Molecular typing and antifungal susceptibility of clinical and environmental Cryptococcus neoformans species complex isolates in Goiania, Brazil.

A total of 124 Cryptococcus isolates, including 84 clinical strains obtained from cerebrospinal fluid from AIDS patients and 40 environmental isolates from pigeon excreta and from Eucalyptus trees, were studied. The varieties, serotypes, phospholipase activity and molecular profile of these isolates were determined. Cryptococcus neoformans var. grubii serotype A was identified in 120 isolates and Cryptococcus gattii serotype B in four isolates. The clinical isolates showed higher phospholipase activity than environmental isolates. Similar patterns of in vitro susceptibility to amphotericin B, fluconazole, itraconazole and voriconazole and no resistance were found for all isolates. Molecular type VNI (C. neoformans var. grubii) was recovered in 80 clinical and 40 environmental isolates while the type VGIII (C. gattii) was found in four clinical isolates. This study demonstrated for the first time the molecular types of clinical and environmental Cryptococcus isolates in the midwest Brazil region.

Bowel preparation for colonoscopy: comparison of mannitol and sodium phosphate. Results of a prospective randomized study.

METHOD: Eighty patients were prospectively randomized for precolonoscopic cleansing either with 750ml of 10% mannitol (Group M) or 180ml of a sodium phosphate preparation (Group NaP). Laboratory examinations before and after preparation on all patients included hemoglobin, hematocrit, sodium, potassium, phosphorous, calcium and serum osmolarity. A questionnaire was used to assess undesirable side effects and patient tolerance to the solution. The quality of preparation was assessed by the endoscopist who was unaware of the solution employed. RESULTS: Statistically significant changes were verified in serum sodium, phosphorous, potassium and calcium between the two groups, but no clinical symptoms were observed. There were no significant differences in the frequency of side effects studied. Six of the eight patients in Group NaP who had taken mannitol for a previous colonoscopy claimed better acceptance of the sodium phosphate solution. The endoscopic-blinded trial reported excellent or good bowel preparation in 85% prepared with sodium phosphate versus 82.5% for mannitol (p=0.37). CONCLUSIONS: Quality of preparation and frequency of side effects was similar in the two solutions. The smaller volume of sodium phosphate necessary for preparation seems to be related to its favorable acceptance. Nevertheless, the retention of sodium and phosphate ions contraindicates the use of sodium phosphate in patients with renal failure, cirrhosis, ascites, and heart failure.

[Muscle-aponeurotic transposition for treatment of anal incontinence]. / Transposições músculo-aponevróticas utilizadas para o tratamento da incontinência anal grave.

The management of anal incontinence varies. It can be treated either clinically or surgically depending on its etiology and the intensity of the signs and symptoms. The variety of procedures and techniques employed in its treatment is proof of the incomprehension of the pathophysiological mechanisms involved as well as their diversity. Sphincteroplasties are indicated for those patients with well-defined muscle injury, usually resulting from obstetrical trauma, iatrogenic surgery or vehicular accidents. In cases of persistent anal incontinence after previous sphincteroplasty or those in which extensive destruction of the sphincteric musculature is confirmed, muscle-aponeurotic transpositions are an attractive option. A detailed survey of the literature of the chief techniques utilized and their results is presented.

[Colonoscopy as a diagnostic and therapeutic method in large intestine diseases. Results of 1715 exams]. / Emprego da colonoscopia como método diagnóstico e terapêutico das doenças do intestino grosso. Resultados observados em 1.715 exames.

Widespread use of colonoscopy in clinical practice results from the continuous progress of the techniques developed for exam completion and from the therapeutic perspective for several colorectal conditions. This paper analyses in a retrospective basis the results associated to the employment of fibrocolonoscopy between 1984 and 1995 at Discipline of Coloproctology from the University of São Paulo School of Medicine. For this period, 1,715 exams were realized. More than 50% of the patients were between the 50th and 70th decade. Habit change of hemorrhage were indications for the exam in more than 35%. Inflammatory bowel disease and cancer follow-up were indications, respectively, in 18% and 16%. "Express mannitol" bowel prep resulted satisfactory in more than 97% but precluded complete exam for seven (0.4%) patients. In 42.5%, colonoscopic examination was normal. Polyps were found in 248 (14.5%) patients for whom 376 polypectomy procedures were done successfully. Endoscopists could not reach the cecum in 68 (3.9%) patients. Incidence of hemorrhage and perforation was nill for this series. Authors conclude that fibrocolonoscopy remains as a safe and efficient method for the diagnosis and treatment (polypectomy) of common colorectal conditions.

[Stoma therapy: an emerging specialty for Brazilian nursing]. / Estomaterapia: uma especialidade que emerge para a enfermagem brasileira.

The authors relate the experience in the organization and development of the I Enterostomal Therapy Specialization Course, the pioneer in Brazil. They report the concepts and history about enterostomal therapy as a specialty; discuss the objectives, contents, teaching strategies, and evaluation process of the course.

Express mannitol: a safe and fast bowel preparation for colonoscopy used on 3,400 consecutive patients

A colonoscopia desempenha um importante papel na investigacao e tratamento das doencas de intestino grosso e seu potencial e favorecido por uma perfeita limpeza do colon antes da realizacao do exame. O preparo de colon ideal para colonoscopia deve ser confiavel, seguro, confortavel e a custo acessivel. Os metodos orais representaram um grande progresso sobre as formas convencionais de preparo. No entanto, era desejavel que se desenvolvesse um metodo mais rapido e que deixasse menores volumes de liquido no interior do colon. Os autores estudaram a fisiologia do manitol administrado por via oral, concluindo que o preparo para colonoscopia poderia ser melhorado pela ingestao de uma dose fixa de 750ml de manitol a 10 por cento, no menor tempo tolerado pelo paciente...

Alteracoes da absorcao intestinal no segmento excluido por derivacoes jejuno-ileais. Estudo experimental. / Changes in intestinal absorption of the segment excluded by jejuno-ileal derivations.Experimental study

Os autores estudaram l4 coelhos mesticos, distribuidos em dois grupos, com numero igual de animais: no grupo I, os coelhos foram submetidos a exclusao cirurgica da metade distal do intestino delgado, os animais do grupo II serviam de controle. Apos 21 dias de evolucao era injetada no intestino dos animais albumina marcada com cromio radioativo, de sorte a se fornecer sempre uma dose de 15 micro Ci de 51Cr/kg de peso corporeo. O ponto escolhido para a injecao era a porcao inicial da alca excluida nos animais do grupo I e o ponto medio do jejuno-ileo no grupo II. Foi, entao, possivel observar que a alca excluida de jejuno-ileo apresentou perda da impermeabilidade seletiva ao material radioativo empregado.Contudo, a metodologia utilizada nao permitiu esclarecer se ocorreu maior absorcao da molecula intacta de albumina marcada, de parte desta molecula ou do cromio liberado por degradacao da substancia radioativa na luz intestinal

Alteracoes estruturais no tubo digestivo apos derivacoes jejuno-ileais. / Structural changes in digestive tract after jejunoileal bypass

Os autores estudaram 42 coelhos mesticos, distribuidos em dois grupos, cada qual com 21 animais: os coelhos do grupo I foram submetidos a exclusao cirurgica da metade distal do intestino delgado; os animais do grupo II serviam como controle. No vigesimo primeiro dia de evolucao, os animais eram anestesiados realizando-se laparotomia para retirada de segmentos do intestino, em pontos previamente determinados. Tais segmentos foram estudados por meio de exame histologico habitual, ao microscopio ocular e foram avaliados sob o ponto de espessura das diferentes tunicas por meio de tecnica original. Nessas condicoes, foi possivel verificar que os animais do grupo I apresentavam espessamento da submucosa do segmento que permaneceu no transito e atrofia da mucosa de alca excluida. Do ponto de vista microscopico, observaram-se: no segmento que permanece no transito, edema da tunica muscular e infiltrado linfoplasmocitario da mucosa; na alca excluida, edema da submucosa e da muscular e infiltrado linfoplasmocitario da mucosa, com intensidade variavel conforme o nivel da alca examinada