RESUMO
We report a patient who suffered an accidental complete amputation of the right forearm followed by a successful replantation and comment on the indications and management of macro-replantations of the upper limbs. This is the first time that a successful surgical procedure of this nature has been performed in Bolivia, with no post-operative complications and excellent long-term functional recovery.
Assuntos
Acidentes de Trabalho , Amputação Traumática/cirurgia , Traumatismos do Antebraço/cirurgia , Reimplante , Adulto , Humanos , MasculinoRESUMO
PIP: Northern Belize, composed of Orange Walk and Corozal districts, is the sugar-producing region of Belize, a newly independent country on the Caribbean coast of Central America, and because of the extensive involvement in the modern sugar industry, existing status differentials in Orange Walk have increased. Town farmers have increased their sugarcane license sizes more than villagers and also are much more likely to meet or exceed their delivery quotas than villagers. There has been the differentiation of a new middle socioeconomic stratum in Orange Walk, with a much higher proportion of villagers remaining in the lower stratum than townspeople. With greater involvement in the market economy, there has been a decline in the social integration of groups in the district as well as less symbiosis between husband and wife and among related male age mates. Some people now consistently work for others; there was an egalitarian labor exchange before. With the decline in subsistence production, the extensive reciprocity in food among related women diminishes. Women have participated in the overall changes in Orange Walk, yet their position vis-a-vis men has become weaker. Women are most likely to hold licenses in the communities that participated earliest in the sugar industry and that are the most traditional. With greater market involvement, women become less likely to hold licenses. Women's licenses have not increased to the same degree as those of men. And, with the income from sugar and wage labor, the family income is more and more viewed as belonging to men, rather than being the result of a joint family enterprise. Women become dependent on what men give them, with less control and security. With declining subsistence production, women have a reduced basis of involvement in traditional reciprocal food exchanges with other households. They lose some independent sources of money income with the result of increasing undernutrition for young children. The economic developments with the sugar industry reinforced the traditional sexual division of labor and enhanced the position of men; it undermined sources of economic security controlled by women. The holding of sugarcane licenses by women is not the base it might be, since women do not engage in the actual production themselves. Women have responded by increasing their sexuality and childbearing to influence their men and by closer bonds with their children for old age security. New bases for women have appeared, but in small numbers, such as school teaching and office work. Since the population is growing more rapidly than the creation of new employment, this is not a widely available option. Prospects for the future involve further manifestations of the processes already examined.^ieng