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PURPOSE: To investigate the incidence and possible risk factors of upper deep vein obstruction in patients both prior to first cardiac device implantation and before device revision. MATERIALS AND METHODS: Records of asymptomatic patients undergoing contrast venography prior to implantation or revision of a cardiac device from 09/2009 to 04/2012 were reviewed. Venograms were used to determine the presence of venous obstruction. Interrelations between the incidence of venous obstruction and patient- or device-related parameters were identified using Fisher's exact test and univariate logistic regression. Multivariate logistic regression was used to identify independent predictors of venous obstruction. RESULTS: 456 patients met the inclusion criteria (330 males, 126 females, 67.8  ±â€Š 12.9 years). 100 patients underwent first implantation, and 356 patients underwent device revision (mean time since implantation 82.5  ±  75.3 months). Venous obstruction was present in 11.0 % and 30.1 % before implantation and revision, respectively. Only presence of ventricular escape rhythm was significantly related to venous occlusion (p < 0.001) prior to first implantation. Prior to revision, significant predictors were male sex (p = 0.01), time since implantation (p < 0.0001), presence of escape rhythm (p = 0.02), compromised coagulation (p = 0.02), phenprocoumon (p = 0.005), and peripheral arterial disease (p = 0.01). CONCLUSION: Although several risk factors could be identified, reliable prediction of venous obstruction was not possible. Therefore, we advocate performing venography in all patients prior to device revision or upgrade to avoid complications. In cases of first device implantation, the risks associated with venography should be weighed against the surprisingly high rate of deep upper vein obstruction.

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The adenosine A2A receptor (AA2AR) has emerged as an attractive target for the treatment of Parkinson's disease. Evidence suggests that antagonists of the AA2AR may be neuroprotective and may help to alleviate the symptoms of Parkinson's disease. During last decade, many efforts have been accomplished searching potent and selective AA2AR antagonists. In this field, various xanthines and non-xanthine heterocyclic compounds of monocyclic, bicyclic and tricyclic nucleus possessing very good affinity with a broad range of selectivity have been proposed. The aim of this article is to summarize available data on different chemical classes of AA2AR antagonists including those in clinical development, and briefly present an overview of the structure-activity relationships found for these compounds.

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Os autores apresentam estudo prospectivo sobre a drenagem ou nao da cavidade peritoneal, em 170 casos de apendicectomias por apendicite aguda. A drenagem da cavidade abdominal foi executada aleatoriamente, por sorteio, sem levar em consideracao o tipo de apendicite, grau de toxemia ou a extensao da peritonite. A idade media dos doentes foi de 24,8 anos, sendo 122 homens e 48 mulheres. O tempo medio de evolucao do quadro ate o momento da cirurgia foi de 38,8 horas. Em 150 casos foi realizada a incisao de Mac Burney e, em 20, incisao de Jalaguier. Setenta e cinco doentes foram drenados e 95 nao. Os drenos foram exteriorizados sistematicamente por contra-abertura na fossa iliaca direita. As condutas de drenagem, ou nao, ocorreram de forma equitativa nas diferentes formas anatomopatologicas do apendice (gangrenado ou nao-gangrenado) e nos diferentes tipos de liquido peritoneal (purulento ou nao-purulento, bacteriologicamente positivo e negativo).Os doentes drenados tiveram permanencia hospitalar mais prolongada e nitidamente maior numero de complicacoes pos-operatorias

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Os autores apresentam um caso de fratura de penis em paciente jovem durante o intercurso sexual. Comentam sobre a etiologia, quadro clinico e o tratamento, ressaltando a importancia da cirurgia imediata

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The results of treatment with cimetidine in 12 patients with postoperative peptic ulcer are presented. Anterior surgical procedures were: Billroth II gastrectomy (8 cases), proximal selective vagotomy (1 case), truncal vagotomy plus pyloroplasty (1 case), gastroenteroanastomosis (1 case) and intrathoracic esophagogastric anastomosis (1 case). Clinical diagnosis was confirmed by radiology and endoscopy. Gastric secretion, both, basal and stimulated by Histalog was considered high (basal from 0,82 to 4,68 mEq/1 stimulated from 6,06 to 54,1 mEq/1). The patients were treated with 1,0 g of cimetidine daily, divided in four dosis. Healing assessed endoscopically, was seen in 75%. Treatment with cimetidine failed in three patients (25%) who were submitted to selective vagotomy and their ulcers healed. The authors conclude that treatment with cimetidine in postoperative peptic ulcer is effective and should be the first choice before surgical reoperation.

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E apresentado o resultado do tratamento com a cimetidina em 12 doentes com ulcera peptica pos-operatoria. Os procedimentos cirurgicos anteriores foram: gastrectomia a BII (oito casos), vagotomia gastrica proximal (1 caso), vagotomia troncular mais piloroplastia (1 caso). O diagnostico clinico foi confirmado pela radiologia e endoscopia. A secrecao gastrica basal e estimulada pelo Histalog foi considerada elevada(basal de 0,82 a 4,68 mEq/ 1 e estimulada de 6,06 a 54,1 mEq/1).Os doentes foram tratados com 1,0 g de cimetidina diarias, divididas em quatro doses. A cicatrizacao foi comprovada endoscopicamente em 75% dos casos. O tratamento com a cimetidina falhou em tres doentes (25%) que, submetidos posteriormente a uma vagotomia seletiva, tiveram suas ulceras cicatrizadas. Concluem que o tratamento da ulcera peptica pos-operatoria com a cimetidina e eficaz e deve ser tentado como primeira opcao, antes de se indicar tratamento cirurgico

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