distance between meters, from the filtration and from the average beam energy. Calibrations were performed directly against a standard 30 cm3 cylindrical chamber or a parallel-plate monitor chamber, and indirectly against the PDC meter. Results The lowest energy dependence was observed for transmitted beams. The cross calibration between the Diamentor E2 and the PDC meters, and the PDC presented the greatest propagation of uncertainties. Conclusion The calibration coefficient of the PDC meter showed to be more stable with voltage, while the Diamentor E2 calibration coefficient was more variable. On the other hand, the PDC meter presented greater uncertainty in readings (5.0%) than with the use of the monitor chamber (3.5%) as a reference.

Ambient radiation levels in positron emission tomography/computed tomography (PET/CT) imaging center

Objective: To evaluate the level of ambient radiation in a PET/CT center. Materials and Methods: Previously selected and calibrated TLD-100H thermoluminescent dosimeters were utilized to measure room radiation levels. During 32 days, the detectors were placed in several strategically selected points inside the PET/CT center and in adjacent buildings. After the exposure period the dosimeters were collected and processed to determine the radiation level. Results: In none of the points selected for measurements the values exceeded the radiation dose threshold for controlled area (5 mSv/year) or free area (0.5 mSv/year) as recommended by the Brazilian regulations. Conclusion: In the present study the authors demonstrated that the whole shielding system is appropriate and, consequently, the workers are exposed to doses below the threshold established by Brazilian standards, provided the radiation protection standards are followed.

Dosimetric evaluation of X-ray examinations of paranasal sinuses in pediatric patients

Abstract Objective: To estimate the entrance surface air kerma (Ka,e) and air kerma in the region of radiosensitive organs in radiographs of pediatric paranasal sinuses. Materials and Methods: Patient data and irradiation parameters were collected in examinations of the paranasal sinuses in children from 0 to 15 years of age at two children's hospitals in the city of Recife, PE, Brazil. We estimated the Ka,e using the X-ray tube outputs and selected parameters. To estimate the air kerma values in the regions of the eyes and thyroid, we used thermoluminescent dosimeters. Results: The Ka,e values ranged from 0.065 to 1.446 mGy in cavum radiographs, from 0.104 to 7.298 mGy in Caldwell views, and from 0.113 to 7.824 mGy in Waters views. Air kerma values in the region of the eyes ranged from 0.001 to 0.968 mGy in cavum radiographs and from 0.011 to 0.422 mGy in Caldwell and Waters views . In the thyroid region, air kerma values ranged from 0.005 to 0.932 mGy in cavum radiographs and from 0.002 to 0.972 mGy in Caldwell and Waters views. Conclusion: The radiation levels used at the institutions under study were higher than those recommended in international protocols. We recommend that interventions be initiated in order to reduce patient exposure to radiation and therefore the risks associated with radiological examination of the paranasal sinuses.

Balloon-based adjuvant radiotherapy in breast cancer: comparison between 99mTc and HDR 192Ir

Abstract Objective: To perform a comparative dosimetric analysis, based on computer simulations, of temporary balloon implants with 99mTc and balloon brachytherapy with high-dose-rate (HDR) 192Ir, as boosts to radiotherapy. We hypothesized that the two techniques would produce equivalent doses under pre-established conditions of activity and exposure time. Materials and Methods: Simulations of implants with 99mTc-filled and HDR 192Ir-filled balloons were performed with the Siscodes/MCNP5, modeling in voxels a magnetic resonance imaging set related to a young female. Spatial dose rate distributions were determined. In the dosimetric analysis of the protocols, the exposure time and the level of activity required were specified. Results: The 99mTc balloon presented a weighted dose rate in the tumor bed of 0.428 cGy.h-1.mCi-1 and 0.190 cGyh-1.mCi-1 at the balloon surface and at 8-10 mm from the surface, respectively, compared with 0.499 and 0.150 cGyh-1.mCi-1, respectively, for the HDR 192Ir balloon. An exposure time of 24 hours was required for the 99mTc balloon to produce a boost of 10.14 Gy with 1.0 Ci, whereas only 24 minutes with 10.0 Ci segments were required for the HDR 192Ir balloon to produce a boost of 5.14 Gy at the same reference point, or 10.28 Gy in two 24-minutes fractions. Conclusion: Temporary 99mTc balloon implantation is an attractive option for adjuvant radiotherapy in breast cancer, because of its availability, economic viability, and similar dosimetry in comparison with the use of HDR 192Ir balloon implantation, which is the current standard in clinical practice.

Dosimetria esporular: Bacillus subtilis TKJ6312 como biossensor de radiação solar biologicamente ativa

Since 2000, spore dosimetry and spectral photometry have been performed in parallel at the Southern Space Observatory, São Martinho da Serra (Southern Brazil). A comparative study involving data from Punta Arenas - Chile (53.2º S), São Martinho da Serra (29.5º S), Padang - Indonesia (0.9ºS), Brussels - Belgium (50.9º N) and Kiyotake - Japan (31.9º N) from 2000 to 2006 is presented. The Spore Inactivation Doses presented the higher values in summer (973 ± 73 for Punta Arenas and 4,369 ± 202 for São Martinho da Serra, as well 1,402 ± 170 and 3,400 ± 1,674 for Brussels and Kiyotake, respectively). The simplicity, robustness and high resistance of bacterial spores makes the biosensor an potential biological tool for UV-B monitoring.

Substitutos do " novo" mundo para as antigas plantas raras: um estudo de caso dos bálsamos

Convinced that the " true balsam" was lost forever, Conrad Gesner described other substances with similar healing virtues. However, he was not the only one in the 16th to search for other varieties of balsamic oleoresins. The arrival of the Europeans to the Americas allowed the finding of native plants with properties similar to those of the original balsam, including Balsam of Peru, Balsam of Tolu and particularly in the Brazilian area, Balsam of Copaiba. Focusing on the Brazilian context, this paper analyzes two different moments in the transit of the newly found varieties of balsams to the pharmacopeia and materia medica.

Leiomioma do esôfago removido por videolaparoscopia

This report describes a leiomyoma of the inferior third section of the esophagus removed during laparoscopic cholecystectomy. The patient is a woman 55-years-age, carrying esophageal myoma of 40 mm in diameter wide, situated in the posterior wall of the lower esophagus. Indications for surgery were based mainly on the growth of the mass (6 mm when discovered 7 years previously, increased to 40 mm). Recently the patient returned suffering from pain, which could be attributed to his litiasic cholecystopaty. A small degree of low disphagia could also be observed. Radiologic imaging, direct endoscopic examination and endoscopic ultrasound showed that the mioma protruded on to the oesophagic lumen, discreetly diminishing there. A laparoscopic esophageal myomectomy was indicated at the same session of the laparoscopic cholecystectomy. Once the pneunoperitoneum was installed, five ports were placed as if for a hiatus hernia surgery. The cholecystectomy was uneventful. Next, an esophagoscopy was performed so as to determine the precise area covering the base of the tumour; at the right-lateral site. Longitudinal and circular fibres of the esophagus was severed over the lesion and the enucleation of the tumour was performed alternating the monopolar dissection, bipolar and hidrodisection. Control-endoscopy was carried out to verify mucosa integrity. Four suture points with poliglactine 3-0 string so as to close the musculature followed this. One suture was placed in for diminution of the size of the esophagean hiatus. Total time of intervention: two hours (30m for the cholecystectomy and one hour and thirty minutes for the myomectomy). Postoperative period: uneventful. Disappearance of the disphagia was observed. Radiologic transit control with water-soluble contrast at 4th post-operative day: good passage. Diagnosis from laboratory of pathology: conjunctive tumour formed by muscle non-striated cells: leiomyoma. The patient was re-examined on the two-month postoperative follow-up. General conditions were good and there were no complain of dysphagia. Neither there were any symptoms of gastro-esophageal reflux.

Anastomose duodenoduodenal na pancreatoduodenectomia por pancreatite crônica

Literature has been showing a tendency of reducing the limits of Whipple's resection. The main technical advance was the pylorus preserving resection, technique proposed by Traverso and Longmire in 1978. The pancreticoduodenectomy for chronic pancreatitis, is probably the best opportunity to apply this type of procedure. In these specific patients, the author preserved the pylorus and the third portion of the duodenum. The gastrointestinal transit was reconstructed by the duodenumduodenal anastomosis and the bile duct and the pancreas were drained in a Roux-en-way loop . Follow-up showed no important complication, with no problems related to gastric emptying and without pain.