To evaluate the clinical and evolutive aspects of chronic chagasic patients.Three hundred chronic chagasic patients, 180 females, with age ranging from 19 to 81 years (55.6 +/- 13.1) were retrospectively studied. Patients were divided according to the following clinical types: indeterminated, cardiac (with the subtypes: arrhythmogenic, dilated and mixed), digestive isolated and digestive plus cardiac involvement. The following variables were analysed: prevalence of each clinical forms, symptoms, electrocardiographic pattern and clinical outcome.At the start of the study, 73 (24.3%) patients were in indetermined type, 106 (35.3%) in cardiac arrhythmogenic, 95 (31.6%) in mixed, 7 (2.3%) in dilated, 16 (5.3%) in digestive plus cardiac type and 3 (1%) in the pure digestive type. The most prevalent symptoms were dyspnea on efforts (57%), palpitations (41.33%) and chest pain (33%). The most frequent electrocardiographic pattern was right bundle branch block plus antero-superior fascicular block, in 30% of the patients. The average follow-up time was 7.8 +/- 6.1 years and the outcome was considered good in 20 patients (6.6%), stable in 214 (71.3%) and bad in 66 (23%). At the end of the follow-up, 9 patients have evaluated from the indeterminated to the cardiac and digestive types, and 19 (17.92%), from the arrhythmogenic to mixed cardiac subtype. The follow-up was lost in 79 patients (26.3%), most of them, probably dead.With a mean time of 7.8 years, 12.3% of the patients in the indeterminated type evolved to the cardiac and/or digestive type; right brundle branch block with antero-superior fascicular block was the most prevalent electrocardiographic pattern; the outcome was stable or good in the majority of these patients.
Elective neck dissection in patients with recurrent head and neck squamous cell carcinoma (HNSCC) without evidence of neck disease(crN0) is poorly defined. A retrospective review was carried out on 165 crN0 patients treated with salvage surgery and elective neck dissection.Multivariate Cox analysis and recursive partitioning analysis were used to evaluate prognostic factors. The frequency of occultneck node metastases in the neck dissection (rpN+) was 16.4%. The risk of occult metastases for glottic rpT1-T2 recurrences was 5.9%, forglottic rpT3-T4 recurrences 13.2%, for non-glottic rpT1-T2 recurrences 16.1% and for locally advanced (rpT3-T4) non-glottic recurrences31.1%. Patients with occult neck node metastases (rpN+) had a 5-year adjusted survival rate of 38.1%, while patients without nodal disease(rpN0) had a 5-year adjusted survival rate of 71.1% (p = 0.0001). Elective neck dissection can be omitted in crN0 patients with rT1-T2glottic recurrence. We consider it advisable to perform elective neck dissection in all other situations.
A 21-year-old man presented with a 10-year history of a malabsorption syndrome of moderate severity, splenomegaly, and recurrent respiratory infections. Investigations revealed total atrophy of the villi and primary agammaglobulinemia. A gluten-free diet was ineffective. In spite of the absence of lambliasis, treatment with metronidazole produced objective clinical improvement and biological signs of healing of the malabsorption syndrome, but no alteration in the agammaglobulinemia. The authors discuss the relationship between total villous atrophy and primary agammaglobulinemias and the mode of action of metronidazole.
The results of renal transplantation for end-stage diabetic nephropathy in 17 patients--11 receiving cadaver (CD) grafts and 6 related living donor (RLD) grafts--are reported. The transplants were rejected in 5 cases, in 4 acutely, and these patients were returned to haemodialysis; 3 of them subsequently died. One patient died of heart failure, but the graft was still functioning. The remaining 11 patients enjoy good renal function. The outcome was superior to results on dialysis, particularly for RLD grafts, and was comparable to results of transplantation for non-diabetic renal failure. Visual acuity tended to stabilize or improve after transplantation, but peripheral vascular disease progressed. Blood glucose control was suboptimal and requires more attention. Lipoproteins did not differ from those in non-diabetic patients. Renal transplantation is feasible and probably the preferred method of treatment for end-stage diabetic nephropathy.
The level of knowledge concerning American tegumentary leishmaniasis (ATL) and use of alternative therapies was evaluated in five rural communities in Buriticupu, Maranhao State, Brazil. The study lasted from September 1997 to January 1998. Local inhabitants answered an interview on housing conditions, epidemiological aspects, prevention, standard clinical treatment, and alternative therapies. The study population was 378 (19%) out of a total of 1,980 inhabitants, from Sexta Vicinal (35), Quinta Vicinal (63), Trilha 410 (96), Vila Uniao (85), and Buritizinho (99). Of the interviewees, 72% had little knowledge of ATL transmission, 96% had heard something about the disease from friends, and 60.7% knew ATL by the local term lesh. Glucantime was the most familiar drug for treatment, while 29.6% referred to use of herbal remedies on the ulcers. Citrus limon (lemon) was the plant most frequently used, and 15.4% of the interviewees used it as a powder spread on the wound. We conclude that the population had little correct knowledge of ATL in the five areas studied, especially with regard to prevention and treatment.
A highly specific and sensitive PCR assay for the envelope glycoprotein gp50 has been developed for the detection of PRV-DNA sequences. Primer pairs from PRV gp50 gene were used with the enzyme uracil N-glycosylase and dUTP instead dTTP to prevent contamination due to PCR product carry-over. Biotinylated PCR products were captured in microtiter wells by specific oligonucleotide covalently linked to the polystyrene wells. After recognition of the biotinylated PCR product with a streptavidin phosphatase conjugate, a chemiluminescent detection was realised. Different factors influencing the binding, the hybridization and the detection efficiency have been tested.