RESUMO

OBJECTIVE: To look into the effects of different anesthesia methods on the labor process and the expression of serum estrogen and progesterone in primiparas with painless labor. METHODS: 60 primiparas receiving painless labor were selected as the research objects, and they were divided into either a Spinal & Continuous epidural anesthesia group (n = 30) or a continuous epidural anesthesia group (n = 30), anesthesia is administered using the corresponding anesthesia method. The authors compared serum estrogen and progesterone, inflammatory index expression, pain degree and neonatal health status in different periods. RESULTS: At T2 and T3, serum P, LH, FSH and E2 levels in the Spinal & Continuous epidural anesthesia group were signally lower than those in the Spinal & Continuous epidural anesthesia group (p < 0.05). Spinal & Continuous epidural anesthesia group harbored faster onset and longer duration of sensory block and motor block than the Continuous epidural anesthesia group (p < 0.05). SAS and SDS scores of the Spinal & Continuous epidural anesthesia group were clearly lower than those of the Continuous epidural anesthesia group (p < 0.05). VAS score and serum TNF-α, IL-6 levels of pregnant women in the Spinal & Continuous epidural anesthesia group were memorably lower than those in the Continuous epidural anesthesia group at T2 and T3 (p < 0.05). The total incidence of postoperative complications in the Spinal & Continuous epidural anesthesia group was distinctively lower than that in the Continuous epidural anesthesia group (p < 0.05). CONCLUSION: Spinal anesthesia combined with continuous epidural anesthesia has a better anesthesia effect in the painless labor of primiparas, which can effectually ameliorate the labor process and the expression of serum estrogen and progesterone.

Assuntos

RESUMO

In this present study, carried out between November 2020 and July 2023 at Londrina's University Hospital, patients with active lesions of cutaneous leishmaniasis (CL) were analyzed regarding pain perception and anatomopathological aspects of the ulcers. Pain was assessed using a numerical rating scale (NRS) to compare five patients diagnosed with CL with four control patients diagnosed with vascular skin ulcers. Histopathological evaluations were used to investigate the nociceptor neuron-Leishmania interface. Patients with CL ulcers reported less pain compared to patients with vascular ulcers (2.60 ± 2.30 and 7.25 ± 0.95, respectively, p = 0.0072). Histopathology evidenced Leishmania spp. amastigote forms nearby sensory nerve fibers in profound dermis. Schwann cells marker (S100 protein) was detected, and caspase-3 activation was not evidenced in the in the nerve fibers of CL patients' samples, suggesting absence of apoptotic activity in nerve endings. Additionally, samples taken from the active edge of the lesion were negative for bacilli acid-alcohol resistant (BAAR), which excludes concomitant leprosy, in which painless lesions are also observed. Thus, the present data unveil for the first time anatomopathological and microbiological details of painless ulcers in CL patients, which has important clinical implications for a better understanding on the intriguing painless clinical characteristic of CL.

Assuntos

RESUMO

Subacute thyroiditis (SAT) is an inflammatory disease of the thyroid gland with multiple etiologies and clinical features, often challenging to recognize. The classic presentation is the painful, granulomatous thyroiditis (DeQuervain's) characterized by diffuse swelling of the gland, usually preceded by an upper respiratory tract infection. A painless variant, also referred to as autoimmune subacute thyroiditis, has been documented and is strongly linked to postpartum state, reported following ~10% of pregnancies. It can be differentiated from the former by the presence of anti-thyroid antibodies, which classifies it as an autoimmune thyroiditis. Any spontaneous development of painful swelling of the thyroid gland warrants a complete work up that includes thyroid hormones, thyroid autoimmune panel, acute phase reactant titers, and, if available, imaging that may lead to the diagnosis of an inflammatory or infectious cause of thyroiditis.

Tiroiditis Subaguda, es una enfermedad inflamatoria de la glándula Tiroides que tiene muchas etiologías y características clínicas, y frecuentemente difícil de reconocer. La presentación clásica es: tiroiditis granu-lomatosa dolorosa caracterizada de hinchazón difusa de la glándula del Tiroides, usualmente precedida de una infección respiratoria de las vías áreas superior (como una infección viral). Existe una variante sin dolor, tam-bién referida como tiroiditis subaguda autoinmune, ha sido documentado y es muy ligada al estado postparto, en un 10% de los embarazos. La Tiroiditis postparto Puede ser diferenciada de la anterior por la presencia de anticuerpos lo que la clasifica como una tiroiditis auto-inmune. Cualquier desarrollo espontaneo de una hin-chazón dolorosa de la tiroides garantiza su evaluación de una manera formal, que incluye las hormonas del tiroides, panel tiroideo de autoinmunidad títulos de los factores que reaccionan agudamente, y si está disponible imágenes como una ultrasonografía que conlleva al di-agnóstico de una Tiroiditis inflamatoria o de origen in-feccioso.

Assuntos

RESUMO

Resumo Discute-se a difusão das práticas de parto natural por meio da análise dos livros Parto natural: guia para os futuros pais, escrito pelo obstetra americano Frederick Goodrich Jr. em 1950 e publicado no Brasil a partir de 1955, e Parto natural sem dor, escrito pelo obstetra brasileiro George Beutner, em 1962. Ambos tiveram boa entrada na cultura brasileira e influenciaram a forma de pensar o parto e de parir, tanto no âmbito da obstetrícia brasileira como no que concerne às representações das mulheres. A partir das contribuições de Roger Chartier e das concepções sobre medicalização, concluímos que essas novas práticas de preparação do parto compartilhavam as visões médicas sobre o parto e o nascimento predominantes no período.

Abstract The article explores the dissemination of natural childbirth practices through an analysis of the books Parto natural: guia para os futuros pais, written by U.S. obstetrician Frederick Goodrich Jr. in 1950, under the title Natural Childbirth: a manual for expectant parents, and first published in Brazil in 1955, and of Parto natural sem dor, written by Brazilian obstetrician Beutner in 1962. Both books found a place in Brazilian culture and influenced thinking about childbirth and delivery in the field of Brazilian obstetrics and in representations of women. Based on Roger Chartier's contributions and on concepts of medicalization, we conclude that these new practices for childbirth preparation shared the period's prevalent medical views of childbirth and delivery.

Assuntos

RESUMO

Resumo Entre 1945-1964 o Brasil vivia uma acelerada modernização. Transformando-se numa sociedade urbana, sob o jugo do higienismo, procurava refutar práticas e costumes considerados tradicionais e arcaicos. Nesse contexto, a figura tradicional da parteira é preterida socialmente para dar espaço ao conhecimento médico, que passa a incidir sobre o partejar e o maternar. Este texto analisa o Boletim da LBA, investigando o processo de medicalização e cientifização da maternidade e do parto, tomando em observação os embates científicos e morais sobre maternidade e parto que ocupavam as páginas da publicação oficial da maior instituição de assistência no país.

Abstract Between 1945 and 1964, Brazil underwent an accelerated process of modernization. Increasingly urbanized and guided by the precepts of social hygiene, the country was keen to refute any practices or customs regarded as traditional or old-fashioned. As such, the traditional figure of the midwife was supplanted by medical knowledge, which came to exert influence on childbirth and motherhood. This text analyzes Boletim da LBA, investigating the medicalization and scientification of childbirth and motherhood and focusing on the scientific and moral clashes about motherhood and childbirth contained in this, the official publication of the country's largest welfare institution.

Assuntos

RESUMO

Resumen ANTECEDENTES: Los linfomas mamarios primarios constituyen menos de 1% de todos los linfomas no-Hodgkin, 1.7-2.2% de todos los linfomas no-Hodgkin nodales adicionales y 0.04-0.5% de todas las neoplasias malignas de la mama. El linfoma de células del manto representa 4% de los linfomas en Estados Unidos, y entre 7-9% en Europa y se diagnostica en pacientes con una mediana de edad de 60 años. Aparece en mujeres posmenopáusicas en forma de masa mamaria indolora, unilateral. El linfoma de mama secundario es sistémico, con afectación simultánea o posterior en otro sitio. CASO CLÍNICO: Paciente con una tumoración mamaria, inicialmente postraumática, que en el contexto de plaquetopenia se catalogó clínica y radiológicamente como hematoma y que, más tarde, el diagnóstico fue: linfoma de células del manto secundario a linfoma previo nodal inguinal en segunda línea de tratamiento con quimioterapia. CONCLUSIONES: La persistencia o el rápido crecimiento de un hematoma mamario o de una lesión con apariencia radiológica benigna, sobre todo con antecedente de linfoma previo, puede resultar maligna. La biopsia mediante aguja gruesa es decisiva en el diagnóstico porque permite el estudio histológico e inmunohistoquímico para la confirmación molecular. El tratamiento se basa, sobre todo, en quimio y radioterapia, opciones que mejoran la supervivencia y disminuyen la recurrencia.

Abstract BACKGROUND: Primary mammary lymphomas represent less than 1% of all Non Hodgking Lymphomas (NHL). Mantle cell lymphoma (MCL) represents 4% of lymphomas in the United States, and 7-9% in Europe and is diagnosed in patients with a median age of 60 years. Unilateral painless mammary mass in postmenopausal women use to be the clinical presentation. Secondary breast lymphoma is defined as the presence of systemic lymphoma with breast involvement, as the patient below. CLINICAL CASE: 57-year-old female patient with post-traumatic mammary tumor, with history of thrombocytopenia, first-time diagnosed of hematoma, with breast enlargement and later diagnosed as lymphoma of mantle cells with pathology test and classified as secondary to previous inguinal nodal lymphoma. CONCLUSIONS: It is important to keep in mind this diagnosis in view of the persistence or rapid growth of a mammary hematoma or other lesion with benign radiological appearance. The biopsy is the gold standard for diagnosis, since it allows the histological and immunohistochemical study, for molecular confirmation. The treatment is mainly based on chemo / radiotherapy, which improves survival and decreases recurrence.