A technique has been developed, based on magnetic field measurements, to localize, in three dimensions, hypodermic and sewing needles lost in the human body. A theoretical model for the magnetic field generated by needles has been elaborated and experimentally validated. Using this model, the localization technique gives information about needle's centre, orientation and depth. The clinical measurements have been made using a SQUID system, with patients being moved under the sensor with the aid of an X-Y bed. The magnetic field associated with the remanent magnetization of the needle is acquired on-line and mapped over a plane. In all six cases that occurred, the technique allowed surgical localization of the needles with ease and high precision. This procedure can decrease the surgery time for extraction of foreign bodies by a large factor, and also reduce the generally high odds of failure.

From 1989 onward a Down Syndrome (DS) outpatient clinic was started to focus all medical, cytogenetic and counselling aspects for DS patients and their families. Four hundred and sixty DS patients have been attending our hospital during this period ranging in age from birth to adolescence. Since our hospital is a paediatric referral centre in Rio de Janeiro (Brazil), most DS patients are among the paediatric range of individuals seen in our clinic. Furthermore, a specific clinical programme was established with the purpose of monitoring clinical complications, specially those occurring before one year of age.Among 145 DS patients investigated by abdominal ultrasound (US) scans, 16 (11%) biliary tract abnormalities were detected consisting of 10 asymptomatic biliary stones (radiolucence), 3 biliary sludge, and 3 intrinsic gallbladder abnormalities (transverse septum, fibrosis and irregular shape in one patient each). Most of these patients were white (n = 12), male (n = 9) and 14 of them diagnosed before one year of age. None had perinatal complications or total parenteral nutrition and 4 patients underwent surgery with no further complications. Congenital heart disease was present in 6 patients, consisting of isolated VSD (n = 2) combined either with ASD or PDA, isolated ASD (n = 1) and one PDA combined with congenital megacolon. Other abdominal US abnormalities were observed, mainly unilateral nonvisualized kidneys in 2 patients and renal hydronephrosis in 5 patients (one bilateral). On a prospective basis, another DS clinical programme at a paediatric Brazilian hospital at SFio Paulo state (Z. Mustacchi) had similar findings in their patients scanned by us.Therefore, it seems wise to perform at least one ultrasound scan in every DS patient, since a very unusual high frequency of previously unreported abdominal abnormalities can be found and detected at infant age.

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CONTEXT AND OBJECTIVE: Although studies have demonstrated increased frequency of gallbladder abnormalities among Down’s syndrome (DS) patients in some countries, there is only one paper on this subject in the Brazilian literature. The aim of this study was to demonstrate the prevalence, clinical characteristics and evolution of lithiasis and biliary sludge among DS patients in a maternity and children’s hospital in Rio de Janeiro. DESIGN AND SETTING: This was a cross-sectional study followed by a retrospective cohort study on all individuals with an ultrasound diagnosis of gallbladder abnormalities. METHODS: 547 DS patients (53.2% male, 46.8% female) attending the Instituto Fernandes Figueira in 2001 underwent abdominal ultrasound examination at ages of between one day and three years (mean: five months). Clinical and ultrasound data were analyzed. RESULTS: In 50 patients (9.1%), the ultrasound demonstrated gallbladder abnormalities (6.9% lithiasis and 2.1% biliary sludge). Spontaneous resolution was observed in 66.7% of the patients with biliary sludge and 28.9% with lithiasis. Cholecystectomy was carried out on 26.3% of the patients with gallstones. CONCLUSION: The results from this study and comparison with the literature suggest that DS patients are at risk of developing lithiasis and biliary sludge and should be monitored throughout the neonatal period, even if there are no known risk factors for gallstone formation. Most frequently, these gallbladder abnormalities occur without symptoms and spontaneously resolve in most non-symptomatic patients. DS patients should be monitored with serial abdominal ultrasound, and cholecystectomy is indicated for symptomatic cases or when cholecystitis is present.

Resumo Relato de caso de doença da arranhadura do gato (DAG), em um paciente lactente, com história epidemiológica negativa, descrevendo o rastreamento diagnóstico, a imagem ao ultra-som, a evolução clínica e o prognóstico. B. quintana foi identificada em aspirado de secreção ganglionar pelo método de PCR. B. henselae, embora seja o agente causal habitualmente responsável pela DAG, não foi isolada. Os autores concluem que a pesquisa de B. quintana e B. henselae deve ser incluída na investigação de adenites, principalmente quando a evolução é subaguda, mesmo em lactentes e, ainda que a história epidemiológica seja negativa. Desde a descrição da doença da arranhadura do gato como entidade clínica por Debré et al em 1950, o agente etiológico desta doença tem sido muito discutido. Nos últimos dois anos, trabalhos têm demonstrado o papel do gênero Bartonella (B.), em especial B. henselae, na etiologia desta doença, concluindo que a Afipia felis não tem um papel tão significativo como lhe era atribuído até então 6 9 19 . A Bartonella quintana está mais freqüentemente associado à febre das trincheiras, angiomatose bacilar cutânea, endocardite, febre e bacteremia em imunossuprimidos e imunocompetentes, do que à DAG 2 8 9 11 19 . N ó s d e s c r e v e m o s a q u i u m c a s o d e adenomegalia submandibular, cujo agente etiológico isolado pelo método de reação de cadeia de polimerase (PCR) foi B. quintana.

Bladder and cloacal exstrophy are rare malformations associated with abnormalities in the pelvis. The objectives in reconstruction are to obtain a closed and continent bladder, with an acceptable cosmetic appearance. Treatment for the abnormalities of pelvic anatomy is an important part of achieving successful treatment for these urological conditions. This article aims to describe the technique of bilateral anterior pelvic osteotomy for treating bladder and cloacal exstrophy, and presents two cases to demonstrate the difficulties and applications of the technique.

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