Epidemiology and Estimated Cost of Brachial Plexus Surgeries Performed through the Unified Health System in Brazil (2008­2016)

Introduction The brachial plexus is responsible for the innervation of the upper extremity of the body. About 10 to 20% of the peripheral nerve lesions are brachial plexus lesions. Objective To describe the epidemiology of the brachial plexus microsurgery with exploration and neurolysis (BPMEN) and the brachial plexus microsurgery with nerve graft (BPMNG) performed through the Brazilian Unified Health System (SUS, in the Portuguese acronym) from 2008 to 2016. Methodology A descriptive epidemiological study whose data were obtained from the Department of Informatics of the SUS (Datasus, in the Portuguese acronym). The study consisted of all patients submitted to BPMEN (code: 0403020034) and to BPMNG (code: 0403020042). Result/Discussion A total of 5,295 procedures were performed with an annual incidence of 2.94/1 million inhabitants. The hospital expenses of these 2 codes totaled R$ 4,492,603.88 (US$ 1,417,225.10). The BPMNG code presented an annual average of expenses with professional services of R$ 99,732.20 (US$ 31,461.26), and total expenses of R$ 897,589.83 (US$ 283,151.36). The amount transferred to the physician in this code in 2008 was R$ 294.56 (US$ 92.92), and currently it is R$ 441.84 (US$ 139.38). The BPMEN code presented an annual average of expenses of R$ 68,579.15 (US$ 21,633.80), with total expenses of R$ 617,212.40 (US$ 194,704.22). The amount transferred to the physician in this code in 2008 was R$ 153.44 (US$ 48.40), and currently it is R$ 230.16 (US$72.60). Both codes presented a lag in the transfer values to the physician that ranged from 16.55 to 17.64% when using the Brazilian national price index for the general consumer (IPCA, in the Portuguese acronym) as an inflation parameter during the period studied. The mean number of hospitalization days for these 2 codes was 3.79. Conclusion The absence of deaths and the low rate of hospital stay confirm that the procedure is safe, with a low morbimortality rate. Both codes presented a lag in the transfer values to the physician at the end of the period.

The Impact of Inflation on the Medical and Hospital Money Transfers of the Neurosurgical Procedures of the Brazilian Unified Healthcare System from 2008 to 2017

Introduction There are more than 1,500 hospital procedures included in the Brazilian Unified Healthcare System's (SUS, in the Portuguese acronym) table, which is the reference for service payment provided by establishments serving the public health network, and they are stagnant. The underfinancing of procedures is so dramatic that in some cases the amounts paid by the SUS are even lower than the taxes generated by the costs of the same procedures in Brazilian private hospitals. This article aims to compare the evolution of the compensation of neurosurgical procedures by calculating the percentile of the lag in the values transferred to both neurosurgeons and hospitals, according to the SUS table, establishing the ideal and real values according to the current inflation, in a retrospective 9-year comparison. Methodology This is an observational, comparative, retrospective study, based on the values of medical and hospital money transfers of 25 neurosurgical procedures in 2008, which were corrected according to the 2017 National Consumer Price Index (IPCA, in the Portuguese acronym). Results Through this study, from 2008 to 2017, the transfers of medical fees regarding neurosurgical techniques are almost completely outdated. As examples, we can mention: the external/subgaleal ventricular shunt, with a deficit of 43.6%; the electrode implant for brain stimulation, with - 41.67%; and decompressive craniotomy, with - 32.21% in relation to the corrected value. Only 4 of the 25 neurosurgeries present a value above that predicted by the IPCA, one of them being cerebral aneurysm embolization larger than 1.5 cm with a narrow neck (þ 8.0%). Regarding the money transfers to hospitals, all procedures are 43.6% lower than expected, since there was no readjustment in the amounts paid to the institutions in the analyzed period. For example, in 2008, for the transposition of the cubital nerve, R$ 267.30 were transferred, and the same amount was maintained in 2017; and, for the surgical treatment of compressive syndrome in osteofibrous tunnel at carpal level (R$ 145.18), the amount also remained fixed throughout these 9 years. Conclusion Because they did not follow the evolution of the economy, in 80% of the surgeries, the neurosurgeons did not have their economic demands met regarding the procedures performed through SUS. And the data became even more alarming when the money transfers to hospitals were evaluated, since there was no evolution in the money transfers for any of the neurosurgeries evaluated.

Subthalamic Nucleus: Neuroanatomical Review

Discovered in 1865 by Jules Bernard Luys, the subthalamic nucleus is a set of small nuclei located in the diencephalon, inferior to the thalamus and superior to the substantia nigra, that can be visualized in a posterior coronal section. Histologically, it consists of neurons compactly distributed and filled with a large number of blood vessels and sparse myelinated fibers. This review presents an analysis of this anatomical region, considering what is most recent in the literature. Subthalamic neurons are excitatory and use glutamate as the neurotransmitter. In healthy individuals, these neurons are inhibited by nerve cells located in the side globus pallidus. However, if the fibers that make up the afferent circuit are damaged, the neurons become highly excitable, thus causing motor disturbances that can be classified as hyperkinetic, for example ballism and chorea, or hypokinetic, for example Parkinson disease (PD). The advent of deep brain stimulation has given the subthalamic nucleus great visibility. Studies reveal that the stimulation of this nucleus improves themotor symptoms of PD.

Neurectomy of C2 for the Treatment of Occipital Neuralgia: Case Report

Occipital neuralgia (ON) is an uncommon cause of headache, and it is characterized by a stabbing paroxysmal pain that radiates to the occipital region. The present study includes a review of the literature and a case report. The etiology of this pathology can vary from traumas, infections, compressions of nerves or vertebrae, skull base surgeries, to degenerative changes and congenital anomalies. However, most of the time, the etiology is considered idiopathic. The diagnosis is essentially clinical. However, it is crucial that other types of primary headache are excluded. The treatment for ON may be based on nerve blocks, medications or surgeries. Neurectomy of the second spinal nerve is among the surgical techniques available.

Compressive Neuropathy of the Ulnar Nerve in the Hypothenar Region by Lipoma: Case Report

Lipomas are well-defined tumors of the adipose tissue that often occur in the torso or the extremities of adult patients. These tumors usually develop painlessly and insidiously, but theymay compress adjacent structures. The objective of the present study is to describe the case of a 68-year-old female patient with a giant lipoma located at the hypothenar region, with manifestation of compression of the common palmar digital nerves, the ulnar nerve, andthe abductormuscle of theVfinger. Regarding the symptoms, the patient feltmoderate pain in the hypothenar region, with no Tinel sign, and no changes in the motor function or sensibility of the digits innervated by the ulnar nerve. Lipomasmay present a varied range of histological characteristics, and malignant tumors may be a differential diagnosis. An imaging exammay aid in the diagnosis, which is confirmed by a histopathological study. For the present case, as recommended in the literature, a surgical procedure was performed for the resection of the tumor, which resulted in the control of the symptoms.

The Influence of the Type of Surgical Thread and Suture in the Open Carpal Tunnel Syndrome Surgery

Carpal tunnel syndrome (CTS) is the result of compression and/or traction of the median nerve in the carpal tunnel. It is the most frequent compressive neuropathy of the upper limbs and it is usually idiopathic. Diagnosis is essentially clinical, defined by symptoms and provocative tests. Decompression of themedian nerve by section of the transverse carpus ligament is the treatment of choice, but the lack of consensus on the type of suture and surgical thread to be used in the open carpal tunnel decompression surgery justifies the importance of evaluating the comparative results of existing studies, aiming to describe the influence of different types of sutures and surgical threads to guide the professionals about the most appropriate conduct. This is a systematic review of the international and national literature. Four studies comparing the influence of surgical threads and one study evaluating the influence of the type of suture were found. From the comparative studies, it was observed that there is advantage in the use of nonabsorbable suture due to the lower occurrence of inflammation and postoperative wound complications. When using Donatti sutures, wound edge inversion is less likely to occur comparedwith single individual sutures, but they are also related to longer postoperative pain.

Abducens Nerve Palsy as Initial Manifestation of Chronic Subdural Hematoma: Case Report

Chronic subdural hematoma (CSDH) is a form of progressive intracranial hemorrhage, typically associated with cases of trauma. The manifestation of this comorbidity with abducens palsy is a rare finding. The present work aims to describe the case of an adult patient with abducens nerve palsy as a manifestation of CSDH. Chronic subdural hematoma is most commonly found in elderly patients, with systemic hypertension as amanifestation. The relation with the sixth cranial nerve is unusual and draws attention to the case reported. In addition, the prognosis is positive, since trepanation and drainage surgery was performed, as it is recommended in the literature.

Peripheral Nerve Schwannomas: A Literature Review

Introduction Schwannomas are benign tumors originating from the cells, which wrap around axons that are usually encapsulated and solitary. These tumors usually lead to little or no symptomatology. They are usually the most common peripheral nerve tumors in adults, with their highest incidence between the third and fifth decades of life. Objective To perform a review about schwannoma of the peripheral nerves, presenting its definition, epidemiology, diagnosis, symptomatology and treatment. Methodology This is a descriptive work, based on a review of articles available in the PubMed database with the descriptors schwannoma and peripheral nerves. Results and Discussion Only papers published between 1981 and 2019, describing studies in humans, and that were available as full articles were selected. A total of 391 articles were included; after reading the titles, we noted that 67 articles fit the topic of the present study. Among the articles selected for reading, 33 fit the objectives of the present work, and were considered for the writing of the present article. Conclusion Schwannomas are benign myelin sheath tumors that develop with local symptomatology or asymptomatic and present a good surgical prognosis with generally reduced rates of surgical complications.

Epidemiology and Estimated Cost of Surgery for Chronic Subdural Hematoma Conducted by the Unified Health System in Brazil (2008­2016)

Introduction Chronic subdural hematoma (CSH) is one of the most frequent forms of intracranial hemorrhage. It is a collection of encapsulated, well-delimited fluid and/or coagulated blood in several clotting stages located between the dura mater and the arachnoid mater. Objective To describe the epidemiological aspects of CSH described in the database of the Brazilian Unified Health System (SUS, in the Portuguese acronym) regarding admission numbers, hospitalization expenses, health care professional expenses, mortality rate, and death numbers by region from 2008 to the first half of 2016. Methods The present work was performed between August and September 2016 with a review about the epidemiological aspects of CSH in Brazil according to the Informatics Department of the Unified Health System (DATASUS) database, encompassing the period from January 2008 to June 2016, and to scientific papers from the past 10 years which were electronically published at the PubMed, Scielo, and LILACS databases. Results From 2008 to the first half of 2016, the total values were the following: hospital admission authorizations (HAAs). 33,878; hospital expenses, BRL 65,909,429.22; health care professional expenses, BRL 25,158,683.21; deaths, 2,758; and mortality rates ranging from 6.47 to 12.63%. Conclusion In spite of the high clinical relevance of CSH, epidemiological studies about this condition are limited. As such, the present paper is an updated approach on CSH, focusing on its epidemiological aspects according to the DATASUS database.

Epidemiology and Estimated Cost of Microsurgical Treatment of Peripheral Nerve Tumor Conducted by the Brazilian Unified Health Care System (2008­2016)

Introduction Primary nerve tumors correspond to 5% of the soft tissue neoplasms affecting the upper limbs, with benign lesions being more frequent than malignant lesions. Objective To describe the epidemiological data of the microsurgical treatment of peripheral nerve tumors performed by the Brazilian Unified Health System (SUS, in the Portuguese acronym), with the code 0403020131, from 2008 to 2016, regarding the number of annual procedures, hospital and professional expenses, the average duration of hospital stay, and the number of deaths. Methods This is a descriptive epidemiological study whose data were obtained by consulting the database provided by the Health Informatics Department of the Brazilian Ministry of Health (DATASUS, in the Portuguese acronym). Results/Discussion A total of 6,012 procedures were performed during the period studied, with an average of 688 procedures per year. The average hospital stay was of 2.13 days. There was nomortality rate. The average annual cost of the professional was BRL 50,091.45; and the average hospital expenses were BRL111,887.94. Conclusion The microsurgical treatment of peripheral nerve tumors is a safe surgical procedure with zero mortality rate and short hospital stay. There was no national data on tumors of this nature in the medical literature.

Epidemiology and Estimated Cost of Surgery for Cubital Tunnel Syndrome Conducted by the Unified Health System in Brazil (2005­2015)

Introduction Cubital tunnel syndrome (CTS) is responsible for one of the types of ulnar nerve neuropathy and is the second cause of compressive neuropathy of the upper limb, only surpassed by carpal tunnel syndrome. Objective To describe the epidemiological data of the ulnar nerve transposition surgical code in the treatment of CTS by the United Health System (SUS) from 2005 to 2015. Methodology This is a descriptive epidemiological study, in which data were obtained through consultation of the DATASUS database. Results/Discussion During this period, 774 procedures were performed and, despite the addition of 20.3 million people to the Brazilian population, the incidence was 0.33/ 1,000,000. National and international epidemiology point to a slightly higher prevalence of the procedure between men, in the fourth and fifth decades of life. Low permanence rate, as well as the absence of hospital deaths related to the procedure, infer that the procedure is safe, with low morbidity and mortality rates. Conclusion The annual incidence of the cubital syndrome submitted to surgical treatment at SUS in the Brazilian population was 1/7,670,833 in 2005 and½,174,468 in 2015. The cost of each surgical procedure during the same period ranged from R$ 318.88 to R$ 539.74. The mean hospitalization time for CTS surgery was 1.85 days.

Double Crush Syndrome of the Median Nerve: A Literature Review

Double crush syndrome (DCS) is defined as the compressive involvement of the same peripheral nerve in different segments.When this syndrome affects the median nerve, a proximal compression of a spinal nerve that will constitute this structure (often the spinal nerve at the C6 vertebra) is usually noted at the cervical spine level as a herniated disc and as a distal compression at the level of the carpal tunnel. Epidemiological data on median nerve compromise by DCS are still very scarce in the medical literature. The diagnosis can be inferred by symptoms and signs occurring proximally and distally in the arm, as well as by alterations revealed by upper limb electromyography and neuroimaging studies, such as magnetic resonance imaging (MRI) of the cervical spine. Nowadays, information on which compressed neuroanatomical point should be initially addressed still depends on further studies. Limited data infer that these patients, when submitted to surgical treatment in only one of the median nerve compression points, evolve with worse functional outcomes than the surgically-treated group with carpal tunnel syndrome without DCS.

Resting Tremor after Mild Head Injury: Case Report

Over the past few decades, it has been recognized that traumatic brain injury (TBI) may result in various movement disorders. However, moderate or mild TBI only rarely causes persistent post-traumatic movement disorders. In the present report, we describe a case of secondary tremor due to amild head injury with a transitory loss of consciousness. A 26- year-old man developed an isolated rest tremor of the hands and legs without other neurologic signs. The interval between the head trauma and the onset of the symptomswas 4 months. Neuroimaging studies reveled gliosis in the lentiform nucleus. Haloperidol administration resulted in tremor reduction. A rest tremor, similar to essential tremor, can be a rare complication of head trauma. Haloperidolmay be an effective and safe treatment modality for post-traumatic tremor. Further studies are needed to clarify the optimal drug for the treatment of post-traumatic tremor.

Does the Bethesda category predict aggressive features in differentiated thyroid cancer?

ABSTRACT Objective: To analyze the importance of preoperative cytology of thyroid nodules and its relationship with mortality risk, recurrence risk, dynamic stratification, and aggressive characteristics (vascular invasion, aggressive histology, incomplete tumor resection, extrathyroidal extension of the tumor, and presence of lymph node and distant metastases). Subjects and methods: Retrospective evaluation of 153 patients diagnosed with differentiated thyroid carcinoma (DTC) and following up at the Hospital Universitário Presidente Dutra between January 1999 and December 2016. Results: In all, 96% of the patients were female, 79.7% had papillary carcinoma and the most common fine-needle aspiration (FNA) result was Bethesda II (29.4%). The mean age was 43.11 ± 12.8 years. Overall, 85% of the patients progressed without any evidence of disease. There was a statistically significant relationship between the presurgical FNA and the presence of extrathyroidal extension, vascular invasion, and lymph node metastasis. Conclusions: The preoperative cytology of the nodule may have an impact on the follow-up of patients with DTC. Future studies in a larger population are required to confirm this finding.

Prevalence of hepatic arterial variations with implications in pancreatoduodenectomy / Prevalência de variações arteriais hepáticas com implicações em pancreatoduodenectomia

ABSTRACT Background: Pancreaticoduodenectomy is the usual surgical option for curative treatment of periampullary cancer and carries a significant mortality. Arterial anomalies of the celiac axis are not uncommon and might lead to iatrogenic lesions or requiring arterial resection/reconstruction in a pancreatoduodenectomy. Aim: Determine the prevalence of arterial variations having implications in pancreatoduodenectomy. Methods: Celiac trunk and hepatic arterial system anatomy was retrospectively evaluated in 200 abdominal enhanced computed tomography studies. Results: Normal anatomy of hepatic arterial system was found in 87% of cases. An anomalous right hepatic artery was identified in 13% of cases. In 12 cases there was a substitute right hepatic artery arising from superior mesenteric artery and in two cases an accessory right hepatic artery with similar origin. A hepatomesenteric trunk was identified in seven cases and in five there was a right hepatic artery directly from the celiac trunk. All cases of anomalous right hepatic artery had a route was behind the pancreatic head and then, posteriorly and laterally, to the main portal vein before reaching the liver. Conclusions: Hepatic artery variations, such as anomalous right hepatic artery crossing posterior to the portal vein, are frequently seen (13%). These patients, when undergoing pancreatoduodenectomy, may require a change in the surgical approach to achieve an adequate resection. Preoperative imaging can clearly identify such variations and help to achieve a safer pancreatic head dissection with proper surgical planning.

RESUMO Racional: Pancreatoduodenectomia consiste no procedimento cirúrgico usual para tratamento curativo de neoplasias periampulares e apresenta mortalidade significativa. Variações arteriais do tronco celíaco não são incomuns e podem favorecer lesões iatrogênicas ou exigirem realização de ressecção/reconstrução arterial durante pancreatoduodenectomia. Objetivo: Determinar a prevalência de variações arteriais que apresentam implicações durante pancreatoduodenectomia. Métodos: A anatomia do tronco celíaco e sistema arterial hepático foi investigada retrospectivamente em 200 exames tomográficos contrastados do abdome. Resultados: Anatomia normal do sistema arterial hepático foi observada em 87% dos casos. Presença de uma artéria hepática direita anômala foi identificada em 13%. Em 12 casos houve uma artéria hepática direita substituta originária da artéria mesentérica superior, em dois uma artéria hepática direita acessória com origem similar. Tronco hepaticomesentérico foi identificado em sete casos e em cinco houve uma artéria hepática direita originária diretamente do tronco celíaco. Em todos casos de artéria hepática direita anômala seu curso foi por trás da cabeça do pâncreas e com trajeto passando posteriormente ao tronco da veia porta e após percorrendo sua face lateral direita antes de alcançar o fígado. Conclusões: Variações arteriais hepáticas, como artéria hepática direita anômala com trajeto posterior à veia porta, são frequentes (13%). Nestes pacientes, quando submetidos à pancreatoduodenectomia, pode ser necessária alteração na abordagem cirúrgica para ressecção adequada. Exames de imagem pré-operatórios podem claramente identificar estas variações e auxiliar na realização de dissecção segura da cabeça do pâncreas com adequado planejamento cirúrgico.

Síndrome compressiva de múltiplos nervos na dermatopolimiosite: relato de caso / Multiple Nerve Compression Syndrome in Dermatopolymyositis: Case Report

A dermatopolimiosite émiopatia inflamatória de etiologia provavelmente autoimune e comportamento heterogêneo, afetando principalmente pele e músculos e ocasionando manifestações exantemáticas características, como o eritema heliótropo e a pápula de Gottron, e fraqueza muscular proximal simétrica. A associação dessa patologia a neuropatias periféricas é pouco conhecida, podendo raramente ocorrer neuropatia múltipla. O objetivo deste artigo é relatar um caso de síndrome compressiva de múltiplos nervos em portador de dermatopolimiosite. O paciente apresentava fraqueza muscular proximal e exantema característico e foi submetido à revisão laboratorial, ressonância magnética de abdome e eletroneuromiografia, que mostraram alterações. Foi então tratado através da neurólise do nervo mediano ao nível do túnel do carpo e do nervo ulnar ao nível do túnel cubital. Trata-se de importante possibilidade terapêutica em casos como o descrito,mas estudos de maior porte sobre a descompressão simultânea dos túneis carpal e ulnar são necessários.

Dermatopolymyositis is an inflammatory myopathy ­ whose etiology is probably autoimmune ­ that has heterogeneous manifestations that occur mainly in skin and muscles and cause characteristic rash, such as heliotrope rash, Gottron's sign and symmetric proximal weakness. The association between this pathology and peripheral neuropathies is little known and multiple neuropathies rarely occur. The purpose of this article is to report a case of multiple nerve compression syndrome in a patient with dermatopolymyositis. The patient had proximal weakness and characteristic rash and underwent a laboratorial review, abdominal MRI and electromyography, which showed changes. So he was treated by neurolysis of median and ulnar nerves at carpal and cubital tunnels levels, respectively. It is an important therapeutic possibility in cases like this, but larger studies on simultaneous decompression of carpal and cubital tunnels are necessary.

Neuralgia occipital: relato de caso e revisão / Occipital Neuralgia: Case Report and Review

Neuralgia occipital (NO) é uma causa incomum de cefaleia caracterizada por dor paroxística, do tipo pontada, que se irradia para a região occipital. O objetivo deste artigo é relatar o caso de uma paciente com NO e descrever a técnica cirúrgica utilizada. O estudo compreende um levantamento bibliográfico para o conhecimento e melhor abordagem sobre o assunto. Com base na literatura, observa-se que a etiologia pode variar desde traumas, infecções, cirurgias de base de crânio, compressões de nervos ou vértebras até alterações degenerativas e anomalias congênitas. Porém, em sua maioria, os casos são idiopáticos. Apesar de o diagnóstico ser essencialmente clínico, é fundamental que sejam excluídos outros tipos de cefaleias primárias. De acordo com a gravidade e o tempo de evolução do caso, o tratamento da NO pode basear-se em bloqueios nervosos, medicamentos ­ como anti-inflamatórios não-esteroides e relaxantes musculares ­ ou cirurgias. Entre os procedimentos cirúrgicos disponíveis, encontram-se a descompressão do nervo occipital maior, ablação por radiofrequência e implantação de neuroestimulador.

Occipital Neuralgia (ON) is an uncommon cause of headache, characterized by paroxysmal pain, stabbing that radiates to occipital region. This article aims at reviewing the literature to the approach to the subject and performs the case report of patient who present with ON and underwent a surgical treatment. Based on the literature and analysis showed the etiologymay vary from trauma, infections, skull base surgery, compression of nerves or vertebrae to degenerative changes and congenital anomalies. However, most cases are idiopathic. Although the diagnosis is essentially clinical, it is essential that other types of primary headaches are excluded. According to severity and the time course of the case, the treatment of ON may be based on nerve blocks, medications like non-steroidal anti-inflammatory drugs and muscle relaxants. Surgical treatment for ON are nerve decompression, pulsed radiofrequency ablation and stimulator implantation.

INFLAMMATORY DISORDERS ASSOCIATED WITH HELICOBACTER PYLORI IN THE ROUX-EN-Y BYPASS GASTRIC POUCH / ALTERAÇÕES INFLAMATÓRIAS ASSOCIADAS AO HELICOBACTER PYLORI NA BOLSA GÁSTRICA DE BYPASS EM Y-DE-ROUX

ABSTRACT Background: The prevalence of Helicobacter pylori in obese candidates for bariatric surgery and its role in the emergence of inflammatory lesions after surgery has not been well established. Aim: To identify the incidence of inflammatory lesions in the stomach after bariatric surgery and to correlate it with H. pylori infection. Methods: This is a prospective study with 216 patients undergoing Roux-en-Y gastric bypass. These patients underwent histopathological endoscopy to detect H. pylori prior to surgery. Positive cases were treated with antibiotics and a proton inhibitor pump followed by endoscopic follow-up in the 6th and 12th month after surgery. Results: Most patients were female (68.1%), with grade III obesity (92.4%). Preoperative endoscopy revealed gastritis in 96.8%, with H. pylori infection in 40.7% (88/216). A biopsy was carried out in 151 patients, revealing H. pylori in 60/151, related to signs of inflammation in 90% (54/60). In the 6th and 12th month after surgery, the endoscopy and the histopathological exam showed a normal gastric pouch in 84% of patients and the incidence of H. pylori was 11% and 16%, respectively. The presence of inflammation was related to H. pylori infection (p<0,001). Conclusion: H. pylori has a similar prevalence in both obese patients scheduled to undergo bariatric surgery and the general population. There is a low incidence of it in the 6th and 12th months after surgery, probably owing to its eradication when detected prior to surgery. When inflammatory disease is present in the new gastric reservoir it is directly related to H. pylori infection.

RESUMO Racional: Helicobacter pylori é responsável por várias doenças gastrointestinais. Com o aumento de cirurgia bariátrica no país, há poucos estudos sobre a prevalência desta bactéria em obesos com indicação cirúrgica e o seu papel no surgimento de lesões inflamatórias no pós-operatório. Objetivo - Identificar a incidência de lesões inflamatórias no estômago pós-cirurgia bariátrica e correlacionar com a infecção por H. pylori. Métodos - Estudo prospectivo com dois grupos de pacientes. Em ambos os grupos verificou-se a prevalência do H. pylori no pré-operatório através de histopatologia, mas em apenas um dos grupos, nos casos de H. pylori positivo realizou-se o tratamento com antibioticoterapia e inibidor de bomba de próton com realização de nova endoscopia no 6° e 12° mês pós-operatório. Resultados: Avaliou-se 216 pacientes, com as seguintes características: sexo feminino (68,1%), faixa etária entre 30-40 anos, com 31,9% e 31%, respectivamente. De acordo com o IMC, 17,6% apresentavam obesidade moderada, 82,4% obesidade severa/mórbida e 9,7% superobesidade. Nos pacientes submetidos à endoscopia, a positividade do H. pylori se manifestou em 40,7%, sendo responsável pela atividade inflamatória na mucosa gástrica (p<0,001). No pós-operatório, investigou-se a mucosa gástrica através de endoscopia e histopatologia no 6° e 12° mês, que demonstrou normalidade no neorreservatorio gástrico em 84% dos pacientes, e a incidência de H. pylori foi 11% aos seis meses e 16% aos 12 meses, sendo a presença de processo inflamatório relacionado com a infecção pela bactéria (p<0,001). Conclusão - H. pylori apresenta prevalência similar tanto em obesos que irão submeter-se à cirurgia bariátrica quanto à população em geral; há baixa incidência dele no 6° e 12° mês após a operação e isto deve-se provavelmente à sua erradicação quando detectado no pré-operatório; quando presente a doença inflamatória no neorreservatório gástrico possui relação direta com a infecção por H. pylori.

Schwannoma como etiologia de síndrome do túnel do carpo ­ relato de caso / Schwannoma as a Cause of Carpal Tunnel Syndrome ­ a Case Report

A síndrome do túnel do carpo (STC) é uma condição clínica resultante da compressão do nervo mediano no túnel do carpo. É a neuropatia de maior incidência no membro superior e apresenta diferentes etiologias, entre elas o distúrbio osteomuscular relacionado ao trabalho (DORT) e, mais raramente, a tumores de nervo periférico. O DORT é a etiologiamais comum da STC e vemaumentando sua incidência por causa de sua associação com o trabalho. Eentre os tumores que envolvem o nervo mediano está o schwannoma, ou neurilemoma, que também é o tumor benigno mais comum de nervos periféricos. Este relato almeja descrever um caso de schwannoma como etiologia da STC.

The carpal tunnel syndrome (CTS) is a clinical condition resulting from compression of the median nerve in the carpal tunnel. It is the neuropathy of higher incidence in the upper limb and as different etiologies, is related to work-related musculoskeletal disorders (WMSDs) and rarely tumors of peripheral nerve. The WMSDs are the most common, and its incidence is increasing more andmore due to the intimate association with type of work. Among the tumors involving median nerve is the Schwannoma, or neurilemoma. The Schwannoma is the most common benign tumor of the peripheral nerve. This report aims to describe a case of schwannoma as a cause of CTS.