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ABSTRACT Candida spp. is associated with almost 80% of all nosocomial fungal infections and is considered a major cause of blood stream infections. In humans, Cryptococcosis is a disease of the lungs caused by the fungi Cryptococcus gattii and Cryptococcus neoformans. It can be potentially fatal, especially in immune-compromised patients. In a search for antifungal drugs, Deguelia duckeana extracts were assayed against these two fungi and also against Candida albicans, which causes candidiasis. Hexane branches and CH2Cl2 root extracts as well as the substances 4-hydroxylonchocarpine, 3,5,4′-trimethoxy-4-prenylstilbene and 3′,4′-methylenedioxy-7-methoxyflavone were assayed to determine the minimal inhibitory concentration. Phytochemical study of CH2Cl2 root and hexane branch extracts from D. duckeana A.M.G. Azevedo, Fabaceae, resulted in the isolation and characterization of nine phenolic compounds: 4-hydroxyderricine, 4-hydroxylonchocarpine, 3′,4′,7-trimethoxy-flavonol, 5,4′-dihydroxy-isolonchocarpine, 4-hydroxyderricidine, derricidine, 3,5,4′-trimethoxy-stilbene, 3′,4′,7-trimethoxyflavone and yangambin. The only active extract was a CH2Cl2 root showing minimal inhibitory concentration 800 µg/ml against C. gattii, and the investigation of compounds obtained from this extract showed that 4-hydroxylonchocarpine was active against all three fungi (C. neoformans, C. gattii and C. albicans). These results suggest that D. duckeana extracts have potential therapeutic value for the treatment of pathogenic fungi.
ABSTRACT
INTRODUÇÃO: Em 2007 os autores descreveram a primeira hepatectomia direita por videolaparoscopia realizada no Brasil. Hepatectomia direita ampliada, também conhecida como trisegmentectomia direita, é procedimento altamente complexo e implica em grande retirada do volume hepático. Os autores descrevem a primeira trisegmentectomia direita por videolaparoscopia realizada no Brasil. TÉCNICA: O paciente é colocado em posição supina em decúbito lateral esquerdo. O cirurgião se coloca entre as pernas da paciente. Utilizamos cinco trocartes, três de 12 mm e dois de 5 mm. Devido à embolização prévia da veia porta direita, o hilo hepático não é dissecado. O pedículo portal direito é seccionado com grampeador laparoscópico de carga vascular por meio de acesso intra-hepático, segundo técnica previamente descrita pelos autores. A seguir procede-se a mobilização do fígado direito seguido de dissecção da veia cava retro-hepática e secção da veia hepática direita. Estes passos são realizados sem manobra de Pringle. O fígado é seccionado com combinação de bisturi harmônico e grampeador endoscópico. O pedículo do segmento 4 é seccionado dentro do fígado. O espécime é retirado por meio de incisão supra-púbica e a área cruenta é revista para verificar hemostasia. O procedimento é encerrado e dreno de sistema fechado é posicionado junto à área cruenta. CONCLUSÃO: Trisegmentectomia hepática direita por videolaparoscopia é procedimento factível e seguro e deve ser considerado para pacientes selecionados. Este procedimento deve ser realizado em centros especializados e por cirurgiões com experiência tanto em cirurgia hepática como cirurgia laparoscópica avançada.
BACKGROUND: Laparoscopic right liver trisectionectomy is a very complex procedure and, to our knowledge, there is only one technical description so far in the English literature. The authors describe the first totally laparoscopic right trisectionectomy performed in Brazil. METHOD: Patient is placed in left semi-lateral decubitus position with surgeon standing between patients' legs. Five trocars, three 12 mm and two 5mm, were used. Due to previous right portal vein embolization, hepatic pedicle is not dissected. Intrahepatic access to the main right Glissonian pedicle is achieved with two small incisions: on the right portion of caudate lobe and another in front of the hilum. A vascular stapling device is inserted between these incisions and fired. Right liver is then mobilized and inferior vena cava is dissected. Right hepatic vein is divided with vascular endoscopic stapler. Line of liver transection is marked along the liver surface including segment 4. Glissonian pedicle from segment 4 is divided during liver transection. Liver transection is accomplished with harmonic scalpel and endoscopic stapling device as appropriate. Specimen is extracted through a suprapubic incision and pneumoperitoneum is reestablished. Raw surface area is checked for hemostasia and biliary leakage. One round abdominal drain is left in place. Right hepatic trisectionectomy is then completed. Conclusion: Totally laparoscopic right trisectionectomy is safe and feasible in selected patients and should be considered for patients with benign or malignant liver neoplasms. However, this complex procedure should be performed by surgeons who have both experience in advanced laparoscopic procedures and open hepatic surgery.