[Vestibular evoked myogenic potential findings on multiple sclerosis]. / Hallazgos de potenciales vestibulares miogénicos evocados en la esclerosis múltiple.

INTRODUCTION: Vestibular evoked myogenic potential (VEMP) elicited by acoustic stimulation, has been proposed in the assessment of vestibulospinal pathways. AIM: To research the clinical utility of VEMP on multiple sclerosis (MS). SUBJECTS AND METHODS: Forty-four individuals were evaluated (30 normal state and 14 had MS). The acoustic stimuli were short tone burst (1 kHz, 118 dBNa, rise-fall 1 ms, plateau 2 ms) presented through a supra-aural earphone. The stimulation rate was 5 stimuli per second. RESULTS: All the healthy subjects showed a normal VEMP response. In the MS group, abnormal VEMP was recorded among 92.8% of patients and normal in just one case. The P13-N23 increased of prolongation which was the most frequently alteration (57.1%), followed by absence of response among four (28.5%) cases. CONCLUSION: VEMP was considered a good method of diagnostic support of vestibulospinal tract in cases of MS.

Brazilian paediatricians' awareness of national guidelines for community-acquired pneumonia.

BACKGROUND: The Integrated Management of Childhood Illness (IMCI) strategy uses simple clinical signs for the diagnosis and severity evaluation of community-acquired pneumonia (CAP). OBJECTIVE: To describe paediatrician awareness of the IMCI strategy for CAP. DESIGN: A cross-sectional study analysing a descriptive case of severe CAP, presented as part of the Brazilian Board of Paediatrician Evaluation (BBPE) tests. RESULTS: Eighty-six (774/898) per cent of paediatricians followed the IMCI protocol to treat CAP. Although hospitalisation was considered in 90% of the answers, only 35% based this decision on lower chest indrawing. CONCLUSION: The BBPE showed that most physicians are aware of the IMCI recommendations.

Determination of radial artery compliance can increase the diagnostic power of pulse wave velocity measurement.

Pulse wave velocity (PWV) is an indicator associated with the arterial stiffness. Although this technique has been used in the diagnosis of systemic arterial hypertension (SAH), it cannot supply alone enough information about the pathogenesis of this disturbance. This paper aims to determine the compliance of brachial-radial arterial segment by applying a three-element windkessel model, and by using the same pressure waveforms acquired to calculate the PWV. The proposed method to determine the arterial compliance was evaluated with a physical simulation of the arterial system, where parameters were known, resulting in an estimation error of 0.73 x 10(-7) cm5 dyne(-1). In a clinical study the estimated compliance was statistically different (p < 0.01) in a controlled group ((3.12 +/- 3.53) x 10(-7) cm5 dyne(-1)) and in an SAH group ((1.04 +/- 0.74) x 10(-7) cm5 dyne(-1)). It was observed that the PWV value calculated using the maximum of the first derivative of the pressure waveform upstroke as characteristic points was the best correlated (r = -0.71) with the determined compliance. Because SAH normally results, among other causes. from a decreased arterial compliance the results suggest that the determined compliance could be used concomitantly with PWV to supply more diagnostic information about the pathogenesis of SAH.

Knowledge of pediatricians in Rio de Janeiro, Brazil, about inhalation therapy in asthmatic children.

BACKGROUND: Despite the numerous guidelines on the diagnosis and treatment of asthma, there are data that indicate that general pediatrician's knowledge of the disease and its preferred treatment is limited, which may influence the quality of care given to asthmatic children. The purpose of this study was to describe pediatrician's knowledge of spacers and of concepts of chilhood asthma, as well as their prescribing habits concerning inhalation therapy, in the public health system of the city of Rio de Janeiro. METHODS AND RESULTS: A descriptive cross-sectional study was performed in a sample of 72 pediatricians from the public health system of Rio de Janeiro. A questionnaire was used to assess prescriptions for spacers, the reasons whay spacers were not used, the models employed, classification of asthma according to clinical severity and symptom frequency, recommendation for the correct spacer volume according to age group, and the concept of asthma as an inflammatory disease. Seventy percent (51/72) of the physicians did not routinely prescribe the spacer. The reasons given were as follows: a) lack of spacer availability in the public health system in 55 % (28/51); b) high cost in 57 % (29/51); c) the complexity of their use in 35 % (18/51); d) unwillingness to use aerosol type medication in 15 % (8/51), and e)lack of knowledge of their function and utilization in 59 % (30/51). Of the 30 % (21/72) who reported they regularly and routinely prescribed the spacer in daily practice, 48 % (10/21) stated that this routine prescription, even when indicated, was below 25 % of what was expected and makeshift models were preferred by 24 % (5/21) of the pediatricians. Six percent of the pediatricians chose the appropriate spacer volume according to age group, 62.5 % (45/72) reported that they classified asthma according to severity, 16 % (7/45) gave the correct answers when classifying asthma according to national consensus, and 22 % (16/72) considered asthma to be an inflammatory disease. CONCLUSIONS: The results of this study suggest that pediatrician's knowledge of inhalation therapy with dosed aerosol spacers and of asthma-related concepts in the public health system in Rio de Janeiro is limited. This may restrict the quality of care given to the asthmatic children in the city and suggests the need for training programs for the management of asthmatic children.

Alterations in plasma prolactin and glucose levels induced by surgical stress in hyperprolactinemic female rats

The effects of hyperprolactinemia on plasma prolactin (PRL) and glucose were investigated in female rats submitted to surgical stress (laparotomy under ether anesthesia). Wistar rats weighing 250-280g received pituitary grafs under the kidney capsule three weeks before the experiments (N = 15) while a control group underwent sham transplantation (N = 14). The sham-operated rats presented a threefold increase of PRL levels as early as after 5 min of surgical stress (P<0.01); the PRL levels reached a peak at about 15 min and returned to baseline at 40 min. The PRL levels of the grafted rats were increased 3.5-fold compared to the sham-operated controls before stress (20.2 + 5.6 ng/ml vs 5.8 + 0.9 ng/ml, respectively; P<0.05), but did not change significantly during the experimental period. Plasma glucose was already significantly increased at 5 min in sham-operated control and grafted rats (P<0.01) and reached maximal concentrations at about 15 min. The grafted rats presented higher glucose levels than sham-operated controls before stress (122.2 + 3.3 vs 100.5 + 4.2 mg/dl; P<0.01) and at 40 min (182.6 + 13.6 vs 146.7 + 8.4 mg/dl; P<0.05). The hyperprolactinemic rats showed impaired surgical stress-induced PRL release and higher glucose levels both at rest and during the first postoperative hour. These results indicate that chronic hyperprolactinemia inhibited PRL secretion and enhanced the hyperglycemic stress response in the female rat.

Melanoma cutâneo: diagnóstico clínico x anatomopatológico / Cutaneous melanoma: clinical diagnosis x anatomopathological diagnosis

Com o objetivo de avaliar a habilidade dos médicos näo-dermatologistas em diagnosticar clinicamente o melanoma cutâneo, fez-se estudo retrospectivo comparando-se as hipóteses clínicas e os diagnósticos anatomopatológicos de pacients biopsiados. O índice de acerto diagnóstico foi de apenas 51//, inferior ao relatado por outros autores. Houve dificuldade no diagnóstico diferencial com outras lesöes dermatológicas pigmentadas, e a maioria dos casos foi diagnosticada em estagios avançados de invasäo tumoral. Estes dados indicam a necessidade de treinamento dos médicos em geral no reconhecimento clínico dos melanomas e de suas lesöes precursoras