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Using Holter recordings and based on the principle that most of the survivors of acute myocardial infarction who are going to die suddenly after hospital discharge are those who present ventricular premature beats (VPB), the authors have studied the effect of three different antidysrhythmic drugs - procainamide (PA), oxprenolol (OX) and amiodarones. (AMIOD) - in late phase of acute myocardial infarction. All the trials have been controlled Procainamide (47 patients studied), in comparison with placebo (PL), revealed to be effective (a) in supressing and diminishing VPB/hour (p=0.0425), and (b) in maintaining patients with no VPB (PA 89.6% - PL 64.7%). Oxprenolol (27 patients studied), in comparison with placebo, revealed to be effective (a) in maintaining patients with no VPB (p=0.0525), and (b) in avoiding the increase of VPB/hour (p=0.0576). Finally amiodarone (37 patients studied), in comparison with placebo, was effective (a) in maintaining patients with no VPB (AMIOD 50% - PL 39%), (b) in diminishing VPB/hour (AMIOD 29% - PL 9%), and (c) in avoiding the increase of VPB/hour (AMIOD 79% - PL 48%). The authors finish their paper emphasizing that no antidysrhythmic drug should be introduced in clinical practice before being submitted to controlled studies with Holter electrocardiography.

Background: High dose chemotherapy with autologous stem cell transplantation (HDCT-ASCT) has been administered to patients with high-risk germ cell tumours (GCT). The role of this treatment for GCT still remains unclear, including the identification of subgroups more likely to benefit from such strategy., Methods: A retrospective review was conducted of all male patients with gonadal and extra gonadal GCT treated with HDCT-ASCT between 1996 and 2008 at the Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG)., Results: Twenty patients were treated with HDCT-ASCT, 17 with primary testicular tumours, two mediastinal and one retroperitoneal GCT. According to the International Germ Cell Cancer Consensus Group (IGCCCG) classification, at diagnosis three patients had good risk, four intermediate, eight poor but for the patients left the risk group could not be ascertained. In eight patients HDCT-ASCT was used upfront, after induction with first-line conventional chemotherapy, and in the remaining 12 for relapsed GCT. One patient had platinum-resistant and another platinum-refractory disease. Only two patients had Beyer score > 2. All but one patient were treated with ICE (Ifosfamide, Carboplatin, Etoposide). Six patients underwent a second HDCT-ASCT course. The 5-year overall survival and progression free survival were respectively 53% and 44%; both patients with mediastinal GCT are long term survivors., Conclusion: Randomized studies to date have failed to indicate a survival advantage for HDCT-ASCT in GCT. This series is small and heterogeneous which prevents us from drawing conclusions regarding the benefit of this treatment for GCT. However, we could confirm the lack of benefit of HDCT-ASCT for platinum-resistant GCT and to question the absolute contraindication to this therapeutic modality in mediastinal GCT. HDCT-ASCT should therefore be performed exclusively in experienced centers and, preferably, in the setting of clinical trials.

The development of biotechnology drugs represents one of the great advances in medical therapy and it was observed an exponential growth in its use. The resource to these drugs in Oncology and Hematology is no exception and it soon became an essential element of an integrated and directed therapy strategy. The expiry of the first biotechnology drugs patents has opened the door for the development and marketing of biosimilars, which entry in the Portuguese market was recently approved. This article was built on the analysis of the available state-of-the-art information on biotechnology drugs, biosimilars and current legislation and it expresses the opinion of Oncology and Hematology experts about the substituition of biological drugs by biosimilars in clinical practice.

The administration of cytotoxic chemotherapy may be complicated by the emergence of neutropenia and febrile neutropenia, frequently determining hospital admission and intravenous treatment with broad spectrum antibiotics. Frequently, it is necessary to reduce the dose or to delay the administration of the cytotoxic drugs reducing the relative dose intensity of the chemotherapy regimen. Granulocyte growth factors stimulate the proliferation and differentiation of neutrophils and reduce the number of days of severe neutropenia and febrile neutropenia associated with cytotoxic chemotherapy. They are also indicated for the collection of hematopoietic progenitors for autologous and allogeneic transplantation, as well as in non malignant diseases associated with chronic neutropenia. This article reviews the evidence supporting the use of granulocyte growth factors in Hematology.