Relationship between gross and microscopic findings in 200 consecutive autopsies: cost/benefit value of the histopathological study of all organs and systems

Background: Despite the development in diagnostic medicine, discrepancy between clinical diagnoses and the ones obtained by autopsy has remained around 10-20%. It is important to revert this tendency by measures that value the realization and optimization of autopsies. Objectives: Prospectively compare gross and microscopic findings of 200 autopsies, viewing to analyze the impact and the cost/benefit value of the histopathological study of all organs over provisory microscopic diagnoses and over enclosure final awards. Methods: We analyzed 200 consecutive autopsies performed at Departamento de Patologia da Escola Paulista de Medicina/UNIFESP and evaluated agreement and disagreement between provisory gross diagnoses and final microscopic ones. Results: There was agreement between gross and microscopic findings in 143 cases (71.5%) and disagreement in 22 cases (11%), classified as light in 14 cases (7%) and serious in eight cases (4%). In 35 cases (17.5%), histopathological study revealed alterations with no gross significance which had final histological diagnosis. Conclusion: The high agreement index detected between gross and microscopic findings, most discrepancies being classified as light, seems to indicate that autopsies may be closed with histopathological study limited to the most evident gross alterations, with significant cost reduction (around R$300 per autopsy) and great improvement in the return, in a short period of time, of information to the institution clinical staff.Introdução: Apesar dos avanços na área da medicina diagnóstica, a discrepância entre os diagnósticos clínicos e os da autópsia tem permanecido em torno de 10-20$ 300,00 por autópsia) e grande melhoria no retorno, em curto período de tempo, da informação para o corpo clínico da instituição.UNIFESP-EPM Depto. de PatologiaUNIFESP, EPM, Depto. de PatologiaSciEL

What is the Diagnosis?

A 58-year-old man was hospitalized for syncope followed by fast restoration of consciousness (approximately, 15 seconds)

Comparison of Electrocardiographic Criteria for Identifying Left Ventricular Hypertrophy in Athletes from Different Sports Modalities

OBJECTIVES: In athletes, isolated electrocardiogram high voltage criteria are widely used to evaluate left ventricular hypertrophy, but positive findings are thought to represent normal electrocardiogram alterations. However, which electrocardiogram criterion can best detect left ventricular hypertrophy in athletes of various sport modalities remains unknown. METHODS: Five electrocardiogram criteria used to detect left ventricular hypertrophy were tested in 180 male athletes grouped according to their sport modality: 67% low-static and high-dynamic components and 33% high-static and high-dynamic components of exercise. The following echocardiogram parameters are the gold standard for diagnosing left ventricular hypertrophy: left ventricular mass index ≥134 g.m-2, relative wall thickness ≥0.42 mm, left ventricular diastolic diameter index ≥32 mm.m-2, septum wall thickness ≥13 mm, and posterior wall thickness ≥13 mm. Results for the various criteria were compared using the kappa coefficient. Significance was established at

Perioperative Care of Patients Undergoing Surgery During Coronavirus Pandemic

While the coronavirus-19 has already infected over 2.2 million patients and killed over 150 thousand people worldwide, in Brazil, there are now 374 thousand confirmed cases and 23 thousand casualties. Apparently, the country has not yet reached the expected peak of infections, based on the experience of previously affected countries. Many considerations have been made concerning surgical cases during the COVID pandemic. Some recommendations include delaying all electives cases to save beds, equipment, and medical staff for COVID-19 infected patients. At the same time, it is known that not all elective cases are optional. Surgery cancellation may, eventually, be deleterious to the patient. Urgent and emergency procedures will still have to be undertaken and are of great concern since noninfected subjects can be infected by the coronavirus-19 during hospitalization and, likewise, asymptomatic COVID-19 infected patients may be operated and spread the virus to the environment, contaminating the medical team and other patients. The purpose of this article was to discuss whether elective surgeries should be performed and, if performed, what precautions should be taken in order to protect both the patients and the hospital staff. Also, the conduction of urgent cases will be addressed

Perioperative Care of Patients Undergoing Surgery During Coronavirus Pandemic

While the coronavirus-19 has already infected over 2.2 million patients and killed over 150 thousand people worldwide, in Brazil, there are now 374 thousand confirmed cases and 23 thousand casualties. Apparently, the country has not yet reached the expected peak of infections, based on the experience of previously affected countries. Many considerations have been made concerning surgical cases during the COVID pandemic. Some recommendations include delaying all electives cases to save beds, equipment, and medical staff for COVID-19 infected patients. At the same time, it is known that not all elective cases are optional. Surgery cancellation may, eventually, be deleterious to the patient. Urgent and emergency procedures will still have to be undertaken and are of great concern since noninfected subjects can be infected by the coronavirus-19 during hospitalization and, likewise, asymptomatic COVID-19 infected patients may be operated and spread the virus to the environment, contaminating the medical team and other patients. The purpose of this article was to discuss whether elective surgeries should be performed and, if performed, what precautions should be taken in order to protect both the patients and the hospital staff. Also, the conduction of urgent cases will be addressed

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Comparison of Electrocardiographic Criteria for Identifying Left Ventricular Hypertrophy in Athletes from Different Sports Modalities

OBJECTIVES: In athletes, isolated electrocardiogram high voltage criteria are widely used to evaluate left ventricular hypertrophy, but positive findings are thought to represent normal electrocardiogram alterations. However, which electrocardiogram criterion can best detect left ventricular hypertrophy in athletes of various sport modalities remains unknown. METHODS: Five electrocardiogram criteria used to detect left ventricular hypertrophy were tested in 180 male athletes grouped according to their sport modality: 67% low-static and high-dynamic components and 33% high-static and high-dynamic components of exercise. The following echocardiogram parameters are the gold standard for diagnosing left ventricular hypertrophy: left ventricular mass index ≥134 g.m-2, relative wall thickness ≥0.42 mm, left ventricular diastolic diameter index ≥32 mm.m-2, septum wall thickness ≥13 mm, and posterior wall thickness ≥13 mm. Results for the various criteria were compared using the kappa coefficient. Significance was established at p<0.05. RESULTS: Fifty athletes (28%) presented with left ventricular hypertrophy according to electrocardiogram findings, with the following sensitivities and specificities, respectively: 38-53% and 79-83% (Perugia), 22-40% and 89-91% (Cornell), 24-29% and 90% (Romhilt-Estes), 68-87% and 20-23% (Sokolow-Lyon), and 0% and 99% (Gubner). The Perugia and Cornell criteria had higher negative predictive values for the low-static and high-dynamic subgroup. Kappa coefficients were higher for Romhilt-Estes, Cornell and Perugia criteria than for Sokolow-Lyon and Gubner criteria. CONCLUSION: All five evaluated criteria are inadequate for detecting left ventricular hypertrophy, but the Perugia, Cornell and Romhilt-Estes criteria are useful for excluding its presence. The Perugia and Cornell criteria were more effective at excluding left ventricular hypertrophy in athletes involved in a sport modality with low-static and high-dynamic component predominance

Athlete’s heart in a Brazilian paralympic judo team. Case series study

ABSTRACT BACKGROUND: Athlete’s heart is a term describing the cardiovascular effects of long-term conditioning among highly trained athletes. It is a variation of normal standards. DESIGN AND SETTING: Case series study at the cardiology division of a public university hospital. METHODS: We studied 14 visually handicapped paralympic athletes (8 men) in the national judo team. They were 26.3 ± 6.4 years old, with body mass index 25 ± 14, and had been practicing judo for 9.2 ± 7.9 years. Clinical evaluations, electrocardiograms, exercise testing and echocardiograms were performed by independent observers. RESULTS: Signs of athlete’s heart were found in all athletes, comprising left ventricular hypertrophy (5 cases), sinus bradycardia (5), T-wave juvenile pattern (3), T wave juvenile pattern (3), left atrial hypertrophy (2) and increased left ventricular volume (9 cases; 62.22 ± 6.46 ml/m2). There were very strong correlations between left ventricular mass/body surface and endurance time (r: 0.91) and estimated peak oxygen uptake (r: 0.8). The correlations between left ventricular internal diastolic dimension and endurance time (r: 0.91) and estimated peak oxygen uptake (r: 0.8) were strong. Despite increased left ventricular dimensions (4 cases), atrial dimensions (1) and relative wall thickness (4), all athletes had normal left ventricular mass/body surface (89.98 ± 21.93 g/m²). The exercise testing was normal: exercise duration 706 ± 45 seconds and estimated peak oxygen uptake 62.70 ± 9.99 mlO2/min. CONCLUSIONS: Signs of athlete’s heart were seen frequently in the paralympic judo team. These demonstrated the presence of mild cardiac adaptations to training

"Modernidad alimentaria y afrancesamiento. Ciudad de Córdoba (Argentina) en el tránsito del siglo XIX al XX"

Desde las últimas décadas del siglo XIX, la provincia de Córdoba (Argentina) experimentó una modernización que involucró transformaciones mayores en la economía, la sociedad, la cultura y la política. Esta modernización estuvo asociada a la emergencia de una modernidad alimentaria, europeizante, materializada en dos dinámicas de cambio de los patrones de consumo: una implicó cierto afrancesamiento de los hábitos de los sectores acomodados; la otra, un intercambio recíproco entre los sectores populares nativos y los inmigrantes extranjeros. Esta contribución examina la primera dinámica, protagonizada por los sectores acomodados, que durante la década de 1870 sustituyeron sus patrones hispano-criollos por los franceses.Fil: Remedi, Fernando Javier. Centro de Estudios Históricos "Profesor Carlos S. A. Segreti"; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba; Argentin