[Evaluation of middle cerebral artery blood flow velocity with transcranial Doppler in carotid endarterectomy]. / Avaliação da velocidade de fluxo sangüíneo na artéria cerebral média, pelo Doppler transcraniano, na cirurgia de endarterectomia da carótida.

Thirty patients, submitted to 34 carotid endarterectomies, from September, 1992 to April, 1996, on Hospital Albert Einstein, São Paulo, have been studied. In these surgeries, Middle Cerebral Artery (MCA) was miniaturized with Transcranial Doppler (TCD). The purpose of this study were to verify the relationship between MCA blood flow velocity with postoperative neurologic complications: studying the velocity variations with risk of cerebral low perfusion and carotid stump back pressure, during carotid clamping; confirming that the TCD information, could show when it is necessary to use shunting, and its efficiency; and to know whether the method could detect intraoperative embolization. The equipment used was a Transpect TCD-EME 2000. During surgery, when carotid stump back pressure was bellow of 54.4 mmHg, Pruitt-Inahara shunt was applied. The flow velocity value observed with TCD was divided in 3 parts: phase 1, basal, since anesthesy induction until carotid clamping; phase 2, clamping, during the period when the carotid artery was occluded; phase 3, post-declamping, from the time the carotid artery was declamping until the end of surgery. The MCA flow velocity was available on three phases, in cm/s and percentually on phases 2 and 3, in relation to basal phase. The embolizations, detected by TCD, were classified in: a) a few embolizations in less than 10 second period, b) many embolizations in more than 10 second period. Based on the results obtained, its possible to conclude that the MCA flow velocity is related to the risk of cerebral low perfusion during carotid clamping; it was not possible to stablish any relation of MCA flow velocity to carotid stump back pressure; the TCD informs when the use of shunt is necessary and its efficiency; the postoperative neurologic complications were caused by embolizations. The conclusion is that the TCD is useful and easily applicated on carotid endarterectomy.

Mucin genes are regulated by estrogen and dexamethasone.

This study demonstrates for the first time that mucin gene expression can be significantly up-regulated by steroid hormones. The effects of estrogen, progesterone and dexamethasone on the expression of three mucin genes, MUC1, MUC4 and MUC5c were determined in a human epithelial cell line. This cell line secretes mucin and contains steroid receptors. Steady-state mRNA levels were quantified by slot blot hybridization using radiolabelled oligonucleotide probes. Normally, these genes (originally isolated from airways) are expressed at low constitutive levels. However, steady state levels of MUC4 and MUC5c mRNA were up-regulated at least 3-4 fold by estrogen supplementation, and 1.5-2 fold by dexamethasone. MUC1 mRNA levels were minimally affected. Progesterone supplementation had no effect but was able to interfere with the up-regulation by estrogen. The mechanism of regulation remains to be determined but may be transcriptional. However, steroids have been shown to control gene expression at several different levels.

Aneurisma anastomótico da artéria mesentérica inferior: relato de um caso / Anastomotic aneurysm of the inferior mesenteric artery: case report

Os autores relatam caso de um homem com 56 anos de idade que se queixava de dor na regiäo lombar com irradiaçäo para os membros inferiores por três meses, dois anos após a correçäo de aneurisma da aorta infra-renal. Após estudos diagnósticos - como tomografia computadorizada - e angiográficos, o paciente foi encaminhado ao centro cirúrgico com diagnóstico de falso aneurisam do terço médio da prótese. No ato cirúrgico verificou-se que o falso aneurisma teve origem devido à deiscência da anastomosoe artéria mesentérica inferior que havia sido implantada na prótese.

The relationship between anthropometric parameters and measurements of the human inguinal region.

Several reports suggest a definite relationship between inguinal hernia and pelvic measurements. In order to assess this opinion, measurements of the inguinal region, in particular of the inguinal triangle (Hesselbach) were statistically compared with 14 different anthropometric parameters in 73 white human male corpses. The correlation tests between the inguinal and anthropometric parameters showed very low r values, generally being null to three decimal places. The importance and possible etiologic role of these findings are discussed.

[New tactical maneuver for hemostasis of parenchymal organs]. / Nova manobra tática para hemostasia de órgãos parenquimatosos.

The authors report a new surgical procedure destined to realize the hemostasis suture of parenchymatous organs, mainly spleen and liver. The suture is done with needle and absorbable suture material appropriate for the lesion and small hemostatic gere plates. The main qualities of these procedure are the passage of the suture wire in the easiest direction for the surgeon and the confection of these manoeuvre out of abdominal cavity. This procedure was applicated, until now, in nine cases with fully success.

Circulação extracorpórea com hemofiltração durante cirurgia cardíaca / Extracorporeal circulation with hemofiltration during cardiac surgery

A hemofiltracao foi estudada em 7 caes, durante circulacao extracorporea. O hemodialisador tipo bobina (Travenol CD-1000) foi empregado, em substituicao ao hemofiltro padrao, variando-se a pressao transmembrana e o fluxo de perfusao no dialisador. O maior volume/minuto de ultrafiltrado (36,6 ml min) foi obtido com o uso de pressao negativa, aplicada em circuito especial no hemodialisador (com 650 ml/min de fluxo de perfusao). Menos importantes para a eficiencia da ultrafiltracao foram as variacoes da pressao positiva no hemodialisador