Coronary heart disease risk assessment in HIV‐infected patients: a comparison of Framingham,PROCAM and SCORE risk assessment functions

Objectives: The aim of this was to compare the performance of the Framingham, Systematic Coronary Risk Evaluation (SCORE) and Prospective Cardiovascular Munster (PROCAM) scoring systems in the risk assessment of HIV‐infected patients with no overt vascular disease. Methods: A cross‐sectional study of 220 HIV‐infected patients was conducted at the outpatient clinic of a referral and training centre in infectious and parasitic diseases in Belo Horizonte, Brazil. The Framingham, SCORE and PROCAM equations were calculated. Patients were classified as having low, moderate or high risk, which according to the Framingham and PROCAM equations corresponded to < 10%, 10–20% and > 20% respectively, and according to SCORE corresponded to < 3%, 3–4% and ≥5% respectively. Cohen’s kappa coefficient was used to assess agreement between the methods. Results: Of a total of 220 HIV‐infected patients, 56 were antiretroviral (ARV)‐naïve while 164 had already been treated with ARV. The prevalence of patients with a high 10‐year cardiovascular risk was 3.7%, 2.5% and 1.9% according to the Framingham, PROCAM and SCORE equations respectively. The degree of agreement was moderate between the Framingham and PROCAM risk estimates (kappa = 0.433; p < 0.001), poor‐to‐fair between the Framingham and SCORE estimates (kappa = 0.220; p < 0.001) and moderate between the PROCAM and SCORE systems (kappa = 0.478; p < 0.001). Conclusions: There are differences in risk assessment and in the identification of high risk individuals between the three risk functions under evaluation and only a prospective study will be capable of assessing which offers the best current sensitivity, specificity and predictive values for the population under investigation.     

Chronic Portal Vein Thrombosis After Liver Transplantation in a Child Treated by a Combined Minimally Invasive Approach

Portal vein thrombosis (PVT) after orthotopic liver transplantation is an infrequent complication, and when it is present surgical treatment is considered for traditional management. Percutaneous transhepatic portal vein angioplasty has been described as an option to treat PVT with a lower morbidity than conventional surgical treatments. This article describes a case of chronic PVT in a child after a living donor liver transplantation managed by percutaneous transhepatic and surgical approaches.     

Ciprofloxacin sensitizes hormone-refractory prostate cancer cell lines to doxorubicin and docetaxel treatment on a schedule-dependent manner

Purpose  Combination therapy has generated a significant interest in the clinical setting since certain agents, with known mechanisms of action and non-overlapping toxicities may increase the therapeutic potential of anticancer drugs by decreasing systemic toxicity and overcoming drug resistance. Doxorubicin and docetaxel, two standard antineoplastic agents in hormone-refractory prostate cancer (HRPC) therapy and ciprofloxacin were evaluated singly and in several simultaneous and sequential drug combination schemes, against PC-3 and LNCaP cell lines. Methods  Cellular viability was determined by the resazurin assay and the assessment of synergism, additivity or antagonism was carried out by the median effect analysis. The importance of dose, exposure time and type of administration were investigated and compared. Results  Ciprofloxacin–doxorubicin or docetaxel combinations resulted in prominent additive or synergistic effects in both cell lines, when the cells were pre-treated with ciprofloxacin. These results suggest a rationale for dose reduction of doxorubicin and docetaxel in prostate cancer therapy, since the doses needed to achieve 50% cell death may be decreased by approximately 4- to 15-fold or 3- to 8-fold, respectively, after a pre-treatment with ciprofloxacin. In contrast, the referred combinations yielded moderate antagonistic effects when used concurrently in this in vitro system. Conclusions  Ciprofloxacin sensitized HRPC cells to doxorubicin or docetaxel-induced growth inhibition and, therefore, may play a role as chemosensitizing agent in prostate cancer treatment.     

Case report: intra-partum utero-ovarian vessels rupture

Case  We report the rare case of a 39-year-old woman who had an intra-partum hemoperitoneum that resulted from spontaneous rupture of the utero-ovarian vessels. During the expulsive efforts, the patient repeatedly complained of bilateral shoulder discomfort and some respiratory difficulty. Because she had hemodynamic instability and an abdomino-pelvic ultrasound revealed the presence of extensive free fluid within the peritoneal cavity, the patient underwent an exploratory laparotomy. The surgery revealed an extensive laceration of the anterior leaf of the left broad ligament and vesico-uterine peritoneum, and active bleeding from the utero-ovarian vessels with no evidence of uterine rupture. Conclusion  Intra-partum haemoperitoneum resulting from rupture of the utero-ovarian vessels is a rare obstetrical emergency that needs rapid resuscitation with fluid and/or blood replacement and prompt surgical intervention.