Carcinoma of the stomach following the Chernobyl nuclear accident

Medical consequences of many nuclear accidents on humans are well studied, but the results pertaining to gastric cancer patients who were exposed to radiation as a result of the Chernobyl nuclear accident have not been analysed. In this study, the outcome of the surgical treatment of 68 gastric cancer patients who were exposed to radiation as a result of the Chernobyl nuclear accident was compared with that of 117 consecutive gastric cancer patients from uncontaminated areas of the Ukraine. Patients in the study group was significantly younger than that of the control group. Comparative analysis showed the same frequency of regional metastases (65.7% versus 71.1%, P > 0.05), but a smaller number of distant metastases (23.8% versus 38.1%, P < 0.05) in the study group. 41.2% of patients in the study group underwent total gastrectomy compared to 19.6% of patients in the control group (P = 0.002). Postoperative complications developed in 13.2% of patients in the study group, while postoperative mortality in the study group was 7.3% compared to 1.7% in the control group. A significant decrease in CD16 cells was noted in patients from the study group following the operative procedure. Young age, invasive tumours with smaller number of distant metastases, frequent necessity for total gastrectomy and combined operations with adjacent organs, a higher level of postoperative morbidity and mortality and low levels of natural killer cells (CD16+) with a tendency to decrease after surgery are characteristic of patients with carcinoma of the stomach affected by the Chernobyl accident.     

Overestimate of vaccine coverage? New evidence from a survey in Pau da Lima]

To evaluate vaccination coverage in children 0 to 5 years of age, a cross-sectional study based on a household survey was carried out in 1992 in the Pau de Lima Health District, Salvador, Bahia, Brazil, using a cluster sampling technique. The district was subdivided into 30 small areas that were homogeneous with respect to socioeconomic characteristics. Information on the vaccination status of 385 children was obtained through verification of a vaccination card or campaign voucher, or, in the absence of these items, through verbal confirmation from the mother or other responsible person. Based on all the sources of information, the study found vaccination coverage rates in the entire age range of 69% for polio vaccine; 56% for DTP; 74% for measles vaccine; and 87% for BCG. These results suggest that rates obtained from routine records of the health services and vaccination campaigns may be overestimates. The authors discuss the implications of the low coverage rates found in the entire age group and especially among children under 1 year old.     

Highly sensitive thromboplastins do not improve INR precision

OBJECTIVE: Severe obesity (ie, at least 100% overweight or body mass index > or =40 kg/m2) is associated with significant morbidity and increased mortality. It is apparently becoming more common in this country. Conventional weight-loss treatments are usually ineffective for severe obesity and bariatric surgery is recommended as a treatment option. However, longitudinal data on the long-term outcome of bariatric surgery are sparse. Available data indicate that the outcome of bariatric surgery, although usually favorable in the short term, is variable and weight regain sometimes occurs at 2 years after surgery. The objective of this study is to present a review of the outcome of bariatric surgery in three areas: weight loss and improvement in health status, changes in eating behavior, and psychosocial adjustment. The study will also review how eating behavior, energy metabolism, and psychosocial functioning may affect the outcome of bariatric surgery. Suggestions for additional research in these areas are made. METHOD: Literature review. RESULTS: On average, most patients lose 60% of excess weight after gastric bypass and 40% after vertical banded gastroplasty. In about 30% of patients, weight regain occurs at 18 months to 2 years after surgery. Binge eating behavior, which is common among the morbidly obese, may recur after surgery and is associated with weight regain. Energy metabolism may affect the outcome of bariatric surgery, but it has not been systematically studied in this population. Presurgery psychosocial functioning does not seem to affect the outcome of surgery, and psychosocial outcome is generally encouraging over the short term, but there are reports of poor adjustment after weight loss, including alcohol abuse and suicide. CONCLUSIONS: Factors leading to poor outcome of bariatric surgery, such as binge eating and lowered energy metabolism, should be studied to improve patient selection and outcome. Long-term outcome data on psychosocial functioning are lacking. Longitudinal studies to examine the long-term outcome of bariatric surgery and the prognostic indicators are needed.     

Social and medical rehabilitation of patients subjected to surgery on account of aneurysms of the anterior connecting artery

The report contains data concerning occupational and social rehabilitation of 46 patients operated on for aneurysma of the anterior communicative artery. It was established that the occupational prognosis depends upon the severity of the hemmorhage, character of surgical operation. Of significance are the conditions of work, time after the surgical operation. The authors mark that in 2/3 of the operated on patients the working capacity is being restored. A spontaneous restoration of diaturbed functions is slow and is not always sufficient. With this purpose it is expedient to repeat courses of a general tonic and special rehabilitative therapy. A favourable factor in the readaptation of patients is their early engagement in working activities. The authors give their recommendations for medical labour expert testimony for this category of patients.     

Study of the phlebotomines (Diptera, Psychodidae), in area of cutaneous leishmaniasis in the State of Mato Grosso do Sul, Brazil

Interleukin-1 beta (IL-1 beta) significantly inhibits insulin secretion from glucose stimulated islet cells. The mechanism for this inhibition has been hypothesized to be due to stimulation of the inducible form of nitric oxide synthase and a resulting increase in nitric oxide (NO) concentration. Ways to block the effect of IL-1 beta have focused on blocking the binding of IL-1 beta to the IL-1 receptor and the use of antioxidants to neutralize increases in NO. This report focuses on a 33 residue peptide synthesized based on the C-terminal region of the IL-1 beta molecule, a reported binding site of the IL-1 beta molecule, and the redoxcycling antioxidant pyrroloquinoline quinone (PQQ). The 33 residue peptide did not function as an antagonist, but as a weak agonist. High concentrations of PQQ itself inhibited glucose-dependent insulin release while low concentrations did not. PQQ had no effect on the actions of IL-1 beta. Three isosteric and isomeric analogues of PQQ were also investigated. One of the PQQ isomers had an inhibitory effect on insulin secretion at low concentrations where PQQ had no effect. These results reflect the sensitivity of islets to oxidative stress.