Transcranial Doppler could help to differentiate the types of dementia? A pilot study when CSF biomarkers are not available.

Our objective was to find a mean flow velocity (MFV) cut-off point to differentiate between normal and cognitive impaired patients using Clinical Dementia Rating (CDR) as a comparison method. To evaluate MFV (in cm/s) and pulsatility index (PI) from the left middle cerebral artery (MCA) and basilar artery using transcranial Doppler in a pilot study from an outpatient cognition unit and compare with cognitively normal older adults (at the age of sixty or older) from the Geriatric Ambulatory of Fluminense Federal University. We hypothesized that there is a MFV and PI cut-off point to potentially distinguish between normal and impaired cognition. Sixty-one patients with cognitive decline, including 18 with amnestic mild cognitive impairment (aMCI), 31 with probable Alzheimer disease (AD), 12 with vascular dementia (VD), and 10 cognitively normal older adults were included in the study. Patients with dementia (both AD and VD, p < 0.01) and aMCI (p < 0.05) had lower MFV than the control group in the MCA (32.2 cm/s, 31.9 cm/s, and 36.6 cm/s, respectively) and dementia patients had higher PI compared to control (AD and VD, both p < 0.05). Basilar MFV showed to be no difference between the patients and the control group. A cut off value of 39.1 cm/s was found in a ROC curve (area under de curve value 0.85, 95% CI 0.75-0.95) for mean MCA MFV to be predictive of cognitive impairment (CDR ≥ 0.5). In this study, the values of MCA MFV below 39.1 cm/s were predictive of cognitive impairment according to CDR. TCD is an inexpensive method that could be used in a clinical scenario to help differentiate normal cognition from cognitive decline. Multicentric and longitudinal studies should be done to validate that.

Diagnosis of prolactinoma in two male-to-female transsexual subjects following high-dose cross-sex hormone therapy.

Male-to-female transsexual persons use oestrogens + antiandrogens to adapt their physical bodies to the female sex. Doses are usually somewhat higher than those used by hypogonadal women receiving oestrogen replacement. Particularly in cases of self-administration of cross-sex hormones, doses may be very high. Oestrogens are powerful stimulators of synthesis and release of prolactin and serum prolactin levels are usually somewhat increased following oestrogen treatment. Prolactinomas have been reported in male-to-female transsexual persons, both after use of high and conventional doses of oestrogens but remain rare events. We report two new cases of prolactinomas in male-to-female transsexual persons, one in a 41-year-old subject who had used nonsupervised high-dose oestrogen treatment since the age of 23 years and another one in a 42 year old who had initiated oestrogen treatment at the age of 17 years. Their serum prolactin levels were strongly increased, and the diagnosis of a pituitary tumour was confirmed by imaging techniques. Both cases responded well to treatment with cabergoline treatment whereupon serum prolactin normalised. Our two cases are added to the three cases of prolactinomas in the literature in persons who had used supraphysiological doses of oestrogens.

Avaliação da resposta ao tratamento combinado em pacientes com Hepatite Crônica C / Assessing response to combined treatment in patients with Chronic Hepatitis C

Atualmente, a terapêutica da Hepatite Crônica C (HCV) baseia-se na combinação de interferon peguilado e ribavirina. O sucesso terapêutico é alcançado em cerca de 40 a 80 %, a depender de fatores do hospedeiro e virais (AU)

Melhor escore de avaliação para hepatocarcinoma / Best score for the evaluation of hepatocellular carcinoma

O hepatocarcinoma é uma das complicações mais freqüente e temida da cirrose hepática, independentemente da etiologia. O tratamento requer escolha cuidadosa, uma vez que a função hepática na cirrose encontra-se prejudicada. É o 4º câncer mais prevalente no mundo e possui alta morbidade e mortalidade (AU)

Avaliação da resposta ao tratamento combinado em pacientes com Hepatite Crônica C

Atualmente, a terapêutica da Hepatite Crônica C (HCV) baseia-se na combinação de interferon peguilado e ribavirina. O sucesso terapêutico é alcançado em cerca de 40 a 80 %, a depender de fatores do hospedeiro e virais

Melhor escore de avaliação para hepatocarcinoma

O hepatocarcinoma é uma das complicações mais freqüente e temida da cirrose hepática, independentemente da etiologia. O tratamento requer escolha cuidadosa, uma vez que a função hepática na cirrose encontra-se prejudicada. É o 4º câncer mais prevalente no mundo e possui alta morbidade e mortalidade

Recovery of fertility after grafting of cryopreserved germinative tissue in female rabbits following radiotherapy.

BACKGROUND: Many cancer survivors face infertility as a consequence of the aggressive treatment they must undergo. Cryopreservation of ovarian tissue before chemotherapy or radiotherapy may allow for tissue transplantation after the treatment, and restoration of fertility. We tested the potential of an orthotopic autografting of cryopreserved germinative tissue in female rabbits with ovarian failure following radiotherapy. METHODS: Ten adult multiparous female rabbits were randomly allocated into two groups, five in group I (control) and five in group II (transplant). All rabbits underwent right oophorectomy with cryopreservation of the germinative tissue, followed by sterilization of the remaining left ovary by radiotherapy. Later, group II rabbits received in the irradiated left ovary an implant of the frozen germinative tissue from the right ovary, whose small pieces were freely spread intracortically in a procedure we named 'intracortical sowing of germinative tissue' (ISGT). RESULTS: All group II rabbits conceived following spontaneous mating within 6 months of the transplant, whereas none of the remaining rabbits in group I had conceived up to 11 months after transplant. CONCLUSIONS: This study suggests that fertility can be restored in rabbits by sowing cortical tissue in a previously irradiated ovary. The clinical feasibility of this technique remains to be determined.

A contribution to the establishment of reference values for total mercury levels in hair and fish in amazonia.

Studies on mercury levels in the Amazonian Region have typically lacked background or reference parameters. A sectional study on Hg concentration in hair and fish was conducted, together with an assessment of the prevalence of signs and symptoms related to Hg poisoning, in four communities in the Amazon Basin not impacted by gold mining, located either by a river course (Santana do Ituqui and Caxiuanã) or by a lake (Aldeia do Lago Grande and Vila do Tabatinga). Mercury determinations in hair and fish were made by flameless atomic absorption spectrophotometry. Mean total Hg in hair was 4.33 microg/g (0.40-11.60 microg/g) in 321 individuals from Santana do Ituqui, 3.98 microg/g (0.40-11.76 microg/g) for 316 persons in Aldeia do Lago Grande, 5.46 microg/g (0.37-49.85 microg/g) for 504 individuals from Vila do Tabatinga and 8.58 microg/g (0.61-45.59 microg/g) for 203 inhabitants from Caxiuanã. Fish consumption was very high in all those communities but no signs or symptoms associated with Hg poisoning were found. Mean Hg concentration in fish varied from 0.006 to 2.529 microg/g for carnivores and from 0.008 to 0.871 microg/g for noncarnivores. These values suggest that further studies including a larger number of communities would eventually lead to values of "normal" Hg concentration in the Amazonian Region quite above the limits suggested by the World Health Organization.

Health effects of residential exposure to aluminum plant air pollution.

In this study, the authors evaluated the relative risk of residential exposure to air pollution from an aluminum plant. The authors used government-compiled data to compare hospital admissions in 1997 for selected respiratory diseases for 2 communities in Brazil. One community, Ouro Preto, was located near an aluminum plant, and the other, Diamantina, was located far from any source of industrial air pollution. The relative risk of hospital admissions for selected respiratory diseases was 4.11 (95% confidence interval = 2.96, 5.70). The risk was highest among individuals between 30 and 39 yr of age (relative risk = 11.70; 95% confidence interval = 1.52, 89.96). Admissions per thousand residents were highest for individuals under 10 yr of age and for individuals older than 70 yr of age. The authors assessed exposure with environmental measurements. Dust deposition was collected in the residences of participants (n = 36 in each location), and the dust was analyzed for aluminum, manganese, magnesium, and calcium content. There were significantly different (p < .05) levels of aluminum in the 2 communities; the highest quantities were found near the aluminum plant. Measurements from independent studies indicated that both 24-hr maximum values and annual mean concentrations of suspended particulate matter exceeded the average of international standards in Ouro Preto (i.e., aluminum plant area). These results suggested that exposure to greater air pollution in the aluminum plant area (i.e., Ouro Preto, Brazil) versus the control area resulted in statistically significant health effects in those individuals who resided in Ouro Preto.

Mercury exposures in riverside Amazon communities in Pará, Brazil.

Cross-sectional studies were conducted in three riverside communities in the state of Pará in the Amazon Region of Brazil. Two of these communities, Brasília Legal and São Luís do Tapajós, are located in a watershed exposed to mercury pollution from artisanal gold mining, and the third, Santana do Ituqui, is outside this area. The studies were based upon a community census and included all persons volunteering for participation in each community. All participants were surveyed by questionnaire for health history, occupation, residence, and diet. Clinical evaluations were also done on each subject, along with collection of blood, urine, feces, and hair. Fish samples were collected to represent the most frequently consumed species. Mercury was measured in hair and fish. Although no signs or symptoms of overt mercury intoxication were observed, persons in Brasília Legal and São Luís do Tapajós had higher levels of mercury in hair than residents of Santana de Ituqui, located out of the risk area. Levels of mercury in fish were below Brazilian health guidance limits, but the high rates of fish consumption among these populations raise concerns for the possible effects of chronic exposure, especially among young children and women of childbearing age.

A program for the control of indoor pollution by metallic mercury.

The objective of this study was to develop an educational program for preventing metallic mercury emissions due to the burning of mercury-gold amalgams inside houses. The main participants were adolescents from a school in the city of Poconé, State of Mato Grosso. The program was developed in five stages, including discussions of the methods and exhibition of slides showing people working in activities including the garimpos, planning activities as dramatizations, making posters and preparing a screenplay for the production of a video, discussing how to prevent indoor burning of gold-mercury amalgams, and a final evaluation of the adolescents about what they had learned during the program. The evaluation of the impact was done through a comparison of correct answers from a questionnaire before and after the development of the educational activities and by means of a comparison of urinary mercury in school students and a group of residents (women) at three different times: before the program (2.30 microgram/L), 6 months after (2.90 microgram/L), and 11 months after (1.49 microgram/L).

Factors associated with Mexico City dentists' willingness to treat AIDS/HIV-positive patients.

OBJECTIVE: The purpose of this study was to investigate the characteristics and infection control practices of dentists in Mexico City in relation to their willingness to treat AIDS/HIV-positive patients. STUDY DESIGN: The population study encompassed Mexico City dentists who were selected according to a geographic criterion. A questionnaire was delivered personally to each participant, and multiple logistic regression was used for data analysis. RESULTS: A total of 598 dentists participated in the study. The response rate was 99.3% (598/602). Seventy-four percent (444) of the dentists said they would be willing to treat AIDS/HIV-positive patients. Among the variables associated with the prediction of willingness to treat these patients were glove-wearing patterns (odds ratio, 2.39; confidence interval, 1.4-4.2), types of available sterilization equipment (odds ratio = 2.42; confidence interval, 1.4-4.1), fear of losing non-AIDS/HIV-positive patients (odds ratio = 4.28; confidence interval, 2.3-8.4), and risk perception of HIV transmission (odds ratio = 2.66; confidence interval, 1.5-4.9). An interaction was found between perception of risk of HIV transmission and increase in costs (odds ratio = 3.35; confidence interval, 1.3-8.9). CONCLUSIONS: Approximately 26% of the Mexico City dentists included in the study were not willing to treat AIDS/HIV-positive patients. Educational programs aimed at misperceptions appear to be warranted.

Hepatic heterogeneity in the response to ATP studied in the bivascularly perfused rat liver.

The zonation of the purinergic action of ATP in the hepatic parenchyma was investigated in the bivascularly perfused rat liver by means of anterograde and retrograde perfusion. Livers from fed rats were used, and ATP was infused according to four different experimental protocols: (A) anterograde perfusion and ATP infusion via the portal vein; (B) anterograde perfusion and ATP via the hepatic artery; (C) retrograde perfusion and ATP via the hepatic vein; (D) retrograde perfusion and ATP via the hepatic artery. The following metabolic parameters were measured: glucose release, lactate production and oxygen consumption. The hemodynamic effects were evaluated by measuring the sinusoidal mean transit times by means of the indicator-dilution technique. ATP was infused during 20 min at four different rates (between 0.06-0.77 micromol min[-1] g liver[-1]; 20-200 microM) in each of the four experimental protocols. The results that were obtained allow several conclusions with respect to the localization of the effects of ATP along the hepatic acini: (1) In retrograde perfusion the sinusoidal mean transit times were approximately twice those observed in anterograde perfusion. ATP increased the sinusoidal mean transit times only in retrograde perfusion (protocols C and D). The effect was more pronounced with protocol D. These results allow the conclusion that the responsive vasoconstrictive elements are localized in a pre-sinusoidal region; (2) All hepatic cells, periportal as well as perivenous, were able to metabolize ATP, so that concentration gradients were generated with all experimental protocols. Extraction of ATP was more pronounced in retrograde perfusion, an observation that can be attributed, partly at least, to the longer sinusoidal transit times. In anterograde perfusion, the extraction of ATP was time-dependent, a phenomenon that cannot be satisfactorily explained with the available data; (3) ATP produced a transient initial inhibition of oxygen uptake when protocols A and B were employed. These protocols are the only ones in which the cells situated shortly after the intrasinusoidal confluence of the portal vein and the hepatic artery were effectively supplied with ATP. The decrease in oxygen consumption was more pronounced at low ATP infusions when protocol B was employed. These observations allow the conclusion that the former phenomenon is localized mainly in cells situated shortly after the intrasinusoidal confluence of the portal vein and hepatic artery. Oxygen consumption in all other cells, especially the proximal periportal ones, is increased by ATP; (4) In agreement with previous data found in the literature, glycogenolysis stimulation by ATP was more pronounced in the periportal region. The cells that respond more intensively are not the proximal periportal ones, but those situated in the region of the intrasinusoidal confluence of the portal vein and the hepatic artery.

Hepatic heterogeneity in the response to AMP studies in the bivascularly perfused rat liver.

The zonation of the purinergic action of AMP in the hepatic parenchyma was investigated in the bivascularly perfused rat liver by means of anterograde and retrograde perfusion. Livers from fed rats were used and AMP (100 microM) was infused according to four different experimental protocols: (A) anterograde perfusion and AMP infusion via the portal vein; (B) anterograde perfusion and AMP infusion via the hepatic artery; (C) retrograde perfusion and AMP via the hepatic vein; (D) retrograde perfusion and AMP via the hepatic artery. The response of the liver cells was heterogeneous. Oxygen uptake inhibition by AMP predominates in cells situated shortly after the intrasinusoidal confluence of the portal vein and hepatic artery. Oxygen consumption in all other cells seems to be increased by AMP. Glycogenolysis stimulation by AMP (glucose release) was more pronounced in the periportal cells situated in the region of the intrasinusoidal confluence of the portal vein and the hepatic artery. It can be concluded that the heterogenic response of the liver to AMP is similar to the heterogenic response to ATP.

Intrathecal reactivity for myelin components precedes development of neurological symptoms in AIDS patients.

The central nervous system is considered an early and common target for the human immunodeficiency virus type 1 (HIV-1). Serum and cerebrospinal fluid (CSF) from 20 HIV positive patients, including 14 with AIDS-dementia complex (CDC stage IV) and 6 asymptomatic individuals (CDC stage II) were analyzed by enzyme immunoassay for detection of antibodies to native myelin basic protein (MBP) and for the amino acid sequence 68-84 exposed after partial degradation of native MBP. Control groups included HIV-1 negative patients with degenerative and/or vascular dementia, chronic multiple sclerosis (MS) and individuals without any sign of neurological or cognitive disturbances. As opposed to control groups, serum and CSF samples from MS and HIV-1 infected patients showed several oligoclonal bands running in the gamma region. AIDS-dementia complex (ADC) patients had increasingly high intrathecal IgG specific antibody titers for the amino acid sequence 68-84 of MBP. Marked intrathecal antibody production for myelin components was also detected in the majority of HIV-1 infected asymptomatic individuals. Such alteration paralleled development of cognitive deficits, neurological abnormalities and appearance of CNS demyelinating plaques. Preferential immune recognition of this myelin epitope within the CSF during early stages of HIV-1 infection might point to an ongoing process of active demyelination and ultimately indicate subclinical CNS involvement.

[Diagnosis of health conditions in a pan-mining community in the Tapajós River Basin, Itaituba, Par , Brazil, 1992]. / Diagnóstico das condições de saúde de uma comunidade garimpeira na regiõ o do Rio Tapajós, Itaituba, Pará, Brasil, 1992.

The purpose of this article is to describe health conditions in a pan-mining community, in particular the interaction of mercury contamination with other health problems. This study was carried out in a panning mine located on Rato Creek, a tributary of the Tapajó s River Basin in the municipality of Itaituba, State of Par The study population consisted of 223 individuals. An epidemiological questionnaire was applied, medical treatment was given, and biological specimens were collected. Testing of fecal samples showed that 96.1% of the individuals had parasites and 66.4% were anemic. Prevalence of hepatitis B virus was 85.0%, and 11 individuals (6.0%) were virus carriers (HBsAg positive). Of 186 patients tested for malaria, 65 individuals (35.0%) had the infection, of whom 34 (52.3%) were asymptomatic. Prevalence of syphillis was 41.6%. Urine mercury levels were measured in 173 individuals. Some 16 (9.2%) of those tested had mercury levels between 10 and 19 ug/l, while 9 patients (5.2%) had levels above 20 ug/l. An overview of general health conditions showed a combination of problems in individuals, who lacked adequate diagnosis, in addition to a high level of self-medication, given the absence of health facilities. In addition, these individuals are threatened by critical levels of mercury contamination. In conclusion, this article gives a general overview of health conditions in these pan-mining communities, demonstrating the multicausal nature of health conditions in the Amazon region, a fact which should be considered when planning appropriate strategies for clinical treatment.

[The knowledge of neurological changes in patients with AIDS]. / Contribuição ao conhecimento das alterações neurológicas em pacientes com SIDA.

We performed a retrospective study of 154 patients with AIDS that presented lesions of the nervous system at necroscopic examination. Necropsies were performed in the Hospital Universitario Antonio Pedro (Niteroi, Brazil). We emphasize epidemiologic and clinical data, neuropathologic findings, evolution time, and anatomo-clinical correlation. Data obtained can contribute in the definition of consequences of neurologic symptoms and signs for early diagnosis and best prognosis in AIDS.