Laparoscopic left lateral segmentectomy for metachronic metastases of small intestine adenocarcinoma: a case report

Hepatectomy has been the standard treatment for metachronic metastases of non-colorectal (NCR) origin, mainly when the disease-free interval is more than two years. Laparoscopic hepatectomy has become the golden standard mainly for left side resections, due to lower morbidity, shorter hospital stay, early recovery and good cosmetic outcome. The authors report the case of a female patient with two metachronic metastases (ten years of disease-free survival), of non-colorectal origin (adenocarcinoma of small intestine), treated by laparoscopic left lateral segmentectomy (left hepatic lobectomy) with success. The postoperative progress was satisfactory. To date, the patient has presented no tumoral recurrence (six months of follow-up period). Laparoscopic left lateral segmentectomy can be satisfactorily performed in selected cases of hepatic metastasis. This approach presents low morbidity and good cosmetic result. The lack of alternative treatments and the poor prognosis of untreated cases have justified surgical resection in order to increase overall survival. Nevertheless, this approach should be performed by hepatic surgery expertise teams trained on advanced laparoscopic procedures.A hepatectomia tem sido o tratamento padrão para metástase de origem não colorretal (NCR) metacrônica, principalmente quando o intervalo livre de doença é maior do que dois anos. A hepatectomia por laparoscopia tem se tornado padrão principalmente para as ressecções à esquerda, haja vista a menor morbidade, menor tempo de internação, reabilitação precoce e melhor resultado estético. Os autores relatam um caso de paciente com duas metástases metacrônicas (10 anos de sobrevida livre de doença), de etiologia não colorretal (adenocarcinoma de intestino delgado), tratada com segmentectomia lateral esquerda (lobectomia hepática esquerda) laparoscópica. Paciente apresentou boa evolução pós-operatória sem recidiva (seis meses de seguimento). Segmentectomia lateral esquerda laparoscópica pode ser satisfatoriamente realizada em casos selecionados de metástases hepáticas, acarretando menor morbidade e melhor resultado estético. A falta de tratamentos alternativos e o prognóstico reservado nos casos de metástases NCR não operadas justificam a ressecção com o objetivo de prolongar a sobrevida. No entanto, essa abordagem deve ser realizada por equipe especializada em cirurgia hepática com treinamento em procedimentos laparoscópicos avançados.Universidade Federal de São Paulo (UNIFESP)Hospital Santa LuciaUniversidade de Brasília (UNB)Hospital de Base do Distrito FederalUniversidade de Brasilia (UNB)UNIFESPSciEL

Solubility and dissolution studies of tibolone polymorphs

Different solid forms of an active pharmaceutical ingredient can have distinct chemical and physical characteristics. In this work, we studied the solubility and dissolution properties of the described tibolone polymorphic forms (I and II). Both forms were successively recrystallized and characterized by powder X-ray diffraction and attenuated total reflection infrared spectroscopy. Equilibrium solubility and dissolution profiles were performed for both forms. Solubility studies demonstrated that form II is statistically more soluble in water, 0.01 mol L-1 HCl and pH 4.5 acetate buffer. The solubility of forms I and II were explained in terms of crystal packing. Dissolution tests of tablets showed a lower release of polymorphic form II than form I from tablets. The results showed an impact of polymorphism on the quality of tibolone tablets and suggest that tibolone forms I and II can show distinct interactions with pharmaceutical excipients used in tablets. Therefore, only form I is acceptable for the preparation of tablet forms. Based on our results, we propose the quality control on tibolone raw materials using X-ray diffraction analysis and attenuated total reflection infrared spectroscopy

Successful surgical management of an extrahepatic biliary cystadenocarcinoma

Extrahepatic bile duct cancer is an uncommon disease, and few cases are curable by surgery. We report a case of extrahepatic biliary cystadenocarcinoma (BCAC) associated with atrophy of the left hepatic lobe. A 54-year old male was admitted with painless obstructive jaundice and a hepatic palpable mass noticed one month before presentation. Liver functions tests were consistent with cholestatic damage and serum carbohydrate antigen 19.9 (CA 19-9) was increased before treatment. Magnetic resonance imaging (MRI) disclosed dilatation of the left hepatic bile duct with irregular wall thickening close to the hepatic confluence, and atrophy of left hepatic lobe. The patient was submitted to en bloc extended left hepatectomy with resection of caudate lobe, hilar lymphadenectomy, and suprapancreatic biliary tree resection. All surgical margins were grossly negative, and postoperative course was uneventful, except for a minor bile leak. The patient was discharged on the 15th postoperative day; he is alive without tumor recurrence one year after primary therapy. Although technically challenging, extended en bloc resection is feasible in adults with extrahepatic BCAC and can improve survival with acceptable and manageable morbidity

Analysis of spironolactone polymorphs in active pharmaceutical ingredients and their effect on tablet dissolution profiles

Spironolactone (SPR) is a steroidal drug administered as a potassium-sparing diuretic for high blood pressure treatment. The drug shows incomplete gastrointestinal absorption due to its poor aqueous solubility. The physicochemical properties of SPR in crystal forms I and II suggest that differences in their aqueous solubility may lead to a lack of bioequivalence between solid-state formulations. In this study, SPR polymorphs in five batches of active pharmaceutical ingredients (APIs) from three manufacturers were characterized using powder X-ray diffraction, infrared spectroscopy, thermal analysis, and solubility measurements. SPR tablets (50 mg) were manufactured in our laboratory using API in pure form II, and API in form II contaminated with form I, which was found in a commercial batch. Physicochemical quality evaluations of the manufactured tablets, along with five SPR tablets marketed in Brazil, were performed, and results indicated differences in their dissolution profiles. In the manufactured tablets, differences were associated with the increased solubility of API in form II contaminated with form I compared to API in pure form II. In the marketed SPR tablets, the formulation composition demonstrated an important role in the dissolution rate of the drug, leading to lack of pharmaceutical equivalence among the drug products

Polymorphism: an evaluation of the potential risk to the quality of drug products from the Farmácia Popular Rede Própria

O polimorfismo em sólidos é um fenômeno frequente em fármacos e pode levar a problemas na qualidade dos medicamentos por alterar suas propriedades físico-químicas, em especial a solubilidade e, consequentemente, a biodisponibilidade. Nesse trabalho realizou-se levantamento bibliográfico sobre os principais estudos e problemas relacionados ao polimorfismo em fármacos presentes nos medicamentos disponibilizados pela Farmácia Popular do Brasil. O polimorfismo deve ser controlado a fim de evitar possível ineficácia terapêutica e/ou dosagem inapropriada dos medicamentos. Destacamos que são poucos os ensaios obrigatórios para identificação e controle desse fenômeno em medicamentos, o que pode acarretar grande problema de saúde pública.Polymorphism in solids is a common phenomenon in drugs, which can lead to compromised quality due to changes in their physicochemical properties, particularly solubility, and, therefore, reduce bioavailability. Herein, a bibliographic survey was performed based on key issues and studies related to polymorphism in active pharmaceutical ingredient (APIs) present in medications from the Farmácia Popular Rede Própria. Polymorphism must be controlled to prevent possible ineffective therapy and/or improper dosage. Few mandatory tests for the identification and control of polymorphism in medications are currently available, which can result in serious public health concerns

Estabelecimento de condições para ensaio de dissolução de cápsulas de cinarizina empregando planejamento fatorial

This work describes the establishment of dissolution test conditions for 75 mg cinnarizine capsules using a multivariate approach. A 2³ full factorial design was carried out to achieve the best conditions and HCl 0.1 mol L-1 as dissolution medium, basket as apparatus at 100 rpm and collect time at 30 min were considered adequate. The quantification was carried out by spectrophotometry at 251 nm. Both dissolution procedure and analytical method were validated and all parameters were within the acceptable limits. Since there is no official monograph for this pharmaceutical product, this dissolution test could be applied for quality control routine

Preliminary biocompatibility investigation of magnetic albumin nanosphere designed as a potential versatile drug delivery system

Background: The magnetic albumin nanosphere (MAN), encapsulating maghemite nanoparticles, was designed as a magnetic drug delivery system (MDDS) able to perform a variety of biomedical applications. It is noteworthy that MAN was efficient in treating Ehrlich’s tumors by the magnetohyperthermia procedure. Methods and materials: In this study, several nanotoxicity tests were systematically carried out in mice from 30 minutes until 30 days after MAN injection to investigate their biocompatibility status. Cytometry analysis, viability tests, micronucleus assay, and histological analysis were performed. Results: Cytometry analysis and viability tests revealed MAN promotes only slight and temporary alterations in the frequency of both leukocyte populations and viable peritoneal cells, respectively. Micronucleus assay showed absolutely no genotoxicity or cytotoxicity effects and histological analysis showed no alterations or even nanoparticle clusters in several investigated organs but, interestingly, revealed the presence of MAN clusters in the central nervous system (CNS). Conclusion: The results showed that MAN has desirable in vivo biocompatibility, presenting potential for use as a MDDS, especially in CNS disease therapy

Implicações da microbiota intestinal humana no processo de obesidade e emagrecimento: revisão sistemática/Implications of the human gut microbiota in obesity and weight loss: systematic review

Introdução: Na última década foram produzidos vários trabalhos que identificaram a população microbiana intestinal humana como um dos braços do projeto Microbioma e posteriormente mais estudos que associaram populações específicas de microorganismos a determinadas funções e processos metabólicos no organismo, entre as diversas vertentes de estudo ressalta-se aqui a influência da microbiota no processo de obesidade e emagrecimento. Objetivo: Realizar revisão sistemática da literatura sobre as implicações da microbiota intestinal humana na gênese da obesidade e no processo de emagrecimento. Materiais e métodos: Revisão sistemática realizada entre agosto e setembro de 2020, de acordo os critérios PRISMA. Utilizou-se das bases de dados PubMed, Scientific Electronic Library Online (SciELO) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) para a pesquisa. Adotou-se exclusivamente o idioma inglês e apenas produções dos últimos 10 anos, com os seguintes termos e operadores: (Human Gut microbiota and obesity  OR dysbiosis and obesity OR human microbiota and weight loss). Resultados: Dos 16.917,000 artigos encontrados, selecionou-se um total de 53 artigos de melhor qualidade que respondessem as perguntas de pesquisa. Conclusão: Modificações da microbiota intestinal humana é capaz de contribuir para a gênese da obesidade, onde filos específicos de microorganismos são associados à maior absorção de energia, processos fermentativos, alterações no metabolismo da glicose e do colesterol, entre outras vias. Assim como os trabalhos que utilizaram da modulação da microbiota intestinal, seja através de modificações dietéticas ou uso de probióticos isoladamente e em conjunto demonstram efetividade no processo de emagrecimento e maior perda de peso sustentada em longo prazo

Obesidade, ingestão de sódio e estilo de vida em hipertensos atendidos na ESF / Obesity, sodium intake and lifestyle in hypertensive patients treated at the FHS

Objetivou-se avaliar o estado nutricional, a ingestão diária de sódio e o estilo de vida em pacientes hipertensos. Aplicaram-se questionários semi-estruturados para avaliar ingestão de sódio e estilo de vida. Coletou-se o peso, a estatura, dobras cutâneas e circunferências para aferição antropométrica. Incluíram-se no estudo 42 indivíduos hipertensos atendidos em uma ESF, 54,76% são do sexo masculino. A média do IMC foi de 28,56 Kg/m², média do percentual de gordura corporal foi de 25,42. Quanto ao tabagismo, 11,90% (n=5) consomem mais de 20 cigarros por dia, constatou-se um alto consumo de bebida alcoólica, 64,29% (n=27) não seguem orientações dietéticas. O sedentarismo prevaleceu em 80,95% (n=34), O consumo médio de sódio foi de 4223,18 mg. Segundo IMC a maioria dos participantes encontram-se com sobrepeso e obesidade. Estilo de vida desfavorável com destaque para a inatividade física, etilismo e tabagismo, hábitos alimentares inadequados e uma alta ingestão de sódio

Evaluation of response to anti-leptospira bacterin vaccination in pregnant ewes and the passive transfer of antibodies to their offspring

Leptospirosis in sheep is often underestimated, and leads to great economic losses for the sheep farming industry. The aim of this study was to evaluate the humoral immune response in pregnant ewes, after the injection of a commercial polyvalent vaccine for leptospirosis, and to observe the transmission of anti-Leptospira antibodies through the colostrum to the offspring. For this, 24 pregnant ewes were vaccinated for leptospirosis.  Blood samples were collected prior to vaccination and then 7, 14, 21, 28, 35, 42 and 49 days after vaccination. In order to evaluate passive immunity transfer, blood samples of 32 lambs were collected during the first 48 hours after birth, and another collection was performed 10 to 21 days after birth. The lambs were placed into 2 groups: Group A (n=16): singleton lambs; and group B (n=16): twins. The sera samples were submitted to the Microscopic Agglutination Test (MAT), in which 21 Leptospira serovars were tested. The results were analyzed in a descriptive form. The number of sheep reactive to MAT gradually increased until 21 days after vaccination, and decreased right after. Of all the serovars contained in the vaccine, the largest proportion of animals were seroconverted to Hardjoprajtino serovar, Serjoe serogroup. Anti-Leptospira antibodies transferred through colostrum to lambs were detected by MAT in the serum collected 24-48 hours after birth.  It was observed that 65.6% (21 out of 32) of the lambs were reactive. In the subsequent collections that occurred from 10 to 21 days after birth, a decrease in the number of animals reactive to the MAT was detected. There was no significant statistical difference for the passive transfer of antibodies between single or twin lambs