The prevalence of gallstones was determined in Curitiba. A total of 384 patients older than 20 years of age was randomly selected from four general hospitals and subjected to ultrasonographic examination of the gallbladder. Of the 384 patients, 327 had normal gallbladder (85.2%) and 57 (14.8%) had gallstones (48 patients) or had been previously subjected to cholecystectomy due to gallstones (9 patients). Six out of the 48 patients with gallstones referred biliary colic (12.5%). Gallstone prevalence increased with age and number of pregnancies.
The hepatodiaphragmatic interposition of the colon (Chilaiditi's Syndrome) and associated volvulus of the transverse colon is a rare cause of mechanical intestinal obstruction. The preoperative diagnosis is extremely difficult. We report a 26-year-old- male case, symptomatic since childhood, whose diagnosis by barium enema was confirmed surgically in Hospital Universitário de Taubaté. He underwent a transversectomy, and presented an intestinal obstruction in the post-operative period. Two reoperations were required. He has remained well, with outpatient supervision.
A multicentric double-blind randomized study was organized to investigate the relationship between insulin antibodies and metabolic control in type I diabetics who changed from bovine insulin to monopic porcine and monocomponent human insulin. Twenty eight type I diabetic patients treated with bovine insulin (proinsulin less than 3,000 ppm) were selected. In a 6 month study, 9 patients maintained bovine insulin, 9 changed to monopic porcine insulin (proinsulin less than 10 ppm) and 10 to human insulin (proinsulin less than 1 ppm). The insulin were a gift from Biobras laboratory. The insulin antibodies (IA) were measured by an ELISA method and the metabolic control assessed by fasting blood sugar (FBS), 24 hour glucosuria and glycated protein (GP) measured by affinity chromatography method. After switching insulin therapy, IA decreased with porcine and human insulin, but increased with bovine insulin. Concerning metabolic control, only an increase of FBS with human insulin was found. In the beginning of study, there was negative correlation between IA and 24h glucosuria (rs = -0.509; p = 0.006). In conclusion, there was no improvement of metabolic control, in spite of a decrease of IA in type I diabetics treated during 6 months with less immunogenic insulin preparations.
During the period February 1987-June 1988, we examined 542 stool samples of 271 HIV positive patients both with and without full-blown AIDS. One hundred patients with either acute or chronic diarrhea and 180 patients without diarrhea were studied. The stool samples were examined for the presence of Cryptosporidium sp., other protozoa, helmints, and pathogenic enterobacteria. We found a prevalence of 14.3% of Cryptosporidium sp. in patients with full-blown disease and diarrhea. We encountered no Cryptosporidium sp. among asymptomatic patients. The occurrence of diarrhea was significantly associated with a CD4/CD8 ratio lower than 0.4, with the finding of Cryptosporidium sp. in the stools, being a CDC group IV, and with a positive stool culture for pathogenic enterobacteria. The diarrhea caused by Cryptosporidium sp. could not be distinguished, on clinical grounds, from diarrhea caused by other etiologic agents.
The study of the direct involvement of colony stimulating factors, interleukins, and other purified factors in distinct steps of hematopoiesis has been complicated by the in vitro presence of non-hematopoietic cells which can intermediate the effects observed on hematopoietic precursors. The review covers the recent finding that the CD34 antigen is expressed on the membranes of essentially all pluripotent stem cells, but is lacking in the majority of the differentiated blood and stromal bone marrow cells. This finding allowed in vitro experiments with selected CD34+ hematopoietic precursors, and a consequent reevaluation of the participation of different factors in their differentiation. The role of interferons, tumor necrosis factors, and transforming growth factors beta in the negative regulation of hematopoiesis is also analysed.
The authors analysed the results of Montenegro Test in 402 patients with mucocutaneous leishmaniasis from Espírito Santo State, where the Leishmania braziliensis braziliensis has been isolated from humans cases and dogs. The test was positive in 371 cases (92.2%) before treatment. The Montenegro Test given during or after treatment changed the results in 17 of 20 negative cases. The remaining 3 cases and 9 which changed the results had positives biopsies. It was demonstrated again the efficiency of the Montenegro Test in the diagnosis of mucocutaneous leishmaniasis.
With the objective of evaluating teaching at the Faculdade de Medicina de Botucatu, UNESP, questionnaires were sent to 605 ex students and with return of 245 answers. The medical course was considered good, Pediatrics and Medicine obtaining the best marks, the evaluation of Medicine, however decreased among the more recently graduated. Surgery, gynecology-obstetrics and public health had a medium evaluation. Ex students were secure in diagnosis, therapeutics and evaluation of laboratory and other subsidiary texts and techniques but criticized the training in more elaborate medical procedures, essential for medical practice. The fragmentation of the curriculum into specialties was also criticized. Many of the ex students suggested as necessary measures of improvement: integration of specialties in the five basic areas of medicine and utilization of the different health services of the city for teaching.
Patients with traumatic or non-traumatic acute abdomen, often exhibit difficulties in the assessment of the real intra-abdominal visceral compromise. This study intends to compare laparoscopy and ultrasonography in patients with non-traumatic or traumatic acute abdomen, in whom there is a doubt on the actual visceral compromise. Forty-five patients were studied in this protocol. Both procedures were performed in 28 and in 17 patients with non-traumatic or traumatic acute abdomen, respectively. The laparoscopic examination was shown to be superior to the ultrasound even when one subtracts from the ultrasound data all pathologies that involved bowel transit and the bowel wall such as the acute appendicitis and cases of pelvic inflammatory disease. The laparoscopic and ultrasound accuracy were 97.8% and 53%, respectively.
A few Brazilian medical teaching programs carried out during the last 40 years, in which the author has participated or has been a witness, are presented and discussed. The examples of the Medical School of Ribeirão Preto, the Medical School of Botucatu and the Catholic University Medical School of Campinas are cited. The "new pathway" to teach and learn medicine, introduced at the Harvard Medical School, is described as a model of the collaborative and cooperative teaching methodology, implanted in the United States and in a few other countries. The need and possibility of introducing new methods of learning and teaching of medicine in Brazil is presented and debated.
A popliteal artery aneurysm was submitted to an exclusion surgery and autologous reversed saphenous vein bypass. The proximal ligation of the popliteal artery was performed 3cm above the aneurysm. A large branch of the artery below this point remained patent maintaining a communication with a branch of deep femoral artery. Due to this fact residual circulation inside the aneurysm was observed. The patient was reoperated in order to ligate the collateral branch and resect part of the aneurysm. This kind of complication of the technique proposed by Edwards is not common and does not invalidate this technique preferred by most surgeons.
The authors present an epidemiological study of 585 primary bone neoplasms and tumor-like lesions in order to investigate their incidence and distribution according to age, sex and skeletal location. A statistical agreement between the pertinent literature and the collected data was found. In this series, the most common benign neoplasms were the osteochondroma (45.3%) followed by chondroma (19.6%). Among the intermediate and malignant neoplasms, osteosarcoma was the most frequent (30.0%) followed by myeloma (16.0%). Fibrous dysplasia accounted for 46.6% of all tumor-like lesions, followed by solitary bone cyst (18.6%).
The initial experience at the Instituto da Criança do Hospital das Clínicas--School of Medicine of São Paulo University with liver transplantation in children is presented. A staff experienced in the management of children, including pediatric surgeons, hepatologists, critical care specialists, anesthesiologists, and other has been joined to draw therapeutic protocols. Afterward, more than 100 experimental liver transplant were performed in animals of medium size (dogs and pigs). From September, 1989 to July 1991, 12 liver transplants were performed on 9 children (3 retransplants) ranging in age from 2.5 to 17 years, being 5 boys and 4 girls. The donors had been selected according to the ABO blood group and body weight. Just once a blood A+ recipient received a liver from a blood O+ donor. The regular postoperative immunosuppression consisted of triple therapy with cyclosporin, prednisone and azathioprine. The postoperative stay in the Intensive Care Unit ranged from 3 to 24 days, according to the necessity of ventilatory support. These was no intraoperative mortality, arterial or venous thromboses, or early biliary complications. The overall survival is 78% (7/9). Primary non-function of the graft was the cause of death in two of our children. Although the number of cases is still small our results are comparable to those of the best liver transplant centers in the world.
In 1,000 students from Great São Paulo First Degree Schools, from 6 to 18 years old, we studied: age, sex, race, weight, height, left arm circumference, blood pressure, pulse and family history of hypertension. Of these 550 were female and 450 male, with predominance of caucasians in both sexes (83.7%). The conclusions of this study were: until 9 years old the blood pressure was similar in both sexes. As the school girls grow up earlier, their blood pressure rose first, but after 16 years this fact changed: 126 +/- 3.5 x 76 +/- 2.8 in males and 115 +/- 2.0 x 74 +/- 1.9 in females. Students with a family history of hypertension had higher blood pressure than students without and the prevalence of systolic and diastolic hypertension was higher in the first group: 12.2 and 13.8 to 4.7 and 3.8% respectively. Diastolic blood pressure was dominant in only in males Negros. The prevalence of systolic and diastolic hypertension was 6.9% in these 1,000 students.
