Transfusão de eritrócitos em crianças internadas em unidade de terapia intensiva pediátrica

JUSTIFICATIVA E OBJETIVOS: As indicações de transfusão de eritrócitos não estão bem estabelecidas em crianças gravemente enfermas. O objetivo deste estudo foi descrever a prática da transfusão de eritrócitos na UTI Pediátrica do Hospital de Clínicas da Universidade Estadual Paulista (HC-UNESP). MÉTODO: Estudo retrospectivo observacional realizado durante o ano de 2003. RESULTADOS: Setenta e cinco pacientes receberam transfusão, havendo registro de 105 indicações. Mais da metade dos pacientes (53,3%) tinha menos que um ano de idade. Taquipnéia (75,2%), palidez (65,7%) e hipotensão (51,4%) foram os registros mais freqüentemente observados antes da transfusão. Além disso, a gasometria evidenciou acidose metabólica (68,08%) e hipoxemia (63,8%). Dos 93 registros de valores de hemoglobina (Hb), 54 (58,1%) estavam entre 7 e 10 g/dL e dos 90 registros de hematócrito (Ht) observou-se que 66 (73,3%) apresentavam valores entre 21% e 30%. As principais indicações de transfusão foram anemia em 75 crianças (71,4%) e sangramento ativo em 26 (24,7%). O valor médio de Hb antes da transfusão foi de 7,82 ± 2,82 g/dL. Sete transfusões foram indicadas para pacientes com valores de Hb > 10 g/dL, crianças estas em pós-operatório imediato de intervenção cirúrgica cardíaca e casos de choque séptico. CONCLUSÕES: A transfusão de eritrócitos vem sendo utilizada criteriosamente, com indicações restritivas (Hb entre 7 e 10 g/dL). Nem sempre há anotação dos valores de Hb imediatamente antes da transfusão. A partir deste estudo, foi elaborado um protocolo de indicação de transfusão na unidade.

Análise das condições de saúde e de vida da população urbana de Botucatu, SP (Brasil): III - Conhecimentos e opiniões dos profissionais de saúde a respeito de sintomas de doenças, 1984

Foram estudados os conhecimentos e opiniões dos profissionais de saúde do Município de Botucatu, SP (Brasil), acerca da freqüência e gravidade de treze sintomas e sinais de doenças, visando à comparação com as opiniões emitidas pela população urbana do Município. Foram entrevistados 435 profissionais de saúde ativos (médicos, enfermeiros, auxiliares e atendentes de enfermagem e outros), a maioria do sexo feminino, com idade de 25 a 44 anos. A categoria de atendentes foi a mais numerosa. de modo geral, os cinco últimos sintomas da relação constante do formulário - sangue no escarro, sangramento vaginal, caroço no seio, acessos e sangue na urina, foram considerados menos freqüentes e mais graves, comparativamente aos oito primeiros: falta de ar, febre, fraqueza, dor nas costas, dor no peito, dor de cabeça, tosse e diarréia. Dentre as categorias, os médicos diferenciaram-se atribuindo, com menor freqüência, escores altos para a freqüência e gravidade. Os clínicos valorizaram mais do que os cirurgiões, esses dois fatores, para quase todos os sintomas. O cotejo com a opinião dos leigos entrevistados revelou semelhanças nas tendências, embora tenha havido, por parte destes, maior valorização da freqüência e gravidade.

EFEITOS DOS MÉTODOS DE ABATE DE BOVINOS NA EFICIÊNCIA da SANGRIA

O objetivo do presente trabalho foi avaliar os efeitos dos métodos de abate de bovinos com insensibilização prévia através de marreta e pistola pneumática de penetração e sem insensibilização, realizada pelo método kasher, na eficiência da sangria. A eficiência da sangria foi avaliada pela determinação da hemoglobina no sangue e na carne. Foram utilizados 240 bovinos sãos, da raça Nelore, abatidos em matadouro-frigorífico sob Serviço de Inspeção Federal, sendo 60 animais abatidos pelo método judaico (kasher), 60 animais insensibilizados através de marreta, 60 animais insensibilizados através de pistola pneumática de penetração e 60 animais insensibilizados através de pistola pneumática de penetração seguida por estimulação elétrica. Foram colhidas amostras de sangue após a sangria dos animais e de carne, na porção torácica do músculo Longus colli, imediatamente após a chegada da carcaça à câmara frigorífica. Os animais abatidos pelo método kasher apresentaram menor teor de hemoglobina residual na carne e melhor eficiência da sangria. A utilização da estimulação elétrica imediatamente após a sangria dos animais atordoados por pistola pneumática, afetou negativamente a eficiência da sangria.

Laparoscopic management of iatrogenic lesions

Purpose: To present our series of patients who underwent laparoscopic correction of iatrogenic lesions and a review of the literature.Patients and Methods: We evaluated 23 patients who underwent laparoscopic correction of iatrogenic lesions. Thirteen patients had open surgery, 6 had an endoscopic procedure, and 4 had a laparoscopic approach as the first surgical procedure. Vesicovaginal fistulas (VVF) developed in seven patients after open abdominal hysterectomies, and 1 patient presented with a VVF after ureterolithotripsy. A urethral cutaneous fistula developed in one patient after a laparoscopic resection of endometriosis nodules, and 1 patient presented with a ureterovaginal fistula after a perineoplasty. Three patients presented with encrusted ureteral stents after ureterolithotripsy. Ureteral stenosis developed in seven patients: three after open abdominal surgery, three after ureteroscopy, and one after pyeloplasty. One patient had a ureteral injury during laparoscopic partial nephrectomy, and two patients had bowel injuries after a tension-free vaginal tape procedure and a laparoscopic radical prostatectomy.Results: All patients underwent laparoscopic correction of the iatrogenic injuries. One patient had an early recurrence of a VVF, and one patient had a recurrence of a ureteral stenosis. There was one conversion to open surgery because of technical difficulties and one major bleeding event that necessitated blood transfusion. A lower limb compartmental syndrome developed in one patient.Conclusion: Despite the small number of patients and different types of surgeries performed, laparoscopic management of iatrogenic lesions seems to be feasible and safe in experienced hands. Its precise role in the management of this stressful condition still needs to be determined.

Retroperitoneoscopic renal biopsy in children

OBJECTIVE: We present our experience in a series of 17 consecutive pediatric patients submitted to retroperitoneal laparoscopic renal biopsy. MATERIALS and METHODS: Retroperitoneal laparoscopic renal biopsy (LRB) was performed in 5 boys and 12 girls. Mean age was 8.1 years and age range from 2 to 12. Two or three trocars were used to expose the inferior pole of the kidney, remove enough cortical parenchymal specimen and fulgurate the biopsy site. Assessment included surgical time, estimated blood loss, hospitalization period, analgesia requirements, complications and number of glomeruli present in the specimen. RESULTS: LRB was successfully performed in all 15 patients (88%). In two cases, LRB was not possible to be performed. One patient was converted to a transperitoneal laparoscopy due to tear in the peritoneum. The other patient had had previous abdominal surgery and, during retroperitoneal balloon dilation, the peritoneum was opened and the open biopsy was performed. A third patient had postoperatively a perirenal hematoma, which was solved spontaneously. Complication rate was 17.6% (3/17 cases). Mean operative time was 65 minutes, while mean estimated blood loss was 52 mL, mean hospital stay was 2.2 days and mean analgesic requirement was 100 mg of tramadol. The mean number of glomeruli present in the specimen was 60. CONCLUSION: Retroperitoneal laparoscopic renal biopsy in children is a simple, safe. Bleeding is still the most common complication. However, direct vision usually allows a safe control of this drawback. In our institution, laparoscopic approach is the chosen procedure in pediatric patients older than one - year - old.

Prevalence of von Willebrand disease in dogs from São Paulo State, Brazil

The aims of the current study were to assess the prevalence of von Willebrand disease (vWD) in dogs from the region of Botucatu, São Paulo State, Brazil, and to evaluate laboratory tests to diagnose this disease. The study included 350 dogs of various ages, different breeds, and both sexes. Dogs included in the study had no historical or clinical evidence of abnormal bleeding. von Willebrand factor antigen (vWF:Ag), buccal mucosal bleeding time, activated partial thromboplastin time, and factor VIII activity were evaluated in their ability to diagnose vWD. The prevalence of vWD in dogs was 1.43% in the Botucatu region of Brazil. Determination of vWF:Ag was the best laboratory test to diagnose vWD.

Use of three rapid detection systems to evaluate the prevalence and dissemination of Salmonella in a Brazilian poultry slaughterhouse

Prevalence and dissemination of Salmonella in a Brazilian poultry slaughterhouse were evaluated by three rapid detection systems (SS/SV(TM), VICAM, OSRT(TM), Unipath/Oxoid, and REVEAL(TM), Neogen), plus the conventional procedure. The carcasses were sampled after bleeding (P1), defeathering (P2), evisceration (P3), washing (P4), chilling (P5) and the packaged end-product (P6). In the first set of carcasses, the Salmonella incidence determined by the conventional method was 38.3% and 22.5% by SS/SV(TM). In the set for evaluation of OSRT(TM), the number of positive samples was the same detected by the cultural procedure (49.0%). In the third set, the positivity by the conventional procedure was 33.3%, and 5.0% by REVEAL(TM). The comparisons of positives in the first and third sets of carcasses were significantly different (P < 0.05). The positivity for Salmonella, in carcasses at P1 to P6, as determined by at least one of the methods, was 47.5%, 47.5%, 32.5%, 30.0%, 30.0% and 37.7%, respectively.

Quality parameters of the tibiae and femora of ostriches

An experiment was carried out to establish mean bone quality values of the tibiae and femora of ostriches and to evaluate these bones. The right leg bones of 10 males and 10 female African Black ostriches were evaluated. Birds were radiographed immediately after slaughter (during bleeding), with the aid of a portable X-ray apparatus. The obtained radiographs were scanned and bone mineral density means were obtained using software. Bone strength, Seedor index, and dry matter percentage were evaluated and correlated to weight gain during the finishing period (3-13 months of age). Mean values of the evaluated bone quality traits, not previously found in literature, were established. There were no significant differences between males and females in performance or bone quality parameters. It was concluded that male and female ostriches present similar performance and bone quality at slaughter age.

Peritonite pós-cobertura em cadela Boxer apresentando síndrome de ovário remanescente (SOR)

The ovarian remnant syndrome (ORS) is defined as the persistence of ovarian activity in surgically spayed females, in which part or the entire ovary remains after the surgical procedure. ORS is characterized as a neo-vascular formation that promotes the organ's functions again, and may occur in cats and dogs. This condition causes the return of all undesirable signs of estrus, like male attraction, vaginal secretion (proestral bleeding), anxiety, pseudocyesis, among other symptoms. The recommended treatment is the surgical removal of the remaining ovary tissue. However, this procedure should be performed at the estrogenic stage of the cycle, when the remaining ovary tissue is enlarged due to the presence of follicles, which facilitates its location. Apparently there are no papers on the consequences of an undesirable breeding. Thus, the objective of this article was to report a case of peritonitis in a bitch with ORS after natural breeding, referred to the Hospital Veterinario da Faculdade de Medicina Veterinaria e Zootecnia da UNESP, campus Botucatu, São Paulo, Brazil.

Local application of tetracycline solution with a microbrush: An alternative treatment for persistent periodontitis

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

Use of the connective tissue graft for the coverage of composite resin-restored root surfaces in maxillary central incisors

The purpose of this article is to report the use of the subepithelial connective tissue graft technique combined with the coronally positioned flap on a composite resin-restored root surface to treat Miller Class I gingival recessions associated with deep cervical abrasions in maxillary central incisors. Clinical measurements, including gingival recession height, probing depth, and bleeding on probing (BoP), were recorded during the preoperative clinical examination and at 2, 6, 12, and 24 months postoperatively. During the follow-up periods, no periodontal pockets or BoP were observed. The periodontal tissue of the teeth presented normal color, texture, and contouring. In addition, it was observed that creeping attachment had occurred on the restoration. This case report shows that this form of treatment can be highly effective and predictable in resolving gingival recession associated with a deep cervical abrasion. (Quintessence Int 2012;43:597-602)

Clinical and microbiological effects of photodynamic therapy associated with nonsurgical periodontal treatment. A 6-month follow-up

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

Occurrence of yeasts, enterococci and other enteric bacteria in subgingival biofilm of HIV-positive patients with chronic gingivitis and necrotizing periodontitis

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

Subgingival microbiota from Cebus apella (capuchin monkey) with different periodontal conditions

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

The Effect of a Supragingival Plaque-Control Regimen on the Subgingival Microbiota in Smokers and Never-Smokers: Evaluation by Real-Time Polymerase Chain Reaction

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)