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Print version ISSN 1807-5932On-line version ISSN 1980-5322

Clinics vol.60 no.2 São Paulo Apr. 2005 



In the april 2005 issue of CLINICS



Mauricio Rocha-e-Silva, Editor

Hospital das Clínicas, Faculty of Medicine, University of São Paulo – São Paulo/SP, Brazil. E-mail:



In this second issue of the renamed Journal of Hospital das Clínicas, we start a new series of review articles in which a more in depth examination of themes is attempted. Our electronic editing is now operational, and we strongly invite future contributors to register and submit their manuscripts online ( since we believe that this will greatly enhance the speed of publication. From the first to this second issue our time from acceptance of the manuscript to the physical appearance of the journal should be shrinking from 5½ to 4½ months. Ten articles on original research are being published.

Xavier Vidal1 evaluated the repair process of lesions in the ventricular myocardium of 26 rats with experimentally induced arterial hypertension induced by systemic blockade of nitric oxide. Blockade elevated arterial pressure and increased cardiac weight, causing wide infarcted myocardial areas, thickening of the muscular tunica with fibrosis, thickening in the wall of small arteries and arterioles, and wall fibrinoid necrosis to nearly complete luminal obliteration. Reparative fibrosis involved mainly oxytalan elastic and collagen fibers, which are considered of great importance for the post infarct repair process occurring during experimental nitric oxide inhibition.

Wertzner et al.2 evaluated speech emission in 40 children with and without phonological disorders by means of the Child Language Assessment phonology tests and two spontaneous speaking tests. Children with diagnosed phonological disorders predictably presented more distortions, but also a greater variability of response, with phonemes described by /s, z, showing the highest frequency of occurrence.

Szachnowicz et al.3 estimated the prevalence of adenocarcinoma in 297 patients with Barrett's esophagus, and in 13 patients undergoing surgery, to conduct detailed macroscopic and microscopic analysis. Immunohistochemical tests for p53 and Ki67 were performed, correlating the type of tumor with its adjacent epithelium. In patients with Barrett's esophagus, the prevalence of adenocarcinoma was 5.7%. Ki67 tested positive in all the patients, while p53 was negative in 67% of the adjacent columnar epithelia and in 42% of the tumors. It is recommended that patients with Barrett's esophagus be followed up for the possibility of progression to malignancy.

Mataloun et al.4 studied the effects of corticosteroids in 38 very low birth weight newborns dependent on mechanical ventilation; the following parameters were analyzed: bronchopulmonary dysplasia, length of stay, mortality, and growth. It is concluded that the use of corticosteroids did not affect the respiratory evolution, or the occurrence of bronchopulmonary dysplasia, but growth velocity was reduced.

Etchebehere et al.5 examined the relationship between surgical procedure and outcome for 23 patients with grade I chondrosarcomas. Eleven patients underwent intralesional resection, 9 underwent wide resection, and 3 underwent radical resection. The follow-up period ranged from 24 to 192 months. None of the patients developed local recurrence or metastases; 7 patients had other general complications. The use of less aggressive procedures for treatment of low-grade chondrosarcomas is thereby recommended.

Roxo Jr et al.6 measured complement levels in 10 Brazilian children during and after meningococcal meningitis to evaluate the functional activity of the classical and alternative pathways of the complement system, as well as the levels of C3, C4, and factor B during the first episode of the meningococcal infection, and during the convalescence period. A significant difference was observed between the alternative pathway lytic activity during infection and the convalescence period. No differences were detected in the other complement parameters analyzed, showing that in the presence of meningococcal meningitis, the alternative pathway is preferentially activated. This is probably due to the greater ability of the meningococcal endotoxin to activate this pathway in vivo.

Okay et al.7 analyzed the frequency of the Df508 mutation in 108 cystic fibrosis patients in São Paulo, in comparison with reported Brazilian data. Cystic fibrosis is the leading cause of genetic disease in Caucasians, and the DF508 deletion is the most common mutation associated with the disease. The 44.5% of affected alleles found is higher than the 33% first described in 1993, but slightly lower than the 48% recently reported. Moreover, the data corroborate the concept that the frequency of the DF508 mutation is lower in Brazil in comparison to Europe and North American (around 70.0%), probably due to a more intense racial miscegenation. These findings should be considered with respect to genetic screening of the population in Brazil.

Braz et al.8 describe the quality of life and occurrence of depression in patients undergoing total (n = 14) and partial (n = 16) laryngectomy. In the total laryngectomy group, reported adverse effects were worsened, in terms of social and emotional function (21.3%), olfaction and taste changes (85.6%), cough (71.3%), speech difficulty (100%), and dysphagia (64.3%). Most of the patients (85.5%) judged their quality of life to be reasonable. In the partial laryngectomy group, reported adverse effects were also worsened, in terms of emotional function (71.4%), speech difficulty (100%), and dysphagia (31.3%). However, most of the patients judged their quality of life to be above the general average.

Millan et al.9 interviewed and tested 60 freshmen students from the Faculty of Medicine, University of São Paulo to determine reasons for choosing the medical profession, as well as to determine whether there are gender differences. Most students were middle class, catholic, and had physicians in their families; they had made an early choice of the medical career and showed an awareness of the difficulties in developing their careers. A strong valuation of the humanistic aspects of medicine was apparent, as well as an openness to new experiences, a deep personal identification with the choice of profession, a critical need for fulfillment in their careers, and conscious and unconscious desires to help people and be recognized for their usefulness, without being narcissistic. Female students were more sensitive and less imaginative, tended to present greater emotional maturity while male students presented a greater tendency towards competition, and were more ambitious.

Ide et al.10 compared aquatic vs. non-aquatic respiratory training programs on muscle strength of 81 healthy senior persons, and concluded that aquatic respiratory exercise improves the inspiratory but not expiratory muscle strength.

In this issue of Clinics we also publish a review on hypertonic resuscitation11 and two letters to the Editors.



1. Xavier-Vidal R. Oxytalan elastic and collagen fibers during the repair process in experimental nitric oxide inhibition. Clinics 2005;60(2):85-92.

2. Wertzner HF, Sotelo MB, Amaro L. Analysis of distortions in children with and without phonological disorders. Clinics 2005;60(2):93-102.

3. Szachnowicz S, Cecconello I, Iriya K, Marson AG, Takeda FR, Gama-Rodrigues JJ. Origin of adenocarcinoma in Barrett's esophagus: p53 and Ki67 expression and histopathologic background. Clinics 2005;60(2):103-112.

4. Mataloun MMGB, Leone CR, Gibelli MAC, Vaz FAC. Effects of corticosteroids in very low birth weight newborns dependent on mechanical ventilation. Clinics 2005;60(2):113-120.

5. Etchebehere M, Camargo OP de, Croci AT, Oliveira CRCM, Baptista AM. Relationship between surgical procedure and outcome for patients with grade I chondrosarcomas. Clinics 2005;60(2):121-126.

6. Roxo Jr. P, Ferriani VPL, Teixeira JE, Barbosa JE. Complement levels in Brazilian children during and after meningococcal meningitis. Clinics 2005;60(2):127-130.

7. Okay TS, Oliveira WP, Raiz-Júnior R, Rodrigues JC, Del Negro GMB. Frequency of the Df508 mutation in 108 cystic fibrosis patients in São Paulo: comparison with reported Brazilian data. Clinics 2005;60(2):131-134.

8. Braz DSA, Ribas MM, Dedivitis RA, Nishimoto IN, Barros APB. Quality of life and depression in patients undergoing total and partial laryngectomy. Clinics 2005;60(2):135-142.

9. Millan LR, Azevedo RS, Rossi E, De Marco OLN, Millan MPB, Arruda PCV. de What is behind a student's choice for becoming a doctor? Clinics 2005;60(2):143-150.

10. Ide MR, Belini MAV, Caromano FA. Effects of an aquatic versus non-aquatic respiratory exercise program on the respiratory muscle strength in healthy aged persons. Clinics 2005;60(2):151-158.

11. Rocha-e-Silva M, Figueiredo LFP de. Small volume hypertonic resuscitation of circulatory shock. Clinics 2005;60(2):159-172.

12. Drager LF, Silva HB, Bortolotto LA. Increased arterial distensibility and renovascular hypertension in goldenhar syndrome. Clinics 2005;60(2):173-176.

13. Zilberstein B, Cleva R de, Testa RS, Sene U, Eshkenazy R, Gama-Rodrigues JJ. Cervical necrotizing fasciitis due to bacterial tonsillitis. Clinics 2005;60(2):177-182.

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