Antimicrobial effect of Pentaclethra Macroloba plant extract against Enterococcus Faecalis.

This study evaluated the antimicrobial efficacy of a new intracanal drug based on Pentaclethra macroloba extract, a plant of Amazonian origin, against Enterococcus faecalis using macrodilution test and intratubular evaluation with Confocal Laser Scanning Microscopy (CLSM). The minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC) of the pure extract of Pentaclethra macroloba andits association with calcium hydroxide and ultracall were determined. Then, thirty-three dentin cylinders were prepared and inoculated with E. faecalis, to evaluate the antimicrobial effect of the medications on the dentinal tubules with CLSM. The data was analyzed using the Kruskal-Wallis and Dunn tests. The extract in association with calcium hydroxide showed a lower CBM, and in the intratubular test all tested medications were effective against E. faecalis (P >0.05). The new intracanal drug based on P. macroloba extract has an antimicrobial effect against E. faecalis and further studies are needed for its clinical use.

[Stevens-Johnson syndrome, toxic epidermal necrolysis and phenytoin. Factors linked to a higher risk]. / Síndrome de Stevens-Johnson, necrólisis epidérmica tóxica y fenitoína. Factores asociados a un aumento del riesgo.

INTRODUCTION: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe, although not very common, clinical skin pictures that are usually related to the use of medication. Several antiepileptic drugs, including phenytoin, have been linked to SJS/TEN. Some authors have described an increased risk for SJS/TEN when phenytoin is associated to radiotherapy, while others report the possibility of an increased risk when it is associated to corticoids. DEVELOPMENT: This work includes a review of the spontaneous reports of suspected cases of phenytoin-linked SJS/TEN recorded in the database of the Pharmacovigilance Department at Pfizer-España between October 2000 and December 2003. Nine cases compatible with SJS/TEN were found; four occurred in cancer patients that had received radiotherapy, three of whom were also treated with corticoids. DISCUSSION AND CONCLUSIONS: After reviewing the spontaneously reported cases in the database of the Pharmacovigilance Department at Pfizer-España as well as the cases in the literature, it can be concluded that when it comes to indicating a prophylactic antiepileptic treatment for cancer patients with cerebral metastasis, the clinician must take into account the existence of a greater risk of SJS/TEN if the patient is going to receive radiotherapy. If the patient already presents a history of skin rashes following administration of an antiepileptic drug, care must be taken in choosing another because phenytoin together with carbamazepine, phenobarbital and lamotrigine have all been linked to SJS/TEN. Cross-sensitivity of carbamazepine and barbiturates with phenytoin has been observed. Gabapentin and valproic acid could be considered as therapeutic options in such cases.

Manifestaciones cutáneas como expresión inicial del cáncer de mama en el varón. Estudio de dos casos / Cutaneous manifestations as first expression of the male breast carcinoma. Report of two cases

El carcinoma de mama en el varón es muy infrecuente. Cerca de 1500 casos nuevos se diagnostican cada año en Estados Unidos. Describimos dos pacientes cuyas lesiones cutáneas fueron la primera manifestación de un carcinoma ductal infiltrante subyacente. Los dos presentaban importantes factores de riesgo descritos por otros autores: enfermedad de Hodgkin tratada previamente con radioterapia, en el primer caso, e historia familiar de cáncer de mama en el segundo. Las publicaciones dermatológicas a este respecto son muy escasas. Un mejor conocimiento de las distintas formas clínicas contribuirá a un diagnóstico y tratamiento precoz (AU)

In vitro interaction of Brazilian strains of the nematode-trapping fungi Arthrobotrys spp. on Panagrellus sp. and Cooperia punctata.

In vitro tests were carried out to verify the activity of 26 Brazilian isolates of predatory fungi of the genus Arthrobotrys on a free-living nematode (Panagrellus sp.) and on infective larvae of Cooperia punctata, a parasitic gastrointestinal nematode of cattle. The results showed that the free-living nematode Panagrellus sp. was the most preyed upon, compared to C. punctata, for all the fungal treatments. Also, variable predatory capacity was observed for different fungal isolates belonging to the same genus when applied to different nematode species.

In vitro interaction of Brazilian strains of the Nematode-trapping fungi Arthrobotrys spp. on Panagrellus sp. and Cooperia punctata

In vitro tests were carried out to verify the activity of 26 Brazilian isolates of predatory fungi of the genus Arthrobotrys on a free-living nematode (Panagrellus sp.) and on infective larvae of Cooperia punctata, a parasitic gastrointestinal nematode of cattle. The results showed that the free-living nematode Panagrellus sp. was the most preyed upon, compared to C. punctata, for all the fungal treatments. Also, variable predatory capacity was observed for different fungal isolates belonging to the same genus when applied to different nematode species

Alteraciones cromosómicas en la leucemia linfoblástica aguda / Cytogenetic abnormalities in acute lymphoblastic leukemia

El análisis citogenético de las células blásticas en niños con leucemia linfoblástica aguda (LLA) ha permitido el reconocimiento de alteraciones cromosómicas específicas de gran importancia pronóstica. La mayoría de los casos de LLA tienen cariotipos alterados, bien en el número de cromosomas (ploidía) bien como cambios estructurales: translocaciones, deleciones o inversiones. Una gran parte de estas alteraciones se asocian con determinados tipos citomorfológicos e inmunológicos; sin embargo, el mayor impacto en el tratamiento de pacientes con LLA ha sido la demostración de que la citogenética es un indicador pronóstico independiente de otras variables clínicas. Determinados cariotipos se asocian con un buen pronóstico, mientras que otros indican un peor resultado, lo cual ha llevado a la administración de terapias alternativas en función del riesgo. La hiperdiploidía con número modal mayor de 50 cromosomas representa el 25-30% de los casos y se relaciona con los mejores resultados, mientras que translocaciones como la t(9;22) y la t(4;11) se asocian a los peores resultados. Este trabajo reúne las anomalías cromosómicas más importantes en LLA, su valor pronóstico y sus implicaciones terapéuticas (AU)

Karyotype and prognosis in adult Spanish acute lymphoblastic leukemia.

The aim of the study was to define the frequency and prognostic significance of acquired chromosomal abnormalities in our adult population and to ascertain whether karyotype represents a significant prognostic factor in adult patients with acute lymphoblastic leukemia (ALL) independently of the new intensive chemotherapy programs and initial clinical characteristics.

Prognostic value of tumoral ploidy in a series of spanish patients with acute lymphoblastic leukemia.

The prognostic value of tumoral ploidy and its relation with nonrandom chromosome alterations were analyzed in 89 cases of acute lymphoblastic leukemia. Ploidy is associated with the number of nonrandom chromosome alterations and survival. The pseudodiploid and hypodiploid groups had a high incidence of nonrandom alterations and poor survival while the diploid and high hyperdiploid groups had a lower incidence of nonrandom alterations and longer survivals. The patients in the low hyperdiploid group with random alterations received the same treatment as the diploid and high hyperdiploid groups but had poor survivals. Our analysis confirms that ploidy is a very important prognostic factor and suggests that patients with low hyperdiploidy should receive intensive therapies similar to those of patients in the groups with a high number of nonrandom alterations.

In vitro activity of Brazilian strains of the predatory fungi Arthrobotrys spp. on free-living nematodes and infective larvae of Haemonchus placei

In vitro tests were carried out to assess the activity of 26 Brazilian isolates of predatory fungi of the genus Arthrobotrys on a free-living nematode (Panagrellus sp.) and on infective larvae of Haemonchus placei, a parasitic gastrointestinal nematode of cattle. The results showed that the free-living nematode Panagrellus sp. was the most preyed upon, compared to H. placei, for all the fungal treatments. Also, variable predatory capacity was observed for different fungal isolates belonging to the same genus when applied to different nematode species

The quarternary molecular architecture of TetA, a secondary tetracycline transporter from Escherichia coli.

TetA, a tetracycline cation/proton antiporter, was expressed in Escherichia coli with a C-terminal tag of six histidines, solubilized in dodecyl maltoside and purified in a single step using Ni2+ affinity chromatography. Two-dimensional crystals were obtained after reconstitution of purified protein with lipids. Electron microscopy of negatively stained crystals revealed a trigonal symmetry, from which we infer that this secondary transporter has a trimeric structure. An overall molecular envelope can be described by a triangle of side approximately 100 A enclosing a central stain-filled depression. These dimensions are consistent with those obtained from projection views of single, isolated TetA particles that also display a trimeric architecture, confirming that the threefold symmetry is not simply a consequence of crystal-packing interactions. These data represent the first direct view of the quarternary arrangement of any antibiotic efflux pump. They are fully consistent with biochemical data on TetA, which indicate that it functions as a multimer and that the monomer consists of two domains, one of which plays the major part in oligomerization interactions.

In vitro activity of Brazilian strains of the predatory fungi Arthrobotrys spp. on free-living nematodes and infective larvae of Haemonchus placei.

In vitro tests were carried out to assess the activity of 26 Brazilian isolates of predatory fungi of the genus Arthrobotrys on a free-living nematode (Panagrellus sp.) and on infective larvae of Haemonchus placei, a parasitic gastrointestinal nematode of cattle. The results showed that the free-living nematode Panagrellus sp. was the most preyed upon, compared to H. placei, for all the fungal treatments. Also, variable predatory capacity was observed for different fungal isolates belonging to the same genus when applied to different nematode species.

Autologous peripheral blood progenitor cell transplantation with <2 x 10(6) CD34(+)/kg: an analysis of variables concerning mobilisation and engraftment.

INTRODUCTION: This study analyses the factors affecting mobilisation and engraftment in autologous peripheral blood progenitor cell transplantation according to the number of CD34(+) re-infused. MATERIALS AND METHODS: A total of 190 patients underwent mobilisation with G-CSF alone (n=113) or in combination with chemotherapy (n=77). A total of 116 patients (61%) were autografted with <2 x 10(6) CD34(+) cells/kg and 74 patients were transplanted with >2 x 10(6) CD34(+) cells/kg. Rates of granulocyte and platelet recovery were estimated using the product-limit method of Kaplan-Meier and compared using a log-rank test. The Cox regression model was used for the multivariate analysis of factors influencing engraftment. Differences between cohorts were evaluated by one-way ANOVA or Mann-Whitney tests, and multivariate analysis was performed using a stepwise lineal regression. RESULTS: Neutrophil and platelet engraftment was significantly longer with <2 x 10(6)/CD34(+)/kg (12 vs 10 days, P=0.014 and 16 vs 13 days, P=0.0001 respectively). Platelet recovery was affected by exposure to alkylating agents (P=0.04), refractory disease (P=0.02) and AML (P=0.0001), but only the last two variables remained significant in Cox regression (P<0.01). Granulocyte engraftment was longer in CML (univariate, P=0.04) and in refractory disease (multivariate, P=0.02). In patients re-infused with >2 x 10(6)/CD34(+)/kg, the Cox model did not identify prognostic factors for haematopoietic recovery. CONCLUSION: Although mobilisation schedules and disease status influenced not only the yield of progenitor cells, but also the engraftment kinetics, the number of CD34(+) re-infused was the main predictor of haematopoietic recovery. While engraftment succeeded in most of the cases, the re-infusion of >2 x 10(6)/CD34(+)/kg resulted in significantly shorter recovery times.

V--Y flap for perineal reconstruction following modified approach to vulvectomy in vulvar cancer.

OBJECTIVE: To evaluate a simple reconstructive procedure used in combination with a modified oncological approach to the treatment of invasive vulvar cancer. Local and systemic morbidity, length of hospital stay, local recurrence, and mortality were evaluated. METHODS: Between September 1995 and January 1997, 19 patients underwent radical vulvectomy and inguinal lymphadenectomy with a modified oncological approach. The modified approach consisted of a triple incision: two inguinal incisions, shorter and following force lines of the groin, and a third incision around the vulvar lesion. Vulvectomy included a 2-cm safety margin around the tumor, based on clinical examination and anatomical-pathological frozen sections of the specimen. This procedure was always followed by perineal reconstruction with V-Y flaps by the plastic surgery team. Median follow-up was 12 months. The complication rate and lengths of hospital stay were evaluated and compared with those in a similar group in which radical vulvectomy was performed associated with two long longitudinal incisions in the groin. The data were statistically analyzed. RESULTS: The perineal and inguinal dehiscence rates in group A (traditional approach) were 68.4% and 78.94%, respectively. The same rates in group B (modified approach), were 10.5% and 36.84%, respectively. Mean hospital stay was 39.5 days in group A (traditional) vs. 14.0 days in group B (modified). At 30 months' median follow-up, the rate of local recurrence in group A (traditional) was 42.0%; at 12 months' median follow-up, local recurrence in group B (modified) was 26.3%. CONCLUSIONS: In this study, the use of V-Y flaps in combination with a modified oncological approach significantly reduced local complication rates and lengths of hospital stay, while observing oncological principles.

Acute megakaryoblastic leukemia in a patient with a familial pericentric inversion of chromosome 8, inv(8)(p23.1q13).

A 7-month-old girl was diagnosed with acute megakaryoblastic leukemia and, at the time of diagnosis, the karyotype was 48-50,XX,+4,+5,del(5)(p13),del(6)(q14), +8,inv(8)(p23.1q13),der(13) t(13;?;?),+19,-20,+21,+22,+mar [cp20]. At relapse, there was clear evidence of her constitutional status as a carrier of the pericentric inversion (8)(p23.1q13). It was a familial inversion affecting the patient's maternal lineage; a history of cancer and bleeding anomalies in carriers of the inversion led us to consider their nonrandom association with these pathologies.

Pregnancy Following Breast Reconstruction with TRAM Flaps.

From a retrospective study of 250 patients submitted to immediate breast reconstruction with TRAM flap after mastectomy for breast cancer, we reported the occurrence of pregnancy in seven cases from January 1992 to January 1996 at the Women's Health Reference Center and at the University of São Paulo Medical School. There were six immediate and one delayed reconstructions. Mean age was 35 years old. Outpatient follow-up was 13 months (mean 6-42 months). Two of the seven patients developed abdominal bulge, but no hernias were detected in this group. All patients were satisfied with the aesthetic result. Seven of them came to term. No abnormalities were found in their children. During the same period of time bulging was found in 10% of the 250 patients. Breast reconstruction with TRAM flap is safe even if patients become pregnant, and in this study TRAM flaps did not cause dyfunctional labor or significant abdominal wall damage.

Continuous expansion for the treatment of skin deformities.

Continuous expansion using an infusion pump was studied in seven patients. Tissue expanders were attached to outpatients under general anesthesia. After a period of 7 days, the skin expansion was initiated with the patient hospitalized. Saline solution (0.9%, 1-3 ml/h) was infused via a gauge needle connected to the expander valve and to the infusion pump. The expansion speed was determined by clinical parameters, such as pain and the expanded tissue viability, until the desired volume was achieved. The total time required for this procedure was 13-18 days. Based on continuous skin expansion, we attempted to test an alternative shorter procedure. This method was well accepted by doctors and patients, and no complications occurred. Although fibrosis was observed, it was not as pronounced as in the outpatients undergoing the conventional expansion treatment. A principal advantage of the continuous expansion method is the increased safety resulting from more effective clinical control and adequate systemic antibiotic therapy. Coupled with on important reduction the expansion time and allowing a faster return of the patients to their activities.