Anticoagulant treatment for subsegmental pulmonary embolism

BackgroundAcute pulmonary embolism (PE) is a common cause of death, accounting for 50,000 to 200,000 deaths annually. It is the third most common cause of mortality among the cardiovascular diseases, after coronary artery disease and stroke.The advent of multi-detector computed tomographic pulmonary angiography (CTPA) has allowed better assessment of PE regarding visualisation of the peripheral pulmonary arteries, increasing its rate of diagnosis. More cases of peripheral PEs, such as isolated subsegmental PE (SSPE) and incidental PE, have thereby been identified. These two conditions are usually found in patients with few or none of the classic PE symptoms such as haemoptysis or pleuritic pain, acute dyspnoea or circulatory collapse. However, in patients with reduced cardio-pulmonary (C/P) reserve the classic PE symptoms can be found with isolated SSPEs. Incidental SSPE is found casually in asymptomatic patients, usually by diagnostic imaging performed for other reasons (for example routine CT for cancer staging in oncologic patients).Traditionally, all PEs are anticoagulated in a similar manner independent of the location, number and size of the thrombi. It has been suggested that many patients with SSPE may be treated without benefit, increasing adverse events by possible unnecessary use of anticoagulants.Patients with isolated SSPE or incidental PE may have a more benign clinical presentation compared with those with proximal PEs. However, the clinical significance in patients and their prognosis have to be studied to evaluate whether anticoagulation therapy is required.ObjectivesTo assess the effectiveness and safety of anticoagulation therapy versus no intervention in patients with isolated subsegmental pulmonary embolism (SSPE) or incidental SSPE.Search methodsThe Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched October 2013) and CENTRAL (2013, Issue 9). MEDLINE, EMBASE, LILACS and clinical trials databases were also searched (October 2013).Selection criteriaRandomised controlled trials of anticoagulation therapy versus no intervention in patients with SSPE or incidental SSPE.Data collection and analysisTwo review authors inspected all citations to ensure reliable selection. We planned for two review authors to independently extract data and to assess the methodological quality of identified trials using the criteria recommended in the Cochrane Handbook for Systematic Reviews of Interventions.Main resultsNo studies were identified that met the inclusion criteria.Authors' conclusionsThere is no randomised controlled trial evidence for the effectiveness and safety of anticoagulation therapy versus no intervention in patients with isolated subsegmental pulmonary embolism (SSPE) or incidental SSPE, and therefore we can not draw any conclusions. Well-conducted research is required before informed practice decisions can be made.

Assessment of chemokine serum levels in epithelial ovarian cancer patients

Aims and background. The study was undertaken to investigate CCL2/MCP-1, CCL3/MIP-l alpha, CCL4/MIP-1 beta, CCL5/RANTES and CXCL8/IL-8 women with epithelial ovarian cancer.Methods and study design. Sixteen patients diagnosed with epithelial ovarian cancer and 18 healthy women with no evidence of malign neoplasia (control group) aged from 23 to 89 years (mean +/- SEM, 58.7 +/- 2.3) were included. The epithelial ovarian cancer patients underwent laparotomy and debulking surgery Chemokines serum levels were measured by cytometric bead array. Statistical analysis was performed using Mann-Whitney and Kendall's tau. P <0.05 was considered statistically significant for all analyses.Results. The tumor staging (FIGO) was classified into: I in 4 cases (25%), III in 5 cases (31.3%) and stage IV in 7 cases (43.8%). Sera chemokine dosages of CCL2 /MCP-1 and CCL4/MIP-1 beta were lower in epithelial ovarian cancer patients than in the control group (P = 0.021 and P = 0.030, respectively). No significant difference between groups was observed in the levels of CCL3/MIP-l alpha, CCL5/RANTES and CXCL8/IL-8. No association between the chemokines analyzed and tumor stage was found. The serum level of CCL4/MIP-1 beta was correlated with CA-125.Conclusions. The study of serum levels of CCL2/MCP-1, CCL3/MIP-l alpha, CCL4/MIP-1 beta, CCL5/RANTES and CXCL8/IL-8 chemokines in epithelial ovarian cancer patients identified a down-regulation in CCL2/MCP-1 and CCL4/MIP-1 beta, which suggests that the two chemokines may play an important role in the pathophysiology of ovarian cancer.

Linfoma cardíaco primário em cão

Lymphomas are malignant neoplasm characterized by proliferation of lymphocytes that originate primarily in lymphoid organ such as lymph nodes, liver, spleen and bone marrow. However the feature of continuous migration of lymphocytes in different organs, this tumor can develop in any organ. Although lymphoma is a very common hematopoietic neoplasm in dogs, cardiac location is rare. The diagnosis of primary cardiac lymphoma may be performed when there is involvement of the heart and/or the pericardium without evidence of involvement in other organs. In veterinary medicine there are few reports on the diagnosis, treatment and prognosis of cardiac lymphoma. Therefore, the purpose of this report is to describe a case of cardiac lymphoma in which the patient responded favorably to chemotherapy employee with disease-free interval of 19 months and highlight the importance of including this neoplasm in the differential diagnosis of diseases that affect the cardiovascular system.

Synchronous Ossifying Fibromas of Maxilla and Mandible

Ossifying fibroma is a benign neoplasm composed of fibrocellular tissue and mineralized material of varying appearance, which is most commonly seen in the posterior region of the mandible as a solitary lesion. We report an unusual case of synchronous ossifying fibroma of maxilla and mandible. To the best of our knowledge, only 13 similar cases have been previously reported.

Metástases de carcinoma de mama em cadelas: avaliação da técnica de linfonodo sentinela

Pós-graduação em Medicina Veterinária - FMVZ

Anestesia convencional e técnica de tumescência em cadelas submetidas à mastectomia. Avaliação da dor pós-operatória

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Invasive head and neck cutaneous squamous cell carcinoma: clinical and histopathological characteristics, frequency of local recurrence and metastasis

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Liquid nitrogen for the treatment of actinic keratosis: A longitudinal assessment

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Nosectomia em felinos portadores de carcinoma espinocelular - Relato de sete casos

Squamous cell carcinoma is a keratinocytes malignant tumor, the definitive diagnosis of this disease is based on histopathology examination of the lesions. The cats nostrils is one of regions commonly affected by this neoplasm. The response to chemotherapeutic agents, cryosurgery and radiotherapy is poor and for this reason surgical resection is instituted for remove the greatest amount of tissue engaged and provide free margins, in case of nasal involvement are indicated nosectomy often needing reconstructive techniques using as advance flaps for synthesis of surgical wounds. Due to the high incidence of feline patients with this entity, this study aims to report and discuss the effectiveness of nosectomy in seven cats with the disease. It is concluded that nosectomy as a therapeutic technique effective in five of seven cats, resecting tumor margin and providing acceptable time and quality life.

Hepatitis C virus molecular evolution: Transmission, disease progression and antiviral therapy

Hepatitis C virus (HCV) infection represents an important public health problem worldwide. Reduction of HCV morbidity and mortality is a current challenge owned to several viral and host factors. Virus molecular evolution plays an important role in HCV transmission, disease progression and therapy outcome. The high degree of genetic heterogeneity characteristic of HCV is a key element for the rapid adaptation of the intrahost viral population to different selection pressures (e.g., host immune responses and antiviral therapy). HCV molecular evolution is shaped by different mechanisms including a high mutation rate, genetic bottlenecks, genetic drift, recombination, temporal variations and compartmentalization. These evolutionary processes constantly rearrange the composition of the HCV intrahost population in a staging manner. Remarkable advances in the understanding of the molecular mechanism controlling HCV replication have facilitated the development of a plethora of direct-acting antiviral agents against HCV. As a result, superior sustained viral responses have been attained. The rapidly evolving field of anti-HCV therapy is expected to broad its landscape even further with newer, more potent antivirals, bringing us one step closer to the interferon-free era. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.

Histopathological and b-mode ultrasound characteristics in a primary canine duodenal adenocarcinoma - case report

Lower gastrointestinal tract neoplasms are rare in domestic animals, representing 3% of all biopsies and necropsies. Our objective is to describe the histopathological and B-mode ultrasound findings in a case of duodenal adenocarcinoma in a dog, since it commonly occurs in the large intestine. On ultrasound examination, there was transmural wall thickening in the duodenum with loss of layer structure, focal peritonitis and adenopathy. Histopathological examination of the intestinal mass revealed a malignant epithelial neoplasm, densely cellular and infiltrative, extending through the lamina propria, submucosa, muscle and hypodermis, characterizing a duodenal adenocarcinoma. We conclude that adenocarcinomas may be included in the differential diagnosis of transmural lesions in the duodenum in B-mode ultrasound examinations, but a laparotomy and biopsy are required for definitive diagnosis.

Proliferating cell nuclear antigen immunoreaction in adrenal-tumors

Aims mid background: We studied, retrospectively, 33 cases of adrenal tumors of children at the Pediatric Endocrinology Unit, Children's Institute, Sao Paulo State University Medical School, from 1975 to 1993. Ail patients had at least 2 years of follow-up with a few exceptions. Methods: Clinical follow-up data were correlated with histopathologic review, laboratory data and cell kinetic evaluation (based on detection of proliferating cell nuclear antigens). Results: With one exception, all the patients had presented signs of androgen production and had high levels of dehydro-epiandrosterone-sulfate. Tumor weight evaluation represented a good parameter of neoplasm evolution: of 19 cases weighing less than 250 g, 17 had no evidence of disease after surgery, and 2 had an unfavorable prognosis. Of 14 cases weighing more than 250 g, only 1 had no evidence of disease and 13 had an unfavorable evolution. Conclusions: Proliferating cell nuclear antigen (PCNA) was not helpful to evaluate adrenal neoplasm evolution: our study did not show any correlation between PCNA score and prognosis.

Tendência de mortalidade de idosos por doenças crônicas no município de Marília-SP, Brasil: 1998 a 2000 e 2005 a 2007

OBJECTIVE: to describe elderly mortality from cardiovascular and respiratory diseases and neoplasms in Marilia (SP). METHODS: this is a descriptive study of mortality from three diseases as defined by the 10th International Classification of Diseases, between 1998-2000 and 2005-2007. Mortality Information System records were used. Mortality rates by age and sex were calculated. RESULTS: circulatory diseases were the main causes of death among the elderly (39.25%). Neoplasm decline was noticed in both sexes and in those aged 60-69, particularly prostate cancer in men (-83.86%) and breast cancer (-70.96%) in this age group. Deaths from respiratory diseases increased in patients aged 80 and older: 39.31% in men and 57.92% in women. CONCLUSION: mortality from circulatory diseases and neoplasms among the elderly showed a decline, with increased mortality from respiratory system problems in patients 80 years of age and older.

Tumor venéreo transmissível canino com enfoque nos diversos tratamentos

The canine Transmissible Venereal Tumor (TVT) is a neoplasm of round cells that primarily affects the external genitalia of both male and female dogs with high casuistry. Its transmission occurs by the tumor cells’ implementation in the mucous membranes during the coitus or in other body parts through licking, scratching or direct contact with the tumor. The clinical manifestations vary according to the location. Despite being a malignant neoplasm, TVT’s metastatic potential is low. The diagnosis is based on macroscopic characteristics, clinical signs, cytology and/or histopathology exam, among which cytology is considered the best method. There are several treatment protocols for the TVT, among which, surgical excision, radiotherapy, immunotherapy and chemotherapy. Chemotherapy with vincristine sulfate is the elected treatment. However, more and more new alternatives have been developed, as the usage of natural products, homeopathy and ivermectina. They can be used as a unique treatment to neoplasm or combined to the chemotherapy in order to decrease the dose and the application number of the chemotherapic and its side effects

Neoplasia mamária em cadelas: aspectos clínico-cirúrgicos

Oncology is presenting an important role in clinical practice as a speciality in recent years in Veterinary Medicine. Mammary gland tumors are detected mainly in old and middleaged bitches that are sexually intact or spayed and the caudal abdominal and inguinal mammary glands are the most affected and they present a percentage up to 75% of malignancy. The majority of dogs with mammary neoplasms are clinically healthy at the time of diagnosis and the tumors can be identified by the owner or a professional during a routine physical examination. Cytological examination of fine needle aspirates can be performed. This procedure is easy and low cost and some criteria that may indicate malignancy are evaluated, however to obtain a definitive diagnosis is performed histopathology of the excised tissue or from biopsy. Regional lymph nodes are the first lymph node to receive lymphatic drainage from the neoplasm. They are at the highest risk of regional metastasis, while the lung is the most common site for distant metastasis. Determining the clinical stage enables the definition of the extension of the tumor. As a consequence, this allows a prognosis to be established and treatment to be planned. The type of therapy to be chosen incites controversy since there are numerous treatment options described, but the surgery is the chosen treatment. However, surgery is not always effective for malignant tumors, and recurrences may occur and in these cases, auxiliary chemotherapy treatments are used. The prognosis for animals that have mammary tumors depends on several factors, such as: size, stage, type of tumor cells and clinical behavior of the tumor, age and medical condition of the animal, and presence of metastasis. Because of this, more detailed studies are needed based on epidemiological surveys in order to provide more informations about risk factors, prevalence and follow-up after treatment of mammary... (Complete abstract click electronic access below)