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Este artigo apresenta o uso do ambiente de autoria Scratch para favorecer a construção de conhecimentos matemáticos e o desenvolvimento do pensamento formal em adolescentes. Apresenta uma contextualização sobre o uso das tecnologias digitais no contexto educacional, o desenvolvimento do pensamento formal, o ambiente de experimentação criado com o ambiente de autoria Scratch visando que os estudantes pudessem ensejar a aquisição de conhecimentos sobre ângulos de reflexão e incidência e por fim os resultados obtidos por meio das observações.

Background Bone marrow stem cells (BMSC) can participate to liver regeneration. However, conflicting results have been reported on this topic in patients undergoing liver resection. Aims To assess the impact of liver resection extent and presence of underlying liver disease in modulating BMSC mobilization. Methods We enrolled 29 patients undergoing liver resection of different extents, 5 surgical controls and 10 blood donors. Circulating CD133+ BMSC were measured by flow cytometry at different time-points after surgery. The hepatic commitment of mobilized BMSC was investigated by polymerase chain reaction. Liver specimens were collected during surgery for histopathological analysis. Hepatocyte growth factor and granulocyte-colony stimulating factor serum levels were measured by enzyme-linked immunosorbent assay. Results BMSC mobilization was found in patients undergoing major liver resection, especially in the presence of underlying disease. Ductular reactions were noted in patients with chronic hepatopathy and the hepatic progenitor-like cells expressed CD133, NCAM, cytokeratin-19, and alpha-fetoprotein. Hepatocyte growth factor and granulocyte-colony stimulating factor levels increased following liver resection and the contemporaneous presence of liver disease was associated with their highest raise. Conclusions Liver repair is mainly an endogenous process. BMSC become important in case of extensive resection, especially in the presence of underlying hepatopathy and hepatic progenitor-like cells activation. Hepatocyte growth factor and granulocyte-colony stimulating factor seem to be involved in the dynamics underlying hepatic regeneration and BMSC recruitment.

Summary Background Little data is available about predictors of sustained virological response (SVR) during anti-viral therapy of patients with decompensated HCV cirrhosis. Aims To determine whether rapid and early virological responses (RVR and EVR) could predict SVR and help optimize treatment in these patients. Methods A total of 94 cirrhotics underwent treatment with peg-interferon alfa-2b (1.5 μg/kg weekly) and ribavirin (800/1200 mg daily) for 48 or 24 weeks for genotypes 1/4 or genotypes 2/3, respectively. Results Overall, SVR was achieved in 33 patients (35.1%), 16% with genotype 1/4 and 56.8% with genotype 2/3 (P

Summary Background Persistence of hepatitis C virus (HCV) in serum is assured after any course of antiviral therapy that failed to obtain a sustained virological response. Aim To evaluate the long-term effect on serum HCV-RNA of a course of pegylated-interferon and ribavirin therapy that was unable to obtain sustained response. Methods Serum HCV-RNA was determined at monthly intervals in 68 non-responders, breakthroughs or relapsers and in 52 naive controls enrolled in a five-year study. Results Five genotype 2 or 3 patients (one non-responder, three breakthroughs, one relapser) cleared HCV-RNA after the end of therapy or relapse, and remained negative until the end of follow-up. HCV-RNA clearance rate in genotype 2 and 3 non-responders, breakthroughs or relapsers was higher than in controls with the same genotypes (22.7% vs. 0%; log-rank 9.62; P

Chronic hepatitis C virus (HCV) infection has been associated with a wide number of immunologic disorders, ranging from clinically silent laboratory abnormalities (eg, autoantibody positivity) to severe systemic diseases (eg, cryoglobulinemic vasculitis). Autoimmune hemolytic anemia (AIHA), due to the production of antibodies against erythrocyte membrane antigens, is an uncommon extrahepatic manifestation in the setting of chronic hepatitis C. Herein we have reported the case of a 57-year-old woman with decompensated HCV-related cirrhosis awaiting orthotopic liver transplantation (OLT) who experienced severe AIHA. After 1 month of treatment with prednisone (1 mg/kg body weight/d), there was no significant amelioration of anemia. Rituximab, an anti-CD20 monoclonal antibody that depletes B-lymphocytes reducing serum immunoglobulins, was initiated (375 mg/m(2) IV, weekly for 4 weeks) with a prompt, sustained increase in hemoglobin. The drug was well tolerated; it did not interfere with the course of the liver disease. Thirty-one months after rituximab therapy with resolution of AIHA, the patient successfully underwent OLT using immunosuppression with tacrolimus and low-dose steroids. The patient was discharged on postoperative day 36. No infectious event occurred in the postoperative period. At 18 months follow-up after OLT, there has been no infectious or hematological event. Our experience supported the safety of rituximab use in patients with advanced HCV-related liver disease before OLT.

Little data is available about predictors of sustained virological response (SVR) during anti-viral therapy of patients with decompensated HCV cirrhosis.To determine whether rapid and early virological responses (RVR and EVR) could predict SVR and help optimize treatment in these patients.A total of 94 cirrhotics underwent treatment with peg-interferon alfa-2b (1.5 microg/kg weekly) and ribavirin (800/1200 mg daily) for 48 or 24 weeks for genotypes 1/4 or genotypes 2/3, respectively.Overall, SVR was achieved in 33 patients (35.1%), 16% with genotype 1/4 and 56.8% with genotype 2/3 (P0.01). At treatment week 4, 34 patients had undetectable HCV-RNA, 10 with genotype 1/4 and 24 with genotype 2/3. Of RVR patients, 24 achieved SVR (70.5%), 6 and 18 with genotypes 1 and non-1. At the multivariate analysis, only EVR, genotypes 2 and 3, and adherence to full course and dosage of therapy retained their independent predictive power, with corresponding ORs of 25.5 (95% CI 3.0-217.3), 4.2 (95% CI 1.2-15.3) and 9.1 (95% CI 2.2-38.0), respectively.In decompensated cirrhotic patients, anti-viral therapy with current regimens is feasible and associated with an overall SVR rate of 35.1%. Treatment ought to be pursued among patients who attain an EVR, and maintain a full course and dosage of therapy.

Persistence of hepatitis C virus (HCV) in serum is assured after any course of antiviral therapy that failed to obtain a sustained virological response.To evaluate the long-term effect on serum HCV-RNA of a course of pegylated-interferon and ribavirin therapy that was unable to obtain sustained response.Serum HCV-RNA was determined at monthly intervals in 68 non-responders, breakthroughs or relapsers and in 52 naïve controls enrolled in a five-year study.Five genotype 2 or 3 patients (one non-responder, three breakthroughs, one relapser) cleared HCV-RNA after the end of therapy or relapse, and remained negative until the end of follow-up. HCV-RNA clearance rate in genotype 2 and 3 non-responders, breakthroughs or relapsers was higher than in controls with the same genotypes (22.7% vs. 0%; log-rank 9.62; P0.002). HCV-RNA at the end of treatment or at relapse was10(5) IU/mL in the five subjects who cleared the virus and10(4) IU/mL in four of them. None of genotype 1 or 4 subjects cleared HCV-RNA during follow-up.Late resolution of HCV infection is possible in genotype 2 or 3 patients with low viral load at the end of therapy or at relapse. In these subjects, HCV-RNA monitoring is advisable during the first year after therapy.

Decompensated liver cirrhosis is characterized by a peripheral vasodilation with a low-resistance hyperdynamic circulation. The sustained increase of cardiac work load associated with such a condition may result in an inconstant and often subclinical series of heart abnormalities, constituting a new clinical entity known as "cirrhotic cardiomyopathy". Cirrhotic cardiomyopathy is variably associated with baseline increase in cardiac output, defective myocardial contractility and lowered systo-diastolic response to inotropic and chronotropic stimuli, down-regulated beta-adrenergic function, slight histo-morphological changes, and impaired electric "recovery" ability of ventricular myocardium. Cirrhotic cardiomyopathy is usually clinically latent or mild, likely because the peripheral vasodilation significantly reduces the left ventricle after-load, thus actually "auto-treating" the patient and masking any severe manifestation of heart failure. In cirrhotic patients, the presence of cirrhotic cardiomyopathy may become unmasked and clinically evident by certain treatment interventions that increase the effective blood volume and cardiac pre-load, including surgical or transjugular intrahepatic porto-systemic shunts, peritoneo-venous shunts (LeVeen) and orthotopic liver transplantation. Under these circumstances, an often transient overt congestive heart failure may develop, with increased cardiac output as well as right atrial, pulmonary artery and capillary wedge pressures.

Through a questionnaire it was evaluated the appropriate access for outpatient activities at not urgent level requested by general practitioners in Lombardia Region in a teaching and research hospital in the centre of Milan. The study took place from November 2003 to May 2004. 852 questionnaires were analyzedfor 16 specialties. Without judging the clinical appropriateness of prescriptions, the urgent level at which the visits were requested was, for the most part of them, not appropriated. But the not appropriated prescriptions were 49% of all the visits. In the case of use of inappropriate urgent level of care, patients were sent back to the general practitioner and in the case of right level of emergency patients were scheduled for a visit after some days. Results of the study will send to general practitioners for a righter use of the hospital level of care.

To measure the level of not appropriated hospital use for some DRG's a Lombardia Region AEP version was applied to two units in the Ospedale Maggiore in Milano. The aims of the study was to evaluate the level of appropriateness in Neurology and Dermatology wards for some DRG's which are at risk to be applied in not appropriated way, to study the reasons of not appropriated use, to educate medical doctors in neurology and dermatology to apply for the right level of care for they patients and to highlight some limits of the Lombardia Regional protocol.

Bone metastases are a quite frequent complication of hepatocellular carcinoma (HCC). They are a substantial fraction (about 14-28%) of the metastatic locations of this neoplasm. Recent studies are indicative of the clinical usefulness of local therapy of HCC bone metastasis, expecially if they are single locations. The presence of a single bone metastasis does not seem to influence short term prognosis of the primary neoplasm and, furthermore, its treatment by radiation, chemio-embolization or surgery may obtain long-term pain control, without the side effects of analgesic drugs. Most frequently, bone metastases of HCC appear in the spine, femur, humerus or ribs. In the last years, some atypical locations, as jaws, gums and skull, were reported. In this paper, we report the case of a painful bone metastasis of HCC, localized at the second phalanx of the second finger of the right hand. To our knowledge, until now only two cases of HCC metastatic location at the bones of the hand have been reported. The lesion has been treated by surgical ablation, obtaining long-term pain remission and the withdrawal of the analgesic drugs. Few weeks later, another bone metastasis appeared, located at the second phalanx of the third finger of the same hand, indicating in this subject a peculiar "metastatic tropism".

Liver hemodynamics is characterized by a dual venous and portal blood supply whose physiologic variations are particularly evident during digestion. In the normal subject portal blood flow is laminar with the left liver receiving the blood from the small intestine while the left liver is supplied by the blood from the spleen and colon. In pathologic conditions increased arterial blood flow accompanies the decreased portal flow. Portal hypertension in its various forms is the most frequent and important circulatory alteration in chronic liver disease; besides the "organic" obstacles to the hepatic blood flow there are the dynamic mechanisms which regulate the vascular resistance in the microcirculation Therapies which impact on liver circulation are surgical, of interventional radiology and medical, used in the prevention and cure of complications of portal hypertension.

Poster: "ECR 2011 / C-1782 / Balloon-occluded percutaneous radio-frequency thermal ablation (RFA) plus transcatheter arterial chemoembolization (TACE): a new combined single-step therapy for treatment of unresectable hepatocellular carcinoma" by: "R. Iezzi, G. L. Rapaccini, A. M. De Gaetano, M. Pompili, A. Gasbarrini, L. Bonomo; Rome/IT"

239 SUSTAINED VIROLOGICAL RESPONSE PREVENTS DEVELOPMENT AND DELAYS PROGRESSION OF PORTAL HYPERTENSION IN HCV-RELATED LIVER CIRROSIS B.E. Annicchiarico, M. Siciliano, A. Iacobellis, A.W. Avolio, G. Caracciolo, A. Andriulli, G. Bombardieri. Internal Medicine, Sacred Heart Catholic University, Roma, Gastroenterology, Casa Sollievo della Sofferenza Hospital, Foggia, Liver Transplantation Unit, Sacred Heart Catholic University, Roma, Italy E-mail: terapiamedica@tin.it

The effect of antiarrhythmic drugs on defibrillation threshold have become an important issue with the increasing use of the automatic implantable cardioverter defibrillator (AICD). In several reports antiarrhythmic therapy has been found to affect the energy required for defibrillation; the present study examined the effects of intravenous propafenone on defibrillation threshold in open chest, anesthetized pigs. Twenty health pigs were studied; 10 pigs free from any drugs (Group 1) and 10 pigs after a constant iv infusion of 0.04 mg/kg/min of propafenone (Group 2). Defibrillation threshold was 21 +/- 5, 20 +/- 5, 21 +/- 6, 19 +/- 4 and 19 +/- 6 J in Group 1 and 20 +/- 7, 18 +/- 9, 15 +/- 5, 14 +/- 7, 9 +/- 6 J in Group 2, respectively at 20, 40, 60, 80 min (p value respectively NS, NS, less than 0.05, less than 0.01, less than 0.001). We conclude that intravenous propafenone reduces the energy requirements for defibrillation in experimental animals.

Glucose, lactate and potassium ions have been continuously measured in whole blood using two extracorporeal electrochemical biosensors and a new flow through potassium electrode using the glucose clamp technique. Experiments were carried out with a properly modified endocrine artificial pancreas “Betalike” by connecting this instrument in series with the lactate and potassium probes. the results showed that it is possible to monitor all three metabolites with accuracy and precision, allowing an improved control in diabetes care.

Succinyl and phthalyl esters of native (M.W. 12 × 10 7 ) and clinical dextrans (M.W. 8 × 10 4 ) May bind Cu ++ and Fe ++ ions, at neutral Ph, giving rise to undialyzable chelates. As regards copper, some information about the metal-polysaccharide bonding have been obtained by EPR analysis.

1. (1) Cystamine is oxidatively deaminated to the corresponding cyclized aminoaldehyde, cystaldimine, by diamineoxidase (diamine: O 2 oxidoreductase (deaminating), EC 1.4.3.6). Cystaldimine undergoes further degradation giving rise to thiocysteamine and a C 2 fragment. 2. (2) Thiocysteamine may be trapped by monoiodoacetic acid and the resulting mixed disulphide 1-amino-3,4-dithiapentane-5-carboxylic acid (carboxymethylthiocysteamine) has been detected by paper, and column, chromatography. 3. (3) Thiocysteamine, being a very unstable compound, spontaneously produces cysteamine, which also has been trapped by monoiodoacetic acid as carboxymethyl cysteamine, and detected by column chromatography. 4. (4) On the basis of the present and previous results, a cycle of reactions is suggested, leading to extensive degradation of cystamine to ammonia, sulphur and a C 2 compound.

Serous diaminoxidase (DAO) was measured in 28 patients affected by burns of various extents 3-8 hours after the lesion. In 32.1%, increases in DAO were encountered and these were greater and more frequent in more extensively affected subjects. After 7-10 days, DAO values were back to normal. Measuring DAO simultaneously in the serum and in the phlyctena fluid, it was observed that the latter constantly contains greater concentrations of the enzyme. This suggests that DAO is released or newly formed at lesional level although it cannot be excluded that the internal organs may also play a part in the release and neoformation of DAO as happens in experimental burns, after i.v. injection of heparin and after subcutaneous inflammation due to terpentine.

Intestinal bleeding from abdominal aortic aneurysm is a rare complication; it represents an exceptional occurrence in patients with abdominal aortic prosthesis. The Authors report one case of intestinal hemorrhage caused by interruption in the posterior suture-line between prosthesis and aorta. The hemorrhage has been the cause of death in this patient 4 months after the operation; the exact diagnosis has been recognized only at autopsy, after a gastroduodenal resection performed for a suspected bleeding peptic ulcer. Pathology, ethiology and diagnosis of this case are commented and discussed.

Liver function tests, hepatitis B virus (HBV) markers and cell-mediated immunity were evaluated in 100 drug addicts and in 54 healthy controls. Liver damage prevalence was much higher in the drug group, both in HBV marker-positive and in marker-negative subjects. Moreover HBV marker distribution was different among addicts in comparison with controls, in which the patterns of infection overcoming were more frequent. Cell-mediated immunity assessment showed a deep depression in the addict group. These data suggest that liver damage in addicts may be due mainly to the immunologic defect, which would have a negative influence on the action of HBV and of other viral and non-viral agents.

Diamine oxidase (DAO) levels were investigated in pleural and ascitic fluids of 142 patients suffering from neoplastic and non neoplastic diseases. While in serous effusions of non neoplastic origin or of neoplastic origin (but non containing neoplastic cells) DAO levels were similar to serum levels; in the malignant fluids containing cells of epithelial origin, DAO was very elevated and largely superior to serum values. This results seems to be of practical importance for diagnostic purposes because points out the presence of carcinomatous cells in the effusions.

PLasmatic Diamineoxidase (DAO) was studied after heparin injections i.v. (50 I.U./kg b.w.) in chronic liver and kidney diseases. The DAO increase after heparin is reduced in patients as to controls. Such a reduction may be consequence of DAO discharge in some organs determined by the deliverance of endogenous heparin.

Copper directly reactive with diethylditiocarbamate, ceruloplasmin, monoamine oxidase (SMAO) and diamine oxidase of the serum (SDAO) were studied in healthy subjects, in nine months pregnant women and in some pathological conditions. Increased values of copper were found in pregnancy. Ceruloplasminaemia was increased in hyperthyroidism, congestive hearth failure, Hodgkin's disease, and in pregnancy. Ceroluplasminaemia was strongly reduced in Wilson's disease. SMAO was increased during pregnancy. Statistical analysis showed no correlations between the variations of the data in different pathological conditions. In healthy subjects and in pregnant women, correlation was found between the values of ceruloplasmin obtained using both enzymatic and KCN methods. Statistical analysis of regression lines obtained in both groups of patients showed significative differences between slopes and elevations. It is possible that ceruloplasmin in pregnant women has different composition compared with healthy controls.

Sulfobromophthalein dye test and galactose tolerance test were performed, using both substances simultaneous i.v. injection, in 48 subjects with chronic persistent hepatitis, chronic active hepatitis and liver cirrhosis (with and without ascites). As control group 10 normal subjects were tested. Sulfobromophthalein excretion constant ( K1BSF ) drawn from the first part of the retention curve, and the galactose excretion constant (K Gal) were considered. The following conclusions were obtained: a) K1 BSF and K Gal are well-correlated; b) K1 BSF appears more sensitive for a whole evaluation of liver involvement, in absence of evident jaundice (total serum bilirubin less than 6 mg/100 ml); c) K Gal is less reliable in presence of ascites because of the artificial increase in galactose plasmatic clearance provoked by the substance passage to the effusion fluid; d) the statistical analysis using discrimining function methods makes possible a better distinction among the various kinds of liver diseases; e) the same type of statistical analysis shows a difference between cirrhotics with ascites responding to medical therapy in comparison to treatment- resistent ascites. This fact may account for a different level of hepatic functional activity.

S-adenosyl-L-methionine (SAM) has proven to be fairly stable in gastric and duodenal juices as well as in bile. It was, therefore, administered orally to six healthy subjects. No increase in SAM levels was observed in the systemic blood. SAM was then directly injected into a jejunal loop of nine patients undergoing cholecystectomy. SAM concentrations increased significantly in venous mesenteric and systemic blood. Infusions of methionine directly into the jejunum by the same method used for SAM did not induce any increase in SAM concentrations in the mesenteric or systemic blood.