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O uso de telas de material aloplástico na cirurgia de reconstrução da parede abdominal é freqüente em casos de trauma, infecção, ressecção de tumores ou até mesmo em necroses por radioterapia2,3,4,5,10,11. Apesar dessa técnica de cobertura ser de uso comum e rotineiro, em alguns casos, uma complicação é a sua exposição 2,5,6,7,8. Os retalhos são utilizados para proporcionar uma cobertura estável da tela exposta 2,3,5,8,9,11,14. Objetivos: esse trabalho descreve 03 casos de cobertura com retalho a ascio cutâneo de exposição de tela de polipropileno(Marlex ®), utilizada em situação da reconstrução de parede abdominal. Métodos: três pacientes foram submetidos à cirurgia parare construção da parede abdominal, em 20006, utilizando-se tela de polipropileno (Marlex ®). Todos evoluíram com exposição da tela. Dois eram do sexo masculino e um, do sexo feminino. No grupo masculino, um dos pacientes havia sido submetido à apendicectomia e evoluiu com fasceíte necrotizante. O outro paciente masculino teve reconstrução de parede abdominal decorrente de complicação de cirurgia para resolução de quadro de oclusão intestinal. A paciente do sexo feminino foi submetida à reconstrução da parede abdominal após peritoneostomia secundária à perfuração iatrogênica de intestino, decorrente de cirurgia ginecológica. Resultados: Os dois pacientes masculinos foram submetidos à cobertura da tela de Marlex® exposta, utilizando-seretalho inguinal, sendo que, em um dos casos, houve realização de retalho em um único tempo cirúrgico. No outro, houve reconstrução cirúrgica em dois tempos. A paciente feminina foi submetida à cirurgia com realização de retalho fasciocutâneo tipo abdominoplastia, em tempo cirúrgico único. Todos os três casos evoluíram bem, sem complicações pós-operatórias, tais como infecção ou necrose.

Background: posthetic mesh are used in abdominal wall reconstruction1,11 due to trauma, infection, tumor resection or even radiation necrosis2,3,4,5,10,11. Although this kind of coverage is widely used, exposure of the material used is a complication that is unlikely to happen2,5,6,7,8. Fasciouscutaneous flaps are used to provide a stable coverage of the exposed mesh2,3,5,8,9,11,14. Objective: thisworkdescribestree 3 casesofmes hexposure after abdominal wall reconstruction treated coverage using fasciouscutaneous flap and reviews the literature. Methods: Three patients undergone abdominal wall reconstruction in 2006 using polypropylene mesh (Marlex ®).All of them developed mesh exposure. Two were men and one was a woman. One of the men was submitted to appendicectomy and evoluated with necrotizing fasciitis; the second male patient suffered from bowel occlusion and the female pacient, was submitted to reconstruction after peritoneostomy due to iatrogenic bowel perforation duing a gynecologic procedure. Results: the two male patientsweresubmittedtomeshexposurecoverageusing inguinal flap. One of them was submitted to a one-step surgical act. The second male patient needed a two-step surgical act. The female patient was submitted to reconstruction using a one-step abdominoplasty flap. All of them evoluated well, with no post-surgical complications as infection or flap necrosis. Conclusions: although there are no statistical significancies in the three cases, we can say that fasciocutaneous flaps2,12,14 are a securemethodforcoverageofmeshexposureinprevious abdominal wall reconstruction.

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The prevalence of insulin resistance and risk factors for chronic diseases is not known in Colombia. The purpose of the study was of determine the association of insulin resistance and risk of chronic diseases in young, apparently healthy adults. By convenience, 97 subjects, mean age of 24 years were studied. Family and personal history, anthropometrics, lipid profile, and a short insulin tolerance test was done to each subject to identify prevalence o insulin resistance and its association with risk factors. Plasma lipids and anthropometrics were within acceptable range. Insulin sensitivity was categorized as high, border high, border low and low. Out of 97 subjects 47 had altered sensitivity. Most women (68%) were classified as border low, and most men (60%) as low. There was a difference between these two categories in waist circumference and weight. Border low and low cases had not less than 3 risk factors but the total number of factors was not different within the 4 groups. More than 50% of cases had family history of chronic diseases, sedentary life and low C-HDL. There was a negative association between insulin sensitivity and fasting Glycaemia and positive with fasting triglycerides, BMI, Waist hip ratio and weight. Results suggest a surprisingly high prevalence of risk factors in a young group associated with altered insulin sensitivity. It may be possible to identify early indicators of risk and develop appropriate strategies for prevention.

En Colombia se desconoce la prevalencia de resistencia a insulina(RI) y factores de riesgo(FR) para el desarrollo de enfermedades crónicas no transmisibles(ECNT). El objetivo del estudio fue determinar asociación entre FR de ECNT y el grado de sensibilidad a insulina (SI)I en adultos jóvenes aparentemente sanos. Se seleccionaron por conveniencia 97 sujetos (24±4.66 años), de quienes se obtuvo historia familiar y personal, antropometría, perfil lipídico y se practicó Test Corto de Tolerancia a Insulina para determinar prevalencia de RI y factores de riesgo asociados. La media del perfil lipídico y la antropometría estuvieron dentro de límites de referencia. La SI se categorizó en Alta, Media-Alta, Media-Baja y Baja, 51% de mujeres y 41% de hombres se ubicaron en los grupos de menor sensibilidad. Se encontró diferencia entre la circunferencia de cintura y peso entre sujetos con SI Baja y Media-Baja y SI Media Alta y Alta. Los grupos con Media-Baja y Baja presentaron como mínimo tres FR. Mas del 50% de los casos con antecedentes familiares de ECNT, sedentarismo, bajo C-HDL. Asociación negativa entre SI y glucosa en ayunas y positiva de triglicéridos en ayunas con el Índice de masa corporal, relación cintura cadera y peso. Los resultados muestran una presencia elevada de FR para el desarrollo de ECNT en población joven asociada a una prevalencia de disminución de la SI mayor que la reportada, permitirán proponer indicadores tempranos para detectar personas a riesgo y utilizar estrategias de prevención adecuadas.

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Foram analisados 71 grupos de maes, em um total de 498 entrevistas individuais feitas pelo Grupo de Incentivo ao Aleitamento Materno (GIAMA), por ocasiao da primeira consulta pos-natal ao Centro de Saude Dr. Sylvio Henrique Braune, em Nova Friburgo-RJ (CSSHB/NF), no periodo de janeiro de 1989 adezembro de 1990, estudando-se as causas de desmame nessa populacao. O indice dealeitamento materno exclusivo no prineiro mes de vida foi de 49,6 por cento e a causa de desmame mais observada (77,9 por cento ) foi a delegacao de que "o leite nao sustenta". O choro do bebe mostrou-se uma importante causa de desmame, porque 68,6 por cento das maes inferiram que "o leite nao sustenta" a partir do choro do bebe. Procura-se, atraves do GIAMA, fornecer apoio e informacoes a mae para capacita-la a lidar adequadamente com as verdadeiras causas do choro do bebe, prevenindo o desmame precoce

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One important indicator of nutritional surveillance is the one devoted to monitor food security. The experience toward the development of one of such indicators is presented. This includes the development of a food basket, defined as the group of foods that meet the characteristics such as is now consumed by important population segments of the community; it contributes a substantial portion of the calories and proteins purchased, and is responsible for an important proportion of the food budget. The concept implies a dynamic food basket, the quantities of which are calculated in a way that simulates the behavior of the consumer and the best nutrition knowledge. For this purpose we use linear program techniques. A measure of the risk of being unable to buy the foods needed for a family is presented, and is used as a proxy for food security risk. In the appendix, the mathematical expressions of the model used for a linear program is also presented.

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One important indicator of nutritional surveillance is the one devoted to monitor food security. The experience toward the development of one of such indicators is presented. This includes the development of a food basket, defined as the group of foods that meet the characteristics such as is now consumed by important population segments of the community; it contributes a substantial portion of the calories and proteins purchased, and is responsible for an important proportion of the food budget. The concept implies a dynamic food basket, the quantities of which are calculated in a way that simultates the behavior of the consumer and the best nutrition knowledge. For this purpose we use linear program techniques. A measure of the risk of being unable to buy the foods needed for a family is presented, and is used as a proxy for food security risk. In the appendix, the mathematical expressions of the model used for a linear program is also presented

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