ABSTRACT
A chronic discharging ear has been a perpetual problem and a source of worry to the otologists for centuries because of its high rate of morbidity. Active squamous chronic otitis media is a commonly encountered disease entity which requires prompt surgical management. The surgical procedure most commonly employed is modified radical mastoidectomy. This results in an 'open' cavity with its attendant problems of recurrent breakdown and discharge. Mastoid obliteration technique would appear to be the best solution for these cavity problems. Forty cases of active squamous chronic otitis media were studied. The patients were randomly divided into two groups of 20 each. The group of 20 controls had an open mastoid cavity. Out of the 20 cases, patients were divided in four groups of 5 each. For each group the mastoid cavity was obliterated with cartilage, bone dust, hydroxyapetite and Singapore swing. Healing of the cavity and the associated cavity problems in terms of pain, discharge, giddiness and wax formation, were assessed. The incidence of pain, discharge, giddiness and wax formation was markedly reduced in obliterated cavities as compared to open cavities. Healing of the cavity as evidenced by epithelialisation, at the end of 6 months, was better in those ears where cavity was obliterated (90%) as compared to those with open cavity (70%). Cases obliterated with bone dust and Singapore swing had better and early epithelialisation (100%) as compared to cartilage and hydroxyapetite (80%).
ABSTRACT
Although the Central American HIV epidemic is concentrated in high-risk groups, HIV incidence is increasing in young women. From 2005 to 2007, we conducted a cross-sectional study of pregnant women in a large public hospital and an HIV clinic in Guatemala City to describe risk factors for HIV infection and inform prevention strategies. For 4629 consenting patients, HIV status was laboratory-confirmed and participant characteristics were assessed by interviewer-administered questionnaires. Lifetime number of sexual partners ranged from 1 to 99, with a median (interquartile range) of 1 (1, 2). 2.6% (120) reported exchanging sex for benefits; 0.1% (3) were sex workers, 2.3% (106) had used illegal drugs, 31.1% (1421) planned their pregnancy and 31.8% (1455) experienced abuse. In logistic regression analyses, HIV status was predicted by one variable describing women's behaviour (lifetime sexual partners) and three variables describing partner risks (partner HIV+, migrant worker or suspected unfaithful). Women in our sample exhibited few behavioural risks for HIV but significant vulnerability via partner behaviours. To stem feminization of the epidemic, health authorities should complement existing prevention interventions in high-risk populations with directed efforts towards bridging populations such as migrant workers. We identify four locally adapted HIV prevention strategies.
Subject(s)
HIV Infections/epidemiology , Pregnancy Complications, Infectious/epidemiology , Adolescent , Cross-Sectional Studies , Female , Guatemala/epidemiology , Humans , Pregnancy , Risk Factors , Sexual Behavior , Sexual Partners , Surveys and Questionnaires , Virology/methodsABSTRACT
Tuberculosis of the temporomandibular joint is a very rare disease. Its close relation to the parotid can cause diagnostic confusion. This case is being reported keeping this point in view.
ABSTRACT
Although trans fatty acids are known to influence essential fatty acid (EFA) metabolism and serum levels of lipids and lipoproteins, little is known about their effects on the metabolism of mammary glands (MGs) during lactation. In this study, 5 groups of lactating Wistar rats were fed semisynthetic diets containing 7% soy oil (control); 7% partially hydrogenated vegetable oil (7% PHVO); 13% PHVO +7% soy oil (13% PHVO); 5% PHVO +2% soy oil (5% PHVO), and 3.5% PHVO +3.5% soy oil (3.5% PHVO). Dams were killed on the 12th day of lactation. Weight, lipid content (LC), in vivo lipogenesis rate (LR) and activity of the lipogenic (ATP-citrate lyase and malic) enzymes were evaluated in the MGs. Maternal food intake, weight gain, and total MG weight were not found to be significantly different between the groups. The groups with 13, 7 and 5% PHVO presented a lower (p < 0.05) LR in MGs when compared to controls, whereas MG LC was higher in the 7 and 13% groups than in controls. The observed decrease in MG lipogenesis was accompanied by a diminution (p < 0.05) in the activities of ATP-citrate lyase and malic enzymes. These data indicate a potential impairment of lipid metabolism in the MG by trans isomers in lactating rats.
Subject(s)
Fatty Acids/administration & dosage , Lactation/metabolism , Lipids/biosynthesis , Mammary Glands, Animal/metabolism , Maternal Nutritional Physiological Phenomena/physiology , ATP Citrate (pro-S)-Lyase/metabolism , Analysis of Variance , Animals , Body Weight/drug effects , Eating/drug effects , Female , Malate Dehydrogenase/metabolism , Rats , Rats, Wistar , Time FactorsABSTRACT
Se diseñó un estudio descriptivio, prospectivo, serie de casos, con el objetivo de analizar la experiencia con la técnica de fijación transpedicular, para el tratamiento de espondilolistesis degenerativa, espondilolisis y canal lumbar estrecho. Ochenta pacientes (42 hombres y 38 mujeres) fueron intervenidos entre febrero de 1992 y febrero de 2002; el promedio de edad era de 46,3 años y el seguimiento mínimo de 7 meses. Los casos se tabularon segun diagnóstico, presentación clínica, intervenciones previas, procedimientos descompresivos asociados a la fijación, nivel anatómico de lesión, número de vértebras fijadas, número de tornillos colocados, tipo de injertos óseos y complicaciones. En 33 pacientes se diagnosticó espondilolistesis degenerativa, espondilolisis en 24, canal lumbar estrecho en 20, espondilolistesis displasica en 2.5/100 y espondiloptosis en 1/100. Las presentaciones clínicas mas frecuentes fueron dolor radicular y dolor lumbar, con 33.8/100 cada una. Se realizó artrodesis L5-S1 en 38 pacientes y L4 L5 en 15 pacientes. Como complicaciones encontramos infección profunda en 7.5/100 de los casos, deficit neurológico en 5/100, ruptura de duramadre 3.8/100, falsa ruta de tornillos, falla osea y ruptura de material en 2.5/100 cada uno y seroma en 1.3/100. No se presentó seudoartrosis.La fijación transpedicular es una técnica segura para el tratamiento de las enfermedades mencionadas. Con la fijación transpedicular el promedio de vértebras fijadas es menor que con las técnicas de Harrington y Luque, preservando en mayor grado la movilidad articular. La asociación de la fijación transpedicular con artrodesis y fusión mediante colocación de injertos autógenos, disminuye la incidencia de suroartrosis.
Subject(s)
Lumbar Vertebrae , Orthopedic Fixation Devices , Spondylolisthesis , Spondylolysis , ColombiaABSTRACT
Four patients with deep neck or retropharyngeal abscesses underwent CT-guided aspiration and drainage from either of two percutaneous approaches. Percutaneous drainage contributed to prompt and/or dramatic clinical responses in all four patients by effecting decompression of the abscess cavities and by improving the ability to assess infectious organisms. There were no complications in this small group. Precutaneous drainage obviated more traditional invasive surgery.
Subject(s)
Abscess/diagnostic imaging , Abscess/surgery , Drainage , Neck , Tomography, X-Ray Computed , Adolescent , Adult , Child , Child, Preschool , Humans , Infant , Middle Aged , Treatment OutcomeABSTRACT
Instrumentacion segmentaria espinal de Luque, con implante rectangular, fue utilizada como metodo de tratamiento en nueve pacientes, con historia de trauma cervical y diagnostico de luxaciones, fracturas, luxofracturas, inestables. Tres de los casos seleccionados correspondieron respectivamente a luxacion occipito- cervical, luxacion C7-T1 y fractura de odontoides. Los resultados fueron satisfactorios con fusion precoz, rehabilitacion temprana y mejoria neurologica. La limitacion de la movilidad de la columna cervical no fue incapacitante, excepto en el caso en que se involucraron los niveles occipital C1-C2.
Subject(s)
Adolescent , Adult , Middle Aged , Humans , Male , Spinal Injuries/surgery , Surgical Procedures, Operative , Cervical Vertebrae/surgeryABSTRACT
We describe a patient with a long history of rheumatoid arthritis who presented in full cardiopulmonary arrest. He was given intracardiac epinephrine. Fibroptic laryngoscopy determined the cause of the arrest to be upper airway obstruction from cricoarytenoid joint ankylosis, a complication of long-standing rheumatoid arthritis. The patient underwent a tracheostomy, recovered uneventfully, and was doing well nine months later. The literature is reviewed, and the pathophysiology, clinical findings, presentations, and treatment of this potentially fatal entity are described.
Subject(s)
Airway Obstruction/etiology , Heart Arrest/complications , Airway Obstruction/complications , Airway Obstruction/diagnosis , Airway Obstruction/therapy , Ankylosis/etiology , Ankylosis/therapy , Arthritis, Rheumatoid/complications , Diagnosis, Differential , Epinephrine/therapeutic use , Heart Arrest/etiology , Heart Arrest/therapy , Humans , Male , Middle Aged , Resuscitation , TracheotomyABSTRACT
Inverted nasal papillomas are rare tumors in children. Four large series include only a single patient (of a total of 269) younger than 20 years. We report the occurrence of an inverted nasal papilloma in a 10-year-old boy; this tumor exhibited clinical and histopathologic features identical to those of similar neoplasms in adults. Inverted papillomas in children should be treated by wide local excision, usually using a lateral rhinotomy approach. The rationale for such aggressive surgery is based on the high rate of recurrence (25% to 75%) and a propensity for the development of carcinomas (5% to 15%) as associated lesions.
Subject(s)
Nose Neoplasms/etiology , Papilloma/etiology , Child , Humans , Male , Nasal Cavity , Nose/surgery , Nose Neoplasms/pathology , Nose Neoplasms/surgery , Papilloma/pathology , Papilloma/surgeryABSTRACT
Foi feita uma pesquisa cataminestica sobre as causas e os moveis de internacao em hospitais psiquiatricos na cidade do Rio de Janeiro, referentes aos anos de 1900 e 1925. Esse relatorio preliminar cobre parte de pesquisa mais ampla que se estendera aos anos de 1950 e 1975. Sao discutidas as rotinas de internacao, a incidencia de determinados diagnosticos face ao conhecimento cientifico da epoca. Entre 1900 e 1925 nota-se uma discreta alteracao en relacao a importancia de agentes familiares e sociais na hospitalizacao de pacientes psiquiatricos, apesar da permanente importancia do aparelho policial nesse procedimento. Ressalta-se nas anamneses compulsadas a preocupacao fundamental com os aspectos descritivos dos casos, valorizando-se sobremaneira a importancia dos segmentos sociais na decisao de se internar o paciente psiquiatrico
Subject(s)
Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Humans , Male , Mental Health , Mental Disorders , Hospitalization , Brazil , Public Health , Hospitals, PsychiatricABSTRACT
Foi feita uma pesquisa cataminestica sobre as causas e os moveis de internacao em hospitais psiquiatricos na cidade do Rio de Janeiro, referentes aos anos de 1900 e 1925. Esse relatorio preliminar cobre parte de pesquisa mais ampla que se estendera aos anos de 1950 e 1975. Sao discutidas as rotinas de internacao, a incidencia de determinados diagnosticos face ao conhecimento cientifico da epoca. Entre 1900 e 1925 nota-se uma discreta alteracao en relacao a importancia de agentes familiares e sociais na hospitalizacao de pacientes psiquiatricos, apesar da permanente importancia do aparelho policial nesse procedimento. Ressalta-se nas anamneses compulsadas a preocupacao fundamental com os aspectos descritivos dos casos, valorizando-se sobremaneira a importancia dos segmentos sociais na decisao de se internar o paciente psiquiatrico
