Efeito do BAP no cultivo in vitro de Ocimum selloi Benth / Effect of BAP on in vitro culture of Ocimum selloi Benth

Visando promover a proliferação de brotações em segmentos apicais e nodais de Ocimum selloi em diferentes concentrações de BAP, plantas jovens de 60 dias serviram de doadoras de segmentos apicais e nodais. Os segmentos foram inoculados em meio MS preparado com a metade da concentração dos sais, e acrescido de 1,5% de sacarose e diferentes concentrações de BAP. O experimento foi conduzido no delineamento fatorial, 3 x 4, sendo 3 as posições dos segmentos de O. selloi (segmento apical, primeiro e segundo segmentos nodais) e 4 concentrações de BAP (0 - controle; 2; 4 e 6 mg L-1). Aos 30 dias, foram avaliados o número, comprimento e biomassa fresca e seca de brotos e raízes. Os primeiros e segundos segmentos apresentaram melhores resultados na indução de brotos de O. selloi, 7 e 8 brotos/explante, nas diferentes concentrações de BAP; porém, não houve formação de raízes na presença da citocinina. Nas condições testadas, recomenda-se o uso do primeiro e segundo segmento nodal suplementando o meio de cultivo com BAP para a proliferação in vitro de brotações de O. selloi.

The present study was undertaken to develop the proliferation of sprouts in apical and nodal segments of Ocimum selloi with different BAP levels. Young plants aged 60 days were used as donors of nodal and apical segments. The segments were inoculated in MS medium at half the concentration of salts supplemented with 1.5% of sucrose and different BAP levels. The experiment was in 3 x 4 factorial arrangement, 3 positions of O. selloi segments (apical segment; first and second nodal segment) and 3 BAP levels (0 - control; 2; 4 and 6 mg L-1). After 30 days, the number, the length, and the fresh and dry biomass of sprouts and roots were evaluated. The first and the second segments showed better results in inducing O. selloi sprouts, 7 and 8 sprouts/explant, at the different BAP levels, but there was not root formation in the presence of the cytokinin. Under the tested conditions, use of the first and the second nodal segments is recommended in addition to supplementing the culture medium with BAP for in vitro proliferation of O. selloi sprouts.

Electrogastrography.

Electrogastrography (EGG) is the recording and the interpretation of gastric electrical activity. Recordings can be made from the gastrointestinal mucosa, serosa, or skin surface. Because of its ease of use, cutaneous EGG has gained wide acceptance. Many technical problems have been solved to obtain a good graph. The EGG is usually evaluated in terms of changes in the EGG waves amplitude and frequency. Deviations from the normal frequency of 3 cycles per minute may be referred to as brachy- or tachyarrhythmia. The clinical use of EGG has been most widely evaluated in patients with gastroparesis and functional dyspepsia. Scintigraphic gastric emptying is considered the gold standard test for evaluating gastroparesis and 13C-octanoate breath test an ideal alternative because does not use ionizing radiation. While gastric emptying evaluates the efficiency of gastric emptying, EGG focuses on the underlying myoelectrical activity. Using both EGG and 13C-octanoate breath test will be possible to detect many subset of dyspeptic patients and to understand the underlying problem.

Campylobacter jejuni enterocolitis presenting as inflammatory bowel disease.

We report a case of Campylobacter jejuni enterocolitis presenting as inflammatory bowel disease in a 19-year old woman. After a useless course of corticosteroids, ceftazidime and metronidazole, she was successfully treated with erythromicin. Campylobacter species represent an important cause of gastroenteritis in children and adults. The rate of Campylobacter isolation is 5-6 per 100,000 persons. This rate, however, grossly understimates the actual number of Campylobacter infections. In most cases, Campylobacter enteritis is a self-limiting disease, rarely associated with severe complications. Our case demonstrates the difficulty in distinguishing inflammatory bowel disease (Crohn's disease or ulcerative colitis) at onset from atypical infectious colitis. Unfortunately, corticosteroids (necessary for the treatment of inflammatory bowel disease) may exacerbate infectious etiologies. Campylobacter jejuni should be ruled out when assessing inflammatory bowel diseases at onset (as during flare-ups), especially if corticosteroids or immunosuppressive therapies are required.

Hepatopulmonary syndrome. A review of the literature.

The majority of cirrhotic patients present dyspnea, but most of the time this is a consequence of ascites, hepatic hydrothorax or cardiopulmonary disease. Very few of these patients undergo the hepatopulmonary syndrome, an infrequent complication of chronic liver disease, especially when associated with portal hypertension and cirrhosis. Hepatopulmonary syndrome is characterised by dyspnea and, consequently, arterial hypoxemia, due to intrapulmonary vasodilation and shunting. The real pathogenesis of this vasodilation is still unknown, although many hypotheses have been suggested. Furthermore, no medical therapy appears to be really useful in the treatment of hepatopulmonary syndrome. At the present time, the only treatment that is efficacious for the resolution, or for the improvement of blood gas oxygenation abnormalities, is orthotopic liver transplantation.

[Physiopathologic approach in esophageal motor disorders: from the diagnosis to therapeutic implications]. / L'approccio fisiopatologico nei disordini motori dell'esofago. Dalla diagnosi alle implicazioni terapeutiche.

Motor disorders are an important chapter in esophageal pathology; from a clinical point of view, these disorders are characterised by dysphagia, non-cardiac chest pain, pyrosis and regurgitation. It is important to underline that chest pain and dysphagia are not specific to motility disorders; in fact, they are also present in other pathologies like peptic or infective esophagitis. In order to attribute these symptoms to a functional cause, it is first of all is necessary to exclude an organic pathology; this can be done with the help of radiological and endoscopical examination when the symptoms are dysphagia, pyrosis and regurgitation, or with electrocardiography or angiography, when the symptom is chest pain. The functional pathology is marines studied by manometric and pH-metric techniques. The manometric technique represents an important instrument for diagnosing esophageal motor disease. The aim of this study, after a review of the literature, is to describe the principal esophageal motor disorders and the physiopathological approach, that have important implications in diagnosis and therapy.

[Whipple's disease: progress in the diagnosis and review of the literature]. / Morbo di Whipple: attualità diagnostiche e revisione della letteratura.

Whipple's disease is a rare, chronic, multisystemic disease characterized by the presence of fever, diarrhea, weight loss and malabsorption, preceded by arthritis. Although Whipple's disease almost always includes involvement of the small intestine and the presence of malabsorption, it commonly affects other organs, especially the heart, brain, eyes and joints. Whipple's disease greately mimics other diseases and is caused by a cultivation-resistant bacterium. The disease is fatal unless patients are treated with antibiotics. The diagnosis of Whipple's disease can be made by histologic analysis of small-intestinal biopsy specimens. Identification of Whipple bacterium, Tropheryma whippelii, has led to the development of the polymerase chain reaction This technique can be used to detect the bacterium in many organs and fluids, including synovial tissue and fluid. Affected patients tend to have dilated intestinal villi that are infiltrated with foamy macrophages.

Laser thermal ablation in the treatment of small hepatocellular carcinoma: results in 74 patients.

PURPOSE: To evaluate the safety, local effectiveness, and long-term results of laser thermal ablation (LTA) in the treatment of small hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Ninety-two biopsies proved small HCCs (range, 0.8-4.0 cm) in 74 patients who were treated percutaneously with LTA in an outpatient clinic. A laser at a power of 5.0 W was coupled with one to four fibers that were advanced through 21-gauge needle(s) for 6-12 minutes. All lesions were evaluated with computed tomography (CT) for changes in size and vascular pattern, recurrence rates, and cumulative survival rates. Patients were examined for complications. RESULTS: No major complications occurred in 117 LTA sessions, with an average of 1.3 sessions per tumor. At 3 months, CT scans showed a nonenhancing area (complete necrosis) in 89 (97%) of 92 lesions. During follow-up (range, 6-66 months; mean, 25.3 months), 84 tumors (91%) decreased in size. The local recurrence rates (range, 1-5 years) ranged from 1.6% to 6.0%. Recurrence rates (range, 12-60 months) in other liver segments ranged from 24% to 73%. Cancer-free survival rates (range, 1-4 years) ranged from 73% to 24%. Overall survival rates were 99%, 68%, and 15% at 1, 3, and 5 years, respectively. Twenty-one patients (28%) died. CONCLUSION: LTA is a safe and effective treatment for small HCC.

Hepatocellular carcinoma: long-term results of combined treatment with laser thermal ablation and transcatheter arterial chemoembolization.

PURPOSE: To determine the potential long-term effectiveness of laser thermal ablation (LTA) followed by transcatheter arterial chemoembolization (TACE) in the percutaneous ablation of large hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Thirty large HCCs 3.5-9.6 cm in diameter (mean diameter, 5.2 cm) and 15 small HCCs 0.8-3.0 cm (mean diameter, 1.9 cm) were treated with ultrasonographically guided LTA with TACE and with LTA alone, respectively, in 30 patients: 19 with a solitary large HCC, and 11 with one to three additional synchronous small HCCS: A 1.064-microm neodymium yttrium-aluminium-garnet (Nd-YAG) laser at a power of 5.0 W was coupled with one to four quartz optic fibers that were advanced through 21-gauge needles. Segmental TACE was performed 30-90 days after LTA. All lesions were evaluated for change in size at computed tomography (CT), alpha-fetoprotein (AFP) levels, recurrence rates, and cumulative survival rates. RESULTS: No major complications occurred in 127 LTA sessions. CT showed complete tumor necrosis in 27 (90%) of 30 large HCCS: Twenty-eight patients were followed up for 6-41 months (mean, 17.1 months). In 25 patients, all lesions appeared stable or smaller at CT. AFP levels decreased to the normal range in all patients with high pretreatment values. The 1-, 2-, and 3-year local recurrence rate was 7% in large HCCS: Complete tumor necrosis was achieved in all 15 (100%) small HCCs; none of them recurred locally. The 1-, 2-, and 3-year cumulative survival rates were 92%, 68%, and 40%, respectively. CONCLUSION: LTA followed by TACE is an effective palliative therapy in treating large HCCS:

Severe thyrotoxicosis due to hyperfunctioning liver metastasis from follicular carcinoma: treatment with (131)I and interstitial laser ablation.

Liver metastases from differentiated thyroid tumors are unusual clinical findings, and are only rarely hyperfunctioning. We report a case of thyrotoxicosis caused by a huge and surgically unresectable liver metastasis from follicular thyroid cancer, unresponsive to treatment with large doses of thionamides. To avoid the hazardous side effects of (131)I treatment in a severely thyrotoxic patient, a preliminary debulking of the liver mass was performed by means of percutaneous interstitial laser photocoagulation. Three treatments (total energy delivery: 7200 J) were performed under ultrasound guidance, with no serious complications, during a 2-week period. One month later, serum thyroid hormones had decreased, general condition was improved, and magnetic resonance evaluation revealed large and well-defined areas of necrosis of metastatic tissue. During the following 10 months, the patient underwent 3 radioiodine treatments. Eighteen months after diagnosis, thyroid hormones were within normal levels, liver mass decreased, and the clinical condition markedly improved. The combination of percutaneous interstitial laser photocoagulation treatment and radioiodine therapy made possible the effective management of a hyperfunctioning and surgically untreatable liver metastasis from thyroid follicular carcinoma, avoiding the side effects of (131)I therapy in a thyrotoxic patient and increasing the effectiveness of radioiodine-induced neoplastic tissue ablation.

[Pelvic floor dyssynergia: videoproctographic analysis and pathologic associations in defecation obstruction syndrome]. / Dissinergia addomino-pelvica: analisi videoproctografica e associazioni patologiche nella sindrome da ostruita defecazione.

INTRODUCTION: Pelvic floor dyssynergia is included pathophysiologically in the functional dyschezia group. It is characterized by the paradoxical contraction or lack of relaxation of the puborectal muscle and/or external sphincter during defecation, with consequent functional outlet obstruction. The diagnosis is not always easy because there is no really specific test, nor any diagnostic gold standard; also, many pathophysiologic and epidemiologic findings are still unknown. We tried to define the diagnostic criteria of this condition with the statistical analysis of the main defecographic parameters and to assess the radiologic correlation between functional forms and "mixed" forms, that is those associated with other anorectal disorders. MATERIAL AND METHODS: We reviewed 121 videoproctographic examinations performed January, 1995, to December, 1996, in patients with clinical and instrumental signs suggestive of pelvic floor dyssynergia and compared the findings with those of a control group of 20 patients with no defecation disorders. We also assessed the frequency of the major anorectal disorders associated with pelvic floor dyssynergia relative to the pure form. RESULTS: Initiation time (11 s versus 1 s; p < .05), evacuation time (47 s versus 10 s; p < .01) and the rate of residual contrast material (57 versus 7) were on average greater in dyssynergia patients. These parameters provide important information on the degree and rapidity of rectal voiding. 81% of our dyssynergia patients had rectal voiding time > 30 s, with final residual contrast material 1/3 to 2/3 of the initial volume. Posterior anorectal angle measurements showed significant differences on strain and evacuation and in anorectal angle excursion at rest/on evacuation (4 +/- 17 degrees; p < .01). Anorectal angle excursion < 15 degrees or its paradoxical reduction was associated with anal diameter < 12 mm during voiding in 85% of cases. We subdivided our population into 4 groups: group A (15 patients: median age: 38 +/- 14 years) with dyssynergia only: group B (22 patients; median age: 54 +/- 23 years) with dyssynergia associated with a functional megarectum); group C (66 patients; median age: 52 +/- 14 years) with mixed pathophysiological patterns such as megarectum, rectocele, intrarectal intussusception, mucosal prolapse and perineal descent; group D (18 patients; median age: 52 +/- 16 years) with the same characteristics as in group C but also with hemorrhoids and anal fissures. DISCUSSION AND CONCLUSIONS: At first (digital radiography) and second level (videoproctography), the diagnosis of pelvic floor dyssynergia is based manly on dynamic parameters (initiation and evacuation times) correlated with the residual contrast agent volume. At baseline, the diagnosis is based on the reduced/no excursion of the anorectal angle between rest and evacuation, together with a narrowed anal eanal. The rate of pure pelvic floor dyssynergia was lower (12.4%) than that of the pathophysiologically mixed patterns and the median age of this group of patients was 38 +/- 14 years, which is statistically lower than that of the other groups (52 +/- 14). Comparing the frequency of purely functional forms in the age range < 40 years, we observed a statistically significant difference (p < .001), which suggests that this disorder is always the first cause of the outlet obstruction syndrome.

Evaluation of the vascular pattern of hepatocellular carcinoma with dynamic computed tomography and its use in identifying optimal temporal windows for helical computed tomography.

The aim of this work was to study the vascularization of hepatocellular carcinoma (HCC) by means of dynamic CT and to demonstrate the existence of optimal temporal windows for visualization of HCC in order to develop new protocols for helical CT of the liver. We studied, by means of dynamic CT, 42 histologically proved HCCs in 30 patients after injecting contrast medium (100 ml, 3 ml/s). We performed a time-density analysis of the aorta, liver, portal vein, spleen and lesion. We identified three temporal curves of attenuation of the neoplastic tissue. Curve 1 was three-phasic: hyperattenuation, isoattenuation and hypoattenuation; curve 2 was two-phasic: hyperattenuation and isoattenuation; curve 3 was two-phasic: isoattenuation and hypoattenuation. Thirty-two lesions were homogeneous (curve 1 in 22 cases, 68.7 %; curve 2 in 7 cases, 21.8 %; curve 3 in 3 cases, 9.4 %), whereas 10 lesions were non-homogeneous. Two optimal temporal windows were identified: the first, with predominantly hyperattenuating lesions (range 29-65 s, 90.4 % sensitivity); the second, with predominantly hypoattenuating lesions (range 132.1-360 s, 76.1 %). There is an interposed time range of reduced visualization (range 62-127 s, 54.7 %) in which lesions are isoattenuating. Combined CT study during the first and second temporal windows improves the detection of HCCs especially for homogeneous and small lesions. The intermediate isoattenuation time range does not increase lesion detection rate.

[Interstitial photocoagulation with laser in the treatment of liver metastasis]. / La fotocoagulazione interstiziale con laser nel trattamento delle metastasi epatiche.

Interstitial laser photocoagulation (ILP) causes tumor necrosis with local hyperthermia produced by laser light energy. We treated with US-guided ILP 14 patients (7 men and 7 women; mean age: 67 years) and 20 metastases: 9 of them were < 3 cm in max. diameter and 11 were > 3 cm (mean diameter: 2.9 cm); 14 metastases were from colon carcinoma, 5 from breast cancer and 1 from lung cancer. ILP was performed with 300 and 600 microns quartz fiberoptic guides advanced in 21-18G Chiba needles and a continuous-wave Nd: YAG laser with 1064 nm wavelength. We used single expositions of 5-6 minutes with an irradiation power of 5 watts and scheduled 3 treatment sessions, performing CT scans and biopsies at the end of each session. The extent of induced necrosis was classified as follows on the basis of CT findings: grade 1 = 100% necrosis; grade 2 = necrosis > 50%; grade 3 = necrosis < 50%. The average follow-up was 6 months. After the 3 scheduled treatment sessions, CT showed grade 1 necrosis in all the lesions < 3 cm in diameter and in 4/9 (44%) lesions > 3 cm and grade 2 and 3 necrosis in the remaining cases (necrosis > 50% in 95% of the lesions and 92% of the patients). The cytologic findings were in agreement with CT results in all grade 2 and 3 cases, but in one grade 1 necrosis cytology showed residual viable tumor. To conclude, ILP is a safe and well-tolerated procedure. Maximum efficacy was observed in the lesions < 3 cm, while lesion volume was markedly reduced in the lesions > 3 cm. US is a useful tool in the real-time monitoring of this procedure and CT is the most accurate imaging technique to assess treatment efficacy.

A randomized trial of ultrasound-guided anterior subcostal liver biopsy versus the conventional Menghini technique.

An ultrasound-guided double pass biopsy technique using a large bore cutting needle via an anterior subcostal route (USAB) is described. The diagnostic adequacy of this biopsy procedure was evaluated in comparison with the traditional Menghini technique in 200 cases of suspected chronic liver disease randomly assigned to the two different procedures. Retrieval rate was better in the USAB group. The sample length was less than 15 mm in four cases in the USAB group and in 19 cases in the Menghini group. In three cases in the USAB group the second pass modified the diagnosis of the first specimen from chronic active hepatitis to active cirrhosis. In order to evaluate the safety and discomfort of the two procedures 340 patients assigned to the different techniques had liver ultrasound scans 6 and 24 h following percutaneous biopsy. USAB was associated with a reduced frequency of complications (one out of 170 patients vs. seven out of 170 patients who had the intercostal Menghini procedure). In our study, USAB seems to offer better sampling and size of individual samples, together with reduced frequency of major and minor complications.

[Fine needle aspiration biopsy (FNAG) guided with tomodensitometry of pulmonary and mediastinal masses. Personal experience]. / La biopsia per aspirazione con ago sottile (FNAB) sotto guida tomodensitometrica (TC) delle masse polmonari e mediastiniche. Esperienza personale.

CT-guided fine-needle aspiration biopsy (FNAB) was performed on the patients with pulmonary or mediastinal masses to obtain material for cytologic/histologic diagnosis. Diagnostic accuracy and safety of the technique were evaluated in 75 patients affected with thoracic lesions still undiagnosed after thorough radiological and endoscopic investigations. The cytologic and/or microhistologic samples allowed a correct diagnosis to be made in 61 cases (81%), with no false positives and 7 false negatives (9%). The samples were inadequate for diagnostic purposes in 7 cases (9%). Specificity, sensitivity, and diagnostic accuracy were 68%, 76%, and 81%, respectively. No major complication was recorded and a case of asymptomatic pneumothorax resolved spontaneously within 48 hours. CT-guided FNAB of space-occupying lesions in the lung and mediastinum is therefore a rapid and valuable diagnostic tool and is quite safe when performed by skilled operators.