Practices in primary health care oriented toward the harmful consumption of drugs / Las prácticas en la atención primaria de salud relacionados con el consumo nocivo de las drogas / Práticas na Atenção Básica voltadas para o consumo prejudicial de drogas

Objective To analyze the practices of primary care focused on the harmful consumption of drugs. Method This is a qualitative study, developed with a dialectical-critical approach. Data collection was carried out through semi-structured interviews with 10 employees of a basic health unit (UBS). Results The demands are not accepted, and if they go beyond the barriers shaped by the historical absence of health care practices for drug users and moralistic and preconceived ideologies, they are not reinterpreted as health needs; practices that meet these demands and go beyond the barriers are poor; the functionalist approach, which explains drug use as a disease and considers drug users as deviants, supports the few existing practices. Conclusion primary health care is mistakenly focused on addiction; it lacks structural elements of the production process in health and internal dynamics of the working processes that would foster the development of collective practices. .

Objetivo El estudio tiene como objetivo analizar las prácticas de atención primaria dirigidos a lo consumo prejudicial de drogas. Método Se trata de un estudio cualitativo, desarrollado en la perspectiva dialéctica crítica. La recolección de datos se realizó a través de entrevistas semiestructuradas con 10 empleados de una Unidad Básica de Salud. Resultados Muestran que: las demandas no son aceptadas, y si van más allá de las barreras - formadas por la ausencia histórica de la práctica de la atención de salud para los consumidores de drogas y las ideologías morales y preconcebidas -, no son reinterpretados como necesidades de salud; las prácticas que satisfagan esas demandas son pobres; detrás de estas escasas prácticas, está la perspectiva funcionalista, que considera el uso de drogas como una enfermedad y los usuarios de drogas como desviados; los trabajadores valoran la formación clínica y culpan a los usuarios por los problemas que enfrentan. Conclusión Se pode concluir que la atención primaria: es equívoca hacia el objeto de la dependencia; carece de los elementos estructurales del proceso de producción en la salud y las dinámicas internas de los procesos de trabajo que fomenten el desarrollo de las prácticas colectivas.

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Objetivo Analisar as práticas de atenção básica voltadas ao consumo prejudicial de drogas. Método Estudo qualitativo, desenvolvido na perspectiva dialético-crítica. A coleta de dados foi realizada através de entrevistas semiestruturadas com 10 trabalhadores de uma Unidade Básica de Saúde (UBS). Resultados As demandas não são acolhidas e, quando ultrapassam as barreiras - conformadas pela ausência histórica de práticas de atenção à saúde ao usuário de drogas e por ideologias moralistas e preconceituosas -, não são reinterpretadas como necessidades de saúde; as práticas que atendem essas demandas são precárias; a perspectiva funcionalista, que compreende o consumo de drogas como doença e considera usuários de drogas como desviantes, embasa as escassas práticas existentes. Conclusão A atenção básica encontra-se equivocamente voltada para a dependência; carece de elementos estruturais do processo de produção em saúde e da dinamicidade interna aos processos de trabalho, que favoreceriam o desenvolvimento de práticas coletivas. .

The Expression of Thymidine Phosphorylase in Cancer-infiltrating Inflammatory Cells in Stomach Cancer

Thymidine phosphorylase (TP) has shown to be up-regulated in several cancers and to play a role in angiogenesis and invasion. Most studies regarding TP have focused on cancer cells. Recently, evidences suggest that TP in cancer-infiltrating inflammatory cells (CIICs) also affect the cancer cell behavior. To evaluate the significance of TP expression of CIICs in gastric cancer, we assessed TP expression of cancer cells and CIICs separately using immunohistochemical assay on 116 paraffin-embedded tissue samples from stomach cancer patients and investigated their clinical significance. When subjects were divided into 4 groups according to the TP expression: cancer/matrix (+/+), C/M (+/-), C/M (-/+), and C/M (-/-), intratumoral microvessel density scores were higher in the C/M (+/-) group than in the C/M (-/-) group (p=0.02). For lymph node metastasis and survival, there were no significant differences among the 4 groups. However, there were significant differences in survival (p=0.035) and LN metastasis (p=0.023) between the two groups divided by TP expression of CIICs alone irrespective of TP expression of cancer cells. Taken together, this study suggested the TP expression in CIICs could affect lymph node metastasis and patients' survival in gastric cancer.

The Characteristics of Incidental Pituitary Microadenomas in 120 Korean Forensic Autopsy Cases

To investigate the characteristics of incidental pituitary microadenomas, we examined 120 pituitary glands from Korean forensic autopsy cases, from which eight tumors were identified (incidence 6.7%). The average age of the affected subjects was 50 yr (range: 33-96 yr) with a female predominance. The maximum diameters of the tumors ranged from 0.4 to 5.4 mm (mean: 2.8 mm). Immunohistochemical analysis of pituitary hormones revealed three growth hormone-secreting adenomas, one prolactin-producing adenoma, one gonadotropin-producing adenoma, one plurihormonal adenoma, and two null cell adenomas. MIB-1 staining for Ki-67 antigen showed no positive expression. The microvessel density (MVD) of the pituitary microadenomas ranged from 2.3 to 11.6% (mean: 5.3%) and was significantly lower than that of nonneoplastic pituitary glands (11.9-20.1%, mean: 14.8%). Our study provides reference data on incidental pituitary microadenomas in the Korean population.

Reatividade linfonodal e densidade microvascular nas metástases cervicais de carcinoma epidermóide com tumor primário oculto / Lymph node reactivity and microvessel density in neck metastases of unknown primary squamous cell carcinoma

INTRODUÇÃO: A neoangiogênese e a resposta imunológica são mecanismos importantes no desenvolvimento das metástases. OBJETIVO: Avaliar a reatividade linfonodal e a densidade microvascular nas metástases cervicais de carcinoma epidermóide com tumor primário oculto, considerando a sua relação com outras variáveis histológicas e clínicas. TIPO DE ESTUDO: Série de casos, retrospectiva. CASUíSTICA E MÉTODO: 19 pacientes submetidos a esvaziamento cervical entre 1983 e 2000. Os linfonodos foram reavaliados quanto ao tipo de reatividade, considerando a área cortical e paracortical. Nas metástases foi avaliado o grau de diferenciação, desmoplasia, necrose, e densidade microvascular (CD34). Foi estabelecida a relação entre as diferentes variáveis histológicas e clínicas, incluindo o estadiamento e a evolução dos pacientes. RESULTADOS: A densidade microvascular apresentou mediana de 91 vasos/mm2, variando de 28 a 145. A reatividade paracortical foi mais freqüente nos pacientes com menos de 55 anos (90 por cento x 44 por cento, p= 0,05). A sobrevida livre de doença foi de 52 por cento em 3 anos, sendo similar entre os pacientes com maior ou menor densidade microvascular tumoral. CONCLUSÕES: A densidade microvascular nas metástases de tumor primário oculto apresenta grande variação individual. Não foi possível estabelecer relação entre a densidade microvascular e as variáveis clínicas e histológicas estudadas.

BACKGROUND: neoangiogenesis and the immune response are important mechanisms in metastasis development. AIM: to evaluate lymph node reactivity and microvessel density in neck metastasis of occult primary squamous cell carcinoma considering their histological and clinical variables. STUDY DESIGN: retrospesctive case-series. METHOD: 19 patients with neck metastasis of occult primary squamous cell carcinoma who underwent neck dissection between 1983 and 2000 were selected. The lymph nodes were reevaluated on the type of reactivity in both the cortical and paracortical areas, and the metastasis were assessed as to grade, desmoplasia, necrosis and microvessel density (CD34). The relationship between histological and clinical variables was evaluated. RESULTS: the median microvessel density was 91 vessels/mm2, varying from 28 to 145. Paracortical hyperplasia was more common in patients below 55 years of age (90 percent x 44 percent, p= 0.05), but there was no relationship between reactivity patterns and microvessel density with prognosis. The disease-free survival was 52 percent in 3 years, being similar in both groups, with higher or lower microvessel densities. CONCLUSION: microvessel density in neck metastasis of occult primary squamous cell carcinoma had a great individual variability. It wasnÆt possible to establish the relationship between microvessel density and the clinical or histological variables studied.

Angiogenesis in myelodysplastic syndromes (MDS) in Indian patients.

Angiogenesis plays an important role in the pathogenesis of haematological neoplasms and may be correlated with the prognosis. We recently evaluated the microvessel densities in trephine biopsy sections of seventeen patients of myelodysplastic syndromes (MDS). Of the 17 cases, 2 were RAEB-t, 3 were RAEB, one was RARS and 11 were of the subtype RA (FAB subtyping). The microvessel counts were measured in the bone marrow biopsy sections by immunohistochemical staining, using CD34 reactive monoclonal antibodies. MVD was significantly higher in the cases of RAEB and RAEB-t as compared to the cases of RA. The average MVD per x400 in the cases of RA was 5.7 +/- 4.7 with a median value of 4.65 (range 19) whereas it was 45.4 +/- 10.0 and 44.0 (range 27.3) respectively in RAEB and RAEB-t (p <.001), the 95% confidence interval being (2.94, 8.5) and (36.6, 54.3), for the two groups respectively. This finding may imply that subtypes of MDS with a higher tendency for converting to acute leukaemia are associated with increased angiogenesis as compared to other subtypes where the risk of progression to acute leukaemia is much lower.

Characterisation and quantification of mucosal vasculature in oral submucous fibrosis.

AIM: Quantitative assessment of the mucosal vascularity in oral sub mucous fibrosis (OSF) by image analysis using OPTIMAS ver 6.0 software. The vascularity was assessed by estimating (a) the mean vascular density, (b) the mean vascular area percentage, and (c) the mean vascular luminal diameter. SUBJECT AND METHODS: Twenty (20) OSF and ten (10) age and sex matched healthy volunteers comprised the study group. The 5 microm thick H and E stained mucosal sections were examined and quantified in an image analyzer for number, size, density of vessels, and percentage of vascular area using an area morphometry tool. ANOVA is used to test equality of several means without affecting Type 1 error. RESULT: The mean vascular density is found to be more or less same in the test and control samples (F = 0.82, P>0.05). The mean vascular percentage area shows an increasing trend as the disease progresses (F = 8.63, p<0.01). The mean vascular luminal diameter also shows an increasing trend as the disease progresses (F = 34.1, p<0.001). CONCLUSION: The usual tissue reaction resultant to ischaemia / hypoxia does not seem to operate in this disease, which is preconditioned by significant stromal changes as part of the disease process. The mean vascular dilatation noted is assumed to be an adaptive response to compensate tissue ischaemia/hypoxia.

Expression of PTEN and Its Correlation with Angiogenesis in Gastric Carcinoma / 대한소화기학회지

BACKGROUND/AIMS: Phosphatase and tensin homolog deleted on chromosome ten (PTEN) is a recently clarified tumor suppressor gene located in 10q23.3. Alterations of this gene are associated with tumor progression and unfavorable outcome in various human cancers. Recently, PTEN has a possible role in angiogenesis by modulating angiogenic factor including vascular endothelial growth factor (VEGF). The aim of this study was to investigate the roles of PTEN and VEGF status for angiogenesis in human gastric cancer. METHODS: We conducted an immunohistochemical investigation of PTEN and VEGF expression in 90 cases of paraffin section obtained from gastric cancer patients undergone surgical treatment. RESULTS: Negative expression of PTEN and positive expression of VEGF in gastric cancer tissues, were demonstrated in 40.0% and 77.8% of cases, respectively. However, no significant correlation was found between PTEN, VEGF expression and various clinicopathological parameters. PTEN expression did not correlate significantly with VEGF expression (p=0.301). High microvessel density (MVD) was significantly associated with lymph node metastasis and poor survival (p=0.014, 0.011, respectively). The mean MVD value of PTEN negative tumors was 90.4+/-43.0 and significantly higher than that of PTEN positive tumors (p=0.028). The mean MVD value of VEGF positive tumors was 86.4+/-36.7 and significantly higher than that of VEGF negative tumors (p=0.002). The mean MVD value of PTEN negative and VEGF positive tumors was 98.0+/-42.2, and significantly higher than those of the others. CONCLUSIONS: These results suggest that loss of PTEN expression may play a critical role in tumor progression and metastasis by stimulating tumor angiogenesis in human gastric cancer.

Tumour angiogenesis and C-myc expression in breast carcinomas.

Angiogenesis in tumors has been widely studied and has been considered to be a prognostic factor particularly in breast carcinomas. The myc family of proto oncogenes has shown an amplification in breast carcinomas. The aim of this study was to assess MVD (micro vessel density) and the expression of c-myc in invasive breast carcinomas. Formalin fixed, routinely processed, paraffin embedded tissue was stained with H&E for classification and grading according to the Nottingham modification of Bloom and Richardson criteria. Immunohistochemical staining using primary antibody against F VIII antigen and anti C-myc were carried out. LSAB method was employed with AEC as chromogen and Gill's Haematoxylin as counter stain. Micro vessels were counted and positivity indicated by a cherry red staining in the cytoplasm of the tumour cells. Grades I, II and III showed 12.22 %, 20.9% and 24.5 % positivity of micro vessel density (MVD). Fifty percent of Grade 1, 69.2 % of Grade II and 24.5 % of Grade III tumours expressed c-myc proteins. In our study we found a positive association between tumour grade and micro vessel density, signifying a poor prognosis for tumours with high MVD. C-myc expression also showed a positive association with increasing grade.

Estudo quantitativo da microcirculaçäo miocárdica na hipertensäo arterial por progressiva inibiçäo da síntese do óxido nítrico / Quantitative study of myocradial microcirculation in arterial hypertension due to progressive inhibition of NO synthesis

OBJECTIVE- To study the quantitative changes in intramyocardial blood vessels in rats in whom nitric oxide synthesis was inhibited. METHODS - Four groups of 10 rats were studied: control (C25 and C40) and L-NAME(L25 and L40). The animals L25 and L40 received L-NAME in the dosage of 50mg/kg/day for 25 and 40 days, respectively. On days 26 and 41 the animals in groups 25 and 40 were sacrificed. Analysis of the myocardium was performed using light microscopy and stereology. RESULTS - Arterial blood pressure and heart weight increased 74.5 and 57.8 per cent after 25 days and 90.2 and 34.6 per cent after 40 days, respectively. Comparing the L-NAME rats with the respective controls revealed that vessel volume density decreased 31.3 per cent after 40 days, and the vessel length-density decreased 53.5 per cent after 25 days and 25.7 per cent after 40 days. The mean cross-sectional area of the vessels showed an important reduction of 154.6 per cent after 25 days. The intramyocardial vessels decreased significantly in length- density in the L-NAME animals. The mean cross-sectional area of the vessels, which normally increases during heart growth between 25 and 40 days, showed a precocious increase by the 25th day in the L-NAME rats. This suggests an increase of the size of the heart, including blood vessels. CONCLUSION - The inhibition of the NO synthesis provokes rarefaction in the intramyocardial vessels that progresses with the time of administration of L-NAME.

El desafío de la microcirculación / The challenge of the microcirculation

Se analiza el papel preponderante que juega en la medicina actual la valoración del lecho microcirculatorio en varias patologías. Se hace un repaso de los métodos de diágnostico disponibles. Se presenta una clasificación clínica de Acrosíndromes.

Isquemia intestinal no sectorial / Monocclusive mesenteric ischemia

El déficit circulatorio de este cuadro se ubica en la microcirculación intestinal por falla de bomba, shock o uso de digital. Dolor abdominal repentino, distensión, enterorragia y los antecedentes llevan a la sospecha clínica y al diagnóstico. El tratamiento es en principio médico, con el esquema de Boley (Tolazolina y papaverina), controlado por arteriografía; si no cede, el intestino necrótico debe ser removido quirúrgicamente. Se consideran 22 casos. Todos consultaron por dolor abdominal repentino, distensión y enterorragia. Sólo tres carecían de antecedentes, los 19 restantes provenían de terapia intensiva, unidad coronaria o tenían tratamiento con digital. Se utilizó el análisis univariable de variables cualitativas. Se operaron 18 (81,8 por ciento), falleciendo sin operar 4 (18 por ciento). La mortalidad global fue de 15 (68,1 por ciento). Siete (31,8 por ciento) tuvieron buena evolución, ellos presentaron sólo lesiones de intestino delgado

Alteraciones de la microvasculatura en la miocarditis crónica chagásica. Una posible causa de lesiones isquemicas / Alterations of microvasculature in the chronic chagasic myocarditis: A possible cause of ischemic injuries

Las lesiones isquémicas agudas focales del miocardio son producidas por lesiones orgánicas o por vaso espasmo de la microvasculatura del miocardio. Se analizan 112 casos de miocarditis crónica chagásica (MCCH) con nidos parasitarios (Grupo 1A,n=23) y sin nidos (Grupo 1Bn=89) en los cuales se comprobaron lesiones de la microvasculatura especialmente arteriolares, capilares y venosas (25.8 por ciento ). Este grupo se comparó con 50 casos de miocarditis crónicas inespecíficas con lesiones de la microvasculatura (28.8 por ciento ) (Grupo 2). La miocitolisis y la necrosis de la fibra fueron más frecuentes en el (Grupo 1A)(100 por ciento ) y no se encontraron diferencias significativas entre los grupos 1B y 2 y respectivamente.Las lesiones histopatológicas de las arteriolas y vénulas observadas en este análisis fueron similares a las descritas en otras enfermedades como diábetes, sarcoidosis, cardiomiopatía dilatada e hipertrófica. Concluimos que las lesiones inflamatorias perivasculares y microcavernomas fueron los hallazgos más característicos encontrados en la (MCCH) y las lesiones asteriolares estaban relacionadas con la miocitolisis y la necrosis focal de las fibras miocárdicas

Los sistemas reológicos en la microcirculación pulmonar / The rheological systems inthe pulmonary microcirculation

El objetivo primordial de esta revisión, estriba en recalcar la importancia de la microcirculación en el desarrollo de la patología pulmonar y señalar la influencia que su conocimiento ha ejercido en la creación de modernos esquemas terapeúticos en todas las áreas de la medicina. La reología, ciencia que estudia las propiedades viscoelásticas de la microcirculación y la interrelación que se sucede entre sus componentes, nos ha permitido explicar fenómenos tales como la nutrición, oxigenación y drenaje celular, cuyo desequilibrio desencadena graves procesos patológicos y a la vez crear esquemas terapéuticos capaces de modificar la viscosidad sanguínea sin alterar la nutrición y oxigenación tisular. Estos nuevos conceptos, no sólo serán aplicados próximanente en el desarrollo de sustancias capaces de reemplazar el tejido hemático en un momento dado, sino que actualmente, fármacos como la pentoxifilina, se utiliza como preventivos de procesos isquémicos a nivel de los sistemas cardiopulmonar y nervioso central.