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Introducción. En pacientes con dedo en resorte y fracaso del tratamiento conservador, los procedimientos mínimamente invasivos pueden formar parte del arsenal terapéutico de un médico rehabilitador intervencionista. El objetivo de nuestro estudio es encontrar en voluntarios una «zona segura» y describir en cadáver una nueva técnica de liberación percutánea de la polea A1. Material y métodos. En 100 dedos de 10 voluntarios empleamos ecografía Doppler para situar las estructuras en riesgo (arterias, nervios y tendones). Desde el punto más volar de la vaina sinovial, línea teórica estándar para la liberación de la polea A1, medimos la posición relativa de las paredes arteriales más próximas y definimos un sector denominado «zona segura» (en que 0° era el punto más radial y 180°, el más cubital). Posteriormente, liberamos la polea A1 en 46 dedos de 5 cadáveres, y colocamos nuestro instrumento de corte palmarmente y desde un posicionamiento intravaginal, así lo dirigimos hacia la «zona segura» descrita. Mediante disección, evaluamos la precisión, seguridad y eficacia del método. Resultados. Con los valores de referencia descritos, la posición media a la pared arterial más cercana fue de 8,96 (3,5-20,6) mm para la arteria digital radial y 7,59 (3,7-16,8) mm para la arteria digital cubital. La liberación fue completa en 44 dedos (95,7%) con una liberación incompleta de menos de 1,6mm en dos dedos. Conclusiones. Nuestro estudio describe una «zona segura» situada palmarmente a la vaina sinovial de A1 desde la que realizar una liberación percutánea intravaginal guiada por ecografía. La rehabilitación intervencionista del dedo en resorte es una técnica eficaz y segura(AU)

Introduction. In patients with trigger finger and failure of conservative treatments, the use of minimally invasive procedures can be a part of the therapeutic armamentarium of an interventionist rehabilitation physician. The objective of our study is to find in a «safe zone» in volunteer subjects and to describe a percutaneous technique for releasing the A1 pulley in cadavers. Materials y methods. In 100 fingers of 10 volunteers, we used the Doppler ultrasound to locate the structures at risk (arteries, nerves and tendons). From the synovial sheath's most volar point, we measured the relative position of the nearest arterial wall to define a sector called «safe area» (the most radial point was set as 0° and the most ulnar as 180°). We then released the A1 pulley in 46 fingers in 5 cadavers, directing the cutting device volarly and from an intrasheath position towards our «safe area». The accuracy, safety and efficacy of the method was evaluated by surgical exposure. Results. The average position of the nearest arterial wall was at 8.96mm (3.5-20.6) for the radial and at 7.59mm (3.7-16.8) for the ulnar digital arteries. A complete release was achieved in 44 fingers (95.7%) with an incomplete release of less than 1.6mm in two digits. Conclusions. Our present study describes a «safe area», volar to the synovial sheath at A1, from which we can perform a percutaneous intravaginal ultrasound guided release. Interventionist rehabilitation shows efficacy and safety in the treatment of trigger digits(AU)

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Of all malignant neoplasias affecting women, breast cancer has the highest incidence rate in Brazil. The objective of the present study was to determine the frequency of genetic modifications in families with medium and high risk for breast and ovarian cancer from different regions of Brazil. An exploratory, descriptive study was carried out on the prevalence of the BRCA1 and BRCA2 mutations in case series of high-risk families for breast and/or ovarian cancer. After heredogram construction, a blood sample was taken and DNA extraction was performed in all index cases. The protein truncation test was used to screen for truncated mutations in exon 11 of the BRCA1 gene and in exons 10 and 11 of the BRCA2 gene. Of the 612 individuals submitted to genetic testing, 21 (3.4 percent), 19 women and 2 men, had mutations in the BRCA1 or BRCA2 genes. Of the 19 BRCA1 mutations found in the 18 participants, 7 consisted of ins6kb mutations, 4 were 5382insC, 3 were 2156delGinsCC, 2 were 185delAG, 1 was C1201G, 1 was C3522T, and 1 was 3450del4. With respect to the BRCA2 gene, 3 mutations were found: 5878del10, 5036delA and 4232insA (one case each). The prevalence of germline mutations in the BRCA1 and BRCA2 genes found in the present study was lower than reported by other studies on high-risk Brazilian populations. The inclusion of individuals with medium risk may have contributed to the lower prevalence observed.

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Of all malignant neoplasias affecting women, breast cancer has the highest incidence rate in Brazil. The objective of the present study was to determine the frequency of genetic modifications in families with medium and high risk for breast and ovarian cancer from different regions of Brazil. An exploratory, descriptive study was carried out on the prevalence of the BRCA1 and BRCA2 mutations in case series of high-risk families for breast and/or ovarian cancer. After heredogram construction, a blood sample was taken and DNA extraction was performed in all index cases. The protein truncation test was used to screen for truncated mutations in exon 11 of the BRCA1 gene and in exons 10 and 11 of the BRCA2 gene. Of the 612 individuals submitted to genetic testing, 21 (3.4%), 19 women and 2 men, had mutations in the BRCA1 or BRCA2 genes. Of the 19 BRCA1 mutations found in the 18 participants, 7 consisted of ins6kb mutations, 4 were 5382insC, 3 were 2156delGinsCC, 2 were 185delAG, 1 was C1201G, 1 was C3522T, and 1 was 3450del4. With respect to the BRCA2 gene, 3 mutations were found: 5878del10, 5036delA and 4232insA (one case each). The prevalence of germline mutations in the BRCA1 and BRCA2 genes found in the present study was lower than reported by other studies on high-risk Brazilian populations. The inclusion of individuals with medium risk may have contributed to the lower prevalence observed.

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BACKGROUND: Increased BRCA1 and BRCA2 germline mutation rates have been reported in Ashkenazi Jewish women in North America, Europe and Israel, and have been mentioned as possibly related to a higher incidence of breast and ovarian cancer among these communities. The present study was carried out with the aim of obtaining evidence on the magnitude of breast cancer as a cause of death among Ashkenazi women in Brazil. METHODS: We reviewed all death certificates archived in the Jewish Burial Societies of São Paulo (1971-1997) and Porto Alegre (1948-1997), two of the main and oldest Jewish communities in Brazil. Breast cancer observed deaths were compared with expected deaths according to breast cancer mortality in the general population. RESULTS: The observed ratios were approximately quite close to unity, suggesting a similar breast cancer mortality pattern among the Ashkenazi population and the general population in both cities. These results maintain similar behavior regardless of whether analyzed before or after the mid-1980s, when mammography came to be increasingly performed in Brazil. Cancer proportional mortality ratios were 1.04 (0.83-1.29) in São Paulo and 1.16 (0.84-1.57) in Porto Alegre before 1985, and 1.17 (1.00-1.44) and 1.21 (0.81-1.79), respectively, between 1985 and 1997. Some evidence of the maintenance of protective risk factors such as high parity has been observed among Ashkenazi women in São Paulo. CONCLUSION: A quite similar breast cancer mortality pattern was observed between Ashkenazi Jewish women and the general population in São Paulo and Porto Alegre, Brazil. These results may suggest an environmental role on germ mutation expression reported in this ethnic group.

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Social change has been involved in the unequal distribution patterns of chronic diseases in several populations. Among Indian communities experiencing life pattern changes, international studies have reported increased prevalence of hypertension and other cardiovascular risk factors. Such increased prevalence was ascertained in a survey conducted in 1999 in selected Guaraní-Mbyá communities (Sapukai, Paraty-Mirim, and Araponga) in the State of Rio de Janeiro, Brazil. A population census was carried out and interviews and clinical and biochemical evaluations were conducted with 80 men and 71 women. Observed prevalence of selected risk factors in the overall sample, including men and women, was as follows for the three communities: hypertension (4.8%, 2.6%, 7.4%); overweight (26.7%, 19.5%, 34.8%); total cholesterol levels (2.8%, 2.7%, 2.9%), and increased triglyceride levels (12.6%, 9.5%, 15.9%). All prevalence rates were higher among women and at older ages. The results suggest that the Guaraní communities have a moderate risk of chronic diseases and that measures to reduce these risk factors should be adopted.

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A case study was carried out to explore the occurrence of a cancer cluster in 1992 among young indian adults adults living in an Amazonian village near two 500 kV power transmission lines that began operating a decade ago. Current blood levels of DDT and organophosphorus pesticides and metal levels in hair samples were measured. Extremely low magnetic field exposure was determined during current daily activities carried out by the Indian villagers. Taking into account the cancer incidence rates in different Brazilian cities, the probability of the occurrence of this cluster by chance was considered remote (p< 0.003, Poisson distribution). High blood levels of p,p'-DDT (median levels ranging from 26 to 58 ppb) were observed. As a whole, this community showed a pattern of low exposure to organophosphorus pesticides, and high recent exposure was only observed in a few blood samples. Continuous exposure to extremely low electromagnetic fields originated in the power transmission lines (which reached 95.0 mG under the lines) was observed on several opportunities during daily activities carried out by Indian villagers. Further observational studies should evaluate the interaction between exposure to extremely low electromagnetic fields and prior exposure to tumor initiators in cancer development.

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Antecedents of family aggregation of breast and ovarian cancer are observed in only 5-8% of all breast cancer cases. Nevertheless, this variable displays one of the highest risk ratios associated to breast cancer outcome. Despite recent identification of genetic mutations associated with family aggregation of these tumors, mainly at BRCA1 and BRCA2 genes, knowledge on the interaction between environmental agents in these families remains quite unclear. In this paper we ascertained the correlation among ages of the onset of breast/ovarian cancer in 260 Brazilian families with those cancer aggregations. Further we estimated the median age of the onset of breast cancer among four generations. We observed that the higher the number of family cancer cases, the highest is the correlation of ages for the onset of breast cancer. We also observed a 8-10 year decline in the mean age-of-onset of breast/ovarian cancer from one generation to another in the studied families. If these results could be confirmed elsewhere, we believe that the hypothesis of interaction between environmental risks factors in families indeed showing breast/ovarian cancer aggregation is reinforced.

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This paper presents the main epidemiological characteristics of AIDS cases observed among adult women in Rio de Janeiro Municipality (Rio) during 1980-89. Higher incidence rates as compared to Brazilian and Canadian women, rising participation of either sexual transmission and EV drug addiction and an increasing involvement of young women were also observed. The disease does not present a random spatial distribution in Rio, and case clusters in definite high risks areas were shown. Tuberculosis was found to be the second most frequent opportunistic infection detected among cases. Finally, some of the main trends and questions related to AIDS control among women in the studied area are discussed.

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Apresentação que expõe os resultados da pesquisa que avaliou a variação temporal e a distribuição espacial de leucemia em Goiânia, após o acidente com o Césio 137. O estudo compreende o período de 1988 a 2002 e analisou a população por sexo e faixa etária, apontando os grupos que potencialmente tiveram mais contato com o acidente e que ainda hoje pedem reparações na justiça pelos danos. Inclui dados sobre a incidência de leucemia em diferentes períodos na região, a incidência de câncer na região e em outras regiões do Brasil, o mapa das áreas mais afetas pelo acidente, a distribuição dos 183 casos de leucemia em Goiânia de 1997-2002 e a distribuição da população na região. Expõe as conclusões e as limitações do estudo.