Código rojo, un ejemplo de sistema de respuesta rápida / The Red Code, an example of a rapid response system

Introducción. Los sistemas de respuesta rápida, o códigos de emergencia, son equipos multidisciplinarios que buscan prevenir el paro cardiopulmonar y la muerte. Objetivo. Destacar la importancia que tiene la implementación de los sistemas de respuesta rápida, como el código rojo, en el manejo de las complicaciones de la paciente obstétrica.Metodología. Artículo de revisión basado en literatura obtenida de bases de datos de PubMed, Science Direct, Ovid. Resultados. El origen de estos códigos se remonta a los primeros grupos de reanimación cardiopulmonar, cuando en la década del 30 del siglo pasado, se comenzaron a implementar medidas que permitieran un manejo inmediato del paro cardiaco por personal capacitado en reanimación. Más tarde, en la década del 80, la disponibilidad del desfibrilador automático externo en las unidades de atención prehospitalaria, permitió avanzar en la administración de la terapia eléctrica antes de llegar al hospital, hasta lograr, en la actualidad, una amplia difusión y capacitación en reanimación con recomendaciones de obligatoriedad para los servicios que atienden urgencias prehospitalarias y hospitalarias. A partir de estas experiencias, se han venido implementando grupos de reanimación especializados en el manejo de la paciente con hemorragia obstétrica y se ha observado una disminución en la mortalidad de estas pacientes. Conclusiones. Con la evidencia de que varias muertes ocurrían por efectos adversos y complicaciones médicas, se renueva el concepto de implementación de estos sistemas de respuesta rápida como estrategia eficaz para disminuir la morbimortalidad. Bajo esta premisa, nació en Colombia el código rojo, el cual pretende reducir la muerte materna por hemorragia obstétrica.

Comparación de dos métodos usados para el reconocimiento de arritmias: Experimento educativo controlado en estudiantes de medicina / Two comparative methods for cardiac arrythmias recognition: Experiment controlled education of medical students

Antecedentes: La habilidad para reconocer arritmias es esencial para los proveedores de reanimación cardiopulmonar avanzada. El desarrollo de esta habilidad es dispendioso, pero no se han identificado las mejores estrategias educativas para optimizar este proceso. Objetivo: Evaluar y comparar la efectividad y recordación de dos métodos de aprendizaje usados por estudiantes de medicina para reconocer arritmias cardiacas. Material y Métodos: El estudio incluyó 99 estudiantes de medicina que se asignaron aleatoriamente a dos grupos. En un grupo se enseñó un método de cuatro pasos (n = 51) y en el otro un método de diez pasos (n = 48). En cada grupo se enseñó el método respectivo en una conferencia de 60 minutos de duración. Después se realizó una prueba específica para cada grupo con el fin de evaluar la percepción de “facilidad”, el uso y la recordación de cada método. Adicionalmente se evaluó la capacidad para reconocer arritmias en una prueba práctica general para los dos grupos. Resultados: Las características de base no eran diferentes entre los dos grupos antes de la asignación aleatoria. La capacidad para reconocer arritmias fue mejor en el grupo de cuatro pasos, porque aumenta la proporción de estudiantes con puntajes =30 puntos sobre 50 (82% vs 19%; RR 4.39, IC 95% 2.40-8.02; NNT 2), aumenta la mediana de puntajes (34 ± 8 vs 23 ± 8; valor P < 0.01), es más fácil de recordar en orden (kappa 0.89 vs 0.56; valor P < 0.01) y es percibido como un método más fácil de aprender y recordar.Conclusión: El método de cuatro pasos comparado con el de diez pasos aumenta la capacidad para reconocer arritmias por parte de estudiantes de medicina, además, es más fácil de aprender y de recordar.

Background: The skill for read arrhythmias is essential in cardiopulmonary resuscitation providers. But the development of these skill is hard, and the better educational strategies for improves this process are not identified. Objective: To evaluate and compare the effectiveness of two methods for teaching cardiac arrhythmias to medical school students. Material and Methods: In the study, 99 medical school students was included and randomly allocated in two groups: four steps method group (n = 51) and ten steps method group (n = 48). In each group the assigned method was given in a conference of 60 minutes of duration. Following, a specific test was made in each group for the evaluation of “facility”, use and knowledge of methods. Furthermore the skill for read arrhythmias was evaluated with a general test. Results: Basal characteristics are no different between groups before random allocation. The skill for read arrhythmias was better in the four steps group, because proportion of students with >30 points over 50 is more (82% vs 19%; RR 4.39, IC 95% 2.40-8.02; NNT 2), median of scores is better (34 ± 8 vs 23 ± 8; P value < 0.01), the adequate order is more remembered (kappa 0.89 vs 0.56; P value < 0.01) and is an easier method for to learn. Conclusions: The four steps method when is compared with a ten steps method raise the skill for read arrhythmias in medical school students, furthermore, is easier for learn and remember.

Analgesia preventiva en mujeres programadaspara esterilización definitiva conelectrofulguración de trompas uterinas porlaparoscopia: Experimento clínico controlado, aleatorizado, con doble enmascaramiento / Preventive analgesia in women scheduled for definitive sterilization with electrofulguration of uterine tubes by laparoscopy Controlled, randomized clinical trial with double masking

Antecedentes: La analgesia preventiva continúa siendo fuente de discusión y desacuerdo entre los especialistas que manejan el dolor. Hay resultados contradictorios, incluidos algunos metaanálisis, sobre la efectividad de la analgesia preventiva con ketamina. Objetivo: Evaluar la eficacia de la ketamina preventiva en la cirugía ambulatoria de mujeres programadas para esterilización definitiva con electrofulguración por laparoscopia, en la disminución del dolor postoperatorio, comparada contra ketamina administrada de manera no preventiva. materiales y métodos: Entre diciembre de 2007 y enero de 2008 se incluyeron 130 mujeres de la Clínica Piloto de Profamilia, en Bogotá (Colombia), que deseaban planificar mediante ligadura de trompas. Fueron asignadas de manera aleatoria simple a dos grupos: a 71 pacientes se les administró ketamina antes de la incisión quirúrgica (0.25 mg/kg) y a 59 pacientes se les administró ketamina a la misma dosis al fnal del procedimiento. La administración de ketamina y la evaluación de los desenlaces se realizaron de manera enmascarada. Resultados: El nivel de dolor medido mediante la Escala Visual Análoga (EVA) fue similar para ambos grupos, aunque hubo una mayor proporción de pacientes con dolor al minuto 15 en el grupo de ketamina preventiva (19.7% vs. 6.8%, p=0.03). El grupo de ketamina no preventiva presentó más náusea (15% vs 10%) y mareo (46% vs. 37%), aunque esto no fue significativo (p>0,05) Conclusión: La eficacia de la ketamina preventiva para el alivio del dolor postoperatorio no fue diferenre a la de la ketamina no preventiva .

Background: The pre-emptive analgesia keeps being a source of discussion and discord between the spe-cialists in the pain management. There are contradictory results, even in meta-analysis, about effectiveness of preemptive analgesia with ketamine. Objective: To evaluate effectiveness of ketamine as preemptive analgesia in women under laparoscopic electrofulguration of Falopio tubes, in control of postoperative pain, compared with ketamine administered in a non preemptive way. material and methods: 130 women who wanted a defnitive contraceptive method as laparoscopic tubal ligation were included with the diagnosis of satisfed parity, from the Clínica Piloto de Profamilia, in Bogotá (Colombia), between december 2007 and january o2008. They were randomly assigned in two groups: 71 received preemptive ketamine (before initiating the surgical procedure, dose of 0,25 mg/kg) and the other 59 patients received ketamine, the same doses, at the end of the procedure. Both, administration of ketamine and evaluation of patients outcomes, were made in blinded form. Results: Patients were similar at the start of the study. The level of pain measured with a visual analog scale (VAS) was similar for both groups, there was a higher proportion of patients with pain in the preemp-tive ketamine group to the minute 15 (29.7% vs 6.8%) Ketamine non preemptive group, felt more nauseous (25% vs. 10% and seasickness (46% vs 37%), this was not signifcative (p>0.05)). Conclusions: The preemptive ketamine wasn't different in effectiveness to ketamine administered in non preemptive way for the relief of postoperative pain .

Evaluación de la conducta adolescente con las Escalas de Achenbach: ¿existe concordancia entre diferentes informantes?

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Summary: Introduction Behavioural problems in adolescents are thought to be relevant as strong predictors for the detection of other psychological disorders. For this reason and due to the importance they present by themselves, carrying out an adequate assessment of them is fundamental. Mental health professionals have diverse opinions about the value and importance of the different informants. The majority choose of their sources according to the disorder and necessities of each evaluator. On the other hand, the need to obtain data about adolescents' functioning from multiple resources has been emphasised and numerous reasons have been exposed. Concretely, the fact of carrying out the most objective and complete evaluations as possible has been considered essential in those studies aimed at evaluating behavioural alteration in adolescents. For this reason, Achenbach developed three versions of his scale: one for the parents, another for the teachers and a third one for the adolescents themselves. Numerous investigations have studied the concordance between groups of informants about different behavioural alterations in adolescents, but none have carried out a complete analysis of all informants in all subscales (not only the total ones). For this reason, the current study has been developed with the aim of contributing to obtain an enriching vision for the professional in the field. Objectives. a) To systematically explore agreement patterns between adolescents, teachers and parents who inform of behavioural problems in adolescents in the general population and b) in those cases in which no agreement is found, to analyse the level of disagreement between each pair of informants for each subscale. Methodology. Cross-sectional and descriptive study Participants. The study was formed by 160 triads of parents, teachers and 13-16 year old adolescents selected from several schools in Barcelona. Instruments. The three forms of the Achenbach scale to measure behavioural alterations were applied. The scale was translated into Spanish by the Unit of Epidemiology and Diagnostic in Psychopathology of the Development of the Universidad Autónoma de Barcelona: Youth Self-Report, self-evaluated, Child Behaviour Checklist/4-18 and Teacher's Report Form, both heteroevaluated and completed by parents and teachers, respectively. These three forms contain a 89-item set that evaluates the same behaviour, where eight items are organised in scales of syndromes derived empirically and which are invariant throughout informants. The eight subscales are: withdrawn, somatic complaints, anxious/depressed, social problems, thought problems, attention problems, delinquent behaviour and aggressive behaviour. Some of them are grouped in second order factors: the first three in internalising, the last two in externalising, and the rest of them provide a total problems punctuation. Statistical procedure. Agreement values were analysed for each pair of informants and each subscale through the Intraclass Correlation Coefficient (ICC). A value below 0.40 indicates low concordance. In these cases, the statistical analysis proceeds with the discordance analysis by pairs of informants and for each subscale through the Bland Altman Method. Results. A low concordance (below 0.40) between informants was found especially in internalizing scales (0.230). A slightly higher value was found in attention (0.334), aggressive behaviour (0.371), externalizing (0.357), and total subscales (0.327). Secondly, it was observed that, when informing about somatic complains, thought and attention problems, internalising items and the total scale, parents reported more alterations, followed by adolescents and teachers. Also, parents indicated more withdrawal problems in adolescents, although in this case they were followed by teachers and adolescents themselves. Finally, in the evaluation of the anxiety/depression scales, social problems, delinquent behaviour, aggressiveness and externalising conducts, adolescents informed of more alterations followed by their parents, and then by the teachers. Regarding the agreement/disagreement variability throughout the scales scores, the discordance between different informants was higher when the punctuation was further away from normality, generally when the scales were scored higher. Discussion. The normative criteria of comparison and the reference frames for each group of informants are different. For instance, the fact that teachers report less behavioural alterations could be explained because of their familiarity in dealing with adolescents and a higher tolerance towards some behaviors. In general terms, this result fits in with most conclusions from investigations carried out in this field. On the other hand, the fact that parents inform of more internalising problems could be attributed to adolescent behaviour which would in turn alter the family context. Another explanation might be that parents are on the whole more implicated and more sensitive in detecting certain conducts or behavioural alterations in their offspring. In any case, it is disputable whether the lack of concordance between the different informants does really exist or, on the contrary, adolescent behaviour changes depending on the context. Finally, a result contradicting those found in the studies reviewed is that adolescents are the ones who report more externalising problems. Other authors have found that adolescents inform more about internalising problems, something which should be expected taking into account that they are the ones who know themselves better. This could be possibly explained by the presence of more social desirability/undesirability among the adolescents of our sample in front of their pair group when answering to the evaluation scales; this may be due to the group context in which the case was applied. The main limitation of the present study that it was carried out with a general population sample, although from another point of view this may be considered as a gain of the study. We recommend carrying out explicative studies about discordance, which could clarify the predictive validity of each informant group and make variations in the type of sample under study. Conclusions. Data from different sources contribute with specific information of relative validity. This is why a multidimensional, multisituational and mulitiinformant approach is fundamental. This is necessary not only to evaluate behavioural alterations in adolescents within a research context, but also when taking diagnostic decisions in a clinical context, because, depending on the chosen informant, the diagnostic criteria for one disorder or another might change. Also, our results imply that there may be an underdetection of behavioural problems in adolescents by the adults, which would result in a lower psychological demand than the necessary.

¿Explica la esquizotipia la discordancia entre informantes de alteraciones conductuales adolescentes?

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Summary: Introduction. Behavioural alterations are a quite potent predictor for schizophrenia. Very often, apparently healthy adolescents (who will later develop schizophrenia) present altered conducts similar to those manifested by schizophrenic subjects and as predictors for the disorder. There are studies that describe the relationship between these behavioural alterations and the features found in schizotypical personality disorder or schizophrenic symptoms. In this way, it has been established that those subjects who obtain high scores in schizotypy present more behavioural alterations. Concretely, the different behavioural alterations have been differentially related to the positive and negative subtypes of the schizotypical personality, suggesting continuity between the nature of premorbid conducts and the adult symptoms patterns in which the illness develops. On the other hand, comparing adolescents that will later develop schizophrenia with those who will not, it has been found that the best schizophrenia predictor is a poor behavioural adjustment. Moreover, if the teachers' reports are examined, there can be certain aspects such as the early behavioural patterns which will identify children who, for instance, will develop schizophrenia thirty years later, or even differential patterns according to the gender of the subjects. Therefore, if we want to carry out a schizophrenia prediction according to these behavioural criteria, knowing which informants are more useful and how their opinions match among them is of a great interest. Until this moment, the majority of studies have pointed out at the ability of teachers to identify conducts that can be used to select people at risk for schizophrenia. However, having into account that numerous studies conclude that there is a lack of agreement between these and other different informants for behavioural alterations in adolescents, the importance of studying the variables that can be influencing this matter must be raised. Following with the line of our research group a question is raised. We wonder if the presence of schizotypical personality traits makes the adolescents behaviour more ambiguous, with the consequent difficulty to define it in a coincident way from different evaluators and from themselves. Objectives. To analyse the influence of the schizotypical personality (assessed with the Oxford-Liverpool Inventory of Feelings and Experiences), the demographic variable gender and the interaction between them, in the discordance of different informants (parents, teachers and adolescents) when they inform about behavioural problems in adolescents (assessed with the Achenbach's scales). Methodology. This is an analytic transversal study that can be framed into a longitudinal study of 2 cohorts from the general population, which started on 2000 and has been then followed-up ("Psychoeducation program and early detection of schizophrenic disorders of adolescent onset"). Participants. 160 triads of parents, teachers and adolescents from 13 to 16 years old selected from 7 schools of Barcelona took part in the study. Instruments. The three forms of the Achenbach scale for the measure of behavioural alterations were applied: Youth Self- Report, Child Behaviour Checklist/4-18 and Teacher's Report Form. These forms contain 8 scales which are invariant throughout informants: Withdrawn, somatic complaints, anxious/depressed, social problems, thought problems, attention problems, delinquent behaviour and aggressive behaviour. Some of them are grouped in second order factors: Internalizing, externalizing and total. To evaluate the psychometrical schizotypical personality of adolescents we used the Oxford-Liverpool Inventory for Feelings and Experiences. It consists of an autoadministered inventory with 159 items that includes four schizotypical scales. The Unusual Experiences scale reflects the positive dimension of schizotypy and includes items of unusual perception aberrations and magical thinking. The Introvert Anhedonia Scale reflects the negative dimension of schizotypy and consists of items assessing restricted affect, social isolation and anhedonia. The Cognitive Disorganization Scale refers to disorganized aspects of the psychosis and it is composed of items assessing difficulties in concentration and decision-making. Finally, the Impulsive Nonconformity Scale reflects the characteristics of impulsive-type personality, social anxiety and maladjusted behaviours. Statistical proceed. Multiple regression analyses were carried out in order to revise the influence of the schizotypical personality, the demographic variable gender and the interaction between them as possible explicative variables, in the discordance between different informants about behavioural problems of adolescents. The dependent variable was a measure of the level of discordance between the three groups of informants. Results. A major discordance between informants of behavioural problems was found as schizotypy was higher. Concretely, a larger number of unusual experiences in adolescents increase the discordance for thought and internalizing problems. Discordance is also higher in aggressiveness and anxiety/depression as cognitive disorganization increases. Also, the higher the introverted anhedonia, the higher the discordance is for social problems, anxiety/depression, attention, externalizing problems, and for the total. To finish, a high score in non-conformity impulsivity increases the discordance for attention, delinquency and aggressive problems. About the influence of gender, discordance between informants for anxiety/depression is higher for females than for males. However, this varies when the interaction effects found are considered. In this way, a differential effect for the increase of non-conformity impulsivity and introvert anhedonia can be observed in males and females. Therefore, discordance between informants is higher when evaluating anxiety/ depression in males when non-conformity impulsivity is high. Just the opposite happens for girls. In addition, the discordance for the internalizing subscale increases just as the introverted anhedonia raises for females, but it decreases when evaluating males. Discussion. It seems clear that no source of data can be substituted for any other when evaluating behavioural problems in adolescents and much less when attention is centred in those adolescents who score high in schizotypy. Specifically, when evaluating the behaviour of those subjects who score high in the positive dimension of schizotypy, the agreement between informants decreases for thought and internalizing problems; and, when the behaviour of those who are defined for a more negative schizotypy is evaluated, the agreement decreases for social problems, anxiety/ depression, externalizing and total. Having all this into account and adding information that other authors have found related to each schizotypy subtype (which, besides, are the ones which more concordance show), some conclusions could be raised. It can be assumed as evident that schizotypical personality (and each trait type) and the subjacent conduct in these subjects can generate a difficulty in perceiving certain conducts which are not predominant in the subject, with the consequent discordance between informants. For future studies, it would be very interesting to carry out studies examined which group of informants augurs the behavioural predisposition for schizophrenia and its dimensions in the most accurately way possible. Conclusions. A most exact and objective method to assess behavioural problems as well-demonstrated predictor to schizophrenia, is necessary in order to select vulnerable teenagers to the illness and to develop programs of early intervention.

Edema pulmonar en cirugía laparoscópica ginecológica / Pulmonary edema in surgery laparoscópica gynaecological

Reporte de de un caso de edema pulmonar en el postoperatorio inmediato de uan cirugia laparascópica ginecológica. La etiología del edema pulmonar en este caso no pudo ser determinada con precisión, pero se plantea con precisión, pero se plantearon dos posibles causas que lo explicaran. La primera sería un aumento súbito del retorno venoso luego de la remoción del CO2 de la cavidad peritoneal, lo que a su vez producira una sobre carga de liquidos. La segunda sería un aumento en la permeabilidad capilar pulmonar que podria resultar...

Epidemiological and clinical aspects of snakebites in Bolívar state Venezuela

Se estudia retrospectivamente los aspectos clínicos y epidemiológicos de los pacientes con mordeduras de serpientes en el Estado Bolívar, Venezuela. Se revisaron los expedientes de 284 pacientes del Hospital Universitario "Ruíz y Páez" en Ciudad Bolívar, Venezuela, desde enero 1990 hasta diciembre 1999 que sufrieron mordeduras de serpientes. La mayoría de estos pacientes fueron trabajadores rurales, 155 (76,4) hombres y 48 (23,6 por ciento) mujeres, con edades entre un año y mayores de sesenta años. Ciento cuatro (51,7 por ciento) pacientes fueron mordidos por serpientes del genero Bothrops, 75 (37,0 por ciento) por Crotalus y 23 (11,3 por ciento) por Lachesis. Cientoveinticuatro (86,2 por ciento) fueron mordidos en las piernas y 28 (13,8 por ciento) en el brazo. De enero a noviembre fueron los meses de mayor incidencia de envenamientos botrópicos, mientras los envenenamientos crotálicos fueron de junio a diciembre. Los envenenamientos lachésicos fueron de octubre a diciembre. Este estudio mostró que la prevalencia de envenenamientos crotálicos en el estado Bolívar fue más elevado que en otra región de Venezuela. promover estudios epidemiológicos prospectivos será necesario para una mejor comprensión de estas conclusiones

Epidemiological and clinical aspects of snakebite in Monagas state Venezuela

Fueron estudiados retrospectivamente ciento cincuenta y ocho pacientes mordidos por serpientes venenosas en las historias médicas del Hospital Manuel Nuñez Tovar del estado Monagas, Venezuela desde enero de 1990 hasta diciembre de 1999. La mayoría de estos pacientes fueron trabajadores rurales: 124 (78 por ciento) hombres y 34 (22 por ciento) mujeres, en edades desde 1 hasta más de 60 años. Ciento cinco (67 por ciento) pacientes fueron diagnósticados con mordedura de serpientes del género Bothrops y 53 (33 por ciento) por Crotalus. Ciento veinte y un (76 por ciento) fueron mordidos en las piernas y 37 (24 por ciento) en los brazos. Los meses de enero, abril, mayo, septiembre, octubre, noviembre y diciembre fueron los de mayor incidencia para el envenenamiento bothrópico mientras en envenenamiento crotálico fue mayor en los meses de marzo, agosto y diciembre. Este trabajo mostró que la prevalencia del envenenamiento crotálico fue muy alta en comparación con otros estados del país. Estudios adicionales de epidemiología prospectiva serán necesarios para un mejor entendimiento de los hallazgos observados en este trabajo

Epidemiological and clinical aspects of snakebites in Monagas state, Venezuela

Fueron estudiados retrospectivamente ciento cincuenta y ocho pacientes mordidos por serpientes venenosas en las historias médicas del Hospital Manuel Nuñez Tovar del estado Monagas, Venezuela desde enero de 1990 hasta diciembre 1999. La mayoría de estos pacientes fueron trabajadores rurales: 124 (78 por ciento) hombres y 34 (22 por ciento) mujeres, en edades desde 1 hasta mas de 60 años. Ciento cinco (67 por ciento) pacientes fueron diagnosticados con mordedura de serpientes del género Bothrops y 53 (33 por ciento) por Crotalus. Ciento veinte y un (76 por ciento) fueron mordidos en las piernas y 37 (24 por ciento) en los brazos. Los meses de enero, abril, mayo, septiembre, octubre noviembre y diciembre fueron los de mayor incidencia para el envenenamiento bothrópico, mientras el envenenamiento crotálico fue mayor en los meses de marzo, agosto y diciembre. Este trabajo mostró que la prevalencia del envenenamiento crotálico fue muy alta en comparación con otros estados del país. Estudios adicionales en epidemiología prospectiva serán necesarios para un mejor entendimiento de los hallazgos observados en este trabajo

Anopheles aquasalis eggs from two Venezuelan localities compared by scanning electron microscopy

Anopheles (Nyssorhynchus) aquasalis, is the main coastal vector of malaria from northeastern Venezuela to southeastern Brazil. Several authors have argued that An. aquasalis is a high polymorphic species while others indicated that it is a complex of closely related species. This investigation compared the morphology of An. aquasalis eggs from Sinamaica (Zulia State) and Yaguaraparo (Sucre State), the west and east of Venezuela, respectively. We were able to separate eggs from the two localities using discriminant analyses based on ratios and percentages of anterior and posterior tubercles measured by scanning electron microscopy. The results of this work suggest that An. aquasalis has high intraspecific variation.

Pie plano en el niño y acortamiento de sóleo y gemelos / The flat foot inthe children and shortening of soleo and geminus

El pie plano se menciona como una situación temporal que corrige espontáneamente. Se presentan 16 pacientes con pie plano y acortamiento sóleo y gemelos estudiándose clínico y radiológicamente. Se aplica tratamiento con ejercicios de estiramiento muscular y ortesis de polipropileno. Se obtuvieron excelentes y buenos resultados con el tratamiento conservador en 26 pies y malos resultados en 6 pies ameritando tratamiento quirúrgico que consistió en alargamiento del tendón de aquiles y atrodesis sub-astragalina. Se obtuvo en 3 pacientes excelentes y buenos resultados y en 2 pies malos resultados

Contribuicao ao estudo do nervo maxilar da fossa pterigopalatina. / Maxillary nerve of the pterygopalatine fossa

O conteudo nervoso da fossa pterigopalatina foi estudado pelos autores atraves da microdisseccao em 20 hemi-cabecas, com acesso pelas vias endonasal e transmaxilar. Neste trabalho inicial foi realizado o estudo sistematico do nervo maxilar e de sua ramificacao no interior da fossa, desde a emergencia atraves do forame redondo ate a penetracao do canal infra-orbital. Intensa e complexa ramificacao foi observada, com a emissao de ramos em todas as direcoes, alem de numerosas anastomoses em suas trajetorias. Puderam ser identificados diversos ramos, como orbitarios, ganglionares, palatinos, antrais e alveolares superiores posteriores e medios

Variacao anatomica do plexo infra-orbital. Relato de um caso. / Anatomical variation of the infra-orbital plexus. Report of a case

Os autores relatam um caso de variacao anatomica do plexo infra-orbital em uma cirurgia do seio maxilar. Ressaltam a possibilidade do encontro de estruturas vizinhas ao antro dentro desta, e comentam a anatomia e variacoes do plexo infra-orbital. Salientam a necessidade de um exame pre-operatorio detalhado da cavidade sinusal, antes de um procedimento cirurgico a este nivel. O intuito e o de preservar estruturas anatomicas que porventura estejam no interior do seio maxilar