Radioactive synovectomy with (90) yttrium and (153) samarium hydroxyapatite in haemophilic joints: preliminary study on radiation safety.

Most countries still do not achieve 1 IU of factor VIII/capita sufficient for survival. Although primary prophylaxis prevents synovitis, is not universally used. Chronic synovitis is treated with arthroscopy at expense of considerable amount of coagulation factors, and specialized surgeons. Radioactive synovectomy (RS) is a minimally invasive and cost effective alternative to arthroscopy, often considered first the option for persistent synovitis. Even without established causation with cancer, RS is avoided by some, due to this concern. We aim contributing to the understanding of RS safety regarding malignancy, presenting a large number of treated patients, and a single case of cancer. Three centres in Brazil applied RS with (90) Yttrium Citrate, (90) Yttrium hydroxyapatite or (153) Samarium hydroxyapatite in haemophilic joints and performed a survey addressing cancer in these patients. Four hundred and eighty eight patients (ages 3-51) received 1-3 RS (total 842) and follow-up was 6 months to 9 years. One patient aged 14 years presented Ewing sarcoma, 11 months after RS. The tumour was treated successfully with surgery and chemotherapy. Causality of cancer by RS is improbable in this case. Accordingly, latency here is far below minimum 5-10 years for radio-induction of solid tumours. Moreover, ES is not a typically radio-induced tumour, even at high doses. In agreement with others, though recognizing limitations, this study suggests RS is safe regarding cancer induction. Synovitis is a known burden for patients. The decision of making reasonable usage of RS should be outweighed with the risks of leaving synovitis untreated.

Anatomy of the proximal tibiofibular joint.

This paper describes the anatomy and function of the proximal tibiofibular joint (PTFJ). The physical dimensions of the joint and the topology of the articular surfaces are described. It is noted that the inclination of the joint is variable, and that joints with a steeper slope away from the transverse plane are less mobile. The ligamentous and tendinous attachments are described. Finally, the histological features of the articular surfaces are presented. The clinical importance of the anatomical features is discussed.

Pneumotorax espontaneo. / Spontaneous pneumothorax

Os autores apresentam uma coletanea de 35 casos de pneumotorax espontaneo, tratados no Hospital Central da Santa Casa de S.Paulo. Discutem a etiologia, a fisiopatologia, diagnostico, tratamento e comparam os resultados obtidos com os outros autores

Implicacoes medicas e socio-economicas do tabagismo em familias de baixa renda em Sao Paulo (Capital). / Medical and socio-economic involvements of smoking in low-income families in Sao Paulo (Capital)

Foi realizada uma pesquisa entre as puerperas de duas maternidades de Sao Paulo, procurando-se determinar algumas implicacoes medicas e socio-economicas do tabagismo em familias de baixa renda. Concluiu-se que uma parcela significativa do orcamento familiar e destinada ao tabagismo (media de 9,8%), sendo superior as fatias orcamentarias destinadas aos gastos com transporte (media 5,8%) e com a compra de leite (media de 8,3%)