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Revista da Associação Médica Brasileira

Print version ISSN 0104-4230

Rev. Assoc. Med. Bras. vol.55 no.6 São Paulo  2009

https://doi.org/10.1590/S0104-42302009000600024 

ARTIGO DE REVISÃO

 

Insights from Brazilian medical journals

 

 

Bruno Caramelli

Professor associado do departamento de Cardiopneumologia da Faculdade de Medicina da Universidade de São Paulo - Diretor da unidade clínica de Medicina Interdisciplinar em Cardiologia do InCor-HCFMUSP, São Paulo, SP

 

 


SUMMARY

This brand-new series of articles aims at delivering to national and international readers some of the cutting-edge contributions from the Brazilian medical literature. Recently papers published in the main Brazilian medical journals are carefully selected and analyzed by skilled medical editors. In addition we asked editors to choose keywords to be highlighted in order to claim for reader's attention. Articles are organized by area of interest to facilitate reading. To get the most of the limited available editorial space we did not include the names of the authors of the related articles in the text itself but a complete reference guide is provided at the end of the article. The result carries the most important messages from the original paper accompanied by a personal interpretation. Directed to the busy medical doctor we hope that this initiative may help in the successful translation of knowledge from scientific evidence to clinical practice.

Keywords: Science. Brazil. Medicine. Research.


RESUMO

Esta nova série de artigos tem por objetivo levar aos leitores nacionais e internacionais algumas das mais importantes contribuições provenientes da literatura médica brasileira recente. Os artigos originais mais relevantes são selecionados por experientes editores a quem solicitamos que escolham palavras- chaves para que sejam destacadas para chamar a atenção do leitor. Para facilitar a leitura, os artigos são organizados por área de interesse. Para aproveitar ao máximo o limitado espaço editorial não são incluídos os nomes dos autores dos artigos. Entretanto, a referência completa é oferecida ao final do artigo. O resultado final traz o que há de melhor do artigo, seguido de uma sintética interpretação pessoal. Endereçado ao médico ocupado, esperamos que esta inciativa possa contribuir para o sucesso da translação do conhecimento da evidência científica para a prática clínica.

Unitermos: Ciência. Brasil. Medicina. Pesquisa.


 

 

CARDIOVASCULAR SYSTEM

Coronary artery disease

Interesting data were reported regarding an issue frequently debated between dentists and cardiologists: safety of local anesthesia with vasoconstrictors during dental procedures. The results reassure that this procedure can be safely utilized in patients with coronary artery disease and ventricular arrhythmia.1,2 Two well designed cost-effectiveness studies suggested that for the Brazilian Health system, prehospital thrombolysis represents an advantage over conventional treatment and that the use of sirolimus eluted Stents is more suitable for patients with high risk of restenosis. 3,4 Two elegant experimental studies showed, in the first one, that ventricular remodeling after induced myocardial infarction in young rats is more favorable than in adults and, in the second one, that hypertonic saline solution administration for patients with decompensated heart failure is safe and improve clinical and renal parameters. 5,6 Finally, for the joy of cardiovascular surgeons, a four-year prospective study suggests that coronary bypass surgery is associated with a better quality of life when compared to angioplasty and medical treatment. 7

 

CARDIOVASCULAR SURGERY 1

Complications after coronary artery bypass surgery is associated to increased case fatality and elevation of cost and length of hospital stay. Two articles suggest that prophylactic temporary atrial pacing is effective in preventing atrial fibrillation after coronary artery bypass surgery (CABG) without extracorporeal circulation. 8,9 In addition, the importance of noninvasive ventilation after extubation and in the setting of acute respiratory failure complicating CABG and preoperative physiotherapy were highlighted.10-12 Regarding detection of perioperative myocardial infarction, data suggested that cardiovascular magnetic resonance imaging is more sensitive that myocardial scintigraphy for the identification of small areas of myocardial necrosis.13 A prevalence of 20.9% was reported for supravalvular pulmonary stenosis associated to Jatene operation for Transposition of Great Arteries. Moreover, the authors described that once identified and in the need of surgical treatment, it can be performed at low mortality levels. 14

 

METHODS IN CARDIOLOGY

Left ventricular mass and hypertrophy was addressed in two studies proposing a new score and reviewing existing criteria.15,16 Findings obtained at necropsy from individuals with cardiac amyloidosis were compared to clinical, EKG and Echocardiographic parameters registered during life.17 The analysis of heart rate variability in menopausal women suggested that aerobic training can improve autonomic cardiac function.18 Apical aneurysm, a landmark of chronic Chagas heart disease, was evaluated by scintigraphy and possible clinical implications were suggested in a study with 13 paptients.19

 

HYPERTENSION AND RISK FACTORS

Resistance exercise training have shown to decrease blood pressure and could help in the management of elderly hypertensive women.20 Also in women it was observed that a decrease of at least 5% in weight is associated with improved inflammatory status and decreased insulin resistance, regardless of changes in adiponectin and TNF-alpha levels.21 Normotensive and previously non-trained young women observed reductions in blood pressure after a 16 week weight training program.22 Vegetarianism has been advocated as a supplementary treatment for the prevention of cardiovascular disease. In a comparison study, the authors found that vegetarians have a lower cardiovascular risk estimated by the Framingham score index.23 Children with AIDS acquired by vertical transmission is becoming more frequently diagnosed as life expectancy have improved for adults. In a study with 93 of these children, cardiac involvement was described and left ventricular dysfunction was the most common abnormality on echocardiogram. 24

 

CARDIOVASCULAR SURGERY 2

Technical aspects of cardiovascular surgery received special attention. Encouraging results were reported regarding preparation of saphenous vein by no touch technique, combination of transmyocardial laser revascularization and cell therapy for refractory angina, and mitral valve replacement with chordae tendineae preservation in end-stage dilated cardiomyopathy.25-27 Conversely, studies addressing the perioperative period and pharmacological protection of ischemic myocardium also disclosed promising results with glucose-insulin-potassium solution (GYK), diltiazem (neuroprotection in rabbits with occluded aorta), and the addition of procaine in the cardioplegic crystalloid solution.28-30

 

SURGERY

Non-cardiac surgery

Non-cardiac surgery in the elderly population is increasing. Evaluation of the inherent risks and determination of the predictors of complications is mandatory to guarantee a favorable risk/benefit ratio. A sample of subjects aging 71 years in average (14% older that 80 years old) was evaluated in order to investigate the prognostic factors for mortality related to non-cardiac surgery. The mortality rate was 8.2%, and the complication rate was 15.8%. Multiple logistic regression showed that a history of coronary heart disease (OR: 3.75; p=0.02) and/or valvular heart disease (OR: 31.79; p=0.006) were predictors of mortality. 31 In another study involving 700 patients submitted to non-cardiac surgery a novel risk estimation score was proposed and tested. The authors found it as good as the American College of Physicians score index in determining the risk of cardiovascular complications and identified new variables related to surgical risk.32 Significant alterations of variables related to pulmonary function were identified in the postoperative period of craniotomy and should be included in future studies direct to prevent complications. Indeed, a study involving patients submitted to upper abdominal surgery showed that chest physiotherapy during the immediate postoperative period was effective for improving oxygen-hemoglobin saturation.33-34 In another study it was demonstrated that endotracheal tube (ET) cuffs filled with alkalinized lidocaine seem to be safer than conventional air-filled ET cuffs. 35

 

UROLOGY

Urinary incontinence is major problem involving social compromise and several medical conditions. Multidisciplinary approaches as well as new effective therapies are very welcome. In a randomized, controlled trial it was demonstrated that exercises directed to pelvic floor muscles, electrical stimulation, and vaginal cones are effective treatments for women with urodynamic stress urinary incontinence 36,37.

The issue of ability and experience of surgeons was evaluated in sixty-seven patients submitted to transurethral resection of the prostate. The authors found that a surgeon's experience was associated to reduction in the need of a second intervention due to recurring adenomas or adenomas that were incompletely resected.38

 

PATHOLOGY

An investigation for clinico-pathological discrepancies in a retrospective analysis of 288 autopsy records disclosed overall major and minor discrepancy rates of 16.3% and 28.1%, respectively. The more frequent missed diagnoses were pulmonary embolism, pneumonia, and myocardial infarction. Aging 60 or older and female gender were risk factors for diagnostic disagreement.39

 

INFECTION

A cohort of 406 HIV infected patients was evaluated in order to identify the difficulties related to the use of antiretroviral therapy. Adverse reactions to medication and scheduling were the main reports. The HIV-seropositive status disclosure, anxiety, absence of psychotherapy, higher CD4+ cell count (> 200/mm3) and high (> 4) adverse reaction count, CDC clinical category A, pill burden (> 7 pills), use of other medications, and low understanding of medical orientation were independently associated with the degree of difficulty.40

 

PEDIATRICS

The influence of regional cultural factors on the Clinical indicators of child development was addressed in the capitals of nine Brazilian States. The authors found that habits and culture did not affect the results and that the Clinical Indicators of Risks in Infant Development proved to be a robust method despite the specificities of each region.41 In an interesting study directed to investigate the role of tepid sponging to promote fever control in children the authors observed that tepid sponging plus dipyrone was better than dipyrone alone during the first 15 minutes, but the latter presented better fever control over the two-hour period. Tepid sponging caused mild discomfort, crying and irritability for most of the children. 42

 

HEMATOLOGY

The crosses evaluation method (+/++/+++/++++) is frequently used in clinical practice as reference criteria for several signs and symptoms. In an elegant study investigators compare the accuracy of two different methods for the determination of hemoglobin levels in patients with anemia: four-level crosses and a simple prediction of hemoglobin level. Comparing to real hemoglobin levels, the authors found that hemoglobin prediction was more accurate than evaluation by the four-level method.43 In another study, by reducing the median length of hospital stay without increasing morbidity and mortality a promising new hematopoietic stem cell transplantation program allowed an increment in the number of transplantations.44

 

OBSTETRICS

In a study with thirty-two pregnant women labor analgesia preformed by two different methods was compared. Examining maternal-fetal aspects, authors observed that both a low-dose of ropivacaine and a lower dose of this drug associated to clonidine relieved maternal pain during obstetric labor. In addition, it was suggested that newborns of mothers who received only ropivacaine had some advantages in neurological variables. 45

Exercise and sport sciences

To evaluate cardiorespiratory fitness behavior a group of 963 adolescents were studied during the performance of the PACER (Progressive Aerobic Cardiovascular Endurance Run) test. Clinical, social and economical data were obtained from a participants. The authors found that 2/3 of males and 1/3 of females did not reach the healthy fitness criterion. In addition it was observed an association between low socioeconomical status and the lowest levels of cardiorespiratory fitness.46 On the other hand, evaluating body adiposity of 511 children from high socioeconomic status it was observed that a high percentage of them present important health risk factors at early ages.47 Similarly, in another sample of adolescents, body overweight figured out as the only variable related to increased arterial blood pressure, irrespective of gender and age.48

Creatine supplementation one of the most frequently used interventions done by athletes was evaluated in two studies. I an animal study, despite altering the lean body mass, the supplementation did not affect the performance of the animals.49 In a group of eighteen male college students submitted to strength training, it was observed that training was able to increase the resultant of dynamic maximum strength (RDMS) independently of creatine ingestion.50

Leisure time physical activity in postpartum period (LPA) was evaluated in four-hundred women. The authors found that the highest score of LPA was associated to having black or mixed skin colors, being older and higher parity.51 In a study with nine hundred and sixty women aging above 60, the association between level of physical activity and cardiorespiratory capacity was evaluated. The authors found that the superior tercile of the total physical activity level was the one which presented the lowest decrease in the cardiorespiratory capacity and the non-practitioner of physical exercises sub-group presented the highest decrease, suggesting a positive influence of moderate physical exercises practice over the cardiorespiratory capacity. 52

 

ORTHOPEDICS

Multiple knee ligament injuries are not a homogeneous group of conditions that may deserve different evaluations and treatments. Evaluating more than on hundred patients with chronic multiple ligament injuries, authors found an association between falls, practice of sports and injury both to anterior cruciate and other ligament other than posterior. On the other hand, injury both to the posterior and other ligament, including or not the anterior cruciate, are related to traffic accidents and direct trauma caused by an object on the knee.53

To identify and analyze the profile of patients that were victims of car traffic violence eighty-four individuals were studied. Most of them were motorcyclists, 83% were male, youngsters, who had graduated in high school, with a monthly income equivalent to two minimum wages, and only 36.5% had a formal job. Most fractures were on the lower limbs (54%).54 In a prospective study, 25 individuals were randomized to receive treatment with cryotherapy, exercise or short waves for knee osteoarthritis. All groups showed similar improvement in functional quality.55

Falls are very important health problems in the elderly. Two recent studies reported interesting findings n this issue. The data from 205 hospitalized patients > 60 years old, with fractures resulting from falls were compared to 205 patients in the same age group and without fractures. The authors found that the use of medication was associated to fractures resulting from falls.56 In another sample, the authors found association between falls and being older, weaker, and unable to watch television.57

Two studies investigated imaging aspects and genetic and environmental factors involved on intervertebral disc degeneration.58-59 Quite different epidemiological and clinical data about trauma injuries among the elderly and musculoskeletal injuries in elite female basketball athletes were reported in two studies.60-61 Two experimental studies in animal models present promising results with low-power laser therapy for peripheral nerves' regeneration and ligamentotaxis sequencing in vertebral canal decompression.62-63

Mensagens dos periódicos de medicina brasileiros

 

REFERENCES

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2. Neves RS, Neves IL, Giorgi DM, Grupi CJ, César LA, Hueb W, et al. Effects of epinephrine in local dental anesthesia in patients with coronary artery disease. Arq Bras Cardiol. 2007;88(5):545-51.         [ Links ]

3. Araújo DV, Tura BR, Brasileiro AL, Luz Neto H, Pavão AL, Teich V.Cost-effectiveness of prehospital versus inhospital thrombolysis in acute myocardial infarction. Arq Bras Cardiol. 2008;90(2):91-8.         [ Links ]

4. Polanczyk CA, Wainstein MV, Ribeiro JP.Cost-effectiveness of sirolimus-eluting stents in percutaneous coronary interventions in Brazil. Arq Bras Cardiol. 2007;88(4):464-74.         [ Links ]

5. Pabis FC, Miyague NI, Francisco JC, Woitowicz V, Carvalho KA, Faria-Neto JR, et al. Echocardiographic assessment of myocardial infarction evolution in young and adult rats. Arq Bras Cardiol. 2008;91(5):321-6.         [ Links ]

6. Issa VS, Bacal F, Mangini S, Carneiro RM, Azevedo CH, Chizzola PR, et al. Hypertonic saline solution for renal failure prevention in patients with decompensated heart failure. Arq Bras Cardiol. 2007;89(4):251-5        [ Links ]

7. Takiuti ME, Hueb W, Hiscock SB, Nogueira CR, Girardi P, Fernandes F, et al. Quality of life after surgical myocardial revascularization, angioplasty or medical treatment. Arq Bras Cardiol. 2007;88(5):537-44.         [ Links ]

8. Silva FM, Milani R, Précoma D, Guimarães M, Moutinho JA, Barboza L, et al. Influence of external temporary biatrial pacing on the prevention of atrial fibrillation after coronary artery bypass without extracorporeal circulation. Arq Bras Cardiol. 2008;90(2):80-5.         [ Links ]

9. Avila Neto V, Costa R, Silva KR, Martins AL, Moreira LF, Santos LB, et al. Effect of temporary right atrial pacing in prevention of atrial fibrillation after coronary artery bypass graft surgery. Rev Bras Cir Cardiovasc. 2007 Sep;22(3):332-40.         [ Links ]10. Coimbra VR, Lara Rde A, Flores EG, Nozawa E, Auler Jr JO, Feltrim MI Application of noninvasive ventilation in acute respiratory failure after cardiovascular surgery. Arq Bras Cardiol. 2007;89(5):270-6, 298-305.         [ Links ]

11. Felcar JM, Guitti JC, Marson AC, Cardoso JR. Preoperative physiotherapy in prevention of pulmonary complications in pediatric cardiac surgery. Rev Bras Cir Cardiovasc. 2008;23(3):383-8.         [ Links ]

12. Lopes CR, Brandão CM, Nozawa E, Auler Jr JO. Benefits of non-invasive ventilation after extubation in the postoperative period of heart surgery. Rev Bras Cir Cardiovasc. 2008;23(3):344-50.         [ Links ]

13. Monte GU, Drager LF, Souza FS, Avila LF, Parga Filho JR, César LA, Izaki M, et al. Magnetic resonance vs technetium-99m pyrophosphate scintigraphy in the detection of perioperative myocardial necrosis. Arq Bras Cardiol. 2008;91(2):113-8.         [ Links ]

14. Jatene MB, Jatene IB, Oliveira PM, Moysés RA, Souza LC, Fontes V, et al. Prevalence and surgical approach of supravalvular pulmonary stenosis after Jatene operation for transposition of great arteries. Arq Bras Cardiol. 2008;91(1):17-24.         [ Links ]

15. Mazzaro CL, Costa FA, Bombig MT, Luna Filho B, Paola AA, Carvalho AC, et al. Ventricular mass and electrocardiographic criteria of hypertrophy: evaluation of new score. Arq Bras Cardiol. 2008;90(4):227-31.         [ Links ]

16. Rodrigues SL, D'Angelo L, Pereira AC, Krieger JE, Mill JG. Revision of the Sokolow-Lyon-Rappaport and cornell voltage criteria for left ventricular hypertrophy. Arq Bras Cardiol. 2008;90(1):46-53.         [ Links ]

17. Gutierrez PS, Fernandes F, Mady C, Higuchi ML. Clinical, electrocardiographic and echocardiographic findings in significant cardiac amyloidosis detected only at necropsy: comparison with cases diagnosed in life. Arq Bras Cardiol. 2008;90(3):191-6.         [ Links ]

18. Paschoal MA, Polessi EA, Simioni FC. Evaluation of heart rate variability in trained and sedentary climacteric women. Arq Bras Cardiol. 2008;90(2):74-79.         [ Links ]

19. Simões MV, Oliveira LF, Hiss FC, Figueiredo AB, Pintya AO, Maciel BC, et al. Characterization of the apical aneurysm of chronic Chagas' heart disease by scintigraphic image co-registration. Arq Bras Cardiol. 2007;89(2):119-21, 131-4.         [ Links ]

20. Terra DF, Mota MR, Rabelo HT, Bezerra LM, Lima RM, Ribeiro AG, et al. Reduction of arterial pressure and double product at rest after resistance exercise training in elderly hypertensive women. Arq Bras Cardiol. 2008;91(5):299-305.         [ Links ]

21. Borges RL, Ribeiro-Filho FF, Carvalho KM, Zanella MT.[Impact of weight loss on adipocytokines, C-reactive protein and insulin sensitivity in hypertensive women with central obesity] Arq Bras Cardiol. 2007;89(6):409-14.         [ Links ]

22. Gerage A, Cyrino ES, Schiavoni D, Nakamura FY, Ronque ERV, Gurjão ALD, et al. Effect of 16-week weight training over blood pressure in normotensive and non-trained women. Rev Bras Med Esporte. 2009;13(6):361-5.         [ Links ]

23. Teixeira Rde C, Molina Mdel C, Zandonade E, Mill JG. Cardiovascular risk in vegetarians and omnivores: a comparative study. Arq Bras Cardiol. 2007;89(4):237-44.         [ Links ]

24. Cunha MC, Siqueira Filho AG, Santos SR, Abreu TF, Oliveira RH, Baptista DM, et al. AIDS in childhood: cardiac involvement with and without triple combination antiretroviral therapy. Arq Bras Cardiol. 2008;90(1):11-7.         [ Links ]

25. Silva VF, Ishigai MM, Freymüller E, Branco JN, Gaia DF, Gabriel EA, et al. Microscopic and ultrastructural evaluation of the saphenous vein endothelium for CABG prepared by the no touch technique. Rev Bras Cir Cardiovasc. 2008;23(3):323-9.         [ Links ]

26. Dallan LA, Gowdak LH, Lisboa LA, Schettert I, Krieger JE, Cesar LA, et al. Cell therapy plus transmyocardial laser revascularization: a proposed alternative procedure for refractory angina. Rev Bras Cir Cardiovasc. 2008;23(1):46-52.         [ Links ]

27. Gaiotto FA, Puig LB, Mady C, Fernandes F, Tossuniam CE, Pardi MM, et al. Mitral valve replacement with chordae tendineae preservation, traction and fixation in end-stage dilated cardiomyopathy. Rev Bras Cir Cardiovasc. 2007;22(1):68-74.         [ Links ]

28. Barcellos Cda S, Wender OC, Azambuja PC. Clinical and hemodynamic outcome following coronary artery bypass surgery in diabetic patients using glucose-insulin-potassium (GIK) solution: a randomized clinical trial. Rev Bras Cir Cardiovasc. 2007;22(3):275-84.         [ Links ]

29. Saba T, Manduz S, Sapmaz I, Tunel A, Aker H, Dogan K. Neuroprotective effects of diltiazem in rabbits with occluded aorta. Rev Bras Cir Cardiovasc. 2007;22(4):416-24.         [ Links ]

30. Dussin LH, Moura L, Gib MC, Saadi EK, Barbosa GV, Wender OC. ltrastructural study of the myocardium using cardioplegic crystalloid solution with and without procaine in patients undergoing aortic valve replacement. Rev Bras Cir Cardiovasc. 2008;23(3):389-95.         [ Links ]

31. Machado AN; Sitta MC; Jacob Filho W; Garcez-Leme, LE. Prognostic factors for mortality among patients above the 6th decade undergoing non-cardiac surgery: cares - clinical assessment and research in elderly surgical patients. Clinics. 2008,63(2):151-6.         [ Links ]

32. Pinho C, Grandini PC, Gualandro DM, Calderaro D, Monachini M, Caramelli B. Multicenter study of perioperative evaluation for noncardiac surgeries in Brazil (EMAPO). Clinics. 2007;62(1):17-22.         [ Links ]

33. Manzano RM, Carvalho CR, Saraiva-Romanholo BM, Vieira JE. Chest physiotherapy during immediate postoperative period among patients undergoing upper abdominal surgery: randomized clinical trial. São Paulo Med J. 2008;126(5):269-73.         [ Links ]

34. Sogame LC, Faresin SM, Vidotto MC, Jardim JR. Postoperative study of vital capacity and ventilation measurements following elective craniotomy. São Paulo Med J. 2008 Jan 2;126(1):11-6.         [ Links ]

35. Navarro LH, Braz JR, Nakamura G, Lima RM, Silva FP, Módolo NS. Effectiveness and safety of endotracheal tube cuffs filled with air versus filled with alkalinized lidocaine: a randomized clinical trial. São Paulo Med J. 2007;125(6):322-8.         [ Links ]

36. Castro RA; Arruda RM; Zanetti MRD; Santos PD; Sartori MGF; Girão MJBC. Single-blind, randomized, controlled trial of pelvic floor muscle training, electrical stimulation, vaginal cones, and no active treatment in the management of stress urinary incontinence. Clinics. 2008;63(4):465-472.         [ Links ]

37. Zanetti MR, Castro Rde A, Rotta AL, Santos PD, Sartori M, Girão MJ. Impact of supervised physiotherapeutic pelvic floor exercises for treating female stress urinary incontinence. São Paulo Med J. 2007;125(5):265-9.         [ Links ]

38. Cury J, Coelho RF, Bruschini H, Srougi M. Is the ability to perform transurethral resection of the prostate influenced by the surgeon's previous experience? Clinics. 2008;63(3):315-20.         [ Links ]

39. Kotovicz F, Mauad T, Saldiva PH. Clinico-pathological discrepancies in a general university hospital in São Paulo, Brazil. Clinics. 2008;63(5):581-8.         [ Links ]

40. Guimarães MD, Rocha GM, Campos LN, De Freitas FM, Gualberto FA, Teixeira RA, De Castilho FM. Difficulties reported by HIV-infected patients using antiretroviral therapy in Brazil. Clinics. 2008;63(2):165-72.         [ Links ]

41. Carvalho AL, Silva LF, Grisi SJ, Escobar AM. Clinical indicators of child development in the capitals of nine Brazilian states: the influence of regional cultural factors. Clinics. 2008;63(1):51-8.         [ Links ]

42. Alves JG, Almeida ND, Almeida CD. Tepid sponging plus dipyrone versus dipyrone alone for reducing body temperature in febrile children. São Paulo Med J. 2008;126(2):107-11.         [ Links ]

43. Benseñor IM, Calich AL, Brunoni AR, Espírito-Santo FF, Mancini RL, Drager LF, et al. Accuracy of anemia diagnosis by physical examination. São Paulo Med J. 2007;125(3):170-3.         [ Links ]

44. Nicolau JE, Melo LM, Sturaro D, Saboya R, Dulley FL. Evaluation of early hospital discharge after allogeneic bone marrow transplantation for chronic myeloid leukemia. São Paulo Med J. 2007 May 3;125(3):174-9.         [ Links ]

45. Nakamura G, Ganem EM, Módolo NS, Rugolo LM, Castiglia YM. Labor analgesia with ropivacaine added to clonidine: a randomized clinical trial. São Paulo Med J. 2008 Mar 6;126(2):102-6.         [ Links ]

46. Vasques DG, da Silva KS, Lopes AS. Cardiorespiratory fitness of adolescents from Florianópolis, SC. Rev Bras Med Esporte. 2007;13(6):376-80.         [ Links ]

47. Ronque ERV, Guariglia DA, Cyrino ES, Carvalho FO, De Avelar AAM. Body composition in seven-to-ten-year old children of high socioeconomic status. Rev Bras Med Esporte. 2007;13(6):366-70.         [ Links ]

48. Da Silva KS, De Farias-Júnior JC. Risk factors associated with high blood pressure in adolescents. Rev Bras Med Esporte. 2007;13(4):237-40.         [ Links ]

49. Franco FSC, Natali AJ, Costa NMB, Lunz WGGJ, Carneiro-Junior MA, et al . Effects of creatine supplementation and power training on performance and lean body mass of rats. Rev Bras Med Esporte. 2007;13(5):297-302.         [ Links ]

50. De Souza-Júnior TP, Dubas JP, Pereira B, De Oliveira PR. Creatine supplementation and strength training: alterations in the resultant of dynamic maximum strength and anthropometric variables in college students submitted to 8 weeks of strength training (hypertrophy). Rev Bras Med Esporte. 2007;13(5):303-9.         [ Links ]

51. Kac G, Pacheco AHRN, Araújo DMR, Da Rocha CMM, De Sousa EB, Coelho N LP et al. Associated factors to physical activity practice in leisure in postpartum women. Rev Bras Med Esporte. 2007;13(2):86-90.         [ Links ]

52. Krause MP, Buzzachera CF, Hallage T, Pulner S, Silva SG. Influence of the level of physical activity over the cardiorespiratory capacity in older women. Rev Bras Med Esporte. 2007;13(2):97-102.         [ Links ]

53. Bispo Junior RZ, Kawano CT, Guedes AV. Chronic multiple knee ligament injuries: epidemiological analysis of more than one hundred cases. Clinics. 2008;63(1):3-8.         [ Links ]

54. Dos Anjos KC, Evangelista MRB, Silva JS, Zumiotti AV. A patient victim of car traffic violence: an analysis of socioeconomic profile, accident characteristics and Social Services intervention in the emergency room. Acta Ortop Bras. 2007;15(5):262-6.         [ Links ]

55. Silva ALP, Imoto DM, Croci AT. Comparison of cryotherapy, exercise and short waves in knee osteoarthritis treatment. Acta Ortop Bras. 2007;15(4):204-9.         [ Links ]

56. Hamra A, Ribeiro MB, Miguel OF. Correlation between fractures resulting from falls and previous drug use. Acta Ortop Bras. 2007;15(3):143-5.         [ Links ]

57. Rebelatto JR, De Castro AP, Chan A. Falls in institutionalized elderly people: general characteristics, determinant factors and relationship with handgrip strength. Acta Ortop Bras. 2007;15(3):151-4.         [ Links ]

58. Nunes FTB, Conforti-Froes NDT, Negrelli WF, Souza DRS. Genetic and environmental factors involved on intervertebral disc degeneration. Acta Ortop Bras. 2007;15(1):9-13.         [ Links ]

59. de Oliveira VM, Puertas EB, Alves MTS, Yamashita HK. Comparative study of normal and degenerated intervertebral discs' mechanoreceptors of human lumar spine X-ray, magnetic resonance and anatomopathologic study. Acta Ortop Bras. 2007;15(1): 35-39.         [ Links ]

60. da Silva AS, Abdalla RJ, Fisberg M. Incidence of musculoskeletal injuries in elite female basketball athletes. Acta Ortop Bras. 2007;15(1):43-6.         [ Links ]

61. Katz M, Okuma MAA, dos Santos ALG, Guglielmetti CLB, Sakaki MH, Zumiotti AV. Epidemiology of high-energy trauma injuries among the elderly. Acta Ortop Bras. 2008;16(5): 279-83.         [ Links ]

62. Endo C, Barbieri CH, Mazzer N, Fasan VS. Low-power laser therapy accelerates peripheral nerves' regeneration. Acta Ortop Bras. 2008;16(5):305-10.         [ Links ]

63. de Castro IJC, Shimano AC, Bellucci AD, Defino HLA. Experimental study of ligamentotaxis maneuvers sequencing in vertebral canal decompression. Acta Ortop bras. 2008;16(5):291-5.         [ Links ]

 

 

Artigo recebido: 21/09/09
Aceito para publicação: 05/10/09

 

 

Trabalho realizado na Faculdade de Medicina de São Paulo, S. Paulo, SP
* Correspondência: bcaramel@usp.br

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