[Perinatal asphyxia and heart problems]. / Asfixia perinatal e problemas cardíacos.

PURPOSE: To evaluate the severity of cardiac complications of neonatal asphyxia in relation to the length and degree of hypoxia. METHODS: Ninety babies with an Apgar score < or = 6 were examined in the intensive care unit at our institution during seven years. Arterial blood for measuring pH, glucose, LDH and MB fraction of CK, together with serial electrocardiogram (ECG), echocardiogram and chest X rays was obtained. The fatal cases were studied with macro and microscopic examination. RESULTS: From a total of 90 cases, 73 were premature: 30 (41%) appropriate for gestation age (AGA) and 43 (59%) small for gestation age (SGA). Twenty one (23%) cases had arterial pH < 7.2. The most common clinical conditions were: pneumonia 28 (31%), anemia 24 (26%) and jaundice 12 (13%). The main cardiological findings were: systolic murmur in 46 (50%), signs of heart hypertrophy in 18 (20%) and heart failure in 8 (9%). On ECG the main findings were ST and T abnormalities. The echocardiogram showed a patent ductus arteriosus (PDA) in 20 (22%), tricuspid regurgitation in 6 (7%), pulmonary hypertension in 6 (7%), dyskinesia and ventricular dilatation in 4 (5%). Necropsy was performed in 23 cases and macro and microscopy obtained in 14; the most frequent findings were: myocite necrosis in 8 (54%), congestion, vacuolization and loss of striae in 4 (29%). CONCLUSION: In the majority of cases, patients had a benign course, even those presenting with severe acidemia. Many abnormal EKGs and echocardiograms became normal after a few weeks. Among those who had a fatal outcome, the severity of histological lesions was observed in babies who had suffered asphyxia for more prolonged periods.

Reimplantacao de dedos - uma tecnica cirurgica altamente especializada. / Reimplantation of fingers - a highly specialized surgical technic

Os autores relatam suas experiencias em reimplantacao de dedos. Eles descrevem e comentam as indicacoes, tecnica cirurgica, principios de microcirurgia e os cuidados pos-operatorios

Reimplantacao de dedos - uma tecnica cirurgica especializada. / Reimplantation of fingers - a special surgical technique

Os autores relatam suas experiencias em reimplantacao de dedos. Eles descrevem e comentam as indicacoes, tecnicas cirurgicas principios de microcirurgia e os cuidados pos-operatorios. A microcirurgia vascular e nervosa e um ramo altamente especializado da cirurgia.Utiliza material ultrafiono e sofisticado com o auxilio do microscopio. A era da reimplantacao comecou com R. Malt (4) em 1962, obtendo exito na reimplantacao de um braco completamente seccionado. Nas amputacoes, medidas urgentes, sao necessarias, nao somente para assegurar sucesso na reimplantacao, bem como para torna-la possivel. O dedo, a mao ou parte amputada devera ser colocada "dentro de um saco plastico e depositado em um recipiente contendo gelo. (1). Fig 5. Na extremidade proximal, arterias e veias nao devem ser pincadas, "e necessario somente um curativo compressivo e elevar o membro, evitando hemorragias". O paciente devera ser encaminhado com urgencia ao servico especializado, para que possa ser iniciada a revascularizacao, no maximo, dentro de 10 horas seguintes ao traumatismo