Explorer l'expérience vécue de la personne/famille tout au long du parcours de chirurgie pour un cancer pancréatique

Rapport de stage présenté à la Faculté des sciences infirmières en vue de l'obtention du grade de Maître ès sciences (M.Sc.) en sciences infirmières option expertise-conseil en soins infirmiers

Physiology of the blood of cat fishes

The vast areas of derelict swamps covered by macrophyton and swarmed by insects scattered in different parts of India are at present either under total negligence or utilized as waste disposal dumps. Eventhough Indian subcontinent is ranked among the first ten fish producing countries in the world, the fish production is not at par with the increasing need of protein in the average Indian diet. So the water areas which become unusable for conventional human activities like the swamps could be used for fish culture which would increase the availability of protein in the form of fish flesh, thus providing new opportunities to the fishermen. But the conversion of swamps for fish culture would entail considerable expenditure. Hence the significance of a group of fresh water fishes which have made their favourable abode the muddy swamps of tropics depending partly on accessory _respiration to survive in the inimical environment. The homeostasis achieved in such a hostile, hypoxic medium make them excellent choices for culture in the derelict freshwater bodies of India. These air breathing fishes form an economically important group which are highly esteemed as food fishes in many parts of South Asia and Africa. Though their natural habitat seems to be the marshes, they have also conquered other freshwater bodies like ponds, tanks, rivers and flooded paddy fields. They can also tolerate slightly brackish waters. They are known for their nutritive, invigorating and therapeutic qualities and are recommended by physicians as diet during convalescence (Jhingran, 1982)

Factores asociados al dolor crónico posoperatorio en pacientes llevados a herniorrafia inguinal

Introducción: La herniorrafia inguinal se asocia hasta en un 50% de los casos con dolor crónico posoperatorio (DCP), y en algunos puede ser incapacitante. En este estudio se evaluaron los factores asociados al DCP en pacientes llevados a herniorrafia inguinal. Métodología: Se realizó un estudio de cohorte multicéntrico. Se obtuvo información sociodemográfica y de antecedentes personales. Se determinó la presencia e intensidad de dolor agudo posoperatorio (DAP) y se evaluaron los factores asociados al DCP con seguimiento a los dos meses del posoperatorio. Se establecieron asociaciones con la prueba chi cuadrado. Mediante una regresión lineal se evaluó el papel de los factores de confusión. Resultados: Se analizaron 108 pacientes. 54.7% presentaron DCP. La edad menor de 40 años, el DAP no controlado, el DAP severo, y el dolor no controlado entre la primera y tercera semanas del POP se relacionaron con mayor riesgo de DCP. La edad mayor a 65, el uso de opioides intratecales, la visualización y preservación de los nervios durante la cirugía, y el uso de tres o más analgésicos intravenosos con bloqueo ilioinguinal/iliohipogástrico fueron factores protectores. Discusión: El DCP es frecuente en nuestro medio. La prevención y manejo eficientes del DAP utilizando analgesia multimodal, el uso de opioide intratecal, y la identificación y preservación de los nervios en el área quirúrgica ayudan a prevenir el desarrollo de DCP. Estudios de este tipo realizados a una escala más grande, permitirán identificar otros factores relacionados con esta patología. Palabras clave: Dolor crónico postoperatorio, herniorrafia inguinal, inguinodina, factores asociados.

Nutritional status and clinical outcome in elderly female surgical orthopaedic patients

The possible relationship between nutritional status and clinical outcome following orthopaedic hip surgery was investigated. The nutritional status of 60 elderly female patients admitted for elective total hip replacement (THR) and emergency fractured neck of femur surgery (FNF) was measured over time. Specific measures of clinical outcome, including well-being and functional status, were monitored during hospital stay and at 4, 8 and 26 weeks following discharge. Patients were allocated to a high nutritional risk group where any three of the following were less than the 5th percentile value: serum albumin, haemoglobin, triceps skinfold thickness, mid-upper arm muscle circumference and body weight. Using this definition, malnutrition was present in 4% of THR patients and 41% of FNF patients. It was found that the high risk patients had significantly longer convalescence periods, (median stay27.5 days compared with 0 days, P < 0.0009), and a greater proportion were dependent upon walking frames at 6 months (46% compared with 11%, P < 0.01). Fifty percent of the high risk patients had been living independently prior to admission, in contrast only 29% had returned to their homes at 6 months after discharge. The results indicate an apparent link between clinical outcome and nutritional status based upon the allocation procedure employed, which has the potential for ensuring cost-effective nutritional intervention.

Fatores associados à condição de saúde bucal de pacientes internados em hospitais públicos do município de Natal-RN

The hospitalization is an event that can attack any person, independent of gender, race, social and economical condition. Last year, the prevalence of hospitalization was 8.1 for 100 inhabitants and the average time of hospitalization was 8.5 days for each patient one in Natal city. Therefore, an important point is whether the attention to the patients during the permanence in these health establishments incorporates the health integral model suggested by the principles proposed by the National Health System in Brazil (SUS), with actions of promotion and protection by different kinds of professionals, beside those called convalescence. Then, the aim of this study was to evaluate the patient s oral health conditions hosted in public hospitals of the Natal city, looking for to establish its relationship with several risk factors by two dimensions: the characteristics of the hospitalization and the patient s general and economical conditions. We accomplished a cross-sectional study with 205 patients distributed among the hospitals Onofre Lopes, Giselda Trigueiro and Monsenhor Walfredo Gurgel, looking for to know the socio-demographic characteristics, the food habits and of oral hygiene and the conditions of oral health, through the Visible Plaque Index and Gingival Bleeding Index. We observed that the conditions of the patient s oral health interned at public hospitals of reference of the municipal district of Natal is bad, existing accumulation of dental plaque and, consequently, a great number of patients with gingival bleeding. However, the time of hospitalization and its reason, the type of medicine used in this time and the toothbrush frequency were not configured as risk factors for this oral health condition

Incidência de disfagia orofaríngea após acidente vascular encefálico em hospital público de referência

A doença vascular encefálica (AVE) é a principal causa de morte no Brasil. As seqüelas em indivíduos pós-acidente vascular encefálico incluem distúrbios motores, distúrbios de fala ou de linguagem e distúrbios de deglutição. A disfagia orofaríngea ocorre em cerca de 50% dos pacientes com AVE. Este estudo teve por objetivo determinar a incidência da disfagia após AVE. Foram avaliados todos os pacientes que deram entrada em hospital universitário de referência no período de um ano, tão logo apresentassem condições para avaliação clínica, fonoaudiológica e neurológica (102 pacientes), com análise objetiva da deglutição (61 pacientes). Foi observada incidência de disfagia em 76,5% dos pacientes avaliados clinicamente, este percentual elevando-se a 91% com avaliação videofluoroscópica. A alta incidência de disfagia observada neste estudo que avaliou pacientes com amplo espectro de gravidade, em diferentes fases de recuperação, ressalta a importância de equipe multidisciplinar, incluindo fonoaudiólogos capacitados, para avaliar os distúrbios da deglutição nos diversos momentos de recuperação dos AVEs.

Rabdomiolise e mioglobinuria: relato de caso agudo com boa evolução

Os autores registram um caso de mioglobinúria confirmada pela eletroforese de proteínas da urina. A eletromiografia revelou alterações de tipo polimiosítico. A biópsia muscular do deltóide esquerdo mostrou processo inflamatório muscular inespecífico. O tratamento instituído baseou-se em repouso, hiperhidratação e alcalinização da urina. Os autores enfatizam a importância do diagnóstico pela relativa benignidade do processo, que tende para a cura se forem superadas as sérias complicações da fase aguda, a iatrogenia medicamentosa e por procedimentos diagnósticos desnecessários no início da doença.

Pneumoencéfalo intraventricular após perfuração acidental de dura-máter. Relato de caso

BACKGROUND AND OBJECTIVES: The loss of resistance to air to identify the epidural space is widely used. However, the accidental perforation of the dura mater is one of the possible complications of this procedure, with an estimated incidence between 1% and 2%. The objective of this report was to describe the case of a patient with intraventricular pneumocephalus after the accidental perforation of the dura mater using the loss of resistance with air technique. CASE REPORT: Female patient, 26 years old, 75 kg, 1.67 m, physical status ASA I, with a 38-week pregnancy, was referred to the obstetric service for a cesarean section. Venipuncture was performed after placement of the monitoring. The patient was placed in a sitting position for administration of the epidural anesthesia. During the identification of the epidural space with the loss of resistance with air technique, an accidental perforation of the dura mater was diagnosed by observing free flow of CSF through the needle. The technique was modified to epidural anesthesia and anesthetics were administered by the needle placed in the subarachnoid space. In the first 24 hours, the patient developed headache and she was treated with caffeine, dypirone, hydration, hydrocortisone, and bed rest; despite those measures, the patient's symptoms worsened and evolved to headache in decubitus. A CT scan of the head showed the presence of pneumocephalus. After evaluation by a specialist, the patient remained under observation, with progressive improvement of the symptoms and was discharged from the hospital in the fifth day, without complications. CONCLUSIONS: Pneumocephalus after accidental perforation of the dura mater presented headache with the characteristics of headache secondary to loss of CSF, but with spontaneous resolution after the air was absorbed. Invasive measures, such as epidural blood patch, were not necessary. © Sociedade Brasileira de Anestesiologia, 2006.

Teníase: Uma causa rara de apendicite aguda

Acute appendicitis is the most common surgical condition of acute abdomen. Approximately 7 percent of the population will have appendicitis during their lifetime, with the peak incidence occurring between 10 through 30 years-old Obstruction of the appendix lumen with subsequent bacterial infection initiates the pathophysiological sequence of acute appendicitis. Obstruction may have multiple causes, including fecalith, lymphoid hyperplasia (related to viral illnesses, including upper respiratory infection, mononucleosis, and gastroenteritis), foreign bodies, carcinoid tumor and parasites. In Asia, Africa and Latin America, Enterobius vermicularis has been reported as the main parasite that causes appendix obstruction. Rarely, Taenia sp., has been pointed as a cause of parasitic appendicitis. We reported a 30 years-old patient clinically diagnosed with acute appendicitis. The appendectomy was performed through a McBurney incision. The patient's convalescence was uneventful, and he was discharged from hospital 48 hours after operation. Histological examination of the appendix showed acute appendicitis, and it was found aparasite (Taenia sp.) lying inside of the appendix lumen at a transverse section. He has received 10 mg/Kg weight of praziquantel for taeniasis treatment.

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.

Leucometric analysis of 1-day-old chicks inoculated with Salmonella Typhimurium or Lactobacilli

Salmonella infection is responsible for major economic losses in poultry industry. Consequently, the development of new methods for fighting such disease is desirable, such as the use of acid-lactic bacteria. However, reference values of chicks in such conditions are dissimilar to those of other species. Leucometry reference values for chicks have not been reported. The aim of this article was to evaluate and determine the leucometric values of chicks inoculated with Salmonella Typhimurium or treated with Lactobacilli probiotics. In this study, 144 1-day-old birds were divided in three groups of 48 animals each (non-treated group, Salmonella Typhimurium (ST)-inoculated group, and Lactobacilli inoculated group). A total of four blood collections were made with the first one performed 3 h after inoculation with ST or treatment with Lactobacilli. Subsequent samples were obtained every 48 h for 7 days. Leucometric evaluation was performed immediately after each collection. All birds presented an initial decrease pattern in general leukocyte values, and the chicks inoculated with ST revealed lymphomonoheteropaenic leukopaenia, eosinophilia and basophilia in conjunction with convalescence after 96 h of inoculation. The animals inoculated with Lactobacilli revealed leucocytosis with monocytosis, lymphocytosis and marked eosinopaenia. We conclude that there is no efficient bone marrow response in 1-day-old chicks challenged with Salmonella Typhimurium; additionally, an immunostimulatory effect in 1-day-old chicks treated with Lactobacilli-modulated probiotics could be stated. © 2011 Springer-Verlag London Limited.

Estudo comparativo entre as técnicas de video-toracoscopia e toracotomia para fenestração de disco intervertebral em cães

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação dos níveis de ruído e das soluções arquitetônicas adotadas em ambientes das unidades de urgência e emergência no município de Belém-PA

Nos grandes centros urbanos pode-se constatar que o nível de ruído é tão elevado que ameaça a integridade psicológica e física dos habitantes. Entretanto, observa-se que muito do ruído no ambiente hospitalar origina-se de dentro do hospital, tendo como uma das principais fontes geradoras de ruído nas unidades os equipamentos e a conversação entre a equipe hospitalar. A perda auditiva induzida pelo ruído (PAIR) é uma das consequências que o ruído elevado pode acarretar à saúde, entre outros danos. Assim, o ambiente hospitalar que deveria ser sereno e silencioso transforma-se em um espaço ruidoso e estressante, aumentando a ansiedade e a percepção dolorosa do paciente, reduzindo o sono e estendendo a convalescença. Objetivo: Avaliar as condições acústicas dos principais ambientes nas unidades de urgência e emergência no município de Belém, Estado do Pará, Brasil. Verificar a adequação às normas sanitárias e técnicas vigentes, com a simulação de um ambiente piloto validado com a utilização do software ODEON e apresentar soluções virtuais de condicionamento acústico. Material e Métodos: foi utilizado o equipamento Medidor de Nível Sonoro com certificado de calibração da Rede Brasileira de Calibração (RBC) para aferição dos NPS nos períodos diurno e noturno, de acordo com o estabelecido pela NBR 10.151 (2000), além da observação e identificação das fontes de ruído dos ambientes. Resultados: Os valores obtidos durante as aferições dos NPS nos ambientes do Hospital A foram de 58 dB(A) a 70 dB(A) e do Hospital B foram de 62 dB(A) a 70 dB(A). O ambiente piloto foi selecionado de acordo com os resultados e com o tempo de permanência da equipe de saúde e dos pacientes. Conclusão: foi desenvolvido o modelo computacional validado do ambiente piloto, gerando um modelo proposto com intervenções arquitetônicas visando o conforto acústico da equipe de saúde e dos pacientes. Os ambientes pesquisados não apresentaram níveis de ruído superiores a 85 dB(A), comprovando que não há risco ocupacional para as equipes de saúde. Entretanto, níveis de ruídos elevados, por mais que não causem PAIR nos trabalhadores, são responsáveis por estimular ou até mesmo por desencadear diversos sintomas que prejudicam a capacidade laborativa da equipe de saúde, além de aumentar a convalescença e prejudicar a recuperação dos pacientes.

Acid-base and biochemical stabilization and quality of recovery in male cats with urethral obstruction and anesthetized with propofol or a combination of ketamine and diazepam

This study compared acid-base and biochemical changes and quality of recovery in male cats with experimentally induced urethral obstruction and anesthetized with either propofol or a combination of ketamine and diazepam for urethral catheterization. Ten male cats with urethral obstruction were enrolled for urethral catheterization and anesthetized with either ketamine-diazepam (KD) or propofol (P). Lactated Ringer's solution was administered by intravenous (IV) beginning 15 min before and continuing for 48 h after relief of urethral obstruction. Quality of recovery and time to standing were evaluated. The urethral catheter was maintained to measure urinary output. Hematocrit (Hct), total plasma protein (TPP), albumin, total protein (TP), blood urea nitrogen (BUN), creatinine, pH, bicarbonate (HCO3-), chloride, base excess, anion gap, sodium, potassium, and partial pressure of carbon dioxide in mixed venous blood (pvCO(2)) were measured before urethral obstruction, at start of fluid therapy (0 h), and at subsequent intervals. The quality of recovery and time to standing were respectively 4 and 75 min in the KD group and 5 and 16 min in the P group. The blood urea nitrogen values were increased at 0, 2, and 8 h in both groups. Serum creatinine increased at 0 and 2 h in cats administered KD and at 0, 2, and 8 h in cats receiving P, although the values were above the reference range in both groups until 8 h. Acidosis occurred for up to 2 h in both groups. Acid-base and biochemical stabilization were similar in cats anesthetized with propofol or with ketamine-diazepam. Cats that received propofol recovered much faster, but the ketamine-diazepam combination was shown to be more advantageous when treating uncooperative cats as it can be administered by intramuscular (IM) injection.