Vegetating lesions that appear in the scar after neoadjuvant therapy for rectal tumors: tumor regrowth or benign neoplasm?

Introduction: After the diagnosis of neoplasm of the middle and distal rectum, patients are often submitted to oncological treatment by neoadjuvant therapy. At the end of this treatment, those patients who show complete clinical response can choose, together with their physician, to adopt the watch-and-wait strategy; although it implies lower morbidity for the patient, this strategy is dependent on strict adherence to treatment follow-up for the early identification of any future local injury. Materials and Methods: Survey of data from medical records and description, and discussion of case reports with a literature review in books and databases. Results: We report the case of a 73-year-old patient diagnosed with moderately differentiated adenocarcinoma of the middle rectum, Stage II (cT3bN0M0), who presented complete clinical response after undergoing treatment with neoadjuvant therapy. Together with the assistant team, the watch-and-wait strategy was chosen. During the follow-up, an endoscopic examination showed a vegetating at the proximal limit of the tumor scar. We chose to perform submucosal endoscopic dissection. The report of the anatomopathological examination evidenced a serrated adenoma with narrow margins free of neoplasia. Conclusion: Patient adherence to cancer treatment using the watch-and-wait strategy is essential for the early identification of new local lesions. After resection of the lesion identified in the tumor scar site as a neoplasm-free lesion, it is consistent to think that this lesion would be the origin of the neoplasm, given the adenomatous origin. (AU)

Hemophilia B acquired after cadaveric liver transplantation: a case report.

Hemophilia B is a recessive hereditary disease, and manifestations result from coagulation factor IX deficiency. Although improbable, as factor IX is produced exclusively in the liver, the possibility of developing the disease after transplantation represents an infrequent but potentially morbid complication. Standard laboratory tests may be insufficient to determine the probability of transmission of this pathology. This report describes the case of a patient who developed hemophilia B after liver transplantation whose donor had no prior knowledge of the disease.

Chemical composition of essential oils from different parts of Protium heptaphyllum (Aubl.) Marchand and their in vitro antibacterial activity.

In Brazilian folk medicine, Protium heptaphyllum is used to treat inflammatory conditions and to hasten wound repair. This paper aims to investigate the chemical composition and the in vitro antibacterial effects of the essential oils (EOs) obtained from P. heptaphyllum leaves and ripe and unripe fruits against a representative panel of oral pathogens. The GC-FID and GC-MS analysis revealed that the major components determined in P. heptaphyllum essential oils were myrcene (59.0%), ß-elemene (17.2%), limonene (12.9%), spathulenol (12.6%), α-cubebene (11.6%), germacrene D (10.6%), trans-nerolidol (9.8%), and α-cadinol (8.8%). The essential oils of the ripe and unripe fruits showed the strongest antibacterial activity against the anaerobic bacteria Prevotella nigrescens (MIC = 50 µg/mL). The leaf essential oil displayed very promising activity against Streptococcus mutans (MIC = 50 µg/mL) and Streptococcus mitis (MIC = 62.5 µg/mL). The antibacterial activity of EOs against oral pathogens is also described for the first time. [Formula: see text].

Targeted Isolation of Indolopyridoquinazoline Alkaloids from Conchocarpus fontanesianus Based on Molecular Networks.

A dichloromethane-soluble fraction of the stem bark of Conchocarpus fontanesianus showed antifungal activity against Candida albicans in a bioautography assay. Off-line high-pressure liquid chromatography activity-based profiling of this extract enabled a precise localization of the compounds responsible for the antifungal activity that were isolated and identified as the known compounds flindersine (17) and 8-methoxyflindersine (18). As well as the identification of the bioactive principles, the ultra-high-pressure liquid chromatography-high-resolution mass spectrometry metabolite profiling of the dichloromethane stem bark fraction allowed the detection of more than 1000 components. Some of these could be assigned putatively to secondary metabolites previously isolated from the family Rutaceae. Generation of a molecular network based on MS(2) spectra indicated the presence of indolopyridoquinazoline alkaloids and related scaffolds. Efficient targeted isolation of these compounds was performed by geometric transfer of the analytical high-pressure liquid chromatography profiling conditions to preparative medium-pressure liquid chromatography. This yielded six new indolopyridoquinazoline alkaloids (5, 16, 19-22) that were assigned structurally. The medium-pressure liquid chromatography separations afforded additionally 16 other compounds. This work has demonstrated the usefulness of molecular networks to target the isolation of new natural products and the value of this approach for dereplication. A detailed analysis of the constituents of the stem bark of C. fontanesianus was conducted.

Chemical Composition and in vitro Biological Activities of Essential Oils from Conchocarpus fontanesianus (A. St.-Hil.) Kallunki & Pirani (Rutaceae).

This study aimed at assessing the chemical composition of the essential oils from leaves and fruits of Conchocarpus fontanesianus, an endemic Brazilian species of Rutaceae. The plant material was harvested from two regions of the Atlantic rainforest in the State of São Paulo. The volatile compounds in the essential oils were extracted by hydrodistillation (HD), and analyzed by GC/FID and GC/MS, allowing the quantification and identification of 54 components in total, which comprise about 97% of the total oil composition. From the leaves collected in Caraguatatuba and Juréia-Itatins, the major volatile compounds identified were as follows: spathulenol (22.32% and 16.67%) and α-cadinol (9.7% and 14.76%). However, ß-myrcene (34.56%), (+)-epi-bicyclosesquiphellandrene (8.71%), and bicyclogermacrene (5.80%) were dominant in the fruits collected only in Juréia-Itatins. The in vitro biological activities were tested to evaluate the cytotoxic, antifungal, and antioxidant potential of essential oils from leaves and fruits.

Biliary atresia: a multidisciplinary approach to diagnosis and management.

CONTEXT: Biliary atresia is an inflammatory cholangiopathy of infancy that results in progressive fibrosis and obliteration of bile ducts and represents the main indication for liver transplant in young children. In spite of extensive investigation, its etiology has remained poorly understood. Timely surgical intervention (Kasai procedure) may result in significant benefit to these patients and represents the final goal of an accurate diagnostic evaluation. OBJECTIVE: To present an overview of biliary atresia, including clinical and surgical approaches to this disease, with emphasis on the histopathologic evaluation. DATA SOURCES: Review of relevant literature indexed in PubMed (US National Library of Medicine). CONCLUSION: A well-coordinated multidisciplinary approach is required in the assessment of suspected cases of biliary atresia. Pathologic examination of biopsy specimens is an integral part of the diagnostic algorithm and, therefore, plays a pivotal role in the diagnostic evaluation of this disease.

Uso da internet pelos pacientes como fonte de informação em saúde e a sua influência na relação médico-paciente / Use of the internet by patients as a source of health information and its influence on the physician-patient relationship

Introdução: O amplo desenvolvimento no campo tecnológico facilitou o acesso à informação principalmente pela internet. O objetivo deste estudo foi avaliar o uso da internet como ferramenta de busca de informações em saúde pelos pacientes, comparando os atendidos na rede pública e privada de saúde, e sua influência na relação médico-paciente. Métodos: Estudo transversal. Participaram do estudo pacientes entre 18-60 anos, em sala de espera para atendimento ambulatorial na clínica Pró-vida e da Secretaria de Saúde no Município de Tubarão, Santa Catarina. Foi utilizado questionário com questões sobre o uso da internet pelos pacientes e a sua influência na relação médico-paciente. Resultados: Dos 216 pacientes participantes, a média de idade foi de 41,2 (DP=12,4) e 67,1% eram mulheres. Maior escolaridade, cor de pele branca, maior renda familiar e uso de convênio médico ou atendimento particular estiveram associados ao grupo atendido na Clínica Pró-vida. Do total, 63,4% acessavam a internet. Houve associação entre uso da internet e atendimento na rede privada (p=0,007). Indivíduos na faixa etária entre 31-45 anos de idade utilizavam mais a internet (42,3%; p<0,001) e as mulheres consultavam mais a internet para informações sobre saúde (p=0,003). Conclusão: Metade dos pacientes utiliza a internet como fonte de informações sobre saúde, 25,5% conversa com o seu médico sobre as informações adquiridas pela internet, sem mudar ou interferir no tratamento médico e, dos pacientes que contam para seus médicos a busca de informações na internet, apenas 16% apresentaram reação negativa por parte do médico, não prejudicando a relação médico-paciente

Introduction: The widespread development in the technological field has facilitated access to information, especially through the internet. The aim of this study was to evaluate the use of the internet by patients as a tool for finding health information, comparing those served by public and private health networks, and its influence on the doctor-patient relationship. Methods: A cross-sectional study including outpatients aged 18-60 years in the waiting rooms of línica Pro-vida and the public Health Department of Tubarão, Santa Catarina. We used a questionnaire with questions about Internet use by patients and its influence on the doctor-patient relationship. Results: Of the 216 participants, the mean age was 41.2 (SD = 12.4) and 67.1% were women. Higher schooling, white skin color, higher family income, and use of private health insurance or care were associated with the group treated at Clínica Pró-vida. Of the total, 63.4% accessed the internet. There was an association of internet use with care in the private network (p = 0.007). Individuals aged between 31-45 years used the internet more (42.3%, p <0.001), and more women searched the internet for health information (p = 0.003). Conclusion: Half the patients use the internet as a source of health information, 25.5% talk with their doctors about internet-acquired information, without changing or interfering with the medical treatment. Of the patients who tell their doctors about their search for information on the internet, only 16% reported a negative reaction by the physician, but without negatively interfering with the doctor-patient relationship

Anticholinesterase activity evaluation of alkaloids and coumarin from stems of Conchocarpus fontanesianus

Conchocarpus fontanesianus (A. St.-Hill.) Kallunki & Pirani, Rutaceae, popularly known as pitaguará, is a native and endemic tree from São Paulo and Rio de Janeiro States, Brazil. Based in the information that anticholinesterasic derivatives could act as new prototypes to treatment of Alzheimer disease, this work describes the fractionation guided by evaluation of the anticholinesterase activity of the ethanolic stems extract from C. fontanesianus. This procedure afforded the alkaloids dictamnine (1), γ-fagarine (2), skimianine (3), and 2-phenyl-1-methyl-4-quinolone (4), as well as the coumarin marmesin (5).

A influência da Internet na relação médico-paciente na percepção do médico / Physicians’ perception of the influence of the Internet on the physician-patient relationship

Introdução: O acesso à informação técnico-científica, principalmente por meio da Internet, aliado ao aumento do nível educacional das populações, tem feito surgir um paciente que busca informações sobre sua doença, sintomas, medicamentos e custos de internação e tratamento. O objetivo deste estudo foi verificar a influência da Internet na relação médico-paciente pela percepção dos médicos. Métodos: Estudo quali-quantitativo. Participaram médicos professores de universidade do Sul do Brasil. Foi utilizado questionário autoaplicável com questões sobre a percepção do médico quanto ao uso da Internet pelos pacientes e se ela interfere na relação médico-paciente. Resultados: Dos 116 médicos, 85,3% achavam que pacientes acessam a Internet e 92% utilizam as informações na consulta seguinte. Quando o paciente busca informações na Internet, o tempo de consulta fica maior segundo 46,6% dos entrevistados e 42,2% afirmaram que pacientes trouxeram informações desconhecidas. Do total, 58,6% consideravam que as informações da Internet são importantes para o paciente conhecer sobre a doença e ter adesão ao tratamento, melhorando a relação médico-paciente. Conclusão: Os médicos acham que a Internet ajuda na relação médico-paciente em 56,9% dos casos, atrapalha em 15,5% e não interfere em 27,6%

Introduction: Access to scientific and technical information, primarily through the Internet, along with the increased educational level of populations, has given rise to patients seeking information about their illness, symptoms, medication, and hospitalization and treatment costs. The aim of this study was to investigate the influence of the Internet on the patient-physician relationship as perceived by physicians. Methods: A qualitative and quantitative study. The participants were medical professors in a south Brazilian university. We used a self-administered questionnaire about physician perception regarding the use of Internet by patients and whether it interferes with the doctor-patient relationship. Results: Of 116 physicians 85.3% thought that patients do access the Internet and 92% use such information in the following visit. When the patient seeks information on the Internet, the medical visit takes longer, according to 46.6% of the respondents, and 42.2% stated that patients brought unknown information. Of the total, 58.6% felt that information from the Internet is important as it increases patients’ knowledge about the disease as well as treatment adherence, thus improving the doctor-patient relationship. Conclusion: Physicians think that the Internet helps the doctor-patient relationship in 56.9% of cases, hamper it in 15.5%, and does not interfere with it in 27.6%

Antígenos bacterianos de uso sublingual versus placebo em pacientes com amigdalites de repetiçäo: estudo duplo-cego / Sublingual bacterial antigens versus placebo for patients with recurrent tonsillitis: double-blind study

Objetivo: Observar se o uso de antígenos sublinguais diminui os sintomas da amigdalite. Método: Estudo controlado, randomizado, duplo-cego com 54 pacientes que apresentavam amigdalites de repetiçäo. Antígenos bacterianos com lisozima na apresentaçäo de comprimidos sublinguais foram utilizados em jejum por três meses por 27 pacientes. O placebo foi utilizado na mesma posologia. Ao final de cada mês e três meses após o final do tratamento os pacientes responderam a um questionário indicando a presença ou ausência dos sintomas e sinais encontrados nos episódios de amigdalites. Resultados: Tanto os pacientes que utilizaram os antígenos como os placebos relataram uma diminuiçäo na freqüência das amigdalites e uma melhora na intensidade dos sintomas, permitindo a realizaçäo de atividades diárias mesmo durante a doença. A freqüência da dor, hipertrofia de tonsilas e halitose foi estatisticamente menor aos 90 dias de uso de antígenos. Nenhum paciente apresentou efeitos colaterais ao uso do placebo ou antígenos. Conclusäo: Para pacientes com contra-indicaçäo cirúrgica ou que recusem o tratamento cirúrgico, o uso deste preparado de antígenos com lisozima pode diminuir o incômodo causado pela dor, hipertrofia ou halitose, sintomas típicos da amigdalite de repetiçäo. O efeito da medicaçäo ocorreu no terceiro mês de uso e näo perdurou depois de três meses após a suspensäo da mesma.

Aspectos epidemiológicos das condiçöes de segurança e acuidade visual em condutores de veículo de Uberaba, Minas Gerais, 1996 / Epidemiological aspects on safety condition and visual acuity among vehicles drivers in Uberaba, Minas Gerais, 1996

A partir de trabalho integrado entre a Policia Rodoviária Federal, o Departamento Nacional de Estradas e Rodagem e a Faculdade de Medicina do Triângulo Mineiro, realizou-se estudo das condiçöes de segurança em veículos e da acuidade visual de motoristas que trafegavam em rodovias próximas ao município de Uberaba, MG. Entre 260 motoristas, observou-se que 27,3 por cento näo usavam cinto de segurança; 19,7 por cento näo apresentavam faroletes, farois e lanternas em condiçöes adequadas; 14,1 näo usavam luz de freio; 9,8 por cento näo tinham, em seus veículos, o funcionamento de setas; 37,7 por cento apresentavam alteraçöes visuais no olho direito e 41,2 por cento no olho esquerdo. Entre os que usavam correçäo visual, 43,9 por cento estavam com correçäo inadequada.