Esvaziamento radical versus seletivo (supraomohióideo) no tratamento do carcinoma epidermóide do andar inferior da boca

O paradigma terapêutico para o CEC do andar inferior da boca sofreu modificações em decorrência da sobrevida. OBJETIVO: Estudo comparativo do esvaziamento cervical radical e seletivo. MATERIAL E MÉTODO: Análise de 460 pacientes atendidos no Depto. de CCP e ORL do Hospital Heliópolis, de 1978 a 2002. Para esvaziamento radical foram avaliados os padrões de metastatização dos níveis IV e V, para o seletivo a ocorrência e localização das recidivas. O método estatístico utilizado foi o teste do qui-quadrado. RESULTADOS: Nos esvaziamentos radicais a taxa de metastatização nos níveis IV e V foram 5,8% e 4,6%, nos pacientes cNO e de 9,9% (nível IV) e 5,9% (nível V) para cN+, enquanto o nível I isolado estava comprometido em 11,0% nos cN0 e 5,5% nos cN+. Nos esvaziamentos seletivos ocorreram 4 recidivas (4,1%) em 97 esvaziamentos nos pN0 e 2 (10,0%) em 20 esvaziamentos. Nos casos pN+, não houve vantagens na indicação de radioterapia sobre os não irradiados (5,6% e 5,7% respectivamente). CONCLUSÃO: É possível realizar esvaziamento seletivo no tratamento das metástases do andar inferior de boca.

Fatores prognósticos no tratamento do carcinoma epidermóide da laringe: cirurgia conservadora x radical

O tratamento do carcinoma da laringe tem como desafio a cura do paciente e a preservação do órgão. OBJETIVO: A avaliação dos subsítios na disseminação do carcinoma e a sua influência no tratamento cirúrgico da laringe, no controle local e na sobrevida. MATERIAL E MÉTODO: Cento e sessenta pacientes tratados na Escola Paulista de Medicina - Hospital São Paulo, no período de janeiro de 1998 a dezembro de 2004, foram compilados para análise da disseminação do carcinoma dos subsítios da laringe. Foram incluídos pacientes com seguimento mínimo de 2 anos, após diagnóstico e tratamento. A avaliação estatística foi: Teste X2, Teste de Fisher e a Curva de Kaplan-Meier. Forma de Estudo: Estudo de Coorte Histórica Longitudinal (Trabalho Clínico Retrospectivo). RESULTADOS: A comissura posterior e a infraglote, respectivamente, foram significantes para a laringectomia total: tumores glóticos AC: (p=0,03) AP: (p=0,0001); AC: (p=0,0007) AP: (p<0,0001). A infraglote foi significante nos tumores G+SG na AP: (p=0,04), e na taxa de óbitos AP: (p=0,03). CONCLUSÃO: A laringectomia total é o tratamento de eleição na presença de alto comprometimento da comissura posterior e da infraglote. Esta última pode comprometer a sobrevida, conforme a invasão local, mesmo na presença de margens cirúrgicas livres.

Effects of levels of potassium and nitrogen on yields and post-harvest conservation of onions in winter

Potassium and nitrogen are the elements present in the highest percentage in the onion dry matter. The objective of this experiment was to evaluate yield and post-harvest conservation of Vale Ouro IPA-11 onion cultivar regarding to nitrogen and potassium levels. The experiment was carried out in Petrolina-PE, Brazil, from June to September 2009. The experimental design was a completely randomized block in a 4 x 3 factorial design, composed of four nitrogen levels (0, 60, 120 and 180 kg ha-1) and three potassium levels (0, 90 and 180 kg ha-1) with three replications. The highest yield of commercial bulbs was achieved at an estimated N level of 172.6 kg ha-1. The lowest yield of noncommercial bulbs was estimated at N level of 147.0 kg ha-1. Lower percentage of smaller bulbs (class 2) were obtained by increasing levels of N x K, with a quadratic effect at the dose of 90 kg ha-1 K2O and minimum production point with 127.6 kg N ha-1 (20.3%). Regarding larger caliber bulbs (class 4), linear effects were found both in the absence and for the level of 90 kg ha-1 of K2O as levels of N were increased. When the highest level of 180 kg ha-1 K2O was applied, the level of 92.8 kg ha-1 of N was estimated as the one that would promote the highest bulb yield of this class (35.4%), and 5.3% was found in the lack of potassium fertilization.

A implementação de inovação radical em empresas maduras

A cada dia surgem mais provas da importância da inovação radical ou revolucionária na determinação do sucesso das empresas, em longo prazo, no mercado competitivo atual. Embora esse reconhecimento tenha estado presente em muitas empresas sólidas, existem dúvidas no que diz respeito à maneira segundo a qual a inovação deve ser implementada. O presente artigo baseia-se em um estudo longitudinal de 12 projetos de inovação radical em 10 empresas maduras de grande porte, no período de seis anos. O ciclo de vida dos projetos de inovação radical é diferente daquele de projetos incrementais, devido ao grande número de incertezas e descontinuidades. Tais características exigem que os projetos de inovação radical sejam gerenciados de forma diversa daquela aplicada aos projetos incrementais. Demonstramos sete fatores estratégicos decisivos para realizar-se a implementação bem-sucedida da inovação radical.

Aprendizagem contestada em ambiente de mudança radical

Este artigo oferece uma análise da aprendizagem nas organizações em condições de mudança radical, em que a reestruturação da organização foi motivada por uma mudança na ideologia e na propriedade. Discute-se que, nessas circunstâncias, a aprendizagem não representa necessariamente uma melhoria para o coletivo como um todo. A fonte empírica para este artigo é um estudo de caso da Telemig, uma das principais companhias brasileiras de telecomunicações. A pesquisa empregou múltiplos métodos e fontes permitindo uma investigação do conteúdo e do processo de aprendizagem, e de seus agentes ao longo do tempo. O estudo elabora e ilustra o conceito de "aprendizagem contestada", concluindo que este necessita ser incorporado à teoria da aprendizagem nas organizações.

Long term (five-year) survival following radical surgical treatment plus adjuvant chemotherapy (FAM) in advanced gastric cancer: a controlled study

Several drugs and their associations are being used for adjuvant or complementary chemotherapy with the aim of improving results of gastric cancer treatment. The objective of this study was to verify the impact of these drugs on nutrition and on survival rate after radical treatment of 53 patients with gastric cancer in stage III of the TNM classification. A control group including 28 patients who had only undergone radical resection was compared to a group of 25 patients who underwent the same operative technique followed by adjuvant polychemotherapy with FAM (5-fluorouracil, Adriamycin, and mitomycin C). In this latter group, chemotherapy toxicity in relation to hepatic, renal, cardiologic, neurological, hematologic, gastrointestinal, and dermatological functions was also studied. There was no significant difference on admission between both groups in relation to gender, race, macroscopic tumoral type of tumor according to the Borrmann classification, location of the tumor in the stomach, length of the gastric resection, or response to cutaneous tests on delayed sensitivity. Chemotherapy was started on average, 2.3 months following surgical treatment. Clinical and laboratory follow-up of all patients continued for 5 years. The following conclusions were reached: 1) The nutritional status and incidence of gastrointestinal manifestation were similar in both groups; 2) There was no occurrence of cardiac, renal, neurological, or hepatic toxicity or death due to the chemotherapeutic method per se; 3) Dermatological alterations and hematological toxicity occurred exclusively in patients who underwent polychemotherapy; 4) There was no significant difference between the rate and site of tumoral recurrence, the disease-free interval, or the survival rate of both study groups; 5) Therefore, we concluded, after a 5-year follow-up, chemotherapy with the FAM regimen did not increase the survival rate.

Urethral catheter removal 7 or 14 days after radical retropubic prostatectomy: clinical implications and complications in a randomized study

PURPOSE: To evaluate the hypothesis that a 7-day period of indwelling catheter after radical retropubic prostatectomy is effective and safe without the need of performing cystography. METHODS: In the period from January of 2000 to July of 2002, 73 patients underwent radical retropubic prostatectomy, and these patients were prospectively randomized in 2 groups: Group 1-37 patients who had the urethral catheter removed 7 days after the procedure, and Group 2-36 patients who had the catheter removed 14 days after the surgery. The 2 groups were similar, the surgeons and the technique were the same, and no cystography was performed to evaluate the presence of leaks. RESULTS: Two patients in Group 1 had bleeding and clot retention after having the catheter taken out in the seventh postoperative day and were managed by putting the catheter back in for 7 more days. Two patients in Group 2 developed bladder neck stricture and were treated by bladder neck incision with success. The continence rate was the same, with 2 cases of incontinence in each group. About 2 pads a day were used by the patients with incontinence. The average follow-up was 17.5 months (12-36 months). No urinary fistula, urinoma, or pelvic abscesses developed after catheter removal. Two patients were excluded from the analysis of this series: 1 died with a pulmonary embolus in the third postoperative day, and 1 developed a urinary suprapubic fistula before catheter withdrawal, which was maintained for 16 days. CONCLUSION: Withdrawal of the urethral catheter 7 days after radical retropubic prostatectomy, without performing cystography, has a low rate of short-term complications that are equivalent to withdrawal 14 days after the surgery.

Flowering levels, harvest season and yields of cupuassu (Theobroma grandiflorum)

Cupuassu (Theobroma grandiflorum), a specie native to Amazonia, has been planted commercially in Brazil to satisfy the demand for the flavorful juice obtained from the pulp around its seeds. The trees are notorious for low and irregular fruit production. Data gathered over two seasons from trees in a germplasm collection in Pará, Brazil, showed that some of them fruited more regularly than others. Differences in fruit production correlated to differences in flower production. Tree-to-tree variation in flower production, fruit production, and consistency of both over time suggest considerable scope for improving yields by selection. Hand pollinations resulted in a much higher frequency of fruit set than open pollinations, indicating that lack of effective pollination is also a reason for low yield. However, attempts to increase the level of effective pollination are handicapped by low knowledge about the pollinators of cupuassu and their behavior.

Caracterização físico-química de polpas de frutos da Amazônia e sua correlação com a atividade anti-radical livre

Características físico-químicas (cor, pH, acidez total titulável, sólidos solúveis totais, conteúdo de lipídios e umidade) e níveis de compostos bioativos (ácido ascórbico, fenólicos totais) foram determinados em quinze amostras de polpas de frutos procedentes da região Amazônica (abiu, acerola, açaí, araçá-boi, bacaba, bacuri, buriti, cajá, cajarana, caju, cupuaçu, graviola, murici, noni e tamarindo). A atividade de radicais livres foi avaliada pelo método de ABTS. Algumas polpas apresentaram alta potencialidade antioxidante, associada com a atividade antirradicais livres obtida e os conteúdos dos componentes bioativos como compostos fenólicos e ácido ascórbico, destacando-se acerola e acaí. O conteúdo total de compostos fenólicos foi correlacionado à capacidade antioxidante das polpas.

THE ROLE OF MINERAL NUTRITION ON YIELDS AND FRUIT QUALITY IN GRAPEVINE, PEAR AND APPLE

ABSTRACT Fertilization of temperate fruit trees, such as grapevine ( Vitis spp.), apple ( Malus domestica), and pear ( Pyrus communis) is an important tool to achive maximum yield and fruit quality. Fertilizers are provided when soil fertility does not allow trees to express their genetic potential, and time and rate of application should be scheduled to promote fruit quality. Grapevine berries, must and wine quality are affected principally by N, that regulate the synthesis of some important compounds, such as anthocyanins, which are responsible for coloring of the must and the wine. Fermenation of the must may stop in grapes with low concentration of N because N is requested in high amount by yeasts. An N excess may increase the pulp to peel ratio, diluting the concentration of anthocyanins and promoting the migration of anthocyanins from berries to the growing plant organs; a decrease of grape juice soluble solid concentration is also expected because of an increase in vegetative growth. Potassium is also important for wine quality contributing to adequate berry maturation, concentration of sugars, synthesis of phenols and the regulation of pH and acidity. In apple and pear, Ca and K are important for fruit quality and storage. Potassium is the most important component of fruit, however, any excess should be avoided and an adequate K:Ca balance should be achieved. Adequate concentration of Ca in the fruit prevents pre- and post-harvest fruit disorders and, at the same time, increases tolerance to pathogens. Although N promotes adequate growth soil N availability should be monitored to avoid excessive N uptake that may decrease fruit skin color and storability.

Reduções enantiosseletivas de cetonas utilizando-se fermento de pão

Baker's yeast has been successful employed to reduce carbonyl compounds carrying appropriated substituents at distances under the electronic influence of the keto group. High yields and enantiomeric excess (ee) were obtained with 1,2-alkanedione, 1,2-alkanedione (2-O-methyloxime) and 1,3-alkanedione. Potential chiral building blocks were obtained and applied for stereoselective synthesis of valuable compounds. Evidence for a free radical chain process was obtained with baker's yeast reduction of a-iodoacetophenone using radical inhibitors.

Macrolactamas bioativas e síntese de macrociclos por reação de carbociclização radicalar mediada por hidreto de tri-n-butilestanho

This review presents natural, semi-synthetic and synthetic bioactive macrolactams and their structure-activity relationships when available. For macrolactams in clinical use the advantages and disadvantages in relation to other drugs are presented, and for synthetic macrolactams the method used in the cyclization is showed. Regarding macrocyclic synthesis by the tri-n-butyltin hydride-mediated radicalar carbocyclization reaction the precursor, the reaction conditions, products and yields, mechanism and cyclization mode are discussed.

Analysis of passion fruit rinds (Passiflora edulis): isoorientin quantification by HPTLC and evaluation of antioxidant (radical scavenging) capacity

The content of isoorientin in passion fruit rinds (Passiflora edulis fo. flavicarpa O. Degener) was determined by HPTLC (high performance thin layer chromatography) with densitometric analysis. The results revealed a higher amount of isoorientin in healthy rinds of P. edulis (92.275 ± 0.610 mg L-1) than in rinds with typical symptoms of PWV (Passion fruit Woodiness Virus) infection (28.931 ± 0.346 mg L-1). The HPTLC data, allied to assays of radical scavenging activity, suggest the potential of P. edulis rinds as a natural source of flavonoids or as a possible functional food.