Revista paulista de medicina最新文献

Gallbladder lesions by blunt abdominal trauma are rare, due to the organ's anatomical particularities. Diagnosis is difficult, and it generally occurs during surgery. The trauma is usually associated with other lesions and is related to very serious traumas or to deceleration. Due to the scarcity of publications on this topic and to its reduced incidence, we present here a report of five patients who had suffered blunt abdominal trauma with gallbladder lesion and who were attended at the General Hospital (of the University of São Paulo Medical School) Emergency Service between 1986 and 1991. Furthermore, we analyze the incidence of this trauma, presence of associated lesion, treatment, morbidity and mortality of the patients, as well as a review of the literature.

The Bruno Balke test is one of the methods available to measure the oxygen intake in wheelchair users. The equation of the test is:intake O2 = 33+ (speed average-133) x 0.17 ml/kg x min. (-1). The average speed represents the acceleration and may be used to measure the level of physical fitness. In order to verify the efficiency of this kind of evaluation, we selected ten male, sedentary paraplegic patients, level D5-D12 in an ordinary rehabilitation program and ten paraplegic athletes. All of them were submitted to the Bruno Balke test. The results demonstrated that the average speed, the covered distance and the oxygen intake were significantly greater in athletes than in sedentary individuals.

The authors study the vertebral artery from its origin to termination, especially in its course inter and intra transverse process and show its relation to venous and nervous structures, as well as its behavior toward adjacent conjunctive tissue. They discuss the relation of the anatomy to the physiopathology of the vertebral artery and come to the conclusion that the vertebral artery is fixed to adjacent structures in the fibrous osteomuscular tunnel by means of a continuous lamina of collagen along its entire course and that there is considerable independence between the artery and the branches of these final nerves.

The frequency of X-chromatin was determined in pregnant women during the second trimester of gestation in order to establish possible correlations with the changes in steroid hormone levels occurring during this period and compare the curve with that for normal nonpregnant women. The mean frequency of X-chromatin in oral mucosa cells from a salivary suspension was 19.97% for the 24 patients studied, a statistically higher value than that obtained for nonpregnant women.

Total knee arthroplasty has been showed to be a satisfactory procedure mainly in relation to designs evolution of condylar or surface prostheses. In this matter, the concepts of prostheses of Gunston Polycentric (2), Freeman-Swanson (1) and the Total Condylar (3) were particularly important. The present status of development of condylar or surface arthroplasties allows to establish that in the majority of cases, arthrodesis of the knee is a salvage procedure. The alternative procedures indicated must always be considered. The conservative treatments as anti-inflammatory drugs and physiotherapy as well as arthroscopy, arthrotomy, synovectomy and osteotomies can be performed. These procedures are indicated depending on age, joint condition and type of disease. The knee arthroplasty requires skill and training of the surgeon, particularly if we consider the deformities and instabilities to be corrected and joint function to be aimed. On the other hand, the major problem may be the selection of the patient who will be operated on for a given type of total knee arthroplasty.

Since Aubaniac (1) described the puncture of the subclavian vein in 1952, and specially after the standardization of parenteral nutrition by Dudrick et al. (11) in 1968, much has been published about complications caused by percutaneous central venous catheterization. Among the various complications provoked by this procedure, a very important one is "primary sepsis" or "catheter-related sepsis", both because of its frequency and because of the morbidity and mortality it causes (18,19). It is, however, difficult to diagnose this complication. The main difficulty lies in differentiating catheters that are really causing sepsis from those that, though showing "positive culture" do not cause bacteremia and are not responsible for the occasional signs of infection that a patient may show (6,7). This difficulty in diagnosing has led to the recommendation that all catheters suspected of causing sepsis be systematically removed. This procedure has the effect of exposing patients in serious condition and with limited venous access to the risks of new punctures. Usually these risks are unnecessary, since 75 to 90% of the catheters removed for this reason are not the real source of infection (3, 17, 19, 21, 22). In 1977, Maki et al. (18) proposed a semiquantitative catheter tip culture that showed considerable correlation with positive hemoculture for the same microorganisms; that is, capable of identifying which "positive catheters" were really causing sepsis. Subsequent research confirmed these results, showing that the semiquantitative catheter tip culture had specificity and sensibility over 80% (10, 15).(ABSTRACT TRUNCATED AT 250 WORDS)

A study was conducted on material obtained by capillarity puncture (74 punctures) from 71 patients with breast tumors. The material was fixed in absolute alcohol and stained by the Papanicolaou method and the result was classified as insufficient material, or as negative, suspect or positive cytology. After tumor exeresis, the anatomopathological results of each patient were compared to the cytology data. A single false-positive case was obtained among 44 patients (97% specificity) and 9 false-negative cases were obtained among 16 patients (56% sensitivity).

The first reference concerning the multiple primary malignant neoplasms was made by Bilroth, 1880 and since then a large number of studies have been published. Furthermore, an increasing incidence of simultaneous cancers are currently observed (16,18). At the same time, several retrospective populational studies evidenced the association between breast and endometrium carcinoma. It is well known that both uterus and breast are hormone-dependent organs and are likely to be influenced by the same oncogenic stimulus, either of endocrine nature or dietary origin (2, 3, 14). The risk of developing endometrial carcinoma is higher in patients already affected by breast neoplasm and is much more evident in older women within the first five years following the diagnosis of breast tumor. Conversely, patients with endometrial carcinoma may present a second mammary neoplasm and the relative risk is around 2.0 (1, 17). Although the existence of a correlation between these two primary malignant neoplasms is clearly observed, the absence of systematic studies directed to the screening of endometrial cancer in women with breast carcinoma is surprising. This study deals with histological analysis of the endometrium of postmenopausal patients with breast cancer and aims to determine the possible changes that might have occurred in the onset of the disease.