Tratamento endoscópico endonasal de tumores nasossinusais malignos : resseção e reconstrução

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Cuidar no parto : prática de episiotomia

Enquadramento – A episiotomia é uma incisão feita no períneo para aumentar o canal vaginal com o objetivo de evitar outros traumas perineais durante o parto. No entanto, esta prática, por si só, já se considera um trauma perineal pelo corte em estruturas que podem desencadear problemas futuros. A Organização Mundial de Saúde (1996) recomenda a utilização limitada da episiotomia uma vez que não existem evidências credíveis de que a utilização generalizada ou de rotina desta prática tenha um efeito benéfico. Objetivos: Demonstrar evidência científica dos determinantes da prática de episiotomia seletiva em mulheres com parto normal/eutócico; identificar a prevalência de episiotomia; analisar os fatores (variáveis sociodemográficas, variáveis relativas ao recém-nascido, variáveis contextuais da gravidez e contextuais do parto) que influenciam na ocorrência de episiotomia. Métodos: O estudo empírico I seguiu a metodologia de revisão sistemática da literatura. Efetuou-se uma pesquisa na EBSCO, PubMed, SciELO, RCAAP de estudos publicados entre janeiro de 2008 e 23 de dezembro de 2014. Os estudos encontrados foram avaliados tendo em consideração os critérios de inclusão previamente estabelecidos. Dois revisores avaliaram a qualidade dos estudos a incluir utilizando a grelha para avaliação crítica de um estudo descrevendo um ensaio clínico prospetivo, aleatorizado e controlado de Carneiro (2008). Após avaliação crítica da qualidade, foram incluídos no corpus do estudo 4 artigos nos quais se obteve um score entre 87,5% e 95%. O estudo empírico II enquadra-se num estudo quantitativo, transversal, descritivo e retrospetivo, desenvolvido no serviço de Obstetrícia do Centro Hospitalar Cova da Beira, segundo um processo de amostragem não probabilística por conveniência (n = 382). A recolha de dados efetuou-se através da consulta dos processos clínicos das mulheres com idade ≥ 18 anos que tiveram um parto vaginal com feto vivo após as 37 semanas de gestação. Resultados: Evidência de que a episiotomia não deve ser realizada de forma rotineira, cujo uso deve restringir-se a situações clínicas específicas. A episiotomia seletiva, comparada com a episiotomia de rotina, está relacionada com um menor risco de trauma do períneo posterior, a uma menor necessidade de sutura e a menos complicações na cicatrização. Amostra constituída por 382 mulheres, na faixa etária dos 18-46 anos. Apenas, não se procedeu à episiotomia em 41,7% da amostra, apontando para a presença da episiotomia seletiva. Número significativo de mulheres com parto eutócico (80,5%), com sutura (95,0%), laceração de grau I (64,9%), dor perineal (89,1%) sujeitas a episiotomia (58,3%). A maioria dos recém-nascidos nasceram com peso normal (92,3%), com um valor expressivo de mulheres sujeitas a episiotomia (91,4%). Ainda se constatou a existência de casos, apesar de reduzidos, em que o recém-nascido nasceu macrossómico (5,4%), tendo-se recorrido igualmente a esta prática. Não há uma associação direta entre a realização de episiotomia e os scores do APGAR. Conclusão: Face a estes resultados e com base na evidência científica disponível que recomenda, desde há vários anos, que se faça um uso seletivo da episiotomia, sugere-se que os profissionais de saúde estejam mais despertos para esta realidade, de modo a que se possam anular as resistências e as barreiras de mudanças por parte dos mesmos face ao uso seletivo da episiotomia. Para promover essa mudança de comportamentos é importante não só mostrar as evidências científicas, bem como transpô-las para a prática, capacitando os profissionais de saúde, sobretudo os enfermeiros, na sua atuação. Palavras-chave: Parto Normal/eutócico; Episiotomia; Episiotomia seletiva; Episiotomia de rotina.

Detrital zircon geochronology data, petrographic point count data and paleocurrent indicator data of Triassic turbidites in the Nanpanjiang Basin, South China

Triassic turbidites of the Nanpanjiang basin of south China represent the most expansive and voluminous siliciclastic turbidite accumulation in south China. The Nanpanjiang basin occurs at a critical junction between the southern margin of the south China plate and the Indochina, Siamo and Sibumasu plates to the south and southwest. The Triassic Yangtze carbonate shelf and isolated carbonated platforms in the basin have been extensively studied, but silicilastic turbidites in the basin have received relatively little attention. Deciphering the facies, paleocurrent indicators and provenance of the Triassic turbidites is important for several reasons: it promises to help resolve the timing of plate collisions along suture zones bordering the basin to the south and southwest, it will enable evaluation of which suture zones and Precambrian massifs were source areas, and it will allow an evaluation of the impact of the siliciclastic flux on carbonate platform evolution within the basin. Turbidites in the basin include the Early Triassic Shipao Formation and the Middle-Late Triassic Baifeng, Xinyuan, Lanmu Bianyang and Laishike formations. Each ranges upward of 700 m and the thickest is nearly 3 km. The turbidites contain very-fine sand in the northern part of the basin whereas the central and southern parts of the basin also commonly contain fine and rarely medium sand size. Coarser sand sizes occur where paleocurrents are from the south, and in this area some turbidites exhibit complete bouma sequences with graded A divisions. Successions contain numerous alternations between mud-rich and sand-rich intervals with thickness trends corresponding to proximal/ distal fan components. Spectacularly preserved sedimentary structures enable robust evaluation of turbidite systems and paleocurrent analyses. Analysis of paleocurrent measurements indicates two major directions of sediment fill. The northern part of the basin was sourced primarily by the Jiangnan massif in the northeast, and the central and southern parts of the basin were sourced primarily from suture zones and the Yunkai massif to the south and southeast respectively. Sandstones of the Lower Triassic Shipao Fm. have volcaniclastic composition including embayed quartz and glass shards. Middle Triassic sandstones are moderately mature, matrix-rich, lithic wackes. The average QFL ratio from all point count samples is 54.1/18.1/27.8% and the QmFLt ratio is 37.8/ 18.1/ 44.1%. Lithic fragments are dominantly claystone and siltstone clasts and metasedimentary clasts such as quartz mica tectonite. Volcanic lithics are rare. Most samples fall in the recycled orogen field of QmFLt plots, indicating a relatively quartz and lithic rich composition consistent with derivation from Precambrian massifs such as the Jiangnan, and Yunkai. A few samples from the southwest part of the basin fall into the dissected arc field, indicating a somewhat more lithic and feldspar-rich composition consistent with derivation from a suture zone Analysis of detrial zircon populations from 17 samples collected across the basin indicate: (1) Several samples contain zircons with concordant ages greater than 3000 Ma, (2) there are widespread peaks across the basin at 1800 Ma and 2500, (3) a widespread 900 Ma population, (3) a widespread population of zircons at 440 Ma, and (5) a larger population of younger zircons about 250 Ma in the southwestern part which is replaced to the north and northwest by a somewhat older population around 260-290 Ma. The 900 Ma provenance fits derivation from the Jiangnan Massif, the 2500, 1800, and 440 Ma provenance fits the Yunkai massif, and the 250 Ma is consistent with convergence and arc development in suture zones bordering the basin on the south or southwest. Early siliciclastic turbidite flux, proximal to source areas impacted carbonate platform evolution by infilling the basin, reducing accommodation space, stabilizing carbonate platform margins and promoting margin progradation. Late arrival, in areas far from source areas caused margin aggradation over a starved basin, development of high relief aggradational escarpments and unstable scalloped margins.

Brain injury prediction using the translational energy criterion: an experimental study. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

The cranial anatomy of the mail-cheeked fishes.

Mode of access: Internet.

Studien zur vergleichenden Entwicklungsgeschichte des Kopfes der Kranioten /

"Verzeichnis der Litteratur," i. 91-93.

Studi anatomici sul cranio e sull'encefalo psicologici e freniatrici.

Mode of access: Internet.

Studies from the Museum of Zoology in University College, Dundee.

Editor: D. W. Thompson.

Philosophy and psychology pamphlets

A collection of miscellaneous pamphlets.

Physical anthropology of the Lenape or Delawares, and of the eastern Indians in general,

Contributions from the Museum of the American Indian, Heye Foundation, vol. 3.

Installation

Color photograph of a mannequin's severed head, with skull and bones underneath. Caption by Ava Janus

Installation and "1915 Genocide 1945"

Color photograph of a mannequin's severed head, skull and bones underneath Kevorkian's painting "1915 Genocide 1945." Caption by Ava Janus

Primary tumors of the calvaria, with special consideration of the clinical problems

Mode of access: Internet.

A new crocodilian from the Lower Cretaceous Crato Formation of north-eastern Brazil

A new mesosuchian crocoddian from the Nova Olinda Member of the Crato Formation (Lower Cretaceous, Aptian) of north-eastern Brazil is described. Susisuchus anatoceps gen. et sp. nov. is the first crocodillan to be reported from this formation. It is represented by an incomplete, partially articulated skeleton: the skull and mandible, partial postcranial axial skeleton, forelimbs and portions of the osteodermal skeleton. Preservation of soft tissues includes the skin surrounding both forelimbs and the digits of the right hand. The state of preservation of the specimen suggests that it was incorporated into the basin as a desiccated carcass. Susisuchus anatoceps is one of the oldest crocodilians with a eusuchian-type dorsal shield, comprising a tetraserial paravertebral shield and, either side of this, two sagittal rows of accessory osteoderms. It also possesses amphicoelous thoracic, lumbar and caudal vertebrae. This combination of postcranial features have never before been seen in a crocodilian and warrant the erection of a new family within Mesosuchia: Susisuchidae. Taxonomically, S. anatoceps is similar to a number of Lower Cretaceous mesosuchians previously considered to have given rise to eusuchians, most notably the Glen Rose crocodilian and a new, but as yet undescribed crocodillan from the Lower Cretaceous Winton Formation of western Queensland, Australia. Preliminary preparation of the Winton crocodilian indicates that it may belong to Susisuchidae, supporting the hypotheses of interchange between the vertebrate faunas of South America and Australia during the Lower Cretaceous.

Big cat scan: magnetic resonance imaging of the tiger

In August 2002, we performed MRI scans on a female juvenile Bengal tiger. We present the clinical course, imaging and autopsy findings, and some comparative anatomy of the tiger brain and skull. Magnetic resonance images of a tiger have not previously been published.