Laser-assisted MAL-PDT associated with acoustic pressure wave ultrasound with short incubation time for field cancerization treatment: A left-right comparison.

BACKGROUND: Laser-assisted MAL-PDT has been reported to increase the effectiveness of conventional PDT. Nonetheless, clinical effects of this association when reducing MAL incubation time is poorly discussed. Furthermore, the association of acoustic pressure wave ultrasound with laser-assisted MAL-PDT with short incubation time for field cancerization had not been reported before. OBJECTIVES: To compare clinical effects of ablative fractional laser-assisted MAL-PDT associated with acoustic pressure wave ultrasound (IMPACT US) with 1-hour incubation time and conventional MAL-PDT for skin field cancerization on the forearms, as well as the impact on safety and tolerability. METHODS: Fifteen patients with 638 AK (grade I-III) with field cancerized-skin on the forearms were enrolled in this left-right trial. Two protocols were randomly chosen. One side was treated with conventional MAL-PDT, whereas the other with laser-assisted MAL-PDT associated with acoustic pressure wave ultrasound with 1-hour incubation time. Actinic keratoses were quantitively measured, and the other signs of sun-damaged skin, like pigmentation and texture, in field cancerized skin were qualitatively evaluated before and after six months. Side effects were assessed subjectively during the procedure and one week after. RESULTS: All patients completed the study. At six months after treatment, both protocols reduced the number of AK (72%; CO2 + PDT, and 65%; MAL-PDT). The difference between these two protocols was not statistically significant (p = 0.77). The improvement of pigmentation and texture of field cancerized skin was more significant on the side treated with laser-assisted MAL-PDT associated with acoustic pressure wave ultrasound. Both protocols were well tolerated and without significant difference in adverse events. CONCLUSION: Laser-assisted MAL-PDT using CO2 laser and acoustic pressure wave ultrasound with short incubation time of 1 h was as effective as conventional MAL-PDT for field-cancerized skin with actinic keratosis in forearms with better cosmetic outcome.

Enhancing longevity of pacemakers through reprogramming. Underutilization and cost-effectiveness.

OBJECTIVE: This study was performed to observe the number of pacemakers that had never been reprogrammed after implantation, and the effect of optimised output programming on estimated longevity of pulse generators in patients with pacemaker METHODS: Sixty patients with Teletronics Reflex pacemakers were evaluated in a pacemaker clinic, from the time of the beginning of its activities, in June 1998, until March 1999. Telemetry was performed during the first clinic visit, and we observed how many pulse generators retained nominal output settings of the manufactures indicating the absence of reprogramming until that date. After evaluation of the capture threshold, reprogramming of pacemakers was performed with a safety margin of 2 to 2.5:1, and we compared the estimated longevity based on battery current at the manufacturer's settings with that based on settings achieved after reprogramming. RESULTS: In 95% of the cases, the original programmed setting was never reprogrammed before the patients attended the pacemaker clinic. Reprogramming the pacemaker prolonged estimated pulse generator life by 19.7+/-15.6 months (35.5%). CONCLUSION: The majority of the pacemakers evaluated had never been reprogrammed. Estimated pulse generator longevity can be prolonged significantly, using this simple, safe, efficacious, and cost-effective procedure.

[Influence of body fat topography on glucose homeostasis and serum lipids]. / Influência da topografia da gordura corporal na homeostase da glicose e nos lípidos séricos.

Predominant fat distribution in the upper body segment evaluated by waist to hip circunference ratio (WHR) has been associated with diabetes mellitus and cardiovascular morbidity excess. To investigate metabolic alterations underlying this risk excess, we selected 2 groups of 10 obese women without history of hypertension, menstrual irregularities or oral contraceptives, matched according to age (mean +/- SD): 30.5 +/- 5.3 vs 30.6 +/- 5.8 years and BMI 35.5 +/- 6.5 vs 35.7 +/- 6.7 Kg/m2. Each matched pair had a difference in WHR superior to 0.15 (0.83 +/- 0.04 vs 1.02 +/- 0.05). Insulin and C peptide were determined during an oral glucose tolerance test (75 g). At 30, 60, 90 and 120 minutes differences were significant for glycaemia, insulinaemia and C peptide. Fasting triglycerides were 103 +/- 48 in the lower WHR group vs 164 +/- 84 mg/dl (p less than 0.05); total cholesterol 186.5 +/- 31 vs 215.2 +/- 29.4 mg/dl (p less than 0.05); LDL cholesterol/HDL cholesterol 2.46 +/- 0.89 vs 3.18 +/- 0.96 (p less than 0.05). No significant differences were found in androgenic activity. We conclude that preferential fat distribution in the upper segment is, by itself, an aggravating factor of metabolic alterations associated with obesity, particularly dyslipidaemia and hyperinsulinaemia.

Traumatismos cardiacos penetrantes experiencia de 24 casos atendidos no hospital pronto-socorro. / Penetrating cardiac trauma - experience of 24 patients operated at hospital pronto-socorro

Os autores apresentam a experiencia da Clinica Cirurgica do Hospital Joao XXIII de Belo Horizonte no tratamento cirurgico das feridas cardiacas penetrantes, no periodo de janeiro de 1975 a dezembro de 1980, num total de 24 casos. O indice de sucesso obtido foi de 87,5%, com apenas tres obitos na serie. Um historico do tratamento desse tipo de lesao, assim, como uma revisao da bibliografia especifica sao feitos. A serie e analisada estatisticamente no que se refere a diagnostico e tratamento das lesoes, assim como tambem ao local predominante das feridas. O tratamento inicial dos pacientes e seu tratamento cirurgico sao revistos, procurando-se obter uma metodizacao de atendimento.Finalmente, concluem com a analise dos resultados, reafirmando sua preferencia por um tratamento cirurgico imediato dos caso

Traumatismos arteriais perifericos. Analise de 42 casos. / Peripheral arteries trauma. Analysis of 42 cases

Os autores relatam sua casuistica no atendimento de traumatismos arteriais perifericos agudos no Hospital Joao XXIII de Belo Horizonte, no periodo de 1976 a 1979. Fazem referencias a respeito dos tipos de lesao observados, sua localizacao, sua morbidade e mortalidade, os metodos de tratamento empregados e os fatores que influenciaram a recuperacao dos pacientes. Quarenta e dois casos foram responsaveis por 50% das lesoes, e que as arterias mais acometidas foram a braquial e a femoral superficial. Fazem tambem uma revisao das controversias ainda existentes no tratamento das lesoes arteriais, agudas e as comparam com sua propria casuistica. O indice de sucesso nesta serie foi de 84%

Analytical characterization of urinary proteins by sodium dodecyl sulphate-polyacrylamide gel electrophoresis in renal disease. Clinical and histopathological correlations.

Sodium dodecyl sulphate-polyacrylamide gel electrophoresis is a method allowing the separation of proteins according to their molecular sizes. For this reason this method is rather useful for the classification of proteinurias as tubular, glomerular, or mixed. In the present study a good correlation was observed between the results of urine electrophoresis in sodium dodecyl sulphate-polyacrylamide gel and both clinical and histopathological data from 32 patients with different forms of renal disease.