A percepção dos enfermeiros acerca do exame físico realizado em pacientes hematológicos hospitalizados / La percepción de los enfermeros acerca del examen físico realizado en pacientes hematológicos hospitalizados / The Perception of Patients about Physical Examination Performed in Hospitalized Hematologic Patients

Introdução: Para garantir a confiabilidade na assistência de enfermagem a pacientes com distúrbios hematológicos, por meio de procedimentos seguros, baseados em ações as mais científicas possíveis, é imprescindível a realização de um exame físico de qualidade, com foco nos principais distúrbios acometidos por esses pacientes. Objetivo: Identificar a percepção dos enfermeiros durante a realização do exame físico em pacientes hospitalizados com distúrbios hematológicos. Métodos: Pesquisa qualitativa com dez enfermeiros atuantes no cuidado a pacientes hematológicos em um hospital referência de doenças hematológicas do estado do Rio de Janeiro. Os dados foram coletados mediante entrevista semi estruturada e analisados através de análise temática. Resultados: Identificamos que 100 porcento participantes responderam que realizam o exame físico na sua prática profissional. Em relação à pergunta que abordava o principal componente que deve ser identificado pelo enfermeiro durante a execução do exame físico do cliente hematológico, encontramos que o sangramento foi à resposta mais verbalizada pelos participantes. Observou-se uma preocupação na identificação dos problemas psicoemocionais decorrentes de uma patologia hematológica. Conclusão: A identificação correta dos problemas apresentados pelos pacientes hematológicos, através de uma avaliação clínica cuidadosa, torna-se fundamental para o desenvolvimento de ações que favoreçam uma melhora na qualidade da assistência a saúde(AU)

Introducción: Para garantizar la confiabilidad en la asistencia de enfermería a pacientes con disturbios hematológicos, por medio de procedimientos seguros, basados en acciones las más científicas posibles, es imprescindible la realización de un examen físico de calidad, con foco en los principales disturbios acometidos por esos pacientes. Objetivo: Identificar las percepciones de las enfermeras durante el examen físico en pacientes hospitalizados con trastornos hematológicos. Métodos: Investigación cualitativa con diez enfermeros actuantes en el cuidado a pacientes hematológicos, en un hospital referencia de enfermedades hematológicas del estado de Río de Janeiro. Los datos fueron recolectados mediante entrevista semiestructurada y analizados a través de análisis temático. Resultados: Todos los participantes respondieron que realizaban el examen físico en su práctica profesional. En relación a la pregunta que abordaba el principal componente que debe ser identificado por el enfermero durante la ejecución del examen físico del cliente hematológico, el sangrado fue a la respuesta más verbalizada por los participantes. Se observó una preocupación en la identificación de los problemas psicoemocionales derivados de una patología hematológica. Conclusión: La identificación correcta de los problemas presentados por los pacientes hematológicos, a través de una evaluación clínica cuidadosa, se vuelve fundamental para el desarrollo de acciones que favorezcan una mejora en la calidad de la asistencia a la salud(AU)

Introduction: To guarantee nursing care reliability to patients with hematological disorders, through safe procedures, based on the most possible scientific actions, it is essential to perform a quality physical examination, with a focus on the main disturbances undertaken by those patients Objective: To identify the perceptions of nurses during the physical examination in hospitalized patients with hematological disorders. Methods: Qualitative research with ten nurses participating in the care of hematological patients, in a reference hospital for hematological diseases in Rio de Janeiro State. The data were collected through semi-structured interviews and analyzed through thematic analysis. Results: All participants responded that they performed the physical examination in their professional practice. Regarding the question about the main component that should be identified by the nurse during the execution of the physical examination of the hematological client, bleeding was the response most verbalized by the participants. Concern was observed in the identification of psychoemotional problems derived from a hematological condition. Conclusion: The correct identification of the problems presented by hematological patients, through careful clinical evaluation, becomes fundamental for the development of actions that favor an improvement in the quality of health care(AU)

Effects of pesticides on rural workers: haematological parameters and symptomalogical reports / Efeitos dos pesticidas sobre trabalhadores rurais: parâmetros hematológicos e relatos sintomatológicos

Abstract Exposure to pesticides by the rural population is increasing worldwide. Pesticides can induce the development of different diseases such as cancer and diseases of the central nervous system. This study analysed the clinical symptoms and haematological changes of a rural population in Conceição do Castelo, Espirito Santo, Brazil. For evaluation of symptomatology exposure to pesticides, 142 rural workers were interviewed. Of these, 22 workers were selected for haematological tests randomly as to evaluate haematological changes during the period of exposure to pesticides. Haematological analyses showed that erythrocytes, haemoglobin, haematocrit, mean corpuscular (VCM) volume, mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC) are in accordance with the reference intervals in haematology. Variations in the concentrations of rods and neutrophils indicates that exposure to pesticides increases the amount of those cells. Haematological disorders in rural workers exposed to pesticides can be correlated with reported symptoms. The results described in this study are relevant to the health public and reinforce the concern about the indiscriminate use of pesticides.

Resumo A exposição a pesticidas pela população rural está crescendo em todo o mundo. Os pesticidas podem induzir o desenvolvimento de diferentes doenças, como o cancer e as do sistema nervoso central. Este estudo analisou os sintomas clínicos e alterações hematológicas de uma população rural em Conceição do Castelo, Espírito Santo, Brasil. Para a avaliação da exposição a pesticidas e sintomatologias, 142 trabalhadores rurais foram entrevistados. Destes, 22 trabalhadores foram selecionados de randomicamente para testes hematológicos e avaliação de alterações hematológicas durante o período de exposição a pesticidas. Análises hematológicas mostraram que eritrócitos, hemoglobina, hematócrito, volume corpuscular médio (VCM), hemoglobina corpuscular média (HCM), concentração de hemoglobina corpuscular média (CHCM) estão em conformidade com os intervalos de referência. As variações nas concentrações de bastonetes e neutrófilos indicam que a exposição a pesticidas aumenta a quantidade dessas células. Alterações hematológicas em trabalhadores rurais expostos a pesticidas podem ser correlacionados com alguns sintomas relatados. Os resultados descritos neste estudo são relevantes para a saúde pública e para reforçar a preocupação com o uso indiscriminado de pesticidas.

Normoblastemia multinuclear en un recién nacido secundaria a hipoxia / Multinucleated normoblastemia in a newborn secondary to hypoxia

Es posible detectar normoblastos en los frotis de sangre periférica de los recién nacidos. En general, la cantidad de normoblastos por cada 100 leucocitos está en el intervalo de 0 a 10. Se observan con más frecuencia de lo usual ante una situación de hipoxia porque la hipoxia intrauterina aumenta la producción de eritrocitos. Sin embargo, no se había informado antes un caso de normoblastos multinucleados en un recién nacido a causa de la hipoxia. Presentamos el caso de un recién nacido con normoblastos multinucleados secundarios a hipoxia intrauterina. Este caso es importante porque es la primera vez que se han detectado normoblastos multinucleados en el frotis de sangre periférica de un recién nacido hipóxico.

Normoblasts may be seen in peripheral blood smear of newborns. The number of normoblasts per 100 white blood cells is generally in the range of 0-10.They can be seen more common than usual in hypoxic condition, because intrauterine hypoxia increases the production of red blood cells. However, multinucleated normoblasts in a newborn caused by hypoxia haven't been reported before. We present a newborn with multinucleated normoblasts secondary to intrauterine hypoxia. This case is important; because it is the first time multinucleated normoblasts in peripheral blood smear of a hypoxic newborn has been detected.

Bicytopenia and leukoerythroblastosis: a rare initial presentation of signet ring cell gastric adenocarcinoma

Gastric adenocarcinoma is a common neoplasia and is responsible for up to 30% of the overall deaths due to cancer. Advanced disease is mostly characterized by peritoneum, liver, and lung involvement. The spread of the disease to the bone is rare, and bone marrow dissemination is even rarer. In this setting, leukoerythroblastosis may be the initial manifestation of the disease. The authors report the case of a 64-year-old Caucasian man who sought medical care complaining of back pain, weakness, and weight loss. The physical examination revealed pallor, and the laboratory work-up depicted severe anemia and thrombocytopenia; the peripheral blood smear was consistent with leukoerythroblastosis. The ongoing investigation through a bone marrow biopsy showed massive involvement of the bone marrow by a signet ring cell adenocarcinoma. During hospitalization, the patient presented melena, and an upper digestive endoscopy depicted an ulcerated and infiltrative lesion in the cardia, upon which the histological examination revealed a signet ring cell adenocarcinoma. This case highlights the bone marrow invasion represented by bicytopenia and leukoerythroblastosis as the initial manifestation of this histological type of gastric cancer. Although treatment attempts were made with chemotherapy and radiotherapy, the patient died early on, showing the aggressive behavior of this form of tumoral presentation.

Alteraciones hematológicas en la diabetes mellitus / Blood disorders in diabetes mellitus

Although it has been treated in a limited way the relationship between diabetes and hematopoietic system, there is evidence demonstrating thedeleterious effect of hyperglycemia on the three cell lines: red blood cells, white cells and platelets. Different forms of anemia associated with hyperglycemia are analyzed and erythrocyte alterations observed in diabetes. In chronic decompensated patients have been demonstrated alterationsof monocytes, lymphocytes and polymorphonuclear particularly, with decreased chemotaxis, adherence, phagocytosis and opsonization. Hyperglycemia determines a prothrombotic state by platelet hyperreactivity, which is a marker of inflammation...

Toxicity Profile of Temozolomide in the Treatment of 300 Malignant Glioma Patients in Korea

This study evaluated the toxicity profiles of temozolomide in the treatment of malignant glioma as either concurrent or adjuvant chemotherapy. We retrospectively reviewed the medical records of 300 malignant glioma patients treated with temozolomide in two medical institutions in Korea between 2004 and 2010. Two hundred nine patients experienced a total of 618 toxicities during temozolomide therapy. A total of 84.8% of the 618 toxicities were Common Terminology Criteria for Adverse Events (CTCAE) grade 1 or 2, while 15.2% were grade 3 or 4. Among the hematologic toxicities, thrombocytopenia (13.7%), anemia (11.0%), and AST/ALT increases (7.0%) were common. Among the non-hematologic toxicities, nausea (44.3%), vomiting (37.0%), and anorexia (14.3%) were the three most common toxicities. There was no mortality due to temozolomide. Although temozolomide showed many types of toxicities, the majority of the toxicities were tolerable and of lower grade. Gastrointestinal troubles are the most common toxicities in Korean patients treated with temozolomide.

Aportes y consideraciones sobre la infección por los virus linfotrópicos-T humanos tipo 1 y 2 en Argentina / Contributions to the knowledge of Human T-Cell Lymphotropic Virus Type 1 and 2 (HTLV-1/2) infections in Argentina

El virus linfotrópicos-T humanos tipo 1 (HTLV-1) es el agente etiológico de una enfermedad hematológica de mal pronóstico, la leucemia de células T del adulto (ATL) y de una enfermedad neurológica invalidante, la mielopatía asociada al HTLV-1/paraparesia espástica tropical (HAM/TSP) para las cuales no existe un tratamiento eficaz. El virus linfotrópico-T humano tipo 2 (HTLV-2) ha sido relacionado a síndromes neurológicos, aumento de infecciones y mortalidad. En Argentina, existe una restricción étnica/geográfica con una región endémica para el HTLV-1 en el Noroeste (Aymarás) y otra para el HTLV-2 en la Región Chaqueña (Tobas y Wichis). El aumento de corrientes migratorias a partir de áreas endémicas ha contribuido a la mayor circulación de estos virus en el país, hecho que plantea el desafío de poder brindar un diagnóstico final y una atención integral a los individuos. Este manuscrito comprende una revisión actualizada y la experiencia de nuestro grupo sobre estas infecciones...

HTLV-1 is the ethiologic agent of an hematologic disease with bad prognosis, Adult T-cell Leukemia (ATL) lethal in short time and a chronic and progressively invalidant neurological disease, HTLV-1 Associated Mielopathy/Tropical Spastic Paraparesis (HAM/TSP), for which no effective treatment is available. HTLV-2 has been related to neurologic syndromes, an increase in infections and mortality. In Argentina, the infection shows an ethnic/geographic restriction with an endemic regions for HTLV-1 in the Northeast (Aymaras) and for HTLV-2 in the Chaqueña Region (Tobas y Wichis). The increasing migrations from endemic areas have contributed to a major circulatin of these viruses and detection of HAM/TSP and ATL cases countrywide. This situation poses the challenge of giving a complete and final diagnosis and an integral care to infected individuals. This manuscript describes general aspects of HTLV-1/2 and the situation and experience of our group on these infections in the country...

Outcomes and organ dysfunctions of critically ill patients with systemic lupus erythematosus and other systemic rheumatic diseases

Our objective was to compare the pattern of organ dysfunctions and outcomes of critically ill patients with systemic lupus erythematosus (SLE) with patients with other systemic rheumatic diseases (SRD). We studied 116 critically ill SRD patients, 59 SLE and 57 other-SRD patients. The SLE group was younger and included more women. Respiratory failure (61 percent) and shock (39 percent) were the most common causes of ICU admission for other-SRD and SLE groups, respectively. ICU length-of-stay was similar for the two groups. The 60-day survival adjusted for the groups’ baseline imbalances was not different (P = 0.792). Total SOFA scores were equal for the two groups at admission and during ICU stay, although respiratory function was worse in the other-SRD group at admission and renal and hematological functions were worse in the SLE group at admission. The incidence of severe respiratory dysfunction (respiratory SOFA >2) at admission was higher in the other-SRD group, whereas severe hematological dysfunction (hematological SOFA >2) during ICU stay was higher in the SLE group. SLE patients were younger and displayed a decreased incidence of respiratory failure compared to patients with other-SRDs. However, the incidences of renal and hematological failure and the presence of shock at admission were higher in the SLE group. The 60-day survival rates were similar.

Pediatric patients with bicytopenia/pancytopenia: Review of etiologies and clinico-hematological profile at a tertiary center.

Background: The etiology of bicytopenia/pancytopenia varies widely in children, ranging from transient marrow viral suppression to marrow infiltration by fatal malignancy. Depending on the etiology, the clinical presentation can be with fever, pallor or infection. Knowing the exact etiology is important for specific treatment and prognostication. Aims: To evaluate the etiological and clinico-hematological profile in children with bicytopenia and pancytopenia. Materials and Methods: A review of bicytopenic and pancytopenic children referred for bone marrow examination from January 2007 to December 2008 was done. Detailed history, clinical examination and hematological parameters at presentation were recorded. Results and Conclusion: During the study period, a total of 990 children were referred for bone marrow examination for different indications. Of these, 571 (57.7%) had either pancytopenia (17.7%) or bicytopenia (40%). Commonest form of bicytopenia was anemia and thrombocytopenia seen in 77.5% cases, followed by anemia and leukopenia in 17.3% and leukopenia and thrombocytopenia in 5.5% cases. Most common etiology was acute leukemia (66.9%) in bicytopenic children and aplastic anemia (33.8%) in pancytopenic children. Children with bicytopenia had a higher incidence of underlying malignancy (69.5% vs. 26.6%), splenomegaly (60.5% vs. 37.4%), lymphadenopathy (41.8% vs. 15.1%) and circulating blasts (64.6% vs. 20.1%) and a lower incidence of bleeding manifestations (12.1% vs. 26.6%) as compared to children with pancytopenia.

Dieta vegetariana en la edad pediátrica / Vegetarian diet at pediatric age

The vegetarian diet constitutes an option among particular nutrition practices that can be adopted by the family or by the child-adolescent inspired by different motivations. A good planning is critical in order to appropriately satisfy the macro- and micro-nutrient requirements at different ages and stages of life, so that the child achieves normal growth and development. There are nutrients to which we must pay attention, because by excluding certain types of food from our diet a deficiency may arise. Among this types of food are: Omega-3 fatty acids, specially docosahexaenoic acid (DHA) which is important for the neurodevelopment and for the improvement of the sense of vision during pregnancy and the first year of life; iron deficiency can cause anemia; zinc, calcium and vitamin D deficiency that can have an impact on bone mineralization in the long term; and vitamin B12, this one is very important because its deficiency can cause potential neurological damages and hematological alterations in the child. This article presents a review on how to assess the diet of the child, the suggested study and the management of deficiencies, which can be handled by a well-balanced intake of other types of food and by the consumption of fortified foods or pharmacological supplementation in order to prevent clinical complications resulting from specific deficiencies. The benefits of a vegetarian diet are mainly the following: an improvement of the lipid panel, a reduction in the risk of cardiovascular diseases and cancer. In addition, people that follow a vegetarian diet have healthier life habits.

La dieta vegetariana es una opción dentro de las alimentaciones especiales, la cual por diferentes motivaciones, la familia o el niño-adolescente puede adoptar. Resulta muy importante una buena planificación de ésta para cubrir adecuadamente los requerimientos de macro y micronutrientes en las diferentes edades de manera que el niño logre un crecimiento y desarrollo normales. Existen nutrientes a los cuales debemos estar atentos, porque al excluir ciertos alimentos de la dieta se puede propiciar su deficiencia. Dentro de estos alimentos están: los ácidos grasos omega 3, especialmente el docosahexaenoico (DHA) que participa en el neurodesarrollo y mejora la agudeza visual al estar presente durante el período de gestación y primer año de vida; el hierro, que al estar deficiente puede producir anemia; zinc, calcio y vitamina D que puede repercutir en la mineralización ósea como consecuencia a largo plazo; y la vitamina B 12, esta última de gran importancia por el potencial daño neurológico y alteraciones hematológicas que puede producir su carencia en el niño. En este artículo se revisa cómo evaluar la dieta de cada niño; el estudio sugerido y el manejo de las deficiencias, la cuales pueden ser manejadas mediante el consumo de otros alimentos en forma balanceada; y la utilización de alimentos fortificados o suplementación farmacológica de manera de evitar las complicaciones clínicas derivadas de las deficiencias específicas. Los beneficios de una dieta vegetariana son principalmente una mejoría del perfil lipídico, reducción del riesgo de enfermedades cardiovasculares y cánceres. Además, las personas que siguen una dieta vegetariana tienen hábitos de vida más saludables.

Terapia transfusional en dengue / Transfusion therapy in dengue

La infección por el virus del Dengue, en sus manifestaciones de Dengue Hemorrágico y de Síndrome de Dengue Shock, ha cobrado gran importancia en nuestro país desde 1989, en todos estos años se ha logrado una adecuada identificación y tratamiento de las complicaciones de esta enfermedad disminuyendo de manera importante la mortalidad sin embargo aún hay controversias en cuanto a las pautas de la Terapia Transfusional de manera que en el presente artículo haremos una revisión de las alteraciones hematológicas principales y trataremos de establecer algunos lineamientos para una adecuada Terapia Transfusional de nuestros casos.

Unusual haematological alterations in rheumatoid arthritis.

Three cases of rheumatoid arthritis (RA), presenting with refractory anaemia, thrombocytopenia and peripheral lymphocytosis respectively, were observed. In all the cases haematological manifestations were unrelated to disease activity or drug toxicity. These patients were detected to have pure red cell aplasia (PRCA) (normocytic normochromic anaemia, reticulocytopenia and absence of erythroid precursors in the bone marrow), immune thrombocytopenia (IT) (absence of splenomegaly and presence of increased megakaryocytes in the bone marrow) and multiple myeloma (MM) (lytic lesions on skull, paraproteinaemia and bone marrow plasmacytosis) respectively. PRCA and IT responded to glucocorticoids. Association with these three haematological alterations has rarely been reported. Our report highlights the need to regularly monitor blood counts in patients with RA.

Citomorfología de médula ósea en pacientes con SIDA / Bone marrow cytomorphology in patients with AIDS

El objetivo de éste estudio fue analizar las características citomorfológicas de la médula ósea de pacientes con SIDA y correlacionarlas con las alteraciones hematológicas periféricas. Se incluyeron 29 pacientes en quienes el aspirado de médula ósea se realizó con las técnicas habituales y el hemograma se efectuó en el mismo momento. Los motivos de petición del aspirado medular fueron: citopenias (58 por ciento), fiebre de origen desconocido (38 por ciento) e investigación de patología tumoral (4 por ciento). El 92 por ciento de los pacientes presentó citopenias: anemia (52 por ciento), trombocitopenia (4 por ciento), bicitopenia (16 por ciento) y pancitopenia (28 por ciento). Un caso mostró fibrosis medular y no pudo ser evaluado. En los casos restantes, se constató celularidad medular normal (64 por ciento) o aumentada (36 por ciento). La relación mieloide/eritroide (M/E) fue: disminuida (46 por ciento), normal (36 por ciento) o aumentada (18 por ciento). Las principales anomalías citomorfológicas fueron: diseritropoyesis con rasgos megaloblásticos (63 por ciento), disgranulopoyesis con asincronismo madurativo entre núcleo y citoplasma, hipo/hipergranularidad y desviación a la derecha (48 por ciento) y distrombopoyesis con megacariocitos hipolobulados o núcleos desnudos de megacariocitos (41 por ciento). Además, se constató aumento de células plasmáticas (39 por ciento, algunas con morfología anormal), de eosinófilos (14 por ciento), de linfocitos (11 por ciento) y presencia de células tipo Gaucher. Las citopenias estuvieron asociadas a una médula ósea normo o hipercelular y la anemia a una meyor frecuencia de displasia eritroide. En 6/28 pacientes (21 por ciento), la médula ósea proporcionó diagnóstico morfológico. En conclusión, los hallazgos realizados indican que, si bien algunas anomalías citomorfológicas de la médula ósea no son específicas, determinados rasgos morfológicos podrían sugerir infección por VIH

Esplenectomía laparoscópica / Esplenectomía laparoscópica

La esplenectomía laparoscópica (EL) ofrece las ventajas de la cirugía laparoscópica. La mejor indicación de la EL la constituyen las enfermedades hematológicas benignas. Desde octubre de 1996 hasta agosto del 2000 se intentaron realizar 22 esplenectomías por el método laparoscópico. Las indicaciones más frecuentes fueron las enfermedades hematológicas benignas: la púrpura trombocitopénica idiopática en 9 pacientes, la microesferocitosis hereditaria en 4, la anemia hemolítica autoinmune en 5, la estadiación del linfoma de Hodgkin en 2, 1 caso de tumor quístico del bazo y 1 caso de hiperesplenismo sin causa demostrada. Se analizan los resultados en estos primeros 22 casos y se describe la técnica quirúrgica. La edad promedio fue de 34,3 años, con rango de 16 a 73 años. El tiempo quirúrgico promedio fue de 147 min. Se convirtieron a cirugía abierta 4 pacientes por sangrado transoperatorio. Ocurrieron accidentes operatorios en 4 pacientes. No se presentaron complicaciones posoperatorias. El proceder se asoció con colecistectomía laparoscópica en 6 pacientes y biopsia de ganglio mesentérico con biopsia hepática en 2 pacientes. El sangrado transoperatorio promedio fue de 467 mL. La EL es una técnica reproducible y segura que brinda las ventajas de la cirugía laparoscópica (menor morbilidad y mortalidad posoperatoria), sobre todo en las enfermedades hematológicas benignas con bazo de tamaño normal o esplenomegalia no mayor de 25 cm, a pesar del efecto negativo de la curva de aprendizaje(AU)

The laparoscopic splenectomy (LS) offers the advantages of the laparoscopic surgery. The best indication of LS are the bening hematological diseases. 22 splenectomies were performed by the laparoscopic method from October, 1996, to August, 2000. The most frequent indications were the bening hematological diseases: idiopathic thrombocytopenic purpura in 9 patients, hereditary microspherocytosis in 4, autoimmune hemolitic anaemia in 5, Hodgkin lymphoma staging in 2, 1 case of cystic spleen tumor and 1 case of hypersplenism of undemonstrated cause. The results obtained in these first 22 cases are analyzed and the surgical technique is described. The average age was 34.3 years old with a range from 16 to 73 years old. The average surgical time was 147 min. Open surgery was performed in 4 patients due to postoperative bleeding. Surgical accidents occurred in 4 patients. No postoperative complications were reported. The procedure was associated with laparoscopic cholecystectomy in 6 patients and with biopsy of mesenteric ganglion with liver biopsy in 2 patients. The average transoperative bleeding was 467 mL. The LS is a reproducible and safe technique having the advantages of laparoscopic surgery (lower morbidity and postoperative mortality), mainly in the bening hematologic diseases with spleen of normal size or splenomegaly not exceeding 25 cm, in spite of the negative effect of the learning curve(AU)

Manifestaciones extraintestinales de la enfermedad de Crohn / Crohnïs disease extraintestinal manifestations

La Enfermedad de Crohn es una inflamación intestinal crónica cuyos síntomas comprometen el tracto intestinal desde la boca hasta el ano. Hay algunas manifestaciones extraintestinales en alrededor del 25 al 30 por ciento de los pacientes, las que son más comunes en enfermedad de colon, en comparación con las que afectan el intestino delgado. En este artículo se revisan los distintos síntomas y signos de varios órganos afectados, como la piel, articulaciones, tracto biliar, ojos y otras manifestaciones menos comunes. Es frecuente que varios órganos se vean afectados simultáneamente. El curso de las manifestaciones extraintestinales sigue generalemente el de la enfermedad intestinal, tanto en las crisis, remisiones y la respuesta a esteroides. En algunas ocasiones raras, las manifestaciones extraintestinales de la Enfermedad de Crohn y la colitis ulcerosa se presentan con mayor severidad y anterioridad que las manifestaciones intestinales, lo que hace indispensable considerarlas en el diagnóstico diferencial

Alteracoes hematologicas ligadas ao alcoolismo / Hematological disorders related to alcoholism

O alcool produz varios efeitos na medula ossea, resultando em anemia, leucopenia e trombocitopenia. A ingestao cronica de etanol contribui para o aparecimento de disfuncoes plaquetarias e anemias carenciais, principalmente por deficiencias de folato...

Concurrent chemotherapy and radiotherapy in invasive cervical cancer patients with high risk factors

The aim of this study was to evaluate the survival of 395 previously untreated cervical cancer patients with at least one high risk factor following concurrent chemoradiation and to assess the toxicities. Two different chemotherapy regimens were used for concurrent chemoradiation. In the patients with squamous cell carcinoma, 100 mg/m2 of cisplatin was infused intravenously, followed immediately by five consecutive daily administrations of 5-fluorouracil, 1,000 mg/m2/day, each infused intravenously over 24 hr. As for the patients with adenocarcinoma, 70 mg/m2 of cisplatin, 250 mg/m2 of cytoxan and 45 mg/m2 of adriamycin were administered intravenously on days 1, 2, and 3, respectively. The 5-year survival rate was 54.4+ACU- with stage III and IV, 62.6+ACU- with lymph node metastasis on computed tomogram or MRI, 77.9+ACU- with stage I-II disease with lesion size +AD4- or +AD0-4 cm, and 50.3+ACU- with small cell carcinoma or adenocarcinoma. Side effects from concurrent chemoradiation such as nausea, vomiting, and alopecia were present in all 395 cases. Anemia, leukopenia, thrombocytopenia, hepatotoxicity, and nephrotoxicity were observed to varying degrees, but there was no toxic death. This study suggests that cisplatin-based concurrent chemoradiation in treating cervical cancer patients with high risk factors is effective and relatively well tolerated, with acceptable toxicity.

Concurrent chemotherapy and radiotherapy in invasive cervical cancer patients with high risk factors

The aim of this study was to evaluate the survival of 395 previously untreated cervical cancer patients with at least one high risk factor following concurrent chemoradiation and to assess the toxicities. Two different chemotherapy regimens were used for concurrent chemoradiation. In the patients with squamous cell carcinoma, 100 mg/m2 of cisplatin was infused intravenously, followed immediately by five consecutive daily administrations of 5-fluorouracil, 1,000 mg/m2/day, each infused intravenously over 24 hr. As for the patients with adenocarcinoma, 70 mg/m2 of cisplatin, 250 mg/m2 of cytoxan and 45 mg/m2 of adriamycin were administered intravenously on days 1, 2, and 3, respectively. The 5-year survival rate was 54.4+ACU- with stage III and IV, 62.6+ACU- with lymph node metastasis on computed tomogram or MRI, 77.9+ACU- with stage I-II disease with lesion size +AD4- or +AD0-4 cm, and 50.3+ACU- with small cell carcinoma or adenocarcinoma. Side effects from concurrent chemoradiation such as nausea, vomiting, and alopecia were present in all 395 cases. Anemia, leukopenia, thrombocytopenia, hepatotoxicity, and nephrotoxicity were observed to varying degrees, but there was no toxic death. This study suggests that cisplatin-based concurrent chemoradiation in treating cervical cancer patients with high risk factors is effective and relatively well tolerated, with acceptable toxicity.

Hemograma na prática médica / Blood count in medical practice

O hemograma é um exame complementar que não apenas é do interesse do âmbito da Hematologia, assim como é do interesse de várias especialidades médicas, tais como Infectologia, Reumatologia, Pneumologia etc., sendo portanto um exame de interesse multidisciplinar. O autor descreve neste trabalho as principais alterações da série vermelha, como a descrição dos principais valores hematimétricos e sua importância clínica, as alterações relativas à série branca (leucograma) e finalmente as alterações relativas às plaquetas