Isokinetic assessment of knee flexor/extensor muscular strength in elderly women

OBJECTIVE: To assess knee flexor-extensor muscular strength in elderly women with no previous history of musculoskeletal disorders on the lower limbs using an isokinetic dynamometer, in order to obtain data that could be used as a comparative parameter in the evaluation of elderly women with knee disorders, thus facilitating a better rehabilitation of these patients. METHODS: Twenty-six volunteers aged 75 to 83 years were studied using a Cybex® 6000 isokinetic dynamometer. The chosen angular velocity was 60 º/s, and concentric exercise was used for either flexion or extension. The studied parameters were: peak torque, angle of peak torque, and flexor-extensor torque rate. RESULTS: There were no differences between dominant (D) and nondominant (ND) knee peak torque values. This was true for both flexor (D = 42.46 ± 9.09 Nm / ND = 40.65 ± 9.38 Nm) and extensor (D = 76.92 ± 13.97 Nm / ND = 77.65 ± 15.21 Nm) movements. The descriptive statistical analysis of the values obtained for the flexor-extensor peak torque rate and for the angle of occurrence of peak torque was the same for the dominant and nondominant sides. CONCLUSIONS: The values of peak torque for the contralateral side can be used as a reference during rehabilitation of elderly women with acute disease of the knee, and the angular velocity of 60 º/s is proper and safe for isokinetic assessment of elderly people.

Use of tacrolimus in rescue therapy of acute and chronic rejection in liver transplantation

PURPOSE: To study the indications and results of tacrolimus as rescue therapy for acute cellular or chronic rejection in liver transplantation. PATIENTS AND METHODS: Eighteen liver transplant recipients who underwent rescue therapy with tacrolimus between March 1995 and August 1999 were retrospectively studied. The treatment indication, patients, and graft situation were recorded as of October 31st, 1999. The response to tacrolimus was defined as patient survival with a functional graft and histological reversal of acute cellular, or for chronic rejection, bilirubin serum levels decreasing to up to twice the upper normal limit. RESULTS: Fourteen cases (77.8%) presented a good response. The response rate for the different indications was: (1) acute cellular + sepsis - 0/1 case; (2) recurrent acute cellular - 1/1 case; (3) OKT3-resistant acute cellular - 2/2 cases; (4) steroid-resistant acute cellular + active viral infection - 3/3 cases; (5) chronic rejection - 8/11 cases (72.7% response rate). The 4 patients who did not respond died. CONCLUSION: Tacrolimus rescue therapy was successful in most cases of acute cellular and chronic rejection in liver transplantation.

Dura mater mitral and tricuspid bioprostheses: 30 years of follow-up

PURPOSE: The dura mater bioprosthesis was developed in the Department of Cardiopneumology of the Hospital das Clínicas of the University of São Paulo Medical School in 1971. Here, we present the clinical results of the dura mater bioprosthesis over 30 years of follow-up. METHODS: We studied 70 consecutive patients who underwent mitral or tricuspid valve replacement with a dura mater bioprosthesis between January 1971 and August 1972. RESULTS: The early mortality was 10% (7 patients). The follow-up was 87% complete (9 patients were lost to follow-up). Two patients were alive and asymptomatic 30 years after valve replacement; 33 patients underwent reoperations due to valve dysfunction, and 19 died during the follow-up period. At 30 years, the actuarial survival was 49.2 ± 8.6%; freedom from rupture, 27.0 ± 10.2%; freedom from calcification, 78.8 ± 8.6%; and freedom from reoperation, 18.8 ± 7.5%. CONCLUSIONS: The dura mater bioprosthesis played an important role in the treatment of patients with mitral and tricuspid valve disease. The low rate of thromboembolism and the long period of follow-up without evidence of valve dysfunction, which occurred for several of our patients, are important characteristics of these bioprosthesis.

Conservative therapies for hemorrhagic radiation proctitis: a review

Chronic radiation proctitis represents a challenging condition seen with increased frequency due to the common use of radiation for treatment of pelvic cancer. Hemorrhagic radiation proctitis represents the most feared complication of chronic radiation proctitis. There is no consensus for the management of this condition despite the great number of clinical approaches and techniques that have been employed. Rectal resection represents an available option although associated with high morbidity and risk of permanent colostomy. The effectiveness of nonoperative approaches remains far from desirable, and hemorrhagic recurrence represents a major drawback that leads to a need for consecutive therapeutic sessions and combination of techniques. We conducted a critical review of published reports regarding conservative management of hemorrhagic chronic radiation proctitis. Although prospective randomized trials about hemorrhagic radiation proctitis are still lacking, there is enough evidence to conclude that topical formalin therapy and an endoscopic approach delivering an argon plasma coagulation represent available options associated with elevated effectiveness for interruption of rectal bleeding in patients with chronic radiation proctitis.

Peri-intraventricular hemorrhage in newborns weighing less than 1500 grams: comparative analysis between 2 institutions

PURPOSE: This study aims to characterize the peri-intraventricular hemorrhages in the neonatal period in very low birth weight newborns in 2 institutions that provide neonatal tertiary assistance. METHOD: This was a comparative and observational study in 2 neonatal intensive care units, the Maternity Hospital of Campinas and the "Centro de Atenção Integrada à Saúde da Mulher" of the State University of Campinas, from December 01, 1998 to November 30, 1999. We examined 187 newborns for peri-intraventricular hemorrhages, using transfontanel ultrasound (76 and 11 respectively at the first and second unit), and classified them into 4 grades. We observed their gender, intrauterine growth, weight, and gestational age at birth. RESULTS: We diagnosed 34 cases of peri-intraventricular hemorrhages (13 and 21, respectively), and both groups differed as to the birth weight and the adequacy of weight to the gestational age at birth. There was no difference in the prevalence or extent of peri-intraventricular hemorrhages among cases. There was a statistically significant occurrence of lower birth weight at gestational ages of less than 30 weeks. CONCLUSIONS: The prevalence of peri-intraventricular hemorrhages in our study was compared to that reported in the world literature. Although the cases of the second institution had a smaller mean birth weight, the prevalence of peri-intraventricular hemorrhages was similar to that at the first institution, probably because in the first one, 69% of the gestational ages of the neonates with hemorrhage were less than 30 weeks as compared to 48% in the second one. We stress the importance of the ultrasonographic method for diagnosing peri-intraventricular hemorrhages in very low birth weight newborns.

Surgical treatment of rectal prolapse: experience and late results with 51 patients

The "best" surgical technique for the management of complete rectal prolapse remains unknown. Due to its low incidence, it is very difficult to achieve a representative number of cases, and there are no large prospective randomized trials to attest to the superiority of one operation over another. PURPOSE: Analyze the results of surgical treatment of complete rectal prolapse during 1980 and 2002. METHOD: Retrospective study. RESULTS: Fifty-one patients underwent surgical treatment during this period. The mean age was 56.7 years, with 39 females. Besides the prolapse itself, 33 patients complained of mucous discharge, 31 of fecal incontinence, 14 of constipation, 17 of rectal bleeding, and 3 of urinary incontinence. Abdominal operations were performed in 36 (71%) cases. Presacral rectopexy was the most common abdominal procedure (29 cases) followed by presacral rectopexy associated with sigmoidectomy (5 cases). The most common perineal procedure was perineal rectosigmoidectomy associated with levatorplasty (12 cases). Intraoperative bleeding from the presacral space developed in 2 cases, and a rectovaginal fistula occurred in another patient after a perineal rectosigmoidectomy. There were 2 recurrences after a mean follow-up of 49 months, which were treated by reoperation. CONCLUSION: Abdominal and perineal procedures can be used to manage complete rectal prolapse with safety and good long-term results. Age, associated medical conditions, and symptoms of fecal incontinence or constipation are the main features that one should bear in mind in order to choose the best surgical approach.

Umbilical mass as the sole presenting symptom of pancreatic cancer: a case report

Umbilical nodes are rare. The metastatic involvement of the region was first described in 1846. Sister Mary Joseph was the first observer to establish the correlation between carcinomas and umbilical nodes. The umbilical node may be the sole presenting sign of cancer and is usually associated with advanced disease and poor prognosis. A 64-year-old woman, previously healthy, presented vague abdominal discomfort and a hard umbilical nodule for 1 week, which was first diagnosed as an incarcerated umbilical hernia. She underwent a new clinical assessment and biopsy. After immunohistochemical analysis and computerized tomography, she was diagnosed with pancreatic cancer. The clinical staging showed advanced disease with distant metastasis. She received palliative chemotherapy. After 8 months, she was alive in poor clinical condition. Clinical suspicion should lead to a careful additional evaluation whenever an umbilical nodule presents with malignant signs.

Anorectal leiomyomas: report of two cases with different anatomical patterns and literature review

Gastrointestinal mesenchymal tumors comprise a rare group of gastrointestinal tract wall tumors that have long been a source of confusion and controversy, especially in terms of pathological classification, preoperative diagnosis, management strategies, and prognosis. This report describes the clinical manifestations and management of 2 rectal leiomyomas and reviews the pertinent literature. Case 1: A 44-year-old woman was admitted reporting a nodule in the right para-anal region for the previous 2 years. At proctological examination, a 4-cm diameter fibrous mass situated in the para-anal region that produced an arch under the smooth muscle on the right rectal wall just above the anorectal ring was noted. Computed tomography and magnetic resonance imaging of the abdomen and pelvis showed the lesion and detected no other abnormalities. Surgical treatment consisted of wide local resection of the tumor through a para-anal incision, with no attempts to perform lymphadenectomy. Case 2: A 40-year-old male patient was admitted reporting constant anal pain for 4 months. He presented a 3-cm submucosal nodule at the anterior rectal wall just above the dentate line. After 2 inconclusive preoperative biopsies, transanal resection of the tumor was performed. Histological analysis of the specimen showed a benign leiomyoma. A review of the literature is presented, emphasizing some clinical and therapeutic aspects of this unusual rectal tumor.

Hypertension in employees of a University General Hospital

PURPOSE: To find out the prevalence of hypertension in employees of the Hospital and relate it to social demographic variables. METHODS: Blood pressure measurement was performed with a mercury sphygmomanometer, using an appropriate cuff size for arm circumference, weight, and height in a population sample of 864 individuals out of the 9,905 employees of a University General Hospital stratified by gender, age, and job position. RESULTS: Hypertension prevalence was 26% (62% of these reported being aware of their hypertension and 38% were unaware but had systolic/diastolic blood pressures of >140 and/or >90 mm Hg at the moment of the measurement). Of those who were aware of having hypertension, 51% were found to be hypertensive at the moment of the measurement. The prevalence was found to be 17%, 23%, and 29% (P <.05) in physicians, nursing staff, and "others", respectively. The univariate analysis showed a significant odds ratio for the male gender, age >50 years, work unit being the Institute of Radiology and the Administration Building, educational level 10 years, and body mass index >30 kg/m². The multivariate logistic regression model revealed a statistically significant association of hypertension with the following variables: gender, age, skin color, family income, and body mass index. CONCLUSIONS: Hypertension prevalence was high, mainly in those who were not physicians or members of the nursing staff. High-risk groups (obese, non-white, men, low family income) should be better advised of prevention and early diagnosis of hypertension by means of special programs.

Bacia do rio Parauari-Maués-Açu. Aspectos químicos devidos as alterações hidrológicas da Bacia

As condições hidroquímicas da bacia do Rio Parauari-Maués-Açu, estão estudadas a partir da determinações do ph, cálcio, magnésio, sódio, potássio, ferro, cloretos, cobre, zinco e mangnês, nas diferentes épocas do ano. Para isso, foram realizadas quatro excursões e estabelecidos onze pontos de coletas de amostras de água, ao longo do rio principal e igarapés afluentes.As análises mostraram claramente flutuações sazonais no rio que constitui o eixo principal da bacia, o Parauari-Maués-Açu e em alguns de seus principais tributários, como os rios Nambi , Amanã e Urupadi. Essas flutuações estão estritamente relacionadas com os períodos de cheia, seca e intermediários, mostrando a importância dessa massa de água na movimentação de sais, ao longo da bacia.

Rios da Bacia Amazônica. I. Afluentes do rio Negro

Foram analisadas e comparadas neste trabalho, quanto às qualidades físico-químicas, amostras de água de 29 (vinte e nove) afluentes do rio Negro, A maioria das águas e muito pobre em sais dissolvidos, e por outro lado bastante ácida, sendo observado que. as substâncias coloridas exercem influencia sobre algum parâmetros químicos isto bem demonstrado pelos resultados de coeficiente, de correlação a 5%. Os rios da margem esquerda provenientes das, montanhas localizadas ao norte são mais férteis em substâncias nutritivas minerais. Já os da margem direita, que em sua maioria nascem em terras alagadiças e em campinas, são considerados extremamente pobres. De um modo geral, são as condições físico-químicas e biológicas que influenciam os resultados de nitrogênio. Discute-se também a hipótese da fertilização de pequenas áreas inundáveis que atualmente estão de formando no baixo rio Negro, bem como o aparecimento de macrófitas aquáticas.

Rios da bacia amazônica II. Os afluentes do rio Branco (*)

Foram coletadas amostras de água em 13 rios pertencentes a bacia do Rio Branco e analizados, quanto aos seguintes parêmetros físico-químicos: pH, condutibilidade elétrica, Ca, Mg, Na, K, Fe solúvel, Fe complexado e total, Mn, P tota, N-Kjedahl, NH4, N-orgânigo, SO4, Côr, Material Húmico, Cl, Si e Al total. Foram analizados os resultados estatísticos do coeficiente de correlação a 5%. Essa bacia possui rios com relativas concentrações de sais minerais no que é muito bem demonstrado pelo PROJETO RADAM BRASILvol. 8 1975, e rios bastantes pobres em eletrólitos. Três desses rios, o Uraricoera, Mucajaí e o Branco, possuem várzeas agricultáveis, principalmente a região do baixo Rio Branco, que deveria ser melhor aproveitada para cultura de subsistência do Território de Roraima.

Teores de flúor em águas da cidade de Manaus

The fluorine content of 10 major sources of water supply from the city of Manaus was determined. The method used in this investigation consisted of the Willard-Winter technique, with modification. The values obtained were very low, showing that the water of the city of Manaus does not offer adequate protection against dental caries..

Avaliação de técnicas de segmentação e classificação automática de imagens landsat-tm no mapeamento do uso do solo na Amazônia1

O mapeamento do uso da terra é fundamental para o entendimento dos processos de mudanças globais, especialmente em regiões como a Amazônia que estão sofrendo grande pressão de desenvolvimento. Tradicionalmente estes mapeamentos têm sido feitos utilizando técnicas de interpretação visual de imagens de satélites, que, embora de resultados satisfatórios, demandam muito tempo e alto custo. Neste trabalho é proposta uma técnica de segmentação da imagens com base em um algoritmo de crescimento de regiões, seguida de uma classificação não-supervisionada por regiões. Desta forma, a classificação temática se refere a um conjunto de elementos (pixels da imagem), beneficiando-se portanto da informação contextual e minimizando as limitações das técnicas de processamento digital baseadas em análise pontual (pixel-a-pixel). Esta técnica foi avaliada numa área típica da Amazônia, situada ao norte de Manaus, AM, utilizando imagens do sensor "Thematic Mapper" - TM do satélite Landsat, tanto na sua forma original quanto decomposta em elementos puros como vegetação verde, vegetação seca (madeira), sombra e solo, aqui denominada imagem misturas. Os resultados foram validados por um mapa de referência gerado a partir de técnicas consagradas de interpretação visual, com verificação de campo, e indicaram que a classificação automática é viável para o mapeamento de uso da terra na Amazônia. Testes estatísticos indicaram que houve concordância significativa entre as classificações automáticas digitais e o mapa de referência (em tomo de 95% de confiança).

Modificações do microclima e regime hidrológico devido ao desmatamento na Amazônia: estudo de um caso em Rondônia (Ro), Brasil

As mudanças no microclima e no balanço hídrico devido ao desmatamento na Amazônia (região de Ji-Paraná-RO) foram estudadas com dados meteorológicos coletados de janeiro/92 até outubro/93, em sítios experimentais de floresta tropical e de pastagem. Observou-se que a troca de vegetação (desmatamento) reduz a precipitação total em 10%, diminui a evapotranspiração real de 24% e também apresenta uma maior amplitude térmica da temperatura do ar de 1,6 °C. A análise do balanço hídrico mostra claramente que a floresta tropical consegue extrair mais água do que o sítio de pastagem durante a estação seca, embora os dois sítios possuam comportamentos similares durante a estação chuvosa.