In the December 2005 issue of Clinics

EDITORIAL

In the December 2005 issue of Clinics

Mauricio Rocha-e-Silva, Editor

Hospital das Clínicas, São Paulo University Medical School - São Paulo/SP, Brazil. Email: [e-mail]

This issue of CLINICS closes our first year of existence. Technically, CLINICS is a new journal, but it follows on 59 years of a continuously published medical journal from Hospital das Clínicas, São Paulo University Medical School. The new name is part of a continuous effort to upgrade to international standards. A healthy growth rate was inherited from the previous editor, Pedro Puech-Leão, but there have been major improvements. The new name is SCIELO and PUBMED registered from its first issue, electronic online editing has been adopted, and the Editorial Board is broader. As we closed this issue, on November 20, we had received a total of 183 new manuscripts, a 44% increase over 2004 and a 62% increase over 2003. Manuscripts are coming from a broader geographical range, making us more representative of Brazil as a whole, and include 14 articles from other countries - twice the total of foreign submissions in the journal's entire past history. Rejection rates increased progressively from 10% in 2001 to 54% this year. We therefore decided to make CLINICS the feature of this issue.

Borghi-Silva et al. evaluated the association of positive end expiratory pressure to physiotherapy intervention during Phase I of cardiac surgery rehabilitation, on the behavior of pulmonary function and inspiratory muscle strength before and after (5^th post-op day) cardiac surgery. Eight patients underwent respiratory exercises with positive expiratory pressure associated to physiotherapy intervention, while 12 received physiotherapy intervention alone. All spirometrically measured pulmonary function was reduced in the physiotherapy alone group, but only vital capacity was reduced in the exercised groups. Cardiac surgery thus appears to reduce inspiratory muscle strength, an effect which is partially countered by exercising the respiratory musculature.

Caruso et al. tested the hypothesis that inspiratory muscle training, starting from the beginning of mechanical ventilation, would abbreviate the time to weaning and decrease re-intubation rates. The evolution of inspiratory muscle strength with and without inspiratory muscle training is also described. In an adult intensive care unit, 12 patients were given inspiratory muscle training twice a day, while 13 other patients were not. Weaning duration and re-intubation rate were not different between groups, leading to the conclusion that inspiratory muscle training is ineffective in this condition.

Camargo et al. clinically and radiographically re-evaluated 214 patients treated for aggressive benign bone lesions with curettage, cauterization, and methylmethacrylate cementation over a 24 year period (average: 10.6 years). Evaluation was performed according to the Musculoskeletal Tumor Society Score (MSTS) functional evaluation system. An excellent score was recorded in 166 cases (78%), a good score in 26 (12%), fair in 11 (5%), and poor in 11 (5%). Most common complications were late osteoarthrosis in 25 cases (12%); infection, 12 (6%); pathologic fracture, 11 (5%); and local recurrence, 19 (9%), with no methylmethacrylate related deleterious effects. The 1998 evaluation showed no significant change compared to the previous one, in 1985.

Oliveira et al. conducted an exploratory survey, interviewing 107 mainly Brazilian adult patients suffering from cataract, to identify their perceptions regarding the disease and its surgical treatment. Most of the patients believe that cataract is caused by old age and/or overuse of the eyes in the workplace, although a minority thinks it is caused by a spell. Most expect cataract to lead to blindness or depression. A significant number avoid surgical procedure for fear of death, excessive pain, or blindness. A number of other misconceptions were identified, leading to the prospect of better management of such patients.

Wolosker et al. prospectively evaluated 48 patients undergoing infra-inguinal arterial reconstruction for ischemic lesions caused by external aggression, and compared them to 52 patients undergoing the same procedure for spontaneously occurring ischemic lesions. Analyzed variables were limb salvage and graft functioning rates. Patients with spontaneous lesions had significantly lower rates of limb salvage and graft functioning than those with lesions secondary to external aggression (42.3% versus 87.5%, respectively for both outcomes). External aggression is thereby ranked as a contributing factor to critical ischemic lesions but results in a better evolution of the graft and better limb salvage.

Vaz et al. evaluated the diagnostic accuracy of magnetic resonance imaging of the knee in identifying traumatic intra-articular knee lesions (medial meniscus, lateral meniscus, anterior cruciate ligament, posterior cruciate ligament, articular cartilage) in 300 patients. For meniscal and ligamentous lesions MRI had very high (>90%) levels of sensitivity, specificity, positive predictive value, positive-negative value and accuracy. Likelihood of positive and negative ratio was also excellent. For articular cartilage lesions, results were not nearly as precise. MRI is therefore an excellent tool for meniscal and ligamentous diagnosis, but not for chondral lesions.

Petroianu et al. retrospectively studied 86 patients, over 21 years, submitted to partial splenectomy for various causes (most frequent: portal hypertension due to schistosomiasis and trauma). Increased white blood cell and platelet counts were the only hematological abnormalities. No immunologic deficit was found. Esophageal varices were still present in portal hypertension patients without rebleeding. Ultrasound, tomography, and scintigraphy confirmed the presence of functional splenic remnants with no significant size alteration.

Eisig et al. analyzed the results of a short course (7 day) furazolidone-based quadruple therapy applied to 62 patients with peptic ulcer disease who had previously been treated for Helicobacter pylori eradication without success. Four patients did not complete the study, only 1 on account of adverse side effects. Under this protocol, H. pylori eradication was achieved in 39/58 patients with only mild adverse events reported. This furazolidone based procedure was well tolerated, inexpensive, and effective, being therefore suggested as a good option for developing countries.

Berger et al. evaluated the frequency of an allelic variant (Trp8Arg/Ile15Thr) in the luteinizing hormone b-subunit gene in a Brazilian population of 202 (115 women) adults with normal sexual function and 48 adults (24 women) with hypogonadotropic hypogonadism. The genetic variant was present at a similar frequency in the healthy subjects (14.4%) and the patients (16.6%) with no effect on luteinizing hormone levels, either in the healthy subjects, or in hypogonadotropic hypogonadism patients. The allelic variant is thus described as a common polymorphism in the Brazilian population, with no influence on hypogonadotropic hypogonadism.

We are also publishing an expert review on Blunt Cerebrovascular Lesions, 2 case reports, and an technical note on a new method for quantitative sweat evaluation.

Publication Dates

• Publication in this collection
  12 Dec 2005
• Date of issue
  Dec 2005