Three-dimensional measurements of the lower extremity in children and adolescents using a low-dose biplanar X-ray device.

OBJECTIVE: To evaluate three-dimensional (3D) measurements of the lower extremity using a biplanar low-dose X-ray device in children and adolescents. METHODS: Firstly, 3D measurements of eight dried bones were analysed by a biplanar low-dose X-ray device (LDX) using stereoscopic software and compared with 3D computed tomography (CT). Secondly, 47 lower limbs of children and adolescents were studied using LDX two-dimensional (2D) and 3D measurements. Both parts were evaluated for femoral and tibial lengths and mechanical angles, frontal and lateral knee angulations, and the femoral neck-shaft angle. RESULTS: The 3D specimen comparison between LDX and CT measurements showed no significant differences: femoral length (P = 0.069), tibial length (P = 0.059), femoral mechanical angle (P = 0.475), tibial mechanical angle (P = 0.067), frontal knee angulation (P = 0.198), lateral knee angulation (P = 0.646) and femoral neck-shaft angle (P = 0.068). The comparison between LDX 2D and 3D measurements showed significant differences in tibial length (P = 0.003), femoral mechanical angle (P < 0.001) and femoral neck-shaft angle (P = 0.001); other parameters were unremarkable. CONCLUSIONS: The 3D LDX system presented reliable measurements compared with 3D CT. Differences between LDX 2D and 3D measurements were noted in the femoral mechanical angle, femoral neck-shaft angle and tibial length. Moderate to good interobserver agreement for the 3D LDX measurements were found. KEY POINTS: Low radiation dose is essential when assessing potential lower extremity discrepancies. A new biplanar low-dose X-ray device can assess such discrepancies in children/adolescents. This LDX device provides equally reliable 3D measurements as prevalent practice LDX measurements carry good overall interobserver agreement.

[A retrospective study analysis of urinary hippuric acid levels in occupational toxicology exams]. / Estudo retrospectivo dos níveis de ácido hipúrico urinário em exames de toxicologia ocupacional.

Hippuric acid is the primary metabolite of toluene, a solvent widely used in industrial processes with considerable toxic effects, a fact which justifies regularly monitoring individuals with occupational exposure to this solvent. This work aims at evaluating urinary hippuric acid levels found in workers subject to biological monitoring. A retrospective study was carried out with data referring from 2002 to 2005, in which exams results and employment status were analyzed (periodic, post-employment, and pre-employment exams). Results indicate a significant reduction in hippuric acid levels for 2005. Periodic exams presented higher results than pre-employment and post-employment exams. No significant difference was found in individuals grouped according to their status in each of the established intervals, their reference numbers, and maximum biological levels allowed. Hippuric acid levels detected indicate low risk of toluene exposure for the population under evaluation, probably due to a growing concern with the deployment of measures regarding occupational hygiene.

Estudo retrospectivo dos níveis de ácido hipúrico urinário em exames de toxicologia ocupacional / A retrospective study analysis of urinary hippuric acid levels in occupational toxicology exams

O ácido hipúrico é o principal metabólito do tolueno, solvente amplamente utilizado em processos industriais e com importantes efeitos tóxicos, fato que justifica a preocupação em monitorar regularmente sujeitos com risco de exposição ocupacional a este solvente. O objetivo deste trabalho foi avaliar os níveis de ácido hipúrico encontrados em trabalhadores submetidos à monitorização biológica. Foi realizado um estudo retrospectivo com dados dos anos de 2002 a 2005, no qual foram analisados os resultados e a situação do empregado na oportunidade do exame (periódico, demissional e admissional). Os resultados indicam uma redução significativa nos níveis de ácido hipúrico em 2005. Exames periódicos obtiveram resultados superiores aos exames admissionais e demissionais, e não foi verificada diferença significativa nas proporções dos sujeitos agrupados de acordo com a situação funcional em cada um dos intervalos estabelecidos segundo o valor de referência e o índice biológico máximo permitido. Os níveis de ácido hipúrico detectados indicam um baixo de risco de exposição ao tolueno na população avaliada, provavelmente em decorrência da preocupação crescente com a implantação de medidas de higiene ocupacional.

Hippuric acid is the primary metabolite of toluene, a solvent widely used in industrial processes with considerable toxic effects, a fact which justifies regularly monitoring individuals with occupational exposure to this solvent. This work aims at evaluating urinary hippuric acid levels found in workers subject to biological monitoring. A retrospective study was carried out with data referring from 2002 to 2005, in which exams results and employment status were analyzed (periodic, post-employment, and pre-employment exams). Results indicate a significant reduction in hippuric acid levels for 2005. Periodic exams presented higher results than pre-employment and post-employment exams. No significant difference was found in individuals grouped according to their status in each of the established intervals, their reference numbers, and maximum biological levels allowed. Hippuric acid levels detected indicate low risk of toluene exposure for the population under evaluation, probably due to a growing concern with the deployment of measures regarding occupational hygiene.

Behavior of type 2 diabetes mellitus in morbid obese patients submitted to gastric bypass.

INTRODUCTION: Surgical treatment of obesity has not only resulted in weight loss, but also the control of associated diseases in the postoperative period. The aim of this study was to determine the post-op response of type 2 diabetes mellitus (DM2) to gastric bypass. METHODS: A historical cohort study was performed involving all the diabetic, morbid obese patients who underwent gastric bypass during the period of May 2000 to October 2006 at the Centro da Obesidade Mórbida. Patient records were reviewed with regard to sex, age, anthropometric measurements, glycemia, glycosylated hemoglobin, pre-op insulin, and DM2 outcome. RESULTS: A total of 125 diabetic, morbid obese patients were operated; they had a mean age of 42.6 +/- 9.7 years and body mass index of 49 +/- 8.3 kg/m2. Of these patients, 63 (50.4%) required medication for control of DM2, and the rest managed only with diet. Of these 63 patients, 43 (68.2%) achieved control of DM2 and were discharged without the need for antidiabetic medication, and 20 (31.7%) were discharged still on medication. One month after surgery, seven more patients discontinued medication for DM2, and 18 months after surgery, 97.6% of the patients showed control of DM2. CONCLUSION: Gastric bypass is effective in controlling DM2 in morbid obese patients.

Estrogênio e saúde vascular: sinalização rápida, não-genômica, NO-mediada / Estrogen and vascular health: a non genomic, NO-mediated, rapid signalization

Há grande interesse a respeito dos efeitos do estrogênio na parede vascular, devido à acentuada diferença sexual na incidência da doença coronária clínica, quando comparando mulheres pré-menopáusicas com homens da mesma idade. Investigações clínicas randomizadas recentes surpreendentemente falharam em demonstrar os benefícios da terapia hormonal (TH) para a prevenção primária ou secundária da doença coronária em mulheres pós-menopáusicas. Embora os receptores de estrogênio (ER) sejam tradicionalmente definidos como ativadores transcricionais ligantes-ativados, a presença de ER membrana-associados nas células endoteliais pode também contribuir para o perfil molecular favorável no endotélio. Nessa revisão, descrevemos a evidência de ER localizados na membrana da célula endotelial. É também evidenciada a formação rápida de complexo molecular membrana-associado constituído pelo ER, c-Src e a unidade regulatória p85 da fosfatidilinositol 3-cinase (PI3K), em resposta ao estrogênio. Finalmente, descreve-se como este complexo inicia a atividade enzimática seqüencional, envolvendo a óxido nítrico sintase endotelial (eNOS) e conseqüentemente a liberação exaltada do NO, modulador chave do tono vascular e da saúde dos vasos sangüíneos.

Healthy aging is associated with unaltered production of immunoreactive growth hormone but impaired neuroimmunomodulation.

BACKGROUND: Both endocrine and immune systems are continuously remodeled during aging. OBJECTIVE: Here, we investigated to what extent adrenal and somatosenescence are associated reciprocal changes in the immune system during strictly healthy aging. METHODS: Forty-six elderly subjects and 33 young adults were recruited according to the health criteria of the SENIEUR protocol. Peripheral blood mononuclear cells were isolated and stimulated in vitro with lipopolysaccharide or phytohemagglutinin to assess the production of immunoreactive growth hormone (GH). Peripheral sensitivity to steroids was assessed in vitro by dexamethasone-, cortisol- or dehydroepiandrosterone (DHEA)-induced inhibition of T-cell proliferation. DHEA and GH levels were measured by radioimmunoassays. RESULTS: Healthy elderly had lower salivary DHEA and serum GH levels (somatosenescence). They presented reduced T-cell sensitivity to dexamethasone but similar cellular sensitivities to cortisol and DHEA. Their cells produced similar levels of immunoreactive GH compared to the cells of young adults. CONCLUSIONS: These data indicate that healthy aging is associated with adrenal and somatosenescence as well as impaired neuroendocrine immunoregulation at the level of the lymphocyte. In addition, somatosenescence may not be associated with a reciprocal decline in immunoreactive GH.

A comparison of wedge and needle hepatic biopsy in open bariatric surgery.

BACKGROUND: Morbidly obese patients, despite normal laboratory tests and no clinical evidence of liver disease, present a high prevalence of hepatic histological changes. Liver biopsy is able to provide the diagnosis, staging and assessment of follow-up of hepatic disease, thus helping to define clinical management. There is no agreement on which biopsy technique provides better material for analysis. Considering that subcapsular fibrosis is a common finding, sampling from deeper sites is necessary to achieve an adequate histological assessment. METHODS: A study was done in 264 consecutive morbidly obese patients who underwent open Roux-en-Y gastric bypass between July 2001 and Sept 2004, in whom an intraoperative liver biopsy was taken. The first 107 were wedge biopsies, and the last 157 were needle biopsies. The histological degree of steatosis, presence of fibrosis and adequacy of material from the 2 biopsy techniques were compared. RESULTS: Degree of steatosis in both sampling techniques showed no statistical difference (P=0.132). The presence of fibrosis in wedge biopsies (46.1% fibrosis, n 41) was significantly higher than in needle biopsies (13.7% fibrosis, n 20), P<0.001. As expected, sample size of needle biopsies was smaller than that obtained by the wedge technique (P<0.001), but there was no difference in the quality of material obtained (P=0.95). CONCLUSION: Needle biopsies were as effective as wedge biopsies in assessing the degree of steatosis in morbidly obese patients. More important, the presence of subcapsular fibrosis in needle biopsies was less than in wedge biopsies, suggesting an adequate tissue sample by the less invasive technique.

Histological behavior of hepatic steatosis in morbidly obese patients after weight loss induced by bariatric surgery.

BACKGROUND: Hepatic steatosis has a high prevalence among morbidly obese patients. Its relation to steatohepatitis and cirrhosis has been extensively studied among these patients. The aim of this study was to evaluate the behavior of hepatic steatosis with weight loss 1 year after bariatric surgery. METHODS: This study is a historical cohort that compared liver biopsies obtained from morbidly obese patients during the bariatric operation, with percutaneous biopsies taken from the same patient 1 year after surgery. The results were compared with weight loss, patients' profile (gender, age, body mass index (BMI) and waist/hip ratio), and with the presence of co-morbidities such as diabetes, hypertension, and dyslipidemia. RESULTS: 90 patients who had liver biopsies taken at the operation and postoperative period for bariatric surgery were included. The prevalence of hepatic steatosis was 87.6%. The average percent of excess weight loss was 81.4%. On the second biopsy, 16 patients (17.8%) of the total had the same degree of steatosis, 25 (27.8%) improved their steatosis pattern and 49 (54.4%) had normal hepatic tissue. There was no statistical difference regarding age, BMI, waist/hip ratio, and co-morbidities (P>0.05), but there was a difference in gender (P=0.044). CONCLUSION: Significant improvement in the hepatic histology of steatosis was observed after weight loss induced by bariatric surgery in most patients. There was no patient with a worsening in the histology.

Avaliação da precisão do reposicionamento da maxila pela osteotomia le fort / Evaluation of the precision of the maxilla repositioning by the le fort osteotomy

Durante o transoperatório da cirurgia ortognática, o cirurgião-bucomaxilofacial tem como principal objetivo reproduzir no paciente o que planejou no traçado predictivo e na cirurgia dos modelos. A proposição desse trabalho foi avaliar a precisão do reposicionamento da maxila pela osteotomia Le Fort I utilizando-se um protocolo de precisão nas etapas pré e transoperatórias da cirurgia ortognática. A amostra foi constituída de 22 pacientes que foram submetidos à osteotomia le Fort I pelo mesmo cirurgião. As telerradiografias pós-operatórias foram comparadas com seus correspondentes traçados predictivos por meio de uma análise computadorizada específica. As posições vertical e horizontal da borda incisal do incisivo central superior e da ponta da cúspide mésio-vestibular do primeiro molar superior foram utilizadas como referência para a aferição das alterações do plano palatino. Considerando as referências da maxila como um grupo, não foram observadas diferenças estatisticamente significantes entre os reposicionamentos planejados e os realizados na maxila por meio da osteotomia le Fort I.

The role of ultrasound in the diagnosis of hepatic steatosis in morbidly obese patients.

BACKGROUND: Hepatic steatosis is prevalent in obese patients. Although it requires histology for diagnosis, ultrasound may indicate its presence. We evaluated the importance of ultrasound in the diagnosis of steatosis in morbidly obese patients, and considered its clinical relevance for patients with BMI of 35-40 kg/m(2) without co-morbidities. METHODS: 187 morbidly obese patients submitted to bariatric surgery were prospectively studied. All patients had ultrasound before the operation, and hepatic biopsies during the operation, which were compared. RESULTS: The prevalence of steatosis histologically was 91.4%. The sensitivity and specificity of ultrasound in diagnosing steatosis was 49.1% and 75%, respectively,with a positive predictive value of 95.4%. CONCLUSION: The biopsies found a very high prevalence of steatosis in the studied population. The ultrasound results yielded a high positive predictive value (95.4%), suggesting its use as a diagnostic tool for this co-morbidity in morbidly obese patients. The low sensitivity of the method could be related to the lack of objective criteria for the ultrasound diagnosis of steatosis, and probably, technical problems in performing ultrasound in such patients. We believe that in patients with a BMI of 35-40 kg/m(2) without other comorbidities, the ultrasound finding of steatosis could be of value as an indication for bariatric surgery.

Comparação entre as concentrações de IgG anti-toxoplasma gondii em recém-nascidos não-infectados e suas mães, no período pós-parto imediato / Comparison of anti-Toxoplasma gondii IgG concentrations at delivery in uninfected newborns and their mothers

O objetivo deste artigo é avaliar a correlação entre as concentrações sérias de IgG anti-Toxoplasma em recém-nascidos (RN) sem infecção congênita e suas mães, logo após o nascimento. Levantamento retrospectivo da sorologia neonatal e materna de crianças no HSL-PUCRS nos últimos 4 anos e acompanhadas no Ambulatório de Infecções Congênitas, por suspeita de toxoplasmose congênita. Critérios de inclusão: 1) pacientes acompanhados até a negativação da sorologia, sendo excluída a infecção congênita; 2) que ao nascimento apresentavam apenas IgG positiva, não tendo recebido tratamento específico para toxoplasmose; 3) sorologias feitas na mãe e no RN pelo mesmo método, no laboratório do Hospital; 4) coleta do sangue materno entre 24 horas antes e 24 horas após o parto; 5) não mais de 72 horas de intervalo entre a coleta do sangue materno e a do RN. Foram calculados os coeficientes de variação dos testes e os valores foram considerados diferentes quando não havia sobreposição dos limites. Cinqüenta e dois pares RN/ mãe foram selecionados para o estudo. Vinte e seis apresentavam valor de IgG anti-Toxoplasma maior, 19 valor igual e 7 valor menor que o da mãe. A regressão linear calculada para a amostra (Y = 1,001X + 35,699) mostrou superioridade dos níveis neonatais quando comparados aos maternos. O nível de IgG anti-Tosoplasma no recém-nascido correlacionou-se positivamente com o materno e a previsibilidade de Y a partis de X apresentou alto nível de significância estatística (P < 0,000). O coeficiente de correlação de Pearson foi 0,86 (correlação forte) e o coeficiente de determinação foi de 0,74. Concluiu-se que mantendo correlação linear e positiva com os níveis maternos, os níveis de IgG anti-Tosoplasma dos RNs semtoxoplasmose congênita apresentaram-se, freqüentemente, superiores aos de suas respectivas mães.

Angiotensin I-converting enzyme gene polymorphism in two ethnic groups living in Brazil's southern region: association with age.

BACKGROUND: Several studies have been published on the association between ACE (angiotensin I-converting enzyme) polymorphism and longevity. However, the results are controversial. METHODS: We analyzed the association between ACE polymorphism and age in two different ethnic populations: a population originating from different European countries (Gaucha Population, GP) and a population originating from Japan (JP). Both populations live in Brazil's southern region. RESULTS: We determined the ACE genotype in 834 persons aged 10-104 years. The ACE genotype and allele frequencies differed between the two populations, with the D allele being more frequent in GP than JP. We found an association between the DD genotype and D allele and age in the GP group only. The ACE polymorphism-age association occurred at age >60 years in the GP population with decreasing II frequency. CONCLUSION: We cannot dismiss the possibility of the association between ACE polymorphism and age involving linkage disequilibrium, since the nature of this phenomenon is still controversial. From our studies, it appears that there is a correlation between age, ethnicity, and ACE polymorphism. More of such studies are warranted, as further investigation in this area will have a high clinical relevance to cardiovascular disease and aging research.

Epidemiologia das fraturas mandibulares atendidas no Hospital da Santa Casa de Misericórdia de São Paulo (HSCSP) entre 1996 e 1998 / Epidemiology of mandibular fractures assisted at Santa Casa de Misericórdia de São Paulo Hospital (HSCSP) between 1996 and 1998

As fraturas de mandíbula constituem um segmento importante dos problemas de saúde pública, porque suas seqüelas podem conduzir a sérias inabilidades morfofuncionais. Uma análise qualitativa foi realizada em 195 prontuários entre 1996 e 1998 no serviço de cirurgia Buco-maxilo-facial do HSCSP. Foram observadas 299 fraturas mandibulares. Na correlação entre os parâmetros analisados, optou-se pela distribuição Qui-quadrada (x²), com os graus apropriados de liberdade entre as etiologias que apresentaram maior incidência. Os resultados indicaram 161H e 34M, com média de 30,1 anos para ambos os sexos. A idade de grupo predominante estava entre 20 e 29 anos, com 42,6 por cento dos indivíduos atendidos. As agressões físicas foram responsáveis por 29,8 por cento de tais fraturas, seguidas das quedas, com 25,1 por cento e acidentes de tráfego, com 23,2 por cento. Os ferimentos por arma de fogo constituíram 9,2 por cento da amostra, sendo o dobro dos casos de acidente motociclísticos. As fraturas de mandíbula mais prevalentes foram em corpo, com 32,1 por cento; de côndilos, com 24,1 por cento, e em parassíntese, com 18,7 por cento. As correlações significativas obtidas foram: fratura de sínfise e côndilo direito x² cal = 20.862 e P<0,000; corpo direito e côndilo esquerdo x²cal = 5,831 e P=0,009. Estes valores indicam grande correlação das fraturas por contragolpe e por traumas frontais e, principalmente laterais

Estudo comparativo, inter-raças, a partir de análise cefalométrica computadorizada de Ricketts, em norma lateral, em sujeitos com harmonia facial / Comparative evaluation, inter-races, through cephalometric computerized analysis of Ricketts, in lateral head films, from subjects with facial harmony

Partindo do pressuposto de que o pradrão cefalométrico deve ser raça-específica, esta pesquisa realizou um estudo comparativo entre dimenções cefalométricas lineares e angulares, a partir de telerradiografias, em norma lateral, que compuseram duas amostras, cada uma com 40 sujeitos, de acordo com as raças branca e negra. As radiografias foram submetidas à analise cefalométrica computadorizada de Ricketts, utilizando o Programa Radiocef 2.0. Os valores alcançados tiveram tratamento estatístico, utilizando o teste "t" de Studend para amostras independentes, considerando menor ou igual 0,05. Os resultados obtidos permitem-nos concluir que exitem diferenças estatisticamente significativas entre as dimenções cefalométricas lineares e angulares entre as raças branca e negra, indicando que a estrutura facial do negro é maior que as dos sujeitos brancos. As dimenções cefalométricas que expressam a inclinação e a protrusão dos dentes incisivos, o posicionamento da maxila, o comprimento da mandíbula e a localização do Pório são as mais representativas das diferenças entre as raças estudadas. Este estudo reforça a hipótese de que as normas cefalométricas devem ser elaboradas para cada grupo racial, individualmente

Morphologic aspects of Tetratrichomonas didelphidis isolated from opossums Didelphis marsupialis and Lutreolina crassicaudata

Tetratrichomonas didelphidis (Hegner & Ratcliffe, 1927) Andersen & Reilly, 1965 is a flagellate protozoan found in the intestine, cecum, and colon of Didelphis marsupialis. The parasitic protozoa used in this study was found and isolated in the intestine of opossums in Pavlova starch-containing medium in Florianópolis, State of Santa Catarina, Brazil, from D. marsupialis and Lutreolina crassicaudata. The strains were cultivated in Diamond medium without maltose and with starch solution, pH 7.5 at 28§ C. The specimens were stained by the Giemsa method and Heidenhain's iron hematoxylin. The light microscopy study of the trophozoites revealed the same morphologic characteristics as specimens previously described

Insuficiência renal aguda tratada por diálise em unidade de tratamento intensivo (análise de 124 pacientes consecutivos) / Acute kidney failure treated by dialysis in intensive care unit: analysis of 124 consecutive patients

Insuficiência Renal Aguda (IRA) ainda apresenta elevada mortalidade, especialmente associada a outras falências orgânicas. O presente trabalho: 1) analisa o aspecto clínico de pacientes adultos com IRA internados em Unidade de Tratamento Intensivo (UTI); 2) determina condiçöes prévias, circunstâncias evolutivas e formas de intervençäo associadas a mau prognóstico; 3) tenta prever "desfecho" com índice de "gravidade de doença" reconhecido (APACHE II) e; 4) cria índice prognóstico local. Os prontuários de 124 pacientes consecutivos com IRA em UTI, submetidos a diálise, foram examinados. Variáveis clínicas e demográficas, circunstânciais evolutivas e modalidades de intervençäo foram analisadas, além de permanência em UTI e em diálise. Dois grupos - "sobreviventes" e "nao sobreviventes" - comparados, e as variáveis submetidas a análise univariada e por regressäo logística multivariada. A mortalidade hospitalar foi 81 por cento. Associaram-se à evoluçäo desfavorável: 1. Doença hepática ou biliar, antecedendo; 2; Indice APACHE II ao iniciar; 3. Ventilaçäo mecânica, drogas vasoativas, choque e funçäo renal substituída por método "lento", durante. Idade näo influenciou prognóstico. A mortalidade aumentou com o número de órgäos em falência, näo havendo sobreviventes com mais de três falências, além de IRA. Indice local, com as variáveis selecionadas, permitiria prever "desfecho" em mais de 93 por cento dos pacientes.