[Gastrointestinal stromal tumors - a retrospective study of 43 cases]

BACKGROUND

gastrointestinal stromal tumors (GISTs) are rare (10 to 20/million). They exist in the whole digestive system and its surroundings, and are most common in the stomach (70%), followed by the small intestine (20-25%), colon and rectum (5%), and esophagus ( < 5%). Their clinical presentation varies from small, incidentally found nodules to large and aggressive tumors. Nowadays GISTs are classified according to Fletcher s classification.

OBJECTIVE

to review the features of our GIST population.

METHODS

a retrospective study of GIST patients identified by immunohistochemical criteria, from 1997 to December 2007, and classified according to Fletcher s criteria.

RESULTS

43 patients were included (24 men, 19 women) with a mean age of 62.7 years. Gastric GISTs (20 cases, 46.5%), small intestine GISTs (18 cases, 41.9%); in 5 cases metastases of occult tumors were found. Eighteen cases had no symptoms. Tumors were classified according to Fletcher s criteria as high-risk (n = 19), intermediate-risk (n = 7), low-risk (n = 12), and indeterminate-risk (n = 5). Death occurred in 10 patients, and 13 patients had metastatic disease.

CONCLUSIONS

our results are in accordance with the world literature, in which a majority of cases are men with gastric tumors. The 5-year survival rate was 42%. Fletcher s criteria were easily applicable criteria and could predict tumor behavior.

Predominant polarity in bipolar disorder: diagnostic implications

BACKGROUND

It has been reported that patients with bipolar disorder (BD) remain about 10 years symptomatic before the correct diagnosis is made. This fact is particularly important for patients with predominantly depressed polarity who tend to be diagnosed as suffering from unipolar major depressive disorder and treated with antidepressants. The present study was carried out to assess clinical differences between predominantly manic and depressed BD patients with a special focus on the time that patients remained undiagnosed.

METHODS

Clinical and socio-demographic characteristics were obtained from a sample of 149 euthymic bipolar outpatients. Patients were divided into depressive or manic predominance of polarity. Clinical features, number of years undiagnosed (NYU) and occupational functioning were assessed in the two groups.

RESULTS

Forty-five patients were classified as a "Depressive Polarity" whilst forty-seven were considered as "Manic Polarity". Depressive Polarity was associated with a longer delay to be diagnosed (F=14.43, df=89, p=0.001). The predominantly depressive patients tended to present a depressive onset of illness, earlier age of onset, longer duration of illness and higher number of suicide attempts than manic polarity patients.

CONCLUSION

There was a marked clinical difference between predominantly manic and depressive bipolar patients. Predominantly depressive polarity is associated with a longer delay in receiving a correct diagnosis and effective treatment which has an important impact on the management of the illness.

Effects [correction of Effecs] of the thyroid hormone (T3) on astrocytes

Thyroid hormones have profound effects on growth and development. In the brain L-3,5,3'-triiodothyronine (T3), the bioactive hormone, is involved with the harmonious development acting in neuronal and glial cell differentiation. T3 acts on the cells by interacting with nuclear receptors that can regulate the expression of several genes. Astrocytes also show receptors to the hormone. We reported herein data on the effects of T3 on astrocytes. We have verified that T3 has a morphological effect on cultured cortical astrocytes with rearrangement of GFAP filaments, and induces proliferation in the cultured cerebellar astrocytes of newborn rats. We discuss here the effects of T3 on astrocytes, considering the possibility that thyroid hormone prepares the astrocytes to interact with neurons.

[The prevalence of the principal cardiovascular risk factors in the population of the Azores]

STUDY OBJECTIVE

to characterize the high mortality rate by ischemic heart disease in Azores, by evaluating the main coronary heart disease risk factors prevalence in the population.

DESIGN

sample study referring the population of 5 islands: 37 counties. Aleatory choose in the electoral lists.

SETTING

the selected individuals were convocated by mail to show up at the Hospital for evaluation.

PATIENTS

1089 individuals selected by aleatory choose from the electoral lists.

INTERVENTIONS

the sample was stratified regarding rural (R) and urban (U), by sex feminine (F) and masculine (M), age 20-40 and 40 to 60 years old. All of them were determined three values of blood pressure, and was taken for exact value the medium of the three, inquired the smoking habits and serum lipids were determined. We considered risk factors (RF); blood pressure > 140/90 mmHg, total cholesterol > 200 mg/dl, HDL cholesterol < 35 mg/dl, triglycerides > 180 mg/dl and smoking habits were stratified in three scores: 1: 1-10, 2: 11-20, and 3: more than 20 cigarettes a day.

MAIN RESULTS

total prevalences; HBP 20.4%, smoking habits 33%, total hypercholesterolemia 47.3%, low HDL cholesterol 17.4% and triglycerides 30.5%.

CONCLUSIONS

the values found for total cholesterol, triglycerides and smoking habits were high and superior to the national medium and to those found in reference studies. Preventive strategies are pointed out.

[The circadian profile of ventricular extrasystole]

STUDY OBJECTIVE

to determine the existence of circadian variability (CV) of single ventricular premature beats (VPBs) and study its relationship with the heart rate variation; to compare sub-groups of patients (Pts) with and without antiarrhythmic therapy and with ischemic cardiopathy versus a free structural cardiopathy group.

DESIGN

retrospective study.

PATIENTS AND METHODS

the CV of VPBs was analyzed by Holter monitoring in 147 Pts, 93 male and 54 female with a mean age of 59 +/- 14.6. Seventy seven Pts were not taking antiarrhythmic drugs while 70 were doing it: Amiodarone 23, Propafenone 30, B-Blockers 9, Quinidine and Disopyramide 7, Flecainide 1. Sixty five Pts had ischemic cardiopathy and 37 were free of any structural abnormality. The selection criteria consisted in: 1--more than 100 VPBs/24h; 2--distribution over more than 12 hours; 3--absence of any hour with more than 35% of the total VPBs in the recording. Data were presented in a percentage form and the results evaluation was made by using single and two-harmonic regression models.

MAIN RESULTS

a CV was found to the single VPBs, with minimum values during the nocturnal period and maximum values in the morning, with a significant adjustment to the two-harmonic regression model, defined by the equation y = 4.2 - Q,559 sen (2 pi T/24) - 0.604 cos (2 pi T/24) - 0.417 sen (4 pi T/24) + 0,272 cos (4 pi T/24) (p < 0.001). A strong positive correlation was observed between VPBs and heart rate variability (r = 0.95; p < 0.001). The sub-groups of Pts, whether taking antiarrhythmic drugs or not, also showed a CV with a statistically significant two-harmonic regression pattern, with a major morning increase of VPBs in the antiarrhythmic group. The free structural cardiopathy sub-group displayed a best adjustment to the single harmonic regression model while the ischemic group exhibited a two-harmonic regression pattern.

CONCLUSIONS

a significant circadian variability of VPBs with a bi-modality expression was determined. The majority of the analyzed sub-groups showed the same kind of variation. A strong positive correlation with the heart rate variability was observed.

Microsurgical anatomy of the proximal segments of the middle cerebral artery

The microvascular anatomy of the proximal segments (M1 and M2) of the middle cerebral artery (MCA) was studied in 70 unfixed brain hemispheres from 35 cadavers. The arteries were injected with a tinted polyester resin and dissected under magnification by microsurgical techniques. The authors studied the outer diameter (OD), length, site of origin, and pattern of branching of the main trunk, secondary trunks, and the initial insular portion of the cortical branches of the MCA. The degree of mobilization of the arteries lying over the insular cortex was also assessed. The main trunk of the MCA, which had an OD of 3 +/- 0.1 mm bilaterally and a length of 15 +/- 1.1 mm in the right hemisphere and 15.7 +/- 1.3 mm in the left hemisphere, could be divided into four groups: Group I: absence of a main division (that is, a single-trunk type of MCA) (in 6% of cases); Group II: bifurcation (64%); Group III: trifurcation (29%); and Group IV: quadrifurcation (1%). The secondary trunks resulting from the division of the main trunk of the MCA had a mean OD ranging from 1.4 to 2.3 mm and a mean length that varied from 12.1 to 14.9 mm. The mean OD of the cortical branches measured near their origin in the main and secondary trunks indicated that the angular artery was the largest vessel, with a mean OD of 1.5 mm on both sides of the brain. The temporopolar artery was the smallest, with a mean OD of 0.8 mm in the right hemisphere and 0.9 mm in the left hemisphere. The authors also describe the patterns of origin of the cortical vessels from the main trunk (early branches) and from the secondary trunks, as well as their branching pattern at the site of origin (single vessels and common stems). These anatomical data indicate that it is possible to perform microvascular reconstructive procedures, such as anastomosis, grafting, and reimplantation of branches in the insular area. The advantages of using unfixed specimens, intravascular injections, and magnification to reproduce in vivo conditions as closely as possible are also discussed.

Predicting outcome from closed head injury by early assessment of trauma severity

The relationship between severity of head injury and outcome was studied in 96 patients. Severity was assessed based on the level of coma and presence of mass lesion, hemiparesis, skull fracture, and pupil abnormality. Outcome was assessed using the Wechsler Adult Intelligence Scale, the Halstead-Reitan neuropsychological battery, and the Glasgow Outcome Scale. The relationship between assessment of severity of trauma and the outcome measurements was calculated by multiple regression analysis. Results indicate that coma grade and estimates of premorbid intelligence quotient (IQ) served best to predict IQ as assessed after the injury. The combination of coma grade, mass lesion, and skull fracture were important predictors of the Halstead Impairment Index. Coma grade and pupil abnormality predicted the Glasgow Outcome Scale. Low to moderate relationships were found between the predictor variables and the measurement of IQ and the Glasgow Outcome Scale; multiple regression coefficients were 0.63 and 0.61, respectively. The relationship between measurement of trauma severity and the Halstead Impairment Index was also low (R = 0.37).

Microsurgical anatomy of the recurrent artery of Heubner

The recurrent arteries of Heubner were studied in 30 unfixed human brains (60 hemispheres) obtained from routine autopsies of individuals with a mean age of 34 years. The arteries were injected with tinted polyester resin via cannulation of the internal carotid arteries, and dissected under microscopic magnification. The recurrent artery of Heubner was absent in two hemispheres and double in seven hemispheres, either with a separate origin (in two) or from a common stem (in five). The artery of Heubner had a mean outer diameter of 0.8 +/- 0.04 mm (range 0.3 to 1.5 mm) and a mean length of 23.4 +/- 1.1 mm (range 12 to 38 mm). It originated from the A2 segment of the anterior cerebral artery (ACA) in 57% of the specimens, from the junction of the ACA and the anterior communicating artery in 35%, and from the A1 segment of the ACA in 8%. Three types of recurrent courses were observed. In the Type I or superior course, seen in 41 (63%) of the 65 arteries, the artery followed the superior wall of the A1 segment of the ACA. In the Type II or anterior course, the arteries found in 22 (34%) of specimens maintained a rostral position in relation to the A1 segment. In the Type III or posterior course, taken by two (3%) arteries, a posterior course of the vessel in the anterior perforated substance was found. The branching pattern was identified down to a range of 100 to 200 mu, and the average number of branches was 6.5 +/- 0.4 (range 3 to 12). Four groups of branches were observed. The olfactory group was represented in 91% by a single olfactory branch, with a mean outer diameter of 0.3 +/- 0.03 mm. On average, 1.9 +/- 0.27 frontal branches were found with a mean diameter of 0.13 +/- 0.01 mm. The branches penetrating the anterior perforated substance had a larger outer diameter (mean 0.4 +/- 0.03 mm) with an average number of 2.5 +/- 0.2 branches. The Sylvian fissure branches were more numerous (mean 3 +/- 0.3) with a mean outer diameter of 0.4 +/- 0.03 mm. The point of penetration of the main trunk was found to be constant at the level of the lateral perforated substance-medial Sylvian fissure in 85% of the cases. This report emphasizes the advantages of the intravascular casting resin injection technique in unfixed human brains over other conventional methods. It also describes the application of these anatomic data to the surgical strategy for the anterior circle of Willis, including the possible use of the recurrent artery of Heubner for microvascular reconstructive procedures.