Autoadministración intranasal de anestésico local (ropivacaína) para bloqueo del ganglio esfenopalatino, para tratamiento de neuralgia de la segunda rama del trigémino secundaria a curetaje del seno maxilar: informe de un caso / Intranasal self-administration of local anesthetic (ropivacaine) for sphenopalatine ganglion block, for treatment of second trigeminal branch neuralgia secondary to maxillary sinus curettage: a case report

La neuralgia del trigémino es un dolor facial severo y a menudo subestimado, que afecta a la calidad de vida. El tratamiento farmacológico es insuficiente para controlar el dolor en el 30 % de los casos y, aunque las técnicas de intervención pueden ser efectivas, existe posibilidad de recidiva y complicaciones asociadas. La segunda rama del nervio trigémino atraviesa el ganglio esfenopalatino, que es anatómicamente accesible al bloqueo, debido a su localización superficial en la cavidad nasal. Reportamos un caso clínico de un paciente con neuralgia del trigémino en la segunda rama incontrolada a quien se prescribió bloqueo del ganglio esfenopalatino ambulatorio autoadministrado con hisopo nasal con ropivacaína al 0,75%. Durante las visitas de seguimiento, confirmamos que este tratamiento adyuvante proporcionaba un alivio del dolor significativo durante 24 horas, con descenso del número de exacerbaciones

Trigeminal neuralgia (TN) is a severe and often underestimated facial pain that affects quality of life. Pharmacological treatment is insufficient for pain control in 30 % of cases and, although intervention techniques may be effective, there is a possibility of relapse and associated complications. The second division of the trigeminal nerve (V2) runs through the sphenopalatine ganglion (SPG), which is anatomically accessible to blocking due to its superficial location in the nasal cavity. We report a clinical case of a patient with uncontrolled V2 TN that was put on ambulatory self-administered SPG block with nasal swabs soaked in 0.75% ropivacaine. In the follow-up visits, we confirmed that this adjuvant treatment provided a significant pain relief over 24 hours with a decrease in the number of exacerbations

Intranasal self-administration of local anesthetic (ropivacaine) for sphenopalatine ganglion block, for treatment of second trigeminal branch neuralgia secondary to maxillary sinus curettage: A case report. / Autoadministración intranasal de anestésico local (ropivacaína) para bloqueo del ganglio esfenopalatino, para tratamiento de neuralgia de la segunda rama del trigémino secundaria a curetaje del seno maxilar: informe de un caso.

Trigeminal neuralgia (TN) is a severe and often underestimated facial pain that affects quality of life. Pharmacological treatment is insufficient for pain control in 30% of cases and, although intervention techniques may be effective, there is a possibility of relapse and associated complications. The second division of the trigeminal nerve (V2) runs through the sphenopalatine ganglion (SPG), which is anatomically accessible to blocking due to its superficial location in the nasal cavity. We report a clinical case of a patient with uncontrolled V2 TN that was put on ambulatory self-administered SPG block with nasal swabs soaked in 0.75% ropivacaine. In the follow-up visits, we confirmed that this adjuvant treatment provided a significant pain relief over 24hours with a decrease in the number of exacerbations.

Scrub typhus and spotted fever among hospitalised children in South India: Clinical profile and serological epidemiology.

BACKGROUND: Rickettsial infections are re-emerging. In India, they are now being reported from several areas where they were previously unknown. OBJECTIVES: The objective of this study was to describe the epidemiology, clinical profile and outcome of serologically-confirmed scrub typhus and spotted fever among children in a tertiary care hospital in Bengaluru. MATERIALS AND METHODS: Hospitalised children aged <18 years, with clinical features suggestive of rickettsial disease admitted between January 2010 and October 2012 were included prospectively. Diagnosis was based on scrub typhus and spotted fever-specific IgM and IgG by enzyme-linked immunosorbent assay (ELISA). RESULTS: Of 103 children with clinical features suggestive of rickettsial illness, ELISA test confirmed 53 cases for scrub typhus, 23 cases for spotted fever group and 14 with mixed infection. The average age was 7.3 (±3.9) years and 44 (71.0%) children were male. Majority of cases were from Karnataka (50%), Andhra Pradesh (32.3%) and Tamil Nadu (17.7%). Common clinical features included fever (100%, average duration 11 days), nausea and vomiting (44%), rash (36%); eschar was rare. Compared to the ELISA test, Weil-Felix test (OX-K titre of 1:80) had a sensitivity and specificity of 88.7% and 43.9%, respectively. Treatment with chloramphenicol or doxycycline was given to the majority of the children. Complications included meningoencephalitis (28%), shock (10%), retinal vasculitis (10%) and purpura fulminans (7%). CONCLUSIONS: These findings suggest that the burden of rickettsial infection among children in India is high, with a substantially high complication rate. Rickettsial-specific ELISA tests can help in early diagnosis and early institution of appropriate treatment that may prevent life-threatening complications.

Association of ERBB2 gene status with histopathological parameters and disease-specific survival in gastric carcinoma patients.

The clinical significance of ERBB2 amplification/overexpression in gastric cancer remains unclear. In this study, we evaluated the ERBB2 status in 463 gastric carcinomas using immunohistochemistry (IHC) and fluorescence in situ hybridisation (FISH), and compared the findings with histopathological characteristics and with disease-specific survival. ERBB2 overexpression (2+ and 3+) and amplification (ratio ERBB2/CEP17 >or= 2) were found in 43 (9.3%) and 38 (8.2%) gastric carcinomas, respectively. Perfect IHC/FISH correlation was found for the 19 cases scored as 0 (all negative by FISH), and also for the 25 cases scored as 3+ (all positive by FISH). One out of six carcinomas scored as 1+ and 12 out of 18 carcinomas scored as 2+ were positive by FISH. ERBB2 amplification was associated with gastric carcinomas of intestinal type (P=0.007) and with an expansive growth pattern (P=0.021). ERBB2 amplification was detected in both histological components of two mixed carcinomas, indicating a common clonal origin. A statistically significant association was found between ERBB2 amplification and worse survival in patients with expansive gastric carcinomas (P=0.011). We conclude that ERBB2 status may have clinical significance in subsets of gastric cancer patients, and that further studies are warranted to evaluate whether patients whose gastric carcinomas present ERBB2 amplification/overexpression may benefit from therapy targeting this surface receptor.

Pemetrexed in second line treatment of non-small cell lung cancer - The portuguese experience. / Pemetrexed na segunda linha de tratamento do carcinoma do pulmão de não pequenas células - A experiência portuguesa.

Until 2004, docetaxel in monotherapy was the standard for second-line treatment of non-small cell lung cancer (NSCLC). Pemetrexed (P) has shown similar activity in this setting with a better adverse event profile. In Portugal, it was introduced in October of 2004. We have carried out a retrospective analysis of patients (pts) who received P for second-line NSCLC in Portugal from October 2004 to December 2006. Data were collected from the records of pts with locally advanced or metastatic NSCLC and failed first-line chemotherapy enrolled in centers participating in the Portuguese Lung Cancer Study Group (GECP). Objective response (OR; complete [CR] or partial [PR] response) was evaluated using RECIST and safety was assessed using serious or non-serious adverse events (SAEs/AEs). By December 2006, 19 GECP centers had enrolled 244 pts who had received P for ≥1cycle, and were considered evaluable for both objective response and safety. Demography: male/female, 175/69; median age, 57.0years (range 20-81); smoking status, y/ex/n, 116/57/71; adenocarcinoma / squamous-cell carcinoma/other histology, 141/72/31; mean time to progression (TTP) 8.07months. Disease control in 209 evaluable pts was observed in 116 (55.5%): 2 CR, 45 PR and 69 SD; mean TTP 4.70months. The majority of AEs were grade 3 anemia (15 pts) and neutropenia (18 pts). The mean overall survival was 17.27months. Our retrospective analysis has observed a similar disease control rate with P in 2nd line (55.5%), and TTP (4.7months) in our current unselected population to that published in the literature. P is an option for second-line NSCLC with a good tolerability. Rev Port Pneumol 2008; XIV (Sup.2): S9-S20.

Incidence of cardiovascular events in renal transplant recipients and clinical relevance of modifiable variables.

INTRODUCTION: The aims of this study were to quantify the incidence of cardiovascular events and identify the clinical relevance of modifiable variables. MATERIALS AND METHODS: The 1729 patients who underwent renal transplantation from 1981 to 2004 were evaluated in an observational, prospective follow-up study with no exclusions. A cardiovascular event was defined as the presence of ischemic cardiac disease (chest pain-myocardial infarction), cardiac insufficiency, arrhythmia (auricular fibrillation), peripheral vascular disease, or cerebrovascular accident. A survival analysis was performed using the Kaplan-Meier method. A Cox regression analysis was applied. Having identified the predictive variables of cardiovascular events, the population attributable fraction (PAF) and the etiological fraction (EF) were estimated. A risk score was calculated using Cox regression coefficients. RESULTS: The accumulated incidence of cardiovascular events was 22.2%, with an incidence rate of 468.6 x 10,000 follow-up years. From the Cox regression model, the variables with an independent effect close to statistical significance to predict cardiovascular events were as follows: recipient age (RR = 1.05), smoking at the time of the transplantation (RR = 2.1), left ventricle hypertrophy during follow-up (RR = 2.4), prior diabetes mellitus, and obesity (body mass index >or=30). At the time of transplantation, 41.7% were smokers. During follow-up, a clear difference was observed in the incidence rates of cardiovascular events between smokers and nonsmokers. Similar phenomena were observed for left ventricle hypertrophy and obesity. The resulting scores ranged between 0 and 5. The area under the ROC curve of the score for the prediction of cardiovascular events was 0.74. CONCLUSION: The incidence of cardiovascular events was consistent with the literature. A series of modifiable variables of major clinical relevance exist to decrease the frequency of cardiovascular events following renal transplantation.

Asymptomatic giardiasis and growth in young children; a longitudinal study in Salvador, Brazil.

This study sought to assess the effect of giardiasis on growth of young children. In Salvador, northeast Brazil, 597 children initially aged 6 to 45 months were followed for a year in 1998/9, measured anthropometrically thrice, every 6 months, and monitored for diarrhoea prevalence twice weekly. Stool samples were collected and examined during the second round of anthropometry, and infected children were treated 39 days later, on average (S.D. 20 days). For each 6-month interval, the gains in z-scores of infected and uninfected children were compared, after adjustment for potential confounding factors, including longitudinal prevalence of diarrhoea. No significant difference was found for the first interval but in the second, the gain in adjusted height-for-age z-score was 0.09 less in infected than uninfected children, equivalent to a difference in height gain of 0.5 cm. The shortfall in growth was greater in children who remained free of diarrhoea, and was significantly correlated with the proportion of the second interval during which the child had remained untreated. We conclude that Giardia can impede child growth even when asymptomatic, presumably through malabsorption. This finding challenges the view that young children found to have asymptomatic giardiasis in developing countries should not be treated.

Basiliximab (Simulect) in acute tubular necrosis high-risk kidney transplantation.

BACKGROUND: Basiliximab (Simulect) therapy reduces acute rejection episodes in renal transplantation. Posttransplant acute tubular necrosis (ATN) is a predisposing factor for acute rejection and reduced graft survival. Anti-lymphocyte antibodies have been used to delay the use of calcineurin antagonists in patients receiving cadaveric renal transplants and to prevent acute rejection episodes. The aim of our study was to learn about the effects of Simulect on ATN in high-risk cadaveric renal transplantation recipients. MATERIALS AND METHODS: We studied 93 patients including, 45 who received Simulect (20 mg before transplantation and 20 mg at day 4 posttransplant and 48 patients who did not receive Simulect. All patients received mycophenolate mofetil, steroids, and cyclosporine (46%) or tacrolimus (54%). We defined ATN as the need for dialysis during the first week after transplantation. Risk factors for ATN were: cold ischemia time, donor and recipient age, donor cause of death as stroke, HLA matching, and panel-reactive antibodies. RESULTS: Among 54 patients who experienced ATN, 44% were in the Simulect group and 71% in the other group (P = .01). In the regression analysis, Simulect was shown to be a protective factor: 0.19 (0.05 to 0.62). Presence of de novo diabetes was more frequent in the group that did not receive Simulect (16 [33%] vs 6 [13%]; P = .02). Acute rejection episodes were similar in both groups: 2.5% in the Simulect group versus 4% in the other group (P = .34). CMV infections occurred in 15 patients (33%) from the Simulect group and in 20 patients (42%) in the other group. Seven patients died in the Simulect group, and five patients died in the other group. In general, Simulect was well tolerated and the degree of complications was similar in both groups. CONCLUSION: Simulect reduced the incidence of ATN among patients receiving a high-risk renal graft. It was well tolerated and no adverse effects were observed. The use of Simulect should be considered for patients receiving renal grafts at high risk for ATN.

Characteristics of staff victims of patient assault: ten year analysis of the Assaulted Staff Action Program (ASAP).

Patient assaults on staff have been a continuing risk for inpatient and community-based psychiatric healthcare providers. This study presents a ten-year analysis of the characteristics of staff victims of patient assaults in one public mental health system of care, a period which included the transition to managed care initiatives within this system. Assault data was gathered within the context of the Assaulted Staff Action Program (ASAP), a voluntary, system-wide, peer-help, crisis intervention program that is designed to assist employees with the psychological sequelae of these patient events. In general, the findings were consistent with previously reported inpatient and community studies. Less experienced, less formally trained employees remain at high risk. The impact of managed care initiatives was found in community residences where younger female staff were most at risk. The implications of the findings and possible risk management strategies are discussed.

Enterococcus faecalis resistant to vancomycin and teicoplanin (VanA phenotype) isolated from a bone marrow transplanted patient in Brazil.

We report for the first time in Brazil, a patient from whom an Enterococcus faecalis VanA phenotype was isolated. Glycopeptide resistance is not commonly observed in Enterococcus faecalis, so this finding is of great concern since this species is responsible for 90% of enterococcal infections in Brazil. The isolate was recovered from a surveillance rectal swab culture from a patient with acute lymphocytic leukemia (ALL). Identification to the species level was performed by conventional biochemical tests and Vitek GPI cards. Antimicrobial susceptibility testing was evaluated by use of broth microdilution and Etest (AB BIODISK, Solna, Sweden) methods. The isolate was identified as E. faecalis and was considered resistant to both vancomycin (MIC, > 256 microg/mL) and teicoplanin (MIC, 256 microg/mL). The isolate also showed high level resistance to gentamicin and streptomycin (MICs, > 1024 microg/mL), but was considered susceptible to ampicillin (MIC, 4 microg/mL). Although the frequency of enterococcal infections is very low in most Latin America countries, the finding of glycopeptide (VanA) resistance in E. faecalis increases concern about apreading antimicrobial resistance in this region.

Differences in the perceived well-being of wives and husbands caring for persons with Alzheimer's disease.

This study aimed to examine differences in subjective psychological well-being between husband and wife caregivers of persons with Alzheimer's disease in comparison to the psychological states of noncaregiver husbands and wives similar in age and ethnicity. The principal comparison of interest was whether differences between husband and wife caregivers were greater than those between comparison group husbands and wives. Significant interactions for six out of nine psychological measures indicate that gender-related differences between spouse caregivers were specifically associated with the caregiving role. Possible explanations for the discrepancy between husband and wife caregivers as well as practice implications are discussed.

Value of single Widal test in the diagnosis of typhoid fever.

The usefulness of single Widal test in the diagnosis of typhoid fever was investigated. The test was done on 50 normal children, 50 children with non typhoidal fevers and 30 culture proved typhoid cases. Twenty one (70%) and nine (30%) of thirty typhoid fever cases had 'O' and 'H' agglutinin titer levels of more than or equal to 1:160, respectively as compared to only 3 (3%) and to 1 (1%) among controls. These differences were significant (p < 0.001). Twenty two (73.3%) out of thirty typhoid fever cases had either an 'O' or 'H' agglutinin titer of more than or equal to 1:160 as compared to only 3 (3%) among controls. An 'O' agglutinin titer of 1:160 had a specificity of 97%, a sensitivity of 70% and an accuracy of 90%. An 'H' agglutinin in titer of 1:160 was had a specificity of 97%, a sensitivity of 30% and an accuracy of 83.1%. Based on the above analysis, 'O' or 'H' titers of 1:160 or more were indicative of typhoid fever. Similarly, when the 2 titers were considered together, either 'O' or 'H' titers of 1:160 or more were suggestive.

Desprofissionalizaçäo ou reprofissionalizaçäo: um paralelo entre a advocacia e a medicina / Deprofessionalization or reprofessionalization: a study comparing advocacy and medicine

Utilizando-se do referencial teórico clássico da sociologia das profissöes, o autor discute as transformaçöes ocorridas na profissäo dos advogados nos Estados Unidos e as compara com aquelas observadas na Medicina no Brasil. A opçäo metodológica por comparar profissöes diferentes buscou assegurar uma maior isençäo na análise das características de duas profissöes liberais clássicas e näo comparar duas medicinas. Temas como o controle do mercado, a auto-regulamentaçäo profissional, a má prática profissional e a ética säo discutidos à luz do referencial teórico referido, para questionar a situaçäo da profissäo médica no Brasil

[Deprofessionalization or reprofessionalization: a study comparing law and medicine]. / Desprofissionalizaçäo ou reprofissionalizaçäo: um paralelo entre a advocacia e a medicina.

The author discusses and compares the transformations in the profession of lawyers in the United States of America and the doctors in Brazil according to a theoretical analysis based upon the classical theory of the Sociology of the Professions. The discussion about the deprofessionalization of Medicine is conducted along some of the characteristics outlined by the theory. The author concludes that the challenge that faces medicine is a kind of re-organization that will change necessarily the profession as we know it today, but this change will not affect the professional autonomy or any other of its essential characteristics.

[Specific count of cerebrospinal fluid cells in the counting chamber using supravital staining]. / Contagem específica de células do líquido céfalo raquideano em câmara usando coloração supravital.

The authors adapted to the cerebrospinal fluid (CSF) the staining technic developed by Anguiano and Ancira to perform differential leucocyte counts in the counting chamber. The formula they used is the following: methyl alcohol 1 ml, distilled water 2 ml. To this mixture are added: 6 drops of Leishman stain filtered in Whatman paper number 42; toluidine blue 0.25% aqueous solution (filtered in the same manner), 1 drop; acetate buffer 0.1 M, pH 5.4, 1 drop. The technic varies according to the intensity of pleocytosis. If the CSF is turbid or contains more than 100 cells per c.m. 1 drop is dripped in the bottom of a 10X75 test tube and then 2 drops of the staining fluid are added; the mixture is then shaken; after one or two minutes 1 drop is placed in the Fuchs-Rosenthal counting chamber. If the number of total cells is less than 100 per c.m. different CSF volumes are centrifuged at the rate of 2000 r.p.m., during 6 minutes; the supernatant fluid is poured off and the sedimented cells are suspended in 2 drops of the staining fluid. The morphology of the cells as they appear after they are stained by the supravital staining technic (SVST) is described and illustrated in photomicrographies.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cytologic examination of the cerebrospinal fluid in the diagnosis of primary or metastatic neoplasms of the nervous system]. / Exame citológico do líquido céfalo-raquidiano no diagnóstico de neoplasias primitivas ou metastáticas do sistema nervoso: a propósito de seis casos.

The authors report 6 cases of cerebrospinal fluid (CSF) examinations in which malignant cells were found. In 5 cases the finding was incidental: medulloblastoma (case 1); malignant melanoma (case 2); adenocarcinoma (case 3); meningitis carcinomatosa (case 4) and neuroleukaemia (case 5). In only one case neuroleukaemia was suspected before the study of the CSF (case 6). The unexpected occurrence of malignant cells in the CSF demands the pathologist to be well acquainted with tumor cell cytology, in order to identify them providing so useful information that can decidedly influence subsequent diagnostic and therapeutic procedures. The cell collection technic developed in the authors' laboratory was considered adequate, because both inflammatory and malignant cells were securely identified. Its principle is to obtain thin air-dried smears that dry almost instantaneously on slides, in order the cellular structure be preserved. After centrifuging about 5-8 ml of CSF the tube is inverted so as to pour off the whole of the supernatant fluid. It is kept inverted with the operator's left hand, so that no drop of fluid can run back on to the cells. With his right hand the operator touches the bottom of the inverted tube with a Pasteur micropipette preciously made by distending a microhematocrit tube under the flame of a Bunsen burner and attached with adhesive tape to the handle of a wire loop 2 mm in diameter.(ABSTRACT TRUNCATED AT 250 WORDS)