RESUMEN
Objective A novel technique is described for transpalatal hypophysectomy as an option for sellar region surgery using a microscope and/or endoscope. Technique A straight submucosal tunnel (approximately 20 mm in diameter; 40-50 mm long-half the length required by conventional transsphenoidal hypophysectomy) is dissected in favorable alignment with the main tumor axis, providing a direct view that allows the surgeon to operate on large suprasellar tumors, even in cases of extra-axial expansion. Results In a 25-year period, over 50 patients benefited from this surgery. Macroadenomas devoid of extra-axial expansions were totally excised (76.5%), otherwise, partially (23.5%). Forty-nine patients (98%) were extubated soon after surgery. Mean surgery duration was 3 hour 32 minute, with 2 days 6 hour before free feeding was restored. Postoperative hospitalization under neurosurgical care averaged 6 days 6 hour. Currently, patients undergoing the procedure do not require nasal tampons and can eat soft foods soon after recovery from anesthesia. Although two patients (3.9%) presented with oronasal fistulae postoperatively, no episodes of severe hemorrhage occurred during surgery and there were no cases of liquoric fistulae, visual impairment, panhypopituitarism, or severe syndrome of inappropriate antidiuretic hormone secretion. Conclusion The new surgical approach is safe, effective, and well accepted by patients, who reported low levels of discomfort. Postsurgical complications or sequela are currently rare, but further operations should be performed using more appropriate materials, instruments, and equipment to allow comparisons with other techniques.
RESUMEN
OBJECTIVES: To detect the actual prevalence of systemic hypertension in the city of Campo Grande, MS, Brazil, and frequent factors. METHODS: Cross-sectional study with a randomized sample of the adult population of the city of Campo Grande, MS, in a total of 892 individuals. A questionnaire on age, gender, level of education, smoking, alcohol consumption, and aspects of the treatment was applied. Anthropometric data (weight and height) were collected. According to the WHO, a BMI<25 kg/m2 was considered normal weight; 25>BMI<30 overweight; and BMI> 30 obesity. Criteria for hypertension were based on the JNC VII report, with blood pressure cut-off values of 140 x 90 mmHg. RESULTS: The prevalence of hypertension was 41.4%, varying with age (up to 29 years: 11.8%; 30-39: 24.8%; 40-49: 43.3%; 50-59: 42.4%; 60-69: 48.6% and > 70: 62.3%). A higher prevalence was observed among men (51.8%), whereas among women the prevalence was 33.1%. Individuals with basic level of education tended to present higher rates. Among overweight and obese individuals, a higher prevalence of hypertension was observed: normal BMI (27.9%), overweight (45.6%) and obesity (58.6%). Above 60 years of age, a higher percentage of isolated systolic hypertension was observed, with 16.4% (60-69 years) and 24.6% (>70 years). Daily or weekly alcohol consumption was also related to a higher incidence, of 63.2% and 47.2%, respectively. Only 59.7% were known to be hypertensive. Of the hypertensive individuals, 57.3% were undergoing some type of treatment. Of those undergoing regular treatment, 60.5% presented hypertension. CONCLUSION: The prevalence of hypertension was 41.4%, therefore higher than the average verified in some studies. This calls the attention for worsened epidemiologic conditions and cardiovascular repercussions, thus showing the need for higher public investment on education and orientation of these population groups as regards prevention.
Asunto(s)
Hipertensión/epidemiología , Adulto , Anciano , Brasil/epidemiología , Métodos Epidemiológicos , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJETIVOS: Detectar a real prevalência de hipertensão arterial sistêmica em Campo Grande, MS, e fatores freqüentes. MÉTODOS: Estudo transversal com amostra randomizada da população adulta da cidade de Campo Grande, MS, num total de 892 pessoas. Foi aplicado questionário sobre idade, sexo, escolaridade, tabagismo, etilismo, aspectos sobre o tratamento. Foram colhidos dados antropométricos (peso e altura). Segundo a OMS, foi considerado peso normal: IMC<25 kg/m²; sobrepeso: 25>IMC<30; obeso: IMC> 30. Os critérios para hipertensão foram baseados no VII Joint, com valores de corte de Pressão Arterial de 140 x 90 mmHg. RESULTADOS: A prevalência de hipertensão foi de 41,4 por cento, variando conforme idade (até 29 anos: 11,8 por cento; 30-39: 24,8 por cento; 40-49: 43,3 por cento; 50-59: 42,4 por cento; 60-69: 48,6 por cento e > 70: 62,3 por cento). Houve maior prevalência nos homens (51,8 por cento), enquanto nas mulheres foi de 33,1 por cento. As pessoas com formação escolar de 1° grau primário tendem a apresentar maiores índices pressóricos. Nos indivíduos com sobrepeso e obesidade, observou-se maior prevalência de pressão elevada: IMC normal (27,9 por cento), sobrepeso (45,6 por cento) e obesidade (58,6 por cento). A partir dos 60 anos existe um maior porcentual de hipertensão sistólica isolada, representado por 16,4 por cento (60-69 anos) e de 24,6 por cento (>70 anos). Etilismo diário ou semanal também está relacionado a maior incidência, respectivamente, de 63,2 por cento e 47,2 por cento. Apenas 59,7 por cento eram sabidamente hipertensos. Das pessoas que apresentaram hipertensão, 57,3 por cento fazem algum tratamento. Dos que fazem tratamento regularmente, 60,5 por cento apresentaram hipertensão. CONCLUSÃO: A prevalência de hipertensão foi de 41,4 por cento, ultrapassando a média detectada em alguns trabalhos, alertando para piora epidemiológica e repercussões cardiovasculares, o que evidencia necessidade de maior investimento...
OBJECTIVES: To detect the actual prevalence of systemic hypertension in the city of Campo Grande, MS, Brazil, and frequent factors. METHODS: Cross-sectional study with a randomized sample of the adult population of the city of Campo Grande, MS, in a total of 892 individuals. A questionnaire on age, gender, level of education, smoking, alcohol consumption, and aspects of the treatment was applied. Anthropometric data (weight and height) were collected. According to the WHO, a BMI<25 kg/m² was considered normal weight; 25>BMI<30 overweight; and BMI> 30 obesity. Criteria for hypertension were based on the JNC VII report, with blood pressure cut-off values of 140 x 90 mmHg. RESULTS: The prevalence of hypertension was 41.4 percent, varying with age (up to 29 years: 11.8 percent; 30-39: 24.8 percent; 40-49: 43.3 percent; 50-59: 42.4 percent; 60-69: 48.6 percent and > 70: 62.3 percent). A higher prevalence was observed among men (51.8 percent), whereas among women the prevalence was 33.1 percent.Individuals with basic level of education tended to present higher rates. Among overweight and obese individuals, a higher prevalence of hypertension was observed: normal BMI (27.9 percent), overweight (45.6 percent) and obesity (58.6 percent). Above 60 years of age, a higher percentage of isolated systolic hypertension was observed, with 16.4 percent (60-69 years) and 24.6 percent (>70 years). Daily or weekly alcohol consumption was also related to a higher incidence, of 63.2 percent and 47.2 percent, respectively. Only 59.7 percent were known to be hypertensive. Of the hypertensive individuals, 57.3 percent were undergoing some type of treatment. Of those undergoing regular treatment, 60.5 percent presented hypertension. CONCLUSION: The prevalence of hypertension was 41.4 percent, therefore higher than the average verified in some studies. This calls the attention for worsened epidemiologic conditions and cardiovascular repercussions, thus showing...