ABSTRACT Objective: to understand the psychosocial repercussions of post radiotherapy treatment for cervical cancer. Method: qualitative study, with the participation of patients in post radiotherapy treatment for cervical cancer in an onco-gynecologic nursing outpatient clinic, located in the Municipality of Rio de Janeiro - Brazil. Data were collected during the months of March and April 2019 by means of open interview and submitted to content analysis. Results: four categories were defined: the construct of social roles: the loss of female identity; the sexuality of post-treated women for cervical cancer: marital repercussions; difficulties in adapting to the new life condition: rebuilding the body image; living with cervical cancer: rethinking life and rebuilding values through the support network. Final considerations: the results contribute to the direction of care, increasing the quality of life and helping these women reorganize their professional, social, and family lives.

RESUMEN Objetivo: conocer las repercusiones psicosociales del tratamiento post-radioterapia del cáncer de cuello de útero. Método: estudio cualitativo, con la participación de pacientes en tratamiento post radioterapia para cáncer de cuello uterino en una consulta externa de enfermería oncoginecológica, ubicada en el Municipio de Río de Janeiro - Brasil. Los datos fueron recolectados durante los meses de marzo y abril de 2019 a través de una entrevista abierta y fueron sometidos a un análisis de contenido. Resultados: se definieron cuatro categorías: la construcción de los roles sociales: la pérdida de la identidad femenina; la sexualidad de las mujeres después del tratamiento del cáncer de cuello uterino: las repercusiones conyugales; las dificultades de adaptación a la nueva condición de vida: la reconstrucción de la imagen corporal; la convivencia con el cáncer de cuello uterino: el replanteamiento de la vida y la reconstrucción de los valores a través de la red de apoyo. Consideraciones finales: los resultados contribuyen a la orientación de los cuidados, aumentando la calidad de vida y ayudando a la reorganización de la vida profesional, social y familiar de estas mujeres.

RESUMO Objetivo: compreender as repercussões psicossociais do pós-tratamento radioterápico para o câncer do colo uterino. Método: estudo qualitativo, com a participação de pacientes em pós-tratamento radioterápico para o câncer do colo uterino em um ambulatório de enfermagem oncoginecológica, localizado no Município do Rio de Janeiro - Brasil. Os dados foram coletados durante os meses de março e abril de 2019 por meio de entrevista aberta e submetidos à análise de conteúdo. Resultados: definiram-se quatro categorias: o constructo de papéis sociais: a perda da identidade feminina; a sexualidade da mulher pós-tratamento para o câncer do colo uterino: repercussões conjugais; dificuldades de adaptação à nova condição de vida: reconstruindo a imagem corporal; convivendo com o câncer do colo uterino: repensando a vida e reconstruindo valores através da rede de apoio. Considerações finais: os resultados contribuem para o direcionamento do cuidado, aumentando a qualidade de vida e auxiliando a reorganização da vida profissional, social e familiar dessas mulheres.

RESUMO Antecedentes: A síndrome de Williams-Beauren é doença de acometimento multisistêmico causado pela microdeleção da região 7q11.23. Apesar de haver casos familiares com herança autossômica dominante, a grande maioria dos casos é esporádica. Objetivo: Investigar as principais queixas e achados clínicos da síndrome. Métodos: 757 pais de pacientes inscritos na Associação Brasileira de Síndrome de Williams-Beuren (ABSW) receberam um questionário pelo WhatsApp, entre março e julho de 2017. Resultados: 229 pais de pacientes responderam à pesquisa. A idade de diagnóstico variou de 2 dias até 34 anos (mediana: 3 anos). Os principais achados reportados pelos pais: cólicas abdominais (83,3%), deficiência ponderoestatural (71,5%), dificuldade de alimentação no primeiro ano (68,9%), otite (56,6%), infecções do trato urinário (31,9%), puberdade precoce (27,1%) e escoliose (15,9%). Cardiopatias estavam presentes em 66%, sendo que a mais frequente era a estenose pulmonar supravalvar (36%). Hipertensão arterial foi reportada em 23%. Hipercalcemia foi reportada em 10,5%, principalmente no primeiro ano de vida. Hiperacusia e hiperssociabilidade foram achados comuns (89%). Os principais achados comportamentais e psiquiátricos reportados pelos pais foram: déficit de atenção (89%), crises de raiva (83%), medo excessivo (66%), depressão (64%), ansiedade (67%) e hiperssexualidade (33%). As queixas principais referidas foram hipersensibilidade a sons, personalidade excessivamente amigável, dependência emocional e dificuldades escolares. Em 98,3% dos casos os pais negaram história familial. Conclusões: A síndrome de Williams-Beuren é requer um seguimento e manejo estritos, com diferentes especialidades médicas devido às comorbidades clínicas variadas, que incluem dificuldades de linguagem e aprendizagem escolar, além de dificuldades comportamentais e psiquiátricas.

ABSTRACT Background: Williams-Beuren syndrome is a multisystemic disorder caused by a microdeletion of the 7q11.23 region. Although familial cases with autosomal dominant inheritance have been reported, the vast majority are sporadic. Objective: To investigate the main complaints and clinical findings of patients with Williams-Beuren syndrome. Methods: A total of 757 parents of patients registered in the Brazilian Association of Williams-Beuren Syndrome (ABSW) received a questionnaire via WhatsApp from March to July 2017. Results: In total, 229 parents answered the survey. Age of diagnosis ranged from 2 days to 34 years (median: 3 years). The main clinical findings reported by the parents were abdominal colic (83.3%), failure to thrive (71.5%), feeding difficulty in the first year (68.9%), otitis (56.6%), urinary tract infections (31.9%), precocious puberty (27.1%) and scoliosis (15.9%). Cardiac defects were present in 66% of patients, and the most frequent defect was supravalvular aortic stenosis (36%). Arterial hypertension was reported in 23%. Hypercalcemia was reported in 10.5% of patients, mainly during the first year of life. Hyperacusis and hypersociability were common complaints (both present in 89%). Other behavioral and neuropsychiatric symptoms reported by the parents included attention deficit (89%), anger crises (83%), excessive fear (66%), depression (64%), anxiety (67%) and hypersexuality (33%). The most common complaints were hypersensitivity to sounds, talkative personality, emotional dependence and learning difficulties. In 98.3%, the parents denied family history. Conclusions: Williams-Beuren syndrome requires close follow-up with different medical specialties due to their variable clinical comorbidities, including language and school learning difficulties, behavioral and psychiatric problems.

Abstract Objective: To determine if there are differences in protein profiles in saliva depending if children of caries-free versus caries affected. Material and Methods: A cohort of 91 children with ages between 6 and 19 years, along clinical status of caries experience. Protein profiles in saliva were determined using electrophoresis and the calculation of the percentage of a specific band at a specific molecular weight in relationship to the total protein in that sample (% of total) using molecular weight standards. This quantification was repeated for each protein band across a range of molecular weights for each sample. Chi-square, Fisher’s exact, and Student t-tests were used to compare the distributions between caries-free and caries affected children (α=0.05). Results: Histatin was more likely to be non-detectable or reduced in caries-free children (OR=7.56; 95% CI 1.62-35.13) and these children had on average one less gel band detected by the assay we used. Conclusion: We have found differences in proteins between caries affected and caries-free children, suggesting that this line of investigation holds the promise of providing new tools for caries management.

Introduction: We report the case of a patient who received radiotherapy in childhood for retinoblastoma. The main sequelae of this was, severe bone hemifacial hypoplasia, abnormal dentition, and muscle atrophy. Corrective facial surgery was performed through bone distraction, orthognathic surgery, and facial liposuction, with excellent and stable aesthetic and functional results to date. Case: report A 15 year-old patient with left temporo-parieto-frontal and orbital hypoplasia and midface hypoplasia with an inclined occlusal plane, overjet more than 25 mm and multiple teeth with microdontia and rhizolysis. At 19 years old, presurgical orthodontics and placement of Zurich type maxillar distractors were started. An advancing of 25 mm was achieved. At 21years old, bimaxillary orthognathic surgery and facial liposuction was performed. Results: Patient improvement in facial symmetry, occlusion type I of Angle classification with inclined occlusal plane. Stable results to date on a 23 year-old patient. Continues with post-surgical orthodontic and dental rehabilitation. Discussion: Good bone consolidation was obtained, with excellent bone quality from a clinical and radiological point of view, with no complications. Another benefit is the distraction expanding effect of the soft tissue. Osteogenesis distraction and bimaxillary orthognathic surgery are promising methods in maxillofacial reconstruction on irradiated patients with dentofacial deformity as oncology sequelae.

Introducción: Presentamos a un paciente que recibió tratamiento radioterápico en la infancia por un retinoblastoma. Como principal secuela presenta una severa hipoplasia ósea hemifacial, alteración de la dentición y atrofia muscular. Se realiza cirugía correctora facial mediante distracción ósea, cirugía ortognática y lipoescultura facial con un resultado estético y funcional excelente y estable hasta el momento actual. Caso clínico: Varón de 15 años con hipoplasia témporo-parieto-frontal, orbitaria izquierda y del tercio medio facial con un plano oclusal inclinado, resalte de más de 25 mm y múltiples piezas dentales con microdoncia y rizólisis. A los 19 años, inicia ortodoncia prequirúrgica y la colocación de distractores tipo Zurich en el maxilar superior. Se consigue un avance maxilar de 25 mm. A los 21 años se realiza cirugía ortognática bimaxilar y lipoescultura facial. Resultados: Paciente con mejoría de la simetría facial, oclusión en clase I con plano oclusal alineado. Resultados estables hasta el momento actual, con 23 años. Continúa con ortodoncia posquirúrgica y rehabilitación dental. Discusión: Se obtuvo una buena consolidación, con una calidad ósea excelente desde el punto de vista clínico y radiológico, sin presentar complicaciones. Otro beneficio de la distracción es el efecto expansor de los tejidos blandos. La distracción ósea y la cirugía ortognática bimaxilar son métodos prometedores en la reconstrucción del territorio maxilofacial en pacientes radiados con una deformidad dentofacial como secuela oncológica.

Nodular fasciitis (NF) is a benign proliferation of fibroblast tissue of unknown etiology. It has clinical and histopathological characteristics similar to sarcomas, and is unusual in the maxillofacial area. The usual clinical presentation is a hard consistency, painless and fast growing mass of a hard consistency. Diagnosis is made by a biopsy and histopathology. NF treatment is complete surgical excision of the tumor. The differential diagnosis is essential for the high potential of confusion with sarcomatous lesions, due to the similarity of their clinical and histopathological features. The second case of nodular fasciitis in the frontal region to be reported in the literature is presented, a 43 year-old male, with no previous trauma in the region. Biopsy-excision of the mass was performed and the histological study gave the diagnosis of nodular fasciitis. The patient had no evidence of tumor recurrence and excellent aesthetic results were obtained.

La fascitis nodular es una entidad excepcional en el territorio maxilofacial, consiste en una proliferación benigna del tejido fibroblástico, de etiología desconocida y con características clínicas e histopatológicas similares a los sarcomas. La clínica habitual consiste en una masa de consistencia dura, indolora y de rápido crecimiento. Su diagnóstico se realiza mediante una biopsia y un estudio histopatológico. El tratamiento consiste en la exéresis quirúrgica completa de la lesión. El diagnóstico diferencial es esencial dado el alto potencial de confusión diagnóstica con lesiones sarcomatosas debido a la similitud de sus características clínicas e histopatológicas. Se presenta el segundo caso clínico en la literatura de fascitis nodular en la región frontal, un varón de 43 años de edad, sin sufrir traumatismo previo en dicha localización. Se procedió a la biopsia-exéresis de la lesión con el diagnóstico histológico de fascitis nodular. Sin evidencia de recurrencia del tumor y un resultado estético excelente.

Low-grade myofibroblastic sarcoma (LGMS) represents an atypical tumor composed of myofibroblasts with a predilection for the head and neck, especially in the tongue and oral cavity, with a high tendency to local recurrences and metastases, even after a long period. LGMS arising in the maxillary sinus and in the neck are extremely uncommon. To the best of our knowledge, only 50 cases of low-grade myofibroblastic sarcoma have been reported. We report two cases of LGMS of the maxillary sinus and neck, discussing clinical, histological, inmunohistochemical and therapeutic features.

El sarcoma miofibroblástico de bajo grado (SMFBG) representa un tumor atípico, formado por miofibroblastos, que tiene predilección por cabeza y cuello, en especial la lengua y la cavidad oral, y se caracteriza por una elevada tendencia a las recidivas locales y a las metástasis, incluso después de transcurrido un período prolongado. Los SMFBG que se originan en el seno maxilar y en el cuello son excepcionales. Hasta lo que conocen los autores, solo se han publicado 50 casos de sarcoma miofibroblástico de bajo grado. Describimos 2 casos en los que se identificaron estos tumores, uno en el seno maxilar y el otro en el cuello, y abordamos sus características clínicas, histológicas, inmunohistoquímicas y terapéuticas.

Recurrent sub-maxillary gland disorders are relatively common. They are mainly caused by obstructive gland diseases. Other aetiologies are malignancies, autoimmune, or degenerative diseases. The traditional treatment of the submandibular gland is the surgical excision by a cervical approach. The advantages of this approach are: its simplicity, direct surgical vision, and speed of the procedure. The most important disadvantages are: unsightly cervical scar, and injury risk of the marginal branch of the facial nerve. This paper presents and discusses the intraoral approach to the submandibular gland. The advantages over the conventional approach are: the elimination of the scar and the risk of injury to the marginal branch. The main disadvantages are: the technical difficulty, reduced vision, the longer surgical time, and the possibility of lingual nerve injury. A total of 6 patients, 4 women and 2 men aged 25 to 60 years, underwent a sub-maxillectomy by intraoral approach in the Hospital Universitario de Canarias (Tenerife, Spain). In all cases, the aesthetic and functional results were very satisfactory, with only mild self-limited lingual nerve dysesthesia being observed at two months. We present an alternative to the cervical approach for the submandibular glands; the intraoral approach. The major advantage of this technique is to eliminate the cervical scar.

Las alteraciones recurrentes de las glándulas submaxilares son unos trastornos relativamente frecuentes que se deben, generalmente, a una enfermedad obstructiva de la glándula, entre otras menos frecuentes, como la presencia de neoplasias, enfermedades autoinmunes o degenerativas. El tratamiento quirúrgico habitual consiste en la exéresis de la glándula submaxilar a través de un abordaje cervical. Las ventajas de este abordaje cervical son su sencillez, la visión directa del campo quirúrgico y la rapidez del procedimiento. Las desventajas más relevantes son la cicatriz cervical y la posibilidad de lesión de la rama marginal del nervio facial. Se presenta y discute el abordaje intraoral como acceso a la glándula submaxilar. Su ventaja respecto al abordaje convencional es la eliminación de la cicatriz cervical y el riesgo de lesión de la rama marginal. Sus desventajas fundamentales son la dificultad técnica, la visión reducida, el mayor tiempo quirúrgico empleado y la posibilidad de lesión del nervio lingual. En el Hospital Universitario de Canarias (Tenerife, España), a un total de 6 pacientes, 4 mujeres y 2 varones entre 25 y 60 años, se les realizó una submaxilectomía por abordaje intraoral. En todos los casos los resultados estéticos y funcionales fueron muy satisfactorios, tan solo leves disestesias del nervio lingual autolimitadas en 2 meses. Se presenta una alternativa por vía intraoral al abordaje cervical para la realización de submaxilectomía, con la ventaja principal de eliminar la cicatriz cervical.

Introduction: Microsurgical reconstruction of craniofacial mucocutaneous defects have been performed for many years using well-known techniques, that are mainly based on flaps from the radial forearm, the anterolateral thigh and lateral arm, among others. We present the medial sural artery perforator flap, a new vascularized fasciocutaneous flap for head and neck reconstruction. Material and methods: We present four patients with oral squamous cell carcinoma. A medial sural artery flap was performed for the oral reconstruction after tumour ablation surgery. Results: The medial sural flap showed excellent adaptability and adequate viability in all cases, with good functional and aesthetic results and low donor site morbidity. Conclusion: We present a new reconstructive technique in head and neck defects.

Introducción: La reconstrucción microquirúrgica de defectos mucocutáneos craneofaciales se realiza con técnicas descritas desde hace muchos años y se basan fundamentalmente en el colgajo radial, el anterolateral de muslo y el lateral de brazo, entre otros. Se presenta un nuevo colgajo microvascularizado fasciocutáneo para la reconstrucción de defectos en el territorio de cabeza y cuello, el colgajo de perforantes dependiente de la arteria sural medial. Material y métodos: Se presentan 4 pacientes con carcinoma epidermoide de cavidad oral, donde se realizaron 4 colgajos dependientes de la arteria sural medial para la reconstrucción de sus defectos tras la cirugía ablativa de la lesión tumoral. Resultados: El colgajo sural medial presentó una excelente adaptabilidad y una adecuada viabilidad en todos los casos, con unos buenos resultados funcionales, estéticos y con escasa morbilidad de la zona donante. Conclusión: Se presenta una nueva técnica reconstructiva en defectos de cabeza y cuello.

Dry fecal matter production was estimated from neutral detergent indicators on indigestible fiber, indigestible acid detergent fiber, indigestible dry matter, incubated for 144 hours and 288 hours, as well as chromium oxide (Cr2O3) and enriched and purified isolated lignin (LIPE®) in two sampling schemes (3 and 5 days) on buffaloes. Sample consisted of five castrated animals with average weight of 300 ± 0.6 kg fed on elephant grass cv Cameroon (Pennisetum purpureum). Experimental design consisted of randomized blocks in subdivided plots. Production of dry fecal matter was overestimated when using Cr2O3, indigestible acid detergent fiber 144 hours, indigestible neutral detergent fiber 144 hours, indigestible neutral detergent fiber 288 hours and indigestible dry matter 144 hours, while indigestible acid detergent fiber 288 hours, indigestible dry matter 288 hours and LIPE® did not differ from total collection. The same result was observed for apparent digestibility of nutrients. There was no difference in dry fecal matter production and digestibility between both collection periods of 3 and 5 days, demonstrating that a collection period of three days can be used to estimate dry fecal matter production in buffaloes. A three-day period of sample collection, in order to estimate dry fecal matter production and apparent digestibility coefficients, is therefore recommended. The use of LIPE®, fibers in indigestible acid detergent and indigestible dry matter as indicators, both latter incubated for 288 hours, result in accurate estimates of dry fecal matter production in confined buffaloes, fed on a forage based diet.

Para avaliação do consumo e da digestibilidade aparente dos nutrientes de dietas contendo diferentes níveis (0; 12,0; 25,0; 38,0 e 51,0%) de palma forrageira (Opuntia ficus indica Mill) em substituição total ao milho (Zea mays L.) e parcial ao feno de capim-tifton (Cynodon spp), foram utilizadas cinco vacas da raça Holandesa, distribuídas em quadrado latino 5 × 5. No início do experimento, os animais apresentavam 583 ± 7,07 kg de peso corporal (PC) e período de lactação em torno de 110 dias. Cada período experimental teve duração de 17 dias, dez dias para adaptação dos animais à dieta e sete dias para coleta de dados. O consumo de MS (kg/dia, %PC e g/kg0,75) e os consumos de MO, EE, PB, carboidratos totais (CT), FDN, FDA e NDT (kg/dia) diminuíram linearmente conforme aumentaram os níveis de palma forrageira na dieta. O consumo de CNF, no entanto, aumentou com a inclusão de palma forrageira na dieta. Os coeficientes de digestibilidade aparente de MS, MO, EE, PB, CT e CNF não foram influenciados pela inclusão de palma forrageira na dieta. Entretanto, o coeficiente de digestibilidade aparente da FDN reduziu linearmente com a inclusão de palma forrageira na dieta. A inclusão da palma forrageira nas dietas influenciou negativamente no consumo dos nutrientes e no coeficiente de digestibilidade da FDN.

The experiment was conducted to evaluate the intake and apparent digestibility of the nutrients in diets containing different levels (0, 12.0, 25.0, 38.0, and 51.0%) of forage cactus (Opuntia ficus indica Mill) in total replacement of corn (Zea mays L.) and partial of Tifton hay (Cynodon spp). Five Holstein cows were assigned to a 5x5 latin square. The animals showed an average of 583 ± 7,07 kg BW and lactation period around 110 days. Each experimental period lasted 17 days, 10 days for the adaptation of the animals to the diet and 7 days for data collecting. The DM intake (kg/day, %BW and g/kg0.75), and the intakes of OM, EE, CP, total carbohydrate (TC), NDF, ADF and TDN (kg/day) decreased linearly as forage cactus increased in the diet. However, NFC intake increased with the inclusion of forage cactus in the diet. Apparent digestibilities of DM,OM, EE, CP, TC and NFC were not influenced by the inclusion of the forage cactus in the diet. Nevertheless, NDF apparent digestibility showed a linear decrease as forage cactus increased in the diet. The inclusion of forage cactus in diets showed negative effect on the nutrient intake and the NDF apparent digestibility.

O experimento foi conduzido com o objetivo de avaliar a influência de dietas com teores crescentes de palma forrageira sobre a produção, a composição do leite e o perfil dos ácidos graxos do leite de vacas holandesas em lactação. Os animais (583 ± 7,07 kg) foram alimentados com dietas formuladas com diferentes níveis (0; 12,0; 25,0; 38,0 e 51,0%) de palma forrageira (Opuntia fícus indica Mill) em substituição total ao milho (Zea mays L.) e em substituição parcial ao feno de capim-tifton (Cynodon spp). Foram utilizadas cinco vacas distribuídas em um quadrado latino 5 x 5. Cada período experimental teve duração de 17 dias, dez para adaptação dos animais à dieta e sete para coleta de dados. A produção de leite, total (kg/dia) e corrigida para 3,5% de gordura (kg/dia), o teor de gordura (%) e a produção de gordura (kg/dia) do leite (20,65; 19,76; 3,73 e 0,745, respectivamente) não foram influenciados pela introdução de palma nas dietas. O perfil de ácidos graxos da gordura do leite não foi influenciado (quanto aos ácidos cáprico, láurico, mirístico, linoléico, linolênico e araquídico) pelos níveis de palma na dieta, entretanto, houve aumento linear dos ácidos de cadeia intermediária (palmítico e palmitoléico) e tendência inversa para os ácidos esteárico e oléico. A inclusão de palma forrageira em substituição ao milho e parte do feno de capim-tifton para vacas holandesas em lactação não influenciou a produção e a composição do leite, exceto a concentração dos ácidos graxos de cadeia longa, que apresentou comportamento linear decrescente.

The objective of this trial was to evaluate the effect of replacing Tifton hay and corn with forage cactus (Opuntia ficus indica Mill ) on milk production and composition and milk fatty acid profile in lactating Holstein cows. Animals averaged 583 ± 7.07 kg of body weight in the beginning of the trial and were fed diets containing (% of DM): 0, 12.0, 25.0, 38.0 or 51.0% of forage cactus. Five Holstein cows were randomly assigned to treatments in a 5 x 5 Latin square design. Each experimental period lasted 17 days with 10 days for diet adaptation and seven days for data and sample collection. Milk production, 3.5% fat corrected milk, and milk fat content and yield were not affected by increasing the levels of forage cactus in the diet and averaged 20.65 kg/d, 19.76 kg/d, 3.73% and 0.745 kg/d, respectively. Milk contents of capric, lauric, mirystic, linoleic, linolenic e arachydic acids were not changed when the levels of forage cactus were increased in the diet. However, milk contents of the medium-chain fatty acids palmytic and palmitoleic reduced linearly while the opposite was observed for the long-chain fatty acids estearic and oleic. Although milk production and composition were not affected by replacing corn and Tifton hay with forage cactus, significant changes were found in the milk profile of medium and long-chain fatty acids by increasing the proportion of forage cactus in the diet.

O experimento foi conduzido com os objetivos de estimar a produção e a eficiência de síntese de proteína microbiana utilizando-se a excreção total de derivados de purinas (DP) e avaliar as concentrações de uréia na urina, de uréia e N-uréia no plasma e no leite de vacas holandesas em lactação alimentadas com dietas formuladas com diferentes níveis (0; 12,0; 25,0; 38,0 e 51,0%) de palma forrageira (Opuntia ficus indica Mill) em substituição total ao milho (Zea mays L.) e parcial ao feno de capim-tifton (Cynodon spp). Foram utilizadas cinco vacas holandesas distribuídas em um quadrado latino 5 x 5. Cada período experimental teve duração de 17 dias, dez para adaptação dos animais à dieta e sete para coleta de dados. O volume urinário foi estimado em amostras spot de urina obtidas 4 horas após a alimentação. O volume urinário (27,62 L), a excreção urinária de ácido úrico (35,78 mmol/dia), alantoína na urina (288,42 mmol/dia), alantoína no leite (18,11 mmol/dia) e alantoína total (306,54 mmol/dia), a excreção de derivados de purina total (342,33 mmol/dia) e de purinas absorvidas (350,03 mmol/dia), a síntese de proteína microbiana (1.376,07g/dia) e a eficiência da síntese de proteína microbiana (115,38 g/kgNDTconsumido) não foram afetados pela substituição do milho e do feno de tifton por palma na dieta. A excreção de uréia na urina (mg/kg PV) e as concentrações de uréia e N-uréia no plasma (mg/dL) decresceram de forma linear, enquanto a excreção e as concentrações de uréia e N-uréia no leite e de glicose plasmática não foram influenciadas pelos níveis de palma na dieta. O milho pode ser substituído integralmente e o feno, parcialmente, por palma forrageira em dietas para vacas holandesas em lactação, pois a substituição não afetou a produção de proteína microbiana ou as perdas do nitrogênio dietético pela excreção de uréia.

The objective of this trial was to evaluate the effect of replacing Tifton hay and corn with forage cactus (Opuntia ficus indica Mill ) on microbial protein synthesis and efficiency and N metabolism in lactating Holstein cows. Diets contained (% of DM): 0, 12.0, 25.0, 38.0, or 51.0%) of forage cactus. Five Holstein cows were randomly assigned to treatments in a 5 x 5 Latin square design. Each experimental period lasted 17 days with 10 days for diet adaptation and seven days for data and sample collection. Urinary volume was estimated based on creatinine excretion in spot urine samples obtained four hours after feeding. Urinary volume (27.62 L), urinary excretion of uric acid (35.78 mmol/day) and allantoin (288.42 mmol/day), allantoin in milk (18.11 mmol/day), total allantoin (306.54 mmol/day), total excretion of purine derivatives (342.33 mmol/day), absorbed purines (350.03 mmol/day), microbial protein synthesis (1376.07g/day) and efficiency (115.38 g/kgNDT) were not affected by increasing the levels of forage cactus in the diet. The urinary excretion of urea (mg/kg BW) and the concentrations of urea and urea-N in plasma (mg/dL) decreased linearly while the concentrations of urea and urea-N in milk were not affected when the levels of forage cactus were increased in the diet. Corn can be completely replaced with forage cactus because microbial protein synthesis was not changed and urinary excretion of urea decreased linearly. However, Tifton hay was necessary in the diet to maintain microbial production.

OBJETIVO: Avaliar a eficiência da nutrição parenteral administrada a pacientes oncológicos pediátricos quanto à oferta de energia, indicações e principais dificuldades no procedimento. MÉTODOS: Estudo observacional descritivo, realizado entre julho de 2003 e julho de 2004 no Instituto de Oncologia Pediátrica da Universidade Federal de São Paulo. Critérios de inclusão: pacientes com câncer recebendo nutrição parenteral nas unidades de internação. A análise da adequação energética foi efetuada usando-se equações preditivas para o cálculo do gasto energético basal ajustado para a progressão inicial. RESULTADOS: Foram 41 episódios de nutrição parenteral de, 1.016, internações (4%): 54% do sexo masculino, com mediana de uso de 10 dias (1-51). Demonstrou-se que em 56% dos episódios não se atingiu o gasto energético basal ajustado; 26% ficaram entre 100% e 120% e 18% acima de 120%. A média do gasto energético basal ajustado foi 106%, com desvio-padrão de 38% e a mediana 96%. Os motivos associados às dificuldades para atingir o gasto energético basal foram intolerância metabólica, via de nutrição parenteral não exclusiva, suspensão ou interrupção da sua administração, prescrição sem discussão com nutricionista e uso de via periférica. A principal indicação foi por toxicidade gastrintestinal. O volume desprezado de nutrição parenteral demonstrou-se superior a 10% em 17 de 35 episódios (49%). Proteção contra luz ambiente (capa), avaliada em 19 pacientes durante os dias da administração, detectou ausência em 37 de 315 dias (12%). CONCLUSÃO: A oferta de energia não contemplou as necessidades de alta porcentagem de pacientes, principalmente devido à gravidade do quadro clínico, às interrupções e ao uso de via não exclusiva, reduzindo o período disponível para administração da nutrição. A eficiência dos procedimentos por atuação de equipe multidisciplinar poderia reduzir o prejuízo, garantindo uma oferta mais adequada, aumentando os benefícios da nutrição parenteral.

OBJECTIVE: The objective of this study was to evaluate parenteral nutrition efficiency in supplying energy for pediatric oncology patients, indications and main difficulties in the procedure. METHODS: This was an observational descriptive study done from July 2003 to July 2004 at the Pediatric Oncology Institute of the Universidade Federal de São Paulo. Inclusion criteria: hospitalized cancer patients receiving parenteral. Energy adequateness was analyzed by equations that calculated basal energy expenditure adjusted for initial progression. RESULTS: Forty-one (4%) of the 1016 hospitalized patients received parenteral nutrition: 54% were males and received parenteral nutrition for a median of 10 days (1-51). Fifty-six percent of the episodes did not reach the adjusted basal energy expenditure; 26% remained between 100 and 120% and 18% were above 120%. The mean adjusted basal energy expenditure was 106% with a standard deviation of 38% and a median of 96%. The reasons associated with difficulties to achieve the basal energy expenditure were metabolic intolerance, non-exclusive parenteral nutrition, suspension or interruption of its use, prescription without discussing with nutritionist and use of peripheral route. Parenteral nutrition was mainly indicated in gastrointestinal toxicity. The discarded volume of parenteral nutrition was above 10% in 17 of 35 episodes (49%). Protection from room light (cover) assessed in 19 patients during the days of administration detected an absence of 37 of 315 days (12%). CONCLUSION: Energy supply did not meet the demands of a high percentage of the patients, mainly because of the severity of the clinical scenario, interruptions and non-exclusive use, reducing the amount of time available to administer the nutrition. A multidisciplinary team which would improve the efficiency of the procedures could reduce the losses, guaranteeing a more adequate supply and increasing the benefits of parenteral nutrition.

O objetivo deste estudo foi avaliar a evolução do perfil metabólico-nutricional de crianças e adolescentes com câncer que realizaram transplante de medula óssea. Dezoito pacientes submetidos a transplante de medula óssea foram avaliados prospectivamente de outubro de 2003 a agosto de 2004. A avaliação foi realizada por meio da análise bioquímica de sangue para albumina, lipídeos e glicose em três momentos: antes da infusão da medula óssea, após sete dias e após catorze dias do transplante de medula óssea. O teste de Friedman foi aplicado para comparar as distribuições nos períodos e o teste de Mann'Whitney para comparar as diferenças na evolução entre os grupos de transplante de medula óssea autólogo versus alogênico. Quinze dos dezoito pacientes foram elegíveis: sete portadores de leucemia, quatro de linfomas e quatro de tumores de células germinativas. Os quinze pacientes apresentaram em média 10,7±7,1 anos. Nove realizaram transplante de medula óssea autólogo e seis alogênico aparentado; dois utilizaram ciclosporina A como imunossupressor e três receberam irradiação corporal total como parte da terapia de condicionamento. Treze de quinze usaram nutrição parenteral. A média de internação foi 33±14 dias. As prevalências nos déficits de albumina e HDL-C aumentaram progressivamente durante o acompanhamento: 15%, 31% e 46% e 54%, 69% e 85%, respectivamente. O mesmo ocorreu com os níveis de glicose e triglicérides, com aumento progressivo nas prevalências de anormalidades no decorrer do transplante de medula óssea, que foram de 7%, 43% e 50% e de 31%, 69% e 77%, respectivamente. Níveis de colesterol total e de LDL-C acima do normal foram observados somente em um paciente no primeiro momento (antes da infusão da medula óssea). A análise da evolução das variáveis no decorrer dos três períodos demonstrou que os níveis de HDL-C, glicemia e triglicérides se modificaram significantemente. Quando se compararam pacientes que realizaram transplante de medula óssea alogênico versus autólogo, não foi possível detectar diferença estatisticamente significante. Porém os níveis de HDL-C e de triglicérides apresentaram alterações mais acentuadas nos pacientes que realizaram transplante de medula óssea alogênico. Os resultados sugerem que alterações metabólicas e bioquímicas ocorrem durante o período do transplante. Tais alterações, possivelmente, são multifatoriais, podendo estar associadas com o déficit nutricional, catabolismo protéico e distúrbios no metabolismo energético. Provavelmente, a desnutrição, o uso de nutrição parenteral, bem como a resposta inflamatória e as toxicidades dos medicamentos estejam implicadas como fatores causais desses distúrbios.

The objective was to evaluate the nutritional metabolic profiles in children and adolescents with cancer undergoing bone marrow transplants. Eighteen bone marrow transplantation patients were prospectively evaluated from October 2003 to August 2004. The assessment was based on the biochemical blood analyses of albumin, lipids and glucose at 3 different moments: before the bone marrow transplant, 7 days after the bone marrow transplant and 14 days after the bone marrow transplant. The Friedman test was performed to compare the distributions between the periods and the Mann' Whitney test to compare differences in the evolution between the bone marrow transplant groups: autologous versus allogeneic. Fifteen of the 18 patients were eligible: seven had leukemia, four lymphoma and four germ cell tumors. The mean age of the 15 patients was 10.7±7.1 years. Nine received autologous and six allogeneic-related bone marrow transplants; two used cyclosporin A as an immunosuppressor and three total body irradiation as part of the conditioning regimen. Thirteen of the 15 received parenteral nutrition. The length of stay was 33±14 days. The prevalence of albumin and HDL-C deficits increased progressively during follow up: 15%, 31% and 46% and 54%, 69% and 85%, respectively. The same result was observed with the glucose and triglyceride levels, showing a progressive increase in the prevalence of abnormalities during bone marrow transplantation, with values of 7%, 43% and 50% and 31%, 69% and 77%, respectively. Total cholesterol and LDL-C levels above the normal were only observed in one patient at the first moment (before the bone marrow transplant). The analysis of the evolution of the variables during the three periods demonstrated that the HDL-C, glucose and triglyceride levels changed significantly. No statistically significant differences were observed when comparing patients submitted to allogeneic and autologous bone marrow transplants. However, changes in the HDL-C and triglyceride levels were more accentuated in patients submitted to allogeneic bone marrow transplants. The results suggested that metabolic and biochemical changes occur during the period of bone marrow transplantation. These changes are probably multi-factorial, being associated with nutritional deficits, protein catabolism and disturbances in the energy metabolism. It is probable that malnutrition, the use of parenteral nutrition, as well as the inflammatory response to and toxicity of the drugs applied are implicated as causal factors of these abnormalities.

There has been marked interest in recent years in the use of plants for the treatment of diabetes. Plants have been found in many countries which have been indicated as having hypoglycemic activity. The present work is an up-to-date review with 178 references of crude plant extracts and chemically defined molecules with hypoglycemic activity from South, Central and North America. The review refers to 224 plants with their families, parts used and type of extract, organism tested and activity. It also includes 40 compounds isolated from those plants. Some aspects of recent research with natural products from plants directed to the treatment of diabetes are discussed.