Fatal pulmonary thromboembolism in gastrectomy intraoperative procedures by gastric adenocarcinoma: case report

The case of a patient with gastric adenocarcinoma with indication for gastrectomy is reported. The surgery took place without complications. A palliative, subtotal gastrectomy was performed after para-aortic lymph nodes compromised by neoplasm were found, which was confirmed by pathological exam of frozen sections carried out during the intervention. At the end of the gastroenteroanastomosis procedure, the patient began to show intense bradycardia: 38 beats per minute (bpm), arterial hypotension, changes in the electrocardiogram's waveform (upper unlevelling of segment ST), and cardiac arrest. Resuscitation maneuvers were performed with temporary success. Subsequently, the patient had another circulatory breakdown and again was recovered. Finally, the third cardiac arrest proved to be irreversible, and the intra-operative death occurred. Necropsy showed massive pulmonary embolism. The medical literature has recommended heparinization of patients, in an attempt to avoid pulmonary thromboembolism following major surgical interventions. However, in the present case, heparinization would have been insufficient to prevent death. This case indicates that it is necessary to develop preoperative propedeutics for diagnosing the presence of venous thrombi with potential to migrate, causing pulmonary thromboembolism (PTE). If such thrombi could be detected, preventative measures, such as filter installation in the Cava vein could be undertaken.

Long term (five-year) survival following radical surgical treatment plus adjuvant chemotherapy (FAM) in advanced gastric cancer: a controlled study

Several drugs and their associations are being used for adjuvant or complementary chemotherapy with the aim of improving results of gastric cancer treatment. The objective of this study was to verify the impact of these drugs on nutrition and on survival rate after radical treatment of 53 patients with gastric cancer in stage III of the TNM classification. A control group including 28 patients who had only undergone radical resection was compared to a group of 25 patients who underwent the same operative technique followed by adjuvant polychemotherapy with FAM (5-fluorouracil, Adriamycin, and mitomycin C). In this latter group, chemotherapy toxicity in relation to hepatic, renal, cardiologic, neurological, hematologic, gastrointestinal, and dermatological functions was also studied. There was no significant difference on admission between both groups in relation to gender, race, macroscopic tumoral type of tumor according to the Borrmann classification, location of the tumor in the stomach, length of the gastric resection, or response to cutaneous tests on delayed sensitivity. Chemotherapy was started on average, 2.3 months following surgical treatment. Clinical and laboratory follow-up of all patients continued for 5 years. The following conclusions were reached: 1) The nutritional status and incidence of gastrointestinal manifestation were similar in both groups; 2) There was no occurrence of cardiac, renal, neurological, or hepatic toxicity or death due to the chemotherapeutic method per se; 3) Dermatological alterations and hematological toxicity occurred exclusively in patients who underwent polychemotherapy; 4) There was no significant difference between the rate and site of tumoral recurrence, the disease-free interval, or the survival rate of both study groups; 5) Therefore, we concluded, after a 5-year follow-up, chemotherapy with the FAM regimen did not increase the survival rate.

Widespread hematogenous metastases and Trousseau's syndrome in gastric adenocarcinoma

A case of widespread hematogenous metastases and Trousseau's syndrome is reported in a 40 year-old white housewife with gastric cancer, presenting subdural hematoma, ecchymoses, epistaxis, stomach and uterine bleeding. After undergoing hematoma drainage, she was unsuccessfully treated with platelets, red blood cells, plasma cryoprecipitate transfusions, and antibiotics. Necropsy disclosed gastric ring-signet adenocarcinoma invading the serous layer, with massive disseminated intravascular coagulation and systemic neoplastic embolism. Multiple old and recent hyaline (rich in fibrin and platelets) microthrombi, and tumor emboli were observed in the bone marrow, meninges, liver, lungs, kidneys, lymph nodes, adrenals, thyroid, heart, pancreas, and ovaries (Krukenberg tumor).

Preoperative serum levels of ca 72-4, cea, ca 19-9, and Alpha-fetoprotein in patients with gastric cancer

INTRODUCTION: The clinical importance of preoperative serum levels of CA 72-4, carcinoembryonic antigen (CEA), CA 19-9, and alpha-fetoprotein (AFP) was prospectively evaluated in 44 patients with gastric cancer. METHOD: The serum tumor marker levels were determined by commercial radioimmunoassay kits. Positivity for CA 72-4 (>4 U/mL), CEA (>5 ng/mL), CA 19-9 (>37 U/mL), and AFP (>10 ng/mL) were correlated according to the stage, histology, and lymph node metastasis. RESULTS AND DISCUSSION: CA 72-4 showed a higher positivity rate for gastric cancer (47.7%) than CEA (25%), CA 19-9 (25%), and AFP (0%). The combination of CA 72-4 with CEA and CA 19-9 increased the sensitivity to 61.4%. The positivity rates of CA 72-4 in patients at stages I and II (initial disease) and in patients at stages III and IV (advanced disease) were 9% and 60.6%, respectively (P < 0.005). No correlation was found between CEA and CA 19-9 levels and the stage of gastric cancer. There was a tendency of positivity for CA 72-4 to suggest lymph node involvement, but it was not significant (P = 0.075). Serum levels of tumor markers did not show a correlation with the histological types of gastric cancer. CONCLUSION: Preoperative serum levels of CA 72-4 provided a predictive value in indicating advanced gastric cancer.

Deflation and monetary policy: A look into Japan and the Euro Area

With more than two decades of weak economic performance since the bubble burst in the ‘90s, the Japanese deflationary scenario has become the economic fate every developed economy fears to become. As the euro area continues to experience sustained low inflation, studying the Japanese monetary policy may shed light on how to prevent persistent deflation. Using an SVAR methodology to understand the monetary transmission mechanism, we find some evidence that the euro area may possess characteristics that would eventually lead to a deflationary scenario. The extent of whether it would suffer the same Japanese fate would depend on how macroeconomic policies are timely coordinated as a response to its liquidity problem and increasing public debt across member states.

Gastric myoelectrical activity in neonates of different gestational ages by means of electrogastrography

PURPOSE: to describe the patterns of the gastric myoelectrical activity, pre-and postprandially, in clinically stable neonates of different gestational ages, during their first two weeks of life by means of Electrogastrography. PATIENTS AND METHODS: Electrogastrography was recorded in forty-five clinically stable neonates of different gestational ages (group I: 15 neonates of > 37 weeks, group II: 15 premature neonates of 32-37 weeks; Group III: 15 premature neonates of 28-31 weeks) receiving intermittent enteral feedings during their first two weeks of life. Electrogastrography recordings were performed for 1 hour pre-and postprandially. The Electrogastrography signal was recorded using the portable MicroDigitrapper Electrogastrography recording device and after motion artifacts were deleted, the remaining Electrogastrography data were submitted to quantitative analysis based on the "Running Spectrum Analysis". RESULTS: The percentages of normogastria, pre-and postprandially were greater than the percentages of gastric dysrythmias in all three studied groups. Furthermore, all neonates had the mean values of the Electrogastrography dominant frequency predominantly within the normogastria range, in both periods analyzed. There were no significant differences in the relative change of the Electrogastrography dominant power among the groups. CONCLUSION: This study demonstrates that the Electrogastrography patterns are similar between premature and full term neonates during the pre-and postprandial periods. The results of this study also indicate that the gastric myoelectrical activity in premature and full term neonates is immature, as compared to that described for older neonates, children and adults.

Vantagens da utilização de terra argilosa e fibras naturais em argamassas de cal aérea

Uma argamassa é tradicionalmente efetuada a partir de uma mistura de agregados finos com um ligante e água. Para utilização em rebocos interiores e exteriores devem utilizar-se argamassas que possuam características que sejam compatíveis com as da parede sobre a qual vão ser aplicadas e com as solicitações a que vão estar sujeitas. Em paredes realizadas com base em terra (através de técnicas de taipa, alvenaria de adobe ou de blocos de terra comprimida) utilizavam-se tradicionalmente argamassas só de terra (em interiores) ou de misturas de terra e cal aérea. Embora recentemente não sejam tão correntes, este tipo de argamassas de terra ou particularmente as mistas são muito utilizadas em alguns países desenvolvidos, como é o caso de vários países do Norte da Europa, particularmente devido a aspetos de sustentabilidade e qualidade do ar ambiente. Noutros países, como é o caso da Escócia, estas argamassas voltaram também a ser usadas para o tratamento e refechamento de juntas de assentamento de alvenarias históricas. A adição de fibras naturais (vegetais ou animais) pode ainda otimizar algumas características deste tipo de argamassas, como sejam através da diminuição da condutibilidade térmica e da suscetibilidade à fendilhação. Caracterizaram-se argamassas ao traço volumétrico de 1:2 e 1:3 de cal aérea e areia, nas quais se realizaram substituições parciais da cal ou da areia por terra argilosa caulinítica, e à adição de fibras naturais. Em função das características observadas, a sua utilização não tem de restringir-se à aplicação em paredes realizadas com base em terra, mas pode estender-se a outros suportes, nomeadamente a paredes de alvenaria argamassada antigas, tão frequentes também no património arquitetónico do espaço lusófono e, na maioria dos casos, com necessidades de intervenção com vista à sua conservação e manutenção prementes.

P53 and Rb tumor suppressor gene alterations in gastric cancer

Inactivation of tumor suppressor genes has been frequently observed in gastric carcinogenesis. Our purpose was to study the involvement of p53, APC, DCC, and Rb genes in gastric carcinoma. METHOD: Loss of heterozygosity of the p53, APC, DCC and Rb genes was studied in 22 gastric cancer tissues using polymerase chain reaction; single-strand conformation polymorphism of the p53 gene exons 5-6 and exons 7-8 was studied using 35S-dATP, and p53 expression was detected using a histological immunoperoxidase method with an anti-p53 clone. RESULTS AND DISCUSSION: No loss of heterozygosity was observed in any of these tumor suppressor genes; homozygous deletion was detected in the Rb gene in 23% (3/13) of the cases of intestinal-type gastric carcinoma. Eighteen (81.8%) cases showed band mobility shifts in exons 5-6 and/or 7-8 of the p53 gene. The presence of the p53 protein was positive in gastric cancer cells in 14 cases (63.6%). Normal gastric mucosa showed negative staining for p53; thus, the immunoreactivity was likely to represent mutant forms. The correlation of band mobility shift and the immunoreactivity to anti-p53 was not significant (P = .90). There was no correlation of gene alterations with the disease severity. CONCLUSIONS: The inactivation of Rb and p53 genes is involved in gastric carcinogenesis in our environment. Loss of the Rb gene observed only in the intestinal-type gastric cancer should be further evaluated in association with Helicobacter pylori infection. The p53 gene was affected in both intestinal and diffuse histological types of gastric cancer.

Measuring spillover effects in Euro Area equity and bond markets

Since its inception, the Eurozone has experienced significant financial integration. However, with the recent turbulent period, the dynamics of this integration may have changed. This study analyses the volatility spillovers from the US and aggregate Eurozone markets into ten Euro Area national equity and bond markets, using a regime-switching model with shifting shock sensitivities. The evidence confirms an increased impact of shock spillover intensity after the 2008 crisis in the equity market and a decrease of the same parameters for the bond market. In both markets, the overall impact of the Eurozone is greater when compared to the U.S.

Microsatellite instability in solitary and sporadic gastric cancer

Recently, the presence of microsatellite instability (MSI) has been reported in gastric cancer and associated with older age of presentation, distal tumor location, early disease staging, and better overall prognosis. Different characteristics in presentation and in tumor behavior may be explained by different genetic alterations during carcinogenesis of gastric cancer. Identification of specific genetic pathways in gastric cancer may have direct impact on prognosis and selection of treatment strategies. PATIENTS AND METHODS: All 24 patients were treated by radical surgery. Fragments of normal and tumor tissues were extracted from the specimen and stored at -80ºC before DNA purification and extraction. PCR amplification utilizing microsatellite markers was performed. Tumors presenting PCR products of abnormal sizes were considered positive for microsatellite instability (MSI+). RESULTS: Five patients (21%) had tumors that were MSI+ in at least 1 marker. In the group of patients with Lauren's intestinal-type gastric carcinoma, 3 had tumors that were MSI+ (23%), while in the group of diffuse-type gastric cancer, 2 patients had tumors that were MSI+ (19%). The mean age of presentation and the male:female ratio was similar in both groups. Tumors that were MSI+ were more frequently located in proximal portion of the stomach compared to microsatellite-stable (MSS) tumors (40% vs. 16%). Although there was a trend of patients with MSI+ tumors towards a proximal gastric tumor location, early staging, and negative lymph node metastasis, there was no statistical significance compared to those with MSS tumors (P >.1). Comparison of overall and disease-free survival between gastric tumors that were MSI+ and those that were MSS found no statistically significant differences (P >.1). CONCLUSIONS: Microsatellite instability is a frequent event in gastric carcinogenesis and shows a trend towards distinct clinical and pathological characteristics of gastric cancer.

Geomorphology and land development in the Maraca area of northern Roraima, Brazil.

The geomorphological materials and forms of the Maraca area of Roraima, Brazil are described, an their sgnificance for land development examined. Significant contrasts are noted in areas presently under rainforest and savanna vegetation. Lateritic gravels and extensive shetwash accumulations in savanna areas constrast with incipient or absent plinthite development, few gravels and limited evidence of colluvium under rainforest. Terrain is in general relatively highly-dissected. Slope profiles are characterised, particularly within the savanna zone, by a relatively steep lower concavity. These contrasts are sharply-demarcated by the present savanna/rainforest bondary, unexpectedly in view of the generally accepted hypothesis of repeated contraction an expansion of Amazonian rainforest throughout the Pleistocene. It is concluded that geomorphological conditions in the Maraca area are not favorable for land develoment.

EFICIÊNCIA DE Bacillus thuringieneisE DE DELTAMETRINA, EM APLICAÇÃO AÉREA, PARA O CONTROLE DE Thyrinteina arnobiaSTOLL, 1782 (LEPIDOPTERA: GEOMETRIDAE) EM EUCALIPTAL NO PARÁ

A avaliação da eficiência relativa de formulações de Bacillus thuringiensise de deltametrina, em aplicações aéreas para o controle de Thyrirrteina arnobiaStoll, 1782 (Lepidoptera: Geometndae) em Eucalyptus urophyllaem Monte Dourado no Pará, foi feita no presente ensaio, onde faixas de 10 ha (100x1000 m) foram pulverizadas com formulações comercoais de B. thuringiensise/ou deltametrina. Foram tomados cinco pontos de amostragem para cada tratamento e as avaliações foram feitas 24, 48, 72, 96 e 120 horas após a aplicação dos inseticidas. Cerca de 144 horas após a aplicação, foi feita uma pulverização drástica de uma mistura de malation e deltametrina, para a verificação do número total de insetos presentes nos pontos amostrados. A deltametrina mostrou eficiência máxima nas doses de 200 e 400 ml/ha e grande efeito de impacto sobre a população de lagartas. A ação do B. thuringiensismostrou-se mais lenta, mas o uso de formulações de alta qualidade desta bactéria e promissor para o controle de lagartas em reflorestamentos no trópico úmido, podendo ser usadas isoladamente ou em mistura com a deltametrina para um maior efeito de impacto. Verificou-se, também, o\ue tanto B. thuringiensisquanto a deltametrina tiveram pouco efeito sobre a população de nemípteros predadores. Assim, a deltametrina pode ser usada no controle de lagartas de eucalipto, preservando-se esses inimigos naturais.

Biomassa da parte aérea da vegetação da Floresta Tropical úmida de terra-firme da Amazônia Brasileira

Usando um banco de dados com 315 árvores, com DAP≥5 cm, foram testados quatro modelos estatísticos - linear, não linear e dois logarítmicos - para estimar a biomassa de árvores em pé. Os dados foram coletados, de forma destrutiva, na região de Manaus, Estado do Amazonas, em um sítio coberto por floresta de terra-fírme sobre platôs de latossolo amarelo. Em diferentes simulações com diferentes intensidades de amostragem, os quatro modelos estimam precisamente a biomassa, sendo que o afastamento entre a média observada e a estimada, em nenhuma ocasião ultrapassou 5%. As equações para estimar a biomassa de árvores individuais em uma parcela fixa, distintamente para árvores com 5≤ DAP<20 cm e com DAP≥20 cm, são mais consistentes do que o uso de uma única equação para estimar, genericamente, todas as árvores com DAP≥5 cm. O modelo logarítmico com apenas uma variável independente, o DAP, apresenta resultados tão consistentes e precisos quanto os modelos que se utilizam também da variável altura total da árvore. Além do modelo estatístico para estimar o peso da massa fresca total de uma árvore, outras informações são apresentadas, estratificadas nos diferentes compartimentos (tronco, galho grosso, galho fino, folhas e, eventualmente, flores e frutos) de uma árvore, como: concentração de água para estimar o peso da massa seca, concentração carbono e a contribuição do peso de cada compartimento no peso total.

A new genus of Holothyrina: Neothyridae (Arachnida, Anactinotrichida) from the Manaus area, Amazonas state, Brazil

A new genus of Neothyridae, type species Diplothyrus schubarti sp. n., is described from the leaf litter of a primary forest in the Reserva Florestal Adolpho Ducke, Manaus, Amazonas, Brazil. The two pairs of lateral excretory orifices instead of a single one in the type genus Neothyrus of the family Neothyridae, are diagnostic. A protonymph of Neothyrus ana Lehtinen, 1981, is also described as the first known nymphal stage of this family.

Tree species diversity in a seasonally-dry forest: the case of the Pinkaití site, in the Kayapó Indigenous Area, Southeastern limits of the Amazon

This study investigates patterns of forest structure and tree species diversity in an anthropogenic palm grove and undisturbed areas at the seasonally-dry Pinkaití research station, in the Kayapó Indigenous Area. This site, managed by the Conservation International do Brasil, is the most southeastern site floristically surveyed in the Amazon until now. The secondary and a nearby undisturbed forest were sampled in a group of 52 floristic plots of 0.0625-ha (25x25-m) where all trees with DBH > 10 cm were measured and identified. The analyses were complemented with other two floristic plots of 1-ha (10x1000-m). The present study has shown that the Pinkaití, like other seasonally-dry forests, have great heterogeneity in forest structure and composition, associated with biotic characteristics of the most important tree species, natural disturbance and history of land-use. The palm grove, moderately dominated by the arborescent palm Attalea maripa (Aubl.) Mart., presented high tree species diversity and was floristically similar to undisturbed forests at the study site. It is discussed the importance of large arborescent palms for the seasonally-dry Amazon forests regeneration.