The expanded endoscopic endonasal approaches for the skull base / Abordagens endonasais endoscópicas expandidas para a base do crânio

Antecedentes: Abordagem endoscópica endonasal expandida (AEEE) em cirurgia de base de crânio (CBC) é uma alteração significativa das práticas atuais. Métodos: Analisamos nossa experiência na Universidade de Pittsburgh com AEEE para 800 pacientes de 1998 a julho de 2007. Resultados: Acessos modulares para múltiplas patologias de base do crânio foram concebidos totalmente baseados na anatomia intrínseca da região. Fases de treinamento foram estabelecidas em função do nível de dificuldade técnica e o potencial de risco de lesões vasculares e neurais. Cinco níveis foram definidos de forma incremental. Conclusões: Padronização prática, com formação modular e incremental, é projetada com o intuito de proporcionar aprendizado de modo organizado e seguro das AEEE para a base do crânio. Sugerimos adesão a um programa sistemático de aquisição de habilidades endoscópicas, trabalhar em equipe integrada de cirurgiões e ter amplo domínio tanto da CBC convencional quanto de cirurgia endoscópica. Por isso, a escolha do método cirúrgico deve ser em função específica da anatomia e patologia e não decorrente de viés ou falha de experiência do cirurgião com abordagens alternativas.

Background: Endoscopic endonasal approach (EEA) for skull base surgery (SBS) is a significant modification of the current practice.Methods: We reviewed our experience at the University of Pittsburgh with EEAs for 800 patients from 1998 to July 2007. Results: Modular approaches to multiple pathologies of the skull base were designed totally based on intrinsic anatomy. Stages of training were established based on the level of technical difficulty and potential risk of vascular and neural injury. ive levels were defined in an incremental manner. Conclusions: Practice standardization with modular, incremental training is projected to facilitate the gaining of knowledge and skills to safely master EEAs for SBS in an organized manner. We suggest adherence to the systematic acquisition of ndoscopic skills, to work as an integrated team of surgeons and to have a thorough perspective of conventional SBS and endoscopic surgery. Therefore, the choice of approach must be a specific function of the anatomy and pathology rather than the surgeon’s bias or lack of experience with alternative approaches.

Teens in trouble: cigarette use and risky behaviors among private, high school students in La Paz, Bolivia / Adolescentes en problemas: consumo de cigarrillos y conductas de riesgo en estudiantes de escuelas privadas de enseñanza media superior de La Paz, Bolivia

OBJECTIVE: To describe the prevalence of cigarette smoking and to identify risky behaviors associated with smoking among adolescents attending high schools in a district of La Paz, Bolivia. METHODS: The Youth Risk Behavior Survey was administered to a sample of 394 males and 182 females, from 13-18 years of age, at six, randomly-selected schools in District II of La Paz. Frequencies, chi-square tests, and logistic regression were employed to identify factors associated with cigarette use during the 30 days prior to the survey. RESULTS: Approximately 40 percent of the sample (39.4 percent of males and 33.7 percent of females) had smoked cigarettes in the 30 days prior to interview. For both males and females, consumption of alcohol was the single greatest risk factor associated with cigarette use. The males and females who reported consuming at least one alcoholic beverage on three or more occasions in the previous 30 days were 22.3 and 58.5 times (95 percent CIs: 6.7, 74.1 and 6.8, 502.6, respectively) more likely to smoke tobacco than those who reported no alcohol consumption. Additional risk factors included having participated in a physical fight, having carried a weapon, having had sexual intercourse, and having used illicit drugs during the previous 30 days. CONCLUSIONS: Because teenagers who smoke are also likely to engage in a variety of other risky behaviors, parents, school administrators, and health educators may wish to use smoking to identify at-risk individuals. Among Bolivian teenagers, interventions should focus on preventing cigarette use and associated risk behaviors.

OBJETIVO: Describir la prevalencia del consumo de cigarrillos e identificar las conductas de riesgo asociadas con el hábito de fumar en adolescentes de enseñanza media superior de un distrito de La Paz, Bolivia. MÉTODOS: Se aplicó la Encuesta sobre Conductas de Riesgo en los Jóvenes a una muestra de 394 varones y 182 mujeres de 13-18 años de edad de seis escuelas del Distrito II de La Paz seleccionadas al azar. Se identificaron los factores asociados con el consumo de cigarrillos durante los 30 días previos a la encuesta, mediante el análisis de frecuencias, la prueba de la ji al cuadrado y la regresión logística. RESULTADOS: Aproximadamente 40 por ciento de la muestra (39,4 por ciento de los varones y 33,7 por ciento de las mujeres) había fumado cigarrillos en los 30 días previos a la encuesta. Tanto para ellos como para ellas, el consumo de alcohol fue el mayor factor de riesgo asociado con el consumo de cigarrillos. Los varones y las mujeres que informaron haber consumido al menos una bebida alcohólica en tres ocasiones o más durante los 30 días previos presentaron 22,3 y 58,5 veces (IC95 por ciento: 6,7 a 74,1 y 6,8 a 502,6, respectivamente) mayor probabilidad de fumar que los que informaron no haber consumido alcohol. Otros factores de riesgo adicionales fueron haber participado en una pelea física, haber portado un arma, haber tenido relaciones sexuales y haber tomado alguna droga ilícita durante los 30 días anteriores. CONCLUSIONES: Debido a que los adolescentes que fuman tienden también a incurrir en otras conductas de riesgo, los padres, los responsables escolares y los educadores sanitarios podrían utilizar el hábito de fumar para identificar a los adolescentes en riesgo. Las intervenciones dirigidas a adolescentes bolivianos deben enfocarse en la prevención del consumo de cigarrillos y de las conductas de riesgo asociadas.