Review of Fluconazole Properties and Analytical Methods for Its Determination

Fluconazole, -(2.4-diflurofenil)--(1H-triazol-1-methyl)-1H-1,2,4-triazol-1-ethanol, is an antifungal of 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 it 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 physical-chemical properties of fluconazole and also the methods of analysis applied to the determination of the drug.

REFLUXO GASTROESOFAGICO E SINTOMAS OTORRINOLARINGOLOGICOS

Gastroesophageal reflux and other gastroesophageal diseases produce symptoms in head and neck region leading individuals to search for ear nose and throat consultation. Otolaryngologist may incorporate investigation of reflux in your daily practice. Comments of gastroesophageal reflux and head and neck complaints are done. To illustrate handling of patients suspected of reflux authors relates a case of a dysphagia patient. Close relationship between otolaryngologist and gastroenterologist in reflux investigation is emphasized.

MANIPULANDO A DISFAGIA DE ORIGEN FARINGOESOFAGICA

Non-neoplastic dysphagia originated from motor deficit in the pharynx and from several disorders in the upper esophagus is studied taking into account the basic mechanisms of deglutition in the pharingoesophageal segment. Three groups of patients with dysphagia were investigated with the purpose of discussing the causes of ths symptom. Clinical examinations and electromanometry of the upper digestive tree, test of the laringeal elevation and clinical test of the bolus propulsion through pharynx were carried out. Emotional alterations, gastroesophageal lesions and motor disturbances in the digestive tree, among other, may cause dysphagia and other associated and secondary symptoms. This study points out the role of Otolaryngology in the investigation of swallowing disorders.

Histoplasmose do esôfago: Relato de caso

The authors report a case of a patient with complaint of progressive disphagia. Stenoses of lower third of esophagus was revealed by radiological and endoscopic examinations. Fungi were showed in biopsy of lesion, with demonstration of Histoplasm capsulate by tissue culture. Endoscopic dilatation was performed because especific medical treatment failed but esophageal rupture was observed. Partial esophagectomy was performed with symptoms remission.

Disfagia e alterações emocionais

Swallowing function may be impaired by a number of conditions involving primary or associated emotional distress. When psychogenic dysphagia is suspected, routine investigation using radiological and manometric examination is inappropriate. These cases demand an evaluation of the individual as a whole, interesting the disease as well as the patient's personal problems and concerns. Five cases of patients complaining of swallowing difficulty and showing concurrent emotional distress were studied. Four individuals were anxious and one was depressed. Because of our approach, a close medical-patient-relationship was established. Afterwards, an explanation about the normal swallowing mechanisms and the role of the emotions on it was provided. All patients showed improvement of the symptom in the following 24 hours. Dysphagia can be found in anxiety, depression and conversion hysteria, with high incidence in the urban population of the third world countries. However, several professionals are unaware of these disorders. Our results suggest that this plain approach is an useful tool in managing dysphagic patients and it has validity even in individuals bearing dysphagia due to comproved organic disease. The results also emphasize the importance of the medical patient relationship and the utility of a hollistic evaluation of the disease.

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.