Biomedical subjects
Publications and source records attributed to L Carvalho.
Primary lymphomas of the lung are rare neoplasias that can be easily diagnosed when enough tissue is available, but are easily mistaken for lung carcinomas or mesotheliomas on clinical evaluation. Two surgical cases are described with reference made to their morphological and immunohistochemical characteristics.
We report a case of a 25-year-old women admitted to the emergency room of Santa Maria Hospital with pancytopenia and fever. We describe the diagnostic work-up, laboratory findings, therapy, outcome and follow-up after discharge Lastly, we discuss aplastic anemia as a rare systemic lupus erythematosus complication, with only ten cases reported to date.
OBJECTIVE: the purpose of this study was to measure ecographically and ascertain the characteristics of the abdominal aorta in a sample of the male population over sixty years, and try to correlate the findings with some so-called "risk factors" most currently quoted in the medical press, such as arterial hypertension, diabetes mellitus, tobacco consumption and coronary or cerebrovascular diseases. MATERIAL AND METHODS: this is a preliminary note of the results obtained in the first forty patients in a prospective study (still ongoing). They were choose randomly from all those admitted to the general medicine ward of Medicine I Hosp. St. Maria or attended at the Medicine or Cardiology/Hypertension outpatient clinics at the same hospital. Pearson's linear correlation, Student's t test for not paired samples and chi-square tests were used to analyze the results. MEASUREMENTS AND MAIN RESULTS: the medium value obtained for the abdominal aorta diameter (daa) was 28.8 mm (SD. +/- 3.6). In this sample there was no correlation between the age and daa (r:0.03), nor any statistical difference (chi-square) in the daa between the subgroups creating regarding the existence of hypertension no hypertension, active smoking/no smoking habits, or the association of all these so-called risk factors added to diabetes as opposed to their absence (the number of patients is still insufficient to reach statistical significance). CONCLUSIONS: in this study no risk factor/marker of the aneurysm of the abdominal aorta was so far detected in a population of aged male patients, but in some groups (as in the association of multiple factors) the number of patients was insufficient to reach any significant statistical conclusion.
Treatment of carcinoma of the reproductive organs using both an antiproliferative agent to inhibit cell growth and a cytotoxic agent to kill the neoplastic cells represents an attractive approach to therapy. By using steroids to achieve both effects, it may be possible to avoid some of the dose-limiting side effects of conventional antiproliferative or cytotoxic agents. We screened in vitro 23 selected steroids against four rat prostatic carcinoma cell lines and one human breast carcinoma cell line. Effects of the steroids were measured using a tritiated thymidine uptake assay to assess antiproliferative activity and a colorimetric enzyme-based assay to assess cytotoxicity. Several of the steroids had marked cytostatic and cytotoxic properties rendering them worthy of further evaluation, both separately and in combination.
An anaplastic, metastatic subline of the Dunning rat tumor was exposed to non-cytodestructive doses of the cellular differentiation agents dimethylsulfoxide and difluoromethylornithine. Copenhagen rats hosting prostate tumors were evaluated by comparing solid tumor growth resulting from injection of treated cells with solid tumor growth of untreated control cells. Results showed significantly slower solid tumor growth after a 15 day in vitro exposure of cells to either agent, after oral treatment of host animals for 20 days with either agent before injection of untreated tumor cells, and after oral treatment of host animals with either agent initiated on the day of untreated tumor cell injection. Treatment of animals with established tumors with either agent also had an inhibitory effect on tumor growth, and the effect was related to the length of treatment. Thus, exposure of these highly malignant rat prostate carcinoma cells to non-cytotoxic doses of either agent induced slower tumor growth rates. Treatment with either agent could have selected for a slower growing population of tumor cells. Since a slowing of cell cycle transit times is an early indicator of cellular differentiation, these results could reflect an increase in the capacity of the malignant cells to differentiate.
Chemotherapy for prostatic carcinoma is usually reserved for those patients who have failed conventional therapy. These patients generally are in poor health and tolerate chemotherapy poorly. If doses of conventional agents could be decreased without altering cytotoxic activity, then conventional chemotherapy could become an attractive treatment modality. Dimethylsulfoxide and difluoromethylornithine have been shown to induce differentiation in some tumor systems. Growth alteration effects of these two agents were investigated individually and in association with conventional chemotherapeutic agents cyclophosphamide, cisplatin, and fluorouracil in an experimental prostatic cancer model. Copenhagen rats had subcutaneous tumors induced by injections of cells cultured in vitro from a subline of the Dunning rat prostatic tumor, MAT LyLu. Treatment with chemotherapeutic agents individually and associated with differentiation agents was initiated when tumors were palpable. Tumor growth rates and rat body weights were monitored in all groups. The differentiation agents used singly were not able to retard significantly tumor growth rates. In higher doses, each conventional agent used singly significantly retarded tumor growth. Used in combination, the differentiation agents induced cytodestructive properties of lower doses of conventional agents, but some combinations also increased host toxicity. These data suggest that differentiation agents may provide additional antineoplastic benefits when administered in combination with selected chemotherapeutic agents in the management of prostatic cancer.
Growth alteration effects of an immunomodulator, PSK, were investigated individually and in association with conventional chemotherapeutic agents cyclophosphamide, cisplatin and fluorouracil in an experimental prostatic cancer model. Copenhagen rats had subcutaneous tumors induced by injections of cells cultured in vitro from a highly metastatic hormonally unresponsive subline of the Dunning rat prostatic tumor, MAT-LyLu. Treatment with conventional agents and the immunomodulator agent individually and in combination began three days after tumor cell inoculation. PSK used alone was not able to significantly influence tumor growth. In appropriate doses, each conventional agent significantly retarded tumor growth. Used in combination, PSK and conventional agents retarded tumor growth locally and decreased metastatic spread of the tumor. Animals receiving combination therapy had increased life spans over those animals receiving single standard chemotherapeutic agents. Immunomodulation with PSK may enhance the antineoplastic effects of chemotherapeutic agents and offer a treatment option for hormone resistant prostatic cancer.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The Authors present a case of acute eosinophilic pneumonia (AEP) associated with severe acute respiratory distress syndrome in a previously healthy young adult, medicated with nitrofurantoin. AEP must be included in the differential diagnosis of community adquired pneumonia, as well as a cause of acute respiratory distress syndrome; its diagnosis is suggested by the presence of eosinophilic alveolitis in bronchoalveolar lavage fluid. The early diagnosis of AEP and corticosteroid therapy may be lifesaving.
There are no known biological markers or technologies to predict the natural history of an individual CIN III. The probability of progression is considered greater with the persistence of high-risk human papillomavirus (HPV) infection and age. p53 polymorphism has been associated with cervical carcinogenesis. Hormone-induced cervical cancer is mediated by estrogen receptor (ER) and progesterone receptor (PR). In cervical cancer, increased bcl-2 and Bax immunoreactivity is generally associated with a better prognosis. The purpose of this study was to evaluate the value of HPV 16 and HPV 18 typing and p53 codon polymorphism genotyping by polymerase chain reaction and ER, PR, bcl-2, and Bax expression by immunohistochemistry in predicting the CIN III clinical behavior of CIN III lesions. We studied the expression of these prognostic factors in the CIN III adjacent to squamous cell microinvasive carcinomas of the cervix (MIC) from 29 patients with FIGO stage IA1 cervical cancer and in 25 patients with CIN III and no documented focus of invasion. In the MIC group, only the CIN III was considered at least 2 mm away from the microinvasive complex. The ER, PR, bcl-2, and Bax immunoreactivity was scored as positive (>10% staining cells) and negative (<10% staining cells). No significant difference was observed between MIC and CIN III group concerning HPV infection and p53 polymorphism. The ER, PR, bcl-2, and Bax immunohistochemical expression was stronger and more frequent in the CIN III group. After multivariable analysis, coexpression of ER, PR, and bcl-2 was the only independent factor in defining low risk of progression for CIN III. Our study suggests that coexpression of ER, PR, and bcl-2 may be a useful tool in identifying the CIN III lesions with low risk of progression to cervical cancer.
The predictive value of the Oxfordshire Community Stroke Project ischemic stroke classification for acute stroke complications, therapeutic interventions and disability at discharge was investigated in 297 consecutive first-ever acute stroke patients. More than one medical complication (odds ratio, OR = 2.2), fever (OR = 2.5) and dependency (Rankin grade > 2) at discharge (OR = 2.3) were more frequent in intracerebral hemorrhage patients. Fever and urinary tract infections were the most common complications among ischemic stroke patients. Both were more frequent in total anterior circulation infarct (TACI) patients (OR = 11.5 and OR = 3.7). Neurological deterioration was observed in about 10% of TACI and posterior circulation infarct (POCI) patients. Dependency at discharge was more frequent in TACI patients (OR = 10.3). Logistic regression analysis identified ischemic stroke subgroups (OR = 8.4) and medical complications (OR = 3.8) as predictors of poor outcome (Rankin score > or = 4). A clinical classification is useful to predict possible medical and neurological complications in the acute phase, death and dependency at discharge.
Explore the source record for details and available documents.
The authors report the case of a 30 year-old man, who had recently been to Africa, admitted due to fever and pain in the epigastrium and in the right hypocondrius. The evaluation led to the diagnosis of hepatic amebiasis. The patient was treated accordingly with success. The authors further review hepatic amebiasis, including the epidemiology, diagnostic means and ways of treatment, focusing on medical and surgical approaches and their controversies. The interest of the description of such a clinical case and the review that was made is derived from the current impact of globalization of the economy and its respective consequences due frequent trips to endemic countries. A detailed clinical history, including the epidemiology, is paramount for the suspicion of this diagnosis. Immediate treatment is mandatory, without which the patient may be at risk of serious complications.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
A retrospective study was performed in order to evaluate the diagnostic accuracy for lung cancer in histological biopsy specimens and in cytological examination taken at fibre optic bronchoscopy. Of 530 patients suspected of having a malignant lesion, 150 had pathological confirmation (group A) and 380 did not (group B). In group A biopsy was diagnosed in 78.7% and cytology in 58% of the cases, of which brushing was positive in 94.1% and washing in only 38.6% of the cases. In group B brushing disclosed the condition of lung epithelium in 91.8% and washing in only 48% of the cases. It is concluded that brushing had a higher diagnostic accuracy than washing in both groups, although inferior to biopsy.
High blood pressure in the elderly population is currently one of the most important public health problems. In recent years, a dramatic increase in life expectancy has occurred and cardiovascular diseases are now one of the major causes of morbidity and mortality in this age group. Therefore, high blood pressure in the elderly has been the aim of many trials throughout the world. In Medicine Department 1 of St. Maria Hospital, we designed and implemented a special outpatient follow-up for elderly people (> or = 65 years old) with hypertensive disease. At the end of the first year, 61 patients (22 men and 39 women) with an average age of 71 years (SD +/- 5.3), with known of high blood pressure for an average of 10 years were treated with angiotensin converting enzyme inhibitor (11 patients), calcium channel blockers (6 patients), or a combination of both drugs. The mean blood pressure fell 15 mm Hg (SD +/- 19.6) without deterioration of the renal function. The echocardiographic evaluation showed reduction in the left ventricular dimensions without significant modifications of diastolic, systolic and cardiac output. In addition, there was a significant increase in attention/concentration and memory abilities, however the percentage of depressed patients was the same at the end of the first year of treatment for high blood pressure.