Staff attitudes towards people with intellectual disabilities in Japan and the United States.

BACKGROUND: Staff attitudes may affect choices available to persons with intellectual disabilities (ID). This study examined attitudes towards people with ID among staff working with people with ID in Japan and the United States. METHOD: Attitudes of staff working with people with ID in Japan and the United States were compared using the Community Living Attitudes Scale, Intellectual Disabilities Form. Responses were examined via multivariate analysis of variance. RESULTS: In unadjusted analyses, Japanese staff exhibited a greater tendency towards Sheltering and Exclusion of people with ID and lower endorsement of Empowerment and Similarity of people with ID. After controlling for covariates, the country effect was no longer significant for Sheltering and Exclusion. Age and education were significantly associated with attitudes in the adjusted model. CONCLUSIONS: While attitudes in Japan appeared less supportive of community inclusion of people with ID, some of the differences between countries were attributable to other staff characteristics such as age and education. Findings provide new information about how attitudes of staff in each country compare with each other.

Spontaneous disappearance and reappearance of a ruptured cerebral aneurysm: one case found in a group of 33 consecutive patients with subarachnoid hemorrhage who underwent repeat angiography.

The spontaneous disappearance and reappearance of a ruptured cerebral aneurysm is generally assumed to be a rare phenomenon although the actual incidence is unknown. Among 39 consecutive cases of acute subarachnoid hemorrhage (SAH), 33 were studied by three-dimensional computed tomographic angiography (CTA) within 6 h after the onset of SAH, followed by digital subtraction angiography (DSA) within 24 h after the ictus. Of those patients, one, a 58-year-old woman, had a saccular aneurysm at the distal anterior cerebral artery; the aneurysm was clearly demonstrated by CTA 2.5 h after the SAH onset, but was not shown by a subsequent DSA performed 8.5 h after the ictus. A follow-up DSA detected the neck of aneurysm on day 11, and the whole aneurysm was visualized on day 19. The observations in this particular case suggest that the spontaneous disappearance of a ruptured cerebral aneurysm may occur during the ultra-early stage of SAH and that reappearance may follow during the next few weeks. The patient did not suffer complications such as vasospasm or systemic hypotension nor was she treated with antifibrinolytic agents. The aneurysmal shape and the surrounding clot are considered as putative factors possibly related to the intermittent appearance of the aneurysm.

A morpho-quantitative study of the myenteric ganglia throughout the human digestive tract.

We have examined the sizes of nerve cells present in the myenteric plexus in the human esophagus, stomach, duodenum and sigmoid colon using a nonhistochemical method (Giemsa) in laminar preparations of the muscularis externa. The collagen and elastic system related fibers in the myenteric ganglia were also qualitatively evaluated. The major mean of perikaryal area was observed in the esophagus (489.97 micron 2 +/- 212.35 micron 2) and the minor in the sigmoid colon (241.64 micron 2 +/- 122.62 micron 2). There were no significant differences between the mean areas of the myenteric neurons in the stomach (284.77 micron 2 +/- 134.70 micron 2) and in the duodenum (291.39 micron 2 +/- 157.86 micron 2). In all regions a ganglionic capsule of collagen fibers with thin septa surrounding isolated or grouped neurons was observed. The elastic and elastic-related fibers (elaunin and oxytalan fibers) were also present in both the ganglionic capsule and inside the ganglia. There were no differences among the regions. These data suggest that factors such as size of nerve cells and structural aspects of the ganglionic capsule are not related with the incidence of megaesophagus and megacolon.

[Comparative analysis of PAC-I and PAC-II]. / Análise comparativa entre PAC-I e PAC-II.

Comparison between the results of students' evaluation of the University of São Paulo Medical School with the results of the coordinators' evaluation of their own program is presented; 32 programs during 1996 were studied. In 50% of the cases, the students and professors evaluation were identical. In 28.1% of the cases, the evaluations made by students were higher than the professors' evaluation, mainly in clerkship. In 21.8% of the cases, the contrary took place mainly in the first to fourth year programs.

Prognostic factors to predict outcome following the administration of hypertonic/hyperoncotic solution in hypovolemic patients.

Hypertonic solutions effectively improve hemodynamic parameters in patients admitted to the emergency room. However, no significant differences in outcome were observed compared with standard isotonic treatment in most previously published studies. This study evaluates pretreatment prognostic factors that predict a beneficial effect of hypertonic solution in patients admitted to the emergency room with hemorrhagic hypovolemia in a prospective double-blind fashion. The patients (n = 212) were randomized upon admission to receive 250 mL intravenous (i.v.) bolus of hypertonic 7.5% NaCl + 6% dextran (HSD, n = 101), or isotonic 0.9% NaCl solutions (IS, n = 111) as the first treatment, followed by standard resuscitation. Pretreatment factors assessed were sex, age, cause of hypovolemia, revised trauma score (RTS), Glasgow index, and mean arterial pressure (MAP) on admission. Both groups were compared for survival at 24 h and 30 days postadmission. Infused volumes were registered. HSD administration significantly increased MAP and reduced i.v. crystalloid infusions to maintain hemodynamic parameters, compared with IS. There was no difference between groups in the number of blood transfusions administered. Overall complication rates in both groups were similar (24%). There was a significant difference (p < .03) in overall (30 days) survival rate between HSD (73%) and IS (64%) groups. The 24 h survival rate was significantly lower in IS (72%) compared with HSD (87%); p < .01. Multivariate analyses showed that RTS and MAP were identified as independent predictors for 24 h survival in the group that received HSD. When evaluated for overall survival rate, hypertonic infusion benefited significantly only patients with MAP < 70 mmHg (p < .01).

[Teacher's opinions regarding graduation programs at the University of São Paulo Medical School--PAC-II]. / A opinião dos professores sobre seus programas na graduação médica da FMUSP-O PAC-II.

The authors show the results of the "Curricular Evaluation Program" of University of São Paulo Medical School pertaining to the year of 1996. This program (PAC-II) is based on teachers' opinions regarding the subjects taught (1st to 4th grades) and hospital intern courses. The opinions collected concerning such programs were definitely favorable. Most of the teachers considered the programs to be either good or very good. It was also identified that the hospital intern courses were a little more valued than the other courses taught in the first four grades.

[Program evaluation Curriculum of the University of São Paulo Medical School. For the year 1994 and the period 1989-1994]. / Programa de avaliação curricular da FMUSP--o ano de 1994 e o período de 1989-1994.

The authors present the results of the Program of Curriculum Evaluation of the University of São Paulo Medical School for the year of 1994, as well as the 1989-1994 period. The academic year of 1994 wasn't a good year to the medical graduation regarding disciplines from the first to the fourth year; only 14.3% of the disciplines achieved 90% or more of "excellent" + "good". The disciplines held at internship continued, on the most, doing well. The analysis of the 1989-1994 period outstands different sequential evaluation.

Grynfelt hernia.

Lumbar hernias are very uncommon conditions. Less than 300 cases have been reported in the literature. They result from defects in the posterolateral abdominal wall. The authors report their experience with four lumbar hernias managed at the "Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo" from 1973 to 1993. Age ranged from 54 to 63 years. Three were female, two had right hernias and two had left ones. All patients were treated surgically. Three were repaired by simple suture. The main complications were early recurrence (one case) and infections (one case). In one, a prosthetic mesh (polypropylene) was used to repair the defect, and the recovery was uneventful. Surgical treatment is always indicated in Grynfelt hernia. Approximation of the muscles by primary nonabsorbable suture, grafts or prosthesis are very adequate therapeutic options for lumbar hernias.

[Curriculum evaluation program of the University of São Paulo Medical School--results for 1993 and a 5-year analysis]. / Programa de avaliação curricular da Faculdade de Medicina da Universidade de São Paulo--resultados de 1993 e análise quinqüenal.

The following report contains the results of the "Curricular Evaluation Program" of University of São Paulo Medical School pertaining to the year of 1993 and to the five-year period between 1989 and 1993. This evaluation of all undergraduate courses was made by students, responding to questionnaires supplied at the end of each program. In 1993, 60.6% of programs were considered as very good programs. In relation to 1989-1993 period, are presented the results of a disciplines group of the 4th year and a internship stages of the 5th year.

[Grynfelt's hernia. A case report and review of the literature]. / Hérnia de Grynfelt. Relato de caso e revisão da literatura.

Lumbar hernias are rare lesions. They involve the extrusion of visceral contents through a defect in the posterolateral abdominal wall. Only 250 a 300 cases had been reported in the literature. They occur most often in the superior lumbar triangle (Grynfelt's hernia). All lumbar hernias must be treated with surgery and the preferable surgical approach is done retroperitoneally. Primary repair, autologous tissue or prosthetic material may be used to obliterate the defect. The authors report a case of Grynfelt's hernia in which polypropylene mesch was placed pre-peritonially.

[Opinion of the people in charge of the medical graduation disciplines at the São Paulo University Medical School on the 'curriculum evaluation program']. / Opinião dos responsáveis pelas Disciplinas da Graduação Médica da FMUSP sobre o "Programa de Avaliação Curricular".

Results of "Curricular Evaluation Program" (CEP) of Medical School of S. Paulo University (FMUSP) are presented. CEP numbers are obtained form students answers offered to a padronized questionnaire which included theoretical and practical aspects of curricular process. Authors asked for the opinion of curricular disciplines coordinators of FMUSP about CEP and concluded: 1. CEP has large or reasonable profitability for 95.3% of coordinators; 2. CEP questionnaire was considered adequate by 85.7% of respondents, but 42.8% mentioned deficiencies in questionnaire revitance to them; 3. CEP presents excellent performance at FMUSP departments level.

Scanning electron microscope study of the veins at the human esophago-gastric junction.

Cast of the mucosal and submucosal veins of the esophago-gastric junction were studied in five necropsy specimens by scanning electron microscopy to analyse some of the characteristics of their shape and surface. Two types of veins were described: 1) veins with circumscript, fusiform and/or ampullar bulges and relatively smooth surfaces; 2) veins with numerous, small bulges and blister-shaped micro-dilatations. The role of these features is considered in the formation of esophageal varices.

Functional anatomy of the retro- and suprahepatic portions of the human inferior vena cava and their main affluents.

The arrangement of muscle, collagen and elastic fibers was studied in the retro- and suprahepatic (subdiaphragmatic) portions of the inferior vena cava, the hepatic veins and their main affluents. Distinctive features of the longitudinal and transverse muscle bundles are described. In these portions of the vena cava, both bundle systems are clearly separate and any continuity was observed only at the entrances of the hepatic veins. A musculo-venulolymphatic complex was noted in spurs formed by the vascular junctions. The hepatic veins and their main affluents exhibit an elliptical contour in transverse section, which apparently results from cranial and caudal thickenings of the longitudinal muscle layer. Many of these bundles are in continuity with those of the transverse muscle layer. Terminal elastic tendons were rarely observed in connection with muscle fibers of the inferior vena cava and are not present in the hepatic veins and their main affluents. In terms of form and function, the relatively thin muscular layer has a dilating action on the hepatic venous system because of the external fixed insertion point of the muscle bundles. Such an arrangement and a "polar" disposition of the muscle bundles in the hepatic venous system may assists in "suction" of the blood toward the heart. A sphincteric control of the ostia by means of crossed muscular loops supported by venulo-lymphatic micropads is a possibility.

[Medical pedagogy and special didactics in graduate courses at the medical school of the University of São Paulo, Brazil]. / As disciplinas de didática especial e de pedagogia médica no curso de pós-graduação da Faculdade de Medicina da Universidade de S. Paulo.

Graduate courses of medical pedagogy and special didactics at S. Paulo University Medical School are analysed. The authors present objectives, subject matters and methodologies of both courses, as well as their evaluation by the graduate students. After an initial rejection, the evaluation became very positive (67% in medical pedagogy and 82% in special didactics). Some future perspectives are discussed.

Correlacao entre hipercolesterolemia e dieta deficiente em vitamina C / Correlation between hypercholesterolemia and vitamin C deficient diet

A carencia de vitamina C interfere tanto na atividade da enzima lecitina colesterol acil-transferase como na transformacao do colesterol em seu principal catabolico: os acidos biliares. Tem-se observado ainda, a presenca de varicosidade da veia sublingual em individuos com hipovitaminose C. Selecionamos quinze pacientes com niveis sanguineos de colesterol normais e quinze pacientes hipercolesterolemicos para estudar a correlacao entre a hipercolesterolemia e a deficiencia de ingestao de vitamina C. Realizamos analise estatistica com teste "t" de Student e teste tipo Caso-Controle, obtendo os seguintes dados: (1) Quanto ao nivel de colesterol, os dois grupos apresentaram diferenca significativa, no grupo hipercolesterolemicos com niveis de 422 ñ 116,2018 mg/100 ml e no grupo normocolesterolemicos 160,73 ñ 29,5356 mg/100 ml. (2) A media diaria de vitamina C na dieta e significativamente maior no grupo normocolesterolemico (170,33 ñ 75,18 mg) do que no grupo hipercolesterolemico (39,01 ñ 25,89 mg). (3) O grupo hipercolesterolemico apresenta uma media de ingestao diaria maior do colesterol do que o grupo normocolesterolemico, porem nao ha significancia estatistica. (4) O grupo hipercolesterolemico demonstra a ocorrencia maior de varicosidade sublingual estatisticamente significante em treze casos enquanto que no...

[Correlation between hypercholesterolemia and vitamin C deficient diet]. / Correlação entre hipercolesterolemia e dieta deficiente em vitamina C.

The deficiency of ascorbic acid in the diet affects the activity of lecithin cholesterol acyl-transferase enzyme and transformation of cholesterol to its main catabolic product the biliary acids. Fifteen patients with normal blood levels of cholesterol and fifteen patients with hypercholesterolemia were submitted to a comparative study as to the dietary ingestion of ascorbic acid. Besides this the presence of the varicosity of the sublingual vein--indicating hypovitaminosis C--was investigated in both groups of patients. The "t" Student test and Control-Case test of the results showed that regarding the cholesterol level there was a significant difference between the patients with hypercholesterolemia (422 +/- 116.2018 mg/100 ml) and those with normal cholesterolemia (160.73 +/- 29.5356 mg/100 ml). The ingestion of ascorbic acid in he diet of the normal cholesterolemia group was found to be significantly higher than that of patients with hypercholesterolemia. The ingestion of cholesterol was high in the group of patients with hypercholesterolemia but in comparison with other groups there was no significant difference. The varicosity of the sublingual vein was observed with significantly higher frequency (p < 0.0001) in the group of patients with hypercholesterolemia and lower ingestion of ascorbic acid.

Angioarchitecture of the esophagogastric veins in portal hypertension.

Based on our previous studies on the human normal venous angioarchitecture of the esophagogastric transition segment, we performed a similar analysis in 25 postmortem specimens obtained from subjects with a diagnosis of portal hypertension. The specimens were injected with India ink or barium sulfate and sectioned for histological examination. A 'weak' zone (point of lesser resistance) was described as being the most probable site of origin for the development of varicosities in the complex venous system of the esophagogastric junction. Such a system can be considered to be a physiological hemodynamic venous blockade mechanism interposed between the portal system and the systemic veins. The 'weak' zone is made up by the scarce submucous veins (shunt veins), by the submucous confluent and final confluent trunks, and by the true perforating veins of the tunica muscularis which compose a venous unity located about 3-5.5 cm above the Z (epithelioglandular) line.

[Esophagoplasty with bypass using an isoperistaltic gastric tube in the treatment of cancer of the thoracic esophagus: study of 13 cases]. / Esofagoplastia com tubo gástrico isoperistáltico em derivação no tratamento do câncer do esôfago torácico: estudo de 13 casos.

In order to relieve complete obstruction of the thoracic esophagus due to spinocellular carcinoma, thirteen patients, all of them in good or at least regular general conditions were submitted to a bypass using a isoperistaltic gastric tube. The disease itself was treated by radiotherapy after surgery. Only one patient died at the hospital due to an error in the radiotherapy schedule. Cervical fistula was observed in six patients seven days after surgery; local treatment was enough for complete healing in five out of six. In one patient surgery was performed in order to repair the anastomotic area. Stenosis was observed in three patients but in all cases it was possible to overcome it by endoscopy. With the progress of the disease other complications were observed such as hemoptysis and respiratory distress. The survival rate was nine months (running between five and sixteen) but it should be noted that swallow capacity was maintained until death. The employed of a bypass of isoperistaltic gastric tube seems to be a desirable alternative in the treatment of esophageal cancer because it allows the reestablishment of deglutition before any treatment such as radiotherapy alone or combined with surgery.