Análise epidemiológica dos casos de úlcera de córnea no Hospital Regional de São José / Epidemiologic analysis of the cases of corneal ulcer at the Hospital Regional of São José

A úlcera de córnea é uma das principais causas de diminuição ou perda total da visão, sendo uma emergência oftalmológica que necessita de identificação e tratamento imediato. Este estudo objetiva analisar a magnitude do problema em nosso meio. Métodos: estudo misto com partes transversal e parte longitudinal prospectiva, onde foram analisados vinte e dois pacientes atendidos com a doença no Serviço de Oftalmologia do Hospital Regional São José Dr. Homero de Miranda Gomes, no período de maio de 1995 a julho de 1996. Resultados: observou-se um predomínio do sexo masculino (68,2%) e idade média de 46,36 (d ± 18,46 anos). A história de trauma estava presente em quatro (18,2%) casos e doze (54,5%) pacientes, sendo Staphylococcus SP o agente mais comumente isolado. Em um caso houve crescimento de fungo do gênero Fusarium SP. Conclusões: em vista do pequeno número de casos e da baixa positividade da cultura na amostra, não dá para determinar o agente mais freqüente na gênese da úlcera de córnea. O uso de colírios, principalmente anestésicos, usado por indicação de leigos, farmácias ou pelo próprio paciente, pode ter sido um fator determinante para a baixa positividade da cultura. Campanhas de esclarecimento, ou até mesmo proibição, no caso de colirios anestésicos, seriam necessárias visando, à saúde ocular da população...

The potent role of increased sympathetic tone in pathogenesis of essential hypertension with neurovascular compression.

OBJECTIVE: To study the role of increased sympathetic tone in pathogenesis of hypertension in patients with essential hypertension with neurovascular compression. METHODS: Twenty-three patients with essential hypertension, 13 patients with secondary hypertension, and 46 normotensive subjects were investigated. Neurovascular compression was evaluated by MRT. The power spectral components of heart rate variability as indices of autonomic nerve tone were determined to investigate the possibility that sympathetic tone mediates the neurovascular compression-induced increase in blood pressure. RESULTS: Neurovascular compression of the rostral ventrolateral medulla (RVLM) was observed in 70% of essential hypertension group, none of secondary hyperension group and 16% of normotensive group (P < 0.001). The age-adjusted low-frequency power spectral density (A-PSD) (0.04 to 0.15 Hz), which is an index of sympathetic tone, was significantly higher in patients with essential hypertension (139.5 +/- 6.7%) with neurovascular compression than in essential hypertension patients without neurovascular compression (92.2 +/- 6.8%), normotensive subjects with (102.8 +/- 13.0%) and without neurovascular compression (100.1 +/- 4.1%), and patients with secondary hypertension (95.7 +/- 10.2%) (P < 0.001). There was no significant difference in the high-frequency A-PSD (0.15 to 0.40 Hz), which is an index of vagal tone, among groups. CONCLUSIONS: Neurovascular compression was not always associated with an increase in sympathetic nerve tone. Hypertension was present in subjects with neurovascular compression, who had increased sympathetic tone but not in those with normal sympathetic tone. An increase in sympathetic tone may mediate the neurovascular compression-induced increase in blood pressure. Journal of Human Hypertension (2000) 14, 807-811

Noninvasive, continuous evaluation of peripheral vascular resistance in humans.

We sought a noninvasive alternative method of monitoring peripheral vascular resistance continuously in humans, based on the analysis of arterial pressure waveforms. Radial arterial pressure waveforms were recorded noninvasively with a tonometer and analysed using a neural network method. To test the accuracy of this method, the peripheral vascular resistance was also determined by an invasive thermodilution method using a Swan-Ganz catheter in 20 subjects. To test the method in a clinical application, peripheral vascular resistance was determined by the noninvasive method before and after administration of nifedipine in 6 patients with essential hypertension. Neural network analysis of waveforms reliably yielded values between 0.00 and 1.00. Peripheral vascular resistance determined by neural network analysis and according to the invasive method showed a significant (p< 0.005) positive linear correlation. The peripheral vascular resistance measured by neural network analysis showed a significant (p< 0.05) decrease 30 min after administration of nifedipine, paralleling a decrease in blood pressure. Neural network analysis of tonometric radial artery waveforms provides an accurate, noninvasive, and continuous index of peripheral vascular resistance in human subjects. This simple method should permit more extensive homodynamic studies and larger epidemiological surveys in contrast to those undertaken using invasive techniques.

An autopsy case of malignant lymphoma with Lyell's syndrome.

We present a case of fatal Lyell's syndrome which developed following a CT examination using omnipaque 3000 contrast medium. A 59-year-old man was suffering from malignant lymphoma. He was readmitted to this hospital due to relapse of fever and lymph node swelling. On the day of readmission, generalized erythema, purpura, and mucosal erosions developed after a CT examination. Steroids and chemotherapy were ineffective, and he expired approximately two weeks after admission. Drug-induced dermatopathy or leukemic cell infiltration in the skin was clinically suspected. Histological findings disclosed toxic epidermal necrolysis.

A case of double cancer: a squamous cell carcinoma arising from a long pierced site on the left earlobe and a solid tubular carcinoma of the left breast.

A 43-year-old woman presented with a well differentiated squamous cell carcinoma of the left earlobe where a small hole for pierced type earrings had been made about 20 years earlier. A year after the removal of the tumor, a metastasis of a moderately differentiated squamous cell carcinoma to the left cervical lymph nodes was detected. A month later, a solid tubular carcinoma of the left breast was found. A modified radical neck dissection and a quadrantectomy with an axillary lymph node dissection were performed. A total of 5 courses of peplomycine-mitomycine combinated therapy with 26 Gy of radiotherapy was administered for the cervical lesion. A month of postoperative chemotherapy with tegafur-uracil and medroxyprogesterone acetate and a total of 56 Gy of radiotherapy to the mammary lesion were added. She has been well without recurrence for about a year after the operations. This case is not only a rare double cancer, a combination of a squamous cell carcinoma and a solid tubular carcinoma, but may also be the first case of a squamous cell carcinoma arising at a long pierced site on an earlobe for pierced type earrings.

Thionamide therapy in Graves' disease: relation of relapse rate to duration of therapy.

The present study was undertaken to investigate whether there is a rational basis for the usual long periods of thionamide therapy in patients with hyperthyroid Graves' disease. Eighty untreated patients were given the minimum dose of thionamide drug needed to maintain serum thyroxine, triiodothyronine, and thyrotropin (TSH) concentrations within their normal ranges. Thyrotropin-releasing hormone (TRH) tests were done at 6 monthly intervals for 2 years. Among patients who had positive responses of TSH to TRH, approximately 10 patients every 6 months were asked to stop thionamide therapy and were followed up for at least 1 year after discontinuation of drugs. In the groups treated for 6, 12, 18, and 24 months, relapses occurred in nine of 13, five of nine, three of 12, and two of 11 patients, respectively. Values for thyroid function tests before and at the end of treatment were not different among these four groups of patients. The overall remission rates were not ascertained. However, a minimum of 1 year's treatment is recommended, at least in Japan.

Physiological changes in the treatment of acrophobia (fear of height).

In order to investigate the physiological changes produced by the treatment of acrophobic patients body movement and Microvibration were measured before and after treatment. Eighteen acrophobic patients were assigned at random to 1 of the 2 groups: a treatment group (n = 8) and a non-treatment group (n = 10). The control group consisted of 16 healthy volunteers. Body movement area while viewing a slide of a high place or imagining a high place in the treatment group decreased significantly after treatment. Body movement of the control group showed almost no changes, and that of the non-treatment group was situated between the above-mentioned 2 groups. Simple body movements of the acrophobic patients without any stimulation of height were bigger than those of the control subjects. MV pattern of the treatment group had a tendency to improve under psycho-therapy. Acrophobic patients had more abnormal MV patterns than the normal subjects.