Acesso aos níveis de atenção à saúde em um município do Estado de São Paulo: perspectivas de gestores, profissionais e usuários

Pós-graduação em Saúde Coletiva - FMB

Determinação simultânea de biomarcadores de função renal em urina utilizando dispositivo analítico microfluídico em papel

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Avaliação da resposta inflamatória local após aplicação de células tronco mesenquimais alogênicas em tendão flexor digital superficial de equinos

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Ultrassonografia modo b e elastografia arfi pulmonar e hepática fetal como método preditivo para a maturidade dos conceptos em fase final de gestação de cadelas

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Diagnosis and management of gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is probably one of the most prevalent diseases in the world that also compromises the quality of life of the affected significantly. Its incidence in Brazil is 12%, corresponding to 20 million individuals. OBJECTIVE: To update the GERD management and the new trends on diagnosis and treatment, reviewing the international and Brazilian experience on it. METHOD: The literature review was based on papers published on Medline/Pubmed, SciELO, Lilacs, Embase and Cochrane crossing the following headings: gastroesophageal reflux disease, diagnosis, clinical treatment, surgery, fundoplication. RESULTS: Various factors are involved on GERD physiopathology, the most important being the transient lower esophageal sphincter relaxation. Clinical manifestations are heartburn, regurgitation (typical symptoms), cough, chest pain, asthma, hoarseness and throat clearing (atypical symptoms), which may be followed or not by typical symptoms. GERD patients may present complications such as peptic stenosis, hemorrhage, and Barrett's esophagus, which is the most important predisposing factor to adenocarcinoma. The GERD diagnosis must be based on the anamnesis and the symptoms must be evaluated in terms of duration, intensity, frequency, triggering and relief factors, pattern of evolution and impact on the patient's quality of life. The diagnosis requires confirmation with different exams. The goal of the clinical treatment is to relieve the symptoms and surgical treatment is indicated for patients who require continued drug use, with intolerance to prolonged clinical treatment and with GERD complications. CONCLUSION: GERD is a major digestive health problem and affect 12% of Brazilian people. The anamnesis is fundamental for the diagnosis of GERD, with special analysis of the typical and atypical symptoms (duration, intensity, frequency, triggering and relief factors, evolution and impact on the life quality). High digestive endoscopy and esophageal pHmetry are the most sensitive diagnosctic methods. The clinical treatment is useful in controlling the symptoms; however, the great problem is keeping the patients asymptomatic over time. Surgical treatment is indicated for patients who required continued drug use, intolerant to the drugs and with complicated forms of GERD.

Pancreatic hemangioma manifesting as variceal gastroesophageal bleeding during pregnancy: case report

There are only 10 reported cases of pancreatic hemangiomas in adults, only one of them causing digestive bleeding. We present a case of variceal bleeding and portal hypertension caused by a pancreatic hemangioma. The patient had 19 year-old and was received at her 16th week of pregnancy. She had massive hematemesis, controlled after variceal band ligation. Her image exams revealed a cystic lesion of 164 cm³ in the pancreas tail and signs of portal hypertension. Two months after, the ultrassonographic exam documented the lesion growth, achieving 200 cm³ at that time. The patient was submitted to distal pancreatectomy, and the histopathological analysis revealed a pancreatic hemangioma of 11 x 9 x 8 cm. Therefore, we report the second case of digestive bleeding caused by a pancreatic hemangioma, which had a well documented growth during the pregnancy. Additionally, we review the previous reports of pancreatic hemangiomas and discuss the hypothesis of hormonal infl uence on the natural history of these tumors.

Evaluation of clinical, ultrasonographic and hysteroscopic parameters in the differentiation of endometrial polyps and cancer of endometrium

Study Objective: To evaluate the diagnostic accuracy of transvaginal ultrasound and office hysteroscopy in the differentiation between endometrial polyps and endometrial adenocarcinoma. Design: This is a prospective 100 women longitudinal study, 24 to 80 years, submitted to hysteroscopic polypectomy (n = 80) or surgery due to endometrial adenocarcinoma (n = 20), from january 2010 to December 2011. Clinical, ultrasonographic and hysteroscopic parameters were analyzed and compared with histopathologic find. Statistical analysis were performed utilizing the Tukey, Kruskal-Wallis, Dunn and Mann-Whitney test, with a confidence interval of 95% and p\0, 05 statiscally significant. Setting: Botucatu Medical School. Intervention: Prospective analysis of clinical, ultrasonographic and hysteroscopic parameters in patients with diagnosis suspected of endometrial polyps and adenocarcinoma of endometrium were performed. According to the diagnosis, hysteroscopic polypectomy or pan hysterectomy with lymph node sampling was realized. After the surgery and histopathological study, statistical analysis of parameters was performed and the results were compared between groups. It was Research Ethics Committee approved. Measurements and Main Results: There were no differences between age, BMI, menopause, TH use and associated diseases among groups. The main symptom of endometrial cancer was the postmenopausal bleeding, affecting 84,2% of women against 34,8% of polypectomy group. The majority of women with endometrial polyps were asymptomatic. Transvaginal ultrasonography showed no ability to differentiate cases of endometrial cancer compared with the cases of endometrial polyps, considering the presence of endometrial thickness and blood flow on color Doppler. Office hysteroscopy showed significant changes in 75% of the adenocarcinoma cases, especially the presence of diffuse hypervascularity with atypical vessels. Conclusion: Still remains an inability to establish clinical parameters and reliable ultrasound imaging to differentiate endometrial polyps and cancer of endometrium. Attention should be given to hysteroscopic exams presenting diffuse endometrial hypervascularization with architectural distortion of the vessels. The recommendation of our service remains the systematic removal of all endometrial polyps.

Undifferentiated pulmonary adenocarcinoma of clear cells associated to hypertrophic osteopathy in a dog

Background: Most of the primary pulmonary tumors in dogs are malignant and from epithelial origin, being bronchioalveolar tumors more prevalent. Adenocarcinoma of clear cells, however, is a very rare pulmonary tumor and its origin is still unknown. It is related to several clinical abnormalities, including hypertrophic osteopathy, an unusual paraneoplastic syndrome characterized by a periosteal reaction along the shaft of long bones. Because of the unusual presentation of the pulmonary adenocarcinoma, the aim of this study was to describe the radiographic, histopathological, and immunohistochemical fi ndings of a dog affl icted with hypertrophic osteopathy secondary to an undifferentiated pulmonary adenocarcinoma of clear cells. Case: A 12-year-old, 45 kg, not castrated male Great Dane dog was presented with painful swelling of all four limbs and moderate respiratory distress. Radiographic examination and computed tomography of the limbs showed palisade-like periosteal bone proliferation involving radius, ulna, femur, patella, tibia, fi bula, tarsus, metacarpal, metatarsal and digits, suggesting hypertrophic osteopathy. Radiographic examination and computed tomography of the lungs also showed a round mass well delimited localized in the right diaphragmatic lobe. A lobectomy of the right diaphragmatic lobe and partial lobectomy of accessory lobe were performed. A poorly differentiated clear squamous cell carcinoma was diagnosed by histological examination. An immune-panel of CK5/CK6, CK7, p63 and TTF-1 was used for immunophenotyping. Immunostaining was weakly positive for CK5/CK6 and negative to all others. Therefore, the diagnosis was poorly differentiated clear cell adenocarcinoma. The dog showed improvement in clinical signs seven days after surgery. One month postoperatively, radiographic examination of the limbs showed less intense periosteal reaction and initiation of bone remodeling. Discussion: Primary pulmonary tumors are considered very infrequent in small animals, but its true incidence rate is dif- fi cult to establish in animal populations. The histological origin of the tumor in the present case, as verifi ed in the literature, is not well established by histological analysis. In these situations, the immunohistochemistry panel may be useful. The modifi cation of the diagnosis between histological analysis and by immunohistochemistry, among other factors, might be due to transdifferentiation from one phenotype to another at various stages in the neoplastic process. The clear cell appearance observed in this case may be verifi ed in all types of carcinoma due to intracellular accumulation of glycogen, most of which is dissolved during the preparation of paraffi n sections. This uncommon neoplasm apparently did not infl uence the radiographic or tomographic fi ndings of the hypertrophic osteopathy in the present case. The frequency of metastases depends on the histological type of the tumor, being common in the pulmonary adenocarcinoma and usually to tracheobronchial lymph nodes and pulmonary parenchyma. Although in this case the imaging studies did not show metastases to other pulmonary lobes, the histological exams showed metastatic lesions that may be associated to the dog’s death after the surgery.

Onicodistrofia lupoide simétrica canina: relato de caso

Symmetric lupoid onychodystrophy, or lupoid onychitis, is a multifactor immune-mediated onychopathy. The aim of the present study is to report the occurrence of lupoid onychitis in a two year-old mongrel dog helped at the Small Animal Dermatology Service of Sao Paulo State University Veterinary Hospital, in Botucatu, São Paulo. The animal presented lameness, onycholysis in five digits, paronychia, onychomadesis, nail softening and leuchonychia, as well as melicerous crusts in interdigital spaces and nailbeds. No non-dermatological systemic symptoms were observed. Complementary exams were negative for parasites or fungi. After 15 days of treatment there was partial recovery followed by recurrence. Onychectomy was performed in two digits for histopathological examination and fungal culture, which was negative. Histopathology was consistent with lupoid onychitis, reinforcing the importance of this complementary exam.

Meningite supurativa secundária a otite média e interna em um gato: relato de caso

Suppurative meningitis are rarely reported in dogs and cats. The present study aims to report the occurrence of suppurative meningitis secondary to otitis media and interna in a five-year-old female Persian cat examined at the Veterinary School of Unesp-Botucatu with acute progressive multifocal neurological alterations. Analysis of the cerebrospinal fluid (CSF) demonstrated predominance of neutrophils (90%) and the presence of bacteria. Therapy with antibiotics was initiated, but the animal came to die. beta-hemolytic Staphylococcus, beta-hemolytic Streptococcus and Proteus mirabilis were detected in fragments sent to culture. The present report demonstrates the importance of performing more specific exams such as complete CSF analysis in cases of otitis media and interna. This way, central nervous infections can be diagnosed and treated in a timely manner, as those are acute diseases with poor prognosis.

Lissencefalia em cães e gatos: revisão

Lissencephaly is a condition characterized by a lack of cerebral convolutions and sulci, which results from defective migration of nervous cells precursors in the telencephalus. The cause is presumably genetic. Lhasa-Apso dogs are most frequently affected, even though it may also occur in association with cerebellar hypoplasia in the Irish Setter, Wire-Haired Terrier and Samoieda breeds. This association was also reported in a cat. Clinical signs consist of dementia, aggressiveness, seizures, visual and olfactive dysfunctions, slow postural reactions and reduced menace response. Definitive diagnosis requires exams such as magnetic resonance imaging, cerebral biopsy or necropsy. There is no specific therapy for this disease, and seizures must be treated with anticonvulsants. The aim of this study is to review the literature regarding lissencephaly.

Mastite infecciosa equina: uma visão geral da doença

Mastits is considered uncommon disease in mares. Streptococcus equi, Staphylococcus sp., Corynebacterium sp., Actinobacillus sp., Nocardia sp. and enterobacterias are major microorganisms involved in equine mammary infections. The disease is commonly related to traumatic lesions in mammary glands and teats. Edema, fibrosis, masses to palpation of glands, and viscous to seropurulent milk are mainly clinical signs observed in affected animals. The diagnosis is based on clinical exam of mammary glands and microbiological culture of the milk. There are no standard to use of indirect exams on diagnosis, including California Mastits Test and Somatic Cell Count. Systemic antimicrobials are recommended in therapy, based on previous “in vitro” susceptibility microbiological test. No specific control measures are indicated in equine mastits. The present study reviewed the mastits in mares, with emphasis to etiology, epidemiology findings, clinical manifestation, diagnosis, treatment and control aspects.

Reproductive parameters of dairy goats submitted to estrus synchronization with prostaglandin F2a associated or not to hCG at estrous onset

Coodernação de Aperfeiçoamento de Pessoal de Nível Superior(CAPES)

Qualidade do sono em pacientes com síndrome do túnel do carpo

Pós-graduação em Bases Gerais da Cirurgia - FMB

Relação entre início da resposta faríngea e lateralização da lesão cerebral no acidente vascular encefálico

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)