Origem anômala da artéria pulmonar direita da aorta ascendente (HEMITRUNCUS): uma condição rara que deve ser considerada / Anomalous origin of the right pulmonary artery from the ascending aorta (HEMITRUNCUS): a rare condition that should be considered

INTRODUÇÃO: O hemitruncus arteriosus (HT) é uma cardiopatia congênita muito rara, na qual uma das artérias pulmonares, mais comumente a artéria pulmonar direita (APD), origina-se da aorta ascendente. É uma malformação grave, com rápida evolução para hipertensão pulmonar (HP). Além de gerar sobrecarga pressórica no pulmão que recebe sangue diretamente da aorta, tal condição também causa sobrecarga volumétrica para o pulmão contralateral, irrigado pela artéria com origem no tronco pulmonar que recebe todo o volume sistólico do ventrículo direito (VD). Neste relato, apresentamos o caso de um lactente com diagnóstico de HT realizado através de ecocardiografia, submetido à correção cirúrgica. RELATO DE CASO: Lactente do sexo masculino, 1 mês de vida, nascido a termo. Encaminhado ao centro de referência após achado de sopro cardíaco durante internação hospitalar por infecção respiratória. À admissão, relato de cansaço e sudorese às mamadas, cianose ao choro e baixo ganho pôndero-estatural. Ao exame físico: sopro sistodiastólico 2+/4 na borda esternal esquerda alta, 2Í£bulha fisiológica, dispneia leve e SO2 de 90%. Radiografia de tórax: aumento da área cardíaca e da trama vascular pulmonar, mais evidente à direita. Eletrocardiograma: sinais de sobrecarga do VD. Ecocardiograma: APD com origem na aorta ascendente, com sinais indiretos de HP. O diagnóstico foi confirmado por angiotomografia. Paciente submetido à toracotomia mediana com redirecionamento da APD para o tronco pulmonar, aortoplastia com patch de pericárdio autólogo, secção e sutura do canal arterial. Ecocardiograma pós correção sem lesões residuais. No pós-operatório, recebeu óxido nítrico inalatório, e posteriormente Sildenafil, para manejo da HP. Recebeu alta após 14 dias para seguimento ambulatorial, mantendo-se estável do ponto de vista cardiológico. Conclusão: A origem anômala de uma artéria pulmonar a partir da aorta ascendente é uma malformação rara e potencialmente fatal. Embora possa ocorrer isoladamente, a origem anômala da APD está geralmente associada à persistência do canal arterial, defeito também presente no caso clínico relatado. Esta apresentação é muito mais frequente que a origem anômala da artéria pulmonar esquerda, cuja associação usual é com outros defeitos conotruncais, como a tetralogia de Fallot. Pela rápida evolução para hipertensão arterial pulmonar, a fim de evitar desfechos desfavoráveis, é fundamental que o diagnóstico e o tratamento cirúrgico sejam realizados precocemente.

Modelo de Treinamento para Inserção de Dispositivos Intrauterinos / Training Model for Intrauterine Device Insertion

RESUMO Introdução Aprender praticando exclusivamente em pacientes é cada vez menos aceitável no ensino médico. O ensino baseado em simulação é uma ferramenta capaz de gerar aquisição de habilidades e competências de forma eficaz e em ambiente controlado, sem causar dano ao paciente. A Ginecologia é uma especialidade médica que depende de treinos bem estruturados, e entre os procedimentos ginecológicos destaca-se a inserção dos dispositivos intrauterinos de cobre. Para aumentar a oferta deste método contraceptivo, é preciso capacitação adequada dos profissionais de saúde. Os simuladores físicos imitam a realidade e auxiliam na aquisição de habilidades e competências, tornando de fundamental importância o ensino baseado em simulação para inserção de dispositivos intrauterinos. Objetivo Desenvolver um modelo de treinamento para aquisição de habilidades na inserção de dispositivos intrauterinos. Método Foi desenvolvido um simulador (modelo de utilidade) para inserção de dispositivos intrauterinos, composto por uma base rígida retangular com 17 cm x 15 cm x 21 cm (A x L x P), com peso de 420 gramas, confeccionada em acrinolitrilabutadieno estireno (ABS). Acoplada a este suporte, existe uma estrutura semiflexível, composta por um protótipo de canal vaginal, com colo uterino e região vulvar semelhantes à anatomia humana, confeccionada em ácido poliático flexível (PLA-FLEX). Foram selecionados 15 médicos residentes de Ginecologia e Obstetrícia para treinamento teórico-prático com o simulador proposto pelo estudo para capacitação em inserção de dispositivo intrauterino de cobre. O simulador utilizado neste estudo foi avaliado e validado por especialistas em Ginecologia e Obstetrícia. Resultados Houve melhora estatisticamente significante dos parâmetros avaliados comparando-se a avaliação inicial (pré-treinamento) e final (pós-treinamento) dos residentes, com homogeneidade no desempenho final. Na avaliação inicial, apenas 40% dos dispositivos ficaram bem posicionados, em contraste com 93,3% de sucesso de inserção após implementado o modelo de treinamento. Conclusão Desenvolveu-se um modelo de treinamento baseado em simulação que contribuiu para a aquisição de habilidades de inserção de dispositivo intrauterino de cobre quando aplicado aos residentes de Ginecologia e Obstetrícia.

ABSTRACT Introduction Learning by practicing exclusively on patients is becoming increasingly unacceptable in medical training. Simulation-based teaching is a tool capable of generating skills and competences efficiently and in a controlled environment, without causing harm to patients. Gynecology is a medical specialty that depends on well-structured training; an important gynecological procedure is the insertion of copper intrauterine devices. In order to increase the supply of this contraceptive method to the population the relevant health professionals need to be adequately trained. Physical simulators imitate reality and assist in skills acquisition. Therefore, structured training based on simulation to teach the insertion of intrauterine devices is of fundamental importance to the teaching of gynecology. Objective To develop a training model for skills acquisition for the insertion of intrauterine devices. Method A simulator (utility model) was developed for the insertion of intrauterine devices, composed of a rigid rectangular base made of acrylonitrile butadiene styrene, measuring 17 cm x 15 cm x 21 cm and weighing 420 g. Attached to this support is a semi-flexible structure made of flexible polylactic acid, composed of a prototype vaginal canal, with a uterine cervix and vulvar region, similar to the human anatomy. Fifteen gynecology and obstetrics residents were selected for theoretical and practical training with the simulator proposed by the study for the training of intrauterine copper device insertion. The simulator used in this study was evaluated by specialists in gynecology and obstetrics, who validated it for use in teaching. Results A statistically significant improvement was found in the evaluated parameters, comparing the initial evaluation and the final evaluation of the residents, whose final performances displayed homogeneity. In the initial evaluation only 40% of the devices were well positioned, in contrast to a 93.3% rate of successfull insertion following implementation of the training model. Conclusion A training model was developed to simulate the performance of copper intrauterine device insertion and contributed to the acquisition of skills for this task when applied to gynecology and obstetrics residents.

Effects of nitrofurazone on correction of abdominal wall defect treated with polypropylene mesh involved by fibrous tissue.

PURPOSE: To evaluate the effects of nitrofurazone on the correction of abdominal wall defect treated with polypropylene mesh involved by fibrous tissue in rats. METHODS: A defect in the abdominal wall was created and corrected with polypropylene mesh in 20 rats. They were randomly distributed into four groups: control, fibrous mesh, nitrofurazone and nitrofurazone dip in the mesh. Euthanasia was performed in 21 post-operative days. The healing process was analyzed regarding the meshes and macroscopic and microscopic aspects. RESULTS: All animals had adhesions. However, no statistically significant difference (p>0.05) when compared between groups. Similarly microscopic analysis, in which there was no statistical significance level for the evaluated parameters such as mono and polymorphonuclear lymphocytes, granuloma, fibrosis, necrosis and collagen proliferation. CONCLUSION: There was no significant effect on the abdominal wall defect repair with polypropylene mesh surrounded by fibrous tissue when dipped in nitrofurazone 2%.

Effects of nitrofurazone on correction of abdominal wall defect treated with polypropylene mesh involved by fibrous tissue

PURPOSE:Toevaluate the effects of nitrofurazone on the correction of abdominal wall defect treated with polypropylene mesh involved by fibrous tissue in rats.METHODS: A defect in the abdominal wall was created and corrected with polypropylene mesh in 20 rats. They were randomly distributed into four groups: control, fibrous mesh, nitrofurazone and nitrofurazone dip in the mesh. Euthanasia was performed in 21 post-operative days. The healing process was analyzed regarding the meshes and macroscopic and microscopic aspects.RESULTS:All animals had adhesions. However, no statistically significant difference (p>0.05) when compared between groups. Similarly microscopic analysis, in which there was no statistical significance level for the evaluated parameters such as mono and polymorphonuclear lymphocytes, granuloma, fibrosis, necrosis and collagen proliferation.CONCLUSION:There was no significant effect on the abdominal wall defect repair with polypropylene mesh surrounded by fibrous tissue when dipped in nitrofurazone 2%.

Copaiba oil effect on experimental jaw defect in Wistar rats.

PURPOSE: To evaluate the effects of copaiba oil on jaw defects repair in Wistar rats treated with bioglass or adipose tissue. METHODS: A jaw defect was randomly created in forty-two rats and filled with bioglass or adipose tissue. The two groups (Gbio and Gcell) were subdivided in three subgroups with seven animals each according to gavage administration: control (distillated water), oil (copaiba oil) and melox (meloxicam). Euthanasia was performed after forty post-operative days. The bone formation was analyzed regarding the histological aspects. RESULTS: The osteoclasts activity was observed only in four subgroups (p=0.78). Regarding the osteoblasts presence, it was very similar between the subgroups, the difference was due to Gcell-melox (p=0.009) that presented less osteoblastic activity. The inflammatory cells were more evident in Gcell-melox subgroup, however, there was no difference in comparison with the other subgroups (p=0.52). Bone formation was observed in all subgroups, just two animals showed no bone formation even after 40 days. More than 50% of bone matrix mineralization was observed in 56% (23 animals) of the analyzed areas. The bone matrix mineralization was not different between subgroups (p=0.60). CONCLUSIONS: The subgroups that received copaiba oil showed bone repair, although not statistically significant in comparison to subgroups treated with meloxicam or controls. Copaiba oil administered by gavage had no effect on bone repair in this experimental model.

Copaiba oil effect on experimental jaw defect in Wistar rats

PURPOSE: To evaluate the effects of copaiba oil on jaw defects repair in Wistar rats treated with bioglass or adipose tissue. METHODS: A jaw defect was randomly created in forty-two rats and filled with bioglass or adipose tissue. The two groups (Gbio and Gcell) were subdivided in three subgroups with seven animals each according to gavage administration: control (distillated water), oil (copaiba oil) and melox (meloxicam). Euthanasia was performed after forty post-operative days. The bone formation was analyzed regarding the histological aspects. RESULTS: The osteoclasts activity was observed only in four subgroups (p=0.78). Regarding the osteoblasts presence, it was very similar between the subgroups, the difference was due to Gcell-melox (p=0.009) that presented less osteoblastic activity. The inflammatory cells were more evident in Gcell-melox subgroup, however, there was no difference in comparison with the other subgroups (p=0.52). Bone formation was observed in all subgroups, just two animals showed no bone formation even after 40 days. More than 50% of bone matrix mineralization was observed in 56% (23 animals) of the analyzed areas. The bone matrix mineralization was not different between subgroups (p=0.60). CONCLUSIONS: The subgroups that received copaiba oil showed bone repair, although not statistically significant in comparison to subgroups treated whit meloxicam or controls. Copaiba oil administered by gavage had no effect on bone repair in this experimental model. .