Modifications in Near Infrared Spectroscopy for Cerebral Monitoring During Carotid Endarterectomy in Asymptomatic and Symptomatic Patients.

BACKGROUND: To evaluate trends and differences in Near Infrared Spectroscopy (NIRS) monitoring during carotid endarterectomy (CEA) in patients affected by asymptomatic and symptomatic carotid artery stenosis, to predict postoperative neurological complications (PNCs). METHODS: NIRS data of CEAs performed in a University Hospital were retrospectively reviewed. All the interventions were performed under general anesthesia and patients with intraoperative complications were excluded. Mean regional Oxygen Saturation Index (rSO2), pre-clamp values (mean baseline value, MBv and Single Mark Baseline value, SMBv) were collected and compared to the lowest rSO2 values during carotid cross-clamp (LSO2v) calculated within 3 min (percentage drop, PD). ROC curve analysis with Youden's Test was performed to determine the best threshold value of PD, in order to identify PNCs in both asymptomatic and symptomatic groups. RESULTS: Between 2007 and 2015, a total of 399 CEAs were consecutively performed with NIRS monitoring. Three-hundred-seventy-two CEAs in 355 patients were reviewed. Asymptomatic stenoses were 291 (81.9%), eleven (2.9%) PNC were registered (5 in asymptomatic and 6 in symptomatic group). Asymptomatic and symptomatic diseases had different MBv (69.5 ± 7.5 vs. 71.8 ± 6.9, respectively; P = 0.011) and similar rSO2 value during carotid clamping (63.7 ± 8.0 vs. 63.7 ± 6.7, respectively: P = 0.958). Asymptomatic patients experiencing PNCs had a greater PD than non-PNCs group (20.5 ± 10.2% vs. 12.5 ± 7.6%, respectively using MBv as baseline value; P = 0.002), in contrast, in symptomatic patients, in which a low PD was associated with PNCs, it does not reach statistical significance (using MBv, 12.6 ± 5.4% vs. 14.8 ± 6.7%, respectively; P= 0.476). In order to detect PNCs, ROC analysis revealed an optimal PD cut-off value of -17% in asymptomatic CEAs. (Sensibility (Se) 0.80, Specificity (Sp) 0.76, PPV 0.05, NPV 0.99, Youden's index 0.56; P = 0.020) In symptomatic a threshold value of -9% was found, without reaching statistical significance. CONCLUSIONS: NIRS as cerebral monitoring during CEA can predict PNCs in asymptomatic stenosis. Asymptomatic and symptomatic groups differ in baseline and intraprocedural cut-off values to detect an augmented PNCs risk.

Testes de fala no ruído na clínica audiológica - Uma Revisão Integrativa / Noise speech tests in the audiological clinic - An Integrative Review

Introdução: A audiometria convencional não é suficientemente confiável para prever a compreensão de uma pessoa num ambiente ruidoso e, desta forma, inserir testes de fala no ruído na rotina clínica audiológica pode ser uma ferramenta útil para detectar possíveis problemas da função auditiva central. Objetivo: Realizar uma revisão integrativa da literatura sobre testes de fala no ruído disponíveis para uso na clínica audiológica. Método: Busca de publicações sem delimitação temporal nos bancos de dados Lilacs, PubMed, Medline, IBCS e SciELO, utilizando-se como descritores: teste de fala no ruído, percepção auditiva, testes de discriminação auditiva, distúrbios auditivos, padronização, desenvolvimento, validação, testes do limiar de recepção da fala, percepção auditiva e perda auditiva. Não houve exclusão por período de publicação. Os artigos foram pesquisados nos meses de junho e julho de 2017. Resultados: Foram localizados um total de 1200 artigos e 39 foram inseridos nesta revisão integrativa por satisfazerem os critérios de inclusão. Nos artigos selecionados, foram localizados 25 materiais diferentes que utilizaram para avaliação de fala no ruído: sílabas, palavras, sentenças, dígitos e associação de palavras e tonalidade e palavras e sentenças. Os tipos de ruídos empregados foram: espectro de fala, ruído tipo babble, ruído branco e ruído estacionário e tais materiais foram desenvolvidos para uso em adultos e/ou crianças e sujeitos com e/ou sem perda auditiva. Conclusão: Todos os autores relataram a importância de inserir testes de fala no ruído na rotina clínica, já que só a audiometria convencional não prevê a compreensão de fala em ambiente ruidoso.

Introduction: Conventional audiometry is not reliable enough to predict a person's understanding in a noisy environment, so inserting speech noise tests into the audiological clinical routine can be a useful tool for detecting possible central auditory function problems. Objective: To conduct an integrative literature review on noise speech tests available for use in the audiological clinic. Method: Search for publications without temporal delimitation in the Lilacs, PubMed, Medline, IBCS and SciELO databases, using the following keywords: Noise speech test, auditory perception, auditory discrimination tests, hearing disorders, standardization, development, validation, speech reception threshold tests, hearing perception and hearing loss. There was no exclusion by publication period. The articles were searched in June and July 2017. Results: A total of 1200 articles were found and 39 were included in this integrative review because they met the inclusion criteria. In the selected articles, 25 different materials were used to evaluate speech in noise: syllables, words, sentences, digits and association of words and tone and words and sentences. The types of noise used were: speech spectrum, babble noise, white noise and stationary noise and these materials were developed for use in adults and / or children and subjects with and / or without hearing loss. Conclusion: All authors reported the importance of inserting speech tests in noise into the clinical routine, since only conventional audiometry does not predict speech comprehension in noisy environment.

Introducción: La audiometría convencional no es confiable para predecir la comprensión de una persona en entorno ruidoso, por lo que insertar pruebas de ruido del habla en la rutina audiológica puede ser una herramienta útil para detectar posibles problemas de la función auditiva central. Objetivo: realizar una revisión integral de literatura sobre las pruebas de ruido en el habla disponibles para su uso en la clínica audiológica. Método: Búsqueda de publicaciones sin delimitación temporal en las bases de datos Lilacs, PubMed, Medline, IBCS y SciELO, utilizando las palabras clave: prueba de ruido, percepción auditiva, pruebas de discriminación auditiva, trastornos auditivos, estandarización, desarrollo, validación , pruebas de umbral de recepción del habla, percepción auditiva y pérdida auditiva. No hubo exclusión por período de publicación. Se buscaron los artículos en junio y julio de 2017. Resultados: se encontraron un total de 1200 artículos y se incluyeron 39 en esta revisión porque cumplían con los criterios de inclusión. En los artículos seleccionados, se utilizaron 25 materiales diferentes para evaluar el habla en ruido: sílabas, palabras, oraciones, dígitos y asociación de palabras y tonos y oraciones. Tipos de ruido utilizados: espectro del habla, ruido de balbuceo, ruido blanco y ruido estacionario, y estos materiales se desarrollaron para su uso en adultos y/o niños y sujetos con y/o sin pérdida auditiva. Conclusión: Todos los autores informaron la importancia de insertar pruebas de habla en ruido en la rutina clínica, ya que solo la audiometría convencional no predice la comprensión del habla en entornos ruidosos.

Risk Scoring Systems to Predict Long-Term Mortality After Carotid Endarterectomy in Asymptomatic Patients: A Systematic Review.

The present review was conducted to describe current published risk scoring systems to predict late mortality after carotid endarterectomy (CEA). The aim of the study is to identify simple, clinical, and reproducible tools to predict life expectancy in patients with asymptomatic carotid artery stenosis candidates to CEA and therefore which patients may benefit from surgery, reaching the goal of life expectancy >3 to 5 years, recommended by guidelines. Advantages, disadvantages, feasibility, simplicity, and reproducibility of each selected score were analyzed. Rigorous statistical analysis and validation of the score are essential components to produce a calibrated and usable score. Future studies should address the impact of using these tools in CEA candidates for asymptomatic disease.

Medical Therapy Before Carotid Endarterectomy: Changes Over a 13-Year Period and Comparison Between Asymptomatic and Symptomatic Patients.

We evaluated the evolution of chronic medical therapy in patients admitted for carotid endarterectomy (CEA) over a 13-year period and to analyze the difference in medical treatment between symptomatic and asymptomatic patients. A retrospective study was conducted on patients treated between 2002 and 2015. The use of antiplatelets (acetylsalicylic acid [ASA], ticlopidine, and clopidogrel), oral anticoagulant therapy (OAT), statins and antihypertensives (angiotensin-converting enzyme inhibitors [ACE-I]/angiotensin receptor blockers [ARBs], ß-blockers [BB]) administration was evaluated. During the study period, 852 CEAs were performed in 681 (79.9%) asymptomatic patients. Prescription rate increased significantly for ASA (+29.2%), clopidogrel (+10.3%), statins (+60.8%), ACE-I/ARBs (+31.1%), and BB (+19.3%; all Ptrend < .05). No significant modification was observed for ticlopidine and OAT (ticlopidine use was abandoned in the recent years, but this difference was not significant due to the small numbers). A lower medication intake was recorded for symptomatic patients when compared with asymptomatic patients, except for OAT and clopidogrel. Our analysis suggests that medical therapy has changed over the years for patients with carotid stenosis. Although this is a big step toward best medical therapy, preoperative drug therapy remains suboptimal in symptomatic patients.

Development and validation of a score to predict life expectancy after carotid endarterectomy in asymptomatic patients.

OBJECTIVE: Recent improvement of best medical treatment for carotid stenosis has sparked a debate on the role of surgery-identification of patients who may benefit from carotid endarterectomy (CEA) is crucial to avoid overtreatment. An expected 5-year postoperative survival is one of the main selection criteria. The aim of this study was the development of a score for predicting survival of asymptomatic patients after CEA. METHODS: Our score was derived from a retrospective analysis of 648 consecutive asymptomatic patients from a single hospital. External validation of the score was then performed on a second cohort of 334 asymptomatic patients from two different hospitals in the same area. Factors associated with reduced postoperative survival within the derivation cohort (DC) were identified and tested for statistical significance. Each selected factor was assigned a score proportional to its ß coefficient: 1 point for chronic obstructive pulmonary disease, diabetes mellitus, coronary artery disease, and lack of statin treatment; 4 points for age 70 to 79 years and creatinine concentration ≥1.5 mg/dL; 8 points for age ≥80 years and dialysis. The DC was divided into four groups based on individual scores: group 1, 0 to 3 points; group 2, 4 to 7 points; group 3, 8 to 11 points; and group 4, ≥12 points. Group-specific survival curves were calculated. The validation cohort (VC) was stratified according to the score. Survival of each of the four risk groups within the VC was compared with its analogue from the DC. RESULTS: Median follow-up of the DC and VC was, respectively, 56 and 65 months. Intercohort comparison of 5-year survival was 84.7% ± 1.7% vs 85.2% ± 2% (P = .41). Group-specific 5-year survival within the DC was 97% ± 1.5% (group 1), 88.4% ± 2.2% (group 2), 69.6% ± 4.7% (group 3), and 48.1% ± 13.5% (group 4; P < .0001). Five-year survival within the VC was 95.5% ± 2% (group 1), 89.5% ± 2.7% (group 2), 65% ± 6.1% (group 3), and 44.8% ± 14.1% (group 4; P < .0001). Intercohort comparison of group-specific survival curves showed close similarity throughout the groups. CONCLUSIONS: Our score is a simple clinical tool that allows a quick and reliable prediction of survival in asymptomatic patients who are candidates for CEA. This selective approach is crucial to avoid unnecessary surgery on patients who are less likely to survive long enough to experience the benefits of this preventive procedure.

Role of preoperative serum creatinine and estimated glomerular filtration rate values in asymptomatic patients undergoing carotid endarterectomy.

BACKGROUND: The aim of this study was to evaluate the effect of chronic kidney disease (CKD), assessed by preoperative estimated glomerular filtration rate (eGFR) and serum creatinine (Cr), on postoperative outcomes and long-term survival in asymptomatic patients undergoing carotid endarterectomy (CEA). METHODS: We examined data about patients that underwent CEA between January 2002 and September 2014 in our Institution. Retrospective analysis to assess preoperative comorbidities and postoperative complications was performed. Modification of Diet in Renal Disease (MDRD) formula was used to calculate eGFR. Patients were divided into four groups based on values of preoperative eGFR: group A (≥90 mL/min/1.73 m2), group B (89-60 mL/min/1.73 m2), group C (59-30 mL/min/1.73 m2) and group D (≤29 mL/min/1.73 m2), and into two groups based on preoperative Cr values: group 1 (<1.5 mg/dL) and group 2 (≥1.5 mg/dL). Primary outcomes were death or the development of one or more postoperative major complications within 30 days after surgery, for each group. Survival curves of Kaplan-Meier were plotted for each group of patients to assess long-term mortality. RESULTS: During the study period, 853 CEAs in 808 patients were performed, of which 682 CEA in 645 patients for asymptomatic carotid artery stenosis. Symptomatic patients (19.58%) and patients receiving hemodialysis (0.46%) were excluded. Among CEAs analyzed, 678 (99.4%) had preoperative Cr values recorded and 637 (93.4%) had preoperative eGFR values recorded. The number of patients in each group according to eGFR values was 84 (13.2%) for group A, 250 (39.3%) for group B, 271 (42.5%) for group C and 32 (5.0%) for group D; according to Cr values was 609 (89.8%) for group 1 and 69 (10.2%) for group 2. One death and 24 (3.52%) postoperative major complications, of which 20 postoperative neurological events (NE) and 4 postoperative myocardial infarctions (MI), occurred within 30 days after surgery. The median follow-up was 55 months (IQR 27-84). Regarding general population, multivariate analysis with age found no significant correlation between Cr and primary outcomes, to the contrary of eGFR (OR=1.02; CI: 1.01-1.02; P<0.0001). No significant differences were observed concerning primary outcomes according to eGFR and Cr groups. Five-year survival rates for groups A, B, C and D were 98±0.02%, 90±0.02%, 80±0.03% and 56±0.12% respectively (P<0.0001) and 88±0.02% and 62±0.08% for group 1 and 2 respectively (P<0.0001). CONCLUSIONS: eGFR and Cr classes are not a dependable method in evaluating postoperative complications risk after CEA in asymptomatic patients, although preoperative eGFR values influence 30-days morbility. Both eGFR and Cr groups are reliable predictors to discriminate among asymptomatic patients candidates for CEA, based on their life expectancy.

Open and endovascular elective treatment of abdominal aortic aneurysms: a real-world experience.

PURPOSE: To present a real-world experience of the elective treatment of abdominal aortic aneurysms (AAAs) using both open repair (OR) and endovascular repair (EVAR). METHODS: Data from patients treated consecutively between January 1, 2000 and December 31, 2014 were collected retrospectively and reviewed. The primary outcomes were 30-day mortality and complication rates, freedom from reintervention, and survival in the long-term. RESULTS: We analyzed data on 1112 patients (660 EVAR, 452 OR). The 30-day mortality and complications rates were higher after OR than after EVAR (2.9 vs. 1.1%, P = .03 and 24.7 vs. 1.1%, P < .0001, respectively). At 10 years, survival was 66.1 ± 3.2% after OR and 78.1 ± 2.2% after EVAR (P = .0006) and freedom from reintervention was 93.5 ± 1.8% after OR and 88.4 ± 1.8% after EVAR (P = .005). The preoperative aneurysm diameter was significantly associated with the development of type Ia endoleaks after EVAR (P < .0001) and of a proximal pseudoaneurysm after OR (P < .0001). CONCLUSION: In the long-term, EVAR was associated with higher reintervention rates, but better survival than OR. The preoperative AAA diameter was the most important predictor of the development of endoleaks after EVAR and proximal pseudoaneurysm after OR.

Queixas e hábitos auditivos de usuários de equipamento portátil de som / Complaints and hearing habits of portable stereo set users / Quejas y los hábitos de los usuarios de la audición de sonido portátiles

A exposição a ruídos em atividades de lazer, especialmente com o uso de fones de ouvido, pode afetar a saúde, o trabalho e as relações sociais de usuários desses dispositivos, sobretudo no que diz respeito à intensidade e ao tempo de exposição ao som. Objetivo: Caracterizar as queixas e hábitos auditivos de um grupo de usuários de equipamento portátil de som. Método: Foi aplicado um questionário semiestruturado sobre hábitos auditivos em um grupo de alunos e profissionais de uma universidade privada durante um evento social na própria instituição. Oitenta sujeitos responderam perguntas sobre hábitos e queixas auditivas e tiveram o nível de pressão sonora do equipamento de som (MP3, celular, IPod) estimado por meio de um medidor de nível de pressão sonora. Resultados: As principais queixas referidas após o uso do equipamento foram zumbido, dificuldade para entender e necessidade de aumentar o volume da televisão ou rádio após ouvir música. As queixas auditivas foram mais frequentes entre aqueles usuários que ouviam música em mais elevada intensidade. Conclusão: A maioria dos entrevistados relatou queixas auditivas após o uso do equipamento portátil de som (EPS), sendo mais frequentes entre aqueles que ouviam música em mais elevada intensidade.

Exposure to noise in leisure activities, especially with the use of headphones, can affect the health, labor and social relations of users of these devices, especially with regard to the intensity and the sound exposure time. Objective: To characterize the complaints and hearing habits of a group of adults in their use of portable stereo set. Methods: A semi-structured questionnaire about hearing habits was applied to a group of students during a social event at the University. Eighty subjects answered questions about habits and hearing complaints and had the sound pressure level of sound equipment (MP3, mobile phone, iPod) estimated by means of a sound pressure level meter. Results: The main complaints reported after the use of the equipment were buzzing, trouble understanding and need to increase the volume of television or radio after listening to music. Hearing problems were more frequent among those users who listened to music at a higher intensity. Conclusion: The majority of respondents reported hearing problems after portable stereo set use, which were more frequent among those who listened to music at a higher intensity.

La exposición al ruido en actividades de ocio, especialmente con el uso de auriculares, puede afectar a la salud, el trabajo y las relaciones sociales de los usuarios de estos dispositivos, especialmente en relación con la intensidad y el tiempo de exposición al ruido. Objetivo: Caracterizar las quejas y hábitos de escucha de un grupo de adultos debido al uso portátil equipo de sonido. Se aplicó un cuestionario semi-estructurado sobre hábitos de escucha en un grupo de estudiantes durante un evento social en la Universidad. Método: Ochenta sujetos respondieron preguntas sobre los hábitos y recibir las quejas y tenía el nivel de presión sonora de equipos de sonido (MP3, teléfonos móviles, iPod) estimado utilizando un medidor de nivel de presión sonora. Resultados: Las principales quejas reportadas después de la utilización de los equipos zumbaban, problemas para comprender y necesitan aumentar la intensidad de la televisión o la radio después de escuchar música. las afecciones auditivas fueron más frecuentes entre aquellos usuarios que escucharon música a una mayor intensidad. Conclusión: La mayoría de los encuestados declaró haber oído las quejas después de EPS de uso, que fueron más frecuentes entre los que escuchaban música a una mayor intensidad.

Feeding and reproductive patterns of Astyanax intermedius in a headwater stream of Atlantic Rainforest.

In this paper, we determined diet composition, reproductive periodicity and fecundity of Astyanax intermedius in a headwater stream of a State Park of an Atlantic rainforest. We also evaluated the influence of rainfall, water temperature and fish size on niche width and niche overlap. Sampling was conducted monthly throughout one year in the Ribeirão Grande stream, southeastern Brazil. Diet consisted of 31 food items with equal contribution of allochthonous and autochthonous items. Females were larger than males, and the mean sizes at first maturation were 4.44 cm and 3.92 cm, respectively. Based on 212 pairs of mature ovaries, the number of oocytes per female ranged from 538 to 6,727 (mean = 2,688.7). Niche width and niche overlap were not related to rainfall nor water temperature and only niche width increased with fish size, suggesting that as fish grow, more items are included in diet. Our results suggested that A. intermedius fit as a typical opportunistic strategist which may explain the prevalence of this species in several isolated headwater basins of vegetated Atlantic forested streams where food resources are abundant and distributed throughout the year.

Comparison of posterior and medial approaches for popliteal artery aneurysms.

BACKGROUND: Long-term results of the posterior approach (PA) for the treatment of popliteal artery aneurysms are lacking in the literature. We reviewed our experience during a 13-year period in patients with popliteal artery aneurysms, comparing those treated through a PA with those operated on through a standard medial approach (MA). METHODS: Clinical data of all patients treated between February 1998 and October 2011 were retrospectively reviewed and outcomes analyzed. The Kaplan-Meier method was used to estimate survival, and χ(2), Wilcoxon, and log-rank tests were used for analysis. RESULTS: A total of 77 aneurysms were treated in 65 patients (64 men). Mean age was 68 years (range, 48-96 years). Thirty-six aneurysms were asymptomatic (47%). Mean sac diameter was 2.8 ± 1 cm. A PA was used in 43 PAAs (55%) and an MA in 34. The PA and MA patients differed significantly in age (median being older), smoking history (more frequent in PA), and renal insufficiency and cerebrovascular disease (higher for MA). In 42 cases the aneurysm was symptomatic (54.5%) for chronic limb ischemia, with intermittent claudication in 18 patients, acute ischemia in 17, blue toe syndrome in 3, compression on adjacent structures in 3, and rupture with severe acute pain in 1. All PA repairs consisted of aneurysmectomy with an interposition graft with end-to-end anastomoses; among MA repairs, 22 interposition grafts and 12 bypasses were performed. A polytetrafluoroethylene graft was used in 54 cases. Five patients had an early thrombosis (two PA and three MA). No perioperative deaths occurred. Two patients sustained a permanent (PA) and a temporary (MA) peroneal nerve lesion. There were no early amputations. The median in-hospital stay was longer for MA (10 days) than for PA (7 days; P = .02). Median follow-up was 58.8 months (range, 5 days-166 months). Nine patients died during follow-up of unrelated causes. The 5-year primary and secondary patency rates were 59.6% ± 8.6% and 96.5% ± 3.4%, respectively, for PA, and 65.1% ± 11.1% and 79.4% ± 9.7%, respectively, for MA (P = .53 for primary patency rate and P = .22 for secondary patency rate). Limb salvage was 100% at 5 years and 93.3% ± 6.4% at 10 years for PA and 91.1% ± 6.3% at both time points for MA (P = .28). CONCLUSIONS: PA and MA both achieved satisfactory results in primary and secondary patency rates, as well as limb salvage, during long-term follow-up. The differences between the two groups were small and not statistically significant. PA was burdened by similar postoperative nerve and wound complications compared with MA. The in-hospital stay after PA was significantly lower.

Fonoaudiólogos brasileiros titulados doutores no período de 2009 a 2013: perfil da formação / Brazilian doctors in speech-language pathology and audiology certificated in the period 2009-2013: profile of training

OBJETIVO: analisar a formação de fonoaudiólogos brasileiros titulados doutores no período de 2009 a 2013. MÉTODOS: o levantamento dos dados foi realizado por meio de consulta à Plataforma Lattes do Conselho Nacional de Desenvolvimento Científico e Tecnológico a partir dos termos "Fonoaudiologia" e "doutores", e considerado como critério de inclusão ser fonoaudiólogo e ter-se titulado doutor no período determinado. Os dados foram categorizados segundo as variáveis: sexo, ano de defesa da tese, instituição de ensino, inserção do programa em que a tese foi desenvolvida, segundo área de conhecimento do Conselho Nacional de Desenvolvimento Científico e Tecnológico e temática desenvolvida na tese, de acordo com as áreas estabelecidas na Fonoaudiologia e reconhecidas pela Sociedade Brasileira de Fonoaudiologia. Os dados foram analisados de forma descritiva e estatística. Aplicou-se o teste de associação pelo qui-quadrado e para a análise de tendência foi aplicada a regressão polinomial de segunda ordem. Assumiu-se um nível descritivo de 5%. RESULTADOS: o período avaliado totalizou 271 doutorados defendidos. Desses, maior número de teses foi realizada por mulheres (266-98,2%), no ano de 2012 (72-26,6%), em universidades públicas (216-79,7%), situadas na região Sudeste (188-69,4%), em programas pertencentes à área de Ciências da Saúde (174-64,2%) e de temática relacionada à linguagem (95-35,1%). CONCLUSÕES: o levantamento, somado a pesquisas anteriores, evidencia um total de 775 doutores, com perfil semelhante ao levantado anteriormente, mas diferindo quanto à inserção de fonoaudiólogos em programas de pós-graduação não relacionados apenas à área de saúde, refletindo a ampliação dos diversos campos de atuação desse profissional. .

PURPOSE: to analyze the formation of Brazilian speech-language pathologists (SLP) PhDs in the period 2009-2013. METHODS: data collection was done through consultation with the Lattes Platform from the National Council for Scientific and Technological Development (CNPq) with the descriptors "Language and Hearing Sciences and "PhDs" and considered as inclusion criteria to be speech-language pathologist and have earned a PhD degree in the determined period The data were categorized according to the variables: gender, year of submission of the thesis, School, insertion of program by area of ​​expertise of the CNPq and theme developed in the thesis according to the areas set out in the Language and Hearing Sciences and recognized by the Brazilian Society Speech, Language and Hearing Sciences. Data were analyzed descriptively and statistically. We applied the test of association using the chi-square for trend analysis to second-order polynomial regression was applied and and it was taken a significance level of 5%. RESULTS: the reporting period totaled 271 PhDs degrees and the largest number of theses was achieved by women (266- 98.2%), in 2012 (72- 26.6%), in public universities (216- 79.7%), located in the Southeast region (188 -69.4%), belonging to the Health Sciences Programs (174- 64.2%), and written on language-related topics (95- 35.1%). CONCLUSIONS: the survey, coupled with previous research, showing a total of 775 doctors with similar profile to the previously researches but differing in the SLP insertion in graduate programs not only linked to the health areas, reflecting the expansion of the various performance of this professional fields. .

Use of ultrasound debridement as an adjunctive tool for treating infected prosthetic vascular grafts in the lower extremities.

BACKGROUND: To evaluate the role of an ultrasound (US) debridement system to treat conservatively patients with poor medical conditions who presented with infection of a prosthetic vascular graft in the lower extremities. METHODS: Data of all patients who underwent debridement of the grafts and/or surrounding tissue using an ultrasonic generator (Genera, Italia Medica, Milan, Italy) were recorded and retrospectively reviewed. Based on cultures, patients received specific antibiotic therapy. Partial graft removal, sartorius muscle flap rotation, or negative pressure wound treatment (NPWT) was selectively used. Early and late morbidity and mortality and recurrence were analyzed. RESULTS: Thirteen patients (median age, 72 years; range, 57-92 years; 8 men) were treated (12 Szilagyi grade III and 1 grade II infections) with US debridement without removing the graft (8 cases) or with partial excision and "in situ" reconstruction with a silver prosthetic graft (5 cases). Sartorius flap rotation was associated in 6 and NPWT in 1 case. One patient died perioperatively because of pulmonary edema because of sepsis secondary to treatment failure. Estimated freedom from reinfection was 90.9 ± 9% at 6 months and 77.9 ± 14% at 1 and 2 years. Estimated limb survival was 78.7 ± 13% at 6 months, 65.6 ± 16% at 1 year, and 52.5 ± 18% at 2 years. CONCLUSIONS: US debridement proved to be a valuable aid in the treatment of patients with infected grafts and poor medical conditions. Used in conjunction with antibiotics, it allowed us to be more conservative without compromising the chance of success.

Outcomes of urgent carotid endarterectomy for stable and unstable acute neurologic deficits.

OBJECTIVE: The aim of the study was to assess the outcomes of carotid endarterectomy (CEA) performed in an urgent setting on acutely symptomatic patients selected through a very simple protocol. METHODS: From January 2002 to January 2012, 193 symptomatic patients underwent CEA. Of these, 90 presented with acute symptoms, and after a congruous carotid stenosis was identified, underwent urgent operations (group 1): 27 patients had transient ischemic attack (group 1A), 52 patients had mild to moderate stroke (group 1B), and 11 patients had stroke in evolution (group 1C). The remaining 103 patients with a nonrecent neurologic deficit were treated by elective surgery in the same period (group 2). End points were 30-day neurologic morbidity and mortality. RESULTS: The median delay of urgent CEA (U-CEA) from deficit onset was 48 hours (interquartile range, 13-117 hours). Groups 1 and 2 were comparable in demographics. Acute patients showed a higher rate of stroke at presentation (70% vs 37%; P = .001) and of history of coronary artery disease (30% vs 13.5%; P = .007). Acute patients sustained six postoperative strokes (6.6%). Neurologic outcomes were correlated to clinical presentation: no strokes occurred in group 1A patients, and 5.8% group 1B patients and 27.3% group 1C patients had postoperative stroke (P < .01). Postoperative mortality was 4.4% for U-CEA: one fatal myocardial infarction, one intracranial hemorrhage, and two thromboembolic strokes. Elective patients sustained four postoperative strokes (3.9%), with one death (0.9%) as a consequence of hyperperfusion cerebral edema. U-CEAs performed ≤48 hours from symptom onset had a lower postoperative stroke rate than those performed >48 hours (4.4% vs 8.8%; P = .3). Among patients presenting with a stroke (group 1B), the National Institutes of Health Stroke Scale (NIHSS) assessment at discharge showed improvement in 79% (although only 25% had ≥4 points in reduction), stability in 17%, and deterioration in 4%. Patients with moderate stroke were slightly better in NIHSS improvement than those with mild stroke (median NIHSS variation at discharge, -3 vs -1; P = .001). CONCLUSIONS: Our results with U-CEA confirm that this population has a higher risk profile compared with elective surgery. The type of acute presentation is correlated with perioperative risk. U-CEA was safe when performed on patients presenting with transient ischemic attack. An acceptable complication rate was achieved for patients with minor to moderate strokes. The poorest outcomes occurred in patients presenting with stroke in evolution: U-CEA in these patients should be offered with extreme caution, although we are aware that a conservative treatment may not grant a better prognosis.

Double osteotomy of mandibula in the treatment of carotid body tumors with skull base extension.

We report two patients with a carotid body paraganglioma that extended to the skull base, a position that is surgically inaccessible by means of a traditional lateral cervical approach. In both patients we were able to remove the lesion by performing a double mandibular osteotomy. Both patients underwent preoperative embolization to reduce the mass. In our experience, this approach has allowed a safe radical excision of exceptionally high lesions with only minor permanent nerve damage. In our opinion this advantage definitely outweighs the consequences of the increased invasiveness of this technique.

Tympanometry in infants: a study of the sensitivity and specificity of 226-Hz and 1,000-Hz probe tones.

Introduction For infants under 6 months, the literature recommends 1,000-Hz tympanometry, which has a greater sensitivity for the correct identification of middle ear disorders in this population. Objective To systematically analyze national and international publications found in electronic databases that used tympanometry with 226-Hz and 1,000-Hz probe tones. Data Synthesis Initially, we identified 36 articles in the SciELO database, 11 in the Latin American and Caribbean Literature on the Health Sciences (LILACS) database, 199 in MEDLINE, 0 in the Cochrane database, 16 in ISI Web of Knowledge, and 185 in the Scopus database. We excluded 433 articles because they did not fit the selection criteria, leaving 14 publications that were analyzed in their entirety. Conclusions The 1,000-Hz tone test has greater sensitivity and specificity for the correct identification of tympanometric curve changes. However, it is necessary to clarify the doubts that still exist regarding the use of this test frequency. Improved methods for rating curves, standardization of normality criteria, and the types of curves found in infants should be addressed.

Tympanometry in Infants: A Study of the Sensitivity and Specificity of 226-Hz and 1, 000-Hz Probe Tones

For infants under 6 months, the literature recommends 1,000-Hz tympanometry, which has a greater sensitivity for the correct identification of middle ear disorders in this population. Objective: To systematically analyze national and international publications found in electronic databases that used tympanometry with 226-Hz and 1,000-Hz probe tones. Data Synthesis  Initially, we identified 36 articles in the SciELO database, 11 in the Latin American and Caribbean Literature on the Health Sciences (LILACS) database, 199 in MEDLINE, 0 in the Cochrane database, 16 in ISI Web of Knowledge, and 185 in the Scopus database. We excluded 433 articles because they did not fit the selection criteria, leaving 14 publications that were analyzed in their entirety. Conclusions: The 1,000-Hz tone test has greater sensitivity and specificity for the correct identification of tympanometric curve changes. However, it is necessary to clarify the doubts that still exist regarding the use of this test frequency. Improved methods for rating curves, standardization of normality criteria, and the types of curves found in infants should be addressed...

Emissões otoacústicas em um grupo de crianças com o espectro da neuropatia auditiva: estudo retrospectivo / Otoacoustic emissions in a group ofchildren with auditory neuropathy spectrum disorder: retrospective study

Introdução:O Espectro da Neuropatia Auditiva é uma desordem auditiva com alteração na condução dos impulsos nervosos nas células ciliadas internas e/ou no nervo auditivo com função coclear preservada. Verifi ca-se ausência ou alteração do Potencial Evocado Auditivo de Tronco Encefálico com presença das Emissões Otoacústicas e do microfonismo coclear. O objetivo deste estudo foi analisar a ocorrência ou não do registro das Emissões Otoacústicas em um grupo de crianças com o Espectro da Neuropatia Auditiva, considerando idade, grau da perda auditiva e etiologia. Material e Método: Estudo retrospectivo com levantamento de prontuários dos pacientes atendidos em uma clínica-escola nos últimos 5 anos. Resultados: Obedeceram aos critérios de inclusão os prontuários de 15 crianças, 67% do sexo feminino e 33% do sexo masculino, entre 2 e 17 anos de idade. Foi possível observar que, tanto no grupo com Emissões Otoacústicas presentes, quanto no grupo com ausência de Emissões Otoacústicas, as idades foram semelhantes. A maior porcentagem de ausência de Emissões Otoacústicas foi observada na etiologia hiperbilirrubinemia, com uma menor ocorrência deste fenômeno nos casos de origem genética e ausência deste fenômeno nos casos hereditários e idiopáticos. Conclusões: A ausência das Emissões Otoacústicas não teve relação direta com a idade nem com o grau da perda auditiva e uma maior ocorrência de casos com ausência das Emissões Otoacústicas pôde ser observada nas crianças cuja etiologia do Espectro da Neuropatia Auditiva foi a hiperbilirrubinemia.(AU)

Introduction: Auditory Neuropathy Spectrum Disorder is a hearing disorder with altered auditory nerve impulses conduction in the inner hair cells and / or the auditory nerve with cochlear function preserved. There is absence or alteration of the Auditory Evoked Potential Brain Stem with presence of Otoacoustic Emissions and cochlear microphonics. The aim of this study was to analyze the occurrence or nonoccurrence of Otoacoustic Emissions in a group of children with Auditory Neuropathy Spectrum Disorder, considering factors such as age, degree of hearing loss and etiology. Material and Method: Retrospective study of medical chart survey from patients in a university clinic in the last five years. Results: There were 15 dossiers that fi t the inclusion criteria, 67% females and 33% males, with ages between 2 and 17 years old. It was observed that in both groups, with present Otoacoustic Emissions and with absent Otoacoustic Emissions, the ages were similar. The highest percentage of absent Otoacoustic Emissions was observed in the etiology of hyperbilirubinemia, with a lower occurrence of this phenomenon in cases of genetic origin and absence of this phenomenon in hereditary and idiopathic cases. Conclusions: The absence of Otoacoustic Emissions had no direct relationship with the age of the children neither with the degree of hearing loss, and a higher incidence of cases with absence of Otoacoustic Emissions was observed in children whose etiology of Auditory neuropathy spectrum disorder was hyperbilirubinemia.(AU)

Introducción: El Espectro de Neuropatía Auditiva es un trastorno auditivo con alteración en la conducción del impulso nervioso en las células ciliadas internas y/o en el nervio auditivo con la función coclear conservada. Tiene ausencia o alteración del Potencial Auditivo Evocados de Tronco Encefálico con presencia de Emisiones Otoacústicas y de la microfonía coclear. El objetivo de este estudio fue analizar la ocurrencia o no de la Emisiones Otoacústicas en un grupo de niños con el Espectro de Neuropatía Auditiva , teniendo en cuenta edad, grado de la perdida auditiva y etiología. Material y Método: Estudio retrospectivo de los archivos de los pacientes atendidos en una clínica-escuela en los últimos cinco años. Resultados: atendieron a los criterios de inclusión los registros de 15 niños, 67% mujeres y 33% hombres, entre 2 y 17 años de edad. Se observó que tanto el grupo con Emisiones Otoacústicas presente, como en el grupo con Emisiones Otoacústicas ausente, las edades fueron semejantes. El mayor porcentaje de ausencia de Emisiones Otoacústicas se observó en la etiología de hiperbilirrubinemia, con una menor incidencia de este fenómeno en los casos de origen genético y la ausencia de este fenómeno en los casos hereditarios e idiopáticos Conclusiones: La ausencia de Emisiones Otoacústicas no tubo relación directa con la edad ni con el grado de pérdida auditiva y una mayor incidencia de casos con ausencia de Emisiones Otoacústicas se pudo observar en los niños cuya etiología del Espectro de la Neuropatía Auditiva fue la hiperbilirrubinemia.(AU)

Emissões otoacústicas em um grupo de crianças com o espectro da neuropatia auditiva: estudo retrospectivo / Otoacoustic emissions in a group ofchildren with auditory neuropathy spectrum disorder: retrospective study

Introdução:O Espectro da Neuropatia Auditiva é uma desordem auditiva com alteração na condução dos impulsos nervosos nas células ciliadas internas e/ou no nervo auditivo com função coclear preservada. Verifi ca-se ausência ou alteração do Potencial Evocado Auditivo de Tronco Encefálico com presença das Emissões Otoacústicas e do microfonismo coclear. O objetivo deste estudo foi analisar a ocorrência ou não do registro das Emissões Otoacústicas em um grupo de crianças com o Espectro da Neuropatia Auditiva, considerando idade, grau da perda auditiva e etiologia. Material e Método: Estudo retrospectivo com levantamento de prontuários dos pacientes atendidos em uma clínica-escola nos últimos 5 anos. Resultados: Obedeceram aos critérios de inclusão os prontuários de 15 crianças, 67 do sexo feminino e 33 do sexo masculino, entre 2 e 17 anos de idade. Foi possível observar que, tanto no grupo com Emissões Otoacústicas presentes, quanto no grupo com ausência de Emissões Otoacústicas, as idades foram semelhantes. A maior porcentagem de ausência de Emissões Otoacústicas foi observada na etiologia hiperbilirrubinemia, com uma menor ocorrência deste fenômeno nos casos de origem genética e ausência deste fenômeno nos casos hereditários e idiopáticos. Conclusões: A ausência das Emissões Otoacústicas não teve relação direta com a idade nem com o grau da perda auditiva e uma maior ocorrência de casos com ausência das Emissões Otoacústicas pôde ser observada nas crianças cuja etiologia do Espectro da Neuropatia Auditiva foi a hiperbilirrubinemia.

Introduction: Auditory Neuropathy Spectrum Disorder is a hearing disorder with altered auditory nerve impulses conduction in the inner hair cells and / or the auditory nerve with cochlear function preserved. There is absence or alteration of the Auditory Evoked Potential Brain Stem with presence of Otoacoustic Emissions and cochlear microphonics. The aim of this study was to analyze the occurrence or nonoccurrence of Otoacoustic Emissions in a group of children with Auditory Neuropathy Spectrum Disorder, considering factors such as age, degree of hearing loss and etiology. Material and Method: Retrospective study of medical chart survey from patients in a university clinic in the last five years. Results: There were 15 dossiers that fi t the inclusion criteria, 67 females and 33 males, with ages between 2 and 17 years old. It was observed that in both groups, with present Otoacoustic Emissions and with absent Otoacoustic Emissions, the ages were similar. The highest percentage of absent Otoacoustic Emissions was observed in the etiology of hyperbilirubinemia, with a lower occurrence of this phenomenon in cases of genetic origin and absence of this phenomenon in hereditary and idiopathic cases. Conclusions: The absence of Otoacoustic Emissions had no direct relationship with the age of the children neither with the degree of hearing loss, and a higher incidence of cases with absence of Otoacoustic Emissions was observed in children whose etiology of Auditory neuropathy spectrum disorder was hyperbilirubinemia.

Introducción: El Espectro de Neuropatía Auditiva es un trastorno auditivo con alteración en la conducción del impulso nervioso en las células ciliadas internas y/o en el nervio auditivo con la función coclear conservada. Tiene ausencia o alteración del Potencial Auditivo Evocados de Tronco Encefálico con presencia de Emisiones Otoacústicas y de la microfonía coclear. El objetivo de este estudio fue analizar la ocurrencia o no de la Emisiones Otoacústicas en un grupo de niños con el Espectro de Neuropatía Auditiva , teniendo en cuenta edad, grado de la perdida auditiva y etiología. Material y Método: Estudio retrospectivo de los archivos de los pacientes atendidos en una clínica-escuela en los últimos cinco años. Resultados: atendieron a los criterios de inclusión los registros de 15 niños, 67 mujeres y 33 hombres, entre 2 y 17 años de edad. Se observó que tanto el grupo con Emisiones Otoacústicas presente, como en el grupo con Emisiones Otoacústicas ausente, las edades fueron semejantes. El mayor porcentaje de ausencia de Emisiones Otoacústicas se observó en la etiología de hiperbilirrubinemia, con una menor incidencia de este fenómeno en los casos de origen genético y la ausencia de este fenómeno en los casos hereditarios e idiopáticos Conclusiones: La ausencia de Emisiones Otoacústicas no tubo relación directa con la edad ni con el grado de pérdida auditiva y una mayor incidencia de casos con ausencia de Emisiones Otoacústicas se pudo observar en los niños cuya etiología del Espectro de la Neuropatía Auditiva fue la hiperbilirrubinemia.

Timpanometria com tons teste de 226 Hz e 1 kHz em um grupo de lactentes com indicadores de risco para deficiência auditiva / 226 Hz and 1 kHz tympanometry in infants with risk indicators for hearing loss

OBJETIVO: Analisar os resultados da timpanometria com tom teste de 226 Hz e 1 kHz em lactentes até 6 meses de idade e relacionar com a faixa etária e com os resultados das Emissões Otoacústicas por Estímulo Transiente (EOAT). MÉTODOS: A amostra consistiu de 142 lactentes com indicadores de risco para deficiência auditiva que passaram no Potencial Evocado Auditivo de Tronco Encefálico - Automático (PEATE-A). Estes foram submetidos à timpanometria com tom teste de 226 Hz e 1 kHz e à triagem auditiva por meio das EOAT e do PEATE-A. Os lactentes foram divididos por faixa etária (de 0-90 dias e 91-180 dias) e em grupos 1 e 2, segundo presença ou ausência de EOAT, respectivamente. As curvas timpanométricas foram classificadas em tipos A, Plana, C, Duplo Pico (DP), Assimétrica (ASS) e Invertida (I), e como normal ou alterada. RESULTADOS: Foram analisadas 245 orelhas. A curva do tipo A foi predominante nos dois tons testes e nos dois grupos. Ao analisar os tipos de curva, de acordo com a idade, verificou-se que o tipo A apresentou maior ocorrência, seguida do tipo DP nos lactentes menores de 90 dias e da Plana, nos maiores de 90 dias. O tom de 1 kHz apresentou 74,01 por cento de sensibilidade e 83,94 por cento de especificidade; já o de 226 Hz, 24,00 por cento de sensibilidade e 90,80 por cento de especificidade. CONCLUSÃO: O tom teste de 1 kHz foi o mais sensível para identificar alterações de orelha média e, portanto, o mais adequado para avaliar lactentes até os seis meses de idade.

PURPOSE: To analyze the results of 226 Hz and 1 kHz tympanometry in infants under six months of age, and to relate these results with age and with the results of Transient Evoked Otoacoustic Emissions (TOAE). METHODS: The sample consisted of 142 infants with risk indicators for hearing loss, who had passed the Automated Brainstem Auditory Evoked Potential (A-BAEP). Subjects were submitted to 226 Hz and 1 kHz tympanometry and also to hearing screening with TOAE and A-BAEP. Infants were divided into age groups (0-90 days old and 91-180 days old), and into groups 1 and 2, according to the presence or absence of TOAE, respectively. The tympanometric curves were classified into types A, Flat, C, Double Peak (DP), Asymmetrical (ASS) and Inverted (I), and also as normal or altered. RESULTS: It was analyzed 245 ears. Type A tympanograms were predominant in both probe tones and in both groups. When tympanometric curves were analyzed according to age, it was verified that type A presented higher occurrence, followed by the type DP in infants younger than 90 days, and by the type Flat in infants older than 90 days. The 1 kHz tympanometry presented sensitivity of 74.01 percent, and specificity of 83.94 percent; the 226 Hz tympanometry presented sensitivity of 24.00 percent and specificity of 90.80 percent. CONCLUSION: The probe tone of 1 kHz had higher sensitivity to identify middle ear alterations, and therefore is the most appropriate to evaluate infants under six months of age.