Abstract A 40-year-old woman was scheduled to receive chemotherapy for a high-risk common B-cell acute lymphoblastic leukemia (ALL), diagnosed 10 months earlier in the wake of lower limb bruising and petechiae, and metrorrhagia. At that time, she had thrombocytopenia and a normal transvaginal gynecological ultrasound. Upon admission, she complained of a 3-month history of incapacitating left groin pain radiated to the thigh, and right lower quadrant abdominal pain associated with diarrhea. On physical examination, she had tenderness in the right iliac fossa and a positive psoas sign on the left. Computerized scan of the abdomen and pelvis reported an image compatible with a left psoas abscess and signs of typhlitis. The biopsy of the left psoas muscle demonstrated infiltration by nests and cords of moderately differentiated keratinizing squamous carcinoma. Gynecological examination revealed macroscopic abnormalities of the cervix correlated with the same histopathological diagnosis. The second primary cancers most frequently associated with ALL are Hodgkin lymphoma, squamous skin cancer, endocrine tumors, kidney cancer, non-Hodgkin lymphoma, and breast cancer. Muscle metastases from solid tumors are rare, and usually arise from the lung, kidney, thyroid, and melanoma. Malignant psoas syndrome is caused by neoplastic infiltration of the muscle. The differential diagnosis should be made with a psoas abscess, which may arise from typhlitis if secondary. We have not been able to find records of cervical cancer as second primary cancer after ALL.

Resumen Una mujer de 40 años se internó de forma programada para recibir quimioterapia por una leucemia linfoblástica aguda (LLA) B común de alto riesgo, diagnosticada 10 meses antes a raíz de hemato mas y petequias en los miembros inferiores, y metrorragia. En ese momento, presentaba trombocitopenia y una ecografía ginecológica transvaginal normal. Al ingreso de la internación programada, se quejó de dolor inguinal izquierdo con irradiación al muslo e impotencia funcional de 3 meses de evolución, dolor en fosa ilíaca derecha y diarrea. En el examen físico tenía dolor a la palpación profunda en la fosa ilíaca derecha y signo del psoas positivo a la izquierda. La tomografía de abdomen y pelvis reveló una imagen compatible con un absceso del psoas izquierdo y signos de tiflitis. La biopsia del psoas izquierdo demostró infiltración por nidos y cordones de carcinoma escamoso queratinizante moderadamente diferenciado. El examen ginecológico dirigido evidenció anomalías macroscópicas del cuello uterino correlacionadas con el mismo diagnóstico histopatológico. Los se gundos cánceres primarios más frecuentemente asociados a LLA son linfoma de Hodgkin, cáncer escamoso de piel, tumores endocrinos, cáncer renal, linfoma no-Hodgkin y cáncer de mama. Las metástasis musculares de tumores sólidos son infrecuentes, y habitualmente provienen del pulmón, riñón, tiroides y melanoma. El síndrome del psoas maligno es causado por infiltración neoplásica del músculo. El diagnóstico diferencial debe realizarse con el absceso del psoas, que puede originarse en una tiflitis si es secundario. No hemos podido encontrar registros de cáncer de cuello uterino como segundo cáncer primario luego de LLA.

The Piper species chemistry has been widely investigated and the phytochemical analyses have led to the isolation of a number of active compounds like alkaloids, terpenes and flavones among others. The aim of this study was to evaluate the leishmanicidal activity of 2-[1-hydroxy-3-phenyl-(Z,2E)-2-propenylidene]-4-methyl-4-cyclopentene-1,3-dione (DCPC), a cyclopentenedione derivative isolated from the roots of Piper carniconnectivum C. DC., Piperaceae. Leishmanicidal activity against Leishmania amazonensis promastigotes was assessed, and the risk to host cell was assessed by measuring the cytotoxicity to peritoneal macrophages from BALB/c mice in vitro. L. amazonensis promastigotes and host macrophages were cultured in the presence of 100, 50, 25, 12.5 and 6 µg/mL of the cyclopentenedione derivative for up to 96 h. At the end of this period, the inhibitory concentrations (IC50) were compared with those from untreated cultures. The IC50 for promastigotes was 4.4 µg/mL after 96 h of treatment with the derivative. The 50% cytotoxic concentration (CC50) against murine peritoneal macrophages was 129 µg/mL. These results indicate that DCPC is a promising molecule for the development of leishmanicidal drugs.

As porcelanas aluminosas são utilizadas como materiais de isoladores elétricos de alta tensão. Este tipo de porcelana se caracteriza por apresentar excelentes propriedades físicas, mecânicas e elétricas. As porcelanas aluminosas são fabricadas usando-se formulação de massa do tipo composta contendo caulim, argila plástica, feldspato e alumina. Na literatura é encontrada uma larga faixa de composições para essas porcelanas. Por outro lado, o setor de rochas ornamentais gera enormes quantidades de resíduos sólidos ricos em compostos fundentes, que podem ser usados como matéria-prima alternativa na fabricação de porcelanas. Neste trabalho foi estudada porcelana elétrica aluminosa incorporada com até 35 % em peso de resíduo de rocha ornamental em substituição do feldspato sódico, que é uma matéria-prima natural. As massas cerâmicas foram preparadas pelo processo via seca. Peças de porcelanas aluminosa em forma de disco foram preparadas por prensagem uniaxial a 50 MPa. As amostras foram sinterizadas em forno tubular a 1350 ºC por 1h. As seguintes propriedades tecnológicas foram avaliadas: retração linear, absorção de água, massa específica aparente, porosidade aparente, resistência à compressão e resistividade elétrica. A microestrutura sinterizada foi acompanhada por microscopia eletrônica de varredura e difração de raios X. Os resultados experimentais mostram que o resíduo de rocha ornamental pode substituir em até 10 % em peso o feldspato sódico na formulação de porcelana aluminosa. A microestrutura sinterizada foi fortemente influenciada pela adição do resíduo de rocha ornamental.

Aluminous porcelains are used as materials for high voltage electrical insulation. This type of porcelain is characterized by their excellent physical, mechanical and electrical properties. Aluminous porcelains are manufactured using compound body formulation containing kaolin, plastic clay, feldspar and alumina. A wide range of compositions is found in the literature for these porcelains. On the other hand, the ornamental rock sector generates huge amounts of solid wastes rich in flux materials, which can be used as an alternative raw material in the manufacture of porcelains. The present work studied aluminous electrical porcelain with up to 35 wt.% of ornamental rock waste in replacement of sodium feldspar, which is a natural raw material. The ceramic pastes were prepared by the dry process. Pieces of disc-shaped aluminous porcelain were prepared by uniaxial pressing with 50 MPa. The samples were sintered in a tubular furnace at 1350 °C for 1h. The following technological properties were evaluated: linear shrinkage, water absorption, bulk density, apparent porosity, compressive strength and electrical resistivity. The sintered microstructure was analyzed by scanning electron microscopy and X-ray diffraction. Experimental results show that ornamental rock waste can replace up to 10 % of sodium feldspar in the formulation of aluminous porcelain. The sintered microstructure was strongly influenced by the addition of ornamental rock waste.

O presente estudo investigou a etiologia da erliquiose monocítica canina em 70 cães atendidos no Hospital Veterinário da Universidade Estadual Paulista, na cidade de Botucatu, durante 2001 e 2002. Os cães foram avaliados segundo achados clínicos, epidemiológicos e laboratoriais e pela amplificação parcial e sequenciamento do gene dsb de Ehrlichia. DNA de Ehrlichia canis foi amplificado e sequenciado em 28 (40,0%) cães. Observou-se maior frequência deanimais positivos com idade até 12 meses (P < 0,05). Diarreia, apatia e anorexia foram os sinais clínicos mais frequentes observados em 55,2% (P = 0,05), 47,0% (P > 0,05) e 42,2% (P > 0,05) dos cães PCR positivos, respectivamente. Vinte e cinco cães com anemia (<5,5 × 10(6) eritrócitos.µL-1) e 8 com leucopenia (<5,5 × 10³ leucócitos.µL-1) foram positivos na PCR, porém não apresentaram associação estatística (P > 0,05) frente à infecção por E. canis. Todos os 28 cães positivos na PCR apresentaram trombocitopenia (<175 × 10³ plaquetas.µL-1; P < 0,05). E. canis foi a única espécie de Ehrlichia detectada em cães da região estudada, com alta taxa de infecção em cães jovens e, estatisticamente, associadaa cães trombocitopênicos.

This study investigated the etiology of canine ehrlichiosis and possible clinical and epidemiological data associated with the infection in 70 dogs suspect of ehrlichiosis attended at the Veterinary Hospital of the São Paulo State University in Botucatu city during 2001 and 2002. Dogs were evaluated by clinical-epidemiological and hematological data and molecular analysis by partial amplification and DNA sequencing of the ehrlichial dsb gene. E. canis DNA was amplified and sequenced in 28 (40.0%) dogs. Dogs younger than 12 months old showed significantly higher infection rates (65.0%; P < 0.05). Diarrhea, apathy, and anorexia were the major clinical signs observed in 55.2% (P = 0.05), 47.0% (P > 0.05), and 42.4% (P > 0.05) of the PCR-positive dogs, respectively. Twenty-five anemic (<5.5 × 10(6) RBC.µL-1), and 8 leukopenic (<5.5 × 10³ WBC.µL-1) dogs were PCR-positive (P > 0.05). All 28 PCR-positive dogs showed thrombocytopenia (<175 × 10³ platelets.µL-1) and revealed statistical significance (P < 0.05). E. canis was the only Ehrlichia species found in dogs in the studied region, with higher infection rates in younger dogs, and statisticallyassociated with thrombocytopenia.

Mice genetically selected for high (H) and low (L) antibody production (Selection IV-A) were used as murine experimental model. The aim of the present work was to evaluate the macrophagic activity and to characterize the immune response in Mycobacterium bovis-AN5 infected mice (3X10(7) bacteria). The response profile previously observed in such strains was not similar to that obtained during M. bovis infection; however, it corroborated works carried out using Selection I, which is very similar to Selection IV-A regarding infection by M. tuberculosis and Bacillus Calmette-Guérin (BCG). Considering bacterial recovery, L IV-A mice showed higher control of the infectious process in the lungs than in the spleen, whereas H IV-A mice presented more resistance in the spleen. With respect to macrophagic activity, hydrogen peroxide (H2O2) was probably not involved in the infection control since there was an inhibition in the production of this metabolite. Nitric oxide (NO) and TNF-alpha production seemed to be important in the control of bacterial replication and varied according to the strain, period and organ. Evaluation of the antibody production indicated that the multi-specific effect commonly observed in these strains was not the same in the response to M. bovis. Antibody concentrations were higher in L IV-A than in H IV-A mice at the beginning of the infection, being similar afterwards. Such data were compared with delayed-type hypersensitivity (DTH), which was more intense in H IV-A than in L IV-A mice, indicating that antibody production is independent of the capability to trigger DTH reactions and that cellular and humoral responses to M. bovis antigens show a polygenic control and an independent quantitative genetic regulation. Differences were observed among organs and metabolites, suggesting that different mechanisms play an important role in this infection in natural heterogeneous populations, indicating that NO, TNF-alpha and Th1 cytokines are involved in the infection control.

OBJETIVO: Avaliar a morbimortalidade de homens e mulheres submetidos à cirurgia de revascularização miocárdica isolada e os fatores relacionados às diferenças eventualmente encontradas. MÉTODOS: Análise comparativa de 2032 pacientes, 1402 (69%) homens e 630 (31%) mulheres submetidos consecutivamente à cirurgia, de janeiro 1999 a dezembro 2002. RESULTADOS: As mulheres apresentaram idade média mais elevada, maior número de fatores de risco e taxas de angina instável. Enxertos com artéria torácica interna foram mais freqüentemente usados nos homens, 85,6% vs. 78,3%, p<0,001. Não houve diferenças nas taxas de complicações pós operatórias, exceto as infecções, mais freqüentes nas mulheres. A mortalidade hospitalar foi de 4,1% e 6,3%, para homens e mulheres respectivamente, p=0,026. Na análise multivariada o sexo feminino não foi identificado como fator prognóstico independente para óbito, assim como o uso de enxertos com artéria torácica não foi também isoladamente identificado como fator protetor, porém a interação sexo-artéria torácica interna foi significativa; foram ainda selecionados, idade (OR 1,03; [IC] 95% 1,01 a 1,06; p=0,004), insuficiência renal no pré-operatório (OR 1.82; [IC] 95% 1,07 a 3,11; p=0,028) e cirurgia de urgência/emergência (OR 2,85; [IC] 95% 1,32 a 6,14; p=0,008). CONCLUSÃO: O sexo feminino apresentou maior mortalidade operatória porém não se mostrou fator prognóstico independente para óbito; o uso de enxertos com artéria torácica mostrou-se protetor; pacientes mais idosos, com insuficiência renal e em situação emergencial apresentaram maiores índices de óbito hospitalar.

OBJECTIVE: To assess morbidity and mortality in men and women undergoing isolated myocardial revascularization and to analyze the factors related to differences occasionally found. METHODS: Comparative analysis of 2032 patients, 1402 (69%) men and 630 (31%) women, who consecutively underwent surgery from January 1999 to December 2002. RESULTS: Women had a greater mean age, more risk factors, and a greater incidence of unstable angina. Internal thoracic artery grafts were more frequently used in men, 85.6% vs 78.3%, P < 0.001. No differences in the postoperative complication rates were observed, except for infections, more frequent in women. In-hospital mortality rates were 4.1% and 6.3% for men and women, respectively (P = 0.026). On multivariate analysis, neither the female sex was identified as an independent prognostic factor for death nor was the use of thoracic artery grafts identified as an isolated protective factor. However, sex-internal thoracic artery graft interaction was significant. The following variables were also selected: age (OR = 1.03; 95% CI = 1.01 to 1.06; P = 0.004), preoperative renal failure (OR = 1.82; 95% CI = 1.07 to 3.11; P = 0.028) and urgent/emergency surgery (OR = 2.85; 95% CI = 1.32 to 6.14; P = 0.008). CONCLUSION: The female sex had a greater surgical mortality; this, however, was not an independent prognostic factor for death. The use of thoracic artery grafts proved to be protective. Older patients with renal failure in an emergency situation had greater indices of in-hospital death.

Particle-in-cell (PIC) methods allow the study of plasma behavior by computing the trajectories of finite-size particles under the action of external and self-consistent electric and magnetic fields defined in a grid of points. In this work, the Finite Element Method (FEM) is used in order to obtain the self-consistent fields. An electrostatic PIC-FEM computational code for simulation of one-dimensional (1D) and two-dimensional (2D) plasmas was developed based on two available and independent codes: the first one a 1D PIC code that uses the Finite Difference Method and the other a FEM code developed at the Instituto de Estudos Avancados (IEAv). The Poisson equation is solved and periodic boundary conditions are used. The ion background that neutralizes the total plasma charge is kept fixed and uniformly distributed in the domain of study. The code is tested by studying the fluctuations of the plasma in thermal equilibrium. In thermal equilibrium a plasma sustain fluctuations of various collective modes of electrostatic oscillations, whose spectral distribution can be analytically obtained by using the fluctuation-dissipation theorem and the Kramers-Kronig relation. In both 1D and 2D cases, there are excellent agreement between the spectral distribution curves predicted theoretically and those obtained by simulation for finite size particles and long wavelengths.

Vinte e sete espécies de dípteros caliptrados (Muscidae e Sarcophagidae) foram capturados no período de dezembro de 1993 a novembro de 1994, com armadilhas orientadas pelo vento (W.O.T.) contendo isca de fígado em putrefação, no jardim zoológico da cidade do Rio de Janeiro. As espécies capturadas em maior abundância foram Musca domestica (57,84%), Peckia chrysostoma (28,16%), Ophyra aenescens (17,11%), Oxysarcodexia thornax (17,82%), Synthesiomyia nudiseta (13,05%) e Oxysarcodexia diana (14,52%).

Twenty-seven species of calyptrate muscoids (Muscidae and Sarcophagidae) were collected from December 1993 to November 1994 with wind oriented traps (W.O.T.) baited with decomposing beef liver at the Rio de Janeiro Zoo. The most abundant species found were Musca domestica (57.84%), Peckia chrysostoma (28.16%), Ophyra aenescens (17.11%), Oxysarcodexia thornax (17.82%), Synthesiomyia nudiseta (13.05%), and Oxysarcodexia diana (14.52%).

This is the report of a 46-year-old patient with the preoperative diagnosis of an atrial septal defect (ASD) of the ostium secudum type. After sternectomy, partial agenesis of the left pericardium was diagnosed. It is our opinion that, if the radiographic picture is suggestive of this entity, a clinical search for cardiopulmonary anomalies should be performed, because the majority of these associated anomalies can and should be surgically corrected.

OBJECTIVE: To assess the results observed during the early postoperative period in patients who had the posterior coronary arteries revascularized without cardiopulmonary bypass (CPB), in regard to the following parameters: age, sex,bypass grafts types, morbidity and mortality. METHODS: From January 1995 to June 1998, 673 patients underwent myocardial revascularization (MR). Of this total, 607 (90.20%) MR procedures were performed without CPB. The posterior coronary arteries (PCA) were revascularized in 298 (44.27%) patients, 280 (93.95%) without CPB. The age of the patients ranged from 37 to 88 years (mean, 61 years). The male gender predominated, with 198 men (70.7%). The revascularization of the posterior coronary arteries had the following distribution: diagonalis artery (31 patients, 10%); marginal branches of the circumflex artery (243 patients, 78.7%); posterior ventricular artery (4 patients, 1.3%); and posterior descending artery (31 patients, 10%). RESULTS: Procedure-related complications without death occurred in 7 cases, giving a morbidity of 2.5%. There were 11 deaths in the early postoperative period (mortality of 3.9%). CONCLUSION: Similarly to the anterior coronary arteries, the posterior coronary arteries may benefit from myocardial revascularization without CPB.

Foram investigados todos os óbitos de crianças menores de um ano residentes no Distrito Sanitário de Pau da Lima, Município de Salvador, Brasil, no ano de 1991, através de consultas aos respectivos prontuários hospitalares e visitas domiciliares. O estudo visava a aferir a efetividade dos serviços de saúde por meio da verificação de óbitos potencialmente evitáveis e o grau de adequação dos cuidados médicos prestados às crianças. De um total de 47 óbitos, observou-se que mais da metade dos mesmos ocorreu por causas vulneráveis à ação oportuna dos serviços de saúde, e que 21,3% dos óbitos ocorreram em via pública e domicílios. Houve 76,6% de perdas de informação nas entrevistas com as mães, atribuídas a problemas de preenchimento incompleto ou incorreto da Declaração de óbito, e por mudanças de endereço. A pesquisa dos prontuários nas unidades de saúde registrou perda de 58,3%, revelando o baixo grau de organização das estatísticas hospitalares; prevaleceram atendimentos classificados como pouco adequados e inadequados, principalmente nos itens exame físico e tratamento. Apesar das limitações operacionais do estudo, os resultados apontam problemas de acesso, efetividade e adequação do processo de assistência à saúde.

All deaths of children under one year of age and residing in the Pau da Lima Health District, in the city of Salvador, Bahia, Brazil, during the year 1991 were investigated through home visits and analysis of patient files. The study measured effectiveness of health services by verifying potentially avoidable deaths and the level of medical care these children received. More than half of the total of 47 deaths were related to causes considered amenable to prompt action by health services; 10 (21.3%) of the deaths occurred at home or in public (outside of health care facilities). Loss of information occurred in 36 (76.6%) of the mother's interviews, related to incomplete information on the death certificate and to changes of address. Analysis of patient files in the health clinics showed a 58.3% loss of information, indicating low-quality organization of hospital statistics; there was a prevalence of consultations classified as inadequate or barely adequate, due mainly to problems with physical examination and treatment. Despite this study's operational limitations, the results point to problems of access, effectiveness, and adequacy in the health care process.

Foram investigados todos os óbitos de crianças menores de um ano residentes no Distrito Sanitário de Pau da Lima, Município de Salvador, Brasil, no ano de 1991, através de consultas aos respectivos prontuários hospitalares e visitas domiciliares. O estudo visava a aferir a efetividade dos serviços de saúde por meio da verificação de óbitos potencialmente evitáveis e o grau de adequação dos cuidados médicos prestados às crianças. De um total de 47 óbitos, observou-se que mais da metade dos mesmos ocorreu por causas vulneráveis à ação oportuna dos serviços de saúde, e que 21,3% dos óbitos ocorreram em via pública e domicílios. Houve 76,6% de perdas de informação nas entrevistas com as mães, atribuídas a problemas de preenchimento incompleto ou incorreto da Declaração de óbito, e por mudanças de endereço. A pesquisa dos prontuários nas unidades de saúde registrou perda de 58,3%, revelando o baixo grau de organização das estatísticas hospitalares; prevaleceram atendimentos classificados como pouco adequados e inadequados, principalmente nos itens exame físico e tratamento. Apesar das limitações operacionais do estudo, os resultados apontam problemas de acesso, efetividade e adequação do processo de assistência à saúde.

All deaths of children under one year of age and residing in the Pau da Lima Health District, in the city of Salvador, Bahia, Brazil, during the year 1991 were investigated through home visits and analysis of patient files. The study measured effectiveness of health services by verifying potentially avoidable deaths and the level of medical care these children received. More than half of the total of 47 deaths were related to causes considered amenable to prompt action by health services; 10 (21.3%) of the deaths occurred at home or in public (outside of health care facilities). Loss of information occurred in 36 (76.6%) of the mother's interviews, related to incomplete information on the death certificate and to changes of address. Analysis of patient files in the health clinics showed a 58.3% loss of information, indicating low-quality organization of hospital statistics; there was a prevalence of consultations classified as inadequate or barely adequate, due mainly to problems with physical examination and treatment. Despite this study's operational limitations, the results point to problems of access, effectiveness, and adequacy in the health care process.

Relata-se o primeiro caso de isolamento de Paracoccidioides brasiliensis (P. brasiliensis) em sangue de paciente HIV positivo, 28 anos, sexo masculino, natural de Nova Londrina que, ao exame físico e ultrassonográfico, apresentava esplenomegalia febril a esclarecer. Para estabelecer o diagnóstico etiológico, hemoculturas em triplicata foram realizadas para pesquisa de bactérias aeróbias, micobactérias e fungos. As hemoculturas para bactérias aeróbias e micobactérias foram negativas e P. brasiliensis foi isolado de duas hemoculturas, na fase leveduriforme em ágar BHI, 20 dias após a semeadura, a partir do meio de Negroni. O paciente classificado, segundo o "Centers for Disease Control (CDC)", no grupo IV devido a uma pneumocistose pulmonar, interrompeu o tratamento por problemas particulares na segunda dose de anfotericina B, sendo tratado alternativamente com 800 mg/dia de cetoconazol. O óbito ocorreu um ano após o isolamento do P.brasiliensis em hemocultura.

A case of an AIDS-patient with positive blood culture for Paracoccidioides brasiliensis is reported. The patient was a 29 years old male born in Nova Londrina (Paraná State, Brazil) who presented splenomegaly and fever of unknown origin. Three blood cultures were performed, each one of them for aerobic bacteria, mycobacteria and fungi. Cultures for aerobic bacteria and mycobacteria were negative. However, the yeast phase P. brasiliensis was isolated from two cultures in BHI agar, 20 days after inoculation in Negroni medium. The patient was classified in group V according to the Centers for Disease Control (CDC) criteria for AIDS, due to a Pneumocystis carinii pneumonia. Treatment was discontinued due to an individual decision of the patient on the second dose of amphotericin B. This antibiotic was replaced by ketoconazole in the daily dose of 800 mg. The patient died one year after the isolation of P. brasiliensis on blood culture.