A prospective evaluation of plastibell® circumcision in older children

Introduction and Objective Circumcision is one of the oldest surgical procedures and one of the most frequently performed worldwide. It can be done by many different techniques. This prospective series presents the results of Plastibell® circumcision in children older than 2 years of age, evaluating surgical duration, immediate and late complications, time for plastic device separation and factors associated with it. Materials and Methods We prospectively analyzed 119 children submitted to Plastic Device Circumcision with Plastibell® by only one surgeon from December 2009 to June 2011. In all cases the surgery was done under general anesthesia associated with dorsal penile nerve block. Before surgery length of the penis and latero-lateral diameter of the glans were measured. Surgical duration, time of Plastibell® separation and use of analgesic medication in the post-operative period were evaluated. Patients were followed on days 15, 45, 90 and 120 after surgery. Results Age at surgery varied from 2 to 12.5 (5.9 ± 2.9) years old. Mean surgical time was 3.7 ± 2.0 minutes (1.9 to 9 minutes). Time for plastic device separation ranged from 6 to 26 days (mean: 16 ± 4.2 days), being 14.8 days for children younger than 5 years of age and 17.4 days for those older than 5 years of age (p < 0.0001). The diameter of the Plastibell® does not interfered in separations time (p = 0,484). Late complications occurred in 32 (26.8%) subjects, being the great majority of low clinical significance, especially prepucial adherences, edema of the mucosa and discrete hypertrophy of the scar, all resolving with clinical treatment. One patient still using diaper had meatus stenosis and in one case the Plastibell® device stayed between the glans and the prepuce and needed to be removed manually. conclusions Circumcision using a plastic device is a safe, ...

Aspectos clínicos e epidemiológicos da insuficiência cardíaca / Clinical and epidemilogical aspects of heart failure

Demonstração dos dados clínicos e epidemiológicos de um pequeno, mas representativo número de pacientes atendidos no ambulatório de Cardiologia do Hospital Universitário da Universidade Federal de Juiz de Fora (HU-CAS-UFJF), portadores de Insuficiência Cardíaca (IC), a fim de traçar um paralelo com os dados obtidos no DATASUS e na literatura mundial. Utilizou-se um questionário para definição das características clínicas: sintomas, classe funcional (CF), sexo, idade, raça, medicamentos em uso, resposta terapêutica e etiologia da IC. Todos os pacientes realizaram eletrocardiograma de repouso (ECG) e ecocardiograma bidimensional com doppler. No período de novembro de 2005 a maio de 2006, 35 pacientes com IC foram avaliados. Houve predominância do sexo masculino (60%), a idade variou de 20 a 87 anos e em 28 pacientes se observou excelente resposta terapêutica (CF I), com 3 pacientes em cada uma das CFs II e III, e apenas 1 na CF IV. O ECG mostrou bloqueio do ramo esquerdo (BRE) em 25,7%, fibrilação atrial (FA) em 20%, sobrecarga atrial esquerda (SAE) em 11,42% e hipertrofia ventricular esquerda (HVE) em 11,42%. O ECG foi normal em 8,57%. A fração de ejeção do ventrículo esquerdo (FEVE) esteve reduzida em 28 pacientes (80%). A etiologia mais frequente foi cardiopatia hipertensiva (40%), seguida de miocardiopatia dilatada idiopática (25,72%) e da cardiopatia isquêmica (14%). A síndrome da IC tem diferentes aspectos epidemiológicos regionais, principalmente, na diversidade etiopatogênica, com aumento progressivo de causa aterogênica à medida que se obtém maior desenvolvimento industrial e urbano.

The aim of this study was to investigate clinical and epidemiological data of a small, albeit representative, sample of patients with heart failure (HF), seen at the Cardiology Unity of the Teaching Hospital of the Federal University of Juiz de Fora. These data were compared to those from the world literature. There was a questionnaire to check the following clinical features: symptoms, functional class, sex, age, ethnicity, drugs in use, therapeutic response and the etiology of HF. All the patients underwent electrocardiography at rest and uni e bidimensional Doppler echocardiography. From November 2005 to May 2006, 35 patients with HF were evaluated. 60% were men (age range: 20-87 years), and 28 had a good response to drugs, being classified in functional class I. Classes II and III had 3 patients each. Only 1 patient was in class IV. ECG revealed left bundle branch block in 25.7% of the patients, atrial fibrillation in 20%, left atrial enlargement in 11.42% and left ventricular enlargement in 11.42%. The ECG was normal in 8.57%. Left ventricular ejection fraction was reduced in 28 patients (80%). The most frequent etiology was hypertensive cardiomyopathy (40%), followed by idiopathic dilated cardiomyopathy (25.72%) and ischemic cardiomyopathy (14%). The Framingham study also showed a high prevalence of hypertensive cardiomyopathy as the cause of heart failure. However, due to better blood pressure control, ischemic disease has been the main cause of heart failure in adults in industrially developed and urban regions.