999 resultados para Veia hepática


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o interesse da República de Cabo Verde na utiliza9ao da energia renovável é basicamente económico. O país é muito pobre e todo o custo de energia pesa profundamente na sua economia nacional,visto nao existirem recursos de energia "tradicional". A utiliza~ao da energia renovável para bombagem de água é por isso, de grande importancia porque reduz a importa~ao de petróleo. Tanto a energia eólica como a energia solar oferecem grandes possibilidades em Cabo Verde. O país está sendo atingido pelo pior e mais langa período de seca jamais experimentado na sua história. Pode-se imaginar os problemas enfrentados para abastecimento de água a populac~o, abeberamento de animais e irriga- .., , ,,, , ~ao das poucas areas agrlcolas. O abastecimento de água potável é extremamente importante neste país, é apenas para a sobrevivencia da maior parte da sua popula9ao rural (190.000 habitantes), com pouco poder aquisitivo dado a diminuisao da área agrícola irrigada e a quantidade de gado, nos últimos 15 anos. Na agricultura irrigada, de momento totalizando apenas 2.000 ha, utilizase relativamente grande quantidade de combustível, porque 50% consiste em irrigasao por bombagem. Por esta razao o governo de Cabo Verde estimula fortemente a utilizasao das energias renováveis. As actividades neste campo come~aram em 1977 com a cria~ao da Divisao de Energias Renováveis (DER) dentro do Ministério do Desenvolvimento Rural (MUR). O governo de Cabo Verde e a PNUD (Projecto PNUD CVI/76/X05 - Demonstrasao de Energia Nao Convenciorial) puseram fundos a disposi~ao. Este projecto contribuiu com 3 aerogeradores e um volontário, Sr. Van Meel, que trabalhou anteriormente no Grupo de Energia Eólica de Eindhoven e que faz parte do CWD. Desde o seu início, a Divisao deu prioridade a bombagem de água para o abastecimento de água potável, o que foi e continua a ser urna necessidade urgente nas Ilhas de Cabo Verde. Os Servi~os da Igreja Mundial ofereceram 25 aerobombas Dempster com ventoinha de 8' de diametro e mais tarde a UNICEF distribuiu 10 Dempsters de ]4'. Gradualmente mais organiza90es financiadoras envolveram-se nas actividades da DER, como por exemplo a ClMADE, FAC, Embaixada An~ricana, Embaixada do Canadá, ICCO, etc. O Ministério do Desenvolvimento e Coopera9ao dos Países Baixos (DGIS) encarregou- se, em 1979, da norneasao do voluntárío da PNUD. Também em 1979 a USAID envolveu-se. Foi reconhecido e implementado um projecto de energia renovável (ref. 1). Este projecto comecou em Agosto de 1980. O papel prin cipal do projecto consistia na aquisiq~o de material e equipamento para urna nova oficina da DER. Urna das premissas do projecto era que o DGIS prestaria assistencia él Divisao. A pedido do DGIS a CWD realizou um estudo sobre a viabilidade de aplica9ao de aerobombas durante o primeiro semestre de 1980 (ref. 2). O estudo revelou que 75% das necessidades de água por bombagem em Cabo Verde, pode ria ser desempenhado pelos moinhos. - O projecto proposto diz respeito nao apenas a assistencia técnica, mas também ao financiamento da nova oficina e a aquisi9ao de cerca de 30 moi nhos. Este projecto bilateral entre Cabo Verde e os Países Baixos - Energias Renováveis", depois da aprova<;ao de Cabo Verde e do DGIS, veia a comecar no dia 1 de Julho de 1981 e estendeu-se por 3 anos. O período de 1977 a Julho de 1981 classifica-se agora como a primeira fase das actividades. Durante este período o CWD contribuiu com a assist€ncia técnica. O período de Julho de 1981 a Julho de 1984 é classificado como segunda fase e será relatado neste documento. O projecto foi executado pela DER. O Director da DER é, desde Fevereiro de 1983, o Sr. Daniel Livramento, licenciado em Física (Brasil 1982). Outros funcionários do corpo directivo sao o Sr. David Cardoso (desde Novem bro de 1983) e muito recentemente, desde Maio de 1984, o Sr. F. Ferreira7 A colaboracao dos Países Baixos para o projecto tem sido efectuada por En genheiros Consultores do DHV, em nome e como associados do CWD. O Sr. K.Versteegh, consultor do CWD, comecou a trabalhar para o projecto em 1 de Julho de 1981 e o Sr. N.Pieterse,~consultordo CWD, em 15 de Setembro de 1981. O Sr. Van Meel deixou o projecto a 1 de Novembro de 1981. O projecto foi avaliado em Novembro de 1983, por urna missao tripartida (Cabo Verde, USAID, DGIS) - Ref. 3. As conclusoes desta missao de avaliacao foram, em geral, positivas e o prolongamento do projecto foi fortemen te recomendado, com €nfase sobre aprodu~ao local. Entretanto, a DER e o CWD prepararam urna proposta para a extensao do projecto por mais 3 anos (Ref. 4). Esta extensao foi aprovada por Cabo Verde e pelo DGIS. O Sr. Versteegh foi substituído em Julho de 1984 e o Sr. Pieterse será substituido em Setembro de 1984 pelos Srs. J.Diepens e H. van der Spek, respectivamente. O conteúdo deste relatório é o seguinte: No capitulo 2 é apresentada urna exposi~ao do trabalho que incluiu um resumo das actividades realizadas na fase 1. Nos restantes capítulos descrevem-se as actividades durante a segunda fase. O relatório divide-se em tr€s partes: la. Parte (capítulo 3 a 8) refere-se ao trabalho executado: instalacao, funcionamento e rnanutencao de aerobombas servi~o~ e materiais distribuidos J pessoal e organiza9ao finalidade e sistema económico revisao da pot€ncia da água bombeada apoio ao projecto relatórios 2a. Parte salienta alguns aspectos importantes do projecto: funcionamento e manuten9ao de aerobombas (Cp. 19) metodologia de selec~ao de locais (Cp. 10) alguns estudos dos sistemas de funcionamento (Cp. 1]) elabora~ao de dados do vento (Cp. ]2) rendirnento das aerobombas utilizadas pela DER (Cp. ]3) 3a. Parte apresenta as conclusoes e recomendações (Cp. 14)

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Background and aims: The extent and molecular mechanisms governing plasma extravasation and formation of ascites in cirrhosis are unknown. Vascular endothelial growth factor-A (VEGF-A) and angiopoietin-2 (Ang-2) are endogenous substances with powerful vascular permeability effects. We assessed regional blood flow, vascular leakage, mRNA and tissular expression of VEGF-A and Ang-2 and vascular permeability following VEGF receptor 2 blockade in control and cirrhotic rats to define the vascular territories showing altered vascular permeability in cirrhosis and to determine whether VEGF-A and Ang-2 are involved in this phenomenon. Methods: Arterial blood flow was analysed with the coloured microsphere method. Vascular leakage was measured and visualised with the dye Evan¿s Blue and colloidal carbon techniques, respectively. VEGF-A and Ang-2 expression were determined by real-time polymerase chain reaction (RT-PCR), immunohistochemistry and western blot. The effect on vascular permeability induced by VEGFR2 blockade was assessed by administration of the receptor inhibitor SU11248. Results: Arterial blood flow was increased in the mesentery, pancreas and small intestine but not in the kidney and spleen of cirrhotic rats as compared to controls. Increased vascular leakage was observed in the mesentery and liver, where colloidal carbon spread from microvessels to the adjacent fibrotic tracts. Increased hepatic and mesenteric expression of VEGF-A and Ang-2 was found in cirrhotic rats as compared to controls. Blockade of VEGFR2 markedly reduced hepatic and mesenteric vascular leakage in cirrhotic rats. Conclusions: Enhanced endothelial permeability is restricted to the hepatic and mesenteric vascular beds in cirrhotic rats with ascites and VEGF-A and Ang-2 are key factors in the signalling pathways regulating this dysfunction.

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Normalization of the increased vascular nitric oxide (NO) generation with low doses of NG-nitro-L-arginine methyl ester (L-NAME) corrects the hemodynamic abnormalities of cirrhotic rats with ascites. We have undertaken this study to investigate the effect of the normalization of vascular NO production, as estimated by aortic cyclic guanosine monophosphate (cGMP) concentration and endothelial nitric oxide synthase (eNOS) protein expression in the aorta and mesenteric artery, on sodium and water excretion. Rats with carbon tetrachloride-induced cirrhosis and ascites were investigated using balance studies. The cirrhotic rats were separated into two groups, one receiving 0.5 mg/kg per day of L-NAME (CIR-NAME) during 7 d, whereas the other group (CIR) was administrated the same volume of vehicle. Two other groups of rats were used as controls, one group treated with L-NAME and another group receiving the same volume of vehicle. Sodium and water excretion was measured on days 0 and 7. On day 8, blood samples were collected for electrolyte and hormone measurements, and aorta and mesenteric arteries were harvested for cGMP determination and nitric oxide synthase (NOS) immunoblotting. Aortic cGMP and eNOS protein expression in the aorta and mesenteric artery were increased in CIR as compared with CIR-NAME. Both cirrhotic groups had a similar decrease in sodium excretion on day 0 (0.7 versus 0.6 mmol per day, NS) and a positive sodium balance (+0.9 versus +1.2 mmol per day, NS). On day 7, CIR-NAME rats had an increase in sodium excretion as compared with the CIR rats (sodium excretion: 2.4 versus 0.7 mmol per day, P < 0.001) and a negative sodium balance (-0.5 versus +0.8 mmol per day, P < 0.001). The excretion of a water load was also increased after L-NAME administration (from 28+/-5% to 65+/-7, P < 0.05). Plasma renin activity, aldosterone and arginine vasopressin were also significantly decreased in the CIR-NAME, as compared with the CIR rats. The results thus indicate that normalization of aortic cGMP and eNOS protein expression in vascular tissue is associated with increased sodium and water excretion in cirrhotic rats with ascites.

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Background Patients with cirrhosis in ChildPugh class C or those in class B who have persistent bleeding at endoscopy are at high risk for treatment failure and a poor prognosis, even if they have undergone rescue treatment with a transjugular intrahepatic porto - systemic shunt (TIPS). This study evaluated the earlier use of TIPS in such patients. Methods We randomly assigned, within 24 hours after admission, a total of 63 patients with cirrhosis and acute variceal bleeding who had been treated with vasoactive drugs plus endoscopic therapy to treatment with a polytetrafluoroethylene-covered stent within 72 hours after randomization (early-TIPS group, 32 patients) or continuation of vasoactive-drug therapy, followed after 3 to 5 days by treatment with propranolol or nadolol and long-term endoscopic band ligation (EBL), with insertion of a TIPS if needed as rescue therapy (pharmacotherapyEBL group, 31 patients). Results During a median follow-up of 16 months, rebleeding or failure to control bleeding occurred in 14 patients in the pharmacotherapyEBL group as compared with 1 patient in the early-TIPS group (P=0.001). The 1-year actuarial probability of remaining free of this composite end point was 50% in the pharmacotherapyEBL group versus 97% in the early-TIPS group (P<0.001). Sixteen patients died (12 in the pharmacotherapyEBL group and 4 in the early-TIPS group, P=0.01). The 1-year actuarial survival was 61% in the pharmacotherapyEBL group versus 86% in the early-TIPS group (P<0.001). Seven patients in the pharmacotherapyEBL group received TIPS as rescue therapy, but four died. The number of days in the intensive care unit and the percentage of time in the hospital during follow-up were significantly higher in the pharmacotherapyEBL group than in the early-TIPS group. No significant diferences were observed between the two treatment groups with respect to serious adverse events. Conclusions In these patients with cirrhosis who were hospitalized for acute variceal bleeding and at high risk for treatment failure, the early use of TIPS was associated with signif icant reductions in treatment failure and in mortality. (Current Controlled Trials number, ISRCTN58150114.)

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Bacterial translocation occurs in ascitic cirrhotic rats, but its association with ascites infection is unknown. The aim of this study was to assess the relation between bacterial translocation and ascites infection in cirrhotic rats. Male Sprague-Dawley rats were induced to cirrhosis with intragastric CCl4. Ascitic fluid, portal and peripheral blood, mesenteric lymph nodes, liver and spleen samples were cultured before death in those cirrhotic rats with less (group A) or more (group B) than 250 polymorphonuclear neutrophils/mm3 in ascitic fluid, as well as in healthy control rats. Histological examination of jejunum, ileum, and caecum was also performed. Bacterial translocation occurred in 45% of ascitic rats (without differences between groups A and B), but in 0% controls (p = 0.01). Bacterial translocation was associated with positive ascitic fluid culture in 60% of the cases. In all of them the same bacterial species was isolated in both mesenteric lymph node and ascitic fluid. Submucosal caecal oedema (100%), ileal lymphangiectasia (41%), and caecal inflammatory infiltrate (41%) occurred in ascitic rats, the last being associated with ascitic fluid positive culture (p = 0.04). These results suggests that bacterial translocation occurs frequently in ascitic cirrhotic rats, and may play a permissive, but not unique, part in a number of ascites infections. Whether histological changes seen in cirrhotic ascitic rats favour bacterial translocation remains to be elucidated.

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One hundred and eighty nine patients with primary biliary cirrhosis were entered into a double blind, placebo controlled randomised trial starting in January 1978 to assess the therapeutic value of d-penicillamine 1200 mg daily. Eighteen of the 98 patients receiving d-penicillamine and 22 of the 91 placebo treated patients died during the study. Thirty six per cent of those on d-penicillamine and 8% of those on placebo were withdrawn from the study. No difference in overall survival was noted between the two groups of patients whether the results were analysed for the entire period of observation or only during the period in which the patients were receiving therapy. The mortality rate of those receiving d-penicillamine in histological stage I to II, however, was one third of that of the placebo group although this difference did not reach statistical significance. Using the occurrence rate ratio as the statistical method of analysis, no effect of d-penicillamine was noted on any clinical, biochemical or hist

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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.

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BACKGROUND/AIMS/METHODS During hepatic vein catheterisation, in addition to measurement of hepatic venous pressure gradient (HVPG), iodine wedged retrograde portography can be easily obtained. However, it rarely allows correct visualisation of the portal vein. Recently, CO2 has been suggested to allow better angiographic demonstration of the portal vein than iodine. In this study we investigated the efficacy of CO2 compared with iodinated contrast medium for portal vein imaging and its role in the evaluation of portal hypertension in a series of 100 patients undergoing hepatic vein catheterisation, 71 of whom had liver cirrhosis. RESULTS In the overall series, CO2 venography was markedly superior to iodine, allowing correct visualisation of the different segments of the portal venous system. In addition, CO2, but not iodine, visualised portal-systemic collaterals in 34 patients. In cirrhosis, non-visualisation of the portal vein on CO2 venography occurred in 11 cases; four had portal vein thrombosis and five had communications between different hepatic veins. Among non-cirrhotics, lack of portal vein visualisation had a 90% sensitivity, 88% specificity, 94% negative predictive value, and 83% positive predictive value in the diagnosis of pre-sinusoidal portal hypertension. CONCLUSIONS Visualisation of the venous portal system by CO2 venography is markedly superior to iodine. The use of CO2 wedged portography is a useful and safe complementary procedure during hepatic vein catheterisation which may help to detect portal thrombosis. Also, lack of demonstration of the portal vein in non-cirrhotic patients strongly suggests the presence of pre-sinusoidal portal hypertension.

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Background and aims: Previous clinical trials suggest that adding non-selective beta-blockers improves the efficacy of endoscopic band ligation (EBL) in the prevention of recurrent bleeding, but no study has evaluated whether EBL improves the efficacy of beta-blockers + isosorbide-5-mononitrate. The present study was aimed at evaluating this issue in a multicentre randomised controlled trial (RCT) and to correlate changes in hepatic venous pressure gradient (HVPG) during treatment with clinical outcomes. Methods: 158 patients with cirrhosis, admitted because of variceal bleeding, were randomised to receive nadolol+isosorbide-5-mononitrate alone (Drug: n=78) or combined with EBL (Drug+EBL; n=80). HVPG measurements were performed at randomisation and after 4¿6 weeks on medical therapy. Results: Median follow-up was 15 months. One-year probability of recurrent bleeding was similar in both groups (33% vs 26%: p=0.3). There were no significant differences in survival or need of rescue shunts. Overall adverse events or those requiring hospital admission were significantly more frequent in the Drug+EBL group. Recurrent bleeding was significantly more frequent in HVPG non-responders than in responders (HVPG reduction ¿20% or ¿12 mm Hg). Among non-responders recurrent bleeding was similar in patients treated with Drugs or Drugs+EBL. Conclusions: Adding EBL to pharmacological treatment did not reduce recurrent bleeding, the need for rescue therapy, or mortality, and was associated with more adverse events. Furthermore, associating EBL to drug therapy did not reduce the high rebleeding risk of HVPG non-responders.

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Background: In cirrhosis, repeated flares of portal pressure and collateral blood flow provoked by postprandial hyperaemia may contribute to variceal dilation and rupture. Aim: To examine the effect of the extent of the collateral circulation on the postprandial increase in portal pressure observed in cirrhosis. Patients and methods: The hepatic venous pressure gradient (HVPG), hepatic blood flow and azygos blood flow were measured in 64 patients with cirrhosis before and after a standard liquid meal. Results: Peak increases in HVPG (median+14.9%), hepatic blood flow (median+25.4%), and azygos blood flow (median+32.2%) occurred at 30 min after the meal. Compared with patients with marked postprandial increase in HVPG (above the median, n¿=¿32), those showing mild (<15%, n¿=¿32) increase in HVPG had a higher baseline azygos flow (p<0.01) and underwent a greater postprandial increase in azygos flow (p<0.02). Hepatic blood flow increased similarly in both groups. Postprandial increases in HVPG were inversely correlated (p<0.001) with both baseline azygos flow (r¿=¿¿0.69) and its postprandial increase (r¿=¿¿0.72). Food intake increased nitric oxide products in the azygos (p<0.01), but not in the hepatic vein. Large varices (p<0.01) and previous variceal bleeding (p<0.001) were more frequent in patients with mild increase in HVPG. Conclusions: Postprandial hyperaemia simultaneously increases HVPG and collateral flow. The extent of the collateral circulation determines the HVPG response to food intake. Patients with extensive collateralisation show less pronounced postprandial increases in HVPG, but associated with marked flares in collateral flow. Collateral vessels preserve their ability to dilate in response to increased blood flow.

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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.

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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.

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Els seguiments o monitoritzacions, com els empenys humans, tenen per tret diferencial els alts i baixos, les dents de serra. I aixó, no només és vàlid per al comportament de les variables monitoritzades, sino també per als avatars administratius i financers. Fins l'extrem que la continuitat temporal, i no sols l'antiguitat delsregistres, és la millor mesura de la seriositat en la gestió d'un país; en aquest sentit, és evident que els països anglo-saxons tenen molt que ensenyar als llatins (p.e. en els registres de dades metereològiques).Abans del que haguèssim volgut, els alts i baixos polítics i financers van tocar, fent trontollar l'any 1995, al Seguiment del Patrimoni Biològic de les Illes Medes. L'any 1994 s'acabà el primer cicle del Pla d'Usos de l'Àrea protegida de les illes Medes (sorgit de la llei 19/1990 de 10 de desembre del Parlament de Catalunya).Aquest havia d'obrir les portes a un segon cicle quatrienal en el que, de forma preceptiva segons l'esmentada llei, s'havien de continuar els controls biològics del seu patrimoni natural. Per tant, no calia recorrer al nostre reiterat argument que en ecologia hom precisa de períodes d'estudi relativament llargs per definir amb fiabilitat les tendències de canvi: l'administració havia assumit l'argument i el feia seu. Malgrat tot, no podem dir que causès sorpresa la notícia que, després de moltes dil.lacions, informacions contradictòries i canvis de titularitat en els òrgans de gestió, el seguiment de 1995 es veia desproveït de suport financer (ens apresurem a reconeixer que a nivell d'intencions, el suport de les administracions involucrades no es va veure mai compromés). Conscients de la ingenuïtat d'esperar un suport lliure d'entrebancs, el nostre equip de treball havia assumit, des de l'inici del seguiment en 1990, el risc d'aquesta eventualitat. I havia previst que, arribat el cas, caldria continuar el seguiment, omplint si calia el buit derivat de la manca del marcadministratiu (en aquest cas el nou conveni entre la conselleria d'Agricultura, Ramaderia i Pesca i la Universitat de Barcelona) que per motius diversos no es restablí en tot el curs del 1995. És així que el seguiment del patrimoni natural de l'Àrea protegida de les illes Medes al llarg de l'any 1995 es feu amb recursos propis, la qual cosa vol dir amb moltes estretors econòmiques. Afortunadament, la situaciós'ha redrecat, en renovar-se per tres anys més (1996-1998) el conveni que estableix el seguiment. La satisfacció per la signatura d'aquest nou conveni, em fa alimentar l'esperança que ens anys a venir els nous gestors de la Reserva Marina de les Illes Medes, conscients del paper capdavanter d'aquest espai en la gestió dels espais litorals mediterrànis, no permetràn que tals anomalies es repeteixin.

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O objetivo deste trabalho foi avaliar o efeito da suplementação dietária com ácido L-ascórbico (vitamina C) no ganho de peso e em parâmetros hematológicos de juvenis de tambaqui, Colossoma macropomum. Após dez semanas, em que foram alimentados com dietas contendo 0, 100 e 500 mg de ácido L-ascórbico por kg de ração, os peixes foram capturados e imediatamente anestesiados para a coleta de sangue da veia caudal e determinação dos parâmetros hematológicos. Animais alimentados com maiores níveis de ascorbato mostraram pesos corpóreos maiores, melhores taxas de conversão alimentar e sobrevivência. A asência de ácido L-ascórbico na ração, além de causar redução nos valores de hematócrito e no número de eritrócitos, que caracteriza anemia, provocou aumento no volume corpuscular médio, na hemoglobina corpuscular média e na concentração de hemoglobina corpuscular média. Esses resultados revelam a importância do ácido L-ascórbico na dieta dos juvenis de tambaqui. O nível de 100 mg de ácido L-ascórbico/kg de ração é adequado, garantindo bom ganho de peso e manutenção da homeostase do organismo.