Saphenofemoral arteriovenous fistula as hemodialysis access

Abstract Background An upper limb arteriovenous (AV) fistula is the access of choice for haemodialysis (HD). There have been few reports of saphenofemoral AV fistulas (SFAVF) over the last 10-20 years because of previous suggestions of poor patencies and needling difficulties. Here, we describe our clinical experience with SFAVF. Methods SFAVFs were evaluated using the following variables: immediate results, early and late complications, intraoperative and postoperative complications (up to day 30), efficiency of the fistula after the onset of needling and complications associated to its use. Results Fifty-six SFAVF fistulas were created in 48 patients. Eight patients had two fistulas: 8 patent (16%), 10 transplanted (20%), 12 deaths (24%), 1 low flow (2%) and 20 thrombosis (39%) (first two months of preparation). One patient had severe hypotension during surgery, which caused thrombosis of the fistula, which was successfully thrombectomised, four thrombosed fistulae were successfully thrombectomised and revised on the first postoperative day. After 59 months of follow-up, primary patency was 44%. Conclusion SFAVF is an adequate alternative for patients without the possibility for other access in the upper limbs, allowing efficient dialysis with good long-term patency with a low complication rate.

Comparison between the six-minute walk test and the six-minute step test in post stroke patients

Abstract Background The Stroke remains one of the major chronic diseases worldwide, and is considered a major cause of disability, which results not only in persistent neurological deficits, but also in the high physical deconditioning, nevertheless there are not many forms of assessing functional capacity in this population. We aimed to investigate the feasibility of the Six Minute Walk Teste and the Six-Minute Step Test (6MST) in post-stroke patients and compare the behavior of physiological variables during the 6MST and the Six-Minute Walk Test (6MWT), by correlating the functional performance obtained in both tests. Method The 6MWT was carried out according to the American Thoracic Society (ATS) and the 6MST was performed in six minutes in order to compare it to the 6MWT in a 20 cm step. Was included post-stroke individuals able to walk without aid. All of them did the 6MWT and the 6MST. Results 12 patients participated in the study. There was no statistical difference in the parameters analyzed when tests were compared. There was poor correlation between the functional performance in both tests. Conclusion The 6MWT and the 6MST is feasible for post-stroke patients and physiological responses are equal during the performance of both tests. However, there was no correlation with respect to functional performance, which was assessed by the distance walked in the 6MWT and by the number of steps climbed in the 6MST.

As parcerias entre prefeituras paulistas e o setor privado na política educacional: expressão de simbiose?

O artigo apresenta resultados finais de pesquisa interinstitucional que teve por objetivo analisar a natureza e as consequências de parcerias firmadas entre setores privados e governos municipais paulistas para atendimento da educação infantil e do ensino fundamental. O período correspondeu aos anos de 1996 a 2006, tendo em vista a percepção de que o aumento das responsabilidades dos municípios pela oferta educacional, decorrente da municipalização do ensino fundamental, poderia estimular processos de privatização da educação municipal, por meio do aumento de "parcerias" entre a gestão municipal e o setor privado lucrativo e não lucrativo. O estudo apresenta tendências relacionadas a três modalidades de parcerias: subvenção pública para oferta de vagas em instituições privadas de educação infantil, aquisição de "sistemas" privados de ensino e contratação de assessoria privada para a gestão da educação municipal. As tendências percebidas na análise indicam que as atuais relações entre as esferas públicas e privadas no campo da educação, decorrentes da descentralização havida no setor, representam um movimento em direção a sua privatização.