Resumen La Sierra Nororiental es una de las principales regiones productoras de café en el estado de Puebla, donde destaca el municipio de Hueytamalco por la producción y superficie sembrada. En los últimos años, la producción en esta región ha disminuido de manera considerable debido a los daños ocasionados por la roya del café (Hemileia vastatrix). El objetivo fue conocer el manejo, incidencia y daños de la roya del café en el municipio de Hueytamalco, Puebla. Mediante un muestreo estadístico, se determinó una muestra de 67 productores de café. El trabajo de campo concluyó en diciembre de 2018. La mayoría de los productores manifestaron la presencia de roya en sus predios. Para el manejo de la enfermedad utilizan diferentes fungicidas que son aplicados de manera esporádica y sin asistencia técnica adecuada. La mayor parte de los productores piensa que ha aumentado la incidencia de la roya y consideran que este problema se podría incrementar de manera importante en los siguientes años. Esta situación ha impactado en los rendimientos de café del municipio, sin embargo, los cafeticultores manifestaron interés en continuar con el cultivo.

Abstract The Sierra Nororiental is one of the main coffee-growing regions in the state of Puebla, where the municipality of Hueytamalco stands out for its production and planted area. In recent years, production in this region has decreased considerably due to damage caused by coffee rust (Hemileia vastatrix). The objective was to know the management, incidence, and damage of coffee rust in the municipality of Hueytamalco, Puebla. Through statistical sampling, a sample of 67 coffee growers was determined. Fieldwork concluded in December 2018. Most producers reported the presence of rust on their farms. To manage the disease, they use different fungicides that are applied sporadically and without adequate technical assistance. Most producers think that the incidence of rust has increased and believe that this problem could increase significantly in the coming years. This situation has impacted the municipality’s coffee yields; nevertheless, coffee growers expressed interest in continuing with the crop.

Resumo Fundamento Alguns estudos demonstraram uma maior prevalência de óbitos em portadores de fatores de risco cardiovascular (FRC) durante internação por COVID-19. Objetivos Avaliar o impacto do alto risco cardiovascular em pacientes internados em terapia intensiva por COVID-19 Métodos Estudo retrospectivo com pacientes admitidos em terapia intensiva, com diagnóstico confirmado de COVID-19 por RT-PCR e com pelo menos uma dosagem de troponina durante a internação. Os critérios para definição de paciente de alto risco cardiovascular (ARC) foram: histórico de doença cardiovascular estabelecida (infarto, AVC ou doença arterial periférica), diabetes, doença renal crônica com clearance < 60ml/min ou presença de 3 FRC (hipertensão, tabagismo, dislipidemia ou idade > 65 anos). O desfecho primário deste estudo é mortalidade hospitalar por todas as causas. P<0,05 foi considerado significativo. Resultados Foram incluídos 236 pacientes, média de idade= 61,14±16,2 anos, com 63,1% homens, 55,5% hipertensos e 33,1% diabéticos. Um total de 47,4% dos pacientes apresentavam ARC. Observou-se um aumento significativo da mortalidade conforme aumento do número de fatores de risco (0 FRC: 5,9%; 1 FRC: 17,5%; 2 FRC: 32,2% e ≥3 FRC: 41,2%; p=0,001). Na regressão logística ajustada para gravidade (escore SAPS3), o grupo de alto risco cardiovascular e troponina elevada apresentou maior ocorrência de mortalidade hospitalar (OR 40,38; IC95% 11,78-138,39). Pacientes sem alto risco cardiovascular, mas com troponina elevada, também exibiram associação significativa com o desfecho primário (OR 16,7; IC95% 4,45-62,74). Conclusão Em pacientes internados em terapia intensiva por COVID-19, a presença de alto risco cardiovascular afeta a mortalidade hospitalar somente em pacientes que apresentaram elevação de troponina.

Abstract Background Some studies have shown a higher prevalence of deaths in patients with cardiovascular risk factors (CRF) during hospitalization for COVID-19. Objectives To assess the impact of high cardiovascular risk in patients hospitalized in intensive care for COVID-19 Methods Retrospective study with patients admitted to an intensive care unit, with a diagnosis of COVID-19 confirmed by RT-PCR, and with at least one troponin measurement during hospitalization. The criteria for defining high cardiovascular risk (HCR) patients were: history of established cardiovascular disease (myocardial infarction, stroke, or peripheral arterial disease), diabetes, chronic kidney disease with clearance < 60ml/min, or presence of 3 CRFs (hypertension, smoking, dyslipidemia, or age > 65 years). The primary outcome of this study is all-cause in-hospital mortality. P<0.05 was considered significant. Results This study included 236 patients, mean age = 61.14±16.2 years, with 63.1% men, 55.5% hypertensive, and 33.1% diabetic; 47.4% of the patients also presented HCR. A significant increase in mortality was observed as the number of risk factors increased (0 FRC: 5.9%; 1 FRC: 17.5%; 2 FRC: 32.2% and ≥3 FRC: 41.2%; p=0.001). In the logistic regression adjusted for severity (SAPS3 score), the HCR and myocardial injury group had a higher occurrence of in-hospital mortality (OR 40.38; 95% CI 11.78-138.39). Patients without HCR but with myocardial injury also exhibited a significant association with the primary outcome (OR 16.7; 95% CI 4.45-62.74). Conclusion In patients hospitalized in intensive care for COVID-19, HCR impacts in-hospital mortality only in patients with myocardial injury.

ABSTRACT Acute kidney failure is defined as the loss of kidney function caused by various causes, including infection and drug intake. This entity has high morbidity and mortality in critical care units. Treatment ranges from renal protection to artificial replacement of the functions of the injured kidney. Currently, continuous renal replacement therapy has been used as renal support, and offers greater clinical stability to the most unstable patients. In this review, authors discuss concepts, indications and the most recent studies that validate the use of this therapeutic, as well as the programming method that was used in a patient with diagnosis of icteric-hemorrhagic leptospirosis (Weil syndrome), who was in septic shock with multiorgan dysfunction, where this therapy was used with satisfactory results.

RESUMEN La insuficiencia renal aguda es definida como la pérdida de función del riñón ocasionada por diversas causas, entre ellas infección e ingesta de fármacos. Esta entidad tiene alta morbilidad y mortalidad en las unidades de cuidados críticos. El tratamiento de la misma va desde la propia protección renal hasta la sustitución artificial de las funciones del riñón lesionado. En la actualidad la terapia de reemplazo renal continua se ha utilizado como soporte renal, y ofrece mayor estabilidad clínica a los pacientes más inestables. En esta revisión se comentan conceptos, indicaciones y los más recientes estudios que validan el uso de esta terapéutica, así como el método de programación que se utilizó en un paciente con diagnóstico de una leptospirosis icterohemorrágica (síndrome de Weil), que estuvo en shock séptico con disfunción multiorgánica, donde se empleó esta terapia con resultados satisfactorios.

ABSTRACT Introduction: the spread of multi-resistant microorganisms in the hospital is a major epidemiological and therapeutic problem that particularly affects critical patients admitted to the Intensive Care Unit. Objective: to describe the behavior of nosocomial infections and antimicrobial resistance in the Intensive Care Unit. Materials and Methods: a descriptive, observational and prospective study was carried out in the Intensive Care Unit of the Teaching Clinic-Surgical Hospital Faustino Pérez Hernández, during the first half of 2020. The universe was formed by 102 patients who entered the Intensive Care Unit during the studied period, to whom microbiological studies were carried out. The analyzed variables were the following: causes of admission, age, nosocomial infections, ventilator-associated pneumonia, germs, antimicrobial resistance and mortality. The results were expressed in tables and percentage charts. Results: Male sex showed the highest number of nosocomial infection compared to the female, at different ages of life. The most common cause of admission was polytrauma. The most common site of nosocomial infection was the airway. Germs like fermentative Gram-negative bacilli and enterobacteria predominated. Antibiotics such as beta-lactamase inhibitors, other kinds of penicillin, quinolones, cephalosporin, aminoglycosides and meropenen have acquired a higher percent of resistance. Conclusions: nosocomial infection caused by bacteria that have developed multi-resistance to strategic antibiotics is a problem within the Intensive Care Unit, associated to mechanical ventilation, and leads to high mortality.

RESUMEN Introducción: la diseminación de microorganismos multirresistentes en el hospital, constituye un importante problema epidemiológico y terapéutico que afecta especialmente a pacientes de la Unidad de Cuidados Intensivos. Objetivo: escribir el comportamiento de las infecciones nosocomiales y la resistencia antimicrobiana en la Unidad de Cuidados Intensivos. Materiales y métodos: se realizó un estudio de tipo descriptivo, observacional y prospectivo en la Unidad de Cuidados Intensivos del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, durante el primer semestre de 2020. El universo estuvo constituido por 102 pacientes que ingresaron en la Unidad de Cuidados Intensivos en el período estudiado, a los que se les realizó estudios microbiológicos. Las variables analizas fueron: causas de ingreso, edad, infecciones nosocomiales, neumonía en ventilados, gérmenes, resistencia antimicrobiana y mortalidad. Se expresaron en tablas y gráficos porcentuales. Resultados: el sexo masculino presentó mayor número de infección nosocomial respecto al femenino, en edades diferentes de la vida. La causa más frecuente de ingreso fue el politrauma. El sitio más común de infección nosocomial fue la vía respiratoria. Predominaron gérmenes como los bacilos gramnegativos fermentadores y las enterobacterias. Antibióticos como los inhibidores de las betalactamasas, otras penicilinas, quinolonas, cefalosporinas, aminoglucósidos y meropenen han adquirido un mayor porciento de resistencia. Conclusiones: la infección nosocomial por bacterias multirresistentes a los antibióticos estratégicos, es un problema dentro de la Unidad de Cuidados Intensivos asociado a la ventilación mecánica, que provoca una elevada mortalidad.

Abstract The coronavirus disease 2019 (COVID-19) pandemic represents a challenge for public health and a high risk for patients with pre-existing comorbidity. As of July 20, 2020, the Case Fatality Rate (CFR) was 11.30% and the Mortality Rate (MR) was 31.28 deaths per 100,000 population. In Mexico, the prevalence of obesity, diabetes mellitus, and hypertension among the adult Mexican population is 30%, 9.2%, and 40%, respectively. The objective of this research was to identify the risk factors associated with eight comorbidities and their dependency on age for death caused by COVID-19. Method: This study used the dataset published on July 20, 2020, by the General Directorate of Epidemiology of the Ministry of Health of Mexico. From this dataset, we analysed 130,896 positive COVID-19 cases, where 35,483 (27.107%) patients had one comorbidity, and 95,413 (72.892%) patients had not medical comorbidity. Statistical analyses include the Case Fatality Rate (CFR), the estimation of the Odds Ratio (OR), and its 95% Confidence Interval (CI). Results: The highest CFR was 14.382% for COPD, 10.266% for CKD, 10.126% for diabetes, and 8.954% for hypertension. The obesity CFR was 3.535%. Moreover, we detected a higher risk for patients with COPD, diabetes, and CKD, resulting in OR of 4.443 (95% CI: 3.404-5.799), 3.283 (95% CI: 3.018-3.570), and 3.016 (95% CI: 2.248-4.047), respectively. Conclusion: This study corroborates that the highest risk for severe disease and death caused by COVID-19 among the Mexican population are pre-existing comorbidities. Findings show that COPD, CKD, diabetes, hypertension, and cardiovascular disease increase the risk of death for patients older than 54 years. The most vulnerable age group is older than 65 years.

Resumen La pandemia de la enfermedad por coronavirus 2019 (COVID-19) representa un desafío para la salud pública y un alto riesgo para los pacientes con comorbilidad preexistente. Al 20 de julio de 2020, la Tasa de Casos Fatales fue de 11.30% y la Tasa de Mortalidad fue de 31.28 muertes por 100,000 habitantes. En México, la prevalencia de obesidad, diabetes mellitus e hipertensión entre la población adulta mexicana es de 30%, 9.2% y 40%, respectivamente. El objetivo de esta investigación fue identificar los factores de riesgo asociados a ocho comorbilidades y su dependencia de la edad para la muerte por COVID-19. Método: Este estudio utilizó el conjunto de datos publicado el 20 de julio de 2020 por la Dirección General de Epidemiología de la Secretaría de Salud de México. A partir de este conjunto de datos, se analizaron 130.896 casos positivos de COVID-19, donde 35.483 (27,107%) pacientes tenían una comorbilidad y 95.413 (72,892%) pacientes no tenían comorbilidad médica. Los análisis estadísticos incluyen la tasa de letalidad, la estimación de la razón de probabilidades y su intervalo de confianza del 95%. Resultados: La Tasa de Casos Fatales más altas fue 14.382% para EPOC (Enfermedad Pulmonar Obstructiva Crónica), 10.266% para ERC (Enfermedad Renal Crónica), 10.126% para diabetes y 8.954% para hipertensión. La tasa de riesgo para obesidad fue del 3,535%. Además, se detectó un mayor riesgo para los pacientes con EPOC, diabetes y ERC, lo que resultó en una OR de 4,443 (IC del 95%: 3,404-5,799), 3,283 (IC del 95%: 3,018-3,570) y 3,016 (IC del 95%: 2.248-4.047), respectivamente. Conclusión: Este estudio corrobora que el mayor riesgo de enfermedad grave y muerte causada por COVID-19 entre la población mexicana son las comorbilidades preexistentes. Los resultados muestran que EPOC, ERC, diabetes, hipertensión y enfermedades cardiovasculares aumentan el riesgo de muerte para pacientes mayores a 54 años. El grupo de edad más vulnerable es el de mayor a 65 años.

OBJETIVO: avaliar a aplicabilidade das principais categorias de risco e de fatores morfológicos no prognóstico tumor estromal gastrointestinal. MÉTODOS: cinquenta e quatro casos de GIST foram estudados retrospectivamente considerando-se os principais fatores prognósticos da neoplasia: graus de risco, topografia, tamanho, índice mitótico, necrose, subtipo histológico e imunofenótipo. Foi também verificada a sua associação e a redução da sobrevida global dos pacientes. RESULTADOS: a análise univariada mostrou que os tumores com número de mitoses maior que 5/50CGA (campos de grande aumento), a presença de necrose, de alto risco tanto para os sistemas propostos por Fletcher, quanto para Miettinen tiveram associação significativa com redução da sobrevida (p=0,00001, 0,0056, 0,03 e 0,009, respectivamente). Enquanto que os demais fatores analisados (tamanho, subtipo histológico, topografia e imunofenótipo) não tiveram tal associação. A análise multivariada (índice de Jacard) demonstrou que o grau de risco de Miettinen foi aquele que melhor se relacionou com o prognóstico. CONCLUSÃO: os critérios de risco de Fletcher e de Miettinen são importantes na avaliação do prognóstico de pacientes com tumor estromal gastrointestinal, principalmente este último, que se soma ao índice mitótico e a necrose tumoral.

OBJECTIVE: To evaluate the applicability of the main categories of risk and morphological factors in the prognosis of gastrointestinal stromal tumors. METHODS: we retrospectively studied fifty-four cases of GIST, assessing the main prognostic factors of this neoplasis: risk levels, topography, size, mitotic index, necrosis, histological subtype and immunophenotype. We also verified their association and the reduction of overall survival. RESULTS: Univariate analysis showed that tumors with mitoses number greater than 5 per 50CGA (high-power fields), the presence of necrosis and a high risk for both the systems proposed by Fletcher and Miettinen had a significant association with reduced survival (p = 0.00001, 0.0056, 0.03 and 0.009, respectively). The remaining analyzed factors (size, histological subtype, topography and immunophenotype) had no such association. Multivariate analysis (Jacard index) showed that the Miettinen degree of risk was the one that best correlated with prognosis. CONCLUSION: the risk criteria of Fletcher and Miettinen are important in assessing the prognosis of patients with gastrointestinal stromal tumors, especially the latter, which adds to the mitotic index and the presence of tumor necrosis.

Isoniazid (INH), one of the most important drugs used in antituberculosis (anti-TB) treatment, is also the major drug involved in hepatotoxicity. Differences in INH-induced toxicity have been attributed to genetic variability at several loci, such as NAT2, CYP2E1, GSTM1 and GSTT1, that code for drug-metabolising enzymes. Our goal was to examine the polymorphisms in these enzymes as susceptibility factors to anti-TB drug-induced hepatitis in Brazilian individuals. In a case-control design, 167 unrelated active tuberculosis patients from the University Hospital of the Federal University of Rio de Janeiro, Brazil, were enrolled in this study. Patients with a history of anti-TB drug-induced acute hepatitis (cases with an increase to 3 times the upper limit of normal serum transaminases and symptoms of hepatitis) and patients with no evidence of anti-TB hepatic side effects (controls) were genotyped for NAT2, CYP2E1, GSTM1 and GSTT1 polymorphisms. Slow acetylators had a higher incidence of hepatitis than intermediate/rapid acetylators [22% (18/82) vs. 9.8% (6/61), odds ratio (OR), 2.86, 95% confidence interval (CI), 1.06-7.68, p = 0.04). Logistic regression showed that slow acetylation status was the only independent risk factor (OR 3.59, 95% CI, 2.53-4.64, p = 0.02) for the occurrence of anti-TB drug-induced hepatitis during anti-TB treatment with INH-containing schemes in Brazilian individuals.

The objectives of this investigation were to characterize the quality components of the chickpea fruit, to describe the anatomy of the pod, and to study postharvest technology for increasing the shelf life of the fruits. Green chickpeas cv. 'Blanco Sinaloa' were harvested; proximate analysis, minerals, pH, acidity and total soluble solids were separately analyzed in both pods and seeds. Histological evaluations were done on pods at 0, 6 and 12 days. Four lots of fruits were treated, each with 1) 0.5 μl·L-1 and 2) 1.0 μl·L-1 of 1-methylcyclopropene (1-MCP), 3) sprayed water at 65 °C, and 4) control. Samples were stored for 12 days at 10 °C using PET containers. Evaluations of weight loss, color, and respiration rate were done every 3 days. Chickpea seed and pod showed a good nutritional profile based on the protein, fiber, calcium, potassium, and iron content. Also, in both tissues pH = 6.0 was observed. The cell anatomy of the pod showed a well structured cuticle at day 0, which remained compacted through the storage; also, a change in cells from the parenchyma towards sclerenchyma was observed, indicating cell aging. The 1-MCP treatments significantly decreased weight loss and metabolic activity of chickpeas as compared to control samples; however, none of the treatments showed a significant effect on green color retention.

El objetivo de esta investigación fue caracterizar los componentes de calidad del fruto de garbanzo, describir la anatomía de la vaina y buscar tecnología poscosecha que permitan prolongar la vida del fruto. Se cosecharon garbanzos verdes cv. 'Blanco Sinaloa'; en la vaina y semilla se realizó el análisis proximal, minerales, pH, acidez y sólidos solubles totales. En la vaina se observó la histología del tejido a los 0, 6 y 12 días. Cuatro lotes de frutos fueron tratados con 1) 0.5 μl·L-1 y 2) 1.0 μl·L-1 de 1-metilciclopropeno (1-MCP, al 14 %), 3) asperjado con agua a 65 °C y 4) testigo (sin tratar). Los garbanzos se almacenaron por 12 días a 10 °C en envases de polietileno. Cada tres días se evaluaron la pérdida de peso, el color exterior y la respiración de los frutos. La semilla y la vaina de garbanzo tuvieron adecuada concentración de proteínas, fibra, calcio, potasio y hierro; y un pH = 6. La anatomía celular de la vaina tuvo una cutícula bien estructurada el día cero, la cual se compactó durante el almacenamiento; también, se observaron cambios de las células del parénquima a esclerénquima. Los frutos tratados con 1-MCP redujeron significativamente la pérdida de peso y la actividad metabólica en comparación con el testigo; sin embargo, ningún tratamiento mostró un efecto significativo sobre la retención del color verde de los frutos.

The combined effect of N, P and K chemical fertilizers with vermicompost was studied in tomato planting, vegetation cover of the soil with Mucuna pruriens and minimal farming; in contrast to the conventional farming system with chemical fertilizers and plastic soil padding, for plant nutrition, measurement of some fruit quality parameters and soil microbial activity from 2007 to 2008. The tomato underwent five treatments in two types of crop management. Results showed similar yields and postharvest fruit yields (firmness and weight loss) and absorption of N, P, K, Ca and Mg by the tomato plants, between conventional farming and the use of vegetation cover, minimum farming and fertilization with vermicompost plus 250 N-55 P-100 K. The fruits from treatment T2 displayed appropriate behavior in firmness and weight loss in the postharvest study, and this result was statistically equal to the fruits of treatment T5 during the study. The M. pruriens plants accumulated nitrogen fixed from the atmosphere and residual nitrogen from the soil in an important amount en its biomass, keeping it available for the tomato. The mychorrhizal colonization in tomato plants and the release of CO2 from the soil were higher with the vegetation cover and vermicompost than the conventional handling of the crop.

Se estudió en el cultivo de tomate, el efecto combinado de fertilización química de N, P y K con aplicación de vermicompost, cobertura vegetal del suelo con Mucuna pruriens y labranza mínima; en contraste, al sistema de labranza convencional con fertilización química y acolchado plástico del suelo; para la nutrición de las plantas, medición de algunos parámetros de calidad del fruto y la actividad microbiana del suelo de 2007 a 2008. Se establecieron cinco tratamientos para la siembra del tomate, en los dos tipos de manejo del cultivo. Los resultados mostraron rendimientos similares y calidad poscosecha (firmeza y pérdida de peso) de fruto y absorción de N, P, K, Ca y Mg por las plantas de tomate, entre la labranza convencional del cultivo y el de uso de cobertura vegetal del suelo, labranza mínima y fertilización con vermicompost más 250 N-55 P-100 K. Los frutos procedentes de tratamiento T2 presentaron un comportamiento adecuado en firmeza y pérdida de peso en el estudio poscosecha y este resultado fue estadísticamente igual a los frutos del T5 durante el estudio. Las plantas de M. pruriens acumularon en su biomasa nitrógeno fijado de la atmósfera y residual del suelo en cantidad importante que estuvo disponible para el cultivo de tomate. La colonización micorrízica en las plantas de tomate y la liberación de CO2 del suelo, fueron más altas con la cobertura vegetal y vermicompost que el sistema de manejo convencional del cultivo.

INTRODUÇÃO: os tumores estromais gastrointestinais possuem amplo espectro biológico, variando desde lesões de comportamento benigno até aquelas de caráter maligno, capazes de ampla disseminação e frequentes metástases viscerais. Atualmente, o prognóstico está baseado num escore, denominado grau de risco. Entretanto, este sistema apresenta falhas, com tumores classificados como de riscos intermediário e baixo associados ao desenvolvimento de metástases. Desta forma, são necessários estudos que visem ao aprimoramento desse sistema de classificação, destacando-se nesse campo, nos últimos anos, o índice de proliferação celular que tem mostrado valor prognóstico na predição da agressividade tumoral. OBJETIVOS: analisar critérios morfológicos (tamanho macroscópico, topografia do tumor, índice mitótico, necrose, subtipo histológico), verificar o grau de risco e pesquisar a aplicabilidade dos marcadores imuno-histoquímicos (actina músculo-específico, proteína S-100, Ki67 e p16ink4a) como fatores prognósticos do tumor estromal gastrointestinal (GIST). RESULTADOS: a análise univariada mostrou significância com tumores maiores que 5 cm, número de mitoses maior que 5/50 CGA, presença de necrose, de grau de risco alto e índice de proliferação celular (Ki67) maior que 5% com relação à redução da sobrevida global dos pacientes (p = 0,017; 0,01; 0,001; 0,016; < 0,001 respectivamente). Os outros fatores analisados (subtipo histológico, imunofenótipo e p16ink4a) não mostraram significância. CONCLUSÃO: o grau de risco, o tamanho tumoral, o índice mitótico e a presença de necrose corroboram evidências prévias da sua utilização, como fatores morfológicos prognósticos e o emprego do índice de proliferação celular (Ki67) associado ao grau de risco para melhor esclarecimento do comportamento biológico dos GIST.

INTRODUCTION: Gastrointestinal stromal tumors (GIST) have a wide biological spectrum, ranging from benign to malignant lesions, which are prone to wide spread and frequent visceral metastasis. Currently, the prognosis is based on a score system known as risk level. However, this system has some drawbacks. For instance, tumors classified as low or intermediate risk may be associated with the development of metastasis. Therefore, studies are required to improve this classification system and incorporate recent developments such as cellular proliferation index, which has shown prognostic value in the prediction of tumor aggressiveness. OBJECTIVES: To analyze morphological criteria (macroscopic size, tumor topography, mitotic index, necrosis, histological subtype), observe risk and investigate the usefulness of immunohistochemical markers (muscle-specific actin, S-100 protein, Ki67 and p16ink4a) as prognostic markers of GIST. RESULTS: Univariate analysis showed that a reduced global survival was significantly associated with tumor size greater than 5cm, mitotic index greater than 5/50 CGA, presence of necrosis, a high risk level, and a cellular proliferation index (Ki67) higher than 5% on the reduction of overall survivel of patients (p = 0.017, 0.010, 0.001, 0.016 and 0.0005, respectively). Other factors such as histological subtype, immunophenotype and p16ink4a were not significant. CONCLUSION: According to our data, risk level, tumor size, mitotic index and the presence of necrosis stood as morphological predictors of reduced survival, which underpins previous evidence of their application. The cellular proliferation marker Ki67 associated with risk level also proved to be a useful predictor of tumor aggressiveness.

OBJETIVO: estudar os critérios morfológicos e imunoistoquímicos relacionados ao prognóstico dos tumores estromais gastrointestinais. MÉTODOS: o estudo foi retrospectivo de 42 casos de tumor estromal gastrointestinal (GIST). Vinte e cinco casos foram obtidos no arquivo do Serviço de Anatomia Patológica do Hospital Universitário Gaffrée e Guinle e os outros dezessete, do Serviço de Anatomia Patológica do Hospital Universitário Clementino Fraga Filho. RESULTADOS: de acordo com a análise univariada os tumores maiores que 5 cm, com número de mitoses maior que 5/50 CGA, presença de necrose, de alto risco, revelaram significância em relação a redução da sobrevida (p= 0,017, 0,010, 0,001 e 0,016, respectivamente). Os outros fatores analisados (subtipo histológico, topografia e imunofenótipo) não mostraram significância. CONCLUSÃO: os resultados confirmam a utilidade do grau de risco, do tamanho tumoral, do índice mitótico e da necrose como fatores preditores do comportamento biológico dos tumores estromais gastrointestinais.

OBJECTIVE: study the morphologic criteria and immunohistochemical related with the prognostic of the gastrointestinal stromal tumors. METHODS: the study was retrospective of 42 cases of gastrointestinal stromal tumor (GIST). Twenty-five cases were obtained in the file of the Services of Pathological Anatomy of the Hospital Gaffrée and Guinle and the other 17 of Pathological Anatomy of the Hospital Clementino Fraga Filho. RESULTS: in agreement with the univaried analysis, the tumors largest than 5 cm, with mitoses number greater than 5/50 CGA, presence of necrosis, high risk, revealed significance with regarding the reduction of the survival (P = 0.017, 0.01, 0.001 and 0.016, respectively). The other analyzed factors (histological subtype, topography and imunophenotype) they didn't show significance. CONCLUSION: the results confirm the usefulness of the risk degree, the tumorous size, the mitotic index and the necrosis as predictor factors of the biological behavior of the gastrointestinal stromal tumors.

INTRODUÇÃO: As hemorróidas são muito freqüentes e após o seu tratamento cirúrgico tem se observado que a dor causa muito sofrimento. Várias alternativas tem sido estudadas para melhorar a dor pós-operatória dentre elas a esfincterotomia cirúrgica que pode em alguns casos causar algum grau de incontinência fecal. Por esse motivo vários estudos tem utilizado a esfincterotomia química com nifedipina, diltiazen, trinitrato de glicerina e toxina botulínica. O objetivo dessa pesquisa foi avaliar o efeito da nifedipina tópica nas diminuições das pressões do canal anal e consequente influência na melhora da dor pós-operatória. MATERIAL E MÉTODO: Utilização da nifedipina tópica gel 0,2% (Grupo 1) e lidocaina 2% (Grupo 2) no pós operatório de hemorroidectomia aferindo as pressões no pré, primeiro, quarto e sétimo dias de pós operatório, associado de medida de dor todos os dias do pós-operatório através de tabela analógica. RESULTADOS: Os autores não encontraram diferenças em relação às pressões de canal anal mas em relação à dor referida estas foram em menor intensidade no grupo que recebeu a nifedipina. CONCLUSÕES: a nifedipina gel foi eficiente na analgesia pós-operatória, no entanto não alterou as pressões do canal anal.

INTRODUCTION: Hemorrhoids are very common and pain following their surgical treatment causes great suffering. Various alternatives have been studied for reducing postoperative pain. Among these is surgical sphincterotomy, which may in some cases cause some degree of fecal incontinence. For this reason, several studies have used chemical sphincterotomy, with nifedipine, diltiazem, glycerin trinitrate or botulinum toxin. The objective of the present study was to investigate the effects of topical nifedipine for reducing anal canal pressures and consequently reducing postoperative pain. MATERIAL AND METHOD: Topical gels of 0.2% nifedipine plus 2% lidocaine (Group 1) and 2% lidocaine alone (Group 2) were used following hemorrhoidectomy. Pressures were measured before the operation and on the first, fourth and seventh days after the operation. Pain was also evaluated on all of the first seven postoperative days using a visual analog scale. RESULTS: There were no differences in relation to anal canal pressures, but lower pain levels were reported in the group that received nifedipine. CONCLUSION: Nifedipine gel was efficient for postoperative analgesia, but did not alter anal canal pressures.

RACIONAL: Considerando que o comprometimento linfonodal é o fator determinante no estádio, prognóstico e, conseqüentemente, na indicação de terapia adjuvante em câncer de cólon, e sendo esta responsável pelo aumento significativo na sobrevida global desses pacientes, os métodos para estádio devem conferir a maior precisão possível para que todos os pacientes com doença linfonodal maligna possam se beneficiar desta terapêutica na sua sobrevida global. O estudo do linfonodo sentinela vem progressivamente sendo mais valorizado no sentido de conferir maior precisão nesse estádio, bem como no prognóstico do câncer de cólon. OBJETIVO: Identificar o linfonodo sentinela e melhor estudar o status linfonodal no câncer de cólon. PACIENTES E MÉTODOS: Foram randomizados prospectivamente 31 pacientes com câncer de cólon em dois grupos: no primeiro, o linfonodo sentinela foi identificado usando-se corante azul patente e no segundo houve adição de colóide radioativo marcado com 99mTecnécio. RESULTADOS: Pelo menos um linfonodo sentinela foi identificado em 100% dos casos. O número médio de linfonodo sentinela por paciente foi de 1,96, variando de 1 a 3. A adição do método cintigráfico transoperatório acrescentou cinco linfonodos sentinela, que não haviam sido identificados pelo corante. Em quatro casos (12,9%) apenas o linfonodo sentinela se revelou positivo para malignidade, sendo este comprometimento identificado por hematoxilina e eosina com adição de imunoistoquímica. Nesta casuística não foi identificada drenagem linfática aberrante. CONCLUSÃO: Os métodos são viáveis, seguros, complementares e acrescentam acuidade ao estádio desses tumores.

BACKGROUND AND AIM: Considering that lymph node status is a key factor in colorectal cancer staging, and the main determinant for adjuvant therapy of colorectal cancer being this therapy, responsible for a significant increase in colorectal cancer patients survival, the staging methods should be the most accurate possible in order to offer this individuals the opportunity to be adequate treated in order to achieve the best survival possible. Sentinel lymph node study is progressively being popularized as a method that increases sensibility in detect positive nodes to reveal a more accurate stage and prognosis in colorectal cancer patients. PATIENTS AND METHODS: Thirty one colorectal cancer patients were prospectively studied and sentinel lymph node was identified in 100% of the cases utilizing either patent blue alone, or in association with radiotracer based on technetium 99m colloid solution in a randomized fashion. RESULTS: The mean number of sentinel nodes per patient was 1.96 ranging from 1 to 3 nodes. With the addition of transoperative lymphocintigraphy five extra sentinel nodes, not identified by the blue dye alone, were identified and considered for histopathology study. In four cases (12.9%) the sentinel lymph node was the only site of metastasis, all of them being detected by association of hematoxylin and eosin and immunohistochemical examination. CONCLUSION: Sentinel lymph node detection and analysis is feasible, technique is relatively simple and is able to produce upstage in clorectal cancer. Blue staining and radio guided techniques are both safe and their superposition has shown good results in terms of increase accuracy in our experience. There was no aberrant lymph drainage that would alter resection margins in patients studied. Upstaging rate, identifying potential candidates for adjuvant therapy was 12.9% (4/31). To this individuals chemotherapy could be a chance to increase their global survival.

Reflux esophagitis and Barrett's esophagus after total gastrectomy is related to reconstructive procedure of intestinal continuity. The Roux-en-Y operation with length of limb of 40 cm occasionally is not enough to prevent biliary reflux to distal esophagus. Barrett's esophagus is thought to develop as a consequence of biliary reflux and has a malignant potential. Symptoms of retroesternal burning and dysphagia that does not improve with conservative management has to be treated by an operative procedure. To prevent biliary reflux to distal esophagus after total gastrectomy the lenght of limb of Roux-en-Y should be at lest 60 cm.

Com o objetivo de facilitar o aprendizado da técnica operatória, em especial na realização de nós e suturas cirúrgicas, foi desenvolvido um modelo experimental não biológico, contendo dispositivos simples que simulam diversas situações encontradas no procedimento cirúrgico fundamental