Cholangiocarcinoma: from molecular biology to treatment

Cholangiocarcinoma is a rare tumor originating in the bile ducts, which, according to their anatomical location, is classified as intrahepatic, extrahepatic and hilar. Nevertheless, incidence rates have increased markedly in recent decades. With respect to tumor biology, several genetic alterations correlated with resistance to chemotherapy and radiotherapy have been identified. Here, we highlight changes in KRAS and TP53 genes that are normally associated with a more aggressive phenotype. Also IL-6 and some proteins of the BCL-2 family appear to be involved in the resistance that the cholangiocarcinoma presents toward conventional therapies. With regard to diagnosis, tumor markers most commonly used are CEA and CA 19-9, and although its use isolated appears controversial, their combined value has been increasingly advocated. In imaging terms, various methods are needed, such as abdominal ultrasound, computed tomography and cholangiopancreatography. Regarding therapy, surgical modalities are the only ones that offer chance of cure; however, due to late diagnosis, most patients cannot take advantage of them. Thus, the majority of patients are directed to other therapeutic modalities like chemotherapy, which, in this context, assumes a purely palliative role. Thus, it becomes urgent to investigate new therapeutic options for this highly aggressive type of tumor

Topical Imiquimod Treatment of Lentigo Maligna

Lentigo maligna (LM) is the in situ phase of lentigo maligna melanoma, which may progress to invasive melanoma if left untreated. It mainly occurs on sun-exposed areas of elderly patients. The lesions can be large and conventional surgery can be difficult, particularly on the face. Recent reports indicate that topical imiquimod 5% cream is effective in the treatment of LM. It may be an alternative when surgery or other classical treatments are not possible in elderly patients. We describe an 80-year-old Caucasian woman with a 10-year history of a histologically verified extensive LM of the face. She was treated with imiquimod 5% cream once daily. After four months it showed complete clinical response. One year after the treatment the patient was still free from recurrence

O balão intragástrico nas formas graves de obesidade

Introduction: In patients with morbid obesity the intragastric balloon (IGB) can be a “bridge” to surgery or a temporary treatment in patients who are not candidates for surgery. Objective: Evaluate IGB efficacy in morbidly obese patients. Patients and Methods: In 2003/2004 seventeen IGB Bioenterics ® filled with normal saline and methylene blue were placed in 17 patients [11 women, median age was 49.2 (27-69 years); median body mass index was 55.6 (40.2-74.2 Kg/m2)], followed by nutritionists and/or endocrinologists. They had previously tried dietetic and/or pharmacological measures with limited results. Co-morbidities were present in 13 (76.5%). Results: Eight (47%) patients presented nausea/vomiting in the first 24-72h that persisted in 4 (23.5%) leading to dehydration and pre-renal insufficiency and forcing premature removal of the balloon (0.5 to 4 months). In the other patients, the device was removed at 6 months treatment (in 1 patient at 10 months). All patients suffered weight loss (5-70 Kg); median loss-19.6 Kg (p<0.001). No cases of spontaneous deflation/displacement occurred. Six (35.3%) underwent bariatric surgery. Conclusions: The IGB is a useful method for weight loss in morbidly obese patients. Nausea and vomiting are the most common complications. Although desirable, subsequent surgery is not always performed

IN VITRO ANTIOXIDANT CAPACITY, PHENOLIC, ASCORBIC ACID AND LYCOPENE CONTENT OF GUAVA (Psidium guajava L.) JUICES AND NECTARS

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)The aim of this work was to determine the antioxidant capacity in vitro of three different brands of guava nectars and juices, through free radicals scavenging methods, 1,1-diphenyl-2-picrylhydrazine (DPPH) and 2,2'-azino-bis(3-ethylbenzthiazoline-6-sulphonic acid (ABTS(.+)), and its correlation with the total polyphenolic content, total lycopene and ascorbic acid. Brands revealed statistical differences (p <= 0.05) in antioxidant capacity, ranging from 1.9 to 7.7 molTE/mL. Antioxidant capacity presented positive correlation for ascorbic acid content and polyphenolic compounds, being relatively low for the lycopene. Different process can influence the content of these compounds as well as interfere in their antioxidant capacity. The control of the production process is important to add value to guava products and fulfill the new tendency of the market.272175182Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Intravenous immunoglobulin in dermatology – clinical experience in Hospital de Braga

Introdução: Nos últimos anos tem aumentado a experiência clínica com o uso de Imunoglobulinas Endovenosas (IgEv) em Dermatologia. Apesar da informação limitada na literatura, a utilização off-label das IgEv tem demonstrado eficácia na terapêutica de várias dermatoses refratárias aos tratamentos convencionais. Material e métodos: Efetuou-se um estudo retrospetivo dos doentes com patologia dermatológica tratados com IgEv entre Janeiro de 2004 e Outubro de 2011 no Serviço de Dermatologia do Hospital de Braga. Foram analisadas as características demográficas e clínicas, as terapêuticas efetuadas, a resposta clínica e o perfil de segurança. Resultados: Foram tratados 21 doentes com IgEv em 10 diferentes patologias dermatológicas: quatro doentes com Pênfigo Vulgar [2 com resposta completa (RC), um com resposta parcial (RP) e outro que interrompeu o tratamento por efeito lateral grave]; dois doentes com Penfigóide Bolhoso (um com RC e outro com RP); três doentes com Necrólise Epidérmica Tóxica (NET) com RC; dois doentes com Dermatomiosite (ambos com RP); quatro doentes com Urticária Crónica (um com RC, um com RP, um que não respondeu e outro que suspendeu o tratamento por efeito lateral); dois doentes com Vasculopatia Livedóide com RP; um doente com Síndrome CREST que não melhorou; um doente com Escleromixedema com RP; um doente com Pioderma Gangrenoso com RC e uma doente com Dermite Atópica que interrompeu o tratamento na sequência de gravidez. Com excepção dos 3 doentes com NET, em todos os outros a doença havia sido refratária aos tratamentos sistémicos convencionais. Conclusões: Apesar de a nossa experiência ser limitada, o tratamento com IgEv pode ser benéfico em determinadas patologias que não melhoram com o tratamento clássico. Atendendo ao seu custo elevado e efeito terapêutico variável, o seu uso deve ser criterioso até que mais estudos definam a relação risco-benefício