Paulo Roberto Savassi Rocha

Modified therapy with 5-fluorouracil, doxorubicin, and methotrexate in advanced gastric cancer

Background. In an attempt to decrease the toxic effects of fluorouracil, doxorubicin, and methotrexate (FAMTX) by reducing the dose of methotrexate from 1500 mg/m2, according to the original regimen, to 1000 mg/m2, the authors designed the modified FAMTX treatment that was evaluated in a prospective Phase II‐III randomized trial.

Calcium Metabolism in Pre- and Postmenopausal Morbidly Obese Women at Baseline and After Laparoscopic Roux-En-Y Gastric Bypass

Background: The authors evaluated calcium metabolism in obese women, before and after menopause, at baseline and at 6 and 12 months after laparoscopic Roux-en-Y gastric bypass (LRYGBP). LRYGBP restricts food intake and produces physiological changes that may be similar to those after high Billroth II subtotal gastrectomy. Methods: Serum calcium (Ca), phosphate, bone-specific alkaline phosphatase (BSAP) and 25-hydroxyvitamin D3 (25-OH D) were measured at baseline and 12 months after LRYGBP. Urinary N-telopeptide (u-NTX) was measured at baseline and serum C-telopeptide (s-CTX) at 6 and 12 months after LRYGBP. Parathormone (PTH) was measured at baseline and 6 and 12 months after LRYGBP. Patients were divided into 2 groups: Group I (n=30) pre-menopausal women aged 18-42 y, and Group II (n=30) post-menopausal women aged 40-71 y. Patients with renal, hepatic, metabolic and bone disease, smoking women, as well as patients with u-NTX values at baseline >67 nMBCE/mMCr were excluded. Results: At baseline, PTH was elevated in 10% of patients in each group, correlated positively with BMI, and low serum calcium values were found in 30% of Group I and 16.7% of Group II. High values of serum C-telopetide were seen in Group I at 6 months after surgery and in Group II 12 months after LRYGBP. Group II showed a greater increase in BSAP at 12 months after LRYGBP. 25-0H D decreased in both groups, and a progressive increase in PTH was observed. Serum calcium did not change in both groups. Conclusion: Calcium metabolism is altered in pre- and post-menopausal women following LRYGBP. Calcium and vitamin D supplementation is strongly advised in all patients.

Vasculite cerebral e uso de cocaína e crack

Cocaine and crack abuse is strongly related to stroke, particularly in young patients. The present study reports the case of a cocaine and crack abuser who developed central nervous system vasculitis, resulting in extensive cerebral infarctions, leading to dementia, behavioural disturbances and seizures. The relevance of detecting drug abuse in young stroke patients is stressed. Assessing possible brain lesions in drug abusers with cognitive impairment is also important.

Cervical Lymph Node Dissection in Papillary Thyroid Cancer: Pattern and Predictive Factors of Regional Lymph Node Metastas

Background: Papillary thyroid carcinoma (PTC) exhibits a high index of cervical lymphatic dissemination. Methods: Retrospective study of 101 cases of PTC subjected to total thyroidectomy associated with cervical lymph node dissection. Results: The incidence of neck metastasis was 50.5%, and all the metastases wereipsilateral to the primary tumor. Although the participants with metastases (N+) hadmore dissected lymph nodes than the group without metastases (p = 0.01), the lymphnode size was not a determinant of malignancy (p=0.34). Uni and multivariate analyses showed tumor size ≥ 1.0 cm, angiolymphatic invasion, and multicentric diseases were associated with lymphatic dissemination (p < 0.05). Conclusions: Factors predictive of cervical lymph node metastasis were tumor size ≥ 1.0cm, multicentric disease and angiolymphatic invasion. All the metastases wereipsilateral to the primary tumor. Lymph node size was not a reliable predictor of thepresence or absence of metastasis.

Evidências de hiperfluxo portal no pós-operatório de transplantes hepáticos

OBJECTIVE: A marked impact on the splanchnic circulation is seen in liver cirrhosis. Doppler ultrasonography (DUS) was performed in a group of patients with end-stage liver cirrhosis before, during and after orthotopic liver transplantation (OLT) in order to investigate the hemodynamic changes in portal vein flow velocity. MATERIALS AND METHODS: Fifty-four patients submitted to OLT and intraoperative DUS were prospectively studied from January 2002 to July 2003. Seventeen patients were excluded because of missing data due to either technical difficulties to obtain the measurements or early patient death. All 37 patients included in the analysis had liver cirrhosis mainly associated with hepatitis C virus infection and alcoholic disease. Patients were submitted to DUS just before OLT, intraoperatively after graft reperfusion, and in the postoperative period (1st and 7th postoperative days). Mean flow velocity was measured at main, right and left portal veins. Statistical analysis was performed using paired t test. Differences were significant when p < 0.05. RESULTS: The mean pre-OLT velocity in the portal vein was 16.0 cm/s. Intraoperative measurements obtained few minutes after graft reperfusion showed an increase in portal vein velocity to 84.09 cm/s. Portal flow velocity was 71.0 cm/s and 58.5 cm/s in the 1st and 7th postoperative days, respectively. Intraoperative and postoperative mean flow velocity in the portal vein was significantly higher than in pre-OLT period (p < 0.001). On the 7th postoperative day, the mean flow velocity in the portal vein decreased significantly compared to intraoperative values (p < 0.05). CONCLUSION: In liver transplantation, there is a significantly increase in mean flow velocity in the portal vein immediately after graft reperfusion when compared to pre-OLT data. Likewise, after this initial peak flow there is a significant and progressive decrease in mean flow velocity in the portal vein, which tends to normalize on the 7th postoperative day.

Tolerance of early oral feeding in patients subjected to total laryngectomy

The purpose of this study was to assess the tolerance of early oral feeding after total laryngectomy.

The impact of clinical comorbidities and residual depressive symptoms in sleep quality in euthymic/interepisodic bipolar subjects

Sleep disturbances are feasibly linked with poorer outcome in BD. This study aims to cross-sectionally investigate clinical factors associated with sleep disruption in euthymic BD patients. We assessed sleep quality in a sample of 209 euthymic BD patients with the Pittsburgh Sleep Quality Index. After multiple logistic regression analysis controlling for several confounding factors, the variables number of clinical diseases and Hamilton global score remained significant and independently associated with poor sleep quality. Our results suggest that euthymic BD patients presenting poor sleep quality are more likely to have clinical comorbidities and manifest subsyndromal depressive symptomatology.