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Shoulder rotator cuff tendon tears were evaluated with ultrasonography (US) and magnetic resonance imaging (MRI). Surgical or arthroscopical correlation were available in 25 cases. Overall costs were also considered. Shoulder impingement syndrome diagnosis was done on a clinical basis. Surgery or arthroscopy was considered when conservative treatment failure for 6 months, or when rotator cuff repair was indicated. Ultrasound was performed in 22 patients and MRI in 17 of the 25 patients. Sensitivity, specificity and accuracy were 80%, 100% and 90.9% for US and 90%, 100% and 94.12% for MRI, respectively. In 16 cases both US and MRI were obtained and in this subgroup statistical correlation was excellent (p< 0.001). We concluded that both methods are reliable for rotator cuff full thickness tear evaluation. Since US is less expensive, it could be considered as the screening method when rotator cuff integrity is the main question, and when well trained radiologists and high resolution equipment are available.

INTRODUÇÃO: A preocupação suscitada quanto ao consumo de substâncias psicoativas pelos adolescentes tem mobilizado grandes esforços em todo o mundo na produção de conhecimento sobre este fenômeno. Decidiu-se estudar as taxas de prevalência de consumo de substâncias psicoativas de uso lícito e ilícito, sua distribuição por idade, sexo e a idade da primeira experiência com essas substâncias, entre adolescentes escolares do Município de Ribeirão Preto, SP, Brasil. MATERIAL DE MÉTODO: Um questionário devidamente adaptado e submetido a um teste de confiabilidade foi auto-aplicado a uma amostra proporcional de 1.025 adolescentes matriculados na oitava série do primeiro grau e primeiro, segundo e terceiro anos do segundo grau, das escolas públicas e privadas do município estudado. O questionário continha questões sobre o uso de dez classes de substâncias psicoativas, questões demográficas e informações de validação, além de questões de percepção e comportamento intrínseco ao consumo de drogas. RESULTADOS: Da amostra 88,9% consumiram bebidas alcoólicas alguma vez na vida; 37,7% utilizaram o tabaco; 31,1% os solventes; 10,5% os medicamentos; 6,8% a maconha; 2,7% a cocaína; 1,6% os alucinógenos e 0,3% consumiu alguma substância a base de opiácios. As taxas de consumo cresceram com a idade, para todas as substâncias; no entanto, o uso de tabaco e de substâncias ilícitas mostrou uma desaceleração nos anos que compreendem o final da adolescência. Verificou-se que os meninos consumiram mais do que as meninas, exceto para os medicamentos, com as meninas consumindo barbitúricos, anfetaminas e tranqüilizantes em proporções semelhantes ou maiores que os meninos. A idade da primeira experiência mostrou que o acesso às substâncias psicoativas ocorreu em idades bastante precoces. CONCLUSÕES: As substâncias psicoativas, sejam lícitas ou ilícitas, são freqüentemente experimentadas na adolescência, tanto pelos meninos como pelas meninas, muitas vezes em idades bem precoces.

INTRODUÇÃO: Vários estudos epidemiológicos sobre o consumo de substâncias psicoativas têm incluído em suas análises a avaliação da influência do contexto social nos níveis de prevalência desse consumo. Analisa-se a distribuição do consumo dessas substâncias segundo as classes sociais, numa amostra de adolescentes escolares de Ribeirão Preto, SP, Brasil. MATERIAL E MÉTODO: Um questionário auto-aplicável, adaptado e submetido a um teste de confiabilidade, foi aplicado a uma amostra proporcional de 1.025 adolescentes matriculados na oitava série do primeiro grau e primeiro, segundo e terceiro anos do segundo grau, das escolas públicas e privadas da cidade. O questionário continha questões sobre o uso de dez classes de drogas. Utilizou-se a adaptação de um modelo que identifica 5 frações de classe social (burguesias empresarial, gerencial e pequena burguesia, proletariado e subproletariado), a partir de indicadores que situam os indivíduos dentro das relações sociais de produção. RESULTADOS: As três frações da burguesia foram mais representadas que as outras na população de adolescentes escolares do que na população geral. Não houve diferenças na distribuição do consumo de álcool e tabaco pelas classes sociais, embora se observe uma tendência de maior prevalência nos extremos da escala social. Já o consumo de substâncias ilícitas foi maior nas burguesias e menor no proletariado. CONCLUSÕES: Embora o consumo de substâncias lícitas não tenha diferido entre as classes sociais, o maior consumo de substâncias ilícitas pelos mais ricos provavelmente se deveu ao maior custo desses produtos do que o álcool e o tabaco.

The growth of two groups of infants were evaluated, one of them exclusively breast-fed (105 infants) and the other exclusively bottle-fed (61 infants), and compared with one another and with international standards (NCHS). All infants were evaluated by anthropometry at 1, 2, 3, 4, 5 and 6 months of age. A fourth order polynomial was adopted for each infant and for each anthropometric measurement in order to estimate individual growth, and the 5th, 50th and 95th percentiles for weight and length were obtained. For the age of 6 months, the weights of breast-fed boys and girls were always statistically equal to or higher than those of infants fed cow's milk or those of NCHS standards. Breast-fed boys presented significantly longer length than bottle-fed boys but shorter than NCHS standards, and breast-fed girls presented significantly shorter length than both bottle-fed girls and than NCHS standards. The greater weight of exclusively breast-fed infants when compared to NCHS standards at six months of age, which differentiates the present study from several other ones carried out in developing countries, was probably due to the association of the beneficial effects of breast-feeding with those of pediatric follow-up.

OBJECTIVE: To evaluate the use of the 10th percentile of weight for age as a cut off point for detection of children under nutritional risk, especially for programs of alimentary supplementation. METHODS: 841 children with age between 10 days and 60 months were studied in a primary health care center located in the periphery of Ribeirão Preto, SP, Brazil. It was a cross-sectional study that included age, sex, weight and height, later computing the z scores of weight for age, height for age and weight for height, on the basis of the data of the NCHS. Through 2x2 type tables, where the results in relation with the 10th percentile (above or below this cut off point) and other indices were compared (above or below - 2 z scores), the capacity of 10th percentile of weight for age to detect children with various anthropometric deficits was estimated. RESULTS: The false negative results were always very low, between 0 and 1%, in opposition to the false positive results, that varied from 76.3 to 90.5%. The values of sensitivity/specificity have been 100/85.9%; 93.3/83.8%; 82.9/85.7%, respectively for deficits of weight for age, weight for height and height for age. CONCLUSIONS: The 10th percentile of weight for age was found adequate for population screening of children with weight for the age and weight for the height deficits (high sensitivity), but these children must be better evaluated later on (too many false positive results). For height for age deficits, the 10th percentile resulted inadequate.

Objective: To assess the efficacy of partial left ventriculectomy as a treatment for patients with end-stage heart failure., Methods: From February to June 1995, 7 patients with end-stage heart failure underwent partial left ventriculectomy. Subsequently, patients underwent clinical evaluation every 2 months, and 2-dimensional echocardiography at the 6th and 12th months after cardiac surgery. All patients were given digitalis and diuretics at conventional doses, and captopril or enalapril at maximal tolerated doses., Results: Two (28%) patients died; 1 from cardiac arrhythmia associated with gastrointestinal hemorrhage, and the other suddenly. One (14%) patient developed an embolic cerebrovascular accident. Four (57%) patients were hospitalized for congestive heart failure; all of them had either decreased the daily dose of captopril or enalapril or discontinued the drugs by themselves. Twelve months after ventriculectomy, left ventricular ejection fraction values were greater and left ventricular diastolic dimension and functional class values lower than those found before cardiac operation., Conclusion: Beneficial effects of partial left ventriculectomy are observed one year after the surgical procedure. This technique, therefore, can be useful for the treatment of patients with end-stage heart failure.

Introduction: Many of the epidemiological studies on the consumption of legal and illegal psychoactive substances have included the evaluation of the influence of social context on the levels of prevalence of this consumption using indirect social indicators such as family income, and educational and housing levels in an attempt to identify individuals or groups in different social contexts. The present study investigates the distribution of consumption of psychoactive substances according to social class in a sample of teenage pupils in Ribeirão Preto, SP, Southeastern Brazil., Material and Method: A self-applicable questionnaire duly adapted and submitted to a reliability test was applied to a proportional sample of 1,025 teenagers enrolled in the 8th, 9th, 10th and 12th grades in public and private city schools. The questionnaires contained questions about the use of ten classes of psychoactive substances, demographic questions and validation information, as well as questions about the perception and intrinsic behavior related to drug consumption. The adaptation of a model that identifies 5 social class strata (business middle class, managerial middle class, lower middle class, proletariat and subproletariat) on the basis of indicators that situate the individuals within the social relations of production, was used., Results: The 3 middle class strata were more often represented, whereas the proletariat and subproletariat were less frequently represented in this teenage pupil population than in the population in general. There was no difference in alcohol or tobacco consumption according to social class, although prevalence tended to be higher at the two extremes of the social ladder. In contrast, the consumption of illegal substances was higher in the middle class and lower in the proletariat., Conclusion: Although the consumption of legal substances did not differ among social classes, the higher consumption of illegal substances by the wealthier teenagers was probably due to the higher cost of these products as compared those of alcohol and tobacco.

Introduction: Concern over the consumption of psychoactive substances by teenagers has given rise to a great worldwide effort to produce information about this phenomenon. This study set out to investigate the prevalence of consumption of legal and illegal psychoactive substances, its distribution by age, sex and age at first experience of them, among teenage pupils in county, Ribeirão Preto, SP, Southeastern Brazil., Material and Method: A self-applicable questionnaire duly adapted and submitted to a reliability test was applied to a proportional sample of 1,025 teenagers enrolled in 8th, 9th, 10th and 11th grades at public and private city schools. The questionnaire contained questions about the use of ten classes of psychoactive substances, demographic questions and validation information, as well as questions about the perception and intrinsic behavior related to drug consumption., Results: The sample of 88.9% had consumed alcoholic beverages sometime in their lives, 37.7% had used tobacco, 31.1% solvents, 10.5% medicines, 6.8% marihuana, 2.7% cocaine, 1.6% hallucinogens, and 0.3% of the sample had consumed some opiate substance. The rates of consumption increased with age for all substances; however, the use of tobacco and of illegal substances was less intense during the later years of adolescence. As to sex distribution, boys consumed more than girls, except for medicines, with girls consuming barbiturates, amphetamines and tranquilizers in proportions similar to or higher than those observed among boys. Age at first experience showed that access to psychoactive substances occurred at very early ages., Conclusions: Experimenting with psychoactive substances, whether legal or illegal, is a frequent phenomenon during adolescence, both among boys and girls, often at very early ages.

There is evidence in the literature that death following a bee or wasp sting may result from cardiac involvement. This study describes acute cardiac lesions experimentally induced in Wistar Rats submitted to intravenous inoculation of Africanized bee venom (ABV) and killed 1, 4, and 24 h after inoculation. Significant increases in serum enzyme levels were detected; light microscopy showed necrosis of the myocardium; and enzyme histochemistry showed inactivation of enzymes in and around the areas of necrosis. This is the first report of an acute necrotizing cardiac lesion, similar to human myocardial infarction, produced by the inoculation of ABV.

The aim of this study was to assess the peripheral and cardiac autonomic system by catecholamine measurements in patients with severe chagasic and nonchagasic heart failure. Fifteen chagasic and 16 nonchagasic patients were enrolled in the study. Plasma venous norepinephrine levels (pg/ml) were 397.26 +/- 250.11 for chagasic and 660.05 +/- 455.57 for nonchagasic patients (p > 0.05), plasma venous epinephrine levels 215.84 +/- 254.04 for chagasic and 106.17 +/- 65.90 for nonchagasic patients (p > 0.05), aortic root norepinephrine levels 435.46 +/- 306.60 for chagasic and 668.16 +/- 512.82 for nonchagasic patients (p > 0.05), aortic root epinephrine levels 300.33 +/- 302.69 for chagasic and 199.98 +/- 162.88 for nonchagasic patients (p > 0.05), coronary sinus norepinephrine levels 636.10 +/- 495.22 for chagasic and 552.17 +/- 535.54 for nonchagasic patients (p > 0.05) and coronary sinus epinephrine levels 226.66 +/- 277.47 for chagasic and 69.21 +/- 35.62 for nonchagasic patients (p = 0.02). Myocardial and peripheral norepinephrine and epinephrine extractions were similar for both groups. Taken together, these findings may suggest that chagasic patients with congestive heart failure have biochemical evidence of cardiac autonomic dysfunction with preservation of the peripheral sympathetic activity.

A hundred-forty-one infants born from 26 to 36 weeks, appropriate-for-gestational-age, were followed from birth until the corrected postmenstrual age of 42 weeks. Weight, height and cephalic perimeter were measured on a weekly basis. Based on the average values and percentiles of these measurements it was adjusted a third degree polynomial function. The growth curves obtained, when compared with the so-called intra-uterine growth curves, showed that during the 40th and 42nd postmenstrual weeks the averages and medians are similar. It was observed that the growth dynamics of the preterm infants showed a catch-up pattern in the immediate postnatal period.

The concentration of cardiac tissue noradrenaline (NOR) was determined in Wistar rats injected with 1.5 microliters/100 g body weight Africanized bee venom (ABV) (LD50 = 0.8 microliter/100 g body weight by the intravenous route). The animals were injected with ABV by the intramuscular (IM), intraperitoneal (IP), subcutaneous (SC) and intravenous (IV) routes. Animals injected by the IM, IP and SC routes were sacrificed 4, 7 and 24 hours after injection. The animals injected by the IV route were sacrificed when they became apnoeic (within minutes). NOR levels in animals injected by the IM, IP and SC routes were inconstant and inconclusive. In contrast, animals injected with ABV by the IV route showed a significant decrease in NOR concentration when compared to their respective controls, suggesting tissue NOR release. It is suggested that the mechanism of death of the animals injected IV with ABV seems to be related, at least in part, to functional cardiac alterations secondary to stress-induced NOR release. As a consequence, cardiological monitoring of patients who are victims of multiple bee stings is recommended, together with a judicious evaluation of therapy involving drugs with a sympathomimetic action.

The present study was developed in the CMSCVL, which is a primary medical attendment clinic for children and pregnant women, during the period of 01/10/1980 to 31/12/1984, containing 132 children. The study was longitudinal and respective and the two distinct groups of children may be established, differing in accordance to the hospital stay period of postpartum, in rooming-in or traditional nursery. After the statistic analysis of all the variables involved in the study, the only variable that really resulted was the site of internation during the postpartum period. Although these exist a tendency to the greater frequency of breast feeding in the group that utilized the rooming-in, the statistics analysis showed that this difference is not significant. However should consider the important paper carried out by the CMSCVL, in the encouragement of the practice of the breast-feeding, what may have homogenized the two groups. The medium time of weaning found for the population of 132 children studied was 8 months, while for those children that utilized the rooming-in is system was 10 months and for those that stayed in the traditional nursery it took 9 months. The motives of weaning were also identified for the studied population that showed similarity to other published projects.

The effect of phytohaemagglutinin (PHA) on the adaptation of the proximal jejunal epithelium and on the distal ileal epithelium was studied in rats. The group receiving PHA gained less weight than controls, and the enterocyte population of their jejunal villi, as well as the morphokinetic parameters (length, population, crypt cell production per crypt) of their jejunal and ileal crypts were higher than those of the controls. The proximal lesion caused by PHA (reduction of villus cell populations) stimulates hyperplasia of the crypt-villus unit of the ileal epithelium with the development of adaptation from afar. These adaptations occurred in animals that ingested PHA even in the presence of severe malnutrition.

1. The resting electrocardiogram was obtained from 25 Trypanosoma cruzi-infected rats 30 days after infection (phase I). The resting electrocardiogram was abnormal in 12 (group I) and normal in 13 (group II) animals. Nineteen similar but non-infected animals served as controls. Both the resting electrocardiogram and the ajmaline test were performed 120 and 350 days after infection (phases II and III, respectively). 2. With regard to the resting electrocardiogram of group I animals, left axis deviation was found in 10 of 12 (83%) in phase I, one of 12 (8%) in phase II (P less than 0.05) and in none of phase III (P less than 0.05). An intraventricular conduction delay was found in four of 12 (33%) rats in phase I, two of 12 rats (16%) in phase II (P greater than 0.05) and six of 12 rats (50%) in phase III (P greater than 0.05). The ajmaline test was abnormal in nine of 10 (90%) rats of group I with normal resting electrocardiogram in phase II, and in three of six (50%) animals in phase III (P greater than 0.05). 3. An intraventricular conduction delay was found in the resting electrocardiogram of one of 13 (7%) rats of group II in phase III. The ajmaline test was abnormal in one of 13 (7%) rats in phase II and in one of 12 (8%) rats in phase III. 4. No control rat showed pathological changes.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of iron deficiency anemia on the catecholamine levels and morphology of the heart was studied in young male Wistar rats. The iron-deficient rats showed mild restriction of body weight gain and a striking lowering of blood hemoglobin concentration. In addition the present study demonstrated that the experimental iron deficiency anemia induces cardiac hypertrophy, as revealed by increased heart weight associated with increased size of cardiac muscle cells, as well as decreased myocardium catecholamine levels. The possible meaning of the neurohormonal change in the pathogenesis of the hypertrophic heart is discussed.

A retrospective study of Chagas' heart disease was carried out by a review of 1,345 autopsy reports, with special reference to cardiac thrombus and thromboembolic phenomena. The incidence of cardiac thrombus was higher in cases of heart failure (36%) than in cases of sudden death (15%), higher in heavier hearts, and unrelated to age or sex. The left- and right-sided cardiac chambers were equally affected by thrombus. Endocarditis and blood stasis were considered important factors in the pathogenesis of cardiac thrombus. Thromboembolic phenomena were more common in the systemic circulation but caused relatively more deaths by pulmonary embolism. Fourteen percent of patients with thromboembolic phenomena died from them. Patients with multiple thromboembolic phenomena had a higher risk of death from embolism. Cardiac thrombosis or thromboembolic phenomena, or both, were present in 44% of the cases studied. Prophylactic measures should be taken for these important complications of Chagas' heart disease.