RESUMO
The fracture dislocation of the hip is a rare lesion described up to 4 to 17% of the cases and usually secondary to automobile accidents. Generally of poor prognosis and with already well documented complications such as avascular necrosis of the femoral head, osteoarthritis and heterotopic ossification. The iatrogenic fracture of the neck or head of the proximal femur is a complication even more rare and is not documented its incidence in the world literature. Having as probable causes the irreducibility of a dislocation of hip, more than one attempt of closed reduction, inadequate technique and some problems with the anesthesia and relaxation of the patient. We present the case of a young patient attended in the first eight hours after his accident with an iatrogenic fracture of the femoral head with follow up to 18 months and emphasizing the importance of making an anatomic open reduction and stable fixation in order to get favorable results.
La fractura luxación de la articulación coxofemoral es una lesión rara descrita de 4 a 17% de los casos por lo regular secundaria a accidentes automovilísticos. Generalmente de mal pronóstico y con complicaciones ya bien documentadas como la necrosis avascular de la cabeza femoral, la osteoartritis y la osificación heterotópica. La fractura iatrogénica del cuello o de la cabeza femoral es una complicación aún más rara cuya incidencia no está documentada en la literatura mundial. Como probables causas se tienen la irreductibilidad de una luxación de cadera al hacer más de un intento de manipulaciones cerradas, la ausencia de una adecuada anestesia y la falta de relajación del paciente. Se presenta el caso de una paciente joven atendida en las primeras ocho horas posteriores al accidente con fractura iatrogénica de la cabeza femoral con seguimiento a 18 meses, haciendo énfasis en la importancia de realizar una reducción anatómica y fijación estable para obtener resultados favorables.
Assuntos
Fraturas do Fêmur , Luxação do Quadril , Doença Iatrogênica , Fraturas do Fêmur/etiologia , Fêmur , Cabeça do Fêmur , Fixação Interna de Fraturas , Luxação do Quadril/cirurgia , Humanos , Resultado do TratamentoRESUMO
The goal of this study was to compare American eel Anguilla rostrata life history in two inland river systems in Arkansas, U.S.A., that ultimately discharge into the Gulf of Mexico via the Mississippi River and the Red-Atchafalaya catchments. From 21 June 2011 to 24 April 2014, 238 yellow-phase A. rostrata were captured in the middle Ouachita River and tributaries using boat electrofishing and 39 in the lower White River using multiple sampling gears. Most of them were caught downstream of dams in both basins (61%). Medium-sized A. rostrata ranging from 225 to 350 mm total length (LT ) were the most abundant size group in the Ouachita River basin, but they were absent from the White River. Mean LT at age 4 years (i.e. youngest shared age) was 150 mm greater for the White River than the Ouachita River basin. Anguilla rostrata appeared to have a greater initial LT (i.e. minimum size upon arrival) in the White River that allowed them to reach a gonado-somatic index (IG ) of 1·5 up to 4 years earlier, and downstream migration appeared to occur 5 years earlier at 100 mm greater LT ; these differences may be related to increased river fragmentation by dams in the Ouachita River basin. Growth and maturation of A. rostrata in this study were more similar to southern populations along the Atlantic coast than other inland populations. Adult swimbladder nematodes Anguillicoloides crassus were not present in any of the 214 swimbladders inspected. Gulf of Mexico catchments may be valuable production areas for A. rostrata and data from these systems should be considered as range-wide protection and management plans are being developed.
Assuntos
Anguilla/anatomia & histologia , Anguilla/fisiologia , Rios , Distribuição por Idade , Migração Animal , Animais , Arkansas , Tamanho Corporal , Demografia , Golfo do México , México , Razão de Masculinidade , Estados UnidosRESUMO
Poribacterial clone libraries constructed for Aplysina fulva sponge specimens were analysed with respect to diversity and phylogeny. Results imply the coexistence of several, prevalently "intra-specific" poribacterial genotypes in a single sponge host, and suggest quantitative analysis as a desirable approach in studies of the diversity and distribution of poribacterial cohorts in marine sponges.
RESUMO
Poribacterial clone libraries constructed for Aplysina fulva sponge specimens were analysed with respect to diversity and phylogeny. Results imply the coexistence of several, prevalently "intraspecific" poribacterial genotypes in a single sponge host, and suggest quantitative analysis as a desirable approach in studies of the diversity and distribution of poribacterial cohorts in marine sponges.(AU)
Assuntos
Animais , Genótipo , Biodiversidade , Poríferos/fisiologiaRESUMO
Poribacterial clone libraries constructed for Aplysina fulva sponge specimens were analysed with respect to diversity and phylogeny. Results imply the coexistence of several, prevalently "intraspecific" poribacterial genotypes in a single sponge host, and suggest quantitative analysis as a desirable approach in studies of the diversity and distribution of poribacterial cohorts in marine sponges
Assuntos
Microbiologia Ambiental , Variação Genética , Técnicas In Vitro , Filogenia , Poríferos , RNA Bacteriano/isolamento & purificação , Genótipo , Métodos , Estudos de Avaliação como AssuntoRESUMO
The marsupial and placental mammals originated at a time when the pattern of geographical barriers (oceans, shallow seas and mountains) was very different from that of today, and climates were warmer. The sequence of changes in these barriers, and their effects on the dispersal of the mammal families and on the faunas of mammals in the different continents, are reviewed. The mammal fauna of South America changed greatly in the Pliocene/Pleistocene, when the newly-complete Panama Isthmus allowed the North American fauna to enter the continent and replace most of the former South American mammal families. Marsupial, but not placental, mammals reached Australia via Antarctica before Australia became isolated, while rats and bats are the only placentals that dispersed naturally from Asia to Australia in the late Cenozoic. Little is known of the early history of the mammal fauna of India. A few mammal families reached Madagascar from Africa in the early Cenozoic over a chain of islands. Africa was isolated for much of the early Cenozoic, though some groups did succeed in entering from Europe. Before the climate cooled in the mid-Cenozoic, the mammal faunas of the Northern Hemisphere were much richer than those of today.
Assuntos
Clima , Ecossistema , Geografia , Mamíferos , História Natural , Animais , Ecologia , Fenômenos Geológicos , Geologia , América do SulRESUMO
Hospices are in a position to play major roles in the care of terminally ill patients with AIDS. These findings from a national survey of hospices in the United States show that the majority of hospices have cared for at least one PWA. Major factors determining hospice involvement include geographic location and resources. In comparison to other patients in hospice, PWAs are younger, more likely to be male, Black or Hispanic, and covered by Medicaid. The results indicate that hospices are reaching women with AIDS and IVDUs but that minorities continue to be underrepresented in comparison to their distribution among the total AIDS cases in the United States.
Assuntos
Síndrome da Imunodeficiência Adquirida/terapia , Hospitais para Doentes Terminais/organização & administração , Adolescente , Adulto , Idoso , Feminino , Pesquisas sobre Atenção à Saúde , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Grupos Minoritários , Porto Rico , Inquéritos e Questionários , Estados UnidosRESUMO
At an international conference in 1992 on women and health, an attempt was made to redefine health concerns for women of the English-speaking Caribbean in the 1990s. Medical practices in developing countries change as advances are made in public health; clinical issues on the islands now resemble those in the United States (e.g hypertension, cancer, sexually transmitted diseases, domestic violence, and abortion). In the Caribbean, however, these problems exist in a unique socioeconomic context, and women's health there suffers indirectly because of cultural mores. Gender bias in medical education and practice influence treatment of women and obstructs their advancement to policy-making levels in the design and delivery of programs that bear on maternal and child health, among others. The effect of local cultural beliefs and practices on women's health must be considered when setting goals and direction of health policy if aid or educational programs are to be effective.(AU)
Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Educação Médica , Mulheres , Saúde da Mulher , Aborto Induzido , Violência Doméstica , Política de Saúde , Gravidez , Preconceito , Prática Profissional , Infecções Sexualmente Transmissíveis/prevenção & controle , Serviços de Saúde da Mulher , Região do CaribeRESUMO
At an international conference in 1992 on women and health, an attempt was made to redefine health concerns for women of the English-speaking Caribbean in the 1990s. Medical practices in developing countries change as advances are made in public health; clinical issues on the islands now resemble those in the United States (e.g. hypertension, cancer, sexually transmitted diseases, domestic violence, and abortion). In the Caribbean, however, these problems exist in a unique socioeconomic context, and women's health there suffers indirectly because of cultural mores. Gender bias in medical education and practice influences treatment of women and obstructs their advancement to policy-making levels in the design and delivery of programs that bear on maternal and child health, among others. The effect of local cultural beliefs and practices on women's health must be considered when setting goals and direction for health policy if aid or educational programs are to be effective.
PIP: The major women's health issues in the English-speaking Caribbean (e.g., sexually transmitted diseases [STDs], domestic violence, abortion, adolescent pregnancy, cancer, hypertension, and diabetes) now resemble those in the US. In the Caribbean, however, these health problems are rooted in unique cultural, socioeconomic, and environmental contexts that affect their resolution. For example, as a result of poverty and their low social status, women in the Caribbean are relatively powerless in sexual decision making and disadvantaged in terms of protecting themselves against AIDS, other STDs, and unwanted pregnancy. Caribbean-trained physicians directly influence the quality of women's health in the West Indies. Their medical school education affects their diagnostic and interpersonal skills in clinical practice and the ethical values that form the basis of policy making. The University of West Indies (UWI) Faculty of Medicine trains students from 20 English-speaking Caribbean islands at 3 campuses. During 1990-91, 438 male and 350 female medical students were enrolled. The relatively high female enrollment reflects the fact that Caribbean doctors are poorly paid and not highly esteemed, making the field more open to women. However, only 3 of the 31 full professors in the UWI medical faculty are women. Gender bias further hinders the ability of female physicians to form the professional relationships necessary for advancement. Medical education should include training on interpersonal skills, gender issues, and biomedical ethics. More female role models in medical education and female policy makers would substantially alter the scope and effectiveness of reproductive health programs.
Assuntos
Educação Médica , Saúde da Mulher , Mulheres , Aborto Induzido , Adolescente , Adulto , Idoso , Violência Doméstica , Feminino , Granada , Política de Saúde , Humanos , Pessoa de Meia-Idade , Gravidez , Preconceito , Prática Profissional , Infecções Sexualmente Transmissíveis/prevenção & controle , Serviços de Saúde da MulherRESUMO
Samples of the toxic Brazilian plant, Baccharis coridifolia, which is responsible for numerous cases of livestock poisoning in southern Brazil and Argentina, were collected during the growing season, and the toxicities in calves of the plant materials were correlated with the levels of macrocyclic trichothecenes present. Female plants in flower were considerably more toxic than male plants or plants not in flower. Plants not in flower were of intermediate toxicity. The female plants in flower typically contained 5-10 times the levels of toxins as were found in the male plants. In addition, six new glucosides of the macrocyclic trichothecenes were isolated and characterized. The most prominent glucosides, those of roridins A and E, were found in high levels in the female plants.
Assuntos
Micotoxinas/isolamento & purificação , Extratos Vegetais/isolamento & purificação , Plantas Tóxicas , Tricotecenos/isolamento & purificação , Acetilação , Animais , Animais Domésticos , Antibacterianos/química , Antibacterianos/isolamento & purificação , Antibacterianos/toxicidade , Brasil , Fracionamento Químico , Cromatografia Líquida de Alta Pressão , Cromatografia Gasosa-Espectrometria de Massas , Glucosídeos/química , Glucosídeos/isolamento & purificação , Glucosídeos/toxicidade , Espectroscopia de Ressonância Magnética , Micotoxinas/química , Micotoxinas/toxicidade , Extratos Vegetais/química , Extratos Vegetais/toxicidade , Intoxicação por Plantas/etiologia , Intoxicação por Plantas/veterinária , Plantas Tóxicas/química , Relação Estrutura-Atividade , Tricotecenos/química , Tricotecenos/metabolismo , Tricotecenos/toxicidadeRESUMO
A randomized, double-blind, controlled trial was conducted to determine whether vancomycin added to parenteral alimentation solution given via a central venous catheter would decrease the incidence of catheter-related coagulase-negative staphylococcal sepsis. Seventy infants with a central venous catheter (CVC) in place were randomly selected to receive total parenteral nutrition--either the standard solution or a solution containing 25 micrograms of vancomycin per milliliter. Catheter-related sepsis was defined as the isolation of the same bacterial species from specimens of both peripheral and CVC blood with the concentration of bacteria at least tenfold greater in the specimen obtained from the CVC. Specimens from the CVCs were cultured on removal of the catheters to determine colonization. The colonization of catheters by coagulase-negative staphylococci was reduced from 40% to 22% (p = 0.03) in the vancomycin group; catheter-related sepsis was reduced from 15% to no cases (p = 0.004). Fewer infants required CVC reinsertion in the vancomycin-treated group (p = 0.02), who also regained birth weight earlier (13.4 vs 17.1 days (p = 0.014)). Adverse effects of vancomycin infusion were not observed. We conclude that vancomycin added to the solution used for total parenteral nutrition effectively reduces catheter-related sepsis in the neonatal intensive care unit and offers other potential benefits such as the need for fewer catheters and earlier weight gain. However, we do not recommend widespread implementation of this technique until there are data regarding the emergence of vancomycin-resistant organisms.
Assuntos
Bacteriemia/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Recém-Nascido de Baixo Peso , Infecções Estafilocócicas/prevenção & controle , Vancomicina/uso terapêutico , Bacteriemia/etiologia , Coagulase , Método Duplo-Cego , Humanos , Recém-Nascido , Nutrição Parenteral Total , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/etiologia , Análise de Sobrevida , Vancomicina/administração & dosagemRESUMO
OBJECTIVE: The objective of this prospective, randomized clinical trial was to test the hypothesis that there is no difference in the frequency of feeding problems and necrotizing enterocolitis between a group of premature infants who received early enteral feedings while low umbilical artery catheters (LUACs) were in place, and a late group who were not fed until 24 hours after removal of LUACs. PATIENTS AND METHODS: Twenty-nine premature infants (born at 28.5 +/- 3.0 SD weeks of gestational age) who were in stable condition received early enteral feedings at a median of 2 days while a LUAC was in place; 31 infants (born at 28.6 +/- 2.7 SD weeks of gestational age) received late enteral feedings at a median of 5 days of age, 24 hours after the removal of the LUAC. Feeding complications and interventions and nutritional characteristics were recorded prospectively. RESULTS: There were no differences in the baseline perinatal characteristics of the two groups. The incidence of gastric residua and the incidence of abdominal distention were the same in both groups. The early feeding group had significantly fewer percutaneous central venous catheters, evaluations for sepsis, and episodes of receiving nothing by mouth while a gastric suction tube was in place. Infants in the early group received parenteral alimentation-lipid emulsion infusions for a median of 13 days versus 30 days for the late-fed group (p = 0.0028 by Wilcoxon test). There were two cases of necrotizing enterocolitis in the early group versus four cases in the late group. CONCLUSIONS: Premature infants in stable condition who receive enteral feedings while LUACs are in place do not have an increased incidence of feeding problems compared with infants who do not receive enteral feedings until 24 hours after removal of LUACs.
Assuntos
Cateterismo Periférico , Nutrição Enteral/efeitos adversos , Recém-Nascido Prematuro , Cateterismo Periférico/métodos , Enterocolite Pseudomembranosa/etiologia , Feminino , Humanos , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Fatores de Tempo , Artérias UmbilicaisRESUMO
To evaluate the effect of the physical properties of density and viscosity on airway resistance, three perfluorochemical fluids (PFCs) were used: FC-75, Liquivent, and APF-140. Using two different endotracheal tubes (ETT) (3.0mm ID and 4.0mm internal diameter (ID)), the three fluids were studied at steady state flow conditions over a range that approximated peak flow required for liquid ventilation of neonatal lambs (0.005-0.02 l/sec). The slope of airway resistance (Raw)-flow curves and absolute values of Raw for the 3 PFC liquids were higher for the 3.0 ETT compared to the 4.0 ETT. The 3.0 ETT demonstrated resistance changes that were dependent on flow, density and viscosity. The 4.0 ETT showed a resistance-flow relationship that was relatively less dependent on flow, density and viscosity.
Assuntos
Resistência das Vias Respiratórias/efeitos dos fármacos , Fluorocarbonos/farmacologia , Intubação Intratraqueal/métodos , Animais , Animais Recém-Nascidos , Fenômenos Químicos , Físico-Química , Intubação Intratraqueal/instrumentação , OvinosRESUMO
To test the hypothesis that increased positive end-expiratory pressure (PEEP) could prevent deterioration of pulmonary function and lead to more rapid recovery of lung function, we randomly assigned 74 patients undergoing extracorporeal membrane oxygenation (ECMO) at four centers to receive either high (12 to 14 cm H2O) or low (3 to 5 cm H2O) PEEP. The two groups were similar in terms of weight, gestational age, diagnosis, and pre-ECMO course. All other aspects of care were identical. Dynamic lung compliance was measured at baseline and every 12 hours. Radiographs of the chest were obtained daily. Survival rates were similar in the two groups: 36 of 40 for low PEEP and 34 of 34 for high PEEP. The duration of ECMO therapy was 97.4 +/- 36.3 hours in the high-PEEP group and 131.8 +/- 54.5 hours in the low-PEEP group (p less than 0.01). Dynamic lung compliance throughout the first 72 hours of ECMO was significantly higher in patients receiving high PEEP. Radiographic appearance of the lungs correlated well with lung compliance: patients receiving high PEEP had significant deterioration of the radiographic score less frequently than those receiving low PEEP. High PEEP also was associated with significantly fewer complications. We conclude that PEEP of 12 to 14 cm H2O safely prevents deterioration of pulmonary function during ECMO and results in more rapid lung recovery than traditional lung management with low PEEP.
Assuntos
Oxigenação por Membrana Extracorpórea , Respiração com Pressão Positiva/métodos , Oxigenação por Membrana Extracorpórea/métodos , Feminino , Humanos , Recém-Nascido , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Complacência Pulmonar , Masculino , Oxigênio/administração & dosagem , Oxigênio/sangue , Estudos Prospectivos , Radiografia , Insuficiência Respiratória/fisiopatologia , Insuficiência Respiratória/terapia , Taxa de Sobrevida , Fatores de Tempo , Resultado do TratamentoAssuntos
Mortalidade , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Morbidade , Índias OcidentaisRESUMO
An analysis has been made of the causes of death and ages at death from the registrar of deaths on the island of Anguilla from 1885 to 1980. Prior to 1945, infant mortality was about 100 per thousand live births but subsequently started to fall and is now 30. Similarly, deaths under the age of 5 years as a percentage of total deaths was 30 percent but fell to 10 percent in 1980. Infections are now very rarely registerd as cause of death whereas stroke and cancer have become increasingly frequent.(AU)
Assuntos
Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Mortalidade , Fatores Etários , MorbidadeRESUMO
Phenylmercury absorbed through the skin from contaminated diapers affected urinary excretion in infants in Buenos Aires. The effects were reversible and quantitatively related to the concentration of urinary mercury. Excretion of gamma-glutamyl transpeptidase, an enzyme in the brush borders of renal tubular cells, increased in a dose-dependent manner when mercury excretion exceeded a "threshold" value. Urine volume also increased but at a higher threshold with respect to mercury. The results support the threshold concept of the systemic toxicity of metals. gamma-Glutamyl transpeptidase is a useful and sensitive marker for preclinical effects of toxic metals.