Scielo RSS <![CDATA[Sao Paulo Medical Journal]]> http://www.scielo.br/rss.php?pid=1516-318019990001&lang=en vol. 117 num. 1 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.br/img/en/fbpelogp.gif http://www.scielo.br <![CDATA[<b>Uniform requirements for manuscripts, CONSORT statement and more informative abstracts</b>: <b>three fundamental papers for improving the quality of medical publications</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31801999000100001&lng=en&nrm=iso&tlng=en <![CDATA[<b>Maternal mortality in Campinas</b>: <b>evolution, under-registration and avoidanc</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31801999000100002&lng=en&nrm=iso&tlng=en CONTEXT: Up until a few years ago, maternal mortality did not merit much attention as a worldwide public health issue. The health and social development indicator almost exclusively used was infant death. OBJECTIVE: To study the number, characteristics, basic causes and avoidance of maternal mortality (MM) among women living in the city of Campinas, which occurred between 1985 and 1991, identified from all death certificates of women aged 10 through 49 years. DESIGN: Retrospective and descriptive population-based study. SETTING: University Referal Center. SAMPLES: All eligible death certificates classified as declared and presumed maternal deaths according to the Laurenti criteria for the cause of death were selected and complementary studies of the clinical records were performed. MAIN MEASURES: Day of the week and place of occurrence of death; period of occurrence; transfer from another hospital; number of days from delivery/abortion to death; blood transfusion; opportunity for transfusion; complications; autopsy; basic cause of death. RESULTS: Initially 39 declared maternal deaths were identified and a total of 62 were confirmed by the end of the study. This corresponds to an under-registration rate of 37.1% and to an MM ratio of 45.5 per 100,000 live births. Around three-fourths of these maternal deaths were due to a direct obstetrical cause and were considered avoidable. CONCLUSION: Maternal mortality still is high in the municipality of Campinas, although lower than the mean estimated for Brazil. The predominance of direct obstetric causes and avoidable deaths reinforces the need for public health interventions directed towards avoiding them<hr/>OBJETIVOS: Estudar o número e as características das mortes maternas, suas causas e evitabilidade, entre mulheres residentes no município de Campinas no período de 1985 a 1991, identificadas entre todas as declarações de óbito de mulheres com idade entre 10 e 49 anos. TIPO DE ESTUDO: Estudo descritivo de base populacional, retrospectivo. MÉTODO: Selecionaram-se, dentre todas as D.O. elegíveis ao estudo, as classificadas quanto à causa básica do óbito como mortes maternas declaradas e presumíveis, segundo os critérios de Laurenti, que foram complementarmente estudadas através de seus prontuários clínicos. RESULTADOS: Identificaram-se 39 mortes maternas declaradas e um total de 62 confirmadas ao fim do estudo, correspondendo a uma subenumeração de 37,1% e a uma RMM de 45,5 por 100.000 NV. Cerca de três quartos dos óbitos maternos aconteceram por uma causa obstétrica direta e foram considerados evitáveis. CONCLUSÃO:A mortalidade materna ainda é elevada no município de Campinas, embora bem menor que a média estimada para o Brasil. O predomínio de causas obstétricas diretas e de óbitos evitáveis reforça a necessidade de medidas de saúde pública para evitá-los. <![CDATA[<b>Nutritional assessment and serum zinc and copper concentration in leukemic children</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31801999000100003&lng=en&nrm=iso&tlng=en CONTEXT: Malnutrition in childhood cancer is commonly a serious problem. Changes in blood zinc and copper have also been found in malignant diseases. OBJECTIVE: To describe the protein-energy nutritional status and serum zinc and copper of children with newly diagnosed leukemia. DESIGN: Cross-sectional study. SETTING: University referral center. PARTICIPANTS: 23 children with newly diagnosed acute lymphocytic leukemia (ALL) or acute non-lymphocytic leukemia (ANLL) between the ages of 1and 10 years. The control subjects were 31 healthy school children of similar age from local schools. MAIN MEASURES: Anthropometric measurements of height/age and weight/height, food intake and serum levels of zinc and copper. RESULTS: Almost the entire group of children were eutrophic. Zinc and copper intake were below the recommended values. Serum zinc levels were significantly lower and serum copper levels were significantly higher in the leukemic group when compared to normal children. CONCLUSION: At the time of diagnosis the children suffering from leukemia were not overtly malnourished but blood analysis showed alterations in concentrations of the trace elements zinc and copper.<hr/>INTRODUÇÃO: Crianças portadoras de doenças malignas tendem a ter seu estado nutricional comprometido, podendo apresentar também alterações nas concentrações sanguineas de zinco e cobre. OBJETIVO: Investigar os parâmetros antropométricos e os oligoelementos zinco e cobre em uma amostra de crianças portadoras de leucemia. LOCAL: Centro de Referência Universitário PARTICIPANTES: 23 crianças com diagnóstico recente de leucemia linfoide aguda (LLA) ou leucemia não linfoide aguda (LNLA), com idade entre um e 10 anos. O Grupo Controle foi formado por 31 crianças saudáveis da mesma faixa etária. VARIÁVEIS ESTUDADAS: Foi feito um estudo transversal, onde foram avaliados os dados antropométricos de peso e estatura, a ingestão de calorias, proteínas, zinco e cobre e os níveis séricos de zinco e cobre assim como a ingestão destes minerais. TIPO DE ESTUDO: Estudo Transversal RESULTADOS: A maioria das crianças não apresentou comprometimento do estado nutricional e a análise da ingestão alimentar demonstrou que a ingestão de zinco e cobre estava abaixo das recomendações do RDA. Os níveis séricos de zinco foram significantemente menores e os níveis séricos de cobre significantemente maiores nas crianças com leucemia quando comparadas às crianças controle. CONCLUSÃO: O estudo demonstrou que a maioria das crianças eram eutróficas ao diagnóstico, porém apresentavam níveis séricos alterados de zinco e cobre. <![CDATA[<b>Is glycosuria a reliable indicator of adequacy of glucose infusion rate in preterm infants?</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31801999000100004&lng=en&nrm=iso&tlng=en CONTEXT: Adequacy of glucose infusion may be monitored via the glycosuria levels, as there is a relationship between glycemia and glycosuria regulated by the renal glucose threshold. In the neonatal period, however, this relationship is not so clear. OBJECTIVE: To evaluate the occurrence of glycosuria in preterm infants submitted to glucose infusion and to verify the relationship between glycosuria and blood glucose level. DESIGN: Accuracy study. SETTING: Neonatal intensive care unit of General Maternity Hospital. PATIENTS: 40 preterm newborns receiving glucose infusion. PROCEDURES: 511 concomitant determinations of glycemia and glycosuria were performed. These 511 pairs were divided into stable and unstable, according to the clinical status of the newborn at the time of data collection, and they were studied in relation to the gestational age, birth weight and glucose infusion rate. RESULTS: The results revealed a greater frequency of glycosuria in gestational age <FONT FACE="Symbol">£</font> 30 weeks, birth weight &lt;1500 g and glucose infusion rate &gt; 6 mg/kg/min. Eight (25.8%) episodes of positive glycosuria occurred in the absence of hyperglycemia, indicating only a moderate concordance between them. CONCLUSION: Glycosuria alone is an unreliable marker of blood glucose concentration and adequacy of glucose infusion rate. It is therefore necessary to monitor blood glucose levels in infants submitted to continuous glucose infusion.<hr/>OBJETIVOS: Avaliar a ocorrência de glicosúria em recém-nascidos pré-termo submetidos à infusão parenteral de glicose e verificar a relação entre glicemia e glicosúria. METODOLOGIA: Foram realizadas 511 determinações concomitantes de glicemia e glicosúria em 40 recém-nascidos pré-termo recebendo infusão parenteral de glicose. Estes 511 pares foram dicotomizados conforme o “momento” clínico do recém-nascido no instante da coleta, em estáveis e instáveis, e estudados em relação à idade gestacional, peso de nascimento e velocidade de infusão de glicose. RESULTADOS: Os resultados revelaram maior frequência de glicosúria em idade gestacional £ 30semanas, peso de nascimento &lt; 1500g e velocidade de infusão de glicose &gt; 6mg/kg/min. Houve a ocorrência de 8 (25,8%) episódios de glicosúria positiva na ausência de hiperglicemia mostrando somente uma concordância moderada entre os dois fenômenos. CONCLUSÕES: A glicosúria não deve ser utilizada como indicadora de níveis glicêmicos nem de adequação da taxa da infusão de glicose. É necessário, portanto, a monitorização frequente da glicemia em recém-nascidos pré-termo submetidos à infusão de glicose. <![CDATA[<b>Delimitation of homogeneous regions in the UNIFESP/EPM healthcare center coverage area based on sociodemographic indicators</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31801999000100005&lng=en&nrm=iso&tlng=en CONTEXT: The drawing up of adequate Public Health action planning to address the true needs of the population would increase the chances of effectiveness and decrease unnecessary expenses. OBJECTIVE: To identify homogeneous regions in the UNIFESP/EPM healthcare center (HCC) coverage area based on sociodemographic indicators and to relate them to causes of deaths in 1995. DESIGN: Secondary data analysis. SETTING: HCC coverage area; primary care. SAMPLE: Sociodemographic indicators were obtained from special tabulations of the Demographic Census of 1991. MAIN MEASURES: Proportion of children and elderly in the population; family providers’ education level (maximum: &gt;15 years, minimum: &lt;1 year) and income level (maximum: &gt; 20 minimum wages, minimum: &lt;1 minimum wage); proportional mortality distribution. RESULTS: The maximum income permitted the construction of four homogeneous regions, according to income ranking. Although the proportion of children and of elderly did not vary significantly among the regions, minimum income and education showed a statistically significant (p&lt;0.05) difference between the first region (least affluent) and the others. A clear trend of increasing maximum education was observed across the regions. Mortality also differed in the first region, with deaths generated by possibly preventable infections. CONCLUSION: The inequalities observed may contribute to primary health prevention.<hr/>OBJETIVO: Delimitar regiões homogêneas na área de abrangência do Centro de Saúde-Escola-EPM/UNIFESP (CSE) com base em indicadores sociodemográficos, bem como relacioná-los às causas de mortalidade de 1995. TIPO DE ESTUDO: Análise de dados secundários. LOCALIZAÇÃO: Área de abrangência do CSE; atenção primária. VARIÁVEIS ESTUDADAS: Populacionais: proporções de crianças e idosos; chefes de família: instrução (máxima: &gt;15 anos; mínima: &lt;1 ano) e renda (máxima: &gt; 20 salários mínimos; mínima: &lt;1 salário mínimo). Distribuição de mortalidade proporcional RESULTADOS: A renda máxima permitiu a construção de quatro regiões homogêneas, de acordo com sua escala por postos. Embora a proporção de crianças e idosos não tenha variado significantemente entre as regiões, a renda e instrução mínimas apresentaram uma diferença estatisticamente significante (p&lt;0,05) entre a primeira região (menos favorecida) e as demais. Gradiente crescente foi igualmente observado (instrução mínima). A mortalidade também diferiu na primeira região, com óbitos por causas preveníveis. CONCLUSÕES: As desigualdades observadas podem contribuir para a prevenção primária da saúde. <![CDATA[<b>Parapharyngeal space tumors</b>: <b>considerations in 26 cases</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31801999000100006&lng=en&nrm=iso&tlng=en CONTEXT: Parapharyngeal space tumors comprise less than 0.5% of all head and neck neoplasms.1 The majority of these tumors are benign, but surgery is usually required to establish the diagnosis and treat the patients. We present 26 patients treated surgically for tumors arising in the parapharyngeal space (PPS) at the State University of Campinas Hospital – UNICAMP. CASES SERIE: Of these, 17 (65.5%) had benign and 9 (34.6%) malignant neoplasms. The surgical and pathological data relevant to these cases are highlighted, observing any local recurrence, surgical complications and the five-year survival. Neurogenic tumors and soft tissue sarcomas were, respectively, the most frequent benign (35.3%) and malignant neoplasms (44.5%). Benign tumors accounted for the majority of the cases and involved minimal surgical morbidity with no recurrence during a median follow-up of five years. Malignant tumors had a high rate of recurrence and mortality. Surgery is the treatment of choice for PPS tumors. A knowledge of the anatomy of this site is essential for the safe performance of surgical procedures. Malignant neoplasms have a poor prognosis. Fine needle aspiration was helpful in diagnosis of all tumors.<hr/>CONTEXTO: Tumores do espaço parafaríngeo compreendendo menos de 0,5% dos tumores de cabeça e pescoço. A maioria destes são benignos, sendo a cirurgia necessária para tratamento e algumas vezes para diagnóstico dos pacientes. Apresentamos 26 pacientes tratados cirurgicamente no Hospital das Clínicas da UNICAMP por tumores localizados no EPF SÉRIE DE CASOS: A média de idade foi de 53 anos, sendo que dos tumores 17 (65,5%) eram benignos e, 9 (34,6%) malignos. Enfatizaremos as técnicas cirúrgicas e dados anatomopatológicos observando ainda as recidivas e sobrevida. Tumores neurogênicos (35,3%) e sarcomas de partes moles (44,5%) foram os tumores benignos e malignos mais freqüentes. Os tumores benignos apresentaram mínima morbidade cirúrgica e bom prognóstico, inversamente ao ocorrido com os malignos. A cirurgia é o tratamento de escolha para estes tumores, sendo que os malignos apresentaram pior prognóstico. Com exames de imagem, punção aspirativa por agulha fina (PAAF) ou biópsia aberta, obtivemos diagnóstico pré-operatório em todos os casos. <![CDATA[<b>Delayed hemolytic transfusion reaction presenting as a painful crisis in a patient with sickle cell anemia</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31801999000100007&lng=en&nrm=iso&tlng=en CONTEXT: Patients with sickle cell anemia (SCA) are frequently transfused with red blood cells (RBC). Recently, we reported that the calculated risk of RBC alloimmunization per transfused unit in Brazilian patients with SCA is 1.15%. We describe a delayed hemolytic transfusion reaction (DHTR) presenting as a painful crisis in a patient with SCA. CASE REPORT: A 35-year-old Brazilian female with homozygous SCA was admitted for a program of partial exchange transfusion prior to cholecystectomy. Her blood group was O RhD positive and no atypical RBC alloantibody was detected using the indirect antiglobulin technique. Pre-transfusional hemoglobin (Hb) was 8.7 g/dL and isovolumic partial exchange transfusion was performed using 4 units of ABO compatible packed RBC. Five days after the last transfusion she developed generalized joint pain and fever of 39°C. Her Hb level dropped from 12.0 g/dL to 9.3 g/dL and the unconjugated bilirrubin level rose to 27 mmol/L. She was jaundiced and had hemoglobinuria. Hemoglobin electrophoresis showed 48.7% HbS, 46.6% HbA1, 2.7% HbA2, and 2.0% HbF. The patient’s extended RBC phenotype was CDe, K-k+, Kp(a-b+), Fy(a-b-), M+N+s+, Le(a+b-), Di(a-). An RBC alloantibody with specificity to the Rh system (anti-c, titer 1:16.384) was identified by the indirect antiglobulin test. The Rh phenotype of the RBC used in the last packed RBC transfusion was CcDEe. The patient was discharged, asymptomatic, 7 days after admission.<hr/>CONTEXTO: Pacientes com anemia falciforme recebem com freqüência concentrados de glóbulos vermelhos (CGV). Recentemente, nós relatamos que o risco de alo-imunização eritrocitária por unidade transfundida em pacientes brasileiros com anemia falciforme é 1,15%. RELATO DE CASO: Nós descrevemos uma reação transfusional hemolítica tardia (RTHT) apresentando-se como uma crise dolorosa em um paciente com anemia falciforme. <![CDATA[<b>Redundant or duplicate publication</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31801999000100008&lng=en&nrm=iso&tlng=en CONTEXT: Patients with sickle cell anemia (SCA) are frequently transfused with red blood cells (RBC). Recently, we reported that the calculated risk of RBC alloimmunization per transfused unit in Brazilian patients with SCA is 1.15%. We describe a delayed hemolytic transfusion reaction (DHTR) presenting as a painful crisis in a patient with SCA. CASE REPORT: A 35-year-old Brazilian female with homozygous SCA was admitted for a program of partial exchange transfusion prior to cholecystectomy. Her blood group was O RhD positive and no atypical RBC alloantibody was detected using the indirect antiglobulin technique. Pre-transfusional hemoglobin (Hb) was 8.7 g/dL and isovolumic partial exchange transfusion was performed using 4 units of ABO compatible packed RBC. Five days after the last transfusion she developed generalized joint pain and fever of 39°C. Her Hb level dropped from 12.0 g/dL to 9.3 g/dL and the unconjugated bilirrubin level rose to 27 mmol/L. She was jaundiced and had hemoglobinuria. Hemoglobin electrophoresis showed 48.7% HbS, 46.6% HbA1, 2.7% HbA2, and 2.0% HbF. The patient’s extended RBC phenotype was CDe, K-k+, Kp(a-b+), Fy(a-b-), M+N+s+, Le(a+b-), Di(a-). An RBC alloantibody with specificity to the Rh system (anti-c, titer 1:16.384) was identified by the indirect antiglobulin test. The Rh phenotype of the RBC used in the last packed RBC transfusion was CcDEe. The patient was discharged, asymptomatic, 7 days after admission.<hr/>CONTEXTO: Pacientes com anemia falciforme recebem com freqüência concentrados de glóbulos vermelhos (CGV). Recentemente, nós relatamos que o risco de alo-imunização eritrocitária por unidade transfundida em pacientes brasileiros com anemia falciforme é 1,15%. RELATO DE CASO: Nós descrevemos uma reação transfusional hemolítica tardia (RTHT) apresentando-se como uma crise dolorosa em um paciente com anemia falciforme. <![CDATA[<b>Acceptable secondary publication</b>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31801999000100009&lng=en&nrm=iso&tlng=en CONTEXT: Patients with sickle cell anemia (SCA) are frequently transfused with red blood cells (RBC). Recently, we reported that the calculated risk of RBC alloimmunization per transfused unit in Brazilian patients with SCA is 1.15%. We describe a delayed hemolytic transfusion reaction (DHTR) presenting as a painful crisis in a patient with SCA. CASE REPORT: A 35-year-old Brazilian female with homozygous SCA was admitted for a program of partial exchange transfusion prior to cholecystectomy. Her blood group was O RhD positive and no atypical RBC alloantibody was detected using the indirect antiglobulin technique. Pre-transfusional hemoglobin (Hb) was 8.7 g/dL and isovolumic partial exchange transfusion was performed using 4 units of ABO compatible packed RBC. Five days after the last transfusion she developed generalized joint pain and fever of 39°C. Her Hb level dropped from 12.0 g/dL to 9.3 g/dL and the unconjugated bilirrubin level rose to 27 mmol/L. She was jaundiced and had hemoglobinuria. Hemoglobin electrophoresis showed 48.7% HbS, 46.6% HbA1, 2.7% HbA2, and 2.0% HbF. The patient’s extended RBC phenotype was CDe, K-k+, Kp(a-b+), Fy(a-b-), M+N+s+, Le(a+b-), Di(a-). An RBC alloantibody with specificity to the Rh system (anti-c, titer 1:16.384) was identified by the indirect antiglobulin test. The Rh phenotype of the RBC used in the last packed RBC transfusion was CcDEe. The patient was discharged, asymptomatic, 7 days after admission.<hr/>CONTEXTO: Pacientes com anemia falciforme recebem com freqüência concentrados de glóbulos vermelhos (CGV). Recentemente, nós relatamos que o risco de alo-imunização eritrocitária por unidade transfundida em pacientes brasileiros com anemia falciforme é 1,15%. RELATO DE CASO: Nós descrevemos uma reação transfusional hemolítica tardia (RTHT) apresentando-se como uma crise dolorosa em um paciente com anemia falciforme. <![CDATA[<strong>Should there be a recommended limit to the number of references in a scientific article?</strong>]]> http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-31801999000100010&lng=en&nrm=iso&tlng=en CONTEXT: Patients with sickle cell anemia (SCA) are frequently transfused with red blood cells (RBC). Recently, we reported that the calculated risk of RBC alloimmunization per transfused unit in Brazilian patients with SCA is 1.15%. We describe a delayed hemolytic transfusion reaction (DHTR) presenting as a painful crisis in a patient with SCA. CASE REPORT: A 35-year-old Brazilian female with homozygous SCA was admitted for a program of partial exchange transfusion prior to cholecystectomy. Her blood group was O RhD positive and no atypical RBC alloantibody was detected using the indirect antiglobulin technique. Pre-transfusional hemoglobin (Hb) was 8.7 g/dL and isovolumic partial exchange transfusion was performed using 4 units of ABO compatible packed RBC. Five days after the last transfusion she developed generalized joint pain and fever of 39°C. Her Hb level dropped from 12.0 g/dL to 9.3 g/dL and the unconjugated bilirrubin level rose to 27 mmol/L. She was jaundiced and had hemoglobinuria. Hemoglobin electrophoresis showed 48.7% HbS, 46.6% HbA1, 2.7% HbA2, and 2.0% HbF. The patient’s extended RBC phenotype was CDe, K-k+, Kp(a-b+), Fy(a-b-), M+N+s+, Le(a+b-), Di(a-). An RBC alloantibody with specificity to the Rh system (anti-c, titer 1:16.384) was identified by the indirect antiglobulin test. The Rh phenotype of the RBC used in the last packed RBC transfusion was CcDEe. The patient was discharged, asymptomatic, 7 days after admission.<hr/>CONTEXTO: Pacientes com anemia falciforme recebem com freqüência concentrados de glóbulos vermelhos (CGV). Recentemente, nós relatamos que o risco de alo-imunização eritrocitária por unidade transfundida em pacientes brasileiros com anemia falciforme é 1,15%. RELATO DE CASO: Nós descrevemos uma reação transfusional hemolítica tardia (RTHT) apresentando-se como uma crise dolorosa em um paciente com anemia falciforme.