Evidences for subclinic chronic autoimmune thyroid disease in girls with Turner Syndrome

Patients with Turner syndrome (TS) frequently exhibit transient, recurrent and asymptomatic variations of TSH and/or thyroid hormones (TH). This work was carried out to evaluate thyroid function and structure in patients with TS who had had such variations in hormone concentrations. Our sample comprised 24 patients, 17 less than 20-years old. Evaluation included serum levels of TSH, free T4, total T3, TPO and Tg autoantibodies, thyroid ultrasound (US) and scintigraphy with 99mTc-pertechnetate. Thirteen patients had abnormal TSH and/or TH levels; 23 exhibited US features compatible with chronic thyroid disorder, particularly thyromegaly (established according to volume expected for stature) and heterogeneous echogenicity. Uptake was normal in 21 cases and tracer distribution was homogeneous in 22. The finding of abnormal hormone concentrations was independent of age, length of time since the first similar finding, thyroid autoantibodies, number of abnormalities at US and abnormal scintigraphic findings. Patients aged more than 20 years had higher frequency of thyroid antibodies and heterogeneous echogenicity, and thyroid volume was significantly correlated to length of time since detection of the first hormone variation, indicating progressive thyroid disease. These results suggest that subclinical thyroid dysfunction in TS is due to chronic autoimmune thyroid disease.O seguimento de pacientes com síndrome de Turner (ST) freqüentemente revela alterações transitórias, recorrentes e assintomáticas de TSH e/ou hormônios tireóideos (HT). Neste trabalho foram avaliadas estrutura e função da tireóide em portadoras da ST com história de alterações prévias desses hormônios. A casuística incluiu 24 pacientes, 17 com menos de 20 anos, avaliadas laboratorialmente pelas concentrações séricas de TSH, T4 livre, T3 e anticorpos anti-TPO e anti-Tg, e morfologicamente por ultra-sonografia (USG) e cintilografia com pertecnetato-99mTc. Havia alterações de TSH e/ou HT em 13 casos, e em 23 havia alterações USG compatíveis com doença crônica da tireóide, particularmente tireomegalia (estabelecida de acordo com o volume esperado para a estatura) e heterogeneidade do parênquima. A captação foi normal em 21 casos e a distribuição do radiofármaco, homogênea em 22. As alterações hormonais foram independentes da idade, do tempo de evolução, da presença de anticorpos, do número de anomalias USG e de alterações cintilográficas. Pacientes maiores de 20 anos apresentaram maior freqüência de anticorpos e de hipoecogenicidade do parênquima, e houve correlação positiva entre o volume tireóideo e o tempo de evolução, indicando comprometimento progressivo da glândula. Esses resultados sugerem que as alterações encontradas decorram de doença tireóidea auto-imune crônica.401409Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

[evidences For Subclinic Chronic Autoimmune Thyroid Disease In Girls With Turner Syndrome].

Patients with Turner syndrome (TS) frequently exhibit transient, recurrent and asymptomatic variations of TSH and/or thyroid hormones (TH). This work was carried out to evaluate thyroid function and structure in patients with TS who had had such variations in hormone concentrations. Our sample comprised 24 patients, 17 less than 20-years old. Evaluation included serum levels of TSH, free T4, total T3, TPO and Tg autoantibodies, thyroid ultrasound (US) and scintigraphy with 99mTc-pertechnetate. Thirteen patients had abnormal TSH and/or TH levels; 23 exhibited US features compatible with chronic thyroid disorder, particularly thyromegaly (established according to volume expected for stature) and heterogeneous echogenicity. Uptake was normal in 21 cases and tracer distribution was homogeneous in 22. The finding of abnormal hormone concentrations was independent of age, length of time since the first similar finding, thyroid autoantibodies, number of abnormalities at US and abnormal scintigraphic findings. Patients aged more than 20 years had higher frequency of thyroid antibodies and heterogeneous echogenicity, and thyroid volume was significantly correlated to length of time since detection of the first hormone variation, indicating progressive thyroid disease. These results suggest that subclinical thyroid dysfunction in TS is due to chronic autoimmune thyroid disease.51401-

Os primórdios da organização do espaço territorial e da vila cearense: algumas notas

This paper presents, in outline, the action taken by economic agents, representatives of the Church and the Portuguese State in organizing the space of the Captaincy of Ceará in the eighteenth century. The Portuguese State founded towns in strategic locations for better capitalization of the cattle breeder economy, where first settled sesmeiros and the Church. There was no reason or justification of geopolitical nature that demanded technical and financial investments by the Portuguese in the full adequacy of the local conditions to Portuguese urban guidelines. In the face of the late occupation, the article also discusses the late cartographic representation as expressing the lack of interests of the Portuguese administration in relation to a fuller understanding of the region

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

DISCRETE EVENT SIMULATION IN THE HIGH SCHOOL PHYSICAL EDUCATION: APPLICATION IN REFRACTION AND REFLECTION OF LIGHT

This paper describes the application of a model of discrete event simulation (DES) to be used as a teaching resource in the classroom. Some basic concepts of physics related to refraction and reflection of light, typically taught in high school classes were simulated. A comparison of some relevant aspects, relating the simulation models developed in this work with other existing of similar purpose, was held. As a result, it was found that the models built for this work, besides not requiring large resources of laboratory, demonstrate as significant advantages the dynamic visualization of concepts to be taught, the possibility of adaptation to new parameters, in addition to be built in time relatively short

Confiabilidade das medidas de espessura central da córnea com Orbscan II e paquímetro ultra-sônico Reliability of corneal thickness measurements by Orbscan II and ultrasound pachymeter

OBJETIVO: Avaliar a confiabilidade das medidas de espessura central de córnea comparando o Orbscan II com o paquímetro ultra-sônico. MÉTODOS: Foi realizado estudo retrospectivo de 134 olhos, por meio do levantamento de prontuários de 67 pacientes avaliados entre o período de janeiro a junho de 2001. Foram avaliados o sexo, idade, acuidade visual com a melhor correção, refração e medidas de espessura central corneal pelo paquímetro ultra-sônico e Orbscan II. Os dados paquimétricos foram submetidos à análise do teste t pareado e as diferenças consideradas significativas se p<0,05. RESULTADOS: Dos 67 pacientes avaliados 34 (50,7%) eram do sexo feminino e 33 (49,3%) eram do sexo masculino. A idade variou entre 20 e 59 anos com média de 32,44 anos (&plusmn;9,98). A média do equivalente esférico foi de -2,68&plusmn;2,62, da espessura central corneal avaliada com o Orbscan II foi de 534,81&plusmn;34,45 e pelo paquímetro US foi de 535,00&plusmn;29,53 não havendo diferença significativa entre os resultados das medidas de ECC (p = 0,8922). O coeficiente de correlação entre as duas medidas paquimétricas foi de 0,8774, sendo esta uma correlação forte. CONCLUSÃO: A análise de regressão demonstrou que houve alto grau de concordância entre as medidas do paquímetro ultra-sônico e do Orbscan II. O coeficiente de correlação (0,8774) demonstra que os dois métodos possuem significativa correlação linear na medida da espessura central da córnea. Desta maneira, na amostra estudada, o Orbscan II apresentou boa confiabilidade, demonstrando ser exame extremamente útil em pacientes que necessitam serem avaliados para posterior intervenção refrativa.<br>PURPOSE: To access the reliability of corneal thickness measurements by Orbscan II and ultrasound pachymeter. METHODS: A retrospective study of 134 eyes from 67 normal subjects between January and June 2001 was obtained. Sex, age, visual acuity, refractive error and corneal thickness measurements by Orbscan II and ultrasound pachymetry were evaluated. All results were analyzed by the paired t test (p<0.05). RESULTS: Sixty-seven subjects, 34 (50.7%) female and 33 (49.3%) male, with a mean age of 32.44&plusmn;9.98 were evaluated. The mean of spherical equivalent was -2.68&plusmn;2.62. The mean corneal thickness was 534.81&plusmn;34.45 with the Orbscan II system and 535.00&plusmn;29.53 with the ultrasound pachymeter, values that were not significantly different (p=0.8922). The correlation coefficient between both instruments was 0.8774, and it is effective. CONCLUSIONS: Both methods are similar showing good correlation. In this study, the Orbscan II showed reliability, and this tool is extremely useful to evaluate subjects regarding refractive surgery

Cyanoacrylate effects on venous dog wall

Chemical drugs for vein sclerosis and / or obliteration has been used in esophagogastric varices endoscopic management, trying to treat and prevent digestive hemorrhage as an alternative for surgical treatment. The synthetic adhesive ethyl-cyanoacrylate showing fast polymerization, low cost, commercial availability and good fluidity for intravenous injection, was useful for that purpose. OBJECTIVE: To study the ethyl-cyanoacrylate effects on venous wall, in dogs. METHODS: The cephalic vein wall changes were evaluated in 42 male adults mongrel dogs, weighing 10-13 Kg, randomly distributed in three groups (group 1 = 7 days, group 2 = 14 days and group 3 = 21 days). Single punction and injection of 1 ml of ethyl-cyanoacrilate, and 7, 14 and 21 days later operative specimen excision, having inside the polymer. The non-injected contralateral vein remained as control. Histopathological parameters evaluated (hematoxylin-eosin) were: venous obliteration by adhesive polymerization, acute and chronic inflammatory process, venous wall lesion and granulation tissue degree. RESULTS: Statistical analysis showed lumen complete obliteration and venous wall lesion in all injected animals on 7, 14 and 21 days; prominent acute and chronic inflammation on 14 and 21 days and granulation tissue found only on 21 day. CONCLUSION: Complete obliteration and venous wall injury in all injected animals was shown on 7, 14 and 21 days. Prominent acute and chronic inflammation occurred after 14th day, and granulation tissue only after the 21st day.Substâncias químicas têm sido empregadas no tratamento de varizes esofagogástricas na prevenção de hemorragia digestiva e no seu tratamento pela esclerose ou obliteração venosa, como uma alternativa ao tratamento cirúrgico. O adesivo sintético, etil-cianoacrilato, mostrando rápida polimerização, baixo custo, disponibilidade comercial e boa fluidez para a injeção intravenosa, é útil neste propósito. OBJETIVO: Estudar os efeitos do etil-cianoacrilato na parede venosa de cães. MÉTODOS: Foram utilizados 42 cães, sem raça definida, adultos, machos, com peso variando entre 10 a 13 kg, distribuídos de modo aleatório, em três grupos: grupo 1, avaliados após 7 dias, grupo 2 , 14 dias e grupo 3 , 21 dias. O procedimento foi realizado em duas fases. A primeira constou da injeção de 1 ml de etil-cianoacrilato, por punção única, na veia cefálica do membro torácico do cão. A segunda, realizada 7, 14 e 21 dias após, constou da retirada da peça operatória, contendo o polímero no seu interior e da veia contralateral, sem o mesmo, como controle. Para estudo histológico utilizou-se o método da hematoxilina-eosina. Variáveis estudadas: obliteração, reações inflamatórias: aguda e crônica, tecido de granulação e lesão de parede das veias. RESULTADOS: A obliteração ocorreu em todos cães estudados, nos períodos de 7, 14 e 21 dias. A reação inflamatória surgiu no período de 7 dias e foi encontrada em todos animais aos 14 e 21 dias. O tecido de granulação após 21 dias. A lesão de parede venosa ocorreu em todas veias estudadas. CONCLUSÃO: O etil-cianoacrilato em contato com a parede interna de veia superficial provoca obliteração da veia e lesão da parede venosa de cães.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de CirurgiaUniversidade de Mogi das CruzesUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Medicina PreventivaFaculdade de Medicina de Santo AmaroUNIFESP, EPM, Depto. de CirurgiaUNIFESP, EPM, Depto. de Medicina PreventivaSciEL

Ethanolamine oleate effects on venous dog wall

OBJECTIVE: Evaluate the ethanolamine oleate effects on venous dog wall. METHODS: The cephalic vein wall changes were evaluated in 39 male adults mongrel dogs, weighing 10-18 kg, randomly distributed in three groups (group 1 = 7 days, group 2 = 14 days and group 3, 21 days). Single punction and injection of 2 mL of 5 % ethanolamine oleate and 7, 14 and 21 days later operative specimen excision were compared to non-injected contralateral control vein. Histological parameters evaluated (hematoxylin-eosin and Masson's trichrome staining methods) were: venous thrombosis and organization, thrombus recanalization, media layer lesion and inflammatory process, outer wall inflammatory process, hemossiderin, sclerosant spillage outside the outer layer and hyaline amorphous material deposition. RESULTS: Venous thrombosis and thrombus organization were seen in all animals. Thrombus recanalization was not shown until 21 days. Media layer lesion occurred without inflammatory process. Outer wall inflammatory process was seen in all three time periods. Hemossiderin phagocytes occurred on 14th and 21st days. Sclerosant spillage outside the outer layer was seen only on the 7th day. Hyaline amorphous material deposition was seen only on the 21st day. CONCLUSIONS: Ethanolamin oleate in contact with the inner vein wall produced venous thrombosis, organized in all cases. During this study no significant recanalization was observed. Media layer vein lesion was seen in all animals without any correlate inflammatory reactive process. Reactive inflammatory process, hemossiderin phagocytosis, sclerosant spillage and hyaline amorphous material deposition was shown in the adventitia layer.OBJETIVO: Avaliar a resposta biológica que o oleato de etanolamina possa desencadear na parede de veias superficiais normais de cães. MÉTODOS: Utilizados 39 cães, sem raça definida, adultos, machos, com peso variando entre 10 a 18 kg, distribuídos de modo aleatório em três grupos: grupo 1, avaliados após 7 dias, grupo 2, 14 dias e grupo 3, 21 dias. O procedimento foi realizado em duas fases. A primeira constou da injeção de 2 ml do oleato de monoetanolamina a 5%, por punção única na veia cefálica do membro torácico do cão. A segunda, realizada 7, 14 e 21 dias após, constou da retirada da peça operatória, tendo sido executada em três tempos diferentes, conforme o grupo a que pertencia o animal. As veias contralaterais foram extraídas como controle. Para estudo histológico utilizaram-se os métodos de hematoxilina-eosina e tricrômio de Masson. RESULTADOS: A trombose venosa e a organização do trombo ocorreram em todos animais estudados. A recanalização do trombo não foi observada de modo estatisticamente significante, até 21 dias de exame. Encontrou-se lesão de túnica média, que não foi acompanhada de correspondente processo inflamatório. Na túnica adventícia este processo foi visto nos três períodos de tempo estudados. Depósitos de hemossiderina em fagócitos ocorreram aos 14 e 21 dias de experimento. Extravasamento de esclerosante foi observado somente na primeira semana de estudo. Material hialino fibrinóide foi encontrado aos 21 dias de experimento. CONCLUSÕES: O oleato de etanolamina em contato com a parede interna da veia superficial produziu trombose venosa, a qual se organizou em todos os casos, não se observando sua recanalização durante o tempo deste ensaio. Houve lesão da túnica média venosa em todos animais estudados, sem que houvesse processo inflamatório reativo nesse local. Na túnica adventícia venosa surgiu processo inflamatório, além de sinais de extravasamento do esclerosante, da presença de hemossiderina e de material hialino externos à veia.UNIFESP-EPMUNIFESP-EPM Departamento de CirurgiaUniversidade de Mogi das Cruzes (UMC) Curso de Medicina Disciplina de Patologia GeralUNIFESP-EPM Departamento de Medicina PreventivaFaculdade de Medicina de Santo AmaroUNIFESP, EPM, Depto. de CirurgiaUNIFESP, EPM Depto. de Medicina PreventivaSciEL