Tumores neuroendócrinos do trato gastrointestinal

Os tumores neuroendócrinos (TNE) já foram considerados raridades. Atualmente, através de novas técnicas para seu reconhecimento, tem-se identificado um número crescente destas neoplasias, sendo possível estratificá-las em subgrupos, expandindo o espectro dos neoplasmas neuroendócrinos e sua importância na prática cirúrgica atual. A imunocitoquímica, a dosagem de peptídeos e os modernos métodos de imagem proporcionam informações imprescindíveis para um diagnóstico acurado e o tratamento adequado. Este artigo tem por objetivo revisar aspectos referentes aos tumores neuroendócrinos do trato gastrointestinal relativos à história, fisiopatologia, classificação atualizada, diagnóstico e tratamento.

Tumor estromal gastrointestinal de intestino delgado

Stromal tumors of the gastrointestinal tract (gists) represent relatively rare lesions that arise from connective tissue elements located along the entire length of the gut. They were initially identified by immunohistochemical investigation, proving their origin from nondifferentiated mesenchymal cells. Only a minority of this lesions, mainly those confined to the esophagus and rectum, have been shown to correspond to mature, well-differentiated types of neoplasms such as leiomyoma or leiomyosarcoma. The majority of gists corresponds to a heterogeneous group of lesions that have as their common denominator an immature proliferation of epithelioid or spindle cells arising from its muscle layers, or between them, showing partial or incomplete myoide, neural, ganglionic, or mixed features of differentiation. This case report intends to show a gist of small bowel in a male, 46 years old, with a two-year of evolution.

Obstrução gastrointestinal por fitobezoar na cirurgia bariátrica

OBJETIVO: O objetivo do presente estudo foi avaliar o quadro clínico, a incidência, os fatores predisponentes e a evolução de pacientes com fitobezoar após Gastroplastia Vertical e Y de Roux. MÉTODO: No período de Novembro de 1997 à Janeiro de 2004, foram realizadas 512 operações para o tratamento da Obesidade mórbida, seguindo a técnica proposta por Fobi/Capella (Septação gástrica com reconstituição em Y de Roux Proximal). Em dez pacientes foram identificados fitobezoar. RESULTADOS: A incidência de fitobezoar, causando algum tipo de obstrução gastrointestinal, foi de 1,95% (10/512). Todos os casos de fitobezoar estavam relacionados ao fio de sutura inabsorvível do tipo prolene. Sete pacientes apresentaram quadro semioclusivo e de obstrução intestinal e foram tratados com laparotomia exploradora, ressecção da anastomose enteroenteral e confecção de nova enteroenteroanastomose. Nos três pacientes com bezoar situado na anastomose gastrojejunal, a secção do fio e a retirada do corpo estranho foram realizadas por endoscopia digestiva alta. CONCLUSÕES: A confecção de anastomose intestinal com fio inabsorvível predispõe a formação de bezoar em pós-operatório de gastroplastia.

Tumor estromal gastrointestinal: análise de fatores relacionados ao prognóstico

OBJETIVO: estudar os critérios morfológicos e imunoistoquímicos relacionados ao prognóstico dos tumores estromais gastrointestinais. MÉTODOS: o estudo foi retrospectivo de 42 casos de tumor estromal gastrointestinal (GIST). Vinte e cinco casos foram obtidos no arquivo do Serviço de Anatomia Patológica do Hospital Universitário Gaffrée e Guinle e os outros dezessete, do Serviço de Anatomia Patológica do Hospital Universitário Clementino Fraga Filho. RESULTADOS: de acordo com a análise univariada os tumores maiores que 5 cm, com número de mitoses maior que 5/50 CGA, presença de necrose, de alto risco, revelaram significância em relação a redução da sobrevida (p= 0,017, 0,010, 0,001 e 0,016, respectivamente). Os outros fatores analisados (subtipo histológico, topografia e imunofenótipo) não mostraram significância. CONCLUSÃO: os resultados confirmam a utilidade do grau de risco, do tamanho tumoral, do índice mitótico e da necrose como fatores preditores do comportamento biológico dos tumores estromais gastrointestinais.

Tumor estromal gastrointestinal: análise de 146 casos do centro de referência do Instituto Nacional do Câncer - INCA

OBJETIVO: Avaliar os resultados do tratamento de GIST no INCA. MÉTODOS: Análise retrospectiva de todos os casos de GIST tratados no INCA no período de 1997 a 2009. RESULTADOS: Analisamos 146 pacientes, com média de idade de 44,5 anos e predomínio do sexo feminino. O principal sintoma foi dor abdominal. Tivemos ocorrência de segundo primário em 22% dos casos e na imuno-histoquímica, 92% foram positivos para CD117. A localização mais frequente foi estômago e predominou o grupo de alto risco. A cirurgia foi R0 (extenso) em 70% e os principais sítios de metástases foram fígado e peritônio. A sobrevida global foi, respectivamente, em dois e cinco anos de 86% e 59%. Houve significante diferença entre a sobrevida global (p=0,29) do grupo de alto risco versus os demais. CONCLUSÃO: Os nossos pacientes apresentam-se principalmente sob forma de doença de alto risco com repercussão óbvia na sobrevida. O uso de Imatinib melhorou a sobrevida dos pacientes com doença metastática e recidivada. Devemos estudar seu uso no cenário de adjuvância e neoadjuvancia visando melhorar os índices do grupo de alto risco. A criação de centros referenciais é uma necessidade para o estudo de doenças pouco frequentes.

Fraud detection in the banking sector : a multi-agent approach

Fraud is an increasing phenomenon as shown in many surveys carried out by leading international consulting companies in the last years. Despite the evolution of electronic payments and hacking techniques there is still a strong human component in fraud schemes. Conflict of interest in particular is the main contributing factor to the success of internal fraud. In such cases anomaly detection tools are not always the best instruments, since the fraud schemes are based on faking documents in a context dominated by lack of controls, and the perpetrators are those ones who should control possible irregularities. In the banking sector audit team experts can count only on their experience, whistle blowing and the reports sent by their inspectors. The Fraud Interactive Decision Expert System (FIDES), which is the core of this research, is a multi-agent system built to support auditors in evaluating suspicious behaviours and to speed up the evaluation process in order to detect or prevent fraud schemes. The system combines Think-map, Delphi method and Attack trees and it has been built around audit team experts and their needs. The output of FIDES is an attack tree, a tree-based diagram to ”systematically categorize the different ways in which a system can be attacked”. Once the attack tree is built, auditors can choose the path they perceive as more suitable and decide whether or not to start the investigation. The system is meant for use in the future to retrieve old cases in order to match them with new ones and find similarities. The retrieving features of the system will be useful to simplify the risk management phase, since similar countermeasures adopted for past cases might be useful for present ones. Even though FIDES has been built with the banking sector in mind, it can be applied in all those organisations, like insurance companies or public organizations, where anti-fraud activity is based on a central anti-fraud unit and a reporting system.

Comparative study of the different degrees of risk of gastrointestinal stromal tumor

OBJECTIVE: To evaluate the applicability of the main categories of risk and morphological factors in the prognosis of gastrointestinal stromal tumors. METHODS: we retrospectively studied fifty-four cases of GIST, assessing the main prognostic factors of this neoplasis: risk levels, topography, size, mitotic index, necrosis, histological subtype and immunophenotype. We also verified their association and the reduction of overall survival. RESULTS: Univariate analysis showed that tumors with mitoses number greater than 5 per 50CGA (high-power fields), the presence of necrosis and a high risk for both the systems proposed by Fletcher and Miettinen had a significant association with reduced survival (p = 0.00001, 0.0056, 0.03 and 0.009, respectively). The remaining analyzed factors (size, histological subtype, topography and immunophenotype) had no such association. Multivariate analysis (Jacard index) showed that the Miettinen degree of risk was the one that best correlated with prognosis. CONCLUSION: the risk criteria of Fletcher and Miettinen are important in assessing the prognosis of patients with gastrointestinal stromal tumors, especially the latter, which adds to the mitotic index and the presence of tumor necrosis.

Treatment of gastrointestinal stromal tumor (GIST) during bariatric surgery

The gastrointestinal stromal tumor (GIST) is a rare mesenchymal tumor. One should pay special attention when the GIST comes in obese patients during surgery. The laparoscopic resections with standard techniques, such as gastric bypass, have been described with good results. However, GIST resection associated sleeve gastrectomy for the treatment of obesity is rare, but can be done safely, depending on the location of the tumor.

Impact of ivermectin-resistant gastrointestinal nematodes in feedlot cattle in Argentina

The aim was to evaluate for 75 days the impact on production of the remaining burden of ivermectin (IVM)-resistant parasites in naturally infected feedlot calves. The herds came from tick-infested areas of cattle breeding where the systematic use of IVM to control tick increases the gastrointestinal parasites resistant to this drug. This investigation was carried out in two commercial feedlots in Buenos Aires province. In feedlot A, two groups of 35 animal each received IVM 1% and the other received ricobendazole (RBZ) 10% respectively. The same was done in feedlot B. On day 0, two groups of 35 animals were made in feedlots A and B. Fecal samples were taken on days 0, 22, 54 and 75 pos-treatment (PT), and body weight was registered, from each animal. Fecal samples were processed for individual count of eggs per gram (EPG) and pooled fecal culture was carried out for identification of the parasite genus in each sampling. Fecal egg count reduction test (FECR) was calculated on day 22 PT. The study design used was a totally randomized block, with commercial feedlot and sex as block variables. For data analysis, a mixed model of the SAS statistical program was used. The FECR average on day 22 was 28.4% in the IVM group, and 94,2 % in the RBZ group . From this date on, significant differences in EPG were kept until day 54. EPG counts were only equal near the end of the trial, on day 75 (p=0.16). In both commercial feedlots, especially in the IVM group, Cooperia spp. was the most prevalent parasite in the fecal cultures. Significant differences in weight (P<0.01) on post-treatment day 75 was found between the average weight in the RBZ and the IVM group (246 vs. 238 kg respectively), what means a difference of 8.3% in gains. The importance for production in the antiparasite failure treatment in commercial feedlots was demonstrated, and the need of pos-treatment controls to evaluate the efficacy of the antiparasitic administered is emphasized.

Análise da condição corpórea, biometria externa e das vísceras do trato gastrointestinal de canários-da-terra, Sicalis flaveola braziliensis

Analisaram-se em canários-da-terra, Sicalis flaveola brasiliensis, apreendidos pelo Cetas-IBAMA/PB e que morreram logo após sua chegada, as medidas biométricas externas, condições corpóreas e de plumagem, medidas biométricas das vísceras do trato gastrointestinal (TGI), assim como a topografia visceral, a fim de fornecer dados morfológicos e caracterizar as condições em esses pássaros chegaram a esse centro de triagem. A topografia visceral estava em consonância com a de periquitos e avestruz, a exceção que essa última espécie apresenta um ceco. Verificou-se que há relação entre as condições corpóreas desfavoráveis e a perda de plumagem. Conclui-se, que S. flaveola braziliensis possui medidas biométricas em consonância á de outros Passeriformes, contudo possui divergências para aves do mesmo gênero e poucas diferenças biométricas entre machos e fêmeas. Através do estudo, verifica-se que as condições corpóreas de animais traficados devem ser consideradas nos centros de triagem, a fim de se fazer um melhor manejo nutricional e/ou clínico, diminuindo a mortalidade.

Management practices to control gastrointestinal parasites in sheep farms in Minas Gerais, southeastern Brazil

Parasite related problems are considered one of the major health problems for sheep breeding, causing considerable economic losses to commercial husbandry. The aim of this study was to determine the technological level and the level of knowledge of farmers regarding management practices to control gastrointestinal parasites in sheep in Minas Gerais state, southeastern Brazil. The analysis was based on 213 questionnaires applied by official veterinarians of the State Government Agency for Animal Health (Instituto Mineiro de Agropecuária, IMA), covering 16.6% of all counties. From two hundred and thirteen sheep farms sampled, 117 farms had their technological level determined. From the samples, 0.9% were characterized as high level, 45.3% as medium, and 53.0% as low technological level. The flock size ranged from 2 to 1843 with an average of 80.5 sheep per farm. The majority of the sheep production systems was extensive/semi-extensive (74.5%). The management practices adopted by the farmers to reduce parasitism were: split young and adult animals (5.6%), change pasture after deworm the animals (5.2%), use quarantine for incoming animals (2.3%), deworm newly arrived sheep (1.5%), and have regular technical assistance (31.9%). Although 76.5% of the farmers medicate the animals, treatments were performed without any major technical criteria, with an average interval of 4.6 months. The most commonly used drug families were macrocyclic lactones (38.5%) and benzimidazoles (24.9%). The management practices adopted in Minas Gerais are based on old recommendations and may not return in a good set of strategies to prevent parasite infections. Field observations reinforce the finding where farmers have obtained unsatisfactory results in maintaining the health and productivity level of their enterprises.

Fowl adenovirus Group I as a causal agent of inclusion body hepatitis/hydropericardium syndrome (IBH/HPS) outbreak in brazilian broiler flocks

Commercial broiler flocks from a farm located in the State of São Paulo, Brazil, presented diarrhea, depression, increased mortality and poor weight gain. Upon post-mortem examination, classical signs of Inclusion Body Hepatitis/Hydropericardium Syndrome (IBH/HPS) were observed, including enlarged pale yellow-colored livers and straw-colored liquid in the pericardial sac. In addition, gross lesions were also observed in the kidneys, pancreas, thymus, intestines and gallbladder. Samples of these organs were analyzed by PCR for the detection of the hexon gene of the Fowl Adenovirus (FAdVs) Group I. The results were positive for both flocks (A and B) assayed by PCR. The macroscopic lesions associated with the detection of FAdV Group I by PCR in several of these affected organs allowed for the identification of IBH/HPS. In fact, this is the first report in Brazil of IBH/HPS in broilers, which identifies FAdVs group I as a causal agent of the disease. These findings may contribute to the worldwide epidemiology of the adenovirus-mediated hepatitis/hydropericardium syndrome.

A simulation model of the optimal maintenance strategy: conceptual agent-based approach

In this Master’s thesis agent-based modeling has been used to analyze maintenance strategy related phenomena. The main research question that has been answered was: what does the agent-based model made for this study tell us about how different maintenance strategy decisions affect profitability of equipment owners and maintenance service providers? Thus, the main outcome of this study is an analysis of how profitability can be increased in industrial maintenance context. To answer that question, first, a literature review of maintenance strategy, agent-based modeling and maintenance modeling and optimization was conducted. This review provided the basis for making the agent-based model. Making the model followed a standard simulation modeling procedure. With the simulation results from the agent-based model the research question was answered. Specifically, the results of the modeling and this study are: (1) optimizing the point in which a machine is maintained increases profitability for the owner of the machine and also the maintainer with certain conditions; (2) time-based pricing of maintenance services leads to a zero-sum game between the parties; (3) value-based pricing of maintenance services leads to a win-win game between the parties, if the owners of the machines share a substantial amount of their value to the maintainers; and (4) error in machine condition measurement is a critical parameter to optimizing maintenance strategy, and there is real systemic value in having more accurate machine condition measurement systems.

Pasteurella multocida type A as the primary agent of pneumonia and septicaemia in pigs

Abstract: In order to understand better the pathological aspects and spread of Pasteurella multocida type A as the primary cause of pneumonia in pigs, was made an experiment with intranasal inoculation of different concentrations of inocula [Group (G1): 108 Colony Forming Units (CFU)/ml; G2: 107 CFU/ml; G3: 106 CFU/ml and G4: 105 CFU/ml], using two pigs per group. The pigs were obtained from a high health status herd. Pigs were monitored clinically for 4 days and subsequently necropsied. All pigs had clinical signs and lesions associated with respiratory disease. Dyspnoea and hyperthermia were the main clinical signs observed. Suppurative cranioventral bronchopneumonia, in some cases associated with necrosuppurative pleuropneumonia, fibrinous pericarditis and pleuritic, were the most frequent types of lesion found. The disease evolved with septicaemia, characterized by septic infarctions in the liver and spleen, with the detection of P. multocida type A. In this study, P. multocida type A strain #11246 was the primary agent of fibrinous pleuritis and suppurative cranioventral bronchopneumonia, pericarditis and septicaemia in the pigs. All concentrations of inoculum used (105-108 CFU/ml) were able to produce clinical and pathological changes of pneumonia, pleuritis, pericarditis and septicemia in challenged animals.