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FUNDAMENTO: Inúmeros fatores vêm contribuindo para a mudança do perfil do paciente com cardiopatia congênita (CC), incluindo o diagnóstico pré-natal e a disponibilidade de novos procedimentos terapêuticos. O conhecimento dessas mudanças é fundamental para um melhor atendimento. OBJETIVOS: Descrever o perfil dos pacientes com CC de um serviço de referência no Estado do Rio Grande do Sul, Brasil. MÉTODOS: Trata-se de um estudo transversal, com 684 pacientes portadores de CC, em um serviço de cardiologia pediátrica, de janeiro de 2007 a maio de 2008. Esses pacientes foram entrevistados (e/ou seus pais) e examinados (malformações congênitas, medidas antropométricas), além de terem seus prontuários revisados para mais detalhes sobre as cardiopatias, procedimentos e ecocardiografia. RESULTADOS: A idade dos pacientes variou de 16 dias a 66 anos, sendo 51,8% do sexo feminino, com 93,7% de brancos. A idade média determinada pelo diagnóstico foi de 15,8 ± 46,8 meses. As CC mais prevalentes foram a comunicação interventricular, a persistência do canal arterial e a Tetralogia de Fallot. Dos pacientes analisados, 59,1%, com idade média de 44,3 ± 71,2 meses, realizaram algum procedimento terapêutico; 30,4% tinham malformações congênitas extracardíacas; e 12 pacientes tinham síndrome genética comprovada. Quanto ao desenvolvimento, 46,6% tiveram atraso ponderoestatural e 13,7% atraso neuropsicomotor. Além disso, 18,4% apresentaram história familiar de cardiopatia congênita. CONCLUSÕES: O atraso neuropsicomotor e o baixo ganho ponderoestatural podem estar associados às CC. Estabelecer um perfil dos pacientes com CC atendidos em uma instituição de referência pode servir como base para o planejamento adequado do atendimento desta população.BACKGROUND: Several factors, which include prenatal diagnosis and availability of new therapeutic procedures, have contributed to change the profile of patients with congenital heart disease (CHD). Knowing these changes is important to a better health care. OBJECTIVES: Description of profile of patients with CHD in a reference service in the State of Rio Grande do Sul, Brazil. METHODS: It is a cross-sectional study including 684 patients with CHD in a service of pediatric cardiology from January 2007 to May 2008. We interviewed the patients (and/or their parents) and examined these patients (congenital malformations, anthropometric measures). Moreover, their charts were reviewed in order to detail heart diseases, procedures and echocardiography. RESULTS: Patients were from 16 days to 66 years old, 51.8% were female, and 93.7% were Caucasian. The mean age at diagnosis was 15.8 ± 46.8 months. Ventricular septal defect, patent ductus arteriosus and Tetralogy of Fallot were the most prevalent CHD. 59.1% of examined patients, whose average age was 44.3 ± 71.2 months, have been undergoing therapeutic procedures; 30.4% had congenital extracardiac malformations; and 12 patients had genetic syndrome. Regarding development, 46.6% had low weight and height gain, and 13.7% had neuropsychomotor delay. Furthermore, 18.4% had family history of congenital heart disease. CONCLUSIONS: Neuropsychomotor delay and low weight and height gain may be related to CHD. Establishing a profile of patients with CHD, who were treated at an institution of reference, may function as a basis in which health care of this population can be planed appropriately. (Arq Bras Cardiol 2010; 94(3):313-318)

Objetivo. Hacer un análisis de la experiencia recolectada por la Unidad de Cirugía Hepatobiliar y Pancreática del Hospital Pablo Tobón Uribe, de los pacientes con cáncer de vesícula y observar la evolución con el manejo brindado. Pacientes y métodos. Se evaluaron todos los pacientes con carcinoma de vesícula que ingresaron por la Unidad de Cirugía Hepatobiliar y Pancreática entre el 1º de enero de 2004 y el 30 de junio del 2008. Se determinó el método diagnóstico, el estadio de la enfermedad, el tipo de manejo quirúrgico y sus resultados medidos en estancia hospitalaria y mortalidad relacionada, además de la evolución en el tiempo del tratamiento realizado. Resultados. Se recolectaron 40 pacientes con carcinoma de vesícula, 55% mujeres y 45% hombres, con edad promedio de 60,4 años. El diagnóstico se hizo antes de la cirugía en 62,5% de los casos y, por hallazgo incidental luego de colecistectomía en 37,5%. El estudio de imagen más utilizado fue la TAC, tanto para diagnóstico (28%) como para estadificación (53,3%). La estadificación tumoral al momento de la presentación fue estadio IV en el 72,5%, seguido por IB en el 12,5%. Sólo el 22,5% de los pacientes fue susceptible de cirugía con intención curativa; de éstos, 77,8% tuvo diagnóstico después de la colecistectomía inicial. El procedimiento quirúrgico más frecuentemente utilizado fue la hepatectomía central (segmentos IVB/V) más vaciamiento ganglionar del primer nivel. Para estos pacientes, la estancia hospitalaria fue, en promedio, de 7,8 días, con estancia en la unidad de cuidados intensivos de 0,7 días. No se presentó mortalidad relacionada con el procedimiento. La supervivencia promedio general fue de 6,7 meses, con un porcentaje de supervivencia de 27,5% a un año. Conclusión. El carcinoma de vesícula continúa teniendo un mal pronóstico, a pesar de la mejoría en las técnicas de imagen y al manejo quirúrgico radical, debido a que en la mayor parte de los casos en el momento del diagnóstico hay enfermedad avanzada. Sin embargo, éste es el único potencialmente curable.Objectives. To analyze the experience with patients with carcinoma of the gallbladder at the Hepatobiliary and Pancreatic Unit of Pablo Tobón Uribe Hospital (Medellín, Colombia), registering the clinical course and outcomes. Patients and methods. All patients with the diagnosis of carcinoma of the gallbladder admitted to the Hepatobiliary and Pancreatic Unit during the period January 1, 2004, to June 30, 2008 were analyzed. The diagnostic methods were studied, together with the stage of the disease, the type of surgery performed, and the results measured in terms of hospital stay and related mortality. Results. Forty patients were collected, 55% women and 45% men, with average age of 60.4 years. Preoperative diagnosis was established preoperatively in 62.5% of the patients, and as incidental finding at cholecystectomy in 37.5%. CT scan was the most common diagnostic method utilized, both for diagnosis (28%) and for staging (53.3%). Tumor stage at operation was: stage IV in 72.5% of cases, followed by stage IB in 12.5%. In only 22.5% of all patients resection with curative intention was possible, and of these patients, 77.8% had had the diagnosis established after the initial cholecystectomy. Central hepatectomy (segments IVB/V) with first level lymph node dissection was the most common procedure. These patients had an average hospital stay of 7.8 days, with ICU stay of 0.7 days. No mortality related to the procedure occurred. Average postoperative general survival was 6.7 months, with an average one year survival rate of 27.5%. Conclusion. Carcinoma of the gallbladder continues to exhibit an ominous prognosis in spite of the advent of improved diagnostic methods and radical surgical procedures, due mainly to the fact that the majority of cases present with an advanced stage of the disease. However this is still the only treatment modality potentially curable.

La desnutrición tiene una prevalencia alta en los pacientes quirúrgicos y un impacto negativo en el pronóstico, y se asocia con mayores tasas de morbilidad y mortalidad; también con estancias hospitalarias más prolongadas y costos más altos para el sistema de salud. Este artículo describe el impacto de las deficiencias nutricionales en la enfermedad quirúrgica y en la respuesta metabólica al trauma, enfatizando en la relación que existe entre el estado nutricional y metabólico, y el desenlace del paciente quirúrgico. También, presenta el conocimiento científico actual sobre los resultados de la intervención nutricional especializada y su impacto sobre las complicaciones y la mortalidad. En la parte final, describe la fuerte asociación que existe entre estilos de vida y desarrollo, y recaída de cáncer, y cómo la consejería nutricional debería formar parte del arsenal terapéutico del cirujano. Concluye el escrito con una recomendación perentoria para incluir la educación nutricional en las escuelas de medicina y en los posgrados de cirugía general.Malnutrition is a common condition in surgical patients, and is associated with high morbidity and mortality rates. Malnutrition is also related to higher cost for the health system and longer hospital stay. The impact of malnutrition and the need for nutritional treatment in surgery has been widely demonstrated. This article describes the effects of malnutrition on surgical disease and the metabolic response to injury, focusing on the relationship between nutritional status and the outcome of surgery. The article also shows the scientific evidence supporting the modern specialized nutritional therapy and its impact on surgical morbidity and mortality A review of the evidence on the relationship between diet and cancer is presented as a reason for surgeons to assume the nutritional and dietary advice of their own patients. Finally, the author remarks the need for nutritional education in schools of medicine and surgical residence programs.

OBJETIVO: descrever a diversidade genética dos isolados de HIV-1 de mulheres soropositivas acompanhadas em um centro de referência. MÉTODOS: estudo transversal, no qual foram incluídas 96 mulheres com dois testes sorológicos ELISA e um teste confirmatório Western Blot. Das amostras de sangue periférico, foram determinadas a carga viral pelo kit b-DNA e a contagem de linfócitos T CD4 e T CD8 pela citometria de fluxo excalibur. A extração e purificação do DNA pró-viral foi realizada pela reação em cadeia da polimerase (PCR), utilizando o kit QIAamp Blood (Qiagen Inc., Chatsworth, CA, USA). O sequenciamento da região pol foi realizado em 52 isolados com o (3100 Genetic Analyzer, Applied Biosystems Inc., Foster City, CA) e a genotipagem foi investigada pela ferramenta Rega (Rega Subtyping Tool). O padrão de resistência aos antirretrovirais (ARV) foi inferido pelo algoritmo do banco de dados Stanford HIV Resistance. Os estágios clínicos das participantes foram definidos como A, B ou C segundo os critérios do Center for Diseases Control (CDC). Para a análise estatística dos dados, foram utilizados os testes do χ2 para as variáveis categóricas e o teste t de Student para as variáveis numéricas. RESULTADOS: a média de idade da amostra, o tempo médio de doença e de tratamento foram: 33,7; 3,8 e 2,5 anos, respectivamente. A média da carga viral foi log10 2,3 cópias/mL; a dos linfócitos T CD4 e T CD8 foi 494,9 células/µL e 1126,4 células/µL. Sobre o estágio clínico, 30 mulheres estavam no estádio A, 47 no B e 19 no C. O sequenciamento dos 52 isolados encontrou 33 do subtipo B, quatro do F, um do C e 14 do recombinante BF. A análise da resistência aos ARV mostrou 39 (75,0%) isolados susceptíveis, 13 (25,0%) resistentes aos inibidores da transcriptase reversa (INTR) e três (5,7%) aos inibidores da protease (IP). CONCLUSÕES: Houve grande diversidade do HIV-1 e elevado percentual de isolados resistentes aos ARV na amostra estudada.PURPOSE: to describe the genetic diversity of HIV-1 isolates from serum positive women followed up at a reference center. METHODS: transversal study, including 96 women with two ELISA serological tests and a Western Blot confirmatory test. The viral charge was determined by the b-DNA kit, and the counting of T CD4 and T CD8 lymphocytes, by the Excalibur flow cytometry, from the samples of peripheral blood. The extraction and purification of pro-viral DNA was performed by the polymerase (PCR) chain reaction, using the QIAamp Blood kit (Qiagen Inc., Chatsworth, CA, U.S.A.). Sequencing of the pol region was done in 52 isolates with the 3100 Genetic Analyzer (Applied Biosystems Inc., Foster City, CA), and the genotyping was assessed by the Rega Subtyping Tool. The resistance pattern to anti-retrovirals (ARV) was inferred by the algorithm from the Stanford HIV Resistance data bank. Participants' clinical stages were defined as A, B or C, according to the criteria established by the Center for Diseases Control (CDC). For statistical analysis, the χ2 test was used for the categorical variables and the Student's t test, for the numerical variables. RESULTS: The average age of the sample, the disease and treatment average duration were respectively: 33.7 years old, 3.8 and 2.5 years. The viral charge average was log10 2.3 copies/mL; the T CD4 e T CD8 lymphocytes, 494.9 cells/µL and 1126.4 cells/µL. Concerning the clinical stage, 30 women were in stage A, 47 in B and 19 in C. Sequencing from the 52 isolates found 33 of B subtype, 4 of F, 1 of C and 14 of BF recombinant. The analysis of resistance to ARV has shown 39 (75.0%) susceptible isolates, 13 (25.0%) resistant to reversal transcriptase inhibitors (RTIN), and 3 (5.7%) resistant to protease inhibitor (PI). CONCLUSIONS: There has been a large variety of HIV-1 and a high percentage of isolates resistant to ARV in the studied sample.

Twenty-eight Chagas disease patients (CD), 22 with the indeterminate clinical form (IND) and six with the cardiac or digestive form (CARD/DIG), were treated with benznidazole and underwent clinical and laboratorial analysis before (IND and CARD/DIG) and nine years after [patients after treatment (CDt), patients with the indeterminate clinical form at treatment onset (INDt) and with the cardiac or digestive form at treatment onset (CARD/DIGt)] treatment. The data demonstrate that 82.1% of CDt patients (23/28) remained clinically stable and 95.4% of the INDt (21/22) and 33.3% of the CARD/DIGt (2/6) patients showed unaltered physical and laboratorial examinations. The clinical evolution rate was 2%/year and was especially low in INDt patients (0.5%/year) relative to CARD/DIGt patients (7.4%/year). Positive haemoculture in treated patients was observed in 7.1% of the cases. None of the INDt (0/21) and 33.3% of the CARD/DIGt (2/6) patients displayed positive cultures. The PCR presented a positive rate significantly higher (85.2%, 23/27) than haemoculture and two samples from the same patient revealed the same result 57.7% of the patients. Conventional serology-ELISA on 16 paired samples remained positive in all individuals. Semi-quantitative ELISA highlighted significant decreases in reactivity, particularly in INDt relative to IND. Non-conventional serology-FC-ALTA-IgG, after treatment, showed positive results in all sera and 22 paired samples examined at seven and nine years after treatment, demonstrated significantly lower reactivity, particularly in INDt patients. This study was retrospective in nature, had a low number of samples and lacked an intrinsic control group, but the data corroborate other results found in the literature. The data also demonstrate that, even though a cure has not been detected in the none-treated patients, the benefits for clinical evolution were selectively observed in the group of INDt patients and did not occur for CARD/DIGt patients.

Los cuerpos extraños en abdomen constituyen un grupo de pseudotumores que corresponden a material no absorbible que, a diferencia de otros, no cumple ningún efecto terapéutico. Constituyen una complicación de un procedimiento quirúrgico o una nueva patología para el paciente, que obedece a un suceso iatrogénico de gran morbimortalidad y causan dificultades diagnósticas, sobrecostos y posibles problemas médico-legales. Con el advenimiento de la cirugía por laparoscopia (cirugía mínimamente invasiva), su incidencia ha descendido en forma importante. Se presenta un reporte de 6 casos cuyos curso clínico, complicaciones, estudios diagnósticos y tratamiento describen ampliamente las características de esta patología.Retained foreign bodies in the abdomen represent a group of pseudotumors corresponding to non-absorbent material accidentally left during the operation. They are a complication of a surgical procedure representing a new pathology for the patient, a real iatrogenic event associated with significant morbidity and mortality, which creates difficulties in diagnosis, increased costs, and potential medico-legal problems. With the advent of laparoscopic surgery (minimally invasive surgery) there has been an important diminution in the incidence of retained foreign bodies, in English the so called gossypibomas or textilomas. We report 6 cases, whose clinical course, diagnostic studies and treatment amply describe the characteristics of this type of pathology.

Introducción. El linfoma de Burkitt no endémico es un tumor de frecuente localización abdominal, especialmente en niños y jóvenes. Aunque el tratamiento de elección es la quimioterapia, existe controversia sobre el papel que debe jugar la cirugía, especialmente en aquellos casos en los cuales el diagnóstico se establece durante una laparotomía exploradora. Materiales y métodos. Se presentan dos casos: una adolescente de 14 años que presentaba una masa hipogástrica y otra menor en fosa iliaca derecha de rápido crecimiento, y otro adolescente de 13 años con tumor en hipocondrio y flanco izquierdo. Se realizó resección de todo el tumor macroscópico, y se les remitió a quimioterapia. Resultados y discusión. La indicación del tratamiento quirúrgico en el linfoma de Burkitt no está claramente definida. Algunos autores no aceptan la cirugía y añaden que puede retrasar y complicar el tratamiento de quimioterapia, otros defienden la cirugía reductora de la masa tumoral asociada a la quimioterapia. Esta controversia es especialmente importante cuando el diagnóstico se establece en el curso de una laparotomía exploradora, durante la cual hay que decidir si se debe extirpar la masa tumoral o si no se debe hacer, tomando las medidas para evitar la falla renal aguda. En nuestro caso decidimos extirpar todo el tumor macroscópico. La buena evolución posoperatoria de nuestros pacientes y los resultados reportados por varios autores apoyan esta postura.Introduction: Nonendemic Burkitt´s lymphoma is a tumor of frequent abdominal presentation, especially in children and young adults. Although chemotherapy is the preferred therapeutic modality, there is controversy around the role of surgery, particularly in those cases where the diagnosis is established at the time of an exploratory laparotomy. Materials and methods: We report two cases: an adolescent male 14 years of age that exhibited a hypogastric mass and a rapidly growing smaller mass located in the right iliac fossa; both masses were totally excised and the patient was referred for chemotherapy. And a 13 year old female adolescent with a tumor located in the left hypochondrium and flank. Resection of the entire mass was performed and she was referred for chemotherapy. Results and discussion: The indication for the surgical treatment of Burkitt´s lymphoma has not yet been clearly defined. Some authors are against surgery and argue that the operation may delay treatment and yield complications, while other authors defend surgical treatment for reducing tumor mass for better results with chemotherapy. The controversy is quite pertinent when the diagnosis is established during an exploratory laparotomy, since at that time the surgeon must decide if resection should be done or not, taking especial precaution in reference to the potential acute renal failure associated with chemotherapy. Pertaining our two cases, we decided to macroscopically excise the entire tumor masses, and the good results in our patients as well as the results reported by other authors support this modality.

OBJETIVO:Analisar os fatores preditivos na evolução do grau de incapacidade em pacientes com hanseníase. MÉTODOS:Foram analisados dados de coorte retrospectiva, que acompanhou 595 pacientes com incapacidades, registrados em uma unidade de saúde de Belo Horizonte (MG), de 1993 a 2003. Informações sociodemográficas e clínicas dos pacientes foram coletadas dos respectivos prontuários. Comparou-se o grau de incapacidade na admissão e no final do tratamento por meio do teste de homogeneidade marginal. Para identificar os fatores associados à evolução do grau de incapacidade foram utilizadas as análises univariada (teste qui-quadrado de tendência linear) e multivariada pelo algoritmo Chi-square Automatic Interaction Detector. RESULTADOS:Dos casos com registro de grau de incapacidade na admissão e na alta, observou-se que 43,2% que tinham grau 1 na primeira avaliação evoluíram para grau 0. Dos que apresentavam grau 2, 21,3% passaram a ter grau 0 e 20% passaram a grau 1. Na análise univariada as variáveis que se mostraram estatisticamente associadas à evolução no grau de incapacidade foram: neurite, tempo até a ocorrência de neurite, número de nervos acometidos, tipo de tratamento fisioterápico e maior dose de prednisona. Na análise multivariada, o principal fator que se associou à evolução do grau de incapacidade foi o grau de incapacidade na admissão. CONCLUSÕES:Os resultados mostraram a importância do diagnóstico precoce de neuropatia, assim como da eficiente associação das intervenções medicamentosas e não-medicamentosas por meio das técnicas de prevenção de incapacidade e dosagens adequadas de corticoterapia.OBJETIVO: Analizar los factores predictivos en la evolución del grado de incapacidad en pacientes con hanseníasis. MÉTODOS: Fueron analizados datos de cohorte retrospectiva, que acompañó 595 pacientes con incapacidades, registrados en una unidad de salud de Belo Horizonte (Sureste de Brasil), de 1993 a 2003. Informaciones sociodemográficas y clínicas de los pacientes fueron colectadas de los respectivos prontuarios. Se comparó el grado de incapacidad en la admisión y en el final del tratamiento por medio de la prueba de homogeneidad marginal. Para identificar los factores asociados a la evolución del grado de incapacidad fueron utilizados los análisis univariado (prueba chi-cuadrado de tendencia linear) y multivariado por el algoritmo Chi-square Automatic Interaction Detector. RESULTADOS: De los casos con registro de grado de incapacidad en la admisión y en el alta, se observó que 43,2% que tenían grado 1 en la primera evaluación evolucionaron para el grado 0. De los que presentaban grado 2, 21,3% pasaron a tener grado 0 y 20% pasaron a grado 1. En el análisis univariado las variables que se mostraron estadísticamente asociados a la evolución en el grado de incapacidad fueron: neuritis, tiempo hasta la ocurrencia de la neuritis, número de nervios afectados, tipo de tratamiento fisioterapéutico y mayor dosis de prednisona. En el análisis multivariado, el principal factor que se asoció a la evolución del grado de incapacidad fue el grado de incapacidad en la admisión. CONCLUSIONES: Los resultados mostraron la importancia del diagnóstico precoz de neuropatía, así como de la eficiente asociación de las intervenciones medicamentosas y no medicamentosas por medio de las técnicas de prevención de incapacidad y dosis adecuadas de corticoterapia.OBJECTIVE:To analyze predictive factors in the progression of the disability grade in patients with leprosy. METHODS: A retrospective cohort study followed up 595 patients with disability registered at a healthcare unit in the city of Belo Horizonte (Southeastern Brazil) from 1993 to 2003. Patients' sociodemographic and clinical information was collected from the respective medical records. Comparisons were made between the disability grade upon admission and at the end of treatment using a marginal homogeneity test. To determine factors associated with progression in the disability grade, univariate analysis (linear trend chi-square test) was employed, as well as multivariate analysis by means of the algorithm Chi-square Automatic Interaction Detector. RESULTS:Among the cases in which the disability grade was recorded upon admission and upon discharge, 43.2% of the patients who had grade 1 in the first assessment progressed to grade 0. Among those who began with grade 2, 21.3% progressed to grade 0 and 20% progressed to grade 1. In the univariate analysis, the variables that proved to be statistically associated with progression in the disability grade were: neuritis, time elapsed until the occurrence of neuritis, number of damaged nerves, type of physiotherapy treatment and higher dose of prednisone. In the multivariate analysis, the main factor associated with the progression of disability was the disability grade upon admission. CONCLUSIONS: The results showed the importance of an early diagnosis of neuropathy as well as the efficient association of pharmacological and non-pharmacological treatment, through disability prevention techniques and adequate doses of steroid.

El drenaje del espacio pleural es una frecuente práctica clínica de valor diagnóstico y terapéutico. Las indicaciones más frecuentes de este procedimiento tienen que ver con situaciones en las que se producen depósitos de fluidos en esta cavidad, como aire, sangre, linfa, líquido pleural, pus y otros. Es importante conocer la técnica quirúrgica de inserción y las complicaciones más frecuentes derivadas de la colocación de los tubos de tórax. Realizamos una revisión de la literatura existente sobre el tema, enfatizando en estudios que evaluaran las tasas de complicaciones derivadas de las toracostomías cerradas con tubo. Encontramos que la gran mayoría de estudios sobre complicaciones de la colocación de los tubos de tórax son retrospectivos y en el contexto del trauma. Las complicaciones se han clasificado así: por inserción, posicionales e infecciosas. La tasa general de complicaciones se encuentra entre 3,4% y 36%. Las complicaciones por inserción ocurren en 0% a 7,9% de los casos, las posicionales en 2,4% a 33,3% y las infecciosas en 0,8% a 12%, con empiema en 1,1% a 2,7%. También, hay complicaciones anecdóticas reportadas. Las complicaciones producto de la colocación de un tubo de tórax en la cavidad pleural son frecuentes y en muchos casos clínicamente relevantes. El uso de la técnica de disección roma, la habilidad y el conocimiento, la identificación precoz y el manejo de las posibles complicaciones, pueden reducir la morbimortalidad de este procedimiento.Drainage of the thoracic cavity is a frequent clinical procedure performed for diagnostic and therapeutic purposes. Most common indications are related with conditions where air, blood, lymph, pleural fluid, pus, and other materials accumulate in the chest cavity. It is important to know the technique of tube thoracostomy and be familiar with the more frequent associated complications. We have performed a literature review with emphasis on the complications associated with the insertion of intrathoracic tubes. Most papers encountered in the literature are retrospective studies in the context of trauma. General complications rate vary from 3.4% to 36%. Complications derived from tube insertion occur in 0% to 7.9% of cases, those derived from the position of the tube occur in 2.4% to 33.3%, and septic complications in 0.8% to 12%, with empyema in 1.1% to 2.7%. Anedoctal complications are also reported. Complications derived from tube thoracostomy are frequent and in many cases clinically relevant. Blunt dissection technique, appropriate skill and knowledge, and the early identification and management of possible complications tend to reduce the morbidity and mortality rates associated with this porocedure.

FUNDAMENTO: A regeneração dos cardiomiócitos após o infarto do miocárdio (IM) é mais evidente em animais jovens; entretanto, não se sabe se é acompanhada de melhora funcional. OBJETIVO: Realizar a análise funcional pela ecocardiografia (eco) de ratos jovens e adultos submetidos a IM. MÉTODOS: Setenta e dois animais foram incluídos no estudo: 35 ratos jovens (grupo J) com 28 dias, e 37 ratos adultos (grupo A) com 153 dias. Os ratos foram subdivididos em dois subgrupos: infartado (JI e AI) e controle (JC e AC). Os animais foram avaliados por meio de ecocardiograma no 7º e 30º dias de pós-operatório para análise da fração de ejeção (FE) e dos volumes sistólico (VSF) e diastólico (VDF) finais do ventrículo esquerdo. Foram incluídos no grupo de estudo somente animais com FE menor que 40%. RESULTADOS: Na comparação dos VDF e VSF entre infartados e controles, observou-se aumento significativo nos animais adultos infartados nas duas fases analisadas. Nos animais jovens, apenas o VSF, no 7º dia, foi significativamente maior. Na evolução intragrupo, observou-se aumento do VDF e do VSF nos dois subgrupos jovens, proporcional ao crescimento, e somente aumento do VDF no grupo adulto infartado. Houve melhora da FE nos ratos jovens, enquanto nos ratos adultos a FE permaneceu diminuída em relação aos controles. CONCLUSÃO: Os ratos jovens infartados apresentaram melhora da função sistólica e dos volumes ventriculares após 30 dias do infarto, enquanto nos ratos adultos houve aumento do VDF sem melhora da função sistólica.BACKGROUND: The regeneration of cardiomyocytes after a myocardial infarction (MI) is more evident in young animals; however, it is not known whether it is associated with functional improvement. OBJECTIVE: To perform the functional analysis by echocardiography (echo) of young adult rats submitted to MI. METHODS: Seventy-two animals were included in the study: 35 young rats (group Y) that were 28 days old and 37 adult rats (group A) that were 153 days old. The rats were subdivided in two subgroups: infarcted (YI and AI) and control (YC and AC). The animals were assessed by echocardiogram on the 7thand 30th postoperative days for the analysis of the ejection fraction (EF) and the final systolic (FSV) and diastolic volume (FDV) of the left ventricle. Only animals with EF < 40% were included in the study. RESULTS: The comparison of the FDV and FSV between infarcted and control animals showed that there was a significant increase in infarcted adult animals at the two analyzed phases. Among young animals only the FSV was significantly higher on the 7th day. The intragroup evolution analysis showed an increase in FDV and FSV in the two young subgroups, which was proportional to growth and only increase in FDV in the infarcted adult group. There was an improvement in EF in young rats, whereas EF remained decreased in adult rats when compared to controls. CONCLUSION: The infarcted young rats presented improvement in the systolic function and ventricular volumes 30 days after the infarction, whereas the adult rats presented increased FDV with no improvement in systolic function.

Introducción. La anastomosis primaria es una técnica posible en el manejo de la peritonitis secundaria grave en pacientes críticamente enfermos; sin embargo, su uso se ha limitado por el riesgo de complicaciones y muerte. Materiales y métodos. Se seleccionaron pacientes con peritonitis secundaria grave que requerían resección de un segmento del intestino y se manejaron con ligadura transitoria de intestino con hiladilla, abdomen abierto, laparotomías múltiples programadas y posterior anastomosis primaria diferida. Como éxito primario se definió aquel caso en el cual se logró hacer la anastomosis y no tuvo filtración ni fístula. Resultados. Se estudiaron 26 pacientes. El APACHE II promedio fue de 15,3 puntos. Se practicaron 14 anastomosis enteroentéricas, 5 anastomosis colocólicas y 4 anastomosis ileocólicas, y en 3 pacientes no se pudo hacer anastomosis. En promedio, hubo 4 laparotomías múltiples programadas por paciente que se realizaron cada 24 horas antes de la anastomosis. El éxito primario se logró en 20 pacientes (77%). La supervivencia a los 28 días fue de 88,4%, 23 pacientes egresaron vivos y sólo 3 (11,5%) fallecieron en la unidad de cuidados intensivos; estas muertes fueron independientes del procedimiento. Discusión. En pacientes con peritonitis secundaria grave la estrategia de control de daños fue viable y segura, con un éxito primario de 77%, con fístula en 11,5%, y mortalidad de 11,5%.Introduction. Primary anastomosis is a feasible technique in the management of severe secondary peritonitis in critically ill patients; however, its use has been limited due to the risk of complications and death. Materials and methods. We selected patients with severe secondary peritonitis that required resection of an intestinal segment and managed with temporary intestinal ligature, open abdomen, elective repeat laparotomies, and ulterior deferred primary anastomosis. Primordial success was labeled in those patients that had primary anastomosis and no leakage or fistulae. Results. Twenty six patients were included in the study, with a mean APACHE II score of 15.3. There were 6 anastomoses in the small bowel, 5 in the large bowel, 4 of the ileum to the large bowel, and in 3 patients an anastomosis could not be performed. A mean of 4 scheduled relaparotomies were registered, starting 24 hours after the anastomosis. Primordial success was achieved in 20 patients (77%), 28-day survival was 88.3%; 23 patients left the hospital alive, and only 3 (11.5%) died in the ICU; these deaths were independent of the procedure. Discussion. Damage control surgery was feasible and secure in patients with severe secondary peritonitis, with a primary success rate of 77%; fistulae developed in 11.5%, and mortality was 11.5%.

Objective: To describe cardiac surgeries, their approaches, and determine operative mortality according to the type of surgery and the main complications recorded within 30 days postoperatively, performed at the National Cardiovascular Institute of Peru., Materials and Methods: A descriptive study was conducted on all patients over 18 years of age who underwent cardiovascular surgery at the National Cardiovascular Institute "Carlos Alberto Peschiera Carrillo"., Results: During the year 2022, a total of 503 cardiac surgeries were performed. Of the patients undergoing surgery, 63.6% (320) were males. Isolated valvular surgery, primarily aortic or mitral valve replacement, was the most frequent surgical procedure, with 136 surgeries (27.0%). This was followed by myocardial revascularization surgery with 110 procedures (21.9%). Throughout the year, there were 23 deaths, resulting in an overall mortality rate of 4.5%. The mortality rate for elective surgeries was 2.8%, while for emergency surgeries, it was 14.3%. The most common complication was paroxysmal atrial fibrillation (14.0%), followed by surgical site infection with 52 cases (10.3%)., Conclusions: Valvular surgery, whether isolated or combined with other procedures, was the most frequently performed. The obtained mortality rate is considered acceptable for a reference center., Competing Interests: Conflictos de interés Los autores declaran no tener ningún conflicto de interés.

OBJETIVOS: Verificar o perfil de alterações clínicas e, principalmente, laboratoriais hepáticas observadas em pacientes de cada uma das classes de insuficiência cardíaca. MÉTODOS: Por meio de um estudo seccional, foram pesquisados os dados clínicos e laboratoriais (alanina aminotransferase [ALT], aspartato aminotransferase [AST], fosfatase alcalina [FA], gama-glutamil transpeptidase [gama-GT], bilirrubinas e coagulograma) de 50 pacientes internados em 2002 em um hospital terciário com diagnóstico de insuficiência cardíaca. Os doentes foram separados de acordo com sua classe de insuficiência cardíaca e seus dados, comparados estatisticamente. Foram excluídos pacientes com hepatopatia de qualquer etiologia. RESULTADOS: A análise das médias de transaminases revelou aumento significativo apenas nos pacientes da classe IV. Por outro lado, a FA e a gama-GT apresentaram aumento progressivo de acordo com a classe de insuficiência cardíaca. CONCLUSÃO: A insuficiência cardíaca é caracterizada por perfil colestático progressivo de alterações laboratoriais, enquanto as transaminases se elevam apenas na insuficiência cardíaca mais avançada. O entendimento dessas alterações é fundamental para que se evite investigação hepática desnecessária em indivíduos com insuficiência cardíaca.OBJECTIVES: To verify the clinical alterations and, in particular, hepatic laboratory alterations in patients in each of the heart failure (HF) functional classes. METHODS: The clinical and laboratory data - alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AP), gamma-glutamyl transpeptidase (GGT), bilirubin and coagulogram - of 50 patients admitted in 2002 to a tertiary hospital with the diagnosis of heart failure were researched by means of a cross sectional study. The patients were separated in accordance with their HF class and their data were compared statistically. Patients with hepatopathy of any etiology were excluded. RESULTS: Analysis of the mean transaminase values revealed a significant increase only for the Class IV patients. On the other hand, alkaline phosphatase and GGT presented a progressive increase in accordance with the HF class. CONCLUSION: HF is characterized by a progressive cholestatic profile of laboratory alterations, while transaminase values are only elevated in advanced HF. It is of utmost importance to understand these alterations in order to avoid unnecessary hepatic investigations in individuals with heart failure.

OBJETIVOS: Estudar a evolução clínica de gestantes com CMH, a influência da gestação sobre o curso natural da CMH e a freqüência da doença nos filhos dessas mulheres no início da infância. MÉTODOS: Foi realizado um estudo prospectivo em 35 portadoras de CMH com a mesma idade e classe funcional (CF). Vinte e três estavam grávidas (grupo G), e 12 pacientes que não estavam grávidas serviram como controle (grupo NG). Foram realizadas avaliações clínicas mensais, bem como eletrocardiograma e ecocardiograma transtorácico Os desfechos para os filhos foram taxas de natimortalidade e prematuridade e investigação de CMH durante a infância. RESULTADOS: Não houve mortes em nenhum dos dois grupos. A ocorrência de arritmias cardíacas foi significantemente maior (p< 0,05) no grupo NG (33,3% vs. 13,4%), e não foram observadas diferenças nos índices de insuficiência cardíaca (30,3% vs. 16,6%) ou acidente vascular cerebral isquêmico (4,3% vs. 8,3%) entre os grupos (p > 0,05). No grupo NG, a necessidade de hospitalização para tratamento de complicações cardíacas foi mais freqüente (p = 0,05) em pacientes com história familiar de CMH (71,4% vs. 25,0%). Doze pacientes (52%) foram submetidas à cesariana por razões obstétricas, sete bebês (30,4%) nasceram prematuramente e um bebê (4,3%) teve morte neonatal. Uma criança teve diagnóstico clínico de CMH, e seu estudo genético identificou mutação no gene da cadeia pesada da b-miosina, situado no cromossomo 14. CONCLUSÃO: Insuficiência cardíaca é uma complicação freqüente em portadoras de CMH durante a gravidez, principalmente em pacientes com antecedentes familiares da doença, mas não altera o curso natural da CMH. Em uma criança, o exame clínico identificou HMC no início da infância.OBJECTIVES: To study clinical evolution of women with HCM during pregnancy; the influencing factors of gestation on natural course of HCM and the frequency of HCM in their children in early childhood. METHODS: A prospective study was conducted in 35 women with HCM; there were 23 pregnant women (PG group) and 12 nonpregnant control patients (NP group), matched for age and functional class (FC). Clinical monthly evaluations were carried out and electrocardiogram and transthoracic echocardiography tests were performed. The offspring endpoints included stillbirth and prematurity rates and investigation of HCM during childhood. RESULTS: No deaths occurred in either group. Cardiac arrhythmias were significantly (p< 0.05) more frequent in the NP group (33.3% vs. 13.4%), and no differences were observed between the groups (p>0.05) in heart failure (30.3% vs. 16.6%) or ischemic stroke (4.3% vs. 8.3%) rates. In the PG group, required hospitalization for treatment of cardiac complication was more frequent (p=0.05) in patients with family history of HCM (71.4% vs. 25.0%). Cesarean section was performed in 12 (52%) patients, for obstetrical reasons; there were 7 (30.4%) premature babies and 1 (4.3%) neonatal death. One child was clinically diagnosed as having HCM, and his genetic study identified a mutation in the beta myosin heavy chain gene, located on chromosome 14. CONCLUSION: Heart failure is a frequent cardiac complication in women with HCM during pregnancy, particularly in patients with family history of the disease, but this did not influence the natural course of HCM. In one child, clinical examination allowed HCM identification during early childhood.

In this study, we developed a systemic PD model in middle-aged cynomolgus monkeys using individualized low-dose MPTP, to explore effective indicators for the early prediction of clinical outcomes. MPTP was not stopped until the animals showed typical PD motor symptoms on days 10 to 13 after MPTP administration when the Kurlan score reached 10; this abrogated the differences in individual susceptibility to MPTP. The clinical symptoms persisted, peaking on days 3 to 12 after MPTP withdrawal (rapid progress stage), and then the Kurlan score plateaued. A Kurlan score at the end of the rapid progress stage >15 reflected stable or slowly-progressive PD, while a score <15 indicated spontaneous recovery. The entire clinical evolution and outcome of the systemic PD model was characterized in this study, thus providing options for therapeutic and translational research. [ABSTRACT FROM AUTHOR]

FUNDAMENTOS: Os hemangiomas, proliferações benignas do tecido endotelial, são os tumores mais comuns da infância, e a maioria possui apresentação e crescimento típicos. OBJETIVOS: Relatar a experiência do Ambulatório de Dermatologia Infantil do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo em relação à apresentação, evolução e ao tratamento dos hemangiomas da infância, correlacionando-os com dados da literatura. MÉTODOS: Foram avaliados retrospectivamente, mediante análise de prontuários e registros fotográficos, 40 casos de hemangiomas atendidos no período de março de 1994 a novembro de 2004. RESULTADOS: Houve predomínio do sexo feminino na razão de 3:1, e maior número de pacientes brancos (75%). O hemangioma estava presente ao nascimento em 77% dos pacientes. As lesões eram únicas em 85% dos casos, e a maior parte se localizava na região da cabeça e pescoço (57%). A conduta expectante foi a mais adotada, e o seguimento dos pacientes mostrou início da involução da lesão antes dos 12 meses de idade em 65% dos casos. A resolução total ocorreu até três anos de idade em 50% dos pacientes, até os seis anos em 58%, até os nove anos em 83% e até os 11 anos em 100%. CONCLUSÕES: A casuística dos autores é superponível à da literatura mundial em relação às variáveis sexo e cor dos pacientes, número e localização dos hemangiomas, porém com maior porcentagem de lesões presentes ao nascimentoBACKGROUND: Hemangiomas are benign proliferations of endothelial tissue. They are the most common tumors of childhood and the majority has typical presentation and growth patterns. OBJECTIVES: To report the experience of the Outpatients Clinic of Pediatric Dermatology of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo regarding presentation, progression and treatment of hemangiomas in childhood and to correlate them with literature data. METHODS: We retrospectively evaluated 40 cases of hemangioma seen between March 1994 and November 2004, through analysis of medical and photographic records. RESULTS: There was a predominance of females - 3:1 - and white patients (75%). Hemangiomas were present at birth in 77% of patients. In 85% of cases, the lesions were single and the majority was located in the head and neck (57%). The conservative management was adopted in most cases and the follow-up of patients showed involution of lesions started before 12 months of age in 65% of cases. The complete resolution occurred up to 3 years of age in 50% of patients, up to 6 years in 58%, up to 9 years in 83%, and up to 11 years in 100%. CONCLUSIONS: Our cases are similar to those in the international literature in terms of gender and ethnicity, number and location of hemangiomas, although we have a higher percentage of lesions seen at birth.

Background: humeral midshaft fractures should be surgically managed, so the knowledge of functionality, bone healing and pain of these treatments is required to obtain the expected results. The aim of this paper is to compare the results of patients with humeral midshaft fracture operated with intramedullary nails UHN vs. DCP plate. Methods: Comparative study, conducted during the period of June 2014 to June 2015, in patients with humeral midshaft fracture, incidents, operated with intramedullary nails UHN vs. DCP plate. Pain, functional and radiographic assessment were conducted by Andersen, UCLA and simple X ray test, respectively. Results: There were 40 patients, 57.5% with DCP plate, 67.5% male, mean age was 42.38 years, mean operative time was 73.3 minutes, side affected 50% right, 87% had complete consolidation with DCP plate against 70.6% of the patients treated with intramedullary nails UHN. Radiographic consolidation was good for both treatments, functionality and pain patients had presented no statistically significant differences in both groups (p ≥ 0.05). Complications are in the range described worldwide for both treatments. Conclusions: Both treatments are effective for humeral diaphyseal lesions, however should be cautious and try to avoid the complications that can be serious is recommended. [ABSTRACT FROM AUTHOR]

Introduction: Acute coronary syndromes are usually due to plaque rupture, platelet activation, and thrombus formation leading to coronary occlusion and myocardial injury. The use of acetylsalicylic acid, clopidogrel and low molecular weight heparin have reduced the risk of death, myocardial infarction and ischemia recurrence. Objective: To describe the clinical course and benefits of dual antiplatelet therapy associated with thrombolytic therapy in patients with ST-segment elevation acute myocardial infarction (STEMI). Method: A descriptive, cross-sectional, non-randomized, multicenter study was performed between October 2012 and December 2014 at the Intensive Care Units from Arnaldo Milián Castro, Celestino Hernández Robau and Placetas University Hospitals in Villa Clara, Cuba. The study population consisted of 86 patients divided into study and control groups, who met the inclusion criteria. Results: STEMI was more frequent in males and between 70-75 years. Most frequent risk factors were smoking and hypertension in 57.0% of patients in both groups. The anterior wall location presented more complications; patients with inferior location of the infarction were the most benefited with dual antiplatelet therapy. It was found in the study group that the earlier the treatment, the better the evolution and the lower the in-hospital mortality. Conclusions: Dual antiplatelet therapy in patients with STEMI, receiving thrombolytic therapy, decreased ischemic complications frequency. [ABSTRACT FROM AUTHOR]

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Introducción. Los pacientes con demencia tipo Alzheimer presentan riesgo de deterioro del estado nutricional por cambios fisiológicos, socioeconómicos y psicológicos relacionados con la enfermedad, lo que se suma al proceso de envejecimiento. Objetivo. Describir el estado nutricional de los pacientes con demencia tipo Alzheimer del Grupo de Neurociencias de la Universidad de Antioquia según el estadio de evolución. Materiales y métodos. Estudio descriptivo transversal. Cada paciente fue evaluado para obtener información general, de salud, composición corporal, alimentaria, signos clínicos y aspectos psicosociales. Resultados. Se evaluaron 77 pacientes con edad promedio de 65,5±12,8 años, 48 de ellos con antecedentes familiares de la enfermedad y 39 con más de 60 meses de diagnóstico; el estadio más frecuente fue el moderado y el tipo de demencia más común, la familiar precoz; la enfermedad se diagnosticó antes de los 50 años en 26 pacientes. Hubo diferencias estadísticamente significativas en el índice de masa corporal, el área grasa braquial y el área magra braquial por estadio, y mayor compromiso en el estadio grave (p=0,001, p=0,000 y p=0,000); en todos los estadios se presentó compromiso de la reserva energética y muscular. El calcio y los folatos fueron los nutrientes más comprometidos en el consumo. Conclusión. Aun en el estadio inicial, los pacientes presentaron compromiso del estado nutricional, evidenciado por déficit en la reserva energética y muscular, signos clínicos y consumo inadecuado de calcio y folatos. A medida que avanza la enfermedad, el compromiso de los indicadores nutricionales es mayor. Lo anterior evidencia la necesidad del cuidado nutricional individual de acuerdo con el estadio de la enfermedad.

As entomoftoromicoses constituem entidade clínica pertencente ao grupo das zigomicoses, cujos agentes etiológicos são o Conidiobolus coronatus, Conidiobolos incongruus e o Basidiobolos ranarum. Um caso de entomoftoromicose cutâneo-mucosa é descrito em homem de 51 anos de idade, lavrador, procedente da região amazônica do Estado do Maranhão, Brasil. Teve diagnóstico esclarecido por exame anatomopatológico, um ano após as manifestações clínicas iniciais. Como tratamento utilizou-se um dos derivados imidazólicos (cetoconazol®) 400mg/dia divididos em duas tomadas, por 12 meses), mostrando boa tolerância, com resposta favorável. Na última avaliação, 24 meses após início do tratamento, encontrava-se clinicamente curado.Entomophthoromycosis represents a clinical entity belonging to the group of zygomycoses, whose etiological agents are Conidiobolus coronatus, Conidiobolus incongruus and Basidiobolus ranarum. This paper describes the case of a 51-year-old male laborer with mucocutaneous entomophthoromycosis, who originates from the Amazon region of the State of Maranhão, Brazil. The diagnosis was established by anatomopathological examination one year after the onset of clinical manifestations. Treatment consisted of 400 mg daily (divided into two doses every 12 hours) of an imidazole derivative (ketoconazole®), which was tolerated well by the patient who showed a favorable response. The last assessment carried out 24 months after the beginning of treatment revealed that the patient was clinically cured.

OBJETIVO: A aortoplastia trapezoidal é uma variante técnica da anastomose término-terminal que, amparada em elementos da geometria, objetiva aumentar o diâmetro da aorta ao nível da sutura reduzida e, consequentemente, a manutenção de gradientes pressóricos residuais ou recorrentes indesejáveis a curto e a longo prazo. MÉTODOS: Após a ressecção da área coarctada e tecido ductal, são confeccionados em cada coto aórtico 3 trapezóides que, ao serem confrontados, criam linha de sutura com aspecto sinusoidal (zigue-zague). Foram operados por esta técnica 33 pacientes, a maioria homens, com idades variando de 3 meses a 36 anos (m 9,5 ± 9,7). RESULTADOS: Não ocorreu mortalidade imediata ou tardia e o tempo de evolução a longo prazo foi de 1,1 a 7,6 anos (m 3,6 ± 3,4). A maioria dos pacientes ficou assintomática com níveis normais de pressão arterial, possibilitando a descontinuação da terapêutica antihipertensiva (pOBJECTIVE: Trapezoidal aortoplasty is a technical variant of end-to-end anastomosis, which, based on elements of geometry, aims at increasing the diameter of the aorta at the level of the suture, therefore reducing the occurrence of residual or recurrent pressure gradients in the short and long run. METHODS: After resecting the coarcted area and ductal tissue, 3 trapezoids are confected in each aortic stump, which, when confronted, create a suture line with a sinusoidal aspect (zigzag). Thirty-three patients underwent surgery with this technique, 22 (66.7%) males, with ages ranging from 3 months to 36 years (mean of 9.84 ± 9.69). RESULTS: No immediate or late deaths occurred. Follow-up ranged from 1.1 to 7.6 years (mean of 3.6 ± 3.4). Most patients became asymptomatic with normal blood pressure levels, enabling the discontinuation of antihypertensive therapy (P

OBJECTIVES: The present study is aimed at evaluating the long-term outcomes (up to 12 years of follow-up) of patients undergoing aortic valve replacement using bovine pericardial prostheses. METHOD: From March 1992 to January 2003, 287 patients underwent aortic valve replacement as a single procedure, using bovine pericardial prostheses. Of these, 189 (65.9%) were males. Ages ranged from 15 to 82 years with a mean and standard deviation of 53.6 ± 15.1 years and median of 56 years. The diameters of the bioprostheses ranged from 21 to 29 mm, of which 23 mm (105 cases, 36.6%) and 25 mm (105 cases, 36.6%) were the most prevalent sizes. Only in 1 patient was a 29-mm prosthesis implanted. The assessed variables were late overall survival, comparative survival of patients < 70 years and ³ 70 years of age and the percentage of patients free from reoperations due to primary valve failure. Statistical analysis was performed with the aid of actuarial curves (Kaplan-Meier). RESULTS: The overall actuarial survival at the end of 12 years was 91.7 ± 2.2%. Separate analysis of patients < 70 years (Group A= 252 patients) and ³ 70 years (Group B= 35 patients) showed the overall survival in Group A was 94.7 ± 1.7% and 58.1 ± 17.2% in Group B (Logrank test P= 0.0005; Hazard Ratio 0.20 95% CI 0.01 to 0.29). The rate free from reoperation due to primary valve failure was 96.1 ± 2.0% at the end of 12 years. The 4 patients with implantation failure were in Group A and had a mean age of 49.7 years. CONCLUSIONS: The use of bovine pericardial prostheses in patients with aortic valve disease provides an excellent survival rate over 12 years of follow-up. Patients with 70 years and over had a significantly lower survival, but dysfunctions were only observed in the younger group of patients.OBJETIVOS: O presente estudo visa avaliar a evolução a longo prazo (até 12 anos de seguimento) de pacientes submetidos a substituição valvar aórtica por bioprótese de pericárdio bovino. MÉTODO: De março 1992 a janeiro 2003, 287 pacientes foram submetidos a substituição valvar aórtica como procedimento isolado, utilizando-se bioprótese de pericárdio bovino. Destes, 189 (65,9%) eram do sexo masculino. As idades variaram de 15 a 82 anos com média e desvio padrão de 53,6±15,1 anos e mediana de 56 anos. O diâmetro das biopróteses variou de 21 a 29 mm, sendo que os mais prevalentes foram o de 23 mm (105 casos; 36,6%) e o de 25 mm (outros 105 casos; 36,6%). Apenas um paciente recebeu prótese com diâmetro de 29 mm. Os eventos estudados foram sobrevivência tardia global, sobrevivência comparativa em pacientes abaixo de 70 anos e com 70 anos ou mais e porcentagem livre de reintervenções por qualquer causa de disfunção primária da bioprótese. A análise dos resultados foi feita com auxílio de curva atuarial Kaplan-Meier. RESULTADOS: A taxa atuarial de sobrevivência global ao final de 12 anos foi de 91,7±2,2%. A separação em grupos abaixo de 70 anos (Grupo A= 252 pts) e 70 anos ou mais (Grupo B= 35 pts) mostrou que, no grupo A, a sobrevivência global foi de 94,7±1,7%, enquanto que no grupo B foi de 58,1±17,2% (Logrank test p= 0,0005; Hazard Ratio 0,20 IC95% 0,01 a 0,29). A taxa livre de reintervenções por causa primária da bioprótese foi de 96,1±2,0%, ao final de 12 anos. Os quatro pacientes que apresentaram disfunção pertenciam ao grupo A, com média de idade de 49,7 anos. CONCLUSÕES: O uso da bioprótese de pericárdio bovino em portador de doença valvular aórtica proporciona excelente taxa de sobrevivência após 12 anos de seguimento. Pacientes com idade igual ou superior a 70 anos apresentaram sobrevivência significativamente menor, mas as disfunções ocorreram exclusivamente no grupo de menor idade.

OBJECTIVE: To assess the differences between young males and females after acute myocardial infarction. METHODS: We retrospectively studied 236 patients (54 females and 182 males) after acute myocardial infarction and during hospital stay assessed the following parameters: risk factors; the treatment used; the pattern of coronary artery obstruction; left ventricular ejection fraction; complications; and, using a logistic regression model, the factors related to the occurrence of reinfarction and death. RESULTS: No significant difference was observed between the sexes in risk factors, pattern of coronary artery obstruction, and left ventricular function. The time interval between symptom onset and treatment was longer in females (p=0.03), who underwent thrombolysis (p=0.01) and angioplasty (p=0.03) less frequently than males did, but not myocardial revascularization. Female sex (OR = 5.98) and diabetes (OR = 14.52) were independent factors related to the occurrence of reinfarction and death. CONCLUSION: Young males and females after acute myocardial infarction did not differ in coronary risk factors, and clinical and hemodynamic characteristics. Females had their treatment started later, and they underwent chemical thrombolysis and angioplasty less frequently than males did. Female sex and diabetes were related to the occurrence of reinfarction and death.

Introduction: Patients with myocardial infarction often express emotional states including fear of dying when suffering a cardiovascular event. Objective: To determine the relationship between most frequent emotional states post-myocardial infarction and the compensation degree of somatic health status in patients during convalescence. Method: A prospective study was carried out on 31 patients, selected by (nonprobabilistic) purposive sampling, who attended follow-up cardiology consultation at "Hospital Celestino Hernández Robau" from Santa Clara, from September 2014 to March 2015. Document review techniques, interviews, Rotter, IDARE and IDERE tests were applied. Results: Hypertension was the main cardiovascular risk factor (90.3%). There was a male predominance (64.5%) and a partially unbalanced state of somatic health (51.6%), mostly in men (60.0%). Only 25.8% of compensated patients. Generally the average indicator of anxiety and depression predominated; but we found high levels of these emotional states in decompensated and partially unbalanced patients, especially as a state. ** Conclusions: There was a predominance of partially offset somatic state of health. High levels of anxiety and depression states were identified and it was found the existence of an important relation between anxiety-depression emotional states, and the somatic state of health relating to the cardiovascular system in patients convalescent from myocardial infarction. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the clinical evolution and the association between nutritional status and severity of asthma in children and adolescents enrolled in Primary Health Care. Methods: A retrospective cohort study of 219 asthmatic patients (3-17 years old) enrolled in Primary Care Services (PCSs) in Embu das Artes (SP), from 2007 to 2011. Secondary data: gender, age, diagnosis of asthma severity, other atopic diseases, family history of atopy, and body mass index. To evaluate the clinical outcome of asthma, data were collected on number of asthma exacerbations, number of emergency room consultations and doses of inhaled corticosteroids at follow-up visits in the 6th and 12th months. The statistical analysis included chi-square and Kappa agreement index, with 5% set as the significance level. Results: 50.5% of patients started wheezing before the age of 2 years, 99.5% had allergic rhinitis and 65.2% had a positive family history of atopy. Regarding severity, intermittent asthma was more frequent (51.6%) and, in relation to nutritional status, 65.8% of patients had normal weight. There was no association between nutritional status and asthma severity (p=0.409). After 1 year of follow-up, 25.2% of patients showed reduction in exacerbations and emergency room consultations, and 16.2% reduced the amount of inhaled corticosteroids. Conclusions: The monitoring of asthmatic patients in Primary Care Services showed improvement in clinical outcome, with a decreased number of exacerbations, emergency room consultations and doses of inhaled corticosteroids. No association between nutritional status and asthma severity was observed in this study. [ABSTRACT FROM AUTHOR]

Copyright of Investigacion & Educacion en Enfermeria is the property of Universidad de Antioquia, Facultad de Enfermeria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: to relate complaints presented by emergency room patients, classified using the Manchester Triage System, with the final outcome (discharge/death/transfer). Methods: prospective cohort study, involving 509 patients who were admitted to the emergency room and remained there for more than 24 hours after admission, being monitored to the final outcome. Data were analyzed with a statistical program using descriptive and analytical statistics. Results: the mean age of the patients was 59.1 years and 59.3% were male. The main complaints were unwell adult (130 - 22.5%), shortness of breath in adults (81 - 14.0%), abdominal pain in adults (58 - 10.0%) and behaving strangely (34 - 5.9%), with 87% of the patients being discharged. More deaths were found in the patients classified in the severe colors, with 42.8% classified as red, 17.0% as orange and 8.9% as yellow. Among the patients classified as green, 9.6% died. Conclusion: in the various colors of the Manchester Triage System, death prevailed in patients that presented the complaints of unwell adult, shortness of breath, head injury, major trauma, diarrhea and vomiting. The higher the clinical priority the greater the prevalence of death. [ABSTRACT FROM AUTHOR]

American cutaneous leishmaniasis (ACL) may present different clinical manifestations, immune and therapeutic responses, depending on the Leishmania species, as well as inoculum size and factors inherent to the affected individual. Thus, the aim of this study was to carry out clinical-therapeutic follow-up of Brazilian patients with ACL caused by different Leishmania species. Between 2015 and 2018, patients with ACL from Amazonas and Pernambuco states (Brazil) were submitted to blood collection before and after treatment. The qPCR technique was used to quantify the parasite load. To identify the Leishmania species, one of the following techniques was employed: a conventional PCR performed from biopsy or blood DNA, followed by sequencing; or Multilocus Enzyme Electrophoresis from Leishmania isolated from biopsy/aspirated lesion. A total of 10.8% (23/213) of the patients included in positive cases were followed-up. All 23 patients were clinically and epidemiologically compatible with ACL and were also positive in parasitological tests (86.96%), molecular tests (73.91%) or both (60.87%). Seventeen samples collected before treatment and 11 collected after treatment were positive in the qPCR assay, with a mean parasite load (MPL) of 38.33 fg/μL and 11.81 fg/μL, respectively. Eight samples were positive in both collections. Thirteen patients (56.52%) were clinically cured (wound healing). Ten patients (43.47%) were not clinically cured at the time of return with the attending physician. Identification of Leishmania species was carried out in samples from nine patients, and six were identified as L. (Viannia) braziliensis , 2 as L (Viannia) guyanensis and 1 as L (Leishmania) amazonensis. One patient infected with L. guyanensis and other with L. braziliensis were not clinically cured and increased the mean parasite load after treatment. The data obtained from the followed-up patients and the relationship between clinical evolution and the infecting species demonstrate the need to understand its etiology to define the effective therapeutic protocol. [Display omitted] • Brazilian patients infected with different Leishmania species were follow-up. • Parasite load was used to perform pre and post treatment follow-up. • The qPCR technique was used to quantify the parasite load. • To understand ACL etiology is need to define the effective therapeutic protocol. [ABSTRACT FROM AUTHOR]

A hipertensão pulmonar secundária a tromboembolismo é uma doença grave e debilitante. Ocorre em aproximadamente 0,5-1,0% dos pacientes que sobrevivem a um episódio de tromboembolismo agudo. Descreve-se pela primeira vez no Brasil, um paciente de 80 anos de idade com hipertensão pulmonar grave secundária a tromboembolismo, que foi submetido a tromboendarterectomia e que apresentou boa evolução.Os autores acreditam que este procedimento cirúrgico é uma boa opção terapêutica para este tipo de hipertensão pulmonar mesmo em pacientes com idade avançada sem co-morbidades.Pulmonary hypertension secondary to thromboembolism is a serious and debilitating disease. It occurs in approximately 0.5-1.0% of patients who survive an episode of acute thromboembolism. This is the first reported case of successful thromboendarterectomy performed in an elderly patient in Brazil. The patient, an 80-year-old man, presented favorable postoperative evolution. The authors believe this surgical procedure is a viable option for treatment of this type of pulmonary hypertension even in patients of advanced age, providing that there are no comorbidities.

Background: Attention deficit/hyperactivity disorder (ADHD) is a chronic condition with long-term associated risks., Objective: To analyze the clinical status, occupation, and daily life difficulties of two cohorts of children diagnosed with ADHD (2004 and 2009) after five and 10 years., Material and Method: Descriptive, longitudinal study using the WOMI database corresponding to Oviedo, Asturias, Spain. Children with ADHD detected by their primary care pediatrician were included. A voluntary follow-up telephone interview was requested. Outcome variables were current clinical and occupational status, ADHD symptoms according to SNAP-IV, and Strengths and Difficulties Questionnaire (SDQ)., Results: The interviewed sample consisted of 95 subjects, out of whom 71 answered the SNAP-IV and SDQ questionnaires; 60.70% of the sample did not receive treatment at the time of follow-up, 4.7% had no occupation, 25.40% still had ADHD global symptoms above the clinical cutoff point, and 66.2% had difficulties with moderate interference., Conclusions: ADHD symptoms decline as people grow up. Mental health comorbidities and academic dropout were not confirmed in the sample., (Copyright: © 2023 Permanyer.)

Psychogenic functional dysphonia is related to psychological aspects. The type of voice, the articulation and the fluency are sensitive to psychological changes. Voice adjusted with falsetto, is a voice with an extremely high pitch and can be observed in cases of psychogenic dysphonia. A differential diagnosis for psychogenic dysphonia is essential to perform an adequate and effective treatment. Prognostic of a psychogenic dysphonia is generally good. It commonly affects women. The aim of this study is to present the therapy evolution of an individual with psychogenic dysphonia. AJO, 45 years, male, attended to the ambulatory of Voice Evaluation and Therapy as an otorhinolaryngologist indication. His complaint was "my voice is perfect in the morning but it gets acute through the day". At April 18, 2013 he received the medical diagnosis of "reduced mobility of left vocal fold". Treatment based on trigger sound techniques, with direct modification of the symptoms, quickly evolved and had great satisfaction from the patient. When there is a psychogenic dysphonia suspicion, organic changes must be discarded. It is essential to have an evaluation that helps to differentiate diagnosis and therapeutic techniques which encourage the patient. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Medicina e Saúde de Brasília is the property of Revista de Medicina e Saude de Brasilia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The aim of this study was to describe the clinical course of a nine years girl diagnosed with SLI attended the Clinic of Child Language, FOB-USP. Longitudinal carried out was realized, through analysis of medical records and filming. The speech and language therapy began when the child was five years and presented the initial complaint of phonological alterations and impairments in the speech intelligibility. It was found phonological processes not expected for age, alterations in semantic, syntactic and pragmatic and in auditory perceptual processes. The receptive language was preserved. The intervention focused on the organization of linguistics subsystems, mainly the information processing skills. After 12 months, there was evolution of the aspects, except the phonological, with less significant evolution. Activities directed to written language were included when the child started primary school. After 42 months of intervention, there was evolution of phonological aspect. However, this evolution is not observed in spontaneous speech. Alterations in these aspects exert great influence on the performance of written language. The phonological awareness skill is adequate, however, there is difficulty in converting phoneme/grapheme, resulting in performance very short in written language. There is impairment in the linguistic information processing, and persisting alterations, common in the frames of SLI, which lead to gaps in the literacy process. To conduct the therapeutic process is necessary to understand the nature of language difficulties, developing specific strategies geared mainly to linguistic information processing and learning, providing skills and empowering the individual to active participation in school and social settings. [ABSTRACT FROM AUTHOR]

Decision making in health care implies knowledge of the clinical course of the disease. Knowing the course allows us to estimate the likelihood of occurrence of a phenomenon at a given time or its duration. Within the statistical models that allow us to have a summary measure to estimate the time of occurrence of a phenomenon in a given population are the linear regression (the outcome variable is continuous and normally distributed--time to the occurrence of the event--), logistic regression (outcome variable is dichotomous, and it is evaluated at one single interval), and survival curves (outcome event is dichotomous, and it can be evaluated at multiple intervals). The first reference we have of this type of analysis is the work of the astronomer Edmond Halley, an English physicist and mathematician, famous for the calculation of the appearance of the comet orbit, recognized as the first periodic comet (1P/Halley's Comet). Halley also contributed in the area of health to estimate the mortality rate for a Polish population. The survival curve allows us to estimate the probability of an event occurring at different intervals. Also, it leds us to estimate the median survival time of any phenomenon of interest (although the used term is survival, the outcome does not need to be death, it may be the occurrence of any other event). [ABSTRACT FROM AUTHOR]

The authors describe the evolution of schistosomiasis mansoni in inhabitants of Capitão Andrade, Minas Gerais, Brazil, from 1973 to 1994. The prevalence of infection was 60.8% in 1973, 36.2% in 1984, and 27.3% in 1994. The evolution of the clinical forms of the disease in this group was as follows: unchanged in 76.7%, clinical progression in 8.4% and clinical regression in 14.9%. The reduction of the prevalence and severity of Schistosoma mansoni infection over the 21 years period, can be attributed to treatment of infected subjects performed in the area and to the installation of piped water in their dwellings.

The long-term course and prognosis of obsessive-compulsive disorder (OCD) is insufficiently known. To identify predictors of OCD course, follow-up studies of patients with OCD were reviewed and their findings summarized. According to these studies, the following variables were correlated with poor outcome: early onset, severity of OCD symptoms, chronic course, poor social functioning at baseline, lifetime history of comorbid psychiatric and personality disorders, presence of parental Axis I psychiatric diagnosis, and delayed response to serotonin reuptake inhibitors in the beginning of the treatment. Due to the availability of new treatments, most patients with OCD can expect significant improvement, but not complete remission of the disorder. The reviewed follow-up studies support previous reports on the chronicity of OCD.