Hypodermoclysis as a Strategy for Patients With End-of-Life Cancer in Home Care Settings.

BACKGROUND: The increase in the elderly population associated with a higher incidence of cancer strongly endorses palliative care (PC). Hypodermoclysis (HDC) is a feasible technique for drugs and fluids delivery at the home care setting. OBJECTIVES: To assess the use and benefits of HDC in patients with end-of-life cancer assisted by a single home-based palliative care program (HPCP) in Belo Horizonte, Brazil. METHODS: This was a retrospective study that analyzed medical charts from patients with end-of-life cancer who were assisted by an HPCP in a 1-year period of time. RESULTS: A total of 333 patients, 81.7% with advanced cancer, were included. The most frequent symptoms were fatigue (44.4%) and pain (43.2%). Hypodermoclysis was used in 77.5% of the patients for the administration of fluids or medicines. Continuous palliative sedation was applied to 70.5% of patients. The place of death was home for 90.2% of the patients. CONCLUSION: Receiving home care assistance with palliative intention may decrease the need for dying patients with cancer to visit emergency units, as their symptoms were well controlled. Hypodermoclysis was a safe and effective alternative for hydration and drug delivery when provided and supervised by an experienced team. The place of death is a reliable indicator of the quality of death, and, in this study, the HPCP allowed patients to die at home with their families. It is essential for PC professionals to understand the impact of HDC use at home care setting for patients with end-of-life cancer allowing the increase of quality of death indicators.

Human JC polyomavirus in normal colorectal mucosa, hyperplastic polyps, sporadic adenomas, and adenocarcinomas in Portugal.

John Cunningham virus (JCV) infects chronically human populations worldwide and probably might confer a higher risk for colorectal cancer (CRC). The prevalence of JCV DNA has been determined in normal colon mucosa and compared it with different degrees of colorectal lesions, as well as viral presence in the urine of the individuals in the study. JCV DNA was detected by a nested-PCR approach targeting the JCV small-t antigen in 100 healthy controls, and 100 patients undergoing biopsy for diagnosis of colorectal disorders. JCV DNA was detected in 40% of normal mucosa from controls and patients. JCV DNA presence in urine was also similar in controls and patients (37-41% range). JCV DNA detection in normal mucosa and urine reflects the infected population in Portugal. However, in cases with colorectal tumor lesions, JCV DNA was detected in 90% cases, independently of histological type or grade, and this increase was significantly higher with respect to its normal surrounding mucosa. This higher detection of JCV DNA in tumor lesions with respect to its own normal mucosa suggested that a selection for virus containing cells has occurred at some early stage in tumor initiation or progression. JCV may have a specific tropism for colon epithelial cells with some inherent predisposition that makes them more prone to oncogenic transformation, with selection of infected cells. Several p53 polymorphisms in intron 2, common to both groups, were more frequently detected in colorectal pathology cases. A novel p53 mutation in the 3' untranslated region (exon 11) was identified in 10 patients.

Limited effects of activated protein C on red blood cell deformability.

BACKGROUND: Alterations of the microcirculation are common in critically ill patients and persistence of these alterations is associated with poor outcome. Infusion of high doses of activated protein C can ameliorate the microcirculation. Because red blood cells (RBCs) play an essential role in oxygen transport to the tissues, we studied the effects of activated protein C on RBC deformability in septic patients. METHODS: RBC deformability, assessed by ektacytometry (LORCA system) for shear stresses between 0.30 and 50 Pa, was compared in healthy volunteers and in septic patients before and during activated protein C infusion. RESULTS: RBC deformability was altered in septic patients compared to healthy volunteers. RBC deformability improved transiently during activated protein C infusion for shear stresses of 4.89 and 7.78 Pa, but the elongation index increased by just 3.4 and 3.2%, respectively. CONCLUSIONS: RBC deformability was altered in sepsis. Activated protein C had no clinically relevant effects on RBC deformability as assessed using ektacytometry.

JC virus in the pathogenesis of colorectal cancer, an etiological agent or another component in a multistep process?

JCV infection occurs early in childhood and last throughout life. JCV has been associated to colorectal cancer and might contribute to the cancer phenotype by several mechanisms. Among JCV proteins, particularly two of them, large T-antigen and agnoprotein, can interfere with cell cycle control and genomic instability mechanisms, but other viral proteins might also contribute to the process. Part of viral DNA sequences are detected in carcinoma lesions, but less frequently in adenomas, and not in the normal surrounding tissue, suggesting they are integrated in the host cell genome and these integrations have been selected; in addition viral integration can cause a gene, or chromosomal damage. The inflammatory infiltration caused by a local chronic viral infection in the intestine can contribute to the selection and expansion of a tumor prone cell in a cytokine rich microenvironment. JCV may not be the cause of colorectal cancer, but it can be a relevant risk factor and able to facilitate progression at one or several stages in tumor progression. JCV transient effects might lead to selective expansion of tumor cells. Since there is not a direct cause and effect relationship, JCV infection may be an alternative to low frequency cancer predisposition genes.

Características dos pacientes adolescentes e adultos com fibrose cística do Hospital de Clínicas de Porto Alegre / Characteristics of adolescent and adult patients with cystic fibrosis of Hospital de Clínicas de Porto Alegre

Introdução: A expectativa de vida dos pacientes com fibrose cística (FC) tem aumentado progressivamente nas últimas décadas. Objetivos: Determinar as características clínicas dos pacientes com FC em acompanhamento com a equipe de adultos do Hospital de Clínicas de Porto Alegre (HCPA) e determinar quais características estão associadas com a gravidade da obstrução do fluxo aéreo. Pacientes e métodos: Estudo transversal dos pacientes com FC (idade ≥ 16 anos) em acompanhamento na equipe de adultos do HCPA. Foram coletados dados demográficos, clínicos, nutricionais, função pulmonar, testes laboratoriais, achados radiológicos e microbiologia do escarro. Resultados: Trinta e nove pacientes (21 masculinos/18 femininos) consultavam com a equipe de adultos em 2003. A idade mediana foi 22,3 anos e a freqüência da raça branca, 97,4%. Análise genética foi realizada em 27 pacientes. Sete pacientes (25,9%) foram homozigotos para mutação delta F508 e 10 (37%) tinham apenas uma mutação delta F508. O escore clínico de Shwachman-Kulczycki mediano foi 80, o escore de Brasfield mediano foi 14 e o VEF1 médio foi 51,1% do previsto. Quatorze pacientes tinham distúrbio ventilatório obstrutivo (DVO) ausente ou leve, 11 tinham DVO moderado e 14 tinham DVO grave. A gravidade do DVO associou-se com a saturação de oxigênio, escore de dispnéia, escore clínico e escore radiológico. Conclusão: Descrevemos um grupo jovem de pacientes adultos com FC com doença pulmonar moderada a grave, mas com performance boa a excelente na sua atividade diária. A obstrução do fluxo aéreo associou-se à saturação de oxigênio, escore de dispnéia, escore clínico e escore radiológico (AU)

Introduction: Life expectancy of cystic fibrosis (CF) patients has been greatly increased over past decades. Objective: To determine the clinical characteristics of CF patients attending the adult team of Hospital de Clínicas de Porto Alegre (HCPA) and to determine which characteristics are associated with the severity of the air-flow obstruction. Patients and methods: The study comprised a cross-sectional survey of CF patients (age ≥16 years) attending to the adult team of HCPA. Data collected included patient demographics, clinical data, nutritional status, pulmonary function, laboratory tests, radiological findings and sputum microbiology. Results: Thirty-nine patients (21 male/18 female) were attending to the adult team during 2003. The median age was 22.3 years and the frequency of white race was 97.4%. Genetic analysis was performed in 27 patients. Seven patients (25.9%) were homozygous for delta F508 mutation and 10 (37%) had one delta F508 mutation. The median Shwachman-Kulczycki clinical score was 80, the median Brasfield score was 14 and the mean FEV1 was 51.1% predicted. Fourteen patients had normal or mild obstructive ventilatory disorder (OVD), 11 patients had moderate OVD and 14 patients had severe OVD. The severity of the OVD was associated with oxygen saturation, dyspnea score, clinical score and radiographic score. Conclusion: We describe a young group of CF adults with moderate to severe pulmonary disease, but with a good to excellent performance in their daily activity. The air-flow obstruction was associated with oxygen saturation, dyspnea score, clinical score and radiographic score (AU)

Functional variability of the human cortical motor map: electrical stimulation findings in perirolandic epilepsy surgery.

The purpose of this study was to assess the cortical representation of sensorimotor functions in patients undergoing perirolandic epilepsy surgery, focusing on somatotopy, mosaicism, and variability of function in relation to the classic motor homunculus. The authors studied 36 patients in whom intraoperative or extraoperative electrical cortical stimulation to map motor functions was performed. A computer program was devised to register electrode number, stimulation parameters, and response to each stimulus. Electrode position was represented graphically whenever a stimulus was delivered. A total of 43 maps from 36 patients were analyzed. The authors found variations in the organization of M1 (primary motor cortex) in seven patients (19.4%). Four patients (11.1%) presented mosaicism (overlapping of functional areas), two (5.6%) presented variability (inverted disposition of M1 functional areas), and one (2.8%) had both. The results of this study challenge the notion of orderly topographic relationships between the human sensorimotor functions and their representation in the primary motor cortex. These results confirm those of other studies with animals and humans using novel imaging techniques, suggesting that the motor homunculus may not always be considered a definite and absolute representation of M1.