Penile carcinoma: the role of koilocytosis in groin metastasis and the association with disease specific survival.

PURPOSE: We evaluated the influence of koilocytosis, and other clinical and pathological variables in the risk of groin metastasis and death in penile cancer patients. MATERIALS AND METHODS: From January 1994 to January 2004, 172 patients with squamous cell carcinoma of the penis were treated at a single cancer center. Of these patients 144 were retrospectively studied to analyze prognostic factors and establish the role of koilocytosis in penile cancer. Univariate and multivariate analyses were performed, and Kaplan-Meier survival curves were generated. RESULTS: A total of 102 patients (71%) underwent groin dissection, of whom 84 (58.3%) had inguinal metastasis. Koilocytosis was present in 91 patients (63.1%) and it was associated with low and moderate primary tumor grade on univariate analysis (p = 0.0005). Although koilocytosis statistically correlated with Jackson stage (p = 0.017) and tumor grade (p = 0.002), it had no impact on disease specific survival (p = 0.912). Metastatic inguinal disease correlated with patient age, Jackson and disease specific survival. Only Jackson stage and inguinal relapse after groin dissection influenced overall survival on multivariate analysis (each p = 0.001). CONCLUSIONS: According to all studied variables only patient age and Jackson stage correlated with an increased risk of groin disease. Koilocytosis was rarely found in high grade penile tumors and it did not correlate with a high risk of metastatic groin disease or death.

Prevalence of bacteria in the nipple discharge of patients with duct ectasia.

The aim of this study was to identify the aerobic and the anaerobic microorganisms which can be related to duct ectasia. The patients were divided into two groups. Group 1 comprised 100 patients with coloured nipple discharge (duct ectasia group), and Group 2 (the control group) was composed of 50 patients without nipple discharge. The culture media used were BHI-PRAS, blood agar, mannitol agar and MacConkey agar. There was a high frequency of bacterial growth in the two groups: 85% in Group 1 and 88% in Group 2. The most prevalent bacteria were Staphylococcus aureus and Staphylococcus epidermidis. There was a statistically significant higher rate of smokers in the duct ectasia group compared with the control group, 25 (25%) patients vs. 5 (10%), respectively (p = 0.03). These findings allow us to put forth the hypothesis that the genesis of duct ectasia may be a non-infectious inflammatory process.

Transplante de ilhotas pancreáticas em dispositivos de imunoisolamento celular: resultados iniciais / pancreatic islet transplantation in capsules of cellular immunoisolation: preliminary results

O transplante de pâncreas e de ilhotas pancreáticas vem apresentando grande desenvolvimento nos últimos anos. O isolamento das ilhotas em cápsulas com membrana semi-permeáveis pode ser tratamento de escolha para o diabetes, pois dispensa o uso de imunossupressores. O material ideal para a confecçäo de uma cápsula para o isolamento celular ainda permanece um sonho. Um novo material a base de látex natural foi implantado no subcutâneo de ratos normais e diabéticos para estudar a biocompatibilidade e a neoformaçäo vascular. A análise após 21 dias de implante mostrou intensa formaçäo capilar na interface membrana-tecido e pouco tecido fibrótico. Estes achados iniciais mostram que o material pode ter algum potencial para a confecçäo de dispositivos de isolamento celular.

[Plasmodium falciparum malaria. Quadrennial analysis, during 12 years, of the efficacy of quinine treatment]. / Malária por Plasmodium falciparum. Análise quadrienal, durante 12 anos, da eficácia do tratamento com quinino.

The efficacy of quinine for the treatment of falciparum malaria was studied by quadriennal analysis of the medical records of 454 patients admitted to the HDT-GO from 1983 to 1994 and treated with identical doses of quinine alone for 7 days. In the quadriennium from 1983 to 1986, 98.4% of the patients became negative by the 5th day of treatment and 8% presented recurrence (R1); from 1987 to 1990, only 72.9% became negative by the 5th day of treatment, 1.4% remained positive until the 7th day (R2) and 9.7% presented recurrence (R1); from 1991 to 1994, 70.1% became negative by the 5th day of treatment, 3.5% remained positive until the 7th day (R2) and 20% presented recurrence (R1). The increase in parasite clearance time with failure up to the 7th day of treatment (R2) and the increase in recurrence (R1) show that P. falciparum is developing resistance to quinine in the region under study.

Intoxication by star fruit (Averrhoa carambola) in six dialysis patients? (Preliminary report)

We observed six cases of patients in a dialysis programme who were apparently intoxicated by ingestion of star fruit. After ingestion of 2-3 fruits or 150-200 ml of the fruit juice, the six patients, who had previously been stable in a regular dialysis programme, developed a variety of symptoms ranging from insomnia and hiccups to agitation, mental confusion and (in one case) death. In preliminary investigations to characterize the hypothetical neurotoxin in the fruit, an extract, when injected intraperitoneally or intracerebroventricularly in rats, provoked persistent convulsions of the tonic-clonic type. It appears that star fruit (Averrhoa carambola) contains an excitatory neurotoxin. Patients with renal failure on conservative or dialysis treatment should be dissuaded from ingestion of the fruit.

Physical activity, opportunity for reinfection, and sibling history of heart disease as risk factors for Chagas' cardiopathy.

A case-control study was conducted to examine whether physical activity, sibling history of heart disease (HHD), and length of residence in an area endemic for Chagas' disease were associated with the risk of developing Chagas' cardiopathy. Two hundred forty-seven cases of Chagas' heart disease and 345 seropositive subjects with normal ECG (controls) were selected in a population survey in Goiânia, Brazil. Prevalence ratios for exposure variables were estimated for cases in relation to controls and for subgroups of seropositives with selected ECG abnormalities in relation to controls. Increasing age and male sex were consistently and significantly related to an increased risk of ECG abnormalities. HHD was significantly associated with ECG alterations in 3 of the 5 comparison subgroups (any ECG alteration, right bundle branch block, and left anterior hemiblock). No association was found between length of residence in an area endemic, physical activity, and ECG abnormalities. A sample of 529 seronegative subjects were also examined and the interaction between exposure variables and seropositivity was tested to assess whether the associations found were specific for seropositives. Males were at greater risk of any ECG alteration and left anterior hemiblock in relation to females if they were seropositive. An increasing risk of ventricular premature beats with age was clearer for seropositive than for seronegative subjects. Subjects with HHD were at an increased risk of ECG abnormalities and this was greater in those with a positive serological test (P less than 0.05). The findings suggest a possible geographical clustering or a familial aggregation of cases of Chagas' heart disease.

Exercise electrocardiogram tests in manual workers with and without antibodies to Trypanosoma cruzi: a population-based study.

Blood pressure, heart rate and electrocardiographic responses to exercise were compared in a group of 125 subjects with antibodies to Trypanosoma cruzi and in 153 seronegative subjects, randomly selected from persons with no evidence of heart disease in a resting electrocardiogram during a cross-sectional survey among apparently healthy manual workers. The mean heart rates and diastolic and systolic blood pressures of those in each group did not differ statistically at different phases of the exercise test and there was no evidence of a difference in physical fitness between those in the 2 groups. An abnormal test was recorded in 26.2% of seropositive, and in 16.1% of seronegative, subjects (odds ratio adjusted for age, sex and body mass index [OR] = 2.0, 95% confidence interval [95% CI] = 1.1-3.8). No significant difference was observed between the 2 groups in the occurrence of hypertensive response to exercise (6.4% among seropositives and 5.9% among seronegatives), ST depression greater than 1 mm (0.8% and 2.0%), supraventricular premature beats (4.8% and 2.6%) or conduction defects (0.8% and 1.3%). Complex ventricular premature beats were recorded more often in seropositive subjects (12.8% and 3.9%; OR = 3.7, 95% CI = 1.4-9.8, P less than 0.01). The risk of an abnormal test increased with age in both groups. A history of cardiovascular symptoms, gender and body mass was not associated with the risk of an abnormal response in the test. The findings suggest that exercise testing might be a routine procedure when subjects with antibodies to T. cruzi are being assessed for participation in potentially high risk activities, such as heavy manual work.

Trypanosoma cruzi infection and electrocardiographic findings among active manual workers. A population-based study in central Brazil.

In a cross sectional survey of the prevalence of Trypanosoma cruzi infection among urban unskilled workers in Goiânia, Brazil, blood samples from 6222 manual workers from seven institutions were examined for anti-Trypanosoma cruzi antibodies by immunofluorescence, ELISA and haemagglutination tests. ECGs were performed and a clinical history was taken from 624 seropositive and a random sample of 529 seronegative subjects. Abnormal ECGs were found in 15.1% of individuals without Trypanosoma cruzi antibodies and in 44.4% of those with antibodies (p less than 0.001). In general, cardiovascular symptoms reported were not associated with seropositivity nor with ECG alterations but dizziness and dyspnoea were more often reported among those with an abnormal tracing (p less than 0.01). The prevalence of ECG abnormalities increased with age in both groups but was higher among those seropositive in all age groups. An odds ratio of 2.0 (95% Cl 1.2-3.1) and 2.9 (95% Cl 1.5-6.3) of ECG abnormalities, for each decade of life, was estimated for seropositive and seronegative subjects, respectively. Relative risks (based on the odds ratios) for various specific ECG abnormalities, comparing seropositive to seronegative individuals, were calculated after adjustment for age, sex and institution. The odds ratio for complete right bundle branch block was 49.9 (95% CL 12.2-203.4); for left anterior hemiblock was 4.1 (2.8-6.0); for large Q/QS waves was 4.2 (2.4-7.3) and for first degree A-V block was 8.5 (2.6-28.1).

Supersensitivity of the isolated guinea-pig vas deferens induced by a toxic fraction of scorpion venom (Tityus serrulatus).

Tityustoxin (TsTx), a toxic fraction of Tityus serrulatus venom, was studied on the isolated guinea-pig vas deferens. It increased significantly the maximal response of the preparation to both norepinephrine and acetylcholine and decreased the effective median dose of norepinephrine. The effect of TsTx on norepinephrine median dose was unchanged when atropinized or pharmacologically "denervated" preparations were used but was abolished when both procedures were associated. Atropinization of pharmacologically denervated muscles almost never modify the TsTx-induced increase in the maximal response to norepinephrine. On denervated or phentolamine-treated muscles TsTx-induced increase in the maximal response to acetylcholine was abolished. It was concluded that toxin predominantly induces adrenergic postsynaptic supersensitivity. Of minor significance, it also induces presynaptic cholinergic and adrenergic supersensitivity. Comparison of these results with those of crude venom indicates that TsTx effects may result from the sum of the effects of subcomponents not demonstrated by the chemical procedures here utilized.