Carcinoma do esôfago com invasão do canal medular: relato de caso e revisão da literatura

Os autores apresentam o caso de paciente do sexo masculino, 62 anos de idade, com emagrecimento há quatro meses e diminuição da força muscular associada a parestesias em membros inferiores há dois dias. Foi submetido a mielotomografia, que demonstrou massa no mediastino posterior com destruição dos corpos vertebrais e invasão do canal medular, além de espessamento irregular das paredes do esôfago. Na evolução, foi submetido a estudo contrastado do esôfago, que demonstrou falha de enchimento irregular. A biópsia confirmou a presença de carcinoma de células escamosas. Este é o primeiro relato na literatura latino-americana (Lilacs) de carcinoma de esôfago com invasão de canal medular e manifestação inicial de síndrome de compressão medular.

Gamma-ray emission from massive young stellar objects

Context.Massive stars form in dense and massive molecular cores. The exact formation mechanism is unclear, but it is possible that some massive stars are formed by processes similar to those that produce the low-mass stars, with accretion/ejection phenomena occurring at some point of the evolution of the protostar. This picture seems to be supported by the detection of a collimated stellar wind emanating from the massive protostar IRAS 16547-4247. A triple radio source is associated with the protostar: a compact core and two radio lobes. The emission of the southern lobe is clearly non-thermal. Such emission is interpreted as synchrotron radiation produced by relativistic electrons locally accelerated at the termination point of a thermal jet. Since the ambient medium is determined by the properties of the molecular cloud in which the whole system is embedded, we can expect high densities of particles and infrared photons. Because of the confirmed presence of relativistic electrons, inverse Compton and relativistic Bremsstrahlung interactions are unavoidable. Aims.We aim to make quantitative predictions of the spectral energy distribution of the non-thermal spots generated by massive young stellar objects, with emphasis on the particular case of IRAS 16547-4247. Methods.We study the high-energy emission generated by the relativistic electrons which produce the non-thermal radio source in IRAS 16547-4247. We also study the result of proton acceleration at the terminal shock of the thermal jet and make estimates of the secondary gamma rays and electron-positron pairs produced by pion decay. Results.We present spectral energy distributions for the southern lobe of IRAS 16547-4247, for a variety of conditions. We show that high-energy emission might be detectable from this object in the gamma-ray domain. The source may also be detectable in X-rays through long exposures with current X-ray instruments. Conclusions.Gamma-ray telescopes such as GLAST, and even ground-based Cherenkov arrays of new generation can be used to study non-thermal processes occurring during the formation of massive stars.

A microquasar model applied to unidentified gamma-ray sources

Among unidentified gamma-ray sources in the galactic plane, there are some that present significant variability and have been proposed to be high-mass microquasars. To deepen the study of the possible association between variable low galactic latitude gamma-ray sources and microquasars, we have applied a leptonic jet model based on the microquasar scenario that reproduces the gamma-ray spectrum of three unidentified gamma-ray sources, 3EG J1735-1500, 3EG J1828+0142 and GRO J1411-64, and is consistent with the observational constraints at lower energies. We conclude that if these sources were generated by microquasars, the particle acceleration processes could not be as efficient as in other objects of this type that present harder gamma-ray spectra. Moreover, the dominant mechanism of high-energy emission should be synchrotron self-Compton (SSC) scattering, and the radio jets may only be observed at low frequencies. For each particular case, further predictions of jet physical conditions and variability generation mechanisms have been made in the context of the model. Although there might be other candidates able to explain the emission coming from these sources, microquasars cannot be excluded as counterparts. Observations performed by the next generation of gamma-ray instruments, like GLAST, are required to test the proposed model.

Optical spectroscopy of microquasar candidates at low Galactic latitudes

We report optical spectroscopic observations of a sample of 6 low-galactic latitude microquasar candidates selected by cross-identification of X-ray and radio point source catalogs for |b|<5 degrees. Two objects resulted to be of clear extragalactic origin, as an obvious cosmologic redshift has been measured from their emission lines. For the rest, none exhibits a clear stellar-like spectrum as would be expected for genuine Galactic microquasars. Their featureless spectra are consistent with being extragalactic in origin although two of them could be also highly reddened stars. The apparent non-confirmation of our candidates suggests that the population of persistent microquasar systems in the Galaxy is more rare than previously believed. If none of them is galactic, the upper limit to the space density of new Cygnus X-3-like microquasars within 15 kpc would be 1.1\times10^{-12} per cubic pc. A similar upper limit for new LS 5039-like systems within 4 kpc is estimated to be 5.6\times10^{-11} per cubic pc.

LS 5039: A runaway microquasar ejected from the galactic plane

We have compiled optical and radio astrometric data of the microquasar LS 5039 and derived its proper motion. This, together with the distance and radial velocity of the system, allows us to state that this source is escaping from its own regional standard of rest, with a total systemic velocity of about 150 km/s and a component perpendicular to the galactic plane larger than 100 km/s. This is probably the result of an acceleration obtained during the supernova event that created the compact object in this binary system. We have computed the trajectory of LS 5039 in the past, and searched for OB associations and supernova remnants in its path. In particular, we have studied the possible association between LS 5039 and the supernova remnant G016.8-01.1, which, despite our efforts, remains dubious. We have also discovered and studied an HI cavity in the ISM, which could have been created by the stellar wind of LS 5039 or by the progenitor of the compact object in the system. Finally, in the symmetric supernova explosion scenario, we estimate that at least 17 solar masses were lost in order to produce the high eccentricity observed. Such a mass loss could also explain the observed runaway velocity of the microquasar.

O uso da ultra-sonografia no diagnóstico e evolução da apendicite aguda

OBJETIVO: Aproximadamente 35% das apendicites agudas têm diagnóstico clínico pré-operatório duvidoso ou incorreto, particularmente grávidas e crianças. A ultra-sonografia, em virtude do seu baixo custo e facilidade de acesso, tem-se mostrado um método diagnóstico importante. Este estudo propôs-se a demonstrar os principais achados de imagem das diversas fases da apendicite, com o objetivo de auxiliar o ultra-sonografista no diagnóstico precoce desta afecção. MATERIAIS E MÉTODOS: São relatados 14 casos de ultra-sonografias abdominais realizadas no período de janeiro a julho de 2001, em pacientes que se apresentavam com quadro de abdome agudo. O exame foi realizado com transdutores de 3,5 MHz e 7,5 MHz. RESULTADOS: O estudo ultra-sonográfico antes da perfuração demonstra apêndice não compressível, com espessamento e perda focal da definição das paredes. Após a perfuração, o apêndice pode não ser visualizado ao exame de ultra-sonografia, sendo evidenciadas alterações secundárias como efeito de massa, formação de plastrão, liquefação e formação de abscesso, além de ar dentro da coleção. CONCLUSÃO: O diagnóstico precoce da apendicite é essencial para minimizar a morbidade, que se mantém elevada se ocorrer perfuração. Apresentações atípicas resultam em confusão diagnóstica e retarde no tratamento. As principais dificuldades e erros são apendicite retrocecal, apendicite focal ou perfurada.

Amiloidose pulmonar: aspectos na tomografia computadorizada

Neste trabalho foram estudados os aspectos tomográficos observados em cinco pacientes com diagnóstico de amiloidose pulmonar confirmado histopatologicamente. Dois deles apresentaram a forma traqueobrônquica da doença e mostraram nodulações e formação de placas nas paredes traqueais, com calcificações. Dois tinham a forma parenquimatosa difusa, um deles com opacidades reticulares e nodulares subpleurais, e o outro com espessamento nodular de septos interlobulares e consolidações parenquimatosas. Ambos apresentavam calcificações de permeio às lesões. O último paciente tinha a forma nodular da doença, com nódulos de contornos regulares em ambos os pulmões, com calcificações. Os aspectos tomográficos observados, embora não patognomônicos, são muito sugestivos do diagnóstico de amiloidose.

Linfangioliomiomatose pulmonar: aspectos na tomografia computadorizada de alta resolução

Neste trabalho foram estudados, retrospectivamente, 17 pacientes com linfangioliomiomatose pulmonar diagnosticada por biópsia pulmonar a céu aberto. Todos os pacientes eram do sexo feminino, com idade média de 39,6 anos. Duas pacientes tiveram também o diagnóstico de esclerose tuberosa. As pacientes foram submetidas a tomografia computadorizada de alta resolução, cujos achados revelaram cistos com conteúdo gasoso, de formas variadas e com diferentes tamanhos, não ultrapassando 60 mm de diâmetro. A grande maioria tinha as paredes finas. Todos os cistos apresentaram distribuição difusa pelo parênquima pulmonar. Somente duas pacientes apresentaram pneumotórax associado. Nódulos parenquimatosos e espessamento de septos interlobulares não foram observados. Dessa forma, as características tomográficas utilizadas para o diagnóstico foram a ausência de nódulos e a presença de cistos de tamanhos variados, em geral menores que 20 mm, arredondados e distribuídos difusamente pelo parênquima pulmonar.

Bupivacaine 0.5 % versus articaine 4 % for the removal of lower third molars. A crossover randomized controlled trial

Objective: To compare the anesthetic action of 0.5% bupivacaine in relation to 4% articaine, both with 1:200,000 epinephrine, in the surgical removal of lower third molars. As a secondary objective hemodynamic changes using both anesthetics were analyzed. Study Design: Triple-blind crossover randomized clinical trial. Eighteen patients underwent bilateral removal of impacted lower third molars using 0.5% bupivacaine or 4% articaine in two different appointments. Preoperative, intraoperative and postoperative variables were recorded. Differences were assessed with McNemar tests and repeated measures ANOVA tests. Results: Both solutions exhibited similar latency times and intraoperative efficacy. Statistical significant lower pain levels were observed with bupivacaine between the fifth (p=0.011) and the ninth (p=0.007) postoperative hours. Bupivacaine provided significantly longer lasting soft tissue anesthesia (p<0.05). Systolic blood pressure and heart rate values were significantly higher with articaine. Conclusions: Bupivacaine could be a valid alternative to articaine especially due to its early postoperative pain prevention ability.

EVN+MERLIN observations of microquasar candidates at low galactic latitudes

In an attempt to increase the number of known microquasars, Paredes et al. (2002) have presented a long-term project focused on the search for new objects of this type. They performed a cross-identification between X-ray and radio catalogs under very restrictive selection criteria for sources with |b|<5 degrees, and obtained a sample of 13 radio-emitting X-ray sources. Follow-up observations of 6 of these sources with the VLA provided accurate coordinates, which were used to discover optical counterparts for all of them. We have observed these six sources with the EVN and MERLIN at 5 GHz. Five of the six objects have been detected and imaged, presenting different morphologies: one source has a two-sided jet, three sources have one-sided jets, and one source is compact. With all the presently available information, we conclude that two of the sources are promising microquasar candidates in our Galaxy.

High mass microquasars and low latitude gamma-ray sources

Population studies of unidentified EGRET sources suggest that there exist at least three different populations of galactic gamma-ray sources. One of these populations is formed by young objects distributed along the galactic plane with a strong concentration toward the inner spiral arms of the Galaxy. Variability, spectral and correlation analysis indicate that this population is not homogeneous. In particular, there is a subgroup of sources that display clear variability in their gamma-ray fluxes on timescales from days to months. Following the proposal by Kaufman Bernad\'o et al. (2002), we suggest that this group of sources might be high-mass microquasars, i.e. accreting black holes or neutron stars with relativistic jets and early-type stellar companions. We present detailed inhomogeneous models for the gamma-ray emission of these systems that include both external and synchrotron self-Compton interactions. We have included effects of interactions between the jet and all external photon fields to which it is exposed: companion star, accretion disk, and hot corona. We make broadband calculations to predict the spectral energy distribution of these objects from radio up to GeV energies. The results and predictions can be tested by present and future gamma-ray instruments like INTEGRAL, AGILE, and GLAST.

AGNs and microquasars as high-energy gamma-ray sources

The possible associations between the microquasars LS 5039 and LS I +61 303 and the EGRET sources 3EG J1824-1514 and 3EG J0241+6103 suggest that microquasars could also be sources of high-energy gamma-rays. In this work, we present a detailed numerical inverse Compton (IC) model, based on a microquasar scenario, that reproduces the high-energy gamma-ray spectra and variability observed by EGRET for the mentioned sources. Our model considers a population of relativistic electrons entrained in a cylindrical inhomogeneous jet that interact through IC scattering with both the radiation and the magnetic fields.

A prospective, randomized, triple-blind comparison of articaine and bupivacaine for maxillary infiltrations

Objectives: To compare the clinical anesthetic efficacy of 0.5% bupivacaine and 4% articaine (both with 1:200.000 adrenaline) for anterior maxillary infiltration in healthy volunteers. Material and methods: A triple-blind split-mouth randomized clinical trial was carried out in 20 volunteers. A supraperiosteal buccal injection of 0.9 ml of either solution at the apex of the lateral incisor was done in 2 appointments separated 2 weeks apart. The following outcome variables were measured: latency time, anesthetic efficacy (dental pulp, keratinized gingiva, alveolar mucosa and upper lip mucosa and tissue) and the duration of anesthetic effect. Hemodynamic parameters were monitored during the procedure. Results: Latency time recorded was similar for both anesthetic solutions (p>0.05). No statistically significant differences were found in terms of anesthetic efficacy for dental pulp, keratinized gingiva or alveolar mucosa. Articaine had a significant higher proportion of successful anesthesia at 10 minutes after infiltration in lip mucosa and lip skin (p=0.039). The duration of anesthesia was 336 minutes for bupivacaine and 167 minutes for articaine. (p<0.001). No significant hemodynamic alterations were noted during the procedure. Conclusions: Articaine and bupivacaine exhibited similar anesthetic efficacy for maxillary infiltrations. The duration of anesthesia was longer with the bupivacaine solution, but lip anesthesia was better with articaine

p21 as a Transcriptional Co-Repressor of S-Phase and Mitotic Control Genes

It has been previously described that p21 functions not only as a CDK inhibitor but also as a transcriptional co-repressor in some systems. To investigate the roles of p21 in transcriptional control, we studied the gene expression changes in two human cell systems. Using a human leukemia cell line (K562) with inducible p21 expression and human primary keratinocytes with adenoviral-mediated p21 expression, we carried out microarray-based gene expression profiling. We found that p21 rapidly and strongly repressed the mRNA levels of a number of genes involved in cell cycle and mitosis. One of the most strongly down-regulated genes was CCNE2 (cyclin E2 gene). Mutational analysis in K562 cells showed that the N-terminal region of p21 is required for repression of gene expression of CCNE2 and other genes. Chromatin immunoprecipitation assays indicated that p21 was bound to human CCNE2 and other p21-repressed genes gene in the vicinity of the transcription start site. Moreover, p21 repressed human CCNE2 promoter-luciferase constructs in K562 cells. Bioinformatic analysis revealed that the CDE motif is present in most of the promoters of the p21-regulated genes. Altogether, the results suggest that p21 exerts a repressive effect on a relevant number of genes controlling S phase and mitosis. Thus, p21 activity as inhibitor of cell cycle progression would be mediated not only by the inhibition of CDKs but also by the transcriptional down-regulation of key genes.

Identifying variable gamma-ray sources through radio observations

We present preliminary results of a campaign undertaken with different radio interferometers to observe a sample of the most variable unidentified EGRET sources. We expect to detect which of the possible counterparts of the gamma-ray sources (any of the radio emitters in the field) varies in time with similar timescales as the gamma-ray variation. If the gamma-rays are produced in a jet-like source, as we have modelled theoretically, synchrotron emission is also expected at radio wavelengths. Such radio emission should appear variable in time and correlated with the gamma-ray variability.