Fraturas do arco zigomático: cerclagem de contenção

This work proposes an alternative technique for zygomatic fractures contention. Steel wire cerclage supportsan 1.5 Kirchner wire shaped in double U by cutaneous anchorage. This technique can be indicated in casesof closed reduction of zigomatic arch fractures without fixation that may loose reduction if not properlyprotected

Orbital floor reconstruction with high density polyethylene

Surgical interventions in blow out fractures are generally indicated in cases of alterations in orbital function (e.g. diplopia)and for aesthetic reasons (e.g. enophthalmos). In assessing the severity of the injury, the clinician often uses parameterssuch as changes in visual acuity, patient-reported diplopia, changes in globe position and evaluation of the extraocularmuscles in association with imaging exams. Computed tomography has been the modality of choice for detailed imagingdiagnosis and surgical planning of orbital trauma. High density polyethylene may be successfully used in orbital floorreconstruction to restore function and esthetics. Taking into account the follow up of six months, the availability and theadvantages of high density polyethylene implants, it can be concluded that their use in reconstruction of orbital floordefects is a good choice

Gastric Adenocarcinoma After Gastric Bypass For Morbid Obesity: A Case Report And Review Of The Literature.

Gastric adenocarcinoma after gastric bypass for morbid obesity is rare but has been described. The diet restriction, weight loss, and difficult assessment of the bypassed stomach, after this procedure, hinder and delay its diagnosis. We present a 52-year-old man who underwent Roux-en-Y gastric bypass 2 years ago and whose previous upper digestive endoscopy was considered normal. He presented with weight loss, attributed to the procedure, and progressive dysphagia. Upper digestive endoscopy revealed stenosing tumor in gastric pouch whose biopsy showed diffuse-type gastric adenocarcinoma. He underwent total gastrectomy, left lobectomy, distal pancreatectomy and splenectomy, segmental colectomy, and bowel resection with esophagojejunal anastomosis. The histopathological analysis confirmed the presence of gastric cancer. The pathogenesis of gastric pouch adenocarcinoma is discussed with a literature review.201360972

Rare Gastric Inflammatory Myofibroblastic Tumor in an Adult Woman: A Case Report with Review of the Literature

Inflammatory myofibroblastic tumor (IMT) of the stomach is extremely rare and its prognosis is unpredictable. We present a 37-year-old woman with a gastric IMT. She presented epigastric pain since 2 months, anemia and weight loss associated. Physical examination showed cutaneous pallor and mild abdominal tenderness in the epigastrium. Abdominal ultrasonography showed a tumor near the pancreas and the CT scan revealed that the lesion was arising from the stomach. Upper endoscopy showed a submucosal lesion of approximately 7.5 cm located in the posterior wall of the gastric body such as a gastrointestinal stromal tumor (GIST). The patient underwent a subtotal gastrectomy and Billroth I reconstruction. The histopathological and immunohistochemical analysis revealed an IMT that originated from the gastric wall

Parada cardiorrespiratória obstétrica: construção e validação de instrumento para avaliar o conhecimento da enfermagem

Objetivo: Construir e validar instrumento para avaliar o conhecimento da enfermagem sobre parada cardiorrespiratória obstétrica.Métodos: Estudo metodológico composto pela construção do instrumento, validação de conteúdo por 23 especialistas e validação da consistência interna com 74 profissionais da enfermagem e 99 estudantes de enfermagem. Foram considerados válidos os itens comconcordância mínima de 90%, verificada a partir do Índice de Validação de Conteúdo, Razão de Validade de Conteúdo e teste binomial. O alpha de Cronbach foi utilizado para verificar a consistência interna e o valor superior a 0,6 classificado como aceitável.Resultados: O instrumento foi composto por16 questões de múltipla escolha, dos 16 itens avaliados, oito possuíram concordância de 100% e seis 95%. A menor razão de validade de conteúdo foi de 0,82 e o alpha de Cronbach foi de 0,694.Conclusões: O instrumento foi construído e validado, recomendando-se sua utilização para avaliação do conhecimento em parada cardiorrespiratória obstétrica. Palavras-chave: Ensino. Avaliação educacional. Educação em enfermagem. Reanimação cardiopulmonar. Obstetrícia

Analgesic action of laser therapy (LLLT) in an animal model

Objectives: To evaluate the analgesic effect of laser therapy on healthy tissue of mice. Study design: Forty-five animals were divided in three groups of 15: A ? infrared laser irradiation (830 nm, Kondortech®, São Carlos, SP, Brazil); B ? red laser irradiation (660 nm, Kondortech®, São Carlos, SP, Brazil); C ? sham irradiation with laser unit off. After laser application, the mice remained immobilized for the injection of 30 µl of 2% formalin in the plantar pad of the irradiated hind paw. The time that the mouse kept the hind paw lifted was measured at 5 min intervals for 30 minutes. Results: Results showed statistically significant differences comparing the control group with the infrared laser group at 5, 20, 25 and 30 accumulated minutes, and with the red laser group at all time points. The analysis of partial times, at each 5 minutes, showed statistically significant differences between the control and the laser groups up to 20 minutes. Conclusions: Laser therapy had an analgesic effect and red laser had the best results

Combined treatment by antibiotic therapy and surgery of chronic mandibular osteomyelitis: a case report.

Chronic osteomyelitis of the mandible is usually a difficult pathology to resolve. Treatment has included long-term antibiotics,and surgical debridement, aggressive in some cases. This paper reports a 54-year-old female with an eight-month-mandibularchronic osteomyelitis who was successfully treated with the combination of medication and surgical intervention

Reconstrução de assoalho orbital com polietileno de alta densidade

Surgical interventions in blow out fractures are generally indicated in cases of alterations in orbital function (e.g. diplopia)and for aesthetic reasons (e.g. enophthalmos). In assessing the severity of the injury, the clinician often uses parameterssuch as changes in visual acuity, patient-reported diplopia, changes in globe position and evaluation of the extraocularmuscles in association with imaging exams. Computed tomography has been the modality of choice for detailed imagingdiagnosis and surgical planning of orbital trauma. High density polyethylene may be successfully used in orbital floorreconstruction to restore function and esthetics. Taking into account the follow up of six months, the availability and theadvantages of high density polyethylene implants, it can be concluded that their use in reconstruction of orbital floordefects is a good choice.Justifica-se intervir cirurgicamente em fraturas do tipo blow out naqueles casos em que haja alterações da função orbital,como a diplopia, ou mesmo por razões estéticas, como a enoftalmia. Clinicamente, as fraturas do tipo blow out revelamalterações estéticas e funcionais que, associadas aos exames complementares por imagem, como a tomografiacomputadorizada, indicam o procedimento cirúrgico reparador. A utilização do polietileno de alta densidade (PAD) nareconstrução do assoalho orbital reduz a morbidade do enxerto autógeno, apresentando estabilidade e biocompatibilidade.Este artigo discute um caso cirúrgico de evolução favorável após seis meses de reconstrução do assoalho orbital com PAD

Identification of preoperative risk factors for persistent postoperative dysphagia after laparoscopic antireflux surgery

BACKGROUND: Postoperative dysphagia is common after antireflux surgery and generally runs a self-limiting course. Nevertheless, part of these patients report long-term dysphagia. Inadequate surgical technique is a well documented cause of this result. AIM: This retrospective study evaluated the preoperative risk factors not surgery-related for persistent dysphagia after primary laparoscopic antireflux surgery. METHODS: Patients who underwent laparoscopic antireflux surgery by the modified technique of Nissen were evaluated in the preoperative period retrospectively. Postoperative severity of dysphagia was evaluated prospectively using a stantardized scale. Dysphagia after six weeks were defined as persistent. Statistical tests of association and logistic regression were used to identify risk factors associated with persistent dysphagia. RESULTS: A total of 55 patients underwent primary antireflux surgery by a single surgeon team. Of these, 25 patients had preoperative dysphagia (45,45%). Persistent postoperaive dysphagia was reported by 20 (36,36%). Ten patients (18,18%) required postoperative endoscopic dilatation for dysphagia. There was statistical association between satisfaction with surgery and postoperative dysphagia and requiring the use of antireflux medication after the procedure; and between preoperative dysphagia and postoperative dysphagia. Logistic regression identified significant preopertive dysphagia as risk factor for persistent postoperative dysphagia. No correlations were found with preoperative manometry. CONCLUSIONS: Patients with significant preoperative dysphagia were more likely to report persistent postoperative dysphagia. This study confirms that the current manometric criteria used to define esophageal dysmotility are not reliable to identify patients at risk for post-fundoplication dysphagia. Minucious review of the clinical history about the presence and intensity of preoperative dysphagia is important in the selection of candidates for antireflux surgery.RACIONAL: Disfagia no pós-operatório é comum após a operação anti-refluxo. No entanto, uma parte dos pacientes relatam disfagia persistente, e técnica cirúrgica inadequada é uma causa bem documentada deste resultado. OBJETIVO: Este estudo retrospectivo avaliou os fatores de risco no pré-operatório para a disfagia persistente após operação anti-refluxo por via laparoscópica. MÉTODOS: Pacientes submetidos à operação anti-refluxo por via laparoscópica pela técnica de Nissen modificada foram avaliados no pré-operatório de forma retrospectiva. A severidade da disfagia pós-operatória foi avaliada prospectivamente usando uma escala estabelecida. A disfagia após seis semanas foi definida como persistente. Os testes estatísticos de associação e regressão logística foram utilizados para identificar os fatores de risco associados à disfagia persistente. RESULTADOS: Um total de 55 pacientes foram submetidos ao procedimento por via laparoscópica por uma única equipe de cirurgiões. Destes, 25 doentes referiam disfagia pré-operatório (45,45%). A disfagia pós-operatória persistente foi relatada por 20 (36,36%) pacientes. Dez (18,18%) necessitaram de dilatações por endoscopia digestiva. Houve associação estatística entre a satisfação com a operação e disfagia no pós-operatório e exigindo o uso de medicação anti-refluxo após o procedimento, e entre disfagia no pré-operatório e disfagia no pós-operatório. A regressão logística identificou a disfagia no pré-operatório, como fator de risco para a disfagia pós-operatória persistente. Não foram observadas correlações com manometria pré-operatória. CONCLUSÕES: Os pacientes com disfagia no pré-operatório foram mais propensos a relatar disfagia pós-operatória persistente. Os critérios manométricos atuais utilizados para definir dismotilidade esofágica não identificaram pacientes com risco de disfagia persistente pós-fundoplicatura. Análise minuciosa da história clínica sobre a presença e intensidade da disfagia no pré-operatório é muito importante na seleção de candidatos à operação anti-refluxo.16516