The autologous superficial femoral artery as a substitute for the carotid axis in oncologic surgery. Three new cases and a review of the literature

When neck cancer affects the carotid artery, the best therapeutic option is to remove the tumor en bloc, including the affected vessels. When the carotid artery is revascularized, the usual practice according to the literature is to replace the defective carotid artery with an autologous graft from the saphenous vein, although it is also possible to use an autologous superficial femoral artery (SFA). The use of the SFA in oncologic surgery does not seem to be widespread; in fact, we only found 7 references (67 cases). Here we report three cases in which the SFA was employed and offer a review of the literature. The SFA has advantages and disadvantages in comparison with the saphenous vein. The need for interdisciplinary collaboration (otorhinolaryngology/vascular surgery) is very important, especially in situations where the saphenous vein is not available.

Nitric oxide prevents the bacterial translocation and inhibits the systemic inflammatory response produced by implantation of a vascular prosthesis followed by Zymosan A

OBJECTIVE AND DESIGN

To evaluate the beneficial effects of exogenous NO and its levels of action in a model of SIRS/Bacterial Translocation (BT) induced by two sequential insults.

MATERIAL OR SUBJECTS

Eighty-six Wistar rats were submitted to different treatments and their tissue and blood samples were accessed at the end of the experiment.

TREATMENT

Nitric Oxide was compared to Gentamicin as the tested guideline for our study.

METHODS

Dacron graft implantation (first insult) and subsequent administration of Zymosan A((R)) (second insult) were performed in Wistar rats. The animals were divided into 6 groups: I) No manipulation (BASAL: ); II) Laparotomy (L) + mineral oil (SHAM: ); III) L + Graft-Zymosan (GZ) (CONTROL: ); IV) L + GZ + Antibiotic (A) (ASSAY: I); V) L + GZ + NO (ASSAY: II) and VI) L + GZ + A + NO (ASSAY: III). Determinations: Survival, Bacterial Translocation, myeloperoxidase (MPO), Cytokines (TNF-alpha, IL-1beta, IFN-gamma), Oxygen Free Radical (OFR) SOA and detoxifying enzymes (SOD, Superoxide Dismutase, CAT, Catalase and GPX, Glutathione Peroxidase), Cell Adhesion Molecules, CAMs (ICAM-1, VCAM-1 and PECAM-1) and Nuclear Transcription Factor, NFkappaB.

RESULTS

The model established induced a mortality rate of 20% and generated BT in all samples. It also significantly increased all variables, with P < 0.001 for MPO and all Cytokines; P < 0.01 for all OFR, and P < 0.05 for CAMs and for NFkappaB. Treatment with A reduced mortality to 0%, significantly decreased BT, MPO, Cytokines and OFR (P < 0.05), but did not reduce CAMs or NFkappaB. NO, either alone or associated, reduced mortality to 0% and abolished BT, significantly decreasing nearly all the variables studied (P < 0.001 for MPO and all Cytokines; P < 0.01 for OFR, and P < 0.05 for CAMs and for NFkappaB).

CONCLUSIONS

The exogenous administration of NO before the two sequential insults prevented BT and controlled SIRS peripherally and at both cellular and transcriptional level in a lasting manner. In contrast, antibiotic treatment only exerted its action at peripheral level. The association of both treatments did not provide any important advantages.

[Differential patterns of neonatal and post-neonatal mortality rates in Goiânia, Brazil, 1992-1996: use of spatial analysis to identify high-risk areas]

The aim of this study was to investigate the spatial pattern of neonatal and post-neonatal mortality in the city of Goiânia, Central Brazil. Analyses were based on linked birth and death certificates relating to 101,000 in-hospital live births from mothers residing in the city of Goiânia over the 1992-1996 period. Overall neonatal and post-neonatal mortality probabilities were calculated using the linked database. The empirical Bayes method was applied to smooth the estimated rates and minimize random fluctuation. Spatial units of analysis were 65 urban districts, corresponding to the urban planning sectors. The following exploratory spatial analyses were applied: "global" Moran's I statistic, local Moran LISA map, and Gi* local statistics. For both neonatal and post-neonatal mortality there was statistically significant spatial autocorrelation. Results of post-neonatal mortality showed a high-risk cluster located on the outskirts of the city. For the neonatal period, a heterogeneous mortality pattern was found with high-risk districts in all regions, including central areas.

[Differences between the nutritional status of children in public preschools and nutritional transition]

OBJECTIVE: To verify if there are different patterns of nutritional status among preschool children, and if these patterns deserve special interventions. METHODS: This cross-sectional study included 1,200 children from public preschools in Cosmópolis, a small town in the state of São Paulo. The z scores indices for height/age, weight/age, and weight/height were analyzed in terms of age, sex, type of school, and school location. RESULTS: Anthropometric indices were similar to those of the reference population (NCHS). Males had lower indices than females. Important differences in anthropometric indices were found among children from different schools. Higher prevalence of moderate deficits in height and weight was observed in children from non-downtown areas, while higher prevalence of obesity was found in children from downtown areas. However, the prevalence of obesity was higher than the prevalence of malnutrition even in schools located in non-downtown areas. CONCLUSIONS: We concluded that even in a small city and in a relatively homogeneous group, it is possible to detect different nutritional patterns in subgroups of the population. The differences related to nutritional status, and the high prevalence of obesity among children from public schools, point out the need for different approaches and interventions.

Factors associated with overweight and central body fat in the city of Rio de Janeiro: results of a two-stage random sampling survey

The purpose of the survey was to investigate the association of overweight (body mass index, BMI) and central body fat distribution (waist/hip girth ratio WHR) with socio-economic, demographic, lifestyle and dietary variables in the adult population of Rio de Janeiro City, Brazil, 1995-1996. A two-stage random sample population-based survey was performed, with 1455 males and 1906 females above 20 y old resident in Rio de Janeiro City, Brazil. Data were obtained by direct interview and physical examination of the subjects. The intake of selected nutrients (fat, saturated fat, cholesterol) and energy was obtained from a semi-quantitative food frequency questionnaire (FFQ). Variables with at least a marginal univariate association with the dependent variables (BMI and WHR) were selected as predictors in two logistic regression models, and variables statistically significant (P<0.05) were retained in them. Overweight prevalence was 44.9%, and 39.2% of the subjects had excessive central body fat distribution (elevated WHR). The proportions of subjects with an excessive intake of fat, saturated fat and cholesterol were respectively 31%, 42% and 47%. For the BMI model, the variables retained were age (OR=1.5, 95% CI=1.3-1.7), schooling (OR=1.7, 1.4-1.9) and smoking (OR=0.8; 0.7-0.9); and for WHR, age (OR=1.8, 1.5-2.1), schooling (OR=2.2, 1.9-2.6), occupation (OR=1.8, 1.1-2.0) and gender (OR=3.9, 3.2-4.7). Obesity and excessive central body fat are highly prevalent health problems in the studied population. As suggested by the identified risk factors, they should be urgently addressed through health nutrition education and physical activity programs; particularly those directed to the middle aged and female groups.

[Risk factors for neonatal and post-neonatal mortality in the Central-West region of Brazil: linkage between live birth and infant death data banks]

This article focused on risk factors for neonatal and post-neonatal mortality by linking live births and infant death records. The study was conducted in the municipality of Goiânia, in the Central-West region of Brazil. A total of 20,981 live births and 342 infant deaths constitute the retrospective cohort. Neonatal and post-neonatal mortality risks were estimated in this cohort study of live births by logistic regression. In the neonatal period, the highest ORs were for delivery in public hospitals (OR = 2.28; 95% CI 1.57-3.32), pre-term neonates (OR = 8.94; 95% CI 5.85-13.67), and low birth weight (OR = 8.92; 95% CI 5.77-13.79). Cesarean delivery appeared as a protective factor (OR = 0.58; 95% CI 0.43-0.78). For post-neonatal mortality, the highest ORs were for illiterate mothers (OR = 6.25; 95% CI 1.25-31.27), low birth weight (OR = 3.12; 95% CI 1.67-5.84), and delivery in public hospitals (OR = 2.65; 95% CI 1. 13-6.23). The linkage identified socioeconomic variables that were more important risk factors for post-neonatal than neonatal mortality.

[Risk factors in the occurence of short stature of preschool children]

A case-control study was conducted to know the magnitude of the effect of main risk factors for short stature of pre-school children in a city in São Paulo State, in 1995. An anthropometric survey carried out with all children (1201) attending public pre-school classes was used to select the case and the control groups. It was selected a random sample of 165 children among those with stature/age (-1 z score (case) and another sample of 165 among those with stature/age ( +1 z score (control). The mothers or persons responsible for these children were interviewed in order to obtain information on demographic, maternal and socio-economic variables. The multiple logistic hierarchical analysis showed the following variables as associated with pre school children's short stature: mother's educational level (OR = 2,1; CI: 1,1-3,8); per capita family income (0,5 SM (OR = 3,4; CI: 1,5-8,0); number of persons in the house (6 (OR = 3,7; CI: 1,5-9,0); number of domestic equipment (1 (OR = 4,4; CI: 1,8-10,7 ); birth length <48 cm (OR = 7,4; CI: 2,3-23,7 ), mother's stature ( 156,6 cm (OR = 5,9 CI 3,1-11,0) and father's stature (169,5 cm (OR = 4,2; CI: 2,1-8,6). We found that even in a population of preschool children without nutritional deficiency (as measured by the usual anthropometric index) it is possible to observe the effect of socio economic variables in children stature.

[Risk factors for persistent diarrhea in hospitalized children]

A case control study was done among prospectively hospitalized children aged 1-24 months. The aim of the study was to identify the risk factors associated with persistent diarrhea in children. Sixty one children with diarrhea persisting for more than 14 days, observed at the hospital, were included in the investigation as cases and 133 hospitalized children with acute diarrhea was studied as controls. The risk factors studied for association with persistent diarrhea were mother's level of education, weight at birth, use of breast feeding, presence of diarrhea during the three months before hospitalization and nutritional status of the children at the moment of the hospitalization. Mother's level of education (OR = 10.62), the frequency of diarrhea during the three months before hospitalization (OR = 3.62), weight at birth (OR = 6.36) and the use of breast feeding as the only source of food intake (OR = 2.30) were found to be associated with long term diarrhea. When evaluated by the Z score of the weight/age (OR = 20.02), weight/length (OR = 21.13) and length/age (OR = 6.64) ratios, there was a positive correlation between the occurrence of diarrhea and the level of malnutrition. It is concluded that persistent diarrhea is strongly associated with undernutrition and with inherent factors related with it.

Evaluation of the nutritional status of 1st-year school children in Campinas, Brazil

We present findings from a study of nutritional status amongst 1st year primary school children in Brazil. The study was based on a 10% stratified random sample of children in Campinas, Sao Paulo State. The primary schools in the city were grouped into four socio-economic strata (high, medium, low and very low) based on the type of school maintenance (private or maintained by the local or by the State government) and the socio-economic characteristics of the school's catchment area. The nutritional status of 1942 children was assessed by looking at the distributions of z-scores of weight-for-age, height-for-age and weight-for-height in relation to growth charts of the National Center for Health Statistics reference population. In the overall population, 22% of the children were found to be stunted (z-score of height-for-age less than -1.0), 15% wasted (z-score of weight-for-height less than -1.0), 22% underweight (z-score of weight-for-age less than -1.0) and 5% overweight (z-score of weight-for-height greater than 2.0). These figures represent an excess of 6% of stunted children and also 6% of underweight children in comparison with the expected values in the NCHS reference population, and an excess of 2% overweight. The data were analysed by age, sex, ethnic group and socio-economic level. Both stunting and low weight-for-age were observed in 32% of children from the very low socio-economic level, with the highest percentages amongst the oldest children. A total of 11.6% of children from the high socio-economic stratum were obese. These results emphasize the need for different programmes to deal with nutritional problems in different groups of the population.

[The use of the concept of social class in the epidemiological profiles studies: a proposal]

Considerando-se as interferências da dimensão social nos resultados dos estudos epidemiológicos, assinala-se a necessidade de aprofundamento desse tema, para se chegar a tratamento mais adequado das questões sociais nos estudos de distribuição da morbi-mortalidade. Entre as propostas que vêm sendo feitas, ressalta-se a da análise das transformações dos padrões de morbidade entre as diferentes frações de classe social. Proposta que se reveste de grande interesse pelo controverso papel explicativo que encerra. Com o intuito de contribuir para o desenvolvimento de estudos nessa direção, analisam-se algumas dificuldades que cercam o conceito de classe social e apresenta-se uma proposta de aplicação do conceito para estudos epidemiológicos, utilizada em pesquisa realizada em uma amostra da população de Ribeirão Preto, SP, Brasil.

[Household interviews and teaching and research in epidemiology]

São discutidas algumas características das entrevistas domiciliárias em sua utilização nas investigações sobre o processo saúde-doença e no ensino da Epidemiologia. É feito um relato sucinto de algumas experiências de pesquisa e ensino desenvolvidas no Departamento de Medicina Social da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo-USP e no Departamento de Medicina Preventiva e Social da Faculdade de Ciências Médicas da Universidade Estadual de Campinas-UNICAMP, relacionadas a entrevistas domiciliárias. São feitas considerações sobre o elevado interesse do uso de entrevistas domiciliárias para o conhecimento da realidade de saúde dos grupos sociais que constituem a população brasileira, bem como para o desenvolvimento da própria Epidemiologia. É mostrado o enorme potencial relacionado ao ensino da Epidemiologia, a nível de graduação e pós-graduação, que pode ser desenvolvido com investigações epidemiológicas a nível da população.

[Mortality in Brazil in 1980]

Com base na publicação das estatísticas de mortalidade do Brasil, de 1980, foram elaborados alguns indicadores de saúde e índices de mortalidade proporcional por causa básica do óbito. Os dados apontaram, além da precariedade da informação existente, em termos quantitativos e qualitativos, especialmente nas regiões Norte, Nordeste e Centro Oeste, a deficiente situação de saúde da população brasileira, ainda em 1980, com 24,2% dos óbitos ocorridos em crianças menores de um ano, indicador de Swaroop-Uemura de 48,8%, curva Nelson de Moraes do tipo III e quantificação de Guedes de 8,0. É intensa a desigualdade dos indicadores entre as regiões e verifica-se que as populações residentes nas capitais não apresentam índices muito diversos dos constatados para a população do respectivo Estado. As doenças cardiovasculares representaram 32,1% das causas básicas dos óbitos, as infecciosas e parasitárias 11,8%, as neoplasias 10,4% e as causas externas 11,8%. Comparados com os valores observados em outros trabalhos, para períodos anteriores, verifica-se tendência à piora dos indicadores de saúde nas regiões Norte e Nordeste.

[The incidence of surgery in the population of Ribeirão Preto, SP, Brazil]

Foi estudada a incidência de cirurgias na população residente em Ribeirão Preto, São Paulo (Brasil), em 1975, em relação à idade, sexo, categoria de internação do paciente e tipo de internação cirúrgica, utilizando-se as informações coletadas por um Centro de Processamento de Dados Hospitalares. Foram observadas elevadas taxas de cirurgias: 79,8/1000 no sexo feminino e 43,8/1000 no masculino. As intervenções obstétricas representaram 31,8% do total de operações realizadas; no sexo masculino as intervenções ortopédicas foram as de maior incidência. A proporção de internações com ocorrência de cirurgia foi mais elevada nos pacientes particulares. As operações ortopédicas e plásticas incidiram relativamente mais nos beneciários da Previdência Social e nos indigentes, enquanto que as otorrinológicas e urológicas foram proporcionalmente mais freqüentes nos pacientes particulares.

[Hospital morbidity and mortality of children less than 1 year old in Riberão Preto, SP (Brazil), 1975]

Foi estudada a morbi-mortalidade hospitalar de crianças menores de um ano, residentes em Ribeirão Preto, SP (Brasil), internadas nos hospitais gerais e no Pronto Socorro Infantil desse município, em 1975. Detectou-se um elevado coeficiente de internação para essa faixa etária (437/1000) sendo maior no sexo masculino. Apenas três diagnósticos-diarréia, desidratação e pneumonia - foram responsáveis por 80,36% das internações. A morbidade hospitalar apresentou diferenças segundo a categoria de internação das crianças. Observou-se que 75% dos óbitos hospitalares foram decorrentes de doenças infecciosas. A letalidade hospitalar foi 3 vezes mais elevada nas crianças "indigentes" do que naquelas de categoria particular.