[Mesenteric lymph node cavitation: a rare complication of celiac disease in the adult]. / Cavitación ganlionar mesentérica: una rara complicación de la enfermedad celíaca del adulto.

A case of coeliac disease (CD) and mesenteric lymph node cavitation (MLNC) in a 42-years-old female is presented. The other cases reported in the literature are also reviewed. The most important ganglionar histological features are described and a pathogenic explanation is suggested.

[Tuberculous pericarditis: diagnostic value of adenosine deaminase]. / Péricardite tuberculeuse: valeur diagnostique de l'adénosine désaminase.

Adenosine desaminase activity was measured in the pericardiac fluid of 35 patients with pericarditis of undetermined origin who were operated upon for diagnostic or therapeutic purposes. The causes of pericarditis fell into 6 categories: I, tuberculosis (8 cases); II, idiopathy (17 cases); III, neoplasia (6 cases); IV, purulent bacterial infection (2 cases); V, constriction (2 cases) and VI, radiotherapy (1 case). The highest mean adenosine desaminase value (143 U/l) was found in group I. Other values were 34 in group II, 48 in group III and 45 in groups IV to VI. There was a statistically significant difference in this respect between group I and the other groups (P less than 0.0001). If 60 U/l is taken as discriminant value for the diagnosis of tuberculous pericarditis, then the adenosine desaminase value has a 100 percent sensitivity and an 80 percent specificity. Measuring this value therefore is a very promising procedure.

[Sequential chemo-radiation in non-small cell lung cancer: a retrospective study of 100 patients]. / Quimio-radioterapia sequencial no carcinoma pulmonar não de pequenas células: estudo retrospectivo de 100 doentes.

Combined chemotherapy and radiotherapy has shown to be the correct treatment of unresectable non-small cell lung cancer, after many years of poor survival figures with standard radiotherapy alone. It has also been demonstrated that the benefit of chemotherapy is mainly achieved if cisplatin-based schedules are used. The authors present a retrospective study of 100 cases of stage III non-small cell lung cancer treated with a sequential approach of chemotherapy and radiotherapy and evaluate median and overall survival, local progression-free survival and distant progression-free survival. The results of our series are quite similar to those published in literature.

[Economic impact of a health care program on antibiotics]. / Impacto Económico de um Programa de Qualidade Assistencial em Antibióticos.

The increased use of more expensive broad-spectrum antibiotics has had an impact on health care costs and the potential emergence of antimicrobial resistance. Antimicrobial drug prescription programs resulted in a significant reduction in the inappropriate use of certain antibiotics and in the pharmacy budget. The authors present the economic impact of an antimicrobial drug prescription program in a small community hospital.

[Drug surveillance: concepts, objectives, and methods]. / Farmacovigilância: conceitos, objectivos e métodos.

Adverse reactions to drugs, by their frequency and morbidity, constitute a very important problem in clinical practice today. However, it is not always possible to establish the definitive causal relationship between the drug and the clinico-laboratory situation. This is not only due to the variability of these findings and the inherent difficulties of the methodology used, but also the fact that most doctors show little sensitivity to such an important subject. In this paper we present a short review of the drug surveillance programme: basic concepts, objectives and the most important methodology, as well as the current situation in the EEC countries.

[Intracavitary heart metastasis of testicular embryonic tumor]. / Metástase cardíaca intracavitária de um tumor embrionário testicular.

Cardiac intracavitary metastasis are very uncommon. A 19 years old patient with an embryonic tumour of the testes extending into the right ventricle, which manifested as heart failure, is presented. To our knowledge, this is the first case report of a teratoma with carcinoma of the testis involving the right ventricle.

[Epidemiologic study of bronchial asthma in schoolchildren from the Azores (Faial)]. / Estudo epidemiológico sobre asma brônquica numa população escolar dos Açores (Faial).

Epidemiologic data on prevalence of bronchial asthma among childhood in the Azores have been unknown so far. In October of 1993 a study was carried out to determine the prevalence of bronchial asthma in children aged 6-12 years on the island of Faial. Nine hundred and twenty seven schoolchildren, representing more than 95% of children within this age group, were studied. A questionnaire was distributed to be filled out by their parents and returned to the schools. Children were considered to have bronchial hyperreactivity when they had an episodical wheeze, spontaneous or related to cold, exercise, airway infections or allergic exposure, and to have asthma when they had been diagnosed by a doctor or had consulted their physicians for dispnea accompanied by wheezing and had received asthma medication in the last year or in their lifetime. The cumulative prevalence of asthma was 8% (CI 95%: 7-9%). Asthma was significantly more common in males (69%; CI 95%: 57-78%) than in females (31%) (p < 0.001). Seventy percent of the diagnoses were made in the first 5 years of life. Allergy was reported more often among asthmatic children (71%: CI 95%: 59-81%) than in the non-asthmatic group (29%) (p < 0.001). Seventy seven percent (CI 95%: 65-85%) of asthmatic subjects had a family history of asthma. Asthma was not reported significantly more often in households with smokers than in those without smokers.

[Reactive arthritis caused by Giardia lamblia in a patient with secretory IgA deficiency]. / Artrite reactiva por Giardia lamblia num doente com défice de IgA secretora.

The authors report a case of seronegative polyarthritis resistant to the anti-inflammatory therapy in a 16-year-old male with intermittent diarrhea. A stool examination showed the presence of cysts of Giardia lamblia and an immunological study detected a partial serum IgA deficiency, including its secretory fraction. Based on clinical, analytical and radiological findings and the clinical improvement after treatment with metronidazole, a diagnosis of reactive arthritis associated to chronic giardiasis was made. Authors make a brief review of the literature the regarding this case.

[The epidemiology of proximal femur fracture at the Hospital da Horta (Azores)]. / Epidemiologia da fractura da extremidade proximal do fémur no Hospital da Horta (Açores).

The aim of this study was to know the incidence of osteoporotic hip fracture in a defined area of the Azores. The catchment area included the islands of Faial, Pico, Flores and Corvo, with 11,617 subjects aged 50 or more: 5,373 males and 6,244 females. The time period of the survey was 1991 to 1993. Data was obtained from the records of the Orthopedic Department of Hospital Horta. Thirty seven fractures were diagnosed during the time survey: 12 in 1991, 13 in 1992 and 12 in 1993. The age-adjusted mean incidence rates of hip fracture for the population over 49 years old was 10.3/10,000: 5.6/10,000 in men and 14.4/10,000 in women. Most fractures occurred in women over the age of 65 years. The ratio of male to female cases was 1:3. The mean age of all patients was 77 +/- 8 years of age: 72 +/- 8 in males and 79 +/- 6 in females (p = 0.05). About 70 percent of these patients were treated surgically. The acute mortality rate was 8 percent and the mean age of the deceased patients, 82 +/- 6, was significantly higher than the mean age of the survivors, 73 +/- 6 (p = 0.01).

[Appropriateness admissions to the Department of Internal Medicine of the Hospital de Santa Luzia (Elvas) evaluated by the AEP (Appropriateness Evaluation Protocol)]. / Adequação dos internamentos num Serviço de Medicina. Aplicação da escala AEP (Appropriateness Evaluation Protocol).

The authors analyse the appropriateness admissions to the Internal Medicine ward of the Hospital de Santa Luzia (Elvas). A retrospective study was performed during 6 months of 2001, using the Appropriateness Evaluation Protocol (AEP). Non-appropriateness admissions were found in 19% (CI95%: 16-22), and this group of patients had less mean age (63 + 16 vs 69 + 16; p <0.01), and less mean days of admission (7.1 + 6 vs 9.3 + 7; p <0.01) than group with appropriateness admissions. Appropriateness admissions were mainly found in patients admitted from the emergency room (86% vs 49%; p <0.001). Most of patients with non-appropriate admissions were admitted to undergo diagnostic tests (44%; CI95%: 35-53), or to be referred to other medical centres for specialized study and/or treatment (12%; CI95%: 6-18).

[Microangiopathic hemolytic anemia associated with neoplasms: an analysis of 5 cases and a review of the literature]. / Anemia hemolítica microangiopática asociada a neoplasias: análisis de cinco casos y revisión de la literatura.

From January of 1990 to June of 1993 a diagnosis of microangiopathic hemolytic anemia (MHA) was made in 5 out off 121 new patients with malignant tumor. There were 3 females and 2 males, with a mean age of 57 yr (range: 43-75), and a primary tumor in stomach (n = 2), pancreas (n = 1) and of unknown origin (n = 2). In all cases histologic type was adenocarcinoma and diagnosis was obtained by marrow examination. Four patients developed a disseminated intravascular coagulation syndrome. Intravascular deposits of fibrin, intimal proliferation and tumoral microembolisms were noted in 2 cases. Patients did not received chemotherapy, and the median survival was 7 days (range: 3-61).