Infrared microspectroscopy of inflammatory process and colon tumors.

According to the last global burden of disease published by the World Health Organization, tumors were the third leading cause of death worldwide in 2004. Among the different types of tumors, colorectal cancer ranks as the fourth most lethal. To date, tumor diagnosis is based mainly on the identification of morphological changes in tissues. Considering that these changes appears after many biochemical reactions, the development of vibrational techniques may contribute to the early detection of tumors, since they are able to detect such reactions. The present study aimed to develop a methodology based on infrared microspectroscopy to characterize colon samples, providing complementary information to the pathologist and facilitating the early diagnosis of tumors. The study groups were composed by human colon samples obtained from paraffin-embedded biopsies. The groups are divided in normal (n=20), inflammation (n=17) and tumor (n=18). Two adjacent slices were acquired from each block. The first one was subjected to chemical dewaxing and H&E staining. The infrared imaging was performed on the second slice, which was not dewaxed or stained. A computational preprocessing methodology was employed to identify the paraffin in the images and to perform spectral baseline correction. Such methodology was adapted to include two types of spectral quality control. Afterwards the preprocessing step, spectra belonging to the same image were analyzed and grouped according to their biochemical similarities. One pathologist associated each obtained group with some histological structure based on the H&E stained slice. Such analysis highlighted the biochemical differences between the three studied groups. Results showed that severe inflammation presents biochemical features similar to the tumors ones, indicating that tumors can develop from inflammatory process. A spectral database was constructed containing the biochemical information identified in the previous step. Spectra obtained from new samples were confronted with the database information, leading to their classification into one of the three groups: normal, inflammation or tumor. Internal and external validation were performed based on the classification sensitivity, specificity and accuracy. Comparison between the classification results and H&E stained sections revealed some discrepancies. Some regions histologically normal were identified as inflammation by the classification algorithm. Similarly, some regions presenting inflammatory lesions in the stained section were classified into the tumor group. Such differences were considered as misclassification, but they may actually evidence that biochemical changes are in course in the analyzed sample. In the latter case, the method developed throughout this thesis would have proved able to identify early stages of inflammatory and tumor lesions. It is necessary to perform additional experiments to elucidate this discrepancy between the classification results and the morphological features. One solution would be the use of immunohistochemistry techniques with specific markers for tumor and inflammation. Another option includes the recovering of the medical records of patients who participated in this study in order to check, in later times to the biopsy collection, whether they actually developed the lesions supposedly detected in this research.

Estudo observacional do uso da hipodermóclise em cuidados paliativos oncológicos

Hipodermóclise (HDC) é uma importante técnica alternativa para a administração de medicamentos e fluidos pela via subcutânea. É usada com frequência para o controle dos sintomas em pacientes em cuidados paliativos com dificuldade de acesso venoso e que são incapazes de tolerar medicação oral. No entanto, raros estudos abordaram o uso da HDC de uma forma global, para reposição hidroeletrolítica e terapia medicamentosa, tanto na forma contínua quanto intermitente, observando detalhes e complicações do seu uso. Os objetivos deste estudo incluíram caracterizar o uso da HDC para administração de medicamentos, soluções e eletrólitos e avaliar as possíveis complicações locais, identificando também outros fatores que influenciam sua ocorrência. Estudo observacional prospectivo com coleta de dados em prontuário e acompanhamento diário de pacientes internados com câncer avançado, da equipe de Cuidados Paliativos do Instituto do Câncer do Estado de São Paulo (ICESP) em uso de HDC, verificando local de punção, medicamentos administrados e possíveis complicações, acompanhando os detalhes de seu uso. A análise estatística não-paramétrica e método de regressão logística foram realizados. Foram acompanhados 99 pacientes com 243 punções, das quais 166 (68,3%) em coxa e 46 (18,9%) em abdome. Os medicamentos mais utilizados foram morfina em 122 (50,2%) punções, seguido de dipirona em 118 (48,6%) e dexametasona em 86 (35,4%). A solução mais prescrita foi a glicofisiológica em 38 (15,6%) punções, pelo seu aporte calórico. 13,6% das punções (33 de 243) tiveram complicações, sendo apenas seis casos maiores (edema). Complicações ocorreram mais frequentemente até o segundo dia da punção e foram associadas com o número (p=0,007) e o volume (p=0,042) de medicamentos administrados e também com a solução glicofisiológica (p=0,003) e os eletrólitos cloreto de potássio (p=0,037) e cloreto de sódio (p=0,013). Este estudo permitiu o conhecimento de fatores associados a complicações e propõe algumas recomendações, como: individualização da terapia, especialmente relacionada com o volume de escolha, número de medicamentos administrados e evitar a adição de eletrólitos na solução glicofisiológica

Account books of Thomas Cradock, 1786-1818 (inclusive)

Account books listing patients, medicines administered, and fees charged by Dr. Thomas Cradock (1752-1821), primarily in Maryland, from 1786 to 1818. In addition to recording names, Cradock occasionally noted demographic information, the patient's location, or their occupation: from 1813 to 1816, he treated Richard Gent, a free African-American man; in 1813, he attended to John Bell, who lived in the Foggy Bottom neighborhood of Washington, D.C. Cradock further noted if the patient was a slave and the name of his or her owner. He would also administer care on behalf of corporate entities, such as Powhatan Factory, which apparently refused him payment. He also sometimes included a diagnosis: in the cases of a Mr. Rowles and Mrs. Violet West, he administered unspecified medicines for gonorrhea at a cost of ten dollars. Commonly prescribed drugs included emetics, cathartics, and anodynes. Cradock also provided smallpox vaccination for his patients. He accepted both cash and payment-in-kind. Tipped into the first volume is an envelope containing a letter from the Medical and Chirurgical Faculty of Maryland to Mrs. Thomas Craddock in 1899 requesting a loan of portrait of Dr. Thomas Craddock [sic]. The three volumes also each contain an index to patient names.

Small Pocks, 1775-1779 (inclusive)

Ledger containing accounts of smallpox inoculation by Dr. John Jeffries (1745-1819) at Rainsford Island Hospital in Boston, Massachusetts, from June to July 1775; at a West Boston smallpox hospital in July 1775; and in Halifax, Nova Scotia, between 1776 and 1779. The accounts include dates, names, ages and physical condition of patients, and details regarding the method of delivery. Among the patients he inoculated was his son, John, at Rainsford Island Hospital on 14 June 1775.

Account books of William Aspinwall, 1776-1812 (inclusive)

Two account books containing entries noting patients visited, fees charged, and small accounts of Dr. William Aspinwall (1743-1823) in Boston and Brookline, Massachusetts, from 1776 to 1812. He includes sections for "Women's Accounts" with charges generally rendered to their husbands or other male relatives. There is also an entry charging the town of Cambridge, Massachusetts, four dollars and fifty cents for medicines and attendance to a boy who contracted smallpox.

Account book of Job Godfrey, 1787-1809 (inclusive)

Ledger kept by Dr. Job Godfrey (1742-1813) of Taunton, Massachusetts, containing records of patients, medical services rendered, and fees charged between 1791 and 1797, which were updated with payment transactions through 1809. There are also notes on Godfrey's medical practice dated from 1787, including an entry on a nine-year-old girl he dissected after her death. There are additionally credits or debits listed for household transactions.

Account book of Daniel Brigham, 1781-1798 (inclusive)

Account book maintained by Dr. Daniel Brigham (1760-1830) for services provided to approximately 180 patients, treated primarily in Northborough, Westborough, and Marlborough, Massachusetts, and surrounding towns between 1781 and 1798. The ledger details the charges for his visits to patients and medicines he prescribed. Common charges included one shilling, four pence for Brigham to visit and administer an emetic or cathartic to a patient. A visit and bloodletting by Brigham cost one patient two shillings, eight pence. He charged six shillings to amputate a toe, and eight pence to extract a tooth. Includes an index to patient names. The ledger also records household and miscellaneous expenses of Brigham.

Student lecture notes on the Theory & Practice of Physic, and patient case histories, of Lyman Spalding, 1795-1799 (inclusive)

Contains notes taken by Harvard student Lyman Spalding from lectures delivered by Hersey Professor of the Theory and Practice of Physic Benjamin Waterhouse (1754-1846) in 1795. The notes cover the history of medicine, theories of contemporary physicians like Herman Boerhaave, William Cullen, and John Brown, and topics like fetal growth, digestion, and circulation. The volume also contains six pages of patient case notes from Spalding’s medical practice in Walpole, New Hampshire, in 1799, which detail the patients’ symptoms and course of treatment he pursued. In the case of a young man who complained of pain in his breast following a wrestling match, Spalding bled him and prescribed a cathartic of soap and aloes. Spalding also operated on a man who cut off part of his ankle with an ax.

Notebook of Moses Appleton, 1794-1837 (inclusive)

Contains notes taken by Moses Appleton (1773-1849) on anatomy lectures delivered at Harvard by John Warren (1753-1815). Other lecture topics included midwifery and surgery. Also includes a transcript of an examination given by Warren to his students on anatomy and surgery, as well as exams given by Harvard Professor Benjamin Waterhouse (1754-1846) and Harvard Professor Aaron Dexter (1750-1829) on the theory and practice of physic, and chemistry, respectively. There are additionally patient case notes and transcriptions of notes and correspondence from physicians Appleton consulted, and a list of operations Appleton performed between 1796 and 1828, primarily repairing dislocated joints and fractured bones. Also includes obituaries of citizens of Waterville, Maine, from 1807 to 1837.

Doctor Daniel Brigham's Book, 1789-1810 (inclusive)

Ledger maintained by Dr. Daniel Brigham (1760-1837) containing financial accounts for medical patients treated primarily in Northborough, Westborough, and Marlborough, Massachusetts from 1789 to 1837. The ledger details the charges for medical services and the corresponding payments, often made by payment-in-kind. Common charges included a shilling for a visit and administration of cathartics, emetics, or anodynes. Extraction of a tooth cost eight pence, and Brigham charged one woman nine shillings for delivering her son. A number of entries are obscured by pasted-in newspaper articles.

Account book of David Townsend, 1774-1791

Account book kept by Dr. David Townsend (1753-1829) that records patients treated, illnesses, and fees charged in Boston, Massachusetts, and neighboring towns from 1774 to 1791. His patients included a number of soldiers and sailors, as well as figures like the French-American writer John Hector St. John (1735-1813). Townsend's treatments typically consisted of delivering cathartics or emetics. For the family of Samuel Appleton, Townsend administered smallpox inoculation in 1776, charging him 4 pounds, 4 shillings. Townsend sometimes recorded the occupation or race of the patient. For example, he attended the delivery of a child of Sappho Henshaw, "black girl," in 1786; in 1787 he attended to an unnamed "black man at [who lived at the] corner of Board Alley" in the North End of Boston. Other patients included John Hancock (1736-1793) and members of Hancock's household, as well as Federalist publisher John Fenno (1751-1798).

Kine Pox, 1775-1802 (inclusive)

Ledger containing lists and charts of smallpox inoculation cases and patient case histories of Boston physician John Jeffries (1745-1819), recorded from November 1775 to June 1802. Descriptions include patients’ names, ages, and physical condition, method of inoculation and symptoms. The entries dated 1800-1802 are not in chronological order.

Cases copied by James Lloyd from Mr. Steed, apothecary in Guy's Hospital, London, 1751-1787 (inclusive)

Contains medical cases copied by James Lloyd (1728-1810), primarily between 1751 and 1754, from Mr. Steed, an apothecary at Guy's Hospital in London, England. The volume has additional medical cases dating from 1780 to 1787. Lloyd transcribed the names, ages, and symptoms of the patients, as well as the medicines and medical care delivered to them. The volume is divided into chapters based on the type of case, which included vision loss; fluor albus, or leucorrhoea; diabetes; and dysentery. There is also a letter pasted into the volume addressed to Dr. Brigham of the Boston Medical Library Association from Lloyd's great-grandson, dated 4 November 1887.

Eficiência do metotrexato na artrite psoriática

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Revisiting a series of epithelial salivary gland tumors in children and adolescents in southern Portugal

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014