Double outlet right ventricle with intact atrial septum and restrictive ventricular septal defect: an analysis of two cases.

Two cases of double outlet right ventricle with restrictive ventricular septal defect are described. This is an uncommon presentation that causes left ventricular dysfunction because of left ventricular outflow tract obstruction. The presence of an intact atrial septum leads to severe pulmonary hypertension, which tends to aggravate the right ventricular output.

Endosonographic diagnosis of intraluminal diverticulum.

After a long symptom period of 19 years a submucosal tumor was suspected on endoscopy to account for the patient's intermittent nausea and abdominal pain. Duodenal waterfilling during endoscopic ultrasound led to the endosonographic diagnosis of an intraluminal duodenal diverticulum which was removed surgically. The patient became completely asymptomatic.

[Von Willebrand factor and pulmonary endothelial dysfunction. Prognostic implications].

Purpose: To analyze quantitative and structural changes in circulating von Willebrand factor (vWF) in 40 precapillary pulmonary hypertensive patients, as an attempt to identify possible correlations between endothelial cell dysfunction and patient short-term (one year) survival.

Methods: Plasma antigenic activity of vWF (vWF:Ag) was analyzed by immunoelectrophoresis. The relative concentration of vWF low molecular weight multimers (LMWM%) and the composition of vWF subunit were determined by densitometric analysis of Western blots.

Adventitial layer enlargement correlates with the percentage of medial thickness in peripheral pulmonary arteries from patients with congenital heart defects.

Arterial walls undergo modifications during the course of pulmonary hypertension, particularly in the medial and intimal layers, leading to progressive occlusion of the lumen. Adventitial layer enlargement has been described as being present in the experimental hypoxic model and in the persistent pulmonary hypertension of the newborn. It was suggested that this enlargement may be related to stimulating factors derived from the medial smooth muscle cells.

[Childhood hypoglycemia - still a challenge].

Objective: Hypoglycemia in the infant is potentially hazardous to the central nervous system(CNS), and any delay in solving the problem may impose irreversible sequelae. The aim of this review is to provide basic knowledge to the pediatrician to adequately deal with a hypoglycemic patient.

Methods: Bibliographic review was performed in the Medline for the last 10 years, and the most pertinent papers were selected.

[Ambulatory blood pressure monitoring in normal adolescents].

Purpose: To evaluate technical aspects of ambulatory blood pressure monitoring (ABPM) in normal adolescents.

Methods: Forty five normal adolescents (27 female), 10-18 years old.

Results: ABPM recordings showed a mean of 90% successful readings; 30% of the patients complained of sleep disruption related to the functioning of the ABPM monitor; the mean systolic, diastolic and heart rate fall during sleep was 13%, 23% and 24% respectively; the mean systolic and diastolic blood pressure load, while awake, was in male adolescents 25.

[Blood pressure measurement. Criteria employed in scientific articles published in Brazilian journals].

Purpose: To evaluate the criteria used for the technique of blood pressure measurement in scientific articles published in Brazilian journals.

Methods: Two hundred twenty three scientific articles from 18 medical journals, published between 1989 and 1994 were evaluated, in order to identify the type of sphygmomanometer used; the state of calibration; the cuff size; the position of the patient during the measurement; whether the blood pressure measurement was obtained after a resting period; the phase used to identify the systolic and diastolic pressures; and the number of readings taken.

Results: There was no reference in the articles about the following data: the type of sphygmomanometer in 51%, the accuracy of calibration in 82%, the cuff size in 64%, the position of the patient in 25%, the rest period before measurement in 60%, the systolic and diastolic phases in 49%, and the number of measurements in 52%.

[Clinical manifestations in complex partial crisis of the temporal lobe: a video-electroencephalographic study].

We analysed 27 complex partial seizures arising from the temporal lobes recorded on videotape simultaneously with the EEG emphasizing the motor manifestations specially dystonic posturing, ictal paresis and head and eye forced deviation (version). The temporal lobe origin of the seizures was based on the agreement of many scalp-sphenoidal or zygomatic interictal and ictal EEG recordings, CT and MRI findings, interictal and, in some patients, ictal SPECT studies. 8 patients had surgery.

[Cardiac manifestations of hyperthyroidism in the elderly].

Purpose: To evaluate the cardiocirculatory abnormalities of hyperthyroidism in the elderly.

Patients And Methods: Twenty-four hyperthyroid patients, 18 women and six men, aged 60 to 87 (average 73.5) years were studied.

[Immunoprophylaxis of hepatitis B: vaccination at a general hospital in São Paulo using methods adapted to our socioeconomic reality].

The vaccination program against hepatitis B at the hospital of the "Real Sociedade Portuguesa de Beneficiência" in São Paulo was carried out successfully. Out of 554 persons that received the initial 3 vaccine doses 520 completed the program (93.86%) which is an achievement comparable to the best ones of the published series.

[Primary reading epilepsy: therapeutic efficacy of clonazepam in one case].

Primary reading epilepsy is a rare form of reflex epilepsy, in which reading is the specific stimulus evoking attacks. The authors report a case of an 18-year-old man who since the age of 17 presented myoclonic jaw jerking provoked exclusively by reading. In one episode, in which reading was not interrupted, jerks were followed by a generalized convulsive seizure.

Infective endocarditis in the 1980s: experience at a heart hospital.

Three hundred episodes of infective endocarditis (IE) in 287 patients were studied from October 1978 to August 1986. The patients were in the age range of 0.2-78 (mean 30.

Assessment of the mutagenic potential of ethanol auto engine exhaust gases by the Salmonella typhimurium microsomal mutagenesis assay, using a direct exposure method.

The mutagenic activity of the new Brazilian fuel, ethanol, was determined by employing the Salmonella typhimurium microsomal mutagenesis assay (TA97, TA98, TA100, TA102, and TA104) and a direct exposure method. This methodology was first used to determine the mutagenic activity of gasoline, revealing mutagenic activity of base-pair substitution without any need for metabolic activation, indicating the presence of direct-action mutagens. Experiments with ethanol suggest an indirect mutagenic activity of the oxidant type.

[Hemorrhagic infarction due to myocardial reperfusion. Report of 4 cases].

Four different clinical cases in which the myocardial reperfusion occurred after acute myocardial infarction, and was followed by significant hemorrhagic ventricular damage. We discuss some possible etiologic mechanism of the problem and present some methods of myocardial protection which are meant to lessen those negative effects of the reperfusion. We conclude setting the difficulty to determine the critical moment after which the myocardial reperfusion turns inefficient or even harmful.

[Mitral valve prolapse in infective endocarditis. Incidence and characteristics].

Unlabelled: PURPOSE valve prolapse (MVP) cases, complicated with infective endocarditis (IE), seen at a cardiologic reference hospital.

Methods: The MVP cases were diagnosed within a series of 276 cases of IE without previous cardiac surgery with clinical-echocardiographic criteria. We emphasised in our study; a) incidence; b) age and sex distribution; c) risk factors for IE; d) clinical-bacteriological data; e) echocardiographic features; f) therapeutic aspects; f) evolution and complications.

[Surgical treatment of inguinal hernias with local anesthesia].

Eighty-four cases of inguinal hernioplasty by Bassini's modified technique were performed using 1% lidocaine in regional infiltration block. The report analyzes the use of local anesthesia in the treatment of inguinal hernias. All patients had small reducible and non-recurrent inguinal hernia.

[Nursing care for the newborns with congenital Chagas' disease].

In Brazil, due to the urbanization of the rural diseases, the health services must be prepared to detect precociously the infections, control the propagation and attend these sick people. The authors did a bibliographic surveying about congenital Chagas' disease, presented a study with a good evolution, tried to determine the nursing care to these newborns and the respectives objectives.

[Present aspects of neuropsychosurgery nursing].

A brief review of the medical literature, on neuropsychosurgery and the specific aspects of nursing care are presented. Emphasis is given to the importance of an objective attitude towards the results of this type of surgery.

[Intolerance glucose control in the parenteral hyperalimentation].

Ten non-diabetic surgical patients, submitted to parenteral hyperalimentation, were prospectively studied, in order to determine the incidence of glucose intolerance during this treatment. Additionally three methods for the control of glucose metabolism, namely glucosuria and gtycemia, given by reagent strips, and standard blood sugar, determined at the auto-analyser, were compared, with the purpose of establishing which of these tests is best suited for routine utilization. It was concluded that: 1) The incidence of glucose intolerance, defined as one or more episodes of positive glucosuria, or of blood sugar higher than 180mg/100 ml, was 60% in the first day of intravenous nutrition, and 80% if the whole period of treatment; 2) Glucose intolerance was more often detected by urine testing than by blood determinations, either with Dextrositx or at the a auto-analyser as the glucosuria test: was performed much more frequently; 3) It is concluded that although the findings of tests for glucosuria may not adequately reflect glucose metabolism in all circumstances, they represent the choice examination for basic monitoring of patients receiving intravenous hyperalimentation, as soon as renal function is satisfactory, because of its low expense and its easy application.