Neurological complications of hematopoietic stem cell transplantation (HSCT): a retrospective study in a HSCT center in Brazil.

We present the neurological complications evaluated in a series of 1000 patients who underwent hematopoietic stem cell transplantation (HSCT). Central nervous system (CNS) neurological complications, particularly brain hemorrhages, were the most common, followed by seizures and CNS infections. An unusual neurological complication was Wernicke's encephalopathy. Less frequent neurological complications were metabolic encephalopathy, neuroleptic malignant syndrome, reversible posterior leukoencephalopathy syndrome, brain infarct and movement disorders. The most common neurological complication of the peripheral nervous system was herpes zoster radiculopathy, while peripheral neuropathies, inflammatory myopathy and myotonia were very rarely found.

Allogeneic bone marrow transplantation for severe aplastic anemia patients with risk factors for poor prognosis: is fludarabine a requirement? / Transplante alogênico de medula óssea em portadores de anemia aplásica severa com fatores de mau prognóstico: é necessário fludarabina?

Hematopoietic progenitor cell transplantation from HLA-identical sibling donors cures 70-90 percent of Severe Aplastic Anemia (sAA) patients. Older age, heavy exposure to transfusions, immunosuppression treatment (IST) with a long interval from diagnosis to transplant and infection at procedure are associated with poor outcomes. We transplanted 18 patients with sAA and at least one risk factor (RF) for poor prognosis (age >35 years, >50 transfusions prior to transplant, unresponsiveness to previous IST and bacterial or fungal infection at transplant) from 2001 to 2005, using cyclophosphamide (CY - 5 patients) or busulfan plus CY (13 patients). Sixteen patients engrafted, two died with no engraftment, three patients had evidence of graft failure at days +67, +524 and +638 (two died and one was rescued with IST). Grade III/IV mucositis occurred in 39 percent but neither aGVHD nor cGVHD were observed. The Kaplan-Meier probability of survival was 75 percent at 2.14 years, with a trend favoring survival by number of RF (1 versus =2 RF) (P = 0.06). These results are comparable to recent data reported with fludarabine-based conditioning in patients with poor prognosis sAA. Due to the small sample size, prospective clinical trials with larger cohorts of patients are needed to confirm the real benefits of fludarabine-based conditioning, and also to define the best agent(s) to be associated with Fludarabine as preparative regimen for sAA patients with poor prognosis.

Transplante de medula óssea de doador irmão HLA-idêntico pode curar 70 por cento-90 por cento dos portadores de anemia aplásica severa (AAs). Pacientes mais idosos, muito transfundidos, longamente tratados com imunossupressão (IS) e com infecções ao tempo do transplante têm pior evolução. Nós transplantamos 18 pacientes com AAs e pelo menos um dos fatores associados a pior prognóstico (idade >35 anos, >50 transfusões antes do transplante, falta de resposta à imunossupressão prévia e infecção bacteriana ou fúngica ao transplante) de 2001 a 2005, com ciclofosfamida (Cy - 5 pacientes) ou bussulfan mais Cy (13 pacientes). Dezesseis pacientes apresentaram pega do enxerto, dois morreram sem pega, três tiveram rejeição aos dias +67, +524 e +638 (dois morreram e um foi resgatado com IS). Mucosite grau III/IV ocorreu em 39 por cento e não observamos DECH aguda ou crônica. A probabilidade de sobrevida pelo método de Kaplan-Meier foi de 75 por cento aos 2,14 anos, e uma tendência a melhor sobrevida foi encontrada entre os portadores de apenas um fator de risco ao transplante (P: .06). Estes resultados são comparáveis a recentes relatos de literatura envolvendo condicionamentos baseados em fludarabina para tratar pacientes com alto risco. Devido à pequena amostra analisada, estudos clínicos prospectivos com maior número de pacientes são necessários, visando comprovar o real benefício dos condicionamentos baseados em fludarabina, definir o melhor agente a ser a ela associado e assim obter o melhor condicionamento para portadores de AAs com fatores de mau prognóstico para o transplante.

Neurological complications of hematopoietic stem cell transplantation (HSCT): a retrospective study in a HSCT center in Brazil / Complicações neurológicas do transplante de células tronco hematopoiéticas (TCTH): estudo retrospectivo em um centro de TCTH no Brasil

We present the neurological complications evaluated in a series of 1000 patients who underwent hematopoietic stem cell transplantation (HSCT). Central nervous system (CNS) neurological complications, particularly brain hemorrhages, were the most common, followed by seizures and CNS infections. An unusual neurological complication was Wernicke's encephalopathy. Less frequent neurological complications were metabolic encephalopathy, neuroleptic malignant syndrome, reversible posterior leukoencephalopathy syndrome, brain infarct and movement disorders. The most common neurological complication of the peripheral nervous system was herpes zoster radiculopathy, while peripheral neuropathies, inflammatory myopathy and myotonia were very rarely found.

Apresentamos as complicações neurológicas avaliadas em uma série de 1000 pacientes submetidos ao transplante de células tronco hematopoiéticas (TCTH). As complicações neurológicas do sistema nervoso central foram as mais encontradas, particularmente as hemorragias encefálicas, seguidas por crises convulsivas e por infecções. Uma complicação peculiar foi a encefalopatia de Wernicke. Menos freqüentemente foram encontrados casos de encefalopatia metabólica, síndrome maligna neuroléptica, leucoencefalopatia posterior reversível, infarto cerebral e os distúrbios do movimento. Entre as complicações neurológicas do sistema nervoso periférico a mais encontrada foi a radiculopatia pelo herpes zoster, enquanto que raramente se observaram casos de polineuropatias periféricas, miopatia inflamatória e de miotonia.

Clinical picture and laboratorial evaluation in human loxoscelism

Loxosceles spiders are found globally, especially in South and North America. In Brazil, approximately 10,000 cases of Loxosceles spp. spider bites are reported annually. Herein weanalyzed 81 patients diagnosed as either cutaneous or cutaneous-hemolytic loxoscelism, in a geographical area where most accidents are caused by Loxosceles gaucho, and wereport their clinical and laboratory data obtained during week 1 and 2 after the bite. Massive hemolysis was noticed in only 2 cases, but high serum bilirubin and LDH levels, suggestive of hemolysis, were noticed in 25 cases on admission. Anemia was not frequent (14.7%), and reticulocytosis was particularly noticed during week 2 (in 56% of patients).High D-dimer levels were suggestive of endothelial cell activation and intravascular thrombin generation, but thrombocytopenia was noticed in only 17.6% of patients in week1. Acute kidney injury (AKI) only occurred in patients with massive hemolysis. The definitive diagnosis of overt disseminated intravascular coagulation (DIC) could not beestablished on admission. Fever was associated with the presence of hemolysis (p » 0.03). Altogether, these findings provide evidence that mild hemolysis is frequent in loxoscelism and suggest that AKI is uncommon, exclusively occurring in patients with massive hemolysis.

Bites by the colubrid snake Philodryas patagoniensis A clinicaland epidemiological study of 297 cases

We retrospectively analyzed 297 proven cases of Philodryas patagoniensis bites admitted to Hospital Vital Brazil (HVB), Butantan Institute, São Paulo, Brazil, between 1959 and 2008.Only cases in which the causative animal was brought and identified were included. Part of the snakes brought by the patients was still preserved in the collection maintained by theLaboratory of Herpetology. Of the 297 cases, in 199 it was possible to describe the gender of the snake, and seventy three (61.3%) of them were female. The length of snakes (snoutventlength) ranged from 160 to 1080 mm. In 117 snakes their state of preservationenabled the dissection and examination of their stomach contents. The stomach wasempty in 106 snakes (89.1%). Most bites occurred in the seasons of spring and summer (n » 196, 66.0%) and during warmer periods of the day. The mean age of the victims was 24.1 15.1 years old and 206 (69.4%) patients were men. Around 92% of the patientssought medical care within 6 h after the bite. Both lower (n » 188, 63.3%) and upper limbs (n » 102, 34.3%) were most frequently bitten, especially the feet and hands (n » 205, 69.0%). The local clinical manifestations were pain (n » 151, 50.8%), transitory bleeding (n » 106, 35.7%), erythema (n » 47, 15.8%) and edema (n » 39, 13.1%). Ecchymosis was not observed. Only 7 (2.4%) patients reported systemic symptoms...

Reversible posterior leucoencephalopathy syndrome associated with bone marrow transplantation

Reversible posterior leucoencephalopathy syndrome (RPLS) has previously been described in patients who have renal insufficiency, eclampsia, hypertensive encephalopathy and patients receiving immunosuppressive therapy. The mechanism by which immunosuppressive agents can cause this syndrome is not clear, but it is probably related with cytotoxic effects of these agents on the vascular endothelium. We report eight patients who received cyclosporine A (CSA) after allogeneic bone marrow transplantation or as treatment for severe aplastic anemia (SSA) who developed posterior leucoencephalopathy. The most common signs and symptoms were seizures and headache. Neurological dysfunction occurred preceded by or concomitant with high blood pressure and some degree of acute renal failure in six patients. Computerized tomography studies showed low-density white matter lesions involving the posterior areas of cerebral hemispheres. Symptoms and neuroimaging abnormalities were reversible and improvement occurred in all patients when given lower doses of CSA or when the drug was withdrawn. RPLS may be considered an expression of CSA neurotoxicity

Alergia ocupacional causada pelo veneno de serpente Bothrops jararaca em biológos / Occupational allergy in biologist caused by the Bothrops jararaca sanke venom

Objetivo: Revisar a literatura para investigar a associação entre o uso dos esteróides inalados e a presença da doença periodontal. Fontes dos dados: Foi realizada uma revisão consultando a base de dados do Medline acessando o Pubmed; foram também consultadas as fontes de dados 880, Lilacs e Scielo, com as palavras-chaves: periodontal disease (gingivitis and periodontitis) - asthma - inhaled steroids. Síntese dos dados: Os esteróides inalados se constituem na medicação de primeira escolha para o tratamento da asma persistente, sendo bem documentado os efeitos adversos na cavidade bucal, como disfagia, faringite e candidíase. Existem alguns dados sobre os possíveis efeitos deletérios que os este¬róides inalados possam causar nos dentes e gengiva, como exacerbação da inflamação gengiva I, perda de inserção clínica periodontal e perda das unidades dentárias. Conclusão: Parece haver uma associação positiva entre o uso de esteróides inalados e alterações periodontais.

Objective: Review the literature to investigate the association between the use of inhaled steroids and the presence of periodontal disease. Source of data: Literature review was carried out in Medline, Lilacs, Scielo and BBO by Pubmed, using the key-words: periodontal disease (gingivitis and periodontitis) - asthma - inhaled steroids. Syntheses of data: Inhaled steroids are the main drug in the treatment of persistent asthma. Adverse side effects in the oral cavity are well documented, such as dysphagia, pharyngitis and candidiasis. There are some data on possible negative effects steroids cause to teeth and gums, like gingival inflammation, lack of clinical attachment and loss of teeth. Conclusion: The review suggests there is a positive association between the use of inhaled steroids and periodontal alterations.

Linfoma primário de mama: relato de caso / Primary brast lymphoma: case report

Os linfomas primários da mama säo neoplasias incomuns (0.04 por cento a 0.74 por cento dos tumores mamários), originárias do tecido linfóide periductal e perilobular da mama e, eventualmente, relacionadas com o tecido linfóide associado às mucosas. Suas manifestaçöes clínicas säo indistinguíveis das de outros tumores da mama e mesmo sofisticados métodos de imagem näo permitem seu disgnóstico definitivo. A histologia, associada ou näo à imunohistoquímica, é fundamental para o diagnóstico desses tumores, em sua maioria imunofenotipicamente de linhagem B. A sua raridade ainda näo permitiu a padronizaçäo da terapêutica mais apropriada, mas acredita-se que a quimioterapia seguida de radioterapia da área envolvida säo necessárias, enquanto a cirurgia radical deve ser abandonada. A sobrevida está diretamente relacionada ao estadiamento e ao número de fatores de risco. Cerca de 75 por cento dos pacientes tratados em estágios iniciais da doença estäo vivos apó 5 anos, enquanto menos de 50 por cento dos tratados com doenç mais avançada se encontram vivos após o mesmo período.

Esplenectomia no tratamento da purpura trombocitopenica imune / Splenectomy for immune thrombocytopenic purpura

Setenta e quatro pacientes com purpura trombocitopenica imune foram submetidos a esplenectomia. Todos os pacientes tinham sido previamente tratados com corticoide. Apos a esplenectomia, 56 pacientes (76%) apresentaram contagem de plaquetas constantemente acima de 150.000 ul (remissao completa)oito (11%) entre 50.000-150.000 ul (remissao parcial) e 10 (13%) abaixo de50.000 ul (insucesso). A remissao completa foi mais frequente nos pacientes queapresentavam contagem de plaquetas acima de 50.000 ul durante a administracaopre-operatoria de corticoide. Nao houve diferenca significante entre os diversosgrupos etarios com relaçao a remissao completa.