Pseudo-Kaposi's Sarcoma Because of Suction-Socket Lower Limb Prosthesis

Pseudo-Kaposi sarcoma is a benign reactive vascular proliferation mainly involving the lower legs, which can be related to acquired chronic venous insufficiency or congenital arteriovenous malformations. In its most common presentation, acroangiodermatitis is seen in patients with chronic venous insufficiency of the lower limbs as an exaggeration of the stasis dermatitis. However, rare reports of acroangiodermatitis include descriptions in amputees (especially in those with poorly fitting suction-type devices), in patients undergoing hemodialysis (with lesions developing distally to arteriovenous shunts) and in patients with paralyzed legs. We report on a 28 year-old-male who presented pseudo-Kaposi's sarcoma in an amputation stump because of suction-socket lower limb prosthesis.

Thoracic Duct Decompression for Protein-Losing Enteropathy in Failing Fontan Circulation

An infrequent but devastating late complication of Fontan circulation is protein-losing enteropathy (PLE), which results from unbalanced lymphatic homeostasis. Surgical decompression of the thoracic duct by redirecting its drainage to the pulmonary venous atrium has been introduced recently as a possible treatment. This report describes a single-institution experience with this innovative procedure in 2 patients with failing Fontan circulation with PLE refractory to optimized medical therapy.

Can the complex mixture of sediment contaminants cause endocrine disruption on a benthic fish? A case study with Solea senegalensis

Pollution in coastal ecosystems is a serious threat to the biota and human populations there residing. Anthropogenic activities in these ecosystems are the main cause of contamination by endocrine disruption compounds (EDCs), which can interfere with hormonal regulation and cause adverse effects to growth, stress response and reproduction. Although the chemical nature of many EDCs is unknown, it is believed that most are organic contaminants. Under an environmental risk assessment for a contaminated estuary (the Sado, SW Portugal), the present work intended to detect endocrine disruption in a flatsfish, Solea senegalensis Kaup, 1858, and its potential relationship to organic toxicants. Animals were collected from two areas in the estuary with distinct influences (industrial and rural) and from an external reference area. To evaluate endocrine disruption, hepatic vitellogenin (VTG) concentrations in males and gonad histology were analysed. As biomarkers of exposure to organic contaminants, cytochrome P450 (CYP1A) induction and the ethoxyresorufin-O-deethylase (EROD) activity were determined. The results were contrasted to sediment contamination levels, which are overall considered low, although the area presents a complex mixture of toxicants. Either males or females were found sexually immature and showed no significant evidence of degenerative pathologies. However, hepatic VTG concentrations in males from the industrial area in estuary were superior than those from the Reference, even reaching levels comparable to those in females, which may indicate an oestrogenic effect resulting from the complex contaminant mixture. These individuals also presented higher levels of CYP1A induction and EROD activity, which is consistent with contamination by organic substances. The combination of the results suggest that the exposure of flatfish to an environment contaminated by mixed toxicants, even at low levels, may cause endocrine disruption, therefore affecting populations, which implies the need for further research in identification of potential EDCs, their sources and risks at ecosystem scale.

Exposi����o a ozono em cabinas de avi��o

RESUMO - O ozono �� o principal componente da polui����o fotoqu��mica do ar. Como agente irritante do aparelho respirat��rio, os seus efeitos sobre a sa��de caracterizam-se, essencialmente, por tosse, dispneia, desconforto tor��cico e altera����es da fun����o pulmonar, encontrando-se tamb��m associadas �� exposi����o ambiental a O3 tanto uma maior frequ��ncia e gravidade de crises de asma como a ocorr��ncia de quadros cl��nicos de irrita����o conjuntival. �� sobretudo a partir dos anos 50, com a descoberta de concentra����es elevadas de ozono em ambientes de trabalho respeitantes �� actividade de soldadura ��a arco��, que aquele g��s passa a ser encarado como factor profissional de risco. No in��cio dos anos 60 surgem os primeiros estudos de exposi����o a O3 em cabinas de avi��o, suscitados pela ocorr��ncia, em tripulantes e passageiros, de queixas cl��nicas de irrita����o do tracto respirat��rio. Esta sintomatologia era, at�� ent��o, atribu��da �� ac����o de outros factores, designadamente o sistema de ventila����o e o baixo teor de humidade do ar. Posteriormente, alguns estudos revelaram que, em voos comerciais subs��nicos, os teores elevados de O3 observados no interior das cabinas poderiam ser provocados pela sua insuficiente destrui����o nos sistemas de entrada de ar.O presente estudo, efectuado em voos de longo curso realizados em aeronaves Airbus A340-300 numa ��nica rota comercial, teve por objectivo avaliar a exposi����o a ozono no ar interior em cabina de avi��o. Os teores m��dios de concentra����o de ozono observados foram inferiores aos valores suscept��veis de provocarem efeitos adversos sobre o aparelho respirat��rio. Como valor m��ximo instant��neo, foi atingida a concentra����o de 152 ppb. Adicionalmente, foi constatada a influ��ncia das esta����es do ano nos teores de O3. O conjunto dos resultados obtidos permite concluir que as concentra����es de ozono no ar interior nas cabinas de avi��o estudadas s��o inferiores ��s correspondentes concentra����es m��ximas admiss��veis, tendo, em todos os voos, sido observado o cumprimento da norma da FAA respeitante �� protec����o da exposi����o ao ozono em cabinas de aeronaves de avia����o comercial.

Exposi����o profissional ao chumbo : an��lise da indu����o de efeitos genot��xicos

RESUMO - A exposi����o cont��nua a subst��ncias qu��micas tem consequ��ncias para a sa��de humana, algumas das quais n��o est��o ainda totalmente estabelecidas. A toxicologia ocupacional �� uma ��rea interdisciplinar que envolve conhecimentos de higiene e de medicina ocupacional, de epidemiologia e de toxicologia e que tem por principal objectivo prevenir a ocorr��ncia de efeitos adversos decorrentes do ambiente ocupacional sendo um dos seus principais pap��is fornecer o m��ximo de dados que possam contribuir para o conhecimento dos potenciais efeitos na sa��de. O chumbo �� um t��xico de caracter��sticas cumulativas que provoca na sa��de efeitos principalmente sist��micos, ou seja, o efeito t��xico manifesta-se em locais afastados do contacto inicial que resultam essencialmente de exposi����es cr��nicas, resultantes de per��odos de exposi����o mais ou menos longos ao metal (entre meses e anos). Pode interagir com diferentes ��rg��os e tecidos, ligando-se a mol��culas e constituintes celulares. Uma vez que n��o possui qualquer fun����o fisiol��gica, a presen��a do chumbo no organismo humano resulta numa s��rie de efeitos prejudiciais que afectam diversos ��rg��os e sistemas. A toxicidade do chumbo manifesta-se em diversos ��rg��os e tecidos, nomeadamente no sistema hematopoi��tico, no sistema nervoso, no rim, no aparelho reprodutor, no sistema cardiovascular, no sistema end��crino e no sistema imunit��rio. Da interfer��ncia do chumbo com o funcionamento de alguns sistemas biol��gicos resultam um conjunto de altera����es fundamentais ao n��vel dos processos de transporte atrav��s das membranas, da integridade estrutural e funcional das enzimas e de v��rias vias metab��licas, em especial da fosforila����o oxidativa e da s��ntese do heme sendo os primeiros efeitos bioqu��micos do chumbo detectados a partir de valores de plumb��mia inferiores a 10 ��g/dL. As medidas de higiene e seguran��a actualmente em vigor nos pa��ses desenvolvidos asseguram que os casos de intoxica����o grave s��o cada vez menos frequentes. No entanto, o risco de exposi����o a n��vel ocupacional existe em todas as actividades que envolvem materiais que o contenham como as explora����es mineiras, as fundi����es prim��ria e secund��ria, a produ����o de baterias de chumbo ��cido, a produ����o de vidro com pigmentos de chumbo, as soldaduras de repara����o autom��vel e a instru����o de tiro. Desde 2006 o chumbo �� considerado pela International Agency for Research on Cancer (IARC) uma subst��ncia carcinog��nica do grupo 2A (prov��vel carcinog��nio para o ser humano). Considera-se, assim, que o chumbo tem, inequivocamente, capacidade de induzir cancro em animais experimentais mas que, embora haja fortes ind��cios de que os mecanismos que medeiam a carcinog��nese desses compostos ocorrem no ser humano, os dados dispon��veis ainda n��o podem assegurar essa rela����o. Com este estudo pretendeu-se contribuir para o conhecimento da toxicidade do chumbo atrav��s do estudo da exposi����o ao chumbo e da influ��ncia da susceptibilidade individual (em industrias sem co-exposi����o significativa a outros agentes conhecidos ou suspeitos de serem carcinog��nicos). Pretendeu-se estudar o caso atrav��s de uma abordagem m��ltipla que permitisse relacionar diferentes tipos de marcadores biol��gicos uma vez que a monitoriza����o biol��gica integra todas as poss��veis vias de entrada no organismo (para al��m da via respirat��ria), eventuais exposi����es fora do contexto estritamente profissional assim como uma s��rie de factores intr��nsecos individuais (relacionados com modos de via, de natureza fisiol��gica e comportamentais). Sendo a co-exposi����o a outros compostos com propriedades genot��xicas e carcinog��nicas uma quest��o dif��cil de tornear quando se quer avaliar o potencial genot��xico do chumbo em popula����es expostas, ocupacional ou ambientalmente este estudo tem a vantagem de ter sido efectuado em popula����es sem co-exposi����o conhecida a outras subst��ncias deste tipo, permitindo concluir sobre os efeitos resultantes apenas da exposi����o a chumbo na popula����o humana, contribuindo para explicar algumas das aparentes inconsist��ncias e contradi����es entre diferentes estudos sobre este tema. Os indicadores de exposi����o usados foram: indicadores de dose interna (doseamento de chumbo e de PPZ no sangue), indicadores de efeitos adversos no heme e genot��xicos (actividade da ALAD, teste do cometa e muta����o em TCR) e indicadores de susceptibilidade (polimorfismos gen��ticos de ALAD e VDR) atrav��s de uma abordagem estat��stica de compara����o directa de sub-grupos previamente definidos na popula����o e da aplica����o de um modelo de regress��o m��ltipla. Este estudo revelou que os n��veis de plumb��mia na popula����o portuguesa baixaram significativamente nos ��ltimos 10 anos, tanto na popula����o ocupacionalmente exposta como na popula����o em geral e que a presen��a do gen��tipo B-B (do gene VDR) �� preditiva das varia����es de plumb��mia, quando comparada com o gen��tipo mais frequente na popula����o, B-b; ao contr��rio, o gen��tipo b-b n��o aparenta ter influ��ncia em nenhum dos marcadores estudados. No que diz respeito a efeitos genot��xicos concluiu-se que estes n��o se manifestaram na popula����o estudada, levando a concluir que nos n��veis de exposi����o estudados, o chumbo n��o tem capacidade de induzir este tipo de efeitos per si levando ao refor��o da hip��tese, j�� levantada por outros autores, de que o mecanismo de genotoxicidade do chumbo seja essencialmente de promo����o de processos de genotoxicidade desencadeados por outros agentes. A realiza����o de estudos de efeitos genot��xicos e de stress oxidativo desenhados de forma a comparar grupos de trabalhadores expostos apenas a chumbo com grupos de trabalhadores com o mesmo n��vel de exposi����o a chumbo, mas com co-exposi����o a outros agentes reconhecidamente carcinog��nicos poder�� ajudar a aumentar o conhecimento deste efeito do chumbo na sa��de humana.

In vitro action of antiparasitic drugs, especially artesunate, against Toxoplasma gondii

INTRODUCTION: Toxoplasmosis is usually a benign infection, except in the event of ocular, central nervous system (CNS), or congenital disease and particularly when the patient is immunocompromised. Treatment consists of drugs that frequently cause adverse effects; thus, newer, more effective drugs are needed. In this study, the possible activity of artesunate, a drug successfully being used for the treatment of malaria, on Toxoplasma gondii growth in cell culture is evaluated and compared with the action of drugs that are already being used against this parasite. METHODS: LLC-MK2 cells were cultivated in RPMI medium, kept in disposable plastic bottles, and incubated at 36��C with 5% CO2. Tachyzoites of the RH strain were used. The following drugs were tested: artesunate, cotrimoxazole, pentamidine, pyrimethamine, quinine, and trimethoprim. The effects of these drugs on tachyzoites and LLC-MK2 cells were analyzed using nonlinear regression analysis with Prism 3.0 software. RESULTS: Artesunate showed a mean tachyzoite inhibitory concentration (IC50) of 0.075��M and an LLC MK2 toxicity of 2.003��M. Pyrimethamine was effective at an IC50 of 0.482��M and a toxicity of 11.178��M. Trimethoprim alone was effective against the in vitro parasite. Cotrimoxazole also was effective against the parasite but at higher concentrations than those observed for artesunate and pyrimethamine. Pentamidine and quinine had no inhibitory effect over tachyzoites. CONCLUSIONS: Artesunate is proven in vitro to be a useful alternative for the treatment of toxoplasmosis, implying a subsequent in vivo effect and suggesting the mechanism of this drug against the parasite.

Immune reconstitution inflammatory syndrome in HIV and sporotrichosis coinfection: report of two cases and review of the literature

We report 2 cases of patients with immune reconstitution inflammatory syndrome (IRIS) associated with cutaneous disseminated sporotrichosis and human immunodeficiency virus (HIV) coinfection. The patients received specific treatment for sporotrichosis. However, after 4 and 5 weeks from the beginning of antiretroviral therapy, both patients experienced clinical exacerbation of skin lesions despite increased T CD4+ cells (T cells cluster of differentiation 4 positive) count and decreased viral load. Despite this exacerbation, subsequent mycological examination after systemic corticosteroid administration did not reveal fungal growth. Accordingly, they were diagnosed with IRIS. However, the sudden withdrawal of the corticosteroids resulted in the recurrence of IRIS symptoms. No serious adverse effects could be attributed to prednisone. We recommend corticosteroid treatment for mild-to-moderate cases of IRIS in sporotrichosis and HIV coinfection with close follow-up.

Avalia����o econ��mica em transplanta����o renal : abordagem estrat��gica do processo de doa����o e an��lise de custo-utilidade do programa de transplanta����o renal versus hemodi��lise

SUM��RIO - O desafio atual da Sa��de P��blica �� assegurar a sustentabilidade financeira do sistema de sa��de. Em ambiente de recursos escassos, as an��lises econ��micas aplicadas �� presta����o dos cuidados de sa��de s��o um contributo para a tomada de decis��o que visa a maximiza����o do bem-estar social sujeita a restri����o or��amental. Portugal �� um pa��s com 10,6 milh��es de habitantes (2011) com uma incid��ncia e preval��ncia elevadas de doen��a renal cr��nica estadio 5 (DRC5), respetivamente, 234 doentes por milh��o de habitantes (pmh) e 1.600 doentes/pmh. O crescimento de doen��as associadas ��s causas de DRC, nomeadamente, diabetes Mellitus e hipertens��o arterial, antecipam uma tend��ncia para o aumento do n��mero de doentes. Em 2011, dos 17.553 doentes em tratamento substitutivo renal, 59% encontrava-se em programa de hemodi��lise (Hd) em centros de di��lise extra-hospitalares, 37% viviam com um enxerto renal funcionante e 4% estavam em di��lise peritoneal (SPN, 2011). A lista ativa para transplante (Tx) renal registava 2.500 doentes (SPN 2009). O Tx renal �� a melhor modalidade terap��utica pela melhoria da sobrevida, qualidade de vida e rela����o custo-efetividade, mas a elegibilidade para Tx e a oferta de ��rg��os condicionam esta op����o. Esta investiga����o desenvolveu-se em duas vertentes: i) determinar o r��cio custo-utilidade incremental do Tx renal comparado com a Hd; ii) avaliar a capacidade m��xima de dadores de cad��ver em Portugal, as caracter��sticas e as causas de morte dos dadores potenciais a n��vel nacional, por hospital e por Gabinete Coordenador de Colheita e Transplanta����o (GCCT), e analisar o desempenho da rede de colheita de ��rg��os para Tx. Realizou-se um estudo observacional/n��o interventivo, prospetivo e anal��tico que incidiu sobre uma coorte de doentes em Hd que foi submetida a Tx renal. O tempo de seguimento m��nimo foi de um ano e m��ximo de tr��s anos. No in��cio do estudo, colheram-se dados sociodemogr��ficos e cl��nicos em 386 doentes em Hd, eleg��veis para Tx renal. A qualidade de vida relacionada com a sa��de (QVRS) foi avaliada nos doentes em Hd (tempo 0) e nos transplantados, aos tr��s, seis, 12 meses, e depois, anualmente. Inclu��ram-se os doentes que por fal��ncia do enxerto renal transitaram para Hd. Na sua medi����o, utilizou-se um instrumento baseado em prefer��ncias da popula����o, o EuroQol-5D, que permite o posterior c��lculo dos QALY. Num grupo de 82 doentes, a QVRS em Hd foi avaliada em dois tempos de resposta o que permitiu a an��lise da sua evolu����o. Realizou-se uma an��lise custo-utilidade do Tx renal comparado com a Hd na perspetiva da sociedade. Identificaram-se os custos diretos, m��dicos e n��o m��dicos, e as altera����es de produtividade em Hd e Tx renal. Inclu��ram-se os custos da colheita de ��rg��os, sele����o dos candidatos a Tx renal e follow-up dos dadores vivos. Cada doente transplantado foi utilizado como controle de si pr��prio em di��lise. Avaliou-se o custo m��dio anual em programa de Hd cr��nica relativo ao ano anterior �� Tx renal. Os custos do Tx foram avaliados prospetivamente. Considerou-se como horizonte temporal o ciclo de vida nas duas modalidades. Usaram-se taxas de atualiza����o de 0%, 3% e 5% na atualiza����o dos custos e QALY e efetuaram-se an��lises de sensibilidade one way. Entre 2008 e 2010, 65 doentes foram submetidos a Tx renal. Registaram-se, prospetivamente, os resultados em sa��de inclu��ndo os internamentos e os efeitos adversos da imunossupress��o, e o consumo dos recursos em sa��de. Utilizaram-se modelos de medidas repetidas na avalia����o da evolu����o da QVRS e modelos de regress��o m��ltipla na an��lise da associa����o da QVRS e dos custos do transplante com as caracter��sticas basais dos doentes e os eventos cl��nicos. Comparativamente �� Hd, observou-se melhoria da utilidade ao 3�� m��s de Tx e a qualidade de vida aferida pela escala EQ-VAS melhorou em todos os tempos de observa����o ap��s o Tx renal. O custo m��dio da Hd foi de 32.567,57���, considerado uniforme ao longo do tempo. O custo m��dio do Tx renal foi de 60.210,09��� no 1�� ano e 12.956,77��� nos anos seguintes. O r��cio custo-utilidade do Tx renal vs Hd cr��nica foi de 2.004,75���/QALY. A partir de uma sobreviv��ncia do enxerto de dois anos e cinco meses, o Tx associou-se a poupan��a dos custos. Utilizaram-se os dados nacionais dos Grupos de Diagn��stico Homog��neos e realizou-se um estudo retrospectivo que abrangeu as mortes ocorridas em 34 hospitais com colheita de ��rg��os, em 2006. Considerou-se como dador potencial o indiv��duo com idade entre 1-70 anos cuja morte ocorrera a n��vel hospitalar, e que apresentasse crit��rios de adequa����o �� doa����o de rim. Analisou-se a associa����o dos dadores potenciais com caracter��sticas populacionais e hospitalares. O desempenho das organiza����es de colheita de ��rg��os foi avaliado pela taxa de convers��o (r��cio entre os dadores potenciais e efetivos) e pelo n��mero de dadores potenciais por milh��o de habitantes a n��vel nacional, regional e por Gabinete Coordenador de Colheita e Transplanta����o (GCCT). Identificaram-se 3.838 dadores potenciais dos quais 608 apresentaram c��digos da Classifica����o Internacional de Doen��as, 9.�� Revis��o, Modifica����es Cl��nicas (CID- 9-MC) que, com maior frequ��ncia, evoluem para a morte cerebral. O modelo logit para dados agrupados identificou a idade, o r��cio da lota����o em Unidades de Cuidados Intensivos e lota����o de agudos, exist��ncia de GCCT e de Unidade de Transplanta����o, e mortalidade por acidente de trabalho como fatores preditivos da convers��o dum dador potencial em efetivo e atrav��s das estimativas do modelo logit quantificou-se a probabilidade dessa convers��o. A doa����o de ��rg��os deve ser assumida como uma prioridade e as autoridades em sa��de devem assegurar o financiamento dos hospitais com programas de doa����o, evitando o desperd��cio de ��rg��os para transplanta����o, enquanto um bem p��blico e escasso. A colheita de ��rg��os deve ser considerada uma op����o estrat��gica da atividade hospitalar orientada para a organiza����o e planeamento de servi��os que maximizem a convers��o de dadores potenciais em efetivos incluindo esse crit��rio como medida de qualidade e efetividade do desempenho hospitalar. Os resultados deste estudo demonstram que: 1) o Tx renal proporciona ganhos em sa��de, aumento da sobrevida e qualidade de vida, e poupan��a de custos; 2) em Portugal, a taxa m��xima de efic��cia da convers��o dos dadores cadav��ricos em dadores potenciais est�� longe de ser atingida. O investimento na rede de colheita de ��rg��os para Tx �� essencial para assegurar a sustentabilidade financeira e promover a qualidade, efici��ncia e equidade dos cuidados em sa��de prestados na DRC5.

Use of corticosteroids and the outcome of infants with bronchopulmonary dysplasia

Ventilator-dependent premature infants are often treated with dexamethasone. Several trials showed that steroids while improve pulmonary compliance and facilitate extubation, some treated infants may have adverse effects, such as alterations of growth curves. We conducted this retrospective study to evaluate the effects of steroids on mechanical ventilation, oxygen therapy, hospital length stay and mortality, in ventilator-dependent infants with bronchopulmonary dysplasia (BPD) (defined as the need of oxygen supplementation at 28 days of life). Twenty-six newborns with BPD were evaluated during 9 -- 42 days postpartum (mean = 31 days) and were divided into two groups: Group I - 14 newborns that did not receive dexamethasone, and Group II - 12 newborns that received dexamethasone at 14 --21 days of life. Dexamethasone was given at a dose of 0.25 mg per kilogram of body weight twice daily intravenously for 3 days, after which the dose was tapered. RESULTS: There were no statistically significant differences in the mean length of mechanical ventilation (Group I - 37 days, Group II - 35 days); oxygen supplementation (Group I - 16 days, Group II - 29 days); hospital stay (Group I - 72 days, Group II - 113 days); mortality (Group I - 35.7%, Group II - 41.6%). At birth, Group II was lighter (BW: Group I - 1154 grams �� 302, Group II - 791 grams �� 165; p < 0.05) and smaller (height: Group I - 37.22 cm �� 3.3, Group II - 33.5 �� 2.4; p< 0.05) than Group I. At 40 weeks, there were no statistically significant differences between groups in relation to anthropometric measurements. CONCLUSIONS: The use of corticosteroids in bronchopulmonary dysplasic infants may influence the somatic growth during its use. However, after its suspension, a recovery seems to occur, suggesting that its influence could be transitory.

Neuromuscular blockade in children

Neuromuscular blocking agents (NMBAs) have been widely used to control patients who need to be immobilized for some kind of medical intervention, such as an invasive procedure or synchronism with mechanical ventilation. The purpose of this monograph is to review the pharmacology of the NMBAs, to compare the main differences between the neuromuscular junction in neonates, infants, toddlers and adults, and moreover to discuss their indications in critically ill pediatric patients. Continuous improvement of knowledge about NMBAs pharmacology, adverse effects, and the many other remaining unanswered questions about neuromuscular junction and neuromuscular blockade in children is essential for the correct use of these drugs. Therefore, the indication of these agents in pediatrics is determined with extreme judiciousness. Computorized (Medline 1990-2000) and active search of articles were the mechanisms used in this review.

Omeprazole, Furazolidone, and Tetracycline: an eradication treatment for resistant H. pylori in Brazilian patients with peptic ulcer disease

OBJECTIVES: To determine the efficacy of a simple, short-term and low-cost eradication treatment for Helicobacter pylori (H. pylori) using omeprazole, tetracycline, and furazolidone in a Brazilian peptic ulcer population, divided into 2 subgroups: untreated and previously treated for the infection. PATIENTS AND METHODS: Patients with peptic ulcer disease diagnosed by endoscopic examination and infected by H. pylori diagnosed by the rapid urease test (RUT) and histological examination, untreated and previously unsuccessfully treated by macrolides and nitroimidazole, were medicated with omeprazole 20 mg daily dose and tetracycline 500 mg and furazolidone 200 mg given 3 times a day for 7 days. Another endoscopy or a breath test was performed 12 weeks after the end of treatment. Patients were considered cured of the infection if a RUT and histologic examination proved negative or a breath test was negative for the bacterium. RESULTS: Sixty-four patients were included in the study. The women were the predominant sex (58%); the mean age was 46 years. Thirty-three percent of the patients were tobacco users, and duodenal ulcer was identified in 80% of patients. For the 59 patients that underwent follow-up examinations, eradication was verified in 44 (75%). The eradication rate for the intention-to-treat group was 69%. The incidence of severe adverse effects was 15%. CONCLUSION: The treatment provides good efficacy for H. pylori eradication in patients who were previously treated without success, but it causes severe adverse effects that prevented adequate use of the medications in 15% of the patients.

Hormone replacement therapy and the risk of breast cancer: assessment of therapy acceptance in a cohort of previously treated breast cancer patients

INTRODUCTION: In the postmenopausal period, an average of 25% of women will present symptomatic ovarian failure requiring hormonal replacement therapy. Estrogen can relieve vasomotor symptoms. Hormonal replacement therapy is generally not recommended for breast cancer patients due to the potential risk of tumor recurrence. To answer the questions about the safety of hormonal replacement therapy in this subgroup of women, it is necessary to establish the acceptance of treatment. METHODS: Between September 1998 and February 2001, a cohort of 216 breast cancer patients were asked to complete a questionnaire. All patients had completed their treatment and were informed about survival rates after breast cancer and hormonal replacement therapy. RESULTS: Among the 216 patients, 134 (62%) would refuse hormonal replacement therapy. A hundred patients were afraid of relapse (74.6%). Adjuvant tamoxifen therapy was the only statistically significant variable (70.3% versus 29.7% p=0.003). Understanding clinical stage (p= 0.045) and type of medical assistance (private versus public , p=0.033) also seemed to influence the decision. Early stage disease (p= 0.22), type of surgical procedure (radical versus conservative, p=0.67), adjuvant chemotherapy (p=0.082) or marital status (p=0.98 ) were not statistically significant in decision making. Several patients submitted to adjuvant chemotherapy (41.6%) would accept hormonal replacement therapy under medical supervision, as did most of advanced clinical stage patients (58.3%; p=0.022). CONCLUSION: There is a high level of rejection for hormonal replacement therapy among breast cancer patients when current data on tumor cure rates, and potential risks of estrogen use is available. Adverse effects of tamoxifen in the adjuvant setting may be the reason for refusal of hormonal replacement therapy .

Use of tacrolimus in rescue therapy of acute and chronic rejection in liver transplantation

PURPOSE: To study the indications and results of tacrolimus as rescue therapy for acute cellular or chronic rejection in liver transplantation. PATIENTS AND METHODS: Eighteen liver transplant recipients who underwent rescue therapy with tacrolimus between March 1995 and August 1999 were retrospectively studied. The treatment indication, patients, and graft situation were recorded as of October 31st, 1999. The response to tacrolimus was defined as patient survival with a functional graft and histological reversal of acute cellular, or for chronic rejection, bilirubin serum levels decreasing to up to twice the upper normal limit. RESULTS: Fourteen cases (77.8%) presented a good response. The response rate for the different indications was: (1) acute cellular + sepsis - 0/1 case; (2) recurrent acute cellular - 1/1 case; (3) OKT3-resistant acute cellular - 2/2 cases; (4) steroid-resistant acute cellular + active viral infection - 3/3 cases; (5) chronic rejection - 8/11 cases (72.7% response rate). The 4 patients who did not respond died. CONCLUSION: Tacrolimus rescue therapy was successful in most cases of acute cellular and chronic rejection in liver transplantation.

Ecstasy intoxication: the toxicological basis for treatment

Youngsters are increasingly using 3,4 methylenedioxymethamphetamine, known as ecstasy, because it is wrongly believed that it does not induce harm. However, there are many reports of adverse effects, including acute intoxication, abuse potential, and possible neurotoxic effects. Therefore, health care providers need to promptly recognize the symptoms of systemic intoxication in order to initiate early treatment. The drug is used by the oral route for long hours during crowded dance parties. Acutely, ecstasy increases the release of serotonin and decreases its reuptake, leading to hypertension, hyperthermia, trismus, and vomiting. There is debate on whether recreational doses of ecstasy cause permanent damage to human serotonergic neurons. Ecstasy users showed a high risk of developing psychopathological disturbances. The prolonged use of ecstasy might induce dependence, characterized by tolerance and hangover. Acute ecstasy intoxication needs emergency-type treatment to avoid the dose-dependent increase in adverse reactions and in severity of complications. There are no specific antidotes to be used during acute intoxication. Supportive measures and medical treatment for each one of the complications should be implemented, keeping in mind that symptoms originate mainly from the central nervous system and the cardiovascular system.