Revista da Associa??o Médica Brasileira (English Edition)最新文献

The present article aimed to review some important aspects regarding the work and life of the legendary English surgeon William Ernest Miles. His masterwork began at the beginning of the 20^th century, when he devised the first radical procedure that aimed to control rectal cancer, after analyzing the poor outcomes of perineal resections for the disease. The famous 1908 publication, focusing on the technique and early results of abdominoperineal excision influenced numerous surgeons for decades, at a time when most rectal tumors were managed through rectal amputation, regardless of their location. Miles was recognized as a brilliant, fast, and skilled surgeon, and his fame attracted many surgeons to watch him at work in London at that time. He was also recognized as a gentle and kind man who became a trusted leader in coloproctology. In this context, he also made various contributions in the field of anorectal diseases, such as hemorrhoids, anal fistula, anal fissure, and rectal procidentia. Thus, he deserves the honors as the pioneer in the elaboration and refinement of a surgical technique that allowed a significant decrease in tumor recurrence and mortality. Furthermore, the Miles operation shifted the perspectives of rectal cancer, and for that his name will always be regarded as one of the giants in the history of colorectal surgery.

Objective

To analyze the misoprostol use in pregnancies with intrauterine fetal death (IUFD), considering mode of delivery and induction-delivery interval.

Methods

Descriptive study including 171 pregnant women with IUFD, in the second or third trimester, submitted to labor induction with vaginal misoprostol and/or induc-tion/augmentation with intravenous oxytocin, from 2005 to 2008, at a teaching-hospital of the Brazilian Unified Health System (Sistema Único de Saúde - SUS).

Results

Misoprostol alone (treatment A), misoprostol plus oxytocin (treatment B), and oxytocin alone (treatment C) were administered in 9.3%, 19.9%, and 70.8% of the cases, respectively. One-third of pregnancies were less than 28 weeks, and 2.9% required a cae-sarean section. The percentage of vaginal delivery in treatments A and B combined (98.0%) was similar to treatment C (96.7%). The mean induction-delivery interval was 15.4hours. Comparing multiple groups, the mean induction-delivery interval was significantly shorter in treatment A (20.1hours) than in treatment B (33.3hours), and was longer than in treatment C (9.7hours). The majority (71%) of cases required a single administration of misoprostol, and the total dosage was lower in treatment A (mean: 98.4 μg) compared with treatment B (mean: 157.0 μg).

Conclusion

Misoprostol effectively contributed to delivery of IUFD by vaginal route assisted under routine conditions of a public health service in Brazil, demonstrating its importance in cases resistant to usual induction methods, and its availability in Brazilian public health services is recommended.

Objective

To determine the prevalence of obesity in asthmatic patients attending at an out-patient clinic, and to investigate its relationships with asthma severity and level of asthma control.

Methods

In a cross-sectional study we recruited patients aged 11 years and older with con-firmed asthma diagnosis from the outpatient asthma clinic of Hospital de Clínicas de Porto Alegre, Brazil. They underwent an evaluation by a general questionnaire, an asthma control questionnaire and by pulmonary function tests. Nutritional status was classified by body mass index (BMI).

Results

272 patients were included in the study. Mean age was 51.1 ± 16.5 years and there were 206 (74.9%) female patients. Mean BMI was 27.5 ± 5.3 kg/m², and 96 (35.3%) patients were classified as normal weight, 97 (35.7%) as overweight and 79 (29%) as obesity.There was a significant higher proportion of female than male patients (34.3% vs. 13.2%, p = 0.002) in the obesity group. There were no significant differences with respect to asthma control (p = 0.741) and severity classification (p = 0.506). The FEV₁% predicted was significantly higher in the obese than in the non-obese group (73.7% vs. 67.2%, p = 0.037). Logistic regression analysis identified sex (OR = 3.84, p = 0.002) as an independent factor associated with obesity.

Conclusions

This study showed a high prevalence of obesity in asthmatic patients. Obese andnon-obese subjects were similar in regard to asthma severity and level of asthma control. Female sex was associated with obesity in this asthma population.

Objective

To compare angiographic findings of diabetic and nondiabetic patients with critical limb ischemia.

Methods

We included 161 patients with infrainguinal critical limb ischemia (CLI). We evaluated the clinical and arteriographic (number and presence of opacification of leg arteries) of the two groups of patients. Statistical analysis was performed using EPI-INFO.

Results

Most patients were category 5 of Rutherford's Classification and had femoropopliteal disease. Seventy-two percent of nondiabetic and 67% of diabetic patients had opacification of the fibular artery (p = 0.25), which is the most present artery in both groups. Diabetic patients had less opacification of the posterior tibial artery in the univariate analysis (29% vs. 47%, p = 0.008). But only female sex showed a significant risk for the absence of the posterior tibial artery in logistic regression (OR = 2.6; p = 0.01).

Conclusion

The peroneal artery was the most frequently found artery in angiograms of diabetic and nondiabetic patients with CLI. Diabetic and nondiabetic patients did not differ in angiographic findings of the leg.