RESUMEN
Forensic Dentistry is a dental science with a broad of activities, one of the most important is human identification. One of the mainmethodological resources to identify carbonized human remains is the comparative analysis of the dental records - antemortem data - withthe postmortem data found in the remains. Specifically in this case it was possible to unveil the person's identity with the aid of a detailedradiographic image obtained in the emergency sector of a dental institution. It must be stressed however, that the dental records of thispatient (with the dental treatment planning and anamnesis) were carelessly registered or even incomplete. It is important to note that theemergency services have the duty of not neglecting the process of obtaining information to fill the dental files of their patients, as thiswould turn the human identification process almost impossible, with dire personal, social, juridical and humanitarian consequences.
A odontologia legal é uma especialidade odontológica que possui uma ampla gama de atuação com destaque para a identificação humana.No contexto da identificação humana um dos principais recursos metodológicos para chegar-se a identidade de corpos carbonizados é aanalise comparativa do prontuário odontológico - dados antemortem - com as informações encontradas no exame necroscópico - dadospostmortem. No caso em tela a afirmação da identidade do indivíduo foi possível principalmente pela presença de documento radiográficoconstante do prontuário clínico elaborado no setor de urgência de uma Instituição de Ensino Odontológico, radiografia esta com riquezade detalhes e particularidades. Entretanto, ressalta-se que as fichas clínicas (anamnese e planejamento) constantes do referido prontuáriomostraram-se sucintas ou mesmo incompletas. Não sendo escusa a serviços de urgência negligenciar o protocolo de elaboração do prontuárioclínico odontológico, uma vez que tal prerrogativa poderia inviabilizar o processo de identificação humana, com conseqüências pessoais,sociais, jurídicas e humanitárias.
Asunto(s)
Humanos , Antropología Forense , Cadáver , Ficha Clínica , Odontología Forense , Radiografía DentalRESUMEN
JUSTIFICATIVA E OBJETIVOS: O trauma cirúrgico envolvido na colecistectomia videolaparoscópica é sabidamente menor que o do método convencional aberto, entretanto as queixas de dor pós-operatória têm sido relatadas por vários autores. Dentre as técnicas analgésicas a anestesia peridural é eficiente na redução da dor pós-operatória no método convencional, mas raramente é utilizada como método complementar nas colecistectomias por via laparoscópica. O objetivo deste estudo foi avaliar a eficácia da anestesia peridural associada com anestesia geral para controle da dor pós-operatória em pacientes submetidos à colecistectomia videolaparoscópica. MÉTODO: Cinquenta e dois pacientes submetidos à colecistectomia videolaparoscópica foram divididos aleatoriamente em dois grupos. Um grupo recebeu anestesia geral e o outro recebeu anestesia geral associada à anestesia peridural. A avaliação da intensidade da dor foi feita com a escala numérica de dor na sala de recuperação pós-anestésica, nas primeiras 24 horas e após as 48 horas que sucederam a cirurgia. RESULTADOS: Em ambos os grupos a qualidade da analgesia pós-operatória foi similar nos momentos avaliados. O grupo que recebeu anestesia peridural associada à anestesia geral apresentou a vantagem de consumir menos anestésico inalatório, mas com maior ocorrência de retenção urinária. CONCLUSÃO: Os resultados do estudo não evidenciaram razão para a associação da anestesia geral com a peridural em colecistectomia videolaparoscópica, pois a analgesia pós-operatória foi semelhante, porém com mais riscos para o paciente.Descritores: Anestesia peridural, Anti-inflamatório não esteroide, Dor pós-operatória, Colecistectomia videolaparoscópica.
BACKGROUND AND OBJECTIVES: Surgical trauma of videolaparoscopic cholecystectomy is knowingly lower as compared to the conventional open method, however postoperative pain complaints have been reported by several authors. Among analgesic techniques, epidural anesthesia is efficient to decrease postoperative pain of the conventional method, but is seldom used as additional method for laparoscopic cholecystectomies. This study aimed at evaluating the effectiveness of epidural anesthesia associated to general anesthesia to control postoperative pain in patients submitted to videolaparoscopic cholecystectomies. METHOD: Participated in this study 52 patients submitted to videolaparoscopic cholecystectomy, who were randomly distributed in two groups. One group received general anesthesia and the other received general anesthesia associated to epidural anesthesia. Pain intensity was evaluated with the pain numeric scale at the post-anesthetic care unit, in the first 24 and 48 hours after surgery completion. RESULTS: Postoperative analgesia quality was similar for both groups in evaluated moments. The group receiving epidural anesthesia associated to general anesthesia had the advantage of consuming less inhalational anesthetics, but there has been more urinary retention. CONCLUSION: Study results have not evidenced a reason to associate general and epidural anesthesia for videolaparoscopic cholecystectomy because postoperative analgesia was similar, however with higher risks for patients.
RESUMEN
OBJECTIVES/HYPOTHESIS: The primary objective was to evaluate the association of palatine (T/P) tonsil size determined by radiography with pulmonary artery pressure (PAP) measured by Doppler echocardiography in children with surgical indication for adenotonsillar hypertrophy. The secondary objective was to evaluate if tonsil size could help to identify children at higher risk of pulmonary artery hypertension (PAH). STUDY DESIGN: Cross-sectional study. METHODS: The study was conducted with a consecutive sample of children with indication of adenotonsillectomy for sleep-disordered breathing. T/P was measured by lateral neck radiography, PAP by echodopplercardiography, and symptoms and quality of life by the Obstructive Sleep Apnea (OSA)-18 questionnaire. T/P was plotted in a receiver operating characteristic (ROC) curve to determine the best cut-off point to identify children with PAH. RESULTS: A total of 45 children participated in the study. The mean age was 72.0 +/- 32.3 months, and six (13%) patients had PAH. Correlation between systolic PAP and T/P was strong (r = 0.624; P < .0001). T/P was significantly higher in patients with PAH (P < .001). OSA-18 score did not significantly correlate with the variables. The cut-off point identified in the ROC was 0.66, which was the minimum T/P where sensitivity was still 100%. Mean systolic pulmonary artery pressure in children with T/P >0.66 was significantly higher than in those with T/P <0.66 (P < .001). CONCLUSIONS: T/P showed a good correlation with PAP in children with adenotonsillar hypertrophy and surgical indication for sleep-disordered breathing. Children with T/P >0.66 can be at greater risk for cardiac complications and should be submitted to complementary studies with echodopplercardiography or given preference for surgery.