Cardiac transplantation and neoplasms: experiences at Escola Paulista de Medicina of the Federal University of São Paulo

OBJECTIVE: To study the occurrence and types of neoplasms developed by patients who underwent an orthotopic cardiac transplantation under the Program of Cardiac Transplantation of Escola Paulista de Medicina, Federal University of São Paulo. METHODS: This is an observational study of 106 patients who underwent orthotopic cardiac transplantation from November 1986 to September 2002 and survived at least thirty days following the procedure. The triple immunosuppressive regimen given included cyclosporin A, azathioprine and a corticosteroid agent. Only two patients received OKT3 in addition to the regimen established. Mean follow-up was 61.4 months (ranging from two months to 192 months). RESULTS: Twenty-three patients (21.3%) developed neoplasms - 56.5% of these were skin neoplasm, 30.1%, solid tumors, and 13.4% of post-transplant lymphoproliferative disease (PTLD). Mean interval between transplantation and diagnosis of neoplasm was: 54.9 months for skin neoplasm; 24.8 months for solid tumors and 70.3 months for PTLD. CONCLUSION: Malignant neoplasms are relatively common in the population studied. Skin cancer was the most common type compared to the other types of neoplasms. Solid tumors were more frequently diagnosed than the lymphoproliferative diseases in the population examined.OBJETIVOS: Analisar ocorrência e tipos de neoplasias que se desenvolveram em pacientes submetidos a transplante cardíaco ortotópico, no Programa de Transplante Cardíaco da Escola de Paulista de Medicina da Universidade Federal de São Paulo (UNIFESP). MÉTODOS: O presente estudo apresenta uma análise observacional de 106 pacientes submetidos a transplante cardíaco ortotópico, no período de novembro de 1986 a setembro de 2002, que sobreviveram por período superior a trinta dias após o procedimento. O regime de imunossupressão consistiu de terapia tríplice com ciclosporina A, azatioprina e corticosteróide. Apenas dois pacientes receberam, além da terapia tríplice, a adição de ortoclone OKT-3. O período médio de acompanhamento foi de 61,4 meses. (variação de dois meses a 192 meses). RESULTADOS: Vinte e três pacientes (21,3%) desenvolveram neoplasias, dos quais 56,5% apresentaram neoplasia de pele, 30,1% apresentaram tumores sólidos e 13,4%, doença linfoproliferativa pós-transplante (DLPT). O intervalo médio entre o transplante e o diagnóstico de neoplasia foi: pele - 54,9 meses, tumores sólidos - 24,8 meses e DLPT - 70,3 meses. CONCLUSÕES: A ocorrência de neoplasias malignas foi relativamente comum na população analisada. O câncer de pele prevaleceu em relação às demais neoplasias e os tumores sólidos foram mais diagnosticados do que as doenças linfoproliferativas nessa série de pacientes.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Resposta hematológica, respiratória e cardiocirculatória de eqüinos submetidos a três protocolos de indução anestésica

O presente trabalho investigou os efeitos hematológicos, respiratórios e cardiocirculatórios de eqüinos PSI submetidos a três diferentes protocolos de indução anestésica. Os grupos (G1, G2 e G3), constituídos de 10 animais cada, receberam: acepromazina 0,1 mg/kg, guaifenesina 113 mg/kg e tiopental sódico 2 g (G1); levomepromazina 0,2 mg/kg, midazolam 0,1 mg/kg e cloridrato de cetamina 2,0 mg/kg (G2); e cloridrato de detomidina 20 µg/kg e tiletamina-zolazepam 1,1 mg/kg (G3). As avaliações realizadas constaram de exame clínico, análise hematológica, hemogasometria arterial e avaliação eletrocardiográfica. As colheitas de dados foram procedidas antes da administração de qualquer fármaco e quinze minutos após a administração do último. Os resultados mostraram que os três protocolos utilizados são efetivos como indutores da anestesia geral em eqüinos. A avaliação da função respiratória não permite destaque positivo ou negativo para nenhum dos protocolos. As alterações cardiocirculatórias observadas foram de caráter temporário e sem significado clínico. As principais diferenças observadas foram a preparação laboriosa da combinação usada no G1, a necessidade mais freqüente de suplementação anestésica no G2 e a ocorrência de dificuldade de manejo do animal após a pré-anestesia no G3, em virtude das dificuldades de deambulação.This research studied the hematological, respiratory and cardiocirculatory effects in thoroughbred equine subjects after the administration of 3 different induction protocols for general anesthesia. The animals were distributed in 3 groups. The animals from group 1 (G1) received acepromazine (0.1 mg/kg), guaiphenesin (113 mg/kg) and thiopental (2 g). The animals from group 2 (G2) received levomepromazin (0.2 mg/kg), midazolam (0.1 mg/kg) and ketamine (2.0 mg/kg). The animals from group 3 (G3) received detomidine (20 µg/kg) and tiletamine-zolazepam (1.1 mg/kg). The evaluation included clinical examination, venous blood samples for hematological analysis, arterial blood samples for gasometric analysis and eletrocardiographic records. Clinical parameters were observed, samples were taken and the ECG was recorded before any drug administration and 15 minutes after the last medication. The 3 protocols showed to be adequate when used before general anesthesia. Respiratory parameters showed no differences among the 3 groups. The cardiocirculatory events were transient and without clinical significance. The differences among the groups were related to the preparation of solutions (G1), frequency in drug supplementation (G2) and handling the animals (G3)

Effect of dry needling and instrumental myofascial release on masticatory, facial, and cervical muscles of patients with temporomandibular disorders of muscular origin

To evaluate the effectiveness of dry needling (DN) and instrumental myofascial release (IMR) therapies in the cervico-cranio-mandibular system through pain, bite force, and distribution of occlusal contacts in patients with muscular temporomandibular disorders. MATERIAL AND METHODS: Thirty patients were divided into treatment groups: DN (n=15) and IMR (n=15). Therapeutic efficacy regarding pain perception and tolerance of masticatory, facial, and cervical muscles, bite force, and distribution of occlusal contacts were analyzed in this observational longitudinal clinical study pre/post-intervention and pre/post one month of therapeutic intervention. The data were tabulated and statistically analyzed (repeated measures and Bonferroni post-hoc test, p<0.05). RESULTS: There was a statistically significant difference in pain between the groups in the comparison of pre- and post-intervention with effect on time versus intervention in the head and neck. Pain perception and tolerance showed a statistical effect of time on the temporal, suboccipital, sternocleidomastoid, mental (right and left), right masseter, and left trapezius muscles. There was a statistically significant effect of the intervention on the mentalis, supraorbital, and infraorbital (right and left) muscles. There was a statistically significant effect of the interaction on the upper masseter (right and left), anterior temporal (left), suboccipital, sternocleidomastoid, and mentalis (left) muscles. There was an increase in post-intervention molar bite force in the groups, with a statistical effect on time versus intervention in the right and left regions. Contact of occlusal forces at the maxilla/mandible interface showed a difference between the mean times on teeth 26-36 after versus 1 month after the intervention. CONCLUSIONS: The two therapeutic techniques are viable for the treatment of muscular temporomandibular disorders; however, IMR proved to be more effective immediately after the intervention and after one month. Key words:Temporomandibular disorders, pain, masticatory muscles, facial muscles, cervical muscles, dry needling, instrumental myofascial release

Locais‑chave para avaliação de genótipos de soja na Região Central do Brasil

The objective of this work was to identify key locations for the establishment of soybean (Glycine max) genetic breeding programs, in the Central Region of Brazil. Grain yield data of three maturity groups of soybean genotypes, from regional trials conducted over three years, at 18 locations in Brazilian Cerrado were used. A key location for the early phases of the breeding program was defined as the site that best classifies the winning genotypes in the region. Key locations for the final phases were defined as those sites that best represent each environmental stratum, in relation to the adaptability of the respective winning genotype. This adaptability was estimated by additive main effects and multiplicative interaction (AMMI) model analysis, using the distance between the score of each location in a stratum and the score of the winning genotype, which characterizes such stratum in an AMMI biplot. The locations that best classified the winning genotypes over space and time were Mineiros, Placas and Rio Verde. For the final phases of genotype selection, with data from the three maturity group, the recommended locations were: Buritis, Chapadão do Céu, Iraí, Pamplona, Placas, Planaltina, Rio Verde, Sacramento, Senador Canedo, Uberaba, and Uberlândia.O objetivo deste trabalho foi identificar locais-chave para o estabelecimento de programas de melhoramento genético de soja (Glycine max), na Região Central do Brasil. Foram utilizados dados de produtividade de grãos de genótipos de soja, de três ciclos de maturação, obtidos de ensaios regionais conduzidos por três anos em 18 localidades da região. O local-chave para a condução das fases preliminares do programa foi definido como a localidade que melhor classifica os genótipos vencedores na região. Os locais-chave para as fases finais foram definidos como os que melhor representam cada estrato ambiental identificado, em termos da adaptabilidade do respectivo genótipo vencedor. Essa adaptabilidade foi estimada por meio do modelo de efeitos principais aditivos e interação multiplicativa (AMMI), tendo-se utilizado a distância entre os pontos (escores) correspondentes a cada local em um estrato e o escore do genótipo vencedor que caracteriza aquele estrato, em um "biplot" AMMI. Os locais que melhor classificaram os genótipos vencedores ao longo do espaço e do tempo foram: Mineiros, Placas e Rio Verde. Para as fases finais de seleção de genótipos, com os dados dos três ciclos de maturação, os locais recomendados foram: Buritis, Chapadão do Céu, Iraí, Pamplona, Placas, Planaltina, Rio Verde, Sacramento, Senador Canedo, Uberaba e Uberlândia

Nectomys squamipes (Rodentia: Cricetidae) as an experimental model for schistosomiasis mansoni

Twenty specimens of Nectomys squamipes born in captivity, were infected with 500 cercariae by the transcutaneous route. Coprologic examinations were carried out from the 5th to 23rd week after infection. On the 7th, 8th, 12th, 16th, and 23rd weeks the animals were sacrificed and perfused. The oogram was performed in segments of the small intestine (proximal, medial and distal portions) and the large intestine. The average pre-patent period was of 42 days. The average number of eggs varied from 350 on 6th week, to 800 on the 13th. From the 14th week on, the average number of eggs eliminated was lower than 50 per gram of feces. The recovery of worms kept steady on the 7th, 8th, and 12th week (16.85%; 15.45% and 11.95%), decreasing to 7.70% on the 16th week and 8.45% on the 23rd week. The proportion of male/female worms was about the same on the first two weeks, but from the 12th week on, the proportion was: 1,4/1 on the 12th week; 2,5/1 on the 16thweek and 1,8/1 on the 23rd weekThese observations suggest that N. squamipes may used as an experimental model for schistosomiasis mansoni, to wich it develops resistance mechanism, useful for immunity studies

Glutamine dipeptide supplementation improves clinical responses in patients with diabetic foot syndrome

The effect of glutamine dipeptide (GDP) supplementation in patients with diabetic foot syndrome was evaluated. A total of 22 patients took part in the study. GDP was supplied in 10 g sachets, and was dissolved in water immediately before use, with ingestion once a day, after lunch or after dinner (20 g/day) over a period of 30 days. Quantification of foot insensitive areas, oxidative stress, blood cytokines, and biochemical, hematological and toxicological parameters was performed before and after GDP supplementation. We observed an increase in blood levels of interferon-α (P=0.023), interferon-γ (P=0.038), interleukin-4 (P=0.003), interleukin-6 (P=0.0025), interleukin-7 (P=0.028), interleukin-12 p40 (P=0.017), interleukin-13 (P=0.001), leukocytes (P=0.037), eosinophils (P=0.049), and typical lymphocytes (

Taper function for thinning planting of Pinus taeda L.

O presente trabalho teve como objetivo avaliar a precisão de três funções de afilamento para estimar diâmetros e volumes ao longo do fuste de Pinus taeda L. A base de dados foi composta por 320 árvores cubadas pelo método de Smalian, sendo os diâmetros medidos nas alturas de 0,1 m, 0,5 m, 1,3 m, 2,0 m e, posteriormente, a cada 1,0 m, até atingir a altura total. Essas árvores têm idades variando de 11 a 26 anos, podadas e com ocorrência de 2 a 6 desbastes até o corte final. Os modelos testados foram os de Schöepfer, Hradetzky e de Kozak et al. As análises estatísticas dos modelos testados foram realizadas através da análise gráfica dos resíduos, coeficiente de determinação ajustado (R2), erro-padrão da estimativa (Syx%) e análise gráfica dos perfis médios. Conclui-se que os modelos de Hradetzky e o de Shöepfer obtiveram resultados semelhantes e satisfatórios, com alto valor de coeficiente de determinação e baixo erro-padrão da estimativa, tanto para estimar diâmetros quanto volume, por serem modelos cujos parâmetros conseguem descrever melhor a extremidade superior e inferior da árvore. _______________________________________________________________________________________ ABSTRACT: This research aimed to evaluate accuracy of three taper functions in order to estimate diameters and volumes along the stem of Pinus taeda. The database consisted of 320 trees on which diameters were measured at heights of 0.1 m, 0.5 m, 1.3 m, 2.0 m, then at every 1.0 m, until the total height. The age of these trees ranged from 11 to 26 years old and they were submitted to one pruning and thinned two to six times until the final cut. The tested models were those from Schöepfer, Hradetzky and Kozak et al.. The statistical analysis performed were graphical analysis of residuals, adjusted coefficient of determination (R2), standard error of estimate (Syx%), and graphical analysis of the mean profiles. As result, models from Hradetzky and Shöepfer obtained similar and satisfactory results, with high coefficient value of determination and low standard error of estimate, as to diameter as well to volume estimates; it is because these are models whose parameters can better describe both extremities of the tree