Management of tracheobronchial foreign body in children

To study cases of foreign bodies (FB) in the tracheobronchial tree investigating the clinical and radiological FB characteristics, complications and endoscopic and surgical intervention. Medical and radiological records review of all FB aspiration cases treated at S (a) over tilde uo Paulo State University Hospital over the last 30 years. One hundred and sixty-four FB cases were analyzed; 57% were male, 84% of these were under 16 years old. The most common clinical manifestations were coughing (68.3%) and choking (54.9%). The most common FBs were seeds (peanut, bean, maize) and also small metal or plastic objects. Radiography was normal in 21.3%, atelectasis was present in 40.9%, hyperinsufflation in 17.1% and the FB was radio-opaque in 20.7%. FB time in the bronchial tree varied from hours to years. The most serious complications, as fibroatelectasis and difficult resolution pneumonia, were caused by the long time that the FB remained in the bronchial tree. FB extraction was by endoscopy in 89% of cases, while 6% required surgical extraction or resection of destroyed part of lung, and 5% spontaneously eliminated the FB. There was no mortality in this series. Coughing and choking were the commonest clinical findings. Most FBs were dried seeds. Complications were due to delays in diagnosis, and most would not have existed if the doctor had given credence to the history. Radiography can be normal as most FBs are radiotransparent. FB extraction was by endoscopy, but a few cases required surgery and others were spontaneously eliminated.

Persistent Pleuropulmonary Air Leak Treated with Autologous Blood: Results from a University Hospital and Review of Literature

Background: Persistent air leak after pulmonary resection is a difficult complication for thoracic surgeons to manage. Objectives: To show the results of our experience treating persistent pleuropulmonary air leak with autologous blood and review the literature on this specific method of treatment. Methods: Retrospective study of patients with persistent aerial pleuropulmonary fistula treated with autologous blood. The patient's own blood was collected from a peripheral vein and directly introduced through the pleural drain. An inverted siphon was located in the drainage system to avoid prolonged clamping of the drain. This siphon impeded blood return but not air escape. Results: Between January 2001 and August 2008, 27 patients were treated by the above method. Patient age ranged from 2 to 74 years, and 78% were male. Each procedure used a mean quantity of 92 ml blood. Mean persistent air leak time before pleurodesis was 10.6 days and mean time to fistula resolution after pleurodesis was 1.5 days. Twenty-three (85%) patients had persistent pleuropulmonary air leak closed with the above procedure. Conclusion: Treating persistent pleuropulmonary air leak with autologous blood is promising, but further studies are required to quantify its real effectiveness. Copyright (C) 2009 S. Karger AG, Basel

Pancreas Transplantation Prevents Morphologic and Ultrastructural Changes in Pulmonary Parenchyma of Alloxan-Induced Diabetic Rats

Purpose. The aim of this study was to evaluate whether pancreas transplantation (PT) is a suitable method for controlling histopathologic changes in lungs of alloxan-induced diabetic rats.Methods. Sixty inbred male Lewis rats were randomly assigned to 3 experimental groups: NC, 20 nondiabetic control rats; DC, 20 untreated diabetic control rats; and PT, 20 diabetic rats that received syngeneic PT from normal donor Lewis rats. Each group was further divided into 2 subgroups of 10 rats each, which were killed after 4 and 12 weeks of follow-up. Clinical and laboratory parameters, fresh and fixed lung weights, and fixed lung volumes were recorded for all rats. Total number of alveoli, alveolar perimeter, alveolar surface area, and alveolar epithelial (AE) and endothelial capillary (EC) basal laminae thickening were randomly measured in 5 rats from each subgroup by using an image analyzer. For light microscopy, 250 alveoli were analyzed in each subgroup. For electron microscopy, 50 electron micrographs were examined for each subgroup.Results. The DC rats showed elevated blood glucose and glycosylated hemoglobin levels, with insulin blood levels significantly lower than the NC rats (P < .001). Fresh and fixed lung weights and fixed volumes were significantly reduced in these rats, although their proportions to body weight were increased at 12 weeks (P < .01). The total number of alveoli in diabetic rats was higher than in control rats, whereas alveolar perimeter and surface area were significantly diminished (P < .01). AE and EC basal laminae were significantly thicker in DC than in NC (P < .01). Successful PT corrected all clinical and metabolic changes in diabetic rats, with sustained normoglycemia throughout the study. Morphologic and morphometric changes observed in diabetic lungs were completely prevented in PT rats from 4 weeks after transplant.Conclusion. We conclude that PT can control morphologic and ultrastructural changes in pulmonary parenchyma, suggesting a promising perspective for preventing other chronic diabetic lesions.

Osteocondromatose múltipla hereditária com envolvimento costal

This is a case report on Hereditary Multiple Osteochondromatosis (HMO) with rib involvement. The authors present aspects of thoracic surface anatomy, and thoracic images (X-rays, computed tomography, magnetic nuclear resonance), as well as the operating procedure.

Câncer de pulmão: histologia, estádio, tratamento e sobrevida

OBJETIVO: Analisar os principais tipos histológicos, estádio, tratamento e sobrevida dos portadores de câncer de pulmão. MÉTODOS: Estudo retrospectivo a partir da análise dos prontuários de pacientes acompanhados no Hospital das Clínicas da Faculdade de Medicina de Botucatu, num período de seis anos. RESULTADOS: de janeiro de 2000 a janeiro de 2006, foram acompanhados 240 doentes com câncer de pulmão, com predominância do sexo masculino (64%). O tipo histológico mais freqüente foi o carcinoma escamoso (37,5%), seguido pelo adenocarcinoma (30%), carcinoma neuroendócrino (19,6%) e carcinoma de grandes células (6,6%). Apenas 131 pacientes (54,6%) foram tratados. Destes, 52 pacientes (39,7%) foram submetidos à quimioterapia exclusiva, 32 (24,4%) realizaram quimioterapia associada à radioterapia e 47 (35,9%) foram submetidos à cirurgia associada ou não à quimioterapia exclusiva e/ou radioterapia. Somente 27 pacientes (20,6%) foram submetidos à cirurgia exclusiva.Em relação ao estadiamento, 34,4% apresentavam, no momento do diagnóstico, estádio IV, 20,6% estádio IIIB, 16,8% estádio IIIA e os outros 28,2% pertenciam aos estádios I e II. A sobrevida em cinco anos foi de 65% para o estádio I e 25% para os estádios remanescentes. CONCLUSÕES: O tipo histológico predominante foi o carcinoma escamoso e o de menor freqüência foi o carcinoma de grandes células. A maioria se encontrava em estádio avançado ao diagnóstico, estando nos estádios iniciais menos de 30% dos casos. Isto justifica a baixa sobrevida e a pequena quantidade de pacientes submetidos ao tratamento cirúrgico exclusivo, em comparação à maioria que foi submetida à quimioterapia exclusiva.

Uma abordagem dialógica para a utilização de atividades experimentais em sala de aula

The belief of using experimental activities in the teaching of Physics as a strategy to produce a more efficient teaching-learning process is great among teachers and the school community. However, there are many difficulties for their implementation and when it happens they do not contribute for an improvement in class efficiency due to the method used. In this work, we developed a proposal for using these activities in Physics classes in high school, from a critical-reflexive approach in which the constant dialogue between the participants in the teaching-learning process is fundamental. The work was developed in two ways. The first, where the author/writer created an educational material and applied it in classroom and a second one, where he presented the idea to other teachers and undergraduate students from the Physics course at UFRN and IFRN (former CEFET-RN) through an extended workshop entitled "The role of experimental activities in the Physics teaching". This workshop had the duration of 60 hours and was implemented in 4 steps: i) sensitization and formation, ii) material development, iii) material implementation and iv) evaluation by teachers and students from the classes where the material was applied. The goal of this workshop was to present the approach, evaluate how the participants received the idea and how they would apply it in real situations. The results of the application in classroom allowed us to reach some conclusions. This approach was well received by the students as well as by the workshop participants. Despite some difficulties in relation to the handling of the implementation results by the workshop participants, they indicated changes in these professionals teaching practice and the introduction of experimental activities has been an important subsidy to assist them in Physics class in high school

Fatores de sucesso ou insucesso do turismo ambientalmente sustentável : percepção das autoridades públicas no pólo costa das dunas do Rio Grande do Norte

This study aims to compare the thermal performance of tiles made from recycled material (waste packaging cardboard with aluminized film) with the tiles of fiber and bitumen, fiber cement and red ceramic with the aim of verifying the suitability of tile to be used in hot and humid climate of low latitude. The samples were selected according to the availability from Natal RN market, as they are sold to the consumers. The methodology was based on studies that used experimental apparatus composed of thermal chambers heated by banks of incandescent bulbs, to analyze the thermal performance of materials. The tiles in the study were submitted to analysis of thermal performance, thermophysical properties and absorptance, using chambers of thermal performance, measuring the thermophysical properties and portable spectrometer, respectively. Comparative analysis of thermal performance between two samples of the recycled material with dimple sizes and different amounts of aluminum were made, in order to verify, if these characteristics had some interference on the thermal performance of them; the results showed no significant performance differences between the samples. The data obtained in chambers of thermal performance and confirmed by statistical analysis, showed, that the tile of recycled material have similar thermal performance to the tile of fiber cement. In addition to these tests was carried out the automatic monitoring of a building covered with tiles of recycled material, to verify its thermal performance in a real situation. The results showed that recycled shingles must be used with technical criteria similar to those used for fiber cement tiles, with regard to the heat gain into the building. Within these criteria should be taken into account local characteristics, especially in regions with hot and humid climate, and its use must be associated, according to the literature, to elements of thermal insulation and use of passive techniques such as vented attics, ceilings and right foot higher

O sensemaking e o Comitê Regional das Associações e Cooperativas do Artesanato Seridoense :buscando compreender um complexo de relações

The generation of direction, sensemaking, is the process where the actors start to perceive the events around them establishing and creating meanings in their actions that they play daily. At the moment where they happen the interactions in a net business-oriented between the actors are that sensemaking is generated. A business-oriented example of a relationship net is the work developed for the Committee of Associations and Regional Cooperatives of Handcraft of Seridó - CRACAS. This organization, with headquarters in the city of Caicó - Rio Grande of North exists with the objective to manage the net of craftsmen of the region of the norteriograndense Seridó. The present inquiry had as objective generality to understand the generation of sensible of the activities carried through for the organizational, inserted actors in the CRACAS in Caicó/RN, directed toward the use of the resources in its daily business-oriented. The specific objectives had been) To identify the resources used for the organizational actors of the CRACAS; b) To apprehend the way for which the craftsmen play activities directed toward the control and use of the available resources in its environment business-oriented; c) To identify the role played for the organizational actors (craftsmen) in its business-oriented daily activities; d) To understand as the organizational actors of the CRACAS they generate sensible of its business-oriented activities and finally e) To verify the principles that guide the interactions of the craftsmen. Of this process of empirical inquiry, the methodology used in the inquiry consisted of a Study of Case in the CRACAS and the seven Associations of the Embroidering it. It was concluded that sensemaking happens during the accomplishment of the activity as during the confection of the products. In accordance with craftsman the financial resources do not come from the CRACAS. One evidenced that the seven cities of the business-oriented embroidering interact as a net of the handcraft and that it exists a lack of resources and infrastructure in the associations

Avaliação do Tratamento da Paracoccidioidomicose Com O Ketoconazol

Foram, tratados 12 doentes atendidos na Disciplina de Moléstias Infecciosas e Parasitárias da Faculdade de Medicina de Botucatu com diagnóstico etiológico de paracoccidioidomicose que apresentavam lesões orgânicas múltiplas e evolução prolongada. O tratamento foi realizado por 18 meses, com o ketoconazol, pela via oral, nas doses diárias de 400 mg no primeiro mês e de 200 mg nos meses seguintes. Todos os doentes foram acompanhados durante o tratamento e, em média 4 meses e meio após o mesmo, clínica, radiológica e sorologicamente pelas reações de imunofluorescência indireta, precipitinas e imunodifusão em gel. A competência imunitária foi avaliada em todos os doentes antes do tratamento e repetida em quatro, no final do mesmo. Os resultados mostraram que houve recaída em 5 doentes. A droga foi bem tolerada e a imunodifusão em gel e a hemossedimentação foram as provas que mostraram maior paralelismo com a evolução clínica.

Práticas agroecológicas para o cultivo do gergelim (Sesamum indicum L.)

The exceeded use of the natural resources required by the modern agriculture has been caused soil impoverishment, soil salinization and soil compaction. The unreasonable use of chemical fertilizers and pesticides causes chemical imbalances in the plant tissues, nutritional losses, taste chances and human health problems. The monocrops are more vulnerable to the pest and disease attacks. The aim of this work were to indicate the better relative planting time of the cowpea bean for the sesame/cowpea bean intercropping based on the evaluation of agronomic, economic, ecological and physiological parameters and to evaluate the viability of the cow urine and cassava wastewater use as alternative fertilizers on the sesame cultivation. In a field essay, when the sesame/cowpea bean was evaluate, the mainly treatments were the single planting of the two cultures and the multiple cropping, with the cowpea bean being planted on the same time, 7, 14 and 21 days after the sesame. The mainly treatments of the second essay were the combined doses of the cow urine (0 and 50 ml) and cassava wastewater (0, 500 and 1000 mL). In the intercrop evaluation significant differences were found between the treatments for the most of the parameters. It was verified that as the sowing of the cowpea bean was retarded in relation to the sesame sowing, the sesame performance increased when the cowpea bean performance decreased. The treatment 7 days balanced the competition relations that occurred between the two crops in the intercrop. The sesame presented little pronounced responses to the different doses of cassava wastewater. The cow urine affected the sesame growth and the growth rates increased with the increasing of the application of the product. The responses of the sesame growth to the cow urine application must be related both the nutritional richness of the product and the presence of growth stimulating substances. The obtained results indicated that in the sesame/cowpea bean intercropping, when the sesame is planted 7 days after the sesame, there is a higher possibility of the net gains to the farmer. Cow urine and cassava wastewater may be used as additional organic fertilizers

O espaço central das atenções: o corredor de integração da região metropolitana de Natal

This work considers the space study of the main road runner of integration of the Region Metropolitan of Natal (RMN) in formation, emphasizing its repercussion for the geographic context of the city, where we identify the positive and negative aspects of such space configuration, as for the aspects of the urban inaquality, economic centrality and of flows, promoted for the state and private capital (national and foreign). The linear convergence and polinucleately of geographic objects in that we identify as Central Space of Attentions (CSA), promoted, and still it promotes, important repercussion in the space estructuretion of the peripheral areas of the RMN, such as in the constitution of the "Capital Value of the Space". In this direction, to endorse the analysis of such reading, choose as cientific ballast the geographic theory, in a perspective dialectic, as well as we rescue contributions of the science of the administration, sociology, economy, amongst others. From the empirical research, subsidized with the application of forms together the entrepreneurs whom they possess investments in the CSA, as well as in the rescue of information you register in cadastre in the Junta Comercial do Estado do Rio Grande do Norte (JUNCERN) and telephonic list, we construct a proposal of reading of the current period of training of the process of space production to which is rank the CSA. The analysis of the data, under a comparative space angle, presents an important contribution to reevaluate the urban space of the RMN in its bigger aspect, exceeding the limits of the studied road corridor

Comparison between actual and predicted postoperative stair-climbing test, walk test and spirometric values in patients undergoing lung resection

OBJETIVO: Verificar se os testes: Volume Expiratório Forçado no 1º segundo (VEF1), Teste de Caminhada de 6 minutos (TC6) e Teste de Escada (TE) se alteram proporcionalmente ao pulmão funcionante ressecado. MÉTODOS: Foram incluídos pacientes candidatos a toracotomia para ressecção pulmonar. No pré-operatório (pré) e no mínimo três meses após a cirurgia (pós), realizaram espirometria, TC6 e TE. O TE foi realizado em escada com 12,16m de altura. O tempo para subir todos os degraus o mais rápido possível foi chamado tempo de escada (tTE). Os cálculos dos valores dos testes preditos para o pós-operatório (ppo) foram realizados conforme o número de segmentos funcionantes perdidos. Os valores pré, ppo e pós foram comparados entre si para cada teste. Estatística: foi utilizada a análise de variância para medidas repetidas (ANOVA), com significância de 5%. RESULTADOS: Foram estudados 40 pacientes. A ressecção pulmonar variou desde o ganho de dois segmentos funcionantes até a perda de 9. Os valores pré, ppo e pós foram respectivamente: VEF1 -pré = 2,6±0,8L, ppo = 2,3±0,8L, pós = 2,3±0,8L (VEF1pré > VEF1ppo = VEF1pós), TC6-pré = 604±63m, ppo = 529±103m, pós = 599±74m (TC6pré = TC6pós > TC6ppo), tTE-pré = 32,9±7,6s, ppo = 37,8±12,1s, pós = 33,7±8,5s (tTEpré = tTEpós < tTEppo). CONCLUSÃO: Nas ressecções pulmonares, este grupo de pacientes perdeu função pulmonar medida através da espirometria, mas não perdeu a capacidade de exercício, medida através dos testes de escada e caminhada.