Revista paulista de medicina最新文献

The purpose of the present study was to analyze in detail the kidney lesions of diabetic patients. Revision of the histopathologic aspects of this nephropathy was performed, seeking to approach the pathophysiology of its formation. In 200 consecutive necropsies of cadavers of diabetic patients examined at the Pathology Department of the Medical School of the São Paulo University, some degree of nephropathy was found in 158 cases. The slides from paraffin sections of these cases were reviewed according to a morphologic protocol previously established. Diffuse, nodular and mixed glomerulosclerosis were encountered in 42.2%, 21.5% and 5.7% respectively. Subcapsular drop and exudative lesion appeared in 12.7% and 15.2% of the cases. We also encountered arteriosclerosis in 81.6%, arteriolosclerosis in 88.6%, necrotizing papillitis in 11.4% and acute and chronic pyelonephritis in 23.4% and 20.9% respectively. We concluded that glomerular and vascular hyalin alterations were the most frequent findings in diabetic patients.

Of a total of 111 children with primary immunodeficiency, 20 had phagocytic disorders (18%) and 10 of them (8 boys and 2 girls) were diagnosed as chronic granulomatous disease (CGD). The children presented with repeated infections already during the first months of life. The main clinical findings were: abscess (n = 8), otitis (n = 8), pneumonia (n = 8), lymphadenitis and pyodermitis (n = 6) and septicemia (4), NBT reduction was almost absent in all the children, except one of them. Bactericidal activity against S. aureus and phagocytosis were impaired in CGD patients. Different patterns of laboratory tests and prognosis were observed and girls had a better evolution.

Bacteremia is related to high morbidity and lethality. The present investigation was conducted to evaluate the variables associated with outcomes of bacteremia at a University Hospital in São Paulo, Brazil. Patients with bacteremia were identified through positive blood cultures performed at the microbiology laboratory between August 1985 and July 1986. Their charts were reviewed and the following variables were considered: age, sex, presence of underlying disease, where was the bacteremia acquired, source of infection, presence of shock and appropriateness of antimicrobial therapy. In the period of the study, there were 362 cases of bacteremia out of 16,636 admissions to the hospital. The lethality rate was 33.4%, six times higher than the mortality rate for non-bacteremic patients. Age greater than 40 years, presence of severe underlying disease, nosocomial acquisition, respiratory tract as the source of bacteremia, presence of shock and, being infected with Pseudomonas sp were significantly associated with fatal outcome. Appropriate antimicrobial therapy reduced the incidence of shock and improved survival of patients with bacteremia. This study provides information on outcome of patients with bacteremia at a University Hospital in Brazil and, settles the variables associated with poor outcome in these patients.

Fifty patients with metastatic or invasive gestational trophoblastic disease (GTD) were admitted at the "Hospital das Clínicas" of the Ribeirão Preto School of Medicine of the São Paulo University between January 1980 and December 1990. Of these 50 patients, 44 (88%) had GTD following abortion, 5 (10%) after term pregnancies and one (2%) after an ectopic pregnancy. Thirty five (70%) had invasive GTD and 15 (30%) metastatic GTD. The sites of metastases were: lung, 8 (53.3%), pelvis, 4 (26.6%), central nervous system, 2 (13.3%) and right auricle, 1 (6.6%). Human chorionic gonadotropin, pelvic arteriography and ultrasonography were used in the diagnosis of invasive GTD. 25 of the 41 patients with low-risk metastatic and invasive GTD were treated with monochemotherapy. There were 6 (24%) failures and the remaining 19 patients (76%) had complete remission of the disease after 2.89 mean cycles. Sixteen patients were treated with polichemotherapy, there were 2 (12.5%) failures and the remaining 14 had complete remission after a 2.3 mean cycles. No statistical differences between the two types of chemotherapy were observed. Four (8%) deaths were recorded.

The emergency department thoracotomy as a ressuscitative measure is a controversial subject in trauma surgery. Indiscriminate indication has occurred due to unclearness upon the real value of this procedure, but further critical evaluation has reduced initial enthusiasm rather emphasizing a more rational approach by systematization of criteria for selective indication. Clinical outcome is related to injury mechanism and patients conditions upon admission. According to vital signs the patients conditions are classified as fatal, agonic and shock; survival rates oscillate between 0 to 40%. This study presents a review of the literature discussing indications, technical aspects, complications and clinical outcome of emergency department thoracotomy in trauma patients.

The role of serum prolactin in sexual dysfunction has not yet been clarified. Moderate elevations of prolactin levels, without any associated disorder, occur frequently. A random group of 600 patients was studied to determine the level of prolactin in which medical treatment was necessary. Among these patients 23 (3.8%) presented hyperprolactinemia and were divided into two groups: Group 1--Twelve patients with prolactin levels ranging from 20 to 40 ng/ml, and Group 2--Eleven patients with levels higher than 40 ng/ml. In Group 1, prolactin of all patients returned to normal levels after treatment, but only one patient (8.3%) achieved full erection; on the other hand, in Group 2, nine out of eleven patients prolactin returned to normal after treatment and 77.7% achieved full erection.