Ferulic acid as major antioxidant phenolic compound of the Tetragonisca angustula honey collected in Vera Cruz - Itaparica Island, Bahia, Brazil

Abstract The antioxidant activity of Tetragonisca angustula honey (TAH) and its ethanolic extract (TAEE) were investigated. The total levels of phenolic (TPC) and flavonoids (TFC) were also evaluated. The results for TPC were 19.91 ± 0.38 and 29.37 ± 1.82 mg GAE g-1 and for TFC 0.20 ± 0.02 and 0.14 ± 0.01 mg QE g-1 of TAH and TAEE, respectively. Antioxidant activities were 73.29 ± 0.49% and 93.36 ± 0.27% in the DPPH● assay and 71.73 ± 4.07% and 97.86 ± 0.35% in ABTS●+ for TAH and TAEE, respectively. The total reducing activity was determined by the method of reducing power (PR) and iron ion (Fe III) and the results varied in PR from 151.7 ± 25.7 and 230.7 ± 25.2 mg GAE L-1, for TAH and TAEE respectively and for (Fe III) in EC50 0.284 in TAEE and 0.687 in TAH. Chemical analysis by HPLC-DAD of the ethanolic extract (TAEE) revealed the presence of ferulic acid as majority phenolic component in the extract. The 1H NMR analysis confirmed this structure and showed the also presence of glucose, citric acid, succinic acid, proline and hydrocarbon derivatives. In addition, the botanical origin was also investigated and showed a multifloral characteristic, having found 19 pollen types with a botanical predominance of the Anacardiaceae family, with Tapirira pollen occurring as predominant (42.6%) and Schinus as secondary (25.7%). The results showed that T. angustula honey is an interesting source of antioxidant phenolic compounds due to its floral origin and can act as a protector of human health when consumed.

Evaluation of antioxidant, photoprotective and antinociceptive activities of Marcetia macrophylla extract: potential for formulation of sunscreens

The antioxidant, photoprotective and antinociceptive Marcetia macrophylla active extract was investigated as an active ingredient in a sunscreen cream formulation. Thus, the M. macrophylla extract showed IC50 of 3.43 mg/ml of the antioxidant (DPPH∙ scavenging test) and Sun Protection Factor of 20.25 (SPF/UV-B, at 250 µg/ml) and UV-A of 78.09% (photobleaching trans-resveratrol test). The antinociceptive activity was superior to all standards tested using the in vivo acetic acid-induced writhing test (99.14% at the dose of 200 mg/kg) and the high-performance liquid chromatography coupled with diode array detector and mass spectroscopy multi-stage (HPLC-DAD-MS/MS) enabled the structural characterization of the quercetin-3-O-hexoside, quercetin-3-O-pentoside and quercetin-3-O-desoxihexoside. The pharmaceutical formulation containing the Marcetia macrophylla crude active extract was prepared and the physicochemical tests (organoleptic characteristics, pH analysis and centrifugation), the in vitro UVB (sun protection factor, SPF) and UVA (β-carotene) using the spectroscopic method were investigated. The formulation showed satisfactory results concerning the physicochemical parameters evaluated and active against the UV test. Thus, M. macrophylla showed biological activities with potential use in pharmaceutical preparations.

Antinociceptive and anti-inflammatory activities of Hymenaea martiana Hayne (Fabaceae) in mice

Hymenaea martiana is a species popularly known in Northeastern Brazil as "jatobá" and used in folk medicine to treat pain and inflammation. The aim of this work was to evaluate the antinociceptive and anti-inflammatory activity of H. martiana. In the present study, we carried out an investigation about the effects of the crude ethanolic extract (Hm-EtOH) and the ethyl acetate fraction (Hm-AcOEt) in models of nociception and inflammation in mice. Chemical (acetic acid-induced writhing and formalin) and thermal stimuli (hot plate) were used for the evaluation of antinociceptive activity, while for the anti-inflammatory profile paw edema induced by carrageenan was used, along with leukocyte migration to the peritoneal cavity. The presence of the flavonoid astilbin in the samples was characterized through HPLC-DAD-MS analysis. Hm-EtOH and Hm-AcOEt (100, 200 and 400 mg.kg-1, i.p.) significantly reduced the number of abdominal contortions and decreased the paw licking time in the formalin test. In the hot plate, the extract increased the latency time of animals. Hm-EtOH and Hm-AcOEt inhibited significantly the increase in the edema after the administration of carrageenan. Hm-EtOH and Hm-AcOEt inhibited leukocyte migration in the peritonitis test. HPLC-DAD-MS analysis of Hm-EtOH and Hm-AcOEt revealed the presence of the flavonoid astilbin in the samples. According to the results of this study, both Hm-EtOH and Hm-AcOEt have antinociceptive and anti-inflammatory activities, which could be related with the presence of flavonoid in the extracts. The results reinforce the popular use of this plant.

Assessment of the antibacterial, cytotoxic and antioxidant activities of Morus nigra L. (Moraceae)

This study was carried out to assess the antibacterial, cytotoxic and antioxidant activities of extracts of Morus nigra L. HPLC was used to determine the fingerprint chromatogram of the crude ethanolic extract (Mn-EtOH). The antibacterial effect was assessed through the method of microdilution. The cytotoxicity was tested against human tumour cell lines using the 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay. The total phenolic and flavonoid contents were also assessed through the Folin-Ciocalteu and aluminum chloride methods, respectively. Antioxidant activities of the extracts were evaluated by using 2,2-diphenyl-1-picrylhydrazil (DPPH) radical scavenging and β-carotene-linoleic acid bleaching methods. The presence of phenolic compounds in Mn-EtOH was confirmed using HPLC. The extracts showed activity against most microorganisms tested. The extracts did not show any expressive antiproliferative effect in the assessment of cytotoxicity. The most significant total phenolic content was 153.00 ± 11.34 mg of gallic acid equivalent/g to the ethyl acetate extract (AcOEt). The total flavonoid content was 292.50 ± 70.34 mg of catechin equivalent/g to the AcOEt extract, which presented the best antioxidant activity (IC50 50.40 ± 1.16 μg/mL) for DPPH scavenging. We can conclude that this species shows strong antibacterial and antioxidant activities, as well as weak cytotoxic effects.

Produção total de gases e degradabilidade in vitro de dietas com torta de girassol

Objetivou-se determinar o efeito de níveis crescentes de torta de girassol em dietas para ruminantes sobre a digestibilidade in vitro da matéria seca (DIVMS), matéria orgânica (DIVMO), proteína bruta (DIVPB), a cinética da produção cumulativa de gases, parâmetros da fermentação ruminal, concentração de N- amoniacal (N-NH3) e pH in vitro. Utilizou feno de Tifton e os concentrados caracterizaram-se pela presença de 0 g/kg, 100 g/kg, 200 g/kg e 300 g/kg de inclusão da torta de girassol no concentrado. Houve influência significativa (p0,05) pelas dietas experimentais, porém, houve efeito linear decrescente (p

Vocal fold myofibroblast profile of scarring

OBJECTIVES/HYPOTHESIS

Vocal fold fibroblasts (VFF) are responsible for extracellular matrix synthesis supporting lamina propria in normal and diseased conditions. When tissue is injured, VFF become activated and differentiate into myofibroblasts to facilitate wound healing response. We investigated if vocal fold myofibroblasts can be utilized as surrogate cells for scarred VFF.

STUDY DESIGN

In vitro.

METHODS

Normal VFF cell lines from a 21-year-old male (N21), 59-year-old female (N59), and a scar VFF cell line from a 56-year-old female (S56) were used in this study. 10 ng/mL of transforming growth factor (TGFβ1) was applied for 5 days to normal VFF. Myofibroblast differentiation was determined with immunocytochemistry and western blot, measuring alpha smooth muscle actin (α-SMA). Cell growth, proliferation, contractile properties, and gene expression profiles were evaluated.

RESULTS

N21, N59, and S56 VFF presented elongated configuration. N21+ and N21- VFF demonstrated significantly greater proliferation compared to N59+, N59-, and S56 VFF at 6 days. α-SMA was expressed in all cells. Fibronectin, alpha smooth actin, connective tissue growth factor, and metallopeptidase inhibitor were the highest genes expression in VFF treated with transforming growth factor β1 (TGFβ1). At 24 hours, S56 VFF showed lower contraction compared to N21+ and N59+ VFF, but at 60 hours S56 VFF had lower collagen contraction compared to all cell groups. Highest collagen contraction matrices were measured with VFF treated with TGFβ1 at 24 hours and N59- VFF at 60 hours.

CONCLUSION

VFF treated with TGFβ1 (myofibroblasts) appear to have similar phenotypic characteristics but different genotypic behavior compared to scar VFF.

LEVEL OF EVIDENCE

N/A. Laryngoscope, 126:E110-E117, 2016.

Alterations in extracellular matrix composition in the aging larynx

OBJECTIVE

To study by immunohistochemistry the alterations of collagens I, III, IV, and V and elastin in the aging process of the human larynx.

STUDY DESIGN

Cadaver study.

SETTING

Universidade Estadual Paulista, Botucatu Medical School, São Paulo State University (UNESP), Brazil.

SUBJECTS AND METHODS

Thirty vocal folds were obtained at autopsy from 10 adult men (aged 30 to 50 years) and 20 geriatric men (10 aged 60 to 75 years and 10 aged >75 years). Mid membranous vocal fold slides were subjected to immunohistochemical reactions. Digital imaging software (ImageJ) was used to quantify the increase in brownish staining of the lamina propria structures of vocal folds, from superficial to deep layers.

RESULTS

There was an increase of collagen I and III immunoexpression in the elderly larynges, in both layers. Collagens IV and V were immunoexpressed in the vessels endothelium of the lamina propria and in the basement membrane. The immunoexpression of elastin decreased in the elderly larynges, in both lamina propria layers of the vocal folds.

CONCLUSION

A clear increase of collagens I and III and a decrease of elastic fibers were observed in the lamina propria of vocal folds. The concentration of collagens IV and V was the same across age groups. These findings suggest that as men age, the density of the extracellular matrix increases, brought about by an increase in collagen, while the loss of elastin results in decreased viscoelasticity.

Psychogenic dysphonia: diversity of clinical and vocal manifestations in a case series

Introduction

Objective

Methods

Results

Conclusions

Hyaluronic Acid Behavior in the Lamina Propria of the Larynx with Advancing Age

Objectives

To analyze the hyaluronic acid behavior in the lamina propria of the larynx with advancing age.

Study Design

Prospective study.

Setting

UNESP-Univ Estadual Paulista, Botucatu Medical School, Brazil.

Subjects and Methods

Thirty vocal folds were obtained at necropsy from 10 adult males (30–50 years old) and 20 geriatric males (10: 60–75 years old; 10: over 76 years old). Midmembranous vocal fold sections were subjected to immunohistochemical reactions. Digital imaging software (ImageJ) was used to quantify the hyaluronic acid distribution over the lamina propria of vocal folds, from superficial to deep layers.

Results

Hyaluronic acid distribution was homogeneous for the larynges, at both superficial and deep layers (41.6 and 38.5, respectively). For both 30- to 50-year-old men geriatric age groups, hyaluronic acid level was lower at both layers.

Conclusion

Hyaluronic acid level in the lamina propria of the larynx of geriatric men decreases with advancing age at both layers of the lamina.

Clinical practice: vocal nodules in dysphonic children

Common among children, vocal symptoms are a cause of concern for parents who seek elucidation of their diagnosis and treatment. Vocal nodules are the major cause of dysphonias in children and are related to vocal abuse. We conducted a literature review considering clinical, physiopathological, epidemiological, and histological aspects of vocal nodules, as well as diagnostic methods, highlighting the main studies addressing this issue. The controversial points of treatments were also discussed.

Laryngeal and voice disorders in patients with gastroesophageal symptoms. Correlation with pH-monitoring

PURPOSE

To investigate laryngeal and voice disorders in patients with gastroesophageal symptoms and their correlation with pH-monitoring.

METHODS

A prospective study was carried out in patients attended at the Voice Disorder Outpatient Clinics of Botucatu Medical School in a five-year period and had vocal and gastroesophagic symptoms. Patients underwent videolaryngoscopy, auditory-perceptual vocal analyses, computerized acoustic vocal analysis and dual probe pH-monitoring for 24 hours.

RESULTS

Fifty-seven patients were included (aged between 21 and 65 years; 45 women and 12 men), 18 had normal (31.6%) and 39 had abnormal pH-monitoring results (68.4%). Videolaryngoscopy recorded several laryngeal lesions for both patients with normal and abnormal pH-monitoring, but mostly for the latter group, highlighting posterior pachyderma. Auditory-perceptual vocal assessments identified vocal changes of several intensities for both groups but especially for patients with abnormal pH-monitoring results. All acoustic parameters, except f0, were abnormal for both groups, compared to the control population.

CONCLUSION

Acoustic and perceptual vocal changes and laryngeal lesions were recorded for both patients with normal pH-monitoring results and patients with abnormal pH-monitoring results, evidencing the importance of clinical history and videolaryngoscopic findings for diagnosing acid laryngitis.

Comparative study of the behavior of p53 immunoexpression in smoking associated lesions: Reinke's edema and laryngeal carcinoma

OBJECTIVE

To assess the behavior of the immunoexpression of protein p53 in Reinke's edema and laryngeal squamous cell carcinoma.

STUDY DESIGN

retrospective.

METHODS

we recovered the histological paraffin blocks of patients who were subjected to Reinke's edema and laryngeal squamous cell carcinoma surgery in 2000-2011. The paraffin blocks were cut into 3-µm sections; the specimens were prepared in silanized slides (one slide for each paraffin block) and subjected to immunohistochemical reaction according to the Avidin Biotin Peroxidase method. Monoclonal primary anti-p53 antibodies were used at 1:50 dilution. Slides were examined under a light microscope at different magnitudes and results were interpreted based on the degree of brown staining in the nuclei of epithelial cells and in the extent of the fragment by using a semi-quantitative score from 0 to 3.

RESULTS

67 slides of Reinke's edema and 60 slides of laryngeal squamous cell carcinoma were included. Scores 2 and 3 for staining of the nuclei of epithelial cells were recorded for 46 slides of Reinke's edema (68.65%) and for 57 slides of laryngeal squamous cell carcinoma (95%). As to the extent of the fragment, scores 2 and 3 were recorded for 74% slides of Reinke's edema and for 95% slides of carcinomas.

CONCLUSION

the positive immunoexpression for protein p53, positive in 95% carcinomas and 74% Reinke's edemas, makes us aware of the possible preneoplastic condition of the latter lesion. Further studies are needed to identify and reveal the genetic changes that lead to these results.

Os distúrbios fonoarticulatórios na síndrome de Down e a intervenção precoce

TEMA: a criança com Síndrome de Down apresenta um atraso na aquisição e desenvolvimento dos aspectos fonoarticulatórios, atraso este, que tem sido atribuído a características físicas e ambientais que influenciam negativamente no processo de desenvolvimento. Caracterizar os aspectos fonoarticulatórios dos sujeitos com Síndrome de Down pode proporcionar uma melhor compreensão das alterações abordadas na reabilitação em suas diversas modalidades e contribuir na evolução terapêutica. Por esta razão decidiu-se focar com maior profundidade em um dos aspectos mais importantes da comunicação, a fonoarticulação. OBJETIVO: caracterizar as alterações fonoarticulatórias encontradas em indivíduos portadores da Síndrome de Down, por meio de uma revisão bibliográfica, enfocando a importância da intervenção precoce frente a tais circunstâncias. CONCLUSÃO: a falta de estimulação e o encaminhamento tardio irão interferir no desenvolvimento fonoarticulatório, assim, por meio da intervenção precoce, será possível a obtenção de melhores resultados, fazendo com que grandes problemas tornem-se alterações mínimas.

Alterações orofaciais em doenças alérgicas de vias aéreas

OBJETIVO: Apontar as possíveis alterações orofaciais decorrentes do sintoma "obstrução nasal" em pacientes portadores de doenças alérgicas de vias aéreas superiores, por meio de revisão de literatura. FONTES DE DADOS: Levantamento bibliográfico utilizando bancos de dados eletrônicos, como Medline, Ovid, SciELO e Lilacs, com as palavras-chave "asthma", "rhinitis" e "mouth breathing", abrangendo os 30 últimos anos. Foram incluídos artigos de revisão, estudos observacionais e ensaios clínicos. SÍNTESE DOS DADOS: A obstrução nasal é encontrada freqüentemente em doenças alérgicas de vias aéreas, como rinite e asma. A respiração bucal decorrente da obstrução nasal pode interferir de maneira direta no desenvolvimento infantil, com alterações no crescimento do crânio e orofacial, na fala, na alimentação, na postura corporal, na qualidade do sono e no desempenho escolar. CONCLUSÕES: Devido à variedade de alterações orofaciais encontradas na criança respiradora bucal decorrente de obstrução nasal por doenças alérgicas de vias aéreas, é necessário realizar diagnóstico e tratamento precoces por uma equipe multidisciplinar, composta por médico, ortodontista e fonoaudiólogo, contemplando a visão de uma via respiratória única, que traz conseqüências ao crescimento e desenvolvimento do sistema motor oral.

The newborn pain cry: descriptive acoustic spectrographic analysis

INTRODUCTION

Study the characteristics of pain vocal emission of newborns during venepuncture through acoustic analysis and relate it to NIPS pain scale and some variables of the newborns.

METHODS

Emissions of 111 healthy term newborns were recorded, whose lifetime varied from 24 to 72 h. The acoustic analysis was realized with GRAM 5.7 software verifying the occurrence of tense strangled voice quality, sounds, concentration of acoustic energy, breaks, double harmonic breaks and frequency instability, type of phonation, vocal attack and cough. The NIPS scale was realized during venepuncture and descriptive statistical analysis and correlation through Spearman test.

RESULTS

Hundred percent of the emissions had guttural sounds, vowels, hard vocal attack, frequency, breaks, double harmonic breaks and tense strangled voice quality; 34.2% higher fundamental frequency; 62.2% periods of emission absence and 100% occurrence of tracing instability, concentration of acoustic energy, inspiratory and expiratory phonation. The cough occurred in 14.4%. The signs of vocal tract constriction associated with all the parameters. There was a negative correlation between the higher fundamental frequencies and the weight of newborns and positive correlation between cough and NIPS score.

CONCLUSIONS

The newborn pain emission is tense and strident, the modifications of frequency and spectrographic tracing and the presence of sounds show laryngeal and vocal tract participation. The smaller the newborn weight, the bigger the presence of higher fundamental frequency with tense strangled voice quality and the bigger the NIPS score, the more frequent the cough. Such characteristics make pain crying peculiar, helping in the evaluation of pain during a procedure.

Valor e variações da freqüência fundamental no choro de dor de recém-nascidos

OBJETIVO: estudar o valor da freqüência fundamental e suas variações presentes no choro de dor de recém-nascidos. MÉTODOS: foram gravadas as emissões de 111 recém-nascidos de termo e saudáveis, com idade de 24 a 72 horas durante procedimento da punção venosa periférica. A análise acústica foi realizada por meio dos softwares VOXMETRIA 1.1 com extração do valor da freqüência fundamental e GRAM 5.7 para verificar a ocorrência de variações da freqüência fundamental como quebras, bitonalidade e freqüência hiperaguda. A escala de dor NIPS foi realizada no momento da punção. A análise estatística é descritiva com extração dos valores de média, desvio-padrão e freqüência de ocorrência dos eventos. RESULTADOS: os recém-nascidos apresentaram 100% de suas emissões com variações de freqüência, ou seja, quebras e bitonalidade. A freqüência hiperaguda foi encontrada em 34,2% dos recém-nascidos. CONCLUSÃO: por meio do choro, o recém-nascido comunica sua dor. A emissão de dor do recém-nascido é tensa e estridente, com freqüência fundamental aguda e variações encontradas no traçado espectrográfico, como quebras, bitonalidade e freqüência hiperaguda. Tais características são importantes para chamar a atenção do adulto no pronto atendimento ao recém-nascido e auxiliar na avaliação de dor durante um procedimento.

The neonate cry after cesarean section and vaginal delivery during the first minutes of life

Although the option for vaginal delivery is most physiological, the achievement of cesarean section is very common in Brazil. The neonate cry represents the beginning of both processes, physiological adaptation and human vocal communication. The cry emission depends on the functioning of respiratory and laryngeal muscles, which are controlled by the nervous system. The acoustic analysis of neonate cry is useful in the assessment of healthy babies and can be used to characterize the signals of diseases through a previously multidisciplinary diagnosis, with immediate medical intervention. The present study compared the acoustic cry characteristics of 30 healthy newborn after a cesarean section and 30 healthy newborn after a vaginal delivery, of both genders, from the exact moment of birth until the first 5 min of life. Using the softwares VOXMETRIA and GRAM, it was possible to analyze the duration, frequency, intensity, occurrence, localization and inspiratory phonation, besides the type of spectrographic tracings. The acoustic cry characteristics of newborns after a C section and a vaginal delivery could evidence not only harmonic, expiratory, acute and strong emissions, but also emissions rich in sounds and varied in types of melody. The differences found can be related to the physiology of birth.

Cyclosporine versus tacrolimus in kidney transplantation: are there differences in nephrotoxicity?

Cyclosporine and tacrolimus, two calcineurin inhibitors, show different side effects and toxicities. The data concerning their nephrotoxicity are few and conflicting. A retrospective study was performed in 2 groups of renal transplant recipients treated with cyclosporine or tacrolimus to evaluate graft function and side effects. All patients had completed at least 6 months of follow-up before inclusion in the study. Group I included 10 patients who were converted from cyclosporine to tacrolimus, due to cosmetic problems or due to chronic graft dysfunction with creatinine values <3 mg/dL. After conversion, there was a significant reduction in creatinine values (from 2.43 +/- 1.21 to 1.86 +/- 0.72 mg/dL; P =.023) and an improvement in creatinine clearance (from 47.5 +/- 19.2 to 56.1 +/- 18.9 mL/min; P =.047). The lipid profile did not change, but there was a trend to better blood pressure control with less antihypertensive drugs. Group II compared 2 subgroups of patients receiving kidneys from the same donor, one treated with cyclosporine and the other with tacrolimus. Tacrolimus patients showed better renal function; namely, creatinine was 1.15 +/- 0.27 versus 1.44 +/- 0.33 mg/dL (P =.029) and creatinine clearance was 87.7 +/- 27.1 versus 60.3 +/- 25.9 mL/min (P =.043). Lipid and blood pressure values were not different between the 2 subgroups, but tacrolimus patients tended to need a lower number of antihypertensive medications. The incidence of de novo diabetes mellitus was approximately 20% among patients using tacrolimus. We concluded that tacrolimus may be less nephrotoxic than cyclosporine. Tacrolimus patients showed better graft function and easier blood pressure control, but a high incidence of posttransplantation diabetes mellitus.

A new flavonol from leaves of Eugenia jambolana

Leaves of Eugenia jambolana yielded the new flavonol, myricetin 3-O-(4"-acetyl)-alpha-L-rhamnopyranoside (1).

Further lipophilic flavonols in Vellozia graminifolia (Velloziaceae) by high temperature gas chromatography: quick detection of new compounds

Further lipophilic flavonols present in Vellozia graminifolia have been determined by high temperature high resolution gas chromatography (HTHRGC) and by HTHRGC coupled to mass spectrometry (MS). These methods resulted in the detection, isolation and characterisation of a monoisoprenylated flavonol 3,5,4'-trimethoxy-3'-hydroxy-6,7-(2"-isopropenyldihydrofurano)flavone from the ethyl acetate extract of the whole plant. The structural elucidation was accomplished using spectral data, including two-dimensional NMR, and on chemical transformations. Both HTHRGC and HTHRGC-MS were shown to be alternative and extremely valuable methods for the quick screening of flavonoid aglycones and other chemical metabolites of the Velloziaceae.

[Intensive care units for patients with cerebrovascular strokes. Are they worthwhile?]

In Portugal, strokes are the leading cause of mortality and one of the most important causes of hospital admission. An educational programme at several levels, involving the media, populations and health professionals, is necessary to reduce mortality and morbidity rates as well as the resulting high costs. According to international literature, stroke units have shown efficacy in the reduction of mortality, morbidity and costs. They are therefore worthwhile and it is time they were considered.

Maternal and perinatal implications of the use of human recombinant erythropoietin

BACKGROUND

The use of human recombinant erythropoietin (rHuEPO) in pregnant patients has been limited by the fear of eventual maternal and fetal repercussions (either direct or indirect).

METHODS

The authors present their experience with the use of rHuEPO during pregnancy, with two pregnant women with kidney transplants and in three others with chronic renal insufficiency (one with diabetic nephropathy, another dialysis dependent), all with hematocrit below 30% and adequate iron reserves.

RESULTS

Three of the patients had needed blood transfusions before beginning therapy, and another needed transfusion after significant metrorrhagia. The length of the treatment varied between 2 and 23 weeks and the hematocrit at delivery varied between 26% and 36%. Secondary effects (appearance or worsening of hypertension and seizures) were nil. There was one fetal death at 23 weeks of pregnancy (following an abruptio placenta), two neonates weighing between the 5th and the 10th percentiles, and three needing phototherapy (1 to 2 days). One year after birth, all showed a normal ponderal and neurologic development.

CONCLUSIONS

Among the cases presented, no maternal and perinatal complications attributable to rHuEPO were registered. It is important that institutions report their experiences with the use of rHuEPO, given its restrictive indications and the limited experience of each institution.

Vibrio metschnikovii among diarrheal patients during cholera epidemic in Recife Brazil

Although known since the last century, Vibrio metschnikovii was only appropriately described and recognized as a new species within the genus Vibrio in 1978. Rarely is the organism linked to human disease. Only once has V. metschnikovii been incriminated as responsible for human diarrhea, and affecting an old woman who suffered from diabetes and had a hepatoma. During the first two years of the present cholera epidemic, which reached Recife in March, 1992, we screened for vibrio nearly 4000 diarrheal fecal specimens submitted to a private clinical laboratory for detection of enteropathogenic microorganisms. Now, we report six cases of diarrhea associated with V. metschnikovii affecting individuals not suffering of any apparent underlying systemic illness.

[Quality control of vagotomy in duodenal ulcer perforation]

The efficacy of truncal vagotomy combined with pyloroplasty has been studied in 56 patients, divided into the following groups: Group I-29 patients submitted to bilateral truncal vagotomy (BTV) and pyloroplasty, as the method of treatment to solve the problem of perforated duodenal ulcer (initial and retrospective phase of study). Group II-With 11 patients, who underwent the same operation as those in Group I but with the surgeon's knowledge of the results of phase I and also awareness of the laboratory control of its surgery (prospective phase). Group III-A control Group of 16 patients, with chronic duodenal ulcer submitted to a routine proximal gastric vagotomy (superselective or hyperselective vagotomy). All of the patients were clinically evaluated and all of them have done acid secretion studies (Kay and Sham-Feeding test). Basal acid output (BAO), maximum acid output after Sham-Feeding (PAOsf), and pentagastrine (PAOpg), were determined in order to control the efficacy of vagotomy. In group III, results were compared with those obtained pre-operatively. In Group I, 48.27% of patients had a PAOsf higher than 4 mEq/hour-value which has been considered the maximum level of normality after complete BTV without gastric resection. In Group II, the number of patients with incomplete vagotomy decrease to 18.18%. In Group III, all the patients had a PAOsf lower than 4 mEq/hour and 83.81% of acidity reduction after Sham-Feeding test, in comparision with the pre-operative values.(ABSTRACT TRUNCATED AT 250 WORDS)

[Surgical therapy of peptic stenosis of the esophagus in adults]

One hundred and one patients with reflux esophagitis and strictures, submitted to different kinds of surgical solutions over the last 16 years, were revised. Seventy seven patients had dilatable stricture and the lower esophageal sphincter mechanism could be brought intra-abdominally in 70. In 36 there was radiographic evidence of hiatal hernia and 8 had a Barrett esophagus. The surgical technique employed in these cases was transgastric dilatation of the stricture, and Nissen fundoplication in 63 and partial fundoplication in 13 patients with peptic stricture post BI or BII6, gastroenterostomy or pyloromyotomy and vagotomy and post Heller myotomy. The post-operative mortality was 2.6% (2 in 77 patients) and morbidity 14.3%. Results after 5 years of follow-up have been classified as good to excellent in 88.3%. Six out of 9 remaining patients needed more than 3 dilatations in the first year after surgery and 3 of these were reoperated. Twenty four patients had a fixed stricture: In 22 of them, the area of esophagogastric stenosis was resected with replacement of the esophagus by colon interposition in 6, jejunum in 14, and a gastric tube with cervical anastomosis in 2. In two patients of advanced age and with respiratory problems a retrosternal by-pass with colon was performed. In this group the post-operative mortality was 12.5% (3 in 24 patients) and the morbidity 25%. The most common problems after one year of surgery were diarrhea (4 patients) and gastric fullness in 2. Eleven patients remained asymptomatic after 5 years (9 with jejunum interposition and 3 with colon) and 3 with jejunum were alive after 10 years.(ABSTRACT TRUNCATED AT 250 WORDS)

[Total gastrectomy with creation of a new stomach using the jejunum. A retrospective study of 120 patients]

Results obtained in 120 patients with gastric carcinoma, and submitted between 1982 and 1989, to a total gastrectomy and a new technique of reconstruction with jejunum, are analyzed retrospectively. This technique associates, a jejunoplication around the terminal esophagus with the purpose to eliminate the entero-esophageal reflux and the risk of dehiscence, and a double jejuno-jejunostomy with the target to delay the emptying of foods and to increase the reservoir function of the neo-stomach. In 63 of these patients a lymphadenectomy type R2-R3 has been held and in the remainder a type R1 lymph node dissection. Pre-operative chemotherapy was done when there was significant weight loss or proved obstruction of the cardia or pylorus by a radioisotopic method. Post-operative chemotherapy was continued immediately after operation in all the patients with pre-operative improvement. Operative mortality until the 60th day of Hospital stay was 5.8% and was mainly related with the advanced age of the patients and the spread and localization of the tumor. Operative morbidity was also more marked in tumors spreading to the cardia. The five years actuarial survival rate was 17.2% to the stage III and IV and 38.8% to the stage I and II. The quality of life of the patients has been favored by the kind of gastric reconstruction that has been used: Jejunoplication reduce the entero-esophageal reflux to nearly 20% and the double enterostomy, specially if the duodenal transit is maintained, induce a more slow post-operative emptying than other kinds of reconstruction. This fact is related with a more physiologic absorption of glucose and to a more favorable nutritional condition.

[Preservation of the liver using a new solution of phosphate-buffered saccharose]

The efficacy of the new phosphate-buffered sucrose solution (PBS), was compared with the conventional Euro-Collins (EC) and the lactated Ringer solution (LR), in its capacity to preserve the canine liver in cold storage. Three groups of 6 canine livers, each group in one of those solutions, were put in cold storage for 24 h at 4 degrees centigrade. At the end of this period the effect of warm hepatic reperfusion was studied in relationship with the following parameters: weight of the liver, bile excretion, hepatic biopsy, Na, K, Ca, P and some tests used to evaluate the hepatic function. The results obtained confirm, that PBS has an important impermeant effect over the hepatocyte, simulating that described recently by Lam et al to the kidney. Contrary to the EC and LR, the PBS inhibits hypothermic cell swelling, is more effective in the preservation of the liver histology, and has an opposed effect to the weight gain tendency induced by cold storage. During the period of warm reperfusion, high volumes of bile excretion and lesser levels of K depletion were observed in the PBS model. PBS is easy to prepare, and it is not expensive. For these reasons PBS could be an advantageous substitute of the EC in liver preservation.