[Intervertebral disk disease among oil drilling workers]. / Doença do disco intervertebral em trabalhadores da perfuração de petróleo.

A cross-sectional study among 1,026 oil drilling workers in Northeast Brazil found a prevalence rate of 5% for intervertebral disk disease, varying from 1.8% (activities without heavy lifting) and 4.5% (occasional lifting) to 7.2% (routine lifting). Disease prevalence was 10.5% among drilling workers with more than 15 years in the industry and 11.3% among those over 40 years of age. Prevalence ratio (PR) for the association between working in oil drilling operations and intervertebral disk disease was 2.3 (95% CI: 1.3-4.0). Retrospective information about exposure was collected to minimize the healthy worker survival effect. Using information on current occupation instead of occupational life history would cause an underestimated PR of 1.1 (95% CI: 0.6-1.9). Logistic regression showed results similar to the tabular analysis. Neither confounding nor interaction was evident. Growth of the Brazilian oil industry and recent changes in the work force contract and management, involving changes in risk management and health control, indicate a need for prompt ergonomic intervention in order to control intervertebral disk disease among oil drilling workers.

Origin of an ovarian steroid cell tumor causing isosexual pseudoprecocious puberty demonstrated by the expression of adrenal steroidogenic enzymes and adrenocorticotropin receptor.

Ovarian steroid cell tumors are rare neoplasms composed of typical steroid hormone-secreting cells. Most ovarian steroid cell tumors, however, cannot be appropriately classified on a morphological basis, because the neoplastic cells closely resemble adrenal cortical cells. Nevertheless, the true adrenal origin of such tumors has been difficult to demonstrate. Here we report a 3-yr-old girl with isosexual pseudoprecocious puberty due to an ovarian steroid tumor whose adrenal cell origin was determined by the presence of messenger ribonucleic acid (mRNA) of adrenal-specific steroidogenic P450 enzymes (P450c11 and P450c21) and ACTH receptor (ACTHR). Her height was +2.3 SD, and she had Tanner stage III breast development, Tanner stage II pubic hair, and a normal clitoris. Bone age was 5 yr. Basal gonadotropin levels were undetectable (<0.6 U/L for LH and <1.0 U/L for FSH) and remained undetectable after stimulation with 100 microg GnRH, i.v. Basal serum testosterone and 17-hydroxyprogesterone levels were slightly elevated, whereas basal serum androstenedione, estradiol, and dehydroepiandrosterone sulfate levels were clearly elevated. Pelvic ultrasound disclosed an enlarged uterus and an adnexal multicystic mass in the right ovary, and pathological studies disclosed an ovarian steroid cell tumor. To establish the cellular origin of the tumor we determined the presence of mRNA for P450c11, P450c21, and ACTHR in tumor tissue and normal adrenal and ovarian tissue. Detection of ACTHR, P450c21, and P450c11 mRNAs isoforms was achieved in tumoral and adrenal control tissue, but not in the ovary control tissue. The RT-PCR products of P450c11 from adrenal control tissue were composed by both BglI-sensitive and -resistant complementary DNAs, indicating the presence of both P450c11AS and P450c11beta, whereas RT-PCR product from the tumor was resistant to BglI digestion, indicating only the presence of P450c11beta. We conclude that the histological origin of so-called adrenal rest tumor could be reliably determined by assessing the expression of specific genes in the tumor as P450c11beta and P450c21. The use ofthese molecular tools will allow a more precise classification of an important subset of the ovarian steroid cell tumors and can help to identify ectopic adrenal tissue in ovary and testis.

[Arterial hypertension and alcoholism among workers in an oil refinery]. / Hipertensão arterial e alcoolismo em trabalhadores de uma refinaria de petróleo.

The role of alcohol ingestion in the incidence of arterial hypertension has not been completely established. In addition, there are few studies addressing this point in relation to populations of workers. The objective of this study was to evaluate the association between alcoholism and arterial hypertension among workers in an oil refinery in Mataripe, Bahia, Brazil, from 1986 to 1993. We designed a retrospective cohort study with a 7-year follow-up in a stratified systematic sample of 335 workers from the refinery. Arterial hypertension was diagnosed based on blood pressure measurements done during routine medical examinations. At the beginning of follow-up, three groups were defined using the CAGE test of alcohol dependency: nondrinkers (n = 121), CAGE-negative workers (n = 116), and CAGE-positive workers (n = 98). In comparison with the CAGE-negative group, the CAGE-positive group had both greater relative risk and greater attributable risk for developing arterial hypertension (RR = 2.58; AR = 24.95 per 1,000 person-years). The CAGE-positive group also had greater risks compared to nondrinkers (RR = 2.06; AR = 20.97 per 1,000 person-years). The attributable fractions for the same two comparisons of groups were 61% and 51%, respectively. Rate standardization by age or smoking habit did not substantially change the results. Alcoholism is an important risk factor for arterial hypertension.

Medidas combinadas para conservaçäo de sangue em cirurgia ortopédica / Combined measures for blood conservation in ortopedic surgery

As proporçöes pandêmicas que vem atingindo a disseminaçäo da AIDS provocaram, na populaçäo médica e leiga, uma crescente conscientizaçäo sobre os riscos envolvidos em hemoterapia, trazendo, em consequência, uma maior atençäo para outros efeitos deletérios, como a transmissäo de doenças diversas, bem como reaçöes pós-transfusionais de fundo imunológico. Em virtude desta, as pesquisas em hemoterapia voltaram-se para diversas técnicas que visam a evitar transfusöes homólogas. Associaçöes sinérgicas dessas técnicas säo atualmente revistas, propostas e investigadas, com revisäo de limites teóricos, antes considerados intransponíveis. Este estudo apresenta uma rápida revisäo bibliográfica, enfocando as tendências mais atuais e discussäo de casos em que foi efetuada hemodiluiçäo progressiva, associada à autotransfusäo per-operatória de lavado de hemácias recuperadas da ferida operatória, em Artrodese Posterior de Coluna. Os pacientes foram monitorizados por meio de gasometrias, hematócrito e dosagens de lactato e glicemia, seriados, no pré, per e pós-operatório, inclusive no momento de máxima hemodiluiçäo. É necessária uma atualizaçäo constante do profissional de saúde com respeito ao uso e às limitaçöes dessas técnicas, e, inclusive, a elaboraçäo de rotinas e trabalhos científicos, com o estabelecimento de parâmetros autóctones de atuaçäo. A otimizaçäo do uso do sangue e de hemoderivados, em benefício do paciente e da instituiçäo, somente pode ser efetivada com a participaçäo integrada de todos os profissionais de saúde na abordagem do paciente e na avaliaçäo dos resultados por meio de estudos científicos.