Factors associated with adherence to antiretroviral therapy in HIV-infected subjects and the use of indicators to characterize the treatment adhesion profile.

At present, there is no gold standard to assess patient adherence to combination antiretroviral therapy (cART). Therefore, this study aimed to characterize the epidemiological profile, delineate adherence indicators, and identify factors associated with adherence and delays in obtaining medication in patients registered at the Specialized Assistance Service in HIV/AIDS in Brazil. This is a descriptive study based on secondary data obtained from official databases of the Brazilian Ministry of Health. Adherence and delay were measured by the frequency of cART medication acquisition in 24 months, and a multivariate linear regression model was developed to identify the factors associated with non-adherence and delays. In 50.2% of the subjects, the viral load remained undetectable throughout the study period. Only 12.4% of patients were fully adherent to cART. Regarding indicators, a value of 0.83 was found for adherence, 0.09 for delay in days, and 0.21 for the number of times the patient was late to obtain the medication. The multivariate analysis showed that males, age between 20 and 59 years, having not changed the cART, and the presence of ≥1000 HIV RNA copies/mL were predictive factors for adherence and delays (P≤0.01). We demonstrated that monitoring cART medication distribution is possible using health indicators, and identifying the factors associated with poor adherence to cART helps characterize patients at higher risks of unsuccessful therapy.

Factors associated with adherence to antiretroviral therapy in HIV-infected subjects and the use of indicators to characterize the treatment adhesion profile

At present, there is no gold standard to assess patient adherence to combination antiretroviral therapy (cART). Therefore, this study aimed to characterize the epidemiological profile, delineate adherence indicators, and identify factors associated with adherence and delays in obtaining medication in patients registered at the Specialized Assistance Service in HIV/AIDS in Brazil. This is a descriptive study based on secondary data obtained from official databases of the Brazilian Ministry of Health. Adherence and delay were measured by the frequency of cART medication acquisition in 24 months, and a multivariate linear regression model was developed to identify the factors associated with non-adherence and delays. In 50.2% of the subjects, the viral load remained undetectable throughout the study period. Only 12.4% of patients were fully adherent to cART. Regarding indicators, a value of 0.83 was found for adherence, 0.09 for delay in days, and 0.21 for the number of times the patient was late to obtain the medication. The multivariate analysis showed that males, age between 20 and 59 years, having not changed the cART, and the presence of ≥1000 HIV RNA copies/mL were predictive factors for adherence and delays (P≤0.01). We demonstrated that monitoring cART medication distribution is possible using health indicators, and identifying the factors associated with poor adherence to cART helps characterize patients at higher risks of unsuccessful therapy.

Effect of the subdose of human chorionic gonadotropin applied in the Hou Hai acupoint on ovulation induction in mares / [Efeito da subdose de gonadotrofina coriônica humana aplicada no acuponto Hou Hai sobre a indução da ovulação em éguas]

The objective of this study was to evaluate the effects of an hCG sub dose applied at the Hou Hai acupoint on corpus luteum (CL) quality and ovulation induction in mares. Fifteen crossbred mares were distributed in randomized blocks and used in three periods with each period employed as the blocking factor in three treatments: T1 = 1500 IU of hCG via intravenous (IV); T2 = 450 IU of hCG applied at the false acupoint (IV); and T3 = 450 IU of hCG applied at the Hou Hai acupoint. Mean diameter of the CL, serum concentration of progesterone (P4), vascularization of the pre-ovulatory follicle and CL were evaluated. Females administered 450 IU of hCG at the Hou Hai acupoint exhibited greater ovulation rates (33.33%) 48h after induction; The minimum number of colored pixel (NCP) of the pre-ovulatory follicle of control females was superior (40.33) to that of mares administered 450 IU of hCG IV at the false acupoint (36.84) and similar to that of those administered hCG at the Hou Hai acupoint (39.31). Further, moderately positive correlations were found between the CL diameter and the P4 concentration on D8 (P<0.05). IV administration of 450 IU of hCG or at the Hou Hai acupoint was efficient at inducing ovulation and ensuring the quality of CL in mares.(AU)

O objetivo foi avaliar os efeitos de uma subdose de hCG aplicada no acuponto Hou Hai na qualidade do corpo lúteo (CL) e na indução da ovulação em éguas. Quinze éguas mestiças foram distribuídas em blocos ao acaso, sendo o período utilizado como fator de blocagem, em: T1 = 1500 UI de hCG por via intravenosa (IV); T2 = 450 UI de hCG aplicado no falso acuponto (IV) e T3 = 450 UI de hCG aplicada no acuponto Hou Hai. Avaliou-se diâmetro médio do CL, concentração sérica de progesterona (P4), vascularização do folículo pré-ovulatório e do CL. As fêmeas que receberam 450 UI de hCG no acuponto Hou Hai apresentaram maiores taxas de ovulação (33,33%) 48h após a indução. O número de pixels coloridos (NPC) mínimo do folículo pré-ovulatório das fêmeas do grupo controle foi superior (40,33) ao das éguas que receberam 450 UI de hCG IV no falso acuponto (36,84) e semelhante ao das éguas que receberam hCG no acuponto Hou Hai (39,31); correlações moderadamente positivas foram encontradas entre o diâmetro do CL e a concentração de P4, ambos no D8 (P <0,05). A administração IV de 450 UI de hCG ou no acuponto Hou Hai foi eficiente na indução da ovulação e na garantia da qualidade do CL nas éguas.(AU)

Estruturas fetais e suas correlações com a predição do dia antes do parto em raças de cães miniaturas / Fetal structures and their correlations with a prediction of the parturition date in the miniature canine breeds

Avaliou-se a correlação entre estruturas fetais e extrafetais com a predição do dia antes do parto (DAP) em raças de cães miniaturas. Para isso, realizou-se um experimento, utilizando-se 12 cadelas, com peso corporal entre 3,0kg e 5,0kg, sendo seis da raça Chihuahua, duas da raça Shih-Tzu, duas da raça Spitz Alemão e duas da raça Yorkshire. Foram mensurados, por meio da ultrassonografia, diâmetro biparietal (DBP), diâmetro torácico (DTX), diâmetro abdominal (DAB), comprimento craniocaudal (CCC), diâmetro da cavidade coriônica interna (DCI) e espessura da placenta (EP), a partir do 15º dia após a última monta. Foram estudadas as correlações simples e a significância dos coeficientes de regressão linear simples e o coeficiente de determinação (R), com nível de significância estabelecido em P<0,05. Entre os parâmetros avaliados, DBP, DTX, DAB e CCC foram os mais correlacionados com tempo gestacional, podendo ser utilizados para prever dia antes do parto em cadelas de raças miniaturas.(AU)

The correlation between fetal and extra-fetal structures with the pre-delivery prediction (DAP) in miniature dog breeds was evaluated. For this, an experiment was carried out using 12 bitches, with body weight between 3.0kg and 5.0kg, being 6 Chihuahua, 2 Shih-Tzu, 2 German Spitz and 2 Yorkshire breed. The Biparietal Diameter (BD), Thoracic Diameter (TD), Abdominal Diameter (AD), Crown-rump length (CRL), Internal Chorionic Cavity Diameter (ICD) and Placenta Thickness (PT) were measured by ultrasonography from the 15th day after the last mating. The simple correlations and significance of simple linear regression coefficients and the coefficient of determination (R) were studied, with a significance level of P<0.05. BD, T, AD and CRL were the most correlated with gestational time, and can be used to predict day before delivery in miniature breed bitches.(AU)

Utilização da lipoproteína de baixa densidade, em diferentes concentrações, em meio diluidor para criopreservação do sêmen ovino / Use of low density lipoprotein in different concentrations in diluent medium for cryopreservation of ovine semen

A utilização da gema de ovo dificulta a padronização de meios diluidores e apresenta riscos biológicos. Assim, este estudo avaliou diferentes concentrações da lipoproteína de baixa densidade (LDL), em substituição à gema de ovo, para a confecção de diluentes para criopreservação espermática em ovinos. Foram utilizados um diluidor controle (CTR= 20% de gema de ovo) e cinco tratamentos, substituindo-se a gema pelas diferentes proporções de LDL (T1=6%; T2=8%; T3=12%; T4=16%; T5=20%), todos à base de TRIS-glicerol. Para o estudo, utilizaram-se dois ejaculados, de seis reprodutores da raça Santa Inês. Sessenta dias após a criopreservação, as amostras foram descongeladas e avaliadas subjetivamente quanto à motilidade total (MT, %) e progressiva (MP, %), ao vigor (1-5) e à integridade funcional (choque hisposmótico com água destilada, %) e estrutural (corante supravital eosina, %) das membranas espermáticas. As avaliações de vigor e funcionalidade de membrana não diferiram (P>0,05) entre os grupos. Entretanto, os grupos T4 (P<0,01) e T5 (P<0,05) foram superiores ao CTR para os parâmetros MT, MP e integridade estrutural de membrana, o que confirma que as LDLs podem ser alternativas eficientes para substituição da gema de ovo em diluidores para criopreservação de sêmen ovino.(AU)

The use of egg yolk makes it difficult to standardize extenders and presents biological hazards. Thus, this study evaluated different concentrations of low-density lipoprotein (LDL) to replace yolk extenders for production of sperm for cryopreservation in ovine. A control extender was used (CTR= 20% yolk) and five treatments, replacing the yolk by different ratios of LDL (T1= 6%; T2= 8%, T3= 12%; T4= 16%; T5= 20%) all based on TRIS-glycerol. For the study, two ejaculates from six Santa Ines breeding were used. Sixty days after cryopreservation, the samples were thawed and evaluated for total motility (MT, %) and progressive motility (MP, %), vigor (1-5) and the functional integrity (hyposmotic shock with distilled water, %) and structural (supravital dye eosin, %) of the sperm membranes. The evaluations of strength and membrane functionality didn't differ (P> 0.05) between groups. However, T4 (P< 0.01) and T5 (P< 0.05) groups were superior to the CTR for the MT, MP, and membrane structural integrity parameters, which confirms that LDLs can be efficient alternatives for yolk replacement in extenders for cryopreservation of ovine semen.(AU)

Determination of the optimal programmed intermittent epidural bolus volume of bupivacaine 0.0625% with fentanyl 2 µg.ml-1 at a fixed interval of forty minutes: a biased coin up-and-down sequential allocation trial.

The optimum time interval for 10 ml boluses of bupivacaine 0.0625% + fentanyl 2 µg.ml-1 as part of a programmed intermittent epidural bolus regimen has been found to be 40 min. This regimen was shown to be effective without the use of supplementary patient-controlled epidural analgesia boluses in 90% of women during the first stage of labour, although with a rate of sensory block to ice above T6 in 34% of women. We aimed to determine the optimum programmed intermittent epidural bolus volume at a 40 min interval to provide effective analgesia in 90% of women (EV90 ) during the first stage of labour, without the use of patient-controlled epidural analgesia. We performed a prospective double-blind dose-finding study using the biased coin up-and-down sequential allocation method in 40 women. The estimated EV90 was 11.0 (95%CI 10.0-11.7) ml with the isotonic regression method and 10.7 (95%CI 10.3-11.0) ml with the truncated Dixon and Mood method. Overall, 18 women had a sensory block above T6, and 37 women exhibited no motor block. No women required treatment for hypotension. In conclusion, it is not possible to reduce the programmed intermittent epidural bolus volume from 10 ml, used in our current regimen, without compromising the quality of analgesia. Using this regimen, a high proportion of women will develop a sensory block above T6.

Tumor da célula da granulosa associado à piometra em uma gata de sete meses / Granulosa-cell tumor associated with pyometra in a seven months old cat

As neoplasias ovarianas em gatas são raras e, quando relatadas, estão associadas a animais senis, assim como a piometra de causa não iatrogênica. O objetivo deste trabalho foi relatar o caso de uma gata jovem com neoplasia ovariana, tumor de células da granulosa associado ao complexo hiperplasia endometrial cística/piometra (HECP). O animal foi atendido no setor de Reprodução Animal e Obstetrícia Veterinária (RAOV) de um Hospital Veterinário Escola, com histórico de monta natural recente, anorexia, êmese, polidipsia, poliúria e descarga vaginal purulenta. Ao exame físico, observou-se apatia, mucosas ictéricas, aumento de volume da região abdominal e presença de secreção vaginal purulenta. À ultrassonografia, foi visibilizado conteúdo ecogênico no útero diagnóstico de HECP e estrutura ecogênica na cavidade abdominal, na região ovariana, confirmado pelo exame histopatológico como sendo tumor das células da granulosa. A conduta terapêutica adotada foi a cirurgia de ovariossalpingo-histerectomia (OSH).(AU)

Ovarian neoplasias in cats are rare, and are associated with advanced ages, as well as non-iatrogenic pyometra. The objective of the present study was to report a case of a young cat showing signs of a rare neoplasia, the granulosa-cell tumor, associated with complex cystic endometrial hyperplasia/pyometra (HECP). The animal was attended in the Animal Reproduction and Veterinary Obstetrics sector of a Teaching Veterinary Hospital with a history of natural breeding, anorexia, emesis, polydipsia, polyuria, and purulent vaginal discharge. During clinical examination, apathy, icterus, swelling of the abdomen, and purulent vaginal discharge were observed. On the ultrasonographic exam, an echogenic content inside the uterus was observed, leading to diagnosis of HECP and an echogenic structure in the abdominal cavity, in ovarian region, confirmed by histopathology as being of granulosa cells. The therapeutic conduct adopted was salpingo-oophorectomy and hysterectomy surgery (OSH).(AU)

Phase 3 trial of three thalidomide-containing regimens in patients with newly diagnosed multiple myeloma not transplant-eligible.

The introduction of agents such as thalidomide, lenalidomide, and bortezomib has changed the management of patients with multiple myeloma who are not eligible for autologous transplantation, many of whom are elderly. We sought to compare three thalidomide-based oral regimens among such patients in Latin America. We randomized patients with newly diagnosed multiple myeloma with measurable disease to one of the following regimens: melphalan, prednisone, and thalidomide (MPT); cyclophosphamide, thalidomide, and dexamethasone (CTD); and thalidomide and dexamethasone (TD). The TD arm was closed prematurely and was analyzed only descriptively. The primary endpoint was the overall response rate (ORR), whereas progression-free survival (PFS) and overall survival (OS) were secondary endpoints. The accrual rate was slower than expected, and the study was terminated after 82 patients had been randomized. The ORRs were 67.9 % with MPT, 89.7 % with CTD, and 68.7 % with TD (p = 0.056 for the comparison between MPT and CTD). The median PFS was 24.1 months for MPT, 25.9 months for CTD, and 21.5 months for TD. There were no statistically significant differences in PFS or OS between MPT and CTD. In an unplanned logistic regression analysis, ORR was significantly associated with treatment with CTD (p = 0.046) and with performance status of 0 or 1 (p = 0.035). Based on the current results, no definitive recommendations can be made regarding the comparative merit of the regimens tested. Nevertheless and until the results of further studies become available, we recommend either CTD or MPT as suitable frontline regimens for patients with multiple myeloma who are not candidates to transplantation in settings where lenalidomide and bortezomib are not available.

A conceptual model for barrier free facilities planning.

This paper presents the proposal of a model for planning a barrier free industrial facilities, considering the demands that inclusion requires, ranging from outside the factory (social environment), to the needs of the production system and the workstation. Along with literature review, the demands were identified in a shoe manufacturer that employs people with disabilities, and organized taxonomically in agreement with the structure for planning facilities. The results show that the problems are not primarily related to eliminating architectural barriers and factors aimed at preventing risks to people's health and safety but, rather, are related to the company's cultural environment, because the main hazards are managerial. In special cases, it is suggested there is a need to adjust those parts of tasks that the worker cannot do, or even to re-schedule work so as to make it possible for employees with disabilities to perform their tasks.

Evaluation of sperm DNA peroxidation in fertile and subfertile dogs.

Oxidative stress (OS) has been recognized as one of the most important causes of male infertility. The antioxidant activities of seminal plasma and epididymal fluid are not enough to prevent OS, which can damage sperm membranes and DNA, so antioxidant supplementation has been used as a treatment of male infertility. The aim of this experiment was to evaluate the DNA peroxidation before and after antioxidant supplementation with vitamin C and E in dogs with and without fertility problems. A total of eleven dogs were used and were divided in two groups: fertile group (G1), dogs with normal spermiogram (n = 5); subfertile group (G2): dogs with low sperm count (<20 × 10(6) sptz/ml) and/or more than 30% of total sperm pathology (n = 6). Both groups received 500 mg/day of vitamin C and 500 mg/day of vitamin E for 60 days. A semen sample was collected before (M1) and after (M2) oral supplementation. Samples were analysed for DNA peroxidation by measuring the 8-hydroxy-2'-deoxyguanosine concentration. No significant difference was observed between groups at either time. Oral supplementation with 500 mg/day of vitamin C and 500 mg/day of vitamin E did not change the DNA peroxidation in fertile and subfertile dogs.

Estrutura populacional e incremento corrente anual de casca-de-anta (Drimys brasiliensis Miers - Winteraceae) em Caçador, Santa Catarina, Brasil / Population structure and annual increment in "casca-de-anta" (Drimys brasiliensis Miers - Winteraceae) from Caçador Municipality, Santa Catarina State, Brazil

Drimys brasiliensis Miers, conhecida como cataia ou casca-de-anta, é árvore nativa da Mata Atlântica e as cascas tem sido utilizadas medicinalmente a partir da exploração de plantas em populações naturais. Este trabalho teve como objetivo estudar a demografia de duas populações naturais de D. brasiliensis, (1) Reserva Genética Florestal de Caçador (RGFC) e (2) Floresta Nacional de Caçador (FLONA), ambas no município de Caçador (SC), visando fundamentar estratégias de exploração sustentável e conservação deste recurso florestal não-madeireiro. A maior luminosidade no sub-bosque existente na FLONA atuou positivamente na espécie, aumentado a capacidade de incremento em diâmetro à altura do peito (DAP), altura (H) e área basal (AB), além de antecipar a reprodução em plantas de menor porte. A análise do padrão espacial das plantas reprodutivas na RGFC mostrou padrão agregado, e na FLONA até a distância de 25 metros. Esse comportamento indicou que a espécie apresenta potencial de manejo em florestas secundárias, formação sucessional em que se encontra a maioria dos remanescentes de Mata Atlântica, além de indicar potencial para cultivo em sistemas agroflorestais.

Known as "cataia" or "casca-de-anta", Drimys brasiliensis Miers is a tree native to the Atlantic Forest and its barks have been medicinally used by exploring natural populations. The present work aimed to study the demography of two D. brasiliensis natural populations, (1) Caçador Forest Genetic Reserve (RGFC) and(2) Caçador National Forest (FLONA), both located in Caçador Municipality, Santa Catarina State, Brazil, in order to establish strategies for sustainable exploration and conservation of such non-timber forest resource. The higher luminosity in FLONA understory was beneficial to the species by increasing their increment capability regarding diameter at breast height (DBH), height (H) and basal area (BA), and made the reproduction in smaller plants earlier. The spatial analysis of reproductive plants in RGFC had an aggregate pattern, whereas in FLONA until 25m distance was detected. Such results indicated that this species presents potential for management in secondary forests, the successional formation where the major Atlantic Forest remnants are found, as well as potential for cultivation in agroforestry systems.

Patient socioeconomic status as a prognostic factor for allo-SCT.

The aim of the present study was to assess the influence of socioeconomic status (SeS) on the outcome of allo-SCT at a Brazilian SCT center. In total, 201 patients receiving HLA-identical related allo-SCTs were studied. The median age was 30 years. Overall, 163 patients had malignancies (CML 68, ALL/AML 63, myelodysplastic syndrome 12 and others 20). SeS was defined according to the Brazilian Association of Market Research Agencies classification, where people are clustered in groups A-E (richest to poorest). In total, 146 patients (72%) were classified as richest (A+B+C) and 55 (28%) as poorest (D+E). The D+E SeS group was associated with a higher incidence of chronic GVHD and acute GVHD (hazard ratio (HR)=2.61; P=0.001 and HR=2.62; P=0.001, respectively), better platelet and neutrophil engraftment (HR=1.94; P=<0.001 and HR=2.12; P=0.001) and with a higher TRM in multivariate analysis (HR=1.92; P=0.039). Estimated overall survival at 5 years was 55.2%. A D+E SeS (HR=2.13; P=0.001) was associated with a worse survival on multivariate analysis. In conclusion, a lower SeS is a strong prognostic factor in patients undergoing allo-SCT in Brazil, influencing engraftment, TRM and overall survival.

Cirurgia de catarata em cães: observações trans e pós-operatórias em 10 casos

O artigo não apresenta resumo.

Contribuição da rinoscopia posterior com biopsia assistida no diagnóstico de neoplasias nasais de 31 cães

O artigo não apresenta resumo.

Estudo comparativo experimental na formação de neuromas: anastomose epineural em “looping” com fio de sutura e cola de fibrina / Experimental comparative study in neuromas formation: epineural anastomosis in “looping” with suture lineand fibrin glue

Neuromas podem ocorrer em todas as especialidades cirúrgicas, limitando os pacientes em suas atividades diárias. Até a presente data, não há técnica que seja uniforme e bem sucedida na prevenção e tratamento dos neuromas. Neste estudo, realizou-se anastomose epineural em “looping” utilizando fio de sutura (GSA) e cola de fibrina (GFB) em nervo ciático posterior de ratos. A anastomose epineural foi realizada no lado esquerdo, enquanto que o lado direito serviu como controle, realizando-se apenas a secção do nervo contralateral (GCA e GCB). A mensuração do neuroma foi realizada através de cortes histopatológicos. Demonstrou-se que o grupo GFB apresentou menor formação de neuromas em relação ao GCB e GSA (p<0,05). Não obstante ser impossível extrapolar estes resultados para humanos, acreditamos que ambas as técnicas de anastomose epineural são viáveis para futuros estudos clínicos.

Neuromas may occur virtually in all surgical specialties causing an important activity limitation in patients lives. Until now there is no technique that has proven success in neuromas prevention and treatment. In the present study looping epineural anastomosis was performed with suture line (GSA) and fibrin glue (GFB) in posterior sciatic nerve. While epineural anastomosis was done on the left side, the right side was used as control, by just transecting the nerve (GCA and GCB). The neuroma measurement was achieved by histopathology. It was showed that GFB group presented less neuromas formation compared to GCB and GSA (p<0,05). Although these results cannot be projected to humans, we believe that both epineural anastomosis techniques should be further studied in clinical trials.

Pemphigoid nodularis (non-bullous): a clinicopathological study of five cases.

Pemphigoid nodularis is a rare clinical variant of pemphigoid characterized by overlapping clinical features of both prurigo nodularis lesions and pemphigoid-like blisters. In pemphigoid nodularis, the immunopathological findings are identical to those of bullous pemphigoid (BP). We describe five patients who presented with the typical clinical phenotype of prurigo nodularis, who were found to have circulating and tissue-bound antibasement membrane zone autoantibodies. By immunoelectron microscopy and Western immunoblotting studies, the circulating antibodies were shown to target the hemidesmosome and specifically the BP antigens 1 and 2 (BP180 and BP230). In contrast to the majority of reported cases, none of these patients has ever developed blisters. The role of antibasement membrane zone antibodies in the development of the eruption, or the role of the eruption in the development and persistence of autoantibodies, is not clear. These cases demonstrate that the presence of these antibodies is not sufficient for the development of blisters.

Outcome of treatment in adult acute lymphoblastic leukemia in southern Brazil using a modified german multicenter acute lymphoblastic leukemia protocol.

Reports on treatment outcomes in adults with acute lymphoblastic leukemia (ALL) in Brazil are sparse. To evaluate the outcome of patients with ALL managed by the public healthcare system, we studied 42 adults treated from 1990 to 1997 in the Division of Hematology at Hospital de Clínicas, Porto Alegre, Brazil. Of these patients, 14/42 were females and their median age at diagnosis was 26 (17-64) years. The diagnosis of ALL was based on cytological examination of marrow smears, and immunophenotypic and cytogenetic studies, when available. Fifty percent of the patients expressed CD10, 30% were CD10 negative and CD19 positive and 20% expressed T markers. Philadelphia chromosome was found in 4 (7.14%). The chemotherapy protocol was adapted from the German Multicenter ALL (GMALL) 02-84 protocol. The complete remission rate was 93% and the overall survival at 5 years was 41%. No particular risk factor was identified in our series. These results are comparable to the findings of other international studies.

Treatment of angiofibromas with a scanning carbon dioxide laser: a clinicopathologic study with long-term follow-up.

BACKGROUND: Facial angiofibromas in tuberous sclerosis have been managed with various treatment modalities, including carbon dioxide (CO(2)) laser resurfacing. OBJECTIVE: Our purpose was to perform a long-term clinicopathologic assessment of CO(2) laser treatment of angiofibromas. METHODS: This was a retrospective case review of 10 patients treated with a scanning CO(2) laser to flatten lesions. Baseline clinical photographs and those taken at 6, 12, and 24 months after the operation were assessed by a blinded observer. Patients also evaluated outcomes. Biopsy specimens taken immediately and at 4 months after the operation were reviewed. RESULTS: Three groups of patients were identified: the first comprised 2 patients with sustained excellent and good outcomes. A second group (3 patients) had excellent outcomes in the early and medium term but then demonstrated partial deterioration. The last group (5 patients) had a range of early results with invariably poor outcomes at 24 months. In contrast, patients' self-assessment at 24 months was good or excellent in 8 of 10 cases. All biopsy specimens taken immediately after the procedure demonstrated ablation extending into the papillary dermis. Residual angiofibromas were present in 6 biopsy specimens. At 4 months, all biopsy specimens showed a band of superficial dermal fibrosis, but distinguishing between this and adjacent angiofibromas was often difficult. Long-term side effects included 2 cases of subtle hypopigmentation. CONCLUSION: The long-term results of CO(2) laser treatment of angiofibromas are unpredictable. The marked improvement obtained at 6 months is sustained in only a minority of cases at 24 months. Despite this, patient satisfaction appears relatively high. Initial clinical improvement may be the result of a combination of destruction of angiofibromas and their sequestration under postoperative fibrosis. The benefits of therapy should be weighed against both early morbidity and the risks of long-term complications such as scarring and hypopigmentation.

"Me da um eixo". / Give me support

Os autores se ocupam, a partir de um ponto de vista psicanalitico, do desenvolvimento personalogico antes da chamada relacao objetal, numa fase de ligacao primordial centrovertida EU-TU (unidade), uma totalidade representada pela uniao diferenciada de crianca/mae. Das vicissitudes desta fase vao depender as caracteristicas das relacoes objetais. Focalizam os fracassos personalogicos decorrentes de graves falhas na etapa pre-relacional, como o hospitalismo, a cristalizacao da totalidade centrovertida e a identificacao alienizante e concluem propondo modificacoes no setting que possam favorecer a terapia

[Methods of treatment of perferating plantar pain by using a pneumatic sole]. / Proposta de tratamento do mal perfurante plantar (MPP) pela palmilha pneumática.

A--A natural hydrostatic phenomenon, at the level of the ends of the plantar arcs, diffuses body weight, as PAIN plays the role of outsentry (fig.--1) (5); B--Plantar perforating ulceration (PPU) is caused by a combination of INSENSITIVITY and TRAUMATIS (1); C--The patient reposing, as body weight (traumatism) effects disappear, cicatrization process can be easily observed; D--PNEUMATIC INSOLE, being elastic, diffuses localized compression at the ends of the plantar arcs, reduces attrition, makes easier blood circulation, as well as cure and prophylaxis of PPU (fig.--6) (3).