Bowel-associated dermatosis-arthritis syndrome in an adolescent with short bowel syndrome

Bowel-associated dermatosis-arthritis syndrome (BADAS) is a neutrophilic dermatosis, characterized by the occurrence of arthritis and skin lesions related to bowel disease with or without bowel bypass. We report an unusual case of BADAS in a 15-year-old white male with congenital aganglionosis of the colon and hypoganglionosis of the small intestine and multiple bowel surgeries in childhood complicated by short bowel syndrome. He presented with recurrent peripheral polyarthritis, tenosynovitis, and painful erythematous subcutaneous nodules located on the dorsolateral regions of the legs and on the dorsa of the feet. Histological examination disclosed a neutrophilic dermatosis confirming the diagnosis of BADAS.Although an uncommon disease, especially at pediatric age, it is important to evoke the diagnosis of BADAS in children and adolescents with bowel disease, because treatment options and prognosis are distinct from other rheumatologic conditions.

Dacriocistorrinostomia endoscópica nasal: resultados do Hospital Professor Doutor Fernando Fonseca

Objectivo: analisar os resultados da experiência de um hospital distrital na realização de dacriocistorrinostomias (DCR) endoscópicas e determinar o papel actual desta técnica para tratamento de obstruções da via nasolacrimal. Materiais e Métodos: Reviram-se os processos clínicos de 67 dacriocistorrinostomias endoscópicas consecutivas realizadas no Hospital Fernando Fonseca entre Janeiro de 1997 e Dezembro de 2012. Analisou-se a clínica apresentada pelos doentes, o nível da estenose detectado na dacriocistografia, as complicações intra e pós-operatórias e os resultados funcionais e anatómicos pós-operatórios. Resultados: Dos 51 doentes, 12 eram do sexo masculino e 34 do sexo feminino, com média de idades de 57 anos. A epífora foi a queixa predominante. Com a excepção de dois casos, todas as cirurgias foram executadas com instrumentos de dissecção motorizados. O sucesso da DCR endoscópica foi de 78,1%. Conclusões: A DCR endoscópica é uma técnica simples, segura e eficaz para o tratamento das obstruções distais da via nasolacrimal.

Bowel-associated dermatosis-arthritis syndrome in an adolescent with short bowel syndrome

Bowel-associated dermatosis-arthritis syndrome (BADAS) is a neutrophilic dermatosis, characterized by the occurrence of arthritis and skin lesions related to bowel disease with or without bowel bypass. We report an unusual case of BADAS in a 15-year-old white male with congenital aganglionosis of the colon and hypoganglionosis of the small intestine and multiple bowel surgeries in childhood complicated by short bowel syndrome. He presented with recurrent peripheral polyarthritis, tenosynovitis, and painful erythematous subcutaneous nodules located on the dorsolateral regions of the legs and on the dorsa of the feet. Histological examination disclosed a neutrophilic dermatosis confirming the diagnosis of BADAS.Although an uncommon disease, especially at pediatric age, it is important to evoke the diagnosis of BADAS in children and adolescents with bowel disease, because treatment options and prognosis are distinct from other rheumatologic conditions.

Resultados de cirurgia estapédica: a experiência recente do Hospital Professor Doutor Fernando Fonseca

Objectivo: analisar a experiência recente em cirurgia estapédica do Hospital Professor Doutor Fernando Fonseca, recorrendo à avaliação dos seus resultados audiométricos. Materiais e métodos: avaliação retrospectiva de processos clínicos referentes a 155 cirurgias estapédicas consecutivas realizadas no Hospital Professor Doutor Fernando Fonseca, entre Janeiro de 2006 e Dezembro de 2010. Resultados: a média de idades foi de 43,6 anos. A média de 4 frequências (0.5, 1, 2 e 4 kHz) do gap aero-ósseo pós- operatório foi de 5,2 dB. O ganho auditivo médio registado foi de 27 dB sendo a taxa de sucesso cirúrgico de 88,2%. A alteração da condução óssea nas altas frequências foi de 4,9 dB. Conclusões: A cirurgia estapédica apresenta uma elevada taxa de sucesso e baixa frequência de complicações, sendo uma opção preferencial no tratamento da otosclerose. Os resultados deste trabalho confirmam-no reforçando o recurso à cirurgia estapédica no Hospital Professor Doutor Fernando Fonseca.

La colecistectomía laparoscópica en el Hospital Vicente Corral Moscoso de Cuenca, 1994-2008

Antecedentes. La colecistectomía laparoscópica (CL, Cole-Lap) es el tratamiento de elección en la patología biliar benigna, la que presenta una elevada incidencia en nuestra ciudad y país. En el hospital Vicente Corral, cirujanos en formación y docentes, han participado en el desarrollo de esta técnica desde su inicio. Objetivo. Describir y compartir la experiencia de 14 años de colecistectomía laparoscópica en el Hospital Vicente Corral M. Métodos. Se presenta la casuística descriptiva y retrospectiva de 2.200 pacientes intervenidos por colecistectomía laparoscópica desde mayo de 1994 hasta enero 2008. Resultados. De 2.200 CL, el 79% son de sexo femenino, con promedio de edad de 43 años, con diagnóstico intraoperatorio de colecistitis crónica litiásica en el 82%. Se presentaron complicaciones entre mayores y menores en el 38%, las perforaciones de vesícula con salida de la bilis y las hemorragias provenientes de la arteria cística fueron las más frecuentes. La lesión de la vía biliar principal se registró en el 0.12%. En las 100 primeras cirugías se presentaron 25 complicaciones, mientras que en las 100 últimas fueron 34. El tiempo operatorio promedio fue de 35 minutos en el 2008. Discusión. La colecistectomía laparoscópica demuestra, en nuestro estudio, ser un procedimiento seguro y efectivo en pacientes con colecistitis calculosa aguda o crónica.

Early allergen exposure and atopic eczema

Background The relationship between exposure to indoor aeroallergens in early life and subsequent eczema is unclear. We have previously failed to show any significant associations between early life exposure to house dust mite and cat fur allergens and either sensitization to these allergens or wheeze. We have also previously reported a lower prevalence of parent-reported, doctor-diagnosed eczema by age 2 years for children exposed to higher concentrations of house dust mite, but no other associations with other definitions of eczema or for exposure to cat allergen. Objectives To extend the exposure–response analysis of allergen exposure and eczema outcomes measured up to age 8 years, and to investigate the role of other genetic and environmental determinants. Methods A total of 593 children (92Æ4% of those eligible) born to all newly pregnant women attending one of three general practitioner surgeries in Ashford, Kent, were followed from birth to age 8 years. Concentrations of house dust mite and cat allergen were measured in dust samples collected from the home at 8 weeks after birth. The risk of subsequent eczema as defined by the U.K. diagnostic criteria was determined according to different levels (quintiles) of allergen exposure at birth. Results By age 8 years, 150 (25Æ3%) children had met the diagnostic criteria for eczema at least once. Visible flexural dermatitis was recorded at least once for 129 (28Æ0%). As in other studies, parental allergic history was positively associated with most eczema outcomes, as were higher maternal education and less crowded homes. No clear linear associations between early exposure to house dust mite or cat allergen were found, regardless of the definition of eczema used. The risk of eczema appeared to increase for the three lowest quintiles of house dust mite allergen exposure (odds ratio, OR 1Æ37 for third quintile compared with first), and then to fall for the two highest quintiles (OR 0Æ66 and 0Æ71) even after controlling for confounding factors. Conclusions The lack of any clear exposure–disease relationship between allergens in early life and subsequent eczema argues against allergen exposure being a major factor causing eczema. If the lower levels of eczema at higher levels of house dust mite are confirmed, then interventions aimed at reducing house dust mite in early infancy could paradoxically increase the risk of subsequent eczema.

Stapedotomy and its effect on hearing – our experience with 54 cases.

Introduction: This study reviews the cases of stapedotomy and evaluates its effectiveness at improving hearing loss in patients with otosclerosis. Materials and methods: Retrospective review of patients’ records who had clinical and audiometric diagnosis of otosclerosis from January to December 2012. Results: A total of 54 stapedotomy surgeries (52 unilateral and 1 bilateral surgeries) were received. Average post-operative ABG for 0.5, 1, 2 and 4 KHz showed that 61.1% had complete closure of ABG (ABG < 10 dB) compared with 1.6% preoperatively and 85.2% had closure of ABG to within 20dB compared with 4.7% preoperatively (t – 13.89, p = 0.000). More than 94% had hearing improvement and 81.5% had ABG closure greater than 10 dB postoperatively (mean gain 23.38 ± 12.37, t = 13.89, p = 0.000). A total of 13% complications were recorded with TM perforation (5.6%) being the commonest complication. Conclusion: Stapedotomy is an effective surgical procedure for the treatment of otosclerosis which leads to improvement in patients’ quality of life. A favorable hearing outcome can be obtained by the combination of experienced hands with minimal surgical trauma and appropriate surgical technique.

Orthopaedic anaesthesia for upper extremity procedures in a Nigerian hospital

Background General anaesthesia and regional anaesthesia have been used successfully for upper extremity orthopaedic procedures. Despite the advantages of regional anaesthesia, there is low utilisation in Nigeria. In this study, we assessed the types of anaesthesia employed for upper extremity surgeries in our centre. Methods After obtaining approval from the institutional ethics committee, all the patients who had upper extremity surgeries from 1 January 2011 to 31 December 2012 were included in this review. Both prospective and retrospective data were gathered. The choice of anaesthesia was at the discretion of the attending anaesthetist. Results A total of 226 patients with a male-to-female ratio of 1.6:1 and median age of 35.0 (range 2 – 89) years, had orthopaedic upper extremity procedures during the study period. Sixty-three cases (27.9%) had general anaesthesia, 5 (2.2%) combined regional and general anaesthesia while 158 (69.9%) had regional blocks. The regional blocks comprised 145 (89%) different approaches to the brachial plexus and 18 (11%) local anaesthetic infiltrations. The arm was the site mostly operated upon; while supraclavicular and axillary brachial plexus blocks were performed in equal amounts. In 14 (6.2%) patients, brachial plexus blocks were performed with spinal anaesthesia because of concomitant iliac crest bone grafts. While the duration of surgery did not differ significantly, regional anaesthesia provided a significantly longer duration of anaesthesia than general anaesthesia (251 ± 70.8 min versus 141.3 ± 65.5 min; p = 0.0000001). Conclusion There is a high use of regional anaesthesia for upper extremity orthopaedic surgeries in our centre, which is a positive development in a resource limited setting.

Nutritional status and its impact on time and relocation in postoperative complications of abdominal patients undergoing surgery

Introduction: The nutritional state is the independent factor that most influences the post-operational results in elective surgeries. Objective: to evaluate the influence of the nutritional state on the hospitalization period and on the post-operative complications of patients submitted to abdominal surgery. Methods: prospective study with 99 surgical patients over 18 years of age, submitted to abdominal surgeries in the period from April to October of 2013, in the Instituto de Medicina Integral Professor Fernando Figueira (IMIP). All patients were submitted to anthropometric nutritional evaluations through the body mass Index (BMI), arm circumference (AC) and triceps skinfold thickness (TEST). The biochemical evaluation was carried out from the leukogram and serum albumin results. The identification of candidate patients to nutritional therapy (NT) was carried out through the nutritional risk (NR) evaluation by using the BMI, loss of weight and hypoalbuminemia. The information about post-operational complications, hospitalization period and clinical diagnosis was collected from the medical records. Program SPSS version 13.0 and significance level of 5% were used for the statistical analysis. Results: The malnutrition diagnosed by the AC showed significant positive association with the presence of post-operative complications (p=0.02) and with hospitalization period (p=0.02). The presence of NR was greater when evaluated by hypoalbuminemia (28.9%), however, only 4% of the sample carried out the NT in the pre-operational period. The hospitalization period was greater for patients with malignant neoplasia (p<0.01). Conclusion: The malnutrition diagnosis of patients submitted to abdominal surgeries is associated to greater risk of post-operational complications and longer hospitalization permanence.

A microbiology study of the surgical site infection, at a hospital in northern Portugal

Surgical site infections (SSIs) remain a major clinical problem in terms of morbidity, mortality, time spent in hospital and overall direct and indirect costs. Objectives: To measure the prevalence of the SSI, by type of surgery and microbiologically characterization, in adult patients undergoing surgery during 2015 at a public hospital in northern Portugal. Methods: A prospective study, attended by 609 adult patients, undergoing surgery. The sociodemographic and clinical data of the population, as well as the surgical procedure and microbiological study were analyzed using Microsoft Access 2013. Results: In the sample of 609 adults undergoing surgery, it was found that 62.89% of surgical wound were cleaned, 15.8% were clean-contaminated, 8.70% were contaminated and 9.36% infected. About 62.52% of the intervened patients had antibiotic prophylaxis prior to surgery. Out of all surgeries, 33.3% were laparoscopic. The percentage of SSI was 5.74%; In these positive cases, only 3.61% was identiied the responsible bacteria. The urgent surgeries have more infections when compared to the programmed ones. In colon surgery the number of infections was 60% after cholecystectomy (22.86%). In hernioplasty, infection occurred in only 2.86% of the patients. The most isolated bacteria was Escherichia coli with 59%, in which 30% are -producing-lactamases of extended spectrum, followed by Pseudomonas aeruginosa (13.6%) and Serratia marcescens (13.6%). The mortality rate was 14.8%. Pseudomonas aeruginosa was isolated in 3 of 4 patients who died. Conclusions: The most microorganisms belong to the group of Gram-negative and are usually linked to infections associated with health care.

Thermal analysis in the drilling of solid rigid foam materials and ex-vivo bovine bones

Bone is a dynamic, highly vascularized tissue with a unique capacity to heal and regenerate without scarring. However, drilling remains a concern in several clinical procedures due to thermal damage of the bone and surrounding tissue. The success of this surgeries is dependent of many factors and also in temperature generation during the drilling bone. When an excessive heat is produced during the drilling, thermal necrosis can occur and the bone suffers injuries. Studies have shown that the increased temperature is directly related with the drilling parameters, particularly, the drill speed, feed-rate, applied force, the depth of cut, the geometry of the drill bit, the use or not of a cooling system and also the type of bone.

Cuidados paliativo em crianças portadoras de malformações cerebrais

Tese (doutorado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Bioética, 2016.

Estudo retrospetivo sobre traqueostomia permanente como tratamento cirúrgico em cães com síndrome braquicefálica obstrutiva

Dissertação de Mestrado Integrado em Medicina Veterinária

Manejo del dolor postoperatorio con morfina en anestesia espinal en cirugía gineco-obstétrica de la Fundación Pablo Jaramillo Crespo

Objetivo: Evaluar la eficacia del tratamiento del dolor postoperatorio con el uso de la morfina en anestesia conductiva en pacientes con cirugía ginecológica, obstétrica. Fundación Pablo Jaramillo Crespo; septiembre- diciembre de 2011. Métodos: Estudio observacional, analítico, prospectivo y cuantitativo. Se incluyeron, con la clasificación de la Sociedad Americana de Anestesiología (ASA) I y II a 231 pacientes, entre 15 y 65 años, hospitalizadas en la Fundación Pablo Jaramillo Crespo, por cirugía ginecológica-obstétrica, realizadas desde septiembre a diciembre de 2011. Se administraron dosis de morfina: 2 mg para epidural y 0,2 mg para anestesia raquídea. El dolor fue evaluado a las 12 y 24 horas, con la escala visual analógica de la intensidad del dolor (EVA). Resultados: La morfina utilizada no tuvo preservantes; se observó que la anestesia raquídea muestra una ligera ventaja a la epidural, con mejor tolerancia al dolor a las 12 y 24 horas (p<0.05) No hubo relación entre la etiología de las cirugías ginecológicas y obstétricas con el dolor a las 12 y 24 horas (p>0.05). En 25.78 % de los casos, la analgesia de la morfina, por administración raquídea, se complementó con el uso de ketorolaco por vía intravenosa. Un 49.2% de las pacientes no mostró efectos secundarios; de estos, los más observados fueron: el prurito (13.14 %), retención urinaria (11.3%), náuseas (9.8%) y vómitos (6.9%). Conclusión: el uso de morfina en dosis: 2 mg para epidural y 0.2 mg para anestesia raquídea, proporciona una favorable recuperación del dolor en las pacientes con cirugía ginecológica y obstétrica. Los efectos secundarios provocados por su administración pueden manejarse de manera eficiente sin alterar la recuperación postoperatoria

Efeitos do debilitamento dos músculos oblíquos na correção cirúrgica da esotropia

Tese (doutorado)—Universidade de Brasília, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Médicas, 2016.