Revista paulista de medicina最新文献

The author presents a new drill guide for reconstruction of the knee ligament called "Guia Universal Isométrico Acoplado--G.U.I.A." (Universal Coupled Isometric Guide). The guides uses the posterior region of the intercondylar notch to obtain the femoral tunnel for the anterior cruciate ligament (ACL). Based on biomechanics, literature and cadaver knee studies, the guide has proved to be practical, to facilitate the preparation of isometric tunnels and to avoid iatrogenic injuries.

The purpose of this study was to evaluate MRI findings in a group of patients with Wilson's disease, trying to establish possible correlations between clinical and image data. Sixteen patients (8 males and 8 females), with ages ranging from 11 to 50 years, and duration of illness ranging from 5 months to 32 years, were submitted to MRI in a 1.5T System. Four patients were asymptomatic, 4 had mild neurological findings, 2 were moderately affected and the remaining 6 had a severe form of the disease. All patients were receiving D-penicillamine by the time of the study. The most symptomatic patients presented five or more sites of abnormalities on MRI. The putamen was affected in all symptomatic individuals and one asymptomatic and 11 of them presented dystonia on neurological examination. A striking feature was the peripheral localization of putaminal hyperintense lesions on T2 weighted images. In eight cases, striatum or "substantia nigra" lesions explained parkinsonism observed on neurological examination. MRI seems to be an efficient method to study neurological involvement of Wilson's disease allowing some interesting anatomo-clinical correlations.

Ultrastructural initial changes study of convoluted proximal tubule after single dose of 154.8 mC/kg (600R), X-ray whole body radiation was performed in 12 C57BL mice. Twenty-four hours later, mitochondria evidenced proeminent changes such as cristolyses, dilatation and vacuolization. Within 72 hours, heterochromatin nuclei increased and vanished 144 hours after X-ray exposure. Such findings suggest that recovery probably happened because convoluted proximal tubules take place, regeneration occurs in a slow rate.

A series of 110 muscle and 40 skin biopsy specimens were examined using direct immunofluorescence aiming to identify features that may differentiate the myopathy of connective tissue disease from other muscle diseases. The skeletal muscle fluorescence was positive in 75% of the patients with muscle diseases. The sarcolemmal staining was higher in mitochondrial encephalomyopathy. Fiber and vascular staining occurred in all muscle diseases, except in cases of myasthenia. Our results showed that 42% of patients with polymyositis and 43% of patients with peripheral motor neuron diseases have vascular deposits of immune complexes suggesting that these two diseases could result from an immune-complex-induced vasculopathy. The IF test in skin specimens was positive in 60% of the patients with muscular diseases. The absence of immunoglobulin deposit at the dermoepidermal junction and at epidermal nuclei in cases of peripheral motor neuron disease suggest that this skin test may be useful in the differentiation of muscle diseases.

Two cases of peripheral T-cell lymphomas in HIV-positive patients are reported: one case of T-pleomorphic small cell non-Hodgkin lymphoma in a 27 year-old bisexual male, and one case of a T-pleomorphic medium and large cell non-Hodgkin lymphoma in a 27 year-old female, whose husband was drug addicted. Both cases were studied on a morphological and immunohistological basis.

The authors evaluated 50 patients with endometrial carcinoma studying the prognostic parameters: histologic grade, myometrial invasion and lymph-vascular space invasion. The patients were divided into two groups: A--a good prognosis group (33 cases)--with no recurrences and/or metastasis occurring for five years; and B--a bad prognosis group (17 cases)--with recurrence and/or metastasis or death within five years. We concluded that lymph-vascular space invasion was more frequent in group B, and was a reliable parameter for bad prognosis. The lymph-vascular space invasion was always accompanied by myometrial invasion and patients whose myometrium had not been involved did not have lymph-vascular space invasion. In both groups, in well-differentiated tumors, there was no lymph-vascular space involvement. The well-differentiated tumors were statistically more frequent in the good prognosis group. Myometrial invasion was not statistically significant as a prognostic parameter.

In order to evaluate the pattern of ANA testing solicitation, 506 patients with ANA testing requested from July 1st. 1988 to December 31st, 1988, had their charts reviewed. These patients, randomly selected, were regularly attending the outpatient clinic at the "Escola Paulista de Medicina" (EPM). 289 patients were followed up at the Rheumatology Division (group A) and 217 patients at other clinical divisions at EPM (group B). The diseases that most frequently motivated the request for ANA test were: group A--SLE (22.5%), RA (18.0%), undefined arthropathies (6.2%), PSS and CREST (5.9%) and Raynaud phenomena (5.5%); and group B--rheumatic diseases (24.4%), nephropathies (17.1%), neuropathies (16.6%), dermopathies (7.8%), hemopathies (4.6%), pneumopathies (4.2%) and ophthalmopathies (3.7%). The positivity of ANA test in groups A and B was 32.9% and 17.5% respectively. 94 SLE patients were clinically diagnosed. The positivity of ANA and anti-dsDNA tests in this group was respectively 85.1% and 26.6%. The sensitivity and specificity of 1982 ARA revised criteria were 94.7% and 99% respectively. The likelihood ratio (LR) of a positive or a negative test was established for this population. LR of a positive test was 6.5 while for a negative test it was 0.17. The ANA test, although lacking specificity, has been commonly requested by different specialties in order to practically rule-out the diagnosis of some connective rheumatic diseases. Immunofluorescence technique (IF) using antibodies conjugated with fluorochromes. was first described by Coons et al. in 1941. This method has been used as an important diagnostic tool in routine laboratory tests ever since.(ABSTRACT TRUNCATED AT 250 WORDS)

Objective of the study: To determine the maximal bronchodilator dose of procaterol and pirbuterol administered by inhalation with an without an aerochamber (Aerocâmera) to children with acute bronchial asthma attacks.

Type of study: Prospective. 18 children (6-15 years of age) with acute bronchial asthma attacks (FEV1 < 80% of the predicted value) received pirbuterol (N = 10) or procaterol (N = 8) by metered-dose inhaler, one puff every 5 minutes, for a total of five doses. During another acute attack, the same patient received the same medication with the aid of a spacer (Aerocâmera). Clinical evaluation and pulmonary function tests were performed 5 minutes after each inhaled dose.

Results: For both drugs, maximal bronchodilation was obtained after the second dose. No significant side effects were observed even after procaterol doses of 50 micrograms or pirbuterol doses of 1000 micrograms. The results were unaffected by the use of the spacer.

Conclusions: The doses that induced maximal bronchodilation were 400 micrograms pirbuterol and 20 micrograms procaterol. Although the spacer did not change the results, it is a valuable aid for patients who have difficulty in using the metered-dose inhaler (M.D.I.).