Resultados comparativos das reações intra-dermicas com antígenos de bacilos ácido-alcool-resistentes (Leprolinas "Souza-Araújo") e emulsão de lepromas (Lepromina): (Primeira Nota)

Em 20 portadores de Lepra, internados na Colônia de São Roque, Paraná, 13 dos quais eram da forma lepromatosa e os 7 restantes da forma nervosa pura ou tuberculoide, o autor estudou a reação intradérmica de antigenos bacilares (Leprolinas Souza-Araujo 1, 1a, 3, 5, 5a), comparativamente com as reações produzidas, ao mesmo tempo, com antígeno lepromatoso (Emulsão de lepromas, lepromina). Observou o seguinte: 1.° - Que a lepromina, comportou-se como habitualmente, isto é, negativa nos lepromatosos e ositiva nos nervosos e tuberculoides e sempre mais intensa ao fim da quarta semana. 2.° - Que as leprolinas provocam reações, que o autor não conclui serem positivas ou negativas no sentido imunológico da expressão em virtude de estar estudando-as neste sentido, nos leprotomatosos e tuberculoides, mas, sempre mais intensas entre a 1.ª e 2.ª semanas, diminuindo de intensidade na 3.ª e desaparecendo ou quase desaparecendo ao fim da quarta semana: nódulos, nódulos-eritema, ulcerações. 3.° - Que nestas reações houve destruição de tecidos, pois a presença tardia de cicatrizes, mesmo quando não houve ulceração, mostra êste fato. 4.° - Que as inoculações das lepromina, não trouxeram nenhum inconveniente a saúde dos paciente; embora um deles tenha apresentado nos primeiros dias leve reação geral; outro, intensa fusão de suas lesões nodulars de lepra e, dois outros, a chamada Reação leprótica.

As Leprolinas "Souza-Araujo" e a sua rápida acção terapêutica nos males perfurantes plantares lepróticos

The A. remembers the history of his lepra-culture and the method he uses to prepare with it the antigen called Leprolin Souza-Araujo, giving photographic illustrations upon the subject. The A. says that the results published about the general action of his Leprolin in leprosy must be revised or rectificated. But he says that the rapid action of his antigen upon perforant ulcers in lepers is consecrated by a large experience. He cured, in relatively short time, perforant ulcers in five lepers. Dr. CASSIANO, from Baurú leper Colony (S. Paulo) treated 21 such cases. The median time of treatment was 23 days and the median dosage of Leprolin injected in each patient was 7.7 cm3. All lesions were cured. After 18 months observation three cases relapsed and 18 (or 85.7%) remained cured. Dr. CALDEIRA, Director of padre DAMIEN Leper Colony (Ubá, Minas Gerais) treated regularly with Leprolin 50 cases of severe perforant ulcers and obtained cure in 46 (or 92%). ina special meeting held in Minas Gerais nineteen leprologists examined the cases of Dr. CALDEIRA and considered the results he have obtained as "magnifico", in the sense as "unic". This experiment is being continued in various brazilian leper colonies and the Author offers, graciously, his antigen to be tried also in foreing countries.

Morfologia do Mycobacterium leprae hominis e do M. leprae muris: estudo baseado na microscopia electrônica e de contraste de fases

Hansen's Bacillus: By electron microscopy this bacillus shows membrane and halo, this being more visible when sorrounding the globi or bundles of bacilli; shows, also, free granules of various sizes which were before considered as dust of the dyes; shows external granules bound with the membrane and some times branching. By phases contrast microscopy examining leproma suspensions and subcataneous lymph at 400 x we saw many free granules with intense rotatory movement; granulated bacilli with screw, skip or stroke motion, producing slow progressive motion. All such elementes are surrounded by a halo, corresponding to the classical gloea. By a patient and delayed examination we were able to see that the internal granules are motile and help the progression of the bacilli, giving the impression that the cytoplasm is liquid. By a lasting observation we could see the larger granules form prolapse, like a pseudopode and abandon the bacilli and going in very rapid rotatory movement. There are branched bacilli; there are pedunculated fred granules like comets. The addition of a drop of formol at the preparation stops all movements. Stefansky's Bacillus: Repeated examination by RCA electron microscope, type EMU-25 of fresh suspensions of rat lepromas, led us to confirm the close relationship between human and murine leprosy agents. We examined also material from carabo (Lepra bubalorum) from Java, but due to fixation, the material was unsuitable for comparative studies. The Stefansky's bacilli showed also emmbranes and halos, internal or external granules (smaller than those of Hansen's bacillus). The bacilli shaded by chromium look thicker and shorter than those of Hansen. Due to electron bombardment both, Hansen's and Stefansky's baccilli suffer considerable alterations in their structure, showing black barrs of chromatin condensation at their extremities as also in their centers. By phase microscopy the Stefansky's bacilli showed elements with 1, 2 (bipolar), 3 or more internal small granules, developing identical movements as those of Hansen. The globi seem to be non-motile but the free bacilli appearing around the globi show intense movement. At 1000 x the examination is less satisfactory than at 400 x. The addition of formol solution in the preparation suppresses all movements, even the brownian, but the material becomes more suitable for the study of static morphology of the bacilli. CONCLUSION - The electron and phases contrast microscopy of leprous material from different types and phases of the disease may explain some of the unknown aspects of the biology and morphology of the bacilli.

Prova da hemodispersão sedimentar

Os autores analisam pormenorizadamente o sistema soro-hematia formolizada no qual se processa a aglutino-sedimentação (Fenômeno de Rubino). Cada fase do referido sistema é investigada do ponto de vista físico-químico. Os dados obtidos são aproveitados pelos autores na elaboração de um sistema análogo, porém, com parâmetros próprios diferentes dos fixados por Rubino. Escolheu-se como evidência do fenômeno não a alutino-sedimentação função do tempo, porém, o aspecto da massa globular sedimentada após 24 horas a ± 10ºC (Hemodispersão sedimentar). A nova técnica proposta, aplicada sistematicamente, permitiu aos autores concluírem a) não há 'especificidade" correlacionada com enfermidades; b) o fenômeno resulta da atividade combinada de gamaglobulinas como dipolos, íons positivos do meio e polaridade propícia das hematias formolizadas; c)o aumento das gamaglobulinas séricas, sobretudo daquelas de ponto iso-elétrico do pH sanguíneo, determina o fenômeno, independentemente da causa mórbida que originou a hipergamaglobulinemia; d) sobretudo na lepra lepromatosa, o aumento das referidas gamaglobulinas é muito freqüente, e mantém-se muito tempo mesmo após regressão clínica da doença. É sugerida uma explicação para este último fato; e)os autores também referem uma atividade especial do formol sobre os soros reatores, propondo uma hipótese para a mesma.

Procedimentos, Normas E Directrizes Do Atendimento Das Pessoas Que Vivem Com o Virus DaImunodificiencia Humana

Os avanços conseguidos em matéria de terapêutica anti-retroviral fazem com que a associação entre o tratamento e a prevenção seja um aspecto fundamental da resposta à epidemia. Neste sentido o Ministério da Saúde aprovou o documento “Política de cuidados integrados às pessoas que vivem com o VIH”, em Julho de 2004, que constitui a base da organização do atendimento, e determina a elaboração de protocolos de terapêutica anti-retroviral e de abordagem das infecções/doenças oportunistas e de um manual de procedimentos. O presente documento pretende ser um manual para orientar as actuações dos técnicos de Saúde no atendimento dos pacientes com infecção VIH definindo as regras para o diagnóstico, seguimento e notificação dos casos

Lepromatous leprosy: a review and case report

Leprosy is a contagious and chronic systemic granulomatous disease caused by Mycobacterium leprae (Hansen"s bacillus). It is transmitted from person to person and has a long incubation period (between two and six years). The disease presents polar clinical forms (the"multibacillary" lepromatous leprosy and the"paucibacillary" tuberculoid leprosy), as well as other intermediate forms with hybrid characteristics. Oral manifestations usually appear in lepromatous leprosy and occur in 20-60% of cases. They may take the form of multiple nodules (lepromas) that progress to necrosis and ulceration. The ulcers are slow to heal, and produce atrophic scarring or even tissue destruction. The lesions are usually located on the hard and soft palate, in the uvula, on the underside of the tongue, and on the lips and gums. There may also be destruction of the anterior maxilla and loss of teeth. The diagnosis, based on clinical suspicion, is confirmed through bacteriological and histopathological analyses, as well as by means of the lepromin test (intradermal reaction that is usually negative in lepromatous leprosy form and positive in the tuberculoid form). The differential diagnosis includes systemic lupus erythematosus, sarcoidosis, cutaneous leishmaniasis and other skin diseases, tertiary syphilis, lymphomas, systemic mycosis, traumatic lesions and malignant neoplasias, among other disorders. Treatment is difficult as it must be continued for long periods, requires several drugs with adverse effects and proves very expensive, particularly for less developed countries. The most commonly used drugs are dapsone, rifampicin and clofazimine. Quinolones, such as ofloxacin and pefloxacin, as well as some macrolides, such as clarithromycin and minocyclin, are also effective. The present case report describes a patient with lepromatous leprosy acquired within a contagious family setting during childhood and adolescence

Operative Treatment of Ovarian Cancer and Borderline Tumors in Different Hospital Categories in Finland

Surgery is the cornerstone of ovarian cancer treatment and maximal cytoreduction is important. In the early 1980’s primary surgical treatment of ovarian cancer was performed in over 80 hospitals in Finland. The significance of the operative volume of the hospital, of the training of the surgeons and of centralization of surgical treatment has been widely discussed. The aim of the present study was to evaluate the outcome of surgical treatment of ovarian cancer in different hospital categories retrospectively and prospectively, and to analyze if any differences are reflected in survival. The retrospective study included 3851 ovarian cancer patients operated between 1983 and 1994 in Finland. The data was analyzed according to hospital category (university, central, and other) and by quartiles of the hospital operative volume. The results showed that patients operated in the highest operative volume hospitals had the best relative survival. When stratifying the analysis by the period of diagnosis (1983-1988 and 1989-1994), the university hospitals improved their performance the most. The prospective part of the thesis was initiated in 1999 and included 307 patients with invasive ovarian cancer and 65 patients with an ovarian borderline tumor. The baseline and 5-year surveys used a questionnaire that was filled in by the operating surgeons. For analysis of the 5-year followup data, the hospitals were divided into three categories (<10, 10-20, or >20 patients operated in 1999). The effect of the surgical volume was analyzed also as a continuous variable (1-47 operations per year). In university hospitals, pelvic lymphadenectomy was performed in 88 %, and para-aortic lymphadenectomy in 73 %, of the patients with stage I disease. The corresponding figures ranged from 11 % to 21 % in the other hospitals. For stage III ovarian cancer patients operated by gynecological oncologists, the estimated odds ratio for no macroscopic residual tumor was 3.0 times higher (95 % CI 1.2-7.5) than for those operated by general gynecologists. In the university and other hospitals 82% of the patients received platinum-based chemotherapy. Platinum + taxane combination was given to 63 % of the patients in the university and in 49 % in the other hospitals (p = 0.0763). Only a minority of the patients with tumors of borderline malignancy were staged according to recommendations, most often multiple peritoneal biopsies and omentectomy were neglected. FIGO stage, patient age, and residual tumor were independent prognostic factors of cancer-specific 5-year survival. A higher hospital operative volume was also a significant prognostic factor for better cancer-specific survival (p = 0.036) and disease-free survival (p = 0.048). In conclusion, ovarian cancer patients operated in high-volume university hospitals were more often optimally debulked and had a significantly better cancer-specific survival than patients operated in other hospitals. These results favor centralization of primary surgical treatment of ovarian cancer.

Los orígenes del lazareto pabellonario. La arquitectura cuarentenaria en el cambio del setecientos al ochocientos

El modelo de lazareto pabellonario se configuró a partir de las bases científicas establecidas durante el proceso de reforma hospitalaria acaecido en Francia en el último tercio del setecientos. La adopción de soluciones que dieran forma a la nueva tipología cuarentenaria no vino dada precisamente por el ejemplo prestado por los nuevos tipos de hospital resultantes de este debate sino por el de otras instalaciones de cuarentena y, en general, de encierro, ya existentes. En este artículo se analizarán todos los factores que influyeron en la configuración de este modelo de lazaretos.

Lepromatous leprosy: a review and case report

Leprosy is a contagious and chronic systemic granulomatous disease caused by Mycobacterium leprae (Hansen"s bacillus). It is transmitted from person to person and has a long incubation period (between two and six years). The disease presents polar clinical forms (the"multibacillary" lepromatous leprosy and the"paucibacillary" tuberculoid leprosy), as well as other intermediate forms with hybrid characteristics. Oral manifestations usually appear in lepromatous leprosy and occur in 20-60% of cases. They may take the form of multiple nodules (lepromas) that progress to necrosis and ulceration. The ulcers are slow to heal, and produce atrophic scarring or even tissue destruction. The lesions are usually located on the hard and soft palate, in the uvula, on the underside of the tongue, and on the lips and gums. There may also be destruction of the anterior maxilla and loss of teeth. The diagnosis, based on clinical suspicion, is confirmed through bacteriological and histopathological analyses, as well as by means of the lepromin test (intradermal reaction that is usually negative in lepromatous leprosy form and positive in the tuberculoid form). The differential diagnosis includes systemic lupus erythematosus, sarcoidosis, cutaneous leishmaniasis and other skin diseases, tertiary syphilis, lymphomas, systemic mycosis, traumatic lesions and malignant neoplasias, among other disorders. Treatment is difficult as it must be continued for long periods, requires several drugs with adverse effects and proves very expensive, particularly for less developed countries. The most commonly used drugs are dapsone, rifampicin and clofazimine. Quinolones, such as ofloxacin and pefloxacin, as well as some macrolides, such as clarithromycin and minocyclin, are also effective. The present case report describes a patient with lepromatous leprosy acquired within a contagious family setting during childhood and adolescence

Lääketiede

Lääketieteen pääkokoelma sijaitsee Terveystieteiden osastokirjastossa, jossa painettu yleiskokoelma koostuu 4856 nimekkeestä (painettujen monografiasarjojen osat mukana luvussa). Lääketieteen kokoelmasta 19 % on Tampereen yliopistossa julkaistuja väitöskirjoja. Terveydenhuoltoalaa yleensä käsittelevää kirjallisuutta on noin 10 %. Lääketieteen eri osa-alueita käsittelevästä kirjallisuudesta suurimmat ryhmät muodostavat psykiatria (noin 11 % koko kokoelmasta), hermosto (noin 7 %), käytännön lääketiede (noin 6 %) lastentaudit (5.4 %), luusto ja lihaksisto (5.4 %), geriatria (noin 5 %) ja verenkiertoelimet (noin 4 %). Käsikirjasto sisältää 175 nimekettä lääketieteen ja terveydenhuoltoalan sanastoja, sanakirjoja ja hakuteoksia. Painettuja lehtiä on 58 nimekettä: Lääketiede yleensä (14 nimekettä), terveydenhuolto ja sairaalat (8) hammaslääketiede (6), psykiatria (4), geriatria (3), muut lääketieteen erityisalueet (35). Sähkökirjoja kokoelmassa on noin 2500 nimekettä: Ebrary (2350), MDConsult (51), Thieme ElectronicBook Library (42), Ovid (35), Netlibrary (15) sekä 12 elektronista hakuteosta mm. Acronyms and Initials for Health Information Resources, Encyclopedia of Molecular Medicine, Käypä hoito, Oxford Reference Online: Medicine, RxList – The Internet Drug Index. Verkkolehtiä kokoelmassa on noin 3200 nimekettä, joista vapaasti verkossa saatavissa lähes 900 nimekettä (28 %). Tietokantoja on 41: mm. lehtitietokanta ScienceDirect ja viitetietokantoja mm. BMJ Clinical Evidence, EBM Reviews, Medic, Medline (Ovid), PsycINFO, Terveysportti, Web of Science.

Synnytys

Sairaala. Synnytys. Leikkausääniä. Valitusta. Ponnistelua. Instrumenttien ääniä. Lapsi syntyy.

Hospital-Colónia Rovisco Pais: um projeto de uma cidade ideal?

Este artigo decorre de um projeto de investigação intitulado “Hospital-Colónia Rovisco Pais: antropologia e história em contexto”, apoiado em 2005 pelo Instituto de Investigação Interdisciplinar da Universidade de Coimbra. Procurarei interrogar a associação estabelecida pelo médico português Fernando Bissaya Barreto (1886-1974) entre o falanstério, concebido por Charles Fourier (1772-1837) nos anos 20 e 30 do século XIX, e as suas propostas de construção de um Hospital-Asilo-Colónia para “alienados” e, posteriormente, para doentes com lepra, atualmente designada por doença de Hansen ou hanseníase, por referência ao médico norueguês Armauer Hansen (1841-1912), que em 1872 identificou o Mycrobacterium Leprae. O propósito será averiguar as possíveis relações entre algumas utopias modernas de cidades ideais que, segundo Jane Jacobs em Morte e Vida das Grandes Cidades, influenciaram o que ela designa por princípios do urbanismo moderno ortodoxo, baseados no que os urbanistas gostariam que as cidades fossem e não no que elas são, e algumas estruturas de isolamento, nomeadamente colónias agrícolas, construídas para todos aqueles que representavam uma ameaça à utopia de uma sociedade perfeita.

WHO disability grade does not influence physical activity in Brazilian leprosy patients

Disability caused by leprosy may be associated with stigma. The aim of this work is to describe the degree of disability, quality of life and level of physical activity of individuals with leprosy and to identify possible correlations between these factors. Ninety-seven patients from two referral centres were studied. A complete medical history was taken and the World Health Organization degree of physical disability classification (WHO-DG), the International Physical Activity Questionnaire (IPAQ) and the Medical Outcome Study 36-item Short-form health Survey (SF36) were applied. The mean age of patients was 51 +/- 14.9 years old; participants were predominantly men, married, unemployed, had concluded treatment and had had lepromatous leprosy. The WHO-DG and the level of physical activity (P-value = 0.36) were not correlated. The WHO-DG showed that 72.2% of patients had disabilities, 37-1% of whom performed vigorous physical activities. No significant association was observed between the WHO-DG and the domains of the QoL SF-36 except for functional capacity (P-value = 0.02); the physical capacity is generally 'very good' when individuals have no disabilities and 'bad' with severe disabilities. In conclusion, the WHO-DG of leprosy patients does not affect the level of physical activities or quality of life except functional capacity. There is no significant association between physical activities and quality of life in these individuals.