Predictive factors in the long term outcome in gastro-oesophageal reflux disease: six years follow up of 107 patients

There is little information concerning the long term outcome of patients with gastro-oesophageal reflux disease (GORD). Thus 109 patients with reflux symptoms (33 with erosive oesophagitis) with a diagnosis of GORD after clinical evaluation and oesophageal testing were studied. All patients were treated with a stepwise approach: (a) lifestyle changes were suggested aimed at reducing reflux and antacids and the prokinetic agent domperidone were prescribed; (b) H2 blockers were added after two months when symptoms persisted; (c) anti-reflux surgery was indicated when there was no response to (b). Treatment was adjusted to maintain clinical remission during follow up. Long term treatment need was defined as minor when conservative measures sufficed for proper control, and as major if daily H2 blockers or surgery were required. The results showed that one third of the patients each had initial therapeutic need (a), (b), and (c). Of 103 patients available for follow up at three years and 89 at six years, respective therapeutic needs were minor in 52% and 55% and major in 48% and 45%. Eighty per cent of patients in (a), 67% in (b), and 17% in (c) required only conservative measures at six years. A decreasing lower oesophageal sphincter pressure (p < 0.001), radiological reflux (p = 0.028), and erosive oesophagitis (p = 0.031), but not initial clinical scores, were independent predictors of major therapeutic need as shown by multivariate analysis. The long term outcome of GORD is better than previously perceived.

Adição de areia para dispersão de solos na análise granulométrica

A acurácia da análise granulométrica depende da obtenção de suspensões de solo completamente dispersas e estáveis para possibilitar a separação das suas frações granulométricas. O objetivo do presente trabalho foi avaliar a eficácia da adição de quantidades e tamanhos de grãos de areia na fase de dispersão da análise granulométrica de solos, visando à maior acurácia na obtenção dos resultados da análise granulométrica. Os solos utilizados foram: Latossolo Vermelho eutroférrico (LVef), LatossoloVermelho acriférrico (LVwf), Latossolo Vermelho eutrófico (LVe), Argissolo Vermelho-Amarelo eutrófico (PVAe) e Nitossolo Vermelho eutroférrico (NVef). A dispersão das amostras dos solos foi realizada por meio da adição de hidróxido de sódio e agitação rotativa (60 rpm) por 16 h. O delineamento experimental adotado foi o inteiramente casualizado, com esquema fatorial 6 x 2, com três repetições. Os tratamentos foram constituídos por seis quantidades (0, 5, 10, 15, 20 e 25 g) e dois diâmetros (2,0-1,0 e 1,0-0,5 mm) de areia, adicionados na fase de dispersão da análise granulométrica dos solos. De acordo com as equações ajustadas, a adição de areia com diâmetro entre 1,0 e 0,5 mm nas quantidades de 21,4 g para LVef, 19,6 g para LVwf e 25,8 g para NVef proporciona, respectivamente para esses solos, aumentos de 50, 38 e 14,5 % nos teores de argila. No LVe e no PVAe não se justifica a adição de areia na análise granulométrica, pois esses solos não apresentaram problemas de dispersão. Os resultados demonstram que a adição de 25 g de areia, com diâmetro entre 1,0 e 0,5 mm, na fase de dispersão da análise granulométrica de solos argilosos com altos teores de óxidos de Fe e com dificuldades de dispersão, é eficiente para promover efetiva dispersão das partículas primárias do solo.

Crop sequences in no-tillage system: effects on soil fertility and soybean, maize and rice yield

Decomposing crop residues in no-tillage system can alter soil chemical properties, which may consequently influence the productivity of succession crops. The objective of this study was to evaluate soil chemical properties and soybean, maize and rice yield, grown in the summer, after winter crops in a no-tillage system. The experiment was carried out in Jaboticabal, SP, Brazil (21 ° 15 ' 22 '' S; 48 ° 18 ' 58 '' W) on a Red Latosol (Oxisol), in a completely randomized block design, in strip plots with three replications. The treatments consisted of four summer crop sequences (maize monocrop, soybean monocrop, soybean/maize rotation and rice/bean/cotton rotation) combined with seven winter crops (maize, sunflower, oilseed radish, pearl millet, pigeon pea, grain sorghum and sunn hemp). The experiment began in September 2002. After the winter crops in the 2005/2006 growing season and before the sowing of summer crops in the 2006/2007 season, soil samples were collected in the layers 0-2.5; 2.5-5.0; 5-10; 10-20; and 20-30 cm. Organic matter, pH, P, K+, Ca2+, Mg2+, and H + Al were determined in each soil sample. In the summer soybean/maize rotation and in maize the organic matter contents and P levels were lower, in the layers 0-10 cm and 0-20 cm, respectively. Summer rice/bean/cotton rotation increased soil K levels at 0-10 cm depth when sunn hemp and oilseed radish had previously been grown in the winter, and in the 0-2.5 cm layer for millet. Sunn hemp, millet, oilseed radish and sorghum grown in the winter increased organic matter contents in the soil down to 30 cm. Higher P levels were found at the depths 0-2.5 cm and 0-5 cm, respectively, when sunn hemp and oilseed radish were grown in the winter. Highest grain yields for soybean in monoculture were obtained in succession to winter oilseed radish and sunn hemp and in rotation with maize, after oilseed radish, sunn hemp and millet. Maize yields were highest in succession to winter oilseed radish, millet and pigeon pea. Rice yields were lowest when grown after sorghum.

Influence of liming on residual soil respiration and chemical properties in a tropical no-tillage system

Because of the climate changes occurring across the planet, especially global warming, the different forms of agricultural soil use have attracted researchers´ attention. Changes in soil management may influence soil respiration and, consequently, C sequestration. The objectives of this study were to evaluate the long-term influence of liming on soil respiration and correlate it with soil chemical properties after two years of liming in a no-tillage system. A randomized complete block design was used with six replications. The experimental treatments consisted of four lime rates and a control treatment without lime. Two years after liming, soil CO2 emission was measured and the soil sampled (layers 0-5, 5-10, 10-20, and 20-30 cm). The P, Ca2+ e Mg2+ soil contents and pH and base saturation were determined. CO2 emission from soil limed at the recommended rate was 24.1 % higher, and at twice the recommended rate, 47.4 % higher than from unlimed soil. Liming improved the chemical properties, and the linear increase in soil respiration rate correlated positively with the P, Ca2+ and Mg2+ soil contents, pH and base saturation, and negatively with H + Al and Al3+ contents. The correlation coefficient between soil respiration rate and chemical properties was highest in the 10-20 cm layer.

Soil uses in the sugarcane fallow period to improve chemical and physical properties of two latosols (oxisols)

Sugarcane production should be integrated with crop diversification with a view to competitive and sustainable results in economic, social and environmental aspects. The purpose of this study was to assess the influence of different soil uses during the sugarcane fallow period on the chemical and physical properties of eutroferric Red Latosol - LVef (Oxisol) and Acric Latosol - LVw (Acric Oxisol), in Jaboticabal, São Paulo State, Brazil (21º14'05'' S, 48º17'09'' W, 600 m asl). A randomized block design was used with five replications and four treatments, consisting of different soil uses (crops) in the sugarcane fallow period: soybean only, soybean/fallow/soybean, soybean/millet/soybean, and soybean/sunn hemp/soybean. After two soybean crops, the LVef chemical properties remained at intermediate to high levels; while those of the LVw, classified as intermediate to high in the beginning, increased to high levels. Thus, the different soil uses during the sugarcane fallow period allowed the maintenance of LVef fertility levels and the improvement of those of the LVw. Two soybean crops increased macroporosity in the 0.0-0.1 m layer of the LVef; reduced soil aggregates in the 0.0-0.1 and 0.1-0.2 m layers of both soils, and reduced aggregate stability in these two layers of the LVw. Planting pearl millet or sunn hemp between the two soybean growing seasons promoted the formation of larger soil aggregates in the surface layer (0.0-0.1 m) of the LVw.

Sequências de culturas em sistema de semeadura direta: I - produção de matéria seca e acúmulo de nutrientes

Em sistema de semeadura direta, os resíduos das culturas de entressafra são utilizados com as finalidades de proteger a superfície do solo dos agentes erosivos e de promover a ciclagem de nutrientes. O objetivo deste trabalho foi avaliar a produção de matéria seca e o acúmulo de nutrientes nos resíduos vegetais provenientes de diferentes sequências de culturas em semeadura direta. O experimento foi conduzido em Jaboticabal-SP (48° 18' W e 21° 15' S), em um Latossolo Vermelho eutrófico. O delineamento experimental foi em faixas, com três repetições. Os tratamentos foram constituídos pela combinação de três sequências de culturas de verão (rotação soja-milho e monoculturas de milho e de soja) com sete culturas de entressafra (milho, sorgo, girassol, crotalária, guandu, nabo forrageiro e milheto). O experimento iniciou-se em 2002, e o presente estudo refere-se aos anos agrícolas 2007/2008 e 2008/2009. Avaliaram-se as quantidades de matéria seca e o acúmulo de nutrientes pelas culturas. As culturas com colheita de grãos na entressafra (milho, sorgo e girassol) produziram resíduos com menor quantidade de nutrientes acumulados e em menor quantidade de matéria seca, quando comparadas às culturas com trituração no florescimento (crotalária, guandu, nabo forrageiro e milheto). Milheto e crotalária apresentaram as maiores produções de matéria seca e os maiores acúmulos de nutrientes. O milheto mostrou os maiores acúmulos de K e Mg, e a crotalária, maiores acúmulos de N e P. As gramíneas cultivadas na entressafra apresentaram maior desenvolvimento quando em sucessão ao cultivo de soja no verão anterior, com maior produção de matéria seca de milheto e, também, maior produtividade de grãos de milho e sorgo.

Sequências de culturas em sistema de semeadura direta: II - decomposição e liberação de nutrientes na entressafra

Os nutrientes acumulados nos resíduos das culturas, ao serem liberados no processo de decomposição, retornam ao solo e podem ficar disponíveis às culturas em sucessão. O objetivo deste trabalho foi avaliar a decomposição e liberação de nutrientes de resíduos vegetais de espécies utilizadas na entressafra em diferentes sequências de culturas em sistema de semeadura direta. O experimento foi conduzido em Jaboticabal-SP (48° 18' W e 21° 15' S), em um Latossolo Vermelho eutrófico. O delineamento experimental foi em faixas, com três repetições. Os tratamentos constituíram da combinação de três sequências de culturas de verão (rotação soja-milho e monoculturas de milho e de soja) com sete culturas de entressafra (milho, sorgo, girassol, crotalária, guandu, nabo forrageiro e milheto). O experimento foi iniciado em 2002, e o presente estudo refere-se aos anos agrícolas 2007/2008 e 2008/2009. Avaliaram-se a decomposição e a liberação de nutrientes utilizando sacolas de decomposição, com coletas aos 15, 30, 60, 120 e 180 dias após a trituração das culturas. A cobertura do solo foi avaliada após a trituração das culturas e ao final do ano agrícola. Os resíduos de crotalária, milho, sorgo, girassol apresentaram menores taxas de decomposição. Crotalária, guandu, nabo forrageiro e milheto proporcionaram resíduos que liberaram maior quantidade de nutrientes quando comparados ao milho, sorgo e girassol. Crotalária e milheto destacaram-se como as culturas mais adequadas para cultivo na entressafra, em especial a crotalária, devido à baixa taxa de decomposição e à elevada quantidade de nutrientes liberados na decomposição, e o milheto, em razão da elevada quantidade de nutrientes remanescentes nos resíduos no final do ano agrícola. Sequências de culturas que envolveram cultivo de girassol na entressafra proporcionaram menor cobertura do solo pelos resíduos vegetais.

Heràclit, 85 Diels-Kranz inconvenients i grandesa de l'ànim abrandat

This article intends to be an accurate comrnentary of the Heraclitus185 Diels-Kranz fragment. The author considers, on the other side, that its meaning speah-s perfectly about the Prof: Josep Alsina's temperatment, in honor of whom he thought of writing this work.

Can Soil Penetration Resistance and Bulk Density Be Determined in a Single Undisturbed Sample?

Soil quality indicators such as penetration resistance (PR) and bulk density (BD) are traditionally determined in a single undisturbed soil sample. The aim of this study was to assess the effect of PR measurements of undisturbed samples on the determination of BD in the same sample of two soils differing in clay contents. To this end, samples were collected from the 0.00-0.10 and 0.10-0.20 m layers of two soils of clayey and very clayey texture. Volumetric rings were used to collect a total of 120 undisturbed soil samples from each soil layer that were divided into two subsets containing 60 units each. One sample set, designated “perforated samples”, was used to determine PR and BD in the same undisturbed sample; the other, named “intact samples”, was used to determine BD only. Bulk density values for perforated and intact samples were compared by analysis of variance, using a completely randomized experimental design. Means were compared by the t-test at 5 %. The BD values for the clayey soil were similar in perforated and intact samples from the two layers. However, BD of the very clayey soil was lower in the perforated than in the intact samples at both depths. Therefore, PR and BD in clayey soils can be accurately determined in the same undisturbed sample whereas in very clayey soils, different samples are required for this purpose.

Estudio comparativo de dos estrategias para el tratamiento del dolor durante la ablación de fibrilación auricular: analgesia frente a sedación

Antecedentes: Las aplicaciones de radiofrecuencia durante la ablación de la fibrilación auricular (FA) producen dolor y ansiedad. El tratamiento habitual se basa en la administración de analgésicos y sedación. La sedación intensa puede producir inestabilidad hemodinámica y desaturaciones.Objetivos: Comparar la incidencia de desaturaciones en relación a la utilización de dos protocolos distintos de tratamiento del dolor durante la ablación de FA. Uno de los protocolos está basado en la sedación con propofol (protocolo 1) y el otro en la analgesia intensa (protocolo 2).Resultados: Hemos analizado los datos de recogidos durante el procedimiento en un grupo de 43 pacientes tratados según el protocolo 1 y otro grupo de 43 pacientes tratados según el protocolo 2. Las variables analizadas han sido: la desaturación máxima, la dosis media de propofol y la dosis media de fentanilo. Las dosis de propofol necesarias en los pacientes del protocolo 1 han sido mayores que con el protocolo 2 (2,4±1,4mg/kg vs 1,7±0,5 mg/kg; p=0,005). La dosis de fentanilo en los pacientes del protocolo 1 han sido menores que en los del protocolo 2 (35,4±17,3mg vs 51,1±18,6mg vs; p<0,001). El 83,65% de los pacientes del protocolo 2 se mantuvo por encima del 94% de saturación frente al 58,1% de pacientes del protocolo 1. Conclusiones: Con el tratamiento basado en la analgesia para los procedimientos de ablación de FA se consigue que una menor proporción de pacientes tengan desaturaciones.

A comparison of the accuracy of peritoneoscopy and liver biopsy in the diagnosis of cirrhosis

The accuracy of peritoneoscopy and liver biopsy in the diagnosis of hepatic cirrhosis was compared in 473 consecutive patients submitted to both procedures. One hundred and fifty-two of them had cirrhosis diagnosed by one or both methods. There was 73% agreement between the two procedures. `Apparent' false-negative results were 17·7% for peritoneoscopy and 9·3% for liver biopsy. The incidence of false-negative results in the diagnosis of cirrhosis can be reduced by combining both procedures.

Predictive factors in the long term outcome in gastro-oesophageal reflux disease: six years follow up of 107 patients

There is little information concerning the long term outcome of patients with gastro-oesophageal reflux disease (GORD). Thus 109 patients with reflux symptoms (33 with erosive oesophagitis) with a diagnosis of GORD after clinical evaluation and oesophageal testing were studied. All patients were treated with a stepwise approach: (a) lifestyle changes were suggested aimed at reducing reflux and antacids and the prokinetic agent domperidone were prescribed; (b) H2 blockers were added after two months when symptoms persisted; (c) anti-reflux surgery was indicated when there was no response to (b). Treatment was adjusted to maintain clinical remission during follow up. Long term treatment need was defined as minor when conservative measures sufficed for proper control, and as major if daily H2 blockers or surgery were required. The results showed that one third of the patients each had initial therapeutic need (a), (b), and (c). Of 103 patients available for follow up at three years and 89 at six years, respective therapeutic needs were minor in 52% and 55% and major in 48% and 45%. Eighty per cent of patients in (a), 67% in (b), and 17% in (c) required only conservative measures at six years. A decreasing lower oesophageal sphincter pressure (p < 0.001), radiological reflux (p = 0.028), and erosive oesophagitis (p = 0.031), but not initial clinical scores, were independent predictors of major therapeutic need as shown by multivariate analysis. The long term outcome of GORD is better than previously perceived.

Spectrum of gluten sensitive enteropathy in first degree relatives of patients with coeliac disease: clinical relevance of lymphocytic enteritis.

Background: Limited data on a short series of patients suggest that lymphocytic enteritis (classically considered as latent coeliac disease) may produce symptoms of malabsorption, although the true prevalence of this situation is unknown. Serological markers of coeliac disease are of little diagnostic value in identifying these patients. Aims: To evaluate the usefulness of human leucocyte antigen-DQ2 genotyping followed by duodenal biopsy for the detection of gluten-sensitive enteropathy in first-degree relatives of patients with coeliac disease and to assess the clinical relevance of lymphocytic enteritis diagnosed with this screening strategy. Patients and methods: 221 first-degree relatives of 82 DQ2+ patients with coeliac disease were consecutively included. Duodenal biopsy (for histological examination and tissue transglutaminase antibody assay in culture supernatant) was carried out on all DQ2+ relatives. Clinical features, biochemical parameters and bone mineral density were recorded. Results: 130 relatives (58.8%) were DQ2+, showing the following histological stages: 64 (49.2%) Marsh 0; 32 (24.6%) Marsh I; 1 (0.8%) Marsh II; 13 (10.0%) Marsh III; 15.4% refused the biopsy. 49 relatives showed gluten sensitive enteropathy, 46 with histological abnormalities and 3 with Marsh 0 but positive tissue transglutaminase antibody in culture supernatant. Only 17 of 221 relatives had positive serological markers. Differences in the diagnostic yield between the proposed strategy and serology were significant (22.2% v 7.2%, p<0.001). Relatives with Marsh I and Marsh II¿III were more often symptomatic (56.3% and 53.8%, respectively) than relatives with normal mucosa (21.1%; p=0.002). Marsh I relatives had more severe abdominal pain (p=0.006), severe distension (p=0.047) and anaemia (p=0.038) than those with Marsh 0. The prevalence of abnormal bone mineral density was similar in relatives with Marsh I (37%) and Marsh III (44.4%). Conclusions: The high number of symptomatic patients with lymphocytic enteritis (Marsh I) supports the need for a strategy based on human leucocyte antigen-DQ2 genotyping followed by duodenal biopsy in relatives of patients with coeliac disease and modifies the current concept that villous atrophy is required to prescribe a gluten-free diet.

Upper gastrointestinal bleeding in cirrhosis: clinical and endoscopic correlations

The clinical data of 180 episodes of upper gastrointestinal bleeding in 168 patients with cirrhosis of the liver are examined. The source of bleeding had been determined by early endoscopy in all cases. In men under the age of 50 years, and without symptoms of liver failure, bleeding was due to ruptured gastro-oesophageal varices in 84% of cases. Severe liver failure was associated with acute lesions of gastric mucosa in many cases. No presumptive diagnosis of the source of haemorrhage could be based on the examination of other clinical data (presence of ascites, mode of presentation and pattern of bleeding, history of ulcer disease, alcoholism, and previous medication.