Tribezoar gigante associado a maus-tratos na infância: relato de um caso / Giant trychobezoar associated to child abuse and neglect: a case report

Relata-se o caso de uma paciente de 9 anos portadora de tricotilomania que desenvolveu um tricobezoar gigante e a associaçäo deste com maus-tratos. Säo revisados os principais tipos de bezoar, bem como suas apresentaçöes clínicas, diagnósticos e terapêuticas. Ressalta-se a importância do diagnóstico diferencial de patologias gástricas em crianças, a necessidade do tratamento dos estressores psicológicos que levam à tricotilomania e o papel da endoscopia digestiva associada à cirurgia no manejo destes casos

Volume e pressåo do balonete do tubo traqueal para oclusåo da traquéia / Tracheal tube cuff volume and pressure required for tracheal occlusion

Background and objectives - High tracheal tube cuff pressures are recognized as harmful to the tracheal mucosa. In this study, the authors evaluated the minimum intracuff volume required for trachela occlusion and prevention of leakage during positive pressure ventilation. They also evaluated cuff pressure upon tracheal occlusion and when a three fold volume was used (as compared to the minimum volume required). Methods - 42 female patients were studied, allocated into four groups: Group A (n=32) control; Group B (n=16): tube 8.5; Group C (n=16): tube 8.0; Group D (n=10): three fold volumes. A stethoscope positioned on the sternal furcula was used for detection of tracheal occlusion. The minimum intracuff volume required for tracheal occlusion and the corresponding pressure were studied, as well as the pressure determined by a 3 fold volume. Results - The minimum occlusion volume in 32 patients was 2.47 (+-1.13)ml and the corresponding cuff pressure was 10.34 (+-2.91)mmHg. In the group of 10 patients in which a volume of 7.5ml was used, the mean pressure was 54.2 (+-0,79)mmHg. There were statistically significant differences between the mean pressures (p<0.001). Conclusions - Intracuff volumes and pressures required for tracheal occlusion are low when low pressure, large residual volume, thin wall cuffs are used. The authors recommend monitoring of intracuff volumes and pressures to prevent tracheal mucosa injury secondary to the use of high intracuff pressures