bluuebunny/crossref_metadata_2025 huggingface dataset:
Detecção de Listeria, Salmonella e Klebsiella em serviço de alimentação hospitalar
Authors: Pinto Uelinton Manoel , Cardoso Rodrigo Rezende , Vanetti Maria Cristina Dantas
Published: April 2005

OBJETIVO: A presença de Listeria monocytogenes, Salmonella sp. e Klebsiella sp. em dietas enterais e em ambientes, utensílios e equipamentos de preparo de alimentos em serviço de alimentação hospitalar, foi o objetivo desta pesquisa. MÉTODOS: A contaminação de ambientes, utensílios e equipamentos de preparo de alimentos em serviço de alimentação hospitalar por Listeria monocytogenes, Salmonella sp. e Klebsiella sp. foi avaliada em 50 amostras coletadas pela técnica de swab. Quatro amostras de dietas enterais também foram analisadas. Colônias típicas de bactérias do gênero Listeria foram isoladas de dieta enteral em ágar Oxford e a identificação da espécie L. monocytogenes foi feita por testes bioquímicos e imunológicos. RESULTADOS: A presença de Salmonella foi detectada em dieta enteral e identificada como S. rissen por sorologia. Pela relevância como agente causador de infecções hospitalares, bactérias do gênero Klebsiella foram pesquisadas e isoladas em ágar seletivo MacConkey-inositol-carbenicilina. K. pneumoniae foi encontrada em equipamento e utensílio e K. oxytoca em ambiente, equipamento e dieta enteral. Os isolados de L. monocytogenes apresentaram resistência apenas ao antibiótico cefoxitina e os do gênero Klebsiella foram resistentes a ampicilina e amoxilina. S. rissen foi sensível aos 13 antibióticos avaliados. CONCLUSÃO: A contaminação de 11% das amostras analisadas com pelo menos um dos patógenos, alerta para a necessidade de implantação de um rigoroso sistema de controle de qualidade nas áreas de manipulação dos alimentos, a fim de aumentar a segurança alimentar dos pacientes hospitalizados.
Impacto da ingestão de cálcio sobre a mineralização óssea em adolescentes
Authors: Silva Carla Cristiane da , Teixeira Altamir Santos , Goldberg Tamara Beres Lederer
Published: April 2005

A puberdade destaca-se como período fundamental para a aquisição de massa óssea. Durante essa fase da vida, a mineralização encontra-se aumentada com taxas de formação óssea superior às de reabsorção. Nesse sentido, o objetivo desta revisão foi investigar a inter-relação da ingestão dietética de cálcio com a mineralização óssea, durante a puberdade. Entre os fatores influenciadores nutricionais, merecem destaque o fosfato e o magnésio, que, juntamente com o cálcio, mantêm a integridade estrutural do esqueleto. A revisão de literatura indicou que os excessos de proteína e de refrigerantes, na alimentação dos jovens, acarretam comprometimento na mineralização óssea, embora os dados sejam ainda contraditórios. Conclui-se que, durante o período da puberdade, é indicado manter o aporte de cálcio em níveis adequados, na perspectiva de maximizar o pico da massa óssea.
Alimentos modificados e suas implicações no metabolismo energético
Authors: Mourão Denise Machado , Monteiro Josefina Bressan Resende , Hermsdorff Helen Hermana Miranda , Teixeira Marta Cristina Leite
Published: April 2005

OBJETIVO: Comparar o efeito de duas dietas, modificadas no perfil de seus carboidratos, no metabolismo energético de homens com peso normal e com sobrepeso. MÉTODOS: Três formulações convencionais e suas formulações correspondentes diet, compuseram as dietas isoenergéticas padrão e a dieta modificada, respectivamente. Utilizou-se a calorimetria indireta, para obtenção dos dados referentes ao metabolismo energético. A amostra foi de 13 homens em cada grupo. RESULTADOS: O grupo com sobrepeso apresentou um gasto energético superior e uma termogênese inferior (p<0,01) ao grupo com eutróficos, independentemente da dieta. Verificou-se um quociente respiratório de repouso, gasto energético de repouso, termogênese, e oxidação de carboidratos, superior (p<0,05), após o uso de dieta modificada, independentemente do grupo. CONCLUSÃO: Os resultados sugerem que uma dieta isoenergética, com maior quantidade de carboidratos complexos, tende a elevar o quociente respiratório, promovendo, assim, um aumento da termogênese e do gasto energético.
Avaliação nutricional de pacientes em hemodiálise
Authors: Cabral Poliana Coelho , Diniz Alcides da Silva , Arruda Ilma Kruze Grande de
Published: April 2005

OBJETIVO: O objetivo deste estudo foi o de avaliar o estado nutricional e a ingestão de energia e de nutrientes de uma população em hemodiálise no Hospital das Clínicas, Universidade Federal de Pernambuco. MÉTODOS: De um total de 47 pacientes em hemodiálise de manutenção, 37 indivíduos (18 homens e 19 mulheres, idade 50,4 ± 16,3 anos) foram selecionados. O índice de massa corporal foi utilizado para a classificação do estado nutricional e a dieta foi investigada por meio do método do diário alimentar de 4 dias. RESULTADOS: Os resultados evidenciaram um predomínio de indivíduos eutróficos (62,2%) e igual prevalência de baixo peso e excesso de peso (18,9% de pacientes em cada caso). Com relação à dieta, os achados desta pesquisa revelaram um adequado consumo energético-protéico. De uma forma geral, a ingestão média diária de nutrientes foi considerada adequada, exceto pelo cálcio e pela vitamina A, que apresentaram <50,0% e <70,0% da ingestão diária recomendada, respectivamente. CONCLUSÃO: Esses resultados indicam que se deve dar atenção cuidadosa às diferenças regionais e nacionais que influenciam o estado nutricional e a ingestão dietética de pacientes em hemodiálise.
Obtenção e caracterização química e nutricional de diferentes concentrados de caseína
Authors: Roman Janesca Alban , Sgarbieri Valdemiro Carlos
Published: April 2005

OBJETIVO: O objetivo deste trabalho foi avaliar a composição centesimal, o perfil de aminoácidos e as características nutricionais de três concentrados de caseína, obtidos do leite bovino por diferentes processos. MÉTODOS: Os concentrados de caseína foram analisados pelos seguintes processos: uma caseína comercial, obtida por precipitação ácida seguida de neutralização; caseína obtida pela coagulação enzimática; caseína micelar obtida, respectivamente, pelos processos de microfiltração e diafiltração em membrana. A composição centesimal foi determinada por meio de procedimentos descritos no manual Official Methods of Analysis. O perfil de aminoácidos foi determinado após hidrólise ácida da proteína (HCl 6N, 105°C, 22h) em auto-analisador de aminoácidos, dotado de coluna de troca catiônica e reação pós-coluna com ninidrina. Os perfis de aminoácidos essenciais dos diferentes concentrados de caseína foram comparados e estão de acordo com o padrão Food and Agriculture Organization/World Health Organization, para crianças de 2 a 5 anos de idade. O valor nutritivo foi determinado em ratos da linhagem Wistar, recém desmamados, por meio dos índices, digestibilidade aparente da proteína, quociente de eficiência líquida da proteína e quociente de eficiência protéica operacional. RESULTADOS: A caseína comercial apresentou maior concentração de proteína (92,0%), que a caseína micelar (86,0%) e o coágulo de caseína (72,0%). Os animais nas dietas com as diferentes fontes de proteína, não apresentaram diferenças significativas quanto ao ganho de peso e ingestão de dieta. Maior digestibilidade (93,8%) foi verificada na caseína comercial, comparada à dos outros dois concentrados (91,0%). CONCLUSÃO: Os concentrados de caseína apresentaram diferenças quanto à composição centesimal, sendo a caseína comercial superior na concentração protéica. O coágulo de caseína apresentou resultados inferiores aos demais concentrados, quanto aos índices quociente de eficiência líquida da proteína e quociente de eficiência protéica operacional.
A suplementação de glutamina é benéfica em crianças com doenças graves?
Authors: Pacífico Stefânia Lucizani , Leite Heitor Pons , Carvalho Werther Brunow de
Published: April 2005

Embora haja vários estudos clínicos randômicos avaliando os benefícios da suplementação de glutamina em pacientes adultos, há pouca informação em pacientes pediátricos, particularmente naqueles com doenças graves. O objetivo deste estudo foi avaliar criticamente os estudos sobre suplementação de glutamina, para verificar os possíveis benefícios clínicos desta suplementação em crianças gravemente doentes. Levou-se a cabo uma pesquisa dos estudos publicados entre 1992 e 2003, do tipo prospectivo, randômico e controlado, conduzidos em pacientes pediátricos gravemente doentes, divididos em dois grupos: o dos que receberam suplementos de glutamina por via enteral ou parenteral, e o dos que receberam placebo. As variáveis de desfecho foram: tempo para atingir oferta plena de dieta enteral, tempo de hospitalização, complicações e mortalidade. Foram utilizadas as bases de dados Medline, LILACS e Cochrane, com as palavras-chave: glutamine, critically ill, trauma, sepsis, burned, injured, bone marrow transplantation, intensive care, mechanical ventilation. Dos 33 estudos inicialmente identificados, 7 preencheram os critérios de inclusão. A análise dos resultados mostrou que nos pacientes suplementados com glutamina, houve melhor aceitação por via enteral e redução do tempo de nutrição parenteral em recém-nascidos, não havendo efeito sobre o tempo de internação, custos hospitalares e mortalidade. Os estudos controlados na faixa etária pediátrica, não permitem que se adote o uso rotineiro da glutamina em crianças gravemente enfermas. O número reduzido de pacientes e a heterogeneidade quanto ao grupo etário, doenças e via de administração são fatores que limitam a interpretação dos resultados.
Disponibilidad de alimentos como factor determinante de la Seguridad Alimentaria y Nutricional y sus representaciones en Brasil
Authors: Pedraza Dixis Figueroa
Published: April 2005

Objetivamos discutir la situación de la disponibilidad de alimentos en Brasil, partiendo de la literatura científica y asociando a ella la discusión. Éste es el primero de seis artículos, abordando tanto los factores determinantes y los resultantes de la Seguridad Alimentaria y Nutricional, como las condiciones en que Brasil se encuentra con relación a los mismos. En todos los artículos, hemos seguido un único padrón, abordando: (i): el concepto/factor a estudiar; (ii): la forma de medir ese factor; (iii): una caracterización brasileña del tema; (iv): conclusiones globales e interrelacionadas; (v): consideraciones finales, que apuntan las implicaciones del factor estudiado, en relación a las estrategias importantes que deben ser formuladas. Brasil es un país en el que la disponibilidad de alimentos no constituye un factor limitante de su Seguridad Alimentaria y Nutricional. Sin embargo, tanto la incertidumbre acerca de la sustentabilidad, o sea, la habilidad del sistema alimentario en sostenerse suficiente y equitativo a largo plazo, como la desigualdad o iniquidad económica, son factores que siguen comprometiendo el sistema alimentario brasileño.
Hairy cell leukemia: a histo-cytochemical and ultra-structural study
Authors: Gonsalez Denize , Oliveira José Salvador Rodrigues , Haapalainen Edna , Kerbauy José
Published: April 2005

We studied five patients with hairy cell leukemia (HCL) diagnosed within the last ten years at the Department of Hematology of Universidade Federal de São Paulo - Escola Paulista de Medicina. Our purpose was to analyze the value of transmission electron microscopy (TEM) by comparing this method with the conventional ones. At diagnosis, patients presented weight loss, spleen enlargement and hairy cells (HC) in peripheral blood and bone marrow slides. HC was characterized by morphology and tartrate test resistance in the acid phosphatase reaction (TRAP). At the evaluation time, the amount of HC ranged from 1% to 85% of WBC count. All patients, except two, had phenotype B. In these last two, TRAP as well as phenotype B could not be documented due to low HC numbers in their exams. Cytoplasmatic projections and the absence of lamellar ribosomic complex were the most frequent ultrastructural findings, even in those patients with the lowest HC numbers. Based on these features, TEM is an efficient method for searching for HC at HCL diagnosis and during the course of the disease.
Anticardiolipin antibody in recurrent spontaneous aborting and fertile women
Authors: Couto Egle , Barini Ricardo , Silva João Luiz Pinto e , Moraes Denise Rocha Lima Pita de , Carvalho Lucia Maria Fagian de
Published: April 2005

OBJECTIVE: To determine the association between the presence of anticardiolipin antibody and a history of recurrent spontaneous abortion. STUDY DESIGN: clinical controlled study LOCATION: Department of Gynecology and Obstetrics - University of Campinas (UNICAMP) SUBJECTS: 52 individuals with recurrent spontaneous abortion were included in Group 1 and 104 individuals with at least one live born child in Group 2. Elapsed time from last delivery to blood sampling varied from six months to two years. METHOD: Between November 1993 and November 1994, patients' blood samples were screened for anticardiolipin antibody by ELISA, as described by Triplett, Barna and Unger (1993). ANALYSIS: Chi-square and Fisher's Exact tests were used for statistical analysis. Student's "t" test was used to compare the means. RESULTS: There was no statistical difference in the presence of the anticardiolipin antibody between Group I (zero and 2.9%) and Group 2 (7.7 and 5.8%). CONCLUSION: There was no association between the presence of anticardiolipin antibody and recurrent spontaneous abortion.
Seasonal variation of blood pressure in maintenance hemodialysis
Authors: Castro Manuel Carlos Martins de , Mion Jr. Décio , Marcondes Marcello , Sabbaga Emil
Published: April 2005

CONTEXT: Seasonal variation in arterial blood pressure has been reported in studies with hypertensive and normotensive subjects. However, the influence of seasonal change on blood pressure of hemodialysis patients has not been reported. OBJECTIVE: To investigate the seasonal variation of blood pressure in Brazil, a tropical country, in patients on hemodialysis. DESIGN: Prospective, cohort study. SETTING: Dialysis unit of a tertiary medical center (a teaching hospital of the University of São Paulo School of Medicine, São Paulo). PATIENTS: Sixteen patients with chronic renal failure undergoing hemodialysis. OUTCOMES: Blood pressure, body weight, and ambient temperature were evaluated during 6 hemodialysis sessions carried out on 13 days during the four seasons. RESULTS: The diastolic blood pressure was lower in summer than in fall and winter (95 ± 8 vs 107 ± 10 and 101 ± 10 mmHg, respectively; p < 0.05). The same was observed with mean blood pressure (116 ± 8 vs 130 ± 11 and 124 ± 9 mmHg, respectively; p < 0.01). On the other hand, the ambient temperature was higher in summer than in fall and winter (23.0 ± 1.6 vs 19.5 ± 3.0 and 15.8 ± 1.9 ºC, respectively; p < 0.01). CONCLUSIONS: We concluded that for patients with chronic renal failure the blood pressure has a seasonal variation with higher pressures in fall and winter than in summer. Thus, further studies are needed to elucidate the impact of this observation on the adjustment of antihypertensive treatment and on morbidity and mortality in maintenance dialysis patients.
The spectrum of bone disease in 200 chronic hemodialysis patients: a correlation between clinical, biochemical and histological findings
Authors: Duarte Maria Eugênia Leite , Peixoto Ana Lúcia Passos , Pacheco Andréa da Silva , Peixoto Angela Vieira , Rodriguez Rodrigo Dezerto , Lugon Jocemir Ronaldo , Cruz Elisa Albuquerque Sampaio da
Published: April 2005

INTRODUCTION: Renal osteodystrophy includes the complete range of mineral metabolism disorders that affect the skeleton in patients with chronic renal failure. PATIENTS AND METHODS: 200 patients with end-stage renal disease and on dialysis were investigated regarding the clinical, biochemical and histological findings of bone disease. RESULTS: The spectrum of renal osteodystrophy consisted mainly of high turnover bone lesions (74.5%), including osteitis fibrosa in 57.5%. Patients with mild bone disease were on dialysis for shorter periods of time and were mostly asymptomatic. Patients with aluminum-related bone disease (16.5%) had the greatest aluminum exposure, either orally or parenterally, and together with patients with high turnover mixed disease, were the most symptomatic. Although on a non-regular basis, the vast majority of the patients (82.5%) had been receiving vitamin D. The incidence of adynamic bone disease was high (n=8) among parathyroidectomized patients (n=12). Significantly higher serum levels of alkaline phosphatase were observed in osteitis fibrosa. CONCLUSIONS: The use of calcitriol and phosphate-binding agents on a non-regular basis seems to be the reason for the apparent reduced response to the treatment of secondary hyperparathyroidism. Alkaline phosphatase has been shown to be a fair marker for bone turnover in patients with osteitis fibrosa. The severity of the clinical manifestations of bone disease correlates with the histological features of bone lesion and to the time spent on dialysis.
Metabolic and hematologic changes occurring after rapid intravenous infusion of gammaglobulin in patients with antibody deficiency syndromes
Authors: Costa-Carvalho Beatriz Tavares , Lin Marisa , Solé Dirceu , Carneiro-Sampaio Magda Maria Sales , Sorensen Ricardo Uhr , Naspitz Charles Kirov
Published: April 2005

OBJECTIVE: We wished to investigate whether increased IgG infusion rates are associated with metabolic and hematologic changes in pediatric patients with antibody deficiency syndromes. METHODS: We studied 7 patients (2-16 years old) with primary antibody deficiencies who had been on regular IgG replacement treatment, 350-600 mg/kg/dose every 3 weeks with a 3% IVIG preparation, for periods ranging from 6 months to 4 years. Initially, the IgG concentration of IVIG preparations was increased to 6, 9 and 12% in consecutive infusions at a constant IgG infusion rate of 4 mg/kg/min. Subsequently, the infusion rates were increased to 8, 12, and 16 mg/kg/min using the IVIG 12% preparation. RESULTS: Clinically, all patients tolerated increases in IVIG concentrations while the infusion rate was 4 mg/kg/min. However, 3 patients presented side effects when the infusion rate was increased to 8 and 16 mg/kg/min. CONCLUSION: We conclude that metabolic and hematologic sides effects occur with rapid infusion of IVIG even in patients who tolerate the increased infusion rate clinically. The advantages of using high infusion rates have to be re-evaluated.
a-Interferon therapy for HBV-related glomerulonephritis
Authors: Lopes Neto Edmundo Pessoa de Almeida , Lopes Lucila Valente , Kirsztajn Gianna Mastroianni , Cruz Cibele Nascimento , Ferraz Maria Lucia Gomes , Silva Antonio Eduardo Benedito
Published: April 2005

We report a case of a patient with hepatitis B virus (HBV)-related membranous glomerulonephritis (MGN) who showed improvement after interferon-a (IFN-a) therapy. A 35-year-old man with nephrotic syndrome and HBV antigens received a 24-week course of IFN-a. At the end of therapy there was an elevation in the level of plasma aminotransferase and an increase in proteinuria, which were followed by antigen/antibody seroconversion. This "flare-up" before seroconversion suggests an increase in disease activity in the liver and kidney, demonstrating in vivo HBV involvement in MGN.
The value of unenhanced CT in the diagnosis of acute appendicitis
Authors: D'Ippolito Giuseppe , Mello Giselle Guedes Netto de , Szejnfeld Jacob
Published: April 2005

OBJECTIVE: To establish the accuracy of unenhanced CT in the preoperative diagnosis of acute appendicitis. DESIGN: Accuracy study, prospective and blinded. SETTING: The University Hospital. PARTICIPANTS: 52 patients with clinical and laboratorial manifestations of acute appendicitis. CT diagnosis was made by: presence of an abnormal appendix, appendiceal calculi with pericecal phlegmon or alterations in the pericecal appendicular site and absence of signs that may lead to other diagnosis. MAIN OUTCOME MEASURES: Overall accuracy, comparing the tomographic aspects with the intra-operative findings and pathological reports ("gold standard"). RESULTS: Acute appendicitis was confirmed in 44 cases. Efficacy was 92%, sensitivity was 91%, specificity was 100%, positive predictive value was 100% and negative predictive value was 67%. CONCLUSIONS: Unenhanced CT presents a similar overall accuracy to that reported by other authors who studied enhanced CT diagnosis of acute appendicitis.
The relationship of host immune cells, cytokine and nitric oxide production to tumor cells in ovarian carcinoma
Authors: Murta Beatriz Martins Tavares , Machado Jother Soares , Zaparoli Mateus , Lara Vítor Carvalho , Murta Eddie Fernando Candido
Published: April 2005

AIMS: This brief review focuses on the current understanding of the complex relationship of tumor-associated mononuclear cells (TAMs) with neoplastic cells, summarizing their immunological efficiency, cytokine profile and production of nitric oxide (NO) in the tumor microenvironment, with current insights on how this might affect tumor growth. DATA SOURCE: Data was obtained through Medline from articles indexed during the last 10 years. The main key words used in the research were: cancer, ovarian cancer, cytokine, nitric oxide (NO), mononuclear cell, lymphocyte, macrophage. SELECTION OF STUDIES AND DATA COLLECTION: 30 studies were reviewed, which contained data regarding the production of cytokines and NO by TAMs or malignant cells, and tried to establish a correlation between these mediators and tumor growth, especially in ovarian carcinoma. DATA SUMMARY: TAMs consist mainly of macrophages and T lymphocytes which present lower proliferative indices and cytotoxicity compared to autologous blood monocytes, although they are able to release various cytokines. The profile of cytokine expression could help to explain both the immunological impairment observed in patients with advanced carcinoma diseases and the potential of TAMs to exert antitumor activity, which makes these cells an attractive target for therapeutic intervention. NO is also produced in the tumor microenvironment. Several reports in animals suggest a tumoricidal role for NO, but in human tumors its role has not been well-established and may change during tumor progression.
Soluble transferrin receptor in sickle cell diseases: correlation with spleen function
Authors: Grotto Helena Zerlotti Wolf , Kimura Elza Miyuki , Carneiro Márcia Victor
Published: April 2005

OBJECTIVE: To correlate spleen function with soluble transferrin receptor (sTfR) levels and red cell ferritin (RCF) values in patients with sickle cell diseases. DESIGN: Prospective study. LOCATION: University Hospital, School of Medical Sciences, State University of Campinas; a tertiary hospital. PARTICIPANTS: 60 patients with sickle cell diseases, in a steady state, who had not received blood transfusions for 3 months; 28 normal individuals with no clinical or laboratory signs of anemia. MEASUREMENTS: Determination of serum iron, transferrin iron-binding capacity, serum ferritin, RCF and sTfR. Evaluation of spleen function: erythrocytes with pits were quantified. RESULTS: Patients with sickle cell anemia had sTfR levels significantly higher than in normal individuals or those with HbSC (p=0.0001) and there was an inverse correlation between sTfR and fetal Hb (p=0.0016). RCF values were significantly higher in sickle cell anemia patients than in normal individuals or those with HbSC (p=0.0001), and there was a correlation between RCF and pitted erythrocytes (p=0.0512). CONCLUSION: The association between sTfR and fetal Hb confirms the contribution of fetal Hb to improving the hemolytic state by minimizing the consequent reactive erythrocyte expansion. High sTfR levels are not related to the degree of spleen function deficiency seen in sickle cell disease patients. The deficiency in the exocytosis process of the spleen occurring in sickle cell anemia patients may contribute to their accumulation of RCF.
Identification and medical importance of coagulase-negative staphylococci species
Authors: Minto Elaine Cristina Manini , Barelli Cristiane , Martinez Roberto , Darini Ana Lúcia da Costa
Published: April 2005

A total of 126 coagulase-negative staphylococci strains (CNS) were isolated from blood samples and from the intravenous catheters and cerebrospinal fluid of 103 patients admitted to the University Hospital of Ribeirão Preto. Staphylococcus epidermidis (68.2%), S. haemolyticus (11.1%) and S. hominis (3.2%) were the most frequent species. The last two CNS showed greater resistance to antimicrobial agents than S. epidermidis. CNS were the agents of infection in 10.7% of the patients and the agents of intravenous catheter colonization in 18.4% of the cases.
Severity and prognosis in intensive care: prospective application of the Apache II Index
Authors: Costa Joel Isidoro , Amaral José Luiz Gomes do , Munechika Masashi , Juliano Yara , Bezerra Filho José Gomes
Published: April 2005

CONTEXT: The performance of each ICU needs to be assessed within the overall context of medical care, as well as by the institution which the ICU forms part of. Evaluation mechanisms in the field of intensive care have been developed that are recognized worldwide within the scientific literature. OBJECTIVE: To study outcomes from groups of critical patients and to compare their actual and estimated mortality rates. DESIGN: Prospective study of patients' outcomes. SETTING: A tertiary care unit for a period of 13 months (anesthesiology intensive care unit at the Escola Paulista de Medicina). PARTICIPANTS: 520 patients selected according to sex, age and nature of hospitalization. DIAGNOSTIC TEST: The modified APACHE II prognostic index was applied in order to assess clinical severity and anticipation of mortality in three groups who had non-surgical treatment, emergency surgery and elective surgery. MAIN MEASUREMENTS: The APACHE II index. RESULTS: The application of this index allowed patients to be stratified and expected death risks for both subgroups and the entire sample population to be calculated. The observed mortality rate was greater than the expected rate (28.5% versus 23.6%, respectively), with a statistically significant difference. The standardized mortality rate was 1.20. Patients who obtained scores above 25 presented a significant outcome towards death. The most severe and worst evolving cases were, in decreasing order: non-surgical, emergency surgical and scheduled surgical patients; the actual general mortality rate was higher than the expected one. CONCLUSIONS: The use of the APACHE II index made it possible to stratify critical patient groups according to the severity of their condition.
Lymphocele: a possible relationship with acute cellular rejection in kidney transplantation
Authors: Lipay Marco Aurélio Silva , Noronha Irene de Lourdes , Vidonho Júnior Armando , Romão Júnior João Egídio , Campagnari João Carlos , Srougi Miguel
Published: April 2005

CONTEXT: The incidence of lymphocele after renal transplantation varies between 0.6 and 18% of cases, and many factors have been associated to its etiology. Cellular rejection of the kidney allograft has been described as a possible causal factor of lymphocele. OBJECTIVE: To analyze the possible relationship between lymphocele and acute cellular rejection. DESIGN: A retrospective study. SETTING: A referral hospital center. SAMPLE: 170 patients submitted to kidney transplantation from March 1992 to January 1997. A standard technique for renal transplantation was used. RESULTS: Of the 19 patients that developed lymphocele, 16 presented at least one episode of acute cell rejection (84%), and were treated with methylprednisolone. The relation between lymphocele and rejection was statistically significant (p = 0.04). Treatment of lymphocele consisted of peritoneal marsupialization in 3 patients (15.3%), percutaneous drainage in 7 (36.8%), laparascopic marsupialization in 2 (10.5%), and conservative treatment in 7 patients (36.8%). Evolution was favorable in 15 patients (78.9%), 1 patient (5.3%) died due to a cause unrelated to lymphocele, and 3 (15.8%) lost the graft due to immunological factors. The average follow-up period was 24.5 months. CONCLUSION: The high incidence of acute cell rejection in patients with lymphocele suggests a possible causal relationship between both conditions.
Prognostic factors in non-Hodgkin lymphomas
Authors: Cecyn Karin Zattar , Oliveira José Salvador Rodrigues de , Alves Antônio Correia , Silva Maria Regina Regis , Kerbauy José
Published: April 2005

CONTEXT: In Hodgkin's disease, each clinical or pathologic stage can be related to the extent of the area involved and predicts the next anatomical region at risk for tumor dissemination. OBJECTIVE: To determine the best prognostic factors that could predict survival in non-Hodgkin lymphoma cases. DESIGN: A retrospective study. LOCATION: Department of Hematology and Transfusion Medicine, Universidade Federal de São Paulo - Escola Paulista de Medicina. PARTICIPANTS: 142 patients with non-Hodgkin lymphoma diagnosed between February 1988 and March 1993. MAIN MEASUREMENTS: Histological subset, Sex, Age, Race, B symptoms, Performance status, Stage, Extranodal disease, Bulk disease, Mediastinal disease, CNS involvement, BM infiltration, Level of DHL, Immunophenotype. RESULTS: In the first study (113 patients), the following variables had a worse influence on survival: yellow race (P<0.1); ECOG II, III e IV (P<0.1) and extranodal disease (P<0.1) for high grade lymphomas; constitutional symptoms (P<0.1), ECOG II, III e IV (P<0.1) and involvement of CNS (P<0.1) for intermediate grade and the subtype lymphoplasmocytoid (P=0.0186) for low grade lymphomas. In the second survey (93 patients), when treatment was included, the variables related to NHL survival were: CNS involvement (P<0.1) for high grade lymphomas, constitutional symptoms (P<0.1), ECOG II, III, IV (P=0.0185) and also CNS involvement (P<0.1) for the intermediate group. There were no variables related to the survival for low-grade lymphomas. CONCLUSIONS: The intermediate grade lymphomas were more compatible with data found in the literature, probably because of the larger number of patients. In this specific case, the treatment did not have an influence on the survival.
Cystic struma ovarii: a rare presentation of an infrequent tumor
Authors: Carvalho Rita Barbosa de , Cintra Maria Letícia , Matos Patrícia Sabino de , Campos Paulo Sérgio Bueno de
Published: April 2005

CONTEXT: Struma ovarii, a rare neoplasm, is a monophyletic teratoma composed of thyroid tissue. It is generally considered to account for less than 5% of mature teratomas. CASE REPORT: A diagnosis of struma ovarii may be the source of many diagnostic problems. It may be cystic and microscopic examination may only reveal a few typical thyroid follicles, resulting in confusion with other cystic ovarian tumors. Extensive sampling should be undertaken and immunohistochemistry may be decisive in establishing the thyroid nature of the epithelial lining. The authors report two cases of cystic struma ovarii, and discuss diagnostic criteria and the limitations of frozen biopsies in these tumors.
Comparison of vaginal wall sling and modified vaginal wall sling for stress urinary incontinence
Authors: Bezerra Carlos Alberto , Sadi Marcus Vinicius
Published: April 2005

CONTEXT: There are several controversies about which is the best form of surgical treatment for stress urinary incontinence in women. The vaginal wall sling in its original and modified form were presented by Raz as new options for treatment of these conditions, but there is a lack of comparative clinical trials using both techniques. OBJECTIVE: To compare the effectiveness of the original and the modified vaginal wall sling. DESIGN: A comparative, prospective, non-randomized clinical trial. SETTING: Public and private health care units (Urology Division, Faculty of Medicine of the ABC Foundation, and Universidade Federal de São Paulo / Escola Paulista de Medicina). PARTICIPANTS: Twenty patients with anatomical and intrinsic sphincter deficiency stress urinary incontinence were surgically treated for evaluating the initial results of the vaginal wall sling, from February 5, 1994, to June 27, 1996. INTERVENTIONS: The patients were divided into two groups. Group A (n = 10) were treated with the original vaginal wall sling. Group B (n = 10) were treated with the modified vaginal wall sling. Both groups were statistically similar according to clinical and urodynamic parameters. MAIN MEASUREMENTS: Cure and complication rates. RESULTS: Follow-up ranged from 19 to 43 months (median = 28) for group A. The overall cure rate was 70%. Fifty per cent of the patients had urinary retention of 7 to 35 days. There were no major complications. Follow-up ranged from 14 to 26 months (median = 18) for Group B. The cure rate was 80%. Two patients had urinary retention of 7 and 55 days. There were no major complications. CONCLUSIONS: The vaginal wall sling is as effective as the modified vaginal wall sling but has a higher rate of urinary retention.
Incidence of Gardnerella vaginalis, Candida sp and human papilloma virus in cytological smears
Authors: Murta Eddie Fernando Candido , Souza Maria Azniv Hazarabedian de , Araújo Júnior Eduardo , Adad Sheila Jorge
Published: April 2005

CONTEXT: In spite of the wide-ranging literature on the microbiology of normal and abnormal flora of the vagina, there are few studies on the relationship between human papilloma virus (HPV) and other vaginal microorganisms. OBJECTIVE: To analyze the frequency of infection by human papilloma virus (HPV) and other agents like Candida sp., Gardnerella vaginalis and Trichomonas vaginalis in cytological smears. DESIGN STUDY: Retrospective study SETTING: A public tertiary referral center. SAMPLE: An analysis of 17,391 cytologies from outpatients seen between January 1997 and August 1998. The control group was made up of patients in the same age group and same period with no cytological evidence of HPV infection. Patients with a diagnosis of cervical intraepithelial neoplasia (CIN) II or III were excluded from this analysis. MAIN MEASUREMENTS: The diagnosis of HPV infection was made in accordance with the criteria of Schneider et al. and the diagnosis of Gardnerella vaginalis was made with a finding of clue cells. RESULTS: 390 (2.24%) had alterations consistent with infection by HPV, sometimes associated with CIN I. The results showed that Gardnerella vaginalis was the most frequent agent in women with HPV infection (23.6% versus 17.4%; P <0.05), while in the control group the most frequent agent was Candida sp. (23.9% versus 13.8%; p <0.001). CONCLUSION: In spite of this study being based solely on cytological criteria, in which specific HPV and Gardnerella diagnostic tests were not used, the cytological smear is widely used in clinical practice and the data presented in this investigation show that there is an association between Gardnerella vaginalis and HPV infection. It remains to be established whether the microorganisms favor each other.
Duodenal damage complicating percutaneous access to kidney
Authors: Lopes Neto Antonio Corrêa , Tobias-Machado Marcos , Juliano Roberto Vaz , Lipay Marco Aurélio , Borrelli Milton , Wroclawski Eric Roger
Published: April 2005

CONTEXT: Since the first percutaneous nephrostomy performed by Goodwin in 1954, technical advances in accessing the kidneys via percutaneous puncture have increased the use of this procedure and thus the complications too. Among these complications, digestive tract damage is not common. DESIGN: Case report. CASE REPORT: We report a duodenal lesion that was corrected using surgical exploration and we touch on the therapeutic options, which may be conservative or interventionist. We chose conservative treatment, which has been approached in diverse manners in the literature.
Detection of human papillomavirus in epithelial lesions of the conjunctiva
Authors: Palazzi Maristela Amaral , Erwenne Clélia Maria , Villa Luísa Lina
Published: April 2005

CONTEXT: Many factors like exposure to UV radiation, climatic conditions, genetic predisposition, immunological state and, more recently, the presence of HPV have been implicated in the genesis of some lesions of the conjunctiva, especially the carcinoma. OBJECTIVE: To evaluate the presence of HPV DNA in acquired lesions of the conjunctiva and in normal mucosa. TYPE OF STUDY: Cross-sectional study. SETTING: A public university referral center (the Ophthalmology Service of the A.C. Camargo Hospital - A. Prudente Foundation, São Paulo). PARTICIPANTS: Thirty patients with acquired lesions of the conjunctiva and 60 matched controls (by age and sex) were evaluated in this study, from June 1993 to March 1995. PROCEDURES: The detection of HPV DNA in the normal conjunctiva and in acquired lesions was done by the PCR technique and dot blot hybridization. The material was collected by scraping the normal mucosa and the surface of the lesions. A fragment of fresh frozen tissue and paraffin embedded specimens of each lesion were also included. MAIN MEASUREMENTS: The association between the HPV infection and the presence or absence of conjunctival lesions. RESULTS: Sequences of HPV DNA were detected in 4 of the 31 lesions evaluated (12.9%) and in the healthy mucosa of one individual of the control group (1.6%). HPV type 16 was detected in 2 carcinomas and in the normal mucosa of one individual of the control group. HPV type 11 was demonstrated in 2 papillomas of one patient with lesions in both eyes. CONCLUSIONS: The low frequency of HPV DNA found in the lesions of this sample and the detection of the viral genome in the normal mucosa indicate that there is a weak possibility of association between HPV infection and the carcinoma of the conjunctiva.
Is intra-operative gamma probe detection really necessary for inguinal sentinel lymph node biopsy?
Authors: Oliveira Filho Renato Santos de , Santos Ivan Dunshe Abranches Oliveira , Ferreira Lydia Massako , Almeida Fernando Augusto de , Enokihara Milvia Maria Simões e Silvia , Barbieri Antonio , Tovo Filho Reinaldo
Published: April 2005

CONTEXT: Sentinel node (SN) biopsy has changed the surgical treatment of malignant melanoma. The literature has emphasized the importance of gamma probe detection (GPD) of the SN. OBJECTIVE: Our objective was to evaluate the efficacy of patent blue dye (PBD) and GPD for SN biopsy in different lymphatic basins. DESIGN: Patients with cutaneous malignant melanoma in stages I and II were submitted to biopsy of the SN, identified by PBD and GPD, as part of a research project. SETTING: Patients were seen at Hospital São Paulo by a multidisciplinary group (Plastic Surgery Tumor Branch, Nuclear Medicine and Pathology). PATIENTS: 64 patients with localized malignant melanoma were studied. The median age was 46.5 years. The primary tumor was located in the neck, trunk or extremities. INTERVENTIONS: Preoperative lymphoscintigraphy, lymphatic mapping with PBD and intraoperative GPD was performed on all patients. The SN was examined by conventional and immunohistochemical staining. If the SN was not found or contained micrometastases, only complete lymphadenectomy was performed. MAIN MEASUREMENTS: The SN was identified by PBD if it was blue-stained, and by GPD if demonstrated activity five times greater than the adipose tissue of the neighborhood. RESULTS: Seventy lymphatic basins were explored. Lymphoscintigraphy showed ambiguous drainage in 7 patients. GPD identified the SN in 68 basins (97%) and PBD in 53 (76%). PBD and GPD identified SN in 100% of the inguinal basins. For the remaining basins both techniques were complementary. A metastatic SN was found in 10 basins. Three patients with negative SN had recurrence (median follow-up = 11 months). CONCLUSION: Although both GPD and PBD are useful and complementary, PBD alone identified the SN in 100% of the inguinal lymphatic basins.
Calcified abdominal pregnancy with eighteen years of evolution: case report
Authors: Passini Júnior Renato , Knobel Roxana , Parpinelli Mary Ângela , Pereira Belmiro Gonçalves , Amaral Eliana , Surita Fernanda Garanhani de Castro , Lett Caio Rogério de Araújo
Published: April 2005

CONTEXT: The lithopedion (calcified abdominal pregnancy) is a rare phenomenon and there are less than 300 cases reported in the medical literature. CASE REPORT: In this case, a 40 year-old patient had had her only pregnancy 18 years earlier, without medical assistance since then. She came to our hospital with pain and tumoral mass of approximately 20 centimeters in diameter. Complementary examinations (abdominal X-ray, ultrasonography and computerized tomography) demonstrated an extra-uterine abdominal 31-week pregnancy with calcification areas. Exploratory laparotomy was performed, with extirpation of a well-conserved fetus with partially calcified ovular membranes.
Ewing's sarcoma of the head and neck
Authors: Fonseca Adriano Santana , Mezzalira Raquel , Crespo Agrício Nubiato , Bortoleto Junior Antônio Emílio , Paschoal Jorge Rizzato
Published: April 2005

CONTEXT: Ewing's sarcoma is a rare neoplasm, which usually arises in long bones of the limbs and in flat bones of the pelvis, with the involvement of head and neck bones being very unusual. CASE REPORT: a case of Ewing's sarcoma occurring in the mandible of a 35-year-old female. Pain and swelling of the tumor were the main complaints. The early hypothesis was an undifferentiated malignant neoplasm, possibly a sarcoma. The CT scan depicted an expansive lesion, encapsulated, with septa and characteristics of soft tissue, involving the left side of the mandible and extending to the surrounding tissues. The patient underwent surgical excision of the lesion, the definitive diagnosis of Ewing's sarcoma was established, and the patient commenced on radiotherapy.
Knowledge of newborn healthcare among pregnant women: basis for promotional and educational programs on breastfeeding
Authors: Issler Hugo , Sá Márcia Borges Sanches Rodrigues de , Senna Dulce Maria
Published: April 2005

CONTEXT: Promotional and educational programs relating to breastfeeding are important for reversing the decline in this practice. Most programs are centered exclusively on breastfeeding, although general knowledge about newborn healthcare may be important, especially among pregnant women. OBJECTIVE: To study pregnant women's knowledge about general healthcare of newborns, including breastfeeding aspects. TYPE OF STUDY: Cross-sectional. SETTING: Prof. Samuel Barnsley Pessoa Health School Center, Faculty of Medicine, Universidade de São Paulo, Brazil. PARTICIPANTS: All pregnant women who were registered in the prenatal care program during six consecutive months. MAIN MEASUREMENTS: Aspects of the current gestation, previous gestations and childbirths, knowledge of the general aspects of newborn healthcare and of breastfeeding practices. RESULTS: The results show that only a little over half of the pregnant women had received any information on newborn healthcare. Misinformation was clearly present regarding proper care of the umbilical stump and the nature of jaundice, and worst regarding how to treat oral thrush and jaundice, and about vaccination. In relation to breastfeeding, even though almost all the pregnant women declared their intention to breastfeed, less than half had a concrete response regarding how long to do it for. The low rates obtained in the topics dealing with the duration, nursing intervals and the attitude to be taken towards hypogalactia show unfamiliarity with the breastfeeding technique. The "weak milk" belief, the misinformation about contraceptive methods during breastfeeding and the cost of artificial formulas also have a negative impact on this practice. CONCLUSIONS: Pregnant women's knowledge of newborn healthcare is low, as much in the aspects of general care as in relation to the practice of breastfeeding. These findings must be taken into consideration in educative programs promoting breastfeeding.
Ingestion of caustic substances and its complications
Authors: Mamede Rui Celso Martins , Mello Filho Francisco Veríssimo de
Published: April 2005

CONTEXT: Caustic substances cause tissue destruction through liquefaction or coagulation reactions and the intensity of destruction depends on the type, concentration, time of contact and amount of the substance ingested. OBJECTIVES: To analyze the complications in patients who ingested caustic substances and correlate them with the amount of caustic soda ingested. DESIGN: Retrospective study. SETTING: University hospital, a referral center. PARTICIPANTS: A total of 239 patients who ingested caustic soda. MAIN MEASUREMENTS: The amount of granulated caustic substance ingested was measured as tablespoonfuls and the following complications were analyzed: esophagitis, esophageal stenosis and progression to cancer, fistulas, perforations, stomach lesions, brain abscesses, and death. Stenosis was classified as mild, moderate or severe according to the radiological findings. RESULTS: We observed an 89.3% incidence of esophagitis; 72.6% of the cases involved progression to stenosis and 1% died during the acute phase. Stenosis was mild in 17.6% of cases, moderate in 59.3% and severe in 23%. The incidence of stenosis was 80.8% in women and 62.5% in men. The incidence of stenosis was 46.9% in the group that ingested "fragments" and 93.6% in the group that ingested one or more tablespoonfuls of caustic substances. Among subjects who ingested one or more tablespoonfuls, 32.2% developed lesions of the stomach-duodenum, whereas the ingestion of "fragments" was not sufficient to induce these lesions. There was no correlation between the intensity of lesions of the esophagus and of the stomach. Progression to cancer of the esophagus occurred in 1.8% of cases, death during the chronic phase in 1.4%, perforations in 4.6%, fistulas in 0.9%, and brain abscesses in 1.4%. CONCLUSIONS: The complications were related to the amount of caustic soda ingested. Small amounts caused esophagitis or stenosis and large amounts increased the risk of fistulas, perforations and death.
Rapidly progressive antineutrophil cytoplasm antibodies associated with pulmonary-renal syndrome in a 10-year-old girl
Authors: Blanco Filho Fermin , Ernesto Luci Carla , Rosa Mônica Assis , Stuginski Luis Antônio , Zlochevsky Eliana Regina , Blanco Fernando
Published: April 2005

CONTEXT: The term pulmonary-renal syndrome has been used frequently to describe the clinical manifestations of a great number of diseases in which pulmonary hemorrhage and glomerulonephritis coexist. The classic example of this type of vasculitis is Goodpasture´s syndrome, a term used to describe the association of pulmonary hemorrhage, glomerulonephritis and the presence of circulating antiglomerular basement membrane antibodies (anti-GBM). Among the several types of systemic vasculitides that can present clinical manifestations of the pulmonary-renal syndrome, we focus the discussion on two types more frequently associated with antineutrophil cytoplasm antibodies (ANCA), microscopic polyangiitis and Wegener´s granulomatosis, concerning a 10 year old girl with clinical signs and symptoms of pulmonary-renal syndrome, with positive ANCA and rapidly progressive evolution. CASE REPORT: We describe the case of a 10-year-old girl referred to our hospital for evaluation of profound anemia detected in a primary health center. Five days before entry she had experienced malaise, pallor and began to cough up blood-tinged sputum that was at first attributed to dental bleeding. She was admitted to the infirmary with hemoglobin = 4 mg/dL, hematocrit = 14%, platelets = 260,000, white blood cells = 8300, 74% segmented, 4% eosinophils, 19% lymphocytes and 3% monocytes. Radiographs of the chest revealed bilateral diffuse interstitial alveolar infiltrates. There was progressive worsening of cough and respiratory distress during the admission day, when she began to cough up large quantities of blood and hematuria was noted. There was rapid and progressive loss of renal function and massive lung hemorrhage. The antineutrophil cytoplasm antibody (ANCA) test with antigen specificity for myeloperoxidase (anti-MPO) was positive and the circulating anti-GBM showed an indeterminate result.