RESUMO
BACKGROUND: Chlamydia trachomatis (Ct) is not a disease subject to mandatory reporting in Brazil, and the prevalence rate of this genital infection varies according to the region in which studies are conducted, as well as by the detection technique employed. Ct has been associated with persistence of Human papillomavirus (HPV) infection and the facilitation of cervical carcinoma development. We evaluated the Chlamydia trachomatis infection and its association with cytology, p16/Ki-67 dual-stained cytology and cervical intraepithelial lesions status in a screening cohort in Brazil. METHODS: This was a cross-sectional study of 1481 cervical samples from asymptomatic women aged 18 to 64. Samples were collected for liquid-based cytology and Ct detection by polymerase chain reaction. p16/Ki-67 double staining was performed on samples with abnormal cytology. Statistical analysis was by chi-square and likelihood-ratio tests. Odds ratio (OR) and 95% confidence intervals (95% CI) were determined. RESULTS: The frequency of Ct was 15.6% and its presence was not associated with detection of p16/Ki-67 [OR = 1.35 (0.5-3.4)]. There was also no association between abnormal cervical cytology and Ct-positivity [OR = 1.21 (0.46-3.2)]. Associations were observed between p16/Ki-67 and high-grade lesions detected by cytology and in biopsies [OR = 3.55 (1.50-8.42) and OR = 19.00 (0.6-7.2), respectively]. CONCLUSIONS: The asymptomatic women in our study had a high frequency of Ct infection but this was not associated with p16/Ki-67 detection in samples with abnormal cytology. The expression of p16/Ki-67 was highest in women with high-grade CIN (p = 0.003).
RESUMO
Few data are available in the literature concerning the efficacy of standard hysteroscope disinfection procedures to prevent hepatitis B transmission. The aim of the present study was to determine the risk of hepatitis B virus (HBV) transmission during hysteroscopy among anti-HBc-seropositive women. Serum and hysteroscopic samples were collected from 62 women after diagnostic hysteroscopy. All samples were tested for serologic HBV markers. Polymerase chain reactions (PCR) were carried out to amplify regions C and S of the viral genome and only samples amplified by both pairs of primers were considered to be positive. Anti-HBc was repeatedly reactive in 48 (77 percent) of 62 serum samples, and HBsAg was detected in 8 (13 percent). At least one HBV serologic marker was found in 49 (79 percent) samples. Only one sample was HBsAg positive and anti-HBc negative. HBV-DNA was detected by PCR in 7 serum samples but in only 3 hysteroscopic samples obtained just after hysteroscopy. It is noteworthy that high levels of anti-HBc IgM were detected in one HBsAg-negative patient who showed an HBV-DNA-positive hysteroscopic sample. An elevated sample/cut-off ratio for anti-HBc IgM suggests recent infection and reinforces the need for testing for HBsAg and anti-HBc before hysteroscopy, since acute hepatitis B can be clinically asymptomatic. Viral DNA was not detected in any hysteroscopic samples collected after washing and disinfecting procedures with glutaraldehyde. We conclude that HBV-DNA can be found in the hysteroscope soon after hysteroscopy, but standard disinfecting procedures are effective in viral removal.
Assuntos
Humanos , Feminino , Desinfecção , Hepatite B , Anticorpos Anti-Hepatite B , Vírus da Hepatite B , Histeroscopia , Biomarcadores , DNA Viral , Fatores de RiscoRESUMO
Few data are available in the literature concerning the efficacy of standard hysteroscope disinfection procedures to prevent hepatitis B transmission. The aim of the present study was to determine the risk of hepatitis B virus (HBV) transmission during hysteroscopy among anti-HBc-seropositive women. Serum and hysteroscopic samples were collected from 62 women after diagnostic hysteroscopy. All samples were tested for serologic HBV markers. Polymerase chain reactions (PCR) were carried out to amplify regions C and S of the viral genome and only samples amplified by both pairs of primers were considered to be positive. Anti-HBc was repeatedly reactive in 48 (77%) of 62 serum samples, and HBsAg was detected in 8 (13%). At least one HBV serologic marker was found in 49 (79%) samples. Only one sample was HBsAg positive and anti-HBc negative. HBV-DNA was detected by PCR in 7 serum samples but in only 3 hysteroscopic samples obtained just after hysteroscopy. It is noteworthy that high levels of anti-HBc IgM were detected in one HBsAg-negative patient who showed an HBV-DNA-positive hysteroscopic sample. An elevated sample/cut-off ratio for anti-HBc IgM suggests recent infection and reinforces the need for testing for HBsAg and anti-HBc before hysteroscopy, since acute hepatitis B can be clinically asymptomatic. Viral DNA was not detected in any hysteroscopic samples collected after washing and disinfecting procedures with glutaraldehyde. We conclude that HBV-DNA can be found in the hysteroscope soon after hysteroscopy, but standard disinfecting procedures are effective in viral removal.
Assuntos
Desinfecção , Anticorpos Anti-Hepatite B/análise , Vírus da Hepatite B/imunologia , Hepatite B/transmissão , Histeroscopia/efeitos adversos , Biomarcadores/análise , Biomarcadores/sangue , DNA Viral/análise , Feminino , Anticorpos Anti-Hepatite B/sangue , Humanos , Reação em Cadeia da Polimerase , Fatores de RiscoRESUMO
Complicated cardiologic patients with brain ischemia and heart failure need long term enteral nutrition. Long term nasoenteral tube feeding may cause complications that could be avoided with percutaneous endoscopic gastrostomy. The aim of this study was to evaluate the indications for percutaneous endoscopic gastrostomy and its main complications. Twelve patients were submitted to percutaneous endoscopic gastrostomy (eight male) with main age of 62.42 +/- 22.10 years old. Brain ischemia was the main indication of percutaneous endoscopic gastrostomy and occurred after 35.58 +/- 26.79 days, after initiated enteral nutrition. There were no complications during procedure. On late post operatory period there were local infection in one cases, treated with local care. In conclusion, percutaneous endoscopic gastrostomy is a secure technique with low incidence of complications and its indication should be earlier.
Assuntos
Isquemia Encefálica/cirurgia , Endoscopia Gastrointestinal/métodos , Nutrição Enteral/métodos , Gastrostomia/métodos , Cardiopatias/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/etiologia , Isquemia Encefálica/terapia , Baixo Débito Cardíaco/etiologia , Baixo Débito Cardíaco/cirurgia , Baixo Débito Cardíaco/terapia , Criança , Endoscopia Gastrointestinal/efeitos adversos , Nutrição Enteral/efeitos adversos , Feminino , Gastrostomia/efeitos adversos , Cardiopatias/complicações , Cardiopatias/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
The author's experience with 42 colonoscopies in 41 patients with barium enema diagnosis of Crohn's disease is presented. The radiologic, endoscopic, histologic and surgical results are compared. According to radiological localization, the patients were classified in these groups: anorectal (9.7%), colic (51.2%) and ileocolic (39.1%). In 34 patients (80.9%) the endoscopic appearance was compatible with Crohn's disease, and in 24 (70.5%) the histologic examination confirmed the diagnosis. Endoscopic findings were as follows: segmental lesions in 34 (100%), aphthous ulcers in 18 (52.9%), cleft-like ulceration in 24 (70.5%) and cobblestone mucosa in 28 (82.3%). In 8 patients where endoscopy was not suggestive of Crohn's disease, the histologic examination was also negative, showing that colonoscopy was better than barium enema. Twenty patients with endoscopic diagnosis of Crohn's disease were operated and the diagnosis was confirmed in all. Endoscopic biopsies were positive in 12 (60%) of these operated patients. The author concludes that the endoscopic diagnosis of Crohn's disease can be made regardless of biopsy results.
Assuntos
Colonoscopia , Doença de Crohn/diagnóstico , Adolescente , Adulto , Idoso , Sulfato de Bário , Colite/diagnóstico , Colite/cirurgia , Doença de Crohn/cirurgia , Enema , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The authors present an objective review of the main emergencies regarding peptic ulcer disease, gastric and duodenal. The complications, perforation, bleeding and pyloric stenosis, are dealt with in detail, regarding diagnosis and best therapeutic orientation, either clinical or surgical.
Assuntos
Úlcera Péptica Hemorrágica/terapia , Úlcera Péptica Perfurada/terapia , Úlcera Péptica/terapia , Emergências , Humanos , Úlcera Péptica/diagnóstico , Úlcera Péptica/cirurgiaRESUMO
In this study 29 patients were carriers of diverticular disease of the colons (DDC) and 29 patients with irritable bowel syndrome (IBS). The patients were diagnosed by means of a directed anamnesis standardized by the radiologic study of the colons. The methodology included, radiologic study of the colons, endoscopic examination of the colon (colonoscopy with biopsy) and anatomic pathologic examination of the fragments obtained in the endoscopy. It was tried, by means of colonoscopy with biopsy and anatomic pathological examination, to demonstrate, classify and relate, in agreement with pre-established criterion, the degree of intensity of the inflammatory process in the colic mucosa. According to the results we may conclude that: 1) colonoscopy in the studied inflammatory diseases is important for diagnosis, evaluation of the inflammatory process, identification of associated illness and material obtention for the anatomic pathological examination; 2) there is always a chronic inflammatory process, in variable degrees, of the colic mucosa in DDC and in IBS; 3) colonoscopy with biopsy and the anatomic pathological examination are adequate to diagnose with precision the degree of intensity of the chronic inflammatory process of the colic mucosa and the presence of associated disease in DDC and in IBS.
Assuntos
Doenças Funcionais do Colo/diagnóstico , Colonoscopia , Doença Diverticular do Colo/diagnóstico , Adulto , Idoso , Doenças Funcionais do Colo/patologia , Doenças Funcionais do Colo/psicologia , Doença Diverticular do Colo/patologia , Doença Diverticular do Colo/psicologia , Enema , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estresse Psicológico/complicaçõesRESUMO
Foram estudados 29 pacientes com diagnostico de doenca diverticular do colon (DDC) e 29 pacientes portadores da sindrome do colon irritavel (SCI). Os pacientes foram diagnosticados atraves da anamnese padronizada e do exame radiologico dos colons.A metodologia empregada consta de exame radiologico dos colons, exame endoscopico dos colons (colonoscopia com biopsia) e exame anatomopatologico dos fragmentos obtidos pela endoscopia. Procurou-se atraves da colonoscopia com biopsia, classificar e relacionar entre si, de acordo com os criterios previamente estabelecidos o grau de intensidade do processo inflamatorio da mucosa colica, chegando-se as seguintes conclusoes: 1) a colonoscopia nas afeccoes inflamatorias examinadas e importante para o diagnostico,avaliacao do processo inflamatorio, identificacao de molestias associadas e obtencao de material para exame anatomopatologico; 2) existe na maioria das vezes, um processo inflamatorio cronico, em graus variaveis na mucosa colica na DDC e na SCI; 3) a colonoscopia com biopsia e o exame anatomopatologico sao adequados para diagnosticar com precisao o grau de intensidade do processo inflamatorio cronico da mucosa colica e a presenca de molestias associadas na DDC e na SCI
Assuntos
Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Colonoscopia , Doença Diverticular do Colo , Doenças Funcionais do ColoRESUMO
Since the initial description of Crohn's disease (CD) located in the distal ileum, great number of cases has been observed, and we know that this disease can occur in any part of the digestive tube, from mouth to anus. The duodenal involvement is rare and no more than two hundred cases have been observed. A case of Crohn's disease located in the duodenum, with a severe acalculus cholecystitis, without intestinal involvement is presented. Radiological study showed a stenotic process in the first, second and third duodenal portion, later on confirmed by endoscopy. This was confirmed at surgery, when a gastrojejunostomy with truncal vagotomy, cholecystectomy, besides duodenum and liver biopsies were performed. The patient is asymptomatic four years after surgery. It is considered that bile reflux, resulting from involvement of Vater papilla by CD, is responsible factor of the biliary pathology.
Assuntos
Colecistite/complicações , Doença de Crohn/complicações , Colangiografia , Colecistite/diagnóstico , Colecistite/cirurgia , Doença de Crohn/diagnóstico , Doença de Crohn/cirurgia , Duodenite/complicações , Duodenite/diagnóstico , Duodeno/patologia , Vesícula Biliar/patologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Desde a descricao inicial da doenca de Crohn (DC) com localizacao no ileo distal, um grande numero de casos tem sido relatado, sabendo-se que atualmente esta afeccao pode comprometer qualquer segmento do tubo digestivo, desde a boca ate o anus. O envolvimento duodenal no entanto, e mais raro sendo relatados nao mais do que duas centenas de casos. E apresentado um caso da DC localizada no duodeno, acompanhada de colecistite aguda alitiasica sem contudo apresentar envolvimento intestinal. O aspecto radiologico era de um processo estenotico envolvendo a primeira e segunda porcoes do duodeno, que foi posteriormente confirmado pela endoscopia.A operacao confirmou-se a existencia destes achados tendo sido praticado a gastrojejunostomia com vagotomia troncular, colecistectomia, coledoscotomia, alem de biopsia duodenal e hepatica. O decurso pos-operatorio foi sem intercorrencia, encontrando-se o paciente assintomatico num periodo de seguimento de quatro anos. Considera-se o refluxo duodeno-biliar, consequente ao comprometimento da papila de Vater pela DC, como o fator desencadeante da patologia biliar
Assuntos
Pessoa de Meia-Idade , Humanos , Masculino , Colecistite , Doença de CrohnRESUMO
The authors report five members of a family, having colonic polyposis, whose parents had adenomas that posteriorly degenerated to carcinoma, while sons had juvenile polyposis. Such aspects were considered as familial, evolutive and genetic. In contrast to adenomas, juvenile polyposis or hamartomas were always considered as benign lesions, with no susceptibility to malignancy. Nevertheless, these lesions must be considered as having degenerative potential at least similar to the originating tissue and, perhaps, even higher, once the sick tissue shows abnormal growth rate. These observations raise an important problem, namely, evaluating an eventual existence of malignancy among patients with juvenile polyposis which, if actually confirmed, could result in changes of its concepts and of its therapeutic approaches. The acknowledgement of the association between malignant potenial with genetics, could also result in better prevention for colonic cancer, once known its hereditary predisposition. The expectation of new cases among members of a same family should promote prevention before cancer appears. Thus, with this approach, the transcolonoscopic removal of polyps, mostly among families presenting high cancer potential, should avoid the sequence "adenoma-carcinoma".
Assuntos
Neoplasias do Colo/genética , Hamartoma/genética , Neoplasia Endócrina Múltipla/genética , Adolescente , Adulto , Criança , Neoplasias do Colo/diagnóstico , Hamartoma/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasia Endócrina Múltipla/diagnósticoAssuntos
Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Hamartoma , Neoplasia Endócrina Múltipla , Neoplasias do ColoRESUMO
The approach to the integrated diagnosis of the patient with biliary tract diseases is reviewed as a basis for the appropriate treatment, taking into account the functional disturbances and the organic elements including malformation, inflammation, infection, gallstone and neoplasia. The role of impaired emptying of the gallbladder is emphasized. This condition may give origin to inflammation of the gallbladder is emphasized. This condition may give origin to inflammation of the gallbladder which is caused by the irritative action of concentrated bile acids as a consequence of the stagnated bile in the gallbladder with poor emptying. Other consequences of bile stagnation in the gallbladder is gallstone formation and biliary infection by bacterias. Thus, increase of gallbladder emptying and of bile production are advised in the treatment of biliary diseases. Such two effects can be obtained by the diet using adequate amounts of vegetables, oils and eggs and by drugs such as choleretics. A new choleretic drug-the cicloxilic acid-was used in 102 patients, 48 out of them with gallstone and 54 without lithiasis. The following three actions of this drug were recorded: a decrease of gastrointestinal gaseousness; a decrease of abdominal discomfort and soreness, and a mild laxative effect with stool of less consistency.
Assuntos
Doenças dos Ductos Biliares/tratamento farmacológico , Colagogos e Coleréticos/uso terapêutico , Adolescente , Adulto , Idoso , Discinesia Biliar/tratamento farmacológico , Criança , Colangite/tratamento farmacológico , Colelitíase/tratamento farmacológico , Ensaios Clínicos como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Sao revistos os criterios de diagnostico integral das doencas das vias biliares nos aspectos funcional, organico e psicossomatico e as respectivas bases fisiopatologicas para a orientacao do tratamento dietetico e medicamentoso. E ressaltada a importancia de estimular a motilidade atraves de alimentos e drogas, assim como da colerese. Experimentou-se uma nova droga coleretica - o acido cicloxilio - em 120 pacientes, 48 dos quais tinham litiase biliar e 54, ou colecistite cronica nao calculosa (20 pacientes), ou discinesia biliar funcional (26 pacientes), ou discinesia mecanica (8 pacientes). Os seguintes tres efeitos dessa droga foram observados diminuicao dos gases abdominais, abrandamento do desconforto e do dolorimento abdominais e fezes menos consistentes. Nao foram notados efeitos colaterais com a administracao da droga
Assuntos
Discinesia Biliar , Colagogos e Coleréticos , Doenças dos Ductos BiliaresRESUMO
O efeito da atropina sobre a resposta contratil induzida por acetilcolina (Ach), potassio (K), bario (Ba) e calcio (Ca), em ileo isolado de cobaia, foi estudado. As contracoes induzidas por Ach e Ba foram antagonizadas competitivamente, enquanto as contracoes provocadas por K e Ca nao o foram. Concluiu-se que a atropina tem uma relativa especificidade pelo receptor muscarinico mesmo em concentracoes mais elevadas e, desta forma, se comporta diferentemente dos anestesicos locais que sao considerados inibidores inespecificos da contracao do musculo liso