No abstract

SummaryObjective: Compare exercise tolerance by children and adolescents submitted to treadmill stress test (TST) following Bruce Protocol (BP) or Ramp Protocol (RP), as well as describe velocity and inclination reached with ramp protocol to help set protocol exercise standards.Methods: Observational, case-based study, with history control of 1,006 children and adolescents in the 4 to 17-yearold range who were submitted to TST between October, 1986 and February, 2003, and who concluded one of the two protocols. Those who interrupted their ET for other reasons rather than physical exhaustion, those on medication that interfered in HR and those with physical constraints to exercise were excluded. Statistical analysis of data considered p<0.05 as significance level; with confidence interval at 95%.Results: Exercise time close to 10 minutes in RP was significantly higher than in BP. HR max reached was higher than 180 bpm in both protocols. Inclination showed to be slightly higher in younger girls in Bruce Protocol. Velocity and VO 2 max showed to be higher for all age ranges for those in the Ramp Protocol. Conclusion

The lengthening of QT dispersion may reflect on cardiac involvement in rheumatic fever and be a new important parameter in the diagnosis and therapeutic decision for rheumatic carditis.

This is a report of a nine-year-old boy with both mitral stenosis and regurgitation and extensive endomyocardial fibrosis of the left ventricle. Focus is given to the singularity of the fibrotic process, with an emphasis on the etiopatho-genic aspects.

No abstract

We report the case of a 33-year-old male with primary seminoma of the anterior mediastinum with initial clinical manifestations suggestive of heart disease.

No abstract

Guidelines for the treatment of osteoarthritis Guidelines for the treatment of osteoarthritis (OA) have several purposes, but a major one relates to its use by regulatory or medical insurance agencies that use it to help guide their response to requests for drugs to treat patients. Data have recently been published which record the efficacy of non-steroidal antiinflammatory drugs (NSAIDs) over paracetamol (acetaminophen) and report patients' preferences for NSAIDs rather than paracetamol in the treatment of OA. 1-7 Furthermore, inflammation is a common accompaniment of moderate to severe OA. 8-10 Therefore it would seem appropriate to consider the use of NSAIDs as the primary treatment in the group of patients with OA with moderate to severe pain or inflammation as part of their disease. The EULAR Guidelines state that paracetamol is the first line of treatment for all patients with OA, 11 despite the recent evidence that NSAIDs are more efficacious than paracetamol and that paracetamol is associated with more gastrointestinal toxicity than was previously thought. 12 Would it not be more appropriate to suggest that patients who have moderate to severe pain and/or OA with inflammatory components be given NSAIDs as the first line of treatment, leaving paracetamol for symptomatic use in those patients with lesser degrees of pain or lack of overt inflammation?