AVALIAÇÃO DAS ALTERAÇÕES DENTOESQUELÉTICAS DECORRENTES DO TRATAMENTO DA MALOCLUSÃO DE CLASSE II COM O APARELHO FORSUS POR MEIO DE TOMOGRAFIA COMPUTADORIZADA

Este estudo teve como objetivo avaliar cefalometricamente as alterações dentoesqueléticas decorrentes do tratamento da maloclusão de Classe II, divisão 1, com o aparelho Forsus®, por meio de Tomografia Computadorizada de Feixe Cônico (TCFC). O grupo avaliado foi composto por 10 pacientes, sendo 7 do sexo masculino e 3 do sexo feminino, com idade média de 16,1 anos, maloclusão com severidade mínima de 1/2 Classe II, trespasse horizontal mínimo de 5 mm, padrão facial meso ou braquifacial. Estes jovens se encontravam no estágio IV ou V de maturação óssea, verificada pelas vértebras cervicais. O tempo de uso do aparelho Forsus foi de 7,16 meses (média), período de avaliação compreendido entre a aquisição da primeira teleradiografia gerada através da TCFC (T1 - pré-Forsus) e da segunda teleradiografia (T2 - pós-Forsus). Para análise estatística foi utilizado o teste-t pareado. Os resultados mostraram um pequeno crescimento mandibular que, juntamente com uma diminuição do SNA levaram a uma melhora da relação maxilomandibular. Houve uma rotação no sentido anti-horário da mandíbula e do plano oclusal no sentido horário. Os incisivos superiores foram retruídos, verticalizados e extruídos e os molares superiores distalizaram por inclinação. Houve vestibularização, protrusão e intrusão dos incisivos inferiores, além de mesialização e extrusão dos molares inferiores. Desta maneira, conclui-se que o aparelho Forsus foi efetivo na correção da maloclusão de Classe II, propiciando maiores alterações dentoalveolares do que esqueléticas.(AU)

Avaliação do potencial da fibra e casca de coco maduro, casca de coco verde e cacto pré-tratados visando à produção de etanol

The present work investigated the potential of different residual lignocellulosic materials generated in rural and urban areas (coconut fibre mature, green coconut shell and mature coconut shell), and vegetable cultivated in inhospitable environments (cactus) aimed at the production of ethanol, being all materials abundant in the Northeast region of Brazil. These materials were submitted to pretreatments with alkaline hydrogen peroxide followed by sodium hydroxide (AHP-SHP), autohydrolysis (AP), hydrothermal catalyzed with sodium hydroxide (HCSHP) and alkali ethanol organosolv (AEOP). These materials pretreated were submitted to enzymatic hydrolysis and strategies of simultaneous saccharification and fermentation (SSF) and saccharification and fermentation semi-simultaneous (SSSF) by Saccharomyces cerevisiae, Zymomonas mobilis and Pichia stipitis. It was also evaluated the presence of inhibitory compounds (hydroxymethylfurfural, furfural, acetic acid, formic acid and levulinic acid) and seawater during the fermentative process. Materials pretreated with AHP-SHP have resulted in delignification of the materials in a range between 54 and 71%, containing between 51.80 and 54.91% of cellulose, between 17.65 and 28.36% of hemicellulose, between 7.99 and 10.12% of lignin. Enzymatic hydrolysis resulted in the conversions in glucose between 68 and 76%. Conversion yields in ethanol using SSF and SSSF for coconut fibre mature pretreated ranged from 0.40 and 0.43 g/g, 0.43 and 0.45 g/g, respectively. Materials pretreated by AP showed yields of solids between 42.92 and 92.74%, containing between 30.65 and 51.61% of cellulose, 21.34 and 41.28% of lignin. Enzymatic hydrolysis resulted in glucose conversions between 84.10 and 92.52%. Proceeds from conversion into ethanol using green coconut shell pretreated, in strategy SSF and SSSF, were between 0.43 and 0.45 g/g. Coconut fibre mature pretreated by HCSHP presented solids yields between 21.64 and 60.52%, with increased in cellulose between 28.40 and 131.20%, reduction of hemicellulose between 43.22 and 69.04% and reduction in lignin between 8.27 and 89.13%. Enzymatic hydrolysis resulted in the conversion in glucose of 90.72%. Ethanol yields using the SSF and SSSF were 0.43 and 0.46 g/g, respectively. Materials pretreated by AEOP showed solid reductions between 10.75 and 43.18%, cellulose increase up to 121.67%, hemicellulose reduction up to 77.09% and lignin reduced up to 78.22%. Enzymatic hydrolysis resulted in the conversion of glucose between 77.54 and 84.27%. Yields conversion into ethanol using the SSF and SSSF with cactus pretreated ranged from 0.41 and 0.44 g/g, 0.43 and 0.46 g/g, respectively. Fermentations carried out in bioreactors resulted in yields and ethanol production form 0.42 and 0.46 g/g and 7.62 and 12.42 g/L, respectively. The inhibitory compounds showed negative synergistic effects in fermentations performed by P. stipitis, Z. mobilis and S. cerevisiae. Formic acid and acetic acid showed most significant effects among the inhibitory compounds, followed by hydroxymethylfurfural, furfural and levulinic acid. Fermentations carried out in culture medium diluted with seawater showed promising results, especially for S. cerevisiae (0.50 g/g) and Z. mobilis (0.49 g/g). The different results obtained in this study indicate that lignocellulosic materials, pretreatments, fermentative processes strategies and the microorganisms studied deserve attention because they are promising and capable of being used in the context of biorefinery, aiming the ethanol production.

Influência da granulometria e taxas de filtração no tratamento de água utilizando dupla filtração

The contamination of water sources of public drinking by waste originated by anthropogenic activities has brought various risks to human health. Among the consequences of such activities can highlight the bloom of microalgae and cyanobacteria, which have the potential to produce toxins dangerous to humans, and the presence of humic substances that are generated by the decomposition of natural organic matter (NOM), such as vegetation. When found in water sources for public supply, present negative aspects conferring high color, odor and taste. The double filtration technology has good efficiency in water with the presence of cyanobacteria and different quality variations. Therefore, this study aimed to evaluate the behavior of the technique of double filtration with pre-oxidation for water purifiers the lagoon of Extremoz-RN, which currently has high concentrations of cyanobacteria. The research is summarized in four phases: the first phase turned to static tests in jarteste equipment in the laboratory and subsequent phases were tested in the Pilot Plant of Double Filtration. For the second and third stage filtration rates were tested filtration rates of 120 and 180 m3 / m2 .day for ascending boulders filters and 160 and 240 m3 / m2 .day in the filters in quick sand descendants. The last phase aimed to evaluate the double filtration with pre-oxidation. The results demonstrated that the system could produce double filtration in all trials of good quality water according to the Decree nº. 2914/11 of the Ministry of Health. The use of preoxidation favored the removal of microcystin and color at the end of the tests, reaching a percentage of color removal around 60%. The analysis of variance in the data, enabled prove that the filtration rates of 180 m3 / m2.d the gravel filter and 240 m3 /m2 .d in rapid filters, were the most significant for the removal of turbidity. The ascending filter of boulder 4 with particle size finer filter layer showed the best performance and the best means of turbidity and apparent color. The rapid filter downward 1 was more efficient in removing turbidity reaching removal about 100%

Conservação de material genético de espécies silvestres do bioma caatinga utilizando a manipulação oócitos inclusos em folículos ovarianos pré antrais (MOIFOPA)

The objective of the present thesis was to use the manipulation of oocytes enclosed in preantral follicles (MOEPF) as a tool for the female gametes rescue and optimization, from wild species of Caatinga biome. The thesis was divided into 4 experiments. At first experiment, it was performed the estimative and description of the agouti (Dasyprocta leporina) preantral follicles (PF) histologic and ultrastructural features, in which it was estimated 4419.8 ± 532.26 and 5397.52 ± 574.91 follicles for the right and left ovary, respectively, and the majority (86,63%) belonged to the primordial follicles category (P<0.05). Most of the population consists of morphologically normal follicles (70.78%), presenting a large and central nuclei and uniform cytoplasm. At ultrastructural evaluation it was verified the presence of a great number of round mitochondrias associated to lipid droplets. In the second experiment, it was performed the estimative and description of yellow-toothed cavies (Galea spixii) PF characteristics, also, the evaluation of the effect of solid surface vitrification (SSV) on the in situ PF morphology. The total of 416.0 ± 342.8 PF was estimated for the ovary pair and the presence of a large quantity of primary follicles (P<0.05) was evidenced. Most of the PF was morphologically normal (94.6%), in which the oocyte nuclei presented condensed granules of heterochromatin. Round or elongated shaped mitochondria constituted the most abundant organelles. In regard of the SSV, the protocol using the dimethylsulfoxide (DMSO) 3M possibility the preservation of 69.5% of morphologically normal PF, which was evidenced by the light and transmission electronic microscopy. At third experiment, the evaluation of the SSV procedure on the morphology and viability in situ PF form collared peccaries (Pecari tajacu) was performed. No differences were observed among treatments, in which the use of DMSO, ethylene glycol (EG) and dimethylformamide (DMF) as cryoprotectants, regardless its concentration, promoted the morphology preservation of much than 70% of PF. Concerning the PF viability, the DMSO and EG promoted the best preservation. The fourth experiment aimed to evaluate the effect of α MEM+ or TCM199 associated or not to 50 ng of FSHr on the morphology, activation and growth of collared peccaries PF, in vitro cultured (IVC) during 1 or 7 days and the effect on the extracellular matrix (ECM). After 7 days of IVC only the use of TCM199/FSH maintained the proportion of intact PF, similar to day 1(63.2%), however, no differences were observed among treatments (P>0.05). Also, an improvement of the proportion of intact growing PF was verified (P>0.05). By the Ag-NOR analysis it was observed that only the treatment using TCM199/FSH promoted the maintenance of cell proliferation similar to day 1 (P>0.05). The picrosirius red stain revealed that ECM remained intact in all treatments (P>0.05). Thus, as the general conclusion, the use of MOEPF in the refereed species allowed the knowledge of aspects related to its reproductive morphology and physiology, enabling the germplasm conservation, with the possibility of germplasm bank formation, as the elucidation of mechanisms related to the PF survive and in vitro development.

Prevalência e fatores associados à diminuição da função pulmonar em obesos em pré-operatório de cirurgia bariátrica

Introduction: Obesity shows changes in pulmonary function and respiratory mechanics, however, little is known regarding the prevalence of worsening respiratory function when considering the increase in central or peripheral adiposity or general obesity. Objectives: To analyze the association between anthropometric adiposity and decreased lung function in obese. Materials and Methods: Patients eligible for this study obese individuals (IMC≥30kg/m2) in pre-bariatric surgery and referred for Treatment Clinic of Obesity and Related Diseases, located at the University Hospital Onofre Lopes (HUOL), from October 2005 and July 2014. The evaluation included clinical information and measurement of anthropometric measures (body mass index (BMI), body fat index (BFI) and waist circumference (WC) and neck (NC)) and spirometric. The prevalence and analysis by Poisson regression was performed considering the following outcome variables: forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and Maximum Voluntary Ventilation (MVV) and as predictor variables were considered: BMI, IAC, WC and NC and as control variables: age, gender, smoking history and comorbidities (diabetes mellitus, dyslipidemia and hypertension). Statistical analysis was performed using Statistical Package for Social Sciences software (SPSS - version 20.0). Results: We analyzed 384 individuals, 75% women, mean BMI: 46.6 (± 8.7) kg/m2, IAC: 49.26 (± 9.48)%, WC: 130.84 (± 16.23) cm and NC: 42.3 (± 4.6) cm. The higher prevalence of FVC and FEV1 <80% was observed in individuals with NC above 42 cm, followed those with a BMI above 45 kg/m2. Multivariate analysis using Poisson regression showed as risk factors associated with FVC <80%, the variables: NC above 42 cm (odds ratio (OR) 2.41) and BMI over 45Kg/m2 (OR 1.71 ). As for FEV1 <80% predicted, all predictor variables were associated, with the largest odds presented by the NC (3.40). MVVV was not associated with any studied varaible. Conclusion: Individuals with NC above 42 cm had higher prevalence of reduced lung function and the NC was the measure with the highest association with reduced lung function in obese.

Metodologia de estimação de estados para tratamento de medições errôneas e registros não sincronizados em algoritmos de localização de faltas em linhas de transmissão

The performance of algorithms for fault location i n transmission lines is directly related to the accuracy of its input data. Thus, fa ctors such as errors in the line parameters, failures in synchronization of oscillographic recor ds and errors in measurements of voltage and current can significantly influence the accurac y of algorithms that use bad data to indicate the fault location. This work presents a new method ology for fault location in transmission lines based on the theory of state estimation in or der to determine the location of faults more accurately by considering realistic systematic erro rs that may be present in measurements of voltage and current. The methodology was implemente d in two stages: pre-fault and post- fault. In the first step, assuming non-synchronized data, the synchronization angle and positive sequence line parameters are estimated, an d in the second, the fault distance is estimated. Besides calculating the most likely faul t distance obtained from measurement errors, the variance associated with the distance f ound is also determined, using the errors theory. This is one of the main contributions of th is work, since, with the proposed algorithm, it is possible to determine a most likely zone of f ault incidence, with approximately 95,45% of confidence. Tests for evaluation and validation of the proposed algorithm were realized from actual records of faults and from simulations of fictitious transmission systems using ATP software. The obtained results are relevant to show that the proposed estimation approach works even adopting realistic variances, c ompatible with real equipments errors.

Estudo comparativo dos processos eletroquímicos oxidativos avançados (PEOAs) no tratamento de efluentes contendo corantes orgânicos de difícil degradação

Organic dyes have been widely used in various branches of dyeing industries. These compounds are known to be very toxic, mutagenic, cancinogenic only cause aesthetic pollution and irreversible damage to aquatic ecosystems and human health. Are recalcitrant contaminants due to its high stability and resistance to photobleaching and bio. Given this context, the search for technologies that can minimize the effects of such pollutants is required. In recent decades the Electrochemical Oxidation Process Advanced (PEOAs) based on the generation of strongly oxidizing species (radicals ●OH) offer promising approaches for the prevention of problems caused by industrial effluents. This study analyzed the degradation and mineralization of textile dyes and the study of a real effluent in order to assess the feasibility of PEOAs: Electro-Fenton (EF), Photo Electro-Fenton (PEF) and anodic oxidation (AO), and these methods still was studied the Solar Fotoelectro-Fenton (SPEF) in a pre-pilot plant, in order to study the electrochemical treatment on an industrial scale. In the study has compared the effect of PEOAs in the removal of color, TOC and decay kinetics of degradation of the compounds, and also for using the Congo Red (CR) SPEF studies were performed mineralization current efficiency (MCE). The best results are given to the treatment of the PEF for all the studied dyes. From the results it was possible to choose the PEF as the most effective and promising for application of treatment when compared to other methods of treatment, and prove from SPEF that the process can be used in industrial scales, since this method PEF has been improved and solar irradiation replaced the UVA lamp.

Estudo comparativo dos processos eletroquímicos oxidativos avançados (PEOAs) no tratamento de efluentes contendo corantes orgânicos de difícil degradação

Organic dyes have been widely used in various branches of dyeing industries. These compounds are known to be very toxic, mutagenic, cancinogenic only cause aesthetic pollution and irreversible damage to aquatic ecosystems and human health. Are recalcitrant contaminants due to its high stability and resistance to photobleaching and bio. Given this context, the search for technologies that can minimize the effects of such pollutants is required. In recent decades the Electrochemical Oxidation Process Advanced (PEOAs) based on the generation of strongly oxidizing species (radicals ●OH) offer promising approaches for the prevention of problems caused by industrial effluents. This study analyzed the degradation and mineralization of textile dyes and the study of a real effluent in order to assess the feasibility of PEOAs: Electro-Fenton (EF), Photo Electro-Fenton (PEF) and anodic oxidation (AO), and these methods still was studied the Solar Fotoelectro-Fenton (SPEF) in a pre-pilot plant, in order to study the electrochemical treatment on an industrial scale. In the study has compared the effect of PEOAs in the removal of color, TOC and decay kinetics of degradation of the compounds, and also for using the Congo Red (CR) SPEF studies were performed mineralization current efficiency (MCE). The best results are given to the treatment of the PEF for all the studied dyes. From the results it was possible to choose the PEF as the most effective and promising for application of treatment when compared to other methods of treatment, and prove from SPEF that the process can be used in industrial scales, since this method PEF has been improved and solar irradiation replaced the UVA lamp.

Avaliação de processo de lodos ativos por batelada seguido de tratamento terciário com ênfase na remoção de matéria orgânica e na sedimentabilidade do lodo

This paper evaluate the performance of a Wastewater Treatment Plant (WWTP) in sequential batch activated sludge modality with tertiary treatment step, located in high temperature region. It also presents the analysis of organic matter’s removal and the evaluation of sludge sedimentation conditions through reactors in bench scale, fed with different substrate’s and biomass’ concentrations, from the WWTP in study. The results showed high efficiency and stability of the treatment process using Sequential Batch Reactors for domestic sewage, even with sudden changes of organic and hydraulic load, reaching more than 90% of efficiency in the removal of biodegradable organic matter. The removal of organic matter and sedimentation tests in bench reactors showed the good performance in respect of the organic matter’s removal, however, the high concentration of micro-organism results in a lower sludge sedimentation rate, which can compromise the quality of the final effluent. The relation Food/Microorganism in the conditions of the WWTP’s current operation showed a value of 0.06 gCOD/gVSS.d. and zonal sedimentation velocity of 0.59 m/h, the great ratio of the concentration of the substrate by biomass concentration, which obtained the maximum operational efficiency, showed a value of 0.09 gCOD/gVSS.d. and zonal sedimentation velocity of 1.4 m/h.

Avaliação de processo de lodos ativos por batelada seguido de tratamento terciário com ênfase na remoção de matéria orgânica e na sedimentabilidade do lodo

This paper evaluate the performance of a Wastewater Treatment Plant (WWTP) in sequential batch activated sludge modality with tertiary treatment step, located in high temperature region. It also presents the analysis of organic matter’s removal and the evaluation of sludge sedimentation conditions through reactors in bench scale, fed with different substrate’s and biomass’ concentrations, from the WWTP in study. The results showed high efficiency and stability of the treatment process using Sequential Batch Reactors for domestic sewage, even with sudden changes of organic and hydraulic load, reaching more than 90% of efficiency in the removal of biodegradable organic matter. The removal of organic matter and sedimentation tests in bench reactors showed the good performance in respect of the organic matter’s removal, however, the high concentration of micro-organism results in a lower sludge sedimentation rate, which can compromise the quality of the final effluent. The relation Food/Microorganism in the conditions of the WWTP’s current operation showed a value of 0.06 gCOD/gVSS.d. and zonal sedimentation velocity of 0.59 m/h, the great ratio of the concentration of the substrate by biomass concentration, which obtained the maximum operational efficiency, showed a value of 0.09 gCOD/gVSS.d. and zonal sedimentation velocity of 1.4 m/h.

Inter-relação entre lesão cervical não cariosa e comprometimento periodontal: diagnóstico, tratamento e previsibilidade - estudo clínico prospectivo e laboratorial

The coexistence of gingival recession (GR) with root coverage indication and non-carious cervical lesions (LCNC) generates the need for a protocol that respects and promotes health of dental and periodontal tissues and allows treatment predictability. The main objectives of this theses were: (1) verify, through clinical evaluations, the connective tissue graft for root coverage on direct and indirect restorations made of ceramic resin; (2) analyze the influence of the battery level of the LED curing unit in the composite resin characteristics; (3) assess the influence of restorative materials, composite resin and ceramics, on the viability of gingival fibroblasts from primary culture. Nine patients with good oral hygiene and occlusal stability diagnosed with LCNCs the anterior teeth including premolars associated with gingival recession (class I and II of Miller) and only gingival recession were selected. After initial clinical examination, occlusal adjustment was performed and the patients had their teeth randomized allocated on direct composite resin restoration of LCNC, polishing and GR treatment with connective tissue graft and advanced coronally flap CR group (n = 15); and indirect ceramic restoration of the LCNC's and GR treatment (CTG+CAF) Group C (n = 15). The GR presented teeth with no clinically formed LCNCs cavity were treated using (CTG+CAF) being the control group (n = 15). Sorption and solubility tests, analysis of the degree of conversion and diametral tensile strength were performed in composite resin samples (n = 10) photoactivated by 100, 50 and 10% battery charge LED unit. The viability of fibroblasts on composite resin, ceramics and dentin disks (n = 3) was examined. Clinical follow-up was performed for three months. The data obtained at different stages were tabulated and subjected to analysis for detection of normal distribution and homogeneity. The results showed that: the LED unit with 10% battery affects the characteristics of the composite resin; restorative materials present biocompatibility with gingival fibroblasts; and the association of surgical and restorative treatment of teeth affected by NCCL and GR presents successful results at 3-month follow-up.

Gestação após gastroplastia para tratamento de obesidade mórbida: série de casos e revisão da literatura

Objetivo: relatar a evolução de uma série de casos de gestação em mulheres previamente submetidas à cirurgia de bypass gástrico para tratamento de obesidade grave. Métodos: cinco casos consecutivos de gravidez após gastroplastia ocorridos entre 2001 e 2004 foram avaliados. As pacientes tinham idade entre 30 e 34 anos e todas haviam sido submetidas à cirurgia de Capella. Aspectos clínicos, laboratoriais e do acompanhamento materno e fetal foram considerados, durante o período gestacional e após o parto. Foi realizada revisão da literatura internacional, por meio das bases de dados MEDLINE e Web of Science, utilizando os seguintes unitermos: gastroplasty, gastric bypass surgery, bariatric surgery e pregnancy. Resultados: todas as gestações observadas foram únicas e não ocorreram complicações obstétricas, durante o seguimento pré-natal e parto. Também não houve registro de recém-nascidos prematuros ou de baixo peso ao nascimento. Conclusão: nossos dados sugerem que a gravidez após gastroplastia é segura para a mãe e feto. Entretanto, em virtude do limitado volume de informação disponível sobre o tema, investigações adicionais são necessárias para estabelecer recomendações apropriadas com relação ao seguimento dessas gestações _________________________________________________ABSTRACT Purpose: we report a small series of pregnant women who underwent gastric bypass surgery for severe obesity, with a review of the literature on this topic. Methods: five consecutive cases of pregnancy after gastroplasty between 2001 and 2004 were evaluated, and clinical, laboratory and therapeutic features were considered. Patients were 30 to 34 years old and all had been submitted to gastroplasty by the Capella technique. The outcomes for both the pregnant woman and the fetus were evaluated. A search of the English language literature was done through MEDLINE and Web of Science databases with the following terms: gastroplasty, gastric bypass surgery, bariatric surgery, and pregnancy. Results: all 5 pregnancies were singleton. No major obstetric complications were observed and there were no premature or lowbirth weight infants. Conclusion: our data suggest that pregnancy following gastroplasty is safe for mother and fetus. However, since information about this topic is limited, further investigations are required to establish appropriate recommendations concerning the follow-up of these pregnancies

Impacto da Insuficiência Renal no Prognóstico dos Doentes Submetidos a Reparação de Aneurisma da Aorta Abdominal - Cirurgia Convencional vs. Tratamento Endovascular do Aneurisma da Aorta

Introdução: A correção cirúrgica do aneurisma da aorta abdominal (AAA), por Endovascular Aneurysm Repair (EVAR) ou cirurgia convencional (CC), pode agravar a função renal a curto prazo. Esta complicação, mais frequente nos doentes com insuficiência renal crónica (IRC), associa-se a pior prognóstico a longo prazo. O objetivo deste trabalho foi quantificar o agravamento da função renal após reparação do AAA em doentes com IRC prévia e demonstrar o consequente aumento da morbimortalidade. Métodos: Estudo retrospetivo em doentes com IRC estádios Chronic Kidney Disease 3-4 (TFGe 15-59ml/min), submetidos a correção eletiva de AAA entre fevereiro/2011 e fevereiro/2015 numa instituição terciária. Variáveis estudadas: idade, sexo, tipo de intervenção (convencional/EVAR) e estádio CKD. Endpoints: variação da creatinina e taxa de filtração glomerular com a cirurgia, complicações renais pós-operatórias, necessidade de reintervenção cirúrgica e mortalidade. A análise estatística foi realizada em SPSS. Resultados: Foram incluídos 71doentes. Quinze doentes (21%) foram operados por CC e 56 (78%) por EVAR. À data da intervenção, os doentes encontravam-se nos seguintes estádios da DRC: CKD 3 --- 65 (91%) e CKD 4 --- 6 (9%). A variac¸ão da TFG com a cirurgia foi −1,08±18,01mg/dl. Verificou-se IRC agudizada pós-operatória em 22 (31%) doentes e necessidade de diálise em 5 (7%). A mortalidade global foi 8,5%. Os doentes operados por EVAR tinham DRC mais avançada pré-operatoriamente, mas apresentaram menor agravamento da função renal. Variação TFG: EVAR 1,14±16,26ml/min vs. CC 9,40±22,11ml/min (p=0,022); variação creatinina: EVAR 0,17±1,03mg/dl vs. CC 0,81±1,47mg/dl (p=0,02). A agudização da IRC pós-operatória foi superior no grupo CC (53,3 vs. 28,6%; p=0,072), assim como a necessidade de diálise (20 vs. 3,6%, p=0,06). Os 6 doentes que faleceram (EVAR: 3; CC: 3) apresentaram maior agravamento da função renal (variação da creatinina: 1,41±1,63mg/dl vs. 0,20±1,07mg/dl, p=0,001; variação da TFG: −19,0±16,55ml/min; 0,57±17,34ml/min, p=0,007) e necessidade de diálise (50 vs. 3,1%, p=0,003). Conclusão: Os resultados demonstraram uma tendência para uma menor probabilidade de IRA, menor necessidade de diálise pós-operatória e menor mortalidade nos doentes tratados por EVAR. Contudo, o impacto da administração de contraste a médio/longo prazo, decorrente dos programas de vigilância pós-EVAR, deve ser considerado. Julgamos ser possível considerar que a realização de EVAR para o tratamento de doentes com AAA e IRC é um procedimento pelo menos tão seguro como a CC.

Gestação após gastroplastia para tratamento de obesidade mórbida: série de casos e revisão da literatura

relatar a evolução de uma série de casos de gestação em mulheres previamente submetidas à cirurgia de bypass gástrico para tratamento de obesidade grave. Métodos: cinco casos consecutivos de gravidez após gastroplastia ocorridos entre 2001 e 2004 foram avaliados. As pacientes tinham idade entre 30 e 34 anos e todas haviam sido submetidas à cirurgia de Capella. Aspectos clínicos, laboratoriais e do acompanhamento materno e fetal foram considerados, durante o período gestacional e após o parto. Foi realizada revisão da literatura internacional, por meio das bases de dados MEDLINE e Web of Science, utilizando os seguintes unitermos: gastroplasty, gastric bypass surgery, bariatric surgery e pregnancy. Resultados: todas as gestações observadas foram únicas e não ocorreram complicações obstétricas, durante o seguimento pré-natal e parto. Também não houve registro de recém-nascidos prematuros ou de baixo peso ao nascimento. Conclusão: nossos dados sugerem que a gravidez após gastroplastia é segura para a mãe e feto. Entretanto, em virtude do limitado volume de informação disponível sobre o tema, investigações adicionais são necessárias para estabelecer recomendações apropriadas com relação ao seguimento dessas gestações

Gestação após gastroplastia para tratamento de obesidade mórbida: série de casos e revisão da literatura

Objetivo: relatar a evolução de uma série de casos de gestação em mulheres previamente submetidas à cirurgia de bypass gástrico para tratamento de obesidade grave. Métodos: cinco casos consecutivos de gravidez após gastroplastia ocorridos entre 2001 e 2004 foram avaliados. As pacientes tinham idade entre 30 e 34 anos e todas haviam sido submetidas à cirurgia de Capella. Aspectos clínicos, laboratoriais e do acompanhamento materno e fetal foram considerados, durante o período gestacional e após o parto. Foi realizada revisão da literatura internacional, por meio das bases de dados MEDLINE e Web of Science, utilizando os seguintes unitermos: gastroplasty, gastric bypass surgery, bariatric surgery e pregnancy. Resultados: todas as gestações observadas foram únicas e não ocorreram complicações obstétricas, durante o seguimento pré-natal e parto. Também não houve registro de recém-nascidos prematuros ou de baixo peso ao nascimento. Conclusão: nossos dados sugerem que a gravidez após gastroplastia é segura para a mãe e feto. Entretanto, em virtude do limitado volume de informação disponível sobre o tema, investigações adicionais são necessárias para estabelecer recomendações apropriadas com relação ao seguimento dessas gestações _________________________________________________ABSTRACT Purpose: we report a small series of pregnant women who underwent gastric bypass surgery for severe obesity, with a review of the literature on this topic. Methods: five consecutive cases of pregnancy after gastroplasty between 2001 and 2004 were evaluated, and clinical, laboratory and therapeutic features were considered. Patients were 30 to 34 years old and all had been submitted to gastroplasty by the Capella technique. The outcomes for both the pregnant woman and the fetus were evaluated. A search of the English language literature was done through MEDLINE and Web of Science databases with the following terms: gastroplasty, gastric bypass surgery, bariatric surgery, and pregnancy. Results: all 5 pregnancies were singleton. No major obstetric complications were observed and there were no premature or lowbirth weight infants. Conclusion: our data suggest that pregnancy following gastroplasty is safe for mother and fetus. However, since information about this topic is limited, further investigations are required to establish appropriate recommendations concerning the follow-up of these pregnancies