ABSTRACT
Hereditary Angioedema (HEA), a disease caused by a mutation in the gene that encodes for the production of the fraction C1 in the complement (C1-INH), is a rare pathology (1/50.000) that causes swelling of the skin and submucosa in various organs, either naturally triggered or provoked by physical and psychological traumas, infections, or by the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and angiotensin-converting enzyme inhibitors (ACEIs). Surgical trauma may spur the HEA crisis, leading to complications such as the swelling of the respiratory tracts and hemodynamic instability. Thus, the pre-surgical approach to HEA patients requires a specific plan that ensures short term prophylaxis, careful intra-operative management, rescue therapy and intensive post-surgery care. We present a report on a video-laparoscopic cholecystectomy approach for a 28-year-old woman diagnosed with asthma and HEA with symptomatic choledocholithiasis. We opted for short-term prophylaxis and immunology with the intravenous application of C1-INH. Ultrasonography imaging showed arterial wall oedema, which could correspond to a manifestation of C1-INH deficiency in the wall of the manipulated arteries during ultrasonography-guided puncture. Once the patient recovered consciousness, she was transferred to the intensive care unit and was discharged on the 6th day of hospitalisation.
ABSTRACT
A Estratégia de Sáude da Família é proposta paragarantir uma atenção integral, territorial e longitudinal. Noprocesso de qualificação do cuidado da saúde da família edas redes territoriais, o Ministério da Saúde em 2008 inicia aimplantação dos Núcleos de Apoio à Saúde da Família (NASF)com o intuito de dar suporte e ampliar o escopo das equipesde saúde da família (eSF). Objetivos: Analisar os processosde trabalhos dos NASF junto às equipes de saúde da famíliade João Pessoa e seu impacto na construção de redesterritoriais de cuidados em saúde. Material e Métodos: Foramrealizadas entrevistas semiestruturadas e observaçãoparticipante não sistemática das atividades de apoiadoresdeste municipio, entre setembro e dezembro de 2012. Todasas entrevistas foram gravadas com o conhecimento dosentrevistados sendo todo material produzido submetido àanálise de conteúdo temática. Resultados: Observou-se queo NASF assume a proposta de apoio matricial, com forte viéspolítico-institucional, que na prática se converte em relaçõesadministrativas-gerenciais, nas quais os profisisonaisreconhecem o apoiador como chefe, a quem solicitam oacionamento de outros equipamentos no territorio,fragilizando a equipe como a articuladora de redes territoriais.Conclusão: A experiência evidencia a pluralidade de açõesdos NASF sendo influenciada diretamente pelos modelos degestão local e produzindo relações de apoio administrativasgerenciaisque pouco fortalecem a construção das RAS...
The Family Health Strategy is proposed to ensurea comprehensive, territorial and longitudinal care. In theprocess of qualification of family health care and territorialnetworks, the Ministry of Health in 2008 began theimplementation of Centers of Support for Family Health (CSFH)in order to support and extend the scope of family healthteams. Object: This study aimed to analyze the workprocesses of CSFH with the family health teams in JoãoPessoa as well as their impact on the development of aregional health care network. Material and Methods: Semistructuredinterviews and unsystematic participantobservation of supporters activities were carried outbetween September and December 2012. The studyparticipants were aware that interviews were being recordedand signed an informed consent form prior to participation.All collected data were subjected to thematic contentanalysis. Results: We observed that the CSFH assume theproposed matrix support, with strong political-institutionalbias. In practical terms, this turns into administrativemanagerialrelationships in which the supporter is recognizedas chief by the other professionals to whom they requestactivation of other equipment in the territory. As a result, theteam is weakened while articulator of territorial networks.Conclusion: Experience has shown the plurality of CSFHactions directly influenced by local management models andadministrative-managerial relationships that have little effectson the development of health care networks...
