Pyloric atresia and Down's syndrome: prenatal double bubble false sign. / Atresia pilórica y síndrome de Down: falso signo de la doble burbuja prenatal.

Pyloric atresia is a rare malformation, with an incidence of 1:100,000 live newborns. Male to female ratio is 1/1. Typically, it is an isolated malformation, with a good prognosis, but 20-40% of cases present epidermolysis bullosa, and to a lesser extent, multiple intestinal atresias. We present the case of a pre-term newborn prenatally diagnosed with polyhydramnios, duodenal atresia with "double bubble" sign, and suspected Down's syndrome, who eventually had pyloric atresia.

La atresia pilórica es una malformación rara, presenta una incidencia de 1:100.000 recién nacidos vivos y la ratio hombre/mujer es de 1/1. Generalmente es una malformación aislada, con buen pronóstico, pero entre el 20-40% de los casos se asocia a epidermólisis bullosa y en menor frecuencia a otras atresias intestinales múltiples. Presentamos un caso de recién nacido pretérmino con atresia pilórica con el diagnóstico prenatal de polihidramnios, atresia duodenal con signo de 'doble burbuja' y sospecha de síndrome de Down.

Atresia pilórica y síndrome de Down: falso signo de la doble burbuja prenatal / Pyloric atresia and Down’s syndrome: prenatal double bubble false sign

La atresia pilórica es una malformación rara, presenta una incidenciade 1:100.000 recién nacidos vivos y la ratio hombre/mujer es de 1/1.Generalmente es una malformación aislada, con buen pronóstico, peroentre el 20-40% de los casos se asocia a epidermólisis bullosa y enmenor frecuencia a otras atresias intestinales múltiples.Presentamos un caso de recién nacido pretérmino con atresia piló-rica con el diagnóstico prenatal de polihidramnios, atresia duodenal consigno de ‘doble burbuja’ y sospecha de síndrome de Down.(AU)

Objective. Pyloric atresia is a rare malformation, with an incidenceof 1:100,000 live newborns. Male to female ratio is 1/1. Typically, itis an isolated malformation, with a good prognosis, but 20-40% ofcases present epidermolysis bullosa, and to a lesser extent, multipleintestinal atresias.We present the case of a pre-term newborn prenatally diagnosedwith polyhydramnios, duodenal atresia with “double bubble” sign, andsuspected Down’s syndrome, who eventually had pyloric atresia.(AU)

[Meconium periorchitis prenatal diagnosis: review of the literature, about 3 cases]. / Periorquitis meconial diagnóstico prenatal: revisión de la literatura, a propósito de 3 casos.

OBJECTIVE: To assess the importance of prenatal ultrasound diagnosis of the fetus carrying meconium periorchitis and its predictive relevance for fetal monitoring and prognosis in the context of acute fetal intestinal disease. MATERIAL AND METHODS: Three male fetuses have been diagnosed of meconium periorchitis in our Unit of Fetal Medicine in the last 5 years. Their prenatal ultrasound diagnoses were: testicular tumor (n=1); Meconium periorchitis with acute fetal intestinal perforation (n=2). Gestational age at diagnosis was 33, 34 and 35 weeks. Ultrasound signs at diagnosis were: Increased size of scrotal zone, with hyperechogenic lesions inside and permanence of peritoneum-vaginal canal; at abdominal zone, echographic signs of intestinal disease with or without meconium peritonitis were found (hyperechogenic lesions, edema of intestinal loops and ascites). All three neonates were assessed postnatally by ultrasound and therapeutic indication. RESULTS: Fetal ultrasound findings influenced both evolution and termination of pregnancy. The diagnosis of meconium periorchitis was confirmed postnatally in all cases: in the 1st case, delivered at term, scrotal tumoral pathology was ruled out and did not require abdominal surgery; the other 2 patients were delivered at the same week of prenatal diagnosis and an inguinal-scrotal surgery with intestinal approach because of meconium peritonitis was performed. No patient underwent orchiectomy, maintaining the teste-epididymal binomial intact. CONCLUSION: Prenatal ultrasound diagnosis of meconium periorchitis requires a strict ultrasound follow-up of the fetus as it is a specific marker of intestinal perforation, which can lead to the termination of pregnancy and avoid appearance of complicated meconium peritonitis.

OBJETIVO: Evaluar la importancia del diagnóstico ecográfico prenatal del feto portador de periorquitis meconial y su relevancia predictiva del seguimiento y pronóstico fetal en el contexto de una enfermedad intestinal fetal aguda. MATERIAL Y METODOS: En los últimos 5 años en la Unidad de Medicina Fetal se han diagnosticado tres fetos varones de periorquitis meconial cuyos diagnósticos ecográficos prenatales fueron: tumor testicular (n=1); y periorquitis meconial con perforación intestinal aguda fetal (n=2). La edad gestacional al diagnóstico fue de 33, 34 y 35 semanas. Los signos ecográficos al diagnóstico fueron: a nivel escrotal, aumento del tamaño, lesiones hiperecogénicas y permanencia del conducto peritoneo-vaginal; a nivel abdominal pueden existir signos ecográficos de enfermedad intestinal con o sin peritonitis meconial (lesiones hiperecogénicas, edemas de asas y ascitis). Los tres neonatos fueron evaluados postnatalmente mediante ecografía comparativa de los hallazgos prenatales e indicación terapéutica. RESULTADOS: Los hallazgos ecográficos fetales influyeron en la evolución y finalización de la gestación. El diagnóstico de periorquitis meconial fue confirmado postnatalmente en los tres casos: en el 1er caso a término, se descartó patología tumoral escrotal y no requirió cirugía abdominal; en los otros dos pacientes se indicó finalizar la gestación tras el diagnóstico prenatal y se realizó cirugía inguino-escrotal y abordaje intestinal por la peritonitis meconial. CONCLUSION: El diagnóstico ecográfico prenatal de periorquitis meconial obliga a un seguimiento ecográfico estricto del feto al ser un marcador específico de perforación intestinal, que puede conllevar la finalización de la gestación y evitar la aparición de una peritonitis meconial complicada.

Hemophagocytic syndrome secondary to tuberculosis at 24-week gestation.

Hemophagocytic syndrome is a life-threatening disease characterized by the uncontrolled activation of macrophages, resulting in hemophagocytosis of blood cells in the bone marrow. A 20-year-old gravida at 23-week and 5-day gestation was admitted to hospital to evaluate fever up to 104°F of unknown origin, moderate cytopenia, and elevated levels of liver enzymes. Bone marrow biopsy confirmed hemophagocytic syndrome, and polymerase chain reaction came back positive for Mycobacterium tuberculosis. Supportive care and tuberculosis treatment resulted in clinical improvement. At 27 weeks and 5 days, premature rupture of the membranes occurred, and because of the high probability of reactivating the hemophagocytic syndrome, a cesarean section was performed at 29-week and 2-day gestation. Hemophagocytic syndrome is an uncommon disease which rarely appears during pregnancy. Early diagnosis and treatment can save both maternal and fetal lives.

[Benefits of spironolactone as the optimal treatment for drug resistant hypertension. Pathway-2 trial review]. / Utilidad de la espironolactona en el manejo farmacológico de la hipertensión arterial resistente. Comentarios sobre el estudio Pathway-2.

Pathway-2 is the first randomised, double-blind and crossover trial that compares spironolactone as a fourth drug with alfa-blocker, beta-blocker and placebo. This study shows that spironolactone is the drug with more possibilities of success for the management of patients with difficult-to-treat hypertension in patients with a combination of three drugs and poor control. The results validate the widespread treatment with mineralocorticoid receptor antagonists in resistant hypertension.

Comparison of the larvicidal efficacies of moxidectin or a five-day regimen of fenbendazole in horses harboring cyathostomin populations resistant to the adulticidal dosage of fenbendazole.

Despite widespread acknowledgement of cyathostomin resistance to adult icidal dosages of benzimidazole (BZD) anthelmintics, many strongyle control programs continue to feature regularly scheduled larvicidal treatment with fenbendazole (FBZ). However, no studies have been conducted to evaluate the efficacy of larvicidal regimens against encysted cyathostomins in a BZD-resistant (BZD-R) population. A masked, randomized, controlled clinical study was conducted with 18 juvenile horses harboring populations of cyathostomins that were considered BZD-R on the basis of fecal egg count reduction (FECR). Horses were blocked by prior history, ranked by egg counts, and allocated randomly to one of three treatment groups: 1--control, 2--FBZ >10mg/kg once daily for five consecutive days, or 3--moxidectin (MOX) >0.4 mg/kg once. Fecal samples were collected prior to treatment and seven and 14 days after the final dose of anthelmintic. On Days 18-20, complete replicates of horses were euthanatized and necropsied, and 1% aliquots of large intestinal contents were recovered for determination of complete worm counts. The cecum and ventral colon were weighed, and measured proportions of the respective organ walls were processed for quantitation and characterization of encysted cyathostomin populations. The five-day regimen of FBZ achieved 44.6% fecal egg count reduction, had 56.4% activity against luminal adults and larvae, and was 38.6% and 71.2% effective against encysted early third stage (EL3) and late third stage/ fourth stage (LL3/L4) cyathostomin larvae, respectively. In contrast, MOX provided 99.9% FECR, removed 99.8% of luminal stages, and exhibited 63.6% and 85.2% efficacy against EL3 and LL3/L4 mucosal cyathostomins, respectively. Although BZD-R was the most feasible explanation for the lower larvicidal efficacies of FBZ, mean larval counts of moxidectin-treated horses were not significantly different from controls or those treated with FBZ. The lack of significant differences between larvicidal treatments was partially attributed to a small sample size and high variability among worm burdens. Historical differences in the time intervals between treatment and necropsy were identified as a confounding factor for accurate estimation of larvicidal efficacy. Determining appropriate post-treatment intervals for measuring larvicidal efficacy remains a critical regulatory and scientific challenge for this therapeutic area.

Effects of daily pyrantel tartrate on strongylid population dynamics and performance parameters of young horses repeatedly infected with cyathostomins and Strongylus vulgaris.

Strongylid infections are ubiquitous in grazing horse populations. Infections with cyathostomin (small strongyle) and strongylin (large strongyle) nematodes have long been associated with clinical disease in horses, but little is known about their subclinical impact. A masked, randomized, controlled study was conducted to evaluate the effects of daily administration of pyrantel tartrate on body condition scores, weight gain, fecal egg counts, and total worm counts of young horses repeatedly inoculated with strongylid larvae. Twenty eight immature horses were treated with larvicidal anthelmintic regimens and randomly allocated to two groups. Group 1 horses were given a pelleted placebo product once daily, and those in Group 2 received pyrantel tartrate once daily at ∼ 2.64 mg/kg body weight. On five days during each week, ∼ 5000 infective cyathostomin larvae were administered to each horse. In addition, horses received ∼ 25 infective Strongylus vulgaris larvae once weekly. Horses were maintained on pasture for 154 days and had ad libitum access to grass hay throughout. At approximate, 14-day intervals, body weights were measured, body condition scores were assigned, fecal samples were collected for egg counts, and blood samples were collected for measurement of S. vulgaris antibodies and various physiologic parameters. After 22 weeks at pasture and 14-17 days in confinement, horses were euthanatized and necropsied. Nematodes were recovered and counted from aliquots of organ contents, representative samples of large intestinal mucosa, and the root of the cranial mesenteric artery. Daily treatment with pyrantel tartrate at the recommended dosage significantly reduced numbers of adult cyathostomins in the gut lumen and early third-stage larvae in the cecal mucosa, increased the proportions of fourth-stage larvae in the gut contents, and was accompanied by significant improvements in body condition scores. Fecal egg counts of horses receiving daily pyrantel tartrate were significantly reduced, with percentages of efficacy ranging from 84.4% to 98.9%, but egg counts of both groups increased significantly over the course of the study. Treatment also significantly reduced the numbers of S. vulgaris larvae in the cranial mesenteric artery by 99.2%. Serum antibodies to S. vulgaris apparently persisted from pre-enrollment infections, but ELISA values gradually declined over the course of the study. This study has provided useful insights into the effects of daily pyrantel tartrate on the dynamics of cyathostomin infection, and into some subclinical effects of strongylid parasitism in horses.

Efficacy of domperidone gel in an induced model of fescue toxicosis in periparturient mares.

The objective was to evaluate the efficacy of domperidone in the prevention of reproductive complications of fescue toxicosis in periparturient mares. Pregnant mares at ≤310 days of gestation were fed ≥200 µg ergovaline per kg diet daily in endophyte-infected fescue hay and seed, starting ≥30 days before their expected foaling date (EFD: 340 days after breeding). Thirty-five mares were randomized to a treatment group to receive either domperidone gel (n = 20, 1.1 mg/kg, PO, once daily) or placebo (n = 15). Treatment was initiated 10 to 15 days before the EFD and continued for 5 days after foaling. "Treatment success" was defined as foaling within 14 days of the EFD, adequate mammary development on the day of foaling, and adequate lactation for 5 days postpartum. Twenty-seven mares were included in the effectiveness analysis. More mares in the domperidone group (12/13, P < 0.0001) were treatment successes than in the control group (1/14). Gestation length was shorter (P = 0.0011), and lactation at foaling (P = 0.0011) was better for the domperidone-group mares. Foals from two control mares were born dead and four others died or were euthanized within a few days after birth, compared with one foal death (an autolyzed twin) from a domperidone-treated mare. Plasma IgG concentrations were evaluated in 24 foals. Failure of passive transfer of immunoglobulins (IgG <800 mg/dL) occurred in 13/16 (81%) foals of domperidone-group mares and 7/8 (88%) foals of control mares. In conclusion, the reproductive complications of fescue toxicosis in periparturient mares induced by a fescue seed/hay model were prevented by treatment with domperidone.

Enhanced protection by melatonin and meloxicam combination in experimental infection by Trypanosoma cruzi.

The aim of this study was to evaluate a possible synergism between melatonin and meloxicam in up-regulating the immune response in male Wistar rats infected with Trypanosoma cruzi during immunosuppression phenomenon, which characterizes the acute phase of the Chagas' disease. Male Wistar rats were infected with the Y strain of T. cruzi. Experiments were performed on 7, 14 and 21 days post-infection. Several immunological parameters were evaluated including gamma-interferon (IFN-gamma), interleukin-2 (IL-2), nitric oxide (NO) and prostaglandin E(2) (PGE(2)). The combined treatment with melatonin and meloxicam significantly enhanced the release of IL-2 and INF-gamma into animals' serum, when compared with the infected control groups during the course of infection. Furthermore, the blockade of PGE(2) synthesis and the increased release of NO by macrophage cells from T. cruzi-infected animals contributed to regulate the production of Th1 subset cytokines significantly reducing the parasitaemia in animals treated with the combination of both substances. Therefore, our results suggest that the association of melatonin and meloxicam was more effective in protecting animals against the harmful actions of T. cruzi infection as compared with the treatments of meloxicam or melatonin alone.

Histopathological changes in the placentas and fetuses of mice infected with Trypanosoma cruzi isolated from the Myotis nigricans nigricans bat.

Histopathological changes and placental transmission were studied in the late stages of pregnancy in mice infected with a strain of Trypanosoma cruzi, isolated from a Myotis nigricans nigricans bat. Large amastigote nests were observed in uterine muscles, as well as in decidual and endothelial placental cells. In addition, persistent coagulative and fibrotic vascular degeneration was observed. Large amastigote burdens were found in giant cells, spongioblasts and endothelial cells within the labyrinthine layer. Transplacental transmission was confirmed in 30% of the fetuses examined, in which amastigote nests were seen only in striated muscle. During the acute phase, intrauterine development was impaired as the result of parasitic invasion of the placenta, and fetal mortality rose to 10%.

Validity of four indirect methods to measure adherence in primary care hypertensives.

High blood pressure (HBP) is one of the most important risk factors for morbidity and mortality in the world. Non-adherence to medication is associated with the lack of control of HBP. The objective of this study was to assess the validity of four indirect methods for measuring adherence to medication to control HBP in primary health care. A random sample of 120 hypertensive patients who were undergoing treatment for at least 2 months in a primary care unit in Florianópolis (Brazil) were included in the study. The independent variables were four indirect methods to measure adherence to medication: knowledge regarding the HBP medication, the blood pressure level, attitude regarding the medication intake (Morisky-Green test) and self-reported adherence. The classification of HBP was based on criteria established by the Brazilian Ministry of Health. The gold standard used for measuring adherence was the pill count. Logistic regression was used to estimate sensitivity (highest value of 88.2% for self-report), specificity (highest value of 70.7% for HBP control), positive predictive value (highest value of 46.4% for HBP control) and negative predictive value (highest value of 79.1% for Morisky-Green test) for each of the indirect methods. No indirect method of measuring adherence had a good positive predictive value for adherence, which was best predicted by patients' age and whether they managed to control HBP. The results also revealed low treatment adherence (31.2%) and low control of HBP (37.6%). Non-adherence was mainly associated with side effects of the treatment.

Haematological and histopathological findings after ovariectomy in Trypanosoma cruzi infected mice.

The aim of this study was to investigate the influences of ovariectomy on histopathological and hematological parameters during the course of Trypanosoma cruzi infection. Hematological and immunological homeostasis is influenced by gonadal steroid hormones. Ovariectomy exerts profound influences on parasitic diseases including T. cruzi infection through modulation of the host's immune response. Three groups of female Mus musculus were infected with 4000 blood trypomastigotes of the Y strain of T. cruzi. One group was subjected to ovariectomy, another to simulated surgery before the infection, and a third group of unoperated animals were used as controls. Marked differences were detected in the responses of blood and tissue parasites. On day 9, post-infection parasitism was significantly higher in ovariectomized animals (P<0.05). These results were confirmed by histopathological studies, in which ovariectomized animals displayed hearts with higher number of amastigote burdens, increased inflammatory infiltrate, enhanced tissue fibers disorganization and decreased lytic antibody percentage, when compared to their counterparts. On day 9 the hematological changes were more apparent, with a decrease in erythrocytes, platelets and leucocytes for ovariectomized infected animals. Simulated surgery, as a stressful agent, did not cause any imbalance in parasitism or in the hemogram profile. The results confirm the importance of the female steroids in resistance against T. cruzi infection.

Estrogen and progesterone receptors in human papilloma virus-related cervical neoplasia

Estrogen (ER) and progesterone (PR) receptors in the normal uterine cervix, cervical intraepithelial neoplasia and invasive carcinoma were studied in consecutive samples from Hospital do Câncer, São Paulo, between 1996 and 1997. Tissue was collected by removing a fragment of the tumoral area using a 5-mm diameter biopsy punch, followed by removal of a macroscopically normal area as close as possible from the tumor. Histopathological confirmation was obtained for all specimens analyzed. A total of 24 normal tissues, 17 cases of cervical intraepithelial neoplasia and 7 of invasive carcinomas were studied. The ER/PR ratio was determined by immunohistochemistry using monoclonal antibodies specific for each receptor. Adjacent tissue slides were submitted to generic PCR for human papillomavirus (HPV) DNA detection followed by typing by dot blot hybridization. About half (45.8 percent) of the tumors were HPV DNA positive while 29.1 percent of the patients were also HPV positive in their respective normal tissue. ER was negative in the tumoral epithelium of 11 HPV-positive patients (P = 0.04). There was a trend in the ER distribution in normal tissue that was opposite to that from lesions, but it was not statistically significant (P = 0.069). No difference in ER distribution in stromal tissues was observed between HPV-positive and HPV-negative tissues. PR staining was negative in the epithelium of all cases studied. The results obtained from this small number of cases cannot be considered to be conclusive but do suggest that factors related to viral infection affect the expression of these ER/PR cervix receptors.

Estrogen and progesterone receptors in human papilloma virus-related cervical neoplasia.

Estrogen (ER) and progesterone (PR) receptors in the normal uterine cervix, cervical intraepithelial neoplasia and invasive carcinoma were studied in consecutive samples from Hospital do Cáncer, São Paulo, between 1996 and 1997. Tissue was collected by removing a fragment of the tumoral area using a 5-mm diameter biopsy punch, followed by removal of a macroscopically normal area as close as possible from the tumor. Histopathological confirmation was obtained for all specimens analyzed. A total of 24 normal tissues, 17 cases of cervical intraepithelial neoplasia and 7 of invasive carcinomas were studied. The ER/PR ratio was determined by immunohistochemistry using monoclonal antibodies specific for each receptor. Adjacent tissue slides were submitted to generic PCR for human papillomavirus (HPV) DNA detection followed by typing by dot blot hybridization. About half (45.8%) of the tumors were HPV DNA positive while 29.1% of the patients were also HPV positive in their respective normal tissue. ER was negative in the tumoral epithelium of 11 HPV-positive patients (P=0.04). There was a trend in the ER distribution in normal tissue that was opposite to that from lesions, but it was not statistically significant (P=0.069). No difference in ER distribution in stromal tissues was observed between HPV-positive and HPV-negative tissues. PR staining was negative in the epithelium of all cases studied. The results obtained from this small number of cases cannot be considered to be conclusive but do suggest that factors related to viral infection affect the expression of these ER/PR cervix receptors.

Lafoensia pacari extract inhibits IL-5 production in toxocariasis.

Toxocariasis is an infection induced by Toxocara canis, an intestinal parasite of dogs. In this study, an experimental murine model of toxocariasis was used to evaluate the anti-inflammatory activity of an ethanolic extract of Lafoensia pacari stem bark. Mice infected with T. canis were treated with L. pacari extract (200 mg/kg, p.o.). Subsequently, we observed a reduction in the number of eosinophils in the peritoneal cavity, bronchoalveolar fluid, blood and bone marrow. Production of interleukin (IL)-5, a major cytokine involved in eosinophilic differentiation, proliferation and activation, is also an important marker for infection. The reduced levels of IL-5 observed in serum, lung homogenates and bronchoalveolar fluid demonstrated the anti-inflammatory mechanisms of L. pacari. Larvae recovery from infected mice treated with L. pacari was comparable with that from untreated mice, suggesting that L. pacari is not toxic to the parasite. Nonetheless, our results demonstrate a potential therapeutic effect of L. pacari extract in IL-5-mediated inflammatory diseases and provide new prospects for the development of drugs to treat IL-5-dependent allergic diseases such as parasite infection and asthma.

Molecular genetic characterization of different Trypanosoma cruzi strains and comparison of their development in Mus musculus and Calomys callosus.

Trypanosoma cruzi populations are characterized by diverse morphology, heterogeneous biological behavior, high genetic variability, and distinctly different clinical courses. The first objective of this work was to characterize different strains of T. cruzi with various molecular markers [simple-sequence-repeat PCR, randomly amplified polymorphic DNA (RAPD)-PCR, mini-exon genes]. All examined strains could be divided into two major lineages. Only one strain showed a different banding pattern in RAPD-PCR, which could be a further indication of the existence of a third lineage. The second aim was to examine the biological behavior of the different strains. Two animal models, Calomys callosus and Mus musculus, were infected. The results provide strong evidence that the biological behavior of the strains is not only lineage-specific. It appears that all factors, such as the infecting strain belonging to a certain lineage, the predominant morphological form of the isolate, and the immune response of the respective infected host, play an important role in the course of this infection.

Cervical coinfection with human papillomavirus (HPV) types as a predictor of acquisition and persistence of HPV infection.

Interest in coinfection with multiple types of human papillomavirus (HPV) has increased in response to the possibility of vaccination and the discovery that the host immune response appears to be mainly type specific. This study attempts to document the occurrence of coinfection with multiple HPV types and to determine whether these coinfections predicted acquisition or persistence of other HPV types in a prospective cohort of women in Brazil. Multiple HPV types were detected at the same visit in one-fifth of all women who tested positive for HPV at any time. Acquisition of an HPV infection was more likely among women with any HPV type detected on study entry. Persistence of HPV infection, the true precursor of cervical abnormalities, was independent of coinfection with other HPV types. Given the increasing prominence of HPV vaccination as a potential preventive approach, it is imperative that additional insights on cross-type protection be obtained from longer-term longitudinal investigations.

Influence of male gonadal hormones on the parasitemia and humoral response of male Calomys callosus infected with the Y strain of Trypanosoma cruzi.

Effects of orchiectomy on male Calomys callosus infected with the Y strain of Trypanosoma cruzi were studied. Male C. callosus of the same age and weight were divided into three groups: intact, sham operated, and castrated. After 1 month they were inoculated (i.p.) with 4000 blood trypomastigotes. Parasitemia was lower in orchiectomized animals than in the intact and sham groups. Hormone replacement with decanoate testosterone raised the parasitemia of castrated animals to levels similar to those of their intact and sham counterparts. Antibody levels were monitored by complement-mediated lysis. The trypomastigote lysis percentage varied through the course of infection, according to hormonal status and number of parasites during the acute phase. The most significant differences were found on the 30th day after infection, when lytic antibodies of intact males were high compared to the orchiectomized and sham groups. Higher resistance with lower lysis indexes were observed after orchiectomy, compared to intact and sham males.

Fraturas do terço distal do rádio na criança / Fractures of the distal third of the radium in children

As fraturas do antebraço na criança são freqüentes e, dentre estas, as mais comuns são as que acometem seu terço distal. De evolução normalmente favorável, poucos cuidados demandam além da correta imobilização, que pode ser ou não precedida de redução. Algumas vezes, no entanto, podem sofrer uma deformidade dorsal t¡pica, que, dependendo do grau de angulação volar, leva à indicação de procedimentos corretivos sob anestesia, como a caloclasia e redução, ou a redução aberta ou fechada seguida de fixação. Os autores discutem os mais conhecidos fatores causais relacionados com o aparecimento do desvio dorsal e sugerem a poss¡vel influência mecânica do comprimento relativo da ulna em relação ao rádio, com especial enfoque à articulação radioulnar distal. Recomendam maior atenção nas fraturas do terço distal do antebraço, especialmente nas fraturas "isoladas" do rádio nos pacientes portadores da variante ulna minus, em que permanece ¡ntegra a articulação radioulnar distal.