Subject(s)
Melanoma , Skin Neoplasms , Humans , Melanoma/pathology , Melanoma/surgery , Skin Neoplasms/pathology , Male , Female , Middle Aged , Aged , Melanoma, Cutaneous Malignant , Retrospective StudiesABSTRACT
We compared central and peripheral arterial stiffness response patterns between persons with and without intellectual and developmental disabilities (IDD) of different age groups at rest and following a cardiopulmonary exercise test (CPET). Fifteen young adults with and without IDD, and 15 middle-aged adults without IDD performed a CPET. Central and peripheral arterial stiffness were measured at rest and following CPET using estimates of carotid-femoral (cfPWV), carotid-radial (crPWV), and carotid-ankle (cdPWV) pulse wave velocity derived from piezoelectric mechano-transducers. cfPWV remained unchanged following CPET in adults with and without IDD but increased in middle-aged adults (d = 0.85; 95% CI: 0.27-1.42 m·s-1, p = 0.005), whereas cdPWV was similarly reduced (d = -0.77; 95% CI: -1.06 to -0.48 m·s-1, p < 0.001) in all groups. crPWV remained unchanged in all groups. These results were independent of exercise-related changes in mean arterial pressure. Overall group differences suggested that persons with IDD (d = -1.78; 95% CI: -3.20 to -0.37 m·s-1, p = 0.009) and without IDD (d = -1.84; 95% CI: -3.26 to -0.43 m·s-1, p = 0.007) had lower cfPWV than middle-aged adults. We found no evidence of early vascular aging and diminished vascular reserve following CPET in adults with IDD.
Subject(s)
Vascular Stiffness , Blood Pressure , Carotid Arteries , Child , Developmental Disabilities , Exercise , Humans , Middle Aged , Pulse Wave Analysis , Vascular Stiffness/physiology , Young AdultABSTRACT
Objetivo: compreender as vivências cotidianas de usuários, em demanda espontânea, para o acesso e a acessibilidade no Sistema Único de Saúde na porta de entrada da Atenção Primária à Saúde. Materiais e métodos: estudo de casos múltiplos holístico-qualitativo, fundamentado na sociologia compreensiva do cotidiano, com 60 participantes de município de gran-de porte do estado de Minas Gerais, Brasil. Resultados:a demanda espontânea, no cotidiano, está voltada para o agendamento de consultas, para o aten-dimento médico e para o acesso aos exames, em uma assistência ao adoecimento. Os usuários apresentam dificuldades para o acesso e a acessibilidade às ações e aos serviços. Conclusões: o acesso aos serviços de saúde da Atenção Primária/Estratégia Saúde da Família continua desafiador, restritivo e burocrático, regulado pela demanda espontânea do usuário e pela agenda médica.
Objetivo: comprender las vivencias cotidianas de los usuarios en demanda espontánea en cuanto al acceso al Sistema Único de Salud en la puerta de entrada a la atención primaria en salud. Materiales y métodos: estudio de caso múltiple holístico-cualitativo, basado en la sociología integral de la vida cotidiana, con 60 participantes de un municipio en el estado de Minas Gerais, Brasil. Resultados: la demanda espontánea, en la vida diaria, está dirigida a programar citas, brindar atención médica y gestionar la realización de exámenes, brindado asistencia en caso de enfermedad. Se evidencia que los usuarios tienen dificultades de acceso y accesibilidad a servicios y procedimientos. Conclusiones: el acceso a los servicios de atención primaria en salud (Estrategia de Salud de la Familia) sigue siendo desafiador, restrictivo y burocrático, regulado por la demanda espontánea del usuario y la agenda médica.
Objective: To understand the daily experiences of spontaneous demand users regarding access and accessi-bility to the Unified Health System (Sistema Único de Saúde) through the gateway of primary health care. Materiales and methods: Holistic and qualitative multiple case study based on comprehensive sociology that addresses the every-day life of 60 participants in the state of Minas Gerais, Brazil. Results: Spontaneous demand, in real life, is aimed at scheduling patients appointments, medical care and exams, assisting them in case of illness. Findings show that users have difficulties in accessing services and procedures. Conclusions: Access to primary care services (Family Health Strategy) continues to be challenging, restrictive and bureaucratic, and is regulated by the spontaneous demand of users and the medical agenda
Subject(s)
Humans , Primary Health Care , Unified Health System , Health Services Accessibility , Health Services Needs and DemandABSTRACT
The Estlander flap is an axial-pattern, lip-switch technique used to reconstruct lip defects that include the oral commissure. We describe a neurotised modification that may confer functional advantages by preserving sensation and helping to maintain oral competence. This is achieved by preservation of the mental nerve branches to the lip and facial nerve branches to the orbicularis oris muscle in the flap.
Subject(s)
Amputation, Traumatic/surgery , Finger Injuries/surgery , Plastic Surgery Procedures/methods , Surgical Flaps , Adult , Humans , MaleSubject(s)
Cardiac Catheterization , Echocardiography, Three-Dimensional , Heart Septal Defects, Atrial/diagnostic imaging , Heart Septal Defects, Atrial/therapy , Surgical Mesh , Adult , Cardiac Catheterization/methods , Cardiac Surgical Procedures/instrumentation , Equipment Design , Female , HumansABSTRACT
OBJECTIVE: To compare the efficacy, safety and morbidity of surgical versus percutaneous atrial septal defect (ASD) closure. POPULATION AND METHODS: We studied all cases of ASD closure (surgical or percutaneous) performed in our hospital during the last 5 years. We analyzed the clinical and echocardiographic characteristics of both groups and compared the success rate of the procedure, events, days of hospital stay and evolution during the 1st year. RESULTS: 63 patients (pts) with ostium secundum ASD were treated in our hospital in the last 5 years; 25 (60% female) underwent surgery (A) while 38 (68% female) underwent percutaneous closure with an Amplatzer device (B); mean age was 38 (13-67) and 40 years (15-72), respectively. Dyspnea and fatigue were the most frequent symptoms in both groups (57% A; 29% B), while the most frequent signs were fixed splitting of S2 (78% A; 88% B) and systolic murmur at the left sternal border (82% A; 87% B). Previous ECG presented incomplete right bundle branch block in 63% of both groups. The size of the ASDs, as well as Qp:Qs, were greater in the surgical group: 24.6 (5-50) vs. 18.97 mm and 3.1 (1.5-6.5) vs. 2.7 (1.2-5.2) respectively. Right cardiac chambers were enlarged in 92% of pts in A vs. 84% in B. Paradoxical interventricular septal motion (PSM) was present in 78% of pts in A and 67% in B. The success rate (100%) was similar in both groups but immediate minor events were more frequent in A (28 vs. 13%). Duration of hospital stay was longer in A: 5.4 days (3-9) vs. 1.5 days (1-4). Normalization of right cardiac chamber diameter was faster in B: 73% in the 1st control echocardiogram (at 0-64 days, mean 29) vs. 60% in A, performed at a later stage (45-455 days after the procedure, mean 155). At the time of reassessment PSM was still present in all the pts of group A and in only 10% of B (p < 0.0001). CONCLUSIONS: The success rate of ASD closure is 100% with both procedures and complications are rare. The percutaneous technique, however, permits a shorter hospital stay, involves less morbidity, and, despite sample limitations, seems to be associated with faster anatomical recovery. Therefore, in our opinion, surgical treatment should be reserved for those cases in which closure with an Amplatzer device is not technically or anatomically possible.
