Post-parotitis myocarditis: case report

In November, 1993,M.G., a 6 year and 11 month-old girl, was admitted at Hospital Infantil Joana de Gusm?o--Florianópolis, SC, Brazil--with post-parotitis myocarditis and congestive heart failure. Three days after admission it was evidenced, on an echocardiogram, a thrombus in the left ventricle apex which, despite of correct treatment, embolized to iliac and small mesenteric arteries. Epidemic parotitis (mumps) is very common, being endemic around the world. Complications are rare and myocarditis, one of them, is more common than diagnosed because of its poor and benign manifestations, generally transient abnormalities of cardiac rhythm and conduction. This case was astonishing because of its rare subsequent event, that is, the formation of a ventricular mural thrombus during an acute myocarditis.     

Anodontites trapesialis: A biological monitor of organochlorine pesticides

The mussel Anodontites trapesialis (Lam, 1819) was used as an indicator of organochlorine pollutants in the Pardo River, located in the municipality of Ribeirão Preto (21° 07S and 47° 45W), State of São Paulo, Brazil.Biological monitoring was performed for one year at the site of a sugar cane grove on the left bank of the river. Forty-three animals were placed in two aluminum enclosures on the river bottom at this site and 4 animals of each enclosure were sacrificed for pesticide analysis at 3-month intervals, each collection corresponding to one season of the year.The animals were found to have been exposed to DDT, lindane, heptachlor, aldrin and dieldrin. Endrin was not detected in any of the analyses.Research supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP).     

Changes in local cerebral blood flow,local EEG,and flow in the distal stump of the middle cerebral artery in cats with occlusion of the middle cerebral artery

Summary The local EEG, the local cerebral blood flow (1CBF), and the flow in the distal stump of the occluded middle cerebral artery were simultaneously recorded in 28 acute experiments in cats. Nembutal anaesthesia was used eleven times, and Halothane anaesthesia 17 times.The recordings were made via platinum electrodes: 12 in the ischaemic hemisphere, and 2–3 in the opposite non-ischaemic hemisphere. The flow in the occluded middle cerebral artery was recorded via a platinum electrode introduced into this artery via the transorbital approach. The changes in 1EEG, 1CBF, and middle cerebral artery flow were studied during normotension, hypertension, and hypotension. A beneficial effect of hypertension was noted in the acute phase of brain ischaemia. Hypertension counteracted also the diaschisis in the non-ischaemic part of the ischaemic hemisphere and in the opposite non-ischaemic hemisphere. A correlation between 1EEG changes and 1CBF changes was noted. In addition an interesting discrepancy was observed between the rapid H₂ clearance in the middle cerebral artery stump and the much slower H₂ clearance in the ischaemic brain area.Significant differences between experiments under Halothane and experiments under Nembutal anaesthesia were noted. In the acute phase those changes are probably the result of the different levels of blood pressure in those two groups.     

Controversies over the surgical placebo: legal issues and the ethical debate

The debate on controlled surgery trials has had some rather "sensational" repercussions, enlivening the placebo issue. In France, there is a consensus on the ethical conditions necessary for proper protection of individual persons. This consensus has taken on a legal form with the promulgation of the Huriet law. For this reason, all studies and research protocols in medicine and surgery are examined by ethics committees (CCPPRB) who assess the inclusion conditions within the framework of biomedical research and in compliance with the concept that individual participants must be give proper protection. These committees are faced with increasingly complex situations, particularly concerning the pertinence of information give to the participant and the modalities of consent. In France, standard measures were established after a parliamentary debate issuing from a wider public debate. The issue has become a social transaction between biomedical research professionals and the society in general. The international debate over the surgery placebo is an interesting illustration of how mediation institutions, working along the principles of ethical committees, play a key role in social awareness of the ethical issues involved before an innovating practice is initiated. But how legitimate are sensational pieces published in the media, which as is clearly demonstrated with the debate over the surgical placebo, are almost always individual points of view? Shouldn't the debate take into account the contributions of ethical committees which integrate representatives of the social community as well as the importance of a legal framework for individual protection as proposed by the French law? Shouldn't personal points of view be counterbalanced by regularly expressed ethical committee opinions formed after appropriate ethics-oriented discussion going beyond the simple question of "should we do it", a question often dismissed by extreme theoretical arguments that leave unanswered the practical question of "how should we do it"?     

Localized fibrosis of the corpus cavernosum: an example of fibrosis arising from the vascular smooth muscle cells. Report of a case with histogenetic considerations

We report a rare case of a localized fibrosis of the corpus cavernosum (CC) presenting as a nodular mass in the dorsal region of the penis without abnormal curvature of the organ. Histological and immunohistochemical examination revealed a fibrotic process, involving CC but not tunica albuginea, arising from the smooth muscle cells of the vascular channels. Two different morphological phases were identified in these vascular lesions: proliferative and residual phase. The proliferative phase was characterized by hyperplasia and moderate fibrous thickness of the smooth muscle layer of the vascular channels of CC, resulting with the formation of concentric perivascular cuffs and nodules. The residual phase was characterized by a progressive nodular fibrotic transformation with narrowing of the original vascular channels and replacement of the normal CC structures. The cells of this phase exhibited an immunophenotype of both fibroblasts (vimentin+; alpha-smooth muscle actin-) and myofibroblasts (vimentin+; alpha-smooth muscle actin+). The clinicopathological features of the lesion and histogenetic considerations are discussed.     

Psoas abscess: diagnostic and therapeutic considerations in six patients

Psoas abscess (PA) is an infrequent clinical entity and presents diagnostic and therapeutic challenges. Six cases are reported concerning diagnostic and therapeutic considerations. Clinical diagnosis is difficult because of non-specific symptoms. The primary psoas abscess has no definite etiology and is spread by hematogeneous route from a distant occult site. The PA can also be secondary to gastrointestinal pathology through direct infection of adjacent structures. The most common causes are Crohn's disease, appendicitis, diverticulitis and carcinoma. Routine laboratory evaluation is seldom useful for localizing the disease process. Conventional radiological techniques are often unhelpful. Modern imaging diagnosis techniques such as ultrasound and computerized tomography have allowed for a refinement in both the etiologic diagnosis and the treatment by means of CT-guided or ultrasound-guided percutaneous drainage of the abscess, thus avoiding surgical drainage in many cases. Immediately on diagnosis of PA prompt treatment is necessary. Percutaneous drainage should be performed whenever possible and in case of failure, surgical drainage should be practiced as well as intestinal resection, whenever indicated.     

Checklists for Assessing Skills of Children With Type 1 Diabetes on Insulin Injection Technique

Background:School-aged children often participate in type 1 diabetes (T1D) self-care tasks. Despite widespread discussion about the importance of developing self-care skills in childhood, few explain how the health care team should assess the skills of children with T1D when performing insulin injections.Objective:We sought to assess content validity evidence in two checklists regarding injection technique performed by children.Methods:Two checklists were designed based on a systematic review of the insulin injection technique. Experts in pediatric diabetes, health literacy, and diabetes education assessed the checklists regarding their clarity, objectivity, and relevance. Content validity was assessed using the content validity ratio (CVR).Results:Eleven providers (72% nurses or physicians, professional experience 19.4 ± 10.1 years, 45% of specialists in endocrinology, and 18% in pediatrics) participated in the assessment. Experts considered items containing the word homogeneity inappropriate. Items related to the needle insertion angle and the skin fold did not reach the CVR critical value. The final version of the checklist for syringe injection comprised 22 items with CVR = 0.91, and the checklist for pen injection comprised 18 items with CVR = 0.87.Conclusions:The checklists presented clear, objective, and relevant content that assesses the skills of children with T1D for insulin injection. The checklists formally present the order of the technique and all the steps for insulin injection and allow a quantitative assessment of the operational skills of children. The developed instruments offer providers the possibility of continuous assessment of the progress of the pediatric clientele until they reach independence in diabetes self-care.