A amizade política de idosos voluntários / The political friendship of elderly volunteers

O objetivo do presente artigo é discutir a relevância da amizade política para os idosos colaboradores do Projeto “Idosos Colaboradores” da Universidade Aberta da Terceira Idade - UnATI/UERJ, expressa na minha pesquisa de Mestrado em Serviço Social da PUC-Rio em 2005. O estudo foi fundamentado teoricamente na obra de Hannah Arendt, que apresenta a dimensão política da amizade como uma ação desenvolvida pelo diálogo público e plural no mundo comum a todos. Verificamos nas entrevistas que os idosos apresentaram elementos significativos que identificam a prática da amizade política. A amizade política possibilita o debate e a luta dos idosos, junto com as demais gerações, para assegurar e ampliar os seus direitos, garantidos nas políticas sociais.(AU)

The aim of this article is to discuss the relevance of political friendship for the elderly collaborating with the “Elderly Collaborators” Project sponsored by the Third Age Open University (UnATI/UERJ), which is mentioned in my research for granting a M.S degree in Social Services at the Pontifical Catholic University of Rio de Janeiro, in the year of 2005. This study was theoretically based on Hannah Arendt’s works, which presents the political dimension of friendship as an action developed by the public and plural dialogs in the world common to all people. The interviews showed that the elderly presented significant elements that point out to the practice of political friendship. The political friendship enables the debate and the struggle of the elderly, along with the other generations, to assure and increase their rights, which are ensured in the social policies.(AU)

A amizade política de idosos voluntários / The political friendship of elderly volunteers

O objetivo do presente artigo é discutir a relevância da amizade política para os idosos colaboradores do Projeto “Idosos Colaboradores” da Universidade Aberta da Terceira Idade - UnATI/UERJ, expressa na minha pesquisa de Mestrado em Serviço Social da PUC-Rio em 2005. O estudo foi fundamentado teoricamente na obra de Hannah Arendt, que apresenta a dimensão política da amizade como uma ação desenvolvida pelo diálogo público e plural no mundo comum a todos. Verificamos nas entrevistas que os idosos apresentaram elementos significativos que identificam a prática da amizade política. A amizade política possibilita o debate e a luta dos idosos, junto com as demais gerações, para assegurar e ampliar os seus direitos, garantidos nas políticas sociais.

The aim of this article is to discuss the relevance of political friendship for the elderly collaborating with the “Elderly Collaborators” Project sponsored by the Third Age Open University (UnATI/UERJ), which is mentioned in my research for granting a M.S degree in Social Services at the Pontifical Catholic University of Rio de Janeiro, in the year of 2005. This study was theoretically based on Hannah Arendt’s works, which presents the political dimension of friendship as an action developed by the public and plural dialogs in the world common to all people. The interviews showed that the elderly presented significant elements that point out to the practice of political friendship. The political friendship enables the debate and the struggle of the elderly, along with the other generations, to assure and increase their rights, which are ensured in the social policies.

Markers of acute coronary syndrome in emergency room.

Acute coronary syndromes (ACS) encompasses a spectrum of coronary heart diseases, ranging in severity from unstable angina to ST-elevation myocardial infarction (STEMI). Early diagnosis and risk stratification are needed in order to address correctly hospitalization and treatment. Although the diagnosis of STEMI in the presence of typical electrocardiogram (ECG) changes and symptoms is easy and does not require the use of biomarkers, cardiac biomarkers are particularly important in the Emergency Department (ED), where about 25% of patients admitted are affected by ACS but clinical presentation is often atypical and ECG alterations may be absent. The ideal marker in the ED should have rapid release, high sensitivity and specificity and risk stratifying properties. Classic cardiac biomarkers, like myoglobin, cardiac troponin T or I and creatine kinase-MB, have a poor sensitivity, dependent on the time past from the onset of symptoms to presentation, the duration of ischemia and the amount of myocardial tissue involved. Although the serial testing of these cardiac biomarkers can improve the detection of myocardial necrosis, there is still a need for the development of early markers that can reliably rule out ACS from the ED at presentation and also detect myocardial ischemia in the absence of irreversible myocyte injury. There are several markers which represent the different features of ACS pathogenesis and that can be divided into three major groups: markers of cardiac ischemia and necrosis, markers of inflammation and coronary plaque instability and marker of cardiac function.

Transient global amnesia and brain lesions: new hints into clinical criteria.

BACKGROUND AND PURPOSE: Transient global amnesia (TGA) is the abrupt onset of anterograde amnesia with repetitive queries. Different hypotheses have been considered for its aetiology, but it still remains obscure. In 1990, Hodges and Warlow proposed clinical criteria for TGA. Applying these criteria, clinical studies looked for an unifying theory, considering TGA almost a primary and benign disorder. However, spare descriptions of TGA in patients with brain structural lesions have been reported. The aim of this study was to evaluate the prevalence of brain structural lesions among TGA patients. METHODS: One hundred and thirty clinically defined TGA were consecutively recruited. Among them, 13 patients (10%) showed brain structural lesions (TGA-b). RESULTS: No significant difference in clinical features, duration of TGA episode, age of onset, gender between primary TGA (TGA-p) and TGA-b were found. Triggering factors were comparable, suggesting that TGA-b should be considered in the spectrum of TGA, being clinically indistinguishable. CONCLUSIONS: Transient global amnesia deserves a careful neuroimaging study and clinical follow-up considering the high prevalence of brain lesions among these patients and the impossibility to exclude TGA-b by clinical features. The follow-up of these patients and the evaluation of involved brain areas might help to further elucidate the pathogenetic mechanisms of the disease.

New approaches in parotid gland surgery.

Various skin incision for access to the parotid region are described by different authors, which differ in extension and localization of the scar. Therefore after parotidectomy, patients are often left with a retromandibular and cervical depression. Maintaining normal facial contour may be difficult in parotidectomy defects, but a good symmetry can and should be achieved when reconstructing the parotid region with a specific approach. The authors show their experience in parotid gland surgery using a new skin incision to improve the aesthetic and functional results and three different techniques the reconstruction of the parotid region.

Primary non-Hodgkin's lymphoma of the mandible. Report of a case.

A case of a 45-year-old white man admitted for an osteomyelitis and subsequently diagnosed affected by an IE stage, diffuse high grade large B cell non-Hodgkin's lymphoma of the mandible is reported. The patient presented a swelling in the right mandibular region with paraesthesia of the ipsilateral lower lip without nodal involvement of the neck. After an incisional biopsy, which showed a diffuse high grade large B-cell non-Hodgkin's lymphoma, the patient was staged and treated with CEOP protocol for six courses and subsequently external beam radiation therapy with complete remission of the lesion.

[Endoscopic excisional biopsy with laser CO2 for the diagnosis and treatment of glottic carcinoma (T1-selected T2)]. / Endoscopic excisional biopsy with laser CO2 for the diagnosis and treatment of glottic carcinoma (T1-selected T2).

UNLABELLED: AIMS AND BACKGROUNDS: In T1-T2a glottic carcinoma before considering which type of treatment is the best option a biopsy is necessary. A peculiar aspect of this type of lesions is the fact that in the same specimen it is possible to find different grade of dysplasia even carcinoma in situ or microinvasive or invasive. An incisional biopsy could mislead the diagnosis. The aim of this study was to report the oncological results of the excisional biopsy for T1-T2a glottic cancer. MATERIALS AND METHODS: From November 1999 to December 2001, 18 patients (13 T1, 5 T2a) with carcinoma of the vocal cord underwent excisional biopsy of the lesion. In the case of negative margins no further treatment was done. The average follow-up was 2 years and 3 months. RESULTS: Local control was achieved in 100% for T1, 80% for T2. Radiotherapy was added in 2 cases. CONCLUSION: In our experience "excisional biopsy" for unadvanced glottic tumors is an ideal surgical technique for a one stage procedure of diagnosis and therapy.

[The stapler in total laryngectomy with closed technique]. / The stapler in total laryngectomy with closed technique.

UNLABELLED: AIMS AND BACKGROUNDS: The use of the stapler in total laryngectomy with closed technique is described by the authors. MATERIALS AND METHODS: From October 1999 to December 2002, 27 total laryngectomy were performed, 15 with a stapler and 5 cases had a primary tracheoesophageal puncture. RESULTS: Only one patient developed a pharyngocutaneous fistula, no other patients experienced post-operative complications. All cases in this study had negative surgical margins. CONCLUSION: The correct indication for the use of the stapler is a tumor that needs a total laryngectomy, but completely endolaryngeal. The technique allows to remove the nso-gastric tube at the end of the first week after the operation, to avoid soiling the surgical field, to reduce the time in theatre. This technique seems to be safe as the traditional suture.

[Treatment of the facial nerve and the neck in malignant parotid gland tumors]. / Il trattamento del nervo facciale e del collo nei tumori maligni della ghiandola parotide.

In the surgery of malignancies of the parotid gland the management of the facial nerve and of the neck is very important. In fact, many authors declared as the surgery of parotid gland can be considered as the surgery of facial nerve and others underlined the role of the neck management in a complete treatment of these neoplasms. The features of 47 cases of parotid gland neoplasms observed at the National Cancer Institut of Naples (Naples, Italy) are reported. In all cases a total parotidectomy was performed with neck dissection in case of neck metastases or electively in selected cases and resection of the facial nerve only in case of macroscopic tumor involvement. Radiotherapy was administrated in case of involvement of the facial nerve, and/or of the skin and/or of multiple neck metastases. The results of our experience emphasize as the neoplasms of the parotid gland can be treated sparing the facial nerve when it is clearly not involved without making worse prognosis; on the other side planing a neck dissection should be mandatory in case of high degree malignancies, and/or of tumors larger than T2, and/or of involvement of the facial nerve, and/or of the skin and/or cervical lymph nodes.

Morbidity by plating in maxillofacial surgery.

BACKGROUND: Aim of this paper is to define the behaviour of osteosynthesis plates in maxillofacial area and to determine when to remove them. METHODS: The records of 123 patients treated with osteosynthesis plates were retrospectively assessed. Each case had a follow-up of not less than 5 years. Removal as a consequence of poor surgery was excluded from the study. RESULTS: Osteosynthesis occurred in the mandible in 198 cases and in the upper maxilla in 146 cases, with a further 23 cases treated by plating in other sites. Plates were removed in 21 cases; the most frequent cause of removal was infection (13 sites) followed by nerve palsy and dehiscence. CONCLUSIONS: Infections are without doubt the main cause of plate removal. In orthognathic patients, infections occurred less frequently, nevertheless they remain the main complication. Dysesthesia, along with infections, are the most frequent cause of removal. Plate exposure very rarely are reduction and fixation lost; thus the removal of the plate can be delayed.

Calyceal microlithiasis in children: report on 196 cases.

Recognition of children at greatest risk for urolithiasis may allow early detection or prevention of stone formation. We report clinical data from 196 children aged 0.9-15.9 years in whom renal ultrasound examination revealed hyperechogenic spots in renal calyces less than 3 mm in diameter. We called this finding "calyceal microlithiasis" (CM). There was a history of urolithiasis in 70.4% of patients in at least one first- or second-degree relative. Presenting symptoms were recurrent abdominal pain, dysuria, and hematuria, occurring alone or in combination. Hematuria was the presenting symptom in 41% of patients and was the only urinary finding in more than one-third. Hypercalciuria was present in about one-third and hyperuricuria in one-fifth of the patients. Of 29 patients who were followed for at least 2 years, 9 developed calculi 4-7 mm in diameter. CM possibly represents the first step in calculus formation. The finding of CM might explain a number of symptoms and signs that are often mild and non-specific, thus reducing invasive diagnostic procedures.

Critical illness myopathy and neuropathy.

BACKGROUND: Critically ill patients may develop muscle weakness or paralysis during the course of sepsis and multiple-organ failure. We studied peripheral nerve and muscle disorders (NMD) in comatose patients. METHOD: Comatose patients who developed paralysis associated with absent deep-tendon reflexes had electroneuromyography (ENMG) and muscle-nerve biopsy specimens taken. Onset and duration of sepsis, multiple-organ dysfunction and failure, biochemical alterations, and drugs potentially interfering with nerve-muscle function were recorded. FINDINGS: 24 patients became quadriparetic or quadriplegic; muscle changes were found in 23. Axonal neuropathy was found in eight of 22 patients examined. All patients had prolonged sepsis and multiple-organ dysfunction, but only 14 had multiple-organ failure. Drugs such as steroids, neuromuscular-blocking agents, and aminoglycosides were not responsible for paresis, and the part played by hyperglycaemia and hypoalbuminaemia is uncertain. Attending physicians predicted a fatal outcome in all cases, although six of seven survivors fully recovered within 115-210 days from the onset of paralysis. INTERPRETATION: Comatose patients may become completely paralysed because of NMD. The diagnosis is important to avoid unnecessary investigations and unreasonably pessimistic prognosis. ENMG is essential for the diagnosis and for planning further clinical management. Biopsy needs to be done only when it is necessary to properly classify NMD.

[Effects of propofol in patients in status epilepticus of various origins. Electroencephalographic analysis]. / Effetti del propofol in pazienti in stato di male epilettico di varia origine. Analisi elettroencefalografica.

The authors discuss the effect of propofol administered to epileptic patients in intensive care. Several reports have attributed and antiepileptic effect to this drug, whereas a similar number have correlated it to epileptogenic manifestations of various types. Three "typical" cases of epilepsy were studied: chronic postoperative, chronic and acute post-traumatic. EEG patterns were analysed following continuous administration, using a bolus and using varying doses of the drug itself. Propofol appears to modify EEG patterns in a positive manner and is therefore confirmed as being useful in the sedation of epileptic patients in intensive care.

[The use of propofol in status epilepticus]. / L'impiego del propofol nello stato di male epilettico.

Three cases of status epilepticus not responsive to an aggressive treatment are described. The seizures and EEG activity were rapidly brought under control with a continuous infusion of propofol (3-6 mg/kg/hour), maintained between 21 hours and 7 days. Patient awakening at the end of the infusion period was rapid and without sequelae.

Monitoring of somatosensory evoked potentials during carotid endarterectomy: relationship with different haemodynamic parameters and clinical outcome.

The authors studied the changes of Somatosensory Evoked Potentials (SEPs) performed in 241 anaesthetised patients during 264 carotid endarterectomies (CEs). SEP responses were considered significantly modified when the central conduction time was greater than 1 ms and/or when the amplitude of the complex N20-P25 decreased by at least 50%. Both CCT and N20-P25 have been correlated with different parameters, including the presence or absence of preoperative neurological deficits, the type of general anaesthesia, the status of the contralateral and the ipsilateral carotid artery, stump pressure, the use of an intraluminal shunt and the perioperative results. After carotid cross-clamping SEP responses were within the normal range in 236 CEs (89%), and abnormal in 28 (11%). A shunt was inserted 23 times in 264 (9%) cases. None of the patients operated on in this series experienced a permanent neurological deficit; there were three (1.1%) transient deficits (two Rinds and one TIA) and two deaths from non-neurological causes. Only one of the transient deficits was present when the patient woke from the anaesthetic and this event was predicted by significant modification of the SEP which did not reverse after removal of the clamps (a shunt was not used). None of the patients in our series who did not present significant modifications of SEPs during the operation had any postoperative neurological deficit. The authors conclude that SEP recording is a highly reliable and objective method for continuous monitoring of brain function during CE.

Acute visual disorders in patients on regular dialysis given desferrioxamine as a test.

Aluminium (Al) overload has been recognised as a frequent complication in uraemic patients on regular dialysis treatment. We report how acute visual disorders occurred after performing a desferrioxamine (DFO) test in patients on regular dialysis treatment suspected of having aluminium overload. Fifteen patients on regular dialysis treatment for 132 +/- 73 (range 17-250) months, aged 61 +/- 10 (range 47-79) years were given DFO as a test at standard dosage. In the 13 patients who complained of visual disorders, we performed ophthalmologic examinations soon after DFO administration, and again 5 months later in 11 of them. A decrease in visual acuity and/or dyschromatopsia, transient or permanent, were present in ten patients. Four had permanent maculopathy and three also had a permanent alteration of VEP (visual evoked potential). Visual fields were normal in all patients except one who presented a permanent central scotoma. The EOG (electro-oculogram) was permanently impaired in five patients and some of them had fluoroangiographic alterations due to damage of the pigmented epithelium. Six to eight months after the DFO test four patients still complained of visual acuity reduction. We conclude that there is a high rate of visual disorders after giving DFO at the standard doses; therefore we stress the need to modify the doses commonly used and/or the mode of infusion.

Influence of contralateral carotid artery on neurologic outcome after carotid endarterectomy.

The discrepancy in the literature about the immediate results after carotid endarterectomy in the presence of occluded or seriously stenotic contralateral carotid artery, has encouraged a retrospective study on 230 patients subjected to 255 carotid endarterectomies. 63 operations (group 1) were carried out in the presence of occluded contralateral carotid artery (40 operations) or of seriously stenotic contralateral carotid artery (23 operations). In the remaining 192 operations (group 2) the contralateral carotid artery was normal or not significantly stenotic (less than 60% of diameter reduction). The indication for surgery and age and sex distribution were similar in the two groups. No operations were performed during acute stroke. Patients with previous stroke underwent surgery only after at least 1 month from the onset of symptoms, in stable neurological conditions. All the patients were operated on under general anesthesia and with systemic heparinization; the indication for intraluminal shunt was made on the basis of clinical evaluation, of back pressure value and, in 106 operated cases of somatosensory cortical evoked potentials. At the end of every operation, ultrasonographic and/or angiographic instrumental controls were carried out. No statistically significant difference was evidenced in the incidence in groups 1 and 2 of postoperative transitory neurological insufficiency (both 3.2%, P greater than 0.8), of permanent neurological insufficiency (0% and 1%, P greater than 0.9), of mortality because of neurological (3.2% and 1%, P greater than 0.5) and non neurological causes (1.6% and 0%, P greater than 0.1).(ABSTRACT TRUNCATED AT 250 WORDS)