RESUMEN

OBJECTIVE: This work aims to describe the evolution of the VATS approach from a multiportal access to a biportal access for thoracic herniated disc surgery. Thoracic disc herniation remains a challenging pathology for spine surgeons. Video-Assisted Thoracoscopic Surgery (VATS) of the thoracic spine was described in the 90s and represented an important technical leap by including minimally invasive options for thoracic pathology. Nowadays, VATS in thoracic surgery tends to evolve towards an even less invasive technique, from a multiportal approach to a biportal one. METHODS: We describe the adoption of this approach for our spinal pathology in three patients. We use a two-port VATS. The largest (approximately 5 cm) with an Alexis retractor ® and a second port (1.5 cm) just for the camera. RESULTS: The three patients started walking in less than 24 hours, and none suffered any complications related to the approach. All of them reported tolerable pain at the surgical site. Changing our previous VATS system from 3 to 5 ports was relatively easy regarding the surgical technique. CONCLUSION: This access allows the surgeon to manipulate the instrumentation confidently, and the camera does not fog up as often. Extracting a piece of rib is unnecessary, and theoretically, we only manipulate one or at most two intercostal nerves, so the patient's recovery is favorable.

RESUMEN

The photocatalytic discoloration of industrial dyes, Novacron blue (NB) and Novacron yellow (NY), was investigated using composites based on TiO2 and natural palygorskite (Pal-Ti10 and Pal-Ti30). The method consisted of synthesizing the composites starting from a physical mixture of TiO2 and natural palygorskite in the presence of alcohol, for impregnation through calcination under conditions of temperature equal to 450 °C and atmospheric air. The characterization techniques used in this work were FTIR, XRD, XRF, SEM, particle size analysis and zeta potential. The photocatalysis for the NB dye was investigated through the application of a factorial 24 experimental design, aiming at the best experimental conditions and finally applying them in another NY industrial dye. The investigated concentrations of NB were 10 ppm and 30 ppm, the composites were synthesized using 10 and 30% (p/p) of titanium dioxide in palygorskite, the two pH values were 2.0 and 6.0 and the light intensities 9 and 18 W were used. Tests performed at pH 2.0, Pal-Ti30 composite, power 18 W and 10 ppm of dye showed 100% color removal of both dyes in 90 min. The bleaching process followed the pseudo-first order kinetic model, and the apparent constants (Kapp) were 0.0216 min-1 and 0.0193 min-1 for NB and NY dyes, respectively. The results of total organic carbon (TOC) showed mineralization of 61.70% and 58.06% for NB and NY, respectively, in 90 min of treatment, and the by-products were detected by GC-MS.

Asunto(s)

RESUMEN

Fungal PJI is one of the most feared complications after arthroplasty. Although a rare finding, its high associated morbidity and mortality makes it an important object of study. The most frequent species causing fungal PJI is C. albicans. New technology to treat this type of PJI involves organic-inorganic sol-gels loaded with antifungals, as proposed in this study, in which anidulafungin is associated with organophosphates. This study aimed to evaluate the efficacy of an anidulafungin-loaded organic-inorganic sol-gel in preventing prosthetic joint infection (PJI), caused by Candida albicans using an in vivo murine model that evaluates many different variables. Fifty percent (3/6) of mice in the C. albicans-infected, non-coated, chemical-polished (CP)-implant group had positive culture and 100% of the animals in the C. albicans-infected, anidulafungin-loaded, sol-gel coated (CP + A)-implant group had a negative culture (0/6) (p = 0.023). Taking the microbiology and pathology results into account, 54.5% (6/11) of C. albicans-infected CP-implant mice were diagnosed with a PJI, whilst only 9.1% (1/11) of C. albicans-infected CP + A-implant mice were PJI-positive (p = 0.011). No differences were observed between the bone mineral content and bone mineral density of noninfected CP and noninfected CP + A (p = 0.835, and p = 0.181, respectively). No histological or histochemical differences were found in the tissue area occupied by the implant among CP and CP + A. Only 2 of the 6 behavioural variables evaluated exhibited changes during the study: limping and piloerection. In conclusion, the anidulafungin-loaded sol-gel coating showed an excellent antifungal response in vivo and can prevent PJI due to C. albicans in this experimental model.

RESUMEN

El estudio se realizó en 13 zonas del litoral peruano del lago Titicaca, durante la época seca, desde junio hasta agosto de 2017. En cada zona se determinó la abundancia relativa y uso de microhábitat de Telmatobius culeus. En las zonas de evaluación se utilizó buceo con esnórquel para realizar en cada una tres transectos de 100 m x 2 m, con un total de 38 transectos evaluados. Se registraron 45 individuos en solo seis zonas de evaluación. El mayor número de individuos se encontraron en la zona de Perka Norte, con una abundancia relativa de 10.33 individuos/hora/02 personas a una profundidad de 1.5 m; en siete zonas no se registró ningún individuo. Los individuos fueron encontrados en los siguientes micro hábitats: 17 fueron encontrados sobre la vegetación acuática, 11 en arena combinado con vegetación acuática, 9 en roca combinado con vegetación acuática, 5 en fango combinado con vegetación acuática, 2 en roca y 1 en arena. a la vez se realizó análisis de diferentes parámetros de calidad de agua en cada zona de estudio, como: temperatura, pH, alcalinidad, dureza y oxígeno.

The Telmatobius culeus relative abundance and its microhabitat use was determined. In 13 areas of Peruvian littoral of Lake Titicaca was carried out, during the dry season, since June to August 2017. In each the evaluation areas, snorkeling was used to perform three 100 x 2 m transects. A total of 38 transects were evaluated. 45 individuals were registered in only six evaluation zones. The largest number of individuals were found in the North Perka area, with a relative abundance of 10.33 individuals/hour/02 people, at a depth of 1.5 m; in seven zones no individual was registered. Individuals were found in the following micro habitats: 17 were found on aquatic vegetation, 11 in sand combined with aquatic vegetation, 9 in rock combined with aquatic vegetation, 5 in mud combined with aquatic vegetation, 2 in rock and 1 in sand. At the same time, analyzes of different water quality parameters were performed in each study area, such as: temperature, pH, alkalinity, hardness and oxygen.

RESUMEN

BACKGROUND: Intradural disc herniation is a rare phenomenon in spine surgery. Diagnosis is difficult despite current neuroradiologic imaging techniques. METHOD: We present a case of a 59-year-old man with lumbar and radicular pain and a recurrent lumbar herniation. A laminectomy was performed after no clear disc herniation in the epidural space was found and an intradural mass was palpable. A durotomy showed an intradural disc fragment that was removed, followed by an arthrodesis. CONCLUSION: Only intraoperative findings lead to a definitive diagnosis for intradural herniation. A durotomy needs to be performed. In this case, an arthrodesis was necessary to avoid complications of segmental instability.

Asunto(s)

RESUMEN

This qualitative clinical study investigated the impact of moderate intellectual disability on family dynamics and quality of life. The data were collected using individual interviews with 15 mothers of children with intellectual disabilities, as a convenience sample, and examined with categorical thematic content analysis. The results were discussed using a comprehensive and interpretative approach. Analysis of the interviews showed that care for children with intellectual disabilities is centered on the mother, contributing to the change in family relations. Religious coping appeared as a common strategy for adjusting. Children with intellectual disabilities had less access to services and support than they needed in the areas of health, education, and leisure. Financial constraints and difficulties in community living had a negative impact on the quality of family life. Emotional and psychological support for all the family members, and practical and social support, including income distribution and access to adequate services, proved essential for the well-being of children with intellectual disabilities and their families.

Este estudo clínico-qualitativo investigou o impacto da deficiência intelectual moderada na dinâmica e na qualidade de vida familiar. Os dados foram coletados por meio de entrevistas individuais com 15 mães de deficientes, escolhidas por conveniência, e examinados pela técnica de análise de conteúdo categorial temática. Os resultados foram discutidos usando-se abordagem compreensiva e interpretativa. Da análise das entrevistas apreendeu-se que o cuidado do filho deficiente é centrado na mãe, o que contribuiu para a modificação das relações familiares. O enfrentamento religioso apareceu como estratégia comum de ajuste. Os filhos deficientes tiveram acesso a menos serviços e suportes do que necessitavam, nas áreas de saúde, educação e lazer. Restrições financeiras e dificuldades no convívio comunitário impactaram negativamente na qualidade de vida familiar. Apoio emocional e psicológico para todos os membros da família, e apoio prático e social, incluindo distribuição de renda e acesso a serviços adequados, mostraram-se essenciais para o bem-estar do deficiente e de sua família.

Este estudio clínico-cualitativo investigó el impacto de la deficiencia intelectual moderada en la dinámica y en la calidad de vida familiar. Los datos se recogieron mediante entrevistas individuales con 15 madres de deficientes, escogidas por conveniencia, y examinadas por la técnica de análisis de contenido categorial temático. Los resultados se discutieron usándose un enfoque comprensivo e interpretativo. Del análisis de las entrevistas se aprendió que el cuidado del hijo deficiente está centrado en la madre, lo que contribuyó a la modificación de las relaciones familiares. El enfrentamiento religioso apareció como estrategia común de ajuste. Los hijos deficientes tuvieron acceso a menos servicios y apoyos de los que necesitaban, en las áreas de salud, educación y ocio. Restricciones financieras y dificultades en la convivencia comunitaria impactaron negativamente en la calidad de vida familiar. Apoyo emocional y psicológico para todos los miembros de la familia, y apoyo práctico y social, incluyendo distribución de renta y acceso a servicios adecuados, se mostraron esenciales para el bienestar del deficiente y de su familia.

Asunto(s)

RESUMEN

Medulloblastoma (MB) is a highly aggressive soft tissue neoplasm, classified as a primitive neuroectodermal tumor. It is the most common posterior fossa tumor in children, but occurs rarely in adults. MB accounts for approximately 20% of all primary central nervous system (CNS) tumors of childhood, while its incidence is around 1% of adult brain tumors. Most often it occurs in the cerebellum. We report a case of multicentric MB involving the bilateral cerebellopontine angle (CPA) and right cerebellar hemisphere. The tumor showed isointensity on T1/T2-weighted images, and slight hyperintensity on T2-weighted fluid-attenuated inversion-recovery (FLAIR) images. The MB had restricted diffusion on diffusion-weighted images (DWI). It was not easy to make an accurate diagnosis before biopsy. The lesion in our patient presented with atypical MR image features of medulloblastoma. To our knowledge, this is the first case of bilateral CPA MB.

RESUMEN

Este estudo clínico-qualitativo investigou o impacto da deficiência intelectual moderada na dinâmica e na qualidade de vida familiar. Os dados foram coletados por meio de entrevistas individuais com 15 mães de deficientes, escolhidas por conveniência, e examinados pela técnica de análise de conteúdo categorial temática. Os resultados foram discutidos usando-se abordagem compreensiva e interpretativa. Da análise das entrevistas apreendeu-se que o cuidado do filho deficiente é centrado na mãe, o que contribuiu para a modificação das relações familiares. O enfrentamento religioso apareceu como estratégia comum de ajuste. Os filhos deficientes tiveram acesso a menos serviços e suportes do que necessitavam, nas áreas de saúde, educação e lazer. Restrições financeiras e dificuldades no convívio comunitário impactaram negativamente na qualidade de vida familiar. Apoio emocional e psicológico para todos os membros da família, e apoio prático e social, incluindo distribuição de renda e acesso a serviços adequados, mostraram-se essenciais para o bem-estar do deficiente e de sua família.

This qualitative clinical study investigated the impact of moderate intellectual disability on family dynamics and quality of life. The data were collected using individual interviews with 15 mothers of children with intellectual disabilities, as a convenience sample, and examined with categorical thematic content analysis. The results were discussed using a comprehensive and interpretative approach. Analysis of the interviews showed that care for children with intellectual disabilities is centered on the mother, contributing to the change in family relations. Religious coping appeared as a common strategy for adjusting. Children with intellectual disabilities had less access to services and support than they needed in the areas of health, education, and leisure. Financial constraints and difficulties in community living had a negative impact on the quality of family life. Emotional and psychological support for all the family members, and practical and social support, including income distribution and access to adequate services, proved essential for the well-being of children with intellectual disabilities and their families.

Este estudio clínico-cualitativo investigó el impacto de la deficiencia intelectual moderada en la dinámica y en la calidad de vida familiar. Los datos se recogieron mediante entrevistas individuales con 15 madres de deficientes, escogidas por conveniencia, y examinadas por la técnica de análisis de contenido categorial temático. Los resultados se discutieron usándose un enfoque comprensivo e interpretativo. Del análisis de las entrevistas se aprendió que el cuidado del hijo deficiente está centrado en la madre, lo que contribuyó a la modificación de las relaciones familiares. El enfrentamiento religioso apareció como estrategia común de ajuste. Los hijos deficientes tuvieron acceso a menos servicios y apoyos de los que necesitaban, en las áreas de salud, educación y ocio. Restricciones financieras y dificultades en la convivencia comunitaria impactaron negativamente en la calidad de vida familiar. Apoyo emocional y psicológico para todos los miembros de la familia, y apoyo práctico y social, incluyendo distribución de renta y acceso a servicios adecuados, se mostraron esenciales para el bienestar del deficiente y de su familia.

Asunto(s)

RESUMEN

BACKGROUND: Glioblastoma multiforme (GBS) is a highly malignant glioma that rarely presents as an infratentorial tumor. Multicentric gliomas lesions are widely separated in site and/or time and its incidence has been reported between 0.15 and 10%. Multicentric gliomas involving supratentorial and infratentorial region are even more rare. In most cases, infratentorial disease is seen after surgical manipulation or radiation therapy and is usually located in the cerebellum or cervical region. CASE REPORT: We present a rare case of symptomatic multicentric glioma in the brain, fourth ventricle, cervical as well as lumbar glioblastoma in an adult without previous therapeutic intervention. We also review the literature of this rare presentation. CONCLUSIONS: This report suggests that GBM is a diffuse disease; the more extended the disease, the worse prognosis it has. The management still remains controversial and further studies are required to understand the prognosis factors of dissemination.

RESUMEN

This study presents an integrative review of the scientific literature and federal legislation on public health policies for intellectually disabled in Brazil. Nine articles, published in the PubMed, Scopus, Virtual Health Library and Web of Science databases between 2002 and 2012, were selected. Based on the references of these studies, 6 other articles were identified, totaling 15 studies in the review. Forty-one federal laws produced between 2002 and 2012 were identified. The documents were analyzed and categorized according to the main themes of socioeconomic conditions, violence, mental health, ethics, health needs, health promotion and prevention. From the scientific standpoint, non-specific discussions were observed where intellectual disability was examined with other types of handicaps or concomitantly with other Latin American countries. From the legal standpoint, although laws related to health have been located, there is a lack of studies that address the effectiveness and level of implementation of the proposed policies. The increase in research in this area is a demand of the disabled population itself, and will reveal their specific health needs, and will also support issues such as prevention, promotion, diagnosis and treatment.

Asunto(s)

RESUMEN

Resumo Este estudo apresenta revisão integrativa da literatura científica e da legislação federal sobre políticas públicas de saúde para deficientes intelectuais no Brasil. Foram selecionados 9 artigos veiculados nas bases PubMed, Scopus, Biblioteca Virtual de Saúde e Web of Science entre 2002 e 2012. A partir das referências bibliográficas desses estudos, foram identificados outros 6 artigos, totalizando 15 na revisão. Foram identificadas 41 legislações federais produzidas entre 2002 e 2012. Os documentos foram analisados e categorizados em condições socioeconômicas, violência, saúde mental, ética, necessidades de saúde, promoção e prevenção da saúde. Do ponto de vista científico, observou-se discussões pouco específicas, sendo a deficiência intelectual examinada com os demais tipos ou em concomitância com outros países da América Latina. Do ponto de vista jurídico, embora tenham sido localizadas legislações relacionadas à área da saúde, faltam estudos que abordem a efetividade e o nível de implantação das políticas propostas. O incremento de pesquisas na área é demanda da própria população deficiente e permitirá conhecer suas necessidades de saúde específicas, além de oferecer embasamento em questões como prevenção, promoção, diagnóstico e tratamento.

Abstract This study presents an integrative review of the scientific literature and federal legislation on public health policies for intellectually disabled in Brazil. Nine articles, published in the PubMed, Scopus, Virtual Health Library and Web of Science databases between 2002 and 2012, were selected. Based on the references of these studies, 6 other articles were identified, totaling 15 studies in the review. Forty-one federal laws produced between 2002 and 2012 were identified. The documents were analyzed and categorized according to the main themes of socioeconomic conditions, violence, mental health, ethics, health needs, health promotion and prevention. From the scientific standpoint, non-specific discussions were observed where intellectual disability was examined with other types of handicaps or concomitantly with other Latin American countries. From the legal standpoint, although laws related to health have been located, there is a lack of studies that address the effectiveness and level of implementation of the proposed policies. The increase in research in this area is a demand of the disabled population itself, and will reveal their specific health needs, and will also support issues such as prevention, promotion, diagnosis and treatment.

Asunto(s)

RESUMEN

OBJECTIVES: To evaluate the prevalence of a vascular network adjacent to the insertion of the pes anserinus, so that it could be used as an anatomical reference point to facilitate harvesting flexor grafts for arthroscopic reconstruction of the anterior cruciate ligament (ACL). METHODS: Thirty patients with ACL tears who were going to undergo ACL reconstruction using the tendons of the semitendinosus and gracilis muscles as grafts were selected randomly. During the harvesting of these tendons, the presence or absence of this anatomical reference point was noted. RESULTS: All the patients presented a vascular network of greater or lesser diameter. CONCLUSION: The vascular network seems to be a good reference point during harvesting of the tendons of the semitendinosus and gracilis muscles, for facilitating graft harvesting.

OBJETIVOS: Avaliar a prevalência da trama vascular adjacente à inserção da pata de ganso, para que possa ser usada como referência anatômica para facilitar a retirada de enxerto dos flexores na reconstrução artroscópica do ligamento cruzado anterior (LCA). MÉTODOS: Foram selecionados de forma aleatória 30 pacientes com rotura do LCA, os quais foram submetidos à reconstrução do LCA tendo como enxerto os tendões do semitendíneo (ST) e grácil (G). Durante a retirada dos tendões do ST e G, foi observada a presença ou ausência da referência anatômica. RESULTADOS: Todos os pacientes apresentaram trama vascular em menor ou maior diâmetro. CONCLUSÃO: O uso da trama vascular durante retirada dos tendões do ST e G parece ser uma boa referência anatômica para facilitar a retirada do enxerto.

RESUMEN

OBJECTIVES: To evaluate the prevalence of a vascular network adjacent to the insertion of the pes anserinus, so that it could be used as an anatomical reference point to facilitate harvesting flexor grafts for arthroscopic reconstruction of the anterior cruciate ligament (ACL). METHODS: Thirty patients with ACL tears who were going to undergo ACL reconstruction using the tendons of the semitendinosus and gracilis muscles as grafts were selected randomly. During the harvesting of these tendons, the presence or absence of this anatomical reference point was noted. RESULTS: All the patients presented a vascular network of greater or lesser diameter. CONCLUSION: The vascular network seems to be a good reference point during harvesting of the tendons of the semitendinosus and gracilis muscles, for facilitating graft harvesting. .

OBJETIVOS: Avaliar a prevalência da trama vascular adjacente à inserção da pata de ganso, para que possa ser usada como referência anatômica para facilitar a retirada de enxerto dos flexores na reconstrução artroscópica do ligamento cruzado anterior (LCA). MÉTODOS: Foram selecionados de forma aleatória 30 pacientes com rotura do LCA, os quais foram submetidos à reconstrução do LCA tendo como enxerto os tendões do semitendíneo (ST) e grácil (G). Durante a retirada dos tendões do ST e G, foi observada a presença ou ausência da referência anatômica. RESULTADOS: Todos os pacientes apresentaram trama vascular em menor ou maior diâmetro. CONCLUSÃO: O uso da trama vascular durante retirada dos tendões do ST e G parece ser uma boa referência anatômica para facilitar a retirada do enxerto. .

Asunto(s)

RESUMEN

INTRODUCCIÓN: La hidrocefalia crónica del adulto (HCA) se maneja habitualmente mediante derivación de líquido cefalorraquídeo. La presión hidrostática (variable que depende de la estatura) se considera clave en el funcionamiento del sistema derivativo; no obstante, no disponemos de demostración empírica en la literatura. El objetivo de este trabajo es estudiar la influencia de la estatura como elemento modificador de la presión hidrostática en un sistema derivativo. MATERIAL Y MÉTODO: Presentamos una serie prospectiva de 61 pacientes con criterios diagnósticos de HCA idiopática. En todos los casos fue utilizado un mismo sistema derivativo ventriculoperitoneal (presión apertura valvular: 100 mmH2O). Se registraron variables antropométricas, clínicas, radiológicas, presión intracraneal, test de infusión, respuesta a la derivación y complicaciones posquirúrgicas. RESULTADOS: El 78,7% de los pacientes de la serie presentaron una respuesta clínica favorable tras la derivación. El grupo de pacientes con respuesta positiva presentaba una estatura significativamente mayor (p = 0,005) que el grupo sin respuesta (mediana 165 cm versus 152 cm). También se apreció una correlación significativa entre estatura y disminución del tamaño ventricular. CONCLUSIONES: En nuestra serie, la presión de apertura valvular permanece constante (100 mmHg), y con ello podemos centrarnos en el efecto de la presión hidrostática (estatura) en el sistema derivativo. Hemos obtenido un valor pronóstico positivo para los pacientes más altos, probablemente porque la presión de apertura valvular utilizada es la más adecuada para ellos. Los actuales sistemas derivativos con dispositivo gravitacional también recomiendan contemplar la estatura al configurar el sistema. Nuestro trabajo aporta evidencia empírica a este razonamiento

INTRODUCTION: Normal pressure hydrocephalus (NPH) is a clinical entity frequently managed by means of a cerebrospinal fluid shunt. Hydrodynamic hypotheses consider hydrostatic pressure (as well as height) a very important variable for shunt system function. However, we did not find empirical studies supporting the influence of height on clinical response in the literature. Our objective was to study the prognostic value of height, as a variable related to hydrostatic pressure, when an identical shunt system is used. MATERIAL AND METHOD: A prospective series of 61 idiopathic NPH cases was analyzed. All cases were shunted by means of a ventricle-peritoneal system with a 100 mmH2O opening pressure valve. Anthropometric, clinical, radiological and pressure variables were registered, as well as delay for treatment, improvement and complications. RESULTS: 78.7% of cases improved after shunting. This group of patients was significantly taller (P = .005) than the group without response (median value 165 cm versus 152 cm). There was also a significant correlation between height and ventricular size decrease after the shunt. CONCLUSIONS: In our series opening valve pressure was a constant (100 mmHg) and we could consequently focus on the effect of hydrostatic pressure (height). Moreover, we found a positive predictive value for taller patients, probably because we had selected an opening pressure especially suitable for them. Current gravitational valve shunt systems also recommend considering patient height when customising the system. Our study empirically supports this idea

Asunto(s)

RESUMEN

INTRODUCTION: Normal pressure hydrocephalus (NPH) is a clinical entity frequently managed by means of a cerebrospinal fluid shunt. Hydrodynamic hypotheses consider hydrostatic pressure (as well as height) a very important variable for shunt system function. However, we did not find empirical studies supporting the influence of height on clinical response in the literature. Our objective was to study the prognostic value of height, as a variable related to hydrostatic pressure, when an identical shunt system is used. MATERIAL AND METHOD: A prospective series of 61 idiopathic NPH cases was analyzed. All cases were shunted by means of a ventricle-peritoneal system with a 100mmH2O opening pressure valve. Anthropometric, clinical, radiological and pressure variables were registered, as well as delay for treatment, improvement and complications. RESULTS: 78.7% of cases improved after shunting. This group of patients was significantly taller (P=.005) than the group without response (median value 165cm versus 152cm). There was also a significant correlation between height and ventricular size decrease after the shunt. CONCLUSIONS: In our series opening valve pressure was a constant (100mmHg) and we could consequently focus on the effect of hydrostatic pressure (height). Moreover, we found a positive predictive value for taller patients, probably because we had selected an opening pressure especially suitable for them. Current gravitational valve shunt systems also recommend considering patient height when customising the system. Our study empirically supports this idea.

Asunto(s)