Can lumbar hemorrhagic synovial cyst cause acute radicular compression? Case report.

Lumbar synovial cysts are an uncommon cause of back pain and radiculopathy, usually manifesting with gradual onset of symptoms, secondary to involvement of the spinal canal. Rarely, intracyst hemorrhage occurs, and may acutely present as radicular - or even spinal cord - compression syndrome. Synovial cysts are generally associated with degenerative facets, although the pathogenesis has not been entirely established. We report a case of bleeding complication in a synovial cyst at L2-L3, adjacent to the right interfacet joint, causing acute pain and radiculopathy in a patient on anticoagulation therapy who required surgical resection.

Does Lip-Repositioning Surgery Improve Long-Term Smile Outcome and Dental Esthetics in Patients With Excessive Gingival Display? A Review of the Current Literature.

Focused Clinical Question: In patients with normal crown dimensions and excessive gingival display, does lip-repositioning surgery improve long-term smile outcome and dental esthetics? Clinical Scenario: A 27-year-old systemically healthy female presents with the chief complaint of "excessive gingival display when smiling" (Fig. 1). She reports that orthodontic treatment was performed and that she was referred for orthognathic surgery to correct the maxillary vertical excess and altered passive eruption. Clinically, the patient is periodontally healthy with favorable long-term periodontal prognosis. She is unsatisfied with her smile and states that it is "compromising her self-esteem." However, she refuses to accept the orthognathic surgery because of the extensiveness and morbidity of the procedure. She inquires about alternative solutions for her esthetic problem and whether it is possible to solve her gummy smile with a less invasive procedure. Lip-repositioning and anatomic crown-lengthening surgeries are presented as treatment options. The patient decides to pursue these treatment options. Lip-repositioning surgery is performed as described by Rosenblatt and Simon1 and Simon et al.,2 and healing is uneventful. Anatomic crown lengthening is performed 6 months after the previous surgery. The patient is pleased with the reduction of the excessive gingival display after these procedures (Fig. 2). However, there is lack of clinical evidence regarding the long-term stability of this surgical procedure.

Impact of screening and monitoring of capillary blood glucose in the detection of hyperglycemia and hypoglycemia in non-critical inpatients.

OBJECTIVE: To evaluate the impact of screening hyper and hypoglycemia measured by capillary glycemia and standard monitorization of hyperglycemic patients hospitalized in regular care units of Hospital Israelita Albert Einstein. METHODS: The capillary glycemia was measured by the Precision PCx (Abbott) glucosimeter, using the PrecisionWeb (Abbott) software. The detection of hyper and hypoglycemia during the months of May/June were compared to those of March/April in 2009 and to the frequency of the diagnosis of diabetes in 2007. RESULTS: There was an increase in the glycemia screening from 27.7 to 77.5% of hospitalized patients (p < 0.001), of hyperglycemia detection (from 9.3 to 12.2%; p < 0.001) and of hypoglycemia (from 1.5 to 3.3%; p < 0.001) during the months of May/June 2009. According to this action 14 patients for each additional case of hyperglycemia and 26 cases for each case of hypoglycemia were identified. The detection of hyperglycemia was significantly higher (p < 0.001) than the frequency of registered diagnosis related do diabetes in the year of 2007. CONCLUSIONS: the adoption of an institutional program of glycemia monitorization improves the detection of hyper and hypoglycemia and glycemia control in hospitalized patients in regular care units.

Can lumbar hemorrhagic synovial cyst cause acute radicular compression? Case report / O cisto sinovial hemorrágico lombar pode causar compressão radicular aguda? Relato de caso

Lumbar synovial cysts are an uncommon cause of back pain and radiculopathy, usually manifesting with gradual onset of symptoms, secondary to involvement of the spinal canal. Rarely, intracyst hemorrhage occurs, and may acutely present as radicular - or even spinal cord - compression syndrome. Synovial cysts are generally associated with degenerative facets, although the pathogenesis has not been entirely established. We report a case of bleeding complication in a synovial cyst at L2-L3, adjacent to the right interfacet joint, causing acute pain and radiculopathy in a patient on anticoagulation therapy who required surgical resection.

Cistos sinoviais da coluna lombar são uma causa incomum de dor na coluna e radiculopatia, geralmente com evolução gradual dos sintomas, que são secundários ao comprometimento do canal vertebral. Raramente, há hemorragia intracística, que pode se manifestar de forma aguda com síndrome compressiva radicular ou mesmo medular. Habitualmente, os cistos sinoviais associam-se a doença degenerativa facetária, embora a patogênese não esteja completamente estabelecida. Relatamos aqui um caso em que uma complicação hemorrágica em um cisto sinovial no nível L2-L3, adjacente à interfacetária direita, causou dor lombar e radiculopatia em um paciente em terapia anticoagulante, sendo necessária a ressecção cirúrgica.

In vivo human electrochemical properties of a NiTi-based alloy (Nitinol) used for minimally invasive implants.

The development of a homemade device for in vivo human determination of the open circuit potential (OCP) of Nitinol is described. Pseudo-reference electrodes (316L stainless steel and Pt) were initially tested and validated in vitro using simulated body fluids. As judged from the excellent electrochemical responses in terms of both accuracy and precision, the most ideal system comprised the combination of sterilized Pt (pseudo-reference) and Nitinol (working) needle-shaped electrodes. The average in vivo human OCP determined from independent measurements on six human patients with indication of direct arterial surgery was -0.334 +/- 0.030 V/SCE. This value was in good agreement with data recorded in vitro using simulated body fluids (-0.313 +/- 0.003 V/SCE in AFNOR S90-701 artificial saliva; -0.334 +/- 0.001 V/SCE in artificial urine; -0.239 +/- 0.007 V/SCE in Ringer's solution). The thin surface film protecting the bulk NiTi alloy is therefore not susceptible to active dissolution at rest as long as the break down potentials (>>0.0 V/SCE) so far reported are well above OCP measured in this study. These results highlight the importance of evaluating the corrosion resistance of Nitinol under realistic conditions (mechanical loads, wear and fatigue) in order to establish multifaceted mechanisms that might lead to accelerated dissolution and failure of implanted stents.

Impact of screening and monitoring of capillary blood glucose in the detection of hyperglycemia and hypoglycemia in non-critical inpatients / Impacto do rastreamento e monitoramento de glicemia capilar na detecção de hiperglicemia e hipoglicemia em pacientes não graves internados

Objective: To evaluate the impact of screening hyper and hypoglycemia measured by capillary glycemia and standard monitorization of hyperglycemic patients hospitalized in regular care units of Hospital Israelita Albert Einstein. Methods: The capillary glycemia was measured by the Precision PCx (Abbott) glucosimeter, using the PrecisionWeb (Abbott) software. The detection of hyper and hypoglycemia during the months of May/June were compared to those of March/April in 2009 and to the frequency of the diagnosis of diabetes in 2007. Results: There was an increase in the glycemia screening from 27.7 to 77.5% of hospitalized patients (p < 0.001), of hyperglycemia detection (from 9.3 to 12.2%; p < 0.001) and of hypoglycemia (from 1.5 to 3.3%; p < 0.001) during the months of May/June 2009. According to this action 14 patients for each additional case of hyperglycemia and 26 cases for each case of hypoglycemia were identified. The detection of hyperglycemia was significantly higher (p < 0.001) than the frequency of registered diagnosis related do diabetes in the year of 2007. Conclusions: the adoption of an institutional program of glycemia monitorization improves the detection of hyper and hypoglycemia and glycemia control in hospitalized patients in regular care units.

Objetivo: Analisar o impacto do rastreamento de hiper e hipoglicemia mensurada por glicemia capilar e da monitorização padronizada em pacientes hiperglicêmicos internados em unidades não graves do Hospital Israelita Albert Einstein. Métodos: A glicemia capilar foi mensurada com glucosímetro Precision PCx (Abbott), rastreada com software PrecisionWeb (Abbott). A detecção de hiper e hipoglicemia no bimestre Maio/Junho foi comparada ao bimestre Março/Abril de 2009 e ainda quanto à frequência de diagnósticos relacionados ao diabetes no ano de 2007. Resultados: Houve um aumento do rastreamento de glicemia de 27,7 para 77,5% dos pacientes internados (p < 0,001), na detecção de hiperglicemia (de 9,3 para 12,2%; p < 0,001) e de hipoglicemia (de 1,5 para 3,3%; p < 0,001) no bimestre Maio-Junho de 2009. Com essa iniciativa, foram rastreados 14 pacientes para cada caso adicional de hiperglicemia e 26 pacientes para cada caso de hipoglicemia. A detecção de hiperglicemia foi significantemente maior (p < 0,001) que a frequência de registros de diagnósticos relacionados ao diabetes no ano de 2007. Conclusões: a adoção de um programa institucional de monitoramento de glicemia melhora a detecção de hiper e hipoglicemia e o controle de glicemia em pacientes internados em unidades não graves.

A lovastatina no tratamento da hipercolesterolemia em portadores de diabete näo dependente de insulina / Lovastatin for the Treatment of Hypercholesterolemia in Non-insulin Dependent Diabetic Patients

Objetivo - Avaliar os efeitos da lovastatina como agente capaz de corrigir as anormalidade do perfil lipídico do plasma em pacientes diabéticos näo dependentes de insulina (NIDDM) e portadores de hipercolesterolemia. Métodos - Foram estudados 20 pacientes NIDDM nos quais se diagnosticou hipercolesterolemia, definida como a ocorrência de níveis de LDL-colesterol superiores a 160mg/dl, em pacientes do sexo feminino, e acima de 130mg/dl em pacientes do sexo masculino, ou em mulheres portadoras de qualquer outro fator de risco para doença coronariana. Dos 20 pacientes incluídos, 18 eram hipertensos que foram admintidos no estudo após terem substituído a terapêutica com ß-bloqueadores ou diurêticos por inibidores da enzima conversora ou bloqueadores dos canais de cálcio. O tratamento consistiu na administraçäo de lovastatina por um período de 24 semanas. A dose diária inicial de 20mg era elevada para 40mg, após 6 semanas de uso da droga, caso os níveis de LDL-colesterol se mantivessem acima de 130mg/dl. Resultados - A lovastatina na dose diária de 20mg (9 pacientes) ou 40mg (11 pacientes), reduziu os níveis séricos de LDL-colesterol e do colesterol total em 30// e 21// respectivamente, enquanto os níveis de HDL-colesterol e triglicérides permaneceram inalterados. A medicaçäo foi bem tolerada e nenhum paciente apresentou alteraçöes nos níveis séricos das transaminases ou bilirrubinas. Em 9 dos pacientes estudados houve elevaçäo dos níveis séricos da fosfatase alcalina, sendo que a média do grupo todo se elevou de 109 ñ 59 para 188 ñ 60mµ (p < 0,05), sendo esta a única alteraçäo laboratorial observada, näo associada a qualquer manifestaçäo clínica. Conclusäo - Em NIDDM a lovastatina se mostrou eficiente para promover reduçöes nos níveis séricos do colesterol total e do LDL-colesterol. Embora se desconheça o real significado da elevaçäo nos níveis séricos da fosfatase alcalina, recomendamos, nessa condiçäo, a suspensäo da terapia com essa droga

Purpose- To evaluate the effects of lovastatin as an hypocholesterolemic agent in non-insulin dependent diabetic (NIDDM) patients with high cholesterol plasma levels. Methods - Twenty NIDDM patients were included in this study. Hypercholesterolemia was defined as LDL cholesterol plasma levels above 160mg/dl in female patients and above 130mg/dl in male patients or in women presenting any other risk factor for cardiovascular disease. From the 20 patients included, 18 had also high levels of arterial blood pressure. They were evaluated for admission in the study after they have substituted the antihypertensive medication for at least 6 weeks, from bblockers or diuretics to angiotensin converting enzyme inhibitors or calcium channel blockers. Lovastatin was administered in a initial daily dose of 20mg to all patients for 6 weeks. After this period this dose was increased to 40mg in 11 patients with LDL-cholesterol levels above 130mg/dl. All patients were treated for a total period of 24 weeks. Results - Lovastatin therapy for 24 weeks reduced LDL-cholesterol and total cholesterol plasma levels in 30% and 21°/, respectively, while no changes in HDL cholesterol or triglycerides plasma levels wereobserved. The medication was well tolerated and no changes in bilirrubins or transaminases plasma levels were detected. In 9 patients the serum levels of alkaline phosphatase showed an elevation and the mean level of all group increased from 109±59 to 188±60mm/ml (p< 0.05). This was an isolated abnormality without any other clinical manifestation. Conclusion - Lovastatin in NIDDM showed to be an efficient agent to reduce high levels of LDL-cholesterol and total cholesterol. However, the importance of the abnormality observed in serum alkaline phosphatase levels deserves further investigation. In this condition we recommend discontinuation of lovastatin therapy

Transperitoneal video endoscopic lumbar sympathectomy

The authors report on the first case of video endoscopic transperitoneal lumbar sympathectomy performed in a human being adopting the standard established by SAVINO-NETO (1994) in a experimental study with dogs. The surgery was performed with no technical difficulties, accidents or complication and the patient was able to, precociously, retake his customary activities. The authors commend the introduction of this technique in current surgical procedures.

Curso de laboratório clínico para estudantes e profissionais näo médicos: experiência de 15 anos / Course of clinical laboratory for students and non-physician professionals: experience of 15 years

É apresentado modelo de curso de Laboratório Clínico ministrado a estudantes näo médicos desde 1970. O curso é estruturado em bases formativas e orientado para a a utilizaçäo da rotina dos diversos laboratórios do Campus, sobretudo os pertencentes à Unidade de Laboratório Clínico, que realiza os exames para o Hospital das Clínicas. Os estudantess säo distribuídos pelos diversos laboratórios, onde, sob a forma de rodízios, desenvolvem em tempo integral atividades junto ao pessoal técnico e docente, participam dos plantöes do Laboratório de Emergências, de Seminários e de outras atividades. Os 122 alunos que até o presente ano o freqüentaram, o fizeram dentro das expectativas de aprendizado mínimo esperadas. O programa é extensivo também a profissionais graduados e interessados em aperfeiçoamento de conhecimentos na área. As avaliaçöes realizadas pelos estudantess (por meio de questionários) mostram o curso, em seu conjunto, como Bom , o que concorda com o consenso dos docentes participantes

Cirurgias histeroscopicas: perfil estatistico do Hospital Jaragua - Sao Paulo - SP / Statistic profile of Hospital Jaragua hysteroscopic surgeries - Sao Paulo - SP

Este e um estudo retrospectivo das cirurgias histeroscopicas, realizadas no Hospital Jaragua, no periodo de 1997 a 2000, com o objetivo de estabelecer o perfil estatistico das cirurgias e...

Importancia da colposcopia no diagnostico do cancer do colo uterino / Importance of colposcopy in the diagnostic of uterine cervical cancer

A citologia oncotica continua a ser considerada o exame mais eficiente para prevencao do cancer cervical uterino, apesar de apresentar indice consideravel de...

Efeitos do bloqueio alfa-adrenérgico com indoramina no tratamento da hipertensäo arterial de pacientes diabéticos / Effects of alpha-adrenorgic blocking with indoramin in the treatment of arterial hypertension of diabetic patients

No presente estudo 21 pacientes hipertensos portadores de diabetes mellitus do tipo II (DMH) e 11 pacientes hipertensos essenciais (HE) foram submetidos ao tratamento com indoramina, agente anti-hipertensivo bloqueador dos receptores adrenérgicos alfa, por um período de 28 semanas, no sentido de se avaliar os efeitos da droga sobre os níveis pressóricos e sobre o metabolismo da glicose. Os pacientes dos dois grupos eram portadores de hipertensäo arterial leve e moderada, com pressäo arterial diastólica (PAD) variando entre 95 e 12mmHg. Os pacientes diabéticos encontravam-se sob controle metabólico satisfatório, sendo que sob tratamento dietético associado ou näo a hipoglicemiante oral apresentavam níveis de hemoglobina glicosilada (HbA1) inferiores 11% (valores normais variando entre 6,3 e 8,6%). No grupo DMH oito dos 14 pacientes com hipertensäo leve (PAD < 105mmHg) obtiveram controle pressórico definido com PAD < ou = 90mmHg com uma dose média de indoramina de 69 ñ 26 mg diários. Seis pacientes näo obtiveram controle pressórico apesar da administraçäo da dose máxima de indoramina de 200mg e sete pacientes foram excluídos por efeitos colaterais, sendo que cinco deles encontravam-se recebendo doses de indoramina superiores a 100mg. No grupo HE apenas três pacientes obtiveram controle pressórico. O teste oral de tolerância à glicose realizado antes e após 12 semanas de terapia näo mostrou nos níveis de glicemia e insulinemia nos dois grupos estudados. Também näo foram observadas diferenças significantes nos níveis de HbA1, ácido úrico, creatinina, sódio, potássio, triglicérides e colesterol. Durante o tratamento, concluímos que a administraçäo de doses baixas de indoramina pode ser tentada para o tratamento da hipertensäo arterial leve em pacientes diabéticos uma vez que a droga näo parece afetar o metabolismo da glicose, do potássio ou dos lípides