Revisão sistemática: uma revisão narrativa

OBJETIVO: realizar uma revisão narrativa sobre revisão sistemática. FONTE DOS DADOS: foi realizada busca no Cochrane Methodology Register, na Medline, na LILACS, no Google Scholar e na Cochrane Library, no período de 2000 a janeiro de 2007. Foram utilizados a busca manual das listas de referências e os contatos pessoais. SELEÇÃO DOS ESTUDOS: a estratégia de busca empregou, na Medline, as seguintes combinações dos termos MeSH: "Meta-Analysis" [Publication Type] AND "Evidence-Based Medicine"[MeSH] Limits: Publication Date from 2000 to 2007, Humans, Systematic Reviews. Na LILACS: (metanalise) or "metanalise" [Descritor de assunto] and [ medicina baseada em evidências] or "medicina baseada em evidências" [Descritor de assunto]. No Cochrane Methodology Register e no Google Scholar: "revisão sistemática e metanálise" e "medicina baseada em evidências". Após uma revisão independente por dois revisores, dez artigos que se referiam ao objetivo proposto foram selecionados. SÍNTESE DOS DADOS: os temas mencionados nos estudos foram agrupados em duas categorias: aqueles que se reportavam à história da revisão sistemática e aqueles que definiam Medicina Baseada em Evidência, revisão sistemática e metanálise. CONCLUSÃO: os autores concluem com a necessidade de mais discussões sobre revisão sistemática entre os cirurgiões.

Baço migratório em hérnia paraestomal

The authors report a case of a parastomal hernia that incarcerated a wandering spleen. We present a very rare case of an 85-year-old woman with a giant parastomal hernia. Computed tomography revealed a parastomal hernia with a wandering spleen inside. We introduce a different and simple alternative approach, with the smallest inconvenience as possible to solve the trouble. We carried out the treatment with a prosthetic repair closing the defect with ePTFE mesh, performed through a laparoscopic approach, intraperitoneal, like a tie and move the spleen back to its anatomical place. The result was excellent.

O uso da prótese na correção das hérnias da parede abdominal é um avanço, mas o seu uso indiscriminado, um abuso

The objective is to alert the surgeon about the indiscriminate use of synthetic prosthesis in the correction of inguinal and incisional hernias. The authors provide a brief history of surgery on hernias and a review of the literature, showing the importance of classifying inguinal hernias to fit the type of surgical correction with the defect found, abstaining from treating all hernias, with the same type of surgical procedure. In our opinion, small indirect inguinal hernias (type 1 and 2 of Gilbert) and hernias in women must not, in general, be treated with prostheses. The synthetic material should be reserved for direct and large indirect hernias. Even so, this attitude, besides determining a higher cost for the procedure, can lead to important complications such as infection, rejection, fistula formation, chronic pain, alterations in spermatogenesis and the possibility of carcinogenesis, according to more recent reports. The physiology and anatomy of the abdominal wall should be considered when dealing with incisional hernia corrections, where the surgeon can choose among many techniques to correct those defects, and in selected cases, utilize synthetic material. We conclude that although the use of biomaterials has constituted a great advance in surgery for abdominal wall hernia corrections because they decrease recurrences, and permit treatment of large abdominal hernias, the indiscriminate prosthesis usage is an abuse, and it can determine many serious complications, certainly avoidable with a well indicated non mesh technique .

Reparo intraperitoneal de defeitos da parede ventral do abdome com telas de poliéster com colágeno e polipropileno com ácido poliglicólico

OBJETIVO: Avaliar a incorporação de telas de poliéster revestido em uma de suas faces por colágeno (Parietex, Covidien) e polipropileno recoberto por ácido poliglicólico (Optilene Mesh Elastic e Safil, BBD Aesculap) no reparo de defeitos da parede ventral de coelhos avaliando a cicatrização no aspecto macroscópico, o depósito de colágeno e a imunomarcação tecidual pelos anticorpos MMP-1, MMP-8 e MMP-13. MÉTODOS: Utilizaram-se 16 coelhos, divididos em dois grupos de oito animais, avaliados após eutanásia após 30 e 60 dias de pós-operatório. Os animais foram submetidos à realização de dois defeitos simétricos na parede ventral do abdome, à direita e esquerda da linha alba, que compreendendo todos os folhetos musculares e o peritônio. O reparo dos defeitos foi realizado mediante implante intraperitoneal de dois modelos diferentes de telas. Utilizou-se a tela de poliéster revestido com camada protetora de colágeno (grupo controle) e a tela de polipropilene revestido com malha de ácido poliglicólico (manufaturacao própria, grupo de experimentacao). A avaliacao constou de aspectos clínicos, achados macroscópicos, análise dos colágenos tipos I/III e avaliação imunoistoquímica de metaloproteinases. RESULTADOS: Os resultados da avaliacao clínica e os parâmetros macroscópicos foram semelhantes entre os grupos. 50% dos animais do grupo Parietex tiveram ausência de aderencias intraperitoneais a no 30° dia de pós-operatrório. Em ambos os grupos observou-se reducao das aderências entre o 30° e o 60° dias de pós-operatório, contudo sem diferenca estatística. As aderências observadas foram classificadas principalmente de frouxas. Nao se observou a ocorrencia de complicacoes envolvendo vísceras intraabdominais. No Grupo Parietex houve a ocorrência de formacao de ulceracao da pele que recobria a tela em quatro animais, em comparacao com um no grupo de experimentacao. No Grupo Parietex foi observada uma insuficiencia de reparo após 60 dias. Quanto ao depósito do colágeno tipos I e III, nao houve diferenca significativa entre os grupos. Os resultados da imunoistoquímica referentes aos anticorpos MMP-1 e MMP-8 também não demonstraram diferença significativa entre as telas. CONCLUSÃO: As duas telas pesquisadas obtiveram resultados semelhantes tanto nos aspectos macro como nos microscópicos, podendo ser consideradas semelhantes quanto ao reparo de defeitos cirúrgicos da parede ventral do abdome em coelhos.

Hérnia intercostal transdiafragmática após fratura espontânea de costelas secundária à crise de tosse

One case of transdiafragmatic intercostal hernia after intense coughing fit followed by rib fractures in patient with history of pneumonia is presented. He had a severe coughing fit, developed a right toracoabdominal hematoma and then a tumor that was gradually enlarging. Image exams confirmed the diagnosis. Treatment consisted of surgical repair with the use of a polypropylene prosthetic mesh. It is a rare type of hernia. Only four cases were found in literature. The sooner the disease is diagnosed and treated the better the prognoses will be since it will prevent hernia from strangulation and incarceration.

Revisão sistemática da acurácia dos testes diagnósticos: uma revisão narrativa

Este artigo tem o objetivo de realizar uma revisão narrativa sobre revisão sistemática da acurácia dos testes diagnósticos. Foi realizada busca na Cochrane Methodology Reviews (Cochrane Reviews of Diagnostic Test Accuracy), Medline e LILACS, bem como busca manual das listas de referências dos artigos incluídos na revisão. As estratégias de busca empregadas foram as seguintes, empregando-se títulos de assuntos e termos livres: 1. na Cochrane Methodology Reviews: accuracy study "Methodology" 2. Na Pubmed "Meta-Analysis "[Publication Type] AND "Evidence-Based Medicine"[Mesh]) AND "Sensitivity and Specificity"[Mesh]; 3. Na LILACS: (revisao sistematica) or "literatura de REVISAO como assunto" [Descritor de assunto] and (sistematica) or "SISTEMATICA" [Descritor de assunto] and (acuracia) or "SENSIBILIDADE e especificidade" [Descritor de assunto]. Em suma, a preparação e o planejamento metodológicos das revisões sistemáticas de testes diagnósticos é ulterior àqueles empregados nas revisões sistemáticas das intervenções terapêuticas. Há muitas fontes de heterogeneidade nos desenhos dos estudos de teste diagnóstico, o que dificulta muito a síntese - metanálise - dos seus resultados. Para contornar esse problema, existem atualmente normas, exigidas pelas principais revistas biomédicas, para a submissão de um manuscrito sobre testes diagnósticos.

Efetividade do uso combinado de filme de ácido lático e tela de polipropileno na formação de aderências intraperitoneal: um modelo experimental em ratos

OBJETIVO: Avaliar a eficácia do uso de um biomaterial de ácido lático (SurgiWrap®) como protetor de tela de polipropileno (Marlex®) em relação à formação de aderências intraperitoneais em ratos. MÉTODO: Quarenta ratas Wistar formaram os grupos a seguir: Grupo 0 (Sham) - apenas laparotomia; Grupo I - tela de polipropileno; Grupo II - tela de polipropileno protegida por filme de ácido lático. Estes animais foram operados com laparotomia e colocação das telas no fechamento. Após 21 dias foram sacrificados para análise aderencial quanto ao tipo (0 a 3), porcentagem de área acometida e força necessária para rompimento. RESULTADOS: O Grupo 0 não apresentou aderências intraperitoneais. Em relação à classificação foi evidenciado a maior prevalência de aderências tipo 3 em ambos os grupos. Quanto à força para ruptura aderencial o Grupo 1 obteve média de 1,58 N e o Grupo 2 de 1,23 N. A tela foi envolvida por aderências em mais de 50% da área de sua superfície em 87% no Grupo 1 e 84% no Grupo 2. Por diferentes métodos estatísticos constatou-se que não houve diferença significativa entre os grupos nas variáveis estudadas. CONCLUSÃO: A utilização do combinado tela de polipropileno e bioprotetor de ácido lático demonstrou índices semelhantes em relação à formação de aderências intraperitoneais quando comparada ao uso individual da mesma tela.

Inguinal hernias in patients of 50 years and above. Pattern and outcome

OBJECTIVE: to evaluate a one year experience with inguinal hernia repair, in patients of > 50years, with respect to the type of inguinal hernia, type of surgery, postoperative complications and recurrence. METHODS: a prospective descriptive study of patients (n=57) > 50 years operated for inguinal hernia during a one year period. Tension-free meshplasty and herniorrhaphy, using 3"x6" polypropylene mesh and 2-0 polypropylene suture, were performed in elective and emergency surgery respectively. Follow-up visits were scheduled at six weeks, three and six months postoperatively. RESULTS: the most representative age group was 61-70 years, and all patients were male. 52 (91.22%) patients had unilateral inguinal hernias, while five (8.77%) had bilateral hernias. In 50 (87.71%) patients, the hernia was uncomplicated, while seven (12.28%) patients presented with some complication such as obstruction or strangulation. Elective surgery was performed in 50 (87.71%) patients while seven (12.28%) patients were operated in emergency. Postoperatively, 50 (87.7%) patients had uneventful recovery, while seven (12.28%) patients developed some complications which were treated conservatively. Mean hospital stay was six days. One recurrence was observed and there was no peri/postoperative death. CONCLUSION: tension-free meshplasty and herniorrhaphy are safe, simple and applicable even in elderly patients after adequate pre-operative assessment and optimization. Although associated with longer hospital stay, the mortality rate is nil and complication as well as recurrence rate is low. Hence, timely repair is necessary in elderly patients even in those with comorbid conditions.

Dismenorreia membranosa: uma doença esquecida

OBJETIVO: apresentar uma série de casos de dismenorreia membranosa. MÉTODOS: todas as pacientes foram selecionadas a partir da suspeição diagnóstica, após atendimento clínico em consultório privado por relato de dismenorreia dolorosa associada à eliminação espontânea de material elástico com formato semelhante a útero. Apenas fatos relevantes foram descritos do quadro álgico, história médica atual e pregressa e hábitos de vida. O material eliminado foi encaminhado para laboratório de patologia no qual ocorreu a análise macro e microscópica. Os casos em que não se pode provar a eliminação de material com característica membranácea não foram selecionados. Após a confirmação diagnóstica, realizou-se uma revisão da literatura até o ano de 2008 utilizando o método MeSH com o termo "membranous dysmenorrhea". RESULTADOS: três casos clínicos de dismenorreia foram transcritos. Todos os casos, além do quadro característico de dor e eliminação vaginal de material elástico, foram associados ao uso de métodos anticoncepcionais hormonais. CONCLUSÕES: embora haja apenas escassos relatos de caso de dismenorreia membranosa na literatura científica, sua etiologia deve ser suspeita em casos de dor associada a sangramento vaginal com eliminação de material elástico ou firme. O diagnóstico final é dependente do exame anatomopatológico que nunca deve ser dispensado. Observamos necessidade de mais discussões sobre esta patologia com o objetivo de manter o profissional atualizado para exercer diagnóstico e terapêutica adequados.

Effect of different surface roughnesses on a turbulent boundary layer

The classical treatment of rough wall turbulent boundary layers consists in determining the effect the roughness has on the mean velocity profile. This effect is usually described in terms of the roughness function delta U+. The general implication is that different roughness geometries with the same delta U+ will have similar turbulence characteristics, at least at a sufficient distance from the roughness elements. Measurements over two different surface geometries (a mesh roughness and spanwise circular rods regularly spaced in the streamwise direction) with nominally the same delta U+ indicate significant differences in the Reynolds stresses, especially those involving the wall-normal velocity fluctuation, over the outer region. The differences are such that the Reynolds stress anisotropy is smaller over the mesh roughness than the rod roughness. The Reynolds stress anisotropy is largest for a smooth wall. The small-scale anisotropy and interniittency exhibit much smaller differences when the Taylor microscale Reynolds number and the Kolmogorov-normalized mean shear are nominally the same. There is nonetheless evidence that the small-scale structure over the three-dimensional mesh roughness conforms more closely with isotropy than that over the rod-roughened and smooth walls.

Potential for seed bank formation of two weed species from Brazilian Amazonia

The potential for seed bank formation of two perennial weed species, Ipomoea asarifolia (Desr.) Roem. & Schult. (Convolvulaceae) and Stachytarpheta cayennensis (Rich.) M. Vahl (Verbenaceae), both common in Amazonia , was evaluated in a degraded pasture area in eastern Brazilian Amazonia . Seeds were enclosed in nylon mesh packets and placed at the soil surface or buried at 5 or 10 cm deep. The number of viable seeds was recorded at 6, 10, 14 and 18 months after burial. Results showed that S. cayennensis has the ability to form persistent soil seed bank, while I. asarifolia seeds do not build up in the soil seed bank. For S. cayennensis and, to some extent, for I. asarifolia, seed survival was highest at greater burial depths.

Optimization and validation of the solid-liquid extraction technique for determination of picloram in soils by high performance liquid chromatography

The objective of this study was to optimize and validate the solid-liquid extraction (ESL) technique for determination of picloram residues in soil samples. At the optimization stage, the optimal conditions for extraction of soil samples were determined using univariate analysis. Ratio soil/solution extraction, type and time of agitation, ionic strength and pH of extraction solution were evaluated. Based on the optimized parameters, the following method of extraction and analysis of picloram was developed: weigh 2.00 g of soil dried and sieved through a sieve mesh of 2.0 mm pore, add 20.0 mL of KCl concentration of 0.5 mol L-1, shake the bottle in the vortex for 10 seconds to form suspension and adjust to pH 7.00, with alkaline KOH 0.1 mol L-1. Homogenate the system in a shaker system for 60 minutes and then let it stand for 10 minutes. The bottles are centrifuged for 10 minutes at 3,500 rpm. After the settlement of the soil particles and cleaning of the supernatant extract, an aliquot is withdrawn and analyzed by high performance liquid chromatography. The optimized method was validated by determining the selectivity, linearity, detection and quantification limits, precision and accuracy. The ESL methodology was efficient for analysis of residues of the pesticides studied, with percentages of recovery above 90%. The limits of detection and quantification were 20.0 and 66.0 mg kg-1 soil for the PVA, and 40.0 and 132.0 mg kg-1 soil for the VLA. The coefficients of variation (CV) were equal to 2.32 and 2.69 for PVA and TH soils, respectively. The methodology resulted in low organic solvent consumption and cleaner extracts, as well as no purification steps for chromatographic analysis were required. The parameters evaluated in the validation process indicated that the ESL methodology is efficient for the extraction of picloram residues in soils, with low limits of detection and quantification.

Infestation maps and spatial stability of main weed species in maize culture

A study on the spatial distribution of the major weeds in maize was carried out in 2007 and 2008 in a field located in Golegã (Ribatejo region, Portugal). The geo-referenced sampling focused on 150 points of a 10 x 10 m mesh covering an area of 1.5 ha, before herbicide application and before harvest. In the first year, 40 species (21 botanical families) were identified at seedling stage and only 22 during the last observation. The difference in species richness can be attributed to maize monoculture favouring reduction in species number. Three of the most representative species were selected for the spatial distribution analysis: Solanum nigrum, Chenopodium album and Echinochloa crus-galli. The three species showed an aggregated spatial pattern and spatial stability over both years, although the herbicide effect is evident in the distribution of some of them in the space. These results could be taken into account when planning site-specific treatments in maize.

Sorption and desorption of Suflafenacil in two soils in the state of São Paulo with different physical and chemical attributes

A study was conducted to evaluate the sorption and desorption of 14C herbicide saflufenacil (pyrimidinedione) in two soils in the State of São Paulo, classified as Red Yellow Latosol with clayey texture (LVA-1) and medium texture (LVA-2), using the batch method through isotherms. The soils were air dried and sieved a 2 mm mesh. The radioactivity was determined by liquid scintillation spectrometry in acclimatized room (25 ± 2 °C). Sorption isotherms were conducted for 5 concentrations of saflufenacil (5.0; 2.5; 1.0; 0.5 and 0.05 μg mL-1) and the results were adjusted to the Freundlich equation, thus obtaining the parameters of sorption followed by two extractions with 0.01 M CaCl2 to determine desorption parameters similarly to sorption. The results showed that saflufenacil sorption was low for both soils studied, being greater for the LVA with higher organic matter content. The desorption coefficients were greater than their sorption coefficients, suggesting the occurrence of hysteresis. The sorption and desorption isotherms (classified as type C isotherms), hysteresis and the t-test between the angular coefficient of the respective isotherms showed that both the sorption and desorption occur with equal intensity.

Planktic Cyanobacteria from upper Tietê basin reservoirs, SP, Brazil

Considering the great ecological and sanitary importance of the cyanobacteria and the need of detailed information about these organisms in Brazilian water bodies, the present study aims at contributing towards the knowledge of the cyanobacterial flora of five reservoirs belonging to the upper Tietê Basin, São Paulo: Billings, Guarapiranga, Jundiaí, Pirapora, Ponte Nova and Taiaçupeba. In the past several years, these reservoirs have been submitted to severe environmental deterioration and have repeatedly presented cyanobacterial blooms, including those of toxic species. The samples were collected between 1997 and 2003 either with plankton net (20 µm mesh) or van Dorn's bottle, and preserved with lugol solution or formaldehyde. Some species were isolated and maintained in culture. Forty-eight species of cyanobacteria were identified, with predominance of the order Chroococcales (58%), followed by the orders Oscillatoriales (21%) and Nostocales (21%). Among the 48 studied species, 17 (35%) were considered potentially toxic. The occurrence and biodiversity of the cyanobacteria in each reservoir depend on the environmental conditions. Among the five water bodies, Billings Reservoir presented the most adequate situation for the development of a greater number of species (34), probably due to its high pH values (around 8). Pirapora Reservoir on the other hand, with highest conductivity (445.0 µS cm-1) and lowest Secchi depth values (0.2 m), presented the lowest cyanobacterial biodiversity (14 species).