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.

Cinedacryocystography in the diagnosis of lacrimal obstruction in children

Purpose: To analyze the cinedacryocystography in children with congenital nasolacrimal obstruction suspicion. Methods: The cinedacryocystographic examination was done in 143 children (58% of girls and 42% of boys) younger than 5 years old, suspected of congenital nasolacrimal obstruction. The exams were done under general anesthesia and the children were probed immediately when obstruction was detected. Results: Epiphora, discharge or both were the most common complaints. Nevertheless 11% children had undergone unsuccessfully probing once, no one had any radiologic evaluation previously. The cinedacryocystographic exam showed nasolacrimal duct obstruction in 65,73%. Permeable lacrimal vies were presented in 34,3% of the children with epiphora. The obstruction was mainly at the Arlt's sinus. Using the cinedacryocystography, it was possible to observe the lacrimal sac enlargement and alterations in the contiguous structures such as hypertrophic turbinates (91,1%), sinusitis (44,6%) and septum deviation (24,1%). Conclusion: Cinedacryocystographic evaluation provides important information about lacrimal system obstruction in children, therefore, it is useful in all children with suspected congenital lacrimal obstruction.

Mononeuropathy of the suprascapular nerve: Study of 3 South American cases

In this work 3 new cases of suprascapular nerve mononeuropathy are described. ENMG diagnosis criteria were: a) normal sensory conduction studies of the ipsolateral ulnar, median and radial nerves; b) bilateral suprascapular nerve latencies with bilateral compound muscle action potential, obtained from the infraspinatus muscle with symmetrical techniques; and c) abnormal neurogenic infraspinatus muscle electromyographic findings, coexisting with normal electromyographical data of the ipsolateral deltoideus and supraspinatus muscles. These 3 cases of suprascapular mononeurpathy were found in 6,080 ENMG exams from our University Hospital. For us this mononeuropathy is rare with a 0.05% occurrence.

Abordagem diagnóstica dos pacientes com suspeita de trombose venosa profunda dos membros inferiores

Deep venous thrombosis is a relatively common disease, which can present pulmonary embolism as a complication in its acute phase, and later the post-thrombotic syndrome. Thus, diagnosis should be made as soon as possible, in order to prevent or minimize such complications. Several studies have shown that the symptoms and the clinical signs are inaccurate for the deep venous thrombosis diagnosis and that complementary exams are necessary. As an attempt to simplify the patients' assessment, Well et al., in 1997, developed a clinical prediction index that combines symptoms, signs and risk factors for deep venous thrombosis and managed to make a simpler approach through an association of this index with the complementary exams. Phlebography has been considered the gold standard of complementary exams. However, since it is an invasive exam and thus subject to complications, other diagnostic methods were introduced aiming at making the diagnostic approach simpler and less invasive. Doppler ultrasound, duplex scan, impedance plethysmography, computed tomography, and blood tests such as the D-dimer are some of the available methods for assessing the patient with suspicion of deep venous thrombosis. Among them, duplex scan has shown excellent accuracy and it is currently widely accepted as the first choice test for approaching the patient with deep venous thrombosis. Several authors have suggested an association of diagnostic methods to simplify and make the assessment of such patients more cost-effective, leading to the introduction of a wide range of diagnostic strategies. The different diagnostic methods used for assessing deep venous thrombosis are discussed, as well as a review of the literature on the accuracy, advantages and disadvantages of these methods. Copyright © 2005 by Sociedade Brasileira de Angiologia e Cirurgia Vascular.

Obstrução nasolacrimal congênita - Diagnóstico e tratamento

This article assembled the congenital lacrimal obstruction according embryology, clinical presentation, propedeutic exams and other differential anomalies.

Pelvimetria em macacos-da-noite (Aotus azarai infulatus - KUHL, 1820)

Related data to the diameters of the pelvis from 72 Aotus azarai infulatus, owl monkeys, 42 adult males and 30 adult non-pregnant females, were obtained in vivo by ventrodorsal projection radiographic exams, correlated with sex, the measures of the body and their origin. The mean values of the body length (30.94 cm), tail length (35.63 cm), thoracic perimeter (18.97 cm), hip perimeter (17.11 cm) and the weight (0.96 Kg) were verified. The radiographic images were digitalized and measured, and the mean values were 1.41 cm for the superior biiliac diameter; 1.58 cm for the inferior biiliac diameter; 1.97 cm for the medium biiliac diameter; 2.64 cm for the right diagonal diameter; 2.66 cm for the left diagonal diameter; 2.48 cm for the sacrum-pubic diameter; 3.85 cm 2 for the inlet pelvic area. In conclusion, the pelvis from males and females Aotus azarai infulatus can be classified as dolicopelvic and there is pelvic sexual dimorphism in adult owl monkeys (Aotus azarai infulatus).

Anomalia congênita em vasos da base do coração de um potro

Congenital anomalies of heart and large vessels are among more common found in animals, however rare in horses. This survey describes a cardiac anomaly that presents confluence between aorta wall and lung trunk, ramification of caudal cava vein in left atrium with presence of valve and consequently erroneous position of heart in thoracic cavity of one foal found dead after birth. The diagnostic was carried out for macroscopic finds association during the necropsy and histopathologic exams carried out at School of Veterinary Medicine - Unesp Araçatuba.

Utilização do primeiro ciclo ovulatório da estação reprodutiva para produção de embriões em éguas sob condições tropicais

The efficacy of the first ovulation of the breeding season was determined through the response of first pre-ovulatory follicle of the breeding season to hCG, embryo recovery rate, viability of recovered embryos, serum concentrations of progesterone, and response of first CL to PGF 2α. Thirteenth mares that were in vernal transition were accompanied until the first pre-ovulatory follicle was detected. At this moment, the ovulation was induced with 2,500 IU hCG (IV) and the mares were inseminated every other day until ovulation. Seven days after the ovulation, embryo recovery was performed and the progesterone concentration was determined. After detection of the first pre-ovulatory follicle of breeding season with ≥ 25mm, it took 14.92 ± 10.80 days for the follicle to reach the preovulatory size and 18.00 ± 11.08 days to ovulation. After administration of hCG, 11/13 mares ovulated in 48 hours. These follicles growth 2.19 ± 0.86 mm/day on average. Nine of 13 mares (69.2%) produced embryos and all were considered viable after morfological evaluation and fluorescence exams. The CL appeared competent producing 7.39 ± 2.11 ng/ml P 4 on average, and responding to PGF 2α. According to these results the first ovulatory cycle of the year can be utilized to produce viable embryos.

Follicular dynamics and plasma FSH and progesterone concentrations during follicular deviation in the first post-ovulatory wave in Nelore (Bos indicus) heifers

The objective of the present study was to characterize ovarian follicular dynamics and hormone concentrations during follicular deviation in the first wave after ovulation in Nelore (Bos indicus) heifers. Ultrasonographic exams were performed and blood samples were collected every 12 h from the day of estrus until 120-144 h after ovulation in seven females. Deviation was defined as the point at which the growth rate of the dominant follicle became greater than the growth rate of the largest subordinate follicle. Deviation occurred approximately 65 h after ovulation. Growth rate of the dominant follicle increased (P < 0.05) after deviation, while growth rate of the subordinate follicle decreased (P < 0.05). Diameter of the dominant follicle did not differ from the subordinate follicle at deviation (approximately 5.4 mm). The dominant follicle (7.6 mm) was larger (P < 0.05) than the subordinate follicle (5.3 mm) 96 h after ovulation or 24 h after deviation. Plasma FSH concentrations did not change significantly during the post-ovulatory period. The first significant increase in mean plasma progesterone concentration occurred on the day of follicular deviation. In conclusion, the interval from ovulation to follicular deviation (2.7 days) was similar to that previously reported in B. taurus females, but follicles were smaller. Diameters of the dominant follicle and subordinate follicle did not differ before deviation and deviation was characterized by an increase in dominant follicle and decrease in subordinate follicle growth rate. Variations in FSH concentrations within 12-h intervals were not involved in follicular deviation in Nelore heifers. © 2006 Elsevier B.V. All rights reserved.

Biochemical and hematological study of goats envenomed with natural and 60Co-irradiated bothropic venom

Venoms from snakes of the Bothrops genus are proteolytic, coagulant, hemorrhagic and nephrotoxic, causing edema, necrosis, hemorrhage and intense pain at the bite site, besides systemic alterations. Many adjuvants have been added to the venom used in the sensitization of antiserum-producer animals to increase antigenic induction and reduce the envenomation pathological effects. Gamma radiation from 60Co has been used as an attenuating agent of the venoms toxic properties. The main objective was to study, comparatively, clinical and laboratory aspects of goats inoculated with bothropic (Bothrops jararaca) venom, natural and irradiated from a 60Co source. Twelve goats were divided into two groups of six animals: GINV, inoculated with 0.5mg/kg of natural venom; and GIIV, inoculated with 0.5mg/kg of irradiated venom. Blood samples were collected immediately before and one, two, seven, and thirty days after venom injection. Local lesions were daily evaluated. The following exams were carried out: blood tests; biochemical tests of urea, creatinine, creatine kinase (CK), aspartate amino-transferase (AST) and alanine amino-transferase (ALT); clotting time; platelets count; and total serum immunoglobulin measurement. In the conditions of the present experiment, irradiated venom was less aggressive and more immunogenic than natural venom.

Lombalgia em eqüinos

Back pain, whether they have a primary or secondary origin, is a important cause to the drop of the equine performance, but the size and the complex biomechanics make it difficult to diagnosis and treat the injury. As it is, the knowledge of this anatomic site is of great importance to the thoracolumbar examination. The diagnosis of back pain is done through physical examination and complementary exams, represented by the image methods of diagnosis, such as radiography, ultrasonography and thermography. The most important lesions that cause the back pain in an equine are impingement of the dorsal spinous processes, desmopathy of the supraespinous ligament, osteoarthritis of the articular processes and lesions of the vertebral discs and body. The most common treatments to back pain are the non-steroidal anti-inflammatory drugs, local injections, acupuncture, physiotherapy, training management and surgery.

Avaliação da assistência pré-natal e puerperal desenvolvidas em região do interior do Estado de São Paulo em 2005

Objectives: to evaluate the structure and process of the prenatal and puerperal care given by Direção Regional de Saúde (DIR) XI, at the city of Botucatu, State of São Paulo, Brazil. Methods: an evaluation of resources and activities developed during prenatal and puerperal care in twenty municipalities comprising DIR XI which had adhered the Prenatal and Birth Humanization Program until 2003. Interviews with city managers and analysis of 385 sampled patient charts taking into account recommendations by the Health Department. Results: structure analysis showed that caregiving was centered on medical work; basic equipment and instruments were available; 85.2% of patients began prenatal care with up to 120 days of pregnancy, and 75.9% had at least six prenatal consultations. The active search for absentees and strategies for early prenatal care initiation were observed in 30% and 50% of the municipalities, respectively. Process indicators showed that 3.6% of women had six prenatal consultations, one puerperal consultation, all basic exams and tetanus immunization. Recording of gestational age, arterial blood pressure and weight was of approximately 90%; 58.7% of the women underwent childbirth review and 31.5% were vaccinated. Conclusions: the performance of the set of activities is a challenge to prenatal care at DIR XI.

Doenças respiratórios em aves atendidas no Laboratório de Ornitopatologia da FMVZ-UNESP/Botucatu-SP, Brasil, nos anos de 2005 a 2006

The respiratory tract of birds shows anatomical and physiological characteristics that facilitates the occurrence of disease, mainly those of microbiological origin. This article analyzes the frequency of respiratory diseases in domestic and wild birds treated during the years 2005-2006 at the Ornitopathology Laboratory of the Veterinary Hospital, Faculty of Veterinary Medicine and Zootecnics, São Paulo State University (FMVZ-UNESP). Diagnoses were obtained through clinical and radiographic exams as well as haemogram, microbiological culture, parasitological tests and necropsy, being septicemic processes, aspergillosis and mycoplasmosis the most diagnosed diseases. No zoonotic threats were identified, so the entities were described as of low-impact on public health. However, the above mentioned agents can provoke death of birds and difficult for treating and eradication as well.

Ocorrência de parasitas gastrintestinais em cães e gatos na rotina do laboratório de enfermidades parasitárias da FMVZ/Unesp-Botucatu, SP.

With the object of determining the occurrence and prevalence of parasites in dogs and cats in the region of Botucatu, a survey was conducted from the results of fecal parasitologic exams feces, processed by the laboratory of parasitic diseases of FMVZ-UNESP/Botucatu from January 2002 to December 2006. 1,012 fecal samples of dogs and cats were evaluated by the technique of Willis Mollay and Faust. In dogs the higher incidence was found for Ancylostoma caninum eggs (38%). In cats, the oocysts of Isospora spp were present in 48.38% of positive samples.

Semen variables of sheep (Ovis aries) experimentally infected with Toxoplasma gondii

The influence of Toxoplasma gondii on semen variables and sperm morphology of sheep was evaluated in eight reproductive males distributed into three experimental groups: GI, three sheep inoculated with 2.0 × 105 of P strain oocytes; GII, three sheep infected with 1.0 × 106 of RH strain tachyzoites and; GIII two control sheep. Clinical (rectal temperature, cardiac and respiratory frequencies), parasite and serology exams (IIF) were realized. Sperm variables (volume, motility, vigor and concentration) and semen morphology for each sheep were also evaluated. Thus, semen and blood collections were assessed on post-inoculation days (PIDs)-1,3,5,7,11,14 and weekly thereafter up to PID 70. Clinical alterations were observed (hypothermia and anorexia) in infected sheep from groups GI and GII. Parasitic outbreaks were detected in five sheep. All the infected sheep produced antibodies against T. gondii from PID 5 onwards, reaching a peak of 4096 and 8192 for group GI and GII sheep, respectively. Differences (P < 0.05) were observed regarding the ejaculate volume between the inoculated groups (oocytes and tachyzoites) and control. Even though experimental toxoplasmic infection resulted in clinical symptomology in the inoculated sheep, the minimal alterations in sperm pathologies could not be directly attributed to T. gondii. © 2008 Elsevier B.V. All rights reserved.