Assessment of risk factors for surgery treatment of crohn's disease: a hospital cohort / Avaliação dos fatores de risco para tratamento cirúrgico na doença de crohn: uma coorte hospitalar

ABSTRACT BACKGROUND New therapies have revolutionized the treatment of Crohn's disease (CD), but in some countries, the surgery rate has not changed, the frequency of emergency surgery is underestimated, and surgical risk is poorly studied. AIMS: The aim of this study was to identify risk factors and clinical indications for primary surgery in CD patients at the tertiary hospital. METHODS: This was a retrospective cohort of a prospectively collected database of 107 patients with CD from 2015 to 2021. The main outcomes were the incidence of surgery treatment, types of procedures performed, surgical recurrence, surgery free time, and risk factors for surgery. RESULTS: Surgical intervention was performed in 54.2% of the patients, and most of the procedures were emergency surgeries (68.9%). The elective procedures (31.1%) were performed over 11 years after diagnosis. The main indications for surgery were ileal stricture (34.5%) and anorectal fistulas (20.7%). The most frequent procedure was enterectomy (24.1%). Recurrence surgery was most common in emergency procedures (OR 2.1; 95%CI 1.6-6.6). Montreal phenotype L1 stricture behavior (RR 1.3; 95%CI 1.0-1.8, p=0.04) and perianal disease (RR 1.43; 95%CI 1.2-1.7) increased the risk of emergency surgeries. The multiple linear regression showed age at diagnosis as a risk factor for surgery (p=0.004). The study of surgery free time showed no difference in the Kaplan-Meier curve for Montreal classification (p=0.73). CONCLUSIONS: The risk factors for operative intervention were strictures in ileal and jejunal diseases, age at diagnosis, perianal disease, and emergency indications.

RESUMO RACIONAL Novas terapias revolucionaram o tratamento da Doença de Crohn, mas em alguns países a taxa de cirurgias não se modificou, a frequência de cirurgias de emergência é subestimada e o risco cirúrgico é pouco estudado. OBJETIVOS Analisar fatores de risco e as indicações para cirurgia primária em pacientes com doença de Crohn, em Hospital terciário. MÉTODOS: Análise de banco de dados coletado prospectivamente, de 107 pacientes com doença de Crohn de 2015 a 2021. Os principais desfechos foram a incidência de tratamento cirúrgico, tipos de procedimentos realizados, recidiva cirúrgica, tempo livre de cirurgia e fatores de risco. RESULTADOS: A intervenção cirúrgica foi realizada em 54.2% dos pacientes, sendo a maioria dos procedimentos cirúrgicos de urgência (68.9%). Os procedimentos eletivos (31.1%) foram realizados mais de 11 anos após o diagnóstico. As principais indicações cirúrgicas foram estenose ileal (34,5%) e fístula anorretal (20,7%), sendo o procedimento mais frequente a enterectomia (24,1%). As cirurgias para recidiva foram mais comuns em procedimentos de urgência (OR 2,1; IC95% 1,6-6,6). O fenótipo de comportamento estenosante Montreal L1 (RR = 1,3; IC 95%: 1,0-1,8, p=0,04) e a doença perianal (RR 1,43; IC95% 1,2-1,7) aumentaram o risco de cirurgias de emergência. A regressão linear múltipla mostrou a idade ao diagnóstico como fator de risco para cirurgia (p=0,004). O estudo do tempo livre de cirurgia não mostrou diferença na curva de Kaplan Meier para a classificação Montreal (p=0,73). CONCLUSÕES: Os principais fatores de risco para intervenções cirúrgicas foram estenoses em doenças ileais e jejunais, idade ao diagnóstico, doença perianal e indicações de urgência.

Therapeutic Possibilities for Maxillary Lateral Incisor Agenesis: a Literature Review / Possibilidades Terapêuticas para Agenesia de Incisivo Lateral Superior: uma Revisão de Literatura

Tooth agenesis or hypodontia is a developmental anomaly, where there is absence of one or more dental elements. The absence of maxillary lateral incisor can be uni or bilateral, has an incidence of 20% and is more frequent in females. Is directly related to the establishment of malocclusions and aesthetic dissatisfaction, so it is important to evaluate multidisciplinary parameters for a treatment decision. The objective of the present study is to establish, according to the present literature, clinical criteria for the therapeutic approach of opening or closing dental space of the Maxillary Lateral Incisor Agenesis. A systematized literature review was carried out in online databases: PubMed, Embase and Lilacs. Health descriptors and free terms were combined with Boolean operators to search: "Tooth Agenesis" or "Anodontia" and "Lateral Incisors" and "Treatment" and "Opening Space" or "Space Closure". Clinical studies that presented diagnostic criteria and therapeutic possibilities for Maxillary Lateral Incisor Agenesis, in English and without publication time frame, were included. During the clinical examination, skeletal, dental and periodontal parameters must be carefully observed. The intervention will always consist of a multidisciplinary approach, which may involve orthodontics, prosthetics, dentistry, periodontics and implantology for functional and aesthetic rehabilitation. The interceptive approach is based on early diagnosis and maintenance of the dental space, so orthodontic corrective treatment can be minimized later on. Late intervention includes closing the space with the reanatomization of adjacent dental elements or opening the space for implant and prosthesis installation. (AU)

A agenesia dentária ou hipodontia é uma anomalia de desenvolvimento, onde há ausência de um ou mais elementos dentários. A ausência do incisivo lateral superior possui uma incidência de 20%, mais frequente no sexo feminino e pode ser unilateral ou bilateral e estão diretamente relacionadas ao estabelecimento de maloclusões e insatisfação estética, assim, é importante que os profissionais saibam avaliar os parâmetros multidisciplinares para uma tomada de decisão sobre seu tratamento. O objetivo do presente estudo é estabelecer, segundo a literatura presente, os critérios clínicos para a tomada de decisão terapêutica de abertura ou fechamento de espaço para a Agenesia de Incisivo Lateral Superior. Foi realizada uma Revisão Sistematizada da Literatura nas bases de dados online: PubMed, Embase e Lilacs. Foram combinados descritores em saúde e termos livres com operadores boleanos para realizar a pesquisa nas bases de dados: "Tooth Agenesis" or "Anodontia" and "Lateral Incisors" and "Treatment" and "opening space" or "space closure". Foram incluídos estudos clínicos que apresentaram critérios para o diagnóstico e possibilidades terapêuticas para a Agenesia do Incisivo Lateral Superior, na língua inglesa e sem recorte temporal de publicação. Durante o exame clínico devem ser observados minuciosamente os parâmetros esqueléticos, dentários e periodontais. A intervenção sempre consistirá na abordagem multidisciplinar, podendo envolver ortodontia, prótese, dentística, periodontia e implantodontia para a reabilitação funcional e estética. A abordagem interceptativa consiste em diagnosticar precocemente e manter o espaço dentário, para que possa minimizar terapias ortodônticas corretivas de maior magnitude posteriormente. A intevenção tardia engloba o fechamento do espaço com a reanatomização dos elementos dentários adjacentes e abertura do espaço para instalação de implante e prótese. (AU)

Phytochemical composition and biological activities of extracts from ten species of the family Melastomataceae Juss / Composição fitoquímica e atividades biológicas de extratos de dez espécies da família Melastomataceae Juss

Plants possess a renewable source of metabolites with enormous chemical structural diversity, which may have potential therapeutic relevance. Furthermore, this chemical diversity favors the possibility of finding new and different chemical constituents with antimicrobial, antioxidant and anti-tumor activities. This work analyzed preliminary phytochemical profiles and evaluated the antimicrobial, antioxidant and cytotoxic activities of hexane extracts of leaves of ten species of the family Melastomataceae. Phytochemical screening was performed using staining methods while total phenols and flavonoids were quantified by spectrophotometry. Antimicrobial activity was evaluated using the disk diffusion method. Antioxidant activity was determined by the 2,2-diphenyl-1-picrylhydrazil (DPPH) method. Toxicity was recorded using the lethality test with Artemia salina Leach (1819). Cytotoxic activity of the extracts was assessed in vitro with acute monocytic leukemia cells (THP-1). Phytochemical analysis detected the presence of tannins, terpenes, steroids, polyphenols and flavonoids and the absence of alkaloids. Clidemia capitellata (Bonpl.) D. Don had the greatest amount of polyphenols (205.95 mg/g ± 4.14) while Clidemia hirta (L.) D. Don had the highest content of total flavonoids (143.99 mg/g ± 4.18). The hexane extracts did not show antimicrobial activity nor toxicity against Artemia salina. The extract of Tibouchina francavillana Cogn. was the most active in sequestering the DPPH radical. The extracts showed cytotoxicity in THP-1 cells with the appearance of apoptotic bodies and cell death. The extracts of Miconia amoena, Clidemia sericea and Clidemia capitellata are non-toxic against Artemia salina and induce the formation of apoptotic bodies and cell death of the THP-1 lineage.

Os vegetais apresentam uma fonte renovável de metabólitos com enorme diversidade química estrutural, os quais podem apresentar potencial relevante na terapêutica, aumentando as possibilidades de encontrar novos e diferentes constituintes químicos com atividades antimicrobiana, antioxidante e antitumoral. Este trabalho analisou o perfil fitoquímico preliminar e as atividades antimicrobiana, antioxidante, citotóxica dos extratos em hexano das folhas de dez espécies da família Melastomataceae. A triagem fitoquímica foi executada utilizando métodos de coloração e quantificação de fenóis e flavonoides totais por espectrofotometria. A atividade antimicrobiana foi realizada pelo método de difusão em disco. A atividade antioxidante foi determinada pelo método 2,2-difenil1-picrilhidrazila (DPPH). A toxicidade foi registrada utilizando o ensaio de letalidade com Artemia salina Leach (1819). A atividade citotóxica dos extratos foi realizada in vitro com células leucêmicas monocítica aguda (THP-1). A análise fitoquímica detectou a presença de taninos, terpenos, esteroides, polifenóis, flavonoides e ausência de alcaloides. A maior quantificação de polifenóis foi da Clidemia capitellata (Bonpl.) D. Don (205,95 mg/g ± 4,14) e o extrato de Clidemia hirta (L.) D. Don apresentou maior teor de flavonoides totais (143,99 mg/g ± 4,18). Os extratos hexânicos não demostraram atividade antimicrobiana e nem toxicidade frente à Artemia salina. O extrato de Tibouchina francavillana Cogn. foi o mais ativo no sequestro do radical DPPH. Os extratos apresentaram citotoxicidade em células THP-1, com visualização de corpos apoptóticos e morte celular. Os extratos de Miconia amoena, Clidemia sericea e Clidemia capitellata são atóxicos contra Artemia salina e induzem a formação de corpos apoptóticos e morte celular da linhagem THP-1.

Phytochemical composition and biological activities of extracts from ten species of the family Melastomataceae Juss

Abstract Plants possess a renewable source of metabolites with enormous chemical structural diversity, which may have potential therapeutic relevance. Furthermore, this chemical diversity favors the possibility of finding new and different chemical constituents with antimicrobial, antioxidant and anti-tumor activities. This work analyzed preliminary phytochemical profiles and evaluated the antimicrobial, antioxidant and cytotoxic activities of hexane extracts of leaves of ten species of the family Melastomataceae. Phytochemical screening was performed using staining methods while total phenols and flavonoids were quantified by spectrophotometry. Antimicrobial activity was evaluated using the disk diffusion method. Antioxidant activity was determined by the 2,2-diphenyl-1-picrylhydrazil (DPPH) method. Toxicity was recorded using the lethality test with Artemia salina Leach (1819). Cytotoxic activity of the extracts was assessed in vitro with acute monocytic leukemia cells (THP-1). Phytochemical analysis detected the presence of tannins, terpenes, steroids, polyphenols and flavonoids and the absence of alkaloids. Clidemia capitellata (Bonpl.) D. Don had the greatest amount of polyphenols (205.95 mg/g ± 4.14) while Clidemia hirta (L.) D. Don had the highest content of total flavonoids (143.99 mg/g ± 4.18). The hexane extracts did not show antimicrobial activity nor toxicity against Artemia salina. The extract of Tibouchina francavillana Cogn. was the most active in sequestering the DPPH radical. The extracts showed cytotoxicity in THP-1 cells with the appearance of apoptotic bodies and cell death. The extracts of Miconia amoena, Clidemia sericea and Clidemia capitellata are non-toxic against Artemia salina and induce the formation of apoptotic bodies and cell death of the THP-1 lineage.

Resumo Os vegetais apresentam uma fonte renovável de metabólitos com enorme diversidade química estrutural, os quais podem apresentar potencial relevante na terapêutica, aumentando as possibilidades de encontrar novos e diferentes constituintes químicos com atividades antimicrobiana, antioxidante e antitumoral. Este trabalho analisou o perfil fitoquímico preliminar e as atividades antimicrobiana, antioxidante, citotóxica dos extratos em hexano das folhas de dez espécies da família Melastomataceae. A triagem fitoquímica foi executada utilizando métodos de coloração e quantificação de fenóis e flavonoides totais por espectrofotometria. A atividade antimicrobiana foi realizada pelo método de difusão em disco. A atividade antioxidante foi determinada pelo método 2,2-difenil-1-picrilhidrazila (DPPH). A toxicidade foi registrada utilizando o ensaio de letalidade com Artemia salina Leach (1819). A atividade citotóxica dos extratos foi realizada in vitro com células leucêmicas monocítica aguda (THP-1). A análise fitoquímica detectou a presença de taninos, terpenos, esteroides, polifenóis, flavonoides e ausência de alcaloides. A maior quantificação de polifenóis foi da Clidemia capitellata (Bonpl.) D. Don (205,95 mg/g ± 4,14) e o extrato de Clidemia hirta (L.) D. Don apresentou maior teor de flavonoides totais (143,99 mg/g ± 4,18). Os extratos hexânicos não demostraram atividade antimicrobiana e nem toxicidade frente à Artemia salina. O extrato de Tibouchina francavillana Cogn. foi o mais ativo no sequestro do radical DPPH. Os extratos apresentaram citotoxicidade em células THP-1, com visualização de corpos apoptóticos e morte celular. Os extratos de Miconia amoena, Clidemia sericea e Clidemia capitellata são atóxicos contra Artemia salina e induzem a formação de corpos apoptóticos e morte celular da linhagem THP-1.

Phytochemical composition and biological activities of extracts from ten species of the family Melastomataceae Juss / Composição fitoquímica e atividades biológicas de extratos de dez espécies da família Melastomataceae Juss

Plants possess a renewable source of metabolites with enormous chemical structural diversity, which may have potential therapeutic relevance. Furthermore, this chemical diversity favors the possibility of finding new and different chemical constituents with antimicrobial, antioxidant and anti-tumor activities. This work analyzed preliminary phytochemical profiles and evaluated the antimicrobial, antioxidant and cytotoxic activities of hexane extracts of leaves of ten species of the family Melastomataceae. Phytochemical screening was performed using staining methods while total phenols and flavonoids were quantified by spectrophotometry. Antimicrobial activity was evaluated using the disk diffusion method. Antioxidant activity was determined by the 2,2-diphenyl-1-picrylhydrazil (DPPH) method. Toxicity was recorded using the lethality test with Artemia salina Leach (1819). Cytotoxic activity of the extracts was assessed in vitro with acute monocytic leukemia cells (THP-1). Phytochemical analysis detected the presence of tannins, terpenes, steroids, polyphenols and flavonoids and the absence of alkaloids. Clidemia capitellata (Bonpl.) D. Don had the greatest amount of polyphenols (205.95 mg/g ± 4.14) while Clidemia hirta (L.) D. Don had the highest content of total flavonoids (143.99 mg/g ± 4.18). The hexane extracts did not show antimicrobial activity nor toxicity against Artemia salina. The extract of Tibouchina francavillana Cogn. was the most active in sequestering the DPPH radical. The extracts showed cytotoxicity in THP-1 cells with the appearance of apoptotic bodies and cell death. The extracts of Miconia amoena, Clidemia sericea and Clidemia capitellata are non-toxic against Artemia salina and induce the formation of apoptotic bodies and cell death of the THP-1 lineage.

Os vegetais apresentam uma fonte renovável de metabólitos com enorme diversidade química estrutural, os quais podem apresentar potencial relevante na terapêutica, aumentando as possibilidades de encontrar novos e diferentes constituintes químicos com atividades antimicrobiana, antioxidante e antitumoral. Este trabalho analisou o perfil fitoquímico preliminar e as atividades antimicrobiana, antioxidante, citotóxica dos extratos em hexano das folhas de dez espécies da família Melastomataceae. A triagem fitoquímica foi executada utilizando métodos de coloração e quantificação de fenóis e flavonoides totais por espectrofotometria. A atividade antimicrobiana foi realizada pelo método de difusão em disco. A atividade antioxidante foi determinada pelo método 2,2-difenil1-picrilhidrazila (DPPH). A toxicidade foi registrada utilizando o ensaio de letalidade com Artemia salina Leach (1819). A atividade citotóxica dos extratos foi realizada in vitro com células leucêmicas monocítica aguda (THP-1). A análise fitoquímica detectou a presença de taninos, terpenos, esteroides, polifenóis, flavonoides e ausência de alcaloides. A maior quantificação de polifenóis foi da Clidemia capitellata (Bonpl.) D. Don (205,95 mg/g ± 4,14) e o extrato de Clidemia hirta (L.) D. Don apresentou maior teor de flavonoides totais (143,99 mg/g ± 4,18). Os extratos hexânicos não demostraram atividade antimicrobiana e nem toxicidade frente à Artemia salina. O extrato de Tibouchina francavillana Cogn. foi o mais ativo no sequestro do radical DPPH. Os extratos apresentaram citotoxicidade em células THP-1, com visualização de corpos apoptóticos e morte celular. Os extratos de Miconia amoena, Clidemia sericea e Clidemia capitellata são atóxicos contra Artemia salina e induzem a formação de corpos apoptóticos e morte celular da linhagem THP-1.

Tumor Fibro-histiocítico Plexiforme de Vulva: Relato de Caso / Vulva Plexiform Fibrohistiocytic Tumor: Case Report / Tumor Fibrohistiocítico Plexiforme de la Vulva: Reporte de Caso

Introdução: O tumor fibro-histiocítico plexiforme é uma condição clínica rara, com cerca de 150 casos descritos na literatura. Relato do caso: Paciente, 23 anos, sexo feminino, portadora de lesão nodular em região vulvar sem características de malignidade em exames de ultrassonografia. Realizou acompanhamento clínico, tendo apresentado aumento do tamanho da lesão inicial, sendo optado então por realização de ressecção cirúrgica da lesão. Em estudo histopatológico, evidenciou-se lesão compatível com tumor fibro-histiocítico plexiforme, com margens cirúrgicas livres. No seguimento, a paciente foi encaminhada para avaliação oncológica com a intenção de realizar exames complementares de rastreio e descartar diagnósticos morfologicamente semelhantes. Diante dos exames complementares confirmando o diagnóstico inicial e sem evidência de doença metastática após excisão cirúrgica completa com margens livres, foi iniciado seguimento clínico. Conclusão: Relatar o caso é de extrema importância para divulgar a apresentação clínica, etapas diagnósticas, tratamento proposto e compartilhar informações acerca de evolução clínica apresentada.

Introduction: Plexiform fibrohistiocytic tumor is a rare clinical condition, with about 150 cases described in the literature. Case report: 23-years-old, female patient with nodular lesion in vulva without malignancy characteristics on ultrasound image. She underwent clinical follow-up and after an increase in the size of the lesion, surgical resection was opted. Histopathological findings suggested plexiform fibrohistiocytic tumor, with free surgical margins. In follow up, she was referred to oncological evaluation for screening complementary exams and rule out morphologically similar diagnoses. After the complementary exams confirming the initial diagnosis of plexiform fibrohistiocytic tumor and without evidence of metastatic disease after complete surgical excision with free margins, the patient is in clinical follow-up. Conclusion: Reporting the case is extremely important to disseminate the clinical presentation, diagnostic steps, proposed treatment and share information about the clinical evolution presented.

Introducción: El tumor fibrohistiocítico plexiforme es una condición clínica poco frecuente, con unos 150 casos descritos en la literatura. Reporte del caso: Paciente de 23, sexo feminino, años con lesión nodular en una región vulvar sin características malignas en los exámenes de ultrasonido. Se sometió a un seguimiento clínico, habiendo presentado un aumento en el tamaño de la lesión inicial, y se decidió realizar la resección quirúrgica de la lesión. En un estudio histopatológico, se evidenció una lesión compatible con tumor fibrohistiocítico plexiforme con márgenes quirúrgicos libres. Fue referida para la evaluación oncológica, realizó pruebas complementarias para el cribado y para descartar diagnósticos morfológicamente similares. En vista de las pruebas complementarias que confirman el diagnóstico inicial y sin evidencia de enfermedad metastásica después de una escisión quirúrgica completa con márgenes libres, se inició el seguimiento clínico. Conclusión: Informar del caso es extremadamente importante para difundir la presentación clínica, etapas diagnósticas, tratamiento propuesto y compartir información sobre la evolución clínica presentada.

Análise de erros radiográficos em clínica de odontopediatria de uma instituição de ensino superior de Teresina - Piauí / Analysis of radiographic errors in the pediatric dentistry clinic of a higher education institution in Teresina, Piauí, Brazil

Objetivo: Avaliar a prevalência de erros radiográficos em radiografias periapicais de uma clínica de Odontopediatria em uma instituição de ensino superior de Teresina-Piauí. Métodos: Tratou-se de estudo transversal retrospectivo. Foram coletados dados sociodemográficos e radiográficos (localização e presença de erros de técnica radiográfica, processamento e armazenamento). As radiografias foram analisadas por um único examinador calibrado (kappa > 0,80). Foi realizada análise descritiva dos dados, teste Qui-Quadrado, razão de prevalência não-ajustadas (RPnãoajust) e intervalos de confiança (IC 95%). Considerou-se significativo valor de p < 0,05. Resultados: Das 208 radiografias analisadas, 187 (89,9%) possuíam algum tipo de erro. O erro mais prevalente foi de técnica radiográfica (n = 115; 55,3%). Entre esses, a radiografia tremida foi o mais frequente (n = 57; 28,4%). O erro de processamento mais frequente foi presença de digitais (n = 37; 17,8%). Todos os erros de armazenamento (n = 89; 100%) estavam relacionados a não identificação do paciente. O erro de técnica esteve associado com os pacientes de idade menor que 5 anos (RPnãoajus = 1,2 IC95% 1,1-1,3) comparando com idade entre 6 e 10 anos. Não houve associação entre tipo de erro radiográfico e a dentição avaliada nas radiografias (p > 0,05). Conclusão: A quantidade de erros detectados neste estudo foi alta e o mais frequente foi quanto à técnica radiográfica mal executada. Todos os erros de armazenamento observados foram devido a não identificação do paciente. Há uma maior frequência de erros de técnica radiográfica em pacientes com menos de 5 anos se comparados aos de 6 a 10 anos.

Aim: To evaluate the prevalence of radiographic errors in periapical radiographs of a pediatric dentistry clinic in a higher education institution in Teresina, Piauí, Brazil. Methods: This work is a retrospective cross-sectional study. Sociodemographic and radiographic data (location and presence of radiographic technique errors, processing, and storage) were collected. The radiographs were analyzed by a single calibrated examiner (kappa > 0.80). Descriptive analysis of the data, chi-square test, unadjusted prevalence ratio (PRnon-adjusted), and confidence intervals (95% CI) were performed. A p-value < 0.05 was considered significant. Results: Of the 208 radiographs analyzed in this study, 187 (89.9%) presented some type of error. The most prevalent error was the radiographic technique (n = 115; 55.3%). Among these, shaky radiography was the most frequent (n = 57; 28.4%). The most frequent processing error was the presence of fingerprints (n = 37; 17.8%). All storage errors (n = 89; 100%) were related to failure to identify the patient. The technical error was associated with patients younger than 5 years of age (PRnon-adjusted = 1.2; 95% CI 1.1-1.3) compared with 6 to 10 years of age. No association was observed between the type of radiographic error and the dentition assessed on the radiographs (p > 0.05). Conclusion: The number of errors detected in this study was high and the most frequent concerned the poorly performed radiographic technique. All storage errors observed in this study were due to the failure to identify the patients. Children under 5 years of age proved to be more prone to technical radiographic errors than those of 6 to 10 years of age.

Tansanal total mesorectal excision (TaTME): systematization and mediated results in 10 patients / Excisão total do mesorreto por via transanal (TaTME): sistematização e resultados mediatos em dez pacientes

Abstract Background: Transanal total mesorectal excision is a surgical technique for minimally invasive resection of the rectum and perirectal tissues. It is indicated for patients with medial and distal rectum cancer confined to the mesorectal envelope. This study describes a series of patients undergoing transanal total mesorectal excision. Methods: Ten patients were selected to undergo transanal total mesorectal excision using the SILS-Port® platform. All patients included here had middle or low rectal cancer. Abdominal access for proximal colon mobilization was performed by laparoscopy in all cases. As a rule, in 9 of the 10 cases, the surgical specimen was removed transanally. Result:s During a 41-month period, 10 patients underwent transanal total mesorectal excision based on curative intent. The first indication for transanal total mesorectum excision was medial and distal rectal cancer, locally invasive and confined to the mesortal envelope. The median age of patients with rectal cancer at the time of surgery was 61 years (mean 59.4 years, range 22-78 years), with 80% (8) female and 20% (2) male. The median surgical time was 305' (mean 314', range 260-420'). The median postoperative length of stay was five days (average of 7.3 days, interval of 3-23 days). There was no postoperative mortality. Surgical complications included postoperative ileus (n = 1), bladder paresis (n = 1), and ileostomy stenosis (n = 1). All patients had negative surgical margins for neoplasia and more than 12 resected lymph nodes. The tumors were between 1 and 9 cm from the anal margin. Conclusion: Total transanal mesorectal excision has been shown to be a viable method for oncologic resection of locally advanced rectal cancer with curative intent.

Resumo Contexto: A excisão total do mesorreto por via transanal é uma aborgadem crânio-caudal para a realização de ressecção minimamente invasiva do reto e tecidos perirretais em monobloco. É adequada para pacientes com câncer de reto médio e distal confinados ao envelope mesorretal. Aqui relatamos uma série de pacientes submetidos à excisão total do mesorreto por via transanal. Métodos: Dez pacientes foram selecionados para serem submetidos à excisão total do mesorreto por via transanal utilizando a plataforma SILS-Port®. Todos os pacientes eram portadores de câncer retal de localização extraperitoneal. O acesso abdominal para mobilização do cólon proximal, em todos os casos, foi realizado por laparoscopia. Como regra, a retirada do espécime cirúrgico, em nove casos, ocorreu por via transanal. Resultados: Durante um período de 41 meses, 10 pacientes foram submetidos à excisão total do mesorreto por via transanal com intenção curativa. A indicação primária para excisão total do mesorreto transanal foi o câncer de reto médio e distal, localmente invasor, mas confinado ao envelope mesorretal. A mediana de idade dos pacientes com câncer de reto no momento da cirurgia foi de 61 anos (média de 59,4 anos, faixa de 22-78 anos), sendo 80% (8) do sexo feminino e 20% (2) do sexo masculino. A mediana do tempo cirúrgico foi de 305' (média de 314', intervalo de 260-420'). A mediana do tempo de permanência pós-operatória foi de cinco dias (média de 7,3 dias, intervalo de 3-23 dias). Não houve mortalidade pós-operatória. As complicações cirúrgicas incluíram íleo paralítico (n = 1), paresia vesical (n = 1) e estenose de ileostomia (n = 1). Todos os pacientes tiveram margens cirúrgicas negativas para neoplasia e mais de 12 linfonodos ressecados. Os tumores distavam de 1 a 9 cm da margem anal. Conclusão: A excisão total do mesorreto transanal demonstrou-se um método viável para a ressecção oncológica de câncer de reto localmente avançado com intenção curativa.

A new defecographic parameter for assessing rectal emptying / Um novo parâmetro defecográfico para avaliar o esvaziamento retal

ABSTRACT Purpose: To validate a new defecographic parameter to assess rectal empyting correlating the percentage of weight reduction of barium paste and the variation in the percentage of area reduction of rectum compared before and after defecation during cinedefecography. Method: Thirty-two consecutive female patients with dyschezia who had clinical indication for cinedefecography were selected. Their median age was 58 years old (18-78 years, mean = 55 years). During cinedefecography, we calculated the cross-sectional sagittal area of the rectum before and after defecation and, thus, the percentage of area reduction of the rectum. The percentage of weight reduction of barium paste was calculated after weighing the contrast injected into the rectum and the amount of contrast evacuated, in grams, using a scale. Finally, both percentages were compared and checked for a correlation between them. Pearson's correlation (r) and Student's t test were used for statistical analysis. Results: A correlation between evacuated barium paste and cross-sectional sagittal area of the rectum at the end of defecation was demonstrated (r = 0.668 and p < 0.0001). Conclusion: It is possible to estimate how much barium paste is evacuated based on the variations in cross-sectional sagittal area of the rectum before and after defecation, in cinedefecography.

RESUMO Objetivo: Validar um novo parâmetro defecográfico para avaliar o esvaziamento retal correlacionando o percentual de redução de peso da pasta baritada e a variação da porcentagem da redução da área do reto antes e depois da evacuação durante o exame de cinedefecografia. Métodos: Foram selecionadas 32 pacientes consecutivas do sexo feminino, portadoras de disquezia, com indicação clínica de investigação por cinedefecografia. A mediana de idade da amostra foi 58 anos (18-78 anos, média de 55 anos). Durante o exame de cinedefecografia, calcularam-se as áreas retais pela secção sagital antes e após a defecação e, assim, o percentual de redução da área retal. O percentual de redução do peso do contraste baritado foi calculado após medidas de peso do contraste injetado no reto e da quantidade de contraste evacuado, em gramas, utilizando uma balança. Por fim, os percentuais foram comparados e verificou-se se havia correlação entre eles. Para análise estatística, foram utilizados correlação de Pearson (r)eT este t de Student. Resultados: Foi observada correlação entre o contraste baritado evacuado e a área retal pela secção sagital ao final da evacuação (r = 0.668; p < 0.0001). Conclusões: É possível estimar o percentual de contraste baritado evacuado através da análise da variação da área retal pela secção sagital antes e após a evacuação, utilizando a cinedefecografia.

A case of sporotrichosis caused by different Sporothrix brasiliensis strains: mycological, molecular, and virulence analyses

BACKGROUND Sporotrichosis is a subcutaneous mycosis caused by dimorphic pathogenic fungi belonging to the Sporothrix genus. Pathogenic Sporothrix species typically produce melanin, which is known to be a virulence factor. OBJECTIVES The aim of this study was to perform phenotypic, genotypic, and virulence analyses of two distinct Sporothrix brasiliensis strains isolated from the same lesion on a patient from Rio de Janeiro. METHODS AND FINDINGS Genotypic analyses by partial sequencing of the calmodulin, β-tubulin, and chitin synthase genes, as well as polymerase chain reaction (PCR)-fingerprinting by T3B, M13, and GACA, showed that the isolates were very similar but not identical. Both isolates had similar phenotypic characteristics and effectively produced melanin in their yeast forms, accounting for their ability of causing disease in a murine sporotrichosis model. Remarkably, isolate B was albino in its environmental form but caused more severe disease than the pigmented A isolate. CONCLUSIONS These findings indicate that the patient was infected by two genetically and biologically distinct S. brasiliensis that vary in their production of melanin in their environmental forms. The results underscore the importance of characterizing phenotypically different isolates found in the same clinical specimen or patient.

Pili canaliculi as manifestation of giant axonal neuropathy

Abstract Giant axonal neuropathy is a rare autosomal recessive neurodegenerative disease. The condition is characterized by neurons with abnormally large axons due to intracellular filament accumulation. The swollen axons affect both the peripheral and central nervous system. A 6-year old female patient had been referred to a geneticist reporting problems with walking and hypotonia. At the age of 10, she became wheelchair dependent. Scanning electron microscopy of a curly hair classified it as pili canaliculi. GAN gene sequencing demonstrated mutation c.1456G>A (p.GLU486LYS). At the age of 12, the patient died due to respiratory complications. Dermatologists should be aware of this entity since hair changes are considered suggestive of GAN.

Pitted keratolysis

Abstract Pitted keratolysis is a skin disorder that affects the stratum corneum of the plantar surface and is caused by Gram-positive bacteria. A 30-year-old male presented with small punched-out lesions on the plantar surface. A superficial shaving was carried out for scanning electron microscopy. Hypokeratosis was noted on the plantar skin and in the acrosyringium, where the normal elimination of corneocytes was not seen. At higher magnification (x 3,500) bacteria were easily found on the surface and the described transversal bacterial septation was observed.

Clinical impact of Achromobacter xylosoxidans colonization/infection in patients with cystic fibrosis

The rate of diagnosis of colonization/infection of the airways with Achromobacter xylosoxidans has increased in cystic fibrosis patients, but its clinical significance is still controversial. This retrospective, case-control study aimed to evaluate the clinical impact of A. xylosoxidans colonization/infection in cystic fibrosis patients. Individuals who were chronically colonized/infected (n=10), intermittently colonized/infected (n=15), and never colonized/infected with A. xylosoxidans (n=18) were retrospectively evaluated during two periods that were 2 years apart. Demographic characteristics, clinical data, lung function, and chronic bacterial co-colonization data were evaluated. Of the total study population, 87% were pediatric patients and 65.1% were female. Individuals chronically colonized/infected with A. xylosoxidans had decreased forced expiratory volume in 1 s (51.7% in the chronic colonization/infection group vs 82.7% in the intermittent colonization/infection group vs 76% in the never colonized/infected group). Compared with the other two groups, the rate of co-colonization with methicillin-resistant Staphylococcus aureus was higher in individuals chronically colonized/infected with A. xylosoxidans (P=0.002). Changes in lung function over 2 years in the three groups were not significant, although a trend toward a greater decrease in lung function was observed in the chronically colonized/infected group. Compared with the other two groups, there was a greater number of annual hospitalizations in patients chronically colonized/infected with A. xylosoxidans (P=0.033). In cystic fibrosis patients, there was an increased frequency of A. xylosoxidans colonization/infection in children, and lung function was reduced in patients who were chronically colonized/infected with A. xylosoxidans. Additionally, there were no differences in clinical outcomes during the 2-year period, except for an increased number of hospitalizations in patients with A. xylosoxidans.

Effects of metoclopramide on the expression of metalloproteinases and interleukins in left colonic anastomoses. An experimental study

PURPOSE : To evaluate the effects of metoclopramide on metalloproteinases (MMP) and interleukins (IL) gene expression in colonic anastomoses in rats. METHODS : Eighty rats were divided into two groups for euthanasia on the 3rd or 7th postoperative day (POD), then into two subgroups for sepsis induction or not, and then into subgroups to receive either metoclopramide or saline solution. Left colonic anastomosis were performed and then analyzed. RESULTS : On the 3rd POD, metoclopramide was associated with increased expression of MMP-1a, MMP-13, and TNF-α. On the 7th POD, the transcripts of all MMPs, TNF-α, IL-1β, IFN-γ, and IL-10 of the treated animals became negatively modulated. In the presence of sepsis, metoclopramide did not change MMPs and decreased IL-6, IL-1β, IFN-γ and IL-10 gene expression on the 3rd POD. On the 7th POD, increased expression of all MMPs, IFN-γ and IL-10 and negative modulated TNF-α and IL-6 gene expression. CONCLUSION : Administration of metoclopramide increased metalloproteinases and interleukins gene expression on the 3rd postoperative day and negatively modulated them on the 7th POD. In the presence of abdominal sepsis, metoclopramide did not change MMPs and decreased ILs gene expression on the 3rd POD. On the 7th POD, the drug increased expression of all MMPs.

Scanning electron microscopy of superficial white onychomycosis

AbstractSuperficial white onychomycosis is characterized by opaque, friable, whitish superficial spots on the nail plate. We examined an affected halux nail of a 20-year-old male patient with scanning electron microscopy. The mycological examination isolated Trichophyton mentagrophytes. Abundant hyphae with the formation of arthrospores were found on the nail's surface, forming small fungal colonies. These findings showed the great capacity for dissemination of this form of onychomycosis.

Scanning electron microscopy of the collodion membrane from a self-healing collodion baby

AbstractSelf-healing collodion baby is a well-established subtype of this condition. We examined a male newborn, who was covered by a collodion membrane. The shed membrane was examined with scanning electron microscopy. The outer surface showed a very compact keratin without the normal elimination of corneocytes. The lateral view of the specimen revealed a very thick, horny layer. The inner surface showed the structure of lower corneocytes with polygonal contour. With higher magnifications villous projections were seen in the cell membrane.