Antineutrophil cytoplasmic antibody (Anca)-associated autoimmune disease induced by propylthiouracil

Antithyroid drugs sometimes cause severe complications. Propylthiouracil (PTU) can be associated to ANCA positive vasculitis, most often related to myeloperoxidase subtype (ANCA-MPO). Our objective is to describe a female patient with Graves' disease, who developed PTU induced-autoimmune disease, with cutaneous, pulmonary, and renal lesions, associated with ANCA. Histopathological examination revealed diffuse pulmonary hemorrhage, and focal segmental glomerulosclerosis at the kidney biopsy. She was treated with systemic corticosteroid therapy and cyclophosphamide, with clinical improvement. This case highlights the need for greater awareness of this relatively rare adverse effect of propylthiouracil.     

Implications of a Postoperative Rehabilitation Program on Quality of Life in Women with Primary Breast Cancer Treated with Sentinel Lymph Node Biopsy or Complete Axillary Lymph Node Dissection

Background  The aim of this clinical study was to evaluate quality of life (QoL) in early-stage breast cancer patients and to investigate the effects of a comprehensive rehabilitation program comparing women undergoing sentinel node biopsy (SNB) versus complete axillary lymph node dissection (ALND). QoL was assessed with the Functional Assessment of Cancer Therapy—General and Functional Assessment of Cancer Therapy—Breast (FACT-B) questionnaire. Methods  Eighty-nine women with histologically confirmed primary breast cancer stages I–II were enrolled. Recruitment began on May 2006 and ended on December 2007. According to current standards of care, 58 women were found clinically fit to undergo SNB, and the other 31 were elected for ALND. Thirty women who underwent SNB were randomly allocated to participate in a comprehensive postoperative rehabilitation program, and the 28 remaining were dismissed and scheduled to return for clinical follow-up. Results  Women undergoing ALND had a better QoL within 30 days of surgery on the FACT-B, FACT-G, Trial Outcome Index (TOI), emotional well-being (EWB), and breast concern subscale (BCS) (P < .005) and at 6 months after surgery on the EWB subscale only. Women undergoing SNB had a significant improvement in QoL only on the EWB subscale 6 months after surgery in the group with rehabilitation and 30 days after surgery in the group without rehabilitation. Conclusion  Women undergoing ALND benefited from a rehabilitation program and had a better QoL. Women undergoing BLS, regardless of rehabilitation, showed improvement in QoL for the emotional well-being subscale only.     

Translation and adaptation of the In-Hospital Utstein style into the Portuguese language

Cardiopulmonary arrest (CPA) is a potentially lethal event in which the quality of the service depends on agility, knowledge and the skills of all of the involved team. The development of the guide identifying the significant points during the procedure of an in-hospital CPA appeared in 1997, with the creation of the In-Hospital Utstein. The purpose of this study was the translation and adaptation of the procedures into the Portuguese language. Outcomes of this process resulted in a pre-test instrument administered on 20 CPA patients. The outcome variables were not collected, because it involved accompanying these patients over a lengthy period of time. The most common CPA rhythm was pulseless electrical activity (65%); the defibrillation average time was 1.25 minutes. Some information was not recorded. In conclusion, the instrument is adaptable to the Brazilian reality, therefore improving care administered during the CPA event.     

Functional Outcome after Operative Treatment of Displaced Fractures of the Acetabulum: A 12-month to 5-year Follow-up Investigation

Abstract Purpose:  To review our experience with 82 surgically treated displaced acetabular fractures over a 4-year period. Patients and Methods:  Ninety-three consecutive displaced acetabular fractures were consecutively operated on at Level I Trauma Center from January 1, 2000 through December 31, 2003, and 82 were available for review with a minimum of 12-month follow-up. Clinical (Merle D'Aubigné modified by Matta et al.) and radiographic (Matta) outcomes were evaluated. Complications and secondary operative procedures were documented. Results:  Anatomical reduction was achieved in 89% of the patients. At follow-up examination 12–60 months postoperatively (mean 32 months), clinical results were satisfactory in 65 patients (79.2% of the cases), with 14 excellent and 51 good results, and roentgenographic results were satisfactory in 70 patients (85.4% of the cases). Complications included a 12.2% incidence of sciatic nerve palsy (10 patients, two postoperative and eight posttraumatic), a 2.4% incidence of intraoperative vascular lesion (one external iliac artery and one external iliac vein), a 1.2% incidence of postoperative loss of reduction, a 1.2% incidence of infection, a 1.2% incidence of Brooker et al. class IV heterotopic ossification, a 2.4% incidence of posttraumatic osteoarthritis, and a 2.4% incidence of osteonecrosis of the femoral head. Conclusions:  Operative treatment is an effective method for the management of displaced acetabular fractures. Clinical and roentgenographic results correlate closely with an anatomic reduction. Low complication rate can be expected if adequate preoperative assessment and planning is performed. Strategies to minimize the risk of thromboembolism and heterotopic ossification on the basis of mechanical pneumatic compression and antiinflammatory nonsteroidal drugs, respectively, are reliable techniques for these injuries.     

Retrograde percutaneous enterostomies in children using a needle system with valve mechanism

The technique of enterostomy access frequently uses a needle preloaded with a suture anchor to appose the bowel wall to the abdominal wall. Two of the intrinsic disadvantages of this method are the possible dislodgment of the suture anchor out of the needle hub during the process of guide-wire insertion and the escape of air with subsequent deflation of the viscus, which may necessitate a second puncture. The use of a Check-Flo performer assembly with a valve mechanism provides a leakproof system. It avoids possible dislodgment of the suture anchor during deployment, maintains viscus distension, and may be useful for trainees to do the procedure in a controlled manner.     

Potential management of resistant microbial infections with a novel non-antibiotic: the anti-inflammatory drug diclofenac sodium

Diclofenac sodium (Dc), an anti-inflammatory agent, has remarkable inhibitory action both against drug-sensitive and drug-resistant clinical isolates of various Gram-positive and Gram-negative bacteria. The aim of this study was to determine the ability of Dc to protect mice from a virulent Salmonella infection. Dc injected at 1.5 microg/g and 3.0 microg/g mouse body weight significantly protected animals from the lethality of Salmonella infection. As was the case for the in vitro interaction, Dc in combination with streptomycin was even more effective. The non-antibiotic drug Dc has potential for the management of problematic antibiotic-resistant bacterial infections.     

Prolonged exposure of methicillin-resistant Staphylococcus aureus (MRSA) COL strain to increasing concentrations of oxacillin results in a multidrug-resistant phenotype

Our previous studies demonstrated that exposure of a bacterium to increasing concentrations of an antibiotic would increase resistance to that antibiotic as a consequence of activating efflux pumps. This study utilises the same approach; however, it employs the methicillin-resistant Staphylococcus aureus (MRSA) COL strain, which is highly resistant to oxacillin (OXA). MRSA COL was adapted to 3200 mg/L of OXA. Changes in resistance to other antibiotics were evaluated and efflux pump activity during the adaptation process was determined. MRSA COL was exposed to stepwise two-fold increases of OXA. At the end of each step, minimum inhibitory concentration determination for erythromycin (ERY) and other antibiotics was conducted. Reserpine (RES) was employed to evaluate whether resistance to ERY was dependent on efflux pump activity. Efflux pump activity was also evaluated using the ethidium bromide (EB) assay. DNA typing of the products of each culture step was conducted to assess purity. Serial exposure of MRSA COL to increasing concentrations of OXA resulted in increased resistance to ERY, which could be eliminated with RES. Evaluation of efflux pump activity by the EB method indicated increased efflux activity. Resistance to ERY was accompanied by resistance to kanamycin, amikacin, ofloxacin, norfloxacin, ciprofloxacin and rifampicin. This is the first time that a multidrug-resistant phenotype has been experimentally produced as a consequence of exposure of the organism to an antibiotic to which it is initially highly resistant.     

Effect of thalidomide and pentoxifylline on experimental autoimmune encephalomyelitis (EAE)

Background

Autoimmune encephalomyelitis (EAE) in Lewis rats is a classical experimental model of demyelinating inflammatory disease of the central nervous system. EAE is widely accepted for study of immune-inflammatory mechanisms in the CNS related to multiple sclerosis (MS) due to similar clinical evolution.

Objectives

In the present study we investigated the effects of Thalidomide and pentoxifylline during EAE development in Lewis rats.

Methods

EAE was induced in Lewis rats and treatment with Thalidomide or pentoxifylline was performed. Clinical evaluation was carried out daily. Histopathological analysis of the brain tissue and spinal cord was performed. Griess method was used for determination of NO serum levels. TNF-alpha and IFN-gamma serum levels were investigated using ELISA method.

Results

Thalidomide and pentoxifylline treatment is associated with significant reduction of neuroinflammation in CNS. Serum levels of NO, IFN-gamma and TNF-alpha showed a marked reduction. Such findings were correlated with improvement of clinical symptoms, particularly in thalidomide treated rats.

Conclusions

Taken together the data suggested that thalidomide and pentoxifylline may be therapeutic options for the treatment of MS, however further experiments must be performed to investigate this hypothesis.     

Intrinsic connections of the macaque monkey hippocampal formation: I. Dentate gyrus

We have carried out a detailed analysis of the intrinsic connectivity of the Macaca fascicularis monkey hippocampal formation. Here we report findings on the topographical organization of the major connections of the dentate gyrus. Localized anterograde tracer injections were made at various rostrocaudal levels of the dentate gyrus, and we investigated the three-dimensional organization of the mossy fibers, the associational projection, and the local projections. The mossy fibers travel throughout the transverse extent of CA3 at the level of the cells of origin. Once the mossy fibers reach the distal portion of CA3, they change course and travel for 3-5 mm rostrally. The associational projection, originating from cells in the polymorphic layer, terminates in the inner one-third of the molecular layer. The associational projection, though modest at the level of origin, travels both rostrally and caudally from the injection site for as much as 80% of the rostrocaudal extent of the dentate gyrus. The caudally directed projection is typically more extensive and denser than the rostrally directed projection. Cells in the polymorphic layer originate local projections that terminate in the outer two-thirds of the molecular layer. These projections are densest at the level of the cells of origin but also extend several millimeters rostrocaudally. Overall, the topographic organization of the intrinsic connections of the monkey dentate gyrus is largely similar to that of the rat. Such extensive longitudinal connections have the potential for integrating information across much of the rostrocaudal extent of the dentate gyrus.