Irritable bowel syndrome : the role of gut neuroendocrine peptides

Irritable bowel syndrome (IBS) is a common chronic disorder with a prevalence ranging from 5 to 10 % of the world's population. This condition is characterised by abdominal discomfort or pain, altered bowel habits, and often bloating and abdominal distension. IBS reduces quality of life in the same degree of impairment as major chronic diseases such as congestive heart failure and diabetes and the economic burden on the health care system and society is high. Abnormalities have been reported in the neuroendocrine peptides/amines of the stomach, small- and large intestine in patients with IBS. These abnormalities would cause disturbances in digestion, gastrointestinal motility and visceral hypersensitivity, which have been reported in patients with IBS. These abnormalities seem to contribute to the symptom development and appear to play a central role in the pathogenesis of IBS. Neuroendocrine peptides/amines are potential tools in the treatment and diagnosis of IBS. In particular, the cell density of duodenal chromogranin A expressing cells appears to be a good histopathological marker for the diagnosis of IBS with high sensitivity and specificity.

The use of a synthetic prostaglandin e1 analogue (misoprostol) as an adjunct to pancreatic enzyme replacement in cystic fibrosis

Eleven cystic fibrosis children (mean age, 9.6 years) were chosen at random to participate in a study to observe the effects of concurrently stimulating gastric/duodenal bicarbonate secretion and inhibiting gastric acid secretion, using a methylated prostaglandin E1 analogue in patients with pancreatic insufficiency and taking pancreatic enzymes. Percentage fat absorption in 3-day stool collections were calculated before and after commencing therapy with misoprostol, 400 μg/day in divided doses. We found a significant reduction in fat output (14.7 ± 11.7 versus 7.5 ± 3.5 g/day, p < 0.05) in the study group as a whole and a significant reduction in steatorrhoeic level as a percentage of fat intake in all of the patients with abnormal base-line collections (23.1% versus 9.2% p < 0.002). We conclude that misoprostol should be considered in cystic fibrosis patients with steatorrhoea as a means of improving nutrient absorption. © 1988 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.

The use of a synthetic prostaglandin-E1 analog (misoprostol) as an adjunct to pancreatic-enzyme replacement in cystic-fibrosis

Eleven cystic fibrosis children (mean age, 9.6 years) were chosen at random to participate in a study to observe the effects of concurrently stimulating gastric/duodenal bicarbonate secretion and inhibiting gastric acid secretion, using a methylated prostaglandin E1 analogue in patients with pancreatic insufficiency and taking pancreatic enzymes. Percentage fat absorption in 3-day stool collections were calculated before and after commencing therapy with misoprostol, 400 μg/day in divided doses. We found a significant reduction in fat output (14.7 ± 11.7 versus 7.5 ± 3.5 g/day, p < 0.05) in the study group as a whole and a significant reduction in steatorrhoeic level as a percentage of fat intake in all of the patients with abnormal base-line collections (23.1% versus 9.2%, p < 0.002). We conclude that misoprostol should be considered in cystic fibrosis patients with steatorrhoea as a means of improving nutrient absorption.

Serum immunoreactive pancreatic lipase and cationic trypsinogen for the assessment of exocrine pancreatic function in older patients with cystic fibrosis

Indirect and qualitative tests of pancreatic function are commonly used to screen patients with cystic fibrosis for pancreatic insufficiency. In an attempt to develop a more quantitative assessment, we compared the usefulness of measuring serum pancreatic lipase using a newly developed enzyme-linked immunosorbent immunoassay with that of cationic trypsinogen using a radioimmunoassay in the assessment of exocrine pancreatic function in patients with cystic fibrosis. Previously, we have shown neither lipase nor trypsinogen to be of use in assessing pancreatic function prior to 5 years of age because the majority of patients with cystic fibrosis in early infancy have elevated serum levels regardless of pancreatic function. Therefore, we studied 77 patients with cystic fibrosis older than 5 years of age, 41 with steatorrhea and 36 without steatorrhea. In addition, 28 of 77 patients consented to undergo a quantitative pancreatic stimulation test. There was a significant difference between the steatorrheic and nonsteatorrheic patients with the steatorrheic group having lower lipase and trypsinogen values than the nonsteatorrheic group (P < .001). Sensitivities and specificities in detecting steatorrhea were 95% and 86%, respectively, for lipase and 93% and 92%, respectively, for trypsinogen. No correlations were found between the serum levels of lipase and trypsinogen and their respective duodenal concentrations because of abnormally high serum levels of both enzymes found in some nonsteatorrheic patients. We conclude from this study that both serum lipase and trypsinogen levels accurately detect steatorrhea in patients with cystic fibrosis who are older than 5 years but are imprecise indicators of specific pancreatic exocrine function above the level needed for normal fat absorption.

New aspects of the diagnosis of Helicobacter pylori infection

Aims: Helicobacter pylori infection, although the prevalence is declining in Western world, is still responsible for several clinically important diseases. None of the diagnostic tests is perfect and in this study, the performance of three stool antigen tests was assessed. In areas of high H. pylori prevalence, the definition of patients with the greatest benefit from eradication therapy may be a problem; the role of duodenal gastric metaplasia in categorizing patients at risk for duodenal ulcer was evaluated in this respect. Whether persistent chronic inflammation and elevated H. pylori antibodies after successful eradication are associated with each other or with atrophic gastritis, a long term sequelae of H. pylori infection, were also studied. Patients and methods: The three stool antigen tests were assessed in pre- and post-eradication settings among 364 subjects in two studies as compared to the rapid urease test (RUT), histology, culture, the 13C-urea breath test (UBT) and enzyme immunoassay (EIA) based H. pylori serology. The association between duodenal gastric metaplasia with duodenal ulcer was evaluated in a retrospective study including 1054 patients gastroscopied due to clinical indications and 154 patients previously operated for duodenal ulcer. The extent of duodenal gastric metaplasia was assessed from histological specimens in different patient groups formed on the basis of gastroscopy findings and H. pylori infection. Chronic gastric inflammation (108 patients) and H. pylori antibodies and serum markers for atrophy (77 patients) were assessed in patients earlier treated for H. pylori. Results: Of the stool antigen tests studied, the monoclonal antibody-based EIA-test showed the highest sensitivity and specificity both in the pre-treatment setting (96.9% and 95.9%) and after therapy (96.9% and 97.8%). The polyclonal stool antigen test and the in-office test had at baseline a sensitivity of 91% and 94%, and a specificity of 96% and 89%, respectively and in a post-treatment setting, a sensitivity of 78% and 91%, and a specificity of 97%, respectively. Duodenal gastric metaplasia was strongly associated with H. pylori positive duodenal ulcer (odds ratio 42). Although common still five years after eradication, persistent chronic gastric inflammation (21%) and elevated H. pylori antibodies (33%) were neither associated with each other nor with atrophic gastritis. Conclusions: Current H. pylori infection can feasibly be diagnosed by a monoclonal antibody-based EIA test with the accuracy comparable to that of reference methods. The performance of the polyclonal test as compared to the monoclonal test was inferior especially in the post-treatment setting. The in-office test had a low specificity for primary diagnosis and hence positive test results should probably be confirmed with another test before eradication therapy is prescribed. The presence of widespread duodenal gastric metaplasia showed promising results in detecting patients who should be treated for H. pylori due to an increased risk of duodenal ulcer. If serology is used later on in patients with earlier successfully treated for H. pylori, it should be taken into account that H. pylori antibodies may persist elevated for years for unknown reason. However, this phenomenon was not found to be associated with persistent chronic inflammation or atrophic changes.

Digestion capasity, nutrient digestibilities and physico-chemical conditions in the intestine influenced by the age of growing turkeys

Six experiments have been conducted to examine digestibility and feeding value of domestic Finnish fibre-rich cereals (barley and oats as compared to maize and wheat) and protein sources (rapeseed meal and cake, peas, faba beans, lupin seeds) for growing turkeys and to investigate effects of age of the birds (from 3 to 12 weeks of age) on digestion process and estimated nutrient digestibility and energy values. Besides, an objective of the study was to test applications of digestibility research methodology for turkeys. Total tract digestibility and apparent metabolizable energy (AME) was assayed in experimental cages using excreta collection, and a slaughter method was applied to sample small intestinal digesta for determination of apparent ileal crude protein digestibility (AICPD), jejuno-duodenal digesta viscosity and caecal volatile fatty acid (VFA) concentration. Digesta viscosity decreased and caecal VFA production increased with age of growing turkeys. Digesta retention times in the small intestine were generally longer in the older birds than in the younger ones. Crude fat digestibility and AME increased with age of growing turkeys, especially with viscous diets. AICPD seemed to decrease with age in most cases. Supplementation with β-gucanase-xylanase decreased viscosity, improved crude fat digestibility and metabolizable energy value and increased VFA production especially in barley-fed turkeys and especially in the young birds. Poor protein digestibility and low energy value of rapeseed meal and rapeseed cake decreased their feeding value for turkeys. In addition, a typical goitrogenic effect of rapeseed feeding was detected. Use of legume seeds as feed for growing turkeys is limited mostly by the low energy value in lupin seeds and the low ileal protein and amino acid digestibility in faba beans. Digestibility of fibre-rich protein sources was not improved with age of the turkeys. Euthanizing the turkeys for AICPD determination by carbon dioxide and bleeding led to lower digestibility values than mechanical stunning and cervical dislocation, suggesting inferiority of carbon dioxide stunning in experimental use. Comparison of AICPD and AME results obtained using different markers showed that considerable differences may occur, especially on total tract level, when acid-insoluble ash gave considerably lower AME values than titanium dioxide and chromic oxide.

Helicobacter pylori: resistance and treatment results in Finland

Background: Helicobacter pylori infection is usually acquired in early childhood and is rarely resolved spontaneously. Eradication therapy is currently recommended virtually to all patients. While the first and second therapies are prescribed without knowing the antibiotic resistance of the bacteria, it is important to know the primary resistance in the population. Aim: This study evaluates the primary resistance of H. pylori among patients in primary health care throughout Finland, the efficacy of three eradication regimens, the symptomatic response to successful therapy, and the effect of smoking on gastric histology and humoral response in H. pylori-positive patients. Patients and methods: A total of 23 endoscopy referral centres located throughout Finland recruited 342 adult patients with positive rapid urease test results, who were referred to upper gastrointestinal endoscopy from primary health care. Gastric histology, H. pylori resistance and H. pylori serology were evaluated. The patients were randomized to receive a seven-day regimen, comprising 1) lansoprazole 30 mg b.d., amoxicillin 1 g b.d. and metronidazole 400 mg t.d. (LAM), 2) lansoprazole 30 mg b.d., amoxicillin 1 g b.d. and clarithromycin 500 mg b.d. (LAC) or 3) ranitidine bismuth citrate 400 mg b.d., metronidazole 400 mg t.d. and tetracycline 500 mg q.d. (RMT). The eradication results were assessed, using the 13C-urea breath test 4 weeks after therapy. The patients completed a symptom questionnaire before and a year after the therapy. Results: Primary resistance of H. pylori to metronidazole was 48% among women and 25% among men. In women, metronidazole resistance correlated with previous use of antibiotics for gynaecologic infections and alcohol consumption. Resistance rate to clarithromycin was only 2%. Intention-to-treat cure rates of LAM, LAC, and RMT were 78%, 91% and 81%. While in metronidazole-sensitive cases the cure rates with LAM, LAC and RMT were similar, in metronidazole resistance LAM and RMT were inferior to LAC (53%, 67% and 84%). Previous antibiotic therapies reduced the efficacy of LAC, to the level of RMT. Dyspeptic symptoms in the Gastrointestinal Symptoms Rating Scale (GSRS) were decreased by 30.5%. In logistic regression analysis, duodenal ulcer, gastric antral neutrophilic inflammation and age from 50 to 59 years independently predicted greater decrease in dyspeptic symptoms. In the gastric body, smokers had milder inflammation and less atrophy and in the antrum denser H. pylori load. Smokers also had lower IgG antibody titres against H. pylori and a smaller proportional decrease in antibodies after successful eradication. Smoking tripled the risk of duodenal ulcers. Conclusions: in Finland H. pylori resistance to clarithromycin is low, but metronidazole resistance among women is high making metronidazole-based therapies unfavourable. Thus, LAC is the best choice for first-line eradication therapy. The effect of eradication on dyspeptic symptoms was only modest. Smoking slows the progression of atrophy in the gastric body.

Retroalimentação do controle interno para os órgãos centrais do sistema de planejamento e orçamento federal em questões estruturantes

Analisa o fluxo do processo de retroalimentação da CGU para órgãos centrais do Sistema de Planejamento e Orçamento Federal, bem como as possibilidades de retroalimentação da CGU a esses órgãos. Propõe a previsão na legislação de um Comitê Operacional e de um Comitê Estratégico do Ciclo de Gestão.

[Discurso do Deputado Tenório Cavalcanti : Sessão da Câmara dos Deputados de 09 de agosto de 1956]

Discussão do Projeto de Lei nº 1.234, de 1956, que dispõe sobre a mudança da Capital Federal e dá outras providências. Classifica como demagógica a matéria em apreciação e apresenta aspectos que corroboram sua convicção da inexequibilidade da mudança da Capital Federal, entre eles as críticas do Engenheiro Prestes Maia. Defende a autonomia política do Distrito Federal e a aplicação de verbas no interior do país para cessar o fluxo migratório para o litoral e desenvolver o crescimento do interior do País.

Utilização dos plenários do anexo II pelas comissões permanentes, temporárias e por outros órgãos da Casa

Aborda o fluxo de trabalho que envolve a reserva e utilização de espaços físicos, sob a responsabilidade do Departamento de Comissões da Câmara dos Deputados (DECOM), para a promoção de eventos e de reuniões pelas comissões técnicas e por outros órgãos da Casa. Focaliza a dificuldade de disponibilidade de plenários e propõe soluções para o problema.

Outorgas e renovações de rádio e tv : a radiodifusão no Senado Federal 1999-2008

Aborda a aprovação de outorgas e renovações de rádio e tv pelo Senado Federal. Investiga relatórios de comissões e da Presidência do Senado, no período de 1999 a 2008, para quantificar a aprovação de projetos de decreto legislativo sobre o assunto. Analisa os partidos políticos mais beneficiados, as regiões e os Estados mais contemplados, as categorias de outorgas e renovações mais aprovadas e o fluxo dessas matérias em períodos eleitorais. Verifica a relação entre os projetos de radiodifusão que tramitaram no Senado, no período pesquisado, e a localidade da emissora.

Análise dos resultados oriundos do sorteio público de Municípios : subsídios para o controle preventivo

O Programa de Fiscalização a partir de Sorteios Públicos se caracteriza por ser uma ferramenta potencial de combate à corrupção e de correção de eventuais fragilidades na execução de Políticas Públicas. Tenciona subsidiar possíveis proposições de melhoria do Sorteio de Municípios, a fim de agregar valor aos seus resultados. O estudo pretende demonstrar o nível de eficácia dos resultados na execução de um Programa de Governo executado pelo Ministério das Cidades. Objetiva demonstrar em que ponto as fiscalizações da Controladoria-Geral da União proporcionaram correções, sejam pontuais, sejam preventivas, no fluxo de aplicação dos recursos federais. Como objetivos secundários, aspira avaliar o momento de atuação do controle, o ciclo de operacionalização dos Sorteios, o comportamento dos gestores federais e as técnicas e procedimentos empregados nas fiscalizações.

Processo de melhoria contínua de processos para a Câmara dos Deputados

Apresenta uma proposta para a melhoria contínua de processo de software. Fundamentado nas recomendações das normas e modelos de qualidade, a partir da convicção de que qualquer processo, independente da maturidade, necessita evoluir de uma forma organizada em função das metas estabelecidas pela alta direção e sugestões de melhoria e inovações. Inclui os papéis, o fluxo de trabalho, as atividades a serem executadas, as ferramentas empregadas e os indicadores a serem coletados e avaliados.

O Congresso Nacional e a atividade de inteligência : a função de fiscalização em perspectiva histórica

Traça um panorama histórico da ação fiscalizadora do Congresso Nacional em relação à atividade de inteligência nacional, mais precisamente da Agência Brasileira de Inteligência – ABIN, órgão estatal responsável por essa atividade, na salvaguarda dos conhecimentos sigilosos do Estado, haja vista ser o Congresso Nacional, o órgão responsável pela fiscalização externa da rede e seus componentes. Identificar as vulnerabilidades existentes, principalmente no que tange aos recursos humanos, capital mais precioso desse processo, mas que, pela ganância, vaidade e cobiça, se torna o elo mais vulnerável. A Atividade de Inteligência dentre todas as áreas de controle democrático é a mais arriscada, haja vista a sua importância para o progresso e desenvolvimento de uma Nação. É uma atividade que se desenvolve diuturnamente buscando minimizar as desconfianças de todos os órgãos e organizações estatais envolvidos no processo. A salvaguarda dos documentos e de informações governamentais sigilosas é primordial para a segurança do Estado. A institucionalização da Atividade de Inteligência no Brasil, a partir de 1927, trouxe ao país uma situação antes exercida apenas no âmbito militar. Com leis, decretos, portarias e denominações várias do órgão nacional responsável, são desenvolvidas as ações de coordenação do fluxo de informações necessárias às decisões governamentais. A pesquisa foi realizada com base em fontes históricas e documentais, ressaltando o papel do Congresso Nacional na sua função de fiscalização das políticas de inteligência.

Uma abordagem sobre os controles aplicáveis à tramitação legislativa

Avalia os controles sobre a integridade do texto da proposição inicial e dos demais textos relacionados a ela, que são gerados e apreciados ao longo do processo legislativo, restringindo-se aos projetos de lei ordinária sujeitos à apreciação conclusiva pelas comissões, no âmbito da Câmara dos Deputados. O entendimento dos procedimentos operacionais e de controle vigentes apoia-se em entrevistas e consultas a documentos eletrônicos e impressos, referentes à tramitação de algumas proposições. Existe uma mistura de procedimentos manuais que tratam e controlam documentos impressos, com rotinas programadas em um sistema de computador que tratam e controlam a versão eletrônica desses documentos. A avaliação é baseada na teoria de controles internos utilizada pela área de auditoria. Os controles vigentes revelam-se mais dependentes das pessoas do que o desejável e são mais fortes em momentos específicos da tramitação, como a publicação e a redação final. Parece que a Câmara dos Deputados tem obtido bom desempenho legislativo e eficácia administrativa principalmente por causa da capacitação e honestidade de seus servidores, e que o sistema computadorizado pode facilitar a implantação de melhorias no fluxo de controle, tornando-o mais impessoal, razão pela qual são apresentadas ao final algumas sugestões.