[Suicide by electric shock with the use of engineering skills]. / Samoubiistvo elektricheskim tokom s primeneniem inzhenernykh navykov.

A case of suicide using technical electricity is presented. The fact of electrical injury is confirmed by the typical macroscopic and microscopic picture of an electric mark. The location of the conductors on the body indicated the victim's knowledge of the effect of electric current on the human body, the ways of its propagation through the body through the vital organs, preparation and determination in the implementation of suicidal intentions. The interest of this case lies in the fact that electrical injury as a method of suicide is extremely rare in expert practice.

[The case of the death of a child due to perforation of the walls of the esophagus and aorta caused by a foreign body - an electric battery]. / Sluchai gibeli rebenka vsledstvie perforatsii stenok pishchevoda i aorty, vyzvannoi inorodnym telom ­ elektricheskoi batareikoi.

The results of a detailed investigation of a casuistic case of fatal perforation of the walls of the esophagus and aorta with subsequent acute blood loss as a result of prolonged presence of a foreign body - an electric battery in the esophagus of a child are presented.

[Unusual case of suicide by hanging from the cab door of a MAN truck]. / Neobychnyi sluchai samoubiistva putem povesheniya na dveri kabiny gruzovogo avtomobilya «MAN¼.

An unusual case of suicide by hanging on the door inside the cab of a truck (truck) «MAN¼ is presented: the neck is squeezed between the edge of the movable glass and the edge of the frame of the car door from the driver's seat. The above observation supplements the existing variants about the possibility of hanging with a kind of one-sided open «loop¼.

[Foreign body in the esophagus as a reason to assess the medical aid quality during the forensic medical examination]. / Inorodnoe telo pishchevoda kak povod dlya ustanovleniya pravil'nosti okazaniya meditsinskoi pomoshchi pri proizvodstve sudebno-meditsinskoi ekspertizy.

THE AIM OF THE STUDY: Was to investigate in detail the case of a combination of esophageal injury and aortic aneurysm from the standpoint of the perspective of medical care. It was established that the circumstances of the improper provision of medical care in this case were the subjective nature in the form of insufficient and incorrect provision of it. It is shown that continuous training of doctors and mid-level medical workers within the continuing medical education is a gurantee of proper medical care.

"Evaluating normative epistemic frameworks in medicine: EBM and casuistic medicine".

Since its inception in the early 1990s, evidence-based medicine (EBM) has become the dominant epistemic framework for Western medical practice. However, in light of powerful criticisms against EBM, alternatives such as casuistic medicine have been gaining support in both the medical and philosophical community. In the absence of empirical evidence in support of the claim that EBM improves patient outcomes, and in light of considerations that it is unlikely that such evidence will be forthcoming, another standard is needed to assess EBM against its alternatives. In this paper, I propose a set of criteria for this purpose based on Helen Longino's criteria for assessing the objectivity of a knowledge productive community. I then apply these criteria to assess EBM against a casuistic framework for medical knowledge. I argue that EBM's strict adherence to a hierarchical organization of knowledge can reasonably be expected to block it from fulfilling a high level of objectivity. A casuistic framework, on the other hand, because it emphasizes critical evaluation in conjunction with the flexibility of a case-based approach, could be expected to better facilitate a more optimal epistemic community.

EXPERIENCES IN CLINICAL ETHICS: A PROJECT FOR MEETINGS ON CLINICAL ETHICS IN PALLIATIVE MEDICINE / EXPERIENCIAS EN ÉTICA CLÍNICA: EL PROYECTO DE "ENCUENTROS SOBRE ÉTICA CLÍNICA EN LA MEDICINA PALIATIVA" / EXPERIENCIAS NA ÉTICA CLÍNICA: O PROJETO DE "ENCONTROS SOBRE ÉTICA CLÍNICA NA MEDICINA PALIATIVA"

"Meetings on Clinical Ethics in Palliative Medicine," as outlined in this article, is a project on ethical and clinical training in the area of palliative care. The project is part of a clinical program and broader research pertaining to recovery of the anthropological and ethical roots in the clinical practice of palliative care. It is aimed at professionals and researchers in palliative care and consists of informal meetings where the human and professional values involved in actual clinical cases are analyzed. Anthropology, general ethics, medical epistemology and philosophy of medicine are considered essential in this program of ethical and clinical training, as are the valuable insights provided by the humanities. The specific objective is not only to provide a list of ethical principles, but also to promote an ethical disposition on the part of the person who acts.

"Encuentros sobre ética clínica en la medicina paliativa" es un proyecto de formación ética y clínica en el ámbito de los cuidados paliativos. Hace parte de un programa clínico y de investigación más amplio que pertenece a la línea de recuperación de las raíces antropológicas y éticas en la práctica clínica de los cuidados paliativos. Está dirigido a profesionales e investigadores en cuidados paliativos, y contempla el desarrollo de reuniones informales, donde se analizan los valores humanos y profesionales involucrados en casos clínicos reales. En este programa de formación ética y clínica, se consideran esenciales la antropología, la ética general, la epistemología médica y la filosofía de la medicina, además es valiosa la información proporcionada por las humanidades. El objetivo específico no es solo proporcionar una lista de principios éticos, sino también promover una disposición ética de parte de la persona que actúa.

"Encontros sobre ética clínica na medicina paliativa", apresentado neste artigo, é um projeto de formação ética e clínica no âmbito dos cuidados paliativos. O projeto faz parte de um programa clínico e de pesquisa mais amplo que pertence à linha de recuperação das raízes antropológicas e éticas na prática clínica dos cuidados paliativos. Está dirigido a profissionais e pesquisadores em cuidados paliativos e leva em consideração o desenvolvimento de reuniões informais, em que se analisam os valores humanos e profissionais envolvidos em casos clínicos reais. Nesse programa de formação ética e clínica, consideram-se essenciais a antropologia, a ética geral, a epistemología médica e a filosofia da medicina, além da valiosa informação proporcionada pelas humanas. O objetivo específico não é só oferecer uma lista de princípios éticos, mas também promover uma disposição ética de parte da pessoa que atua.

Análise da casuística das afecções cirúrgicas observadas na Clínica Cirúrgica de Pequenos Animais da FMVZ-USP no período de 1988 a 2007 / Casuistic analysis of surgical diseases in the Small Animal Surgery Sector of FMVZ-USP from 1988 to 2007

A patologia cirúrgica veterinária apresenta moléstias de diversas naturezas que acometem cada vez mais frequentemente os cães e os gatos. Mesmo assim, poucos levantamentos são encontrados a respeito da casuística das ditas afecções cirúrgicas em pequenos animais, principalmente com dados obtidos na realidade do Brasil. O presente trabalho descreve e analisa a frequência de afecções cirúrgicas, na Clínica Cirúrgica de Pequenos Animais da Faculdade de Medicina Veterinária e Zootecnia da Universidade de São Paulo, no período de 1988 a 2007, classificando-as em oito grupos: cárdio-respiratório, digestório, distrofias, genito-urinário, hematopoiético, locomotor, paratopias e pele e anexos. Foram avaliados um total de 18.585 casos cirúrgicos. Foi observado que a espécie canina apresentou número de afecções e procedimentos até seis vezes maior do que os registros em felinos, sendo que as afecções locomotoras apresentaram maior índice de ocorrência tanto em cães como em gatos, constituindo a amostra mais representativa atendida. As afecções associadas ao aparelho genito-urinário apresentaram a segunda maior frequência, principalmente por conta de urolitíases oriundas de hábitos alimentares. Paratopias, afecções do sistema digestório e de pele e anexos foram observadas em frequências próximas em ambas as espécies. Já as distrofias, afecções hematológicas e cardiorespiratórias foram pouco frequentes tanto em cães como em gatos. A média anual de casos submetidos a intervenções cirúrgicas (801,5) demonstra a realidade dos atendimentos cirúrgicos, bem como a caracterização das principais moléstias atendidas e submetidas à intervenção cirúrgica na rotina médica veterinária da cidade de São Paulo e da Grande São Paulo, Brasil.

Veterinary surgical pathology presents a long list of diseases that more often affect dogs and cats each day. Little information has been obtained from literature about surgical effects in dogs and cats. The present study describes and analyzes the frequency of surgical effects served in the Small Animal Surgery Service, Faculty of Veterinary Medicine, University of São Paulo, from 1988 to 2007, classifying the finds in eight categories: cardiorespiratory apparatus, digestor apparatus, dystrophies, genitourinary apparatus, hematopoietic system, locomotor apparatus, paratopies and skin and annexes components. We evaluated a total of 18.585 surgical cases and observed that the number of canine diseases and presented procedures was more than six times the number of records in cats, and locomotor diseases show a higher rate of occurrence in both dogs and cats, constituting the most representative sample found. The diseases associated with genitourinary showed the second highest frequency, mainly due to urolithiasis derived from new eating habits. Paratopies, disorders of the digestive system and skin and appendages were observed on nearby frequencies in both species. The dystrophies, cardiorespiratory and hematological disorders were infrequent both in dogs and in cats. The annual mean of cases (801.5) is adequate to characterize the routine as well as the most common surgical diseases seen in the São Paulo State and São Paulo City.

Narcolepsy in pediatric age - Experience of a tertiary pediatric hospital.

Narcolepsy, a chronic disorder of the sleep-wake cycle of multifactorial etiology, is characterized by excessive daytime sleepiness, often associated with cataplexy, hypnagogic/hypnopompic hallucinations and sleep paralysis. Both early clinical suspicion and therapeutic approach are essential for promotion of cognitive development and social integration of these children. The authors present a descriptive retrospective study of a series of eight children in whom symptoms first started between 6.8 and 10.5 years of age. Diagnostic delay ranged from 4 months to 2 years. One child had H1N1 flu vaccination eight months before the clinical onset. The first multiple sleep latency test was positive in 6 of 8 cases. All cases were treated with methylphenidate, and venlafaxine was associated in 4 of them. In one case the initial therapy was exclusively behavioral. In all cases, symptomatic improvement, better school performance and social integration were achieved after therapeutic adjustment.

Casuística de las micosis de la cavidad bucal(2002-2006): laboratorio de la cátedra de microbiología, Facultad de Odontología, UCV / Casuistry of fungal infections of the oral cavity (2002-2006): Laboratory of the department of Microbiology, Faculty of Dentistry, UCV

En el presente artículo, se hace la segunda revisión de los casos de micosis de la cavidad bucal que se han reportado en el Laboratorio de la Cátedra de Microbiología de la Facultad de Odontología de la Universidad Central de Venezuela, en el lapso de 5 años (Enero 2002-Diciembre 2006), siendo la Estomatitis Subprotésica la micosis que se reportó con mayor frecuencia. Otras micosis reportadas en menor frecuencia fueron: Candidiasis Hiperplásica, Candidiasis Pseudomembranosa, y lesiones asociadas como Queilitis Angular y Glositis Romboidal Media; Histoplasmosis y Paracoccidioidomicosis

In this article, we continue the review of the most frequent oral mycosis that have been reported on a period of five years (January 2002-December 2006) in the laboratory of Microbiology at Dental School of Central University of Venezuela. Pseudomembranous Candidiasis was the most frequent mycosis of the oral cavity reported. Other mycosis reported were: Hyperplasic Candidiasis, Pseudomembranous Candidiasis, and lesions related with oral mycosis like Angular Cheiulitis and Medium Romboidal Glositis, Histoplasmosis and Paracoccidioidomycosis

Doenças de aves selvagens diagnosticadas na Universidade Federal do Paraná (2003-2007) / Diseases of wild birds diagnosed at the Federal University of Paraná, Brazil (2003-2007)

Dentre os 253 atendimentos realizados em aves selvagens entre agosto de 2003 a agosto de 2006 no Ambulatório de Animais Selvagens do Hospital Veterinário da Universidade Federal do Paraná, 45 casos (17,8 por cento) referiram-se a consultas à espécie Serinus canarius (canário-belga). Dentre as aves atendidas e suas respectivas ordens obteve-se uma maior ocorrência da ordem Psittaciforme. As enfermidades mais freqüentemente visualizadas foram as afecções traumáticas com 56 casos (22,13 por cento). Destas, 17 animais (30,91 por cento) possuíam algum tipo de fratura, sendo a fratura rádio-ulnar a mais comum, com 17,65 por cento de ocorrência. As outras moléstias mais relatadas foram a presença de ectoparasitos (12,50 por cento) e endoparasitos (10,68 por cento), doenças respiratórias (10,42 por cento), procedimentos preventivos (7,55 por cento), afecções dermatológicas (6,51 por cento), neoplasias (4,95 por cento), afecções oftálmicas (4,43 por cento), afecções gastrintestinais (3,91 por cento), caquexia (3,39 por cento), afecções neurológicas (2,86 por cento), automutilação (2,86 por cento), obesidade (2,34 por cento), agressão por outros animais (1,56 por cento), doenças nutricionais (1,30 por cento), retenção de ovo (1,04 por cento), bouba aviária (0,78 por cento) e gota úrica (0,52 por cento). Tendo em vista a alta prevalência de traumatismos e presença de ecto e endo parasitas que poderiam ser evitados se estivesse ocorrendo um manejo adequado com a ave, sugere-se a necessidade que o Médico Veterinário assuma um papel mais efetivo na Medicina Veterinária Preventiva buscando informar e debater questões referentes ao modo correto de alimentação, criação e manejo das aves, assim como também o esclarecimento acerca das questões referentes às zoonoses quando da consulta veterinária.

From 253 wild birds attended at the Wild Animal Ambulatory of the Veterinary Hospital, Paraná Federal University, between August 2003 and August 2006, 45 cases (17.8 percent) were related to the species Serinus canarius (Belgian Canary). Within these attended birds and its respective orders, most morbid conditions occurred with the Psittaciforme order and were caused by traumatism, in 45 cases (14.32 percent). Of these, 17 animals (30.91 percent) had bone fractures; the most common were on radius-ulna (17.65 percent). Other conditions were presence of ectoparasites (12.50 percent) and endoparasites (10.68 percent), respiratory disease (10.42 percent), dermatological ailments (6.51 percent), neoplasms (4.95 percent), ophthalmic illnesses (4.43 percent), gastrointestinal diseases (3.91 percent), cachexia (3.39 percent), neurological diseases (2.86 percent), self-mutilation (2.86 percent), obesity (2.34 percent), aggression by other animals (1.56 percent), nutritional deficiencies (1.30 percent), egg retention (1.04 percent), avian poxvirus (0.78 percent) and uric gout (0.52 percent), as well as there was clinical routine measures to be taken (7.55 percent). Traumas and illnesses were observed as the highest prevalence on the casuistic, which could be prevented by correct husbandry practices.

Análise retrospectiva das neoplasias de ânus em pacientes atendidos no HC-FMRP-USP de 1979 a 2004 e revisão da literatura / Retrospective analysis of patients with anal tumors diagnosed at the school of medicine of Ribeirão Preto Hospital and clinics (HC-FMRP), between 1979 and 2004 and literature review

Foram analisados, retrospectivamente, 49 casos de pacientes com neoplasia de ânus, sendo 23 de 1979-1996 e 26 de 1997-2004, 49 por cento masculinos e 51 por cento femininos. Em 81,6 por cento dos pacientes o tratamento foi adjuvante, com radioterapia e esquema de NIGRO, 12,2 por cento metástases à distância e 36,7 por cento perderam o seguimento. Obitos ocorreram em 20,4 por cento. Notou-se diminuição da necessidade da cirurgia de Miles (30,8 por cento vs 43,3 por cento). A perda de seguimento foi menor (19,5 por cento vs 56,5 por cento), mas a mortalidade foi discretamente maior (23,1 por cento vs 17,4 por cento). O tratamento neo-adjuvante com radio e quimioterapia em 96 por cento dos pacientes com neoplasia anal foi capaz de promover remissão da lesão na maioria dos casos (57,5 por cento), confirmados pela biópsia da cicatriz residual, evitando-se amputação cirúrgica do reto. Dados mais recentes mostram que 45 por cento dos pacientes permanecem sem recidiva (seguimento médio 3,5 anos). A alta taxa de mortalidade e o diagnóstico de lesões avançadas podem decorrer da procura tardia do serviço médico.

In total, 49 cases of anal tumor were studied, 23 cases from 1979-1996 and 26 cases from 1997-2004. From the cases studied, 49 percent were male and 51 percent were female patients. Patients that were submitted to radio and chemotherapy by the "nigro scheme" totalized 81.6 percent; 12.2 percent presented metastasis, 36.7 percent lost follow up and 20.4 percent died. There was a reduction of the Miles surgery indication (30.8 percent vs 43.3 percent) and the follow up loss (19.5 percent vs 56.5 percent). The mortality rate was a little higher (23.1 percent vs 17.4 percent). Radio and chemotherapy was used in 96 percent of patients, and promoted lesion remission in 57.5 percent of cases (confirmed by negative anal scar biopsy), avoiding the anal amputation surgery indication. Recent data indicate that 45 percent of patients (3.5 years of average follow up) are still with no recidivated tumor. The prevalence of high mortality rates and the diagnosis of high stage lesions are due to a delay of patients in search for a diagnosis. This might be due to a difficult access to a medical service and to the low social-economical level of our patients. These conditions make the diagnosis and treatment of anal tumors difficult, impairing its prognosis.

Casuística de las micosis de la cavidad bucal, reportadas en el Laboratorio de la Cátedra de Microbiología, Facultad de Odontología, U.C.V. (1997-2001)

En el presente artículo, se hace una revisión de los casos de micosis de la cavidad bucal que se han reportado en un período de 5 años (Enero 1997-Diciembre 2001) en el Laboratorio de la Cátedra de Microbiología de la Facultad de Odontología de la Universidad Central de Venezuela, siendo Candidiasis Atrófica la micosis que se reportó con mayor frecuencia en el lapso antes mencionado. Otras micosis reportadas fueron: Candidiasis Hiperplásica, Candidiasis Pseudomembranosa, , y lesiones asociadas como Queilitis Angular y Glositis Romboidal Media.

do artigo o presente, uma revisão transforma-se dos exemplos do micosis da cavidade oral a que la foram relatados em um período de 5 anos (janeiro1997-Diciembre2001) no laboratório da cadeira do microbiologia da faculdade de Odontologia da Universidade Central de Venezuela, sendo candidiasis Atrófica o micosis que foi relatado a maioria freqüentemente no lapso antes do mencionado. O outro micosis relatado era: Candidiasis Hiperplásica, Candidiasis Pseudomembranosa, , e os ferimentos associaram como o rhomboid angular e médio de Queilitis Glositis.

In this article, we make a review of the most frequent oral mycosis that have been reported on a period of five years (January 1997-December 2001) in the laboratory of Microbiology at Dental School of Central University of Venezuela. Atrophic candidiasis was the most frequent mycosis of the oral cavity reported. Other mycosis reported were: Hyperplasic Candidiasis, Pseudomembranous Candidiasis, and lesions related with oral mycosis like Angular Cheiulitis and Medium Romboidal Glositis.