Sao Paulo Medical Journal (SAO PAULO MED J)

Publications in this journal

• Article: Pereira BM, Calderan TR, Silva MT, Silva AC, Marttos AC Jr, Fraga GP. Initial experience at a university teaching hospital from using telemedicine to promoteeducation through video conferencing. Sao Paulo Med J. 2012;130(1):32-6. PubMedPMID: 22344357.

  Pereira BM, Calderan TR, Silva MT, Silva AC, Marttos AC Jr, Fraga GP
  Sao Paulo Medical Journal 02/2012;
• Article: The male biological clock is ticking: a review of the literature.

  Fabio Firmbach Pasqualotto, Edson Borges Júnior, Eleonora Bedin Pasqualotto
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  ABSTRACT: The term biological clock is usually used by physicians and psychologists to refer to the declining fertility, increasing risk of fetal birth defects and alterations to hormone levels experienced by women as they age. Female fecundity declines slowly after the age of 30 years and more rapidly after 40 and is considered the main limiting factor in treating infertility. However, there are several scientific reports, chapters in books and review articles suggesting that men may also have a biological clock. The aim of our study was to conduct a review of the literature, based on the Medical Literature Analysis and Retrieval System Online (Medline), to evaluate the male biological clock. After adjustments for other factors, the data demonstrate that the likelihood that a fertile couple will take more than 12 months to conceive nearly doubles from 8% when the man is < 25 years old to 15% when he is > 35 years old. Thus, paternal age is a further factor to be taken into account when deciding on the prognosis for infertile couples. Also, increasing male age is associated with a significant decline in fertility (five times longer to achieve pregnancy at the age of 45 years). Patients and their physicians therefore need to understand the effects of the male biological clock on sexual and reproductive health, in that it leads to erectile dysfunction and male infertility, as well as its potential implications for important medical conditions such as diabetes and cardiovascular diseases.
  Sao Paulo Medical Journal 06/2008; 126(3):197-201.
• Article: Factors affecting compliance with the measles vaccination schedule in a Brazilian city.

  Patricia Logullo, Heráclito Barbosa de Carvalho, Renata Saconi, Eduardo Massad
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  ABSTRACT: The success of vaccination campaigns depends on the degree of adherence to immunization initiatives and schedules. Risk factors associated with children's failure to receive the measles vaccine at the correct age were studied in the city of São Paulo, Brazil. Case-control and exploratory study, in the metropolitan area of São Paulo. The caregivers of 122 children were interviewed regarding their perceptions and understanding about the measles vaccination and the disease. The results showed that age, region of residence, marital status and education level were unrelated to taking measles vaccines adequately. Most individuals remembered being informed about the last annual vaccination campaign by television, but no communication channel was significantly associated with vaccination status. The answers to questions about knowledge of the disease or the vaccine, when analyzed alone, were not associated with taking measles vaccinations at the time indicated by health agencies. The results showed that, when parents felt sorry for their children who were going to receive shots, they delayed the vaccination. Most of the children did not take the measles vaccination on the exactly recommended date, but delayed or anticipated the shots. It is clear that there is no compliance with the government's recommended measles vaccination schedule (i.e. first dose at nine and second at 15 months of age, as recommended in 1999 and 2000). Feeling sorry for the children receiving shots can delay vaccination taking.
  Sao Paulo Medical Journal 06/2008; 126(3):166-71.
• Article: Are distal radius fracture classifications reproducible? Intra and interobserver agreement.

  João Carlos Belloti, Marcel Jun Sugawara Tamaoki, Carlos Eduardo da Silveira Franciozi, João Baptista Gomes dos Santos, Daniel Balbachevsky, Eduardo Chap Chap, Walter Manna Albertoni, Flávio Faloppa
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  ABSTRACT: Various classification systems have been proposed for fractures of the distal radius, but the reliability of these classifications is seldom addressed. For a fracture classification to be useful, it must provide prognostic significance, interobserver reliability and intraobserver reproducibility. The aim here was to evaluate the intraobserver and interobserver agreement of distal radius fracture classifications. This was a validation study on interobserver and intraobserver reliability. It was developed in the Department of Orthopedics and Traumatology, Universidade Federal de São Paulo - Escola Paulista de Medicina. X-rays from 98 cases of displaced distal radius fracture were evaluated by five observers: one third-year orthopedic resident (R3), one sixth-year undergraduate medical student (UG6), one radiologist physician (XRP), one orthopedic trauma specialist (OT) and one orthopedic hand surgery specialist (OHS). The radiographs were classified on three different occasions (times T1, T2 and T3) using the Universal (Cooney), Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation (AO/ASIF), Frykman and Fernández classifications. The kappa coefficient (kappa) was applied to assess the degree of agreement. Among the three occasions, the highest mean intraobserver k was observed in the Universal classification (0.61), followed by Fernández (0.59), Frykman (0.55) and AO/ASIF (0.49). The interobserver agreement was unsatisfactory in all classifications. The Fernández classification showed the best agreement (0.44) and the worst was the Frykman classification (0.26). The low agreement levels observed in this study suggest that there is still no classification method with high reproducibility.
  Sao Paulo Medical Journal 06/2008; 126(3):180-5.
• Article: Publish or perish: a provocation.

  Eduardo Katchburian
  Sao Paulo Medical Journal 06/2008; 126(3):202-3.
• Article: Primum non nocere. Quomo sapere?. Firstly, do no harm. How can we know this? Drug-eluting stents versus surgery.

  Alvaro Nagib Atallah
  Sao Paulo Medical Journal 06/2008; 126(3):143-4.
• Article: Postmenopausal intestinal obstructive endometriosis: case report and review of the literature.

  Pedro Popoutchi, Carlos Renato dos Reis Lemos, Julio César Rosa E Silva, Antônio Alberto Nogueira, Omar Feres, José Joaquim Ribeiro da Rocha
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  ABSTRACT: CONTEXT: Endometriosis is characterized by the presence of endometrial tissue outside the uterine cavity, which is commonly detected in gynecological practice but rarely reported as a coloproctological disorder. The objective of the present report was to discuss a rare case of postmenopausal intestinal endometriosis simulating a malignant lesion, following a review of the literature. CASE REPORT: A 74-year-old woman with complaints of hematochezia and tenesmus of two months' duration accompanied by liquid feces and pelvic pain, but with no other gastrointestinal or gynecological complaints, was referred to our service. She had been menopausal for 22 years, with no hormone replacement treatment, and had undergone panhysterectomy three years before the referral to us, due to endometrial thickening and a right adnexal cyst. Five months before this referral, she had undergone laparotomy due to acute obstructive abdomen, which revealed a tumor mass involving the small bowel. Anatomopathological examination of the enterectomy suggested a hypothesis of intestinal endometriosis. A proctological examination was normal. Computed tomography of the pelvis revealed thickening of the rectosigmoid transition and colonoscopy revealed friable tumor formation in the rectum. A biopsy of the lesion revealed mucosal fragments of endometrial type, which led to a review of the previous anatomopathological examination. The patient underwent rectosigmoidectomy with protective transversotomy, with a good postoperative course, and anatomical examination confirmed the intestinal endometriosis. The patient subsequently suffered a stenosing recurrence of the lesion and has undergone colostomy since then.
  Sao Paulo Medical Journal 06/2008; 126(3):190-3.
• Article: Surgical treatment of renal cell carcinoma recurrence at the renal fossa following radical nephrectomy.

  Carlos Márcio Nóbrega de Jesus, Filemón Anastásio Silva Casafus, Aparecido Donizetti Agostinho
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  ABSTRACT: CONTEXT: Isolated renal cell carcinoma recurrence at the renal fossa is a rare event. This condition occurs in 1 to 2% of radical nephrectomy cases. It is usually seen in postoperative follow-up imaging examinations such as abdominal computed tomography or abdominal ultrasound. There is controversy among urologists and oncologists regarding the best way to treat this rare situation, because of the few cases in the literature. CASE REPORT: We report on a case of isolated recurrence at the renal fossa due to renal cell carcinoma (RCC), four and a half years after radical nephrectomy, without evidence of metastases in other organs. The diagnosis was made from abdominal tomography performed during outpatient follow-up, in which a retroperitoneal mass was observed in the renal fossa. Excision was carried out by means of a subcostal transversal incision, without complications. One and a half years after the procedure, there was evidence of metastasis in the left lung and, six months later, another recurrence at the ninth anterior right rib, while the patient remained asymptomatic. Aggressive surgical treatment is a good method for controlling this rare situation of single retroperitoneal RCC recurrence. Abdominal tomography must continue to be performed over long periods of follow-up, to monitor for RCC following radical nephrectomy, in order to diagnose any late retroperitoneal recurrences. These must be treated as single RCC metastases.
  Sao Paulo Medical Journal 06/2008; 126(3):194-6.
• Article: Estimation of absolute renal uptake with technetium-99m dimercaptosuccinic acid: direct comparison with the radioactivity of nephrectomy specimens.

  Mariana da Cunha Lopes de Lima, Celso Darío Ramos, Sérgio Quirino Brunetto, Marcelo Lopes de Lima, Ubirajara Ferreira, Elba Cristina Sá Camargo Etchebehere, Allan de Oliveira Santos, Nelson Rodrigues Netto Júnior, Edwaldo Eduardo Camargo
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  ABSTRACT: Studies using radionuclides are the most appropriate method for estimating renal function. Dimercaptosuccinic acid chelate labeled with technetium-99m (99mTc-DMSA) is the radiopharmaceutical of choice for high-resolution imaging of the renal cortex and estimation of the functional renal mass. The aim of this study was to evaluate a simplified method for determining the absolute renal uptake (ARU) of 99mTc-DMSA prior to nephrectomy, using the radioactivity counts of nephrectomy specimens as the gold standard. Prospective study at the Division of Nuclear Medicine, Department of Radiology, Universidade Estadual de Campinas. Seventeen patients (12 females; range 22-82 years old; mean age 50.8 years old) underwent nephrectomy for various reasons. Renal scintigraphy was performed three to four hours after intravenous administration of a mean dose of 188.7 MBq (5.1 mCi) of 99mTc-DMSA, which was done six to 24 hours before surgery. The in vivo renal uptake of 99mTc-DMSA was determined using the radioactivity of the syringe before the injection (measured using a dose calibrator) and the images of the syringe and kidneys, obtained from a scintillation camera. After surgery, the reference value for renal uptake of 99mTc-DMSA was determined by measuring the radioactivity of the nephrectomy specimen using the same dose calibrator. The ARU measurements were very similar to those obtained using the reference method, as determined by linear regression (r-squared = 0.96). ARU estimation using the proposed method before nephrectomy seems to be accurate and feasible for routine use.
  Sao Paulo Medical Journal 06/2008; 126(3):150-5.
• Article: Expression of MRP1 gene in acute leukemia.

  Frouzandeh Mahjoubi, Masoud Golalipour, Ardeshir Ghavamzadeh, Kamran Alimoghaddam
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  ABSTRACT: Overexpression of the multidrug resistance-associated protein 1 (MRP1) gene has been linked with resistance to chemotherapy in vitro, but little is known about its clinical impact on acute leukemia patients. Our aim was to investigate the possible association between MRP1 gene expression level and clinical outcomes among Iranian leukemia patients. This was an analytical cross-sectional study on patients referred to the Hematology, Oncology and Stem Cell Research Center, Sharyatee Public Hospital, whose diagnosis was acute myelogenous leukemia (AML) or acute lymphoblastic leukemia (ALL). All molecular work was performed at NIGEB (public institution). To correlate with prognostic markers and the clinical outcome of acute leukemia, MRP1 gene expression was assessed in 35 AML cases and 17 ALL cases, using the quantitative real-time polymerase chain reaction and comparing this to the chemotherapy response type. Mean expression in AML patients in complete remission (0.032 +/- 0.031) was significantly lower than in relapsed cases (0.422 +/- 0.297). In contrast, no significant difference in MRP1 mRNA level was observed between complete remission and relapsed ALL patients. There was a difference in MRP1 expression between patients with unfavorable and favorable cytogenetic prognosis (0.670 +/- 0.074 and 0.028 +/- 0.013, respectively). MRP1 expression in M5 was significantly higher (p-value = 0.001) than in other subtypes. The findings suggest that high MRP1 expression was associated with poor clinical outcome and was correlated with the M5 subtype and poor cytogenetic subgroups among AML patients but not among ALL patients.
  Sao Paulo Medical Journal 06/2008; 126(3):172-9.
• Article: Scapular fracture: lower severity and mortality.

  Javad Salimi, Ali Khaji, Mojgan Karbakhsh, Soheil Saadat, Behzad Eftekhar
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  ABSTRACT: The presence of scapular fracture is believed to be associated with high rates of other injuries and accompanying morbidities. The aim was to study injury patterns and their overall outcomes in patients with scapula fractures. Cross-sectional study of trauma patients treated at six general hospitals in Tehran. One-year trauma records were obtained from six general hospitals Among these, forty-one had sustained a scapular fracture and were included in this study. Scapular fracture occurred predominantly among 20 to 50-year-old patients (78%). Road traffic accidents (RTAs) were the main cause of injury (73.2%; 30/41). Pedestrians accounted for 46.7% (14/30) of the injuries due to RTAs. Falls were the next most common cause, accounting for seven cases (17.1%). Body fractures were the most common type of scapular fractures (80%). Eighteen patients (43.9%) had isolated scapular fractures. Limb fracture was the most common associated injury, detected in 18 cases (43.9%). Three patients (7.3%) had severe injuries (injury severity score, ISS >or= 16) which resulted in one death (2.4%). The majority of the patients were treated conservatively (87.8%). Patients with scapula fractures have more severe underlying chest injuries and clavicle fractures. However, this did not correlate with higher rates of injury severity score, intensive care unit admission or mortality.
  Sao Paulo Medical Journal 06/2008; 126(3):186-9.
• Article: Material and human resources for neonatal resuscitation in public maternity hospitals in Brazilian state capitals.

  Maria Fernanda Branco de Almeida, Ruth Guinsburg, José Orleans da Costa, Lêni Márcia Anchieta, Lincoln Marcelo Silveira Freire
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  ABSTRACT: In 2002, the early neonatal mortality rate in Brazil was 12.42 per thousand live births. Perinatal asphyxia was the greatest cause of neonatal death (about 23%). This study aimed to evaluate the availability of the resources required for neonatal resuscitation in delivery rooms of public hospitals in Brazilian state capitals. Multicenter cross-sectional study involving 36 hospitals in 20 Brazilian state capitals in June 2003. Each Brazilian region was represented by 1-4% of its live births. A local coordinator collected data regarding physical infrastructure, supplies and professionals available for neonatal resuscitation in the delivery room. The information was analyzed using the Statistical Package for the Social Sciences, version 10. Among the 36 hospitals, 89% were referral centers for high-risk pregnancies. Each institution had a monthly mean of 365 live births (3% < 1,500 g and 15% < 2,500 g). The 36 hospitals had 125 resuscitation tables (3-4 per hospital), all with overhead radiant heat, oxygen and vacuum sources. Appropriate equipment for pulmonary ventilation was available for more than 90% of the 125 resuscitation tables. On average, one pediatrician, three nurses and five nursing assistants per shift worked in the delivery rooms of each institution. Out of the 874 pediatricians and 1,037 nursing personnel that worked in the delivery rooms of the 36 hospitals, 94% and 22%, respectively, were trained in neonatal resuscitation. The main public maternity hospitals in Brazilian state capitals have the resources to resuscitate neonates at birth.
  Sao Paulo Medical Journal 05/2008; 126(3):156-60.
• Article: Marginal grafts increase early mortality in liver transplantation.

  Telesforo Bacchella, Flávio Henrique Ferreira Galvão, José Luiz Jesus de Almeida, Estela Regina Figueira, Andreza de Moraes, Marcel Cerqueira César Machado
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  ABSTRACT: Expanded donor criteria (marginal) grafts are an important solution for organ shortage. Nevertheless, they raise an ethical dilemma because they may increase the risk of transplant failure. This study compares the outcomes from marginal and non-marginal graft transplantation in 103 cases of liver transplantation due to chronic hepatic failure. One hundred and three consecutive liver transplantations to treat chronic liver disease performed in the Liver Transplantation Service of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo between January 2001 and March 2006 were retrospectively analyzed. We estimated graft quality according to a validated scoring system. We assessed the pre-transplantation liver disease category using the Model for End-Stage Liver Disease (MELD), as low MELD (< 20) or high MELD (>or= 20). The parameters for marginal and non-marginal graft comparison were the one-week, one-month and one-year recipient survival rates, serum liver enzyme peak, post-transplantation hospital stay and incidence of surgical complications and retransplantation. The significance level was 0.05. There were no differences between the groups regarding post-transplantation hospital stay, serum liver enzyme levels and surgical complications. In contrast, marginal grafts decreased overall recipient survival one month after transplantation. Furthermore, low-MELD recipients of non-marginal grafts showed better one-week and one-month survival than did high-MELD recipients of marginal livers. After the first month, patient survival was comparable in all groups up to one year. The use of marginal graft increases early mortality in liver transplantation, particularly among high-MELD recipients.
  Sao Paulo Medical Journal 05/2008; 126(3):161-5.
• Article: Clinical formulas, mother's opinion and ultrasound in predicting birth weight.

  Maria Regina Torloni, Nelson Sass, Jussara Leiko Sato, Ana Carolina Pinheiro Renzi, Maísa Fukuyama, Paula Rubia de Lucca
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  ABSTRACT: Accurate fetal weight estimation is important for labor and delivery management. So far, there has not been any conclusive evidence to indicate that any technique for fetal weight estimation is superior to any other. Clinical formulas for fetal weight estimation are easy to use but have not been extensively studied in the literature. This study aimed to evaluate the accuracy of clinical formulas for fetal weight estimation compared to maternal and ultrasound estimates. Prospective study involving 100 full-term, cephalic, singleton pregnancies delivered within three days of fetal weight estimation. The setting was a tertiary public teaching hospital in São Paulo, Brazil. Upon admission, the mother's opinion about fetal weight was recorded. Symphyseal-fundal height and abdominal girth were measured and two formulas were used to calculate fetal weight. An ultrasound scan was then performed by a specialist to estimate fetal weight. The four estimates were compared with the birth weight. The accuracy of the estimates was assessed by calculating the percentage that was within 10% of actual birth weight for each method. The chi-squared test was used for comparisons and p < 0.05 was considered significant. The birth weight was correctly estimated (+/- 10%) in 59%, 57%, 61%, and 65% of the cases using the mother's estimate, two clinical formulas, and ultrasound estimate, respectively. The accuracy of the four methods did not differ significantly. Clinical formulas for fetal weight prediction are as accurate as maternal and ultrasound estimates.
  Sao Paulo Medical Journal 05/2008; 126(3):145-9.
• Article: Late presentation of posterior urethral valve: two case reports.

  Carlos Márcio Nóbrega de Jesus, José Carlos de Souza Trindade Filho, José Goldberg
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  ABSTRACT: CONTEXT: Posterior urethral valve (PUV) is a widely known condition affecting males that generally presents prenatally or at birth. PUVs have also been occasionally described in literature in cases diagnosed during adolescence or adulthood. CASE REPORT: This report presents two late PUV cases, one in a teenager and the other in an adult. Both cases had had clinical signs of urinary tract infection and obstructive urinary symptoms. The diagnoses were made by means of voiding cystourethrography and urethrocystoscopy. Endoscopic valve fulguration was the treatment chosen for both. Their follow-up was uneventful.
  Sao Paulo Medical Journal 04/2008; 126(2):126-7.
• Article: Selective neck dissection for treating node-positive necks in cases of squamous cell carcinoma of the upper aerodigestive tract.

  Jamile Karina Antonio, Marcelo Benedito Menezes, Norberto Kodi Kavabata, Antonio Augusto Tupinambá Bertelli, William Kikuchi, Antonio José Gonçalves
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  ABSTRACT: Modified radical neck dissection (MRND) is the classical treatment for neck metastases of squamous cell carcinoma (SCC) of the upper aerodigestive tract. However, it may still be accompanied by significant sequelae. One alternative for this treatment would be selective neck dissection (SND), which has a lower incidence of sequelae. The aim of this study was to define which neck metastasis cases would really be suitable candidates for SND. Retrospective clinical-surgical trial at the Division of Head and Neck Surgery, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP). We retrospectively studied 67 patients with SCC of the upper aerodigestive tract, divided into two groups: 1) 47 patients treated by means of SND (node-negative or node-positive), 2) 20 patients treated by means of MRND (all node-positive). Our results demonstrated that there was no difference between the patients treated with SND or MRND in relation to disease evolution, and that the main prognostic factor was lymph node involvement. We observed that patients with pharyngeal SCC and older patients presented worse evolution and would probably not be suitable candidates for SND. SND may be a good option for treating node-positive necks in selected cases.
  Sao Paulo Medical Journal 04/2008; 126(2):112-8.