In The June 2009 Issue of Clinics

In this issue of CLINICS, we wish to highlight a project in which Erbayrak et al. investigated the role of Fecal Calprotectin in evaluating inflammatory bowel disease activity of 65 affected patients versus 20 outpatients as controls. Fecal Calprotectin was found to be is strongly associated with colorectal inflammation indicating organic disease, while all the patients in the control group had a fecal calprotectin value lower than the cut-off point (50 mg/kg). Because Fecal Calprotectin is a simple and non-invasive method for assessing excretion of macrophages into the gut lumen they claim that it can be used to evaluate the response to treatment, to screen asymptomatic patients, and to predict inflammatory bowel disease relapses. 
 
Correia-Deur et al. documented the phenotypes observed in 26 patients with apparent s-medullary thyroid carcinoma cases to attempt to improve earlier diagnoses of this type of carcinoma. Clinical data was reviewed and peripheral blood was collected and screened for RET germline mutations. Calcitonin levels were increased in all cases. After total thyroidectomy associated with extensive cervical lymph node resection, calcitonin values remained low for at least 12 months in eight of the cases (30.8%). Routine thyroid cytology yielded disappointing diagnostic accuracy (46.7%). None of the 26 cases presented germline mutations in the classical hotspots of the RET proto-oncogene. They conclude that cases were identified late. The basal calcitonin measurements and immunostaining for calcitonin were highly useful for diagnosing s-medullary thyroid carcinoma. The rate of complete patient recovery was low, and none of the parameters analyzed were useful predictors of the thyroid tumor size. Our findings support previous recommendations for routine serum calcitonin evaluation and immunostaining analysis involving single thyroid nodules. 
 
Iglezias et al. determined the degree of risk produced by the association of other surgical procedures with surgical myocardial revascularization in octogenarian patients and identified the risk factors that best explain hospital mortality. Patients were stratified into revascularized with and without associated procedures. They conclude that a procedure associated with the surgical myocardial revascularization produces an absolute increase in hospital mortality risk of 45%. Variables that contributed to hospital mortality were preoperative endocarditis, preoperative cardiogenic shock, the use of extracorporeal circulation, the length of time of extracorporeal circulation, postoperative creatinine level, and postoperative need for prolonged respiratory support. 
 
De Oliveira et al. evaluated 60 patients treated for idiopathic chronic testicular pain. Priority was to give clinical treatment, which evolved from simple to more complex measures. Microsurgical treatment was performed on those who experienced no considerable pain relief (10 individuals in our study). They found that over a twenty-four-month follow-up period, 70% of patients showed complete remission and 20% exhibited partial relief from pain. 
 
Bitencourt et al. report on the applications of radioguided surgery in five oncological cases (excluding those related to breast cancer). This has been widely used to identify the sentinel lymph node and occult lesions in patients with breast cancer. However, few studies have reported the use of this technique for non-breast cancer pathologies. The patients presented with recurrence of renal cell carcinoma, cervical recurrence of papillary carcinoma of the thyroid, recurrence of retroperitoneal sarcoma, lesions of the popliteal fossa, and recurrence of rhabdomyosarcoma of a thigh. In each case, the lesions that were marked preoperatively were ultimately successfully excised. They conclude that the procedure allows for more conservative excisions and reduces the surgery-related morbidity. 
 
Rieder et al. investigated the the feasibility and the cardiorespiratory effects of using positive expiratory airway pressure, a physiotherapeutic tool, in comparison with a T-tube, to wean patients from mechanical ventilation. The two procedures were tested in forty patients who met weaning criteria and had been mechanically-ventilated for more than 48 hours, mean age 59 years, including 23 males. They claim that weaning patients from mechanical ventilation with the use of a fixed level of Expiratory Positive Airway Pressure caused an increase in work of breathing that was not accompanied by any other significant cardiorespiratory changes, and suggest that caution must be exercised when using Expiratory Positive Airway Pressure during weaning from mechanical ventilation. 
 
Vaisbich et al. endeavored to characterize clinical, laboratory and genetic parameters of five boys with Nephrogenic diabetes insipidus first diagnosed at 14.6 months (range 6 to 24) and followed for 12.2 years (range 7.8 to 19). Geometric means of the z-scores of weight and stature were −4.5 and −3.6, at diagnosis and −0.3 and −0.9, respectively, at the last medical appointment. Mutations in the AVPR2 gene were found in all patients, and the carrier status was confirmed in four of five cases. Two unrelated children presented identical mutations (S167L) in arginine vasopressin R2. Two of the patients had a mutation that was already described in other Brazilian families (R337X), and one patient showed a de novo mutation (Y128D) in arginine vasopressin R2, since his mother’s molecular analysis was normal. They claim that the clinical and laboratory characterization of Nephrogenic diabetes insipidus is of paramount importance for disease diagnosis and genetic counseling. 
 
De Lima et al. studied the effect of metformin, when administered to first-degree relatives of type 2 diabetes mellitus subjects who have metabolic syndrome and normal glucose tolerance, to determine whether it could improve the cardiovascular risk profile and reduce the levels of both C-reactive protein and fibrinogen. Thirty-one non-diabetic first-degree relatives of type 2 diabetes mellitus subjects with metabolic syndrome were randomized (1:1) and double-blinded for placement in the placebo and metformin groups, and conclude that the treatment given to first-degree relatives of type 2 diabetes mellitus sufferers who have metabolic syndrome and normal glucose tolerance improved the cardiovascular risk profile without changing the levels of C-reactive protein and fibrinogen. 
 
Bonanomi et al. retrospectively reviewed the records of 28 new cases of retinoblastoma, 15 of which were unilateral and 13 of which were bilateral, diagnosed between 2003 and 2005 (mean age 33.8 months for unilateral cases, and 19.15 months for bilateral cases) and conclude that in this population, retinoblastoma was diagnosed too late and most eyes were consequently enucleated. In cases with bilateral disease, half of the eyes were preserved. 
 
Andrade et al. compared the metabolic, hemodynamic, autonomic, and endothelial responses to short-term red wine consumption in subjects with hypercholesterolemia (n = 10) or arterial hypertension (n = 9), and healthy controls (n = 7), and found that red wine enhanced muscle sympathetic fibular nerve activity in hypercholesterolemic and hypertensive patients, but not in controls. At baseline, brachial artery flow-mediated dilation was impaired in patients with hypercholesterolemia and arterial hypertension; red wine restored the dilation in the hypercholesterolemic group but not in the hypertensive group. They claim that red wine elicits different metabolic, autonomic, and endothelial responses among individuals with hypercholesterolemia or arterial hypertension and healthy controls. The findings highlight the need to consider patient characteristics when evaluating the response to red wine. 
 
Aikawa et al. evaluated the effect of mechanical ventilation with positive end expiratory pressure (PEEP) on mesenteric leukocyte-endothelial interactions in 44 male Wistar rats. Rats were exposed to NO PEEP or to PEEP at 0, 5, and 10 cm H2O. After two hours of mechanical ventilation rolling, sticking and migrated leukocytes were significantly increased at a PEEP of 10 cm H2O. They conclude that the highest level of intrathoracic pressure was harmful to mesenteric microcirculation in this experimental model of rats with normal lungs and stable systemic blood pressure, a finding that may have relevance for complications related to mechanical ventilation. 
 
Monaco et al. give us a fascinating computer demonstration of the evolution of aging and its implications for medical practice. They stress that the discussion regarding the evolution of aging is almost as old as Darwinian Evolution Theory, but to date, it has remained one of biology’s unresolved problems. One issue is how to reconcile natural selection, which is understood as a process that purges deleterious characteristics, with senescence, which seems to offer no advantages to the individual. The two popular explanations for the existence of senescence, namely, (1) the removal of elders for the benefit of the species and (2) the progressive deterioration of the organic machine due to continuous use are described as incorrect. They claim that it is important that the physician understand that senescence, defined as the progressive impairment of an organism, does not necessarily accompany aging, defined as the mere passage of time. The concepts of aging (the unavoidable passage of time), senescence (progressive physiologic impairment), and senility (the pathological development of diseases), are discussed. 
 
We also publish 2 review articles, one by Leao et al. on the Oral complications of HIV disease, one by Landim et al. on Asymmetric dimethylarginine and endothelial dysfunction, and 4 case reports.


In ThE JunE 2009 IssuE Of CLInICs
Mauricio Rocha-e-Silva, Editor doi: 10.1590/S1807-59322009000600001 In this issue of CLINICS, we highlight a landmark: CLINICS is now a PUBMEDCENTRAL journal, which means it now complies with the policies of funding agencies, such as, the Wellcome Trust and the Research Councils (United Kingdom), the National Institutes of Health (United States), and the Deutsche Forschungsgemeinschaft (Germany) which request or require deposition of the published articles that they fund into such publicly available databases. We also wish to highlight a intriguing piece of basic research, in which Rocha-Filho et al. designed a study to evaluate the effects of the vasopressin analogue terlipressin versus various fluid resuscitation regimens on hemodynamics, metabolic parameters, blood loss and short-term survival in hemorrhagic shock; however, a result which was not apriori sought for called their attention, namely that the high plasma potassium levels which accompanies hemorrhagic shock appears to be the best correlate with mortality. They conclude that this high potassium level, in addition to providing an early sign of the acute ischemic insult severity, may also be the causal factor responsible for the cardiac arrest related to hemorrhagic shock. We additionally publish 9 clinical studies and 5 other non-clinical studies.
Cerci et al. prospectively investigated the efficacy of positron emission tomography with 2-[18f]-Fluoro-2-Deoxyd-Glucose for initial staging of hodgkin lymphoma in 82 patients with newly diagnosed HL and concluded that it is superior to computerized tomography for the detection of nodal and extra-nodal HL. They recommend that changes in stages based on this method should be confirmed by biopsy.
Garrido et al. examined endobronchial ultrasound for diagnosis of tracheobronchial tree invasion by esophageal cancer in 14 patients and found that the procedure showed signs of tracheobronchial invasion not observed by conven-tional bronchoscopy, adding information to staging in most of the cases when compared with computerized tomography and endoscopic ultrasound.
Accorsi-Neto et al. prospectively evaluated the effects of isoflavones-rich concentrated soy extract on the skin of 23 postmenopausal women and found that its application, examining epidermal thickness, the papillary index (wrinkling), and the amount of dermal elastic and collagen fibers during six consecutive months, caused significant increases in epithelial thickness, the number of elastic and collagen fibers, as well as the blood vessels Fossaluza et al. describe and discuss a minimization procedure specifically designed for a clinical trial that evaluates treatment efficacy for Obsessive-compulsive disorder patients and found that the random arrival order of patients determines different assignments and therefore maintains the unpredictability of the allocation method. They conclude that the proposed procedure allows for the use of a large number of prognostic factors in a given allocation decision.
Pêgo-Fernandes et al. retrospectively compared spirometry data between 39 patients who underwent single-lung or double-lung transplantation over the first year after transplantation and found a clear tendency to greater improvement in FVC and FEV1 in the bilateral transplant group. Among our subjects, double-lung transplantation improved lung function.
Barbosa et al. compared measurements obtained with three different perineometers in 20 nulliparous women with no anatomical alterations and/or dysfunction of the pelvic floor and found that the concordance of the measurements of the intra-vaginal pressure ranged from poor to moderate, suggesting that perineometers of different brands generate different results.
Younes et al. determined clinical, pathological, and treatment-relevant variables associated with long-term (90-month) overall survival in 529 patients admitted with lung metastases, and who underwent thoracotomy for resection after treatment of a primary tumor and confirm that lung metastasectomy is a safe and potentially cura-tive procedure for patients with treated primary tumors. A select group of patients can achieve long-term survival after resection.
Zhang et al. retrospectively studied long-term surgical outcomes of primary congenital glaucoma in 48 patients who underwent primary trabeculectomy, trabeculotomy, or combined trabeculotomy and trabeculectomy in China and conclude, in contrast to most reports, that trabeculectomy and the combined procedure achieved higher long-term success rates than trabeculotomy. The patients with successful surgical results had better vision. They also suggest that compliance with a routine of regular follow-up may increase the chances of a successful surgical outcome.
Nicolau et al. analyzed the role of invasive therapies in 1588 elderly patients with acute myocardial infarction who had been prospectively included in a databank and followed for up to 7.5 years and found that the invasive therapies during the in-hospital phase was at least as effective in elderly patients as in younger patients.
Mailankot et al. evaluated the effects of radio frequency electromagnetic radiation from GSM (0.9/1.8ghz) mobile phones on oxidative stress and sperm motility in rats and found that a 1-hour a day exposure for 28 days resulted in a significant increase in lipid peroxidation and low GSH content in the testis and epididymis.
İnan et al. examined the effects of the histamine h2 receptor antagonist famotidine on the healing of colonic anastomosis in rats and found that it exerts detrimental effects on the anastomotic bursting pressure and hydroxyproline content of perianastomotic tissues in the colon of rats.
Tess et al. evaluated the scientific research productivity of the Heart Institute of São Paulo, Brazil and found 604 original articles and reviews, 246 articles published in national journals (221 with free online access through Sci-ELO) and 348 published in international journals (333 with controlled online access). The average impact of each article for InCor was 2.224 in the period studied.
Oliveira et al. analyzed cutaneous remodeling in the early stage of a scleroderma model (induced through immunization with type V collagen, followed by a challenge with type V collagen plus incomplete Freund's adjuvant) in female New Zealand rabbits and found that Immunized rabbits presented a significant increase in collagen in skin collected seven days after the first immunization. They conclude that the results from this experimental model may be important to a better understanding of the pathogenic mechanisms involved in the beginning of human scleroderma.
Lucato et al. evaluated and compared the efficacy of humidification in available heat and moisture exchanger models under conditions of varying tidal volume, respiratory rate, and flow rate and found that heat and moisture exchangers are more efficient when used with low tidal volume ventilation. The roles of flow and respiratory rate were less important, suggesting that their adjustment has a less significant effect on the performance of heat and moisture exchangers.
We also publish three case reports.