EVALUATION OF THE MORTALITY RATE ONE YEAR AFTER HIP FRACTURE AND FACTORS RELATING TO DIMINISHED SURVIVAL AMONG ELDERLY PEOPLE.

OBJECTIVE: To evaluate the mortality rate after one year and correlated preoperative factors, among patients with hip fractures. METHODS: We prospectively studied 202 out of a total of 376 patients with a diagnosis of hip fracture who were admitted to the Hospital Cristo Redentor, between October 2007 and March 2009. The database with the epidemiological analysis was set up during their hospitalization, and follow-up data were obtained preferentially by phone. RESULTS: The overall mortality rate after one year of follow-up was 28.7% or 58 deaths, among which 11 (5.45%) occurred during hospitalization. Fractures were more prevalent among women (71.3%) and rare among blacks (5%). Among the comorbidities, dementia and depression showed a statistically significant reduction in survival (p = 0.018 and 0.007, respectively). CONCLUSION: The mortality rate after one year of follow-up was 28.7%. Dementia and depression increased this rate.

Avaliação da taxa de mortalidade em um ano após fratura do quadril e fatores relacionados à diminuição de sobrevida no idoso / Evaluation of the mortality rate one year after hip fracture and factors relating to diminished survival among elderly people

OBJETIVO: Avaliar a taxa de mortalidade em um ano e fatores pré-operatórios correlacionados em pacientes com fratura do quadril. MÉTODOS: Os autores estudaram, prospectivamente, 202 de um total de 376 pacientes com diagnóstico de fratura do quadril, que foram admitidos no Hospital Cristo Redentor entre outubro de 2007 e março de 2009. A montagem do banco de dados com análise do perfil epidemiológico foi realizada durante a internação e os dados de seguimento preferencialmente por telefone. RESULTADOS: A taxa de mortalidade total após um ano de seguimento foi de 28,7% ou 58 óbitos, dentre os quais 11 (5,45%) ocorreram na internação. As fraturas foram mais prevalentes em mulheres (71,3%) e pouco comuns em negros (5%). Dentre as comorbidades, demência e depressão apresentaram uma redução estatisticamente significante da sobrevida, (p de 0,018 e de 0,007, respectivamente). CONCLUSÃO: A taxa de mortalidade após um ano de seguimento foi de 28,7%. A demência e a depressão aumentaram esta taxa.

OBJECTIVE: To evaluate the mortality rate at one year and preoperative correlated factors in patients with hip fractures. METHODS: We studied prospectively, 202 of a total of 376 patients with hip fracture who were admitted to the Hospital Cristo Redentor, between October 2007 and March 2009. The assembly of the database with the epidemiological analysis was performed during hospitalization and follow up data preferably by phone. RESULTS: The overall mortality rate after one year of follow-up was 28.7% or 58 deaths, among which 11 (5.45%) occurred during hospitalization. The fractures were more prevalent among women (71.3%) and less common in blacks (5%). Among the comorbidities, dementia and depression showed a statistically significant reduction in survival (p of 0,018 and 0,007, respectively). CONCLUSION: Mortality rate after one year of follow-up was 28,7%. Dementia and depression increased this rate.

Transient middle cerebral artery occlusion in rats as an experimental model of brain ischemia / Modelo experimental de isquemia cerebral em ratos por obliteração temporária da artéria cerebral média

PURPOSE: To assess a rat model of cerebral ischemia induced by occlusion of the middle cerebral artery and its effect on the area of cerebral infarction. METHODS: Brain ischemia was induced in 52 male Wistar rats by introduction of a 3-0 nylon suture into the middle cerebral artery for either 90 (n=28) or 120 (n=24) minutes. Ischemic injury volume was determined by TTC staining, digital photography and analysis with the Image J software. Statistical analysis employed Student’s t test and the Mann-Whitney U test. RESULTS: The groups were similar in terms of weight (p=0.59). The length of thread inserted was 14.7 mm in the 90 min group and 20.2 mm in the 120 min group (p=0.37). Ischemic injury was detected in 11 animals (39 percent) after 90 min and 11 (45 percent) after 120 min (p=0.77). In animals exhibiting injury, filament length was 16.1±11 mm (90 min) vs. 21.9±7.4 mm (120 min) (p=0.15). The mean infarction zone volume was greater after 120 (259.2 mm³) than after 90 min (162.9 mm³) (p=0.04). The neurological deficit score for the 90 and 120 min groups was 2.0 and 2.4, respectively (p=0.84). CONCLUSION: The experimental model induced significant ischemic cerebral injury in both groups.

OBJETIVO: Avaliar o modelo de isquemia cerebral por oclusão da artéria cerebral média, mediante introdução de fio intraluminal por 90 e 120 minutos, e seu efeito sobre a área de infarto cerebral em ratos. MÉTODOS: 52 ratos machos Wistar foram submetidos à isquemia cerebral por introdução de fio de nylon 3-0 na artéria cerebral média por 90 ou 120 minutos. O volume da lesão isquêmica foi determinado pelo corante TTC, fotografia digital e utilização do programa ImageJ. Na análise estatística, foi utilizado o teste t- student e o U de Mann-Whitney. RESULTADOS: O comprimento do fio introduzido foi de 14,7 mm no grupo 90 minutos e 20,2 mm no grupo 120 minutos. Lesão isquêmica foi detectada em 11 animais (39 por cento) no grupo que de 90 minutos e 11 (45 por cento) do grupo de 120 minutos. Nos animais que apresentaram lesão, o comprimento do fio foi de 16,1±11 mm (90 minutos) e 21,9±7,4 mm (120 minutos). O volume médio da área de infarto foi maior no grupo 120 minutos do que no grupo 90 minutos. O escore de déficit neurológico foi de 2,0 no grupo 90 minutos e de 2,4 no grupo 120 minutos. CONCLUSÃO: O modelo experimental estudado induz lesão isquêmica cerebral significativa em ambos os grupos.

Transient middle cerebral artery occlusion in rats as an experimental model of brain ischemia.

PURPOSE: To assess a rat model of cerebral ischemia induced by occlusion of the middle cerebral artery and its effect on the area of cerebral infarction. METHODS: Brain ischemia was induced in 52 male Wistar rats by introduction of a 3-0 nylon suture into the middle cerebral artery for either 90 (n=28) or 120 (n=24) minutes. Ischemic injury volume was determined by TTC staining, digital photography and analysis with the Image J software. Statistical analysis employed Student's t test and the Mann-Whitney U test. RESULTS: The groups were similar in terms of weight (p=0.59). The length of thread inserted was 14.7 mm in the 90 min group and 20.2 mm in the 120 min group (p=0.37). Ischemic injury was detected in 11 animals (39%) after 90 min and 11 (45%) after 120 min (p=0.77). In animals exhibiting injury, filament length was 16.1 ± 11 mm (90 min) vs. 21.9 ± 7.4 mm (120 min) (p=0.15). The mean infarction zone volume was greater after 120 (259.2 mm³) than after 90 min (162.9 mm³) (p=0.04). The neurological deficit score for the 90 and 120 min groups was 2.0 and 2.4, respectively (p=0.84). CONCLUSION: The experimental model induced significant ischemic cerebral injury in both groups.

Intussuscepção de delgado por melanoma maligno de sítio primário incerto / Small bowel intussusception for malignant melanoma of uncertain primary site

A metástase do melanoma maligno do intestino delgado é incomum. As manifestações clínicas são inespecíficas, e o quadro de abdome agudo obstrutivo pode ser a primeira manifestação. Apresenta-se um caso de intussuscepção intestinal devido a um melanoma metastático de sítio primário não detectado. São discutidos sua etiologia, seu diagnóstico e seu tratamento (AU)

Malignant melanoma metastasis to the small bowel is uncommon. Its clinical presentation is inespecific and an obstructive acute abdomen syndrome could be its first manifestation. A case of intestinal intussusception due to a metastatic melanoma with no primary site detected is described. Etiology, diagnosis and treatment are discussed (AU)

Hiperplasia adrenal congênita por deficiência de 11β hidroxilase: apresentação de caso e revisão da literatura / Congenital adrenal hyperplasiaby 11β hydroxylase deficiency: report of a case and review of literature

Apresentamos o caso de uma paciente feminina, 2 meses, que mostrou aumento naconcentração sérica de 17-hidroxiprogesterona basal, sugerindo o diagnóstico de hiperplasiaadrenal congênita (HAC). O seqüenciamento do gene CYP21 não mostrou nenhumamutação e a concentração sérica de 11-desoxicortisol basal estava aumentada, o quenos permitiu diagnosticar um caso de deficiência da enzima 11β-hidroxilase. Existemduas isoenzimas 11β-hidroxilase codificadas por dois genes, CYP11B1 e CYP11B2, responsáveispela síntese de cortisol e aldosterona, respectivamente. Aproximadamente 2/3dos casos por deficiência de 11β-hidroxilase são acompanhados por hipertensão. Classicamente,a ausência de hipertensão nos pacientes com deficiência de 11β-hidroxilase éexplicada pela variabilidade na atividade enzimática. As particularidades deste caso são aausência de hipertensão e a elevação nas concentrações plasmáticas de renina e aldosterona.Essas alterações podem ser explicadas pelo fato de que pacientes com deficiência de11β-hidroxilase normalmente apresentam comprometimento exclusivo da atividade daCYP11B1, sem alterações na CYP11B2. Dessa forma, a síntese de cortisol ficaria prejudicada,mas não a de aldosterona; por conseguinte, a hipotensão provocada pela deficiênciade glicocorticóide levaria ao aumento fisiológico de renina e aldosterona.

We present the case of a two month-old female patient who showed an increase in theserum concentration of basal 17-hydroxyprogesterone, suggesting the diagnosis of congenitaladrenal hyperplasia (CAH). The sequencing of the CYP21 gene didn’t show anymutation and the serum concentration of basal 11-desoxycortisol was increased, whatallowed us to diagnose a case of deficiency of 11β-hydroxylase enzyme. There are two11β-hydroxylase izoenzymes codified by two genes. CYP11B1 and CYP11B2, which areresponsible for the synthesis of cortisol and aldosterone, respectively. Approximately twothirds of the cases due to the deficiency of 11β-hydroxylase also present hypertension.Classically, the absence of hypertension in patients with 11β-hydroxylase deficiency isexplained by the variability in the enzimatic activity. The particularities of this case arethe absence of hypertension and the increase in the plasmatic concentrations of renin andaldosterone. These alterations can be explained by the fact that patients with 11β-hydroxylasedeficiency normally present the exclusive compromising of the activity of CYP11Bwithout alterations in the CYP11B2. This way, the hypotension caused by the glucocorticoiddeficiency would lead to the physiological increase of renin and aldosterone.