Raquianestesia contínua em paciente submetido à gastrectomia parcial. Relato de caso

BACKGROUND AND OBJECTIVES: Due to the high incidence of technical and neurological complications, continuous spinal blocks were not performed for several years. With the advent of intermediate catheters the technique has been used more often and gaining acceptance among anesthesiologists. The objective of this report was to demonstrate the usefulness of the technique as a viable alternative for medium and major size surgeries. CASE REPORT: This is a 58 years old female patient, weighing 62 kg, physical status ASA I, with a history of migraines, low back pain, and prior surgeries under spinal block without intercurrence. The patient was scheduled for exploratory laparotomy for a probable pelvic tumor. After venoclysis with an 18G catheter, monitoring with cardioscope, non-invasive blood pressure and pulse oximetry was instituted; she was sedated with 2 mg of midazolam and 100 μg of fentanyl, and placed in left lateral decubitus. The patient underwent continuous spinal block through the median approach in L 3-L 4; 9 mg of 0.5% hyperbaric bupivacaine and 120 μ g of morphine sulfate were administered. Inspection of the abdominal cavity revealed a gastric stromal tumor that required an increase in the incision for a partial gastrectomy. A small dose of hyperbaric solution was required for the entire procedure, which was associated with complete hemodynamic stability. Postoperative admission to the ICU was not necessary; the patient presented a good evolution without complaints and with a high degree of satisfaction. She was discharged from the hospital after 72 hours without intercurrence. CONCLUSIONS: Intermediate catheters used in continuous spinal blocks have shown the potential to turn it an attractive and useful technique in medium and large size surgeries and it can even be an effective alternative in the management of critical patients to whom hemodynamic repercussions can be harmful.

Viabilidade econômica e seleção de sistemas de irrigação utilizando simulação e dominância estocástica

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Análise da execução de um algoritmo numérico cbs para simulação de escoamento utilizando elementos finitos

This work intends to analyze the application and execution time of a numerical algorithm that simulates incompressible and isothermal flows. It was used the explicit scheme of the Characteristic Based Split (CBS) algorithm and the Artificial Compressibility (AC) scheme for coupling pressure-velocity equations. The discretization was done with the finite element method using a bilinear elements grid. The free software GNU-Octave was used for implementation and execution of routines. The results were analyzed using the classic lid-driven cavity problem. This work shows results for tests with several Reynolds' number. The results for these tests show a good agreement when compared with previous ones obtained from bibliography. The code runtime's analysis shows yet that the matrix's assembly is the part of greater consumption time in the implementation.

Anestesia para colecistectomía videolaparoscópica en paciente portador de enfermedad de Steinert. Relato de caso y revisiõn de la literatura

BACKGROUND AND OBJECTIVES: Myotonic dystrophies are autosomal dominant neuromuscular diseases. Among them, myotonic dystrophy type 1 (MD1), or Steinert disease, is the most common in adults, and besides muscular involvement it also has important systemic manifestations. Myotonic dystrophy type 1 poses a challenge to the anesthesiologist. Those patients are more sensitive to anesthetics and prone to cardiac and pulmonary complications. Besides, the possibility of developing malignant hyperthermia and myotonic episodes is also present. CASE REPORT: This is a 39-year old patient with DM1 who underwent general anesthesia for videolaparoscopic cholecystectomy. Total intravenous anesthesia with propofol, remifentanil, and rocuronium was the technique chosen. Intercurrences were not observed in the 90-minute surgical procedure, but after extubation, the patient developed respiratory failure and myotonia, which made tracheal intubation impossible. A laryngeal mask was used, allowing adequate oxygenation, and mechanical ventilation was maintained until full recovery of the respiratory function. The patient did not develop further complications. CONCLUSIONS: Myotonic dystrophy type 1 presents several particularities to the anesthesiologist. Detailed knowledge of its systemic involvement along with the differentiated action of anesthetic drugs in those patients will provide safer anesthetic-surgical procedure.

La medicion del rendimiento de las clinicas. Exploracion preliminar de un indice paciente

Original en inglés: Perkin, Gordon W., Measuring clinic performance. Publicado en Perspectives, vol. 1, 1969

Simulação da oferta e demanda de recursos hídricos nas bacias dos rios piracicaba, capivarí e jundiaí: Uma análise em dinâmica de sistemas

A dynamic systems water resources simulation model was developed as a tool to help to analyze water resources management alternatives for the Piracicaba, Capivari and Jundiaí River Water Basins (BH-PCJ). Different politics policy were simulated for 40-year. The model estimates water supply and demand, as well as contamination load from several consumers. Six runs were performed using average precipitation value, changing water supply and demand, and different volumes diverted from BH-PCJ to BH-Alto Tietê For the Business as Usual, the Sustainability Index went from 0.41 in 2010 to 0.22 by 2050; the Water Use Index changed from 80.7% in 2010, to 125.5% by 2050; and the Falkenmark Index changed from 1,302 m 3 person -1 year -1 in 2010 to 774 m 3 P -1 year -1 by 2050. It was noticed that sanitation is one of the biggest concerns in the near future at PCJ River Basin.

Avaliação de cargas difusas e simulação de autodepuração no Córrego da Água Branca, Itirapina (SP)

According to CONAMA Resolution No. 357, the Água Branca Creek is framed in Class 2 and along its course the characteristics should be consistent with this class. Evaluation of diffuse loads and simulation of auto-purification in the Água Branca Creek allowed evaluating the alterations in the quality of the freshwater. The major contribution of diffuse loads in the basin of the White Water Creek is related to agriculture. The QUAL2K modeling identified the autopurification zones at Água Branca Creek and indicated the necessity BDO removal of 75%.

Estudo duplo cego com Isoconazol e Terbinafina tópicos no tratamento de um paciente com Tinea nigra plantaris bilateral e sugestões para novos diagnósticos diferenciais

The authors report a case of bilateral Tinea nigra plantaris treated through a double-blind study with the topical antifungal agents Isoconazole and Terbinafine. The objective of the study was to clinically compare the efficacy of these two topical antifungal agents on days 10, 20 and 30 of the treatment. No significant clinical differences were found, as all the plantar lesions regressed completely by the end of the treatment. Our conclusion was that in the case reported, the topical antifungal agents Isoconazole and Terbinafine demonstrated identical efficacy as a clinical cure. We also suggest the inclusion of injuries caused by arthropods of the Diplopoda Class in the differential diagnosis of Tinea nigra plantaris, due to the persistent acral hyperpigmentation.

Simulação de perdas de solo em função de cenários de adequação ambiental em microbacias agrícolas

In São Paulo state, deforestation and agriculture activities are increasing soil losses processes, especially in areas of susceptible soils where soil conservation practices are not adopted. Environmental adequacy at property level regarding Permanent Protection Areas and Legal Reserves is considered a potential factor for reducing soil losses and it was based on this fact that we assessed soil losses of different scenarios of environmental adequacy. Simulations of erosive processes were carried out in 15 catchments of the Corumbataí river basin, with different forest restoration scenarios, as well as the current situation of land use/ land cover. The scenarios include reforestation of Permanent Preservation Areas (PPA); the reforestation hydrological sensitive areas; and two scenarios, the Legal Reserve installation in 20% of each catchment, being one of them for most critical areas in terms of erosion and the other at random. It was observed that the establishment of PPA and the reforestation of hydrological sensitive areas (HSA), offered a small contribution to the control of the erosive process, resulting in a reduction of 10% and 7.4%, respectively, while the legal reserve in critical areas has the significant reduction of 69.8%. The random scenario, in turn, resulted in a reduction of 21.4% of erosion. Results show that reforestation can reduce soil losses, but previous studies of land prioritization and planning could significantly increase its efficiency.

Co-infecção por vírus dengue, sorotipos 1 e 4, em paciente de cidade de porte médio no Brasil

The natural co-infection with dengue virus can occur in highly endemic areas where different serotypes have been observed for many years. We report one case of DENV-1/DENV-4 co-infection in human serum detected by molecular tests. Phylogenetic analysis of the sequences obtained indicated the presence of genotype V and II for DENV-1 and DENV-4, respectively.

Fisioterapia Aquática na Transferência do Sentado para Ortostatismo no Paciente com AVC: Relato de Caso

Introduction. Studies show that 70% of body weight in patients with stroke during the transfer from sitting to standing position is transferred to the uninvolved limb. Significantly interfering with activities of daily living. Objective. The influence of aquatic therapy on eight in the affected hemisphere during the transition from sitting to standing. Method. Participated in this study a patient with right hemiparesis, the protocol lasted eight sessions in a liquid medium. The data of activation of the gluteus muscle were collected from surface electromyography and data as the weight transfer was examined by baropodometry platform. Results. Initial electromyography (151.1uv right gluteus maximus and left gluteus maximus 229.1uv) and Final electromyography (113.6 uv right gluteus maximus and left gluteus maximus113.3uv). Evolution was 19% in weight transferin paretic hemibody compared the pre and post intervention. Conclusion. The results showed that treatment was favorable to the patient, because at the end of application of the observed activation of the gluteus maximus and improved weight-bearing, and consequently these factors interfered positively in the security and independe in transferring from sitting to standing position.

Simulação do caminhamento de herbicidas em diferentes tipos e quantidades de palhadas utilizadas no sistema de plantio direto

Pós-graduação em Agronomia (Agricultura) - FCA

Considerações sobre analgesia controlada pelo paciente (PCA) em hospital universitário

Pós-graduação em Anestesiologia - FMB

Projeto e simulação de um sistema de controle via LMIs da produção de vapor de uma caldeira aquatubular

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Implementação de um controlador PID embarcado para o controle em malha fechada de um estimulador neuromuscular funcional

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)