778 resultados para Obstetrisk anal sfinkterruptur


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Colonisation and infection by Candida species occur frequently in acquired immunodeficiency syndrome (AIDS), but their relationship to the humoral immunity against candidiasis is controversial. To evaluate the levels of antibodies to Candida in the serum and in the saliva of HIV-1-infected patients in relation to the presence of immunodeficiency, oral candidiasis and Candida colonisation, Candida was investigated in the urine and in the oral and anal mucosae of HIV-1-infected patients, AIDS patients and healthy controls. The levels of IgG, IgM and IgA antibodies to Candida were determined in the serum and in the saliva by immunoassay. Candida species were detected in 76% of the patients. Mucosal yeast colonisation and the levels of serum and saliva antibodies to Candida were similar between asymptomatic HIV-infected and non-infected patients. Mucosal colonisation was highest in AIDS patients, who also had higher serum IgA and saliva IgG antibodies. Antibody levels were similar in patients with and without candidiasis oral lesions. Asymptomatic HIV-infected individuals are similar to non-infected individuals with respect to mucosal colonisation as well as serum and saliva levels of antibodies to Candida. The higher mucosal colonisation and clinical candidiasis observed in the AIDS patients apparently stimulated a more intense humoral response to the yeast.

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Chemokines and their receptors regulate the trafficking of immune cells during their development, inflammation, and tissue repair. The single-nucleotide polymorphism (SNP) rs1801157 (previously known as CXCL12-A/ stromal cell-derived factor-1 (SDF1)-3`A) in CXCL12/SDF1 gene was assessed in breast cancer, Hodgkin`s lymphoma (HL), and non-Hodgkin`s lymphoma (NHL), since the chemokine CXCL12, previously known as SDF1, and its receptor CXCR4 regulate leukocyte trafficking and many essential biological processes, including tumor growth, angiogenesis, and metastasis of different types of tumors. Genotyping was performed by PCR-RFLP (polymerase chain reaction followed by restriction fragment length polymorphism) using a restriction enzyme Hpall cleavage. No significant difference was observed in genotype distribution between breast cancer patients (GG: 57.3%; GA: 39.8%; AA: 2.9%) and healthy female controls (GG: 62.9%; GA: 33%; AA: 4.1%) nor between HL patients (GG: 61.1%; GA:27.8%; AA: 11.1%) and healthy controls (GG: 65.6%; GA: 28.9%; AA: 5.5%), whereas a significant difference was observed in genotype distribution between NHL patients (GG: 51.4%; GA: 47.1%; AA: 1.5%) and healthy controls (GG: 65.6%; GA: 28.9%; AA: 5.5%). Further studies will be necessary to elucidate the cancer chemokine network. However, this study suggests that CXCL12 rs1801157 polymorphism may have important implications in the pathogenesis of NHL. J. Clin. Lab. Anal. 23:387-393, 2009. (C) 2009 Wiley-Liss, Inc.

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There seems to be controversy on the anorectal sphincter presentation and anatomical division, as well as on its functional representation. Evaluation of the anorectal sphincter musculature has been achieved through several methods, including anorectal manometry and computerized tomography, but to date there is no experimental model allowing a detailed manometric study of this muscle complex. In this work, we have developed such a model, which should enable the manometric and radiographic study of the anatomical features and functional mechanisms of sphincteric injuries, as well as the assessment of drug effects on the anorectal musculature upon incontinence and constipation. Twenty-two piglets (aged 25-30 days, weighing 5-7 kg) were studied by anorectal manometry (rectoanal inhibitory reflex and vector volume) and computerized tomography (anorectal angle and anal canal length). The data obtained for the rectoanal inhibitory reflex, represented here as the average and standard deviation, were the following: relaxation duration = 14.75 +/- 3.62 s, sphincter basal pressure = 41.58 +/- 8.20 mmHg, relaxation index = 87.26 +/- 11.52%, speed of relaxation = 5.90 +/- 2.10 mm/s, and speed of relaxation recovery = 4.03 +/- 1.78 mm/s. As for the vector volume, results were as follows: vector volume = 2692.32 +/- 1298.12 mmHg(2) cm, sphincter length = 11.82 +/- 2.74 mm, high pressure zone length = 5.09 +/- 1.34 mm, maximum pressure = 61.50 +/- 20.58 mmHg, and asymmetry index = 43.50 +/- 10.03%. Radiographic evaluation led to the following results: anal canal length = 9.61 +/- 2.14 mm and anorectal angle = 137.91 +/- 7.75 degrees. The experimental model designed here allows both anorectal manometry and computerized tomography to be carried out in the same way it is performed in human beings, as long as animal sedation is strictly controlled.

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Anal incontinence causes psychological, social and adaptive troubles prejudicial to the quality of life both in children and adults. Therefore, the detailed knowledge of its causes and the improvement of diagnostic and therapeutic methods increase the possibilities of a more adequate social life to patients with congenital anomalies or sphincteric lesions or degenerations. In this work, a manometric study was developed through an experimental model so as to analyze alterations in behavior of muscle groups responsible for the anorectal sphincteric mechanism, previous to and after proximal and distal lesions. Twenty-two pigs aged between 25 and 30 days, weighing 5-7 kg, were randomly divided into two groups. They were submitted to lesions of different levels in the anorectal muscle. The animals were studied by anorectal manometry (rectoanal inhibitory reflex and vector volume) before and after the lesions. The Student t test and the Wilcoxon test were applied for the statistical analyses, considered p <= 0.05. The proximal lesion preserved sphincter relaxation, retarding its closure [speed of relaxation recovery 4.35 +/- 2.10 vs. 2.70 +/- 1.32 mm/s (p = 0.001)], but it reduced the maximum pressure [62.45 +/- 20.02 vs. 40.36 +/- 12.59 mmHg (p = 0.004)] and vector volume [2,749 +/- 921 vs. 1,591 +/- 1,379 mmHg(2)cm (p = 0.005)]. There was an increment in the high-pressure zone [5.09 +/- 1.04 vs. 6.36 +/- 1.50 mm (p = 0.005)], but the asymmetry percentage and the sphincter length were maintained. The distal lesion did not alter the rectoanal inhibitory reflex, the high-pressure zone length, the asymmetry percentage, or the vector volume. Nevertheless, the sphincter length increased [11.82 +/- 2.82 vs. 14.09 +/- 2.39 mm (p = 0.022)] and the maximum pressure decreased [60.55 +/- 22.05 vs. 40.91 +/- 13.41 mmHg (p = 0.004)]. The alterations observed due to proximal lesion of the anorectal sphincter suggest a direct and more important interference of the levator ani muscle in the function of the sphincteric musculature than that caused by the distal lesion.

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Aim Stapled haemorrhoidopexy may damage the anorectal musculature and its sensorimotor function. Most studies have not used a barostat for the measurement of compliance. This study aimed to investigate the effect of stapled haemorrhoidopexy on rectal compliance and sensitivity. Method After Ethical Committee approval, we studied 10 male patients (mean age 33.8 years) with third- or fourth-degree haemorrhoids. Rectal compliance and sensitivity were measured with a 600-ml bag and an electronic barostat. Volunteers were submitted to two consecutive rectal distension protocols, including continuous distension at 2, 4 and 6 months after stapled haemorrhoidopexy. Intraluminal volume and pressure were recorded, including the first rectal sensation, desire to defecate and onset of rectal pain. Another group of 10 male control patients (mean age 24.9 years) with pilonidal sinus and no haemorrhoids was also included in the study. Results Two months after stapled haemorrhoidopexy, rectal compliance decreased (7.1 +/- 0.2 vs 5.3 +/- 0.1, 6.4 +/- 0.1 vs 5.1 +/- 0.1 and 5.6 +/- 0.2 vs 4.7 +/- 0.1 ml/mmHg for first rectal sensation, desire to defecate and rectal pain, respectively; P < 0.05). The sensitivity threshold volume did not change for the first sensation but decreased significantly for the desier to defecate and pain (p < 0.05) (116.8 +/- 13.8 vs 148.4 +/- 14.61, 251.1 +/- 8.9 vs 185.8 +/- 8.6 and 293.3 +/- 16.6 vs 221.2 +/- 6.0 ml for first rectal sensation, desire to defecate and rectal pain, respectively). Four and 6 months after surgery, rectal compliance and sensitivity returned to levels similar to those in the basal period. Muscle tissue was found in only three of the 10 resected doughnuts. Controls remained without any change in rectal compliance and sensitivity. Conclusion Stapled haemorrhoidopexy transiently decreases rectal compliance and sensitivity threshold in young male patients.

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Benign leiomyomas are common soft tumors, arising especially in the female genital tract; unlike uterine leiomyomas, they rarely occur in perineal regions. They can develop wherever smooth muscle is present. Herein is reported the case of a large perineal leiomyoma in a 36-year-old woman who noted a palpable mass close to the rectum 1 year after she had delivered vaginally, in the same region of as a mediolateral episiotomy. Complete surgical excision was performed. Histopathologic findings were compatible with benign leiomyoma. At postoperative follow-up, no signs of anal dysfunction were noted. There was no pathologic correlation between formation of the leiomyoma and the episiotomy despite a possible association between the presence of fibrosis and development of leiomyomas, which was found during a literature review. Microarray analysis will be necessary to elucidate this hypothesis. Journal of Minimally Invasive Gynecology (2011) 18, 267-269 (C) 2011 AAGL. All rights reserved.

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Acanthoplacatus gen. nov., a new genus of viviparous gyrodactylid, is described from the rns and skin of siganid fishes from the Great Barrier Reef, Australia. The genus is characterized by a muscular, tube-like haptor with 16 marginal hooks on the posterior margin. The ventral lobe of the haptor is located anteriorly relative to the dorsal lobe and contains a pair of hamuli and a ventral bar with posteriorly-projecting ventral bar membrane. A dorsal bar is absent. Five pairs of posterior gland cells surround the posterior terminations of the gut. The male copulatory organ is a muscular, non-eversible bulb with several spines around the distal opening. Species of Acanthoplacatus have a bilateral excretory system consisting of six pairs of flame cells and a pair of excretory bladders. Seven new species are described: Acanthoplacatus adlardi sp. nov. and A. amplihamus sp. nov. from Siganus punctatus (Forster, 1801), A. brauni sp. nov. from S. corallinus (Valenciennes, 1835), A. parvihamus sp. nov. from S. vulpinus (Schlegel and Mueller, 1845), A. puelli sp. nov. from S. puellus Schlegel, 1852, A. shieldsi sp. nov. from S. lineatus (Valenciennes, 1835) and A. sigani sp. nov. from S. fuscescens (Houttuyn, 1782). Species can be discriminated by shape and size of the hamuli, marginal hooks and ventral bar and by male copulatory organ sclerite morphology. Three species (A. brauni sp. nov., A. shieldsi sp. nov. and A. sigani sp. nov.) were assessed for seasonal variation of sclerite size. Ten of thirteen morphological characters showed seasonal variation in size for at least one of the species. The characters were longer in winter except dorsal root tissue cap width. Only one character, marginal hook length, showed significant seasonal variation for all three species. Species of Acanthoplacatus were observed to attach using only the marginal hooks and the role of hamuli in attachment is unclear. The dorsal rn of the host is the preferred site for most species but the anal fin, caudal fin and body surfaces are preferred by some species. Prevalences for species range from 57 to 100%.

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Purpose: To assess the toxicity and the efficacy of preoperative radiotherapy with continuous infusion 5-fluorouracil (5-FU) for locally advanced adenocarcinoma of the rectum. Methods and Materials: Eligible patients had newly diagnosed localized adenocarcinoma of the rectum within 12 cm of the anal verge, Stage T3-4, and were suitable for curative resection. Eighty-two patients were treated with radiotherapy-50.4 Gy in 28 fractions in 5.6 weeks, given concurrently with continuous infusion 5-FU, using either 96-h/week infusion at 300 mg/m(2)/day or 7-days/week infusion at 225 mg/m(2)/day. Results: The median age was 59 years (range, 27-87), and 67% of patients were male. Pretreatment stages of the rectal cancer were T3, 89% and resectable T4, 11%, with endorectal ultrasound confirmation in 67% of patients. Grade 3 acute toxicity occurred in 5 of 82 patients (6%; 95% confidence interval [CI], 2-14%). Types of surgical resection were anterior resection, 61%; abdominoperineal resection, 35%; and other procedures, 4%. There was no operative mortality. Anastomotic leakage after low anterior resection occurred in 3 of 50 patients (6%; 95% CI, 1-17%). The pathologic complete response rate was 16% (95% CI, 9-26%). Pathologic Stages T2 or less occurred in 51%. Conclusion: Preoperative radiotherapy with continuous infusion 5-FU for locally advanced rectal cancer is a safe regimen, with a significant downstaging effect. It does not seem to lead to a significant increase in serious surgical complications. (C) 2001 Elsevier Science Inc.

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Trichogramma australicum larvae develop most rapidly in younger eggs of its host, the pest lepidopteran Helicoverpa armigera . To establish how the developmental stage of the host affects the diet of T. australicum , larvae were fixed in situ in eggs of H. armigera of different ages and the structure of the egg contents and parasitoid gut contents examined histologically. Larvae feeding on newly laid host eggs contain primarily yolk particles in their gut, while larvae feeding on older hosts contain necrotic cells and yolk particles. The gut of T. australicum larvae does not contain organised tissue remnants, indicating that larvae feed primarily by sucking food into their pharynx and feed best on a mixture of particulate semisolids in a liquid matrix. Secretory structures of T. australicum larvae that could be involved in modifying the host environment were examined. The hindgut is modified to form an anal vesicle with a number of attributes suggesting that it may be a specialised secretory structure. The paired salivary glands open to the exterior via a common duct.

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O panorama da judicializa????o das pol??ticas p??blicas (JPP) no Brasil se expande e se diversifica, imprimindo uma presen??a marcante na cena p??blica nacional. Isto tem levado atores da gest??o p??blica a buscarem solu????es alternativas para o tratamento da judicializa????o, quando esta bate ?? porta dos ??rg??os do Executivo, ou mesmo, quando entra sem bater. O presente trabalho visa transpor o debate pouco f??rtil que superdimensiona o papel do ativismo do Judici??rio, para situar a judicializa????o como fen??meno que carrega ao mesmo tempo problemas e janelas de solu????o para demandas cidad??s. Busca-se responder ?? indaga????o: o manejo da judicializa????o atrav??s de solu????es de gest??o para o atendimento de decis??es judiciais e para a preven????o de novos conflitos poderia ser considerado uma pol??tica p??blica? Para tal, ?? proposto um percurso anal??tico (te??rico e emp??rico). S??o confrontados dois campos te??ricos: a teoria da judicializa????o e os modelos anal??ticos de Pol??ticas P??blicas (m??ltiplos fluxos e equil??brio pontuado). A metodologia inclui o estudo de casos m??ltiplos da judicializa????o da Sa??de, por??m com pretens??es de aplica????o geral ?? JPP, mesmo que ainda explorat??ria. Com base na compara????o de casos, ?? constru??da uma tipologia de problemas e solu????es e testada a aplicabilidade dos fluxos de Kingdon (Problemas, Alternativas e Pol??tica) na forma????o da agenda do manejo da judicializa????o. S??o tamb??m estudados os aspectos do deslocamento de arena que a judicializa????o representaria, e da constru????o dessa arena emergente. Ao fim, os achados e possibilidades s??o postos em di??logo com a teoria da judicializa????o das pol??ticas p??blicas, buscando-se perceber as janelas para o estabelecimento de agendas de pol??ticas p??blicas mais sens??veis aos fluxos de judicializa????o

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O presente trabalho traz uma an??lise acerca do Programa de Financiamento ??s Exporta????es (PROEX), programa do governo brasileiro de cr??dito ??s exporta????es, que tem por objetivo dotar os exportadores brasileiros de condi????es de cr??dito similares ??s encontradas no cen??rio internacional, de forma a dar mais competitividade ??s exporta????es brasileiras, principalmente das micro, pequenas e m??dias empresas. O estudo parte de conceitos e referencial anal??tico, referentes ao processo de implementa????o de pol??ticas p??blicas. Tamb??m como aporte te??rico, ?? feita uma explana????o a respeito do papel atribu??do ??s exporta????es no ??mbito das teorias econ??micas e das caracter??sticas do cr??dito internacional, que trazem a essa modalidade seus aspectos ??nicos. A partir de dados or??ament??rios, do desempenho do Programa e da legisla????o pertinente, s??o feitas algumas reflex??es acerca do comportamento do PROEX entre os anos de 2003 e 2012. S??o tamb??m apresentados alguns gargalos observados no processo de implementa????o do Programa.Assim, como principal desafio foi identificada a necessidade de facilita????o na obten????o de garantias para a efetiva????o das opera????es. Uma maior divulga????o tamb??m tornaria o programa mais abrangente, al??m de outros fatores. O Programa parece atingir parcialmente seu objetivo, pois apesar de efetivamente apoiar as exporta????es de micro, pequenas e m??dias empresas e oferecer condi????es mais competitivas para as exporta????es nacionais, ainda carece de uma maior abrang??ncia, principalmente no que diz respeito ao n??mero de empresas atendidas. A cria????o do Fundo de Financiamento ?? Exporta????o(FFEX)dever?? trazer novidades ?? forma de implementa????o e atua????o do PROEX

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Na d??cada de 80, logo depois da eclos??o da crise de endividamento internacional, o tema que prendeu a aten????o de pol??ticos e economistas em todo o mundo foi o ajuste estrutural ou, em termos mais anal??ticos, o ajuste fiscal e as reformas orientadas para o mercado. Nos anos 90, embora o ajuste estrutural permane??a entre os principais objetivos, a ??nfase deslocou-se para a reforma do Estado, particularmente para a reforma administrativa. A quest??o central hoje ?? como reconstruir o Estado ??? como redefinir o novo Estado que est?? surgindo em um mundo globalizado

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Prop??e para fins anal??ticos, o conceito capacidade governativa, definido de maneira ampla, de forma a englobar tanto os aspectos operacionais do aparelho do Estado ??? a?? inclu??dos os requisitos organizacionais e gerenciais ??? como suas dimens??es econ??mica e pol??tica. Indica, ainda, a ambi??ncia mais ou menos democr??tica do sistema pol??tico. Esse conceito operacional permite, assim, a an??lise da efici??ncia e efic??cia do Estado em ajustar a economia, redefinir seu tamanho e suas fun????es, resgatar a d??vida social e manter-se em ambiente democr??tico, desafios impostos e assumidos por todos os governantes do Brasil p??s-constituinte.

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As principais atividades da Secretaria Federal de Controle s??o as de auditoria, fiscaliza????o, acompanhamento dos programas de governo, contabilidade anal??tica, treinamento de gestores e controle na ??rea de pessoal. A SFC tem adotado uma filosofia de trabalho cujos aspectos privilegiados s??o: atua????o descentralizada e junto aos locais onde as a????es ocorrem; tempestividade do controle interno, abrangendo as a????es presentes e n??o apenas as pret??ritas; ??nfase nos trabalhos de natureza preventiva e na orienta????o do gestor, em lugar da a????o apenas fiscalista; acompanhamento dos programas de governo e fornecimento de informa????es gerenciais independentes aos gestores, a fim de subsidiar a tomada de decis??es; fortalecimento das atividades-fim da SFC em lugar das atividades-meio; avalia????o dos resultados da gest??o dos administradores p??blicos, al??m dos aspectos formais e legais. A iniciativa promove a amplia????o da transpar??ncia da atua????o da SFC, redu????o da burocracia, maior possibilidade de atendimento de demandas espec??ficas provenientes dos gestores p??blicos e an??lise permanente dos resultados obtidos, a racionaliza????o dos trabalhos, com redu????o dos custos das auditorias e do n??mero de dilig??ncias, simultaneamente ao aumento da seguran??a dos resultados, a identifica????o de estrat??gias de a????o capazes de reduzir custos da atividade p??blica e substancial diminui????o do custo Brasil

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Painel 4 - Experi??ncias Setoriais: o Monitoramento nas ??reas de Meio Ambiente e Desenvolvimento Social; Palestra 1 - Minist??rio do Desenvolvimento Social e Combate ?? Fome: ???Monitoramento Anal??tico do Plano Brasil Sem Mis??ria e de Programas do Minist??rio do Desenvolvimento Social e Combate Fome???, apresentada por Marconi Fernandes de Sousa; Palestra 2 - Minist??rio do Meio Ambiente: ???Monitoramento de a????es governamentais de mudan??a do clima e combate ao desmatamento por interm??dio de ferramentas gerenciais e satelitais???, apresentada por Carla Leal Louren??o de Miranda, Josana de Oliveira Lima Esser e Nelcil??ndia Pereira de Oliveira