Abordagem initial do paciente com mielopatia aguda não compressiva

Acute myelopathy are characterized by spinal cord dysfunction, developing sensitive, motor and autonomic signs and symptons. Since they are relatively rare, there are some difficulties to early diagnosis and to the beginning of the treatment. So, literature was reviewed to describe the main aetiologies of acute non compressive myelopathy: 1) demyelinating diseases; 2) systemic disease; 3) parainfectious; 4) delayed radiation myelopathy; 5) vascular myelopathy; 6) idiopatic and 7) vitamin B12 deficiency. Besides, we suggest an algorithm to initial approach of these patients and further aethiologic investigation. © Copyright Morelra Jr. Editora.

A família do paciente em situação crônica de vida: a visão de enfermeiros de um hospital de ensino

This exploratory descriptive study, of qualitative nature had the purpose to study how the nurses from a hospital school see the family as care participants. Six nurses from clinics of chronically ill patients were interviewed. The data analysis allowed to infer that the nurses had only little knowledge of the family's thematic during graduation, making the relationship with the accompanying families very difficult. Daily care during hospitalization period is marked by easy moments when members are willing to participate in the process, and by difficulties when they attempt to break institutional rules. It was suggested that new nurses have theoretical foundation to attend the family in several scenarios of care. It was considered the need of investments in professional training, and that the advance of humanization of services implies in exchange and integration of knowledge among patients, family members, health professionals, support staff and managers beyond the science field.

Representación social del paciente que se beneficia de la interacción universidad pública y hospitales generales

Hospitals are very important for the health system. The objective of this quali-quantitative research was to visualize patients' social representation, which profited of the interaction between public universities and hospitals. 105 patients in the waiting rooms at the Integrated Clinic at FOA _ UNESP in the first semester 2005 answered to the question: How did you know about the service at FOA? - in opened interviews, recorded or written. A collective speech of the subject represented the field that allouds a society to speak as one. Twenty three of all patients have been sent to FOA by Health Assistance Centers in Araçatuba (7) and region (16) and twenty one patients assisted in Araçatuba by emergency. We can observe that the interaction between the public universities and general hospitals is a reality.

Modificação no posicionamento do paciente para o procedimento para prolapso e hemorroidas (PPH): Decúbito ventral com coxim e membros inferiores afastados

Our aim is to present a modification in patient placement on surgical table for the treatment of prolapsed hemorrhoids by using PPH technique. We propose a modified jackknife position for PPH procedure where the surgeon stays between patient's legs. The modified jackknife position may provide better surgical field with better view of the dentate line which facilitates pursestring confection. In Brazil, the majority of the surgeons prefer lithotomic position for PPH technique based on Longo's first reports. In our opinion, modified jackknife position provides both better surgical field for pursestring placement and better view of the staple line after PPH firing.

Raquianestesia contínua em paciente submetido à gastrectomia parcial. Relato de caso

BACKGROUND AND OBJECTIVES: Due to the high incidence of technical and neurological complications, continuous spinal blocks were not performed for several years. With the advent of intermediate catheters the technique has been used more often and gaining acceptance among anesthesiologists. The objective of this report was to demonstrate the usefulness of the technique as a viable alternative for medium and major size surgeries. CASE REPORT: This is a 58 years old female patient, weighing 62 kg, physical status ASA I, with a history of migraines, low back pain, and prior surgeries under spinal block without intercurrence. The patient was scheduled for exploratory laparotomy for a probable pelvic tumor. After venoclysis with an 18G catheter, monitoring with cardioscope, non-invasive blood pressure and pulse oximetry was instituted; she was sedated with 2 mg of midazolam and 100 μg of fentanyl, and placed in left lateral decubitus. The patient underwent continuous spinal block through the median approach in L 3-L 4; 9 mg of 0.5% hyperbaric bupivacaine and 120 μ g of morphine sulfate were administered. Inspection of the abdominal cavity revealed a gastric stromal tumor that required an increase in the incision for a partial gastrectomy. A small dose of hyperbaric solution was required for the entire procedure, which was associated with complete hemodynamic stability. Postoperative admission to the ICU was not necessary; the patient presented a good evolution without complaints and with a high degree of satisfaction. She was discharged from the hospital after 72 hours without intercurrence. CONCLUSIONS: Intermediate catheters used in continuous spinal blocks have shown the potential to turn it an attractive and useful technique in medium and large size surgeries and it can even be an effective alternative in the management of critical patients to whom hemodynamic repercussions can be harmful.

Anestesia para colecistectomía videolaparoscópica en paciente portador de enfermedad de Steinert. Relato de caso y revisiõn de la literatura

BACKGROUND AND OBJECTIVES: Myotonic dystrophies are autosomal dominant neuromuscular diseases. Among them, myotonic dystrophy type 1 (MD1), or Steinert disease, is the most common in adults, and besides muscular involvement it also has important systemic manifestations. Myotonic dystrophy type 1 poses a challenge to the anesthesiologist. Those patients are more sensitive to anesthetics and prone to cardiac and pulmonary complications. Besides, the possibility of developing malignant hyperthermia and myotonic episodes is also present. CASE REPORT: This is a 39-year old patient with DM1 who underwent general anesthesia for videolaparoscopic cholecystectomy. Total intravenous anesthesia with propofol, remifentanil, and rocuronium was the technique chosen. Intercurrences were not observed in the 90-minute surgical procedure, but after extubation, the patient developed respiratory failure and myotonia, which made tracheal intubation impossible. A laryngeal mask was used, allowing adequate oxygenation, and mechanical ventilation was maintained until full recovery of the respiratory function. The patient did not develop further complications. CONCLUSIONS: Myotonic dystrophy type 1 presents several particularities to the anesthesiologist. Detailed knowledge of its systemic involvement along with the differentiated action of anesthetic drugs in those patients will provide safer anesthetic-surgical procedure.

Estudo duplo cego com Isoconazol e Terbinafina tópicos no tratamento de um paciente com Tinea nigra plantaris bilateral e sugestões para novos diagnósticos diferenciais

The authors report a case of bilateral Tinea nigra plantaris treated through a double-blind study with the topical antifungal agents Isoconazole and Terbinafine. The objective of the study was to clinically compare the efficacy of these two topical antifungal agents on days 10, 20 and 30 of the treatment. No significant clinical differences were found, as all the plantar lesions regressed completely by the end of the treatment. Our conclusion was that in the case reported, the topical antifungal agents Isoconazole and Terbinafine demonstrated identical efficacy as a clinical cure. We also suggest the inclusion of injuries caused by arthropods of the Diplopoda Class in the differential diagnosis of Tinea nigra plantaris, due to the persistent acral hyperpigmentation.

Co-infecção por vírus dengue, sorotipos 1 e 4, em paciente de cidade de porte médio no Brasil

The natural co-infection with dengue virus can occur in highly endemic areas where different serotypes have been observed for many years. We report one case of DENV-1/DENV-4 co-infection in human serum detected by molecular tests. Phylogenetic analysis of the sequences obtained indicated the presence of genotype V and II for DENV-1 and DENV-4, respectively.

Fisioterapia Aquática na Transferência do Sentado para Ortostatismo no Paciente com AVC: Relato de Caso

Introduction. Studies show that 70% of body weight in patients with stroke during the transfer from sitting to standing position is transferred to the uninvolved limb. Significantly interfering with activities of daily living. Objective. The influence of aquatic therapy on eight in the affected hemisphere during the transition from sitting to standing. Method. Participated in this study a patient with right hemiparesis, the protocol lasted eight sessions in a liquid medium. The data of activation of the gluteus muscle were collected from surface electromyography and data as the weight transfer was examined by baropodometry platform. Results. Initial electromyography (151.1uv right gluteus maximus and left gluteus maximus 229.1uv) and Final electromyography (113.6 uv right gluteus maximus and left gluteus maximus113.3uv). Evolution was 19% in weight transferin paretic hemibody compared the pre and post intervention. Conclusion. The results showed that treatment was favorable to the patient, because at the end of application of the observed activation of the gluteus maximus and improved weight-bearing, and consequently these factors interfered positively in the security and independe in transferring from sitting to standing position.

Considerações sobre analgesia controlada pelo paciente (PCA) em hospital universitário

Pós-graduação em Anestesiologia - FMB

Programa domiciliar de exercícios motores e cognitivos para pacientes no estágio avançado da doença de Alzheimer

Pós-graduação em Ciências da Motricidade - IBRC

Adaptação de um instrumento para classificação de pacientes baseado nas necessidades individualizadas no cuidado de enfermagem do paciente pediátrico oncológico

Pós-graduação em Pesquisa e Desenvolvimento (Biotecnologia Médica) - FMB

Desenvolvimento de critério objetivo para a sinalização da ingestão alimentar deficiente de paciente hospitalizado

Pós-graduação em Alimentos e Nutrição - FCFAR

Fatores de predição de mortalidade em pacientes com insuficiência respiratória crônica em uso de oxigenoterapia domiciliar prolongada

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Avaliação do manejo e do potencial zoonótico de papagaios-verdadeiros (Amazona aestiva) mantidos em cativeiro domiciliar

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