O DNA da relação médico-paciente

Narrative in medicine or, generally, in healthcare, is being stated as a form of patient care humanization (Charon, 2008; Gallian, 2012: 174-177; Carelli, Pompilio, 2013: 677-681; Fernades, 2015: 21-39; Fernandes, 2015: 1-7). An acknowledged milestone among the various groups dedicated to this study is accrediting the doctor-patient relationship as the drive shaft of the understanding between these two poles of the healthcare service(Plapler, Carelli, 2015). Hurwitz (Hurwitz, 2006: 216-240) affirms that the medical consultation is a specific category of encounter which can be analyzed narratively. There are many plausible kinds of textual analysis models that make possible to better understand how this encounter discursively happens and evolves. This relationship, however, has been scientifically evaluated mostly as an intersubjective phenomenon which occurs randomly, in a way the patient (or his/her illnesses) is(are) still considered mostly as objects of health professionals’ knowledge. Our goal here is to show that the knowledge built up through and within this relationship results from the constitution of a specific linkage among elements (attention, time, care and guidance) that are discursively built.A narrativa em medicina e nas demais áreas da saúde está se firmando como um modo de conhecimento do doente e seus males e uma forma de humanização do seu atendimento. Um ponto comum entre os diversos grupos que se dedicam ao estudo da chamada “narrativa médica” é ver a relação médico-paciente como eixo motriz da compreensão entre estes dois polos do atendimento em saúde . Hurwitz estabelece que a consulta médica é uma forma específica de encontro que produz narrativas e, portanto, pode ser analisada narrativamente. São diversas as formas possíveis de análise textual com a finalidade de compreender como essa relação acontece e evolui discursivamente. Tal relação, contudo, tem sido avaliada apenas como um fenômeno inter-subjetivo que ocorre aleatoriamente, em que o paciente (ou suas doenças) ocupam o papel de mero objeto do conhecimento. Nosso objetivo é mostrar que ela ocorre em função de um vínculo específico entre elementos (tempo, cuidado, guia e atenção) que podem ser analisados narrativament

Pharmacokinetics of Photogem Using Fluorescence Spectroscopy in Dimethylhydrazine-Induced Murine Colorectal Carcinoma

This study aimed to investigate the pharmacokinetics of a hematoporphyrin derivative in colonic tumors induced by dimethylhydrazine and adjacent normal colon in Wistar rats using an in vivo fluorescence spectroscopy technique. In conventional clinical application of photodynamic therapy, the interval between photosensitizer (PS) administration and lesion illumination is often standardized without taking into account variations due to the type or localization of the tumor and intrinsic differences in the microcirculation and vascular permeability of each target organ. The analysis of the fluorescence spectra was based on the intensity of porphyrin emission band centered at around 620 nm in normal colon and colon tumors. The photosensitizer fluorescence intensity rapidly grew for carcinoma and normal colon, reaching the maximum values 1 and 3 hours after PS injection, respectively. Data presented here allow us to verify that the best compromise between selectivity and drug concentration for colon carcinoma in rats took place in the interval between 1 to 4 h after PS injection

Absorção de glicose por um segmento de colo distal interposto entre cotos de intestino delgado após ressecção de 80 "por cento" do jejuno-íleo: estudo experimental em ratas

BV UNIFESP: Teses e dissertaçõe

Ablação de tumor de canal anal tratado com laser de diodo: seguimento após 17 meses

The Nd:YAG laser is used as the palliative treatment of obstructive and/or hemorrhagic intestinal lesions with an effective but temporary symptomatic relief, with symptoms and signs recurrence after six to eight weeks. This report describes the treatment of a patient bearing a low rectal adenocarcinoma through diode laser ablation and the result after 17 months

Hemorrhoids: an experimental model in monkeys

PURPOSE: Hemorrhoids are a matter of concern due to a painful outcome. We describe a simple, easy and reliable experimental model to produce hemorrhoids in monkeys. METHODS: 14 monkeys (Cebus apella) were used. After general anesthesia, hemorrhoids were induced by ligation of the inferior hemorrhoidal vein, which is very alike to humans. The vein was located through a perianal incision, dissected and ligated with a 3-0 vicryl. The skin was sutured with a 4-0 catgut thread. Animals were kept in appropriate cages and evaluated daily. RESULTS: Nine days later there were hemorrhoidal piles in the anus in fifty percent (50%) of the animals. Outcome was unremarkable. There was no bleeding and all animals showed no signs of pain or suffering. CONCLUSION: This is an affordable and reliable experimental model to induce hemorrhoids for experimental studies

Morfologia e morfometria de um segmento de colo interposto entre cotos de intestino delgado após ressecção de 80 "por cento" e injeção de hormônios: estudo experimental em ratos

BV UNIFESP: Teses e dissertaçõe

Real time echo-guided endolaser for thermal ablation without perivenous tumescence

Abstract Background There is no consensus in the medical literature on the ideal procedure for endovenous laser application. Objective To assess the safety and efficacy of real time echo-guided endovenous laser for thermal ablation of great saphenous vein (GSV) incompetence, without perivenous tumescence. Methods Thirty-four limbs of patients with CEAP clinical scores of 2 to 6 and bilateral incompetence of the saphenofemoral junction (SFJ) and GSV, confirmed by Echo-Doppler, underwent endovenous laser therapy and were followed for 1 year. Laser ablation was performed using a 600 µ bare optical fiber introduced endovenously close to the malleolus along the full extent of the GSV in an anterograde direction, using a standardized echo-Doppler-guided AND? 15 watt continuous mode 980 nm diode laser with real-time monitoring of thermal ablation of the whole target vein. Adverse effects and complications were recorded. Results Hyperesthesia, cellulitis, and fibrous cord, all transitory, developed in 2.9% of the 34 limbs treated; 8.8% developed hypoesthesia in the perimalleolar region, which was transitory and had no clinical consequences; there were no cases of deep venous thrombosis. Immediate occlusion was achieved in 100% of the 34 saphenous veins that underwent photocoagulation, although one exhibited recanalization without reflux at 1-month follow-up. After 6 months and 1 year, occlusion was 100% according to echo-Doppler findings. Conclusions Real-time echo-guided 980 nm endovenous laser ablation without perivenous tumescence provided controlled thermal ablation with safe, effective, immediate and medium-term GSV occlusion and can therefore be recommended as a method for the treatment of chronic venous disease