Revista do Hospital das Clínicas
type: channel
description: To publish peer-reviewed materials of interest to clinicians and researchers in medicine.
publisher: Universidade de São Paulo. Faculdade de Medicina
language: en
publication name: Revista do Hospital das Clínicas
issn: 0041-8781
items: Pulmonary hemorrhage as a manifestation of systemic lupus erythematosus
items: Advances in radiochemotherapy in the treatment of head and neck cancer
items: Risks and benefits of hormone replacement therapy in older men
items: HIV-1: maternal prognosis
items: The general practitioner and the surgeon: stereotypes and medical specialties
items: Portal hyperflow in patients with hepatosplenic mansonic schistosomiasis
items: Ethical aspects in the management of the terminally ill patient in the pediatric intensive care unit
items: Ethics and the management of terminally ill children
items: Hydronephrosis in Schinzel-Giedion syndrome: an important clue for the diagnosis
items: Titanium pigment in tissues of drug addicts: report of 5 necropsied cases
items: Pulmonary artery catheter complications: report on a case of a knot accident and literature review
items: Anatomic study of the dorsal arterial system of the hand
items: Growth and puberty after treatment for acute lymphoblastic leukemia
items: Relationship between the morphologic alterations of vocal cords from adult autopsies and the cause of death
items: Adductor policis muscle: a new anthropometric parameter
items: Surgery information reduces anxiety in the pre-operative period
items: Homeopathy: do not accept as medicine what has no evidence and contradicts basic science
items: Homeopathy: do not condemn what we do not understand
items: Proton magnetic resonance spectroscopy of the frontal lobe in schizophrenics: a critical review of the methodology
items: Involvement of C4 allotypes in the pathogenesis of human diseases
items: Conjunctival keratoacanthoma
items: Concomitant involvement of the small intestine and the distal esophagus in an infant with massive necrotizing enterocolitis
items: Adnexal torsion following gonadotropin-releasing hormone analog therapy: a case report
items: Nonsmall cell lung cancer: evaluation of 737 consecutive patients in a single institution
items: Systemic hypertension, diabetes mellitus, and dyslipidemia in relation to body mass index: evaluation of a Brazilian population
items: Different doses of exogenous surfactant for treatment of meconium aspiration syndrome in newborn rabbits
items: Effect of clarithromycin on the cell profile of bronchoalveolar lavage fluid in mice with neutrophil-predominant lung disease
items: Dental and facial characteristics of patients with juvenile idiopathic arthritis
items: Hepatitis B: epidemiological, immunological, and serological considerations emphasizing mutation
items: Voiding dysfunction and urodynamic abnormalities in elderly patients

Pulmonary hemorrhage as a manifestation of systemic lupus erythematosus
type: item
description: The authors report a case of a 19-year-old woman admitted for the investigation of fever and hemolytic anemia for the previous 2 months. As an inpatient, she had convulsions and sudden loss of consciousness, developing hemoptysis, hypoxia, and respiratory insufficiency. Examination showed pericardial effusions on the echocardiogram and bilateral alveolar condensations on the thoracic radiograph. A hypothetical diagnosis of systemic lupus erythematosus was made, and measurement of the antinuclear factor was requested along with daily pulse therapy methylprednisolone, in spite of which the outcome was fatal. Afterwards, the result of the antinuclear factor test was positive, with a titer of 1:5120, showing a fine punctiform pattern, fulfilling the criteria for systemic lupus erythematosus according to the American College of Rheumatology. Secondary pulmonary hemorrhage in this connective tissue disease is an uncommon but serious complication that involves a high level of mortality in spite of intensive treatment, as is also reported in the literature.
subject: Case Report
  topic: section
subject: Alveolar hemorrhage
  topic: keywords
subject: Systemic lupus erythematosus
  topic: keywords
subject: Pulmonary capillaritis
  topic: keywords
creator: Bruno Hollanda Santos
creator: Rodrigo Ribeiro Santos
creator: Celeide Fátima Santos
creator: Adriana Maria Kakehasi
creator: Hermann Alexandre Vivacqua Von Tiesenhausen
rights: Copyright (c)
date: 2004-02-01
publication date: 2004-02-01
starting page: 47
ending page: 50
doi: 10.1590/S0041-87812004000100008

Advances in radiochemotherapy in the treatment of head and neck cancer
type: item
description: New advances are being incorporated into the radiochemotherapy treatment of squamous cell carcinoma of the head and neck. Although the overall prognosis is poor in advanced stages, the possibility of incorporating combined protocols of chemotherapy and radiotherapy for organ preservation or for palliation in cases of recurrent/locally advanced stages that are not good surgical candidates must not be forgotten. In this context, there is an urgent need to incorporate quality of life questionnaires and functional evaluation into organ-preservation studies, as well as to assure the importance of surgical salvage after radiotherapy and chemotherapy protocols. The authors provide an extensive review of the advances occurring in the nonsurgical treatment of head and neck cancer. Special attention is given to different radiotherapy protocols, new chemotherapy combinations, molecular markers, and molecular therapy as well as the possibility of incorporating re-irradiation and adjuvant therapy after surgery.
subject: Reviews
  topic: section
subject: Chemotherapy
  topic: keywords
subject: Radiotherapy
  topic: keywords
subject: Head and neck cancer
  topic: keywords
creator: Daniel Herchenhorn
creator: Fernando Luiz Dias
rights: Copyright (c)
date: 2004-02-01
publication date: 2004-02-01
starting page: 39
ending page: 46
doi: 10.1590/S0041-87812004000100007

Risks and benefits of hormone replacement therapy in older men
type: item
description: The use of testosterone in older men, known as male hormonal replacement therapy or androgen replacement therapy, has become of increasing interest to both the medical and lay communities over the past decade. Even though the knowledge of the potential benefits and risks of male Androgen Replacement Therapy has increased dramatically, there is still much that needs to be determined. Although there are a number of potential benefits of male Androgen Replacement Therapy and data concerning clinical effects of such replacement have accumulated, as yet there have not been any large multicenter randomized controlled trials of this therapy. It is the purpose of this article to review what is currently known about the possible risks and benefits of male Androgen Replacement Therapy by discussing the clinical trials to date.
subject: Reviews
  topic: section
subject: Testosterone
  topic: keywords
subject: Androgen
  topic: keywords
subject: Hormones
  topic: keywords
subject: Elderly
  topic: keywords
subject: Replacement
  topic: keywords
creator: Fábio Firmbach Pasqualotto
creator: Antônio Marmo Lucon
creator: Jorge Hallak
creator: Eleonora Bedin Pasqualotto
creator: Sami Arap
rights: Copyright (c)
date: 2004-02-01
publication date: 2004-02-01
starting page: 32
ending page: 38
doi: 10.1590/S0041-87812004000100006

HIV-1: maternal prognosis
type: item
description: Profound modifications in the profile of patients are currently being observed within the epidemic context of AIDS, especially with respect to pauperization and feminization of the disease. The population most frequently affected is in the reproductive age, and among adults aged 18 to 24 years, the ratio is 1 man to 1 woman, a phenomenon occurring uniformly all over the world. One of the main challenges for HIV-1-infected pregnant women and their doctors is the effect of the interaction between HIV infection and pregnancy. The present article is a review of the literature; and its objective is to assess the influence of HIV-1 infection seen from the maternal perspective, with a discussion of immunologic function, maternal prognosis, and the HIV-abortion interface. At present, we cannot conclude that pregnancy has a short-term effect on the evolution of HIV infection, but the concomitance of HIV and pregnancy may adversely affect the prognosis of gestation, especially in view of its frequent association with increased abortion and puerperal morbidity rates.
subject: Reviews
  topic: section
subject: HIV-1
  topic: keywords
subject: Pregnancy
  topic: keywords
subject: Abortion
  topic: keywords
subject: Immunology
  topic: keywords
subject: Prognosis
  topic: keywords
creator: Patrícia El Beitune
creator: Geraldo Duarte
creator: Silvana Maria Quintana
creator: Ernesto Antônio Figueiró-Filho
rights: Copyright (c)
date: 2004-02-01
publication date: 2004-02-01
starting page: 25
ending page: 31
doi: 10.1590/S0041-87812004000100005

The general practitioner and the surgeon: stereotypes and medical specialties
type: item
description: OBJECTIVE: To investigate and characterize the professional stereotypes associated with general medicine and surgery among Brazilian medical residents. METHODS: A randomized sample of residents of the General Medicine and Surgery Residence Programs were interviewed and their perceptions and views of general and surgical doctors were compared. RESULTS: The general practitioner was characterized by the residents in general to be principally a sensitive and concerned doctor with a close relationship with the patient; (45%); calm, tranquil, and balanced (27%); with intellectual skills (25%); meticulous and attentive to details (23%); slow to resolve problems and make decisions (22%); and working more with probabilities and hypotheses (20%). The surgeon was considered to be practical and objective (40%); quickly resolving problems (35%); technical with manual skills (23%); omnipotent, arrogant, and domineering (23%); anxious, stressed, nervous, and temperamental (23%); and more decided, secure, and courageous (20%). Only the residents of general medicine attributed the surgeon with less knowledge of medicine and only the surgeons attributed gender characteristics to their own specialty. CONCLUSION: There was considerable similarity in the description of a typical general practitioner and surgeon among the residents in general, regardless of the specialty they had chosen. It was interesting to observe that these stereotypes persist despite the transformations in the history of medicine, i.e. the first physicians (especially regarding the valorization of knowledge) and the first surgeons, so-called "barber surgeons" in Brazil (associated with less knowledge and the performance of high-risk procedures).
subject: Original Articles
  topic: section
subject: Career choice
  topic: keywords
subject: Specialties
  topic: keywords
subject: medical
  topic: keywords
subject: Education
  topic: keywords
subject: Stereotypes
  topic: keywords
subject: Brazil
  topic: keywords
creator: Patrícia Lacerda Bellodi
rights: Copyright (c)
date: 2004-02-01
publication date: 2004-02-01
starting page: 15
ending page: 24
doi: 10.1590/S0041-87812004000100004

Portal hyperflow in patients with hepatosplenic mansonic schistosomiasis
type: item
description: PURPOSE: The purpose of this study was to assess portal hemodynamics in patients with portal hypertension due to hepatosplenic schistosomiasis as well as to assess the contribution of splanchnic hyperflow to the pathophysiology of the portal hypertension. METHODS: Sixteen patients with schistosomal portal hypertension and previous history of upper digestive bleeding due to esophageal varices rupture underwent elective esophagogastric devascularization and splenectomy and were prospectively studied. All patients underwent intraoperative invasive hemodynamic portal monitoring with a 4F-thermodilution catheter. The intraoperative portal hemodynamic assessment was conducted after laparotomy (initial) and after esophagogastric devascularization (final). RESULTS: The initial portal pressure was elevated (mean 28.5 ± 4.5 mm Hg), and a significant drop of 25% was observed at the end of the surgery (21.9 ± 4.9 mm Hg). The initial portal flow was elevated (mean 1766.9 ± 686.6 mL/min). A significant fall (42%) occurred at the end of the surgical procedure (1025.62 ± 338.7 mL/min). Fourteen patients (87.5%) presented a portal flow of more than 1200 mL/min, and in 5 cases, values greater than 2000 mL/min were observed. CONCLUSIONS: Esophagogastric devascularization and splenectomy promote a significant reduction of the elevated portal pressure and flow in schistosomal portal hypertension. These data favor the hypothesis of portal hyperflow in the physiopathology of portal hypertension of schistosomiasis.
subject: Original Articles
  topic: section
subject: Hemodynamics
  topic: keywords
subject: Portal hypertension
  topic: keywords
subject: Portal system
  topic: keywords
subject: Mansonic schistosomiasis
  topic: keywords
creator: Roberto de Cleva
creator: William Abrão Saad
creator: Paulo Herman
creator: Vincenzo Pugliese
creator: Bruno Zilberstein
creator: Antonio Atílio Laudanna
creator: Joaquim José Gama-Rodrigues
rights: Copyright (c)
date: 2004-02-01
publication date: 2004-02-01
starting page: 10
ending page: 14
doi: 10.1590/S0041-87812004000100003

Ethical aspects in the management of the terminally ill patient in the pediatric intensive care unit
type: item
description: OBJECTIVE: To identify the prevalence of management plans and decision-making processes for terminal care patients in pediatric intensive care units. METHODOLOGY: Evidence-based medicine was done by a systematic review using an electronic data base (LILACS, 1982 through 2000) and (MEDLINE, 1966 through 2000). The key words used are listed and age limits (0 to 18 years) were used. RESULTS: One hundred and eighty two articles were found and after selection according to the exclusion/inclusion criteria and objectives 17 relevant papers were identified. The most common decisions found were do-not-resuscitation orders and withdrawal or withholding life support care. The justifications for these were "imminent death" and "unsatisfatory quality of life". CONCLUSION: Care management was based on ethical principles aiming at improving benefits, avoiding harm, and when possible, respecting the autonomy of the terminally ill patient.
subject: Original Articles
  topic: section
subject: Terminal care
  topic: keywords
subject: Ethics
  topic: keywords
subject: Life support care
  topic: keywords
subject: pediartics
  topic: keywords
subject: Pediatric intensive care unit
  topic: keywords
creator: Lara de Araújo Torreão
creator: Crésio Romeu Pereira
creator: Eduardo Troster
rights: Copyright (c)
date: 2004-02-01
publication date: 2004-02-01
starting page: 3
ending page: 9
doi: 10.1590/S0041-87812004000100002

Ethics and the management of terminally ill children
type: item
subject: Editorial
  topic: section
creator: Marco Segre
rights: Copyright (c)
date: 2004-02-01
publication date: 2004-02-01
starting page: 1
ending page: 2
doi: 10.1590/S0041-87812004000100001

Hydronephrosis in Schinzel-Giedion syndrome: an important clue for the diagnosis
type: item
description: Schinzel-Giedion syndrome is a rare autosomal recessive disorder characterized by coarse facies, midface retraction, hypertrichosis, multiple skeletal anomalies, and cardiac and renal malformations. Craniofacial abnormalities of this syndrome sometimes resemble a storage or metabolic disease. The pathogenesis of the disease remains unknown. The objective of this report was to emphasize the importance of congenital bilateral hydronephrosis for the diagnosis of Schinzel-Giedion syndrome. We describe the first Brazilian case of a newborn with typical facies, generalized hypertrichosis, cardiac and skeletal anomalies, and bilateral hydronephrosis detected during pregnancy and confirmed later by abdominal ultrasonography. Chromosomal constitution was normal. Of the 35 cases already reported in the literature, 31 presented hydronephrosis, which is considered an important clue in diagnosis. If Schinzel-Giedion syndrome were indexed as a cause of congenital hydronephrosis, its identification would be greatly facilitated, since the majority of the other findings in Schinzel-Giedion syndrome are nonspecific and common to many genetic syndromes.
subject: Case Reports
  topic: section
subject: Schinzel-Giedion syndrome
  topic: keywords
subject: Hydronephrosis
  topic: keywords
subject: Midface hypoplasia
  topic: keywords
creator: Lilian Maria José Albano
creator: Paula Priscila Ohara Sakae
creator: Marta Maria Galli Bozzo Mataloun
creator: Clea Rodrigues Leone
creator: Débora R. Bertola
creator: Chong Ae Kim
rights: Copyright (c)
date: 2004-01-01
publication date: 2004-01-01
starting page: 89
ending page: 92
doi: 10.1590/S0041-87812004000200008

Titanium pigment in tissues of drug addicts: report of 5 necropsied cases
type: item
description: The aim of this report is to describe the anatomic-pathologic findings from necropsies of 5 drug addicts with titanium pigment in several organs after chronic intravenous injection of crushed propoxyphene hydrochloride tablets. Samples from liver, spleen, lungs, lymph nodes, and bone marrow were obtained, and after being grossly studied, they were submitted to evaluation using common light and polarized microscopy. In all 5 cases, a pigment with characteristics of titanium dioxide was found within tissue samples of the organs studied. Our findings suggest that research concerning titanium pigment within body tissues should be enhanced, considering the potential contribution of this morphologic data to forensic pathology.
subject: Case Reports
  topic: section
subject: Titanium
  topic: keywords
subject: Drug addiction
  topic: keywords
subject: Propoxyphene hydrochloride
  topic: keywords
subject: Talc
  topic: keywords
subject: Necropsy
  topic: keywords
creator: Marcus Aurelho de Lima
creator: Vitorino Modesto dos Santos
creator: Samia Demachki
creator: Javier Lazo
rights: Copyright (c)
date: 2004-01-01
publication date: 2004-01-01
starting page: 86
ending page: 88
doi: 10.1590/S0041-87812004000200007

Pulmonary artery catheter complications: report on a case of a knot accident and literature review
type: item
description: A particular event concerning a Swan-Ganz catheter complication is reported. A 41-year-old woman was admitted at the emergency room of our hospital with massive gastrointestinal bleeding. A total gastrectomy was performed. During the postoperative period in the intensive care unit , the patient maintained hemodynamic instability. Invasive hemodynamic monitoring with a pulmonary artery catheter was then indicated. During the maneuvers to insert the catheter, a true knot formation was identified at the level of the superior vena cava. Several maneuvers by radiological endovascular invasive techniques allowed removal of the catheter. The authors describe the details of this procedure and provide comments regarding the various techniques that were employed in overcoming this event. A comprehensive review of evidence regarding the benefits and risks of pulmonary artery catheterization was performed. The consensus statement regarding the indications, utilization, and management of the pulmonary artery catheterization that were issued by a consensus conference held in 1996 are also discussed in detail.
subject: Case Reports
  topic: section
subject: Intensive care unity
  topic: keywords
subject: Swan-Ganz catheterization
  topic: keywords
subject: Invasive hemodynamic monitoring
  topic: keywords
subject: Pulmonary artery catheter complications
  topic: keywords
subject: Pulmonary artery catheter knot formation
  topic: keywords
creator: Marcelo Cruz Lopes
creator: Roberto de Cleva
creator: Bruno Zilberstein
creator: Joaquim José Gama-Rodrigues
rights: Copyright (c)
date: 2004-01-01
publication date: 2004-01-01
starting page: 77
ending page: 85
doi: 10.1590/S0041-87812004000200006

Anatomic study of the dorsal arterial system of the hand
type: item
description: Historically, the dorsal arterial system of the hand received less attention than the palmar system. The studies concerning dorsal arterial anatomy present some controversies regarding the origin and presence of the dorsal metacarpal artery branches. Knowledge of the anatomy of dorsal metacarpal arteries is especially applied in the surgical planning for flaps taken from the dorsum of the hand. The purpose of this study is to analyze the arterial anatomy of the dorsum of the hand, compare our observations with those of previous studies from the literature, and therefore to define parameters for surgical planning for flaps supplied by the dorsal metacarpal arteries. METHOD: Twenty-six dissections were performed at the dorsum of the right hand of 26 cadavers by making a distal-based U-shaped incision. After catheterization of the radial artery at the wrist level, a plastic dye solution with low viscosity and quick solidification was injected to allow adequate exposure of even small vessels. The radial artery and its branches, the dorsal arterial arch, the dorsal metacarpal arteries, the distal and proximal communicating branches of the palmar system, and the distal cutaneous branches were carefully dissected and identified. RESULTS: The distal cutaneous branches originating from the dorsal metacarpal arteries were observed in all cases; these were located an average of 1.2 cm proximal from the metacarpophalangeal joint. The first dorsal metacarpal artery presented in 3 different patterns regarding its course: fascial, subfascial, and mixed. The branching pattern of the radial artery at the first intermetacarpal space was its division into 3 branches. We observed the presence of the dorsal arterial arch arising from the radial artery in 100% of the cases. The distance between the dorsal arterial arch and the branching point of the radial artery was an average of 2 cm. The first and second dorsal metacarpal arteries were visualized in all cases. The third and fourth dor…
subject: Original Research
  topic: section
subject: Arterial system
  topic: keywords
subject: Dorsal
  topic: keywords
subject: Hand
  topic: keywords
subject: Anatomy
  topic: keywords
subject: Fasciocutaneous flaps
  topic: keywords
creator: Marcelo Rosa de Rezende
creator: Rames Mattar Júnior
creator: Álvaro Baik Cho
creator: Oswaldo Hideo Hasegawa
creator: Samuel Ribak
rights: Copyright (c)
date: 2004-01-01
publication date: 2004-01-01
starting page: 71
ending page: 76
doi: 10.1590/S0041-87812004000200005

Growth and puberty after treatment for acute lymphoblastic leukemia
type: item
description: Over the last 20 years, after combining treatment of chemotherapy and radiotherapy, there has been an improvement in the survival rate of acute lymphoblastic leukemia patients, with a current cure rate of around 70%. Children with the disease have been enrolled into international treatment protocols designed to improve survival and minimize the serious irreversible late effects. Our oncology unit uses the international protocol: GBTLI LLA-85 and 90, with the drugs methotrexate, cytosine, arabinoside, dexamethasone, and radiotherapy. However, these treatments can cause gonadal damage and growth impairment. PATIENTS AND METHOD: The authors analyzed 20 children off therapy in order to determine the role of the various doses of radiotherapy regarding endocrinological alterations. They were divided into 3 groups according to central nervous system prophylaxis: Group A underwent chemotherapy, group B underwent chemotherapy plus radiotherapy (18 Gy), and group C underwent chemotherapy plus radiotherapy (24 Gy). Serum concentrations of LH, FSH, GH, and testosterone were determined. Imaging studies included bone age, pelvic ultrasound and scrotum, and skull magnetic resonance imaging. RESULTS: Nine of the patients who received radiotherapy had decreased pituitary volume. There was a significant difference in the response to GH and loss of predicted final stature (Bayley-Pinneau) between the 2 irradiated groups and the group that was not irradiated, but there was no difference regarding the radiation doses used (18 or 24 Gy). The final predicted height (Bayley-Pinneau) was significantly less (P = 0.0071) in both groups treated with radiotherapy. Two girls had precocious puberty, and 1 boy with delayed puberty presented calcification of the epididymis. CONCLUSION: Radiotherapy was been responsible for late side effects, especially related to growth and puberty.
subject: Original Research
  topic: section
subject: Endocrine dysfunction in lymphoblastic leukemia
  topic: keywords
subject: Growth and acute leukemia
  topic: keywords
subject: Puberty in lymphoblastic leukemia
  topic: keywords
creator: Claudia Helena Bastos da Silva Alves
creator: Hilton Kuperman
creator: Vaê Dichtchekenian
creator: Durval Damiani
creator: Thais Della Manna
creator: Lilian Maria Cristófani
creator: Vicente Odone Filho
creator: Nuvarte Setian
rights: Copyright (c)
date: 2004-01-01
publication date: 2004-01-01
starting page: 67
ending page: 70
doi: 10.1590/S0041-87812004000200004

Relationship between the morphologic alterations of vocal cords from adult autopsies and the cause of death
type: item
description: PURPOSE: The purpose of this study was to identify the possible alteration in the thickness of the epithelium basal membrane of the vocal cords and correlate it with the cause of death. METHOD: Larynxes collected from adult autopsies during the period of 1993 to 2001 were utilized. We used the hematoxylin-eosin and periodic acid-Schiff staining methods for the morphological and morphometric analysis. RESULTS: Sixty-six vocal cords were analysed; increased thickness was identified in 14 cases (21.2%), with equal proportions between the genders. Increased vocal-cord thickness was more frequent in patients of the white ethnicity (12 cases, 85.7%). Respiratory alterations were found in 10 (71.4%) of the cases with increased vocal-cord thickness. Of the patients that were maintained with mechanical ventilation before death, 7 (18.4%) had thickening of the basal membrane. Among the smokers, 9 (19.63%) had basal membrane thickening. CONCLUSION: No statistically significant differences were found between the cases in which the cause of death was related to respiratory diseases as compared to non-respiratory diseases and the thickening of the basal membrane of the vocal cords. However, new studies are needed in order to verify the etiopathogenesis of this thickening.
subject: Original Research
  topic: section
subject: Adults
  topic: keywords
subject: Autopsy
  topic: keywords
subject: Basal membrane
  topic: keywords
subject: Thickness
  topic: keywords
subject: Vocal cords
  topic: keywords
creator: Ana Karina Marques Salge
creator: Eumenia Costa da Cunha Castro
creator: Mara Lúcia Fonseca Ferraz
creator: Marlene Antônia dos Reis
creator: Vicente de Paula Antunes Teixeira
rights: Copyright (c)
date: 2004-01-01
publication date: 2004-01-01
starting page: 63
ending page: 66
doi: 10.1590/S0041-87812004000200003

Adductor policis muscle: a new anthropometric parameter
type: item
description: PURPOSE: To measure the thickness of adductor pollicis muscle in healthy adults. This measurement will be used as a nutritional anthropometric parameter in further studies. SUBJECTS AND METHOD: Four hundred and twenty-one healthy adults were studied, 209 men and 212 women, with ages ranging from 18 to 87 years, living in Rio de Janeiro. The adductor pollicis muscle was also studied in the human anatomy lab as well as in normal healthy volunteers using CAT scans and nuclear magnetic resonance imaging to ensure that only the adductor pollicis was included in measurement of muscle thickness with a Lange caliper. To standardize the measurement, the methodology was detailed, with subjects sitting with the dominant hand dangling over the homolateral thigh and the elbow bent at approximately a 90° angle. The Lange caliper was applied at a pressure of 10 g/mm², pinching the adductor pollicis muscle at the vertex of an imaginary angle between the thumb and the index finger. The average of 3 consecutive measurements was considered to be the muscle thickness. RESULTS: This study provides the first estimates of adductor pollicis thickness in normal healthy subjects as an anthropometric parameter. The normal values in the dominant hand for men were 12.5 ± 2.8 mm (mean ± SD), median 12 mm, and for women were 10.5 ± 2.3 mm, median 10 mm.
subject: Original Research
  topic: section
subject: Adductor pollicis
  topic: keywords
subject: Muscle atrophy
  topic: keywords
subject: Malnutrition
  topic: keywords
subject: Nutritional assessment
  topic: keywords
subject: Anthropometry
  topic: keywords
creator: Edson Braga Lameu
creator: Mauricio Freitas Gerude
creator: Regina Célia Corrêa
creator: Keite Azevedo Lima
rights: Copyright (c)
date: 2004-01-01
publication date: 2004-01-01
starting page: 57
ending page: 62
doi: 10.1590/S0041-87812004000200002

Surgery information reduces anxiety in the pre-operative period
type: item
description: PURPOSE: Patients preparing to undergo surgery should not suffer needless anxiety. This study aimed to evaluate anxiety levels on the day before surgery as related to the information known by the patient regarding the diagnosis, surgical procedure, or anesthesia. METHOD: Patients reported their knowledge of diagnosis, surgery, and anesthesia. The Spielberger State-Trait Anxiety Inventory (STAI) was used to measure patient anxiety levels. RESULTS: One hundred and forty-nine patients were selected, and 82 females and 38 males were interviewed. Twenty-nine patients were excluded due to illiteracy. The state-anxiety levels were alike for males and females (36.10 ± 11.94 vs. 37.61 ± 8.76) (mean ± SD). Trait-anxiety levels were higher for women (42.55 ± 10.39 vs. 38.08 ± 12.25, P = 0.041). Patient education level did not influence the state-anxiety level but was inversely related to the trait-anxiety level. Knowledge of the diagnosis was clear for 91.7% of patients, of the surgery for 75.0%, and of anesthesia for 37.5%. Unfamiliarity with the surgical procedure raised state-anxiety levels (P = 0.021). A lower state-anxiety level was found among patients who did not know the diagnosis but knew about the surgery (P = 0.038). CONCLUSIONS: Increased knowledge of patients regarding the surgery they are about to undergo may reduce their state-anxiety levels.
subject: Original Research
  topic: section
subject: Anxiety
  topic: keywords
subject: Information
  topic: keywords
subject: Surgery
  topic: keywords
subject: Anesthesia
  topic: keywords
subject: Diagnosis
  topic: keywords
creator: Leandro Yoshinobu Kiyohara
creator: Lilian Kakumu Kayano
creator: Lorena Marçalo Oliveira
creator: Marina Uemori Yamamoto
creator: Marco Makoto Inagaki
creator: Nilson Yuji Ogawa
creator: Polo Eduardo San Martin Gonzales
creator: Rosana Mandelbaum
creator: Sílvio Tanaka Okubo
creator: Thaís Watanuki
creator: Joaquim Edson Vieira
rights: Copyright (c)
date: 2004-01-01
publication date: 2004-01-01
starting page: 51
ending page: 56
doi: 10.1590/S0041-87812004000200001

Homeopathy: do not accept as medicine what has no evidence and contradicts basic science
type: item
subject: Letters to the Editor
  topic: section
creator: Renan Moritz V. R. Almeida
rights: Copyright (c)
date: 2004-01-01
publication date: 2004-01-01
starting page: 155
ending page: 156
doi: 10.1590/S0041-87812004000300012

Homeopathy: do not condemn what we do not understand
type: item
subject: Letters to the Editor
  topic: section
creator: Peter Fisher
creator: Flávio Dantas
rights: Copyright (c)
date: 2004-01-01
publication date: 2004-01-01
starting page: 153
ending page: 154
doi: 10.1590/S0041-87812004000300011

Proton magnetic resonance spectroscopy of the frontal lobe in schizophrenics: a critical review of the methodology
type: item
description: Schizophrenic patients undergoing proton magnetic resonance spectroscopy show alterations in N-acetyl aspartate levels in several brain regions, indicating neuronal dysfunction. The present review focuses on the main proton magnetic resonance spectroscopy studies in the frontal lobe of schizophrenics. A MEDLINE search, from 1991 to March 2004, was carried out using the key-words spectroscopy and schizophrenia and proton and frontal. In addition, articles cited in the reference list of the studies obtained through MEDLINE were included. As a result, 27 articles were selected. The results were inconsistent, 19 papers reporting changes in the N-acetyl aspartate levels, while 8 reported no change. Methodological analysis led to the conclusion that the discrepancy may be due the following factors: (i) number of participants; (ii) variation in the clinical and demographic characteristics of the groups; (iii) little standardization of the acquisition parameters of spectroscopy. Overall, studies that fulfill strict methodological criteria show N-acetyl aspartate decrease in the frontal lobe of male schizophrenics.
subject: Reviews
  topic: section
subject: Spectroscopy
  topic: keywords
subject: Proton
  topic: keywords
subject: Frontal
  topic: keywords
subject: Schizophrenia
  topic: keywords
subject: Review
  topic: keywords
creator: Rafael Faria Sanches
creator: José Alexandre de Souza Crippa
creator: Jaime Eduardo Cecílio Hallak
creator: David Araújo
creator: Antonio Waldo Zuardi
rights: Copyright (c)
date: 2004-01-01
publication date: 2004-01-01
starting page: 145
ending page: 152
doi: 10.1590/S0041-87812004000300010

Involvement of C4 allotypes in the pathogenesis of human diseases
type: item
description: The complement system is an important humoral defense mechanism that plays a relevant role against microbial agents, inflammatory response control, and immunocomplex clearance. Classical complement pathway activation is antibody-dependent. The C4 component participates in the initial step of activation, and C4 expression is determined by 2 pairs of allotypes: C4A and C4B. Deficiencies in C4 allotypes have been associated with several diseases. The aim of the present review is evaluate the reported data in the literature regarding specific C4A and C4B deficiencies and characterize their clinical relevance. We searched the MEDLINE and LILACS databases. Papers referring to total C4 deficiency without allotype evaluation and case reports of primary C4 deficiency were not included. Deficiencies in C4 allotypes have been associated with Mycobacterium leprae infection, erythema nodosum, systemic sclerosis with anti-topoisomerase I antibodies, intermediate congenital adrenal hyperplasia with DR5 genotype, diabetes mellitus type 1 with DR3,4 genotype, and diabetes mellitus with antibodies against islet cells. C4 allotype deficiency is also related to C4B deficiency and autoimmune-associated diseases, such as systemic lupus erythematosus, or diseases with an autoimmune component, such as autism. Some reports associate C4A with thyroiditis after delivery as well as limited and systemic sclerosis without anti-topoisomerase I antibodies. However, the studies with C4A and C4B have been concentrated in isolated populations, and some of the studies could not be reproduced by other authors.
subject: Reviews
  topic: section
subject: C4 allotypes
  topic: keywords
subject: C4A
  topic: keywords
subject: C4B
  topic: keywords
subject: C4
  topic: keywords
subject: Complement
  topic: keywords
subject: Complement deficiency
  topic: keywords
creator: Eliana Sueco Tibana Samano
creator: Lia de Melo Ribeiro
creator: Rosa G. Gorescu
creator: Katya Cristina Rocha
creator: Anete S. Grumach
rights: Copyright (c)
date: 2004-01-01
publication date: 2004-01-01
starting page: 138
ending page: 144
doi: 10.1590/S0041-87812004000300009

Conjunctival keratoacanthoma
type: item
description: Keratoacanthoma generally occurs on the skin; it is rarely found in the conjunctiva. A case of a 34-year-old woman with a rapidly growing conjunctival mass is reported. The tumor was excised with a safety margin to exclude squamous cell carcinoma. Histopathologically it was crateriform and consistent with atypical keratoacanthoma. There has been no recurrence in 2 years of follow-up. Conjunctival keratoacanthoma is rare; differential diagnosis of conventional squamous cell carcinoma and keratoacanthoma can be difficult. We recommend complete surgical excision and careful follow-up of crateriform squamous proliferations.
subject: Case Reports
  topic: section
subject: Conjunctival keratoacanthoma
  topic: keywords
subject: Squamous cell carcinoma
  topic: keywords
subject: Tumor
  topic: keywords
subject: Histopathology
  topic: keywords
subject: Conjunctiva
  topic: keywords
creator: Fernanda Braga Perdigão
creator: Paulo de Tarso P. Pierre-Filho
creator: Renato José Mendonça Natalino
creator: Roberto Caldato
creator: Marcelo Torigoe
creator: Maria Letícia Cintra
rights: Copyright (c)
date: 2004-01-01
publication date: 2004-01-01
starting page: 135
ending page: 137
doi: 10.1590/S0041-87812004000300008

Concomitant involvement of the small intestine and the distal esophagus in an infant with massive necrotizing enterocolitis
type: item
description: Necrotizing enterocolitis is a disease of the newborn that may involve the small intestine and/or the colon, and the stomach. To our knowledge, massive necrosis of the small intestine with concomitant involvement of the esophagus has never been reported. A case of a 6-month-old boy with necrotizing enterocolitis and pan-necrosis of the small intestine, cecum, and the lower third of the esophagus is presented. After 70 days of treatment, intestinal transit was established by an anastomosis between the first centimeter of jejunum and the ascending colon. Finally, esophageal transit was established by a total gastric transposition with cervical esophagogastric anastomosis. The patient was maintained under total parenteral nutrition, and after 19 months he developed fulminant hepatic failure due to parenteral nutrition; he then underwent combined liver and small bowel transplantation. After 2 months, the patient died due to undefined neurologic complications, probably related to infection or immunosuppressive therapy.
subject: Case Reports
  topic: section
subject: Necrotizing enterocolitis
  topic: keywords
subject: Esophageal perforation
  topic: keywords
subject: Total parenteral nutrition
  topic: keywords
subject: Liver-small bowel transplantation
  topic: keywords
creator: Uenis Tannuri
creator: Virginia Antelmi Gomes
creator: Eduardo Juan Troster
rights: Copyright (c)
date: 2004-01-01
publication date: 2004-01-01
starting page: 131
ending page: 134
doi: 10.1590/S0041-87812004000300007

Adnexal torsion following gonadotropin-releasing hormone analog therapy: a case report
type: item
description: Adnexal torsion may occur in girls and adolescents. Often it is associated with ovarian diseases resulting in ovarian enlargement. Adnexal torsion may involve the ovary, fallopian tube or both, and the main sympton is acute pelvic pain. An 8-year-old girl complaining of acute pelvic and abdominal pain, who was previously diagnosed with precocious puberty and who received treatment with a GnRH analog, is reported. Ultrasound demonstrated a normal-sized uterus and bilaterally enlarged ovaries with multiple internal cysts. At laparotomy, we found a complete torsion in the right adnexa. The histological examination revealed massive edema associated with multiple antral follicles and reduction of the follicular reserve.
subject: Case Reports
  topic: section
subject: Ovarian neoplasms
  topic: keywords
subject: Adnexal torsion
  topic: keywords
subject: Precocious puberty
  topic: keywords
subject: GnRH analog
  topic: keywords
creator: Jesus Paula Carvalho
creator: Mara Solange Diegoli
creator: Filomena Marino Carvalho
creator: Carlos Alberto Diegoli
rights: Copyright (c)
date: 2004-01-01
publication date: 2004-01-01
starting page: 128
ending page: 130
doi: 10.1590/S0041-87812004000300006

Nonsmall cell lung cancer: evaluation of 737 consecutive patients in a single institution
type: item
description: OBJECTIVE: To analyze surgical and pathological parameters and outcome and prognostic factors of patients with nonsmall cell lung cancer (NSCLC) who were admitted to a single institution, as well as to correlate these findings to the current staging system. METHOD: Seven hundred and thirty seven patients were diagnosed with NSCLC and admitted to Hospital do Cancer A. C. Camargo from 1990 to 2000. All patients were included in a continuous prospective database, and their data was analyzed. Following staging, a multidisciplinary team decision on adequate management was established. Variables included in this analysis were age, gender, histology, Karnofsky index, weight loss, clinical stage, surgical stage, chemotherapy, radiotherapy, and survival rates. RESULTS: 75.5% of patients were males. The distribution of histologic type was squamous cell carcinoma 51.8%, adenocarcinoma 43.1%, and undifferentiated large cell carcinoma 5.1%. Most patients (73%) presented significant weight loss and a Karnofsky index of 80%. Clinical staging was IA 3.8%, IB 9.2%, IIA 1.4%, IIB 8.1%, IIIA 20.9%, IIIB 22.4%, IV 30.9%. Complete tumor resection was performed in 24.6% of all patients. Surgical stage distribution was IA 25.3%, IB 1.4%, IIB 17.1%, IIIA 16.1%, IIIB 20.3%, IV 11.5%. Chemotherapy and radiotherapy were considered therapeutic options in 43% and 72%, respectively. The overall 5-year survival rate of nonsmall cell lung cancer patients in our study was 28%. Median survival was 18.9 months. CONCLUSIONS: Patients with NSCLC who were admitted to our institution presented with histopathologic and clinical characteristics that were similar to previously published series in cancer hospitals. The best prognosis was associated with complete tumor resection with lymph node dissection, which is only achievable in earlier clinical stages.
subject: Original Research
  topic: section
subject: Lung cancer
  topic: keywords
subject: Nonsmall cell carcinoma
  topic: keywords
subject: Prognostic factors
  topic: keywords
subject: Staging
  topic: keywords
subject: Treatment outcome
  topic: keywords
creator: Riad N. Younes
creator: Fernanda Deutsch
creator: Cristina Badra
creator: Jefferson Gross
creator: Fabio Haddad
creator: Daniel Deheinzelin
rights: Copyright (c)
date: 2004-01-01
publication date: 2004-01-01
starting page: 119
ending page: 127
doi: 10.1590/S0041-87812004000300005

Systemic hypertension, diabetes mellitus, and dyslipidemia in relation to body mass index: evaluation of a Brazilian population
type: item
description: OBJECTIVE: To determine the prevalence of systemic hypertension, diabetes mellitus, hypercholesterolemia, and hypertriglyceridemia in a Brazilian population in relation to body mass index. METHOD: Retrospective evaluation of 1213 adults (mean age: 45.2 ± 12.8; 80.6% females) divided into groups according to body mass index [normal (18.5 - 24.4 kg/m²); overweight (25 - 29.9 kg/m²); grade 1 obesity (30 - 34.9 kg/m²); grade 2 obesity (35 - 39.9 kg/m²), and grade 3 obesity (>; 40 kg/m²)]. The prevalence of hypertension, diabetes mellitus, hypercholesterolemia, and hypertriglyceridemia were analyzed in each group. The severity of cardiovascular risk was determined. High-risk patients were considered those reporting 2 or more of the following factors: systemic hypertension, HDL < 35 mg/dL, total cholesterol >; 240 mg/dL, triglycerides >; 200 mg/dL when HDL < 35 mg/dL, and glycemia >; 126 mg/dL. Moderate-risk patients were those reporting 2 or more of the following factors: systemic hypertension, HDL < 45, triglycerides >; 200 mg/dL, and total cholesterol >; 200 mg/dL. RESULTS: The prevalence of systemic hypertension, diabetes mellitus, hypertriglyceridemia, and low HDL-cholesterol levels increased along with weight, but the prevalence of hypercholesterolemia did not. The odds ratio adjusted for gender and age, according to grade of obesity compared with patients with normal weight were respectively 5.9, 8.6, and 14.8 for systemic hypertension, 3.8, 5.8, and 9.2 for diabetes mellitus and 1.2, 1.3, and 2.6 for hypertriglyceridemia. We also verified that body mass index was positively related to cardiovascular high risk (P < .001) CONCLUSION: In our population, cardiovascular risk increased along with body mass index.
subject: Original Research
  topic: section
subject: Cardiovascular risk factors
  topic: keywords
subject: Obesity
  topic: keywords
subject: Body mass index
  topic: keywords
subject: Diabetes mellitus
  topic: keywords
subject: Systemic hypertension
  topic: keywords
creator: Cintia Cercato
creator: Márcio Corrêa Mancini
creator: Ana Maria Carvalho Arguello
creator: Vanessa Quintas Passos
creator: Sandra Mara Ferreira Villares
creator: Alfredo Halpern
rights: Copyright (c)
date: 2004-01-01
publication date: 2004-01-01
starting page: 113
ending page: 118
doi: 10.1590/S0041-87812004000300004

Different doses of exogenous surfactant for treatment of meconium aspiration syndrome in newborn rabbits
type: item
description: OBJECTIVE: To evaluate the effects of 2 different doses of exogenous surfactant on pulmonary mechanics and on the regularity of pulmonary parenchyma inflation in newborn rabbits. METHOD: Newborn rabbits were submitted to tracheostomy and randomized into 4 study groups: the Control group did not receive any material inside the trachea; the MEC group was instilled with meconium, without surfactant treatment; the S100 and S200 groups were instilled with meconium and were treated with 100 and 200 mg/kg of exogenous surfactant (produced by Instituto Butantan) respectively. Animals from the 4 groups were mechanically ventilated during a 25-minute period. Dynamic compliance, ventilatory pressure, tidal volume, and maximum lung volume (P-V curve) were evaluated. Histological analysis was conducted using the mean linear intercept (Lm), and the lung tissue distortion index (SDI) was derived from the standard deviation of the means of the Lm. One-way analysis of variance was used with a = 0.05. RESULTS: After 25 minutes of ventilation, dynamic compliance (mL/cm H2O · kg) was 0.87 ± 0.07 (Control); 0.49 ± 0.04 (MEC*); 0.67 ± 0.06 (S100); and 0.67 ± 0.08 (S200), and ventilatory pressure (cm H2O) was 9.0 ± 0.9 (Control); 16.5 ± 1.7 (MEC*); 12.4 ± 1.1 (S100); and 12.1 ± 1.5 (S200). Both treated groups had lower Lm values and more homogeneity in the lung parenchyma compared to the MEC group: SDI = 7.5 ± 1.9 (Control); 11.3 ± 2.5 (MEC*), 5.8 ± 1.9 (S100); and 6.7 ± 1.7 (S200) (*P < 0.05 versus all the other groups). CONCLUSIONS: Animals treated with surfactant showed significant improvement in pulmonary mechanics and more regularity of the lung parenchyma in comparison to untreated animals. There was no difference in results after treatment with either of the doses used.
subject: Original Research
  topic: section
subject: Meconium
  topic: keywords
subject: Surfactant inactivation
  topic: keywords
subject: Neonate
  topic: keywords
subject: Newborn animals
  topic: keywords
subject: Pulmonary mechanics
  topic: keywords
creator: João Cesar Lyra
creator: Renata S. Mascaretti
creator: Alexander Roberto Precioso
creator: Yin Chia Chang
creator: Maria Tereza Zulini da Costa
creator: Flávio Adolfo Costa Vaz
creator: Yassuhiko Okay
creator: Celso Moura Rebello
rights: Copyright (c)
date: 2004-01-01
publication date: 2004-01-01
starting page: 104
ending page: 112
doi: 10.1590/S0041-87812004000300003

Effect of clarithromycin on the cell profile of bronchoalveolar lavage fluid in mice with neutrophil-predominant lung disease
type: item
description: OBJECTIVE: Macrolide antibiotics have anti-inflammatory properties in lung diseases. The aim of this study was to investigate the effect of clarithromycin in pulmonary cellular inflammatory response in mice. METHOD: Eight adult Swiss mice were studied. All animals received an intranasal challenge (80 µL) with dead Pseudomonas aeruginosa (1.0 x 10(12) CFU/mL). Bronchoalveolar lavage was performed 2 days later, with total cell count and differential cell analysis. The study group (n = 4) received clarithromycin treatment (50 mg/kg/day, intraperitoneal) for 5 days. Treatment was initiated 2 days before intranasal challenge. RESULTS: There was no significant difference in total cell count between the groups (mean: 2.0 x 10(6) and 1.3 x 10(6), respectively). In both groups, there was a predominance of neutrophils. However, the study group had a higher percentage of lymphocytes in the bronchoalveolar lavage than the control group (median of 19% vs 2.5%, P = .029). CONCLUSION: Clarithromycin alters the cytological pattern of bronchoalveolar lavage of Swiss mice with neutrophil pulmonary inflammation, significantly increasing the percentage of lymphocytes.
subject: Original Research
  topic: section
subject: Clarithromycin
  topic: keywords
subject: Lung inflammation
  topic: keywords
subject: Lung
  topic: keywords
subject: Mice
  topic: keywords
subject: Neutrophil
  topic: keywords
creator: Leonardo Araújo Pinto
creator: Camila Camozzato
creator: Monique Avozani
creator: Denise Cantarelli Machado
creator: Marcus Herbert Jones
creator: Renato Tetelbom Stein
creator: Paulo Márcio Condessa Pitrez
rights: Copyright (c)
date: 2004-01-01
publication date: 2004-01-01
starting page: 99
ending page: 103
doi: 10.1590/S0041-87812004000300002

Dental and facial characteristics of patients with juvenile idiopathic arthritis
type: item
description: OBJECTIVE: It has been shown that the temporomandibular joint is frequently affected by juvenile idiopathic arthritis, and this degenerative disease, which may occur during facial growth, results in severe mandibular dysfunction. However, there are no studies that correlate oral health (tooth decay and gingival diseases) and temporomandibular joint dysfunction in patients with juvenile idiopathic arthritis. The aim of this study is to evaluate the oral and facial characteristics of the patients with juvenile idiopathic arthritis treated in a large teaching hospital. METHOD: Thirty-six patients with juvenile idiopathic arthritis (26 female and 10 male) underwent a systematic clinical evaluation of their dental, oral, and facial structures (DMFT index, plaque and gingival bleeding index, dental relationship, facial profile, and Helkimo's index). The control group was composed of 13 healthy children. RESULTS: The mean age of the patients with juvenile idiopathic arthritis was 10.8 years; convex facial profile was present in 12 juvenile idiopathic arthritis patients, and class II molar relation was present in 12 (P = .032). The indexes of plaque and gingival bleeding were significant in juvenile idiopathic arthritis patients with a higher number of superior limbs joints involved (P = .055). Anterior open bite (5) and temporomandibular joint noise (8) were present in the juvenile idiopathic arthritis group. Of the group in this sample, 94% (P = .017) had temporomandibular joint dysfunction, 80% had decreased mandibular opening (P = 0.0002), and mandibular mobility was severely impaired in 33% (P = .015). CONCLUSION: This study confirms that patients with juvenile idiopathic arthritis a) have a high incidence of mandibular dysfunction that can be attributed to the direct effect of the disease in the temporomandibular joint and b) have a higher incidence of gingival disease that can be considered a secondary effect of juvenile idiopathic arthritis on oral health.
subject: Original Research
  topic: section
subject: Juvenile idiopathic arthritis
  topic: keywords
subject: Dental pain
  topic: keywords
subject: Teeth
  topic: keywords
subject: Temporomandibular joint juvenile
  topic: keywords
subject: Rheumatoid arthritis
  topic: keywords
creator: Cynthia Savioli
creator: Clovis A.A. Silva
creator: H. Ching Lin
creator: Lucia M.M.A. Campos
creator: Eliane F.B.G. Prado
creator: José Tadeu T. Siqueira
rights: Copyright (c)
date: 2004-01-01
publication date: 2004-01-01
starting page: 93
ending page: 98
doi: 10.1590/S0041-87812004000300001

Hepatitis B: epidemiological, immunological, and serological considerations emphasizing mutation
type: item
description: The global prevalence of hepatitis B virus is estimated to be 350 million chronic carriers, varying widely from low (<2%, as in Western Europe, North America, New Zealand, Australia, and Japan) to high (>;8% as in Africa, Southeast Asia, and China). The overall prevalence in Brazil is about 8%. There are currently 7 genotypic variations, from A to G, and also 4 main surface antigen subtypes: adw, ayw, adr, and ayr. There has been great interest in identifying the geographic distribution and prognosis associated with the various genotypes and subtypes. Although the serologic test is highly sensitive and specific, it does not detect cases of mutant hepatitis B, which is increasingly common worldwide due to resistance and vaccine escape, antiviral therapy, and immunosuppression, among other causes. Alterations in surface, polymerase, X region, core, and precore genes have been described. The main mutations occur in surface and in core/precore genes, also known as occult hepatitis, since its serologic markers of active infection (HBsAg) and viral replication (HBeAg) can be negative. Thus, mutation should be suspected when serologic tests to hepatitis B show control of immunity or replication coincident with worsened clinical status and exclusion of other causes of hepatitis.
subject: Reviews
  topic: section
subject: Hepatitis B
  topic: keywords
subject: Edidemiology
  topic: keywords
subject: Serology
  topic: keywords
subject: Mutation
  topic: keywords
creator: Marcelo El Khouri
creator: Vera Aparecida dos Santos
rights: Copyright (c)
date: 2004-01-01
publication date: 2004-01-01
starting page: 216
ending page: 224
doi: 10.1590/S0041-87812004000400011

Voiding dysfunction and urodynamic abnormalities in elderly patients
type: item
description: Lower urinary tract dysfunction is a major cause of morbidity and decreased quality of life in elderly men and women. With the progressive aging of the population, it is important to understand common micturitional disorders that may occur in this population. Most urinary problems in the elderly are multifactorial in origin, demanding a comprehensive assessment of the lower urinary tract organs, functional impairments, and concurrent medical diseases. Urodynamics is a highly valuable tool in the investigation of elderly patients with lower urinary tract symptoms. Urodynamic tests are not always necessary, being indicated after excluding potentially reversible conditions outside the urinary tract that may be causing or contributing to the symptoms. Although urodynamic tests may reveal common diagnoses such as bladder outlet obstruction and stress urinary incontinence in the elderly population, findings such as detrusor overactivity and impaired detrusor contractility are common and have important prognostic and therapeutic implications. The purpose of this article is to describe common urologic problems in the elderly and review the indications for and clinical aspects of urodynamic studies in these conditions.
subject: Reviews
  topic: section
subject: Aging
  topic: keywords
subject: Bladder diseases
  topic: keywords
subject: Urinary incontinence
  topic: keywords
subject: Urodynamics
  topic: keywords
creator: Cristiano M. Gomes
creator: Sami Arap
creator: Flávio E. Trigo-Rocha
rights: Copyright (c)
date: 2004-01-01
publication date: 2004-01-01
starting page: 206
ending page: 215
doi: 10.1590/S0041-87812004000400010