Estratégia anestesiológica para cesariana em paciente portadora de deficiência de fator XI: relato de caso

JUSTIFICATIVA E OBJETIVOS: A deficiência do fator XI é uma doença hematológica rara na população. A hemofilia C (deficiência do fator XI) ocorre em ambos os sexos e normalmente não apresenta qualquer sintomatologia, podendo manifestar-se apenas como hemorragia pós-cirúrgica. É uma doença autossômica recessiva, homozigótica ou heterozigótica, e sua gravidade depende dos níveis de fator XI. O objetivo desse relato foi apresentar a estratégia anestésica em paciente portadora de hemofilia C. RELATO do CASO: Paciente com 32 anos, gesta I/para 0, 39 semanas de gestação programada para cesariana eletiva. Paciente portadora de deficiência de fator XI. Exame clínico e laboratorial sem alterações. Conforme orientação do hematologista, no dia da cesárea a paciente usou prometazina 25 mg; hidrocortisona 500 mg, devido a reações transfusionais prévias, e plasma 10 mL-1.kg-1 num total de 700 mL. Após 2 horas foi submetida ao bloqueio subaracnóideo sob monitorização de rotina. Hidratação com RL 2000 mL. Procedimento anestésico-cirúrgico sem intercorrências. A paciente evoluiu no pós-operatório sem intercorrências, sendo que no 3º DPO fez uso de plasma fresco congelado (PFC) 10.mL-1.kg-1 com o objetivo de evitar sangramento pós cirúrgico tardio. CONCLUSÕES: O objetivo do caso foi apresentar o protocolo anestésico para pacientes portadores de hemofilia C e alertar para a necessidade de investigação em caso de antecedente de sangramento pós-operatório, quando um estudo da coagulação deve ser realizado antes de qualquer procedimento invasivo e, se um TTPA prolongado for encontrado, torna-se imperativo pesquisar a deficiência desse fator.

Facoemulsificação em cães, com e sem implante de lente intra-ocular em piggyback: estudo clínico da inflamação pós-operatória

A uveíte peri e pós-operatória é o maior problema da cirurgia para extração de catarata no cão, sendo considerada o fator mais importante para o sucesso cirúrgico, imediato e tardio. Diversos protocolos pré e pós-operatórios utilizando agentes anti-inflamatórios esteroidais e não-esteroidais têm sido empregados na tentativa de controle da uveíte cirurgicamente induzida. O objetivo do presente estudo foi avaliar a reação inflamatória pós-operatória, clinicamente e por meio da pressão intraocular (PIO), após a cirurgia de facoemulsificação para extração de catarata em cães, com e sem implante de lente intraocular (LIO) em piggyback. Empregaram-se, 25 cães portadores de catarata, subdivididos em dois grupos: G1 (com implante de LIO), G2 (sem implante de LIO). A técnica cirúrgica adotada foi a facoemulsificação bimanual unilateral. Avaliações clínicas e mensurações da PIO foram aferidas antes do procedimento cirúrgico (0) e nos tempos 3, 7, 14, 21, 28 e 60 dias após o ato cirúrgico. Cães do grupo G1 apresentaram sinais clínicos de uveíte visivelmente mais intensos, relativamente aos do G2. Entretanto, a PIO não demonstrou diferença significativa entre os dois grupos analisados, nem entre os olhos operados e os contralaterais. A utilização de duas LIOs humanas em piggyback no cão é exequível, porém suscita mais inflamação e complicações no pós-operatório.

Miocardiopatia diabética

A miocardiopatia diabética é uma doença do músculo cardíaco causada pelo diabetes mellitus e não relacionada às patologias vascular e valvular ou à hipertensão arterial sistêmica. Observações experimentais e clínicas têm demonstrado hipertrofia, necrose, apoptose e aumento do tecido intersticial miocárdico. Acredita-se que a miocardiopatia diabética seja decorrente de anormalidades metabólicas como hiperlipidemia, hiperinsulinemia e hiperglicemia, e de alterações do metabolismo cardíaco. Tais alterações podem causar aumento do estresse oxidativo, fibrose intersticial, perda celular e comprometimento do trânsito intracelular de íons e da homeostase do cálcio. Clinicamente, é possível a detecção de disfunção diastólica assintomática na fase inicial. No momento em que surgem os sinais e sintomas de insuficiência cardíaca, observamos disfunção diastólica isolada, sendo que o comprometimento da função sistólica, habitualmente, é tardio. O tratamento da miocardiopatia diabética com insuficiência cardíaca não difere das miocardiopatias de outras etiologias e deve seguir as diretrizes de acordo com o comprometimento da função ventricular, se diastólica isolada ou diastólica e sistólica.

Caracterização tectono-estratigráfica da sequência transicional na sub-bacia de Sergipe

This thesis deals with the tectonic-stratigraphic evolution of the Transitional Sequence in the Sergipe Sub-basin (the southern segment of the Sergipe-Alagoas Basin, Northeast Brazil), deposited in the time interval of the upper Alagoas/Aptian stage. Sequence boundaries and higher order internal sequences were identified, as well as the structures that affect or control its deposition. This integrated approach aimed to characterize the geodynamic setting and processes active during deposition of the Transitional Sequence, and its relations with the evolutionary tectonic stages recognized in the East Brazilian Margin basins. This subject addresses more general questions discussed in the literature, regarding the evolution from the Rift to the Drift stages, the expression and significance of the breakup unconformity, the relationships between sedimentation and tectonics at extensional settings, as well as the control on subsidence processes during this time interval. The tectonic-stratigraphic analysis of the Transitional Sequence was based on seismic sections and well logs, distributed along the Sergipe Sub-basin (SBSE). Geoseismic sections and seismic facies analysis, stratigraphic profiles and sections, were compiled through the main structural blocks of this sub-basin. These products support the depositional and tectonic-stratigraphic evolutionary models built for this sequence. The structural analysis highlighted similarities in deformation styles and kinematics during deposition of the Rift and Transitional sequences, pointing to continuing lithospheric extensional processes along a NW trend (X strain axis) until the end of deposition of the latter sequence was finished by the end of late Aptian. The late stage of extension/rifting was marked by (i) continuous (or as pulses) fault activity along the basin, controling subsidence and creation of depositional space, thereby characterizing upper crustal thinning and (ii) sagstyle deposition of the Transitional Sequence at a larger scale, reflecting the ductile stretching and thinnning of lower and sub crustal layers combined with an increasing importance of the thermal subsidence regime. Besides the late increments of rift tectonics, the Transitional Sequence is also affected by reactivation of the border faults of SBSE, during and after deposition of the Riachuelo Formation (lower section of the Transgressive Marine Sequence, of Albian age). It is possible that this reactivation reflects (through stress propagation along the newlycreated continental margin) the rifting processes still active further north, between the Alagoas Sub-basin and the Pernambuco-Paraíba Basin. The evaporitic beds of the Transitional Sequence contributed to the development of post-rift structures related to halokinesis and the continental margin collapse, affecting strata of the overlying marine sequences during the Middle Albian to the Maastrichtian, or even the Paleogene time interval. The stratigraphic analysis evidenced 5 depositional sequences of higher order, whose vertical succession indicates an upward increase of the base level, marked by deposition of continental siliciclastic systems overlain by lagunar-evaporitic and restricted marine systems, indicating that the Transitional Sequence was deposited during relative increase of the eustatic sea level. At a 2nd order cycle, the Transitional Sequence may represent the initial deposition of a Transgressive Systems Tract, whose passage to a Marine Transgressive Sequence would also be marked by the drowning of the depositional systems. At a 3rd order cycle, the sequence boundary corresponds to a local unconformity that laterally grades to a widespread correlative conformity. This boundary surface corresponds to a breakup unconformity , being equivalent to the Pre-Albian Unconformity at the SBSE and contrasting with the outstanding Pre-upper Alagoas Unconformity at the base of the Transitional Sequence; the latter is alternatively referred, in the literature, as the breakup unconformity. This Thesis supports the Pre-Albian Unconformity as marker of a major change in the (Rift-Drift) depositional and tectonic setting at SBSE, with equivalent but also diachronous boundary surfaces in other basins of the Atlantic margin. The Pre-upper Alagoas Unconformity developed due to astenosphere uplift (heating under high lithospheric extension rates) and post-dates the last major fault pulse and subsequent extensive block erosion. Later on, the number and net slip of active faults significantly decrease. At deep to ultra deep water basin segments, seaward-dipping reflectors (SDRs) are unconformably overlain by the seismic horizons correlated to the Transitional Sequence. The SDRs volcanic rocks overly (at least in part) continental crust and are tentatively ascribed to melting by adiabatic decompression of the rising astenospheric mantle. Even though being a major feature of SBSE (and possibly of other basins), the Pre-upper Alagoas Unconformity do not correspond to the end of lithospheric extension processes and beginning of seafloor spreading, as shown by the crustal-scale extensional structures that post-date the Transitional Sequence. Based on this whole context, deposition of the Transitional Sequence is better placed at a late interval of the Rift Stage, with the advance of an epicontinental sea over a crustal segment still undergoing extension. Along this segment, sedimentation was controled by a combination of thermal and mechanical subsidence. In continuation, the creation of oceanic lithosphere led to a decline in the mechanical subsidence component, extension was transferred to the mesoceanic ridge and the newly-formed continental margin (and the corresponding Marine Sequence) began to be controlled exclusively by the thermal subsidence component. Classical concepts, multidisciplinary data and new architectural and evolutionary crustal models can be reconciled and better understood under these lines

Petrologia do magmatismo tardi-brasiliano no Maciço São José de Campestre(RN/PB), com ênfase no Plúton Alcalino Caxexa

The area studied is located on the north-easternmost portion of the Borborema Province, on the so-called São José de Campestre Massif, States of RN and PB, Northeast Brazil. Field relations and petrographic, geochemical and isotope data permitted the separation of five suites of plutonic rocks: alkali-feldspar granite (Caxexa Pluton), which constitutes the main subject of this dissertation, amphibole-biotite granite (Cabeçudo Pluton), biotite microgranite, gabbronorite to monzonite (Basic to Intermediate Suite) and aluminous granitoid. The Caxexa Pluton is laterally associated to the Remígio Pocinhos Shear Zone, with its emplacement along the mylonitic contact between the gneissic basement and the micashists. This pluton corresponds to a syntectonic intrusion elongated in the N-S direction, with about 50 km2 of outcropping surface. It is composed exclusively of alkali-feldspar granites, having clinopyroxene (aegirine-augite and hedenbergite), andradite-rich garnet, sphene and magnetite. It is classified geochemically as high silica rocks (>70 % wt), metaluminous to slightly peraluminous (normative corindon < 1%), with high total alkalis (>10% wt), Sr, iron number (#Fe=90-98) and agpaitic index (0.86-1.00), and positive europium anomaly. The Cabeçudo Pluton is composed of porphyritic rocks, commonly containing basic to intermediate magmatic enclaves often with mingling and mixing textures. Petrographically, it presents k-feldspar and plagioclase phenocrysts as the essential minerals, besides the accessories amphibole, biotite, sphene and magnetite. It is metaluminous and shows characteristics transitional between the calc-alkaline and alkaline series (or monzonitic subalkaline). Its REE content is greater than those ones of the Caxexa Pluton and biotite microgranite, and all spectra have negative europium anomalies. The biotite microgranites occur mainly on the central and eastern portion of the mapped area, as dykes and sheets with decimetric thickness, hosted principally in orthogneisses and micashists. Their field relationships as regards the Caxexa and Cabeçudo plutons suggested that they are late-tectonic intrusions. They are typically biotite granites, having also sphene, amphibole, allanite, opaques and zircon in the accessory assemblage. Geochemically they can be distinguished from the porphyritic types because the biotite microgranites are more evolved, peraluminous, and have more fractionated REE spectra. The Basic to Intermediate rocks form a volumetrically expressive elliptical, kilometric scale body on the Southeast, as well as sheets in micashists. They are classified as gabbronorites to monzonites, with the two pyroxenes and biotite, besides subordinated amounts of amphibole, sphene, ilmenite and allanite. These rocks do not show a well-defined geochemical trend, however they may possibly represent a monzonitic (shoshonitic) series. Their REE spectra have negative europium anomalies and REE contents greater than the other suites. The aluminous granitoids are volumetrically restricted, and have been observed in close association with migmatised micashists bordering the gabbronorite pluton. They are composed of almandine-rich garnet, andalusite, biotite and muscovite, and are akin to the peraluminous suites. Rb-Sr (whole rock) and Sm-Nd (whole-rock and mineral) isotopes furnished a minimum estimate of the crystallization (578±14 Ma) and the final resetting age of the Rb-Sr system (536±4 Ma) in the Caxexa Pluton. The aluminous granitoid has a Sm-Nd garnet age similar to that one of the Caxexa Pluton, that is 574±67 Ma. The strong interaction of shear bands and pegmatite dykes favoured the opening of the Rb-Sr system for the Caxexa Pluton and biotite microgranite. The amphibole-plagioclase geothermometer and the Al-in amphibole geobarometer indicate minimum conditions of 560°C and 7 kbar for the Cabeçudo Pluton, 730°C and 6 kbar for the microgranite and 743°C and 5 kbar for the basic to intermediate suite. The Zr saturation geothermometer reveals temperatures of respectively 855°C, 812°C and 957°C for those suites, whereas the Caxexa Pluton shows temperatures of around 757°C. The Caxexa, Cabeçudo and microgranites suites crystallized under high fO2 (presence of magnetite). On the other hand, the occurrence of ilmenite suggests less oxidant conditions in the basic to intermediate suite. Field relations demonstrate the intrusive character of the granitoids into a tectonically relatively stable continental crust. This is corroborated by petrographic and geochemical data, which suggest a late- or post-collisional tectonic context. It follows that the generation and emplacement of those granitoid suites is related to the latest events of the Brasiliano orogeny. Finally, the relationships between eNd (600 Ma), TDM (Nd) and initial Sr isotope ratio (ISr) do not permit to define the precise sources of the granitoids. Nevertheless, trace element modelling and isotopic comparisons suggest the participation of the metasomatised mantle in the generation of these suites, probably modified by different degrees of crustal contamination. In this way, a metasomatised mantle would not be a particular characteristic of the Neoproterozoic lithosphere, but a remarkable feature of this portion of the Borborema Province since Archaean and Paleoproterozoic times.

Mecanismos de alojamento de magmas granitóides :exemplo do plúton de Japi(RN)

This dissertation describes the igneous suites of the Japi granitoid pluton, intrusive in the Paleoproterozoic gneiss-migmatite complex of the eastern domain of the Seridó Belt, northeastern Brazil. Field relations show that the pluton is affected by strong deformation associated to the Brasiliano orogeny (known as the D3 phase) , with a NW-trending extensionalleft-hand senestral shear zone (the Japi Shear Zone, JSZ) bordering the intrusive body to the west. Four plutonic suites are found in the main pluton and as satellyte intrusions, besides Iate pegmatite and pink leucogranites. An alkaline granitoid suite, dominated by syenogranites bearing sodic augite (and subordinate hornblende), define a main elliptical intrusion. In its northern part, this intrusion is made up by concentric sheets, contrasting with a smaller rounded stock to the south. These granites display a pervasive solid-state S>L fabric developed under high T conditions, characterized by plastic deformation of quartz and feldspar. It is especially, developed along the border of the pluton, with inward dips. A regular magmatic layering is present sometimes, parallel to the tectonic foliation. The syntectonic emplacement as regards to the Brasiliano (D3) event is indicated by the common occurrence of dykes and sheets along transtensional or extensional sites of the major structure. Field relations attest to the early emplacement of the alkaline granites as regards to the other suites. A basic-to-intermediate suite occurs as a western satellyte body and occupying the southern tail of the main alkaline pluton. It comprises a wide variety of compositional terms, including primitive gabbros and gabbro-norites, differentiated to monzonitic intermediate facies containing amphibole and biotite as their main mafic phases. These rocks display transitional high-K calc-alkaline to shoshonitic affinities. Porphyritic monzogranite suítes commonly occur as dykes and minor intrusives, isolated or associated with the basic-tointermediate rocks. In the latter case, magma mingling and mixing features attest that these are contemporaneous igneous suites. These granites show K-feldspar phenocrysts and a hornblende+biotite+titanite assemblage, displaying subalkaline/monzonitic geochemical affinities. Both suites exhibit SL magmatic fabrics overprinting or transitional to solid-state D3 deformation related to the JSI. Chemical data clearly show that they are related to different parental magmas. Finally, a microgranite suite occurs along a few topographic ridges paralell to the JSI. It comprises dominantly granodiorites with a mineralogy similar to the one of the porphyritic granitoids. However, discriminant diagrams show their distinct calc-alkaline affinity. The granodiorites display an essencially magmatic fabric, even though an incipient D3 solid-state structure may be developed along the JSI. Intrusion relationships with the previous suites, as well as regards to the D3 structures, point to their Iate emplacement. All these suites are intrusive in a Paleoproterozoic, high-grade gneiss-migmatite complex affected by two previous deformation phases (D1, D2). The fabrics associated with these earlier events are folded and overprinted by the younger D3 structures along the JSZ. The younger deformation is characterized by NE-dipping foliations and N/NE-plunging stretching lineations. In the JSZ northern termination the foliation acquires an ENE orientation, containing a stretching lineation plunging to the south. Symmetric kinematic cri teria developed at this site confirms the transpressional termination of the JSZ, as also shown by orthorrombic quartz c-axis patterns. E-W-trending d extra I shear zones developed in the central part of the JSZ are interpreted as antithetic structures associated to the transtensional deformation along the JSZ. This is consistent with its extensional-transcurrent kinematics and a flat-and-ramp geometry at depth, as shown by gravimetric data. The lateral displacement of the negative residual Bouguer anomalies, as regards to the main outcropping alkaline pluton, may be modelized by other deeper-seated granite bodies. Based on numerical modelling it was possible to infer two distinct intrusion styles for the alkaline pluton. The calculated model values are consistent with an emplacement by sheeting for the northern body, as already suggested by satellyte imagery and field mapping. On the other hand, the results point to a transition towards a diapir-related style associated to the smaller. southern stock. This difference in intrusion styles may relate to intensity variations and transtensional sites of the shear deformation along the JSZ. Trace element and Sr and Nd isotopes of the alkaline granites are compatible with their derivation trom a more basic crustal source, as compared to the presently outcropping highgrade gneisses, with participation (or alternatively dominated by) of an enriched lithospheric mantle component. Like other igneous suites in the Seridó Belt, the high LlL contents and fractionated REE patterns of the basic rocks also point to an enriched mantle as the source for this kind of magmatism. Geochemical and isotope data are compatible with a lower crustal origin for the porphyritic granites. On the basis of the strong control of the JSZ on the emplacement of lower crustal (porphyritic and alkaline granites) or lithospheric mantle (basic rocks, alkaline granites or a component of them) magmas, one may infer a deep root for this structure, bearing an important role in magma extraction, transport and emplacement in the Japi region, eastern domain of the Seridó Belt

Interpretação sísmica e análise de atributos - área do levantamento sísmico 3D de siririzinho (Bacia Sergipe-Alagoas, NE do Brasil)

The main objective of the present thesis was the seismic interpretation and seismic attribute analysis of the 3D seismic data from the Siririzinho high, located in the Sergipe Sub-basin (southern portion of Sergipe-Alagoas Basin). This study has enabled a better understanding of the stratigraphy and structure that the Siririzinho high experienced during its development. In a first analysis, we used two types of filters: the dip-steered median filter, was used to remove random noise and increase the lateral continuity of reflections, and fault-enhancement filter was applied to enhance the reflection discontinuities. After this filtering step similarity and curvature attributes were applied in order to identify and enhance the distribution of faults and fractures. The use of attributes and filtering greatly contributed to the identification and enhancement of continuity of faults. Besides the application of typical attributes (similarity and curvature) neural network and fingerprint techniques were also used, which generate meta-attributes, also aiming to highlight the faults; however, the results were not satisfactory. In a subsequent step, well log and seismic data analysis were performed, which allowed the understanding of the distribution and arrangement of sequences that occur in the Siririzinho high, as well as an understanding of how these units are affected by main structures in the region. The Siririzinho high comprises an elongated structure elongated in the NS direction, capped by four seismo-sequences (informally named, from bottom to top, the sequences I to IV, plus the top of the basement). It was possible to recognize the main NS-oriented faults, which especially affect the sequences I and II, and faults oriented NE-SW, that reach the younger sequences, III and IV. Finally, with the interpretation of seismic horizons corresponding to each of these sequences, it was possible to define a better understanding of geometry, deposition and structural relations in the area.

Mola Completa em Gravidez Gemelar: relato de Caso

A gravidez gemelar na qual coexistem um feto normal e uma mola completa é um evento raro. Complicações clínicas e aumento de risco de malignização são de importância nesta patologia. Este trabalho descreve um caso de diagnóstico tardio em decorrência da presença do feto. Este diagnóstico foi feito no momento da resolução da gestação e confirmado por estudo histopatológico e citometria de fluxo. A resolução da gestação foi por via transpélvica em decorrência de hemorragia uterina maciça. O seguimento pós-molar evidenciou a persistência de níveis elevados de bhCG, obtendo-se remissão completa da doença com o uso do metotrexato. À luz deste caso, discutem-se o diagnóstico, a história natural e a conduta desta rara intercorrência na clínica obstétrica.

Hiperplasia nodular focal do fígado: apresentação de um caso e revisão da literatura

Neste trabalho apresentamos um caso de hiperplasia nodular focal que foi diagnosticado aos seis anos de idade e que está sendo acompanhado até o momento presente. Para o diagnóstico foram imprescindíveis as técnicas de imagem, tendo importância de realce a cintilografia hepatoesplênica e a tomografia computadorizada. Apresentamos, também, revisão da literatura sobre o assunto.

Analysis of tectonic-controlled fluvial morphology and sedimentary processes of the western Amazon Basin: an approach using satellite images and digital elevation model

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Desnutrição protéico-energética no paciente gastrectomizado

Racional - A gastrectomia traz conseqüências nutricionais inevitáveis mas atenuáveis, dependendo da dietoterapia pós-operatória. Embora observada, essa desnutrição protéico-energética é pouco dimensionada, provavelmente, pela falta de consenso metodológico. Objetivo - Avaliar o grau de desnutrição protéico-energética do paciente gastrectomizado, utilizando-se de indicadores isolados ou combinados. Pacientes e Métodos - Foram estudados 71 pacientes com gastrectomia parcial (n = 53) ou total (n =18) em pós-operatório de 6 a 24 meses e 24-60 meses. Os dados dietéticos, composição corporal e bioquímicos foram analisados de acordo com o tipo de gastrectomia e tempo pós-operatório. Resultados - A cirurgia foi conseqüência de complicações de úlcera péptica (68%) ou a câncer gástrico (32%). A perda de peso foi referida por 70% dos pacientes, sendo maior no grupo gastrectomia total (16 ± 5 kg) do que no grupo gastrectomia parcial (10 ± 6 kg). em geral, os pacientes apresentaram déficit antropométrico, albuminemia normal e baixa ingestão calórica, sugerindo deficiência energética crônica. A redução de hemoglobina, hematócrito e ferro ocorreu em maior intensidade e mais precocemente no grupo gastrectomia total. Assim, quando se associou hemoglobina aos indicadores albumina, linfócitos circunferência do braço e prega cutânea subescapular, a prevalência de desnutrição protéico-energética foi maior e em maior intensidade do que na ausência da hemoglobina. Conclusão - A gastrectomia resultou em desnutrição protéico-energética do tipo marasmática, acompanhada de anemia, mais intensa e precoce na gastrectomia total e gradativa na gastrectomia parcial, assemelhando-se à gastrectomia total no pós-operatório tardio.

Cisticercose intramedular: relato de caso e revisão da literatura

Os autores relatam um caso raro de neurocisticercose intramedular em um paciente do sexo masculino, de 36 anos de idade. Foram realizadas tomografia computadorizada e ressonância magnética do crânio, que evidenciaram múltiplas lesões de tamanhos variados, com realce periférico após injeção de meio de contraste. Também foi realizada ressonância magnética da coluna cervical, que evidenciou formação cística com escólex em seu interior ao nível de C5-C6 na região intramedular.

Caracterização dos estádios fenológicos da cúrcuma, em função da época e densidade de plantio

A cúrcuma é uma espécie, originária da Índia, com grande potencial de utilização nos mercados de corantes, medicinal e alimentício. Este trabalho foi conduzido com o objetivo de avaliar a resposta da planta aos fatores época e densidade de plantio, por meio da caracterização dos estádios fenológicos. Verificou-se que o período de crescimento vegetativo caracterizou-se pelas etapas de pré-perfilhamento e perfilhamento. A primeira etapa, de crescimento lento, mostrou-se influenciada significativamente pela época de plantio, havendo maior precocidade no aparecimento de perfilhos com atraso no plantio. A etapa seguinte, de perfilhamento, mostrou acentuado acúmulo de fitomassa, sendo grande a contribuição dos perfilhos. O período de crescimento dos rizomas teve seu início influenciado significativamente pelo fator época de plantio, sendo tanto mais precoce quanto mais tardio foi o plantio. A extensão do período de crescimento foi de 147, 124, 102 e 79 dias para os plantios efetuados em 20 de outubro, 20 de novembro, 20 de dezembro e 20 de janeiro, correspondente a ciclo cultural, respectivamente, de 270, 240, 210 e 180 dias. Somente foi observado efeito significativo do fator densidade de plantio sobre o período de crescimento vegetativo, sendo o comprimento deste inversamente proporcional à densidade utilizada.

Comparison of behavioral and clinical effects of intravenous amitraz or romifidine administration in horses

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

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.