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AIM: Aim of the study was analyzing the association between mode of delivery and neonatal mortality/ morbidity in term pregnancy. METHODS: Cohort study with births of liveborn normally formed fetuses from single term pregnancies in a public teaching hospital in São Paulo, Brazil, from January 2003 to March 2004 (total of 1471 births). Data were collected from medical records. We defined 'elective caesareans' as those performed before labor. Four analyses were made: caesarean vs. vaginal, elective vs. non elective caesarean, elective caesarean vs. trial of labor, elective caesarean vs. women in labor. Outcomes studied were: neonatal deaths, jaundice, low Apgar score at 5 minutes, prolonged mechanical ventilation, convulsions, meconium aspiration syndrome, obstetrical trauma and late discharge. Adjustments were made for possible confounders. The chi square test was used along with logistic regression for the analyses. A significance level of 5% was assumed. RESULTS: A significant negative association between elective caesareans and neonatal death was found, neonatal complications taken as a whole and neonatal complications plus deaths. For example, elective caesarean versus women in labor for the outcome any neonatal complication, adjusted odds ratio 0.59; confidence interval 0.31-0.89. CONCLUSION: The study highlights a significant negative association of elective caesarean and neonatal mortality and morbidity in term pregnancy.

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Decisions for intensive care unit (ICU) admissions in patients with advanced cancer are complex, and the knowledge of survival rates and prognostic factors are essential to these decisions. Ours objectives were to describe the short- and long-term survival of patients with metastatic solid cancer admitted to an ICU due to emergencies and to study the prognostic factors presented at ICU admission that could be associated with hospital mortality. We retrospectively analysed the charts of all patients with metastatic solid cancer admitted over a 1-year period. This gave a study sample of 83 patients. The ICU, hospital, 1-year and 2-year survival rates were 55.4%, 28.9%, 12.0% and 2.4% respectively. Thrombocytopenia (odds ratio 26.2; P = 0.006) and simplified acute physiology score (SAPS II) (odds ratio 1.09; P = 0.026) were independent factors associated with higher hospital mortality. In conclusion, the survival rates of patients with metastatic solid cancer admitted to the ICU due to emergencies were low, but of the same magnitude as other groups of cancer patients admitted to the ICU. The SAPS II score and thrombocytopenia on admission were associated with higher hospital mortality. The characteristics of the metastatic disease, such as number of organs with metastasis and central nervous system metastasis were not associated with the hospital mortality.

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OBJECTIVES: Although maximal inspiratory pressure (MIP) is used as an index of inspiratory muscular strength, there is no consensus on how to measure it. We compared, during weaning from mechanical ventilation, two methods of measurement to determine which shows the greater values (MIPbest) and is more reproducible. One method measured MIP when negative pressure was maintained for at least 1 s after a forceful expiration, and the other method measured MIP with a unidirectional expiratory valve (MIPuni). DESIGN: The study had a crossover design, and patients randomly performed three measurements of each method (t1). The procedure was repeated by the same observer after 20 min (t2). The maximal value in each method was considered. SETTING: ICU, Hospital A.C. Camargo, São Paulo, Brazil. PATIENTS: Fifty-four consecutive patients undergoing short-term mechanical ventilation who became eligible for the study when their physicians decided to restore spontaneous breathing. RESULTS: MIPbest values were arrived at using MIPuni 75% of the time either in tl or t2. MIPuni yielded a higher average of MIPbest values in t1 and t2 (p < 0.0001). The effort-to-effort coefficient of variation of one method compared with the other during t1 and t2 was similar (p > 0.2 for t1; p > 0.8 for t2). Also, when comparing tl and t2, the coefficients of variation were similar for each method (p > 0.62). CONCLUSIONS: Because MIPuni displayed the maximal values, it is the best method for estimating MIP in patients undergoing short-term mechanical ventilation. The reproducibility of consecutive measurements was similar between the methods, even after a short period of time.

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El propósito del presente trabajo fue el de evaluar una posible correlación entre el tono de reposo del canla anal (TR) y la amplitud y duración del reflejo ano rectal inhibitorio (RARI). Fueron estudiados 94 pacientes, 72 mujeres y 22 hombres (9-91 años X = 53). A todos se les realizó exámen manométrico con sistema de tres balones y se determinó la tensión de reposo del canal anal, así como la amplitud y duración del RARI. Los presentes fueron divididos en tres grupos de acuerdo a la tensión de reposo del canal anal. GRUPO I: TR: hasta 79 mmHg. GRUPO II: tr: 80 A 120 MMhG. GRUPO III: TR mayor de 121 mmHg. La amplitud del RARI fue: para el GRUPO I: X = 7,09 DS; 4,93 para el GRUPO II 10,5 DS; 7,3 para el GRUPO III X - 15,14 DS; 8.19. Entre GRUPOS I y III p < 0,001. La duración (d/s) del RARI fue para el GRUPO I: X : 180 DS: 70,1 GRUPO II: X : 175.6 DS: 68 GRUPO III X: 201;6 DS: 86,4. No fueron encontradas diferencias entre los GRUPOS I y II (p<13), I y III (p < 0,17), II y III (p < 0,33). Fue encontrada una positiva correlación de Sperman (p < 0,001) entre TR y la amplitud del RARI. La observación de una correlación positiva entre TR y la amplitud del RARI, sugiere que la integridad funcional del esfinter interno puede ser también evaluada considerando la amplitud pero no la duración del RARI (AU)

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El propósito del presente trabajo fue el de evaluar una posible correlación entre el tono de reposo del canla anal (TR) y la amplitud y duración del reflejo ano rectal inhibitorio (RARI). Fueron estudiados 94 pacientes, 72 mujeres y 22 hombres (9-91 años X = 53). A todos se les realizó exámen manométrico con sistema de tres balones y se determinó la tensión de reposo del canal anal, así como la amplitud y duración del RARI. Los presentes fueron divididos en tres grupos de acuerdo a la tensión de reposo del canal anal. GRUPO I: TR: hasta 79 mmHg. GRUPO II: tr: 80 A 120 MMhG. GRUPO III: TR mayor de 121 mmHg. La amplitud del RARI fue: para el GRUPO I: X = 7,09 DS; 4,93 para el GRUPO II 10,5 DS; 7,3 para el GRUPO III X - 15,14 DS; 8.19. Entre GRUPOS I y III p < 0,001. La duración (d/s) del RARI fue para el GRUPO I: X : 180 DS: 70,1 GRUPO II: X : 175.6 DS: 68 GRUPO III X: 201;6 DS: 86,4. No fueron encontradas diferencias entre los GRUPOS I y II (p<13), I y III (p < 0,17), II y III (p < 0,33). Fue encontrada una positiva correlación de Sperman (p < 0,001) entre TR y la amplitud del RARI. La observación de una correlación positiva entre TR y la amplitud del RARI, sugiere que la integridad funcional del esfinter interno puede ser también evaluada considerando la amplitud pero no la duración del RARI

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The aim of this study was the evaluation of a possible correlation between the resting tone of the anal canal (RT) and amplitude and duration of the recto anal inhibitory reflex (RAIR). 94 subjects, 72 women and 22 men, aged 9-91 years (mean 53 years) were studied. Manometric testing was performed on all subjects with a three balloon system. The maximal anal canal resting tone, the amplitude and duration of the RAIR, were measured. According with the RT, subjects were divided on three groups: GROUP I: RT up to 79 mmHg GROUP II: 80 to 120 mmHg and GROUP III: with RT more than 121 mmHg. The amplitude of RAIR was for GROUP I: mean = 7.09 SD:4.93, GROUP II: mean-10.5 SD:7.3, GROUP III: mean 15.14 DS: 8.19. p less than 0.001 between GROUPS I and III. The duration (d/s) of RAIR was for GROUP I: mean = 180 DS:70, GROUP II: 175.6 DS: 68, GROUP III mean: 201.6 DS 86.4. No differences were found between GROUPS I and II (p less than 0.13), I and III (p less than 0.17), and II and III (p less than 0,33). Positive Sperman correlation (p less than 0,001) was found between RT and amplitude of RAIR. The observation of a positive correlation between RT and RAIR amplitude suggest that the functional integrity of the internal sphincter could be also evaluated by the amplitude but not duration of the RAIR.

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The aim of this study was the evaluation of a possible correlation between the resting tone of the anal canal (RT) and amplitude and duration of the recto anal inhibitory reflex (RAIR). 94 subjects, 72 women and 22 men, aged 9-91 years (mean 53 years) were studied. Manometric testing was performed on all subjects with a three balloon system. The maximal anal canal resting tone, the amplitude and duration of the RAIR, were measured. According with the RT, subjects were divided on three groups: GROUP I: RT up to 79 mmHg GROUP II: 80 to 120 mmHg and GROUP III: with RT more than 121 mmHg. The amplitude of RAIR was for GROUP I: mean = 7.09 SD:4.93, GROUP II: mean-10.5 SD:7.3, GROUP III: mean 15.14 DS: 8.19. p less than 0.001 between GROUPS I and III. The duration (d/s) of RAIR was for GROUP I: mean = 180 DS:70, GROUP II: 175.6 DS: 68, GROUP III mean: 201.6 DS 86.4. No differences were found between GROUPS I and II (p less than 0.13), I and III (p less than 0.17), and II and III (p less than 0,33). Positive Sperman correlation (p less than 0,001) was found between RT and amplitude of RAIR. The observation of a positive correlation between RT and RAIR amplitude suggest that the functional integrity of the internal sphincter could be also evaluated by the amplitude but not duration of the RAIR.

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Twenty patients suffering from irritable bowel syndrome, 14 patients with pain and constipation and 6 patients with pain and diarrhoea, were studied in order to: a) Evaluate the symptomatic response to a Plantago Ovatae fiber medicine. b) Study with radio-opaque markers the colonic transit modifications that could explain the therapeutic responses. There were observed the following results: 1) Pain decreased or disappeared in 80% of the patients. 2) Constipation decreased or disappeared in 78.6% of the patients. 3) Diarrhoea decreased or disappeared in 5 of the 6 patients that were studied. 4) There was a significative increase of the feces weight without changes of the dry residue. 5) Taking all the patients as a whole the number of the retained radio-opaque markers was the same before and after the active treatment. If we evaluate the patients with constipation and the patients with diarrhoea separately the first group shows an acceleration of the colonic transit (fewer retained markers) and the second group shows a decrease of the colonic transit (more retained markers). We draw the conclusion that the Plantago Ovatae fiber regulates or moderates the colon motility and enables a physiological balance of the colonic transit.

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Twenty patients suffering from irritable bowel syndrome, 14 patients with pain and constipation and 6 patients with pain and diarrhoea, were studied in order to: a) Evaluate the symptomatic response to a Plantago Ovatae fiber medicine. b) Study with radio-opaque markers the colonic transit modifications that could explain the therapeutic responses. There were observed the following results: 1) Pain decreased or disappeared in 80

of the patients. 2) Constipation decreased or disappeared in 78.6

of the patients. 3) Diarrhoea decreased or disappeared in 5 of the 6 patients that were studied. 4) There was a significative increase of the feces weight without changes of the dry residue. 5) Taking all the patients as a whole the number of the retained radio-opaque markers was the same before and after the active treatment. If we evaluate the patients with constipation and the patients with diarrhoea separately the first group shows an acceleration of the colonic transit (fewer retained markers) and the second group shows a decrease of the colonic transit (more retained markers). We draw the conclusion that the Plantago Ovatae fiber regulates or moderates the colon motility and enables a physiological balance of the colonic transit.

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Os autores, a proposito de um caso de compressa cirurgica retida no abdomen, fazem uma revisao do assunto, assinalando aspectos diagnosticos clinicos e profilaticos

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