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Introduction: Gastrointestinal stromal tumours (GIST) are mesenchymal tumours of the digestive tract originated in the interstitial cells of Cajal. They express the tyrosine kinase c-kit (CD117) activity receptor. Mutations in this receptor cause neoplastic development. Curative treatment continues to be radical resection of the tumour and is resistant to commonly employed chemotherapy regimens. Imatinib mesilate is a drug that inhibits c-kit activity expressed by GIST and its activity in these tumours has been demonstrated., Material and Methods: Retrospective study of all cases of leiomyoma, leiomyosarcoma, schwannoma, and stromal or mesenchymal tumors from 1989 to July 2004. C-kit and CD34 proteins were detected at immunohistochemical study in addition to the usual markers for mesenchymal tumours., Results: 49 GISTs were diagnosed, 26 males and 23 females (mean age 64.1). Symptoms were digestive tract bleeding (n = 13), abdominal pain (n = 13), intestinal occlusion (n = 4) and others. The lesion was located in small bowel (n = 22), stomach (n = 19), rectum (n = 3), peritoneum (n = 2), esophagus (n = 1), omentum (n = 1), and retroperitoneum (n = 1). Forty-three of the 49 patients underwent surgery; radical resection was performed in 37 (75.5%) and palliative surgery in the other six (16.2%). Two of the patients that did not undergo surgery received chemotherapy. At the time of study, 28 (57.14%) patients remained alive, 23 (46.9%) of whom were disease- free and five (10.2%) were not. Nineteen (38.7%) patients died., Conclusions: The results of our series are similar to the others published. Before the year 2001, surgery was the only successful option for the GIST. Surgical resection continues being the best treatment to definitively cure this disease. Imatinib is used to treat not only resectable tumours, but even to allow the possibility to make a subsequent rescue surgery. On the other hand, Imatinib is used in the treatment of the metastatic disease.

With the purpose of assessing the current program and to adequate its activities to the students' needs, we perform periodical evaluations based on the opinions of the participants involved. During 2002, a new academic plan was implemented for the optional Module "Introduction to Family Medicine", destined to generate professional abilities according to the postulates of the biopsychosocial paradigm. The objective of this study is to evaluate de development of this new academic proposal. We analyzed 132 questionnaires (83% of the population) filled by students that attended the Module during 2002 and 2003. The evaluation consisted on structured questions (answers in numeric scale) and open questions. With the closed questions, we obtained a majority of favorable opinion about the progress of the activities, the modality of work and performance of the educational team. Open questions were classified according to the coincidence and diversity of the opinions. We concluded that this evaluation is appropriate to optimize the progress of the course. From the suggestions provided by the students, we concluded that it would be useful to extend eyewitness activities and to start earlier the rotations at the Department of Family Medicine. After these modifications are made, it would be helpful to perform a new evaluation.

Congenital ventricular aneurysm is an infrequently occurring disease entity that usually affects the left ventricle. Its etiopathology is unknown. Clinical presentation is variable, and the condition is potentially lethal in some cases. Various imaging techniques are useful in diagnosis and enable the condition to be differentiated from congenital left diverticulum. We present a patient with a calcified congenital ventricular aneurysm who presented with supraventricular and ventricular arrhythmias and who was treated by surgical resection.

The aim of this study was to evaluate a new protocol allowing coronary angiography to be performed transradially in spite of the occurrence of iatrogenic radial artery perforation during catheterization. Nine patients with iatrogenic radial artery perforation were managed conservatively by inserting a long arterial sheath in the damaged radial artery up to the brachial artery, after which the diagnostic and/or interventional procedures that had motivated transradial catheterization were completed via the protected radial artery. Radial angiography performed immediately thereafter showed no extravasation, and no major vascular complications developed during follow-up. The day after the procedure, two patients had asymptomatic radial occlusion, but the other seven patients had normal radial pulses and reversed Allen test responses showing normal perfusion. A conservative management technique, installation of a long arterial sheath not only promotes resolution of iatrogenic radial artery perforation but also allows the procedures motivating catheterization to be completed transradially., (Copyright 2004 Wiley-Liss, Inc.)

Introduction: The transradial approach has emerged as an attractive alternative to the femoral approach for coronary angiography and interventions. We describe our experience with the transradial approach and analyze the influence of the learning curve., Patients and Methods: The transradial approach was attempted in patients with a good radial pulse and normal Allen test. When feasible and clinically indicated, we attempted ad hoc intervention. We divided the study population into two groups: Group A (the first 200 cases) and B (all other patients). We compared the radial group with a matched femoral control group., Results: We attempted the transradial approach in 526 patients (77.6% male; age 63.5 +/- 11.51), and obtained a success rate of 93.7%. We found differences between group A and B in the success rate (91.0 vs 95.4%, p = 0,04), duration of procedure [23 (16-29) vs. 19 (15-24) minutes; p < 0.001], and fluoroscopy time [6.4 (4.2-10) vs. 5.0 (3.0-7.7) minutes; p < 0,001]. At 24 h of follow-up, we found small hematomas in 9.4%, bleeding in 4.9%, and radial artery obstruction in 2.8%, with no cases of arteriovenous fistula, pseudoaneurysm, or need for vascular surgery. We attempted intervention in 169 patients with 258 lesions, achieving angiographic success in 96.1%. We found no differences in the characteristics of the lesions and patients, or in the angiographic success rate of the radial and femoral PTCA groups., Conclusions: The transradial approach is a safe and effective alternative to femoral catheterization. There is a significant learning curve associated with the successful performance of transradial procedures.

Understanding of the pathophysiology of atherosclerosis has changed markedly over the past few decades. It is now widely accepted that inflammation plays a fundamental role in the genesis and development of atherosclerosis. Inflammatory mechanisms also appear to determine clinical presentation and disease outcome. Atherosclerotic lesions have high concentrations of inflammatory cells (T lymphocytes and activated macrophages) as well as an abundance of pro-inflammatory cytokines [interleukin (IL)-1, IL-6, IL-8, interferon-gamma, tumor necrosis factor-alpha, etc.] that modulate local inflammatory responses. These may also alter plaque stability and facilitate the development of acute cardiovascular events. The role of anti-inflammatory cytokines in this context remains to be studied. IL-10 is an anti-inflammatory cytokine synthesised by T-lymphocytes and macrophages and has other anti-inflammatory effects. IL-10 expression within human atherosclerotic plaques has been demonstrated and animal experiments have shown that low levels of IL-10 lead to the development of extensive and unstable atherosclerotic lesions. Currently available evidence suggests a potential protective role for IL-10 in atherosclerosis. This new perspective on coronary disease as a chronic inflammatory process may open new avenues for the management of ischemic heart disease.

Cardiac syndrome X defines patients with typical chest pain, transient ischaemic ST segment changes during effort and normal coronary angiograms. An ischaemic origin has been postulated for syndrome X since its description over 30 years ago. This has been based on the fact that patients with cardiac syndrome X have abnormal perfusion scans, a drop in both pH and oxygen saturation of the coronary sinus blood during chest pain and transmyocardial lactate production during stress testing. Moreover, nuclear magnetic resonance spectroscopy studies, demonstrated transient myocardial ischaemia in 20% of women with syndrome X. Microvascular endothelial dysfunction appears to be responsible for at least some of the abnormalities detected in the coronary circulation of patients with syndrome X ("microvascular angina"). ET-1, a potent vasoconstrictor, is synthesised by endothelial cells and may be responsible for coronary flow abnormalities in microvascular angina. Plasma levels of ET-1 are significantly raised in patients with syndrome X, compared to normal controls and a significant relationship has been found between baseline ET levels and abnormal coronary vascular responses in patients with syndrome X. Several investigators, however, have questioned the existence of myocardial ischaemia in patients with cardiac syndrome X. Their arguments are mainly based on the fact that prognosis is good in these patients and that studies with stress echocardiography have consistently failed to show regional wall motion abnormalities, even in patients with typical ischaemic ECG changes. Controversy exists as to the causes of syndrome X and this article reviews the evidence in relation to myocardial ischaemia as a pathogenic mechanism in this syndrome.