Endoscopic ligation of the anterior ethmoidal artery: a cadaver dissection study

Ligadura da artéria etmoidal anterior (AEA) pode ser necessária em casos de epistaxe grave refratária ao tratamento tradicional. O uso da ligadura endoscópica endonasal da AEA ainda é bastante limitado. Existem poucos estudos na literatura sobre a técnica de abordagem endoscópica desta artéria. OBJETIVOS: Demonstrar a aplicabilidade técnica da ligadura periorbitária da AEA por via endoscópica transetmoidal. MATERIAL E MÉTODOS: Estudo prospectivo. 50 fossas nasais de cadáveres foram dissecadas. Após a realização de uma etmoidectomia anterior e remoção parcial da lâmina papirácea, a periórbita foi cuidadosamente dissecada até a identificação da AEA. Após sua identificação, a artéria foi exposta e ligada dentro da órbita. RESULTADOS: Todas as dificuldades inerentes ao procedimento, as complicações associadas, a curva de aprendizado e variações anatômicas foram coletados. CONCLUSÕES: A abordagem endoscópica da AEA na órbita de cadáveres mostrou-se factível. A identificação da artéria é fácil e a técnica evita incisões externas. Este acesso parece ser uma excelente alternativa para a abordagem da AEA. Estudos clínicos futuros são necessários para comprovar os benefícios desta técnica.Anterior ethmoidal artery (AEA) ligation may be necessary in cases of severe epistaxis not controllable with traditional therapy. Endoscopic endonasal ligation of the AEA is not used frequently; there are few studies in the literature for standardization of the endoscopic technique for this vessel. AIM: To demonstrate the feasibility of periorbital AEA ligation in a transethmoidal endoscopic approach. METHODS: A prospective study where 50 nasal cavities were dissected. After anterior ethmoidectomy and partial removal of lamina papyracea, the periorbital area was carefully dissected along a subperiosteal plane to identify the AEA. The vessel was exposed within the orbit and dissected. RESULTS: Data on technical difficulties, complications, the learning curve and anatomical variations were gathered. CONCLUSION: An endonasal endoscopic approach to the AEA within the orbit was shown to be feasible. Identifying the artery is not difficult, and this technique avoids external incisions. This approach appears to be an excellent alternative for approaching the AEA. Further clinical studies are needed to demonstarte the benefits of this technique

Anatomia endoscópica do acesso à região selar e plano esfenoidal

The productive work between otolaryngologists and neurosurgeons has resulted in the emergence of endoscopic endonasal skull base surgery. The goal of the present study is to describe the endoscopic anatomy of the endonasal approach to the sellar region and planum sphenoidale, highlighting the key points of the surgical approach and the neurovascular landmarks. METHOD: Descriptive study of the endoscopic endonasal dissection of 9 fresh cadavers with exposure of the anatomic structures. RESULTS: The endoscopic endonasal ethmoidectomy and sphenoidotomy allows an expanded access to the sellar area and planum sphenoidale. The surface anatomy of the sphenoid sinus is easily identifiable and provides safe landmarks, guiding the intracranial dissection. CONCLUSION: The endoscopic endonasal approach to the skull base by the ENT and neurosurgeon is feasible, but it requires adequate anatomical knowledge and endoscopic skills for its realization, which can be obtained by practicing in cadavers.O trabalho cooperativo entre otorrinolaringologistas e neurocirurgiões resultou no aprimoramento das técnicas cirúrgicas e no surgimento da cirurgia endoscópica endonasal da base do crânio. O estudo tem como objetivo descrever a anatomia endoscópica do acesso endonasal da região selar e plano esfenoidal, destacando os pontos fundamentais do acesso cirúrgico e referências neuro-vasculares. MÉTODO: Estudo descritivo da dissecção endoscópica endonasal de 9 cadáveres frescos com exposição das estruturas anatômicas. RESULTADOS: A etmoidectomia e esfenoidotomia endonasal endoscópica permite um acesso estendido à região selar e plano esfenoidal. A anatomia de superfície do seio esfenoidal é facilmente identificada e fornece pontos de referência seguros, guiando a dissecção intracraniana. CONCLUSÃO: O acesso endoscópico endonasal para a base do crânio pelo otorrinolaringologista e neurocirurgião é perfeitamente viável, mas para isso o conhecimento anatômico da região e de seus pontos de referência é essencial, o que pode ser obtido pelo treinamento em cadáveres

Analysis of 5S program application in the hemodialysis sector in an east center of Minas Gerais hospital

The aplication of Lean Thinking due to decrease losings and increase local organization has been gradually growing in many areas beyond industrial sector and one of those that this thought started to afford lots of benefits is the health sector. This article it´s about a case study that sought to align 5S tool of Lean Methodology in health sector with the objective of bring improvements to the local study process and pitch in advances of Lean HealthCare theme. The study environment chosen is the pharmacy of hemodialysis sector of a hospital located in the east center of Minas Gerais, Brazil, and through the aplication of a 5S audit form it was executed a qualitative-quantitative study. From the quantification of 5S level existant in the pharmacy before and after the 5S program implementation, it was possible to offer as a result improvements proposal to work environment and employees, in addition to recommended actions to keep the program active

Paracoccidioidomicose – acometimento encefálico e medular: relato de caso

The paracoccidioidomycosis (PCM) is a systemic granulomatous mycosis, with Brazil being responsible for 80% of the cases reported in the world. Even in endemic zones its incidence is low (3-4 new cases/million up to 1-3 new cases/100 thousand inhabitants per year). We will report the case of a 54 year old woman, from the rural area in the North region of the state of Goiás, Central area of Brazil. During investigation for the medullar compressive syndro-me, a tumor lesion at the thoracic level was identified, submitted to resection, and diagnostically confirmed as neuroparacoccidioi-domycosis in the anatomical pathology analysis. She was admitted for rehabilitation with the diagnosis of T9 Asia B Paraplegia. During her stay, exams were performed (computerized tomography (CT) of the brain and thorax) to investigate the state of other organs. A thorax CT showed an aspect suggesting PCM with micronodules with center-lobular location and some opaqueness in “tree-in-bud” formation with moderate distortion of the pulmonary architecture, in addition to spots of attenuation in “opaque glass” appearance with non-homogeneous distribution. A cranial CT also suggested PCM in an active phase: nodular areas in nuclear-capsule to the left and corresponding thalamus, with reactional edema and important peripheral emphasis. This disease is a public health problem in Brazil due to is incapacitating potential. It is difficult to diagnose, especially when it attacks the CNS, since this is an uncommon manifestation (pulmonary symptoms are most commonly found).A paracoccidioidomicose (PCM) é uma micose sistêmica, tipo granulomatosa, sendo o Brasil responsável por 80% dos casos relatados no mundo. Mesmo em zonas endêmicas, sua incidência é baixa (3-4 novos casos/milhão até 1-3 novos casos/100mil habitantes ao ano). Relatamos um caso do sexo feminino, 54 anos, procedente do meio rural, região norte do estado de Goiás, centrooeste do Brasil. Durante investigação para síndrome compressiva medular foi identificada lesão tumoral em nível torácico, submetida à ressecção e firmado o diagnóstico de neuroparacoccidioidomicose no anatomopatológico. Foi admitida para reabilitação com diagnóstico de Paraplegia T9 Asia B. Durante a internação foram realizados exames (tomografia computadorizada (TC) de crânio e tórax) para investigação de acometimento de outros órgãos. A TC de tórax demonstrou aspecto sugestivo de PCM com micronódulos de localização centro-lobular e algumas opacidades em “árvore em brotamento” com discreta distorção da arquitetura pulmonar, além de focos de atenuação em “vidro fosco” de distribuição não homogênea. A TC crânio também se mostrou sugestiva de acometimento da PCM em fase ativa: áreas nodulares em cápsulonuclear à esquerda e tálamo correspondente, com edema reacional e importante realce periférico. A doença é um problema de saúde pública no Brasil devido ao seu potencial incapacitante, sendo o diagnóstico difícil especialmente quando acomete SNC, por ser uma manifestação pouco comum (maior acometimento pulmonar)

AGROCLIMATIC ZONING OF CRAMBE AND BEAN FOR THE BACIA DO ALTO PARAGUAI MT, BRAZIL

The economic activities of the Pantanal, were directly influenced by the periodic flooding process. Therefore, it became highly necessary to diversify the economic output of this region, especially in the area of agriculture. An expansion process is thus taking place in the Upper Paraguay River Basin. This study, therefore, aims at performing zoning for cultivation of the Crambe and common bean in the Mato Grosso portion of the Upper Paraguay River Basin. This research was conducted in the University of Mato Grosso - UNEMAT Campus of Tangara da Serra - MT. Data on the temperature and precipitation from 38 meteorological stations were provided by the National Institute of Meteorology - INMET, Forecasting Center Weather and Climate Studies - CPETEC and the Secretary of State and Environmental Development - SEDAM / RO. For the Crambe seeding culture done without utilizing the irrigation systems after the time 9, increases the risk of cultivation failure. In light of this fact it becomes evident that the lack of water is the main limiting factor for cultivating Crambe in the area under study. However, in general, most of the area available in the Upper Paraguay River Basin is able to sustain bean cultivation during all the sowing dates studied. Sowing Crambe from the first to the seventh day of the ten-day period is acertained as good for the fullest extent of the Upper Paraguay River Basin, whereas for the bean this period stretches until the ninth or ten-day perio

Impact of safety-related dose reductions or discontinuations on sustained virologic response in HCV-infected patients: Results from the GUARD-C Cohort

BACKGROUND: Despite the introduction of direct-acting antiviral agents for chronic hepatitis C virus (HCV) infection, peginterferon alfa/ribavirin remains relevant in many resource-constrained settings. The non-randomized GUARD-C cohort investigated baseline predictors of safety-related dose reductions or discontinuations (sr-RD) and their impact on sustained virologic response (SVR) in patients receiving peginterferon alfa/ribavirin in routine practice. METHODS: A total of 3181 HCV-mono-infected treatment-naive patients were assigned to 24 or 48 weeks of peginterferon alfa/ribavirin by their physician. Patients were categorized by time-to-first sr-RD (Week 4/12). Detailed analyses of the impact of sr-RD on SVR24 (HCV RNA <50 IU/mL) were conducted in 951 Caucasian, noncirrhotic genotype (G)1 patients assigned to peginterferon alfa-2a/ribavirin for 48 weeks. The probability of SVR24 was identified by a baseline scoring system (range: 0-9 points) on which scores of 5 to 9 and <5 represent high and low probability of SVR24, respectively. RESULTS: SVR24 rates were 46.1% (754/1634), 77.1% (279/362), 68.0% (514/756), and 51.3% (203/396), respectively, in G1, 2, 3, and 4 patients. Overall, 16.9% and 21.8% patients experienced 651 sr-RD for peginterferon alfa and ribavirin, respectively. Among Caucasian noncirrhotic G1 patients: female sex, lower body mass index, pre-existing cardiovascular/pulmonary disease, and low hematological indices were prognostic factors of sr-RD; SVR24 was lower in patients with 651 vs. no sr-RD by Week 4 (37.9% vs. 54.4%; P = 0.0046) and Week 12 (41.7% vs. 55.3%; P = 0.0016); sr-RD by Week 4/12 significantly reduced SVR24 in patients with scores <5 but not 655. CONCLUSIONS: In conclusion, sr-RD to peginterferon alfa-2a/ribavirin significantly impacts on SVR24 rates in treatment-naive G1 noncirrhotic Caucasian patients. Baseline characteristics can help select patients with a high probability of SVR24 and a low probability of sr-RD with peginterferon alfa-2a/ribavirin

Expressão múltipla VI : desenho aplicado e teoria e prática do desenho : atas das conferências : 2022

Obra publicada no âmbito do 6.º Colóquio de Expressão Múltipla, decorrido a 13 e 14 de Dezembro de 2022Foi apresentada em linha no dia 13 e 14 de dezembro de 2022 a sexta edição do Colóquio Expressão Múltipla: Teoria e Prática do Desenho. Esta edição é marcada por um desdobramento do colóquio em dois momentos distintos e complementares - o Colóquio Expressão Múltipla: Desenho Aplicado e o Colóquio Expressão Múltipla: teoria e prática do Desenho. Se o Colóquio Expressão Múltipla já se edificou enquanto plataforma para pensar a teoria e a prática do Desenho, surge agora a vertente do Desenho Aplicado. Importa referir que esta adição desponta em grande parte por uma direção tomada pelos alunos dos diversos ciclos de estudo do ensino superior, que os liga a secções do desenho próximas de áreas como o Desenho Digital, Banda Desenhada, Concept Art, Ilustração, Desenho em Realidade Virtual, Desenho de reconstrução, Desenho Científico, entre tantos outros tipos de Desenho Aplicado. Por Desenho Aplicado entende-se então um tipo de desenho abrangente que não sendo necessariamente um fim em si mesmo, vai contribuir para o desenvolvimento de outras áreas.info:eu-repo/semantics/publishedVersio