Transrectal endoscopy with three different techniques of rectal suture associate: NOTES survival study with liver biopsy in a swine model / Endoscopia transretal para biópsia hepática associada com três diferentes técnicas de sutura retal: estudo da NOTES em modelo experimental suíno

A cirurgia endoscópica por orifícios naturais (NOTES) representa um novo conceito de cirurgia, caracterizada por ausência de incisões abdominais. Os acessos mais comumente usados são o transvaginal e o transgástrico. Entretanto, as rotas transcolônica e transretal representam alternativas promissoras. O presente estudo objetiva avaliar três diferentes técnicas de sutura retal em três suínos submetidos a NOTES transretal para biópsia hepática, avaliando-se concomitantemente as repercussões clínicas e hematológicas. Sob anestesia geral, foi realizada uma incisão transversal no reto para a passagem do endoscópio até a cavidade abdominal em todos os animais para a realização da biópsia hepática. Cada animal recebeu um tipo de sutura retal: sutura em dois planos; reforço com tela de polipropileno ou reforço com membrana de pericárdio bovino. A NOTES transretal em modelo experimental suíno não apresentou implicações clínicas e hematológicas importantes, o que demonstra um acesso alternativo para biópsia hepática. Nenhum animal apresentou sinais de peritonite, aderências ou deiscência de pontos. O uso de reforço com pericárdio bovino para a sutura retal apresenta um atraso na cicatrização quando comparado com a sutura convencional ou com o uso de tela de polipropileno.(AU)

Transrectal endoscopy with three different techniques of rectal suture associate: NOTES survival study with liver biopsy in a swine model / Endoscopia transretal para biópsia hepática associada com três diferentes técnicas de sutura retal: estudo da NOTES em modelo experimental suíno

A cirurgia endoscópica por orifícios naturais (NOTES) representa um novo conceito de cirurgia, caracterizada por ausência de incisões abdominais. Os acessos mais comumente usados são o transvaginal e o transgástrico. Entretanto, as rotas transcolônica e transretal representam alternativas promissoras. O presente estudo objetiva avaliar três diferentes técnicas de sutura retal em três suínos submetidos a NOTES transretal para biópsia hepática, avaliando-se concomitantemente as repercussões clínicas e hematológicas. Sob anestesia geral, foi realizada uma incisão transversal no reto para a passagem do endoscópio até a cavidade abdominal em todos os animais para a realização da biópsia hepática. Cada animal recebeu um tipo de sutura retal: sutura em dois planos; reforço com tela de polipropileno ou reforço com membrana de pericárdio bovino. A NOTES transretal em modelo experimental suíno não apresentou implicações clínicas e hematológicas importantes, o que demonstra um acesso alternativo para biópsia hepática. Nenhum animal apresentou sinais de peritonite, aderências ou deiscência de pontos. O uso de reforço com pericárdio bovino para a sutura retal apresenta um atraso na cicatrização quando comparado com a sutura convencional ou com o uso de tela de polipropileno.(AU)

Laparoscopic paracostal herniorrhaphy in a dog: case report / Herniorrafia paracostal laparoscópica em um cão: relato de caso

Traumatic paracostal hernia is classified as an abdominal hernia that protrudes from the abdomen to a non physiologic space over the ribs. Treatment requires surgical reconstruction of the disrupted musculature in the thoracoabdominal region. Laparoscopic paracostal herniorrhaphy was performed in an eight-month-old male Teckel, presented after a car accident injury. A three-portal laparoscopic access was used for definitive diagnosis and hernia correction. After traction of the herniated omentum, a thoracoabdominal communication caused a left side pneumothorax, which was successfully drained with a chest tube placement. The herniorrhaphy was accomplished with intracorporeal sutures by a combination of Ford interlocking and cross mattress patterns. The postoperative period was uneventful. The laparoscopic paracostal herniorrhaphy was satisfactory, allowing both diagnosis and correction of the paracostal defect, showing to be a feasible alternative to the open surgery.

A hérnia traumática paracostal é classificada como uma hérnia abdominal com abaulamento do abdômen formando um espaço não fisiológico sobre as costelas. O tratamento consiste em reconstituir cirurgicamente a musculatura rompida da região toracoabdominal. A herniorrafia paracostal laparoscópica foi realizada em um cão da raça Teckel, macho de oito meses de idade, com histórico de trauma automobilístico. Optou-se pela utilização da abordagem laparoscópica tanto para o diagnóstico definitivo quanto para a correção da mesma. Foi utilizado o acesso com três portais, permitindo a tração do omento herniado, momento este em que o animal apresentou pneumotórax devido a uma comunicação toracoabdominal esquerda. O paciente foi submetido à toracocentese e adaptação de dreno no hemitórax esquerdo. A herniorrafia foi realizada com sutura intracorpórea em padrão contínuo de colchoeiro e festonada de Ford com fio monofilamentar náilon zero. O paciente apresentou rápida recuperação pós-operatória, sem ocorrências de recidivas. Assim, a herniorrafia paracostal laparoscópica mostrou-se satisfatória, possibilitando o diagnóstico definitivo e concomitante correção do defeito abdominal e diafragmático, podendo ser indicada como uma alternativa à cirurgia convencional.

Laparoscopic paracostal herniorrhaphy in a dog: case report / Herniorrafia paracostal laparoscópica em um cão: relato de caso

Traumatic paracostal hernia is classified as an abdominal hernia that protrudes from the abdomen to a non physiologic space over the ribs. Treatment requires surgical reconstruction of the disrupted musculature in the thoracoabdominal region. Laparoscopic paracostal herniorrhaphy was performed in an eight-month-old male Teckel, presented after a car accident injury. A three-portal laparoscopic access was used for definitive diagnosis and hernia correction. After traction of the herniated omentum, a thoracoabdominal communication caused a left side pneumothorax, which was successfully drained with a chest tube placement. The herniorrhaphy was accomplished with intracorporeal sutures by a combination of Ford interlocking and cross mattress patterns. The postoperative period was uneventful. The laparoscopic paracostal herniorrhaphy was satisfactory, allowing both diagnosis and correction of the paracostal defect, showing to be a feasible alternative to the open surgery.(AU)

A hérnia traumática paracostal é classificada como uma hérnia abdominal com abaulamento do abdômen formando um espaço não fisiológico sobre as costelas. O tratamento consiste em reconstituir cirurgicamente a musculatura rompida da região toracoabdominal. A herniorrafia paracostal laparoscópica foi realizada em um cão da raça Teckel, macho de oito meses de idade, com histórico de trauma automobilístico. Optou-se pela utilização da abordagem laparoscópica tanto para o diagnóstico definitivo quanto para a correção da mesma. Foi utilizado o acesso com três portais, permitindo a tração do omento herniado, momento este em que o animal apresentou pneumotórax devido a uma comunicação toracoabdominal esquerda. O paciente foi submetido à toracocentese e adaptação de dreno no hemitórax esquerdo. A herniorrafia foi realizada com sutura intracorpórea em padrão contínuo de colchoeiro e festonada de Ford com fio monofilamentar náilon zero. O paciente apresentou rápida recuperação pós-operatória, sem ocorrências de recidivas. Assim, a herniorrafia paracostal laparoscópica mostrou-se satisfatória, possibilitando o diagnóstico definitivo e concomitante correção do defeito abdominal e diafragmático, podendo ser indicada como uma alternativa à cirurgia convencional.(AU)

Use of digital panoramic radiography as an auxiliary means of low bone mineral density detection in post-menopausal women.

OBJECTIVES: To correlate the radiomorphometric indices obtained using digital panoramic radiography (DPR) with bone mineral densities, evaluated by the dual-energy X-ray absorptiometry test, in a population of post-menopausal females to identify patients with asymptomatic low bone mineral densities. METHODS: The morphology of the mandibular cortex was evaluated using the mandibular cortical index (MCI) and the inferior mandibular cortex width was evaluated using the mental index (MI) in 64 female patients who had undergone dual-energy X-ray absorptiometry assessment. Of these patients, 21 were diagnosed with osteopaenia and 20 with osteoporosis, and 23 were normal. Three new indices for evaluating the inferior mandibular cortex width were designed: the mental posterior index 1 (MPI1), MPI2 and MPI3. Statistical analyses were performed using the χ(2) and Kruskal-Wallis tests and the receiver operating characteristic curve. RESULTS: There were significant differences between the normal and lower bone mineral density groups (osteopaenia and osteoporosis) for MCI (p < 0.01). In the osteoporosis group, the MI, MPI1, MPI2 and MPI3 were significantly different from the normal and osteopaenia groups (p < 0.05). The MI, MPI1, MPI2 and MPI3 showed that there is an area in the mandibular cortex, located between the mental foramen and the antegonial region, which is valid for identifying females at high risk for osteoporosis. CONCLUSIONS: The MCI, MI, MPI1, MPI2, and MPI3 radiomorphometric indices evaluated using DPR can be used to identify post-menopausal females with low bone densities and to provide adequate medical treatment for them.

Novel exon nucleotide deletion causes adrenoleukodystrophy in a Brazilian family.

Adrenoleukodystrophy is a neurodegenerative X-linked recessive disorder. It is characterized by abnormal function of peroxisomes, which leads to an accumulation of very long-chain fatty acids in plasma and tissues, especially in the cortex of adrenal glands and white matter of the central nervous system, causing demyelinating disease and adrenocortical insufficiency (Addison's disease). It is caused by a mutation in the ABCD1 gene (ATP-binding cassette, subfamily D, member 1), which encodes the protein adrenoleukodystrophy that is involved in the transport of fatty acids into the peroxisome for degradation. Variable expression has been recognized in families of patients who have this disease. A Brazilian family from Minas Gerais State, Brazil, was studied. The proband is an adult living in Minas Gerais State, Brazil; he had adrenomyeloneuropathy, adrenocortical insufficiency and a stable cerebral form. DNA was extracted from a blood sample and was sequenced to identify the mutation. The patient's exons were cloned for confirmation. A new mutation was found in exon 5 of the ABCD1 gene (c.1430delA), as well as a single-nucleotide polymorphism in exon 6. The mutation causes a frame shift, resulting in a truncated protein with almost total absence of the ATP binding domain.

Evidence that blood pressure remains under the control of arterial baroreceptors in renal hypertensive rats.

The purpose of the present study was to determine the range of the influence of the baroreflex on blood pressure in chronic renal hypertensive rats. Supramaximal electrical stimulation of the aortic depressor nerve and section of the baroreceptor nerves (sinoaortic denervation) were used to obtain a global analysis of the baroreceptor-sympathetic reflex in normotensive control and in chronic (2 months) 1-kidney, 1-clip hypertensive rats. The fall in blood pressure produced by electrical baroreceptor stimulation was greater in renal hypertensive rats than in normotensive controls (right nerve: -47 +/- 8 vs -23 +/- 4 mmHg; left nerve: -51 +/- 7 vs -30 +/- 4 mmHg; and both right and left nerves: -50 +/- 8 vs -30 +/- 4 mmHg; P < 0.05). Furthermore, the increase in blood pressure level produced by baroreceptor denervation in chronic renal hypertensive rats was similar to that observed in control animals 2-5 h (control: 163 +/- 5 vs 121 +/- 1 mmHg; 1K-1C: 203 +/- 7 vs 170 +/- 5 mmHg; P < 0.05) and 24 h (control: 149 +/- 3 vs 121 +/- 1 mmHg; 1K-1C: 198 +/- 8 vs 170 +/- 5 mmHg; P < 0.05) after sinoaortic denervation. Taken together, these data indicate that the central and peripheral components of the baroreflex are acting efficiently at higher arterial pressure in renal hypertensive rats when the aortic nerve is maximally stimulated or the activity is abolished.

Diferentes vias de administração da solução de fosfato monobásico e dibásico de sódio no preparo do cólon para colonoscopia rígida em cães / Different routes in administration of sodium phosphate monobasic and dibasic solution in bowel preparation for rigid colonoscopy in dogs

Foram comparadas duas vias de administração, oral e retal, com a solução de fosfato monobásico e dibásico de sódio (NaP), juntamente com bisacodil via oral, no preparo do cólon para colonoscopia rígida em cães, para avaliar parâmetros clínicos, qualidade do preparo e variações dos eletrólitos fósforo, cálcio, potássio (K+) sódio (Na+) e magnésio (Mg+), além da creatinina, albumina e hemograma. Todos os eletrólitos apresentaram alterações, sendo significativa a queda nos níveis de K+ e Mg+. Não houve alterações eletrocardiográficas, e a redução da microbiota bacteriana foi confirmada nos dois grupos de administração da solução. Os resultados foram similares quanto à incidência de efeitos colaterais, porém a via retal apresentou facilidade na administração, menor retenção fecal no cólon, maior rapidez para realização da colonoscopia, com menor desperdício de tempo na lavagem e na aspiração do conteúdo fecal. O preparo intestinal com bisacodil oral e solução de NaP por via retal foi mais eficaz, podendo ser recomendado em cães que serão submetidos à colonoscopia.

The efficacy of oral and rectal administration of sodium phosphate monobasic and dibasic solution (NaP) combined with bisacodil per oral, as drugs to prepare the colon for rigid colonoscopy in dogs was compa1ed. Clinical parameters; colonic cleaning, plasma concentration of calcium, potassium (K+), sodium (Na+), magnesium (Mg+), creatinine, and albumin, and complete blood count were evaluated. In both groups, all electrolytes presented alterations, with significant reduction of the levels of K+ and Mg+, but there were no electrocardiographic alterations. No difference in the reduction of bacterial population was observed between the two groups. The results were similar regarding the incidence of side effects; however, the rectal route presented less fecal retention in colon and could get patients ready for the procedure faster. The preparation of bowel with bisacodil and NaP solution by rectal route was more effective and could be recommended for colonoscopy in dogs.

Diferentes vias de administração da solução de fosfato monobásico e dibásico de sódio no preparo do cólon para colonoscopia rígida em cães / Different routes in administration of sodium phosphate monobasic and dibasic solution in bowel preparation for rigid colonoscopy in dogs

Foram comparadas duas vias de administração, oral e retal, com a solução de fosfato monobásico e dibásico de sódio (NaP), juntamente com bisacodil via oral, no preparo do cólon para colonoscopia rígida em cães, para avaliar parâmetros clínicos, qualidade do preparo e variações dos eletrólitos fósforo, cálcio, potássio (K+) sódio (Na+) e magnésio (Mg+), além da creatinina, albumina e hemograma. Todos os eletrólitos apresentaram alterações, sendo significativa a queda nos níveis de K+ e Mg+. Não houve alterações eletrocardiográficas, e a redução da microbiota bacteriana foi confirmada nos dois grupos de administração da solução. Os resultados foram similares quanto à incidência de efeitos colaterais, porém a via retal apresentou facilidade na administração, menor retenção fecal no cólon, maior rapidez para realização da colonoscopia, com menor desperdício de tempo na lavagem e na aspiração do conteúdo fecal. O preparo intestinal com bisacodil oral e solução de NaP por via retal foi mais eficaz, podendo ser recomendado em cães que serão submetidos à colonoscopia.(AU)

The efficacy of oral and rectal administration of sodium phosphate monobasic and dibasic solution (NaP) combined with bisacodil per oral, as drugs to prepare the colon for rigid colonoscopy in dogs was compa1ed. Clinical parameters; colonic cleaning, plasma concentration of calcium, potassium (K+), sodium (Na+), magnesium (Mg+), creatinine, and albumin, and complete blood count were evaluated. In both groups, all electrolytes presented alterations, with significant reduction of the levels of K+ and Mg+, but there were no electrocardiographic alterations. No difference in the reduction of bacterial population was observed between the two groups. The results were similar regarding the incidence of side effects; however, the rectal route presented less fecal retention in colon and could get patients ready for the procedure faster. The preparation of bowel with bisacodil and NaP solution by rectal route was more effective and could be recommended for colonoscopy in dogs.(AU)

Influence of anesthetics on pharyngeal flap surgery: a 23-year study.

This study assessed the influence of anesthetics on early complications after pharyngeal flap surgery. A 23-year retrospective chart review was carried out of all patients at the authors' institution who underwent superiorly based pharyngeal flap surgery. Variables analyzed were gender, age at the time of surgery, cleft type, anesthesia procedure used and complications in the early postoperative period. 2299 patients (50% male; 50% female) who underwent pharyngeal flap surgery between 1980 and 2003 were reviewed. The highest number of surgeries was performed in patients aged 11-20 years. There were 1042 patients with at least one type of complication. Of these, 39 required reoperation to control complications such as bleeding and airway obstruction. There were no records of death. Vomiting and pain were the most frequent postoperative complications (16% and 14% of patients, respectively). Lower complication rates were observed when anesthesia protocols included sevoflurane, propofol and opioids.

Membranas de látex natural na herniorrafia diafragmática experimental em cães / Natural latex membranes in experimental diaphragmatic hernioplasty in dogs

Utilizaram-se membranas de látex para o reparo de defeitos diafragmáticos em 12 cães, distribuídos em três grupos: no G1 utilizou-se membrana comercial e no G2, membrana experimental. O G3 foi usado como controle. Foi feito um defeito retangular no músculo diafragma, com 4cm de comprimento por 3cm de largura, que nos grupos G1 e G2 foi substituído pelo implante da membrana de látex correspondente. Os animais foram avaliados por estudo radiográfico, hemograma, videocirurgia e análise histológica. Os resultados mostraram que a membrana de látex do grupo 2 foi eficiente na correção de defeito no diafragma, promovendo a reparação e neovascularização tecidual local, sem causar rejeição durante o período de avaliação.

Latex membranes were experimentally used to repair diaphragmatic defects in 12 dogs, distributed in 3 groups. In group 1, a commercial membrane was used, and in group 2, an experimental membrane. Group 3, animals were used as control. A rectangular defect (4cm in length and 3cm in width) was surgically performed in the diaphragm muscle, which was substituted, in group 1 and 2, by the implantation of corresponding latex membrane. The animals were evaluated by radiography, blood count, video-surgery, and histologic study. Results showed that the latex membrane of group 2, were efficient in the correction of the defect in the diaphragm, promoting the repairing and local neovascularization, without causing rejection during the evaluated period.

Membranas de látex natural na herniorrafia diafragmática experimental em cães / Natural latex membranes in experimental diaphragmatic hernioplasty in dogs

Utilizaram-se membranas de látex para o reparo de defeitos diafragmáticos em 12 cães, distribuídos em três grupos: no G1 utilizou-se membrana comercial e no G2, membrana experimental. O G3 foi usado como controle. Foi feito um defeito retangular no músculo diafragma, com 4cm de comprimento por 3cm de largura, que nos grupos G1 e G2 foi substituído pelo implante da membrana de látex correspondente. Os animais foram avaliados por estudo radiográfico, hemograma, videocirurgia e análise histológica. Os resultados mostraram que a membrana de látex do grupo 2 foi eficiente na correção de defeito no diafragma, promovendo a reparação e neovascularização tecidual local, sem causar rejeição durante o período de avaliação.(AU)

Latex membranes were experimentally used to repair diaphragmatic defects in 12 dogs, distributed in 3 groups. In group 1, a commercial membrane was used, and in group 2, an experimental membrane. Group 3, animals were used as control. A rectangular defect (4cm in length and 3cm in width) was surgically performed in the diaphragm muscle, which was substituted, in group 1 and 2, by the implantation of corresponding latex membrane. The animals were evaluated by radiography, blood count, video-surgery, and histologic study. Results showed that the latex membrane of group 2, were efficient in the correction of the defect in the diaphragm, promoting the repairing and local neovascularization, without causing rejection during the evaluated period.(AU)

Mutation in intron 5 of GTP cyclohydrolase 1 gene causes dopa-responsive dystonia (Segawa syndrome) in a Brazilian family.

Dopa-responsive dystonia (DRD), also known as Segawa syndrome or hereditary progressive dystonia with diurnal fluctuation, is clinically characterized by the occurrence of simultaneous or late Parkinsonism and by an excellent response to treatment with low doses of L-dopa. Diagnosis of DRD is essentially clinical. It is based on clinical history and the response to treatment with low doses of L-dopa. However, due to the low penetrance of the disease, asymptomatic carriers may exist. In these cases, mutational analysis of the GCH1 gene is an alternative to diagnose DRD. In the present study, we investigated a large DRD-carrier family in an attempt to identify the disease-causing mutation. The proband, a young woman diagnosed at the age of 13 years, is the daughter of a healthy non-consanguineous couple with history of several cases, on the maternal side of the family, of tip-toeing, disturbance of gait, Parkinsonism, rigidity and cramps in the lower limbs. Using single strand conformational polymorphism and DNA sequencing techniques to analyze DNA extracted from blood samples, we identified a mutation in the GCH1 gene, IVS5+3insT, which would preclude the formation of the active enzyme due to the formation of truncated peptides.

Lack of association of GSTT1, GSTM1, GSTO1, GSTP1 and CYP1A1 polymorphisms for susceptibility and outcome in Brazilian prostate cancer patients.

The polymorphic inheritance of human drug-metabolizing enzymes, such as those encoded by the GST and CYP systems, has been implicated in both cancer risk and prognostic. In an effort to increase our understanding of the interaction between potential environmental exposure, lifestyle, and genetic factors in the predisposition and response to radiotherapy of prostate cancer patients, we examined GSTT1, GSTM1, GSTO1, GSTP1 and CYP1A1 genotypes in a Brazilian population. We studied 125 prostate cancer patients and 100 benign prostatic hyperplasia patients paired for ethnic and lifestyle characteristics. Lifetime occupational history, dietary patterns, cigarette-smoking, and other anamnestic data were obtained through interviews. Outcome was evaluated in 42 stage

Analgesic and anti-inflammatory dose-response relationship of 7.5 and 15 mg meloxicam after lower third molar removal: a double-blind, randomized, crossover study.

Fifty patients were scheduled to undergo removal of symmetrically positioned lower third molars in two separate appointments. Meloxicam 7.5 or 15 mg was once daily administered in a double-blind, randomized and crossover manner after the surgery for 4 days. Objective and subjective parameters were recorded for comparison of postoperative courses. Patients treated with 7.5mg meloxicam who underwent osteotomy reported higher pain scores at 1.5, 3, 4, 10, 12 and 16 h (P<0.05) and ingested a greater amount of rescue analgesic medication (P<0.05) than those who did not require osteotomy. A higher percentage of patients who underwent osteotomy medicated with 7.5mg meloxicam needed rescue medication as compared to those who did not require osteotomy (P<0.05). There was a similar mouth opening at suture removal compared with preoperative values for both doses (P>0.05). There were no significant differences concerning swelling observed on the 2nd or 7th postoperative days in comparison with baseline (P>0.05) between the two doses. Pain, trismus and swelling after lower third molar removal not requiring osteotomy can be successfully controlled by a dose regimen of 7.5mg meloxicam once daily. For more aggressive extractions 15 mg meloxicam is advisable.

[Captopril use in pregnancy and its effects on the fetus and the newborn: case report]. / Uso de captopril durante a gestação e suas repercussões sobre o feto e o recém-nascido: relato de caso.

Angiotensin-converting enzyme (ACE) inhibitors have been widely used to control hypertension, but their use during gestation may result in fetal death, intra-uterine growth retardation, oligoamnium sequence, hypotension, acute renal failure and ductus arteriosus patency in the newborn. The aim of this case report is to highlight the risks of using this drug during gestation. The authors present a case of captopril use during pregnancy, whose newborn developed acute renal failure and ductus arteriosus patency early in the newborn period. This presentation strengthens the importance of not only monitoring amniotic fluid volume and fetal growth, but also, during the newborn period, control the weight gain, diuresis, systemic arterial pressure and renal function, mainly in the first 72 hours of life.

Estudo epidemiológico do abortamento no Brasil / Epidemiological study of abortion in Brazil

Objetivo: avaliar a prevalência do abortamento induzido em relaçao ao abortamento espontâneo em instituiçoes hospitalares. Delineamento: estudo retrospectivo nao controlado. Local:cinco instituiçoes hospitalares localizadas em diferentes cidades do Brasil (Fortaleza, Recife, Curitiba, Rio de Janeiro e Campinas), de O1.09.1992 a 31.08.1993. Pacientes: 4.408 - Universidade Federal do Ceará (l.l17), Universidade Federal do Rio de Janeiro(l.OO4), Universidade Federal do Paraná (999), Universidade Estadual de Campinas (276) e Universidade Federal de Pernambuco (l.Ol2). Variáveis: perfil obstétrico, dados de planificaçao familiar, variáveis da esfera sócio-econômica, características do abortamento (diagnóstico, tratamento e complicaçoes). Resultados: as pacientes eram solteiras (60 por cento), com início de vida sexual na adolescência (88 por cento). A incidência do abortamento precoce foi de 81 por cento, e a curetagem só ou associada a antibióticos foi o tratamento usado em 95 por cento dos casos. A incidência de abortamento provocado foi de 19 por cento e em 80 por cento dos casos fármacos orais ou injetáveis foram o agente indutor. Conclusoes: a incidência de abortamento induzido é alta, principalmente em mulheres jovens, solteiras, pouco instruídas e com início de vida sexual precoce.

Long-term analysis of the hypertension produced by sinoaortic denervation in the rat.

The increases in pressure lability and in mean arterial pressure (MAP) produced by sinoaortic denervation (SAD) in the rat were studied during a 16 h period of continuous pressure measurement 1, 7, 15, 30, 90 and 180 days after surgery. All groups of SAD rats showed increased pressure lability that was estimated from the standard deviation of approximately 960 pressure values taken one per min from the continuous record. The average standard deviation increased 40-90% and the distribution curves of pressure during the 16 h period was wider in the group of SAD rats than in the controls. Although the increased lability of SAD rats remained unchanged, the average minute-to-minute increase in MAP declined during the postoperative period studied. MAP dropped from 151 +/- 5 mmHg (vs 114 +/- 1 mmHg for the control) on the 1st day to 141 +/- 3, 135 +/- 3, 133 +/- 2, 132 +/- 2 and 130 +/- 2 mmHg on days 7, 15, 30, 90 and 180 after SAD, respectively. Movement-related pressure dips were observed in the SAD rats monitored for 16 h in contrast to the other natural states of behavior (walking, eating, grooming) that usually produced an increase in the MAP of control rats and tended to produce exaggerated pressor responses in SAD rats. SAD rats showed increased pressure lability and an elevation of MAP from 130-135 mmHg to 150 mmHg for up to 10 min in response to an acoustic stimulus. The data demonstrate the importance of using quiet and undisturbed conditions to assess the true pressure increase produced in rats by sinoaortic denervation.(ABSTRACT TRUNCATED AT 250 WORDS)

Pre-medicacao em laparoscopia: grave e rara complicacao. / Premedication in laparoscopy: severe and rare complication

Apos o uso de meperidina e diazepam em veia do dorso da mao de paciente com cirrose e doenca pulmonar cronica obstrutiva com eritrocitose secundaria, sobreveio vasculopatia aguda com necrose de um tendao. Como o tratamento clinico instituido nao obteve resultados adequados, foi indicada a fasciotomia dorsal e palmar para descompressao com boa resposta. Na revisao da literatura, a meperidina nao parece ser a responsavel, assim como o diazepam; o mesmo nao se pode afirmar, porem, em relacao ao solvente usado no diazepam