Endocardite de valva pulmonar em paciente sem fatores de risco clássicos para acometimento do coração direito / Pulmonary valve endocarditis in subjects without classical risk factors for involvement of right heart

Relatamos a seguir um caso clínico de endocardite isolada de valva pulmonar em um paciente sem fatores de risco clássicos para essa patologia.

Erlotinib in combination with capecitabine and docetaxel in patients with metastatic breast cancer: a dose-escalation study.

Capecitabine added to docetaxel extends survival in metastatic breast cancer (MBC) and shows additive efficacy with erlotinib in pre-clinical studies. This study aimed to determine the maximum-tolerated dose (MTD) of capecitabine/docetaxel with erlotinib and assess tolerability, anti-tumour activity and potential pharmacokinetic interactions. Three treatment cohorts were assessed, using different dosing regimens. A total of 24 women with MBC were enrolled sequentially. The regimen comprising erlotinib 100mg/day continuously, capecitabine 825mg/m2 bid on days 1 to 14 and docetaxel 75mg/m2 intravenously every 3 weeks on day 1 was well tolerated and was established as the MTD. Overall response rate was 67%, comprising two complete and 12 partial responders in 21 assessable patients. The most common treatment-related adverse events were gastrointestinal disorders and skin toxicities. Pharmacokinetic studies showed that exposure to the three drugs was not reduced when given in combination. These encouraging preliminary results warrant further trials of the combination in MBC.

Left mini-thoracotomy off-pump coronary revascularization.

OBJECTIVES: Stent restenosis is a common complication in angioplasty. Studies have shown better outcomes when the left internal thoracic artery (LITA) is anastomosed to the left anterior descending artery (LAD). Patient selection, operative technique and results for off-pump left mini-thoracotomy (LME) coronary surgery, as a pilot study, are presented. METHODS: Eighteen patients (three women) with a mean age of 56.6 +/- 9.2 were operated on through a 9-14 cm LME to perform off-pump LITA to LAD anastomoses (14 patients) or diagonalis (DI) and LAD sequential anastomoses (4 men). The grafts were skeletonized during dissection and anastomoses were performed using 7-0 polypropylene running sutures. An access device (CardioThoracic Systems) allowed approach and coronary stabilization. RESULTS: There were no deaths, conversion to sternotomy, transfusions or high enzyme levels. All patients were released from hospital on the 3rd to 5th postoperative days and returned to their day-to-day activities within 30 days. One woman was readmitted for angina, presented with graft occlusion, and a stent was implanted and one man was readmitted for wound infection. Future angiography was performed on six patients and showed patent grafts. CONCLUSION: The operation was performed with low morbid-mortality, short hospital stays and without transfusions. Appropriate instruments and the ability of the surgeon to use his left hand, made this operation technically easy. Randomized studies may prove if there are sufficient clinical and economic benefits over the long term to make this surgery the first choice.

Phase III study of erlotinib in combination with cisplatin and gemcitabine in advanced non-small-cell lung cancer: the Tarceva Lung Cancer Investigation Trial.

PURPOSE: Erlotinib is a potent inhibitor of the epidermal growth factor receptor tyrosine kinase, with single-agent antitumor activity. Preclinically, erlotinib enhanced the cytotoxicity of chemotherapy. This phase III, randomized, double-blind, placebo-controlled, multicenter trial evaluated the efficacy and safety of erlotinib in combination with cisplatin and gemcitabine as first-line treatment for advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Patients received erlotinib (150 mg/d) or placebo, combined with up to six 21-day cycles of chemotherapy (gemcitabine 1,250 mg/m2 on days 1 and 8 and cisplatin 80 mg/m2 on day 1). The primary end point was overall survival (OS). Secondary end points included time to disease progression (TTP), response rate (RR), duration of response, and quality of life (QoL). RESULTS: A total of 1,172 patients were enrolled. Baseline demographic and disease characteristics were well balanced. There were no differences in OS (hazard ratio, 1.06; median, 43 v 44.1 weeks for erlotinib and placebo groups, respectively), TTP, RR, or QoL between treatment arms. In a small group of patients who had never smoked, OS and progression-free survival were increased in the erlotinib group; no other subgroups were found more likely to benefit. Erlotinib with chemotherapy was generally well tolerated; incidence of adverse events was similar between arms, except for an increase in rash and diarrhea with erlotinib (generally mild). CONCLUSION: Erlotinib with concurrent cisplatin and gemcitabine showed no survival benefit compared with chemotherapy alone in patients with chemotherapy-naïve advanced NSCLC.

Revascularização miocárdica por minitoracotomia esquerda: série de casos / Left mini-thoracotomy off-pump coronary revascularization

OBJETIVO: A reestenose é uma das complicações freqüentes das angioplastias. Estudos demonstraram superioridade da anastomose de Artéria Torácica Interna Esquerda (ATIE) para Coronária Interventricular Anterior (DA). Discute-se a indicação, técnica operatória e resultados da Revascularização do Miocárdio por Minitoracotomia Esquerda (MTE) sem extracorpórea. MÉTODO: Foram operados 18 pacientes (três mulheres), idade de 56,6±9,2 anos, com "shunt" intracoronário, para anastomose da ATIE para DA (14 casos) ou Diagonal (DI) e DA (4 homens). Exposição e estabilização foram obtidas com dispositivo Access (CardioThoracicSystems®). O enxerto foi dissecado esqueletizado e anastomosado com fio único de polipropileno 7-0. RESULTADOS: Não ocorreu óbito, conversão para esternotomia, transfusões ou alterações enzimáticas. As altas hospitalares ocorreram entre 3 e 5 dias e todos os pacientes retomaram suas atividades em até 20 dias. Houve uma reinternação por oclusão do enxerto, tratada com angioplastia, e outra por infecção incisional. Seis pacientes reestudados voluntariamente apresentaram angiografia com enxertos pérvios. CONCLUSÃO: A abordagem mostrou-se segura e sem obstáculos técnicos. Houve tempo de hospitalização curto e baixa morbidade, sem uso de hemoderivados. O instrumental apropriado e, casualmente, a aptidão manual esquerda do cirurgião facilitaram a técnica. Estudos randomizados poderão demonstrar se há benefício econômico e/ou clínico, no longo prazo, desta abordagem como tratamento preferencial.

OBJECTIVES: Stent restenosis is a common complication in angioplasty. Studies have shown better outcomes when the left internal thoracic artery (LITA) is anastomosed to the left anterior descending artery (LAD). Patient selection, operative technique and results for off-pump left mini-thoracotomy (LME) coronary surgery, as a pilot study, are presented. METHODS: Eighteen patients (three women) with a mean age of 56.6 ± 9.2 were operated on through a 9-14 cm LME to perform off-pump LITA to LAD anastomoses (14 patients) or diagonalis (DI) and LAD sequential anastomoses (4 men). The grafts were skeletonized during dissection and anastomoses were performed using 7-0 polypropylene running sutures. An access device (CardioThoracic Systems®) allowed approach and coronary stabilization. RESULTS: There were no deaths, conversion to sternotomy, transfusions or high enzyme levels. All patients were released from hospital on the 3rd to 5th postoperative days and returned to their day-to-day activities within 30 days. One woman was readmitted for angina, presented with graft occlusion, and a stent was implanted and one man was readmitted for wound infection. Future angiography was performed on six patients and showed patent grafts. CONCLUSION: The operation was performed with low morbid-mortality, short hospital stays and without transfusions. Appropriate instruments and the ability of the surgeon to use his left hand, made this operation technically easy. Randomized studies may prove if there are sufficient clinical and economic benefits over the long term to make this surgery the first choice.

Prevalência de desnutriçäo em unidade básica de saúde da periferia de Ribeiräo Preto (SP) / Prevalence of malnutrition in primary health care center at Ribeiräo Preto(SP)

Foram estudadas 447 crianças com idades entre zero e cinco anos de uma Unidade Básica de Saúde de Ribeiräo Preto com o objetivo de se determinar a prevalência da desnutriçäo nessa populaçäo por meio de diferentes métodos de avaliaçäo do estado nutricional. Para isso, foram obtidas as medidas antropométricas peso, estatura, perímetro braquial e perímetro craniano, bem como os dados pessoais de cada criança, analisando-se posteriormente o seu estado nutricional pelos métodos de Gomez, Waterlow, Kanawati & McLaren e Shakir. As prevalências foram diferentes de acordo com o método utilizado, variando entre 9,17 por cento e 38,48 por cento, tendo-se observado, em todos os métodos, o predomínio de formas leves de desnutriçäo.