Influence of dressing application time after breast augmentation on cutaneous colonization: A randomized clinical trial.

Concepts regarding the best way to treat a surgical wound vary, in literature, ranging from no dressing use to dressing maintenance for 24 to 48 hours or until suture removal. This study aimed to evaluate the influence of the length of dressing maintenance after breast augmentation with implants on cutaneous colonization and surgical site infection. This is a two-arm, parallel group, randomized clinical trial. Eighty patients who were candidates for augmentation mammoplasty with silicone implants were randomly allocated to two groups, in which the dressing was removed on postoperative day 1 (group A, n = 40) or postoperative day 6 (group B, n = 40). Cutaneous colonization was examined by culturing samples collected before and after dressing removal. The criteria defined by the Centers for Disease Control and Prevention were used to assess surgical site infection. No significant difference regarding cutaneous colonization was observed between groups before dressing application. On postoperative day 6, significantly more bacterial growth was observed in group A (p = 0.01). No surgical site infection occurred. We concluded that maintaining the dressing for 6 days led to a lower cutaneous colonization but did not influence surgical site infection rates.

A comparison of mesial molar root canal preparations using two engine-driven instruments and the balanced-force technique.

The purpose of this study was to compare the effects of two engine-driven, nickel-titanium instrument systems with hand files in the final shape of slight and moderately curved canals. A total of 72 mesial roots of extracted human mandibular molars were divided into three groups: ProFile .04 taper, Pow-R rotary systems, and Flex-R hand-filing technique. The roots were mounted and cross-sectioned at two different horizontal levels using a modified Bramante technique. Pre- and postinstrumented cross-sectional roots were imaged, recorded, and computer analyzed. Results showed that, at the middle third, in almost all groups, there was a tendency of cutting more toward the mesial side with only one exception: Pow-R cut more to the distal side (danger zone) (p < 0.02). At the apical third, Flex-R (p < 0.03) and ProFile (0.001) transported to the mesial side (danger zone) when the curvature increased. When the three techniques were compared analyzing each side and considering the two groups of curvature, at the middle third in the moderately curved-canal group, Flex-R cut statistically more than Pow-R toward the lingual side. The other comparisons showed no statistically significant difference. When the techniques were compared in relation with the degree of curvature, in the apical third, ProFile .04 cut statistically more toward the mesial side in the moderately curved canal group than in the slightly curved canal group. The other comparisons showed no statistically significant difference. Canal preparation time was shorter with hand instrumentation (p < .05) in a few instances.

Blood glucose and insulin response to intravenous glucose by patients with chronic Chagas' disease and alcoholism.

Blood glucose and insulin responses to intravenous glucose 500 mg/kg in a group of alcoholic chagasic patients (Group I, N = 15) were assessed and compared to those of a group of patients with Chagas' disease without alcoholism (Group II, N = 16), a group of alcoholics without Chagas' disease (Group III, N = 22), and a group of non-alcoholics without Chagas' disease (Group IV, N = 15). Determinations of serum glucose and insulin were done under fasting conditions, 5 and 10 min after the injection of 50% glucose. There was no difference in mean serum glucose levels between groups. Mean serum insulin levels at times 5 and 10 min and for the total integrated response were lower (P < 0.05) in Groups I and II as compared to Group IV; at time 10 min the mean was lower (P < 0.05) in Group III as compared to Group IV. There was a nonsignificant trend for a lower insulinemic response in Group I as compared to Group II. These data suggest denervation of or injury to pancreatic B cell by Chagas' disease.

Sulfated glycosaminoglycan composition of human gastric mucosa: effect of aging, chronic superficial gastritis and adenocarcinoma.

The sulfated glycosaminoglycan (SGAG) composition of gastric mucosa from 24 patients with chronic superficial gastritis, 2 patients with adenocarcinoma and 36 normal subjects is reported. The mucosa was obtained by endoscopic biopsy and after histopathological examination the SGAG were extracted and characterized. Three different SGAG were isolated: chondroitin 4,6-sulfate, dermatan sulfate and heparan sulfate. Their relative concentrations for the different groups were submitted to analysis of variance by Scheffe's method. Different SGAG compositions were observed in two gastric regions (antrum and body), in chronic superficial gastritis, in adenocarcinoma and in two age groups (less than 40 years and greater than 40 years). These and other results suggest that these macromolecules might be involved in the processes of cell division and aging.

Radioaerosol 99mTc-DTPA characterization produced by some nebulizers.

1. The radioaerosol 99mTc-DTPA produced by jet and ultrasonic nebulizers was characterized by measuring the median mass diameter (MMD) and geometric standard deviation (sigma g) and these characteristics were interpreted in terms of the aerodynamic principles of inertial impactation. 2. Jet nebulizers of the same model, with different outflows (NSA = 0.14 ml/min; NSB = 0.24 ml/min and NSC = 0.40 ml/min) showed different radioaerosol mass distribution, with MMD (NSC) > MMD (NSA). The ultrasonic nebulizer US-1000 from Narcosul, which is operated with an air flow of 2 l/min and frequency of 1.6 MHz, generated radioaerosol with MMD = 2.40 microns, higher than that obtained with most of the jet nebulizers evaluated (NSA = 1.50 microns; NSB1V = 1.40 microns; NSB2V = 1.20 microns and PITT#1 - 0.80 microns), and the ultrasonic nebulizer presented the highest outflow of the nebulized solution (1.15 ml/min). 3. Connecting one or two impactation reservoirs to the NSB jet nebulizer modified the mass distribution, which became significantly narrower for NSB2V when compared to the other two nebulizers. NSB2V presented a mass percentage with a diameter of 3 microns or less and a sufficient outflow for use in ventilation and pulmonary permeability studies. 4. Comparison of the mass collected in the cascade impactor and the total mass generated by the NSB, NSB1V and NSB2V nebulizers showed, on average, 4.5% efficiency in radioaerosol generation with a diameter of less than 16 microns and 3.2% efficiency for a diameter of 3 microns or less.

Effect of lung resection and sham surgery on the frequency of infection in alloxan-diabetic rats.

The present study was carried out in order to determine the effect of lung resection on the frequency of infections in alloxan-diabetic rats. Adult female Wistar rats were injected with alloxan (40 mg/kg, iv) to induce diabetes mellitus (group D; N = 45) or with vehicle (1.0 ml/kg, iv) to be used as controls (group C; N = 45). Thirty-six days after receiving alloxan both groups were randomly divided into three subgroups: no operation (NO; N = 15), sham operation (SO; N = 15), and left pneumonectomy (PE; N = 15). The rats were sacrificed 36 days after surgery and their lungs were examined microscopically and macroscopically. The occurrence of thoracic wall infection, thoracic wall abscess, lung abscess and pleural empyema was similar in groups D and C. In contrast, the overall infection rate was higher (P<0.05) in the diabetic rats (SO-D and PE-D subgroups, but not in the NO-D subgroup). Considering that the overall infection rate was similar in the SO-D and PE-D subgroups, we suggest that surgery but not pneumonectomy was related to the higher prevalence of infection in diabetic rats.

Effects of almitrine on the ventilatory control, breathing pattern and maximal exercise tolerance in hypoxemic patients with chronic obstructive pulmonary disease.

Almitrine bismesylate improves arterial blood gases in patients with chronic obstructive pulmonary disease (COPD), but side effects such as increase of ventilatory drive and dyspnea have been reported in some studies. We studied 18 COPD patients (mean age = 59.1 years; mean FEV1 = 0.92 1; mean PaO2 = 58.6 mmHg) in a double-blind randomized study using placebo or almitrine 50 mg twice a day by mouth, for 60 days. In contrast to the placebo group, 40% of the patients in the almitrine group presented a significant increase in PaO2 and a decrease in P(A-a)O2 > or = 5 mmHg during submaximal exercise after 60 days of treatment. Ventilatory drive and the breathing pattern were measured at rest and during submaximal exercise. Both groups showed high levels of ventilatory drive and a tachypneic breathing pattern before drug treatment and no modification was found 30 and 60 days after treatment. Metabolic, cardiovascular and ventilatory variables were studied during an incremental to maximum exercise symptom-limited test (cycloergometry). Maximal VO2 ranged from 46 to 52% and heart rate from 76 to 78% in relation to the predicted values. The percent ratio of ventilation at maximal exercise to maximal voluntary ventilation at rest ranged from 86 to 94%. These results show that the reduction of ventilatory capacity was the main factor decreasing the aerobic performance of our COPD patients. Maximal exercise tolerance (VO2 max) did not change after almitrine treatment. Negative factors like an increase in neuromuscular drive did not occur, and positive factors like an increase in PaO2 and oxygen transport had no critical influence on exercise performance in our ventilatory-limited COPD patients.

Estrogenic activity of tamoxifen on normal mammary parenchyma in the luteal phase of the menstrual cycle.

OBJECTIVES: Tamoxifen, an anti-estrogenic drug used in the adjuvant treatment of breast cancer, deserves more investigation for the determination of its efficacy as a prophylactic agent against breast cancer in high risk women. Thus, the action of tamoxifen on the human mammary gland was studied by measuring the number of lysosomes in normal mammary epithelium during the administration of tamoxifen. METHODS: Tamoxifen was administered only during the luteal phase of the menstrual cycle to avoid interference with corpus luteum formation. A fragment of breast tissue adjacent to a fibroadenoma was obtained during surgery from 35 premenopausal women aged 15 to 37 years who had been eumenorrheic for at least 6 months; 18 of these patients were treated with tamoxifen and 17 were used as controls. Lysosome counts were performed under the light microscope on slides submitted to the acid phosphatase cytochemical technique and the data were analyzed statistically by the Mann-Whitney test. RESULTS: The fragments from the group treated with tamoxifen showed a significant decrease in lysosome numbers. CONCLUSIONS: Tamoxifen administered after ovulation significantly decreases the number of lysosomes in the cells of normal mammary epithelium, demonstrating the antiestrogenic effect of the drug on this target tissue.

[A hysteroscopic and anatomicopathological study in women with breast cancer]. / Studio isteroscopico e anatomopatologico in donne con cancro della mammella.

OBJECTIVE: To study the uterine mucosa of women with breast cancer in order to evaluate the frequency of endometrial diseases. EXPERIMENTAL DESIGN: Prospective, controlled study carried out from January to December 1996. SURROUNDINGS: Patients with breast cancer and normal controls from 4 out-patient university services in Porto Alegre, Brazil. PATIENTS: Postmenopausal women without hormonal therapy were compared: 67 of them with breast cancer and 101 normal controls. METHODS: Hysteroscopy followed by endometrial biopsy carried out in both groups as an out-patient procedure. RESULTS: In patients with breast cancer, 29.85% abnormal biopsies were found as follows: 10 endometrial polyps (15.0%), 8 with proliferative changes (11.9%), 1 case of cancer (1.5%), and one case of hyperplasia (1.5%). In the control group 8% abnormal morphological findings were found, as follows: 4 (4%) with endometrial polyps and 4 (4%) with proliferative changes. The differences in abnormal biopsies were statistically significant, mainly in patients with corporal mass index above 27.3. The sensibility of hysteroscopy was 82.14%; its specificity 97.16%; its predictive positive value 85.18% and its predictive negative value 96.48% in detecting endometrial activity, for a prevalence of 16.7% of endometrial activity. CONCLUSIONS: Endometrial evaluation must be included in the initial evaluation of patients with breast cancer, mainly if they were obese. Hysteroscopy, performed in out-patient basis, showed to be an adequate method to evaluate the uterine mucosa, helping to select the area of this cavity for biopsy.

F-waves and conduction velocities range.

A controversial aspect in F-wave studies is if these potentials are generated preferentially by large motoneuron or by motoneuron of all sizes. The purpose of this work is to compare the maximum and minimum conduction velocities of the fibers that generate the M-wave with the maximum and minimum conduction velocities of the F-waves elicited by ulnar nerve stimulation. There were no significant differences between maximum velocities. However, minimum F-wave velocity was significantly higher than minimum conduction velocity, suggesting that the F-waves registered were preferentially generated by the fastest conducting axons.

[Electroneurography of the facial nerve: methods of stimulation and records]. / Eletroneurografia do nervo facial. Métodos de estimulação e registro.

In this study it is, intended to establish the more appropriate points to register the compound action potential from m. frontalis m. orbicularis oculi and nasolabial fold muscles. The optimum site for stimulating electrodes and differences between the first and the last compound action potentials after 20 consecutive stimuli delivered at 1 Hz were analysed.

[Evoked potentials by median nerve stimulation: comparison of central conduction time defined by different measure points]. / Potencial evocado por estimulação do nervo mediano. Comparação do tempo de condução central definido por diferentes pontos de medida.

After stimulation of the right median nerve in 20 normal adult volunteers interpeak latency N13-N20 and the difference in onset latency of the components N11-N20 are compared. A fractionation of the last measure was made at the onset of the P13-14 complex. The results concur with the ones in the literature, and it has been observed that all points measured could be obtained without significant difference on the C6-FZ and P3-FZ montages.

[Related observations for the use of mounting between neck posterior and scalp in evoked potentials by median nerve stimulation]. / Observações relacionadas à utilização de montagens entre a face posterior do pescoço e o couro cabeludo no potencial evocado por estimulação do nervo mediano.

Somatosensory evoked potentials after stimulation of the median nerve were obtained in a group of normal individuals. The components obtained between 12 and 22 ms were analysed with cephalic and non-cephalic references. It is shown that the P13-14 complex is the major contributor for the amplitude of the N13 component recorded with electrodes between the posterior neck and the scalp. It has not been possible to detect differences in amplitude or latencies for the components N18 and P22 recorded between FZ-non cephalic and C6-FZ. Implications of these findings to clinical interpretations of the responses are discussed.

Facial electroneurography in Bell's palsy. Variability in the early stage and comparison between interpretation methods.

To determine the variability of the abnormalities found in the electroneurography (ENG) of the facial nerve in cases of Bell's palsy during the initial two week period was one of the objectives of the authors. A second one was to investigate the value of ENG as a tool to determine an early prognosis of recovery utilizing two different methods. In the first one the amplitude of the compound muscular action potential (CMAP) obtained on the paralyzed side was compared to this potential on the opposite (normal) side. The second method compared the CMAP on the paralyzed side to normal standardized data from normal individuals. A group of 33 patients with Bell's palsy was followed until total recovery of for at least 4 months, if the recovery was not achieved earlier. It was observed that amplitude of the CMAP become stable towards the sixth day of palsy and this is a good time to establish the prognosis. Another conclusion is that both methods were equivalent to determine the prognosis in Bell's palsy.

[Incidence of neurosyphilis and incidence of its clinical forms 1962-1981]. / Incidência da neurossífilis e frequênica de suas formas clínicas no período 1962-1981.

After 1950 it was observed an increase in the incidence of syphilis in the general population and this fact determined an investigation in order to evaluate the possible repercussion of this occurrence on the central nervous system, as an after effect of the elevated incidence. However, in this first study it was verified that there was a progressive and marked decrease of the neurosyphilis incidence in the 1936-1964 period, and that the frequency of meningovascular forms of the disease had increased lately in regard to the parenchymatous forms. The aim of the present work has been the continuation of this study after so many years. The material for this survey consisted of the clinical records of 148 patients picked out from 34.430 cases seen at the Neurological Department of Escola Paulista de Medicina (São Paulo, Brasil), during the 1962-1981 period, i.e., on twenty consecutive years. The results of this complementary investigation have shown instead that the incidence of neurosyphilis remained steady, changing very little every year, with an incidence at the rate of about 1:200. On the other hand, the frequency of the clinical forms of neurosyphilis changed very much. The usual forms such as general paresis and tabes are now scant and the observation of the uncommon forms, seldom seen in the past, is now progressively increasing through the years, so that they are the preponderant clinical forms today.

Nutritional assessment and surgical risk markers in children submitted to cardiac surgery.

In order to assess the nutritional status of children with heart diseases and to evaluate nutritional parameters for predicting postoperative complications, 50 children undergoing to cardiac surgery and classified in high and low surgical risk prospectively evaluated. Assessment parameters included anthropometry and plasma proteins albumin, transferrin and prealbumin. The nutritional classification according to Waterlow's modified criteria showed a high prevalence of malnutrition in the population studied (78%). The measures of arm circumference when located below the 5th percentile showed a significant association with general postoperative complications in the high risk group (arm circumference, p = 0.0019; arm muscle circumference, p = 0.0419). The percentage of weight per height, serum albumin and transferrin has not played a prognostic role concerning postoperative morbidity. The mean value of prealbumin was significantly lower in high risk group patients developing postoperative infections (p < 0.01) compared to those who did not. The sensitivity-specificity analysis of prealbumin as risk indicator for postoperative infection was 87.5% and 59% respectively. The nutritional risk classification seems to be a good way to identify the subgroups of children with additional postoperative surgical risk. However, more specific and sensitive tests are desirable to provide an individual identification of these children.

The progestogen challenge test in postmenopausal women: clinical and morphologic aspects.

The clinical aspects and anatomopathological patterns of 150 postmenopausal women were studied using the progestogen challenge test. An endometrial biopsy was obtained and submitted to the progestogen test. A histopathological analysis of the uterine mucosa from women with a positive progestogen test revealed that the endometrium was active in 44 percent of cases and atrophic or inactive in 56 percent. In contrast, among women with a negative response, the endometrium was atrophic in 94 percent of cases and active in 6 percent. Analysis of clinical aspects did not show significant differences between groups in terms of age; age at menarche and at menopause; fasting blood glucose levels; or body mass. However, postmenopausal time was significantly shorter for women with a positive test, with a correlation between postmenopausal time of one to two years and test positivity. The progestogen challenge test for the detection of atrophic endometrium presented 78.57 percent sensitivity, 77.05 percent specificity, 44 percent positive predictive value, and 94 percent negative predictive value. Thus, when negative, the test is highly valuable, indicating the presence of atrophic endometrium in 94 percent of cases. False-negative results occurred in only 6 percent of the subjects, with no case of hyperplasia detected. However, when the response to the test was positive, the endometrium was atrophic in 56 percent of the cases. We suggest that, in order to avoid invasive procedures, the progestogen challenge test be combined with other methods such as transvaginal ultrasonography.

Iron, copper and alpha 1-antitrypsin deficiency in the liver of cirrhotic and schistosomotic patients.

While a number of studies investigated iron and copper storage or alpha 1-antitrypsin (A1AT) deficiency in the liver of patients with cirrhosis, we did not find any similar study in schistosomotic patients reported in literature. We investigated the storage of both metals and the A1AT deficiency in the liver of 72 cirrhotic and 27 schistosomotic patients (5 with the hepatointestinal and 22 with the hepatoesplenic form of the disease). Forty-four patients with cirrhosis were also alcoholic, and 28 were not. Iron storage was detected in 23 patients with cirrhosis (31.9%); among these 16 (36.3%) were alcoholic and 7 (25.0%) non-alcoholic (the difference was not statistically significant). Thirteen (56.5%), 5 (21.7%) and 5 (21.7%) patients presented I-grade, II-grade, and III-grade iron storage, respectively. Copperstorage was detected in 24 cirrhotic patients (33.3%), 15 being alcoholic (34.0%) in contrast with 9 non-alcoholic patients (32.1%), a statistically non-significant difference. A1AT deficiency was observed in 2 patients with cirrhosis (2.8%), one with history of alcoholism. HBsAg and HBcAg in hepatic tissue were detected in 5 cirrhotic patients (6.9%), three of them with a history of alcoholism. Iron and copper storage and A1AT deficiency were observed in 3 patients with cirrhosis (12.5%), while iron storage and A1AT deficiency were found in 2 additional patients with cirrhosis (2.8%). The authors underline that neither iron nor copper storage nor A1AT deficiency was found in any schistosomotic patient. The authors discuss the possible importance of these data.

Serum type III procollagen peptides in patients with hepatointestinal and compensated hepatoesplenic schistosomiasis forms.

The Serum Type III Procollagen Peptides (SIIIPP) were determined in 35 individuals: 25 untreated schistosomotics: 16 with hepatointestinal (HI) and 9 with the compensated hepatosplenic (CHE) forms and a control group (C) consisted of 10 healthy volunteers. Kits of radioimmunoassay were performed for SIIIPP dosage. It was searched whether there was relationship between the SIIIPP and the serum levels of alanine aminotransferase (ALAT), aspartate aminotransferase (ASAT), alkaline phosphatase (AP) and gamma glutamyltranspeptidase (GGTP). The mean values of SIIIPP in the forms of HI (13.0 ng/ml) and CHE (17.0 ng/ml) were significantly higher than controls (9.0 ng/ml) (p less than 0.05). No significant difference was observed in SIIIP values between the HI and CHE patient groups, and between SIIIPP and ALAT, ASAT, AP and GGTP serum levels.

Serum immunoglobulins in patients with schistosomiasis mansoni.

The authors evaluated immunglobulins IgA, IgC and IgM in two groups of schistosomiasis patients, 20 presenting the hepato-intestinal form (HI) and 20 the hepatosplenic form (HS). The results indicated abnormalities in the following proportions: IgA: HI = 55% HS = 45% IgC: HI = 85% HS = 95% IgM: HI = 75% HS = 85% The authors compare the values of each immunoglobulin in the two groups of patients and evaluate their results.