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In order to establish which are the most frequent endoscopic detectable colorectal disorders in AIDS patients with intestinal complaints we analysed 236 colonoscopies in a series of 186 patients. The colonoscopic procedure was always followed by biopsies, even in the absence of macroscopic lesions. The most frequent diagnosis was colitis due to citomegalovirus infection observed in 64 exams (27.1%) and presented with an inflammatory pattern with ulcers, followed by Cryptosporidium sp., found in 31 exams (13.1%). This infection, conversely, presented as an inflammatory non-ulcerative lesion. Others pathogens found in lower frequency were: Mycobacterium sp., Histoplasma capsulatum, Herpes simplex, Isospora sp., Giardia sp., Candida sp. and Campilobacter sp.. Neoplastic lesions, mostly Kaposy's sarcoma, were detected in 10 of the colonoscopies (4.2%). The most frequent colorectal disorders in AIDS patients detected by endoscopic procedures are citomegalovirus and Cryptosporidium infection. Biopsies are always necessary to confirm the endoscopic diagnosis and to identify the presence of associated pathogens.

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OBJECTIVES: To present the experience with the first 12 living related liver transplants performed at Hospital Sírio-Libanês in São Paulo. METHODS: The donors were the fathers (6) and the mothers (6) with age ranging from 30 to 48 years. All candidates for donation were submitted to a full informed consent form, clinical and radiological evaluation and had blood withdrawn for autotransfusion. Recipient age ranged from 7 months to 10 years whereas recipient weight varied from 6.3 to 34 kg. Six patients were considered as high risk due to complications of advanced liver disease and were submitted to urgent transplantation. RESULTS: Mean donor hospital stay was 10 days with no mortality. Technical complications were observed in 4 recipients. Seven patients presented at least one episode of bacterial, viral or fungal infection. One or more biopsy proven rejection episodes were disclosed in 7 patients. Overall recipient survival was 67%, being 83% for elective cases and 50% for urgent cases. Long term follow up ranged from 8 to 25 months. Seven out of 8 survivors present excellent quality of life and normal liver function. The other patient is currently under reduced immunosuppression due to Epstein-Barr virus infection.CONCLUSIONS: These results demonstrate the safety and viability of living related liver transplantation which, in face of the current donor scarcity, should be considered as a valid option for the treatment of children with end stage liver disease.

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Asthma and cocaine abuse are both common. While cocaine has been associated with numerous pulmonary complications, only smoking cocaine has been clearly linked to the precipitation of life-threatening exacerbations of asthma. We report a case in which nasal insufflation of cocaine ("snorting") triggered a near-fatal asthmatic attack.

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One of the most feared complications in the removal of moderate-sized or large sessile polyps is colonic perforation. Complete colonoscopic total excision of these kinds of polyps can be safely undertaken using laparoscopic assistance, which enables prompt diagnosis and treatment of perforation. Laparoscopy-assisted endoscopic polyp excision can be safely performed, avoiding critical septic complications and can also help in the selection of patients to appropriate colonic resection without increasing morbidity or mortality.

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Gastrointestinal bleeding accounts for 2% of all adult hospital admissions each year. Vascular ectasia is one of the most frequently reported cause of lower gastrointestinal bleeding. In almost 80% of patients with bleeding vascular ectasia will stop spontaneously, but will often recur. Many treatments are proposed like superselective catheterization with infusion of vasoconstrictor by angiography, Laser photocoagulation, heater probe, bipolar electrocoagulation, hot biopsy forceps, have been used in colonoscopy, but some effects are short-lived others are so expensive and without an effective treatment. The authors present one case of bleeding vascular ectasia during colonoscopy submitted to a new, cheap and effective approach with injection a 1:10,000 solution of epinephrine following electrocoagulation by colonoscopy.

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The authors emphasize the colonoscopy's importance and report their experience with the procedure in a general hospital. In a nearly 4 year period, 300 patients were submitted to the procedure, and the main indication was digestive bleeding, followed by alterations of bowels movements. The bowel preparation was done with mannitol ingestion except when contraindicated. The most frequent pathology were polyps and diverticular disease. Fifty three polypectomies were done in 22 patients.

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The authors present their experience with the totally implanted vascular reservoirs for chemotherapy. Thirty-one reservoirs were implanted in 29 patients. Complications were observed in 19.3% of the cases imposing the removal of 12.9% of them. No reservoir have been lately removed because of infection or obstruction. Based on their results, the authors conclude that the totally implanted reservoir is extremely helpful for patients submitted to chemotherapy for long periods.

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Malignant duodenocolic fistula due to carcinoma of the colon is an infrequent condition. The authors describe a case treated by right hemicolectomy associated with gastrectomy and partial duodenectomy. After a review of the literature, they discuss the surgical possibilities.

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An investigation of 142 patients with primary destructive pulmonary tuberculosis was carried out using several immunological tests to estimate the quantitative and functional status of the T- and B-lymphocyte systems and the specific cell-mediated and humoral immunity. It was shown that the status of the immune system, and that of the specific antituberculosis immunity in particular, were dependent on the severity of the tuberculosis process. There were indications that the immune status largely determined the extent of the infiltrative lesions, as well as the course of the disease. In patients with no pronounced defects in cell-mediated immunity in general and in specific immunity in particular, the time needed for sputum samples to become bacterially negative and for the cavities to close was reduced, especially in cases where the initial bacterial excretion was not heavy and the degree of the infiltration was not severe. Defects in the immune system impeded the clinical progress of the tuberculosis patients; moreover, complete clinical recovery in such cases was delayed and there was a higher incidence of reactivation of the disease during the main chemotherapy course as well as of recurrence of the disease at a later date.

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