AMB : revista da Associacao Medica Brasileira最新文献

The prevalence of gallstones was determined in Curitiba. A total of 384 patients older than 20 years of age was randomly selected from four general hospitals and subjected to ultrasonographic examination of the gallbladder. Of the 384 patients, 327 had normal gallbladder (85.2%) and 57 (14.8%) had gallstones (48 patients) or had been previously subjected to cholecystectomy due to gallstones (9 patients). Six out of the 48 patients with gallstones referred biliary colic (12.5%). Gallstone prevalence increased with age and number of pregnancies.

The malnourished alcoholic patient requires frequently hospitalization for treatment and an adequate nutritional support is necessary for recovery of their health. The objective of the present study was to evaluate the nutritional value of an enteral diet based on "soya milk", corn sugar, coconut oil and water. Seven alcoholics, males, with 36.4 year mean age, without any clinical evidence of hepatic cirrhosis and/or pancreatitis, were submitted to three periods of metabolic nitrogen balance (NB), with multiple levels of protein intake (0.4, 0.6 and 0.8 grams of proteins/kg of body weight/day). The nitrogen intake (NI), the fecal nitrogen (FN) and the urinary nitrogen (UN) were determined, and the NB and protein digestibility value were calculated. The net protein utilization (NPU) was calculated by correlation studies between the NI and NB, with a value of 101.3%. The mean true digestibility was 100.1% and the mean requirement for that population was 0.5g protein/kg of body weight/day. Using a 97.5% confidence limit, the protein requirement of the enteral diet was calculated to be 0.8g protein/kg of body weight/day. The enteral diet based on "soya milk" can be profitable for this group of patients. It is a good alternative for use in enteral nutrition, easily available, well tolerable, and of high biological value.

The initial experience at the Instituto da Criança do Hospital das Clínicas--School of Medicine of São Paulo University with liver transplantation in children is presented. A staff experienced in the management of children, including pediatric surgeons, hepatologists, critical care specialists, anesthesiologists, and other has been joined to draw therapeutic protocols. Afterward, more than 100 experimental liver transplant were performed in animals of medium size (dogs and pigs). From September, 1989 to July 1991, 12 liver transplants were performed on 9 children (3 retransplants) ranging in age from 2.5 to 17 years, being 5 boys and 4 girls. The donors had been selected according to the ABO blood group and body weight. Just once a blood A+ recipient received a liver from a blood O+ donor. The regular postoperative immunosuppression consisted of triple therapy with cyclosporin, prednisone and azathioprine. The postoperative stay in the Intensive Care Unit ranged from 3 to 24 days, according to the necessity of ventilatory support. These was no intraoperative mortality, arterial or venous thromboses, or early biliary complications. The overall survival is 78% (7/9). Primary non-function of the graft was the cause of death in two of our children. Although the number of cases is still small our results are comparable to those of the best liver transplant centers in the world.

The authors present an epidemiological study of 585 primary bone neoplasms and tumor-like lesions in order to investigate their incidence and distribution according to age, sex and skeletal location. A statistical agreement between the pertinent literature and the collected data was found. In this series, the most common benign neoplasms were the osteochondroma (45.3%) followed by chondroma (19.6%). Among the intermediate and malignant neoplasms, osteosarcoma was the most frequent (30.0%) followed by myeloma (16.0%). Fibrous dysplasia accounted for 46.6% of all tumor-like lesions, followed by solitary bone cyst (18.6%).

The clinical, biochemical and radiological data of 25 patients with carcinoma of the head of the pancreas were compared with the same parameters of 25 patients with chronic pancreatitis producing cholestasis. History of alcohol abuse, pruritus and palpable gallbladder were the only clinical findings useful for the differential diagnosis. Plasma bilirubin levels were significantly higher in patients with malignancy (20.0 +/- 14.3 vs 2.5 +/- 2.4) but the course of the bilirubinemia was similar in the two groups after hospital admission. Preoperative ultrasound and cholangiography were usefull in differentiating both groups of patients. Sensibility of a point score based on significant differences was 100% for pancreatitis and 96% for malignancy.