O Instituto do Duty to Mitigate the Loss e seu conteúdo eficacional no Direito brasileiro em face da Causalidade Cumulativa do artigo 945 do Código Civil

TCC(graduação) - Universidade Federal de Santa Catarina. Centro de Ciências Jurídicas. Direito.Consiste a presente monografia em análise sobre a existência de espaço no Direito brasileiro para a aplicação do instituto do duty to mitigate the loss, no âmbito extracontratual. Para tanto, desenvolveram-se dois estudos, separadamente. Inicialmente, foram revisitados os requisitos para a responsabilidade aquiliana e, então, focou-se na concorrência de culpa entre o agente e a vítima, prevista pelo artigo 945 do Código Civil, na fixação da indenização a partir deste dispositivo e em sua relação com o princípio da reparação integral do dano, em especial nos casos em que a vítima contribui somente para o agravamento do dano. Num segundo momento, estuda-se o dever de mitigação, sua origem jurisprudencial, desenvolvimento e natureza jurídica na Common Law. Analisa-se, de forma mais aprofundada, como foi recepcionado pelo sistema romano-germânico e sua aplicação e status jurídico na Alemanha e na França, bem como seu emprego em tratados e convenções internacionais. Após, investiga-se qual é o tratamento que a jurisprudência e doutrina brasileiras têm emprestado ao dever de mitigação do dano pela vítima. Por fim, o trabalho se propõe a oferecer um posicionamento inicial sobre a possível sobreposição de conteúdo entre o duty to mitigate the loss e a concorrência de causas na esfera extracontratual, no Direito brasileiro

Successful removal of distal persistent foreign body airway with CO2 cryotherapy in a child

We report a case of a nine-year-old boy with clinical evidence of foreign body (FB) aspiration with 3 months of delay in diagnosis. The bronchoscopy found soft tissue FB with surrounding inflamed granulation tissue at the entrance to the lateral segmental bronchus. Repeated attempts to remove the FB with flexible forceps were unsuccessful due to friable FB and granulation tissue. Ablation of the granulation tissue using nitrous oxide cryotherapy was then successfully performed and the distal and organic FB was extracted. Early diagnosis is important for minimizing granulation tissue development which complicates FB removal. Cryotherapy with a flexible bronchoscope is an option if organic FB cannot be removed using conventional bronchoscopic instrumentation

Colonización de la vía respiratoria de los niños diagnosticados de fibrosis quística por cribado neonatal : diferencias cuantitativas y cualitativas con la población de niños sanos /

Introducción La colonización bacteriana del pulmón es relevante en la progresión y pronóstico de la Fibrosis quística (FQ). El cribado neonatal y la obtención seriada de muestras orofaríngeas para cultivo microbiológico nos ofrece la posibilidad de observar la cronología de la colonización bacteriana de la vía aérea en estos pacientes. Esto hace necesario conocer la flora orofaríngea de los niños no afectos de Fibrosis quística (NOFQ). Objetivos 1) Conocer la cronología de la colonización bacteriana de la vía aérea en pacientes con FQ de 0 a 4 años de edad. 2) Compararla con una población sujetos NOFQ de las mismas edades. 3) Evaluar la afectación de la función pulmonar y la tomografía computarizada pulmonar de los niños con FQ con colonización bacteriana persistente por Pseudomonas aeruginosa o Staphylococcus aureus. Métodos Estudio observacional, prospectivo y longitudinal. Pacientes FQ: Niños diagnosticados de FQ por cribado neonatal, desde octubre de 1999 hasta febrero 2005 y seguidos hasta los cuatro años de edad. Las muestras para cultivo microbiológico se obtuvieron mensualmente y siempre que el paciente presentaba una exacerbación respiratoria Sujetos NOFQ: Niños de 0-4 años que precisaron cirugía menor programada. Las muestras orofaríngeas fueron tomadas durante la inducción anestésica. El estudio del grupo control es transversal. No se obtuvieron muestras mensuales por aspectos éticos. Las muestras se tomaron mediante la técnica de aspirado orofaríngeo (AOF). Se obtuvo consentimiento informado previo. Resultados Se incluyeron 18 pacientes afectos de fibrosis quística (76% niños), obtuvimos de estos 877 muestras de AOF para cultivo (mediana de 12,2 muestras/paciente/año) y se hicieron 438 aislamientos bacterianos. Se obtuvieron 104 muestras para cultivo de los sujetos NOFQ (1 por cada sujeto NOFQ incluido) y se realizaron 36 aislamientos bacterianos. Se aíslan microorganismos potencialmente patógenos en ambos grupos desde el primer mes de vida. La prevalencia de aislamientos bacterianos los primeros meses de vida es elevada y similar en pacientes FQ y sujetos NOFQ. Esta disminuye al aumentar la edad de los niños, pero el descenso es mayor en los sujetos NOFQ (p0.05), pero se observan diferencias en su cronología. En los pacientes FQ predomina la colonización por enterobacterias (Enterobacter spp., E. coli, Klebsiella spp.) los dos primeros años y por S. aureus a partir de los 36 meses de vida. En los sujetos NOFQ, sólo predominan enterobacterias el primer año de vida. En la vía aérea superior de los sujetos NOFQ se aíslan, también, los dos patógenos típicamente asociados a FQ, S. aureus y P. aeruginosa. El 83% de los pacientes FQ presentaron colonización por P. aeruginosa antes de los 3 años de vida, pero en ningún caso ha sido causa de colonización persistente. Se aisló S. aureus en el 72,2% de pacientes antes de los 2 años de vida. Hemos observado que la edad de colonización de S. aureus (mediana de 5 meses) precede a la de colonización por P. aeruginosa (mediana de 12 meses). La función pulmonar de todos los pacientes FQ fue normal. La colonización bacteriana persistente de la vía aérea por S. aureus no ha empeorado su función respiratoria ni su puntuación de TCAR, respecto a los que no la presentan. Conclusiones La colonización bacteriana de la vía aérea de los pacientes FQ y sujetos NOFQ se produce precozmente por las misma especies bacterianas. La cronología de los aislamientos difiere en ambos grupos al aumentar la edad de los niños. La colonización por S. aureus y P. aeruginosa no puede considerarse aisladamente sugestivo de FQIntroduction Pulmonary infection is the most common cause of morbidity and mortality in Cystic Fibrosis (CF). The newborn screening program and the routine oropharyngeal cultures allowed identifying the timing of bacterial colonization. Elucidate bacterial colonization in healthy children (HC) could be necessary. Aims 1) Identify the timing at which CF patients up to four year old acquire bacterial colonization. 2) Elucidate bacterial colonization in healthy infants of the same age. 3) Evaluate the lung function and the lung computerized tomography deterioration in CF patients who are persistently colonized by P. aeruginosa or S. aureus. Methods Observational, prospective and longitudinal study. CF Patients: infant with newly diagnosed cystic fibrosis disease diagnosed by neonatal screening, from October 1999 to February 2005 and followed until the age of four year. Specimens were taken monthly and every time the infant or children developed respiratory tract infection. HI: children under 4 years old, without respiratory pathology, that need minor surgery. Specimens were taken during anaesthesia induction. It was carried out a cross-sectional study for HC. Specimens were taken applying the oropharyngeal suction (OPS) technique. A signed consent was obtained previously. Results Eighteen CF patients were recruited (76% males), 877 OPS specimens were taken (12,2 specimens/patient/year) and 438 bacterial microorganisms were isolated. We took 104 OPS specimens from 104 HC (78,6% males) and 36 microorganisms were isolated. Microorganisms were isolated from both, the CF patients and the HC upper airway since, the first month of life. The prevalence of bacteria isolated during the first three months of life was high and similar at both groups, and was decreasing with age. This decrease was more important at HI than at CF patients (p< 0.05) The most frequently isolated microorganisms were the same species at both groups and no statistically significant differences were found. Nevertheless, the chronology would be different between CF patients and HC. Enterobacterias (Enterobacter spp., E. coli, Klebsiella spp.) were the most frequent bacteria isolated during the first and the second year of life in CF patients and S. aureus was the most prevalent since the fourth year of life. In HC, enterobacterias were the most frequently isolated bacteria only during the first year. We were able to detect S. aureus y P. aeruginosa from the upper airway of HC. At least one P. aeruginosa isolated was detected in 83,3% of CF patients at some time during the study, but we did not detect any persistent colonization by this microorganism. At least one S. aureus isolated was detected in 72,2% of CF patients before 24 months of life. We observed that the acquisition of S. aureus colonization (median 5 months) occurred before the P. aeruginosa colonization (median 12 months). Lung function of all the CF patients was normal. The persistent upper airway S. aureus colonization did not affect lung function neither TCAR punctuation. Conclusions The presence of microorganism in upper airway culture from CF patients and HC begins very early. The chronology of bacterial prevalence differs between CF patients and HC. The presence of PA in an upper airway culture should not be considerered patognomonic for CF

School children with chronic diseases; what are teachers worried about? Let’s not forget asthma!

Carta al director elaborada por el Grupo de trabajo Asma y Educación, de la Sociedad Española de Neumología Pediátrica en respuesta al artículo ‘Escolares con enfermedades crónicas, ¿qué lespreocupa a sus profesores?’. En ella ponen de manifiesto la ausencia en el estudio del asma, enfermedad crónica más frecuente en la edad pediátrica

A Case of Persistent Air Leak Managed by Selective Left Main Bronchus Intubation in an Infant with Pulmonary Tuberculosis

Unusual clinical course Persistent air leak, or persistent pneumothorax, is defined as a pneumothorax that persists beyond the first week, or air leak through a chest drain for more than 48 hours. The most common findings in pediatric pulmonary tuberculosis are parenchymal disease and mediastinal lymphadenopathy, but airway obstruction can cause emphysema and pneumothorax. A case is presented of persistent air leak in a 3-month-old infant with pulmonary tuberculosis that was managed by selective left main bronchus intubation. A 3-month-old boy presented with respiratory distress and fever. Imaging findings suggested pulmonary tuberculosis, and first-line anti-tuberculous treatment was initiated with isoniazid, rifampicin, pyrazinamide, and ethambutol (HRZE). He was discharged home after eight days, but was admitted four days later with respiratory distress. Chest X-rays showed a tension pneumothorax that required drainage and chest computed tomography (CT) showed right lung emphysema. Bronchoscopy found extrinsic obstruction of both main bronchi. Chest drains continued to leak air leak after 48 h. Right middle and lower lobectomy and drainage of multiple lymph nodes resulted in significant improvement. He developed pneumonia and acute respiratory distress syndrome, which prevented mechanical ventilation. The left main bronchus was selectively intubated to allow the air leak to heal and to ventilate the lung. He was extubated 10 days later and recovered completely. This case highlights that when medical management of persistent air leak associated with tuberculosis is not effective, surgery, active ventilation, and selective main bronchus intubation should be considered