Erythrityl tetranitrate: sustained effects on systolic time intervals. changes consistent with sustained preload reduction.

The effects of sustained preload reduction have been demonstrated for several nitrates but not for erythrityl titranitrate. In seven patients with coronary heart disease, a randomized double-blind crossover clinical trial showed that chewable erthrityl tetranitrate, 10 mg, produced significant changes in systolic time intervals consistent with preload reduction and lasting for at least four hours. As compared with placebo, ejection time index (ETI) fell and remained significantly low between 6 and 90 minutes after administration, and pre-ejection period (PEP), isovolumic contraction time IVCT), and pre-ejection period/left ventricular ejection time (PEP/LVET) rose and remained significantly increased between 22 minutes and the four-hour endpoint. We conclude that erythrityl tetranitrate is a physiologically effective long-acting agents in patients with coronary heart disease.

Case report: reactive hemophagocytic syndrome associated with disseminated strongyloidiasis.

The reactive hemophagocytic syndrome is a condition characterized by systemic proliferation of benign hemophagocytic histiocytes, fever, cytopenia, abnormal liver function, and frequently coagulopathy and hepatosplenomegaly. Its occurrence has been documented in association with viral, bacterial, fungal and parasitic infections; a wide spectrum of malignant neoplasms; some miscellaneous disorders; and phenytoin. Disseminated strongyloidiasis is reported in a patients with systemic lupus erythematosus treated with corticosteroids in whom a reactive hemophagocytic syndrome developed and who finally died. This reactive hemophagocytic syndrome is reported for the first time in strongyloidiasis and may not have been recognized in former patients.

[Ovarian abscess due to Actinomyces sp. in absence of an intrauterine contraceptive device]. / Absceso ovárico por Actinomyces sp. en ausencia de un dispositivo intrauterino.

The disease caused by Actinomyces spp. is often of difficult diagnosis. Actinomyces spp. are anaerobic or microaerophilic non-spore-forming gram-positive rods that may reach, occasionally, the normal female genital tract. IUD and pessaries facilitate the access of the microorganisms to the pelvis. We report an unusual case of ovarian infection by Actinomyces sp. in a 41 year-old female without IUD, admitted at the Institute in November 1998, with persistent fever. She had had an early menopause 3 years before, and had received hormonal replacement therapy. Usual and unusual infections were discarded by microbiological and serologic studies. Abdominal ultrasonography showed a slight left pyelocalycial dilatation and a simple cyst in the left ovary; heart ultrasonography was normal. Gynecological examination showed an enlarged uterus, similar to an 8 week pregnancy, painless, and fixed anexial masses. The transvaginal ultrasonography showed uterine myomas, one of them of 42 mm in the isthmus region, large ovaries, cystic, with acoustic shadows, and the left one with a septum. The preoperative diagnosis was infected bilateral cystic teratoma. The procedure was an exploratory laparotomy, followed by a bilateral salpingo-oophorectomy. The specimen studies showed an endometrioma with calcium deposits in the wall of the right ovary, and an abscess in the left ovary, also with calcification of the wall. The sample from the left abscess developed Actinomyces sp. After surgery, and treatment with penicillin, the fever disappeared. It is important to remark that the ovarian infection by Actinomyces sp. can also occur in patients without an IUD or a pessary; it might cause anexial images that can be interpreted as a tumour, inducing to erroneous diagnosis and treatment.

Incidencia de ocorrencias diversas na Maternidade Prof. Monteiro de Moraes no ano de 1979. / Incidence of various occurences at the Maternity Prof Monteiro de Moraes in the year 1979

Houve 8.172 internamentos na Maternidade Prof. Monteiro de Moraes no ano de 1979.Destes, 6305 foram partos, dos quais, 935 cesareas. Houve 1.230 abortamentos correspondendo tal cifra a 19,5% do numero total de partos. Nos 6.305 partos havidos foram identificadas as seguintes ocorrencias obstetricas com os respectivos percentuais gravidez serotina 464 (7,4%); macrossomia fetal 364 (5,8%); eclampsia 33 (0,5%); apresentacao pelvica 202 (3,2%); descolamento prematuro da placenta normalmente inserida 53 (0,8%); placenta previa 43 (0,7%); rotura de utero 6 (0,09%); infeccao puerperal 113 (1,8%); parto gemelar 63 (1,0%) e 16 casos de prenhez ectopica representando 0,2% do total de gravidezes. O obituario materno foi de 14,87% e o perinatal 40%