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OBJECTIVE: To investigate the correlation of HRCT findings with pulmonary metabolic activity in the corresponding regions using 18F-FDG PET/CT and inflammatory markers in patients with systemic sclerosis (SSc)-associated interstitial lung disease (ILD). METHODS: This was a cross-sectional study involving 23 adult patients with SSc-associated ILD without other connective tissue diseases. The study also involved 18F-FDG PET/CT, HRCT, determination of serum chemokine levels, clinical data, and pulmonary function testing. RESULTS: In this cohort of patients with long-term disease (disease duration, 11.8 ± 8.7 years), a nonspecific interstitial pneumonia pattern was found in 19 (82.6%). Honeycombing areas had higher median standardized uptake values (1.95; p = 0.85). Serum levels of soluble tumor necrosis factor receptor 1, soluble tumor necrosis factor receptor 2, C-C motif chemokine ligand 2 (CCL2), and C-X-C motif chemokine ligand 10 were higher in SSc patients than in controls. Serum levels of CCL2-a marker of fibroblast activity-were correlated with pure ground-glass opacity (GGO) areas on HRCT scans (p = 0.007). 18F-FDG PET/CT showed significant metabolic activity for all HRCT patterns. The correlation between serum CCL2 levels and GGO on HRCT scans suggests a central role of fibroblasts in these areas, adding new information towards the understanding of the mechanisms surrounding cellular and molecular elements and their expression on HRCT scans in patients with SSc-associated ILD. CONCLUSIONS: 18F-FDG PET/CT appears to be unable to differentiate the intensity of metabolic activity across HRCT patterns in chronic SSc patients. The association between CCL2 and GGO might be related to fibroblast activity in these areas; however, upregulated CCL2 expression in the lung tissue of SSc patients should be investigated in order to gain a better understanding of this association.

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ABSTRACT Objective: To investigate the correlation of HRCT findings with pulmonary metabolic activity in the corresponding regions using 18F-FDG PET/CT and inflammatory markers in patients with systemic sclerosis (SSc)-associated interstitial lung disease (ILD). Methods: This was a cross-sectional study involving 23 adult patients with SSc-associated ILD without other connective tissue diseases. The study also involved 18F-FDG PET/CT, HRCT, determination of serum chemokine levels, clinical data, and pulmonary function testing. Results: In this cohort of patients with long-term disease (disease duration, 11.8 ± 8.7 years), a nonspecific interstitial pneumonia pattern was found in 19 (82.6%). Honeycombing areas had higher median standardized uptake values (1.95; p = 0.85). Serum levels of soluble tumor necrosis factor receptor 1, soluble tumor necrosis factor receptor 2, C-C motif chemokine ligand 2 (CCL2), and C-X-C motif chemokine ligand 10 were higher in SSc patients than in controls. Serum levels of CCL2-a marker of fibroblast activity-were correlated with pure ground-glass opacity (GGO) areas on HRCT scans (p = 0.007). 18F-FDG PET/CT showed significant metabolic activity for all HRCT patterns. The correlation between serum CCL2 levels and GGO on HRCT scans suggests a central role of fibroblasts in these areas, adding new information towards the understanding of the mechanisms surrounding cellular and molecular elements and their expression on HRCT scans in patients with SSc-associated ILD. Conclusions: 18F-FDG PET/CT appears to be unable to differentiate the intensity of metabolic activity across HRCT patterns in chronic SSc patients. The association between CCL2 and GGO might be related to fibroblast activity in these areas; however, upregulated CCL2 expression in the lung tissue of SSc patients should be investigated in order to gain a better understanding of this association.

RESUMO Objetivo: Investigar a correlação entre achados de TCAR e a atividade metabólica pulmonar nas regiões correspondentes por meio de PET/TC com 18F-FDG e marcadores inflamatórios em pacientes com doença pulmonar intersticial (DPI) associada à esclerose sistêmica (ES). Métodos: Estudo transversal envolvendo 23 pacientes adultos com DPI associada à ES sem outras doenças do tecido conjuntivo. O estudo também envolveu PET/TC com 18F-FDG, TCAR, dosagem sérica de quimiocinas, dados clínicos e testes de função pulmonar. Resultados: Nessa coorte de pacientes com doença de longa duração (11,8 ± 8,7 anos), 19 (82,6%) apresentaram o padrão de pneumonia intersticial não específica. A mediana dos valores padronizados de captação foi maior nas áreas de faveolamento (1,95; p = 0,85). Os níveis séricos de soluble tumor necrosis factor receptor 1, soluble tumor necrosis factor receptor 2, C-C motif chemokine ligand 2 (CCL2) e C-X-C motif chemokine ligand 10 foram maiores nos pacientes com ES que nos controles. Os níveis séricos de CCL2 - um marcador de atividade fibroblástica - correlacionaram-se com áreas de opacidade em vidro fosco (OVF) pura na TCAR (p = 0,007). A PET/TC com 18F-FDG mostrou atividade metabólica significativa para todos os padrões de TCAR. A correlação entre níveis séricos de CCL2 e OVF na TCAR sugere que os fibroblastos desempenham um papel fundamental nessas áreas, acrescentando novas informações para a compreensão dos mecanismos que envolvem elementos celulares e moleculares e sua expressão na TCAR em pacientes com DPI associada à ES. Conclusões: A PET/TC com 18F-FDG aparentemente não consegue diferenciar a intensidade da atividade metabólica nos diferentes padrões de TCAR em pacientes com ES crônica. A associação entre CCL2 e OVF pode estar relacionada à atividade fibroblástica nessas áreas; entretanto, a expressão suprarregulada de CCL2 no tecido pulmonar de pacientes com ES deve ser investigada para que se compreenda melhor essa associação.

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INTRODUCCIÓN: La capacidad de conducir un vehículo motorizado impacta en la participación comunitaria de una persona con lesión medular congénita o adquirida. Al respecto, los simuladores de conducción sirven tanto de en­ frenamiento como para determinar la idoneidad para conducir un vehículo motorizado. OBJETIVO: Describir la experiencia de uso de un simulador de conducción adaptado en entorno de realidad virtual en personas con lesión medular tipo paraplejia de origen congénito o adquirido. MÉTODO: Se selec­cionaron 6 usuarios/as con paraplejia congénita o adquirida, entre 18 y 24 años de edad, sin antecedentes de patología visual, con resistencia máxima y sensibilidad completa en miembros superiores. Todos recibieron 8 sesiones de 40 minutos de uso del simulador. Se aplicó evaluación basal, al primero y tercer mes post intervención sobre estado funcional, impacto psicosocial de la asistencia tecnológica (PIADS) y satisfacción usuaria. RESULTADOS: En PIADS, el puntaje para Adaptabilidad es constante con puntuación máxima midiendo en 1 y 3 meses. En el mismo periodo, el puntaje de Competencia sube de 2,6 a 2,7, mientras que Autoestima sube de 2,1 a 2,2 puntos. En la encuesta de satis­facción destaca la valoración máxima y constante en el ítem "Recomendación del simulador". Ninguno de estos cambios fue estadísticamente significativo. CONCLUSIÓN: Los cambios observados en las puntuaciones, aun no siendo sig­nificativos, son positivos y consistentes con los antecedentes teóricos respecto a la valoración de la experiencia de uso de simulador de conducción adaptado en entorno de realidad virtual.

INTRODUCTION: The ability to drive a motorized vehicle impacts the community participation of a person with congenital or acquired spinal cord injury. In this regard, driving simulators serve both for training and to determine suitability for driving a motorized vehicle. OBJECTIVE: To describe the experience of using an adapted driving simulator in a virtual reality environment in people with paraplegia-type spinal cord injury of congenital or acquired origin. METHOD: 6 users with congenital or acquired paraplegia, between 18 and 24 years of age, with no history of visual pathology, with maximum resistance and com-plete sensitivity in upper limbs, were selected. All received 8 sessions of 40 minutes of use of the simulator. Baseline evaluation was applied, at the first and third month post-intervention on functional status, psychosocial impact of technological assistance (PIADS) and user satisfaction. RESULTS: In PIADS, the score for Adaptability is constant with maximum score measured at 1 and 3 months. In the same period, the Competence score rises from 2.6 to 2.7, while Self-esteem rises from 2.1 to 2.2 points. In the satisfaction survey, the highest and constant rating stands out in the item "Recommendation of the simulator". None of these changes was statistically significant. CONCLUSION: The changes observed in the scores, although not significant, are positive and consistent with the theoretical background regarding the evaluation of the experience of using an adapted driving simulator in a virtual reality environment.

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OBJECTIVE: The objective of this study was to determine the safety and efficacy of renin-angiotensin system (RAS) inhibitors and beta-blockers in chronic Chagas cardiomyopathy. BACKGROUND: Chronic Chagas cardiomyopathy causes substantial morbidity and mortality in Latin America. Whether RAS inhibitors and beta-blockers are safe and beneficial has been challenged because of the lack of formal trials. METHODS: We conducted a double-blind, placebo-controlled, and randomized trial in 42 patients with Trypanosoma cruzi infection and cardiomyopathy. All patients received enalapril (up-titrated to 20 mg BID) and spironolactone (25 mg QD). Subsequently, the patients were randomly assigned to receive placebo (n = 20) or carvedilol up-titrated to 25 mg BID (n = 19). The primary end points were change in left ventricular ejection fraction (LVEF) after RAS inhibition and that after the addition of carvedilol. The secondary end points were changes in other echocardiographic parameters, Framingham score, quality of life (36-item Short-Form Health Survey), New York Heart Association class, radiographic indices, brain natriuretic peptide levels, and chemokines as well as safety end points. RESULTS: Optimization of RAS inhibition was safe, hemodynamically well tolerated, and associated with improvements in Framingham score (P = .001) and quality of life as well as reductions in the cardiothoracic index (P = .002), brain natriuretic peptide level (P = .032), and RANTES (regulated on activation, normal T expressed and secreted) level (P = .001). Left ventricular ejection fraction increased by 2.3% (P = .25); in patients with an LVEF < or = 45% at baseline, it increased by 2.8% (P = .017). Treatment with carvedilol was associated with a trend toward an increase in LVEF (absolute difference between groups, 2.3%; P = .094). The addition of carvedilol was safe, hemodynamically well tolerated, and not associated with symptomatic bradycardia. CONCLUSIONS: In patients with chronic Chagas cardiomyopathy, optimization of treatment with enalapril and spironolactone and subsequent addition of carvedilol were safe and associated with benefits in cardiac function and clinical status. Larger trials are needed to show effects on mortality and/or hospitalization.

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Background: In Chile, the prevalence of teenage pregnancy is 17 percent. Aim: To assess relationship between adolescent pregnancy and school desertion. Patients and methods: At the Hospital Guillermo Grant Benavente's Departament of Obstetrics and Gynecology, in Concepción, Chile, 2001 a comparative, cross sectional and correlational study was conducted. The study group were pregnant adolescents who deserted from school system, divided in two subgroups: 86 adolescents who deserted before pregnancy and 130 who deserted during pregnancy. Results: Twenty percent of teenagers that deserted from school before pregnancy belonged to a sublevel of poverty, compared with 5 percent of those who deserted during pregnancy. Flunk was frequent in both but higher in girls that deserted before pregnancy (46.5 and 36.9 percent respectively, (p <0.001). Economic problems were the main cause of desertion before pregnancy (27.6 percent). Shame (41.6 percent) and obstetric complications (31.7 percent) were the main reasons for deserting during pregnancy. Seventy percent of adolescents who deserted before pregnancy had no educational, working or recreational activities. The parental educational level of both groups was low. Conclusions: There is a relationship between teenage pregnancy and school desertion. Adolescents who deserted from school before pregnancy are more vulnerable (Rev Méd Chile 2004; 132: 65-70).

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BACKGROUND: Problem based learning, integrating basic science with clinical problems, is one of the most recommended forms of teaching for medical schools. AIM: To compare a problem based learning program for physics with traditional teaching methods. MATERIAL AND METHODS: In the physics course, first year medical students were separated in groups with traditional learning and problem based teaching. Both groups were subjected to the same knowledge and qualitative evaluations. RESULTS: At the end of the course, cognitive performance in both groups was similar (60.8 and 61.3% among traditional teaching and problem based learning groups respectively). However, students assigned to the problem based learning group evaluated significantly better the teaching methodology and process. CONCLUSIONS: Physics education, using problem based learning, obtains the same cognitive results but a higher degree of satisfaction than traditional teaching among students.

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BACKGROUND: Continuing medical education is essential to cope with the accelerated evolution of medical knowledge. AIM: To assess the feasibility of a distance medical education program prepared in a written format. SUBJECTS AND METHODS: Ninety physicians, aged 25 to 29 years old and with 1 to 4 years of medical practice, working mostly in rural locations, participated in the program. The sending of 10 issues with medical topics was programmed. The topics were selected according to the results of an survey done among physicians of the region. Each issue contained an evaluation that had to be returned to the authors. RESULTS: Eighty two physicians completed the program and 59 returned the evaluations. The mean obtained score in the cognitive evaluation was 80 +/- 6 points (range 68 to 97 points) of a scale from 0 to 100. The qualitative survey revealed a high degree of approval of the issue's format, contents and evaluation system. The favorable effect on patient's management and on the detection and control of chronic diseases was emphasized. CONCLUSIONS: This distance medical education program had a good receipt and compliance among physicians and contributed to continuing medical training.

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As alterações radiológicas pulmonares em pacientes com esquistossomose mansoni, forma hepatoesplênica, ocorrem em 75% dos casos. As alterações são vasculares e/ou parenquimatosas. As vasculares são mais freqüentes que as parenquimatosas, com retificação ou abaulamento do arco médio. As parenquimatosas consistem de micronódulos ou rosário, mais observadas no lobo inferior do pulmão direito.

The radiological pulmonary alterations evinced by 40 patients with the hepatoesplenic form of schistosomiasis mansoni are observed in 75% of the cases. These alterations are observed on the lung vasculature and/or at the pulmonary parenchyma. The lung vasculature alteration was more frequent than the the parenchymatous, with retification or buldging of the medium arch. The parenchymatous lessions consisted of intestitial nodulation or vascular nodulation, specially observed at the right inferior lobe.

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As alterações radiológicas torácicas na forma hepatointestinal da esquistossomose mansoni, observadas em 70 pacientes, estão principalmente localizadas no arco médio. Possuem freqüência semelhante quanto à retificação ou abaulamento do arco médio e expressam repercussões funcionais arteriolares pulmonares. São benignas merecendo atenção, entretanto, pelo potencial de lesão sobre o sistema cardiopulmonar.

The radiological pulmonary alterations shown by 70 patients with hepatointestinal form of schistosomiasis mansoni are observed specially at the medium arch, which is rectified or bulged. These abnormalities constitute expression of functional alterations of the pulmonary arteriolar vasculature. Though benign, they deserve special attention due to the potential evolution towards cardiopulmonar damage.

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É freqüente o acometimento pulmonar na esquistossomose mansoni aguda, toxêmica, expressão possível de fenômenos mecânicos e imunoalérgicos.

The pulmonary abnormalities on acute, toxemic, schistosomiasis in habitual. They are possibly related to mechanic and immunoallergic phenomena.

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Os autores comparam as alteraçöes radiológicas pulmonares observadas nas fases inicial e tardia da infecçäo esquistossomática nas formas aguda toxêmica (46 pacientes), hepatointestinal (70 pacientes) e hepatoesplênica (40 pacientes).

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Tyrosine protein kinase (TPK) activity is associated to malignant cellular transformation. This work compares TPK activity in 27 surgical biopsy samples of mammary carcinoma, 10 samples of normal mammary tissue. TPK activity was determined in tissue homogenates using (Val5) angiotensin II as exogenous substrate. In samples of mammary carcinoma, TPK activity was 33.86 ñ 31.98 pmol P32/mg protein/30 min. This value was significantly higher that those observed in fibrocystic disease (3.92 ñ 2.35), fibroadenomas (13.86 ñ 10.9) and normal tissue (3.56 ñ 3.02)

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From a clinical point of view, all mammary fibroadenomas are similar. However some of them are not visible in mammograms, phenomenom probably related to glandular density. Aiming to elucidate whether the lack of visibility is caused by the glandular density or by tumor itself, a 3 stage study was performed. In 201 cases the mammographic visibility of fibroadenomas was determined and correlated with patients' age, the presence of fibrocystic disease and tumor histological type; after surgical excision, 18 fibroadenomas were sliced into 5 mm thick samples and X rayed to determine their visibility; finally 2 visible and 2 non visible tumors were calcinated at 550ºC and their ashes subjected to X-ray diffraction analysis. Twenty two percent of fibroadenomas were not vosible on mammography, this percentage was higher for intracanicular tumors, in younger women and in the presence of fibrocystic disease. Sixteen percent of excised and sliced tumors were not visible on X rays. Also, differences were found in X-ray diffraction studies between visible and invisible tumors, probably related to NaCl and KCl tumor content

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Aunque existe acuerdo en que el rendimiento de la termografía como método de diagnóstico en el cáncer de mama es muy escaso, los estudios de la asociación entre ciertos cambios termográficos y el pronóstico de la paciente han obtenido resultados discrepantes. En un grupo de 436 pacientes portadoras de cáncer de mama, en diferentes estadios, estudiadas en un período de 10 años y con una mediana de seguimiento de 34 meses, se analizó la relación de una termografía con signos de crecimiento acelerado (PEV + termográfico) con la sobrevida. Se encontró que aquellas pacientes sin signos termográficos de crecimiento acelerado tenían una sobrevida a 3 años de 84,5% y a 5 años de 72%, lo que resulta significativamente mejor que la sobrevida de aquellas con termografía con signos de crecimiento acelerado en que se encontró una sobrevida a 3 años de 36,7% y a 5 años de 24,5%. Se concluye que la termografía manifestó en esta serie una poderosa capacidad de pronóstico, identificando a aquellas pacientes en que el cáncer se comportaría de manera agresiva

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Success in the treatment of primary hyperparathyroidism rest in the accurate localization and removal of the diseased gland or glands. Computerized tomography and nuclear imaging scans are being used to localize abnormal parathyroid tissue. In the present study, fifteen consecutive patients undergoing surgery for primary hyperparathyroidism were all subjected to these ancillary studies. Results were not revealed to the operating team. In all instances an adenoma was localized during neck exploration. CT Scan failed to localize 73% of the affected glands. Nuclear scans missed almost fifty percent of the parathyroid adenomas. The low yield of these ancillary localizing tests makes them unnecessary in the routine evaluation of patients undergoing surgery for primary hyperparathyroidism

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The post-treatment pulmonary alterations were evaluated in patients (Study 1) and in mice (Study 2) infected with Schistosoma mansoni. Study 1: the patients were examined pre and post-treatment (with ora oxamniquine) and the following exams were performed: sputum for eosinophils and chest x-ray. Study 2: four groups of mice (total = 64) were studied; Group I (infected and treated with oxamniquine); II (infected and not treated); III (not infected and treated) and IV (not infected and not treated). All were x-rayed to check for pulmonary abnormalities pre and post-treatment and lung specimens were studied by optical microscopy and immunofluorescence. We have found abnormalities in the parameters checked in both studies and the results suggest an immunological reaction, probably due to deposition of immune complexes in the lungs, with subsequent activation of the complement system. The experimental study showed that the alterations are not dependent of the presence of eggs and/or worms of S. mansoni in the lungs, thus corroborating the hypothesis of deposition of circulating material.

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