Practical Considerations of Real Life of Hepatocellular Carcinoma in a Tertiary Center of Brazil

ABSTRACT Background. Hepatocellular carcinoma (HCC) is the most common malignancy that develops in cirrhotic livers. Its clinical and epidemiological characteristics and mortality rates vary according to geographical region. The objective of this study was to evaluate the clinical profile, epidemiological characteristics, laboratory parameters, treatment and survival of patients with HCC. Material and methods. Patients with HCC seen between 2000 and 2012 were studied. The Kaplan-Meier method was used for survival analysis according to variables in question. Results. The study included 247 patients with a mean age of 60 ± 10 years. There was a predominance of males (74%). The main etiologies of HCC were HCV infection (55%), excessive alcohol consumption (12%), and HBV infection (8%). Liver cirrhosis was present in 92% of cases. The mean tumor number and diameter were 2 and 5 cm, respectively. Patients meeting the Milan criteria corresponded to 43% of the sample. Liver transplantation was performed in 22.4% of patients of the Milan subset and in 10% of the whole sample. The overall mean survival was 60 months, with a 1-, 3- and 5-year survival probability of 74%, 40% and 29%, respectively. Lower survival was observed among patients with alcoholic etiology. Survival was higher among patients submitted to liver transplantation (P < 0.001), TACE (P < 0.001), or any kind of treatment (P < 0.001). However, no difference was found for surgical resection (P = 0.1) or sorafenib (P = 0.1). Conclusion. Patients with HCC were mainly older men diagnosed at an advanced stage. Treatment was associated with better overall survival, but few patients survived to be treated.

Valores de referência para plumbemia em uma população urbana do Sul do Brasil / Reference values for lead in blood in an urban population in southern Brazil

Objetivo. Descrever os valores de referência para chumbo em sangue em uma população urbana do Município de Londrina, Estado do Paraná, Brasil. Métodos. A população de referência foi constituída por 520 voluntários adultos avaliados de novembro de 1994 a dezembro de 1996. Os critérios de exclusão foram: exposição ocupacional ao chumbo, exposição através de hábitos, fumar mais de 10 cigarros por dia e morar perto de indústrias ou de locais que utilizam o chumbo em seus processos produtivos. Também foram excluídos indivíduos com valores de exames clínicos e laboratoriais fora da normalidade, doenças crônicas e distúrbios cardiovasculares. Os teores de chumbo em sangue foram determinados por espectrofotometria de absorção atômica com chama de ar-acetileno. O limite de detecção obtido foi 1,23 mig/dL. Após as análises de chumbo em sangue, foram determinados valor mínimo, primeiro quartil, mediana, terceiro quartil e valor máximo; média geométrica; intervalo de confiança de 95 por cento; intervalo experimental; e valor de referência. Resultados. Os valores de referência para plumbemia variaram de 1,20 a 13,72 mig/dL. A média geométrica foi igual a 5,5 mig/dL. Conclusões. Em geral, os valores obtidos no presente estudo são mais baixos do que aqueles obtidos em outros países. Estudos adicionais deveriam enfocar a obtenção de valores de referência em outras populações brasileiras que vivem em regiões mais industrializadas.

Objective. To describe the reference values for lead in blood in an urban population in the city of Londrina, in the state of Paraná, Brazil. Materials and methods. The reference population was composed of 520 adult volunteers who were assessed from November 1994 to December 1996. Exclusion criteria were: occupational exposure to lead, exposure through personal habits or practices, smoking more than 10 cigarettes per day, and living near industrial plants or other places that use lead in their production processes. Also excluded were individuals with abnormal clinical or laboratory results or with chronic diseases or cardiovascular disorders. Lead blood levels were determined using air-acetylene flame atomic absorption spectrophotometry. The detectable limit was 1.23 mug/dL. After the analyses of lead in blood, the following values were determined: minimum value, first quartile, median, third quartile, and maximum value; geometric mean; 95 percent confidence interval; experimental interval; and reference value. Results. The reference values for lead in blood ranged from 1.20 mug/dL to 13.72 mug/ dL. The geometric mean was 5.5 mug/dL. Conclusions. In general, the values found in this study are lower than those that have been reported for other countries. Additional data should be gathered from Brazilian populations living in more-industrialized areas.

Valores de referência para plumbemia em populaçäo urbana / Lead reference values in the blood of the urban population

Os valores de referência utilizados no Brasil, para chumbo em sangue, advêm de estudos realizados em outros países onde as condiçöes socioeconômicas, clínicas, nutricionais e ocupacionais diferem bastante das brasileiras. Para garantir uma correta biomonitorizaçäo da populaçäo ocupacionalmente exposto ao chumbo, um dos principais problemas identificados no município estudado, foram estabelecidos valores de referência na populaçäo näo exposta ocupacionalmente da regiäo sul do município. Diferentes estratégias foram utilizadas para assegurar a qualidade de amostragem, que foi dimensionada em 206 sujeitos acima de 15 anos. Sujeitos que apresentaram valores clínicos e laboratoriais fora da faixa de mormalidade foram excluídos, bem como os que apresentaram atividades específicas que pudessem interferir nos valores de plumbemia. Foram encontrados valores de referência para chumbo em sangue de 2,4 a 16,6 ud.dL-1, obtidos através do intervalo x + ou - 2s (onde x é o valor médio e s é o desvio-padrão dos valores observados) e mediana = 7,9 ug.dL-1.

Insuficiência cardíaca neonatal e síndrome de Marfan / Neonatal heart failure and Marfan syndrome

We report the case of a neonate admitted to the hospital in the 4th day of life in severe heart failure due to aortic and mitral regurgitation with a largely dilated aortic root. The associated skeletal features involving the superior and inferior limbs as well as the thorax, and joint hypermobility, allowed the clinical diagnosis of Marfan syndrome. Despite favorable initial response to medical therapy, sudden deterioration led to death two weeks after birth. Typical necroscopic findings were confirmed and the case is considered the most severe clinical manifestation possible to be found in this syndrome

É relatado caso de um neonato internado no 4º dia de vida com insuficiência cardíaca grave, secundária à insuficiência aórtica e mitral, com dilatação acentuada da aorta ascendente. Alterações ósseas características em membros e tórax com hipermobilidade articular permitiram o diagnóstico da síndrome de Marfan. Apesar da evolução inicial favorável com tratamento clínico convencional, súbita piora levou ao óbito no 13º dia de vida. Achados necroscópicos característicos foram encontrados, sendo o caso considerado como a manifestação mais grave possível de ser encontrada nessa síndrome

Hipoplasia congênita isolada do ventrículo direito / Congenital isolated hypoplasia of the right ventricle

Two cases of congenital trabecular hypoplasia of the right ventricle are reported. In the first, the neonatal diagnosis was missed and the child did well until the 13th month of life when a modified Blalock-Taussig shunt was done because of increasing cyanosis. Outcome was good until the 4th year of life when symptomatic atrioventricular block was detected in an emergency situation. A bidirectional Glenn anastomosis and pacemaker implantation were successfully carried out after clinical establization and the child is doing well up to now. The second case presents the disease with its worst features: severe cyanosis and acidosis in the first day of life. A modified Blalock-Taussig shunt was performed and death occurred soon after the operation.