We start off our second volume of Clinics with 8 original articles, 2 reviews and 3 letters.
1. Bonamigo et al are highlighted here in a case-control study on the outcome of surgical repair of sealed ruptured abdominal aortic aneurysms. From a total of 465 patients who underwent infra-renal abdominal aortic aneurysm repair, 13 underwent correction for sealed ruptured aneurysm. They were compared to 26 patients who underwent standard, nonruptured abdominal aortic aneurysm repair immediately preceding and succeeding the 13 sealed ruptured aneurysms. Age, gender, risk factors for atherosclerosis, associated disease, cardiac ischemia, and post-operative complications were similar between groups; early mortality was 7.7% and five year survival 68.4% for sealed ruptured aneurysms, 0% and 84.4% respectively for controls. They conclude that the pre-operative diagnosis of sealed ruptured aneurysms is essential to ensure relatively low mortality rates in this group of patients.
2. Martins et al describe in-vitro sensitivity of dermatophytes to urea and demonstrate that the inhibitory activity of urea on dermatophytes suggests that it could be used as an adjuvant in topical treatments for the parasite.
3. Spiandorello et al retrospectively analyzed use of multiple antimicrobial drugs in 1,166 out of 2,790 clinical patients admitted over 18 month to a 144-bed hospital in search of a prognostic index of hospital mortality. They showed that the use of large amounts of anti-infective drug therapy was associated with higher hospital mortality according to both univariate and logistic regression analysis; this adverse influence was less marked than that of hospitalization in ICU but of a similar order of magnitude as age.
4. Arruda et al studied the effects of intestinal ischemia/reperfusion on bronchial hypereactivity and serum TNF-α increases in rats and found that gut ischemia, either isolated or associated with hepatic ischemia, increased bronchial smooth muscle reactivity, suggesting a possible role for bronchial constriction in respiratory dysfunction following splanchnic ischemia/reperfusion. They also found that this increase occurred in concomitance with serum TNF-α increase, but whether the increase in TNF-α caused this bronchial contractility remains to be determined.
5. Furlanetto and Leme analyze causes, incidence, prevalence, and risk factors for delirium in 103 elderly individuals with hip fracture included consecutively from 01/2001 to 06/2002, and conclude that it is a frequent complication among hospitalized elderly individuals with hip fractures, associated with cognitive and functional deficits, and associated with increases the length of hospital stay and mortality.
6. Figueiredo et al measured the release of the neuronal protein S-100B into the circulation of 50 consecutively admitted patients with a Glasgow Coma Score of 13 - 15 points for risk classification of victims sustaining minor head injury, and compared them with 21 healthy volunteers taken as controls. They conclude that Protein S-100B had a very high sensitivity and negative predictive value which could have an important role in ruling out the need for cranial computed tomography scan after minor head injury. They state that this may be of substantial clinical relevance, particularly in countries where trauma incidence is high and medical resources are limited.
7. Park et al compared the evolution of standard base excess and serum lactate level between 65 surviving and non surviving patients, 25 with severe sepsis and 40 with septic shock resuscitated with early goal-directed therapy. They found evolutive standard base excess and serum lactate level to be outcome markers in such patients, but suggest that other studies are required to determine whether hemodynamic interventions based on standard base excess and serum lactate level should be relied upon to improve their clinical outcomes.
8. Vilela et al studied endothelial function, measuring endothelial dependent and endothelial independent forearm vasodilation in 85 obese volunteers and correlated them with waist-to-hip ratio, body mass index and waist circumference and find that endothelial function correlates better with waist to hip ratio than with any of the other markers of obesisty.
Chandra et al review the role of selectins and nitric oxide in experimental and clinical sepsis and Toledo et al review the impact of the RET proto-oncogene analysis on the clinical management of multiple endocrine neoplasia type 2. We also publish 3 case reports.