[Individuals and changes in health organizations: a psychosociological approach].

The Brazilian health sector has undergone a severe crisis, affecting the case-resolving capacity, efficiency and governability of the health system as a whole and health organizations in particular. Although innovative management systems and tools have been encouraged, such innovations are limited in their ability to spawn organizational change, especially with regard to the challenge of enabling individual adherence to institutional projects and relations involving individuals and organizations. This paper focuses on the French psychosociological approach for analyzing and intervening in organizations, one of whose main thinkers is Eugène Enriquez.

Molecular cloning and characterization of a gene encoding the 29-kDa proteasome subunit from Trypanosoma cruzi.

Antiserum raised against purified Trypanosoma cruzi proteasomes was used to isolate two cDNA clones, tcpr29 and tcpr29B, and the corresponding genomic sequence, termed tcpr29A. Both cDNAs and the gene contain a 798-bp ORF, coding for a 266-amino acid protein, with a predicted molecular mass of 29 kDa. Sequence comparisons show that the protein encoded by tcpr29 belongs to the alpha6 subfamily of proteasome subunits.

[Study of post-myocardial infarction ventricular aneurysms with equilibrium radionuclide angiography. Significance of Fourier analysis].

The concept of left ventricular aneurysm has been a subject of controversy and it's not yet completely settled. This has some implications on the patients selection for surgery and explains the various non-invasive methods so far developed for the clinical assessment of patients with ventricular aneurysms. Seventy-one patients with ischemic heart disease, 65 with recent myocardial infarction, were studied by equilibrium radionuclide angiography (ERNA) in order to define left ventricular wall motion abnormalities.

[Secondary prevention in acute myocardial infarction].

Myocardial infarction is still one of the main causes of mortality and morbidity in Western countries. The advances made in the last 30 years have made it possible to reduce mortality significantly (which is currently below two digits) as well as morbidity. The subject of secondary prevention of myocardial infarction gains particular significance in this context since 10 to 15% of the patients who survive the hospital phase of myocardial infarction die during the first year following discharge and, of these deaths, half occur in the first three months.

Effect of transitory hyperprolactinemia on in vitro fertilization of human oocytes.

Objective: To examine the changes in plasma prolactin (PRL) during ovarian hyperstimulation (OH) and the influence of hyperprolactinemia on folliculogenesis, oocyte retrieval and in vitro fertilization (IVF) success rates and the usefulness of the metoclopramide (MCP) test in predicting the onset of hyperprolactinemia.

Study Design: Forty-nine cycles of OH were induced in 32 infertile women using follicle-stimulating hormone, human menopausal gonadotropin and human chorionic gonadotropin (GI) (n = 36), also in association with gonadotropin-releasing hormone (GII) (n = 13). The MCP test (10 mg, intravenously) was performed on fertile control women (control group, n = 9) and in GI (n = 21) and GII (n = 8) patients.

Knowledge of newborn health care among pregnant women: basis for promotional and educational programs on breastfeeding.

Context: Promotional and educational programs relating to breast feeding are important for reversing the decline in this practice. Most programs are centered exclusively on breast feeding, although general knowledge about newborn health care may be important, especially among pregnant women.

Objective: To study pregnant women's knowledge about general health care of newborns, including breast feeding aspects.

[Applicability of the strategic planning approach to local health organizations].

This paper presents the preliminary results from a study on the limits and possibilities of the strategic planning approach for local health organizations. A comparative analysis is developed between two experiences concerning the application of the strategic situational planning method (PES method) in the management of a health center and hospital. Questions include the following: difficulties with the use of the category actor in local health organizations; possibility of drafting a collective project based on the multiple rationalities existing in such organizations; possibility of improving communications processes with the use of the PES method; difficulties related to organizational culture; and low levels of responsibility, as well as difficulties pertaining to the method's complexity and the possibility of simplifying it, maintaining strategic situational analysis and improving organizations' managerial capacity.

AIDS does not alter the total number of neurons in the hippocampal formation but induces cell atrophy: a stereological study.

Although cognitive dysfunction is a common finding in patients with acquired immunodeficiency syndrome (AIDS) its pathogenesis remains controversial. Given the involvement of the hippocampal formation in the processing of cognitive information and the scarcity of quantitative studies in this brain region, we have examined, using stereological methods, the hippocampal formations of AIDS patients. The study was performed in ten AIDS patients and ten age-matched controls.

Analysis of structural and physico-chemical parameters involved in the specificity of binding between alpha-amylases and their inhibitors.

Enzyme-inhibitor specificity was studied for alpha-amylases and their inhibitors. We purified and cloned the cDNAs of two different alpha-amylase inhibitors from the common bean (Phaseolus vulgaris) and have recently cloned the cDNA of an alpha-amylase of the Mexican bean weevil (Zabrotes subfasciatus), which is inhibited by alpha-amylase inhibitor 2 but not by alpha-amylase inhibitor 1. The crystal structure of AI-1 complexed with pancreatic porcine alpha-amylase allowed us to model the structure of AI-2.

The Toronto SPV bioprosthesis: review of morphological findings in eight valves.

The morphological findings in eight explanted Toronto SPV bioprostheses were described. Clinical records were reviewed for patient information and data regarding the explanted bioprosthesis, all of which were analyzed in detail by gross and histological examination. All valves were also examined radiologically and detailed specimen photographs obtained.

Dilation of the pulmonary autograft after the Ross procedure.

Objective: Dilation of pulmonary autograft after the Ross procedure is being recognized with increasing frequency. This study was undertaken to examine the extent of this problem and factors that may be associated with it.

Methods: The clinical, operative, and echocardiographic data of 118 patients who underwent the Ross procedure were reviewed.

Primary pericardial mesothelioma presenting as constrictive pericarditis.

Primary pericardial mesothelioma is a rare tumour, often discovered late in a patient's clinical course or at autopsy. Antemortem diagnosis is usually made at the time of surgery. A patient who presented with what appeared to be viral pericarditis in October 1997 is reported.

Lupus vulgaris of nose - a case report.

Lupus vulgaris which is a mucocutaneous form of Tuberculosis is not an uncommon condi-tion. But the disease resulting in excessive destruction is rare today. We report a case of lupus vulgaris which almost completely destroyed the nose.

Familial risk among patients with endometriosis.

Purpose: The objective of the present study was to determine the prevalence of endometriosis among the relatives of patients with confirmed endometriosis.

Methods: We analyzed the prevalence of endometriosis among first-, second-, and third-degree relatives in a group of 101 patients with varying symptoms related to endometriosis seen at two public hospitals and submitted to laparoscopy and/or laparotomy. The control group consisted of 43 women submitted to laparoscopy without a diagnosis of endometriosis.

Histologic abnormalities of the ascending aorta and pulmonary trunk in patients with bicuspid aortic valve disease: clinical relevance to the ross procedure.

Objective: Bicuspid aortic valve disease is often associated with dilation of the aortic root and ascending aorta. This study examines the histologic features of the ascending aorta and main pulmonary artery of patients with and without aortic valve disease.

Methods: Samples from ascending aorta and main pulmonary artery were obtained at the time of the operation from 20 patients with bicuspid aortic valve and 11 patients with tricuspid aortic valve disease.

Induction of ovulation with clomiphene citrate in combination with metoclopramide in patients with amenorrhea of hypothalamic origin.

Literature data have demonstrated that the chronic use of metoclopramide (MCP), a dopamine antagonist, causes increased gonadotropin secretion in patients with hypothalamic amenorrhea but without triggering ovulation. It has also been observed that women with hypothalamic amenorrhea respond poorly to ovulation induction with clomiphene citrate (CC). On this basis, the objective of the present study was to determine the effect of MCP on the response to CC in patients with hypothalamic amenorrhea in order to evaluate the validity of the simultaneous use of these drugs as ovulation inducers in this type of chronic anovulation.

[Young-onset multiple sclerosis].

Introduction: Young onset multiple sclerosis is an infrequent situation which may present with atypical symptoms and uncertain outcome.

Objective: Our aim was to assess the clinical presentation and course in young onset multiple sclerosis, and analyze eventual data which might be helpful in establishing its prognosis.

Patients And Methods: We have retrospectively reviewed the clinical protocols of 17 patients with young onset multiple sclerosis, defined as presentation of symptoms before 21 years.

Effectiveness of nutrition centers in Ceará state, northeastern Brazil.

Childhood malnutrition has been a major, long-standing health concern in northeastern Brazil. In response, during 1992-1994, the state government of Ceará, with financial support from the World Bank, established 34 new nutrition centers. During 1996 an evaluation of the centers was conducted to determine their effectiveness in treating children with malnutrition and to identify weaknesses in the system and possible solutions.

Circulatory arrest under moderate systemic hypothermia and cold retrograde cerebral perfusion.

Background: Profound hypothermia is used for circulatory arrest during cardiovascular operations. Cold retrograde cerebral perfusion enhances cerebral protection during circulatory arrest. This study examines the results of circulatory arrest under moderate systemic hypothermia and cold retrograde cerebral perfusion.

Signaling via cAMP in fungi: interconnections with mitogen-activated protein kinase pathways.

The cAMP signal transduction pathway controls a wide variety of processes in fungi. For example, considerable progress has been made in describing the involvement of cAMP pathway components in the control of morphogenesis in Saccharomyces cerevisiae, Ustilago maydis, and Magnaporthe grisea. These morphological processes include the establishment of filamentous growth in S.

Efficacy and tolerability of stavudine plus lamivudine in treatment-naive and treatment-experienced patients with HIV-1 infection.

Background: A combination of two nucleoside analogues is currently the core of any antiretroviral regimen for HIV-1 infection. Stavudine plus lamivudine has shown an additive effect in vitro, as well as an absence of overlapping toxicity and cross-resistance.

Objective: To evaluate the antiviral efficacy of stavudine plus lamivudine in treatment-naive patients and in patients previously treated with other nucleoside reverse transcriptase inhibitors.