Revista paulista de medicina最新文献

The present study reports on diaphragmatic changes observed in 226 patients with diseases of abdominal organs of the digestive system. The group consisted of 121 males (53.5%) and 105 females (46.5%) (mean age: 44.1 +/- 4.3 years; range 15-83 years). The parameter of reference for comparisons between normal and pathological conditions was the normal average difference in height between the hemidiaphragms, which was obtained from 220 postero-anterior chest radiographs. These radiographs were obtained from 99 males (49.5%) and 101 females (50.5%) (mean age; 41.1 +/- 5.6 years; range: 15-78 years) who did not present any symptoms compatible with diseases of the digestive system. Several diseases which affect different abdominal organs were found to cause various differences in height between the left and right hemidiaphragms. The mechanism and clinical applications of the alterations observed are discussed.

Anastomotic dehiscence remains the main cause of morbidity and mortality of intestinal resections, mainly the colorectal (77, 95, 110). Very often in the literature the words dehiscence and fistula are misused for the same meaning. Nevertheless, attention must be paid to the fact that these two situations may be distinct. Dehiscence is defined as the failure of healing of the anastomoses, while fistula is the leakage of the intestinal content into the peritoneal cavity. So, the evidence of fistula is always accompanied by dehiscence, although a dehiscence may not develop into a fistula, should it be blocked by omentum or surrounding organs (110, 117). The incidence of overt dehiscence varies from 0.1% to 30% in the literature (13, 15, 17, 27, 31, 40, 44, 46, 76, 77, 81, 96, 113, 120, 123, 126, 133, 135). The Colon Cancer Project of the Saint Mary's Hospital in London, a multicentric study of patients submitted to bowel resections revealed a post operative mortality of 22% in patients with dehiscence and 7% for uncomplicated anastomoses. This led to the struggle various authors to achieve better results, regarding techniques and suture materials, such as the number of planes involved, inverted or everted sutures, wound healing and the influence of local and systemic factors, like infections, antibiotics, NSAIDs on sutures. Recently, surgical stapling gained importance among surgeons, due to its technical advantages. However, this is still very controversial and must undergo further investigations (93, 107, 109, 112, 115, 116). So, in order to understand the pathophysiology of the complications and to reduce morbidity and mortality, related to intestinal anastomoses, it is necessary to study the events involved in intestinal healing after resection, as well as the technique, materials used and the factors related to anastomotic failure.

Malnutrition frequently occurs among hospitalized children (19, 23, 24) and is associated with increased rates of morbidity and mortality (3, 5). Because of this hypercatabolic condition, a critically ill patient may undergo a process of acute malnutrition within a few days (7, 27, 34). The nutritional or metabolic support provided in these situations is usually by the parenteral or enteral route, depending on the presence of a functioning digestive tract. When exclusively parenteral feeding is used, prolonged fasting may deprive the intestine of specific nutrients and reduce its function of nutrient processing and absorption for lack of a substrate, with the consequent occurrence of atrophy. Clinical and experimental studies have demonstrated the advantages of the enteral route, which is more physiological, has a lower rate of complications and involves easier administration when compared to the parenteral route. Experimental studies (15, 21) have shown a hypoplastic response of the intestinal mucosa of rats after 3 days of parenteral nutrition when compared to controls submitted to enteral feeding. This response was measured in terms of mucosal weight, villus hypoplasia, DNA protein content, enzyme activity, and pancreatic function. Similar changes detected in clinical studies were rapidly reversed to normal after feeding by the digestive route (13). It is suggested that the mechanism of these alterations may involve the absence of intraluminal amino acids needed for enzyme synthesis rather than the lack of specific substrates inducing enzyme production.(ABSTRACT TRUNCATED AT 250 WORDS)

Objective: to verify the effects of Listeria monocytogenes (LM) inoculation in the survival of animals bearing Ehrlich's tumor. KIND OF STUDY: experimental. Animals-isogenic mice, Balb/c, female, 19-21 g. Tumor-Ascitic Ehrlich's tumor, dilution of 5 x 10(5) cells/0.1 ml. Bacteria-LM serotype 4a, solution with 7 x 10(3) bacteria (standard sub-lethal dose). Intervention-a) inoculation of LM in mice bearing Ehrlich tumor at the same time as ascitic cells transplantation. b) inoculation of LM seven days before and, again, seven and fourteen days after ascitic cells transplantation. c) to study the effect of using ampicillin 100 mg/kg, im, simultaneously with the inoculation of Ehrlich tumor and LM organisms and, again, 3, 5, 7, 14, 21 and 30 days after the ascitic cells transplantation.

Analysis: Chi-square test; p < 0.05

Results and conclusion: LM increases significantly the survival of mice bearing Ehrlich tumor even when only one inoculum of viable LM was used, seven days before or seven days after the ascitic cells transplantation. The use of ampicillin after the inoculation of LM and tumor transplantation does not alter the survival of mice.

The present study was undertaken to determine the correlation between free bilirubin and indirect bilirubin in normal newborn infants with non-hemolytic jaundice, and the possible effect of hemolysis on free bilirubin measurement by the peroxidase method. A prospective study protocol was applied at the Neonatal Unit of the Department of Pediatrics, Escola Paulista de Medicina. Forty-three newborn infants were submitted to measurement of free bilirubin and bilirubin fractions and the extent of hemolysis of the sample was determined. Data were analyzed statistically by the Student t-test. A positive and moderate correlation (r = 0.668; p < 0.01) was detected between free bilirubin and indirect bilirubin. The linear regression equation calculated by the least squares method was as follows: f(x) = 4.562 + 0.382x. The concentration of free bilirubin was inversely proportional to sample hemolysis, the difference being greater at 50 mg/dl hemolysis. Despite these results, however, the use of this correlation is delicate due to the impossibility of establishing it in individual cases. Also, since the samples may show some degree of hemolysis, this factor should be minimized by appropriate sample collection before free bilirubin measurement.

Seventy-eight women with breast disease were studied aiming to evaluate the importance of the fine needle aspiration biopsy for its diagnosis and forwarding treatment. Our data showed a high diagnostic accuracy with a low level of false negative results and no false positive. The macroscopic appearance of samples is an important aspect. Clear material prevailed in benign pathology (90%) and the presence of blood was usual in malignant tumors (78.3%).

The objective of this study was to develop a simplified method for the simultaneous analysis of cellular karyotype and phenotype which would permit the identification of cell origin. We studied 6 patients with AML, 3 with CML (one of which was in blastic transformation) and one ALL. We used a method in which the suspension of bone marrow cells was incubated in TC 199 medium with colchicine and with hypotonic solution formed from glycerol, NaCl, KCl, CaCl2, MgCl2 and sucrose. The slides were prepared from this cell suspension by cytospin and stained for peroxidase, PAS, esterases and iron. The karyotype was studied by direct method and culture. It was possible to relate the cytogenetic marker with cytochemistry characteristics in the same cell in 3 cases, showing the feasibility of cytochemistry techniques in cytogenetical preparations. The best preparations were found through peroxidase. The presence of iron granules allowed identification of erythroblastic lineage in the combined staining. Mitosis with a marker chromosome of leukemic clone in an AML cell with negative peroxidase probably showed a proliferation of more primitive precursor not sufficiently differentiated to show markers.