Revista paulista de medicina最新文献

Between 1980 and 1989, 68 tetraplegic patients (69 males and 8 females) with cervical spine fractures were treated with corpectomy, iliac bone grafting and anterior plating. The average age was 27 years (15-58 years). The resected vertebrae was C4 in 4 cases, C5 in 24, C6 in 32 and C7 in 8. The injuries were classified according to Allen et al. in: compressive flexion in 47 cases, vertical compression in 20 and distractive flexion in 1. The neurologic deficit was complete in 30 patients and incomplete in 38 patients. The surgery was performed 7 days (average) (1-28 days) after the trauma. The mean follow-up was 2.8 years (1-9 years). In the postoperative period early mobilization was permitted with a plastic collar. There were 6 deaths that were not related to the technique in the first 4 weeks; the results of the remaining 62 patients are presented hereafter. In the final follow-up we observed that 56 patients had no complications related to the procedure and the spine was stabilized. The following complications were observed in the remaining patients: 5 partial loosening of the plate, but the patients were asymptomatic and 1 complete loosening that was reoperated after 2 weeks. The motor indices improved from 12.4 points initially to 23.7 in the complete tetraplegics and from 30.2 points to 72.5 in the incomplete tetraplegics. We conclude that the anterior plate fixation after anterior decompression for cervical spine fractures avoids the extrusion of the graft and provides immediate stabilization of the spine, permitting early mobilization of the patients.

Malignant tumors of the small intestine are rare and their symptoms are discrete and of a chronic nature. At times they manifest as an acute abdomen, with high mortality. Carcinoid tumors represent one of the types of intestinal tumors, of the neuroendocrine line, more frequently located in the cecal appendix. In the small intestine, carcinoid tumors are most often located in the ileum. Carcinoid tumors produce several hormonal substances, some of which may induce symptoms such as the carcinoid syndrome. Gangrene of the small intestine is a rare complication attributed to hormonal substances produced by the tumor which causes high mortality rates. We report, here, a case of ileal segmental gangrene with an excellent course.

A study was conducted on 115 full-term newborn infants with fetal-maternal ABO or Rh incompatibility submitted to exchange transfusion (EXT) due to hyperbilirubinemia. Donor blood was preserved in sodium citrate-sodium phosphate-dextrose-adenine (CPDA-1) and stored for a maximum of 48 hours. The volume of blood exchange was equivalent to two blood volumes of the infant and the procedure took approximately two hours. The following results were obtained with respect to bilirubins: 1) EXT let to a 44.03% reduction in indirect bilirubin in the ABO group and to a 43.40% reduction in the Rh group, thus demonstrating the efficacy of this procedure. 2) EXT was indicated earlier and in the presence of lower indirect bilirubin levels in the Rh group, which was also the group which required more frequent repetition of EXT (44.40% as opposed to 17.10% for the Rh group. 3) In both the ABO and Rh groups, the indirect bilirubin value that most closely approached the level for EXT indication was that obtained 3 hours post-EXT (least significant percent difference).

Some studies have suggested that premenopausal women show a decline in bone mass in function of age while other studies have not. Bone density in the spinal column and proximal femur (neck, Ward's triangle and trochanter) in 75 healthy white women between the ages of 30 and 49 without a history of irregular menstrual periods was correlated with age, weight, height and body mass. No statistically significant decline in bone density with age was seen during the premenopausal period. There was a positive correlation between bone density in the spine and proximal femur and weight and body mass indices. Our results suggest that healthy women do not show loss before menopause and it also seems that obesity has a favorable effect on these women's bone mass.

Retrospective study carried out in São Paulo, Brazil, from September 1981 through March 1990. During this period the study investigated 19,389 hematological patients, aiming to assess the prevalence and estimate the incidence of drug-induced agranulocytosis. To assess the Hematology Center's catch population, where the study took place, we adopted the incidence of hemophilia A, chronic myeloid leukemia and acute leukemia, described by the international literature as reference for our catch population estimate. Our findings revealed a prevalence of 1 case of agranulocytosis per 3,878 subjects treated at the São Paulo Hematology Center which translates into an incidence of 0.44 to 0.82 cases of agranulocytosis per million inhabitants, per year.

Purpose: Immunological evaluation of patients with cartilage-hair hypoplasia. TYPE: Prospective and retrospective studies.

Place: Division of Allergy, Clinical Immunology and Rheumatology-Dept. of Pediatrics-"Escola Paulista de Medicina".

Patients: Two children with cartilage-hair hypoplasia syndrome.

Methods: Clinical and immunological evaluation. Humoral immunity (immunoglobulin levels, poliovirus antibodies, etc.) and T cell immunity (in vitro cultured lymphocytes stimulated with PHA, Con A and PWN, total T cell and subset determination) were studied.

Results: Cellular immunodeficiency and hypogammaglobulinemia were observed in one patient and normal values in the other.

Conclusions: Immunological evaluation (cellular and humoral) should be performed in all patients with cartilage-hair hypoplasia.

Monitoring the critical care patient by pulse oximetry and capnography permits the early diagnosis and follow-up of various clinical events in a precise manner, with considerable safety and with no need for invasive procedures. These techniques have been extensively evaluated in adults, but only recently have they been studied in pediatric patients, including newborn infants. In the present review we discuss the working principles, indications, advantages and limitations of each technique, as well as the interpretation of the results.