Complicações em cirurgias e procedimentos lipoaspirativos: uma revisão da literatura / Complications in surgeries and lipoaspirative procedures: a review of the literature / Complicaciones en cirugías y procedimientos lipoaspirativos: una revisión de la literatura

O atual estudo objetiva evidenciar as complicações surgidas a partir de uma cirurgia de lipoaspiração no que diz respeito aos seus impactos na saúde dos pacientes. Trata-se de uma revisão integrativa, realizada por meio da pesquisa dos seguintes Descritores em Ciências da Saúde (DeCS): complications and liposuction. Sendo selecionados artigos de 2019 a 2023 que foram publicados até o dia 26/05/2023, selecionando-se 22 artigos, dos quais foram excluídos 15 e restaram apenas 7 artigos revisados. Lipoaspiração se resume em uma técnica cirúrgica que é utilizada para a remoção dos depósitos de gordura, sendo que possui finalidade estética, no entanto este procedimento pode cursar com consequências danosas à saúde dos pacientes como tromboembolismo, sepse e dentre outros. Tendo em vista essas complicações, a melhor opção é o investimento na formação de profissionais de qualidade e uma maior fiscalização aos centros e salas cirúrgicas.

The current study aims to highlight the complications arising from liposuction surgery with regard to its impacts on patients' health. This is an integrative review, carried out through the research of the following Descriptors in Health Sciences (DeCS): complications and liposuction. We selected articles from 2019 to 2023 that were published until 26/05/2023, selecting 22 articles, of which 15 were excluded and only 7 revised articles remained. Liposuction is summarized in a surgical technique that is used for the removal of fat deposits, being that it has aesthetic purpose, however this procedure can occur with harmful consequences to the health of patients such as thromboembolism, sepsis and among others. In view of these complications, the best option is to invest in the training of quality professionals and greater supervision of the operating centers and operating rooms.

El presente estudio tiene como objetivo destacar las complicaciones derivadas de la cirugía de liposucción con respecto a sus impactos en la salud de los pacientes. Se trata de una revisión integradora, realizada a través de una encuesta de los siguientes descriptores en Ciencias de la Salud (DeCS): complicaciones y liposucción. Con los artículos seleccionados de 2019 a 2023 que se publicaron antes del 26/05/2023, se seleccionaron 22 artículos, de los cuales 15 quedaron excluidos y sólo quedaban siete revisados. La lipoaspiración se resume en una técnica quirúrgica que se utiliza para la remoción de depósitos de grasa, y tiene un propósito estético, aunque este procedimiento puede tener consecuencias perjudiciales para la salud de los pacientes como tromboembolismo, sepsis y otros. En vista de estas complicaciones, la mejor opción es invertir en la formación de profesionales de calidad y en una mayor supervisión de los centros y salas quirúrgicos.

Evaluation of oxidative stress in an experimental model of Crohn's disease treated with hyperbaric oxygen therapy

Abstract Introduction: Treatments of Inflammatory Bowel Disease (IBD) are able to control symptoms in most cases, however, a fraction of patients do not improve or have a loss of response to treatments, making it important to explore new therapeutic strategies. Hyperbaric oxygen therapy (HBO) may represent one of them. The aim of this study was to evaluate the effects of HBO therapy in an experimental model of IBD. Methods: Sixty male BALBc mice were divided into six groups. Group 1 was colitis-induced with trinitrobenzene sulfonic acid (TNBS) + ethanol, group 2 received TNBS + ethanol plus HBO, group 3 received only ethanol, group 4 received ethanol plus HBO, group 5 received saline solution, and group 6 received saline solution plus HBO. HBO was performed for four days, subsequently, the mice were evaluated daily. At the end of the study, samples from the intestine were collected for histological analysis as well as for measurement of antioxidant enzymes and cytokine levels. Results: HBO significantly improved the clinical and histological status of the animals. Treatment with HBO increased the activity of the antioxidant enzymes superoxide dismutase (SOD) and glutathione peroxidase (GPx) in all of the groups; moreover, the difference was only significant between the TNBS and TNBS + HBO groups and treatments promoted a reduction in the proinflammatory cytokines IFN-γ, IL-12, IL-17 and TNF-α and increased the anti-inflammatory cytokines IL-4 and IL-10, with no changes in IL-13. Conclusion: HBO effectively treats TNBS-induced colitis by increasing the activity of antioxidant enzymes and modulating cytokine profiles.

Referral reasons for evaluating childhood glaucoma in a tertiary service / Motivos de encaminhamento para avaliação de glaucoma infantil em serviço terciário

ABSTRACT Purpose: To report the distribution of referral reasons for children from a pediatric glaucoma outpatient clinic in a tertiary eye care service. Methods: The medical records of patients aged <18 years who were referred to a pediatric glaucoma center in the city of São Paulo, Brazil, between 2012 and 2018 were retrospectively reviewed. The data collected included the referral reasons, age, hospital of origin, and who detected the ocular alteration. For defining the diagnosis, the Childhood Glaucoma Research Network classification was used. Results: Five hundred sixty-three eyes of 328 patients were included in the study. Glaucoma diagnosis was confirmed in 162 children (49%). In 83 patients (25%), the glaucoma diagnosis was ruled out, and 83 (25%) continued outpatient follow-up for suspected glaucoma. The main referral reasons were a cup-to-disc ratio >0.5 or an asymmetry ≥0.2 (24%), intraocular pressure >21 mmHg (21%), and corneal opacity (15%). In the neonatal period, the referral reasons were corneal opacity, buphthalmos, tearing, and photophobia. After the neonatal period, besides these external changes, other signs were also reasons for referral, such as cup-to-disc ratio >0.5 or asymmetry ≥0.2, intraocular pressure >21 mmHg, and myopic shift. The referrals were made by health professionals in 69% and parental concern in 30% of the cases. In 97% of the primary congenital glaucoma cases, the parents were the first to identify the change and to seek for health care. Conclusions: The referral reasons of the children to a tertiary glaucoma clinic were differed between the age groups and diagnoses. We suggest that awareness with these findings is important to avoid and postpone diagnosis, identify their impacts on prognosis, and avoid spending important resources for the management of diseases with inaccurate referrals.

RESUMO Objetivos: Relatar a distribuição dos motivos de encaminhamento de crianças para ambulatório de glaucoma infantil em um serviço oftalmológico terciário. Métodos: Dados médicos de pacientes menores que 18 anos encaminhados para ambulatório de glaucoma infantil na cidade de São Paulo, Brasil, de 2012 a 2018 foram retrospectivamente analisados. Os dados incluíram os motivos de encaminhamento, a idade, a origem e quem detectou a alteração ocular. Para definição diagnóstica, a classificação do Childhood Glaucoma Research Network foi usada. Resultados: 563 olhos de 328 pacientes foram incluídos no estudo. O diagnóstico de glaucoma foi confirmado em 162 crianças (49%). 83 (25%) pacientes tiveram diagnóstico de glaucoma descartado, e 83 (25%) continuaram em acompanhamento como glaucoma suspeito. Os principais motivos de encaminhamento foram relação escavação-disco >0,5 ou assimetria ≥0,2 (24%), pressão intraocular >21 mmHg (21%) e opacidade corneana (15%). No período neonatal, os motivos de encaminhamento foram opacidade corneana, buftalmo, lacrimejamento e fotofobia. Após o período neonatal, além desses sinais externos, outros sinais foram também motivos de encaminhamento, como escavação-disco >0,5 ou assimetria ≥0,2, pressão intraocular >21 mmHg e miopização. Os encaminhamentos ocorreram por profissionais de saúde em 69% e preocupação dos pais em 30%. Os pais foram os primeiros a identificar as alterações e procurar cuidado médico em 97% dos casos de glaucoma congênito primário. Conclusões: Os motivos de encaminhamento de crianças para um serviço de glaucoma de glaucoma terciário foram determinados e diferem em diferentes faixas etárias e grupos. Os autores reforçam a necessidade de alertar diferentes grupos para os sinais mais comuns, a fim de evitar, não só o adiamento do diagnóstico, o que impacta no prognóstico, mas também despender recursos importantes direcionados ao enfrentamento dessas doenças, com encaminhamentos imprecisos.

Pancreatic endosonographic findings and clinical correlation in Crohn's disease

OBJECTIVES: We aimed to evaluate the incidence of pancreatic alterations in Crohn's disease using endoscopic ultrasound (EUS) and to correlate the number of alterations with current clinical data. METHODS: Patients diagnosed with Crohn's disease (n=51) were examined using EUS, and 11 variables were analyzed. A control group consisted of patients with no history of pancreatic disease or Crohn's disease. Patients presenting with three or more alterations underwent magnetic resonance imaging (MRI). Pancreatic function was determined using a fecal elastase assay. RESULTS: Two of the 51 patients (3.9%) presented with four EUS alterations, 3 (5.9%) presented with three, 11 (21.5%) presented with two, and 13 (25.5%) presented with one; in the control group, only 16% presented with one EUS alteration (p<0.001). Parenchymal abnormalities accounted for 39 of the EUS findings, and ductal abnormalities accounted for 11. Pancreatic lesions were not detected by MRI. Low fecal elastase levels were observed in 4 patients, none of whom presented with significant pancreatic alterations after undergoing EUS. Ileal involvement was predictive of the number of EUS alterations. CONCLUSION: A higher incidence of pancreatic abnormalities was found in patients with Crohn's disease than in individuals in the control group. The majority of these abnormalities are related to parenchymal alterations. In this group of patients, future studies should be conducted to determine whether such morphological abnormalities could evolve to induce exocrine or endocrine pancreatic insufficiency and, if so, identify the risk factors and determine which patients should undergo EUS.

Recommendations for hypofractionated whole-breast irradiation

SUMMARY This recommendation consensus for hypofractionated whole-breast radiotherapy (RT) was organized by the Brazilian Society of Radiotherapy (SBRT) considering the optimal scenario for indication and safety in the technology applied. All controversies and contraindication matters (hypofractionated RT in patients who underwent chemotherapy [CT], hypofractionated RT in lymphatic drainage, hypofractionated RT after mastectomy with or without immediate reconstruction, boost during surgery, hypofractionated RT in patients under 50 years old, hypofractionated RT in large breasts, hypofractionated RT in histology of carcinoma in situ [DCIS]) was discussed during a meeting in person, and a consensus was reached when there was an agreement of at least 75% among panel members. The grade for recommendation was also suggested according to the level of scientific evidence available, qualified as weak, medium, or strong. Thus, this consensus will aid Brazilian radiotherapy experts regarding indications and particularities of this technique as a viable and safe alternative for the national reality.

RESUMO Este consenso de recomendações para a radioterapia (RT) hipofracionada de toda a mama foi organizado pela Sociedade Brasileira de Radioterapia (SBRT) considerando o cenário ideal para indicação e segurança na tecnologia aplicada. Questões de controvérsias e contraindicações (RT hipofracionada em pacientes submetidas à quimioterapia [QT], RT hipofracionada nas drenagens linfáticas, RT hipofracionada após mastectomia com ou sem reconstrução imediata, a realização de reforço de dose em leito cirúrgico [ou boost], RT hipofracionada em pacientes com idade menor que 50 anos, RT hipofracionada em mamas volumosas, RT hipofracionada em histologia de carcinoma in situ [CDIS]) foram discutidas em encontro presencial, sendo o consenso atingido quando existisse concordância de pelo menos 75% dos panelistas. O grau de recomendação foi também sugerido de acordo com o nível de evidência científico disponível, qualificado entre fraco, médio ou forte. Assim, este consenso deverá servir para auxiliar os especialistas da radioterapia brasileira em relação às indicações e particularidades dessa técnica, como uma alternativa segura e viável para a realidade nacional.

As artes adivinhatórias e a psiquiatria do futuro / The divinatory arts and the psychiatry of the future

Resumo Estuda-se a psiquiatria como "arte adivinhatória ou divinatória" engajada na previsão do futuro. Pretende-se assinalar o projeto biopolítico de gerenciamento da vida atrelado à psiquiatria contemporânea. Para tanto, analisa-se a quinta edição do Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM-5), da Associação Americana de Psiquiatria (APA), em sua introdução da discussão da noção de risco, que estabelece ao campo psiquiátrico a prevenção primária como uma de suas metas principais. Isso reflete a reintrodução do eixo dimensional ao modelo categorial adotado pelo DSM, produzindo uma inflação diagnóstica, e denota o mal-estar da psiquiatria contemporânea frente aos seus alcances e limites.(AU)

Abstract Psychiatry is studied as "divinatory art" engaged in predicting the future. It is intended to mark the management of life as a biopolitical enterprise linked to contemporary psychiatry. Therefore, the Diagnostic and Statistical Manual of Mental Disorders - Fifht Edition (DSM-5), edited by American Psychiatric Association (APA), is analyzed focusing the discussion about the notion of risk, establishing primary prevention a major goal of the psychiatric field. This reflects the reintroduction of dimensional axis into the categorical model adopted by DSM that produces a diagnostic inflation, and denotes the discontents of contemporary psychiatry front of their scope and limits.(AU)

The importance of the dentist in the diagnosis of cowden syndrome – Case report

Cowden Syndrome is an autosomal dominant disorder characterized by the development of several hamartomas in a variety of tissues, including the skin, gastrointestinal tract, adipose tissue, and bone and connective tissues. This syndrome is associated with a high risk of developing malignancies, especially breast, thyroid and endometrium cancers. This report presents a case of a 53-year-old patient who sought assistance at the Dentistry Department of the University Hospital of Brasilia (HUB) to receive basic dental treatment. The current and past medical history and oral and facial manifestations led to the diagnosis of Cowden syndrome. This case report aims to highlight the importance of a dental surgeon in the diagnosis of this syndrome, based on the observation of oral manifestations and medical history.

A Síndrome de Cowden é uma desordem hereditária autossômica dominante, caracterizada pelo desenvolvimento de diversos hamartomas em vários tipos de tecidos, incluindo a epiderme, trato gastrointestinal, tecido adiposo e tecidos ósseo e conjuntivo. Essa síndrome é associada a um risco elevado de desenvolvimento de malignidades, especialmente câncer de mama, tireoide e endométrio. Esse relato apresenta o caso de um paciente de 53 anos de idade que procurou o Departamento de Odontologia do Hospital Universitário de Brasília (HUB) para tratamento dental básico. História médica atual e passada e manifestações orais e faciais levaram ao diagnóstico de síndrome de Cowden. Este relato de caso apresenta a importância do cirurgião-dentista no diagnóstico desta síndrome, com base na observação das manifestações orais e história médica.

Relationship between pre-sarcopenia, sarcopenia and bone mineral density in elderly men

Objective Analyze the influence of sarcopenia in bone health of elderly men. Subjects and methods This cross-sectional study evaluated 198 men aged over 60 years. Body composition was measured by dual energy X-ray absorptiometry. The BMD was measured at the femoral neck, total hip, lumbar spine and 33% radius. The diagnosis of abnormal BMD was defined for men who presented densitometric diagnosis of osteopenia or osteoporosis defined by T-score of femoral neck, total hip and lumbar spine. The pre-sarcopenia and sarcopenia were defined according to the European Working Group on Sarcopenia in Older People. Results The group diagnosed with normal BMD, compared to the group of abnormal BMD, have significantly higher body weight, body mass index, grip strength, lean mass, fat mass, and relative appendicular skeletal muscle mass (RASM). However, after multiple linear regression analysis, we found that only the RASM, lean mass, and handgrip strength in the dominant hand influenced the variability of the BMD after adjustment for age and weight. Regression analyzes showed a positive association between greater appendicular lean mass and a smaller number of elderly patients with abnormal BMD diagnostic. The regression analyzes showed that elderly men diagnosed with pre-sarcopenia and sarcopenia had more abnormal BMD than non-sarcopenic elderly men. Conclusion We concluded that pre-sarcopenia and sarcopenia were associated with abnormal BMD. The lean mass, compared to fat mass, has a greater positive influence on the BMD of elderly men. This result suggests the importance of the increase in lean mass for the bone health of elderly men. Arch Endocrinol Metab. 2015;59(1):59-65 .

Prevalence of celiac disease among blood donors in São Paulo: the most populated city in Brazil

OBJECTIVE: Celiac disease is a permanent enteropathy caused by the ingestion of gluten, which leads to an immunemediated inflammation of the small intestine mucosa. The prevalence of celiac disease varies among different nations and ethnic backgrounds, and its diversity is determined by genetic and environmental factors. São Paulo city is one of the largest cities in the world, with a vast population and an important history of internal migratory flow from other Brazilian regions, as well as immigration from other, primarily European, countries, resulting in significant miscegenation. The aim of the present study was to estimate the prevalence of adults with undiagnosed celiac disease among blood donors of São Paulo by collecting information on the ancestry of the population studied. METHODS: The prevalence of celiac disease was assessed by screening for positive IgA transglutaminase and IgA endomysium antibodies in 4,000 donors (volunteers) in the Fundação Pró-Sangue Blood Center of São Paulo, São Paulo, Brazil. The antibody-positive subjects were asked to undergo a small bowel biopsy. RESULTS: Of the 4,000 subjects, twenty-four had positive tests, although both antibody tests were not always concordant. For example, ten subjects were positive for IgA tissue transglutaminase only. In twenty-one positive patients, duodenal biopsies were performed, and the diagnosis of celiac disease was confirmed in fourteen patients (Marsh criteria modified by Oberhuber). In this group, 67% claimed to have European ancestry, mainly from Italy, Portugal and Spain. CONCLUSION: The prevalence of celiac disease is at least 1:286 among supposedly healthy blood bank volunteers in São Paulo, Brazil.

Ultrassonometria do calcâneo, densitometria óssea e morfometria vertebral em homens com idade acima de 60 anos / Quantitative ultrasound of the calcaneus, bone densitometry and vertebral morphometry in men over the age of 60 years

OBJETIVOS: Comparar a ultrassonometria do calcâneo com a densitometria óssea na avaliação de fraturas vertebrais morfométricas em homens acima de 60 anos. SUJEITOS E MÉTODOS: Foram analisados 96 homens com mais de 60 anos por meio de densitometria óssea da coluna, fêmur e rádio, radiografia lateral da coluna torácica e lombar e ultrassonometria do calcâneo. RESULTADOS: Cinquenta e um por cento dos homens apresentaram osteoporose e fraturas vertebrais. Foi observada correlação entre índice de stiffness e T-score da ultrassonometria e as densidades minerais ósseas (DMO) de todos os sítios. Quanto à presença de fraturas, identificou-se correlação com a DMO do rádio ultradistal e 33%. Por meio da curva ROC, observou-se acurácia da DMO do rádio UD na detecção de fraturas vertebrais. CONCLUSÕES: Nosso estudo mostrou correlação entre a ultrassonometria e a densitometria no diagnóstico de osteoporose em homens acima dos 60 anos. Também se identificou correlação entre fratura vertebral morfométrica e a DMO do rádio.

OBJECTIVES: To compare calcaneal ultrasonometry and bone densitometry in the evaluation of morphometric vertebral fractures in men over 60 years of age. SUBJECTS AND METHODS: We studied 96 men over 60 years of age by means of bone densitometry of the spine, femur and radius, lateral radiograph of the thoracic and lumbar spine, and calcaneal ultrasonometry. RESULTS: Fifty-one percent of men had osteoporosis and vertebral fractures. Correlation was found between ultrasonometry stiffness index, T-score and bone mineral density of the spine, femur and radius (p < 0.01). Regarding the presence of fractures, there was a correlation only with BMD of the ultradistal radius (UD) and radius 33%. ROC curve showed accuracy only of UD radius BMD in detecting vertebral fractures. CONCLUSIONS: Our study showed a correlation between osteoporosis diagnosis by ultrasonometry and densitometry in men over 60 years. It also showed a correlation between morphometric vertebral fracture and bone mineral density of the forearm.

Estratégias de vigilância de um acidente envolvendo planta industrial de produção de ácido sulfúrico / Surveillance strategies of an accident involving a sulfuric acid production plant

Após acidente ambiental em empresa produtora de ácido sulfúrico, realizou-se estudo transversal para investigação de sintomas respiratórios e irritativos na população. Aplicou-se questionário em amostra aleatória simples, em pessoas presentes no local no dia da ocorrência, no raio de 900 m do estabelecimento, considerando a direção dos ventos. Foi calculada a prevalência de sintomas segundo gradientes de 300 m e realizado teste de Chi-Quadrado para sintomas isolados e agregados. Os dados foram georreferenciados, e foi ponderada a densidade de sintomas por área. Nas 451 pessoas estudadas, o teste de Chi-Quadrado foi significativo para todos os sintomas, exceto chiado comparando gradientes de distância. Os sintomas agregados apresentaram as seguintes ODDS Ratio (OR): respiratórios altos (OR: 6,18; 2,10; 1,00); irritativos (OR: 6,06; 2,09; 1,00); respiratórios baixos (OR: 4,93; 2,08; 1,00); náuseas e dor de cabeça (OR: 4,66; 2,02; 1,00). Os autores encontraram maior densidade de sintomas nas proximidades da fonte emissora. O estudo contribuiu para desencadear medidas mitigadoras na empresa.

Following an environmental accident in a sulfuric acid production plant, a transversal study was made to investigate respiratory and irritative symptoms on the population. A questionnaire was applied to a simple random sample from people present until 900 meters from the plant by the time of the event, considering the winds' directions. The prevalence of symptoms and Chi-square test was made according to gradients of 300 meters. The density of symptoms per area, geo-referenced, was pondered. The Chi-square test was significant on the 451 people studied for all symptoms, except by wheezing, comparing gradients of distance. The grouped symptoms presented the following ODDS Ratio (OR): high respiratory (OR: 6.18; 2.10; 1.00); irritative (OR: 6.06; 2.09; 1.00); low respiratory (OR: 4.93; 2.08; 1.00); nausea and headache (OR: 4.66; 2.02; 1.00). The authors have found a major density of symptoms in the vicinities of the source. The study contributed to instigate mitigating measures in the company.

Oral cancer staging established by magnetic resonance imaging

The aim of this study was to compare clinical staging and magnetic resonance imaging (MRI) staging for oral cancer, and to assess inter-observer agreement between oral and medical radiologists. A total of 10 patients diagnosed with oral cancer were assessed before treatment. A head and neck surgeon performed clinical TNM staging. Two medical radiologists and two oral radiologists performed a new staging assessment by interpreting MRI scans, without prior knowledge of the clinical staging. They evaluated the extent of the primary tumor (T), metastasis to regional lymph nodes (N) and grouping by stages. The data were analyzed using the Kappa Index. There was significant agreement (p < 0.05) between the clinical and MRI staging assessments made by one oral radiologist for N stage, and between those made by one medical radiologist for the T and N stages and for the grouping by stages. In the MRI assessment, there was significant agreement among all four observers for both T stage and grouping by stages. For the N stage, there was no significant agreement between one oral radiologist and one medical radiologist or between both medical radiologists. There was significant agreement among the remaining radiologists. There was no agreement between the clinical and MRI staging. These results indicate the importance of using MRI for the diagnosis of oral cancer. Training initiatives and calibration of medical and oral radiologists should be promoted to provide an improved multidisciplinary approach to oral cancer.

Mapeamento dos diagnósticos de enfermagem em uma unidade de pneumologia / Mapping nursing diagnoses in a pulmonology unit / Cuadro explicativo de los diagnósticos de enfermería en una unidad de neumología

OBJETIVOS: Identificar os diagnósticos de enfermagem mais frequentes, segundo a taxonomia II da NANDA - I; as características definidoras, fatores relacionados e de risco que deram suporte para elaboração dos mesmos, em pacientes com distúrbios respiratórios. MÉTODOS: Estudo transversal, realizado em um hospital universitário da cidade de São Paulo. Os diagnósticos de enfermagem foram elaborados pela pesquisadora e submetido à validação consensual de três especialistas. Os resultados foram descritos baseados na frequência absoluta e percentual. RESULTADOS: Trinta e quatro pacientes foram avaliados e 35 diagnósticos de enfermagem apresentaram concordância entre a pesquisadora e os especialistas. CONCLUSÃO: Estudos epidemiológicos que informam sobre a frequência dos diagnósticos de enfermagem em uma população contribuem para organizar a base de conhecimento de enfermagem e prever os cuidados de enfermagem necessários a uma população específica.

OBJECTIVES: To identify the most frequent nursing diagnoses according to NANDA International´s Taxonomy II; the defining characteristics, related factors and risk factors, in patients with respiratory disorders. METHODS: Cross-sectional study in a university hospital in São Paulo. The nursing diagnoses were determined by the researcher, and subjected to consensual validation by three experts. Results are based on absolute frequency and percentage. RESULTS: Thirty-four patients were evaluated and 35 nursing diagnoses were identified that achieved consensus across the researcher and the experts. CONCLUSION: Epidemiological studies that report on the frequency of nursing diagnoses in a population contribute to organizing the knowledge base of nursing and the appropriate provision of nursing care required by a specific population.

OBJETIVOS: Identificar los diagnósticos de enfermería más frecuentes, según la taxonomia II de la NANDA - I; las características definidoras, factores relacionados y de riesgo que dieron soporte a la elaboración de los mismos, en pacientes con disturbios respiratorios. MÉTODOS: Estudio transversal, realizado en un hospital universitario de la ciudad de Sao Paulo. Los diagnósticos de enfermería fueron elaborados por la investigadora y sometido a la validación consensual de tres especialistas. Los resultados fueron descritos basados en la frecuencia absoluta y porcentual. RESULTADOS: Fueron evaluados treinta y cuatro pacientes presentando concordancia entre la investigadora y los especialistas 35 diagnósticos de enfermería. CONCLUSIÓN: Estudios epidemiológicos que informan sobre la frecuencia de los diagnósticos de enfermería en una población, contribuyen para organizar la base del conocimiento de enfermería y prever los cuidados de enfermería necesarios a una población específica.

Ressonância magnética no diagnóstico do câncer de boca: revisão da literatura e relato de caso / MRI in the diagnosis of mouth cancer: review and case report

OBJETIVO: Revisar a literatura concernente à utilização da ressonância nuclear magnética no estadiamento do câncer de boca e apresentar caso de neoplasia maligna onde a RNM contribuiu para a detecção da lesão em tecidos moles. RESULTADO E DISCUSSÃO: A RNM é a ferramenta de imagem que evolui com maior rapidez em diagnóstico na área de saúde. Suas vantagens principais são a alta resolução dos tecidos moles e ausência de risco biológico aos pacientes. Com estas qualidades, pode ser usada para detalhar a anatomia, permitindo melhor estadiamento das lesões no câncer bucal, contribuindo igualmente para o diagnóstico precoce de possíveis recidivas. No caso apresentado(neoplasia maligna de pequeno tamanho), a RNM contribuiu para a detecção da lesão em tecidos moles, na extensão da lesão e no planejamento cirúrgico.

OBJECTIVE: To review the literature about cancer staging by using magnetic resonance image (MRI) and to present a case to illustrate the utility of this image diagnosis tool. RESULTS AND DISCUSSION: MRI is the fastest evolving imaging tool for diagnosis in health area. Its main advantages include a high detail resolution soft tissue and no biological risks to patients. Thus, it can be used to evaluate the detailed anatomy of structures, allowing better staging for treatment of patients with oral cavity cancer as well as better assessment of possible post-surgical treatment and/or radiotherapy changes. Early detection of relapses is also a key advantage, which might lead to appropriate monitoring, and protocols that could greatly improve patients’welfare. The present case study illustrates the difference between the CT scan and MRI in the analysis of a small lesion, where CT scan yielded no information on clinical staging while MRI was decisive in the soft tissue injury view, extent of lesion and adequate surgical planning.

Periostite proliferativa associada a dens in dente

Proliferative periostitis is a disease characterized for successive deposition of layers of subperiosteal bone as a response reaction to a chronic inflammatory stimulation. The affected periosteum forms several rows of reactive bone that are parallel and expand the surface of the altered bone. Dens in dente is a developmental malformation resulting from invagination of the crown before calcification has occurred. They are usually diagnosed upon routine clinical and radiographic examination. An unusual case report of a mandibular dens in dente causing proliferative periostitis is presented. The source of infection was related to dens in dente in mandibular left second premolar's crown, which had apparently communication with periodontal tissues. It was successfully treated by surgical therapy with antibiotic duringthe treatment. After the extraction of the affected tooth, radiographic follow-up showed the decrease of proliferative periostitis, and remodelation of the cortical bone.

A periostite proliferativa é uma doença caracterizada por sucessivas deposições de camadas de osso subperióstica como resposta a um estímulo crônico inflamatório. O periósteo afetado forma sucessivas camadas de osso reacional paralelas entre si e expandem a superfície óssea nesse local. Dens in dente é uma alteração do desenvolvimento resultante de invaginação de esmalte para a dentina antes de sua calcificação ocorrer. Usualmente são diagnosticadas em exames clínicos-radiográficos de rotina. Um relato de caso clínico raro é apresentado sobre dens in dente na coroa do segundo pré-molar inferior causando periostite proliferativa. A fonte de infecção foi o dens in dente que tinha comunicação do meio bucal com a área do periodonto. Foi realizada a extração do dente anômalo associado com uso de antibióticos. As radiografias de controle mostraram diminuição da periostite proliferativa como remodelamento do osso cortical.

Seqüelas dentomaxilofaciais em crianças submetida a tratamento multimodal para rabdomiossarcoma / Dentomaxillofacial sequelae in a Child Reated for Rhabdomyosarcoma

O rabdomiosarcoma é o sarcoma de tecidos moles mais comum em crianças e adolescentes. A multimodalidade terapêutica para tumores de cabeça e pescoço, embora eficaz, pode resultar em uma variedade de complicações orais, com efeito significativo sobre o crescimento esquelético maxilomandibular e sobre o desenvolvimento dentário.Neste relato de caso, discutem-se as principais anormalidades tardias encontradas em um sobrevivente pediátrico que teve o tumor, o qual foi irradiado em estádio precoce do desenvolvimento dental. As anormalidades dentomaxilofaciais encontradas incluíram defeitos de esmalte, encurtamento radicular, microdontia, agenesia dentária, mobilidade dentária, micrognatia e assimetria facial. As morbidades cosméticas e funcionais encontradas exigem acompanhamento em longo prazo para melhorar a qualidade de vida da criança após o tratamento da lesão.

Rhabdomyosarcoma is the most common soft tissue sarcoma in children and adolescents. Multi-modality therapy for tumors in the head and neck region may result in a variety of oral complications, with a significant effect on maxillofacial skeletal growth and dental development. This article reports on major oral abnormalities in one long-term survivor of paediatric head and neck rhabdomyosarcoma who had irradiation at an early stage of their teeth’s development. Dentomaxillofacial abnormalities found included enamel defects, disturbance in the root development, microdontia, tooth agenesis, severe dental mobility, micrognatia and facial asymmetry. In addiction, the cosmetic and functional morbidity require follow-up over time to improve patients’ quality of life in survivors of oncologic treatment.

Homens idosos com osteoporose são mais magros, têm menor índice de massa corporal e menor índice de rigidez / Elderly men with osteoporosis are thinner, have lower body mass index and lower stiffness index

Objetivo. Correlacionar o índice de rigidez com os resultados das densitometrias ósseas da coluna lombar, do fêmur proximal e do antebraço distal. Métodos. Foram avaliados 171 homens idosos moradores da comunidade sem diagnóstico de doenças osteometabólicas. A avaliação clínica buscou os fatores de risco de baixa massa óssea e fratura por trauma mínimo. A densitometria óssea considerou para a análise densitométrica as regiões de L1-L4, colo femoral, trocânter, quadril total, rádio 33%. O índice de rigidez foi o parâmetro considerado na ultrassonometria. Os resultados da densitometria e da ultrassonometria ósseas foram avaliados quanto ao T-Score ≤ -2,0 ou > -2,0. Resultados. A idade variou de 60 a 88 anos, com média de 69 ± 6,1. A média do índice de massa corporal foi 25,8 ± 3,6. Verificou-se tabagismo atual em 31,6% e 5,1% referiram etilismo. Receberam diagnóstico de osteoporose 39,2%, e 18,1% tiveram densitometria normal. Houve diferença quanto ao peso, índice de massa corporal, índice de rigidez e o T-Score do índice de rigidez entre os grupos quanto ao T-Score ≤ -2,0. Houve correlações fracas entre o índice de rigidez e as densidades minerais ósseas. Conclusão. As fracas correlações entre o índice de rigidez e as densidades minerais ósseas limitam o uso do método no diagnóstico de osteoporose nessa população. Os achados indicam que o índice de rigidez não é bom preditor da densidade mineral óssea avaliada pela densitometria. Entretanto, os homens com diagnóstico de osteoporose foram mais magros, com menor índice de massa corporal e tiveram menor índice de rigidez.

Objective. To correlate the stiffness index with results of bone densitometry of the lumbar spine, proximal fêmur and distal forearm. Methods. We evaluated 171 community-dwelling elderly men without diagnosed bone diseases. Clinical evaluation assessed risk factors for low bone mass and fracture by minor trauma. Densitometry evaluation considered the boné density measures at the regions of L1-L4, femoral neck, trochanter, total hip, radio 33%. Quantitative ultrasound considered stiffness index in the analysis. The results of bone densitometry and quantitative ultrasound were assessed for T-score ≤ -2.0 or > -2.0. Results. The age ranged from 60 to 88 years, averaging 69 ± 6.1. The mean body mass index was 25.8 ± 3.6. Patients reported smoking in 31.6% and alcohol abuse in 5.1% of times. Osteoporosis was diagnosed in 39.2% and 18.1% had normal density. There was difference as to weight, body mass index, stiffness index and the index T-score of stiffness index between the groups in the T-Score ≤ -2.0. There were weak correlations between the stiffness index and bone mineral density. Conclusion. The poor correlation between stiffness index and bone mineral density limit the use of the method in the diagnosis of osteoporosis in this population. These findings indicate that stiffness index does not predict bone density as effectively as bone densitometry by the current standard methodology. However, men diagnosed with osteoporosis were thinner, with lower body mass index and had lower stiffness index.

Radiografia panorâmica: instrumento auxiliar no diagnóstico da osteoporose: [revisão] / Panoramic radiograph: auxiliary tool in the diagnosis of osteoporosis: [review]

A osteoporose é considerada um problema de saúde pública pela Organização Mundial de Saúde (OMS). A identificação de indivíduos com baixa densidade mineral óssea e alto risco para fratura associada à osteoporose e o estabelecimento de estratégias específicas de prevenção de fraturas são o alicerce de qualquer programa preventivo de osteoporose. O passo seguinte a esse reconhecimento seria o encaminhamento destes indivíduos para realização de densitometria óssea, exame considerado padrão-ouro para o diagnóstico da doença. No entanto, o custo e a falta de acesso da população ao exame são fatores que dificultam a utilização da densitometria como método de rastreamento populacional para a osteoporose. A radiografia panorâmica é importante na rotina de pacientes idosos, particularmente antes da colocação de próteses totais e implantes em edêntulos. Existem medidas qualitativas e quantitativas realizadas nas radiografias panorâmicas, denominadas índices radiomorfométricos, que podem ser capazes de identificar mulheres na pós-menopausa com indicação de realização de densitometria óssea. O objetivo principal deste artigo é discutir a importância da radiografia panorâmica como ferramenta auxiliar no diagnóstico da osteoporose e de baixa densidade mineral óssea.

Osteoporosis is considered as a public health problem by World Health Organization. The identification of subjects at risk of fractures and with low bone mineral density is the basis of any preventive osteoporosis program. Then, high risk individuals should be referred for dual X-ray absorptiometry (DXA). DXA is considered the gold standard of bone mineral density assessment. Nevertheless, bone densitometry has a limited availability for routine use in population screening. Panoramic radiography is conducted routinely in elderly populations, especially for edentulous patients before treating with complete denture or implants. Some panoramic radiographic measurements, also known as panoramic radiomorphometric indices, may identify postmenopausal women that should perform bone densitometry. The main purpose of this paper is to discuss the importance of panoramic radiography as an auxiliary tool in the diagnosis of osteoporosis and low bone mineral density.

Management of recurrent distal tracheal stenosis using an endoprosthesis: a case report / Manejo da estenose traqueal distal recidivada por meio de endoprótese: relato de caso

Os autores apresentam o caso de uma paciente com estenose traqueal distal recidivada após múltiplos procedimentos de ressecção da traquéia. A paciente foi submetida à inserção de uma prótese traqueobrônquica do tipo T-Y para o manejo da obstrução da via aérea distal. A prótese foi adaptada de acordo com as especificações obtidas por meio da tomografia computadorizada do tórax com reconstrução tridimensional.

The authors report the case of a patient with recurrent distal tracheal stenosis after several tracheal resections. A T-Y tracheobronchial stent was inserted for the management of distal airway obstruction. The prosthesis was adapted based on the specifications obtained through a computed tomography scan of the chest with three-dimensional reconstruction.