Bloqueio seletivo dos nervos supraescapular e axilar promove analgesia satisfatória e menor grau de bloqueio motor: comparação com o bloqueio interescalênico

JUSTIFICATIVA E OBJETIVO: Cirurgias artroscópicas do ombro cursam com intensa dor pós-operatória. Diversas técnicas analgésicas têm sido preconizadas. O objetivo deste estudo foi comparar o bloqueio dos nervos supraescapular e axilar nas cirurgias artroscópicas de ombro com a abordagem interescalênica do plexo braquial. MÉTODO: Sessenta e oito pacientes foram alocados em dois grupos de 34, de acordo com a técnica utilizada: grupo interescalênico (GI) e grupo seletivo (GS), sendo ambas as abordagens realizadas com neuroestimulador. No GI, após resposta motora adequada foram injetados 30 mL de levopubivacaína em excesso enantiomérico de 50% a 0,33% com adrenalina 1:200.000. No GS, após resposta motora do nervo supraescapular e axilar, foram injetados 15 mL da mesma substância em cada nervo. em seguida, realizada anestesia geral. Variáveis avaliadas: tempo para realização dos bloqueios, analgesia, consumo de opioide, bloqueio motor, estabilidade cardiocirculatória, satisfação e aceitabilidade pelo paciente. RESULTADOS: Tempo para execução do bloqueio interescalênico foi significativamente menor que para realização do bloqueio seletivo. Analgesia foi significativamente maior no pós-operatório imediato no GI e no pós-operatório tardio no GS. Consumo de morfina foi significativamente maior na primeira hora no GS. Bloqueio motor foi significativamente menor no GS. Estabilidade cardiocirculatória, satisfação e aceitabilidade da técnica pelo paciente não diferiram entre os grupos. Ocorreu uma falha no GI e duas no GS. CONCLUSÕES: Ambas as técnicas são seguras, eficazes com mesmo grau de satisfação e aceitabilidade. O bloqueio seletivo de ambos os nervos apresentou analgesia satisfatória, com a vantagem de proporcionar bloqueio motor restrito ao ombro.

Dimensão fractal na quantificação do grau de rejeição celular miocárdica pós-transplante cardíaco

INTRODUÇÃO: O termo fractal é derivado do latim fractus, que significa irregular ou quebrado, considerando a estrutura observada como tendo uma dimensão não-inteira. Há muitos estudos que empregaram a Dimensão Fractal (DF) como uma ferramenta de diagnóstico. Um dos métodos mais comuns para o seu estudo é a Box-plot counting (Método de contagem de caixas). OBJETIVO: O objetivo do estudo foi tentar estabelecer a contribuição da DF na quantificação da rejeição celular miocárdica após o transplante cardíaco. MÉTODOS: Imagens microscópicas digitalizadas foram capturadas na resolução 800x600 (aumento de 100x). A DF foi calculada com auxílio do software ImageJ, com adaptações. A classificação dos graus de rejeição foi de acordo com a Sociedade Internacional de Transplante Cardíaco e Pulmonar (ISHLT 2004). O relatório final do grau de rejeição foi confirmado e redefinido após exaustiva revisão das lâminas por um patologista experiente externo. No total, 658 lâminas foram avaliadas, com a seguinte distribuição entre os graus de rejeição (R): 335 (0R), 214 (1R), 70 (2R), 39 (3R). Os dados foram analisados estatisticamente com os testes Kruskal-Wallis e curvas ROC sendo considerados significantes valores de P < 0,05. RESULTADOS: Houve diferença estatística significativa entre os diferentes graus de rejeição com exceção da 3R versus 2R. A mesma tendência foi observada na aplicação da curva ROC. CONCLUSÃO: ADF pode contribuir para a avaliação da rejeição celular do miocárdio. Os valores mais elevados estiveram diretamente associados com graus progressivamente maiores de rejeição. Isso pode ajudar na tomada de decisão em casos duvidosos e naqueles que possam necessitar de intensificação da medicação imunossupressora.

Ensino de 2º grau: em busca de uma organização condizente com as novas determinações postas pelo mercado de trabalho

Com o objetivo de compreender o papel e a função fundamental da educação em nível de 2º grau, este artigo tem o intuito de proporcionar ao leitor uma visão dos avanços e possíveis retrocessos acerca do assunto, na discussão que se trava nos meios acadêmicos, buscando fazer uma síntese das idéias correntes sobre o ensino de 2º grau.

Condições associadas ao grau de satisfação com a vida entre a população de idosos

OBJECTIVE: As a result of overall growing population's life expectancy, it has become increasingly important to ensure not only that the elderly have greater longevity but also happiness and life satisfaction. The objective of the study was to describe factors associated with life satisfaction among elderly people.METHODS: Three hundred and sixty-five older persons, selected by means of random stratified proportional sampling, were interviewed in 2003. The instrument used was a combination of Flanagan and Nahas questionnaires and WHOQOL-100. There were added questions concerning physical activity extracted from International Physical Activity Questionnaire, questions regarding reported morbidity and emotional assessment, sociodemographic condition and an open question. The level of life satisfaction was measured using a scale from one to seven by means of visual recognition. Hierarchical logistic regression analysis was performed including life satisfaction as a dependent variable and those included the final questionnaire, in blocks, as independent variables.RESULTS: Most elderly were generally rather satisfied with life as well as with specific aspects. The level of life satisfaction was associated with: comfort at home (OR=11.82; 95% Cl: 3.27; 42.63); appraising leisure as quality of life (OR=3.82; 95% Cl: 2.28; 6.39); waking up feeling well in the morning (OR=2.80; 95% Cl: 1.47; 5.36); not reporting loneliness (OR=2.68; 95% Cl: 1.54; 4.65); having three or more daily meals (OR=2.63; 95% Cl: 1.75; 5.90) and not reporting Diabetes Mellitus (OR-2.63; 95% Cl: 1.3 1; 5.27).CONCLUSIONS: Most elderly in the study were satisfied with life and their satisfaction was associated with situations related to being well and not being diabetic.

Adenocarcinoma polimorfo de baixo grau de malignidade do tipo papilífero. Estudo morfológico e imuno-histoquímico.

Two cases of polymorphous low-grade adenocarcinoma of the papillary type, from minor salivary glands were studied by light microscopy and immunohistochemistry. One case exhibited a predominance of the papillary pattern, whereas the other presented the following patterns of histological appearance: papillary, solid, pseudocystic and tubular. Utilizing the peroxidase-antiperoxidase (PAP) method, the intermediate filament vimentin, keratin and S100 protein were observed in tumor cells. The immunohistochemical analysis revealed two types of neoplastic cells: myoepithelial and luminal.

Prevalência de anodontia entre estudantes do 2O grau da cidade de São José dos Campos-Correlação dessa anomalia entre terceiros molares e outros órgão dentários.

The authors studied 201 school children form both sexes, aging 12 to 14 years, in order to identify anodontia, including in third molars. The results indicated a congenital absence of teeth in 24.37% of the examined children, distributed into 10.44% of boys and 13.93% of girls. Anodontia was observed concerning third molar teeth and other teeth, and the correlation was calculated by the total, sex, and hemiarch. The data were presented and discussed, and the results included several conclusions.

INFLUENCIA DO ACRESCIMO DE MANITOL A SOLUCAO NUTRIENTE NO DESEMPENHO MECANICO E NO GRAU DE EDEMA MIOCARDICO DE CORACOES ISOLADOS DE RATOS

Purpose - To analyse the influence of mannitol added to Krebs-Henseleit (KH) solution on the myocardium edema and myocardial function. Methods - Isolated rat heart under isovolumetric contractions studied according to Langendorff's technique were perfused with KH solution at constant flow during 90 min. The coronary perfusion pressure, diastolic and systolic pressures were recorded at every 15 min. At the end of the experiment, myocardium water content was measured in hearts perfused with KH solution (group I, n = 9) and in hearts perfused with KH solution plus 8 mM mannitol (group II, n = 8). These results were compared to non-perfused control heart (n = 9). Results - Myocardial water content was statistically higher in group I (80.8 ± 1.3%) compared to group II (78.1 ± 0.7%) and control group (75.5 ± 0.5%). Systolic arterial pressure was statistically higher in group I (86.2 ± 11.5 mmHg) compared to group II (72.7 ± 21.1 mmHg). There was no difference in the diastolic pressure between the two groups. Coronary perfusion pressure (Pp) increased progressively during the experiment in both groups. However, Pp was lower in group II than in group I. Conclusion - Mannitol added to KH solution significantly attenuates the myocardium edema in the isolated perfused rat heart.

Aplicação de um instrumento de avaliação do grau de depressão em universitários do interior paulista durante a graduação em enfermagem

The undergraduates in Nursing have been subject of studies on psychic problems, as alterations in behavior interfere in their learning. The aim of this research was to identify and measure the most frequent depression symptoms among the students using Beck's Depression Inventory. Socio-demographic information about the interviewees was also collected. Ninety-nine (99) students (81.82%) participated. The socio-demographic data show women's predominance (96.97%) in average with 20 years of age; 95.96% not originally from Botucatu and family monthly income of 5 to 10 minimum wages. In the total of the sampling, 41.41% presented a certain degree of depression varying from mild to severe. The most frequent symptoms were self-accusation, irritability and fatigue. The investigation shows the need of programs that follow the students during their academic formation.

Proteína da matriz do esmalte associada a R.T.G. e vidro bioativo no tratamento de furca grau III em cães

This study investigated, both histologically and histometrically, the efficacy of enamel matrix derived proteins (EMD) associated with bioactive glass (BG) and an absorbable membrane in the treatment of class III furcation defects in mongrel dogs. After surgical defect creation and chronification, the lesions were randomly divided into three groups according to the treatment employed: Test Group 1 - EMD + BG + membrane, Test Group 2 - EMD + membrane and Control Group - BG + membrane. After a 90-day healing period, the dogs were sacrificed. The descriptive analysis and the histometric data showed similar results for the experimental groups in all studied parameters (MANOVA, p > 0.05). The association of Emdogain® with bioglass and GTR, or with GTR only, showed similar results when compared with the ones obtained with bioglass associated with membrane in the treatment of class III furcation defects in dogs. The three modalities of treatment showed partial filling of the furcations, with bone and cementum regeneration limited to the apical portion of the defects.

Uso do grau de preferência alimentar para a caracterizaç ão da alimentação de peixes na APA de São Pedro e Analândia

We studied feeding habits of four fish species in two watershed at APA - Área de Proteção Ambiental (Area of Environmental Protection) in São Pedro and Analândia, State of São Paulo, southeastern Brazil. Feeding Preference Degree (FPD) was used to demonstrate the importance of each food item for the species of both basins. Feeding habits of both species of lambari was variable. The allochtonous items such as insects, autochtonous items, and vegetal material were very important, characterizing omnivory. The bagre (Rhamdia quelen) fed mainly on insects at the Jacaré-pepira Basin and also on fishes at the Corumbataí basin. The cascudo Hypostomus strigaticeps ingested autochtonous vegetal material and sediments at both basins.

Interação entre grau de perda auditiva e o incômodo com zumbidos em trabalhadores com história de exposição ao ruído

Hearing loss and tinnitus impact the lives of workers in every instance of their lives. Aim: this paper aims to investigate the existence of a dose-response relationship between hearing loss and tinnitus by determining whether higher levels of hearing loss can be associated with increased tinnitus-related discomfort. Materials and method: this cross-sectional case study assessed 284 workers exposed to occupational noise through pure tone audiometry. Test results were categorized as defined by Merluzzi. Individuals complaining of tinnitus answered the adapted and validated Brazilian Portuguese version of the Tinnitus Handicap Inventory. A generalized linear model was adjusted for binomial data to test the interaction between these factors. Results: over 60% of the ears analyzed had hearing loss, while more than 46% of them had tinnitus. Tinnitus prevalence and risk rates increased as pure tone audiometry results got worse. The association between both, considering all hearing loss degrees, was statistically significant. Conclusion: the results point to a statistical association between hearing loss and tinnitus; the greater the hearing loss, the greater the discomfort introduced by tinnitus. 2009 © Revista Brasileira de Otorrinolaringologia.

Grau de dependência de idosos hospitalizados para realização das atividades básicas da vida diária1

This study aimed to identify the level of dependence in elderly inpatients when performing Basic Activities of Daily Living. This quantitative, cross-sectional, descriptive study was conducted in the Adult Ward of the Botucatu University Hospital Emergency Unit - UNESP, Brazil. Data was collected by means of interviews, observation, and individual medical chart consultation, to be analyzed via logistic regression using the statistical software package SAS for Windows, version 9.2. The sample consisted of 71 subjects with a mean age of 74.30 years. It was observed that 30.99% of the older individuals showed to be independent in performing the proposed activities; 22.53% were partly dependent; and 46.48% were fully dependent. Gerontology care must aim at maintaining functional conditions, thus promoting independence and preserving these individuals' dignity.

Construções de reticulados via extensões cíclicas de grau ímpar

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Determinação do grau de ionização de aminoácidos polares carregados

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Estudo imunoistoquímico da expressão de actina, vimentina, calponina e caldesmona no adenoma pleomórfico, adenocarcinoma polimorfo de baixo grau de malignidade e carcinoma adenóide cístico de glândulas salivares

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)