Efficacy and safety of loxoprofen sodium topical patch for the treatment of pain in patients with minor acute traumatic limb injuries in Brazil: a randomized, double-blind, noninferiority trial.

Posttraumatic injury pain is commonly treated with oral nonsteroidal anti-inflammatory drugs. However, oral nonsteroidal anti-inflammatory drugs cause several adverse events, with topical formulations arising as an important alternative. Therefore, we aimed at evaluating the efficacy and safety of loxoprofen patch (LX-P) in the treatment of patients with posttraumatic pain. This phase III, randomized, double-blind, noninferiority study enrolled Brazilian patients aged 18 to 65 years diagnosed with lower and upper limb posttraumatic injury who were experiencing moderate or severe pain. Patients were assigned to active LX-P or to loxoprofen tablet (LX-T), and pain intensity was measured based on a visual analog scale score variation after 7 days of treatment. Data on clinical symptoms, rescue medication use, and adverse events were also collected. Visual analog scale score variation was compared using a 10% noninferiority margin. Two hundred forty-two patients were randomly assigned to LX-P (n = 123) or to LX-T (n = 119). The results showed a reduction in pain after 7 days of treatment: -49.96 (n = 118; SE 1.7) in the LX-P and -47.71 (n = 117; SE 1.6) in the LX-T groups (difference of -2.25; 95% CI: -5.97 to 1.47; P = 0.23). On the safety analysis, the LX-T group presented twice as many patients with treatment-emergent adverse events as the LX-P group (30.8% and 14.2%, respectively). A sensitivity analysis demonstrated that rescue medication use has not affected the primary end point. This study showed that LX-P has a comparable efficacy to LX-T, but with a better safety profile, being a therapeutic option for the treatment of posttraumatic injury pain.

Final efficacy, immunogenicity, and safety analyses of a nine-valent human papillomavirus vaccine in women aged 16-26 years: a randomised, double-blind trial.

BACKGROUND: Primary analyses of a study in young women aged 16-26 years showed efficacy of the nine-valent human papillomavirus (9vHPV; HPV 6, 11, 16, 18, 31, 33, 45, 52, and 58) vaccine against infections and disease related to HPV 31, 33, 45, 52, and 58, and non-inferior HPV 6, 11, 16, and 18 antibody responses when compared with quadrivalent HPV (qHPV; HPV 6, 11, 16, and 18) vaccine. We aimed to report efficacy of the 9vHPV vaccine for up to 6 years following first administration and antibody responses over 5 years. METHODS: We undertook this randomised, double-blind, efficacy, immunogenicity, and safety study of the 9vHPV vaccine study at 105 study sites in 18 countries. Women aged 16-26 years old who were healthy, with no history of abnormal cervical cytology, no previous abnormal cervical biopsy results, and no more than four lifetime sexual partners were randomly assigned (1:1) by central randomisation and block sizes of 2 and 2 to receive three intramuscular injections over 6 months of 9vHPV or qHPV (control) vaccine. All participants, study investigators, and study site personnel, laboratory staff, members of the sponsor's study team, and members of the adjudication pathology panel were masked to vaccination groups. The primary outcomes were incidence of high-grade cervical disease (cervical intraepithelial neoplasia grade 2 or 3, adenocarcinoma in situ, invasive cervical carcinoma), vulvar disease (vulvar intraepithelial neoplasia grade 2/3, vulvar cancer), and vaginal disease (vaginal intraepithelial neoplasia grade 2/3, vaginal cancer) related to HPV 31, 33, 45, 52, and 58 and non-inferiority (excluding a decrease of 1·5 times) of anti-HPV 6, 11, 16, and 18 geometric mean titres (GMT). Tissue samples were adjudicated for histopathology diagnosis and tested for HPV DNA. Serum antibody responses were assessed by competitive Luminex immunoassay. The primary evaluation of efficacy was a superiority analysis in the per-protocol efficacy population, supportive efficacy was analysed in the modified intention-to-treat population, and the primary evaluation of immunogenicity was a non-inferiority analysis. The trial is registered with ClinicalTrials.gov, number NCT00543543. FINDINGS: Between Sept 26, 2007, and Dec 18, 2009, we recruited and randomly assigned 14 215 participants to receive 9vHPV (n=7106) or qHPV (n=7109) vaccine. In the per-protocol population, the incidence of high-grade cervical, vulvar and vaginal disease related to HPV 31, 33, 45, 52, and 58 was 0·5 cases per 10 000 person-years in the 9vHPV and 19·0 cases per 10 000 person-years in the qHPV groups, representing 97·4% efficacy (95% CI 85·0-99·9). HPV 6, 11, 16, and 18 GMTs were non-inferior in the 9vHPV versus qHPV group from month 1 to 3 years after vaccination. No clinically meaningful differences in serious adverse events were noted between the study groups. 11 participants died during the study follow-up period (six in the 9vHPV vaccine group and five in the qHPV vaccine group); none of the deaths were considered vaccine-related. INTERPRETATION: The 9vHPV vaccine prevents infection, cytological abnormalities, high-grade lesions, and cervical procedures related to HPV 31, 33, 45, 52, and 58. Both the 9vHPV vaccine and qHPV vaccine had a similar immunogenicity profile with respect to HPV 6, 11, 16, and 18. Vaccine efficacy was sustained for up to 6 years. The 9vHPV vaccine could potentially provide broader coverage and prevent 90% of cervical cancer cases worldwide. FUNDING: Merck & Co, Inc.

Pain and quality of life in patients undergoing radiotherapy for spinal metastatic disease treatment.

BACKGROUND: Radiotherapy is an important tool in the control of pain in patients with spinal metastatic disease. We aimed to evaluate pain and of quality of life of patients with spinal metastatic disease undergoing radiotherapy with supportive treatment. METHODS: The study enrolled 30 patients. From January 2008 to January 2010, patients selection included those treated with a 20 Gy tumour dose in five fractions. Patients completed the visual analogue scale for pain assessment and the SF-36 questionnaire for quality of life assessment. RESULTS: The most frequent primary sites were breast, multiple myeloma, prostate and lymphoma. It was found that 14 spinal metastatic disease patients (46.66%) had restricted involvement of three or fewer vertebrae, while 16 patients (53.33%) had cases involving more than three vertebrae. The data from the visual analogue scale evaluation of pain showed that the average initial score was 5.7 points, the value 30 days after the end of radiotherapy was 4.60 points and the average value 6 months after treatment was 4.25 points. Notably, this final value was 25.43% lower than the value from the initial analysis. With regard to the quality of life evaluation, only the values for the functional capability and social aspects categories of the questionnaire showed significant improvement. CONCLUSION: Radiotherapy with supportive treatment appears to be an important tool for the treatment of pain in patients with spinal metastatic disease.

Cervical cytology, HPV DNA and mRNA - a comparative study in 162 patients / Citologia cervicovaginal, DNA HPV e RNAm - estudo comparativo em 162 pacientes

In contrast to the general improvement of the socioeconomic status of the Brazilian population, pathologies that are characteristic of poor health assistance persist. Among those, cervical cancer (CC) is emblematic; it still presents a persistently high incidence. Objective: to compare the performance of cervical cytology to HPV DNA and mRNA detection methods in 162 patients undergoing routine gynecological clinical practice. Methods:a total of 162 patients attended during routine gynecological examination in a private clinic in Florianópolis, Santa Catarina, Brazil, had cervical samplescollected and processed for cytopathological and molecular tests, conventional PCR and NASBA. Positive samples positive for HPV DNA were submittedto Type-Specific PCR (TS-HPV PCR). Patients with altered smears were submitted to colposcopy and biopsy. Results: among the 162 samples, 19.8%(32/162) had altered smears, being 4/32 classified as ASC-H, 9/32 as ASC-US, 9/32 as LSIL and 10/32 as HSIL. Biopsies revealed nine cases of CIN I,nine CIN II and one CIN III, while seven were negative for cervical neoplasia. Overall, HPV DNA was detected in 38.3% (62/162) of the samples and HPV E6/E7 mRNA expression was found in 13.6% (22/162). Using TS-HPV PCR, HPV 16 was the most frequent type, found in 8% of the samples (5/62).Considering CIN2+ the gold-standard, cytology had 38.5% of specificity. Sensitivity and specificity of HPV-DNA PCR and NASBA were, respectively,100% and 60%; 18.7% and 68.7%. Conclusion: mRNA E6/E7 expression was not a highly specific or sensitive marker for prevalent cervical disease while HPV DNA may be used for cervical cancer screening only in conjunction to more specific adjuvant tests.

Em contraste com a melhora geral da situação socioeconômica da população brasileira, patologias que são características de uma deficiente assistência à saúde persistem. Entre elas, o câncer cervical (CC) é emblemático, ainda apresentando uma persistente alta incidência. Objetivo: avaliaro desempenho da citologia e de métodos de detecção de DNA e RNAm de HPV em 162 pacientes submetidas a prática clínica ginecológica de rotina.Métodos: cento e sessenta e duas pacientes atendidas em uma clínica particular de Florianópolis, Santa Catarina, Brasil, tiveram amostras cervicais coletadas e processadas para estudo citopatológico e molecular; PCR convencional e NASBA. Amostras positivas para o DNA do HPV foram submetidas àPCR tipo-específica (PCR HPV-TE). Resultados: entre as 162 amostras, 19,8% (32/162) apresentaram esfregaços alterados, sendo 4/32 classificadas comoASC-H, 9/32 como ASC-US, 9/32 como LSIL e 10/32 como HSIL. Biópsias revelaram nove casos de NIC I, nove casos de NIC II e um caso de NIC III. ODNA do HPV foi detectado em 38,3% (62/162) das amostras. Expressão de E6/E7 (RNAm) foi encontrada em 13,6% (22/162) das amostras. Utilizando a PCR tipo-específica (HPV-TE), o HPV 16 foi o tipo mais frequente, encontrado em 8% (5/62) das amostras HPV+. Considerando NIC 2+ o padrão-ouro,a especificidade da citologia foi de apenas 38,5%, enquanto a sensibilidade e a especificidade da PCR DNA e RNAm foram, respectivamente, 100% e 60%;18,7% e 68,7%. Conclusão: a expressão de E6/E7 RNAm não se mostrou um marcador altamente específico ou sensível para doença cervical prevalente,enquanto o DNA HPV pode ser utilizado para rastreamento apenas em conjunto com testes adjuvantes mais específicos.

Tomographic index as auxiliary criteria for surgery indication in fracture dislocation of acetabulum posterior wall.

There are situations which the tomographic exam is done on the affected hip or situations where the contralateral hip presents abnormalities that make it impossible to compare. In this study we aimed to evaluate a tomographic index that does not require comparison between the both hips. Twenty two patients with unilateral acetabular fracture dislocation with fracture of posterior wall were studied. We established the relationship between the remaining posterior wall and the femoral head diameter (head/wall index-H/W index). We evaluated 45 two-dimensional computed tomography scan in normal hips and established the H/W index. In 45 normal hips we simulated a posterior wall fracture with involvement of 25% and 30% of the posterior wall and calculated the H/W index. We divided into five groups with five different H/W index (fractured group with non surgical treatment; fractured group; normal group; normal group with simulated fracture of 25% and; 30% of the posterior wall). 2.4 was the lowest limit of confidence interval of the group with 25% of the posterior wall fracture. When we analyzed the confidence interval of the 30% fracture group the upper limit of the confidence interval was 2.7, close to the lower limit of the surgical group that was 2.9. Thus, we suggest the 2.4 the H/W index limit as an auxiliary criteria to indicate whether or not to operate. H/W index is helpful to decide whether or not surgery indication in the fracture dislocation of the posterior wall of the acetabulum.

The IAP-antagonist ARTS initiates caspase activation upstream of cytochrome C and SMAC/Diablo.

ARTS (Sept4_i2) is a pro-apoptotic tumor suppressor protein that functions as an antagonist of X-linked IAP (XIAP) to promote apoptosis. It is generally thought that mitochondrial outer membrane permeabilization (MOMP) occurs before activation of caspases and is required for it. Here, we show that ARTS initiates caspase activation upstream of MOMP. In living cells, ARTS is localized to the mitochondrial outer membrane. In response to apoptotic signals, ARTS translocates rapidly to the cytosol in a caspase-independent manner, where it binds XIAP and promotes caspase activation. This translocation precedes the release of cytochrome C and SMAC/Diablo, and ARTS function is required for the normal timing of MOMP. We also show that ARTS-induced caspase activation leads to cleavage of the pro-apoptotic Bcl-2 family protein Bid, known to promote MOMP. We propose that translocation of ARTS initiates a first wave of caspase activation that can promote MOMP. This leads to the subsequent release of additional mitochondrial factors, including cytochrome C and SMAC/Diablo, which then amplifies the caspase cascade and causes apoptosis.

Infecção pelo papilomavírus humano (HPV) em mulheres HIV-positivo de Florianópolis, Santa Catarina / Human papillomavirus (HPV) infection in HIV positive women of Florianópolis, Santa Catarina

A infecção por HPV é a doença sexualmente transmissível mais prevalente no mundo todo. A doença induzida por este vírus está na dependência de vários outros fatores que afetam o hospedeiro. O principal fator é a imunossupressão, principalmente associada à infecção pelo HIV. Objetivo: pesquisara presença da infecção pelo HPV em um grupo de mulheres HIV-positivo e comparar com as mulheres HIV-negativo, avaliar as prevalências dos grupos virais de alto e baixo risco oncogênico, a relação destes achados com características socioeconômicas, demográficas e comportamentais, além de variáveis relacionadas ao HIV, como níveis de CD4, CV e TARVC. Métodos: trata-se de estudo transversal, descritivo, onde foram analisadas amostras genitais de 20 mulheres HIV-positivo e 99 HIV-negativo para o DNA-HPV, através do método da captura híbrida. Foram coletados, ainda, dados de prontuário e de questionário aplicado às participantes. Resultados: a prevalência do HPV foi de 70% entre as mulheres HIV-positivo e de 21,2% entre as HIV-negativo.O HPV de alto risco oncogênico esteve presente em 71,4% dos casos HPV-positivo em ambos os grupos, e ambos os tipos virais em 35,7% das mulheres HIV-positivo. A infecção pelo HPV foi associada a idade acima de 35 anos, baixo nível de escolaridade, CD4 entre 200 e 500 células/mm3 e uso de TARVC entre as mulheres HIV-positivo. As demais variáveis não se mostraram associadas à infecção pelo HPV. Conclusão: a prevalência da infecção pelo HPV nas mulheres HIV-positivo foi cerca de 3,3 vezes maior que nas HIV-negativo, sendo a maioria do grupo de alto risco oncogênico.

Evaluation of movements of lower limbs in non-professional ballet dancers: hip abduction and flexion.

BACKGROUND: The literature indicated that the majority of professional ballet dancers present static and active dynamic range of motion difference between left and right lower limbs, however, no previous study focused this difference in non-professional ballet dancers. In this study we aimed to evaluate active movements of the hip in non-professional classical dancers. METHODS: We evaluated 10 non professional ballet dancers (16-23 years old). We measured the active range of motion and flexibility through Well Banks. We compared active range of motion between left and right sides (hip flexion and abduction) and performed correlation between active movements and flexibility. RESULTS: There was a small difference between the right and left sides of the hip in relation to the movements of flexion and abduction, which suggest the dominant side of the subjects, however, there was no statistical significance. Bank of Wells test revealed statistical difference only between the 1st and the 3rd measurement. There was no correlation between the movements of the hip (abduction and flexion, right and left sides) with the three test measurements of the bank of Wells. CONCLUSION: There is no imbalance between the sides of the hip with respect to active abduction and flexion movements in non-professional ballet dancers.

Condiloma acuminado - resposta terapêutica com imiquimode e cirurgia / Genital wart - therapeutic response with immiquimod and surgery

O condiloma acuminado é uma das manifestações do papilomavírus humano (HPV) na área genital. Relata-se o caso de uma paciente do sexo feminino, 27 anos com extensa lesão condilomatosa na região vulvar. O tratamento foi realizado com exérese cirúrgica das lesões maiores, seguido da aplicação de imiquimode nas lesões menores e recidivas, com resolução clínica completa em 8 semanas. Foram abordadas as diferentes formas de tratamento com enfoque na terapêutica com imiquimode.

Condylomata acuminata is one of the genital manifestations of the Human papillomavírus (HPV) infection in the genital area. This is a case report of a 27 years-old female patient with extensive genital warts in the vulvar. The treatment was performed with surgical ressection of the biggest warts and local application of immiquimod in the others lesions and relapses. The complete clinical resolution was observed in 8 weeks. We will review the different forms of treatment emphasing immiquimod treatment.

Infecção pelo Papilomavírus humano (HPV) em mulheres de Florianópolis, Santa Catarina / Human Papillomavirus (HPV) infection in women of Florianópolis, Santa Catarina, Brazil

Introdução: a infecção pelo papilomavírus humano (HPV) é a doença sexualmente transmissível mais frequente no mundo e apresenta um amploespectro de manifestações, desde a infecção assintomática até o carcinoma invasivo. Estima-se que pelo menos 50% das pessoas sexualmente ativas venham a adquirir esta infecção em algum momento de suas vidas. Objetivo: determinar a prevalência da infecção pelo HPV e identificar a frequência dos grupos virais de baixo e alto risco oncogênico em mulheres atendidas para consulta ginecológica de rotina em Florianópolis, bem como verificar a associação entre a presença do vírus e alguns fatores de risco. Métodos: trata-se de estudo transversal, de caráter descritivo. Foram avaliadas 100 mulheres atendidas em ambulatório para consulta ginecológica de rotina, selecionadas aleatoriamente. Todas tiveram amostra cervical submetida ao teste de DNA-HPV pelo método de Captura Híbrida II® e responderam a um questionário sobre fatores de risco. Resultados: das 100 mulheres analisadas, 21 (21%) apresentaram positividade para o DNA-HPV. O HPV de alto risco oncogênico esteve presente em 71% e o de baixo risco em 52% das amostras positivas, incluindo as infecções mistas. A infecção pelo vírus de alto risco foi associada às pacientes com início de atividade sexual precoce. Outros fatores avaliados como idade, escolaridade, número de parceiros sexuais, paridade, uso de anticoncepcionais orais, doença sexualmente transmissível e tabagismo não mostraram relação com a infecção pelo HPV. Conclusão: a prevalência de HPV na população estudada foi de 21%, com 71% para vírus de alto risco e 52% para vírus de baixo risco oncogênico, incluindo infecções mistas. A detecção do vírus de alto risco foi associada ao início precoce de atividade sexual.

Introduction: the Human Papillomavirus (HPV) infection is the most frequent sexually transmitted disease in the world and has many clinical manifestations,from asymptomatic infection to invasive carcinoma. At least 50% of sexually active people will have this infection in their life. Objective:to determine the prevalence of HPV and identify the frequency of high risk and low risk virus groups in women attending gynecologic routine as wellas evaluate the association between the presence of these viruses and some risk factors. Methods: this is a cross-sectional study. A hundred randomized selected women who attended the gynecologic service for routine test were evaluated. All of them had cervical specimens tested for DNA-HPV by the Hybrid Capture II assay and answered a questionnaire to acess risk factors. Results: twenty-one (21%) out of 100 analyzed women showed positivity for DNA-HPV. High risk HPV was detected in 71% and low risk HPV in 52% of positive specimens, including mixed infections. Infection with high risk types was associated with younger age at first sexual intercourse. Other evaluated risk factors such as age, level of education, number of sexual partners, parity, use of oral contraceptives, sexually transmitted disease and smoking did not show relation to HPV infection. Conclusion: the prevalence of HPV in the studied population was 21%, with 71% of high risk virus and 52% of low risk types, including mixed infections. High risk HPV detection was associated with younger age at first sexual intercourse.

Prevenção da infecção por HPV e lesões associadas com o uso de vacinas / HPV infection and lesion prevention using HPV vaccine

O descobrimento de uma vacina capaz de alterar o curso natural do câncer de colo uterino e outras neoplasias decorrentes da infecção pelo HPV criou grandes perspectivas não só na comunidade médica, mas também entre diferentes segmentos da população mundial, tendo sido incluída no calendário vacinal de vários países. Os autores revisam o tema que sugere que a vacina profi lática contra o HPV, apesar de isoladamente não ser capaz de eliminar totalmente o câncer de colo uterino, poderá trazer uma importante contribuição para a saúde pública, quando associada aos programas de rastreamento do câncer cervical. Mesmo sabendo da alta efi cácia das vacinas profi láticas contra tipos específi cos do vírus, serão necessários novos estudos com maior tempo de duração para avaliar os resultados em longo prazo, uma vez que os estudos mais prolongados atingiram apenas nove anos e meio de seguimento. Até o momento, os resultados encontrados sugerem não haver a necessidade de reforço da vacina, mas serão necessárias as avaliações com mais de 10 anos para verifi car a duração da efi cácia, segurança e o tempo de validade da vacina profi lática contra o HPV.

The discovery of a vaccine capable of altering the natural course of cervical and other cancers resulting from HPV infection, not only has greatperspectives in the medical community but also among the different segments of the population. Due to this, is now participates in the immunization schedules of various countries. The aim of this paper is to review the fact that the prophylactic vaccine against HPV, which although alone is not able to completely eliminate cervical cancer, can, in fact bring an important contribution to public health, when associated to screening programs for cervical cancer. Even knowing the high effi cacy of prophylactic vaccines against specifi c types of HPV, further studies, to assess the results in the long term, will be required, since the longest term studies up to press have only reached an 9.5 year follow up period. So far, the results suggest no need for a vaccine booster, however a greater than ten year follow up period will be necessary to evaluate effi cacy, safety time lapse and time of validity of the prophylactic vaccine against HPV.

Pectoralis major tendon reference (PMT): a new method for accurate restoration of humeral length with hemiarthroplasty for fracture.

For hemiarthroplasty reconstruction of a proximal humeral fracture, accurate restoration of humeral head position is challenging, and incorrect prosthetic placement is associated with a poor outcome of surgical treatment. The purpose of this study was to validate the pectoralis major tendon as a reproducible landmark for accurate restoration of humeral length with hemiarthroplasty reconstruction. We dissected 20 cadavers (40 shoulders), and the distance between the upper border of the pectoralis major tendon insertion on the humerus and the top of the humeral head was measured (PMT). The PMT averaged 5.6 +/- 0.5 cm (with a confidence level of 95%). In only 4 of 40 shoulders did this distance exceed 6.0 cm, and there was no correlation between the size of the patient and this measurement. The PMT is a useful landmark that will aid in accurate restoration of humeral length when reconstructing complex proximal humeral fractures where landmarks are otherwise lost because of fracture comminution.

Sugioka's Modified Hungria-Kramer intertrochanteric osteotomy in the treatment of severe slipped capital femoral epiphysis.

From May 1990 to November 1997, 24 cases of severe slipped capital femoral epiphysis were treated by an osteotomy that is a modification of the Hungria-Kramer intertrochanteric osteotomy proposed by Sugioka (Hungria-Kramer-Sugioka osteotomy or HKS osteotomy). The degree of displacement as seen on the frog-leg lateral radiograph of the proximal femur was measured according to the deviation of the longitudinal axis of the epiphysis from the center line of the neck (Fish classification). All hips were considered as grade III and underwent HKS osteotomy. Sugioka's radiographic study (true AP view with the limb internally rotated until the patella is perpendicular to the x-ray beam, and lateral view with the hip in 90 degrees flexion and 45 degrees abduction) was performed before surgery to show that the real direction of the slip was posterior in relation to the neck. Clinical results were assessed according to Merle-D'Aubigné and Postel system modified by Charnley (hip score system that takes into consideration pain, gait, and joint motion). Roentgenographic results were considered good if none of the following was present: joint space decreased by more than 2 mm (chondrolysis), avascular necrosis of the femoral head, neck-shaft angle of less than 120 degrees, nonunion at the osteotomy site, and a epiphyseal plate still open. Follow-up varied from 31 to 120 months (average 65.1 months).

Analysis of plasma homocysteine levels in patients with unstable angina.

OBJECTIVE: To determine the prevalence of hyperhomocystinemia in patients with acute ischemic syndrome of the unstable angina type. METHODS: We prospectively studied 46 patients (24 females) with unstable angina and 46 control patients (19 males), paired by sex and age, blinded to the laboratory data. Details of diets, smoking habits, medication used, body mass index, and the presence of hypertension and diabetes were recorded, as were plasma lipid and glucose levels, C-reactive protein, and lipoperoxidation in all participants. Patients with renal disease were excluded. Plasma homocysteine was estimated using high-pressure liquid chromatography. RESULTS: Plasma homocysteine levels were significantly higher in the group of patients with unstable angina (12.7+/-6.7 micromol/L) than in the control group (8.7+/-4.4 micromol/L) (p<0.05). Among males, homocystinemia was higher in the group with unstable angina than in the control group, but this difference was not statistically significant (14.1+/-5.9 micromol/L versus 11.9+/-4.2 micromol/L). Among females, however, a statistically significant difference was observed between the 2 groups: 11.0+/-7.4 micromol/L versus 6.4+/-2.9 micromol/L (p<0.05) in the unstable angina and control groups, respectively. Approximately 24% of the patients had unstable angina at homocysteine levels above 15 micromol/L. CONCLUSION: High homocysteine levels seem to be a relevant prevalent factor in the population with unstable angina, particularly among females.

Análise dos níveis de homocisteína plasmática em pacientes com angina instável / Analysis of plasma homocysteine levels in patients with unstable angina

OBJECTIVE - To determine the prevalence of hyperhomocystinemia in patients with acute ischemic syndrome of the unstable angina type. METHODS - We prospectively studied 46 patients (24 females) with unstable angina and 46 control patients (19 males), paired by sex and age, blinded to the laboratory data. Details of diets, smoking habits, medication used, body mass index, and the presence of hypertension and diabetes were recorded, as were plasma lipid and glucose levels, C-reactive protein, and lipoperoxidation in all participants. Patients with renal disease were excluded. Plasma homocysteine was estimated using high-pressure liquid chromatography. RESULTS - Plasma homocysteine levels were significantly higher in the group of patients with unstable angina (12.7±6.7 æmol/L) than in the control group (8.7±4.4 æmol/L) (p<0.05). Among males, homocystinemia was higher in the group with unstable angina than in the control group, but this difference was not statistically significant (14.1±5.9 æmol/L versus 11.9±4.2 æmol/L). Among females, however, a statistically significant difference was observed between the 2 groups: 11.0±7.4 æmol/L versus 6.4±2.9 æmol/L (p<0.05) in the unstable angina and control groups, respectively. Approximately 24 percent of the patients had unstable angina at homocysteine levels above 15 æmol/L. CONCLUSION - High homocysteine levels seem to be a relevant prevalent factor in the population with unstable angina, particularly among females

Tratamento das epifisiólises graves pela osteotomia intertrocanterica de Hungria-Kramer modificada por Sugioka / Intertrochanteric osteotomy for severe slipped capital femoral epiphysis

Os autores descrevem uma tecnica cirurgica que denominam osteotomia de Hungria e Kramer modificada por Sugioka (HKS). Apresentam os métodos radiogr ficos que permitem estudar a real posição da cabeça femoral nos escorregamentos graves. Acreditam no principio de que a maioria das epifisi¢lises apresenta desvio para posterior, sendo raros os casos associados com o desvio em varo. Analisam 24 quadris com epifisiolise grave, cronica ou cronica agudizada, operados com essa tecnica, encontrando, respectivamente, 83 por cento de resultados clinicos e radiogr ficos satisfatorios, com acompanhamento medio de 65 meses. Comparativamente a outros métodos operatorios, os resultados são considerados bons, com dois casos de condrolise, uma consolidação em varo, uma pseudartrose e nenhum caso de necrose

Fratura-luxaçäo transescafoperilunar volar do carpo em paciente de 15 anos: relato de um caso / Carpal volar transescaphoid perilunate fracture-luxation in a 15 year old patient: report of a case

Os autores relatam caso de um jovem de 15 anos que, em conseqüência de uma queda de cerca de três metros de altura, teve um traumatismo craniencefálico e uma fratura-luxaçäo transescafoperilunar volar do carpo. Foi submetido a reduçäo cruenta e fixaçäo com fios de Kirschner. Evoluiu de maneira satisfatória, recuperando a mobilidade total da mäo e do punho. Chamam a atençäo para o fato de a fratura-luxaçäo volar ser pouco comum e para o fato de ter sido num paciente de 15 anos de idade.

Hemocramatose, artropatia e prótese total de quadril: relato de um caso / Hemochomatosis, arthropathy, and total hip prosthesis: report of a case

Os autores relatam um caso de hemocromatose associado a artropatia, tecem comentários sobre a raridade da doença, diagnóstico, exames complementares, quadro clínico, evoluçäo e o tratamento artroplástico realizado

Síndrome do túnel do carpo conseqüente a um cisto sinovial intracanal: relato de um caso / Carpal tunnel syndrome due to an intracanal synovial cyst: report of a case

Os autores relatam um caso de síndrome do túnel do carpo em uma paciente do sexo feminino, de 43 anos, com quadros clínico e eletromiográfico característicos. Trata-se de um cisto sinovial intracanal, similar aos reportados por Brooks (1952), Phalen (1966 e Harvey (1981