Liver transplantation according to Milan criteria an overview of the past ten years / Transplante de fígado de acordo com os critérios de Milão: revisão dos últimos 10 anos

Background: Orthotopic liver transplantation (OLT) remains an excellent treatment approach for HCC in well-selected candidates. Milan Criteria (MC) (a single tumor up to 5cm or up to 3 tumors none larger than 3.0 cm) is the most widely used criteria for selection of those patients. Our aim is to study the current situation of the MC focusing on patient survival and tumor recurrence free rate from 1 to 5-yrs after OLT over the past 10 years. Material and Methods: We have reviewed 59 papers published between2000-2009; from Asia (42.3%), Europe (33.9%) and North America (20.4%). 5.525 patients have undergone OLT within MC. The overall patient survival rate and tumor recurrence free rate from 1 to 5-yrs were analyzed. Results: Overall patient survival rates were 1 year (87.26%), 2 years (81.95%), 3 years (77.47%), 4 years (75.24%) and 5 years (72.41%). We have found tumor recurrence free rate of 80.29% and 71.36% at 1 and 5-yrs, respectively. Conclusion: MC has come to simplify the indication for LT in patients with HCC. The best patient survival rate at 1 and 5 years were in North America (88%) and Asia (76,6%), respectively. On the other hand, Europe had the best tumor recurrence free rate at 5 years (91.8%).

Introdução: O transplante de fígado (TF) continua sendo o melhor tratamento para pacientes, bem selecionados, portadores de carcinoma hepatocelular. Os critérios de Milão (CM) ( tumor único até 5 cm e 3 tumores não maiores que 3 cms) são os critérios mais usados para estes pacientes. Nosso objetivo é avaliar a situação atual dos CM principalmente a sobrevida do paciente e a taxa livre de recorrência tumoral após 1 a 5 anos do TF, nos últimos 10 anos. Material e Métodos: Revisamos 59 trabalhos entre200-2009; da Asia (42,3%), Europa (33,9%) e da América do Norte (20,4%). 5.525 pacientes submeteram-se ao TF com os CM. A sobrevida total dos pacientes e a taxa livre de recorrência tumoral foram analisados. Resultados: A taxa de sobrevida total dos pacientes foi em 1 ano de (87,26%), 2 anos (81,95%), 3 anos (77,47%), 4 anos (75,24%) e 5 anos (72,41%). A taxa livre de recorrência tumoral foi de 80,29% e 71,36% em 1 e 5 anos, respectivamente. Conclusão: A melhor taxa de sobrevida dos pacientes foi na América do Norte (88%) e na Asia (76,6%), respectivamente. Por outro lado, a Europa teve a melhor taxa livre de recorrência de doença em 5 anos (91,8%).

Phantom para Medição da Faixa Dinâmica de Equipamentos de Ultra-som Biomédicos / Phantom to Measure Displayed Dynamic Range at Biomedical Ultrasound Equipments

O controle de qualidade da imagem em equipamentos ultra-sônicos de diagnósticos é baseado em parâmetros determinados por norma (IEC, 1996). Todos os parâmetros citados nesta norma, com exceção da Largura de Banda, podem ser avaliados utilizando-se de phantoms de tecidos biológicos. Baseado em normas e procedimentos internacionais, confeccionou-se um phantom para medição do parâmetro Faixa Dinâmica Exibida. Como material mimetizados de tecido, utilizou-se a solução matriz (agar, glicerina e água) adicionada de pó de grafite, apresentando coeficiente de atenuação (alfa 0) e velocidade da onda ultrasônica (c) compatíveis com a norma (alfa 0 = 0,7 dB.cm elevado a menos 1.MHz elevado a -0,83 e v = 1540 m.s elevado a menos 1). Adicionaram-se como conservantes, os antibióticos: clorafenicol, tetraciclina, penicilina G e os antifúngicos nistativa e anfotericina B. Foi também desenvolvido um protocolo detalhado para aplicação do phantom. Este protocolo foi testado em um aparelho comercial novo e os resultados iniciais apresentaram-se satisfatórios sugerindo sua adequação (tanto do phantom como do protocolo) numa aplicação rotineira em aparelhos comerciais

Possible evidence of endothelial cell activation and disturbance in thalassemia: an in vitro study.

Activation of vascular endothelium is considered as an important facet of inflammation, thrombosis, and vasculitis. Activated endothelial cells express a number of immunologically relevant surface markers which are not detected in dormant condition. These surface markers on endothelial cell may involve in adhesion reaction and migration of blood cell components. We demonstrated increased level of the soluble adhesion molecules in circulating blood of both alpha- and beta-thalassemic patients. These adhesion molecules are theoretically known to be released from endothelial cells. The adhesion molecules included soluble Intercellular Adhesion Molecule-1 (sICAM-1), soluble E-Selectin (ELAM-1), soluble Vascular Cell Adhesion Molecule-1 (sVCAM-1), and von Willebrand Factor (vWF). The levels of these adhesion molecules were measured in serum from 32 thalassemic patients and 10 control healthy subjects. As compared to normal, increased sICAM-1 was found in beta-thal/HbE patients with non-splenectomy; BE-NS (p = 0.002), increased ELAM-1 in beta-thal/HbE patients with splenectomy; BE-S (p = 0.01) and HbH with Hb Constant Spring; HbH/CS (p = 0.001), and increased sVCAM-1 in BE-NS; (p = < 0.0001) and BE-S (p = 0.002). Significant increase in von Willebrand Factor (vWF), a marker for endothelial cell, was shown in BE-S (p = 0.04) as compared to normal. Adhesion molecules were also markedly demonstrated in the supernatant of in vitro culture of human vascular endothelial cell in the presence of 30% thalassemic serum, and these adhesion molecules were also detected on the surface of the cells by using the technic of laser scanning confocal microscope and direct immunofluorescence.

A case-control study of acute diarrheal disease among school-age children in southern Thailand.

We conducted a case-control study of school-age children in Phatthalung, a province in southern Thailand using a questionnaire to investigate associations of children's hygiene-related behavior and hygienic conditions in their homes with acute diarrheal disease. We compared 69 acute diarrhea (less than 7 days duration) cases that attended two hospitals in Phatthalung during August 1995 to June 1996 with 69 age-, sex- and address-matched controls in primary schools who had not suffered from diarrheal disease for the past one year before August 1995. Three factors were found to be significantly associated with acute diarrheal disease: farmer or gum planter as the occupation of father [Odds ratio (OR) 6.6; 95% confidence interval (CI) 1.7-26.1, p < 0.01], installation of a refrigerator in children's homes (OR 0.2; CI 0.1-0.8, p < 0.05), and drinking untreated water (OR 2.3; CI 0.9-6.1, p < 0.1). There was no significant difference for sources of drinking water between cases and controls. Considering the data on drinking water, the results indicated that there are some problems with quality of sources of drinking water. The results also suggested that having a refrigerator could have preventive effects on acute diarrheal disease, while inadequate behavior and unhygienic environment in the homes of farmers and gum planters might be related to acute diarrheal among school-age children.

An effective axenic culture system for Trypanosoma brucei rhodesiense blood stream forms in vitro.

An effective axenic culture system for Trypanosoma brucei rhodesiense (ILRAD 1501) bloodstream forms is demonstrated. Bloodstream forms were continuously grown in 25 mM HEPES-buffered D-MEM supplemented with 10 microM bathocuproine sulfonate (BCS), 100 microM cysteine, and 20% heat-inactivated fetal bovine serum at 37 degrees C in vitro. At the initiation of the culture, T. b. rhodesiense bloodstream forms required the presence of 0.2 IU/ml insulin and 1 mM pyruvate, while bloodstream forms were grown in the culture medium without these supplements 4 days after initiation of the culture. Under this culture condition, T. b. rhodesiense bloodstream forms increased in number to 7 to 8 x 10(6) trypanosomes/ml, by day 4 after initiation of the culture. The trypanosomes cultured in this axenic system for 150 days were typically long and slender and retained their virulence for mice. This axenic culture system is extremely useful for in vitro cloning of T. b. rhodesiense bloodstream forms in vitro.

Multi-dot enzyme-linked immunosorbent assay for serodiagnosis of trematodiasis.

A nitrocellulose membrane strip dotted with crude antigens of trematodes, such as Paragonimus miyazakii, P. westermani, Fasciola sp., Clonorchis sinensis and Schistosoma japonicum was applied for serodiagnosis of trematodiasis. With peroxidase conjugated anti-human IgG and 4-chloro-1-naphthol as a substrate, antibodies in trematodiasis patient sera were clearly detected on the strip as bluish purple spots. Densities of the spots correlated well with values obtained by standard micro-ELISA. Cross-reactions among the trematode antigens, which is occurred more frequently than by ELISA, were observed with this method. However, the darkest spot correlated with the infecting parasite in all cases. With the high reliability and advantage that crude antigens can be used, this simple method, multi-dot ELISA, is considered to be useful for serodiagnosis of trematodiasis.