Analgésicos, antipiréticos e antiinflamatórios não esteroidais: dados epidemiológicos em seis centros de controle de intoxicações do Brasil / Analgesics antipiretics and nonsteroidal anti-inflamatory drugs - epidemiological data from six poison control centers

Estudos e registros sobre intoxicações e reações adversas de vários países, incluindo o Brasil, demonstram que os medicamentos são responsáveis por grande parte dos atendimentos nos Centros de Controle de Intoxicações e em especial, os analgésicos, com destaque para dipirona, salicilatos e paracetamol. Com isso, o objetivo foi traçar o perfil epidemiológico das ocorrências envolvendo analgésicos, antipiréticos e antiinflamatórios não esteroidais no período de 1994 a 1997, e consequentemente, fornecer subsídios para a avaliação deste quadro no país. Foram consideradas as consultas envolvendo medicamentos, registradas no período de estudo, pelo grupo de Estudos Epidemiológicos em Toxicologia (GEET) composto por seis Centros de Toxicologia ligados a Hospitais Universitários, das cidades de Campinas (SP), Belo Horizonete (MG), Londrina (PR), Maringá (PR), Ribeirão Preto (SP) e Florianópolis (SC). Dos 75.717 casos registrados, os medicamentos aparecem como a segunda maior causa de notificação, com 22,165, sendo que deste total, 2263 referem-se aos analgésicos. Nas crianças de 1 a 5 anos, os acidentes com antiinflamatórios e salicilatos são os mais frequentes e nos adultos, as tentativas de suicídio com dipirona, especialmente no sexo feminino

Could irrigation, debridement and antibiotic therapy cure an infection of a total hip arthroplasty?

Seven patients suffering from an acute (less than two weeks) infection of a total hip arthroplasty were treated by irrigation and debridement, with appropriate antibiotic therapy and retention of the prosthesis. They were followed for an average of 30 months. Infection did not recur in five (71%) patients, but the other two required further surgery. We conclude that a cure can be obtained by this method, although the results are inferior to re-implantation. A minimal procedure spares a patient the morbidity and cost of a more extensive operation. Higher success rates might have been achieved by selecting patients infected with organisms of low virulence, but there are insufficient data to predict whether this treatment would decrease the success of subsequent re-implantation.

Prevention of deformity during limb lengthening.

Deformity occurs frequently at the site of distraction during leg lengthening and can add to disability. The elastic and nonelastic displacements have been measured in a model that simulates leg lengthening in the laboratory. Measurements have been made for different fixator systems. The angulation in the vertical plane that occurs during leg lengthening is minimized if the distance between the bone and the fixator bar is kept as small as possible, if three screws are inserted in the proximal and distal bone fragments, and if the peak loads on the fixator are reduced by adjusting the rhythm of distraction. However, even if these precautions are taken, the results show that some fixators designed for leg lengthening will fail and lead to deformity at the osteotomy site. This may occur under the repeated cycles of high loads associated with the rises in soft tissue tension that are known to occur in certain groups of patients. This study suggests that deformity can be prevented by the proper selection of a suitable frame and the adjustment of its configuration to meet the loading requirements.

Manual assessment of fracture stiffness.

A fracture stiffness of 15 Nm/degree measured biomechanically has been proposed as a reliable indicator of early fracture union. This study used a fracture model to examine the ability of orthopaedic surgeons to assess the stiffness of a fracture manually. Twenty orthopaedic surgeons were tested along with 20 controls. They each estimated the stiffness of seven rods representing mid-shaft diaphyseal fractures at different stages of healing, and were asked whether the stiffness suggested that union had progressed to the stage where the stabilizing device could be removed. Surgeons were unable to estimate the fracture stiffness accurately, and greatly overestimated rod stiffness particularly for the lower values. This meant that on 83 per cent of occasions when the stiffness was less than 15 Nm/degree, the surgeons considered the fracture models united to a sufficient degree to prescribe removal of the fixator. The results suggest that clinical assessment of fracture stiffness alone may put 83 per cent of patients at risk of refracture or malunion. Manual testing of the mechanical stability of a fracture appears not to be reliable.

Stripping-theory analysis of thick-target neutron production for D + Be.

The Serber theory for deuteron stripping is employed to predict the shape of the neutron energy spectrum produced by 35 MeV deuterons (D+) on a thick beryllium target. In particular, the observation that the maximum of the neutron energy spectrum (at 0degrees relative to the deuteron beam direction) occurs at approximately 0-4Ed, where Ed is the incident deuteron energy, is explained reasonably well by the calculations. The explanation stems mainly from the fact that the stripping theory for thin targets predicts a narrow maximum at 0-5Ed, and thick target effects shift the maximum downward in energy to approximately 0-4Ed. A number of recent spectral measurements are in agreement with these predictions for a wide range of target materials and incident deuteron energies. The application of this theory also accounts for the previously observed Dd2-99 dependence of the absorbed dose in tissue,per unit charge of D+ ions on target, in the direction of the incident beam. This approximate Ed3 dependence is shown to be a characteristic property of deuteron stripping in a thick target and follows directly from the calculations that predict the neutron energy spectrum.